Orthorexia Nervosa: A New Challenge in the Diagnosis and Treatment of Eating Disorders

Abstract— Orthorexia nervosa (ON) is a proposed eating disorder characterized by a pathological preoccupation with consuming healthy and biologically pure foods, which may progress from socially encouraged dietary habits to rigid and restrictive behaviors. Despite increasing attention, ON remains absent from DSM-5 and ICD-11, and its classification as either an eating disorder or an obsessive-compulsive spectrum disorder is still debated. This review synthesizes evidence from 38 studies published between 2004 and 2024, identified through a systematic search of PubMed and Google Scholar, to summarize current knowledge on its risk factors, clinical features, diagnostic challenges, and treatment strategies. Findings indicate that ON prevalence varies widely, with elevated rates among healthcare professionals, athletes, and dietitians. Risk factors include perfectionism, obsessive-compulsive tendencies, psychopathology, and restrictive eating practices. Clinically, ON may lead to malnutrition, medical complications such as anemia, osteopenia, and metabolic acidosis, and significant psychosocial impairment. Diagnostic challenges stem from overlapping symptoms with anorexia nervosa and obsessive-compulsive disorder, as well as the limited validity of commonly used screening tools such as ORTO-15 and Bratman’s Orthorexia Test. Current management emphasizes a multidisciplinary approach, combining cognitive-behavioral therapy, psychoeducation, nutritional counseling, mindfulness-based interventions, and, in severe cases, pharmacotherapy. These findings highlight ON as a clinically relevant but poorly defined condition, underscoring the urgent need for standardized diagnostic criteria, validated assessment instruments, and evidence-based treatment strategies to improve patient outcomes.