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Orthorexia nervosa - An eating disorder, obsessive-compulsive disorder or disturbed eating habit?



The purpose of this article was to describe the phenomenon of a new disorder called orthorexia nervosa. This paper proposes a theoretical framework for the definitions, prevalence, diagnostic criteria, method and treatment of orthorexia. This disturbing behaviour concerns the pathologic obsession for healthy nutrition. In contrast to eating disorders, people with orthorexia are obsessed with food quality rather than quantity and they do not care excessively for thin silhouette like in the case of patients with anorexia and bulimia nervosa. Individuals with orthorexia nervosa are obsessive about healthy food, leading to dietary restrictions and to a variety of negative psychological and social outcomes. The results of previous research show that on the one hand orthorexia is related to anorexia and bulimia nervosa, and on the other hand this syndrome is more closely allied with obsessive-compulsive disorders. In view of the studies presented here we could treat orthorexia as a disturbed eating habit which is connected with obsessive-compulsive symptoms.
Archives of Psychiatry and Psychotherapy, 2012; 1 : 55–60
Anna Brytek-Matera
 
 
  
  
Orthorexia nervosa – an eating disorder, obsessive-
-compulsive disorder or disturbed eating habit?
food restriction / health food / eating attitude
There is relatively little information availa-
ble about orthorexia nervosa (ON) [1] because
it is a new term and does not have a universally
accepted definition or valid diagnostic criteria.
This disturbing behaviour is not present neither
in DSM-IV-TR nor in ICD-10. Orthorexia nervosa
is a new concept about eating behaviour disor-
ders [2] and is composed of pathologic obsession
for biologically pure foods [3], which can cause
substantial dietetic limitations [4] and which is
able to lead to obsessive thoughts about foods,
affective dissatisfactions and intense social iso-
lation [2, 5, 6].
This is not a weight loss regimen but an im-
mense phobia about eating only “pure” food.
Having orthorexia nervosa not only means that
people are obsessed with eating “healthily”, but
also that they have a specific attitude to food,
they prepare their food in a certain way [1] as
well as avoid consumption of some foods or all
of a some group of foods since they consider
them to be harmful for their health. The quali-
ty of the foods they consume is more important
than personal values, interpersonal relations, ca-
reer plans and social relationships [7]. In fact, the
desire to consume healthy foods is not a disturb-
ing behaviour in itself, and it is only defined as
orthorexia nervosa when it causes a person to
give up his or her normal lifestyle [1].
Orthorexia nervosa could be considered as a
disorder connected with behaviour and person-
ality due to paying too much attention to con-
suming healthy food, spending an excessive
56 Anna Brytek-Matera
Archives of Psychiatry and Psychotherapy, 2012; 1: 55–60
amount of time with this preoccupation, and ex-
periencing associated dysfunctions in everyday
life [1]. Orthorexia nervosa can be regarded as
a harmful behaviour, because healthy eating is
connected to fear and worries about health, eat-
ing and quality of food [8].
The term “orthorexia” has been produced from
“orthos”, which literally means “accurate, straight,
right, valid or correct” and “orexis” meaning hun-
ger or appetite. This term is used for “obsession
with healthy and proper nutrition” [1, 6, 9]. Steven
Bratman [6] defined this concept for the first time
in 1997. The author used orthorexia nervosa to de-
fine a pathological fixation on the consumption of
appropriate and healthy food [5]. The term of or-
thorexia is used to describe an unhealthy fixation
scribed orthorexia nervosa as “highly sensitive be-
haviour with regard to healthy nutrition”.
People with orthorexia are likely to shun foods
which may contain pesticide residues or geneti-
cally modified ingredients, unhealthy fatty foods
having too much salt or too much sugar and other
components. The methods of preparation (a partic-
ular way of cutting vegetables) and materials (ce-
ramics only or only wood) are also part of the ob-
sessive ritual [11]. The configuration of the day-
to-day diet, which takes up a lot of time, could be
divided into four phases [2, 5]. The first section is
devoted to thinking with concern and cautiously
about what will be eaten on that day or the fol-
lowing day; a second phase pertaining to the thor-
ough and hypercritical acquisition of each ingredi-
ent; a third phase referring to the culinary prepa-
ration of these ingredients, which must consist of
techniques and procedures that are not linked to
health hazards; the fourth stage is a stage of satis-
faction, comfort or guilt based on the appropriate
enforcement of the three preceding phases. If any
of these phases is not attainable or it is not possible
to abide by these rituals, a sense of guilt and con-
cern for the violation will appear.
In spite of the fact that the diagnostic criteria
are not yet sufficiently verified, they have been
proposed for orthorexia [12]. However, Bratman
and Knight [13] propose a test that allows to es-
tablish whether expression of feeding behaviour
in health education ought to be considered as
pathological or not. Authors [14] have suggest-
ed a short Bratman’s Orthorexia Test (BOT) as a
screening tool useful for early diagnosis of the
disorder. This diagnostic test for orthorexia con-
sists of ten questions (e.g. “Do you spend more
than 3 hours a day thinking about your diet?”,
“Has the quality of your life decreased as the
quality of your diet has increased”, “Do you feel
guilty when you stray from your diet?”). If the
person answers “yes” to 4 or 5 questions, this
means that it is necessary for her/him to relax
more in regard to their food (unless it is a pre-
scription diet). If the person answers “yes” to
all questions, then she/he has an important ob-
session with healthy eating and should examine
this behavior with the help of a qualified profes-
sional [13].
Donini et al. [12] developed the ORTO-15 test
for the diagnosis of orthorexia based on a brief
10-item orthorexia questionnaire by Bratman
[13]. They used some of the items from Brat-
man’s test and added some new items to cre-
ate the ORTO-15 questionnaire. The original ver-
sion of ORTO-15 was first developed in Italy. It
is a 15-item self-report questionnaire that deter-
mines the prevalence of highly sensitive behav-
iour related to health and proper nutrition. Items
assess an individual’s behaviours (obsessive at-
titudes) related to the selection, purchase, prep-
aration, and consumption of food that they con-
sider to be healthy (e.g. “When you go in a food
shop do you feel confused?”, Are you willing
to spend more money to have healthier food?”,
“Do you think your mood affects your eating
behaviour?”). Donini et al. [12] aimed to devel-
op items that would assess individuals in terms
of emotional and rational aspects. For this rea-
son, some items assess the cognitive-rational do-
main, some the clinical domain, and others the
emotional domain. Each item is answered on a
4-point Likert scale. Individuals are required to
answer with “always – often – sometimes – nev-
er”, to reflect how often they define themselves
Orthorexia nervosa – an eating disorder, obsessive-compulsive disorder or disturbed eating habit? 57
Archives of Psychiatry and Psychotherapy, 2012; 1 : 55–60
with these expressions. Items that reflected an
orthorexic tendency are scored as “1”, and items
that reflected a tendency towards normal eat-
ing behaviour are scored as “4”. Scores below 40
points in the ORTO-15 test are defined as orth-
orexic (having highly sensitive behaviour), eat-
ing behaviour reaches more normal standards
as the score increases [12].
Donini et al. [1] investigated the prevalence
rate of orthorexia nervosa by studying 404 peo-
ple in Italy, and provided suggestions for diag-
nostic criteria. Participants were evaluated in
terms of their food selection behaviours, and
obsessive-compulsive and phobic symptoms.
In relation to food selection behaviour, 17.1% (n
= 69) of the sample were defined as ´health fa-
natics´. People diagnosed with orthorexia ner-
vosa accounted for 6.9% (n=28) of their entire
sample. The specific ´feelings´ towards food,
that is ´dangerous´ to describe a conserved prod-
uct, ´artificial´ for industrially produced prod-
ucts and “healthy” for biological produce, as
well as the demonstration of a strong or un-
controllable yearning to eat when feeling nerv-
ous, happy, excited, or guilty has been associat-
ed with orthorexic subjects. The prevalence rate
among people suffering from orthorexia nervo-
sa was higher among men compared to women
(11.3% vs 3.9%). As stated by Donini et al. [1], “it
is possible that with the present trend towards
the presence of men in the world of ´body cul-
ture´ (meaning the attention given to one’s phys-
ical aspect in order to live up to the high lev-
el stereotypes dictated by society), males may
have found an optimal behaviour pattern in the
´health-fanatic´ food choice” [p. 156].
In Spain the prevalence of this disorder is at
present unknown, as it is a new phenomenon,
though some specialty care centers relate be-
tween 0.5% and 1% of orthorexic patients [11].
A Turkish study [7] carried out among 318
resident physicians at a hospital in Ankara, has
found that 45.5% of the participants were exces-
sively sensitive to their own eating habits and
they scored below 40 points in the ORTHO-15
test. It has been seen that medical doctors who
take care of the nutritional quality while buying
foods, score low in ORTO-15, which points to
the fact that they have highly sensitive behav-
iour about healthy nutrition. The average score
on the ORTO-15 is lower in those who do their
shopping themselves, substitute lunch or din-
ner with salad/fruit, and care about the quality
of the things they eat. Indeed, in this study 20.1%
of the male doctors and 38.9% of the female doc-
tors stressed that their food selection had been
affected by TV programs on healthy eating hab-
its. Like authors [7] emphasize, it is a compelling
reason for the fact that such a large number of
people with a high level of education are able to
be so heavily impacted by the media.
It is worth pointing out that the prevalence of
highly sensitive attitudes to healthy eating at
this high socioeconomic level shows that med-
ical doctors are also in need of education about
the tenets of a balanced and proper diet [7].
Another study [3] has found that the preva-
lence of orthorexia was 43.6% among medical
students (n=878) (scored above 27 in the ORTO-
15 test). This research has also shown that the
prevalence of orthorexia among the male medi-
cal students was higher than that among the fe-
male medical students.
Some people with orthorexia are terrified of
unhealthy food due to genetic predisposition, a
perfectionist personality, unrealistic demands,
misinformation or social pressures [9]. The high-
er risk groups for orthorexia nervosa are women,
adolescents, people who practice sports (body-
building, athletics) [2, 5, 15], medical physicians
and medical students [3], dieticians [16] as well
as performance artists [14]. Research concern-
ing orthorexia nervosa among Turkish perform-
ance artists (39 men and 55 women) has shown
that a total of 56.4% of the artists have orthorex-
ia nervosa [14]. While the highest prevalence of
orthorexia nervosa was recorded among opera
singers (81.8%), it was 32.1% among ballet danc-
ers and 36.4% among symphony orchestra mu-
sicians. Hungarian research [8] has shown that
56.9% of the university students have an inclina-
tion to orthorexia nervosa. This study has also
indicated the correlation between orthorexia and
eating and body image disturbance (if orthorex-
ia features are present, the eating and body im-
age disturbance are more intensive).
The results of Turkish research [15] have dem-
onstrated that married people showed more
58 Anna Brytek-Matera
Archives of Psychiatry and Psychotherapy, 2012; 1: 55–60
symptoms than unmarried ones of a tendency
towards orthorexia.
The clinicians and scientists still carry on the
debate on whether orthorexia is a real and unique
disorder and whether it is worth its own catego-
rization in the “Diagnostic and Statistical Manual
of Mental Disorders”
together with eating disor-
ders (anorexia nervosa, bulimia nervosa and eat-
ing disorder not otherwise specified) [5].
On the one hand, eating disorder experts in
the United Kingdom [9] argue that orthorexia is
not currently identified with eating disorder be-
cause it does not begin with low self-esteem, but
it may in time result in an eating disorder as the
diet becomes more refined and compulsive. Or-
thorexia nervosa is marked by an excessive de-
sire to consume pure and healthy foods, unlike
other eating disorders in which a preoccupation
with weight loss is observed [15]. Unlike ano-
rexia and bulimia, which are obsessions about
the quantity of food intake (and also physical
appearance), orthorexia nervosa results from an
obsession about the quality of food intake [6, 7].
In contrast to patients with anorexia and bulim-
ia, the motivation of the people with orthorexia
is not to lose weight but to achieve a feeling of
perfection or purity [5]. On the other hand, even
though orthorexia is not an independent diag-
nostic category, it has some similarities with oth-
er eating disorders: a genetic predisposition to
perfectionism as well as a need for control [5].
Preoccupation with consuming healthy and pure
foods can result in malnutrition and weight loss
as in anorexia nervosa [3]. Nonetheless, some ar-
gue that the preoccupation with food in ortorex-
ia is not as distinctive as in anorexia and bulim-
ia cases, as it is only related to the quality of the
food; therefore, it should not be placed in a sep-
arate category [10].
However, both disorders share many character-
istics. People with orthorexia often have a histo-
ry or features in common with anorexic patients.
1 Since orthorexia nervosa is not recognized as a
mental disorder by the American Psychiatric Associ-
ation (it is not listed in the DSM-IV or planned to be
included in the DSM-V), there are very few peer re-
viewed original papers published in English to date
[e.g. 17, 18, 19].
They are very detailed, careful and tidy persons
with an exaggerated need for self-care and pro-
tection [2, 11]. Bartina [11] supposes that when the
obsession with healthy eating becomes extreme,
the person starts to concentrate only on food and
this leads to severe restrictions as well as biolog-
ical and psychological complications (e.g. severe
social isolation). Being in control of what the per-
son eats becomes a priority. People with orthorex-
ia have a desire to be perfect, which is consistent
with other eating disorders such as anorexia or
bulimia nervosa [11]. Zamora et al. [2] emphasize
that in patients with orthorexia “obsessive-com-
pulsive mechanisms with personality traits similar
to those of restrictive anorexia (rigidity, perfection-
ism, need to control your life transferred to eating),
phobic mechanism (intense anxiety regarding cer-
tain foods and their avoidance) and hypochondri-
ac mechanisms are described” [p. 67].
Orthorexia may be affected by a distorted eat-
ing attitude and obsessive-compulsive symp-
toms. The relationship between changes in eat-
ing behaviour in orthorexia nervosa and obses-
sive–compulsive disorders are presently being
has shown that orthorexic tendency could be re-
lated to a pathological eating attitude
(eating at-
titude was noted to be a good predictor of orth-
orexic tendency) and that obsessive-compulsive
symptoms had a significant effect on orthorex-
ic tendency. Individuals that had higher obses-
sive-compulsive symptoms had greater ortho-
rexic tendencies. The authors’ clinical observa-
tions suggest that the number of people with an
orthorexic tendency is increasing [15].
Mathieu [5] wonders why it could be possible
that someone obsessed with achieving the perfect
diet does not even belong in the category of eat-
ing disorders, but should instead be classified as
having obsessive-compulsive disorder (OCD)?
could be managed in accordance with the iden-
tified symptoms. For people with an orthorexic
tendency, clinicians might focus on the yearning
Food preoccupation, body image for thinness,
vomiting and laxative abuse, dieting, slow eating,
clandestine eating as well as perceived social pres-
sure to gain weight were classified as abnormal eat-
ing attitudes.
Orthorexia nervosa – an eating disorder, obsessive-compulsive disorder or disturbed eating habit? 59
Archives of Psychiatry and Psychotherapy, 2012; 1 : 55–60
to consume “pure healthy foods” rather than con-
centrating on the desire to be thin. The treatment
assumptions that were developed for well-known
eating disorders could then be broadened accord-
ing to the needs of the orthorexic population.
A person suffering from orthorexia should real-
ize that she/he has a problem concerning eating be-
haviour, understand that the quality of food con-
sumed is not the only factor determining health
and learn to eat without falling into an obsession.
The treatment of orthorexia demands a multi-
disciplinary team including physicians, psycho-
therapists and dieticians [11]. In some cases, cog-
nitive behavioural therapy combined with selec-
tive serotonin reuptake inhibitors (such as ser-
traline, fluoxetine and paroxetine) can be useful
in treatment of people with orthorexia [5]. It is
also worth pointing out that unlike other pa-
tients with eating disorders, people with orth-
orexia tend to respond better to treatment, be-
cause of their concerns about their health and
self-care [5]. Working with the immediate envi-
ronment of patients and promoting nutrition ed-
ucation are early components essential to achiev-
ing the final solution to the problem [11].
A healthy diet should have a positive impact
on health and, at the same time, not affect re-
lationships with other people or the quality of
life and emotional states. In recent years, social
awareness of diet, nutrition and healthy eating
has increased
, nevertheless, among some people
to the point where this knowledge shows signs
of an obsession. Instead of caring about provid-
ing the adequate amount of nutrients for the
body, they are preoccupied with worries about
what might constitute the “healthiest” food.
Knowledge about human eating habits as well
as eating behaviour is essential for assessing the
nutritional profile of people addicted to healthy
products, as it is in the case of orthorexia.
Orthorexia nervosa could not be labelled as a
new eating disorder because it does not include
the most characteristic symptoms of anorexia
and bulimia nervosa that is immense fear of be-
coming fat, extreme weight-control behaviour
3 We should take into consideration that popular
media and the food industry (e.g. “natural” foods,
“organic” foods) also have influence on the develop-
ment of orthorexia nervosa.
as well as overevaluation of shape and weight.
However, since orthorexia involves disturbance
of eating habits it ought to be treated as a dis-
order concerning abnormal eating behaviour
inseparably linked with obsessive-compulsive
symptoms (on account of paying too much at-
tention to consuming healthy food and constant
thinking about the quality of food intake).
     
60 Anna Brytek-Matera
Archives of Psychiatry and Psychotherapy, 2012; 1: 55–60
 
 
... A limitation of the latter is that in our analyses, possible healthy methods such as "diet trends" scored the same as unhealthy eating behaviours such as "vomiting". In future research, this could be addressed by using the disordered eating continuum [2] or using standardized instruments to assess subclinical forms of eating disorders, such as early-onset restrictive eating disturbances or orthorexic dieting [22,23,24]. Moreover, our brief assessment of media risk factors could be examined in more depth. ...
Introduction: Recent studies indicate high prevalences of disordered eating or eating disorders in adult athletes and a worrying increase in adolescent athletes. Although several risk factors for developing eating disorders have been identified for adult athletes (e.g., personality factors, sport-related pressure), research on risk factors in adolescent athletes is scarce. Methods: This study investigates the prevalence of disordered eating and eating disorder symptoms and its association with personality- and sport-related risk factors in a sample of 439 elite athletes aged 13–18 years. Self-regulatory personality factors, sports and social pressure, as well as sports biographical data, were investigated in relation to different weight control methods and the Eating Disorder Examination Questionnaire measuring disordered eating and eating disorder symptoms. Results: Results indicate a prevalence rate of clinically significant eating pathology of 5.5% for the total sample, in which female athletes aged 15–18 years show the highest rate (9.6%). The structural equation model indicates a predominant association of sports and social pressure and personality factors with eating disorder symptoms. Conclusion: Being in the age range 15–18 years, being female, and being an athlete in a high-risk sport (e.g., aesthetics, weight class, or endurance sports) were identified as risk factors as well as athletes’ mental association with weight loss and success, and athletes’ perceived social pressure on eating and on body shape. Disordered eating and eating disorders are not only of concern for adults but also for young elite athletes and recommendations for adolescent elite athletes, coaches, and parents are given.
... Even though long-term studies are still missing, the negative effects of ON encompass nutritional deficiencies [19], social isolation [29,30], or even stigmatization by others [31]. In community or students samples, positive associations were found between ON and psychopathology, as studies found that participants who had a history of psychopathology, including depression or anxiety were more at risk for ON [28]. ...
Full-text available
Purpose Studies suggested that menopause is a period of vulnerability for disordered eating behaviors, but whether menopause could be linked to orthorexia nervosa (ON) remains unexplored. Methods A sample composed of 709 women aged between 30 and 71 years (mean age = 43.08 years, SD = 9.24) answered self-administered questionnaires assessing ON (Düsseldorfer Orthorexia Skala, DOS), body image, self-esteem, and psychopathological symptoms. The sample included a Premenopause group of 441 women reporting regular menses, a Perimenopause group of 94 women reporting the recent onset of amenorrhea or menstrual irregularities, and a Postmenopause group of 174 women reporting amenorrhea of natural onset for more than 12 months. Results Group comparison using analysis of covariance with age as covariate showed that ON scores were statistically higher in the two groups of participants dealing with menopause (Peri- and Postmenopause) when compared with women not yet concerned by menopause (Premenopause). A Kendall's tau-b correlation performed between the menopausal status (Pre, Peri, or Postmenopause) and DOS categories (No ON; At risk of ON; Presence of ON) showed a weak but statistically significant positive correlation between the menopausal group and DOS categories (tau-b = 0.136, p < 0.001). In addition, Fisher's exact tests indicated that the percentages of participants in the "At risk of ON" and "Presence of ON" categories were statistically higher in the Postmenopause group in comparison with the Premenopause group (p < 0.001). Depressive symptoms were statistically higher in the Peri- and Post-groups, while anxiety symptoms were stronger in the Peri-group when compared with the Pre-group. Conclusions This study shows an increase of ON in women concerned with menopause, suggesting the existence of a relationship between menopause and ON. Further studies are necessary to identify factors involved in this association. Level of evidence Descriptive (cross-sectional) study, level V.
... Although acceptable foods can vary by individual, for nearly all people with ON, their dietary restrictions include eliminating processed foods (i.e., foods with added preservatives, artificial flavoring or coloring, sugars, fats, and more), and their dietary restrictions gradually become more numerous and intense over time. As those restrictions grow, essential nutrients are often entirely omitted which leads to insufficient diets and ultimately malnutrition [4,5]. In addition, oftentimes any type of deviation from those restrictions is paired with shame, guilt, and even more rigorous diets [6,7]. ...
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Purpose Past research has revealed a link between orthorexia nervosa (ON) and relationship dissatisfaction, which has in turn been found to be correlated with the Dark Triad traits. The current study investigated the association ON has with seeking out relationships and with relationship satisfaction, while also assessing a potential moderating effect of the Dark Triad. Methods Recruited from Reddit forums, 788 adults (74% female, 67% White, 63% aged 25–30 years) completed an online survey with the Orthorexia Nervosa Inventory (ONI), Short Dark Triad (SD3), and Relationship Assessment Scale (RAS). Results Greater ON symptomatology was associated with greater levels of all aspects of the Dark Triad (Machiavellianism, narcissism, and psychopathy), as well as with lower levels of relationship satisfaction (among those in committed romantic relationships) and a lower likelihood of seeking new romantic relationships (among single participants). A regression analysis revealed that the Dark Triad moderated the association between ON and relationship satisfaction, whereby this association was not significant at high levels of the Dark Triad. Conclusion The current research highlights that at low and medium levels of the Dark Triad, greater ON symptomology is associated with lower levels of satisfaction in romantic relationships. Level of evidence Level V, descriptive cross-sectional study.
... While people with celiac disease must exclude gluten from foods for health reasons, people with orthorexia voluntarily pursue healthy eating through a restrictive diet, focusing on food preparation and analyzing the sources of the foods they eat [18]. People with orthorexia exhibit obsessive behaviors related to maintaining and improving their physical health and well-being [19,20]. ...
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Evidence points to a link between celiac disease and eating disorders. Although with the current limited knowledge, orthorexia cannot be formally recognized as an eating disorder, some features are similar. This study is the first to examine individuals with celiac disease in terms of the prevalence of risk of orthorexia. Participants were 123 females diagnosed with celiac disease. The standardized ORTO-15 questionnaire was used to assess the risk of orthorexia. In this study, eating habits and physical activity were assessed. The effect of celiac disease on diet was self-assessed on a 5-point scale. Taking a score of 40 on the ORTO-15 test as the cut-off point, a risk of orthorexia was found in 71% of individuals with celiac disease, but only in 32% when the cut-off point was set at 35. There was a positive correlation between age and ORTO-15 test scores (rho = 0.30). In the group with orthorexia risk, meals were more often self-prepared (94%) compared to those without risk of orthorexia (78%) (p = 0.006). Individuals at risk for orthorexia were less likely to pay attention to the caloric content of food (46%) relative to those without risk of orthorexia (69%) (p = 0.001). For 64% of those at risk for orthorexia vs. 8% without risk had the thought of food that worried them (p = 0.001). Given the survey instrument for assessing the prevalence of orthorexia and the overlap between eating behaviors in celiac disease and orthorexia, the prevalence of orthorexia in celiac disease cannot be clearly established. Therefore, future research should focus on using other research tools to confirm the presence of orthorexia in celiac disease.
... Bireyin büyümesi, vücudun yenilenmesinin sağlanması ve sağlıklı bir şekilde çalışması için farklı türlerde besin bileşenine ihtiyaç duyabilmektedir. Gerekli olan bu besin öğelerinin her birinin dengeli ve yeterli miktarlarda alınması ve bu besinlerin vücut için uygun şekillerde kullanılması yeterli ve dengeli beslenme terimi ile ifade edilmektedir (Brytek, 2012). Son zamanlarda beslenme bilincinin de artmasıyla bireylerin sağlıklı beslenme ve diyet danışmanlık hizmeti alma amacıyla başka destinasyonlara seyahat ettikleri görülmektedir. ...
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It is known that tourists could travel to destinations with different motivations recently. In this study, it’s aimed to reveal push and pull factors that effect to the travelling of the patients who coming to Çanakkale from other destinations in order to receive diet and nutrition counseling. In addition, it’s aimed to reveal patients' reasons for receiving diet and nutrition counseling, the skills that patients’ looking for of the nutritionist and factors, which are effective in patients choosing a nutritionist from other destination to receive this service have examined. The data were collected by interview method, which is one of the qualitative research methods, and analyzed by content analysis method. As a result of the analysis, push factors, pull factors and other examined factors in the tourism movements of the patients with the motivation to receive diet and nutrition counseling have determined. In this context, the pull factors have determined in the travels of the patients are; “positive references, the need to receive quality nutrition counseling, technological possibilities, special offers, impossibilities in the destination, more affordable session fee and geopolitical location of the establishment”. As for that the push factors have detected in the travels of the patients are; “the positive image of the nutritionist, the need to look more attractive, pressures from friends, the need to be healthy, the purpose of gaining self-confidence, the need for healthy nutrition, preparation for parenting and the need to overcome feeling of aging”. In addition, various suggestions have presented in line with the findings.
... There are many publications trying to define ON and to determine diagnosis and treatment strategies, but there are still some uncertainties [1,3,5]. In general, individuals with ON are reported to remove preservatives, additives, food flavoring, pesticides, excess fat, sugar, salt or genetically modified foods from their diets, and spend more than three hours a day on healthy eating [24,25]. Our study observed that individuals with ON tendency paid more attention to energy, macronutrient, fiber, and sugar information on food labels. ...
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Purpose This observational cross-sectional study aimed to evaluate university students’ food label reading habits with and without orthorexia nervosa (ON) tendency. Methods Data were collected online with a questionnaire. The questionnaire form included sociodemographic variables, the ORTO-11 scale, the reading frequency of some components on the food label, and the evaluation of some opinions about the food label. The obtained data were evaluated with SPSS 25.0 statistical package program and GraphPad Prism program. Results A total of 674 university students (mean age: 21.03 ± 2.43 years), 537 women (79.7%) and 137 men (20.3%) were included in the study. It was determined that individuals with ON tendency read some nutrients, content information, serving size, health information, instructions for use, additives and brand more frequently compared to individuals without ON tendency (p < 0.05). At the same time, it was determined that individuals with ON tendency were more likely to agree with the idea that reading food labels is important for a healthy diet, compared to individuals with normal eating behavior (p < 0.001). Conclusion The study findings show that individuals with ON tendency have a higher habits of reading food labels compared to individuals with normal eating behavior. To reach a decision on this issue and to determine the diagnostic criteria for ON, future studies should be conducted on different groups and samples with higher participation, as well as studies using different screening tools to determine the tendency for ON. Level of evidence V, Cross-sectional descriptive study.
... Despite the growing number of scales used to 'detect' ON, debates still wage around whether or not ON as a disorder really exists (Brytek-Matera, 2012). Orthorexic practices can appear to have much in common with 'pro-health' eating behaviours, such as vegetarianism, veganism, raw food diets and more recently clean eating, which are increasingly popular with those aiming at physical, mental or spiritual purification. ...
In this chapter, we examine the construction of the proposed eating disorder orthorexia nervosa (ON), the politics around its potential inclusion in the DSM, the polemic between desirable healthy eating versus pathological or deviant eating and market interests underpinning the identification of new eating disorders.
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Objective: The current study was cross-sectional and aimed to determine the eating behaviors and orthorexia nervosa related factors, the relationship between eating behaviors and orthorexia nervosa (ON), and the frequency of eating behaviors and orthorexia nervosa during the pandemic period in individuals aged 65 and older. Materials and Methods: The sample of the research is a large group of individuals age 65 and older in Turkey. A total of 895 elderly individuals were included in the study. Data were collected with Personal Information Form, Eating Attitude Test (EAT-40) and Orthorexia-15 Scale (ORTO-15). Data were evaluated in SPSS statistical package program 18.0 and frequency, percentage, student-t test, chi-square, Pearson correlation analysis were used as statistical analysis, and type 1 error level was accepted as p<0.05. Results: The risk of orthorexia was found in 45.8% of the elderly individuals and the mean ORTO-15 score was found 34.35±4.428. In addition, it was determined that 99.1% of the elderly had eating attitude and behavior disorders, and the mean EAT-40 score of the elderly individuals was found 68.81±13,873. A negative correlation (r=-.476; p=0.001) was found between EAT-40 and ORTO-15. Therefore, 45.7% of elderly individuals had both orthorexia nervosa risk and eating attitude disorder. Conclusion: This study showed that elderly individuals are at risk of orthorexia and have eating disorders. According results, it would be appropriate to raise awareness of elderly individuals against orthorexia nervosa and also eating attitude and behavior disorder tendencies with a multidisciplinary approach.
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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.
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Orthorexia, from the Greek words orthos (straight, proper) and orexis (appetite), is a newly conceptualized disorder characterized by distorted eating habits and cognitions concerning supposedly healthy nutrition. In this article we present preliminary results of a wider research aimed to investigate the diffusion of Orthorexia in the general population and to highlight its characteristics and particularly the relationship with Eating Disorder and Obsessive-Compulsive Disorder. One-hundred and seventy seven adult subjects from the general population, were administered the ORTO-15 test, a selfadministered questionnaire specifically designed to assess orthorexic symptomatology; note that statistical analyses were repeated twice, referring to different diagnostic thresholds (40/35). Orthorexia had a 57.6% prevalence in our sample, using the 40-point threshold, with a female/male ratio 2:1; the figure was sensibly lower with the 35-point threshold (21%). The results of this study highlight the diffusion of Orthorexia which may constitute an important risk factor for mental and physical health, but also the opportunity of more specific diagnostic instruments, so to facilitate a thorough understanding of this disorder.
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Orthorexia is a new term about eating behavior disorder and consists of pathologic obsession for biologically pure foods, free of herbicides, pesticides, and other artificial substances. It is not an independent diagnostic category, but it has some similarities with other eating disorders. This study was conducted to examine the orthorexia among 878 medical students. Of 878 students, 464 (52.8%) were male and 359 (40.9%) were female. The mean age, height, weight, and body mass index were 21.3 +/- 2.1 years, 171.0 +/- 8.5 cm, 65.6 +/- 12.3 kg, 22.4 +/- 2.99, respectively. The rates of the ORTO-11 scores between 0 and 15 was 1.9%; between 16 and 30, 57.5%; and between 31 and higher, 21.1%. There were 17 students with a score of 0 to 15. The mean score for the ORTO-11 test was 27. There were statistically significant differences between age, sex, and smoking habit of the students. In the male students, there was a statistically significantly higher tendency for orthorexia (P = .001), and there was a statistically significant difference between the age groups for tendency for orthorexia (P = .025). In logistic regression analysis, age, sex, Eating Attitude Test-40 (EAT-40), and height affected the ORTO-11 scores.
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The aim of the study was to determine the prevalence of orthorexia nervosa among the performance artists in the State Opera and Ballet and in the Bilkent University Symphony Orchestra. The study population consisted of 39 men and 55 women for a total of 94 artists with mean age of 33 years. The ORTO-15 test was used to determine the prevalence of orthorexia nervosa. Those subjects who scored below 40 in the ORTO-15 test were classified as having orthorexia nervosa. Mean score of the participants in the ORTO-15 test was 37.9+/-4.46. A total of 56.4% of the artists involved in the research scored below 40 in the ORTO-15 test. While the highest prevalence of orthorexia nervosa was recorded among opera singers (81.8%), it was 32.1% among ballet dancers and 36.4% among symphony orchestra musicians. The differences between the three groups were statistically significant. No difference was noted between mean ORTO-15 score by baseline characteristics as gender, age, educational level, work experience, body mass index, smoking and alcohol consumption. The research group have a higher socio-economic and education level than the majority of the general public in Turkey. Additionally, being an artist in Turkey means being a role model for the general public both in terms one's physical appearance and lifestyle. These may be the reason why artists are more sensitive to this issue.
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Orthorexia is a pathological fixation about the consumption of healthy food. The present study aimed to reveal the psychometric properties of the Turkish version of ORTO-15, which was developed to evaluate orthorexia, and to investigate the relationship betweenorthorexia, and eating attitude, obsessive-compulsive symptoms, and some demographic variables. The study included 994 participants aged between 19 and 66 years. ORTO-15, the Maudsley Obsessive-Compulsive Inventory, and the Eating Attitude Test-40 were administered to the participants. A 3-factor solution with varimax rotation explained 40.62% of the variance. When 4 items with factor loadings below+/- 0.50 were eliminated from ORTO-15, the Cronbach's alpha coefficient was 0.62. The remaining 11 items were thought to have statistically satisfactory properties for the Turkish version of ORTO and were collectively referred to as ORTO-11. This version was used to investigate the relationship between orthorexia, and eating attitude and obsessive-compulsive symptoms. Pathological eating attitude and obsessive-compulsive symptoms were related to orthorexia. Women exhibited more orthorexic symptoms then men. In the present study high a body mass index was an important variable for orthorexia, but only together with gender (female), pathological eating attitude, and increased obsessive-compulsive symptoms. The results, implications, and limitations of the study are discussed. ORTO-11 demonstrated statistically satisfactory properties. Orthorexia was related to pathological eating attitude and obsessive-compulsive symptoms; however, caution should be used when generalizing the reported results.
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To propose a diagnostic proceeding and to try to verify the prevalence of orthorexia nervosa (ON), an eating disorder defined as "a maniacal obsession for healthy foods". 404 subjects were enrolled. Diagnosis of ON was based on both the presence of a disorder with obsessive-compulsive personality features and an exaggerated healthy eating behaviour pattern. Of the 404 subjects examined, 28 were found to suffer from ON (prevalence of 6.9%). The analysis of the physiological characteristics, the social-cultural and the psychological behaviour that characterises subjects suffering from ON shows a higher prevalence in men and in those with a lower level of education. The orthorexic subjects attribute characteristics that show their specific "feelings" towards food ("dangerous" to describe a conserved product, "artificial" for industrially produced products, "healthy" for biological produce) and demonstrate a strong or uncontrollable desire to eat when feeling nervous, excited, happy or guilty.
Many "new" syndromes have been proposed for inclusion in the DSM-V. Some disorders acquired popularity through the Internet, but will they be taken seriously and get accepted by the scientific community? We organized an opinion poll among professionals in the field of eating disorders by presenting them a provisional set of diagnostic criteria of four "new" disorders: Night Eating Syndrome, Orthorexia, Muscle Dysmorphia, and Emetophobia. In general, the opinions did not differ much according to the characteristics of the 111 respondents. Among these professionals, Orthorexia is the best known and Night Eating Syndrome the least. Although the majority is familiar with the concept of Muscle Dysmorphia, it is most often viewed as a creation of the popular media and rarely observed in daily practice. In contrast, the other three disorders seem to be taken more seriously in the sense of "genuine" syndromes, which should receive more attention in research and clinical practice. Emetophobia appears to be the least "fashionable" of the four. The findings are discussed in the light of medialization and medicalization.