Is orthorexia nervosa a healthy way of being or a mental health disorder? Commentary on He et al. (2020)

Orthorexia nervosa is a new syndrome that has seen a marked increase in research in the past decade. Very high prevalence estimates in non-clinical populations have fuelled the debate as to whether it is a disorder in its own right, or only a problem when occurring in the context of another mental health or eating disorder. More recent assessment instruments have gone some way to address this issue. However, He et al.'s (2020, International Journal of Eating Disorder) study in older East Asian persons was not supportive of orthorexia nervosa as a disorder. Rather, people with orthorexia nervosa had better physical and mental health and lower or similar levels of eating disorder features such as body dissatisfaction when compared with people who did not have orthorexia nervosa. Albeit that selection bias in participant recruitment may in part explain their findings, the status of orthorexia nervosa is unresolved. Further studies need to employ appropriate instruments that measure psychopathology and function more broadly and investigate people with orthorexia nervosa symptoms in representative populations with longitudinal designs. The last is critical, as the most compelling evidence supporting a disorder is to find an adverse health impact over time that can be avoided by appropriate intervention.