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On orthorexia nervosa: A review of the literature and proposed diagnostic criteria
... In contrast, although weight and shape concerns are considered to be integral to the psychopathology of AN and BN [9], their relevance is less clear for ON. In the original criteria proposed by Dunn and Bratman [10], dietary restriction to promote optimum health may lead to weight loss for individuals with ON, but the desire to lose weight is absent, hidden or subordinated to ideation about healthy eating. Extant research supports this proposed criterion, finding a strong preoccupation with healthy eating to be negatively correlated with overweight preoccupation and appearance evaluation in a sample of university students [11]. ...
... Currently, four sets of diagnostic criteria for ON have been proposed [10,[15][16][17] and four ON assessments have typically been used in past research [1,16,18,19]. The lack of consensus for defining and measuring the proposed construct results in significant issues with research on ON. ...
... To begin the survey, participants were presented with the proposed diagnostic criteria for ON [10] and asked if they had met clients who fulfilled these criteria. We added, "What diagnosis/diagnoses did you give to clients who fulfilled these criteria?" to the original survey questions, in order to clarify how clinicians are currently categorizing this disordered eating pattern in their practice. ...
Purpose
This study examined U.S. health professionals’ perspectives on the clinical utility, measurement, and etiology of orthorexia nervosa (ON).
Methods
Participants (n = 100) were U.S. health professionals with experience working clinically with eating disorders, including trainees, Ph.D. psychologists, social workers/mental health counselors, and medical health professionals. After reviewing the proposed ON criteria, participants responded to questions regarding the clinical utility, diagnosis, and measurement of ON, and sociocultural influence on the emergence of ON. Views of ON as a useful diagnostic category were examined as a function of participants’ current involvement in clinical versus research activities.
Results
Participants mostly (71.9%) agreed that ON should be a distinct clinical diagnosis. Participants who endorsed ON as a valid diagnosis spent more time on clinical work and less time engaged in research compared to participants who disagreed (both ps < 0.05). Approximately 27% of participants believed additional components should be added to the proposed ON diagnostic criteria. Participants indicated that sociocultural factors have considerable influence on the development of ON, namely the diet and weight loss industry, and the perceptions that biological/organic/vegan and low fat/low carb/gluten free food are the healthiest.
Conclusion
Professionals who spent more time working clinically with eating disorders were more likely to endorse ON as a unique disorder, and professionals who spent more time on research were more likely to disagree. To the extent that professionals who spend more time on research may shape the narrative around ON more visibly, this study underscores the importance of listening to practitioners' experiences in applied settings.
Level of evidence: Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
... Both the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), and the International Statistical Classification of Diseases and Related Health Problems, eleventh revision (ICD-11), do not recognize OrNe as a mental disorder, as there are no official diagnostic criteria. Based on this, individuals who are obsessed about food to achieve good health may exhibit risky behaviors, but so far there is no sufficient evidence to describe OrNe as a disease (Cena et al. 2019;Dunn and Bratman 2016). Nevertheless, it is still possible to identify some characteristic aspects of OrNe. ...
... Research about orthorexia is growing year by year (McComb and Mills 2019; Dunn and Bratman 2016;Cena et al. 2019). However, today the body of scientific evidence is still fragmented about its etiology and clinical implications, being especially scarce in terms of investigation of HeOr. ...
... However, today the body of scientific evidence is still fragmented about its etiology and clinical implications, being especially scarce in terms of investigation of HeOr. Some articles (Dunn and Bratman 2016;Barthels et al. 2015b;Moroze et al. 2015;Donini et al. 2004;Setnick 2013) have suggested diagnostic criteria to guide the clinical community to identify signs and symptoms of OrNe. Cena et al. (2019) carried out a review study and gathered the diagnostic criteria suggestive of OrNe presented in four previous studies. ...
... Orthorexia was initially coined by Bratman (1997) to operationalize the pursuit of a healthy diet that intensifies and becomes a pathological obsession. There is a significant body of evidence suggesting that current conceptualizations of orthorexia nervosa pose the risk of over-diagnosis, with disproportionately high prevalence rates (of up to 90.6% in non-clinical samples; Dunn & Bratman, 2016;Turner & Lefevre, 2017), and followers of diets (e.g., vegetarians and vegans) being prematurely labelled as having orthorexia nervosa (Brytek-Matera, 2019;Heiss, Coffino, & Hormes, 2019;Koeder, 2021Koeder, , 2021entürk et al., 2022. Therefore, making the distinction between the pathological and non-pathological pursuit of a healthy diet is crucial to the advancement of the field. ...
... One major topic of debate in current literature on orthorexia nervosa concerns disentangling the motives behind the pursuit of a healthy diet (see e.g., Atchison & Zickgraf, 2022;Barthels, Kisser, & Pietrowsky, 2021;Messer, Liu, et al., 2022;Pauzé et al., 2021). In contrast to other eating disorders (such as anorexia nervosa and bulimia nervosa), initially, diagnostic criteria for orthorexia nervosa referred to the absence of body-image concerns, and food choices are framed as "health" choices (Dunn & Bratman, 2016). However, in light of evidence to suggest that body-image disturbance may indeed be present in orthorexia nervosa in both women (Messer, Liu, et al., 2022;Parra--Fernández et al., 2018) and men (White, Berry, & Rodgers, 2020), scholars have concluded that the role of body image disturbance in orthorexia nervosa remains unclear and is an important direction for future research (Donini et al., 2022). ...
... This result is in line with previous findings in mixed-gender samples, which have found moderate positive associations between the two constructs (Anastasiades & Argyrides, 2022;Barrada & Roncero, 2018;Barthels et al., 2019), and provide further support for the ongoing debate regarding the bidimensionality of orthorexia, suggesting that following a healthy diet is not necessarily always associated with pathology. Mistaking the mere interest in, and pursuit of a healthy diet for disordered eating has been identified as a common misconception with orthorexia nervosa, one which seems likely to have contributed to issues with measurement (Missbach, Dunn, & König, 2017;Niedzielski & Kaźmierczak-Wojtaś, 2021;Valente, Syurina, & Donini, 2019), overdiagnosis (Bratman, 2017;Brytek-Matera, 2019;Koeder, 2021), and the large variation in prevalence rates (ranging up to 90.6% in non-clinical populations) that have been reported to date (Dunn & Bratman, 2016;Turner & Lefevre, 2017). ...
Current scholarship on orthorexia nervosa remains undecided about the role of body image in this novel eating disorder. This study aimed to explore the role of positive body image in differentiating between healthy orthorexia and orthorexia nervosa and assess how this might differ for men and women. A total of 814 participants (67.1% women; Mage = 40.3, SD = 14.50) completed the Teruel Orthorexia scale, as well as measures of embodiment, intuitive eating, body appreciation and functionality appreciation. A cluster analysis revealed four distinct profiles characterized by high healthy orthorexia and low orthorexia nervosa; low healthy orthorexia and low orthorexia nervosa; low healthy orthorexia and high orthorexia nervosa; and high healthy orthorexia and high orthorexia nervosa. A MANOVA identified significant differences for positive body image between these four clusters, as well as that there were no significant differences between men and women for healthy orthorexia and orthorexia nervosa, despite men scoring significantly higher than women on all measures of positive body image. Cluster × gender interaction effects were found for intuitive eating, functionality appreciation, body appreciation and experience of embodiment. These findings indicate that the role of positive body image in healthy orthorexia and orthorexia nervosa may differ for men and women, making these relationships worthy of further exploration.
... Despite aiming to boost health, ON has been associated with impairments in wellbeing [4], involving complex and often concerning conceptualisations of what constitutes 'health' and 'healthy eating' [5]. By refining food consumption to a restricted number of 'clean' or 'healthy' foods, those with ON are at risk of facing adverse outcomes such as malnutrition, significant weight loss, psychological distress, and damaged social wellbeing [2,6]. While ON is not currently classified as a disorder, several sets of diagnostic criteria have been proposed with a general consensus that ON involves: (1) an obsessional preoccupation with 'healthy' or 'clean' foods; (2) rigid avoidance of food considered to be 'unhealthy' or 'unclean'; (3) distress when 'food rules' are violated; (4) social, physical, and/or psychological wellbeing impairments because of these beliefs and behaviours [6][7][8]. ...
... By refining food consumption to a restricted number of 'clean' or 'healthy' foods, those with ON are at risk of facing adverse outcomes such as malnutrition, significant weight loss, psychological distress, and damaged social wellbeing [2,6]. While ON is not currently classified as a disorder, several sets of diagnostic criteria have been proposed with a general consensus that ON involves: (1) an obsessional preoccupation with 'healthy' or 'clean' foods; (2) rigid avoidance of food considered to be 'unhealthy' or 'unclean'; (3) distress when 'food rules' are violated; (4) social, physical, and/or psychological wellbeing impairments because of these beliefs and behaviours [6][7][8]. Given that ON is a proposed 'new' eating disorder, there is still much to learn about its development, maintenance, and recovery processes. ...
... Understandings of recovery processes and how recovery is conceptualised within the context of ON is currently lacking, likely due to ON not being an officially recognised eating disorder within official diagnostic criteria [6][7][8]. Preliminary research in this area suggests that self-reflection is an important first step in recovery, through which individuals with ON learn to accept their behaviours as disordered and begin their journey of recovery [9]. In an online ethnography, Ross Arguedas [10] found that shifting identities is central to recovery from ON. ...
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.
... In contrast, orthorexia nervosa (ON) is an expression created to refer to a possible new ED, the main symptom of which is an obsessive and insecure focus on eating foods considered healthy [5]. Although this disorder has not yet been inserted by the diagnostic manuals, the literature review conducted by Cena and colleagues [5] highlighted two main pieces of criteria that could become pathognomonic: (1) obsessive focus (inflexible dietary rules, recurrent and persistent food-related worries, and compulsive behaviors) on dietary practices that are believed to promote optimal well-being; and (2) consequent clinically significant impairment (i.e., medical or psychological complications, great distress, and/or impairment of important areas of functioning) [6]. ...
... Therefore, the diet followed by subjects with ON is characterized by a restrictive scheme in which the distortion of the eating habits and the avoidance of specific foods can lead to the shortage of essential nutrients or malnutrition and underweight [7]. Nevertheless, specific behavioral aspects can also be found in terms of ritualized and/or strictly controlled eating habits [5][6][7]. ...
... Unfortunately, not having found research on ON in the literature, it is only possible to hypothesize similarities between the two conditions. However, according to the most recent review that identifies the diagnostic criteria frequently used to identify the ON [5][6][7], the pathognomonic characteristics of OCD seem to have emerged. In particular, obsessiveness and compulsions linked to excessive somatic tension seem to unite the two disorders. ...
1) Background: A new mental illness is attracting the attention of researchers and mental health professionals. Orthorexia nervosa (ON) is a possible new mental disorder, the main symptom of which is an obsessive and insecure focus on healthy foods and consequent compulsive behaviors. There is a common consensus among researchers that ON is considered partly overlapping with obsessive-compulsive disorders (OCDs). (2) Methods: MEDLINE and Scopus were searched for articles published in the last 10 years regarding the psychophysiological aspects of OCD and ON. Eight studies met the eligibility criteria. The inclusion criteria encompassed adults diagnosed with OCD and/or ON. However, only studies involving OCD patients were found. (3) Results: Some research groups have shown that OCD disorders can be considered among anxiety disorders because they are characterized by anxious hyper activation. Other research, however, has shown profiles characterized by low psychophysiological reactivity to stressful stimuli. Despite this, there seems to be a consensus on the poor inhibition abilities, even when activation is low, and the dissociation between cognitive and psychophysiological activation emerged. (4) Conclusions: However discordant, some points seem to bring the researchers to agreement. In fact, there is consensus on conducting a multidimensional assessment that can measure all of the aspects of suffering (cognition, emotion, and behavior) and highlight the poor body-mind integration. This clinical approach would make it possible to propose interventions aimed at treating some mental illnesses such as food obsession that can paradoxically impair the psychophysical balance. Nevertheless, the applied systematizing approach to existing studies on ON is very much needed for better understanding of the psychophysical nature of this new mental illness and its implications for prevention and treatment.
... These eating patterns might become more extreme and cause adverse consequences for physical, social and psychological health (Almeida et al., 2018). Orthorexia is a frequent eating disorder among exercise practitioners, characterized by excessive concern with the consumption of healthy foods, which can trigger malnutrition and harm people's health, becoming pathological (Dunn & Bratman, 2016). The literature demonstrates a positive association between orthorexia symptoms and different variables, such as food pathology (Almeida et al., 2018;Segura-García et al., 2012), behavioral dimensions of the impulse for muscularity and exercise dependence (White et al., 2020), and dissatisfaction with physical appearance (Almeida et al., 2018). ...
... The benefits of regular physical exercise, at all stages of life, are well-established in the literature (Trott et al., 2020) There is evidence that disorders related to body dissatisfaction, such as muscle dysmorphia, are risk factors for the development of dependent behaviors, such as addiction to exercise. However, there are few studies associating the symptoms of muscle dysmorphia with exercise addiction and symptoms of eating disorders, such as orthorexia (Dunn & Bratman, 2016;Trott et al., 2020), in exercise practitioners (Almeida et al., 2018). Research about muscular dysmorphia is usually conducted in selected samples, such as professional athletes or bodybuilders (Longobardi et al., 2017), which makes it impossible to infer data for other populations. ...
... The literature in orthorexia, mainly concerning its prevalence, is dominated by European studies (Dunn & Bratman, 2016), and, in Brazil, given the high rates of physical exercise practitioners, the importance of studies about the risk of orthorexia is highlighted in order to raise awareness and prevent possible damage to health. Thus, the present study aimed to analyze the association of muscle dysmorphia with addiction to exercise and orthorexia in Brazilian amateur athletes. ...
This study aimed to analyze the predictive role of muscle dysmorphia symptoms in exercise addiction and orthorexia in 158 Brazilian exercise practitioners (running = 38, crossfit = 85, bodybuilding = 35) of both sexes (women = 81, men = 77), with a mean age of 31.59 years (± 7.99) and experience of 4.5 years (± 5.27).
The Dedication to Exercise Scale, the Questionnaire for the Diagnosis of Orthorexia, and the Complex in Adonis Questionnaire were used. Data analysis was conducted through Pearson’s correlation and multiple regression analysis (p < .05). It was found that the muscle dysmorphia symptoms predicted positively eexercise addiction (β = .51, p < .001) and negatively orthorexia (β = -.19, p < .01), and it is important to discuss the issue with physical exercise practitioners in order to minimize the prevalence and deleterious effects associated with this psychological disorder.
... However, as the results of these studies may be biased or misleading, these two tools are criticized for their lack of validity and reliability [16]. Depending on the research scale and country, the prevalence of ON is more common (35-89%) among artists, health professionals, nutrition students, dietitians, and athletes, but varies widely from 1-89% [10,17]. Dunn et al. [18] suggested that the frequency of ON was found high in most studies, since the assessment tools they used did not distinguish individuals with ON from individuals with healthy eating habits. ...
... ON is characterized by consuming healthy foods and focusing on their content and quality [31] and is brie y de ned as an obsession with healthy eating [11]. This behavior may include an unbalanced diet due to beliefs about the "purity" of food, strict avoidance of unhealthy foods, feelings of guilt and anxiety after eating violations, or intolerance to other people's food beliefs [17,31]. Extreme orthorexic behaviors may deteriorate physical health due to malnutrition and cause social and academic failures due to obsessive thoughts and behaviors focused on beliefs about healthy eating [17]. ...
... This behavior may include an unbalanced diet due to beliefs about the "purity" of food, strict avoidance of unhealthy foods, feelings of guilt and anxiety after eating violations, or intolerance to other people's food beliefs [17,31]. Extreme orthorexic behaviors may deteriorate physical health due to malnutrition and cause social and academic failures due to obsessive thoughts and behaviors focused on beliefs about healthy eating [17]. ...
Background
There are several scales to evaluate orthorexia nervosa (ON), a pathological obsession, fixation or preoccupation with healthy foods. However, studies report that some of these scales have poor internal consistency and some do not have test-retest reliability, therefore new scales are needed to evaluate ON correctly. This study aims to adapt the Test of Orthorexia Nervosa-17 (TON-17) into Turkish and verify its validity and reliability.
Methods
The study included a total of 539 adults, 131 men (24.3%) and 408 women (75.7%), with a mean age of 30.2 ± 12.26 years. A reliability analysis was performed and a confirmatory factor analysis (CFA) to test its construct validity. Time invariance of the scale was examined by test-retest analysis, and its convergent validity was evaluated by a correlation analysis conducted to test relationships between the scale and other theoretically relevant instruments (EAT-26 and OBQ-9). Analyses were conducted using SPSS Version 23 and the AMOS program.
Results
The Cronbach's α internal consistency coefficient of the total scale was found to be 0.820, suggesting a strong internal consistency. The Cronbach's α values of its factors were 0.681 for the Factor 1, 0.643 for the Factor 2, and 0.726 for the Factor 3. In addition, the test-retest reliability was found as 0.868 for the total scale, suggesting an excellent reliability. The most of fit indices (CMIN/df, RMSEA, AGFI, NFI and TLI) of the scale were acceptable, and the GFI indicated a good model fit.
Conclusion
This study has shown that the Turkish version of TON-17, which is a new tool with three-factor structure to evaluate both healthy and unhealthy orthorexia, is valid and reliable scale. Studies of TON-17 on diverse cultures will contribute to the literature. Therefore, examining the validity and reliability of TON-17 in diverse cultures and populations may contribute to developing the gold standard scale for evaluating ON in future studies.
... Furthermore, Rudolph et al. (2018) stated that exercise addiction, training hours per week, were also linked to a greater orthorexic risk in the context of German fitness sports [16]. However, other authors did not find any correlation [17][18][19]. ...
... The association between demographic variables and orthorexia is still ambiguous. Multiple studies showed that women have higher symptoms of orthorexia compared with men [6,12,19,[28][29][30]; whereas others found the exact opposite [5,31,32] or even no difference at all between the two genders [15,17,[33][34][35][36]. These discordant results may be because these studies were conducted in different countries with cultural dissimilarities and with different assessment tools of Orthorexia. ...
... Hence, the physical activity effect on physical and mental health are outstanding [77]. However, in our study, as shown elsewhere, no correlation between OrNe and physical activity was found [17][18][19]. Previous authors detected a high level of physical activity being associated with greater OrNe risk [14,15]. ...
Abstract Background Recently, there has been a blooming focus on “eating healthy and clean”, with the ideal of being healthy becoming a popular lifestyle trend. Previous research suggested the presence of two forms of orthorexia: Orthorexia Nervosa (OrNe) and Healthy Orthorexia (HeOr). Taking into consideration that orthorexia thoughts are led by the desire to reach an optimal physical health, the dedication to a healthy living may require healthy lifestyle habits: smoking cessation, moderate alcohol intake, and increased physical activity. The main study aim was to determine, among Lebanese adolescents, the association between healthy behaviors and the two likely forms of orthorexia (OrNe and HeOr), given that the adolescent phase is a risky period in the development of eating disorders. Methods A cross-sectional study, conducted between January and April 2022, enrolled 444 adolescents aged between 14 and 18 years, with an equitable random sample from all the Lebanese governorates (mean age 16.23 ± 1.15 years; 60.1% females). The Teruel Orthorexia Scale (TOS) was used to assess orthorexic eating tendencies. The Lebanese Waterpipe Dependence Scale, the Fagerström Test for Nicotine Dependence and the Alcohol Use Disorder Identification Test scales, all validated in adolescents, were used to evaluate the association between orthorexia and healthy behaviors. Results Higher TOS OrNe scores were significantly and highly correlated with the TOS HeOr scores (r = 0.68; p
... Orthorexia nervosa (ON) involves a fixation with eating healthy through strict dietary rules that negatively affect physical and mental health [1]. People with ON have a maladaptive preoccupation with the perceived quality of food consumed (e.g., organic, processed) and its consequences for their health [1,2]. Critically, the maladaptive preoccupation with healthy eating promotes disordered eating behaviors (e.g., extreme fasting and cleanses) that are perceived to be healthy (e.g., detoxifying), but often culminate in the elimination of entire food groups (e.g., "clean" eating) from one's diet [1,2]. ...
... People with ON have a maladaptive preoccupation with the perceived quality of food consumed (e.g., organic, processed) and its consequences for their health [1,2]. Critically, the maladaptive preoccupation with healthy eating promotes disordered eating behaviors (e.g., extreme fasting and cleanses) that are perceived to be healthy (e.g., detoxifying), but often culminate in the elimination of entire food groups (e.g., "clean" eating) from one's diet [1,2]. The restrictive eating patterns in ON are driven by the pursuit of a healthy diet. ...
... ON contrasts with anorexia nervosa (AN) and bulimia nervosa (BN) in which restrictive eating patterns are largely driven by body image concerns [2,3]. Although ON has been viewed as less severe compared to AN and BN [4], the consequences of untreated ON can mirror those of AN and BN, such as nutritional deficiencies [5]. ...
Purpose
Orthorexia nervosa (ON) involves a maladaptive preoccupation with healthy eating through strict dietary rules that negatively affect physical and mental health. Recent evidence suggests that ON symptoms may stem, in part, from having a health-focused self-concept (i.e., overvaluing the importance of health for self-definition and self-worth). Herein, fear of losing control over eating unhealthy foods and disgust for unhealthy foods were examined as potential mediators of the association between health-focused self-concept and ON symptoms.
Methods
The parallel mediation model was tested using a community sample of people who believe they are currently following a healthy eating diet plan and/or believe they are leading a healthy eating lifestyle (N = 442). Participants were recruited from Amazon’s Mechanical Turk and completed a questionnaire battery that included the Health-Focused Self-Concept Scale, questionnaires assessing fear of losing control over eating unhealthy food and disgust with unhealthy food, and the Orthorexia Nervosa Inventory.
Results
As expected, a health-focused self-concept was indirectly and positively associated with ON symptoms via fear and disgust.
Conclusion
The findings conceptually replicate and extend prior research on anorexia nervosa supporting the transdiagnostic utility of a focused self-concept, fear of losing control, and disgust across eating disorders.
Level of evidence
Level V, cross-sectional descriptive study.
... Both the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), and the International Statistical Classification of Diseases and Related Health Problems, eleventh revision (ICD-11), do not recognize OrNe as a mental disorder, as there are no official diagnostic criteria. Based on this, individuals who are obsessed about food to achieve good health may exhibit risky behaviors, but so far there is no sufficient evidence to describe OrNe as a disease (Cena et al. 2019;Dunn and Bratman 2016). Nevertheless, it is still possible to identify some characteristic aspects of OrNe. ...
... Research about orthorexia is growing year by year (McComb and Mills 2019; Dunn and Bratman 2016;Cena et al. 2019). However, today the body of scientific evidence is still fragmented about its etiology and clinical implications, being especially scarce in terms of investigation of HeOr. ...
... However, today the body of scientific evidence is still fragmented about its etiology and clinical implications, being especially scarce in terms of investigation of HeOr. Some articles (Dunn and Bratman 2016;Barthels et al. 2015b;Moroze et al. 2015;Donini et al. 2004;Setnick 2013) have suggested diagnostic criteria to guide the clinical community to identify signs and symptoms of OrNe. Cena et al. (2019) carried out a review study and gathered the diagnostic criteria suggestive of OrNe presented in four previous studies. ...
Orthorexia can be understood as a drive for eating foods perceived to be health-promoting. When this drive includes obsessive thoughts and rigid behaviors about food choices, a person can suffer physical, psychological, and social harms. In the literature, this symptomatology is known as orthorexia nervosa, as it can cause damage in different areas of people’s lives. On the other hand, a drive for healthy eating can also be experienced as a guide to help people make food choices aiming to establish a health-promoting eating habit. This has been named in the literature as healthy orthorexia, but it is not clearly understood yet. The aim of this chapter was to conceptualize healthy orthorexia and explore its forms of evaluation, providing discussion about empirical evidence and practical implications. For that, a background about orthorexia nervosa was also necessary to understand how healthy orthorexia fits into this phenomenon that is still under debate in the clinical and scientific community.
... Depuis la première conceptualisation de l'ON en 1997, cette entité nosologique a fait l'objet d'un intérêt scientifique croissant avec par exemple 140 publications recensées dans PubMed entre 2019 et 2020, contre 89 au cours des 20 dernières années (Fig. 1). Bien que l'ON ne soit pas considérée comme un trouble psychiatrique (American Psychiatric Association, 2013 ; Organisation mondiale de la santé, 2019), plusieurs critères diagnostiques ont été proposés (Barthels et al., 2015 ;Dunn & Bratman, 2016 ;Moroze et al., 2015). ...
... Ce n'est donc pas une adhésion excessive et anormale à des théories sur l'alimentation qui contribue au développement de l'ON, mais une réponse pathologique à des croyances alimentaires (Bratman, 2017). Les restrictions alimentaires des individus présentant une ON se limitent, initialement et généralement, à l'exclusion du sel, du sucre et des matières grasses, mais elles s'intensifient progressivement avec l'interdiction de consommer les aliments contenant par exemple du gluten, des additifs ou encore des conservateurs (Dunn & Bratman, 2016 ;Hristova & Marinov, 2020 ;Lopes et al., 2020). Les aliments « non-sains » sont exclus en fonction de la représentation de ce qu'est l'alimentation saine pour chaque individu ; un aliment considéré comme « sain » ne le sera pas nécessairement par l'autre (Bratman, 2017). ...
... Ces pensées et comportements ont pour objectif principal de favoriser le fait de se sentir en bonne santé et ne sont pas directement associés à des motivations environnementales, éthiques ou religieuses (Dunn & Bratman, 2016 ;Koven & Abry, 2015). Pour autant, chaque violation de ces règles et rituels alimentaires auto-imposés peut entraîner des cognitions et des ressentis négatifs avec une peur exagérée de la maladie, un sentiment d'impureté personnelle, des sensations physiques négatives, de l'anxiété et de la honte (Dunn & Bratman, 2016). ...
L’intérêt porté à la qualité de l’alimentation est de plus en plus répandu dans la société, il peut cependant devenir pathologique avec l’installation d’obsessions alimentaires. Le néologisme orthorexie nerveuse permet de décrire ce rapport obsessionnel à l’alimentation. Bien que l’orthorexie nerveuse soit associée à une altération du fonctionnement de l’individu qui en est atteint, elle ne renvoie pas, aujourd’hui, à un diagnostic psychiatrique car elle reste mal comprise. Les objectifs principaux de cette revue critique de la littérature sont de (1) présenter l’orthorexie nerveuse de sa conceptualisation initiale à sa compréhension actuelle au regard des avancées scientifiques, (2) distinguer l’orthorexie nerveuse de l’anorexie mentale et (3) mettre en évidence l’émergence de l’intérêt croissant, et parfois pathologique, porté à l’alimentation saine au regard de l’évolution sociétale. Pour répondre à ces objectifs, une analyse de la littérature sur l’orthorexie et sur l’alimentation saine a été réalisée et restituée.
... Individuals who display orthorexic tendencies place significant emphasis on food quality and purity and spend a significant amount of time planning and preparing healthy meals [48]. The imposition of extreme restrictions can result in malnourishment and medical complications [15,28], as well as severely reduce the enjoyment of food [18]. ...
... Individuals with AN, Bulimia Nervosa (BN) and Binge Eating Disorder (BED) have reported worse QoL than the general population (e.g., Agh et al., 2016, [21,22,41,61,95]. Research has shown that people with ON also experience reduced QoL due to self-punishment following dietary violations (Koven & Arby, 2015), avoidance of social gatherings where food is involved leading to social isolation [28], depression and anxiety (Bosi et al., 2017). Individuals who have experienced an ED for several years may suffer from impairments in psychological, physical, and social aspects of life [41,95], but no studies have examined the quality of life specific to eating disorders in individuals who display orthorexic symptoms. ...
Orthorexia nervosa (ON) is characterised by an obsessive focus on healthy eating, following restrictive dietary practices and dietary restrictions escalating over time. The aim of this study was to explore mindfulness, mindful eating, self-compassion and quality of life in a female population. Two hundred eighty-eight participants completed Orthorexia, Self-Compassion, Mindful eating, Mindfulness and Eating Disorder Quality of Life scales. The results indicated that there was a negative relationship between ON and mindfulness, self-compassion and mindful eating. Furthermore, the present study found a positive relationship between lower quality of life and ON, while findings indicated that self-compassion and the awareness facet of mindfulness moderated the relationship between ON and QOL. The present results contribute to a better understanding of orthorexic eating behaviours in a female population, and identify the moderating capacity of self-compassion and mindfulness. Further implications and future directions are discussed.
Level of evidence Level V, cross-sectional descriptive study.
... ON is currently not acknowledged as a diagnostic entity in formal psychiatric nosology (ICD-11 and DSM-V), and thus there is still considerable discussion about the diagnostic criteria, methods and tools used for its classification [88]. Furthermore, pathological ON often overlaps with healthy orthorexia and orthorexic behaviors [92]. In that way, assessment of ON may sometimes provide false positive results as people concerned with healthy eating may be over-pathologized as ON sufferers. ...
... Accordingly, many have criticised the methods used to assess ON as too unspecific and insensitive, having various cut-offs, and based on different definitions of ON [5,21,[92][93][94]. Also, to what extent ON represent at the conceptual level represent a pathological state or rather a sensible approach to healthy eating is debated [12]. ...
Aim
Orthorexia Nervosa (ON) describes a pathological obsession with proper and high-quality nutrition that is necessary to research further in order to elucidate its prevalence and correlates which may bear implications for prevention and treatment. The aim of this study was to review studies that report the prevalence of ON in people who exercise, calculate an overall prevalence through a random-effects meta-analysis approach and investigate the association of ON prevalence using a random-effects meta-regression. In addition, a sub-group-analysis based on ON-instruments and a sensitivity analysis excluding students samples, were conducted.
Method
Systematic searches were conducted in the following online databases: PubMed, Embase, Web of Science, PsychInfo, CINAHL, Google Scholar and OpenNet. The following search terms were used: Orthore* AND (prevalenc* OR incidenc* OR frequen* OR cut-off OR epidem*). A total of 613 unique hits were reviewed by two blinded authors, and 24 studies were coded and assessed for risk of bias (Holy et.al). The meta-regression included three independent variables (sex, type of sport, and sample size).
Results
The overall prevalence of ON in the exercising population was 55.3% (95% CI 43.2–66.8). Cochran’s Q was 11,436.38 (df = 23, p < 0.0000), and the I² was 98.4%, indicating high heterogeneity across studies. The sensitivity showed an overall prevalence of 51.3% (95% CI 51.3–70.0). There was a significant difference in prevalence estimates based on the instruments used (Qbet = 33.6, df = 2, p < 0.01).
Discussion
The overall prevalence of ON in exercising populations was very high. The between-study disparity was large and was partly explained by the ON-instrument administered. One fourth of the studies had a moderate risk of bias. The majority of the studies did not specify relevant demographic information about the sample, and information about the type of sport was frequently missing.
... It is often difficult to define the point of transition, but ON can be described as a state in which the pursuit of a healthy diet dominates the individual's life and ceases to serve the purpose of improving health [3,4]. Although, to date, no formal diagnosis of ON has been included in the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) definitions of eating disorders (ED) [2,5], a number of diagnostic criteria have been proposed [6][7][8]. There is some variation between criteria, but the following characteristics are commonly described: an obsession with eating healthy or pure foods, repressive behavior or mental preoccupation in relation to foods considered unhealthy, and emotional distress and fear linked to food perceived as unhealthy and its potential harmful effects on the body and health. ...
... The ORTHO-15, a self-administered questionnaire made up of 15 items on a four-point Likert scale (1 = always, 2 = often, 3 = sometimes, 4 = never), was used to assess the incidence of ON in the study sample [9]. The questionnaire investigated three underlying factors of eating behavior: cognitive-rational (explored by questions 1, 5, 6, 11, 12, 14), clinical (questions 3,7,8,9,15), and emotional (questions 2, 4, 10, 13). A lower score indicates a higher level of ON symptomatology. ...
The aim of this study was to determine the prevalence of orthorexia nervosa (ON) among professional dancers in Greece, as well as its relationship with nutrition, body mass index (BMI), body image flexibility, and parental bonding. The participants were 96 professional dancers, with a mean age of 23.41 ± 5.13 years, who completed a battery of questionnaires recording sociodemographic, clinical, and anthropometric characteristics; adherence to the Mediterranean diet (MedDiet); indications of ON, as determined by the ORTHO-15 questionnaire; body image flexibility, using the body image-acceptance and action questionnaire (BI-AAQ-5); and their recollection of their parents’ attitudes towards them during the first 16 years of life, with the parental bonding instrument (PBI). The study population was classified into two groups, based on BMI: normal weight, and underweight. ON was shown to be significantly correlated with BMI (p = 0.006)-present in normal weight subjects- and body image inflexibility (p < 0.001). Parental body image inflexibility was significantly correlated with a low bonding relationship as perceived in childhood. In conclusion, disordered eating attitudes and body shape concerns are prevalent among professional dancers and appear to be associated with their parental relationship during childhood. Identification of potential ON and development of preventive mechanisms could help to eliminate such concerns and improve the nutrition of professional dancers.
... In 2016, Steven Bratman updated ON definition indicating that new features, in addition to maintaining its original characteristics, should be considered. He also pointed out that social media (SM) platforms, such as Instagram, are contributing to the development of ON not only for health reasons but also for reasons that have to do with appearance (Dunn & Bratman, 2016). ...
... Bratman and Knight (2000) document orthorexic individuals are more concerned with the quality of their diet than with the appearance of their bodies and losing weight. However, Dunn and Bratman (2016) acknowledge that many people believe that being healthy means having a thin body with low fat mass index. In this regard, the current research investigates the link between BD and ON, as well as the role of BD as a mediator in the development of ON. ...
This study investigates the effect of Instagram use, fitness and health-related content, internalization, social comparisons, perfectionism, and obsessive-compulsive personality traits on body dissatisfaction and Orthorexia Nervosa. Moreover, the study discusses the differences between Portuguese and Brazilian societies to underline the potential role of cultural dimensions. A survey-based study with a sample of 238 respondents has been developed to test the proposed model using structural equation modelling. The data analysis shows that the main factors influencing body dissatisfaction and Orthorexia Nervosa are internalizing beauty ideals, social comparisons (both upward and downward), and perfectionism. Body dissatisfaction mediates the path from internalization, upward and downward comparisons, perfectionism from one side, and Orthorexia Nervosa on the other. Finally, results from Portuguese and Brazilian samples were similar revealing no significant role of cultural differences. Based on the findings, the study concludes by discussing the theoretical contributions and providing actionable managerial implications.
... A pattern of eating behavior that is not considered an eating disorder but is characterized by an obsession with food health, food quality, and purity was recently highlighted in the literature and called orthorexia nervosa [1,[15][16][17]. ...
... As a consequence of this obsessively "healthy" eating, one can have a nutritionally unbalanced diet, resulting in restrictions, social isolation, and intolerance with those who eat differently, intensified by behaviors of teaching others what and how to eat. Individuals with orthorexic behaviors report stress, anxiety, shame, guilt, exacerbated fear, a sense of personal impurity, and negative physical sensations when they cannot rigidly maintain behaviors considered healthy [1,[15][16][17]. ...
Possible correlations between orthorexic self-reports, unhealthy nutritional beliefs, behavioral rigidity related to following rules, and distortion of body self-image were investigated. In total, 246 university students of both sexes, from different areas of knowledge, answered a sociodemographic form, the Ortho-15, the Body Shape Questionnaire, the Rigidity Scale, and a Nutritional Beliefs Form. Orthorexic self-reports were observed in 73 men and 106 women. A positive correlation was found between females and orthorexic self-reports (p = 0.036), and severe distortion of body self-image (p = 0.002) and between the latter, the behavioral rigidity scale (p2 = 0.189; p = 0.001), and female sex (p2 = 0.245; p < 0.000). In the logistic regression, women were 1.83 times more likely to present orthorexic behaviors than men. The creation of prevention and treatment strategies aimed at women is suggested and it recommended that studies investigating whether the presence of orthorexic self-reports is a risk factor for the development of eating disorders are carried out.
... A few may feel morally superior to those who do not follow such a diet and eat "unhealthy" foods [8][9][10]. What becomes of essence for those suffering from ON is the highest quality of food they consume [9,[12][13][14][15][16]. Orthorexia can be suspected when the described behavior does not ease and has a negative influence on the wellbeing of an individual [8]. ...
... Therefore, focusing on the quality and type of food consumed may not be a characteristic feature of ON. The rigid selection and gradual reduction of "allowed" products is present in both disorders; people with ON impose dietary restrictions to achieve optimal health and not because of a fear of obesity, as is the case with AN [8,14,25,26]. Deviations from self-imposed nutritional rules are identified by both groups as a lack of self-control [8]. In addition, symptoms are perceived as egosyntonic in both disorders, which may contribute to a low motivation for treatment [3]. ...
The aim of the study was to determine the level of nutrition knowledge and diet quality, understood in terms of healthy and unhealthy eating habits, among young people with orthorexic tendencies. The participants were school students, university students, and those employed in the Lublin region (N = 473). The data were collected by means of a questionnaire. The participants were asked to provide socio-demographic data through filling in the ORTO-15 questionnaire and the Dietary Habits and Nutrition Beliefs Questionnaire (KomPAN). The participants obtained results ranging from 9.3 to 100 (M = 31.15; SD = 11.81) in the non-healthy diet index, from 0.4 to 78.6 in the pro-healthy diet index (M = 21.79; SD = 11.08), and from 0 to 23 in the domain of nutrition knowledge (M = 13; SD = 4.23). A variance analysis showed no significant differences between the pro-healthy diet index and the level of nutrition knowledge. The group with orthorexia obtained statistically higher results in the pro-healthy diet index. Those with a tendency toward orthorexia obtained statistically higher results in the non-healthy diet index. The variance analysis showed that the level of nutrition knowledge of those not focused on healthy foods was significantly lower than in the other groups. The results of the ORTO-15 questionnaire correlated negatively with the pro-healthy diet index and the level of nutrition knowledge, and positively with the non-healthy diet index. We concluded that: 1. the orthorexic group and the group with a tendency toward orthorexia could be characterized with a moderate intensity of a healthy diet and a low intensity of a non-healthy diet; and 2. the level of nutrition knowledge in the orthorexic group did not significantly differ from that of the other groups.
... The term orthorexia nervosa (ON) is referred to the psychological obsession with a healthy, organic and pure diet, and it is often based on stereotyped or erroneous nutritional beliefs, which can lead to dietary restrictions with resulting nutritional deficiencies [1][2][3][4]. Although ON shares several aspects in common with Anorexia Nervosa (AN) [5] and other eating disorders (EDs) [6], and around 70% of health professionals [7,8] believe that ON should be a distinct, clinically recognized ED, it is not included in the ICD-11 (International Statistical Classification of Diseases and Related Health Problems) [9,10]. ...
... EAT-26 is made up of 26 items and represent a screening tool to assess "ED risk" [40]. Although it does not provide a diagnosis of ED, the EAT-26 items include the subscales: "dieting" scale (items 1, 6,7,10,11,12,14,16,17,22,23,24,26) and "bulimia and food preoccupation" scale (items 3,4,9,18,21,25). Four behavioral questions are included to determine the presence of extreme weight-control behaviors. ...
BACKGROUND
Orthorexia nervosa (ON) is the persistent concern of maintaining the self-imposed diet to improve one's health. Many factors have been associated to ON in university students.
AIM
To assess the prevalence of ON in Italian and Spanish university students in relation to eating attitude and psychological distress, and the possible overlaps between ON (evaluated with different scored questionnaires from the originally proposed ORTO-15), distress and risk of eating disorders.
METHODS
This study was carried out on 160 students recruited at La Sapienza University of Rome and at the Catholic University of Murcia. Questionnaires were administered to evaluate ON (ORTO-15 and sub-scores), body concerns (Multidimensional Body-Self Relations Questionnaire, MBSRQ, and Body Uneasiness test, BUT),
psychological distress (Kessler Psychological Distress Scale, K10), physical activity (International Physical Activity Questionnaire, IPAQ), eating attitude (Eating Attitudes Test, EAT-26) and malnutrition (Starvation Symptom Inventory, SSI). Sex differences, within the same country, and differences between Italian and Spanish students, within the same sex, were evaluated.
RESULTS
The ORTO-15 positive subjects, assessed with the originally proposed cut-off, were above 70% in both Italian and Spanish students, with a higher prevalence in the Spanish sample (Italian females 76.3%, Italian males 70.7%; Spanish females 97.0%, Spanish males 96.3%). According to ORTO-7, about 30% of Italian and 48% of Spanish students were positive to ON with no significant sex differences. When excluding students underweight (UW), overweight (OW) or obese (OB), as well as those potentially at risk of eating disorders or presenting mild, moderate and severe distress, in the resultant normal weight (NW)-K10neg-EAT-26neg subgroup, we did not find many correlations observed in the whole sample, including those between ORTO scores and BUT, SSI, Total MBSRQ and some of its components. Moreover, ORTO-7 resulted in the only ON score unrelated with Body Mass Index, MBSRQ components and IPAQassessed intense activity, in the NW-K10neg-EAT-26neg subgroup. After this sort of “exclusion diagnosis”, the prevalence of ON of these students on the overall sample resulted in 16.9%, 12.2%, 15.2% and 25.9% for Italian females, Italian males, Spanish females and Spanish males, respectively.
CONCLUSION
In some university students ON could be a symptom of other conditions related to body image concerns and distress, as well as to high physical activity and appearance, fitness, health or illness orientation (from MBSRQ). However, ORTO-7 became independent from these confounding variables, after the exclusion of UW, OW, OB and students positive to EAT-26 and K10, suggesting the possibility of identifying orthorexic subjects with this specific questionnaire.
... As further criteria, some authors recommend the presence of positive effects from following self-defined healthy eating (Dunn and Bratman 2016) or overvalued ideas about body-and health-related effects of specific foods or food groups (e.g., Barthels et al. 2015). Furthermore, it is discussed whether orthorexic eating behavior might be characterized by a moral or spiritual component leading to a feeling of ethical superiority over the lifestyle and eating habits of others which becomes part of their belief system and identity (Cena et al. 2019). ...
... Reviews estimated that the prevalence of at least some orthorexic behaviors range from 6 to 89% (Dunn and Bratman 2016;McComb and Mills 2019). It is likely that these high numbers can be attributed to psychometrically poor diagnostic tools and their inability to differentiate healthy eating from pathologically obsessive healthy eating. ...
Orthorexia nervosa is described as an obsessivefixation on healthy eating in order to maintain and optimize health. The progressive rigidity of self-impose dietary rules in orthorexia nervosa may resemble the maladaptive cycle of substance abuse. Phenomenological similarities are high time investment and cognitive and behavioral preoccupation. Nevertheless, the obvious negative health consequences of substance use disorders are contrary to the aim of orthorexic eating behavior.
Moreover, Orthorexia nervosa does not allow the identification of specific foods or food groups which might serve as addictive substances. Based on current evidence, there is no link between Orthorexia nervosa and substance use or abuse. Behavioral addictions, defined as compulsive and excessive non-substance-related behaviors, have also been examined in relation to orthorexia nervosa. Addictive and compul-
sive exercising was moderately and positively related to orthorexia nervosa. Evidence of a link with food addiction and internet addiction is still too sparse to allow conclusions. Filling research gaps related to addictions and orthorexia nervosa could help to better understand the etiology of orthorexia nervosa and, thus, assess its distinctiveness from established psychiatric disorders.
... A ortorexia é considerada uma desordem de cunho alimentar que consiste em um empenho demasiado em alimentar-se corretamente (Felipe, González, Álvarez, & Hernández, 2010). Vale ressaltar que a ortorexia se diferencia dos demais distúrbios por não haver uma obsessão pelo corpo perfeito, extrema magreza e pela quantidade de alimento ingerido, mas pela obsessão à qualidade do mesmo (Brytek-Matera, 2012;Dunn & Bratman, 2016). Estudos recentes afirmam que 40-70% de pessoas que sofrem de ortorexia, anorexia nervosa e bulimia nervosa também sofrem de dependência psicológica ao exercício (Brehm & Steffen, 2013;Zeeck et al., 2013;Zeulner et al., 2016). ...
Este estudo analisou a associação da dependência ao exercício com os sinais e sintomas de comportamento ortoréxico e vigorexia de 216 praticantes de exercício físico, de diferentes regiões do Brasil (30,10 ± 9,59 anos). Foram utilizados os seguintes instrumentos: Escala de Dedicação ao Exercício, Questionário do Complexo de Adônis e Questionário de Ortorexia. A análise de dados foi conduzida por meio dos testes de Kolmogorov-Smirnov, Mann-Whitney e correlação de Spearman (p <0,05). Os resultados evidenciaram um baixo grau de dependência psicológica entre os praticantes, com maior tendência dos indivíduos ortoréxicos serem mais dependentes do exercício e apresentarem maior indicativo de vigorexia. Verificou-se associação da ortorexia com a dependência ao exercício e a vigorexia. Concluiu-se que indivíduos ortoréxicos são mais dependentes do exercício físico e apresentam indícios para outros distúrbios alimentares, como também problemas físicos, psicológicos e sociais.
... Indivíduos com comportamentos ortoréxicos relatam sentir estresse e ansiedade ao confrontar conflitos surgidos em consequência de suas decisões em relação à alimentação. A busca por alimentos biologicamente puros, comportamento característico de indivíduos com ON, acarreta em restrições alimentares significativas e consequentemente restrições sociais, uma vez que o ato de comer saudável envolve aspectos sociais (Dunn & Bratman, 2016). ...
Foram investigadas correlações entre relatos de ortorexia nervosa, atitudes alimentares, padrões alimentares e religião em universitários de uma instituição confessional. É um estudo transversal e descritivo, com participação de 205 universitários de ambos os sexos, de diferentes áreas do conhecimento. Responderam a um formulário de caracterização com informações sobre sexo, idade, etnia, graduação, religião, padrão alimentar (onívoro e vegetariano,), e dois questionários: ortho-15 e Disordered Eating Attitude Scale (DEAS-s). Foram identificados relatos de comportamentos ortoréxicos em 176 participantes e relatos de atitudes alimentares não saudáveis em 33 participantes, com prevalência para vegetarianos, com relação significativa entre padrão alimentar vegetariano com religião adventista (p = 0,001) e crenças alimentares (p = 0,025). Sugere-se o avanço do estudo de atitudes alimentares não saudáveis e ortorexia nervosa como comportamentos de risco para transtornos alimentares, a compreensão do comportamento pelas suas variáveis de controle é o caminho para futuras intervenções.
... In another study conducted in 2017, it was determined that there was a negatively weak correlation between being orthorexic and eating attitude scores, which shows contradistinction to this study (12). In a study, it was stressed that orthorexic individuals faced problems such as malnutrition, hypoproteinemia, B12 vitamin deficiency and emphysema more frequently and they even become bedridden as a result of routinized nutrition (22). In this study, it was concluded that the participants' ORTO-11 scores were not correlated with their eating attitude scores. ...
Objective: Orthorexia Nervosa/Healthy Eating Obsession is defined as a pathological obsession for consuming appropriate and healthy food. The aim of this study is to determine the prevalence of orthorexia nervosa in academicians working in a public university and the influencing factors. Methods: This study was concluded between 01 January– 01 March 2020 to determine the prevalence of Orthorexia Nervosa and its correlation with influencing factors. The data of the study were collected using the Eating Attitude Test-40 (EAT-40) and the ORTO-11 along with the information form. Results: In this study, it was observed that an advanced age caused a higher risk of eating disorder. In addition, the variables of being in the age range of 34-41 years, being female, and receiving undergraduate education were significant in terms of reducing the risk of Orthorexia Nervosa (p>0.05). Conclusion: Factors such as industrialization, developments in the socio-economic structure, and mass media cause changes and new tendencies in dietary habits and food consumption. As it is believed that these conditions will become even more widespread in the future and affect all sections of society, including academicians who are accepted to be a risk group due to their perfectionist structure; it is of prime importance to raise awareness of society and inform individuals from a multidisciplinary approach including dieticians.
... 15 Spending a lot of time selecting and planning food, focusing excessively on the method of preparation and consumption, feeling distressed or disgusted when near foods they consider unhealthy, believing exaggeratedly that including or excluding certain foods can prevent or cure illnesses, and affect one's well-being, engaging in behaviors such as judging others based on their diet, experiencing deterioration in body image due to the belief of "impurity," and maintaining the diet they think is the best despite the physiological implications of rigid adherence to this diet, such as malnutrition, are examples of HEF. 3 Individuals with a HEF tend to restrict their consumption because of a pathological desire to be as healthy as possible. 18 Patients with HEF and AN have abnormal eating attitudes and behaviors in common, and both have a limited understanding of the effects of their disorders. ...
Background
In comparison to other eating problems, there is less information on healthy eating fixation (HEF) in the literature.
Purpose
Understanding the effects of previous family experiences, which have a multidimensional impact on the individual and on other eating disorders, is important to better comprehend the HEF.
Methods
The current study examined the relationships between HEF and previous family experiences as well as eating attitudes. It is a cross-sectional survey design with a convenience sample of 18–24-year-olds (n = 225) based on a quantitative analysis method.
Results
Except for “limited social activity,” a sub-factor significantly related to HEF, and “health and social problems,” a sub-factor significantly related to healthy orthorexia (HO), both HEF and HO did not significantly relate to past family life. The outcomes showed that the participants’ eating attitudes had a significant relationship with HEF (r = .57, p < .001) and HO (r = .23, p = .001).
Discussion
The findings suggest that people with HEF have disordered eating attitudes. Furthermore, practitioners should be aware that family factors may be a risk factor for orthorexia.
Translations to Health Education Practice
These results may help to educate and increase awareness among health educators and mental health professionals regarding the identification, treatment, and recovery of eating disorders and HEF.
... According to a survey in the Netherlands, 78% of psychiatrists, psychologists, nutritionists, and therapists regard ON as an independent disease, and 74% favor its inclusion in the DSM [9]. Although the diagnostic criteria for ON have not been strictly defined, the concept of ON is based on food avoidance due to a preoccupation with healthy foods, as listed [10]: (A) obsessive or pathological preoccupation with healthy nutrition; (B) distress or anxiety caused by failure to follow self-imposed rules about eating; (C) psychosocial disturbances in life in addition to malnutrition and weight loss. ...
A 13-year-old girl presented to our hospital with chief complaints of rapid weight loss, fatigue, discomfort, chills in the extremities, and alopecia. We initially suspected anorexia nervosa (AN). However, she did not express fear of gaining weight or have a distorted perception of her weight or body shape; thus, her presentation was not typical of AN. We also suspected avoidant/restrictive food intake disorder (ARFID), but she did not exhibit any food-avoidance behaviors. However, she was obsessed with nutrition control, so we diagnosed her with orthorexia nervosa (ON). She was hospitalized, given education on proper nutrition, and her eating behavior subsequently improved. After discharge, we administered the ORTO-15, which assesses the propensity for ON, and her score met the diagnostic criteria for ON. The incidence of ON has increased during the COVID-19 pandemic. In this case, her obsession was brought about by information she read in magazines and on social media that promoted an unbalanced diet centered almost exclusively on vegetables. Pediatricians should raise awareness of misinformation regarding children's health to ensure healthy growth.
... Orthorexia nervosa (ON) is a term first introduced by Bratman (1997) to describe a fixation on eating only foods believed to be healthy (Bratman & Knight, 2000), which eventually affects individuals' emotional wellbeing (e.g., feelings of intense distress when not being able to adhere to dietary rules), social functioning (e.g., difficulties participating in social eating), and overall mental and physical health (e.g., excessive preoccupation with foods, malnutrition). Despite multiple efforts to specify potential diagnostic criteria for ON (Barthels et al., 2015;Dunn & Bratman, 2016;Moroze et al., 2015;Setnick, 2013), a universal definition is still disputed (Cena et al., 2019;Galfano et al., 2022). Based on its preliminary conceptualization approaches, however, ON has been linked to rigid food rules (e.g., Zickgraf, 2020), perfectionism (Oberle et al., 2017), restrained eating behaviours (e.g., Barthels et al., 2018), and food choices that align with one's definition of health, such as organic, additive-free, low-fat, or environmentally friendly foods . ...
The present study analysed individual experiences of orthorexia nervosa (ON), a term commonly associated with obsessive health behaviors. With no universal definition available in research or practice, this study aimed to analyse six months of publicly available Reddit data to identify common characteristics and perceived causes of ON as reported in eating disorder- (ED) and diet-related subreddits. A Python code was used to extract comments from a publicly available Reddit data archive. To explore themes for each category of subreddit, a text-mining approach was combined with thematic analysis within a social constructionist framework. In both subreddit categories, the manifestation of ON was conceptualized in the context of shifting ED expressions and associated with the perception of food as a threat as well as the pursuit of superiority. In ED-subreddits, commenters discussed ON as a safety mechanism for health anxieties, the role of the body as visualising ON, and ON’s role within a proactive selfcare culture. Diet-related subreddit themes encompassed the conceptualization of ON as health perfectionism, ON’s underlying mental health concerns, and ON pathology as the result of problematic norms. The analysis of 246 online comments revealed a wide scope of ON conceptualizations and highlighted the need for a coherent diagnostic model of ON, which takes into account sociocultural as well as individual factors.
... Orthorexia nervosa (ON) was first described by family doctor Steven Bratman in 1997, using a neologism coined from the Greek (ὀρθός, right and ὄρεξις, appetite) to describe a fixation on "correct" eating he had observed among his patients. In 2016, Bratman and Dunn differentiated ON from a general desire for a healthy lifestyle by specifying that it causes negative consequences such as malnutrition and/or social functioning impairment [1]. ...
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
... ON features a pervasive focus on healthy food, without an apparent focus on weight. However, the worries about food properties typically lead to highly selective dietary habits: subjects progressively eliminate more and more kinds of food, eventually reaching de-nutrition or malnutrition states similar to those of Anorexia nervosa (AN) [3][4][5][6]. ON individuals spend most of their time thinking about food, which become the centre of the whole life. They spend a lot of time in planning what to eat and how to prepare it. ...
Objective
To date, few studies have investigated the relationship between autistic traits and emerging phenotypes of restrictive disorders, such as Orthorexia nervosa (ON). The aim of the present work was to investigate the relationship between ON symptoms and autistic traits in a population of University employees, focusing on the impact of gender, weight and type of diet.Methods
All academic and technical/administrative workers of University of Pisa were invited by mail to fulfil through an anonymous online form the Adult Autism Sub-threshold Spectrum (AdAS Spectrum) and the ORTO-R.ResultsA total of 285 subjects filled out the questionnaires. Participants with significant autistic traits were included into the Broad autism phenotype (BAP) group, while others into the No BAP group. Subjects in the BAP group reported significantly higher ORTO-R scores than others, while no difference was reported for gender, work position, type of diet, age and BMI. Females showed significantly higher ORTO-R scores and lower BMI than males. Older subjects showed a higher BMI. No significant differences in ORTO-R scores were reported depending on type of diet and work position. A decision tree model, with ORTO-R score as dependent variable, revealed in the first step significantly higher ORTO-R scores in the BAP group than in the No BAP group, and in the second step significantly higher ORTO-R scores among females only in the No BAP group.Conclusion
Our results further confirm the association between ON and autism spectrum, which seems to overcome the impact of gender in this population.Level of evidenceLevel V, descriptive study.
... Doğru beslenme anlamına gelen "Ortoreksiya" kelimesi, Yunanca "ortho" (doğru) ve "orexis" (açlık, iştah) anlamındaki kelimelerin bir araya gelmesiyle tanımlanmıştır (4). Bratman'a göre ortoreksiya, sağlığın korunması veya sürdürülmesi amacıyla sağlıklı yeme takıntısının bulunması ve bu yönde kaygılı olma durumudur (5). Donini Pek çok ülke bu ölçeği kendi toplumlarına uyarlayarak kullanmıştır. ...
... People with ON may also experience emotional distress as well as social and educational impairments on both physical and physiological levels [44,45]. In addition, they may experience a high level of frustration when they are not satisfied with their food practices and a feeling of guilt when they do not follow their diet or transgress it [46]. ...
Background
Orthorexia Nervosa is not yet classified as an eating disorder albeit it can be found in different populations. This condition can be characterized by a preoccupation with the quality of food, accompanied by obsessive thoughts regarding eating behaviors, leading to malnutrition. Previous associations have been reported between high levels of eating disorders and lower levels of self-esteem; where individuals have low self-esteem due to the pressured felt to fit the norms of society in beauty standards. The aim of the present study was to evaluate the relationship between religiosity and orthorexia nervosa via either trait or state self-esteem.
Methods
This study was conducted between September 2021 and February 2022 and included 428 participants from all Lebanese governorates. The Teruel Orthorexia Nervosa scale was used to measure orthorexia nervosa. The following scales state self-esteem and religiosity were used to measure self-esteem.
Results
Sociodemographic characteristics (age, gender, marital status, household crowding index, body mass index and education) were entered in the mediation model as confounding variables. Higher religiosity was significantly associated with higher state self-esteem (Beta = 0.07), while higher state self-esteem was significantly associated with lower identification of those that exhibited ON tendencies or symptoms (Beta= -0.11).
Conclusion
A high state self-esteem was correlated with a lower level of orthorexia nervosa. Higher religiosity was shown to be associated with higher self-esteem, which in turn was associated with a decrease in the scores of orthorexia nervosa.
... Recently, Strahler et al. [46] 26), the authors found a significant association between EDs and ON (p < 0.001). A major risk of developing ON in adolescents aged 13-16 years was also found. ...
Orthorexia nervosa (ON) is defined as an exaggerated, obsessive, pathological fixation on healthy food, healthy eating, or health-conscious eating behaviors. In the literature, there is an ongoing debate over whether ON should be considered simply a lifestyle phenomenon or a psychiatric disorder. In this vein, ON seems to share psychopathological characteristics with both eating disorders (EDs) and obsessive-compulsive disorder (OCD). However, there are insufficient data to reconcile the debate. The present study aimed at consolidating evidence on the clinical significance of ON and its relationship with EDs and OCD. A selective review of the literature published between January 2015 and March 2022 was conducted, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Ten studies were included. Some of these studies suggested that ON might follow a full-syndrome DSM-5 ED. Other studies proposed that ON and DSM-5 EDs may co-occur. Finally, only two studies suggested a relationship between ON and OCD. To date, the clinical significance of ON and its relationship with EDs and other DSM-5 psychiatric disorders (e.g., OCD) appears complicated and unclear. Future longitudinal research on the possible clinical course of ON is needed.
... More precisely, individuals with ON are thought to have unrealistic beliefs about the properties and the potential health benefits of food (i.e., believing that eating and/or avoiding several nutrients can help treat or avoid certain diseases) [3,4], and therefore spend most of their time planning, purchasing, and eating "healthy" meals and avoiding or even eliminating entire categories of food perceived as unhealthy [5]. When their personal dietary rules are transgressed, individuals with ON are believed to experience excessive concern and guilt and to further engage in subsequent compensatory behaviors (e.g., intensifying restrictions, excessive exercice or 'cleanses' which reflects a highly restrictive and selective food and/or liquid consumption aiming to rid the body of substances perceived as unhealthy) [4,6]. ...
Background
The profile of adolescents with orthorexic eating behaviors remains to be explored. This study is the first to explore the typology of Lebanese adolescents from a large non-clinical sample based on orthorexia nervosa (ON) and healthy orthorexia (HO).
Method
A total of 555 adolescents (aged between 15 and 18 years) completed a set of questionnaires assessing orthorexic behaviors, self-esteem, stress, depressive and anxiety symptoms. Cluster analysis based on ON and HO scores was used to identify the typology of the sample. More precisely, this analysis was used to reveal and distinguish between naturally occurring subgroups of individuals with different orthorexic eating profiles, within the studied sample. Further, a series of one-way ANOVA was used to compare observed clusters based on their scores on used questionnaires. This analysis was used to capture the behavioral and psychological differences between previously yielded subgroups of individuals.
Results
Cluster analysis based on ON and HO scores yielded 3 distinct groups: “Low orthorexia”, “Moderate in-between orthorexia” and “High in-between orthorexia”. While the first group represented individuals with no particular (healthy or pathological) interest in healthy eating, the two latter groups represented those with respectively moderate and high degrees of an interest in healthy eating that has both pathological and healthy aspects. Significant differences between clusters regarding their levels of stress, depression, anxiety and self-esteem was observed, yet they were found to be negligible due to poor effect sizes.
Conclusion
Findings from this study suggest that ON and HO can indeed co-occur among adolescents, that this co-occurrence can be experienced at different severity levels. Low effect sizes for ANOVA comparisons may suggest the possibility of the co-occurrence of ON and HO reducing the negative effects of ON behavior to some degree. The potential role of confusion around what constitutes "healthy eating" in the emergence of these "in-between orthorexia" profiles is put forward.
En el texto, la Dra. Marianela Rafaela Calvis González y la Dra. Teresa González Véliz
relacionan la masculinidad y el riesgo a través de la historia de Pedro. Para muchos jóvenes como en este caso, resulta difícil hablar de lo que están viviendo y, en ocasiones, lo ocultan. Muchas veces se niegan a tener atención médica, por lo que empeora su situación. La represión de los sentimientos, la falta de oportunidades
para expresarlos y, sobre todo, en situaciones de crisis tener que mantener una máscara de fortaleza, nunca vulnerabilidad, genera un problema muy serio de salud física y emocional en los jóvenes.
El destacar como factor de riesgo, la hipertensión arterial (HTA), que es una enfermedad de etiología multifactorial, controlable, que disminuye la calidad y expectativa de vida, resulta importante de diagnosticar sobre todo en pacientes con antecedentes de riesgo familiar o individual.
AimOrthorexia nervosa (ON) is a condition characterized by an excessive importance attributed to the intake of healthy foods. This study was aimed at investigating the prevalence of ON in subjects with type 1 diabetes (T1D) compared to control subjects.Methods
Patient with T1D using either flash glucose monitoring or continuous glucose monitoring were enrolled. For the selection of control group, each patient was asked to indicate one non-diabetic subject of their same sex and approximate age among colleagues at work and school. Patients and controls completed the following questionnaires: ORTO-15, Dusseldorf Orthorexie Scale (DOS), Eating Disorder Examination Questionnaire (EDE-Q) and Brief Symptom Inventory (BSI). The principal outcome was the prevalence of ON among T1D and control subjects.ResultsWe enrolled 44 patients with T1D aged 39.7 ± 15.7 years, with BMI 24.3 ± 4.3 kg/m2, and mean HbA1c 53.5 [49–57] mmol/mol. Control subjects were similar to T1D with respect to sex, age and BMI. Thirty-two [72%] and 29 [65%] subjects among patients and controls, respectively, had ORTO15 < 40 (between-group p = 0.48). Two (4.5%) and zero subjects among patients and controls, respectively, had DOS ≥ 30 (p = 0.29). Median scores of DOS, but not of ORTO-15, were significantly higher in patients than in controls. None of the metabolic variables showed a correlation with psychometric tests in T1D.Conclusion
Although the prevalence of ON was not significantly higher in T1D than in controls, patients with T1D showed higher scores of some, but not all, tests assessing orthorexia, without any significant correlation with metabolic parameters.
Research suggests that trait perfectionism and perfectionistic self-presentation are related to orthorexia - a pathological obsession with correct nutrition. However, no studies have examined these relationships over time or compared the influence of the two aspects of perfectionism on orthorexia. In the present study we sought to address these two issues. Gym members who engaged in high degrees of exercise were recruited via social media platforms. They completed an online questionnaire that included the Multidimensional Perfectionism Scale-Short Form, Perfectionistic Self-Presentation Scale, and the Eating Habits Questionnaire on two occasions: 177 participants (Mean age = 31.6 years) initially completed the questionnaire and 82 completed the questionnaire six weeks later. A series of multiple regression analyses revealed that (i) trait perfectionism predicted an increase in orthorexia symptomatology over time with socially prescribed perfectionism and other-oriented perfectionism unique predictors of orthorexia, (ii) perfectionistic self-presentation predicted orthorexia over time with nondisplay of imperfection a unique predictor of orthorexia, and (iii) when considered alongside each other, only trait dimensions of perfectionism were unique predictors of orthorexia. The present study provides further evidence that perfectionism is related to orthorexia. In addition, the study also provides preliminary evidence that more engrained trait aspects of perfectionism are more predictive of intensifying orthorexia over time than the self-presentational aspects of perfectionism.
Background
The similarities and differences between the orthorexia nervosa symptoms (ONs) and the symptoms and correlates of eating disorders listed in the DSM-5 need to be elucidated. ONs were examined in a volunteer community sample in conjunction with compulsive exercise, disordered eating, as well as emotional and behavioral correlates of eating disorders.
Methods
Participants were 561 adult volunteers (93 men, 17.09%) aged 19–72 (M = 32.7 ± 11), recruited via social media networks. Participants self-reported online on the following measures: Düsseldorf Orthorexia Scale, Compulsive Exercise Test, Retrospective Child Feeding Questionnaire, Experiences in Close Relationships, Difficulties in Emotional Regulation Scale, Toronto Alexithymia Scale, and Eating Disorder Examination Questionnaire 13. Data was downloaded and analyzed in SPSS26 and Amos26.
Results
A theoretical model of the connections between the study variables was tested via SEM and confirmed. The profiles of participants with high, average and low levels of ONs were compared. Participants with the highest levels also scored highest for compulsive exercise, insecure attachment, alexithymia, emotion regulation difficulties, weight and shape concerns, body dissatisfaction, restriction, bingeing, purging and recollections of their parents being concerned about their overweight, and restricting and monitoring their intake of calorie-rich foods as children.
Discussion
High levels of ONs are related to disordered eating attitudes and behaviors, as well as to emotional and behavioral correlates of eating disorders. It is unclear to what extent these ONs are distinguishable from symptoms of other eating disorders listed in the DSM-5. Longitudinal studies may help to elucidate distinct trajectories and risk factors of ON.
Level of evidence Level III, case–control analytic study.
Prevalencija poremećaja hranjenja u mladih ljudi u stalnom je porastu, što dovodi u fokus ortoreksiju nervozu, osobito u razdobljima pandemije i stresa. Stoga je cilj ovog istraživanja bio utvrditi prevalenciju ortoreksije nervoze u mladih ljudi i povezati je s antropometrijskim parametrima, prehrambenim navikama i percepcijom tjelesnog izgleda. Ovo istraživanje uključivalo je 191 ispitanika u dobi od 18-24 godine, od čega je 85,9 % ženskog spola. Prikupljeni su podaci o tjelesnoj masi i visini ispitanika iz kojih je izračunat indeks tjelesne mase. Prevalencija ortoreksije nervoze procijenjena je pomoću upitnika ORTO-15, dok je upitnik PACS-R (eng. Physical Appearance Comparison Scale – Revised) korišten za procjenu tendencije usporedbe tjelesnog izgleda ispitanika s drugim osobama. Utvrđeno je da 38,2 % ispitanika ima ortoreksiju nervozu. Nije bilo statistički značajnih razlika u indeksu tjelesne mase između ispitanika s obzirom na ortoreksiju nervozu (p=0,276). Ipak, u skupini ispitanika bez utvrđene ortoreksije prevladavali su oni s adekvatnom tjelesnom masom (89,9 %), dok je među ispitanicima s utvrđenom ortoreksijom bio veći udio pothranjenih ispitanika (8,2 %) i onih s prekomjernom tjelesnom masom (15,1 %). Ispitanicima s ortoreksijom pravilna prehrana je važnija nego ispitanicima bez ortoreksije (p=0,001), dok statistički značajne razlike u samoprocjeni kvalitete prehrane nije bilo (p=0,815). Nadalje, utvrđena je statistički značajna negativna korelacija između rezultata PACS-R i ORTO-15 (p<0,01). U konačnici, postojala je statistički značajna razlika u rezultatima PACS-R između ispitanika obzirom na utvrđenu ortoreksiju (p=0,032). Ortoreksija nervoza utvrđena je kod velikog broja ispitanika. Iako su mlade osobe koje su razvile ortoreksiju nervozu uglavnom adekvatne tjelesne mase, imaju veću sklonost uspoređivati svoj fizički izgled s izgledom drugih, što upućuje na iskrivljenu percepciju vlastitog tijela. Ovime se skreće pozornost na važnost educiranja mladih osoba o pravilnoj prehrani, posebice žena, te se potvrđuje važnost interdisciplinarnog pristupa u liječenju ortoreksije nervoze, koja bi trebala uključivati i psihološkupodršku.
Orthorexia nervosa is an eating disorder that is characterized by an obsessive attitude towards healthy eating, which
impairs general health at a level that prevents basic nutrient intake and affects functionality. Hedonic consumption
is defined as shopping in line with the behavior of excessive fondness for pleasure and pleasure, and economic
efficiency, purchasing behavior to reach the highest level of pleasure. Narcissistic personality inventory, orthorexia
nervosa scale and hedonic consumption scale were used in the research. The data were evaluated with the SPSS
statistical program. Frequency and percentage analyzes were used to determine the descriptive characteristics of
the participants, and mean and standard deviation methods were used to analyze the scales. Correlation and
regression analyzes were used for the relationships between the dimensions determining the scale levels of the
participants. As mothers, 184 people, 129 women and 55 men, are distributed in the study. “Narcissistic
personality” 6,554 “hedonic personality” averages 2,817 average 37,500 targets narcissistic personality traits,
hedonic effects, or are targeted on moderate.
The term orthorexia nervosa (ON), presented in 1997 in Yoga Journal by Dr. Steven Bratman, sheds new light on the view on healthy eating habits. He showed that persistent thinking about nutrition does not necessarily have to be associated with anorexia or bulimia, and may turn into something so far unknown - obsessive control over the healthiest eating style, resulting in numerous self-imposed restrictions and in the long run, without appropriate therapy, leading to the deterioration of the current state of health. Orthorexia can have many consequences not only on mental health, but also on physical health. For this reason, the development of standard diagnostic and classification criteria for orthorexia nervosa is a priority. The problem of eating disorders should be the subject of epidemiological research, which will take into account demographic, cultural and socio-economic conditions appropriate for a given population, and will also take into account the pressure of factors related to the food market.
Bu çalışma Covid-19 pandemi döneminde yetişkin bireylerin beslenme durumlarını
değerlendirmek, besin seçim ve alışkanlıklarını, beslenme bilgi düzeylerini, sağlıklı
beslenmeye ilişkin tutumlarını, sağlıklı beslenme takıntı düzeylerini belirlemek ve pandemi sürecinin yetişkin bireylerin elektronik sağlıklı beslenme okuryazarlık düzeyleri üzerindeki etkisini saptamak amacıyla yürütülmüştür. Bireylerin elektronik sağlıklı beslenme okuryazarlık düzeylerini belirleyebilmek için e-Sağlıklı Beslenme Okuryazarlık (e-SBO) ölçeğinin Türkçe’ye adaptasyonu ile geçerlik ve güvenirlik çalışması yapılmıştır. Çalışma Ocak-Mart 2022 ayları arasında sağlıklı beslenmeyle ilişkili içeriklerin paylaşıldığı bir sosyal medya sayfasını takip eden yetişkin bireyler ile çevrimiçi yöntemler kullanılarak yürütülmüştür. Araştırmaya yaş ortalamaları 41.32±12.52 yıl olan 158 birey katılmıştır. Çalışmada bireylere çevrimiçi ortamda genel bilgiler anketi, bir günlük besin tüketim kaydı, Yetişkinler İçin Beslenme Bilgi Düzeyi (YETBİD) ölçeği, Sağlıklı Beslenmeye İlişkin Tutum Ölçeği (SBİTÖ) ve ORTO-15 testi bir kere, e-SBO ölçeği ise pandemi öncesi (geriye dönük) ve sırasında olmak üzere iki kere uygulanmıştır. On beş maddeden oluşan e-SBO ölçeğinin orijinalinde de olduğu gibi beş faktör altında toplandığı, her boyuttaki maddelerin faktör yükü 0.40’ın üzerinde olduğu ve toplam varyans açıklama yüzdesinin %73.5 olduğu saptanmıştır. e-SBO ölçeğin toplam puanı ile tüm alt faktörlerinin puanları arasında orta düzeyde pozitif bir korelasyon bulunmuştur (p=0.000). e-SBO ölçeğinin Cronbach Alpha İç Tutarlılık Katsayısı 0.77, alt boyutlarının Cronbach Alpha İç Tutarlılık Katsayıları ise sırası ile 0.80, 0.68, 0.89, 0.85 ve 0.88 olarak saptanmıştır. e-SBO ölçeğin test ve tekrar test puanlarının korelasyon katsayısı 0.98 olarak belirlenmiştir (p=0.000). Bu sonuçlar e-SBO ölçeğinin Türkçe versiyonunun bireylerin elektronik sağlıklı beslenme okuryazarlık düzeylerini ölçmekte geçerli ve güvenilir bir araç olduğunu göstermektedir. Çalışmaya katılan bireylerin tiamin, niasin, potasyum, kalsiyum, çinko, demir ve selenyum mikro besin ögelerini Türkiye Beslenme Rehberi (TÜBER) 2015 referans değerin altında aldıkları saptanmıştır. Tüm katılımcılar Covid-19 pandemi döneminde besin seçimi ve/veya beslenme alışkanlıklarının değiştiği saptanmıştır (p<0.05). Bununla birlikte Covid-19 pandemi döneminde fastfood/ev dışından yemek yeme alışkanlığına sahip bireylerin Covid-19 pandemi öncesine kıyasla azaldığı saptanmıştır (p<0.05). Covid-19 pandemisi döneminde katılımcıların çoğunluğu daha fazla sigara veya alkol kullanma eğilimi göstermediğini bildirmişken, fiziksel aktivite düzeylerinin ise azaldığını bildirmişlerdir. Katılımcıların Covid-19 pandemi sürecinde D ve C vitaminleri ile çinko ve magnezyum desteği alımlarının istatistiksel olarak anlamlı şekilde yükseldiği saptanmıştır (p<0.05). Bireylerin Covid 19 pandemi sürecindeki YETBİD ve SBİTÖ puanları ile e-SBO puanları arasında pozitif yönde zayıf bir korelasyon (p<0.05), ORTO-15 puanlarıyla ise negatif yönlü çok zayıf bir korelasyon (p>0.05) belirlenmiştir. Tüm katılımcıların Covid-19 pandemi öncesinde e-SBO puan ortalaması 34.0±7.36 puan iken, Covid-19 pandemi dönemindeki e-SBO puan ortalamaları 37.6±7.85 puan yükselmiştir (p<0.05).
This study aimed to evaluate the nutritional status of adults, to determine their food choices and habits, nutritional knowledge levels, attitudes towards healthy eating, level of healthy eating obsession during the Covid-19 pandemic and to determine the effect of the pandemic on the electronic healthy nutrition literacy levels of this population. In order to determine the electronic healthy nutrition literacy levels of individuals, validity and reliability studies were performed for the Turkish version of the e-Healthy Nutrition Literacy (e-HDL) Questionnaire. The study was conducted on 158 adult individuals with a mean age of 41.32±12.52 years, who followed a social media page that shares content related to healthy nutrition, between January and March 2022, using online methods. In the study general information questionnaire, one-day food consumption record, Nutrition Knowledge Level
for Adults (YETBİD) scale, Attitude Scale for Healthy Nutrition (ASHN) and ORTO-15 test were applied once, the e-HDL scale was applied to individuals twice, before
(retrospectively) and during the pandemic, using online methods. It has been observed that the e-HDL questionnaire, which consists of 15 items, is gathered under five factors, as in the original. The factor load of the items in each dimension was found over 0.40 and the percentage of total variance explanation was found 73.5%. When the correlation between the e-HDL questionnaire score and its sub-dimensions is examined, scores of all subdimensions were moderate positively correlated with the total score of the e-HDL questionnaire (p=0.000). In the reliability analysis of the e-HDL questionnaire, Cronbach’s Alpha Internal Consistency Coefficient was found as 0.77, and the sub-dimensions
coefficient was found as 0.80, 0.68, 0.89, 0.85 and 0.88, respectively. The correlation coefficient of the test and retest scores of the e-HDL questionnaire was determined as 0.98 (p=0.000). These results show that the Turkish version of the e-HDL questionnaire is a valid and reliable tool for measuring the electronic healthy nutrition literacy levels of individuals. The intake of thiamine, niacin, potassium, calcium, zinc, iron and selenium micronutrients of the individuals was below the Turkey's Dietary Guidelines (TUBER) 2015 reference value. All participants were found to have changed their food selection and/or eating habits during the Covid-19 pandemic (p<0.05). However, it has been determined that the number of individuals who have the habit of eating fast food/ordered food during the Covid-19 pandemic has decreased compared to the pre-Covid-19 pandemic (p<0.05). During the Covid-19 pandemic, the majority of the participants reported that they did not tend to smoke or drink alcohol more, while their physical activity levels decreased. It was determined that the intake of vitamins D and C, and zinc and magnesium supplements of the participants increased statistically significantly during the Covid-19 pandemic (p<0.05). There is a weak but positive correlation between YETBİD scores (p<0.05) and ASHN scores (p<0.05) with e-HDL questionnaire scores and a weak but negative correlation between ORTO-15 scores (p>0.05) with e-HDL questionnaire scores. While the mean scores of the e-HDL questionnaire before the Covid-19 pandemic was 34.0±7.36 points, the mean scores of the e-HDL questionnaire increased to 37.6±7.85 points during the Covid-19 pandemic (p<0.05).
Climate change affects many of the documented risk factors for eating disorders (EDs) through direct and indirect pathways, yet to date the research in this area is nonexistent. Our aim is to identify the specific mechanisms through which climate change might be associated with increased risk for EDs, an exacerbation in symptoms, or poor clinical outcomes; highlight limited empirical data addressing these issues; and propose directions for a research program in this important area. Pathways for the impact of climate change on eating disorders and related data were reviewed. Four main pathways for the effects of climate change on EDs were identified including (1) decreased food access and security; (2) changes in mean temperature; (3) concerns related to food safety and eco‐anxiety; and (4) indirect pathways through trauma, adversity, and increased mental health concerns. Except for the relationship between increased food insecurity and EDs, these pathways remain largely uninvestigated. Numerous factors may be implicated in the relationship between climate change and EDs. Future work in this area is imperative and should be conducted through a social justice lens with particular attention paid to the global areas most impacted by climate change and related vulnerabilities. Climate change will likely have adverse impacts on individuals with eating disorders and increase the risk for eating disorders. This paper reviews the different ways in which climate change may have these effects and calls for researchers to pay attention to this important area.
Orthorexia nervosa (ON) is a proposed psychological disorder characterized by a pathological preoccupation with healthy eating. The purpose of the current study was to clarify the relationships between ON and related forms of psychopathology. In addition, we sought to explore whether there may be subtypes of ON and if ON is associated with BMI, gender, or social media use. The sample included 333 undergraduate students (72% female, Mage = 20.91) who completed measures of ON, eating disorder (ED) symptoms, obsessive compulsive disorder (OCD), obsessive compulsive personality disorder (OCPD), and health anxiety. Latent profile analysis detected three distinct groups with high ON scores. The ON/ED combined group (n = 16) was characterized by high levels of psychopathology, particularly in the areas of ON and eating disorder symptoms. In comparison, the ON/ED combined, without weight/shape concerns group (n = 35) had fewer body-related concerns. The ON only group (n = 23) reported minimal ED pathology. Regression analyses revealed those in the ON only group were more likely to be male, while the ON/ED group was associated with higher BMI. Being in the ON/ED combined, without weight/shape concerns was associated with viewing and sharing healthy eating content on social media. Our findings suggest that ON has the most overlap with ED pathology as compared to OCD, OCPD, and health anxiety, and that there may be three subtypes of ON. The first two share significant overlap with ED symptomatology while the third appears relatively distinct, characterized by less disordered eating and fewer positive emotions related to healthy eating. Future research should examine these subtypes more closely to determine whether they are clinically meaningful, potentially requiring different interventions.
Purpose Limited research has examined recovery processes and conceptualisations of recovery within Orthorexia Nervosa (ON). This study harnessed online data to examine how people use #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 rollercoaster journey; Finding food freedom; From compulsive exercise to intuitive movement; A community of support. Our findings suggest that people with 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.
Objectif
L’orthorexie, définie comme l’obsession pour l’alimentation saine, est un phénomène en pleine émergence. De plus en plus de chercheurs s’intéressent au sujet mais à ce jour aucun dispositif thérapeutique n’existe pour prendre en charge les personnes qui en souffrent. Il s’agit ici d’expérimenter et d’évaluer un programme thérapeutique auprès de patients souffrant de troubles des conduites alimentaires et ayant des symptômes orthorexiques : le programme ORTO-TCA.
Méthode
Constitué de cinq séances d’ateliers psychothérapeutiques collectifs, ce programme s’inspire des thérapies brèves avec une approche intégrative. Des questionnaires auto-rapportés ont permis d’obtenir une évaluation du programme. Les participantes (n = 5) ont répondu en test-retest à l’Échelle Française d’Orthorexie (EFO-12), à une échelle d’estime corporelle (BES), au questionnaire d’acceptation et d’action (AAQ-II) et en fin de prise en charge à l’Échelle Clinique de Thérapies Médiatisées (ECTM-16).
Résultats
Les analyses quantitatives ne permettent pas d’objectiver des différences significatives pour le niveau d’orthorexie, d’estime corporelle et de flexibilité psychologique. En revanche, les analyses qualitatives du vécu de l’atelier montrent que les participantes du programme expriment globalement des opinions positives. Elles ont ressenti une amélioration, se sont appropriées les outils et ont trouvé que l’atelier était agréable et utile.
Discussion
Cette recherche expérimentale peut être davantage considérée comme une étude de faisabilité et d’acceptabilité en milieu ouvert qu’une évaluation d’un programme psychothérapeutique quant à son impact. Elle soulève d’ailleurs quelques limites méthodologiques (comme l’absence de groupe contrôle) et le contenu du programme gagnerait à être enrichi par d’autres approches (thérapies médiatisées, approche cognitive, etc.).
Conclusion
L’expérimentation de ce dispositif thérapeutique constitue une avancée clinique significative dans la prise en charge de la symptomatologie orthorexique des TCA. Le programme ORTO-TCA peut être considéré comme une piste de traitement sérieuse de l’orthorexie.
Objetivo
Identificar comportamento de risco para o desenvolvimento de ortorexia nervosa em estudantes de Nutrição.
Métodos
Estudo descritivo e transversal. Participaram da pesquisa estudantes de Nutrição, do sexo feminino, com 18 anos de idade ou mais, de uma universidade do Vale do Paraíba do Sul/SP. Foram aplicados três instrumentos, sendo o primeiro para obter informações sobre idade, altura e massa corporal referidos, e ano do curso. Os dados de massa corporal e estatura referidos foram usados para cálculo do índice de massa corporal (IMC) e classificação do estado nutricional. O segundo foi utilizado para identificar distúrbio da imagem corporal, de acordo com a escala de silhuetas. O terceiro foi utilizado para verificar o comportamento de risco para desenvolvimento de ortorexia nervosa (Orto-15).
Resultados
Participaram do estudo 150 alunas, com idade média de 23,21 anos. Observou-se que a maioria das alunas estava eutrófica (74%, n = 111), segundo a classificação do IMC. Em relação à percepção da imagem corporal, verificou-se que 74,7% (n = 112) das alunas do curso de Nutrição apresentavam distúrbio da imagem corporal. Quanto à ortorexia nervosa, observou-se que 88,7% (n = 133) das alunas apresentavam risco de desenvolver comportamento ortoréxico. Ao relacionar o comportamento ortoréxico com a série cursada, com o estado nutricional e com o distúrbio da imagem corporal, verificou-se que não houve associação entre as variáveis (p > 0,05).
Conclusão
Conclui-se que um número considerável das alunas do curso de Nutrição apresenta comportamento ortoréxico e distúrbio da imagem corporal.
The characteristic trait of individuals developing a pathological obsession and preoccupation with healthy foods and a restrictive and avoidant eating behavior is described as orthor-exia nervosa (ON). For ON, neither universal diagnosis criteria nor valid tools for large-scale epidemiologic assessment are available in the literature. The aim of the current study is to analyze the psychometric properties of a translated German version of the ORTO-15 questionnaire. The German version of the ORTO-15, a eating behavior and dieting habits questionnaire were completed by 1029 German-speaking participants (74.6% female) aged between 19 and 70 years (M = 31.21 ± 10.43 years). Our results showed that after confirma-tory factor analysis, the best fitting model of the original version is a single-factor structure (9-item shortened version: ORTO-9-GE). The final model showed only moderate internal consistency (Cronbach's alpha = .67), even after omitting 40% of the original question. A total of 69.1% participants showed orthorectic tendencies. Orthorectic tendencies are associated with special eating behavior features (dieting frequency, vegetarian and vegan diet). Education level did not influence ON tendency and nutritional students did not show higher ON tendency compared to students from other disciplines. This study is the first attempt to translate and to evaluate the psychometric properties of a German version of the ORTO-15 questionnaire. The ORTO-9-GE questionnaire, however, is only a mediocre tool for assessing orthorectic tendencies in individuals and shows moderate reliability and internal consistency. Our research suggests, that future studies are needed to provide more reliable and valid assessment tools to investigate orthorexia nervosa.
This research aims to determine the prevalence of orthorexic behavior in high school students from private and municipal schools located in Temuco, city Chile. The study had a non-experimental, descriptive, cross-sectional design with a quantitative approach. A non-probabilistic approach was used for selecting the sample, which included 205 students divided into 94 females and 111 males ranging from 16 to 18 years of age. The instrument used is called "ORTHO-15". The results indicate that 30.7% of students presented orthorexic behavior, and its prevalence was higher in the municipal school (35.3%) and men (35.1%). Finally the instrument should be applied in wider populations to confirm the presence of this behavior and eventually report its effects.
Orthorexia
nervosa (ON) describes a fixation for proper nutrition and healthy foods that
leads to die-tary restrictions and nutritional deficiencies over time. Given
symptom overlap among ON, obsessive-compulsive disorder (OCD), and anorexia
nervosa (AN), this study examines whether ON has a unique neuropsychological
profile. Participants completed symptom checklists and neuropsychological tests
chosen for their sensitivity to AN and OCD. Results showed that, across the
full sample, ON is independently associated with self-reported weaknesses in Set-Shifting,
Emotional Control, Self-Monitoring, and Working Memory. After controlling for
AN and OCD variables, high- and low-ON groups differed in total correct trials
on the Wisconsin Card Sorting Test. These areas of executive functioning, which
are explained in the context of ON symptomatology, represent what would be
considered the neuropsychological overlap among OCD and AN profiles.
The present study was designed to investigate orthorexia nervosa, or the phenomenon of being preoccupied with consuming healthy food. Specific aims were to explore relationships between orthorexia features and attitudes towards body image, fitness and health in normal weight female and male university students with high levels of healthy food preoccupation, i.e. orthorexia nervosa.
Participants were 327 female (N = 283) and male (N = 44) students aged 18 to 25 years. All participants completed the Polish adaptation of the 15-item questionnaire assessing orthorexia eating behaviours (the ORTHO-15) and the Multidimensional Body-Self Relations Questionnaire (the MBSRQ). Relationships between scores on the ORTHO-15 and MBSRQ were explored in the 213 students who had high levels of preoccupation with a healthy food intake (68.55% women and 43.18% men, respectively).
There were no statistically significant differences in the levels of orthorexia behaviours between females and males. In female students with orthorexia nervosa, preoccupation with consuming healthy food was significantly correlated with the MBSRQ subscale scores for overweight preoccupation, appearance orientation, fitness orientation, health orientation, body areas satisfaction and appearance evaluation. Conversely, in male students with orthorexia nervosa there were no correlations between orthorexic behaviours and the MBSRQ subscales. In female students with orthorexia nervosa multivariable linear regression analysis found high body areas (parts) satisfaction, low fitness orientation, low overweight preoccupation and low appearance orientation were independent predictors of greater fixation on eating healthy food. In male students, we found that aspects of body image were not associated with preoccupation with healthy eating.
A strong preoccupation with healthy and proper food was not associated with an unhealthy body-self relationship among Polish female student with orthorexia nervosa.
Orthorexia nervosa describes a pathological obsession with proper nutrition that is characterized by a restrictive diet, ritualized patterns of eating, and rigid avoidance of foods believed to be unhealthy or impure. Although prompted by a desire to achieve optimum health, orthorexia may lead to nutritional deficiencies, medical complications, and poor quality of life. Despite its being a distinct behavioral pattern that is frequently observed by clinicians, orthorexia has received very little empirical attention and is not yet formally recognized as a psychiatric disorder. In this review, we synthesize existing research to identify what is known about the symptoms, prevalence, neuropsychological profile, and treatment of orthorexia. An examination of diagnostic boundaries reveals important points of symptom overlap between orthorexia and anorexia nervosa, obsessive-compulsive disorder (OCD), obsessive-compulsive personality disorder (OCPD), somatic symptom disorder, illness anxiety disorder, and psychotic spectrum disorders. Neuropsychological data suggest that orthorexic symptoms are independently associated with key facets of executive dysfunction for which some of these conditions already overlap. Discussion of cognitive weaknesses in set-shifting, external attention, and working memory highlights the value of continued research to identify intermediate, transdiagnostic endophenotypes for insight into the neuropathogenesis of orthorexia. An evaluation of current orthorexia measures indicates a need for further psychometric development to ensure that subsequent research has access to reliable and valid assessment tools. Optimized assessment will not only permit a clearer understanding of prevalence rates, psychosocial risk factors, and comorbid psychopathology but will also be needed to index intervention effectiveness. Though the field lacks data on therapeutic outcomes, current best practices suggest that orthorexia can successfully be treated with a combination of cognitive-behavioral therapy, psychoeducation, and medication.
The purpose of this study was to determine the prevalence of orthorexia nervosa in dietitians, as assessed by administering ORTO-15, Eating Attitudes Test-40 (EAT-40) and Maudsley Obsessive-Compulsive Inventory (MOCI). Our study included 117 dietitians (Ankara). Orto-15 test scores below 40 points was considered indicative of orthorexia, while higher scores indicated a normal eating behavior. It was found that participants with ORTO-15 scores less than 40 had higher scores for EAT-40 and MOCI (p < 0.05). The results showed a significant negative correlation between the ORTO-15 and EAT-40 scores and BMI values. In that respect, further investigation with dietitians into orthorexia nervosa is recommended.
BACKGROUND:
The pursuit for healthy food consumption is considered a laudable habit. This attitude can turn into pathological when cognitions and worries about healthy nutrition lead to such an accurate food selection that correct diet becomes the most important part of one's own life leading to important dietary restrictions, stereotyped eating or impairment in important areas of functioning. This behaviour is coined orthorexia nervosa (ON) and can share common characteristics with anorexia nervosa (AN) and bulimia nervosa (BN). The purpose of the present study was to examine the frequency of ON among women with eating disorders (EDs) and to evaluate if it changed after treating the ED.
METHODS:
Thirty-two patients with AN or BN were evaluated by means of the ORTO-15, the Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS) and the Eating Attitude Test (EAT-26) before (t0) and 3 years after the treatment of their ED (t1), and compared to 32 female healthy controls (HC) matched by gender, age, and BMI at t1.
RESULTS:
A significantly higher percentage of patients either at t0 (28 %) or t1 (58 %) resulted positive to ORTO-15 compared to controls (6 %). YBC-EDS and EAT-26 scores were higher among ED patients than in HC, but they decreased from t0 to t1.
CONCLUSIONS:
Orthorexia nervosa symptoms are highly prevalent among patients with AN and BN, and tend to increase after treatment. ON seems associated both with the clinical improvement of AN and BN and the migration towards less severe forms of EDs. It is necessary to clarify if ON residual symptomatology can be responsible for a greater number of relapses and recurrences of EDs.
How can practitioners engage in evidence-based practice when the evidence for effectiveness of psychological treatments comes from randomized controlled trials using patient populations different from those encountered in everyday settings and treatment manuals that seem oversimplified and inflexible? The authors argue that important evidence about best practice comes from case-based research, which builds knowledge in a clinically useful manner and complements what is achieved by multivariate research methods. A multidimensional model of the research process is provided that includes clinical practice and case-based research as significant contributors. The authors summarize the principles of case-based research and provide examples of recent technical advances. Finally, the authors suggest ways in which practitioners can apply the case-based approach in researching and publishing their own cases, perhaps in collaboration with university-based researchers. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
“Orthorexia nervosa” is a term introduced to describe disordered eating behavior with a pathological obsession for healthy nutrition which can result in insufficient diets and serious medical problems. Validated diagnostic criteria have not yet been developed for orthorexia nervosa and as a result, it has not been well studied. In this case, a patient with disordered eating closely resembling the current description for orthorexia nervosa and focused on the micronutrient content of his diet is successfully treated with olanzapine. A review of the literature and proposed diagnostic criteria for this disorder are also provided.
For a better differential diagnosis of eating disorders, it is necessary to investigate their subtypes and develop specific assessment tools to measure their specific symptoms. Orthorexia nervosa is an alleged eating disorder in which the person is excessively preoccupied with healthy food. The ORTO-15, designed by Donini and colleagues, is the first and only at least partially validated instrument to measure this construct. The aims of the present study were to examine the psychometric properties of its Hungarian adaptation (ORTO-11-Hu), and to investigate its relationship to food consumption and lifestyle habits in order to contribute to a better description of the phenomenon.
The ORTO-11-Hu, a lifestyle habits questionnaire, a food choice list indicating foods the participants choose to consume, and ten additional orthorexia-related questions were administered to a group of 810 Hungarian participants (89.4% female) aged between 20 and 70 (M = 32.39 +/- 10.37 years).
Confirmatory factor analysis suggested a single factor structure for the 11-item shortened version of the instrument. Internal consistency of the measure was adequate (Cronbach's alpha = 0.82). No significant differences were found between males and females on the ORTO-11-Hu. Age and body mass index were significantly associated with a tendency towards orthorexia nervosa. Additional orthorexia-related features were significantly correlated with ORTO-11-Hu scores: orthorexia nervosa tendency was associated not only with healthier food choices (eating more whole wheat cereals, less white wheat cereals, more fruit and vegetables) but with shopping in health food stores, as well as with some healthy lifestyle habits (more sports activity, specific dietary behaviors, and less alcohol intake). Individuals with higher orthorexia nervosa tendency also reported a greater tendency to advocate their healthy diet to their friends and family members.
These results provide evidence for the reliability of ORTO-11-Hu and some support for the construct validity of the instrument. The present study also contributes to the establishment of (diagnostic) criteria for this new subtype of eating disorders.
There is a lack of Polish tools to measure behaviour related to orthorexia nervosa. The purpose of the present study was to validate the Polish version of the ORTHO-15 test.
341 women and 59 men (N = 400) were recruited, whose age ranged from 18 to 35 years. Mean age was 23.09 years (SD = 3.14) in women and 24.02 years (SD = 3.87) in men. The ORTHO-15 test and the EAT-26 test were used in the present study.
Factor analysis (exploratory and confirmatory analysis) was used in the present study. Exploratory factor analysis performed on the initial 15 items from a random split half of the study group suggested a nine-item two-factor structure. Confirmatory factor analysis performed on the second randomly selected half of the study group supported this two-factor structure of the ORTHO-15 test. The Polish version of the ORTHO-15 test demonstrated an internal consistency (Cronbach's alpha) equal to 0.644.
The Polish version of the ORTHO-15 test is a reliable and valuable instrument to assess obsessive attitudes related to healthy and proper nutrition in Polish female and male population.
To review the literature on the prevalence, risk groups and risk factors of the alleged eating disorder orthorexia nervosa.
We searched Medline and Pubmed using several key terms relating to orthorexia nervosa (ON) and checked the reference list of the articles that we found. Attention was given to methodological problems in these studies, such as the use of non-validated assessment instruments, small sample size and sample characteristics, which make generalization of the results impossible.
Eleven studies were found. The average prevalence rate for orthorexia was 6.9 % for the general population and 35-57.8 % for high-risk groups (healthcare professionals, artists). Dieticians and other healthcare professionals are at high risk of ON. Risk factors include obsessive-compulsive features, eating-related disturbances and higher socioeconomic status. Relevant clinical experience, published literature and research data have increased in the last few years.
The definition and diagnostic criteria of ON remain unclear. Further studies are needed to clarify appropriate diagnostic methods and the place of ON among psychopathological categories.
In the context of the development of prototypic assessment instruments in the areas of cognition, personality, and adaptive functioning, the issues of standardization, norming procedures, and the important psychometrics of test reliability and validity are evaluated critically. Criteria, guidelines, and simple rules of thumb are provided to assist the clinician faced with the challenge of choosing an appropriate test instrument for a given psychological assessment. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Orthorexia nervosa (ON) is described as an obsessive pathological behavior characterized by a strong preoccupation with healthy eating and the avoidance of foods or ingredients considered unhealthy by the subject. Although it is still not officially recognized as an eating disorder, previous studies have discussed its frequency in some groups and a fifteen-question test (ORTO-15) was developed elsewhere to assess ON behavior.
The present study aimed to evaluate ON behavior in a sample of Brazilian dietitians after testing the psychometric properties of the Portuguese version of ORTO-15.
A total of 392 dietitians answered an online version of the test. The answers were analyzed regarding ON tendency, according with the scoring grid proposed by its authors. Exploratory factor analysis was performed and internal consistency was assessed.
It was found that three questions of the test presented loadings lower than 0.5. The 12 remaining question formed 3 factors with internal consistency of -0.51, 0.63 and 0.47. The answers of the participants to these questions revealed a tendency to orthorexic behavior, mainly regarding aspects such as: making food choices conditioned by worry about health status, evaluating food rather from nutritional quality than from its taste, believing that consuming healthy food may improve appearance, discrediting the influence of mood on eating behavior and banning food choices considered by them as eating transgressions.
There is no evidence of the validity and reliability of the ORTO-15 with the initial psychometric evaluation performed. Further analyses are needed. Nevertheless, it was possible to observe a high frequency of orthorexic behavior among the studied Brazilian dietitians. However, additional studies are needed to completely understand dietitians behavior toward ON.
A case report--a brief written note that describes unique aspects of a clinical case--provides a significant function in medicine given its rapid, succinct, and educational contributions to scientific literature and clinical practice. Despite the growth of, and emphasis on, randomized clinical trials and evidenced-based medicine, case reports continue to provide novel and exceptional knowledge in medical education. The journal BMC Research Notes introduces a new "case reports" section to provide the busy clinician with a forum in which to document any authentic clinical case that provide educational value to current clinical practice. The aim is for this article type to be reviewed, wherever possible, by specialized Associate Editors for the journal, in order to provide rapid but thorough decision making. New ideas often garnered by and documented in case reports will support the advancement of medical science--one research note at a time.
Eating disorders are relatively rare among the general population. This review discusses the literature on the incidence, prevalence and mortality rates of eating disorders. We searched online Medline/Pubmed, Embase and PsycINFO databases for articles published in English using several keyterms relating to eating disorders and epidemiology. Anorexia nervosa is relatively common among young women. While the overall incidence rate remained stable over the past decades, there has been an increase in the high risk-group of 15-19 year old girls. It is unclear whether this reflects earlier detection of anorexia nervosa cases or an earlier age at onset. The occurrence of bulimia nervosa might have decreased since the early nineties of the last century. All eating disorders have an elevated mortality risk; anorexia nervosa the most striking. Compared with the other eating disorders, binge eating disorder is more common among males and older individuals.
Striving for enhancing athletic performance many sportsmen undergo rigid dietary habits, which could lead to eating disorders (EDs) or Orthorexia Nervosa (ON), a psychopathological condition characterized by the obsession for high quality food. The aim of the study was to examine the occurrence of ON in athletes and to verify the relationship between ON and EDs. Five-hundredseventy- seven athletes and 217 matched controls were administered the following tests: ORTO-15, Eating Attitude Test 26 (EAT-26), Body Uneasiness Test (BUT) and Yale-Brown-Corner Eating Disorder Scale (YBC-EDS). High positivity to ORTO-15 (28%) and EAT-26 (14%) emerged in athletes, whereas a high rate of BUT positivity was evident among controls (21%). Multivariate logistic regression analysis revealed that independent predictors of ON are previous dieting, age, positivity to YBC-EDS, positivity to EAT-26, competition level, and number of YBC-EDS preoccupations and rituals. Sharing many features with both EDs and Obsessive-Compulsive Spectrum, ON represents a crossroad between these pathologic conditions and might compromise the health state of an athlete. Therefore, coaches should consider it important to detect symptoms of EDs and ON in their athletes.
30-year-old male was admitted with general weakness and drowsy mental status. He had eaten only 3-4 spoons of brown rice and fresh vegetable without salt for 3 months to treat his tic disorder, and he had been in bed-ridden state. He has had weight loss of 14 kg in the last 3 months. We report a patient with orthorexia nervosa who developed hyponatremia, metabolic acidosis, subcutaneous emphysema, mediastinal emphysema, pneumothorax, and pancytopenia and we will review the literature. Also, we mention to prevent refeeding syndrome, and to start and maintain feeding in malnourished patients.
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.
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.
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.
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.
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.
Unlabelled:
Validity and reliability relate to the interpretation of scores from psychometric instruments (eg, symptom scales, questionnaires, education tests, and observer ratings) used in clinical practice, research, education, and administration. Emerging paradigms replace prior distinctions of face, content, and criterion validity with the unitary concept "construct validity," the degree to which a score can be interpreted as representing the intended underlying construct. Evidence to support the validity argument is collected from 5 sources:
Content:
Do instrument items completely represent the construct?
Response process:
The relationship between the intended construct and the thought processes of subjects or observers.
Internal structure:
Acceptable reliability and factor structure.
Relations to other variables:
Correlation with scores from another instrument assessing the same construct.
Consequences:
Do scores really make a difference? Evidence should be sought from a variety of sources to support a given interpretation. Reliable scores are necessary, but not sufficient, for valid interpretation. Increased attention to the systematic collection of validity evidence for scores from psychometric instruments will improve assessments in research, patient care, and education.
This article describes some of the issues affecting measures that are translated and/or adapted from an original language and culture to a new one. It addresses steps to ensure (a) that the test continues to measure the same psychological characteristics, (b) that the test content is the same, and (c) that the research procedures needed to document that it effectively meets this goal are available. Specifically, the notions of test validation, fairness, and norms are addressed. An argument that such adaptations may be necessary when assessing members of subpopulations in U. S. culture is proposed.
