Orthorexia vs. Anorexia | Is There a Comparison?

Orthorexia nervosa (ON) and anorexia nervosa (AN) share many common symptoms and features, though the two are distinctive eating disorders. Understanding the differences—and similarities—between them can be helpful when looking for appropriate treatment or supporting a loved one with the condition.

What is Orthorexia?

Orthorexia nervosa is one of the more recently recognized eating disorders. It involves a fixation on healthy eating, or “eating clean,” and maintaining other “healthy” habits to the point of interfering with everyday life.

With ON, the strong desire to be healthy is often accompanied by an intense fear of not eating healthy food or not following strict rules or guidelines around food and eating. People with this condition will generally feel guilt, shame, or other unpleasant emotions if they do stray from their own rigid standards.¹

Sadly, the fixation on eating healthy can frequently lead to malnutrition. ON is also frequently marked by an escalating obsession over “healthy eating,” which can lead to someone avoiding entire food groups and adopting other unhealthy and unbalanced habits.¹

Signs of Orthorexia Nervosa

Through the influence of diet and fitness culture, entertainment and advertisements, and even some healthcare professionals, “healthy eating” has been widely seen as moral superiority. This popular way of thinking can make it easy for people to miss the signs of orthorexia nervosa, or even lead people to praise behaviors that may actually be dangerous.

What is Anorexia?

Anorexia nervosa is one of the most well-known eating disorders. It involves an extreme limitation on food intake and an intense fear of gaining weight. Helping maintain this disorder is a distorted body image, with someone often thinking they’re bigger than they actually appear.

While this condition is often associated with extreme thinness, that isn’t always the case. People may exhibit the same symptoms of AN while presenting in a normal or larger body, in a condition called atypical anorexia nervosa (AAN).³

There is also a binge/purge subtype of anorexia nervosa. People with this eating disorder primarily restrict their diet but may also experience binge eating sessions. These are followed by attempts to purge the food through excessive exercise, self-induced vomiting, fasting, or other methods.⁴

Signs of Anorexia Nervosa

Physically, anorexia nervosa can result in:⁵

• Low blood pressure
• Fatigue and/or insomnia
• Constipation or abdominal pain
• Yellow skin
• Thinning hair and brittle nails
• Soft, downy hair covering the body
• Irregular heart rhythm

Anorexia vs. Orthorexia

ON and AN are often confused—and were once thought to be variants of the same condition.¹ But along with their similarities, there are some strong differences between the two.

Similarities Between ON and AN

Anorexia nervosa and orthorexia nervosa can present very similarly, looking like an obsession with food, avoiding eating with others, and an adherence to very specific rules around eating. Physically, both conditions can lead to thinness and signs of malnutrition.

Both orthorexia and anorexia are often linked to other mental health disorders. Obsessive compulsive disorder (OCD), various anxiety disorders, and depression frequently overlap with an AN or ON diagnosis.^1,3

And people with both conditions experience fear of straying from their self-imposed rules around eating. Breaking these “rules” can generally lead to feelings of anxiety, guilt, shame, or other unpleasant emotions or unhelpful behaviors.^1,3

Differences Between ON and AN

While many similarities come to mind when thinking of anorexia vs. orthorexia, there are also a number of subtle—but important—differences.

People with orthorexia nervosa will obsess over the quality of food they’re eating, while people with anorexia nervosa tend to fixate on the quantity of food. That’s because AN is primarily driven by a fear of weight gain, while ON is primarily driven by a fear of eating unclean or unhealthy foods.¹

As a result, people with AN are far more likely to skip meals than those with ON. And this can sometimes—though, not always—result in people with AN presenting in thinner bodies than those with ON.¹

Sadly, the cultural attitudes around healthy eating can also make a difference in how these two conditions are perceived. While someone may be shamed for restricting food intake, people with orthorexia nervosa may be praised for focusing on healthy eating, and it may take longer for them or others to recognize their disordered eating habits.¹

Orthorexia vs. Anorexia: Treatments

While orthorexia nervosa is understood by scientists and doctors, the condition has yet to be recognized as an official diagnosis, so few if any studies have specifically looked at treatments for ON. But the similarities the condition shares with AN and other mental health disorders suggests that certain types of therapies may be more helpful.¹

Still, it’s important for anyone struggling with any type of eating disorder to receive comprehensive treatment. Eating disorders impact emotional, physical, and mental health, and all of these areas should be addressed in the recovery journey.

Treatments for both anorexia and orthorexia can also be administered on a sliding scale. Patients who are more severely impacted may benefit from starting recovery with hospitalization or inpatient treatment, while those who are not as far along in the disorder may prefer partial hospitalization programs or even virtual eating disorder therapy.

Regardless, it’s important to remember that both conditions are treatable, and with the right kind of help and support, full recovery from an eating disorder is always possible.