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Orthorexia nervosa: nosographic category or not?

Fabio Bacchini1, Elena Bossini2

  • 1Laboratory of Applied Epistemology, DADU, University of Sassari, Palazzo del Pou Salit, Piazza Duomo 6, 07041, Alghero, Sassari, Italy. bacchini@uniss.it.

Theoretical Medicine and Bioethics
|September 8, 2025
PubMed
Summary

Orthorexia nervosa, an obsessive focus on healthy eating, faces challenges in being classified as a psychiatric disorder. Current diagnostic criteria may pathologize healthy lifestyles rather than identify a distinct mental illness.

Keywords:
DSM-5Eating disordersEco-anxietyHealthy eatingMental disorderOrthorexia

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Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Eating Disorders

Background:

  • Orthorexia nervosa is characterized by an obsessive fixation on "healthy" eating.
  • Debate exists on classifying orthorexia nervosa as a distinct psychiatric disorder.
  • Distinguishing pathological orthorexia from non-pathological healthy eating is complex.

Purpose of the Study:

  • To analyze conceptual issues in diagnosing orthorexia nervosa.
  • To evaluate proposed diagnostic strategies for orthorexia nervosa.
  • To determine if orthorexia nervosa fits current psychiatric nosological categories.

Main Methods:

  • Literature review of proposed diagnostic criteria for orthorexia nervosa.
  • Analysis of two main diagnostic strategies: physical impairment and psychological distress.
  • Conceptual comparison with similar phenomena (e.g., eco-anxiety).

Main Results:

  • Using physical impairment (malnutrition) as a criterion requires significant conceptual changes to orthorexia nervosa.
  • Using psychological distress risks pathologizing dedicated, non-pathological lifestyles.
  • Current diagnostic approaches present substantial problems for classifying orthorexia nervosa.

Conclusions:

  • Orthorexia nervosa, as currently conceptualized, faces significant challenges as a plausible psychiatric nosographic category.
  • The behavior may represent an adaptive response rather than a mental disorder, similar to eco-anxiety.
  • Further conceptual refinement is needed to address diagnostic ambiguities.