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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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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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Mahfoud D, Pardini S, Mróz M, Hallit S, Obeid S, Akel M, Novara C, Brytek-Matera A. Profiling orthorexia nervosa in young adults: the role of obsessive behaviour, perfectionism, and self-esteem. J Eat Disord 2023; 11:188. [PMID: 37858264 PMCID: PMC10588191 DOI: 10.1186/s40337-023-00915-8] [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: 04/18/2023] [Accepted: 10/17/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Orthorexia nervosa (ON) is a relatively new potential eating disorder characterized by an intense fixation on one's eating habits and the imposition of rigid and inflexible rules on oneself. Psychological factors such as obsessive-compulsive tendencies, perfectionism and self-esteem may interact in complex ways and contribute to the development and maintenance of ON. METHODS This cross-sectional study included 977 participants from Italy, Lebanon, and Poland. Participants completed a questionnaire consisting of socio-demographic information, the Eating Habits Questionnaire, Obsessive-Compulsive Inventory, Obsessive Beliefs Questionnaire-44, Multidimensional Perfectionism Scale, and Rosenberg Self-Esteem Scale. Cluster analysis was used to identify subgroups of individuals with common psychological characteristics associated with ON. RESULTS Three distinct clusters were identified based on their levels of obsession-compulsive beliefs, perfectionism, and self-esteem. The first group, labeled "High Self-Mastery," consisted of 37.0% of participants and exhibited low levels of obsession-compulsion, obsessive beliefs, and perfectionism, but high self-esteem. The second group, "Moderate Self-Mastery," comprised 39.5% of participants and had moderate levels of these traits. The third group, "Low Self-Mastery," consisted of 23.6% of participants and exhibited the highest levels of obsession-compulsion, obsessive beliefs, and perfectionism, but the lowest self-esteem. Additionally, a multivariable analysis revealed that being Lebanese (Beta = 3.39) and belonging to the last cluster (Beta = 4.53) were significantly associated with higher ON tendencies. CONCLUSION Our findings show that individuals with low self-mastery, characterized by low self-esteem and high levels of obsessive perfectionism, are more likely to exhibit ON tendencies. This study emphasizes the need to have a comprehensive understanding of how cultural and psychological factors interact in the development of eating disorders.
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Affiliation(s)
- Daniella Mahfoud
- Eye N' Brain Research Group, Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Susanna Pardini
- Department of General Psychology, University of Padova, 35131, Padua, Italy
| | - Magdalena Mróz
- Eating Behavior Laboratory (EAT Lab), Institute of Psychology, University of Wrocław, 50-527, Wrocław, Poland
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, 11931, Jordan
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Sahar Obeid
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, 4504, Lebanon
| | - Marwan Akel
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Caterina Novara
- Department of General Psychology, University of Padova, 35131, Padua, Italy
| | - Anna Brytek-Matera
- Eating Behavior Laboratory (EAT Lab), Institute of Psychology, University of Wrocław, 50-527, Wrocław, Poland.
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Gerges S, Azzi V, Bianchi D, Laghi F, Pompili S, Malaeb D, Obeid S, Soufia M, Hallit S. Exploring the relationship between dysfunctional metacognitive processes and orthorexia nervosa: the moderating role of emotion regulation strategies. BMC Psychiatry 2023; 23:674. [PMID: 37715193 PMCID: PMC10504706 DOI: 10.1186/s12888-023-05183-z] [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: 06/28/2023] [Accepted: 09/12/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Dysfunctional metacognitive processes and emotional dysregulation have been widely documented in the eating disorder literature. Despite numerous research and recent consensus suggesting the categorization of orthorexia nervosa as a form of eating disorder, no previous study has examined whether aberrant metacognitive processes also correlate with orthorexia nervosa tendencies. This paper investigates potential associations between symptoms of orthorexia nervosa and dysfunctional metacognitive processes while also exploring whether such relationships may be influenced by adaptive/maladaptive emotion regulation strategies. METHODS We conducted a cross-sectional study in all Lebanese governorates. In total, 423 Lebanese adults completed an online questionnaire including the Teruel Orthorexia Scale, the Emotion Regulation Questionnaire, the Difficulties in Emotion Regulation Scale - 16 Item Version, and the Metacognitions Questionnaire - Short Form. RESULTS Higher physical activity, expressive suppression, emotion regulation difficulties, positive metacognitive beliefs about worry, and need to control thoughts were significantly associated with higher orthorexia nervosa. Additionally, the emotion regulation strategies moderated the relationships between two dysfunctional metacognitive processes and orthorexia nervosa. Specifically, cognitive self-consciousness was negatively related to orthorexia nervosa only in individuals with low (versus higher) emotion suppression (maladaptive emotion regulation strategy). In contrast, negative beliefs about worry uncontrollability and danger positively predicted orthorexia nervosa only in individuals with lower (versus high) cognitive reappraisal (adaptive emotion regulation strategy). Lower socio-economic status and having a university level of education compared to secondary level were significantly associated with lower orthorexia nervosa. CONCLUSION Our study provides the first empirical evidence for the existence of significant associations between dysfunctional metacognitive processes and orthorexia nervosa. It also highlights that these pathways are considerably modulated by individuals' ability to regulate their emotions adaptively versus maladaptively. Our findings thus suggest that therapies aimed at improving thought monitoring and emotional regulation may be beneficial for individuals with symptoms of orthorexia nervosa.
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Affiliation(s)
- Sarah Gerges
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Vanessa Azzi
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Dora Bianchi
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Fiorenzo Laghi
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Sara Pompili
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Sahar Obeid
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon
| | - Michel Soufia
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
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Merhy G, Moubarak V, Hallit R, Obeid S, Hallit S. The indirect role of orthorexia nervosa and eating attitudes in the association between perfectionism and muscle dysmorphic disorder in Lebanese male University students - results of a pilot study. BMC Psychiatry 2023; 23:55. [PMID: 36670380 PMCID: PMC9854036 DOI: 10.1186/s12888-023-04549-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The literature highly concentrates on disorders related to body image among women but only minimally when it comes to the male population; hence, in order to provide general practitioners, and primary care physicians in general, and psychiatrists in particular, with additional information concerning muscle dysmorphia among male university students in Lebanon, this study seemed essential, and was therefore conducted to (1) identify the prevalence of MDD, and (2) evaluate the indirect effect of eating attitudes in general and orthorexia nervosa in particular, in the association between perfectionism and muscle dysmorphic disorder (MDD) among a sample of male university students. METHODS In this cross-sectional study conducted between September 2021 and May 2022, 396 male university students from multiple universities in Lebanon filled the online Arabic questionnaire. RESULTS The results showed that 26 (6.6%) of the participants had MDD. Orthorexia nervosa and eating attitudes mediated the association between perfectionism and MDD; higher perfectionism was significantly associated with higher ON and more inappropriate eating; higher ON and more inappropriate eating were significantly associated with higher MDD, whereas perfectionism had a significant total direct effect on MDD. The high prevalence of MDD among male university students in Lebanon implies further investigation on the national level in the country. CONCLUSION Awareness campaigns among the university students could be adopted at the national level to increase the level of knowledge on the concepts of obsessive self-destructive perfectionism, orthorexia nervosa and muscle dysmorphia.
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Affiliation(s)
- Georges Merhy
- grid.444434.70000 0001 2106 3658School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Verginia Moubarak
- grid.444434.70000 0001 2106 3658School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Rabih Hallit
- grid.444434.70000 0001 2106 3658School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon ,Infectious Disease Department, Notre Dame des Secours University Hospital Center, Street 93, Byblos, Postal Code 3, Lebanon ,Infectious Disease Department, Bellevue Medical Center, Mansourieh, Lebanon
| | - Sahar Obeid
- grid.411323.60000 0001 2324 5973Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon. .,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon. .,Applied Science Research Center, Applied Science Private University, Amman, Jordan.
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