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Greville-Harris M, Vuillier L, Goodall S, Talbot CV, Walker C, Appleton KM. Striving for the perfect diet? The mediating role of perfectionism in the relationship between obsessive compulsive symptoms and traits of Orthorexia Nervosa. J Eat Disord 2024; 12:91. [PMID: 38951924 PMCID: PMC11218215 DOI: 10.1186/s40337-024-01032-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/27/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Orthorexia Nervosa (ON) is a disordered eating style involving an unhealthy obsession with 'healthy' or 'clean' eating. Its aetiology is still poorly understood and is not yet recognised in diagnostic manuals. While ON has been associated with Obsessive Compulsive (OC) symptoms and perfectionism, no study to date has looked at the relationship between OC symptoms and ON tendencies via perfectionism, or the influence of two facets of perfectionism in this relationship, namely evaluative concern and achievement striving. Examining the potential role of perfectionism helps to understand the aetiology of ON as well as inform potential treatments tailored specifically for ON and comorbid OC symptoms. METHODS In this cross sectional study, we tested 507 participants (n = 70 males, n = 69 at risk of ON) on questionnaires measuring OC symptoms, perfectionism and ON symptoms. We ran two mediation analyses to look at the overall relationship between perfectionism and OC and ON symptoms (Model 1) as well as the specific contribution of evaluative concern and achievement striving in the relationship between OC and ON symptoms (Model 2). RESULTS We found that perfectionism partially mediated the relationship between OC and ON symptoms. Specifically, we found that while achievement striving and evaluative concern were associated with OC symptoms, only achievement striving was significantly associated with ON symptoms, mediating the relationship between OC and ON symptoms. CONCLUSIONS This study highlighted the role of one key facet of perfectionism (achievement striving) in the aetiology of ON. The role of achievement striving was indicated as a transdiagnostic construct explaining the link between ON and OC symptoms. These findings are discussed in terms of their implications for treatment models, specifically in terms of the potential role of targeting perfectionism in ON treatment.
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Affiliation(s)
- Maddy Greville-Harris
- Department of Psychology, Faculty of Science and Technology Poole House, Talbot Campus, Bournemouth University, Fern Barrow, Poole, Dorset, BH12 5BB, UK.
| | - Laura Vuillier
- Department of Psychology, Faculty of Science and Technology Poole House, Talbot Campus, Bournemouth University, Fern Barrow, Poole, Dorset, BH12 5BB, UK
| | - Summer Goodall
- Department of Psychology, Faculty of Science and Technology Poole House, Talbot Campus, Bournemouth University, Fern Barrow, Poole, Dorset, BH12 5BB, UK
| | - Catherine V Talbot
- Department of Psychology, Faculty of Science and Technology Poole House, Talbot Campus, Bournemouth University, Fern Barrow, Poole, Dorset, BH12 5BB, UK
| | - Cliona Walker
- Department of Psychology, Faculty of Science and Technology Poole House, Talbot Campus, Bournemouth University, Fern Barrow, Poole, Dorset, BH12 5BB, UK
| | - Katherine M Appleton
- Department of Psychology, Faculty of Science and Technology Poole House, Talbot Campus, Bournemouth University, Fern Barrow, Poole, Dorset, BH12 5BB, UK
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Bogár N, Dukay-Szabó S, Simon D, Túry F. Higher orthorexia tendency among female fashion models: an empirical international study. Eat Weight Disord 2024; 29:44. [PMID: 38937320 PMCID: PMC11211108 DOI: 10.1007/s40519-024-01674-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 06/16/2024] [Indexed: 06/29/2024] Open
Abstract
PURPOSE Female fashion models are more at risk for developing eating disorders than non-models due to the intense occupational pressure they face. The present study focuses on assessing whether female models are more prone to report orthorexia nervosa signs and symptoms than non-models. METHODS Female fashion models (n = 179, mean age: 25.9 SD = 4.40 years) and an age adjusted control group (n = 261, mean age: 25.0 SD = 4.97 years) were selected by snowball sampling. Participants filled out an online survey containing anthropometric questions and the 18-item Eating Habits Questionnaire. RESULTS According to BMI, fashion models were underweight (mean BMI = 18.1 SD = 1.68) while control participants' BMI was in the normal range (mean = 22.1 SD = 4.23, p < 0.001). On all three of Eating Habits Questionnaire subscales fashion models showed significantly higher average value (Knowledge subscale: M = 2.42 among models versus M = 2.08 in the control group, p < 0.01, Cohen's d = 0.52; Problems subscale: M = 1.93 among models versus M = 2.61 in the control group, p < 0.01, Cohen's d = 0.49; Feelings subscale: M = 3.20 among models versus M = 2.96 in the control group, p < 0.01, Cohen's d = 0.38). Orthorexic tendencies were reported by 35.1% of the models versus 20.2% of controls. CONCLUSION Fashion models are at risk for the development of eating disorders. Even though not yet included in the DSM-5, the assessment of orthorexia nervosa among fashion models seems to be important. It is suggested to take appropriate measures to prevent the spread of disordered eating habits among models as they can lead to the development of anorexia nervosa or bulimia nervosa. LEVEL OF EVIDENCE Level III, well-designed cohort study.
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Affiliation(s)
- Nikolett Bogár
- Faculty of Medicine, Institute of Behavioural Sciences, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | | | - Dávid Simon
- Department of Statistics, Faculty of Social Sciences, Eötvös Loránd University, Budapest, Hungary
| | - Ferenc Túry
- Faculty of Medicine, Institute of Behavioural Sciences, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary.
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Boutin C, Maïano C, Aimé A. Relation between orthorexia nervosa and healthy orthorexia: A latent profile analysis. Appetite 2024; 194:107165. [PMID: 38103792 DOI: 10.1016/j.appet.2023.107165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/24/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
Orthorexic eating behaviors can be conceptualized as a bidimensional construct encompassing an orthorexia nervosa dimension (ON) and a healthy orthorexia dimension (HO). Although variable-centered studies showed that ON and HO are distinguishable orthorexic eating behaviors, the evidence of whether they can co-occur or be distinct in subgroups of individuals is still limited. The present study aimed to address previous person-centered studies' limitations by examining profiles of ON and HO among a convenience sample of 251 French-speaking Canadian adults (85.7% women; Mage = 33.56). Profile membership was examined as function of participants characteristics such as age, gender, body mass index, frequency of physical activity and sports and vegetarianism. The relation between profile membership, intuitive eating and disordered eating attitudes and behaviors was also assessed. Latent profile analysis (LPA) were used to estimate profiles of ON and HO. Results from LPA did not provide support for the distinguishability of ON and HO. Indeed, they revealed the presence of two profiles showing co-occurring levels of ON and HO that only differed quantitatively: low (68.9% of the sample; low levels of ON and HO) or moderate orthorexic eating behaviors (31.1%; moderate levels of ON and HO). Participants who declared being vegetarian and being more frequently involved in physical activities and sports were more likely to belong to the moderate orthorexic eating behaviors' profile. Finally, participants from the moderate orthorexic eating behaviors' profile showed higher levels of disordered eating attitudes and behaviors, whereas those from the low orthorexic eating behaviors' profile showed higher levels of intuitive eating. Findings from the present study question the distinguishability of ON and HO dimensions. They also suggest that, similarly to ON, HO is also related to higher eating and lifestyle preoccupations.
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Affiliation(s)
- Camille Boutin
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Canada
| | - Christophe Maïano
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Canada; Cyberpsychology Laboratory and Department of Psychoeducation and Psychology, Université du Québec en Outaouais (UQO|Campus de Saint-Jérôme), Saint-Jérôme, Canada.
| | - Annie Aimé
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Canada
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Ng QX, Lee DYX, Yau CE, Han MX, Liew JJL, Teoh SE, Ong C, Yaow CYL, Chee KT. On Orthorexia Nervosa: A Systematic Review of Reviews. Psychopathology 2024; 57:1-14. [PMID: 38432209 PMCID: PMC11326525 DOI: 10.1159/000536379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/15/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Orthorexia nervosa (ON), characterized by a pathological preoccupation with "extreme dietary purity," is increasingly observed as a mental health condition among young adults and the general population. However, its diagnosis is not formally recognized and has remained contentious. OBJECTIVE In this systematic review, we attempt to overview previous reviews on ON, focusing on the methodological and conceptual issues with ON. This would serve both as a summary and a way to highlight gaps in earlier research. METHODS This systematic review took reference from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines, and using combinations of the search terms ("orthorexia" OR "orthorexia nervosa" OR "ON") AND ("review" OR "systematic review" OR "meta-analysis"), a literature search was performed on EMBASE, Medline and PsycINFO databases from inception up to October 31, 2023. Articles were included if (1) they were written or translated into English and (2) contained information pertaining to the diagnostic stability or validity of ON, or instruments used to measure ON symptoms and behaviors. Only review articles with a systematic literature search approach were included. RESULTS A total of 22 reviews were qualitatively reviewed. Several studies have reported variable prevalence of ON and highlighted the lack of thoroughly evaluated measures of ON with clear psychometric properties, with no reliable estimates. ORTO-15 and its variations such as ORTO-11, ORTO-12 are popularly used, although their use is discouraged. Existing instruments lack specificity for pathology and several disagreements on the conceptualization and hence diagnostic criteria of ON exist. DISCUSSION Previous reviews have consistently highlighted the highly variable (and contradictory) prevalence rates with different instruments to measure ON, lack of stable factor structure and psychometrics across ON measures, paucity of data on ON in clinical samples, and a need for a modern re-conceptualization of ON. The diagnosis of ON is challenging as it likely spans a spectrum from "normal" to "abnormal," and "functional" to "dysfunctional." "Non-pathological" orthorexia is not related to psychopathological constructs in the same way that ON is.
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Affiliation(s)
- Qin Xiang Ng
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Dawn Yi Xin Lee
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Chun En Yau
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ming Xuan Han
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
| | - Jacqueline Jin Li Liew
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Seth En Teoh
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Clarence Ong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Clyve Yu Leon Yaow
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kuan Tsee Chee
- Department of General and Community Psychiatry, Institute of Mental Health, Singapore, Singapore
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Huynh PA, Miles S, de Boer K, Meyer D, Nedeljkovic M. A systematic review and meta-analysis of the relationship between obsessive-compulsive symptoms and symptoms of proposed orthorexia nervosa: The contribution of assessments. EUROPEAN EATING DISORDERS REVIEW 2024; 32:257-280. [PMID: 37838984 DOI: 10.1002/erv.3041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/07/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to update the literature on orthorexia nervosa (ON), a proposed diagnosis of pathologically 'healthy' eating, by critically analysing the current evidence for the relationship between ON and obsessive-compulsive (OC) symptoms. Further, this paper aimed to compare the ON/OC relationship significance and strength based on when the ON measurement tool was developed. METHOD PsycINFO, PubMed and Web of Science databases were queried for quantitative, peer-reviewed studies recruiting adult participants, published in English up to April 2023. Studies not directly comparing ON and OC symptoms were excluded. After full-text review and quality assessment, 40 studies were included in the systematic review and 31 studies in the meta-analysis. RESULTS ON assessments created prior to the 2016 revised ON diagnostic criteria do not appear to fully capture OC symptoms. Studies using earlier developed ON assessments demonstrated inconsistent ON/OC relationships whereas studies implementing more recent assessments (from 2018 onwards) found consistently significant, larger relationships, highlighting a previously underrated OC component of ON. CONCLUSIONS Early ON studies, and studies utilising early ON assessments should be interpreted with caution, particularly in relation to OC symptom involvement in ON. Future research should validate novel ON assessments and investigate common underlying factors.
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Affiliation(s)
- Phillipa Ann Huynh
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Stephanie Miles
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
- Orygen, Melbourne, Victoria, Australia
| | - Kathleen de Boer
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Denny Meyer
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Maja Nedeljkovic
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
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Barthels F, Fischer M, Keskini R, Schöl AM, Pietrowsky R. The various facets of orthorexic eating behavior: five case reports of individuals with supposed orthorexia nervosa. J Eat Disord 2024; 12:31. [PMID: 38383470 PMCID: PMC10882829 DOI: 10.1186/s40337-024-00988-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/11/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Orthorexia nervosa, defined as a fixation on eating healthy according to subjective criteria, is recently being discussed as another variant of disordered eating behavior. Further characteristics are rigid adherence to nutritional rules, anxieties and avoidance behavior in the context of eating as well as a focus on health, not on body shape or weight loss, which is supposed to differentiate orthorexic from other disordered eating behavior. Although diagnostic criteria have been suggested, they have rarely been used in case reports published to date. Hence, the aim of this study was to present five individuals with supposed orthorexia nervosa, using preliminary diagnostic criteria to assess their eating behavior. CASE PRESENTATION The five cases (three females, two males) reveal the great variety of disordered eating behavior. Fear of unhealthy overweight (case A), supposed orthorexic eating behavior as a coping strategy for anorexia nervosa (case B), the exclusive consumption of animal products with a total exclusion of fruits and vegetables (case C), the fixation on exercise and athletic goals (case D) as well as a focus on a vegan diet and unprocessed foods (case E) are facets of orthorexia nervosa with varying degrees of impairment. CONCLUSIONS It is concluded that orthorexia nervosa manifests itself in very different ways and that more research is needed in order to determine whether it could be a useful additional category of disordered eating behavior.
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Affiliation(s)
- Friederike Barthels
- Institute of Experimental Psychology, Department of Clinical Psychology, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.
| | - Maren Fischer
- Institute of Experimental Psychology, Department of Clinical Psychology, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Raphaela Keskini
- Institute of Experimental Psychology, Department of Clinical Psychology, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Amelie Marie Schöl
- Institute of Experimental Psychology, Department of Clinical Psychology, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Reinhard Pietrowsky
- Institute of Experimental Psychology, Department of Clinical Psychology, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
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Rossi AA, Mannarini S, Donini LM, Castelnuovo G, Simpson S, Pietrabissa G. Dieting, obsessive-compulsive thoughts, and orthorexia nervosa: Assessing the mediating role of worries about food through a structural equation model approach. Appetite 2024; 193:107164. [PMID: 38103790 DOI: 10.1016/j.appet.2023.107164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/11/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Orthorexia Nervosa (ON) is a condition characterized by an obsessive focus on healthy eating, inflexible dietary rules, and persistent preoccupations with food. Despite it has been recently the subject of increasingly relevant studies, little is known about the mechanisms that might foster ON symptoms. OBJECTIVE This study used a structural equation modeling approach to test the mediating effect of thoughts, worries, and preoccupations about food on the relationship that eating disorders (EDs) attitudes (e.g., dieting) and obsessive-compulsive thoughts and symptoms have with ON in a large community sample. It was hypothesized that the effect of dieting and obsessive-compulsive thoughts and symptoms on ON would be partially mediated by the presence of thoughts, worries, and preoccupations about food. METHODS Data from a cross-sectional sample of 1328 participants (females = 976) recruited from the general population were asked to fill in an online survey comprising the Eating Attitude Test-26 (EAT-26), the Obsessive-compulsive subscale of the Symptom Checklist-90 Revised (SCL-90R-OC) and the Orthorexia Scale-15 (ORTO-15). RESULTS Structural equation models indicated that both obsessive-compulsive thoughts and symptoms and dieting had a direct effect on ON and that food preoccupation partially mediated these relationships. CONCLUSION These findings provide novel insight into the nature of ON that could aid its conceptualization and treatment.
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Affiliation(s)
- Alessandro Alberto Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy; Center for Intervention and Research Studies on the Family, University of Padova, Padova, Italy.
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy; Center for Intervention and Research Studies on the Family, University of Padova, Padova, Italy
| | | | - Gianluca Castelnuovo
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Milano, Italy; IRCCS Istituto Auxologico Italiano, Clinical Psychology Research Laboratory, Milano, Italy
| | - Susan Simpson
- NHS Forth Valley Eating Disorder Service, Stirling, Scotland, UK; Department of Justice & Society, University of South Australia, Australia
| | - Giada Pietrabissa
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Milano, Italy; IRCCS Istituto Auxologico Italiano, Clinical Psychology Research Laboratory, Milano, Italy
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Huynh PA, Miles S, Nedeljkovic M. Perfectionism as a moderator of the relationship between orthorexia nervosa and obsessive-compulsive symptoms. Eat Weight Disord 2024; 29:6. [PMID: 38198059 PMCID: PMC10781834 DOI: 10.1007/s40519-023-01629-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/27/2023] [Indexed: 01/11/2024] Open
Abstract
PURPOSE Orthorexia nervosa (ON), a proposed disorder describing an obsessive focus on "healthy" eating, is characterised as having overlapping symptoms with obsessive-compulsive disorder. However, ON/obsessive-compulsive (OC) symptom relationships are inconsistently reported. The current study aimed to investigate if the contribution of OC symptoms and beliefs explain variability in ON symptoms and determine if perfectionism, a transdiagnostic factor, moderates the ON/OC symptom relationship. METHODS The study comprised 190 participants (Mage = 28.63, SDage = 9.88; 80% female) recruited via an undergraduate research programme, social media, advocacy organisations, and a participant registry. Participants completed an online questionnaire assessing ON, OC, and perfectionism symptoms. RESULTS A linear regression analysis found OC symptoms and beliefs explained 22.9% variability in ON symptoms (p < 0.001, f2 = 0.38) and perfectionism moderated the ON/OC symptom relationship, where higher levels of perfectionism with higher levels of OC symptoms was associated with higher levels of ON symptoms, explaining 2.2% variability (p = .01, f2 = 0.03). CONCLUSION OC symptoms appear more common in ON than previous studies indicate. However, the interaction between perfectionism and OC symptoms may drive obsessions in ON. Findings help refine our current understanding of ON phenomenology with implications for ON treatment development. Future research should further explore perfectionism in ON phenomenology. LEVEL OF EVIDENCE Level V (Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees).
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Affiliation(s)
- Phillipa Ann Huynh
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn Campus, PO Box 218, Hawthorn, VIC, 3122, Australia.
| | - Stephanie Miles
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Orygen, Melbourne, VIC, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Maja Nedeljkovic
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn Campus, PO Box 218, Hawthorn, VIC, 3122, Australia
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KORKMAZ YAYIN B, CEYLAN ERGUN C. Mediator Roles of Perfectionism and Self-Critical Rumination in the Relationship Between Perceived Maternal Rejection and Orthorexia: A Model Testing in a Female Sample. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2023. [DOI: 10.18863/pgy.1191242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Orthorexia nervosa (ON) refers to a pathological obsession with healthy eating characterized by a restrictive diet, ritualized eating patterns, and strict avoidance of foods believed to be unhealthy or unclean. On the other hand, healthy orthorexia (HO) is defined as an interest in healthy eating and a tendency to eat healthy foods. This study aimed to investigate the relationships between the ON, HO, maternal rejection, perfectionism, self-critical rumination, and body attitude in the women sample. 445 female students from diverse universities in Turkey was attended to our study. Participants completed questionnaires regarding ON and HO, body attitude, maternal rejection, perfectionism, and self-critical rumination. The results showed that negative body attitudes could not predict both HO (B=-.008, SE=.039, p=.791) and ON (B=.008, SE=.032, p=.835). However, perfectionism and self-critical rumination had mediator roles in the relationship between ON and HO with maternal rejection, despite this relationship was positive for ON (B = .014, Boot SE = .007, 95% Boot CI [.003, .029]), but negative for HO (B = -.023, Boot SE = .010, 95% Boot CI [-.042, -.008]). Not a negative body attitude, but maternal rejection, perfectionism, and self-critical rumination played roles in developing orthorexic tendencies.
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López-Gil JF, Tárraga-López PJ, Soledad Hershey M, López-Bueno R, Gutiérrez-Espinoza H, Soler-Marín A, Fernández-Montero A, Victoria-Montesinos D. Overall proportion of orthorexia nervosa symptoms: A systematic review and meta-analysis including 30 476 individuals from 18 countries. J Glob Health 2023; 13:04087. [PMID: 37917875 PMCID: PMC10622118 DOI: 10.7189/jogh.13.04087] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
Background To date, no previous meta-analysis has determined the overall proportion of orthorexia nervosa symptoms on a global scale. The aim of the present study was 2-fold: first, to establish the overall proportion of orthorexia nervosa symptoms on a global scale, assessed with the ORTO-15 questionnaire; and second, to determine the role of sex, type of population, mean age, body mass index, and the temporal trend in relation to orthorexia nervosa symptoms. Methods Four databases were searched (PubMed, Scopus, Web of Science, and Cochrane Database of Systematic Reviews) with date limits from January 2005 to June 2023. Studies assessing the proportion of orthorexia nervosa assessed using the ORTO-15 questionnaire with a cutoff of <35 or <40 points were included in this review. Results The overall proportion of orthorexia nervosa symptoms (using the cutoff <35 points) was 27.5% (95% confidence interval (CI) = 23.5-31.6, I2 = 97.0%). In addition, no significant differences were observed between females (34.6%, 95% CI = 29.5-39.8, I2 = 96.1%) and males (32.1%, 95% CI = 26.5-38.1, I2 = 93.1%). According to the type of population, the highest overall proportion was found in people focused on sports performance or body composition (34.5%, 95% CI = 23.1-47.0, I2 = 98.0%). Notwithstanding, caution should be exercised in interpreting this result, as reverse causality could be a potential pitfall in this relationship. Conclusions We found that approximately three out of 10 study participants showed orthorexia nervosa symptoms according to the ORTO-15 tool. This overall proportion was higher in those participants who were athletes or fitness practitioners. Over the years, the proportion of orthorexia nervosa symptoms seems to be increasing. These high percentages and their increase are worrisome from a public health perspective and highlight the need to develop psychometric instruments to aid in clinical diagnosis and treatment efficacy. Registration PROSPERO (CRD42022350873).
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Affiliation(s)
- José Francisco López-Gil
- Navarrabiomed, Hospital Universitario de Navarra, Universidad Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, Spain
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
- One Health Research Group, Universidad de Las Américas, Quito, Ecuador
| | - Pedro Juan Tárraga-López
- Departamento de Ciencias Médicas, Facultad de Medicina, Universidad Castilla-La Mancha, Albacete, Spain
| | - Maria Soledad Hershey
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
- University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, Pamplona, Spain
| | - Rubén López-Bueno
- Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain
| | | | - Antonio Soler-Marín
- Faculty of Pharmacy and Nutrition, Universidad Católica San Antonio de Murcia, Murcia, Spain
| | - Alejandro Fernández-Montero
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Occupational Medicine, University of Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
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Cosh SM, Olson J, Tully PJ. Exploration of orthorexia nervosa and diagnostic overlap with eating disorders, anorexia nervosa and obsessive-compulsive disorder. Int J Eat Disord 2023; 56:2155-2161. [PMID: 37615059 DOI: 10.1002/eat.24051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE Orthorexia nervosa (ON) is characterized as obsessional healthy eating that results in malnutrition and/or psychosocial impairment. Yet, ON shares theoretical overlap with eating disorders (EDs), especially anorexia nervosa (AN), as well as obsessive-compulsive disorder (OCD). This study aimed to further understand ON and its overlap with related disorders by assessing the ability of ON for detecting the presence/absence of threshold ED, AN, and OCD symptoms. METHOD An observational survey was completed by 197 participants recruited through eating disorder, dieting, and mental health support groups. Receiver operating characteristic (ROC) curve analyses determined the predictive ability of ON symptoms (assessed by Eating Habits Questionnaire [EHQ] orthorexia nervosa [OrNe] and healthy orthorexia [HeOr] subscales, and the Orthorexia Nervosa Inventory [ONI]) for detecting disordered eating symptoms (determined by Eating Disorder Examination Questionnaire [EDE-Q] global cut-scores), probable AN (determined by EDE-Q cut-scores and body mass index [BMI] <18.5), and OCD symptoms and obsessional thinking (assessed by the Revised Obsessive-Compulsive Inventory [OCI-R]). RESULTS Results showed both the ONI and EHQ OrNe measures are able to adequately predict ED symptoms and AN; however, both were poor to moderate at detecting OCD symptoms and obsessional thinking. Healthy orthorexia was poor to moderate at detecting outcomes. DISCUSSION These results suggest that ON, as it is currently operationalized, may be more closely related to EDs than OCD, and that ON may represent a subtype of AN. Results also support healthy orthorexia as a distinct construct to ON. While results are limited by the lack of definitive ON diagnostic criteria, findings suggest that treatments developed for EDs might be most suited to ON. PUBLIC SIGNIFICANCE ON has been proposed as a psychiatric disorder, and it shares theoretical overlap with several existing disorders. This study adopts a novel approach to assessing and exploring the overlap of ON with EDs, AN and OCD. Results suggest that ON shares more overlap with EDs and might best be understood as a subtype of EDs or AN.
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Affiliation(s)
- Suzanne M Cosh
- School of Psychology, University of New England, Armidale, New South Wales, Australia
| | - Jemma Olson
- School of Psychology, University of New England, Armidale, New South Wales, Australia
| | - Phillip J Tully
- School of Psychology, University of New England, Armidale, New South Wales, Australia
- Freemasons Centre for Male Health and Wellbeing, Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Aloi M, Moniaci M, Rania M, Carbone EA, Martino G, Segura-Garcia C, Liuzza MT. Relationship between disgust and orthorexia nervosa and psychometric properties of the Italian Dusseldorf orthorexia scale in a general population sample. J Eat Disord 2023; 11:174. [PMID: 37789371 PMCID: PMC10546774 DOI: 10.1186/s40337-023-00899-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/21/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND It remains unclear among clinicians and researchers whether orthorexia nervosa (ON) is a part of the obsessive-compulsive disorder spectrum or eating disorders. Disgust seems to be a shared psychopathological factor in these clinical presentations, indicating a potentially crucial role in ON. On the other hand, numerous psychometric tools have been developed to evaluate ON. The Dusseldorf Orthorexia Scale (DOS) was recently validated in an Italian sample. However, the study's primary limitation was that the scale was only administered to undergraduate university students. This study aimed to investigate the psychometric properties (including factorial structure, reliability, and measurement invariance conditional on sex) of the Italian version of the DOS (I-DOS) on a sample from the general population. Additionally, the study sought to determine the nomological validity of the I-DOS by examining its relationship with disgust sensitivity. METHODS A sample of 521 participants took part in this study and completed a battery that assessed ON and disgust sensitivity. To assess the I-DOS structure, reliability, and measurement invariance we respectively conducted confirmatory factor analysis (CFA), computed McDonalds's omega, and performed hierarchical series of multigroup CFAs. Then, we tested the relationship between ON and disgust sensitivity. RESULTS CFA confirmed the unifactorial model of I-DOS and it respected the configural, metric, and strict invariance while a partial scalar invariance was achieved. It also showed good reliability with an omega of 0.87. In addition, we found a positive relationship between ON and disgust sensitivity, thus confirming the nomological validity of I-DOS. CONCLUSIONS Our findings suggest that the Italian version of the Dusseldorf orthorexia scale (I-DOS) exhibits strong psychometric properties and can be an effective instrument for assessing ON in a general population sample. Notably, the most significant and innovative outcome was the positive correlation between ON and disgust sensitivity. As disgust has been linked to other clinical presentations, this preliminary result could serve as a foundation for future research exploring this phenomenon in greater detail.
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Affiliation(s)
- Matteo Aloi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Martina Moniaci
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Marianna Rania
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy
| | - Elvira Anna Carbone
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Gabriella Martino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Cristina Segura-Garcia
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Viale Europa, 88100, Catanzaro, Italy.
| | - Marco Tullio Liuzza
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
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13
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Zagaria A, Barbaranelli C, Mocini E, Lombardo C. Cross-cultural adaptation and psychometric properties of the Italian version of the Orthorexia Nervosa Inventory (ONI). J Eat Disord 2023; 11:144. [PMID: 37620907 PMCID: PMC10463941 DOI: 10.1186/s40337-023-00858-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Orthorexia Nervosa (ON) is an emerging clinical condition characterized by a pathological fixation with healthy eating. Recently, the Orthorexia Nervosa Inventory (ONI) has emerged as a promising tool for assessing orthorexic tendencies and behaviours, aiming to overcome the well-established limitations of existing measures for ON. The present study aimed to examine the psychometric properties of the Italian version of the ONI. METHODS A total of 879 participants (Mage = 33.22 years, SD = 9.19; 56.9% females) completed the ONI along with the Düsseldorf Orthorexia Scale (DOS), measures of disordered eating, obsessive-compulsive symptoms (OCD), and psychosocial impairment. To establish the factorial validity of the ONI, a competing measurement modeling approach was employed by comparing standard confirmatory factor analytic (CFA) with exploratory structural equation modeling (ESEM) solutions. Model-based omega coefficients were computed to examine the internal consistency of the scale. Factorial invariance tests across gender were conducted within a multi-group framework. RESULTS A three-factor first-order ESEM solution provided the best and most parsimonious representation of the data: χ2(207) = 558.641, p < .001, RMSEA = 0.044 (90% CI 0.040-0.048), CFI = 0.976, TLI = 0.968, SRMR = 0.036. The three latent dimensions, labelled behaviors, emotions, and impairments, showed excellent internal consistency (ω > 0.88). Furthermore, ONI scores were found to be positively correlated with DOS scores, disordered eating, OCD symptoms, and psychosocial impairment, supporting its convergent and criterion validity. Eventually, the ONI was factorially invariant across gender. CONCLUSIONS Overall, the present study provides evidence for the satisfactory psychometric properties of the ONI in the Italian context, endorsing its use in both clinical and research settings.
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Affiliation(s)
- Andrea Zagaria
- Department of Psychology, Sapienza University of Rome, Rome, Italy.
| | | | - Edoardo Mocini
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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14
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Novara C, Piasentin S, Mattioli S, Pardini S, Maggio E. Perfectionism or Perfectionisms in Orthorexia Nervosa. Nutrients 2023; 15:3289. [PMID: 37571233 PMCID: PMC10421058 DOI: 10.3390/nu15153289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023] Open
Abstract
Purpose: Perfectionism is considered a transdiagnostic construct that characterises eating disorders (EDs) and obsessive-compulsive disorder (OCD) and that could also depict orthorexia nervosa (ON). The principal aim of this study was to investigate what dimensions of perfectionism mostly represent ON. Moreover, it was evaluated if dieting impacted the presence of orthorexic features and perfectionistic behaviour. Methods: The sample consisted of two groups-the "Diet" (n = 93), and the "No Diet" (n = 94) groups-composed of people with high and low orthorexic tendencies, respectively. Participants filled out self-report questionnaires to investigate orthorexic tendencies and different facets of perfectionism. Results: Analyses highlighted that people with high orthorexic tendencies showed higher perfectionistic features and that ON had a significant relationship with different facets of perfectionism. No interactions with diet were found. Therefore, no other differences were highlighted when the group type (Diet/No Diet) was considered. Conclusions: Regardless of diet, different facets of perfectionism characterise ON: perfectionism as a personality trait and perfectionism related to EDs and to obsessive-compulsive features. Our results evidenced that perfectionism could also be considered a useful construct in the conceptualization of orthorexia nervosa.
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Affiliation(s)
- Caterina Novara
- Department of General Psychology, University of Padova, Via Venezia 8, 35131 Padova, Italy
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15
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Yassıbaş E, Ayyıldız F. Turkish Version of the New Instrument for Orthorexia Nervosa-Test of Orthorexia Nervosa (TON-17): A Validity and Reliability Study. Nutrients 2023; 15:3178. [PMID: 37513596 PMCID: PMC10384101 DOI: 10.3390/nu15143178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
This study aimed to adapt the Test of Orthorexia Nervosa- (TON-17) into Turkish and verify its validity and reliability. The study included 539 adults with a mean age of 30.2 ± 12.26 years. A reliability analysis was performed, along with a confirmatory factor analysis to test its construct validity. The time-invariance of the scale was examined by test-retest analysis, and its convergent validity was evaluated by a correlation analysis conducted to test the relationships between the scale and Eating Attitudes Test-26 and Obsessive Beliefs Questionnaire-9. Analyses were conducted using SPSS Version 28 and the AMOS-24 software. The Cronbach's α internal consistency coefficient of the total scale was found to be 0.82, suggesting a strong internal consistency. The Cronbach's α values of its factors were 0.68 for the "control of food quality", 0.64 for the "fixation on health and a healthy diet", and 0.73 for the "disorder symptoms". In addition, the test-retest reliability was found to be 0.87 for the total scale, suggesting excellent reliability. Most of the fit indices (CMIN/df, RMSEA, AGFI, NFI, and TLI) of the scale were acceptable, and the GFI indicated a good model fit. This study shows that the Turkish version of TON-17, which is a new tool with a three-factor structure to evaluate orthorexia, is a valid and reliable scale.
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Affiliation(s)
- Emine Yassıbaş
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, 06490 Ankara, Turkey
| | - Feride Ayyıldız
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, 06490 Ankara, Turkey
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16
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Messer M, Liu C, Linardon J. Orthorexia nervosa symptoms prospectively predict symptoms of eating disorders and depression. Eat Behav 2023; 49:101734. [PMID: 37146411 DOI: 10.1016/j.eatbeh.2023.101734] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 03/29/2023] [Accepted: 04/23/2023] [Indexed: 05/07/2023]
Abstract
The possible mental health impacts of orthorexia nervosa (ON) symptoms are poorly understood, as existing research in this field has mostly employed cross-sectional designs. This study investigated whether ON symptoms prospectively predict changes in eating disorder psychopathology and general mental health. A convenience, non-clinical sample of adults (n = 313; 83 % women) completed study measures at baseline (T1) and three-month follow-up (T2). Negative binomial regressions were computed to test whether T1 ON symptoms predict changes in binge eating and driven exercise episodes. Linear regressions were computed to test whether T1 ON symptoms predict changes in eating concerns, depressive symptoms, and life satisfaction. Higher ON symptoms prospectively predicted greater number of binge eating and driven exercise episodes at T2. Higher ON symptoms predicted increased eating concerns and depressive symptoms at T2. ON symptoms did not predict changes in life satisfaction. Findings highlight possible risks associated with ON symptomatology. Efforts to better inform the public about the risks of these pathological eating patterns are needed.
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Affiliation(s)
- Mariel Messer
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
| | - Claudia Liu
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
| | - Jake Linardon
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia; Center for Social and Early Emotional Development, Deakin University, Burwood, Victoria 3125, Australia.
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17
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Maïano C, Aimé A, Almenara CA, Gagnon C, Barrada JR. Psychometric properties of the Teruel Orthorexia Scale (TOS) among a French-Canadian adult sample. Eat Weight Disord 2022; 27:3457-3467. [PMID: 36180717 DOI: 10.1007/s40519-022-01482-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/14/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Psychometric properties of the Teruel Orthorexia Scale (TOS) have been examined in several languages (Arabic, English, Portuguese, Spanish, and Turkish), but not in French. PURPOSE The objective was to examine the psychometric properties of the TOS among a French-Canadian adult sample. METHODS Participants were 296 French-speaking Canadian adults (M = 34.2 years, SD = 11.9, 85.1% women). They completed the TOS alongside with several other measures (e.g., alcoholic consumption, cigarette smoking, disturbed eating attitudes and behaviors, frequency of physical activities, intuitive eating, vegetarian diet, and negative affect). RESULTS The results supported the a priori two-factor representation (orthorexia nervosa and healthy orthorexia) of the French version of the TOS and provided further support for the superiority of an exploratory structural equation modeling approach, relative to a confirmatory factor analytic approach. Furthermore, the results supported no differential item functioning as a function of respondents' characteristics (age, body mass index, diagnosis of eating disorders, frequency of physical activities, gender, and vegetarian diet). Latent mean differences were found in healthy orthorexia and orthorexia nervosa factors as a function of respondents' characteristics. Finally, significant correlations were found between TOS factors and convergent measures (alcohol consumption, cigarette smoking, disturbed eating attitudes and behaviors, intuitive eating, and negative affect). CONCLUSION The present study confirmed that the French version of the TOS has satisfactory psychometric properties (i.e., factor validity and reliability, no differential item functioning, and convergent validity). LEVEL OF EVIDENCE V, cross-sectional study.
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Affiliation(s)
- Christophe Maïano
- Cyberpsychology Laboratory and Department of Psychoeducation and Psychology, Université du Québec en Outaouais (UQO), Campus de Saint-Jérôme, 5 rue Saint-Joseph, Saint-Jérôme, Québec, J7Z 0B7, Canada. .,Department of Psychoeducation and Psychology, Université du Québec en Outaouais (UQO), Saint-Jérôme, Canada.
| | - Annie Aimé
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais (UQO), Saint-Jérôme, Canada
| | - Carlos A Almenara
- School of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Cynthia Gagnon
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais (UQO), Saint-Jérôme, Canada
| | - Juan Ramón Barrada
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
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18
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Li WL, Tan SX, Ouyang RQ, Cui YF, Ma JR, Cheng C, Mu YJ, Zhang SW, Zheng L, Xiong P, Ni WZ, Li LY, Fan LN, Luo YM, Yu YL, Wang ZM, Ding F, Pan QF, Jiang AY, Huang JM, Cao WT, Liu J, Ye YB, Zeng FF. Translation and validation of the Chinese version of the orthorexia nervosa assessment questionnaires among college students. Eat Weight Disord 2022; 27:3389-3398. [PMID: 36071328 DOI: 10.1007/s40519-022-01469-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/21/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The main objective of the study was to translate, validate, and compare the Chinese ORTO scales (ORTO-15 and ORTO-R). The secondary objective was to assess factors that may be related with risk of orthorexia nervosa (ON). METHODS Two cross-sectional surveys were conducted on March-to-June 2021 for ORTO-15 and April 2022 for ORTO-R. ORTO questionnaires were translated into Chinese using the forward-backward-forward method. Exploratory factor analysis (EFA), discriminant validity and confirmatory factor analysis (CFA) were used to examine the construct validity of the questionnaires. The internal consistency was assessed using the Cronbach alpha coefficient and the test-retest reliability. Multivariate linear regression analysis was used to explore potential factors related with ON scores. RESULTS Totally, 1289 and 1084 eligible participants were included for assessment of ORTO-15 and ORTO-R, with the mean age of 20.9 ± 2.0 years and 21.0 ± 2.3 years. The internal consistency of Chinese ORTO-15 scale and ORTO-R scale were both satisfactory (α = 0.79, ICC = 0.79; α = 0.77, ICC = 0.82). However, all ORTO-15 models showed a poor fit using CFA whereas the ORTO-R was characterized by acceptable goodness-of-fit. Multivariate linear regression indicated that physical activities and mental disorders were positively associated with ON risk assessed by both ORTO-R and ORTO-15. CONCLUSION The Chinese ORTO-R scale was a more reliable tool to screen for ON tendencies than the Chinese version of ORTO-15. Mental disorders and physical activities might be associated with the increased ON risk. LEVEL OF EVIDENCE Level V (descriptive cross-sectional study).
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Affiliation(s)
- Wan-Lin Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Si-Xian Tan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Rui-Qing Ouyang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Yun-Feng Cui
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Jun-Rong Ma
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Chen Cheng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Ying-Jun Mu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Shi-Wen Zhang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Lu Zheng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Peng Xiong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Wan-Ze Ni
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Lu-Yao Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Li-Na Fan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Yu-Mei Luo
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Ying-Lin Yu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Zi-Mo Wang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Fan Ding
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Qiao-Fei Pan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - An-Yi Jiang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Jing-Min Huang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China
| | - Wen-Ting Cao
- Department of Medical Statistics and Epidemiology, School of Public Health, Hainan Medical University, Haikou, 571199, Hainan, China
| | - Jun Liu
- Department of Preventive Medicine Laboratory, School of Public Health, Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Yan-Bin Ye
- Department of Nutrition, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Fang-Fang Zeng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou, 510632, Guangdong, China.
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Donini LM, Barrada JR, Barthels F, Dunn TM, Babeau C, Brytek-Matera A, Cena H, Cerolini S, Cho HH, Coimbra M, Cuzzolaro M, Ferreira C, Galfano V, Grammatikopoulou MG, Hallit S, Håman L, Hay P, Jimbo M, Lasson C, Lindgren EC, McGregor R, Minnetti M, Mocini E, Obeid S, Oberle CD, Onieva-Zafra MD, Opitz MC, Parra-Fernández ML, Pietrowsky R, Plasonja N, Poggiogalle E, Rigó A, Rodgers RF, Roncero M, Saldaña C, Segura-Garcia C, Setnick J, Shin JY, Spitoni G, Strahler J, Stroebele-Benschop N, Todisco P, Vacca M, Valente M, Varga M, Zagaria A, Zickgraf HF, Reynolds RC, Lombardo C. A consensus document on definition and diagnostic criteria for orthorexia nervosa. Eat Weight Disord 2022; 27:3695-3711. [PMID: 36436144 PMCID: PMC9803763 DOI: 10.1007/s40519-022-01512-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/12/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Since the term orthorexia nervosa (ON) was coined from the Greek (ὀρθός, right and ὄρεξις, appetite) in 1997 to describe an obsession with "correct" eating, it has been used worldwide without a consistent definition. Although multiple authors have proposed diagnostic criteria, and many theoretical papers have been published, no consensus definition of ON exists, empirical primary evidence is limited, and ON is not a standardized diagnosis. These gaps prevent research to identify risk and protective factors, pathophysiology, functional consequences, and evidence-based therapeutic treatments. The aims of the current study are to categorize the common observations and presentations of ON pathology among experts in the eating disorder field, propose tentative diagnostic criteria, and consider which DSM chapter and category would be most appropriate for ON should it be included. METHODS 47 eating disorder researchers and multidisciplinary treatment specialists from 14 different countries across four continents completed a three-phase modified Delphi process, with 75% agreement determined as the threshold for a statement to be included in the final consensus document. In phase I, participants were asked via online survey to agree or disagree with 67 statements about ON in four categories: A-Definition, Clinical Aspects, Duration; B-Consequences; C-Onset; D-Exclusion Criteria, and comment on their rationale. Responses were used to modify the statements which were then provided to the same participants for phase II, a second round of feedback, again in online survey form. Responses to phase II were used to modify and improve the statements for phase III, in which statements that met the predetermined 75% of agreement threshold were provided for review and commentary by all participants. RESULTS 27 statements met or exceeded the consensus threshold and were compiled into proposed diagnostic criteria for ON. CONCLUSIONS This is the first time a standardized definition of ON has been developed from a worldwide, multidisciplinary cohort of experts. It represents a summary of observations, clinical expertise, and research findings from a wide base of knowledge. It may be used as a base for diagnosis, treatment protocols, and further research to answer the open questions that remain, particularly the functional consequences of ON and how it might be prevented or identified and intervened upon in its early stages. Although the participants encompass many countries and disciplines, further research will be needed to determine if these diagnostic criteria are applicable to the experience of ON in geographic areas not represented in the current expert panel. LEVEL OF EVIDENCE Level V: opinions of expert committees.
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Affiliation(s)
| | | | | | | | | | | | - Hellas Cena
- University of Pavia, Pavia, Italy
- ICS MAUGERI IRCCS, Pavia, Italy
| | | | | | | | | | | | | | | | - Souheil Hallit
- Holy Spirit University of Kaslik, Jounieh, Lebanon
- Effat University (KSA), Jeddah, Saudi Arabia
| | | | | | | | | | | | | | | | | | - Sahar Obeid
- Lebanese American University, Beirut, Lebanon
| | | | | | | | | | | | | | | | - Adrien Rigó
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Rachel F. Rodgers
- Northeastern University, Boston, USA
- Lapeyronie Hospital, CHRU Montpellier, Montpellier, France
| | | | | | | | - Jessica Setnick
- International Federation of Eating Disorder Dietitians, Dallas, USA
| | | | | | | | | | | | | | - Martina Valente
- Amedeo Avogadro University of Eastern Piedmont, Vercelli, Italy
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Negative body image components as risk factors for orthorexia nervosa: Prospective findings. Appetite 2022; 178:106280. [PMID: 35988801 DOI: 10.1016/j.appet.2022.106280] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/01/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022]
Abstract
Emerging theoretical and empirical evidence indicates that negative body image might be implicated in the onset or maintenance of ON symptoms. However, existing research investigating associations between negative body image and ON is limited to cross-sectional designs and has failed to consider the independent role of distinct components of body image. To overcome these limitations, the present study examined the prospective associations between five components of body image (i.e., overvaluation, dissatisfaction, preoccupation, body checking, and body image avoidance) and ON symptoms in community-based adult women. Participants were assessed at baseline and at a three-month follow-up, with 558 women included in the final analyses. After adjusting for baseline ON symptoms, higher scores on each of the five body image components at baseline significantly predicted greater increases in ON symptoms in univariate analyses. However, in multivariate analyses, overvaluation with weight and shape was the only component of body image to uniquely predict ON symptoms. Findings suggest that certain components of negative body image may increase the risk for ON symptoms. Findings also lend support to recent proposals that ON may be better viewed as a variant of an existing eating disorder, given that both appear to share similar underlying risk factors.
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Albery IP, Shove E, Bartlett G, Frings D, Spada MM. Individual differences in selective attentional bias for healthy and unhealthy food-related stimuli and social identity as a vegan/vegetarian dissociate "healthy" and "unhealthy" orthorexia nervosa. Appetite 2022; 178:106261. [PMID: 35931214 DOI: 10.1016/j.appet.2022.106261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/01/2022] [Accepted: 07/27/2022] [Indexed: 11/30/2022]
Abstract
Previous work identified the operation of an attentional bias (AB) towards healthy food related stimuli among those with increasing tendencies towards orthorexia nervosa (ON) using a modified Stroop task. The current work aimed to replicate and extend our understanding of this effect by incorporating alternative measures of AB (i.e., the dot probe task) and ON (i.e., the Teruel Orthorexia Scale [ToS]) in a sample of self-defined vegans/vegetarians. The theoretical assertion of the ToS is the conceptual broadening of orthorexia with differentiable dimensions - one characterised as a "healthy" preoccupation with healthy food/eating patterns (HeOr) and the other by a more underlying pathology (OrNe). This study also aimed to examine the pattern of responding across these two dimensions according to factors known to predict ON. Eighty-six participants (mean age = 33.0 years; 20 males, 66 females) completed measures of obsessive compulsivity, perfectionism, state/trait anxiety and ToS as well as a dot probe designed to measure AB for healthy and unhealthy-related food stimuli, threat ratings of each of words utilised and perceived identity centrality as a vegan/vegetarianism. Results showed a dissociation of predicted determinants for "healthy" ON (HeOr) and pathological ON (OrNe). HeOr was predicted by increasing identity centrality whereas OrNe was predicted by increased OCD and perfectionism, and increased interference for healthy-related food words (in particular slowed disengagement) and not unhealthy related food words. Threat-related ratings of unhealthy food words was shown to be common across both dimensions. This pattern highlights cognitive and individual differences-based correlates of pathological and non-pathological ON.
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Affiliation(s)
- Ian P Albery
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, UK.
| | - Emma Shove
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, UK
| | - Georgina Bartlett
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, UK
| | - Daniel Frings
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, UK
| | - Marcantonio M Spada
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, UK
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22
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Orthorexia Nervosa and Disordered Eating Attitudes, Self-Esteem and Physical Activity among Young Adults. Nutrients 2022; 14:nu14061289. [PMID: 35334945 PMCID: PMC8948728 DOI: 10.3390/nu14061289] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 02/06/2023] Open
Abstract
A relation between Orthorexia Nervosa (ON) and increased frequency of physical activity has been put in evidence by recent studies. It is well known that intense physical exercises are typically related to eating disorders, but its relationship with ON is still a subject of debate. Other transdiagnostic features could be necessary to conceptualize and understand ON; in this way, low self-esteem is related to eating behavior but is not still extensively investigated in ON, and, to date, data are so heterogeneous that they do not allow us to understand if this is a psychological feature somehow associated with ON. The current study aimed to assess whether disordered eating attitudes, self-esteem, and physical activity are associated with ON in young adults from Poland and Italy. Moreover, we investigated the differences by comparing lower and higher ON levels related to disordered eating attitudes, self-esteem, and physical activity. Our results indicated that a great concern about dieting significantly predicted problems associated with healthy eating, knowledge about healthy eating, and feeling positive about healthy eating. In addition, young adults with a high level of ON demonstrated higher levels of disordered eating attitudes and vigorous-intensity physical activity than young adults with a low level of ON. Future studies are needed to assess the direct effect of physical activity and self-esteem on ON.
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Gkiouleka M, Stavraki C, Sergentanis TN, Vassilakou T. Orthorexia Nervosa in Adolescents and Young Adults: A Literature Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:365. [PMID: 35327737 PMCID: PMC8947656 DOI: 10.3390/children9030365] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/20/2022] [Accepted: 02/26/2022] [Indexed: 01/18/2023]
Abstract
Adolescents are a nutritionally vulnerable population; eating disorders are more common among adolescents and young adults. Orthorexia nervosa (ON) is a non-formally recognized condition characterized by an obsessive preoccupation with eating healthy and "pure" foods; the quality and not the quantity of food is pivotal in ON. ON is a complex entity which can be associated with severe diet restrictions, a negative impact on social relationships, and with physical and mental health conditions, including obsessive-compulsive disorder. In light of this, a literature review regarding the background, diagnosis, features, risk factors, interplay with the social media, and management of ON is presented in this article, with a focus on adolescents and young adults.
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Affiliation(s)
- Maria Gkiouleka
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens University Campus, 11521 Athens, Greece; (M.G.); (C.S.); (T.N.S.)
- Health Centre of Nea Kallikrateia, 63080 Nea Kallikrateia, Greece
| | - Christina Stavraki
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens University Campus, 11521 Athens, Greece; (M.G.); (C.S.); (T.N.S.)
- 2nd Primary School of Nafpaktos, 30300 Nafpaktos, Greece
| | - Theodoros N. Sergentanis
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens University Campus, 11521 Athens, Greece; (M.G.); (C.S.); (T.N.S.)
| | - Tonia Vassilakou
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens University Campus, 11521 Athens, Greece; (M.G.); (C.S.); (T.N.S.)
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