Table.

Proposed Diagnostic Criteria for Orthorexia Nervosa¹⁰

Criterion A Obsessive focus on healthy eating, as defined by a dietary theory or set of beliefs whose specific details may vary; marked by exaggerated emotional distress in relationship to food choices perceived as unhealthy; weight loss may ensue as a result of dietary choices, but this is not the primary goal. As evidenced by the following: Compulsive behavior and/or mental preoccupation regarding affirmative and restrictive dietary practices believed by the individual to promote optimum health; Violation of self-imposed dietary rules causes exaggerated fear of disease, sense of personal impurity and/or negative physical sensations, accompanied by anxiety and shame; Dietary restrictions escalate over time, and may come to include elimination of entire food groups and involve progressively more frequent and/or severe “cleanses” (partial fasts) regarded as purifying or detoxifying. This escalation commonly leads to weight loss, but the desire to lose weight is absent, hidden, or subordinated to ideation about healthy eating.

Criterion B The compulsive behavior and mental preoccupation becomes clinically impairing by any of the following: Malnutrition, severe weight loss, or other medical complications from restricted diet; Intrapersonal distress or impairment of social, academic, or vocational functioning secondary to beliefs or behaviors about healthy diet; Positive body image, self-worth, identity and/or satisfaction excessively dependent on compliance with self-defined healthy eating behavior.

Additional features that may confirm a diagnosis of ON include obsessive focus on food choice, planning, purchase, preparation, and consumption; food regarded as source of health rather than pleasure; distress or disgust when in proximity to prohibited foods; exaggerated faith that inclusion or elimination of particular kinds of food can prevent or cure disease or affect daily well-being; periodic shifts in dietary beliefs while other processes persist unchanged; moral judgment of others based on dietary choices; body image distortion around sense of physical impurity rather than weight; persistent belief that dietary practices are health-promoting despite evidence of malnutrition.