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Anorexia nervosa (AN) and orthorexia nervosa (ON) can often be confused with each other due to the similar ways they present. In both eating disorders, there is caloric restriction, a preoccupation with food, and a need for control.
However, it’s essential to be aware that they are very different disorders that should be approached as such when it comes to treatment.
Keep reading to learn how anorexia and orthorexia compare and how to get the right diagnosis for your eating disorder.
Anorexia nervosa is a serious eating disorder characterized by weight loss (although not in all cases), or lack of gaining appropriate weight, distorted body image, caloric restriction, and sometimes the use of compensatory behaviors such as exercising compulsively, self-induced vomiting, and/or the use of laxatives and diuretics.1
AN can affect people of all ages, genders, ethnicities, races, and sexual orientations, but it most frequently begins during adolescence. The cycle of self-starvation in anorexia can cause significant medical consequences, including osteoporosis, infertility, reduced immune function, and damage to the heart in severe cases.2
Orthorexia nervosa
Orthorexia nervosa is an eating disorder characterized by a preoccupation with “healthy” eating, not necessarily to lose weight. People living with ON typically only eat foods they consider “clean” or “pure,” which could involve cutting out all processed foods and/or entire food groups.3
While it’s not yet officially recognized in the DSM-5, orthorexia is on the rise, particularly in certain populations such as those with obsessive-compulsive or perfectionist personality traits, heavy social media users, and people with health or image-related careers (e.g., trainers, athletes, actors, and models).4
Eating a nutritious and balanced diet is great for your overall health and wellness and is important for a healthy lifestyle. However, when it escalates to the point where you’re micromanaging everything you eat, it can result in extreme mental distress and medical complications, including malnutrition and chronic fatigue.
Similarities between anorexia and orthorexia
The two eating disorders do share some similarities. The most noticeable physical symptom of anorexia nervosa is weight loss. Those with orthorexia nervosa can also be underweight depending on the restricted intake.
More consistent similarities between anorexia and orthorexia include but may not be limited to:5,6
Excessive focus on food and eating
Intrusive food-related thoughts
Eating-related issues are the main focus of one’s life
Strict diet and dietary restrictions (restrictive eating habits)
Intense anxiety regarding certain foods/food groups and avoiding said foods
Cognitive distortions about food, such as seeing foods as “good” or “bad”
Inflexibility in behavior and rituals related to the preparation and eating of foods
Obsessive-compulsive personality traits, such as perfectionism or rigidity
Need for control
Co-occurring anxiety and/or depression
A feeling of superiority over others based on one’s eating behaviors
Avoiding social events that involve food
Similar health consequences, such as malnutrition, fatigue, cardiac complications, and social isolation
While it’s clear there are similarities between the two eating disorders, there are also many key differences. Both eating disorders create obsessions with food, but the motivations behind these unhealthy relationships with food are quite different.
People with anorexia nervosa have an extreme fear of gaining weight and generally will avoid food or restrict their intake to reduce their weight. Whereas people with orthorexia nervosa only avoid specific foods, with an unhealthy focus on only consuming “good,” “clean,” or “organic” foods.5
Other key differences between anorexia and orthorexia include:5,6
People with orthorexia are focused on the perceived quality of food and how it relates to their ideas of health, whereas those with AN are focused on food intake and its effect on weight and shape.
Those with AN typically are underweight or have experienced sudden and significant weight loss, whereas those with ON are not always underweight.
Individuals with ON don’t necessarily have body size overestimation (i.e., believe they are larger than they are) or an obsession about their physical appearance, which those with AN do. However, this may not be true for all individuals with ON.
Treatment strategies may vary based on the differences in beliefs about food between the two eating disorders.
How to get a diagnosis for your eating disorder
While the internet is an excellent source of information on eating disorders, it’s impossible to self-diagnose your eating disorder. Despite different eating disorders presenting with similar signs and symptoms, each disorder is its own complex mental health condition that cannot be diagnosed online.
It is always best to speak to a medical professional about your concerns. The roads to recovery for two similarly presenting eating disorders can be very different, which is one of the key reasons why making sure you get the correct diagnosis is so important. Discussions with a healthcare professional who is informed about eating disorders can help differentiate between AN and ON and find the most appropriate treatment.
Learn more about online treatment for anorexia and orthorexia
Before you can receive treatment for an eating disorder, you will need a diagnosis. The first step in getting a diagnosis is talking to your doctor. We know how difficult this can be, but early intervention is one of the most effective actions for long-term recovery.
Here are some tips for speaking with your doctor so you get the most out of your appointment with as little anxiety as possible:
1. Be open and honest about your symptoms and struggles.
Remember, your doctor is there to provide you with an accurate diagnosis and to support you on your journey to recovery. The only way they can do this is if they know what’s really going on.
These are some of the key things to share with your doctor:
How often you restrict your food intake
What food restriction looks like for you
If you feel addicted to exercise
How you feel about weight gain or fluctuations
How you feel about your body
If you engage in compensatory behaviors and how often
Physical symptoms you are experiencing
If you’re feeling depressed or anxious
2. Be prepared ahead of your appointment
Write down all the questions you want to ask, symptoms you want to mention, and any concerns you might have. If you have no idea what to ask, here are a few to get you started:
Do I need a physical exam or tests?
Where can I get more information on my eating disorder?
What are my treatment options?
Can you refer me to a support group for eating disorders?
3. Bring someone to support you
When speaking to your doctor about your eating disorder, it may feel difficult to admit to them for the first time that you’re struggling with issues around your body and food. Having someone you trust with you may make you feel more comfortable so that you can feel safer opening up to your doctor.
4. Advocate for yourself
You know your body better than anyone. If you don’t feel you’re getting what you need from your doctor, such as if they don’t appear to be taking your symptoms seriously, or are participating in fatphobic practices, advocate for better care. Ask to be referred to an eating disorder specialist, or seek out an eating disorder specialist on your own.
What happens next?
Once you have opened up to your doctor, they may refer you to additional care providers or recommend a specific level of care, depending on your physical and mental health situation. Once you have a diagnosis, you will want your doctor to formulate a treatment plan for your individual needs. It is beneficial to your recovery for your treatment to include collaboration from a multidisciplinary treatment team trained on mental disorders, including a psychotherapist, physician, psychiatrist, and dietitian.
The bottom line
There are many similarities between anorexia and orthorexia—both eating disorders usually have restrictive eating behaviors and overvaluation of food, weight, and/or health. However, the critical difference between the two disorders is what motivates these behaviors.
With anorexia, intense fear or weight gain drives disordered eating behaviors. By contrast, for those living with orthorexia, the perceived “purity” and “cleanliness” of foods is the primary motivating factor.
So, while anorexia and orthorexia are similar, they are also different, just like every individual experience with an eating disorder is different.
Whether you have anorexia, orthorexia, or any other eating disorder, know that you’re not alone and your condition is treatable. Help is available now at Within.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
Resources
Anorexia nervosa. National Eating Disorders Association. (2018, February 28). Retrieved October 26, 2022.
