["European Eating Disorders Review, Volume 34, Issue 3, Page 528-543, May 2026. ", "\nABSTRACT\n\nObjective\nIt has been proposed that orthorexia nervosa (ON), which entails a pathological preoccupation with healthy eating, warrants recognition as a distinct eating disorder (ED). However, the distinctive features of ON, and its associated distress and impairment, relative to currently recognised EDs remain unclear. The present study sought to gain a clearer understanding of ED symptomatology, distress, and impairment in ON and EDs.\n\n\nMethod\nAdult participants (n = 751) completed measures assessing ED and ON symptomatology, distress, and impairment. Participants were categorised into those with probable ED/ON (n = 162), ED‐only (n = 312), ON‐only (n = 12) or a healthy comparison (HC) group (n = 265).\n\n\nResults\nThe ON‐only group had significantly higher dietary restraint, shape/weight concerns, and ED‐related and physical impairment than the HC group, and higher dietary restraint and ED‐related impairment than the ED‐only group. The ED/ON group exhibited significantly higher eating, shape, and weight concerns than all groups, and higher ED‐related and general distress and impairment than the ED‐only and HC groups.\n\n\nConclusions\nThe findings support the conceptualisation of ON in the ED category and suggest the concurrent presence of elevated ON in adults with an ED comprises a more severe variant of an ED.\n\n"]