Orthorexia vs Anorexia: Do You Know The Difference?

This blog article is intended to inform and educate and is not a replacement for medical advice.

Orthorexia vs Anorexia: how can you tell the difference between these two restrictive disorders?

With the rise of social media, we are constantly bombarded with unrealistic portrayals of food and body image, blurring the lines between healthy eating and obsession and making us overwhelmed by the pressure to look and eat a certain way. 

Two eating disorders that can sometimes be confused are Orthorexia and Anorexia. While both involve restrictive eating patterns, the motivations and underlying psychology behind them are quite different. 

In this blog post, we will get into the specifics of Orthorexia and Anorexia to understand the key similarities, distinctions, and treatment options for both eating disorders. Let’s get started! 

What is Orthorexia?

Definition of Orthorexia

The term “Orthorexia” was coined by Dr. Steven Bratman in the late 1990s. It literally translates to “correct appetite,” but the reality is far from balanced. People with Orthorexia develop an unhealthy obsession with “healthy” eating. Their focus isn’t just on nourishment; it’s on the quality and purity of food. Organic, local, and unprocessed ingredients are often prioritized, while anything perceived as “unhealthy” becomes forbidden.

For example, clients of mine who suffer from Orthorexia obsessively read food labels, not allowing themselves to eat any added sugar (or other “forbidden” ingredient). Others will not eat meat unless they purchase and cook it themselves, ensuring they know the food’s origin and safe handling in the kitchen. You can see how either of these behaviors would make socializing with friends at a potluck or eating out extremely difficult.

It’s important to note that Orthorexia Nervosa isn’t currently recognized as a formal diagnosis in the DSM-5 (the manual of mental health diagnoses). Even so, orthorexic behaviors and the potential negative consequences on health warrant attention and treatment.

Are you concerned you might have tendencies towards Orthorexia? Check out this Orthorexia Quiz to assess whether your own thoughts and eating habits might be putting your health at risk.

Symptoms of Orthorexia

Orthorexia manifests in various ways, impacting both behavior and mental well-being. Even though there are no official diagnostic criteria, here are some red flags to watch out for:

Behavioral Signs of Orthorexia

  • Excessive research on healthy eating or clean eating.
  • Rigid dietary planning.
  • Difficulty eating out or at social gatherings due to anxieties about ingredients.
  • Bringing one’s own food when traveling or to social events.
  • Increased isolation due to limitations placed on food choices.
  • Elimination of one or more food groups. 
  • Limited or very restrictive diets, such as veganism, in the name of health.

Psychological Symptoms of Orthorexia

  • Intense guilt and shame associated with eating “unhealthy” foods.
  • Anxiety and fear surrounding food choices.
  • Feeling a sense of moral superiority based on diet.
  • Obsessive thoughts about food purity and adherence to strict food rules.
  • Increased levels of perfectionism. 

If left unchecked and untreated, Orthorexia can lead to nutrient deficiencies, social isolation, and a decline in mental health. If you believe you or a loved one have a tendency towards Orthorexia, see your healthcare provider.

What is Anorexia?

Definition of Anorexia

Anorexia Nervosa, defined by the DSM-5, is a serious eating disorder characterized by self-imposed severe dietary restrictions leading to significant weight loss. The primary focus is on weight control with a distorted perception of body image

The intense fear of weight gain in anorexia is extremely strong. This can be seen in their limited intake, focus on low-calorie foods and, often, excessive exercise. They see themselves as overweight even when they are dangerously underweight. Despite stereotypes, anorexia can affect people of all genders, ages, income levels and races. 

Anorexia is officially divided into two different subtypes: the restrictive type and the binge-eating and purging type. Read more about each subtype below.

Anorexia Nervosa Restrictive Type

The first subtype, Restrictive, is characterized by severe limitations on food intake. Individuals with this subtype go to great lengths to minimize their calorie intake and avoid foods they perceive as “forbidden.” People with this type of Anorexia lose weight, sometimes a drastic amount, raising red flags for those around them. 

This restrictive behavior is driven by an intense fear of gaining weight and a distorted perception of their body size and shape. People with Anorexia often see themselves as “overweight” despite being significantly “underweight” (according to the BMI). The restrictive type does not involve regular episodes of binge eating or purging but may include excessive exercise, dieting, or fasting as a method of weight control.

Anorexia Binge Purge Subtype

The second subtype, the Binge Purge Subtype, involves episodes of binge eating followed by purging behaviors to prevent weight gain. Purging can include self-induced vomiting, misuse of laxatives, excessive exercise, diuretics, or enemas. 

Unlike bulimia nervosa, individuals with this subtype of anorexia maintain a significantly, often dangerously, low body weight. The cycle of binging and purging adds an additional layer of physical and emotional distress, complicating the individual’s relationship with food and their body even further.

Atypical Anorexia 

Atypical Anorexia is another variation of this eating disorder. This condition mirrors all the psychological symptoms of anorexia nervosa, such as intense fear of gaining weight and significant dietary restriction, but without the individual being “underweight” by conventional medical standards. 

It’s an important reminder that eating disorders can affect ANYONE, regardless of their body size. Atypical Anorexia challenges the stereotype that eating disorders are only present in those who are visibly underweight, highlighting the necessity for awareness and understanding across all demographics.

Symptoms of Anorexia

Anorexia Nervosa isn’t just about restricting calories. It manifests in a multitude of ways, both physically and emotionally. Here’s a closer look at the warning signs:

Physical Symptoms of Anorexia

  • Fatigue, weakness, lightheadedness, and dizziness.
  • Hair loss, dry skin, and brittle nails.
  • Amenorrhea (absence of menstrual periods) or irregular periods.
  • Digestive problems like early fullness, constipation or bloating.
  • Difficulty regulating body temperature (feeling cold most of the time).
  • Loss of focus and concentration.
  • Difficulty sleeping.

Emotional Symptoms of Anorexia

  • Anxiety and depression.
  • Social isolation and withdrawal from friends, family and activities.
  • Low self-esteem and a distorted body image 
  • Obsessive thoughts about food, weight, and calories.
  • Difficulty expressing emotions in a healthy way.

The distorted body image creates a constant battle, fueling the fear of weight gain and driving unhealthy behaviors. This can lead to feelings of isolation, shame, and a deep sense of despair, and, as weight loss progresses, the health consequences of Anorexia become increasingly severe or even life-threatening. It might lead to muscle loss, heart problems, electrolyte imbalances and, in severe cases, it might be fatal. 

Orthorexia vs Anorexia: Similarities and Key Differences

While both Orthorexia and Anorexia involve restricted eating patterns, there are crucial distinctions in their motivations and underlying psychology. 

Orthorexia vs Anorexia Infographic detailing the similarities and key differences between the two eating disorders.

Here’s a breakdown:

Orthorexia vs Anorexia: Shared Similarities

  • Restrictive Eating: Both disorders involve limiting food intake, often cutting out entire food groups or demonizing certain foods.
  • Safe vs. Fear Foods: Both can develop a rigid list of “safe” and “fear” foods, creating anxiety around meal planning and social situations that involve eating.
  • Guilt and Shame: Individuals with both disorders often feel guilt or shame for eating “fear” or “forbidden” foods.
  • Rigid Thinking: Fixed patterns of thinking around food are hallmarks of both disorders.

Orthorexia vs Anorexia: Key Differences

Motivation

  • Orthorexia: Driven by a desire for purity, health, and feeling in control through diet. 
  • Anorexia: Driven by a fear of weight gain and a distorted body image.

Body Image

  • Orthorexia: Body image may not be a central concern, although there might be a desire to be “healthy-looking.”
  • Anorexia: Preoccupation with body image and a distorted perception of size and shape.

Underlying Psychology

While both eating disorders can be linked to anxiety and OCD, the difference is in the reason behind that psychological distress. 

  • Orthorexia: Anxiety and OCD often center around control and purity of food, rather than weight or size. In fact, studies have shown that there might be a strong link between orthorexia and anxiety. 
  • Anorexia: Anxiety and OCD tendencies are fueled by a deep-seated fear of weight gain and a distorted body image.

Orthorexia vs Anorexia: Cultural “Approval” Of Disordered Behaviors

One reason it is challenging to recognize both Orthorexia and Anorexia early is connected to our culture.

Generally, when we see someone eating “healthy,” we applaud this behavior. After all, shouldn’t we all eat in a way that cares for our health? Lots of fruits and veggies are good for us, right? 

Well, to a point, yes, eating nutritious food is a form of self-care. However, when this drive for healthy eating gets in the way of our mental and physical health or social interactions, raise a red flag. This is a sign that we need to heal our thinking.

The same is true for our cultural tendency to congratulate weight loss. Not all weight loss is positive, but generally it has been culturally acceptable to comment on someone’s changing body size. This commentary is actually damaging – to the person hearing the “praise” as well as to the world at large. 

Praising weight loss encourages someone suffering from an eating disorder to continue disordered behaviors. This social approval cements their already rigid thought patterns. “This is working,” they believe when they hear their weight loss praised, even if “working” means skipping meals, misusing laxatives, or exercising obsessively.  

Additionally, social approval reinforces weight bias, which is what drives us to be dissatisfied with our bodies in the first place. Body dissatisfaction is a main cause of disordered eating and exercise patterns. 

How To Treat Anorexia vs Orthorexia

Treatment for Orthorexia

Overcoming Orthorexia requires a multi-pronged approach that addresses the underlying anxieties and unhealthy food beliefs. Here are some key components:

Cognitive Behavioral Therapy (CBT)

This therapy helps people challenge negative thoughts and beliefs about food (“This food is bad for me”) and develop healthier coping mechanisms for managing anxiety. CBT teaches skills like identifying cognitive distortions (irrational thoughts) and reframing automatic thoughts (replacing negative thoughts with more balanced perspectives). By learning to challenge their rigid thinking patterns, individuals with Orthorexia can develop a more flexible and balanced relationship with food.

Nutritional Counseling

Working with a registered dietitian is crucial to establish a personalized plan and healthy meal plans that incorporate a variety of foods, address any nutritional deficiencies, and most importantly, break the cycle of fear around certain foods. If you’re ready to take that first step towards food freedom, I offer personalized nutrition coaching to help you develop a healthy and sustainable relationship with food.

Support Groups and Community

Connecting with others who understand the struggles of Orthorexia can be incredibly helpful. Support groups and online communities provide a safe space to share experiences, gain encouragement, and learn from others on the road to recovery.

Treatment for Anorexia

Anorexia requires a multidisciplinary approach that tackles the physical, nutritional, and psychological aspects of the disorder. Here’s what treatment might involve:

Multidisciplinary Team

A team of medical professionals, including doctors, therapists, and registered dietitians, work collaboratively to address the various needs of the patient with Anorexia.

Medical Intervention

In most cases, individuals with Anorexia need medical monitoring from their primary care provider and registered dietitian. In severe cases, some individuals need a hospital stay to stabilize their physical health and ensure they are getting adequate nutrition to begin recovery.

Nutritional Rehabilitation

Registered dietitians play a crucial role in creating a safe and structured refeeding plan to help individuals restore their weight in a controlled manner. Dietitians are like food therapists, helping individuals examine their relationship to food and body image and working to help them heal. RDs also provide ongoing support and education about balanced nutrition and movement.

Psychotherapy

Techniques like CBT or family based therapy can address the underlying emotional and psychological issues that contribute to Anorexia. This can help individuals develop a healthier body image, manage anxiety and depression, and improve coping mechanisms.

Types Of Eating Disorder Treatment

The severity of the condition will determine whether inpatient or outpatient treatment is most appropriate. Inpatient treatment occurs in a hospital and provides a structured environment for individuals who need intensive medical monitoring and meal support. 

Residential treatment and Partial Hospitalization Programs (PHP) are highly structured treatment environments that provide therapy, nutrition counseling, meals and meal support, and medical support. With residential treatment, the patient lives at the treatment center for the duration of their stay. 

Conversely, Partial Hospitalization Programs are day treatment programs, with support usually spanning about eight hours per day.

Outpatient eating disorder treatment allows individuals to continue living at home while attending regular treatment sessions and following a structured eating plan. Intensive Outpatient Programs (IOP) provide support several hours per day, whereas outpatient treatment (non-intensive) provides support a few hours per week or every other week. Folks in outpatient treatment generally need less support than those in inpatient, residential or partial hospitalization programs.

Remember, the focus of eating disorder recovery goes beyond just eating and weight gain. Treatment programs address the root causes of the disorder to achieve a lasting recovery.

Final Thoughts on Orthorexia vs Anorexia

Orthorexia and Anorexia are complex eating disorders, not conscious choices. The main commonality between these disorders is restrictive eating, but the motivation for restriction is often different. Both disorders result in isolation and possibly serious mental and physical health consequences.

People struggling with Orthorexia and Anorexia deserve compassion and understanding, not judgment. Treatment is available for both disorders, and includes psychological, nutritional and medical support.


If you or someone you know is struggling with an eating disorder, please know that help is available. Ready to take a step towards a healthier relationship with food? Let me help you nourish your body and mind.