• Even though maladaptive preoccupation with healthy eating through strict dietary rules negatively affects mental health, the evidence presented in this chapter suggests that the relationships between orthorexia nervosa and self-esteem, disordered eating and body image are inconclusive. In individuals with orthorexia nervosa, positive self-esteem appears to be due to maintaining a healthy diet and having control over their desires (e.g. Bratman & Knight, 2000; Kinzl et al., 2006), whereas some evidence has suggested lower levels of self-esteem (e.g. Sfeir et al., 2022). Although Bratman (1997) suggested that orthorexia nervosa excludes body image components, some findings provide evidence supporting the hypothesis that there is an association between orthorexia and body image concerns. For instance, individuals with orthorexia nervosa had been profiled as having lower levels of positive body image (body appreciation, appreciation and respect for the body and experience of embodiment) (Anastasiades & Argyrides, 2023) or displayed negative body image components (e.g. Messer et al., 2022). Despite the lack of conclusive results, it is essential to emphasise that some psychological features common to anorexia nervosa and/or obsessive-compulsive disorder have also been found in individuals with orthorexia nervosa (Figure 10.1).