Eating disorders such as anorexia nervosa (AN) and bulimia nervosa (BN) are frequently diagnosed and treated by physicians and other eating disorders are called as nonspecific eating disorders. In despite of being a little known, these nonspecific eating diorders might be dangerous and severe by reason of the possibility of leading to AN or BN, or being related with other neuropsychiatric disorders such as anxiety or depression (Michalska et al., 2016). The nonspecific eating disorders such as orthorexia nervosa (ON), sleep-related eating disorder (SRED), and bigorexia are not clarified by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) .
Orthorexia nervosa is being evaluated as a new variant of eating disorders . Orthorexia nervosa is derived from the Greek words, orthos (right, correct, straight) and orexis (appetite, desire, hunger). In 1997, American doctor Steven Bratman introduced the term orthorexia in a non-scientific journal to define his own experiences with food and eating. Bratman has described the individuals whose abnormal diets cause to disturbances of daily functioning and malnutrition . ON defines a pathological obsession with a cluster of eating behaviors that involve a fixation to eat accurate or healthy, strictly organic, biologically-pure foods . Healthy eating behaviors can affect health positively. On the other hand, they may also give rise to pathological behaviors such as orthorexia nervosa . It has been demonstrated that orthorexia nervosa is seen as more desirable, less severe, and generally the result of personal preferences for life  and ON may affect approximately 7% of general population and be more common among males . The individuals who practice sports such as athletics or bodybuilding are the groups at higher risk for ON .
Clean dieting trends are becoming very popular nowadays. Clean eating indicates the eating behaviors related with restrictive eating models, optimum nutrition, and evasion of unhealthy, processed, or impure foods. The Raw food diets, the Low Carb High Fat, the placebo diet, Super Healthy Family are the most significant examples for clean eating diets .
Orthorexia nervosa has not been recognized as a disorder by (DSM-5). Scientists and physicians have discussed whether orthorexia might be evaluated as a disorder, an extreme dietary habit, or behavioral addiction . Orthorexia nervosa is not officially defined as a disorder; however, it is similar to eating disorders such as anorexia nervosa and bulimia nervosa. Moreover, it is not stil clear whether orthorexia nervosa belongs to the groups of the obsessive-compulsive disorders or the eating disorders . Orthorexia nervosa has some similar properties with several neuropsychiatric disorders, involving Obsessive-Compulsive Disorder (OCD), anorexia nervosa, illness anxiety disorder, obsessive-compulsive personality disorder, psychotic spectrum disorders, and somatic symptom disorder . Concentration on food, rituals associated with eating, strict eating habits, and very close relationship between self-esteem and eating are the most significant similarities between AN and ON . On the other hand, there are also some notable differences between orthorexia nervosa and eating disorders. Specifically, the individulas with AN are fear of weight gain and being obese, therefore, they restrict food intake in order to lose weight. Conversely, the individuals with ON frequently modify their eating habits to be able to improve their health and to feel pure and clean . While individuals with orthorexia nervosa desire to improve and/or control their health via food and diet, the individuals with anorexia nervosa worry about their physical appearance because of the fear of obesity . Orthorexic individuals indicate obsessive-compulsivebehaviors, such as measuring food, weighing frequentlyand carefully, and extreme meal planning . Furthermore, individuals with orthorexia nervosa continually restrict theirdiets to limitative foods such as raw vegetables .
Orthorexia nervosa is an obsessive-compulsive patternon a healthy diet that has worry for food content . It has been demonstrated that socioeconomic status, education, the internalization of the ideals of society, and the preference for profession are involved in the development of ON. On the other hand, age, gender, body mass index are not so significant factors for the development of ON . Furthermore, Oberle et al. has indicated that perfectionism and narcissism are the demographic characteristics which associated with all points of ON symptomatology . The individuals with ON obsessively protest foods which might involve artificial flavours, pesticide residues, unhealthy fats, artificial colours, foods involving too much sugar or salt, preservant agents, and genetically modified components Furthermore, kitchenware,and the preparation processes of foods are also main componenets of the obsessive ritual .
Diagnosis of Orthorexia Nervosa
Orthorexia nervosa is diagnosed when the individual devotes all her or his life for healthy foods and lifestyle and excludes job and social activities. Rectrictive diets in orthorexia nervosa give rise to deficiencies in nutriton and social problems. The patient must respond confirmingly to at least four out of eleven questions according to Bratman and Knight (Table 1) .
Treatment of Orthorexia Nervosa
Orthorexia nervosa is a multifactorial condition therefore; the team for the treatment of ON should compose of psychotherapists, clinicians, and dieticians. The treatment includes a combination of psychoeducation, drug therapy, and cognitive-behavioral therapy . Selective serotonin reuptake inhibitors such as paroxetine, fluoxetine, and sertraline might be combined with psychotherapy in some cases and the treatment might be beneficial for ON . Moreover, serotonin reuptake inhibitors are also helpful for AN and OCD.
Orthorexia nervosa is not weight loss fast but enormous phobia about eating only clean and pure foods. According to the individuals with orthorexia nervosa, the quality and the preparation ways of the foods they consume are more significant than social interactions, career plans, and personal values . In fact, a healthy diet affects health positively and does not influence social interactions, career plans, emotional states, and quality of life. On the other hand, awareness of diet, food, and healthy eating has been increased by the use of internet and social media recently . Using internet may have great potential for misinformation and it has been demosntrated that searching online for health information increasse anxiety that is called as cyberchondria . Orthorexia nervosa should be classified as a new eating disorder or at least a new neuropsychiatric disorder. Orthorexia nervosa has some disturbances for eating habits and mood. Further studies about nutrional, cognitive, and eating habits of ON have to be done in order to determine clearly the hypercorrect position of orthorexia nervosa.
1. Michalska A, Szeiko N, Jakubczyk A, Woinar M. Nonspecific eating disorders- A subjective review (2016) Psychiatria Polska 50: 497-507.
2. Bundros J, Clifford D, Silliman K, Neyman Morris M. Prevalence of orthorexia nervosa among college students based on Bratman s test associated tendencies (2016) Appetite 101: 86-94.
3. Dunn TM, Bratman,S. On orthorexia nervosa: A review of the literature and proposed diagnostic criteria (2016) Eating Behaviors 21: 11-7.
4. Koven NS, Senbonmatsu R. A neuropsychological evaluation of orthorexia nervosa (2013) Open Journal of Psychiatry 3: 214-222.
5. Rudolph, S. The connection between exercise addiction and orthorexia nervosa in German fitness sports (2017) Eating and Weight Disorders.
6. Simpson CC, Mazzeo SE. Attitudes toward orthorexia nervosa relative to DSM-5 eating disorders (2017) International Journal of Eating Disorders 50: 781-792.
7. Bartrina JA. Orthorexia or when a healthy diet becomes an obsession (2007) Arch Latinoam Nutr, 57: 313-315.
8. Nevin SM, Vartanian LR. The stigma of clean dieting and orthorexia nervosa (2017) Journal of Eating Disorders 5: 37.
9. Haman L, Barker-Ruchti N, Patriksson G, Lindgren EC. Orthorexia nervosa: An integrative literature review of a lifestyle syndrome (2015) International Journal of Qualitative Studies on Health and Well-Being 10: 26799.
10. Janas-Kozik M, Zejda j, Stochel M, Brozek G, Janas A, et al. Orthorexia-a new diagnosis? (2012) Psychiatria Polska 46: 441-450.
11. Brytek-Matera A, Rogoza R, Gramaglia C, Zeppegno P. Predictors of orthorexic behaviours in patients with eating disorders: A preliminary study (2015) BMC Psychiatry 15: 252.
12. Dittfeld A, Gwizdek K, Koszowska A, Nowak J, Broncczyk-Puzon A, et al. Assessing the risk of orthorexia in dietetic and physiotherapy students using the BOT (Bratman Test for Orthorexia) (2016) Pediatric Endocrinology, Diabetes and Metabolism 22: 6-14.
13. Varga M, Dukay-Szabo S, Tury F. Orthorexia nervosa and it s background factors (2013) Ideggyogyaszati Szemle 66: 220-227.
14. Oberle CD, Samaghabadi RO, Hughes EM. Orthorexia nervosa: Assessment and correlates with gender BMI and personality (2017) Appetite 108: 303-310. 15. Avsar O, Kuskucu A, Sancak S, Genc E. Are dopaminergic genotypes risk factors for eating behavior and obesity in adults? (2017) Neuroscience Letters 654: 28-32.
16. Koven NS, Abry AW. The clinical basis of orthorexia nervosa: Emerging perspectives (2015) Neuropsychiatric Disease and Treatment 1: 385-394.
17. Brytek-Matera A. Orthorexia nervosa - An eating disorder, obsesssive-compulsive disorder or disturbed eating habit? (2012) Archives of Psychiatry and Psychotherapy 1: 55-60.
Orçun Avşar, Department of Biotechnology, Yeditepe University, Istanbul, Turkey, Tel: +90 216 578 00 00, E-mail: email@example.com
Avşar O (2017) Orthorexia Nervosa- As an Eating Disorder. EPOA 1: 11-13