Orthorexia Nervosa, Eating Disorders, and Obsessive-Compulsive Disorder: A Selective Review of the Last Seven Years

Abstract

Orthorexia nervosa (ON) is defined as an exaggerated, obsessive, pathological fixation on healthy food, healthy eating, or health-conscious eating behaviors. In the literature, there is an ongoing debate over whether ON should be considered simply a lifestyle phenomenon or a psychiatric disorder. In this vein, ON seems to share psychopathological characteristics with both eating disorders (EDs) and obsessive-compulsive disorder (OCD). However, there are insufficient data to reconcile the debate. The present study aimed at consolidating evidence on the clinical significance of ON and its relationship with EDs and OCD. A selective review of the literature published between January 2015 and March 2022 was conducted, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Ten studies were included. Some of these studies suggested that ON might follow a full-syndrome DSM-5 ED. Other studies proposed that ON and DSM-5 EDs may co-occur. Finally, only two studies suggested a relationship between ON and OCD. To date, the clinical significance of ON and its relationship with EDs and other DSM-5 psychiatric disorders (e.g., OCD) appears complicated and unclear. Future longitudinal research on the possible clinical course of ON is needed.

Mind the Gap: Tools for the Diagnosis and Assessment of Orthorexia Nervosa Based on the Recent Consensus Definition. Reply to Meule, A. Comment on “Sifakaki et al. Orthorexia Nervosa Practices in Rheumatoid Arthritis: The DORA Study. Nutrients 2023, 15, 713”

“…In this manner, all of the existing tools evaluate some, but not all clinical aspects and characteristics of ON. In parallel, despite its inherited limitations that have been discussed in the literature and acknowledged in our work, the ORTO-15 and its variations consist of the most widely used tools to date for the assessment of ON [9], covering 62% of the PubMed hits: more than all of the remaining questionnaires combined (Figure 1). Furthermore, the ORTO-15 and its variations consist of the sole validated, translated and culturally adapted tools in Greece today [4].…”

A Systematic Review of Clinical Psychophysiology of Obsessive–Compulsive Disorders: Does the Obsession with Diet Also Alter the Autonomic Imbalance of Orthorexic Patients?

“…There is an ongoing debate in the literature as to whether ON should be considered just an impaired eating habit, a disorder falling under EDs or obsessive–compulsive disorders (OCDs), or even a disorder in its own right [ 4 , 8 , 9 , 10 ]. However, it seems that the most frequently used terms among researchers to describe ON are the following: obsession, fixation, and worry/concern [ 10 ]. Obsession indicates a persistent and disturbing thought, while fixation is a stereotyped behavior related to an obsessive and unhealthy preoccupation.…”

“…Furthermore, the cognitive schemes associated with a predisposition to obsessiveness favor the adoption of restrictive and/or rigid diets such as those of the ON [ 7 ]. Moreover, as frequently happens in the field of neurotic disorders, there are some comorbidities [ 16 ], including somatic symptom disorders or hypochondriasis (when concerns about health are disproportionate), anxiety and depressive disorders (frequently associated with OCD), and full-blown ED (i.e., severe anorexic conditions) [ 4 , 9 , 10 ] underpinned by rigid personality structure including perfectionism and obsessive–compulsive traits [ 16 , 17 ] as well as negative affectivity and psychoticism [ 16 ]. Thus, the ON syndrome could be another case of OCD in which the pathological control of eating could reflect the existence of a mental condition that compromises the psychophysical balance [ 3 ].…”

“…It is often assumed that a low LF/HF ratio reflects greater parasympathetic activity relative to sympathetic activity. In contrast, a high LF/HF ratio may indicate higher sympathetic activity [ 10 ]. Although both branches influence HR, evidence suggests that the parasympathetic influence is dominant [ 38 , 39 , 40 ], indicating that the heart is under the tonic inhibitory control peripherally via the vagus nerve.…”

Orthorexia nervosa versus healthy orthorexia: Anxiety, perfectionism, and mindfulness as risk and preventative factors of distress

“…However, empirical evidence on orthorexia nervosa is limited (Bartel et al., 2020; Dunn & Bratman, 2016; Gkiouras et al., 2022; Pontillo et al., 2022). With mixed research findings and unclear diagnostic criteria it is not yet recognised by the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5; American Psychiatric Association, 2013).…”