Nothing in excess is good: understand nervous orthorexia and exercise addiction – 08/26/2021

Healthy eating and regular physical activity are among the most promising practices for improving health and preventing or improving various physical and mental disorders. However, when we do it obsessively, both healthy eating and exercise can result in adverse consequences, including emotional distress when self-imposed rules are violated, malnutrition, weight loss, and social and functional impairments.

Two phenomena have received a lot of scientific attention in this regard, orthorexia nervosa and exercise addiction.

Orthorexia nervosa is characterized by fixation and concern for healthy eating. Affected people follow a restrictive diet, avoid unhealthy foods, have ritualized eating patterns, and have strict dietary rules.

Exercise addiction, on the other hand, has been described as a behavioral addiction: exercise plays the most important role in life, exercise creates a positive mood, not exercising results in unpleasant emotional and physical states, conflicts with the social environment and a tendency to return to the original training intensity after trying to reduce loads.

Neither orthorexia nervosa nor exercise addiction are currently recognized as mental disorders.

Orthorexic behaviors and addictive exercises

Symptoms of exercise addiction, a state of compulsive engagement in intense exercise and orthorexic eating attitudes, an obsession with eating only healthy foods often go together. Studies assume that some more general psychological traits underlie this association.

Higher orthorexic eating attitudes in athlete populations seem to confirm this assumption.

Although orthorexia nervosa and exercise addiction may share a common variation, the underlying mechanisms are hardly understood. In addition to possibly similar underlying motifs, eg weight and shape assessment, there are also some features that clearly distinguish the two.

In samples of the general population and among recreational exercisers, men are more exercise addicts than women. In contrast, pathologically relevant orthorexic behaviors are more prevalent in women.

Interestingly, orthorexic eating behaviors seem to be more highly correlated with exercise addiction and exercise orientation in women than in men. These findings indicate that the mechanisms underlying the relationship between exercise dependence and nervous orthorexia may differ between sexes.

Rules and standards

For both orthorexia nervosa and exercise addiction, an overemphasis on standards, duties, and rules, and the compulsive need to follow a strict regimen are factors that contribute to the diagnosis.

Although research on the correlates of orthorexia nervosa and exercise addiction is still in its infancy, some common risk factors have been proposed. Especially younger age, higher socioeconomic status, and lower BMI may be mildly to moderately correlated with orthorexic eating and additive exercise.

Another factor that can influence both orthorexia nervosa and exercise addiction, and can therefore explain their differences and similarities, is personality. On the other hand, personality traits can influence the extent of health-related behaviors. Awareness, in particular, has been linked to less risky but more beneficial health-related behaviors.

A research on the personality profile in orthorexia nervosa is just beginning. There is evidence of slightly higher perfectionism, less persistence, greater need for control, greater harm avoidance, and self-direction in individuals with higher orthorexic behaviors.

Both phenomena were related to psychopathology and worse psychological health, that is, greater stress, anxiety and symptoms of depression, but less satisfaction with life and well-being. Currently, however, it is not known whether orthorexia nervosa and exercise addiction are related to these characteristics in a similar way.


– Strahler, J.; Wachten, H.; Stark, R.; Walter, B. Alike and different: Associations between orthorexic eating behaviors and exercise addiction. International Journal of Eating Disorders, Vol. 54 Nr. 8 Pages: 1415 – 1425. 2021.