Based on available studies, orthorexia can be considered a disorder that falls within the spectrum of eating disorders, though it should not be classified as a classic subtype of anorexia or a pure form of OCD. Studies conducted among medical and nursing candidates reveal that people in these professions, where taking care of health and body appearance plays a key role, are more likely to develop orthorexia nervosa. Perfectionism, which may be reinforced by idealized body images presented in social media, is also a significant risk factor for orthorexia nervosa 19,42. Additionally, easy access to the so-called "experts" and dietary challenges online may promote unhealthy eating practices that may worsen ON symptoms. Studies on orthorexia nervosa in the younger population reveal a number of significant associations with various risk factors, which emphasizes the complexity and multifaceted nature of this disorder. In addition to comorbidities, body image also plays a key role in the development of orthorexia, as it often forms the basis for the creation of unhealthy eating patterns. Such studies can be enriched with imaging diagnostics and more precise screening tests, which will reveal people affected by disorders and people at risk for this type of condition. An ethics statement is not applicable because this study is based exclusively on published literature. As with other human behaviors, ON likely spans a spectrum from "normal" to "abnormal," and "functional" to "dysfunctional." More theoretically driven research is necessary to propel the field forward. Current diagnostic and assessment tools lack the specificity to differentiate pathology and must be improved upon. Patients with ASD may also go to extreme lengths to avoid certain foods due to their sensitivity to tastes and textures (and insensitivity to hunger) . Patients with ON rigidly focus on their diets and perform ritualized patterns of eating 1, 66. Recent literature, while scant, indicates a similar diagnostic overlap between ON and ASD. Individuals with AN report higher levels of social anxiety, isolation, and challenges in interpersonal relationships, which parallel women with ASD. Therefore, we suggest that ON be treated as a distinct disorder within the "Eating Disorders" category in classifications such as the DSM or ICD. Conversely, under-scoring and overlooking cases of ON may involve overlooking a health problem, which can also have serious consequences. For example, an overestimation of the scores obtained may result in the unnecessary implementation of dietary or psychological interventions for patients. In the absence of standardization, a diagnostic tool such as ORTO-15 can lead to an incorrect diagnosis. The reason for this is the varying number of cut-off points used by researchers—some studies use a threshold of 35 points, others 40 or 45 . Orthorexia nervosa is an emerging and controversial eating disorder characterized by an obsessive preoccupation with healthy eating and an extreme fixation on food purity. Similarly, other authors have described the rigid beliefs about healthy eating as a form of obsessive thoughts and the avoidance of subjectively perceived unhealthy foods as a form of compulsive behavior e.g., (23) and higher DOS scores indeed relate to higher obsessive-compulsive symptoms e.g., (24). Specifically, Cena et al. (12) argue that—while established eating disorders and ON share common characteristics such as a concern over food and eating—ON is marked by open, rationalized rules related to eating and a focus on the quality of foods instead of fears of gaining weight and body image disturbances. The analysis also revealed significant correlations between ON, body mass index (BMI), and gender; however, no significant relationship was found between ON and obsessive–compulsive disorder (OCD). Studies of this kind could determine whether ON is distinct or an outgrowth of other disorders, as well as the long-term effects of the disorder. Another major limitation is understanding whether ON represents an independent clinical disorder, whether it belongs to the eating disorder spectrum, or whether it is a form of behavioral addiction or a variant of obsessive–compulsive disorder. Therefore, it is important to introduce and validate standardized diagnostic tools to minimize the risk of misdiagnosis. Additionally, studies suggest that the risk of ON may be particularly high in groups practicing yoga, where a greater tendency to orthorexic behavior is observed . The first one is whether OC (obsessive–compulsive symptoms) should be considered a behavioral phenomenon or lifestyle, or rather a mental disorder. The current lack of unified diagnostic and therapeutic guidelines limits the possibilities of effective intervention, which emphasizes the need for further research on the treatment of orthorexia. Conversely, CBT offers a structured, evidence-based intervention that targets maladaptive thought processes and behaviors related to orthorexia nervosa. Psychoeducation and cognitive-behavioral therapy (CBT) are prominent treatment approaches for individuals with orthorexia nervosa . The concept of orthorexia nervosa is not yet formally recognized by major diagnostic manuals like the DSM-5, further complicating matters. These comorbidities can further complicate the diagnostic process and require a comprehensive assessment to differentiate the primary focus and impact of orthorexia nervosa on an individual’s well-being. Identifying and assessing orthorexia and orthorexia nervosa pose several challenges, primarily due to the absence of standardized diagnostic criteria in major psychiatric classification systems such as the DSM-5 and ICD-10 13,14. Moreover, obsessive-compulsive tendencies can intensify the fixation on food purity and healthiness, leading to repetitive thoughts and behaviors related to dietary choices . Constant exposure to curated images of seemingly "perfect" bodies and "healthy" eating habits can create an environment that normalizes extreme dieting and reinforces that adhering to strict dietary rules is the key to achieving health and success 5,25,44. or they have only been used in a handful of studies yet e.g., the Eating Habits Questionnaire (10) or the Orthorexia Nervosa Inventory (11); cf. However, studies have shown consistently that this instrument has poor psychometric properties, the most prominent of which is its low internal reliability e.g., (7–9). The large majority of studies on ON have been based on a questionnaire measure called the ORTO−15 (3) or several short versions of it e.g., (4–6). It is important to note that the lack of consensus on diagnostic criteria and assessment tools may contribute to the variability in prevalence rates across different studies. Prevalence estimates for orthorexia vary widely, with some studies reporting rates as high as 90.6% among specific populations 11,20,21. In contrast, anorexia nervosa involves severe restriction of caloric intake, often leading to significantly low body weight . Orthorexia nervosa is not considered an official mental disorder; it is not listed by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 ) nor by the International Classification of Diseases (ICD-10 ). Prevalence studies indicate that though the exact rates remain uncertain, both conditions are becoming more prevalent, especially in Western societies with a strong emphasis on health and nutrition . "Clean eating" generally entails prioritizing whole, unprocessed foods while limiting or avoiding heavily refined and artificial ingredients. At the psychological level, individuals who experience high stress, anxiety, or dissatisfaction with other aspects of their lives may turn to food and the illusion of dietary control to cope or gain a sense of mastery 27,28. Additionally, the widespread availability of misinformation and unscientific health claims can further fuel fears about "toxic" foods, perpetuating the pursuit of restrictive and narrow dietary choices. Perfectionism, high levels of neuroticism, and a tendency towards obsessive-compulsive traits may predispose individuals to engage in rigid and extreme dietary behaviors .
