Orthorexia vs. Anorexia: Differences, Similarities & Treatment

Orthorexia Nervosa is a disordered eating pattern characterized by an obsession with “healthy” foods. Orthorexia often leads to a very restrictive diet, making it difficult to get enough calories and nutrients from food. This disorder can look very similar to anorexia, but there are significant differences. 

Anorexia nervosa is a diagnosable eating disorder and involves an extreme restriction of calories paired with an overwhelming fear of gaining weight. This eating disorder has a high mortality rate and can be life-threatening. 

Keep reading to learn more about what makes these two eating concerns different and, most importantly, where you can get help!

What Is Orthorexia?

Orthorexia nervosa is not an official medical diagnosis, but doctors and healthcare providers still recognize it as a severe form of disordered eating. Unfortunately, the lack of distinction and inclusion in the DSM-5 (a manual used for the diagnosis of mental health disorders) can make it harder for healthcare providers to diagnose it accurately.

Having an interest in how nutritional choices affect the body can be a great way to take ownership of your health. However, this interest can quickly become an obsession with only eating “healthy” foods and feeling intense fear around eating anything labeled as “junk” or “bad”. 

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This mentality shift doesn’t happen overnight; it develops over months or sometimes years. Identifying when a healthy habit has developed into an obsession is part of what makes orthorexia so challenging to recognize and treat.  

Symptoms of Orthorexia

• Extreme stress or anxiety about eating “unhealthy” foods. 
• Limited to no mealtime flexibility. 
• Preoccupation with planning, thinking, and worrying about meals. 
• Isolating and avoiding meals with people who don’t share the same food philosophies. 
• Spending hours following social media accounts that use sensational language to describe food. “Clean eating recipes only” or ‘detox smoothie ideas.” 

Popular media buzzwords tied to food will appeal to someone with orthorexia. They are more likely to believe only organic and non-GMO foods are the safest options for their health. 

If you catch yourself avoiding foods because you are worried about messages in the media, you should meet with a dietitian. Nourish offers individualized nutrition counseling with a registered dietitian. Consider booking a virtual appointment to address fears about food in a safe and judgment-free space.  

What Is Anorexia?

Anorexia nervosa is a life-threatening condition affecting men, women, youth, and seniors. It is characterized by severe caloric restriction, which leads to weight loss. Many people who suffer from anorexia will only consume “safe foods” that offer little to no calories. 

People who live in larger bodies have been discriminated against and underdiagnosed because of their size. This has led to many untreated eating disorders because they didn’t “look like” other people with anorexia nervosa.  

An eating disorder should never be diagnosed based on physical appearance. If you are afraid to eat, terrified of weight gain, and suffer from body image distortion, you should be assessed for anorexia nervosa and disordered eating.  

Symptoms of Anorexia  

• Significant weight loss over a short period of time. 
• Distorted body image. 
• Restricting all calories, including food and drink. 
• Frequent exercising or compulsive exercising. 
• Withdrawing from social occasions that revolve around meals and food. 

Unmanaged anorexia can lead to vitamin deficiencies and malnutrition. People with this disorder may need supplements to help meet their dietary requirements while their food intake remains low. Prolonged anorexia can lead to hair thinning, fertility complications, and decreased bone mineral density which increases the risk of fractures.  

A primary intervention for treating anorexia is increasing food intake. This can happen in in-patient clinics or outpatient supervised visits. Having accountability can help ensure that food is consumed. 

Similarities and Differences Between Orthorexia and Anorexia

Both of these conditions result in heavily restricted diets, which can lead to significant weight loss and nutrient deficiencies. It may not be clear if you have orthorexia or anorexia because the symptoms can overlap.

Similarities: 

Similarities between orthorexia and anorexia include: 

• Restricting foods and beverages from the diet. 
• Rigid eating behaviors. 
• Perfectionist tendencies.

Differences:

The differences between orthorexia and anorexia include: 

• Anorexia nervosa disorders restrict calories due to a fear of gaining weight. 
• Orthorexia nervosa restricts foods due to a fear of becoming sick or unwell.

Understanding the motivation behind the restriction can help to clarify what type of eating disorder is present. Only a medical doctor can issue an official eating disorder diagnosis, but working with a dietitian can help you work through  your relationship with food. 

Nourish offers virtual appointments with Registered Dietitians who are specialized in eating disorders. If you suspect you have an eating disorder, consider booking a virtual appointment with a Dietitian. 

Treatment Options

Ongoing counseling from trained professionals is part of the recommended treatment for an eating disorder. This can include dialectal behavior therapy (DBT), which focuses on learning to self-regulate emotions and linked behaviors. Another option may be cognitive behavioral therapy (CBT), which can help you change your thoughts and reactions. 

Your care team will need to follow your physiological health during treatment. You can expect to have your blood pressure assessed, blood work completed regularly, and frequent weigh-ins to ensure your weight is not dropping. 

DBT vs CBT 

Your therapist should assess your thoughts, outlook, and current coping skills to determine if DBT or CBT will be more effective for you. 

• DBT: can help with most anxiety-based eating disorders, including anorexia nervosa and orthorexia.
• CBT: can help with bulimia nervosa, binge eating disorder, and anorexia nervosa in adolescents. 

Some therapists are trained in both styles of treatment and may combine elements from both DBT and CBT into your therapy sessions. The therapist will assess you and decide which type will benefit you most.

Nourish Can Help 

Any eating disorder can negatively impact your physical and mental health. It can strain your relationship with food and affect your body image. A registered dietitian who specializes in eating disorders can help you recover. 

‍Nourish offers individual nutrition counseling that is covered by popular insurance carriers. If you are ready to take the next step on your healing journey, consider booking a virtual appointment with a Registered Dietitian.