Individuals who self-identify as having "orthorexia nervosa" score in the clinical range on the Eating Attitudes Test-26

"Your struggles are valid, you are worthy of help and you deserve to recover": narratives of recovery from orthorexia nervosa

PURPOSE

Limited research has examined recovery processes and conceptualisations of recovery within orthorexia nervosa (ON). This study harnessed Instagram data to examine how people who self-identify with ON use the hashtag #OrthorexiaRecovery and how recovery is represented within this online space.

METHODS

500 textual posts containing #OrthorexiaRecovery were extracted from Instagram. Co-occurring hashtags were analysed descriptively to determine whether this online space is specific to ON, and textual data were analysed using reflexive thematic analysis.

RESULTS

The hashtag analysis indicated that #OrthorexiaRecovery is being used within a wider context of eating disorder recovery and awareness, but also provides deep insights into experiences of recovery from ON. The thematic analysis generated five themes: the invisibility of orthorexia; a turbulent and continuous process; finding food freedom; from compulsive exercise to intuitive movement; a community of support. Our findings suggest that people with self-reported ON experience recovery as a continuous process and the current invisibility of ON within diagnostic criteria and wider society impedes recovery. While working towards recovery, users aimed to be free from diet culture, become more attuned to their bodies, and develop more adaptive relationships with food and fitness. Users noted a general lack of support for people with ON and so used this online space to create a supportive community, though some content was potentially triggering.

CONCLUSION

Our findings highlight the importance of increased recognition of ON and the potential value of targeting societal norms and harnessing social identity resources within therapeutic interventions for ON.

Negative body image components as risk factors for orthorexia nervosa: Prospective findings

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.

Orthorexia and Eating Disorders in Adolescents and Young Adults: A Systematic Review

Background: In recent years a new term in the field of eating behaviors has emerged, namely “orthorexia”. This behavior is associated with significant dietary restrictions and omission of food groups. The aim of the present study is to estimate the possible correlations between orthorexia and eating disorders in young adults and adolescents. Methods: A systematic review of related articles in PubMed, Google Scholar, and PsycInfo was conducted up to 30 June 2021. Results: A total of 37 studies (16,402 subjects) were considered eligible for this systematic review. Significant correlations were observed in most of the studies between orthorexia and eating disorders. However, the majority of studies adopted a cross-sectional design. Conclusions: An association between and eating disorders emerged. Prospective studies seem necessary to investigate associations and succession of orthorexia and eating disorders over time.

Concerns and recommendations for using Amazon MTurk for eating disorder research

OBJECTIVE

Our original aim was to validate and norm common eating disorder (ED) symptom measures in a large, representative community sample of transgender adults in the United States. We recruited via Amazon Mechanical Turk (MTurk), a popular online recruitment and data collection platform both within and outside of the ED field. We present an overview of our experience using MTurk.

METHOD

Recruitment began in Spring 2020; our original target N was 2,250 transgender adults stratified evenly across the United States. Measures included a demographics questionnaire, the Eating Disorder Examination-Questionnaire, and the Eating Attitudes Test-26. Consistent with current literature recommendations, we implemented a comprehensive set of attention and validity measures to reduce and identify bot responding, data farming, and participant misrepresentation.

RESULTS

Recommended validity and attention checks failed to identify the majority of likely invalid responses. Our collection of two similar ED measures, thorough weight history assessment, and gender identity experiences allowed us to examine response concordance and identify impossible and improbable responses, which revealed glaring discrepancies and invalid data. Furthermore, qualitative data (e.g., emails received from MTurk workers) raised concerns about economic conditions facing MTurk workers that could compel misrepresentation.

DISCUSSION

Our results strongly suggest most of our data were invalid, and call into question results of recently published MTurk studies. We assert that caution and rigor must be applied when using MTurk as a recruitment tool for ED research, and offer several suggestions for ED researchers to mitigate and identify invalid data.

Examining Eating Attitudes and Behaviors in Collegiate Athletes, the Association Between Orthorexia Nervosa and Eating Disorders

Purpose: Orthorexia nervosa (Orthorexia) is an eating attitude and behavior associated with a fixation on healthy eating, while eating disorders (EDs) are clinically diagnosed psychiatric disorders associated with marked disturbances in eating that may cause impairment to psychosocial and physical health. The purpose of this study was to examine risk for Orthorexia and EDs in student-athletes across sex and sport type and determine the association between the two.

Methods: Student-athletes (n = 1,090; age: 19.6 ± 1.4 years; females = 756; males = 334) completed a survey including demographics, the ORTO-15 test (<40 and <35 threshold values), the Eating Attitudes Test-26 (EAT-26; >20 score), and additional questions about pathogenic behaviors to screen for EDs.

Results: Using a <40 threshold value for the ORTO-15, 67.9% were at risk for Orthorexia, a more restrictive threshold value of <35 determined 17.7% prevalence across student-athletes with significant differences across sex [ <40: χ(1,1,090)2 = 4.914, p = 0.027; <35: χ(1,1,090)2 = 5.923, p = 0.015). Overall, ED risk (EAT-26 and/or pathogenic behavior use) resulted in a 20.9% prevalence, with significant differences across sex (χ² = 11.360, p < 0.001) and sport-type category (χ² = 10.312, p = 0.035). Multiple logistic regressions indicated a significant association between EAT-26 subscales scores and Orthorexia, and between Orthorexia positivity, ORTO-15 scores, and risk for EDs.

Conclusions: Risk for Orthorexia and ED is present in collegiate student-athletes. While healthy and balanced eating is important, obsessive healthy eating fixations may increase the risk for EDs in athletes. More education and awareness are warranted to minimize the risk for Orthorexia and EDs in student-athletes.

The relationship between orthorexia nervosa symptomatology and body image attitudes and distortion

Orthorexia Nervosa (ON), a condition characterized by a fixation on healthy eating, still does not conform to any consensus concerning diagnostic criteria, notably in regard to a possible body image component. This study investigated the relationship between ON symptomatology, measured with the Eating Habit Questionnaire, and body image attitudes and body image distortion in a non-clinical sample. Explicit body image attitudes and distortion were measured using the Multidimensional Body-Self Relations Questionnaire. Implicit body image attitudes and distortion were assessed using the reverse correlation technique. Correlational analyses showed that ON is associated with both explicit and implicit attitudes and distortion toward body image. More precisely, multivariate analyses combining various body image components showed that ON is mostly associated with explicit overweight preoccupation, explicit investment in physical health and leading a healthy lifestyle, and implicit muscularity distortion. These findings suggest that ON symptomatology is positively associated with body image attitudes and distortion in a non-clinical sample. However, further studies should be conducted to better understand how ON symptomatology relates to body image, especially among clinical samples.

Development and Validation of the Test of Orthorexia Nervosa (TON-17)

This study aims to develop and validate a new self-report questionnaire to measure orthorexia nervosa (ON). Based on a current review of the scientific literature and interviews with people at risk of orthorexia, 40 items were selected to test orthorexia nervosa (TON-40). A total sample of 767 individuals (M = 26.49, SD = 9.66, 56.98% women) participated in the study. The exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and composite construct analysis (CCA) were performed to find an appropriate model of sufficient reliability and validity and stable construction. Convergent validation was performed regarding the correlation of the TON-17 with another measure of ON (ORTO-15), eating disorders (the EAT-26 and DEAS), healthy behavior (the HBI), quality of life (the Brief WHOQOL), physical health (the GRSH), anxiety (the GAD-7), depression (the PHQ-9), and obsessive-compulsive disorder (the OCI-R). Gender, Body Mass Index (BMI), and the medical reasons for a restrictive diet were also examined. As a result of the structural analyses, the number of items was reduced from 40 to 17. The best fit indices of the TON-17 were found for the hierarchical bi-factor model, with three lower-order factors (Control of food quality, Fixation of health and healthy diet, and Disorder symptoms) and one general higher-order factor (Orthorexia). According to the 95th percentile method of estimation, the prevalence of ON was 5.5% for the TON-17 total score. The TON-17 scale and subscales showed good psychometric properties, stability, reliability, and construct validity. The TON-17 indicated a positive relationship with the ORTO-15, EAT-26, DEAS, HBI, OCI-R, GAD-7, and PHQ-9. TON-17 can be considered as a useful tool for assessing the risk of ON.

Orthorexic tendencies in inpatients with mental disorders

OBJECTIVE

Most research on orthorexia nervosa (ON)-the tendency to only eat foods that are perceived as healthy-has been based on non-clinical samples. Thus, we examined prevalence of and changes in orthorexic tendencies in a large sample of inpatients with mental disorders. Cross-sectional and longitudinal associations with body weight and eating disorder (ED) symptoms were tested in subgroups of inpatients with anorexia nervosa (AN) and bulimia nervosa (BN).

METHODS

Inpatients (N = 1167) receiving disorder-specific treatment for disorders classified in the ICD-10 in F3, F4, or F5 completed the Düsseldorf Orthorexia Scale (DOS) at admission and a subset (N = 647) at discharge. ED patients completed the Eating Disorder Inventory-2 and their body weight and height was measured.

RESULTS

Prevalence of ON was higher in ED patients than in all other groups, in which prevalence rates were similar to findings from the general population. Across ED groups, DOS scores decreased from admission to discharge, while there was no change in the other groups. In patients with BN, higher DOS scores related to lower BMI and predicted larger decreases in body dissatisfaction. Across ED groups, higher DOS scores related to higher body dissatisfaction and drive for thinness and predicted larger decreases in drive for thinness.

CONCLUSION

Our results highlight that ON is part of the ED spectrum. Associations with core ED symptoms question the suggested exclusive health focus on eating in ON and its potential as a distinct diagnosis. Rather, ON may represent a phenomenological subtype of restrictive EDs.

Orthorexic tendencies are linked with difficulties with emotion identification and regulation

BACKGROUND

Orthorexia nervosa (ON) is characterised by an unhealthy obsession with healthy eating and while it is not recognised as an eating disorder (or any disorder), current research is exploring similarities and differences with such disorders. The literature has shown that individuals with eating disorders have difficulties identifying and describing emotions (known as alexithymia) as well as regulating them. However no research to date has looked at whether people with orthorexic tendencies also suffer from difficulties with emotions. In this paper, we refer to people with orthorexic tendencies but do not assume that their healthy eating is at a pathological level needing clinical attention.

METHODS

The current study examined this by asking 196 healthy adults with an interest in healthy eating to complete four questionnaires to measure ON (ORTO-15 - reduced to ORTO-7CS), eating psychopathology (EAT-26), alexithymia (TAS-20) and emotion dysregulation (DERS-16).

RESULTS

We found that difficulties identifying and regulating emotions was associated with symptoms of ON, similar to what is found in other eating disorders. We suggest that ON behaviours may be used as a coping strategy in order to feel in control in these participants who have poor emotion regulation abilities.

CONCLUSIONS

Our results show that individuals with ON tendencies may share similar difficulties with emotions compared to other eating disorders. While important, our results are limited by the way we measured ON behaviours and we recommend that further research replicate our findings once a better and more specific tool is developed and validated to screen for ON characteristics more accurately.