<p>Orthorexia nervosa is defined as an exaggerated and obsessive fixation on healthy eating. In recent years, there has been growing debate over whether orthorexia nervosa should be considered a new psychiatric disorder. This paper discusses the conceptual issues that emerge from the attempt to identify the diagnostic criteria for orthorexia nervosa as opposed to non-pathological cases of healthy eating or ‘healthy orthorexia’. The analysis focuses on two main strategies that have been proposed in the literature: using physical impairment (malnutrition) and having recourse to the presence of psychological and psychosocial distress. The first strategy requires fundamental changes in the conceptualization of orthorexia nervosa, while the second risks unacceptably pathologizing uncommon lifestyles devoted to pursuing one specific activity, interest, or plan. Thus, substantial problems undermine the possibility of considering orthorexia nervosa, as it currently stands, as a plausible nosographic category. By proposing an analogy with eco-anxiety, the paper lastly shows that, if one accepts the widespread conceptualization of orthorexia nervosa, this behavior is better interpreted as an adaptive response than as a form of mental disorder.</p>