Scientific review published in Advances in Nutrition notes “great caution should be exercised in extending the label of illness to the phenomenon of orthorexia nervosa”

A healthy diet is positively linked to a higher life expectancy and a lower probability of developing chronic disease.  But what happens when healthy eating is put to the extreme?  When does a behavior with seemingly positive health effects turn unhealthy?  Could an overly strong fixation on healthy eating become a mental illness?  This phenomenon has been termed “orthorexia nervosa” to describe a pathological fixation on healthy eating.

The Orthorexia Nervosa Task Force described the main diagnostic criteria for orthorexia nervosa as “a pathological preoccupation with healthy eating; the emotional consequences, such as stress or anxiety, of noncompliance with self-imposed dietary rules; and psychosocial restrictions in significant areas of life, malnutrition, and weight loss.”  Despite much research and debate, orthorexia nervosa is generally not recognized as a distinct mental illness.  It is not, for example, included in either the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders published in May 2013 or in the 11th version of the International Statistical Classification of Diseases and Related Health Problems adopted in May 2019.

Published in Advances in Nutrition, the international review journal of the American Society for Nutrition, “Classifying Orthorexia Nervosa as a New Mental Illness—Much Discussion, Little Evidence” sheds new light on the current debate over orthorexia nervosa as a distinct mental illness by examining the current body of research and identifying knowledge gaps.

The authors did note the difficulty in conducting their narrative review “due to the use in previous research of nonuniform criteria to diagnose orthorexia nervosa, a multitude of diagnostic methods, and instruments revealed to have poor psychometric quality.” In addition, many of the study sample populations have been “convenience samples” whose results cannot be generalized.  The authors therefore state, “great caution should be exercised in extending the label of illness to the phenomenon of orthorexia nervosa.  More studies are needed to investigate the sole contribution of orthorexia nervosa to pathology before we can reach a conclusion about its significance as a distinct illness.”

In addition, researchers and clinicians must be wary of being ethnocentric.  What may be considered pathological eating behaviors in one context may not be in another.  “Cross-cultural studies and the development of culturally sensitive diagnostic procedures are highly warranted, given the general assumption of the considerable influence of Western culture by many health professionals and some evidence from scientific reports.”

Whether or not orthorexia nervosa can be classified as a distinct mental illness remains debatable; however, it is clear that many people suffer distress in their efforts to adhere to healthy eating patterns.  If you believe that you may suffer from orthorexia nervosa, a discussion with a mental healthcare provider or your general healthcare provider is in order.

References Jana Strahler, Rudolf Stark, Perspective: Classifying Orthorexia Nervosa as a New Mental Illness—Much Discussion, Little Evidence. Advances in Nutrition, DOI:

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