Orthorexia vs Anorexia: What's the difference?

July 2, 2024

By Joan Zhang

Clinically Reviewed by Sehrish Ali, PhD, LPC, CEDS

Orthorexia and anorexia are both eating disorders that can be associated with control and perfectionism. Yet, they have distinct characteristics. Understanding these differences is key to recognizing and effectively treating orthorexia and anorexia. 

We’ll walk through some of the key differences between orthorexia and anorexia, and find out what treatment helps individuals conquer the conditions. 

Let’s get started.

What is Orthorexia?

Definition and Characteristics

Orthorexia, or orthorexia nervosa, is a type of disordered eating that stems from a pre-occupation with eating healthy, “pure,” or “clean” foods. The condition centers around the quality of food. 

People living with orthorexia may focus so much on the nutritional content of their food to the extent it impacts their social, mental and physical well-being.

Symptoms of Orthorexia

While orthorexia is not officially recognized as a mental health diagnosis according to the DSM-V, it does have common symptoms. These include:

  • Obsessive concern with food quality and sourcing (i.e., excessive focus on exclusively “organic” or “fresh” food)
  • Intense fear and avoidance of “unhealthy” foods
  • Social isolation due to dietary habits
  • Excessively critical view of other people’s eating habits
  • Compulsively checking ingredient lists and nutritional labels
  • Fixating on preventing or curing disease with “clean” foods
  • Anxiety and guilt over food choices, e.g., inability to deviate from a specific dietary regimen without feeling extreme anxiety
  • Severe dietary restrictions that lead to malnutrition, e.g., eliminating large groups of food, such as sugar, carbohydrates or animal products, without a medical, ethical, cultural or religious reason for doing so

Causes and Risk Factors

While research on the specific causes of orthorexia remains sparse, several factors can play a role in its development

  • High anxiety 
  • Obsessive-compulsive tendencies
  • A need for control and perfection 
  • Access to “clean” foods (such as organic produce)
  • Use of social media that promotes “clean eating” lifestyles
  • Previous or current eating disorders. (Orthorexia may manifest as a more “socially acceptable” way to restrict food in some cases)
  • Nutritional knowledge (e.g., students studying health-related subjects may be more likely to exhibit orthorexia symptoms than students majoring in other subjects) 

What is Anorexia?

Definition and Characteristics

Anorexia, or anorexia nervosa, is an eating disorder that features a pre-occupation with weight control and body image. 

Individuals living with anorexia tend to have an extreme fear of being overweight (even if they are underweight). They severely restrict their food intake, which negatively affects their physical, social, and mental well-being.

Symptoms of Anorexia

Like orthorexia, anorexia has common symptoms:

  • Extreme weight loss
  • Intense fear of gaining weight
  • Insomnia and fatigue
  • Dizziness or fainting
  • Distorted body image
  • Thinning hair
  • Soft, downy hair covering the body
  • Bluish discoloration of the fingers
  • Preoccupation with food, dieting, and body size
  • Denial of the seriousness of reduced food intake
  • Amenorrhea (when relevant)

Some people living with anorexia may binge and purge, similar to those living with bulimia. Purging can involve self-induced vomiting, causing calluses on the knuckles.

Causes and Risk Factors

The exact cause of anorexia isn’t yet known, but like many diseases, it’s likely a combination of biological, psychological, and environmental factors

Some individuals may have a genetic tendency toward perfectionism and sensitivity, two traits that are associated with anorexia. 

Perfectionism has individuals living with anorexia believe they’re never thin enough. They may also have high anxiety and use restrictive eating as a way to control that, as well. Obsessive-compulsive personality traits, meanwhile, make it easier to stick to restrictive diets and not eat, despite being hungry.

And today’s Western culture, where worth and success are associated with being thin, may also contribute to the development of anorexia.

Key Differences Between Orthorexia and Anorexia

Focus and Motivation

A need for control underlies both orthorexia and anorexia, yet the actual focus and motivation behind each condition is different.

People living with orthorexia focus on the quality of their food. The motivation may often be linked to health and wellness. (One study has suggested a positive relationship between orthorexia and health anxiety). The focus of this condition is on health, not body shape or weight loss.

People living with anorexia focus on the quantity of food, or rather, restricting the amount of food they consume. They still experience hunger, yet their desire to lose weight and achieve an idealized body image overrides the need to answer the body’s call for food.

Behavioral Patterns

Individuals living with orthorexia display an intense fixation on the nutritional content of their meals. They adhere to rigid dietary rules. And despite their intent to be healthy, they may eliminate entire food groups from their diet, and risk malnutrition. 

They may avoid social events where food is served, avoid eating foods prepared by other people, and/or bring their own meals to events to ensure what they’re eating meets their standard of “healthy.” 

Individuals living with anorexia also display certain behaviors. They may rearrange food on a plate, or eat foods in a certain order or manner. They may also eliminate certain types of food, putting themselves at risk of malnutrition. You may hear them make frequent comments about feeling fat or overweight, despite their weight (and fat) loss. 

Fat acts as insulation in our bodies, so people living with anorexia may feel cold all the time. So, they may wear layers to stay warm, as well as loose clothing to hide just how thin they’ve become.

If they do eat, they may exercise excessively afterward to burn off the calories, or go to the bathroom right after eating to purge. They may also avoid social events where food will be served. 

Psychological Aspects

People living with orthorexia experience anxiety and guilt when they consume foods that don’t meet their standards of health. They primarily think about ideal health, avoiding disease, physical purity, and enhanced fitness. 

Individuals living with anorexia have an intense fear of gaining weight and a distorted self-perception, finding fat on their bodies where none exists, for example. They consciously focus on weight and restrict foods primarily based on calories.

People living with anorexia are usually ashamed of their condition and try to hide it, but individuals living with orthorexia may actively attempt to persuade others to follow the same health beliefs. Unlike individuals living with anorexia, they may not always try to conceal their behavior nor do they typically skip meals (unless they’re “cleansing”). That being said, extended periods of orthorexia can often lead to more restrictive behaviors and potentially even the development of anorexia.

Similarities Between Orthorexia and Anorexia

Impact on Health

We’ve already mentioned orthorexia and anorexia can both lead to malnutrition. This lack of nutrients can impact health in other ways, by causing:

  • Anemia
  • Abnormally slow heart rate
  • Irregular heart rhythms
  • Low blood pressure
  • Dehydration
  • Digestive problems
  • General weakness
  • Electrolyte and hormonal imbalances
  • Weakened immune system
  • Metabolic acidosis (when acids build up in your body)

Social and Emotional Effects

Since individuals living with orthorexia or anorexia may avoid social situations involving food, they may eventually find themselves socially isolated, with strained relationships. This isolation then sparks depression. 

Their relationship with food is often fraught with anxiety. With orthorexia, an individual is constantly ensuring their food is “clean,” “whole,” or “pure,” and consuming food not up to their standard also causes great stress and anxiety.

With anorexia, restricting amounts of food can cause anxiety. And if someone living with anorexia does eat, they experience anxiety for “losing control.” They are also constantly battling with body image, never being thin enough. They may feel a “high” when they reach a goal weight. This result may then motivate them to see how much more weight they can lose.

Need for Professional Treatment

Individuals can overcome orthorexia and anorexia. The answer is professional treatment. That includes therapy to tackle the underlying psychological issues, and nutritional counseling that addresses malnutrition, develops healthier eating habits, and improves patients’ relationship with food.

Medical monitoring and medication may also be a part of treatment.

How to Recognize the Signs

Early Warning Signs

Here are some of the early warning signs of orthorexia and anorexia:

  • Extreme changes in eating habits
  • Obsessive behaviors around food and exercise
  • Preoccupation with food, dieting, and body image
  • Extreme anxiety around certain foods 
  • Social withdrawal and isolation

When to Seek Help

If you or someone you know is exhibiting signs of orthorexia or anorexia, it’s important to seek help as soon as possible. The more a condition progresses, the greater risk of negative effects developing, such as malnutrition.

Help usually consists of a healthcare team of doctors, therapists, and dietitians who specialize in eating disorders.

Arise’s Approach to Eating Disorder Treatment

Holistic and Individualized Care

At Arise, we offer a holistic approach to eating disorder treatment, providing individualized care plans that address both the physical and psychological aspects of orthorexia and anorexia.

Collaborative Treatment Plans

We work collaboratively with clients to create treatment plans that incorporate therapy, nutritional counseling, and support groups to foster recovery and promote long-term health. It’s a community that supports healing your relationship with food, body image, and mental health.

Compassionate and Supportive Environment

Individuals recovering from eating disorders created Arise for others who are struggling with orthorexia or anorexia. The Arise team gets it. We provide a compassionate and supportive environment, ensuring clients feel understood and empowered throughout their recovery.

Orthorexia vs. Anorexia: Where to Find Help

It takes just a few minutes to join us and set up your Arise account where you can schedule appointments and meet your care team. Our care team consists of providers who bring their unique identities, experiences, and backgrounds to this purpose. Who you are, where you come from, and your unique story matter to us, and we can’t wait to meet you!

We’re here for you at Arise, whenever you’re ready.