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Relationship between orthorexia and obsessive-compulsive symptoms in patients with generalised anxiety disorder, panic disorder and obsessive compulsive disorder


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Orthorexia nervosa (ON) refers to an intense desire to consume healthy or biologically pure food that is free of artificial products. ON is not regarded as a separate eating disorder, but its clinical presentation shares common features with obsessive- compulsive disorder (OCD) and eating disorders. The current study examined 130 patients who were diagnosed with OCD (n = 49), panic disorder (n = 44), and generalized anxiety disorder (n = 37). Padua Inventory Washington State University Revision (PI-WSUR), The Eating Attitudes Test-40 (EAT-40), and the ORTO-11 test were given to the participants. There were no significant differences between patient groups in the mean scores of eating attitudes and orthorexia symptom severity. No significant association between ORTO-11 scores and body mass index was noted. Moderate correlations (r > 0.30) were obtained between orthorexia symptom severity and obsessive- compulsive symptom severity, EAT-40 total score, and checking and dressing/ grooming compulsions. These findings suggest that ON, a pathological inclination towards an obsession with healthy eating, is not specifically associated with any of the investigated illness groups. However, it has moderate correlations with the ritualistic signs of OCD. Underlying worry may predispose people to develop a compulsion to create the pure diet.
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Yeni Symposium • Aralık 2015 • Cilt: 53 • Sayı: 4
DOI: 10.5455/NYS.20151221025259
Relationship between Orthorexia and Obsessive-Compulsive
Symptoms in Patients with Generalised Anxiety Disorder,
Panic Disorder and Obsessive Compulsive Disorder
Cana Aksoy Poyraz1,
Ebru Yücel Tüfekçioğlu2,
Armağan Özdemir3,
Alper Baş4,
Ayşe Sakallı Kani4,
Ethem Erginöz5,
Alaattin Duran6
1Psychiatrist, 4Resident, 6Professor,
Istanbul University Cerrahpaşa
Medical School, Department of
Psychiatry, Istanbul
2Resident, 5Professor, Istanbul Uni-
versity Cerrahpaşa Medical School,
Department of Public Health, Istan-
3Psychiatrist, Bakırköy Mental
Health and Neurological Diseases
Training and Research Hospital,
Corresponding Author: Cana Aksoy
Poyraz, Psychiatrist, Istanbul Uni-
versity Cerrahpaşa Medical School,
Department of Psychiatry, Istanbul.
Phone: +90 532 715 95 04
Date of Receipt: 04 June 2015
Date of Acceptance: 13 December
Orthorexia nervosa (ON) refers to an intense desire to consume healthy or biologi-
cally pure food that is free of articial products. ON is not regarded as a separate
eating disorder, but its clinical presentation shares common features with obsessi-
ve-compulsive disorder (OCD) and eating disorders. The current study examined 130
patients who were diagnosed with OCD (n = 49), panic disorder (n = 44), and genera-
lized anxiety disorder (n = 37). PaduaInventory WashingtonState UniversityRevisi-
on(PI-WSUR), The Eating Attitudes Test-40 (EAT-40), and the ORTO-11 test were given
to the participants. There were no signicant dierences between patient groups in
the mean scores of eating attitudes and orthorexia symptom severity. No signicant
association between ORTO-11 scores and body mass index was noted. Moderate
correlations (r > 0.30) were obtained between orthorexia symptom severity and ob-
sessive-compulsive symptom severity, EAT-40 total score, and checking and dressing/
grooming compulsions. These ndings suggest that ON, a pathological inclination
towards an obsession with healthy eating, is not specically associated with any of the
investigated illness groups. However, it has moderate correlations with the ritualistic
signs of OCD. Underlying worry may predispose people to develop a compulsion to
create the pure diet.
Key words: OCD, orthorexia, checking
Yaygın Anksiyete Bozukluğu, Panik Bozukluk ve Obsesif Kompulsif Bozukluk
Hastalarında Ortoreksi ile Obsesif Kompulsif Semptomlar Arasındaki İlişkinin
Ortoreksiya nervoza (ON) içinde katkı maddeleri bulundurmayan, sağlıklı ya da biyo-
lojik olarak saf ürünleri tüketmek için duyulan yoğun bir isteği ifade eder. ON ayrı bir
yeme bozukluğu olarak kabul edilmemekle birlikte, klinik görünümü obsesif kompülsif
bozukluk (OKB) ve yeme bozukluklarıyla benzerlik göstermektedir. Bu çalışma OKB (n
= 42), panik bozukluk (n = 33), ve yaygın anksiyete bozukluğu (n = 25) tanısı konulan
100 hastayı incelemektedir. Katılımcılara Padua Envanteri- Washington Eyalet Üniver-
sitesi Revizyonu (PI-R), Yeme Tutumları Testi-40 (EAT-40) ve ORTO-11 testi uygulandı.
Hasta grupları arasında yeme tutumu ve ortoreksi belirti şiddeti ortalama skorları
açısından anlamlı farklılık saptanmadı. ORTO-11 skorları ve beden-kitle indeksi ara-
sında anlamlı bir ilişki bulunmadı. Ortoreksi belirti şiddeti ile obsesif kompülsif belirti
şiddeti, EAT-40 toplam skoru, ve kontrol etme ve giyinme/hazırlanma kompülsiyonları
arasında orta düzeyde korelasyon (r > 0.30) saptandı. Bu bulgular ON’nın sağlıklı yeme
obsesyonuna yönelik bir patolojik eğilim olduğunu ve araştırılan diğer hastalık grupla-
rı ile spesik olarak ilişkili olmadığını göstermektedir. Bununla birlikte, OKB’nin ritüe-
listik bulguları ile orta düzeyde korelasyonu bulunmaktadır. Altta yatan endişe, birey-
lerde saf ve katkısız diyet hazırlanmasına neden olan kompülsiyonun açığa çıkmasını
Anahtar sözcükler: OKB, ortoreksiya, kontrol etme
Araştırma Makalesi DOI: 10.5455/NYS.20160324065040Kısa Araştırma Raporu
Yeni Symposium • Aralık 2015 • Cilt: 53 • Sayı: 4
Orthorexia nervosa (ON) is a new concept that desc-
ribes a strong preoccupation with healthy eating. It
manifests as the avoidance of foods or ingredients
containing additives or preservatives.1 Orthorexic phe-
nomenon can be seen as a continuum of states from
the healthy behaviour to the pathological interest on
healthy food and seems to be prevalent in especially
high risk populations. The term orthorexia nervosa
should be used only for the pathological condition. The-
re is limited epidemiological information on ON. Fidan
et al.2 used the ORTO-11 and found a 43.6 % tendency
rate among medical students. Ramacciotti et al.3 found
57.6 % prevalence of ON measured by ORTO-15 in their
sample of the general population. Whether orthorexic
behaviors prevalent in the population are clinically sigi-
nicant is unclear but it seems to be in close relation
with eating diorders and further investigations are nee-
ded in order to understand the impact of orthorexia on
the course of eating disorders.
The main characteristic of orthorexia is not a weight
loss obsession but rather a strong phobia about eating
only biologically pure food, yet severe weight loss and
malnutrition can occur due to selective eating, and this
may follow a course that resembles anorexia nervosa
(AN).4 Bratman1 contends that the main preoccupation
in ON is the food quality rather than quantity, yet the
dierential diagnosis is not always easy. For example,
during the course of AN, patients might become con-
cerned with the type of food they eat or may use ort-
horexic explanations to mask their true motivation for
weight loss.5 Orthorexia nervosa has indeed overlap-
ping aspects with anorexia nervosa (AN) and bulimia
nervosa (BN). Orthorexia symptoms has been found to
be highly prevalent among patients with AN and buli-
mia nervosa (BN) and was associated both with the cli-
nical improvement of AN and BN and tend to increase
after treatment.6 There are phenomenological similari-
ties between obsessive-compulsive disorder (OCD) and
eating disorders (EDs), such as the obsessional anxiety
that leads to a variety of ritualistic behaviors during
meal planning and preparation. As a result, meal pre-
paration can take quite a lot of time and may comprise
ritualistic features such as whether wooden or ceramic
materials are used in the preparation of foods,4 rep-
resenting compulsive behaviors. Similarly, a common
feature of OCD is the thought that catastrophic outco-
mes would occur that are in proportion with the percei-
ved threat if ritualistic behaviors cannot be completed.7
This feature may also be present in people with ON, as
they may feel guilty if they are not adherent enough
to their rules for healthy eating. Several studies indi-
cate a relationship between orthorexia and obsessive
traits in the normal population.8,9 However, no study
has investigated this association in a clinical sample.
Therefore, the current study aimed to identify whether
people with anxiety disorders and OCD are inclined
towards an excessive preoccupation with consuming
healthy food. We hypothesized that we would nd hi-
gher orthorexia scores in patients with higher scores
of obsessive-compulsive symptomatology. Considering
the phenomenological overlap between obsessions
and worry, patients with generalised anxiety disorder
and panic disorder were included in the present study
to have an inkling whether orthorexia might be speci-
cally linked to obsessing (if higher scores of orthorexia
would nd in OCD) or worrying (if higher scores of ort-
horexia would nd in generalised anxiety disorder or
panic disorder).
This research study was approved by the Istanbul Uni-
versity, Cerrahpaşa Medical Faculty’s Ethics Committee,
and all participants provided written informed consent.
This was a cross-sectional study with 130 patients (97
women, mean age ± SD = 33.95 ± 10.59; 33 men, mean
age ± SD = 31.31 ± 9.98). All patients attended the out-
patient unit of Cerrahpaşa Medical Faculty Department
of Psychiatry, and were diagnosed with generalized
anxiety disorder (GAD), OCD, and panic disorder (PD).
The diagnosis was established by a psychiatrist accor-
ding to DSM-IV criteria.10 All patients were on pharma-
cological treatment of at least 12 weeks with recom-
mended rst-line medications for OCD and anxiety
disorders including SSRIs and clomipramine, with pos-
sible augmentation strategies including antipsychotics
during the study. Orthorexic behavior was assessed
using the ORTO-11 test, an adaptation of the ORTO-15
into Turkish,8 in which lower scores indicate greater
orthorexic behaviors. Patients were also assessed with
the Eating Attitudes Test (EAT)-40,11 developed to me-
asure the risk for eating disorders. Savaşır and Erol12
conducted a reliability and validity study of the EAT-40
Turkish version. A score greater than 30 is considered
to be an indicator of anorexic disorder.
The Padua Inventory-Washington State University Revi-
sion (PI-WSUR), a 41-item self-report measure of obses-
sions and compulsions,13 was also used. The PI-WSUR
consists of 5 subscales: obsessional impulses to harm
self/others, contamination obsessions and washing
compulsions, checking compulsions, obsessional thou-
ghts of harm to self/others, and dressing/grooming
compulsions. The translation of the Turkish version of
the PI-R was done by Yorulmaz et al.14 Weight and he-
ight of all patients were measured, and body mass in-
dex (BMI) was calculated using the weight in kilograms
divided by the square of height in meters.
DOI: 10.5455/NYS.20160324065040Kısa Araştırma Raporu
Yeni Symposium • Aralık 2015 • Cilt: 53 • Sayı: 4
Statistical analysis
The Kolmogorov-Smirnov and Shapiro-Wilk tests were
used to determine normal distribution of the data.
One-way ANOVA and Kruskal-Wallis tests were used to
assess dierences in group means. Pearson two-tailed
correlations and Spearman correlation analyis were
computed between scores on the ORTO-11, EAT-40,
PI-WISUR, and BMI. Finally, we explored if controlling
for BMI inuenced any of these correlations. Statistical
signicance was set at p < 0.05 for group comparisons
and for correlation analyses. Statistical analyses were
carried out using SPSS version 15 for Windows.
The three patient groups did not dier signicantly
with respect to age, gender, education, and BMI (Tab-
le 1). Female gender was predominant in all groups.
The average BMI for men was 25.31 ± 4.22, and for
women it was 25.46 ± 5.43. There was no signicant
dierence between groups in the mean scores of ea-
ting attitudes (p = 0.251) or orthorexia symptom se-
verity (p = 0.948). Obsessive-compulsive symptom se-
verity was higher in the OCD group. The three patient
groups did not dier with respect to checking compul-
sions (p = 0.261), dressing/grooming compulsions (p
= 0.667), obsessional thoughts of harm to self/others
(p = 0.338), and obsessional impulses to harm self/ot-
hers (p = 0.167). The measure of obsession/compulsi-
ons related to contaminations was signicantly higher
in patients with OCD (p = 0.008). Pearson two-tailed
correlations were calculated to determine the relati-
onship between orthorexia and obsessive-compulsive
symptoms and eating attitudes. Moderate correlati-
ons (r > 0.30) were obtained for orthorexia symptom
severity with obsessive-compulsive symptom severity
and EAT-40 total score. Among the OCD subscales,
checking and dressing/grooming compulsions showed
the most signicant correlations with the ORTO-11
total score. Correlations are given in Table 2. Control-
ling for BMI did not change any of these correlations.
DOI: 10.5455/NYS.20160324065040Kısa Araştırma Raporu
Table 1. Sociodemographic and clinical features of the participants
OCD (N=49) GAD (N=37) PD (N=44) p F
Age 31.37±10.97 35.03±9.58 33.43±9.96 0.217
Gender Female=36
Male=14 0.143 X2=3.88
9.92±3.8 9.86±3.91 9.82±3.34 0,998
24.91±3.7 26.07±5,3 24.95±4,82 0,511 0.675
PI-WSUR* 55,98±28.75 36.84±21.88 47.32±28.3 0.018 4.11
EAT-40 12.04±6.31 13.86±6.01 14.22±7.9 0.251
ORTO-11* 28.4±5.76 28.4±5.69 28±7.3 0.948 0.054
*One-way ANOVA test was used.
Table 2. Correlations between ORTO-11, OCD total, EAT-40 total, and OCD subscales.
obsessions and
washing com-
thoughts of
harm to self/
Obsessional im-
pulses to harm
total score
R-0.342 -0.339 -0.355 -0.485 -0.410 -0.235 -0.155
P<0.001 <0.001 <0.001 <0.001 <0.001 0.007 0.078
Pearson two-tailed correlation analysis was performed. Signicance was set to P < 0.01.
Abbreviations: OCD, obsessive-compulsive disorder; EAT, Eating Attitudes Test; PI-WSUR, Padua Inventory-Was-
hington State University Revision.
Yeni Symposium • Aralık 2015 • Cilt: 53 • Sayı: 4
In the current study, no signicant dierences were
found between patients with GAD, PD, or OCD with re-
gard to eating attitudes and orthorexia symptom seve-
rity. Orthorexia symptom severity did not dier signi-
cantly between the three groups. In this study BMI of
patients were within the normal-overweigt limits which
supports the view that even though people show ortho-
rexia features their main motivation is not weight loss.
Most studies have found no association between ON
and BMI.2,8 However, there was a signicant correlation
between EAT-40 scores and the ORTO-11, which indi-
cates that there is an association between orthorexia
and disordered eating behaviors and attitudes. In our
study patients did not score above 30 on EAT-40 which
suggests that the study sample was a lower risk popu-
lation for eating disorders. Thus, a tendency towards
preoccupation with eating or weight may be associated
with a tendency towards healthy eating.
In this study higher obsessive-compulsive scores were
associated with lower scores on ORTO-11, thus indica-
ting a higher tendency for orthorexia. Arusoĝlu et al.8
showed that obsessive-compulsive symptoms had a
signicant eect on orthorexic tendency (measured
with ORTO-11), such that individuals who had higher
obsessive-compulsive symptoms had greater ortho-
rexic tendencies. The most meaningful correlations we
obtained were between the ORTO-11 score and chec-
king and dressing/grooming compulsions. The cogniti-
ve interpretation of OCD suggests that compulsive che-
cking is associated with the belief that one has a special
or heightened responsibility for preventing harm to
others. Increased responsibility, probability of harm,
and anticipated seriousness of harm are three major
determinants of checking behaviors.15 Checking beha-
viors is carried out to protect people from harm; hence,
they are accepted as a form of preventive behavior.15
This is similar to the cognitive processes and behaviors
associated with the prevention of unhealthy food inta-
ke in ON, all of which result from unrealistic worry. The
dressing/grooming compulsions represent the urge to
insist on doing hygiene steps in a xed sequence. If the
sequence is interrupted, patients may again start at the
beginning, which suggests a phenomenological simi-
larity with the ritualistic behavior of preparing food in
people with ON. A hypothesis might be that an inclina-
tion towards an obsession with healthy eating might be
associated with the cognitive dimension of anxiety sen-
sitivity which has most frequently been associated with
pathological worry such as that which occurs in GAD.16
The current scales are insucient to assess obsessive
traits in subjects with orthorexic traits. Donini et al.9
concluded that the ORTO-15 has a notable predictive
capability concerning healthy eating behavior, while it
is less ecient in discriminating the presence of obses-
sive traits. Better scales may further clarify enlighten
obsessive-compulsive traits. Another limitation of the
study was the absence of a control group. Also men
were underrepresentative in the sample. Perhaps dif-
ferences between groups might have been masked
by having males and females combined. Exploring ob-
sessive-compulsive traits such as perfectionism could
enlighten the impact of obsessive-compulsive traits on
orthorexic behaviors. Further investigations should fo-
cus on the eects of obsessive traits on healthy eating
obsessions. Also, in this cohort as all patients were on
treatment, we do not know the eects of treatments
over orthorexia. A better understanding of underlying
cognitive processes may enhance the ecacy of cogni-
tive-behavioral therapies in people with ON.
The study suggests that ON severity was not found hig-
her in any of the investigated illness groups. However,
lack of control group limited us to draw a conclusion
meaningful correlations were obtained between the
ORTO-11 score and checking and dressing/grooming
compulsions, suggesting parallel cognitive processes
with the ritualistic compulsions. Underlying thought
processes such as anxiety due to increased responsibi-
lity may predispose people to develop a compulsion to
eat a pure diet.
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DOI: 10.5455/NYS.20160324065040Kısa Araştırma Raporu
... The previous studies consistently show that as obsessive-compulsive tendencies increase, orthorexic symptoms also increase. This trend is independent of the relationship of obsession and compulsion content with food (Poyraz et al. 2015;Roncero et al. 2017;Segura-Garcia et al. 2015). Nevertheless, Moroze et al. (2015) suggested that obsession may be the root of ON. ...
... DSM-5 (2013) stated that the symptoms should not be better explained by the ritualized eating behavior observed in EDs to diagnose OCD. However, although a relationship was found between orthorexic symptoms and obsessive-compulsive tendencies in many studies among the general population, there was no significant increase in orthorexic symptoms in any of the studies conducted with OCD groups (Poyraz et al. 2015;Vaccari et al. 2021;Yılmaz et al. 2020). ...
... Obsessive-compulsive symptoms in ED and orthorexic individuals are egosyntonic and often do not accept functional disorders associated with their disease (Varga et al. 2013). It has been shown in many studies that as the worsening in eating attitude increases, orthorexic symptoms increase (Arusoğlu et al. 2008, Poyraz et al. 2015, Yılmaz et al. 2020. ...
Orthorexia nervosa is a phenomenon defined as a pathological focus on healthy eating. It is assumed that it shares some common features and possibly overlaps with other mental disorders, especially eating disorders and obsessive compulsive disorder. Research on orthorexia nervosa has been increasing recently. In this section, the definition of orthorexia nervosa, its clinical and sociodemographic characteristics, and its relationship with other mental disorders, especially obsessive compulsive disorder, are evaluated.
... 7,8 Barthels et al suggested that ON may be associated with eating disorders and, in another study, orthorexic symptoms were found to be quite common in patients diagnosed with AN and bulimia nervosa (BN). 9,10 On the other hand, individuals with orthorexic tendencies are overly concerned about consuming healthy and pure foods rather than the amount of food consumed, unlike AN and BN. 8 Previous studies revealed that orthorexic individuals spend most of their time in strict rules and excessive efforts to choose, prepare, and eat healthy food, similar to the patients with OCD, which may cause deterioration in social functions over time. 8,11 Studies in healthy populations have shown that obsessive-compulsive symptoms are associated with orthorexic tendencies. ...
... Orthorexic individuals may feel guilty when they do not follow healthy eating rules. 10 Intense exercise is considered an important factor in the etiology and continuity of eating disorders, especially AN. 13 Orthorexic individuals may experience intense physical activity as well as a healthy diet to achieve excellent physical health. 14 Physical activity can turn into exercise addiction from time to time. ...
... 37,38 Obsessive-compulsive symptoms have a significant effect on orthorexic tendencies, and as these symptoms increase, orthorexic tendencies increase. 10,11 Barthels et al found a high prevalence of ON in a sample of patients with eating disorders; however, they found the prevalence of ON in patients with OCD similar to the general population. 9 Our study results that there was no statistically significant relationship between the severity of OCD and ON, and that there were high orthorexic tendencies in patients with order-symmetry obsessions, which are also common in eating disorders, support the hypothesis that OCD and ON are two separate disorders. ...
Full-text available
Purpose: The term orthorexia nervosa is used to describe the pathological fixation associated with consuming healthy food. It is assumed that orthorexia nervosa shares some phenomenological features with anorexia nervosa, obsessive-compulsive disorder (OCD), and other mental disorders. Individuals with orthorexic tendencies may have high physical activity as well as a healthy diet. This study aimed to investigate the relationship of orthorexia nervosa with obsessive-compulsive symptoms, eating attitudes, and several sociodemographic features. Patients and methods: We included 63 patients diagnosed with OCD, 63 healthy volunteers who perform physical exercises at least three days a week, at least 30 minutes a day, and 63 healthy volunteers who do not perform physical exercises regularly. Sociodemographic data form, Yale-Brown Obsessive Compulsive Scale, ORTO-11 Scale, Eating Attitude Test, Hamilton Anxiety Scale, and Structured Clinical Interview for DSM-5 Disorders (SCID-5 CV) were administered to all participants. OCD data form was also applied to patients with OCD diagnosis. Results: We found a statistically significant relationship between current order-symmetry obsessions and orthorexic tendencies in patients with OCD (p<0.05). There was no relationship between the severity of the disorder and orthorexia nervosa in patients with OCD (p>0.05). Orthorexic tendencies were found to increase as impaired eating attitudes increased in participants who regularly performed physical exercises and patients with OCD (p<0.05). The orthorexic tendencies of participants who regularly performed physical exercises were higher than those diagnosed with OCD and healthy individuals who did not perform physical exercises. Conclusion: The absence of a significant relationship between disorder severity and orthorexia nervosa in patients diagnosed with OCD and the increase in orthorexic tendencies as the deterioration in eating attitudes increases in both patients with OCD and the participants who regularly perform physical exercises suggest that orthorexia nervosa may be closer to the eating disorders group than obsessive-compulsive spectrum. Studies with large samples and different diagnoses are needed to determine the place of orthorexia nervosa in diagnosis and classification systems.
... Niemniej wskazuje się na możliwość rozwoju ON na tle dwóch (zależnych lub nie) zespołów psychopatologicznych. W powyższym przypadku na rozwój ON działałyby dwa mechanizmy: ograniczanie jedzenia (z kręgu ED) i cechy OCD. Tę zależność ujawniają także inne badania oraz opinie specjalistów wiążące cechy ON z ED i OCD (Arusoğlu et al., 2008;Asil i Sürücüoğlu, 2015;Bundros et al., 2016;Hayes et al., 2017;Poyraz et al., 2015;Ryman et al., 2019). Jednocześnie warto rozważyć zbadanie zależności przyczynowo-skutkowych między wymienionymi klasami zaburzeń i określenie związku między cechami ortoreksji a obsesyjno-kompulsyjnymi cechami osobowości, częstymi u osób z AN (Crane et al., 2007 Surprisingly, some features, such as care for the appearance or focusing on the amount (rather than the quality alone) of food, have not been linked with ON, based on the assumption that restrained eating is determined by the fear of gaining weight in AN and by the fear of a given type of food in ON (Catalina Zamora et al., 2005). ...
... In the above case, two mechanisms would contribute to the development of ON: food restriction (from the ED spectrum) and the symptoms of OCD. This relationship was also confirmed by other studies and specialist opinions linking ON behaviours with ED and OCD (Arusoğlu et al., 2008;Asil and Sürücüoğlu, 2015;Bundros et al., 2016;Hayes et al., 2017;Poyraz et al., 2015;Ryman et al., 2019). At the same time, it is worth considering investigating the causal relationship between these classes of disorders as well as to determine the relationship between orthorexic behaviours and obsessive-compulsive personality traits, which are common in individuals with AN (Crane et al., 2007). ...
... To understand the core characteristics of ON, there have, over the years, been investigations into the relationships with other psychopathological constructs, emphasising strong similarities between ON and eating disorders (EDs) [4][5][6], and features analogous with obsessive-compulsive disorder (OCD) [7,8]. However, recent studies have highlighted more similarities between ON and EDs than ON and OCD [9][10][11]. ...
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Purpose: Perfectionism is considered a transdiagnostic construct that characterises eating disorders (EDs) and obsessive-compulsive disorder (OCD) and that could also depict orthorexia nervosa (ON). The principal aim of this study was to investigate what dimensions of perfectionism mostly represent ON. Moreover, it was evaluated if dieting impacted the presence of orthorexic features and perfectionistic behaviour. Methods: The sample consisted of two groups-the "Diet" (n = 93), and the "No Diet" (n = 94) groups-composed of people with high and low orthorexic tendencies, respectively. Participants filled out self-report questionnaires to investigate orthorexic tendencies and different facets of perfectionism. Results: Analyses highlighted that people with high orthorexic tendencies showed higher perfectionistic features and that ON had a significant relationship with different facets of perfectionism. No interactions with diet were found. Therefore, no other differences were highlighted when the group type (Diet/No Diet) was considered. Conclusions: Regardless of diet, different facets of perfectionism characterise ON: perfectionism as a personality trait and perfectionism related to EDs and to obsessive-compulsive features. Our results evidenced that perfectionism could also be considered a useful construct in the conceptualization of orthorexia nervosa.
... As mentioned in the introduction, ON is characterized by obsessions and compulsions about the quality of food [42]. Previous studies concluded that more OCD symptoms are linked with more ON behaviors [2,[43][44][45]. In particular, the OCI washing subscale was found to be significantly associated with ON; we hypothesize that this finding might be related to the fact that during the COVID-19 pandemic, handwashing is applied as an essential measure to prevent the disease's spread [46,47], since hands are a known vector in the transmission of microorganisms. ...
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Background: Orthorexia Nervosa (ON), a compulsive obsession with vigorous eating, has increasingly caught researchers' attention. Although Orthorexia Nervosa has not been labeled an eating disorder, research about ON highlighted a strong link with anorexia nervosa or obsessive-compulsive disorder (OCD). Therefore, this study aimed to (1) validate the Arabic version of the Obsession-Compulsion Inventory (OCI-12 and OCI-4) and (2) check if there is an overlap between ON and OCD among a sample of Lebanese adults. Methods: This cross-sectional study involved 487 Lebanese participants between July and August 2021. The Dusseldorf Orthorexia Scale (DOS) was used to assess ON; scores between 25 and 29 indicate probable ON, whereas scores ≥30 indicate ON tendencies. A confirmatory factor analysis (CFA) was carried out using SPSS AMOS v.24 on the OCI-12 and OCI-4 scales’ items. The root mean square error of approximation (RMSEA) statistic, the Tucker Lewis Index (TLI) and the comparative fit index (CFI) were used to evaluate the goodness-of-fit of the model. Results: The CFA results indicated an excellent fit of the model: the Maximum Likelihood Chi-Square = 147.73 and Degrees of Freedom = 48, which gave a χ2/df = 3.08, TLI=0.934, CFI=0.952, and RMSEA=0.065 [95% CI 0.054-0.078]. The fit indices of the one-factor structure of the OCI-4 were excellent as well: χ2/df = 6.15/2= 3.08, TLI= 0.95, CFI= 0.98 and RMSEA= 0.065 [95% CI 0.007-0.127]. The Area Under the Curve was 0.600 [95% CI 0.524-0.674]. There was no cutoff value that showed good sensitivity or specificity at the same time. At the DOS cutoff of 25, sensitivity was 19.1%, whereas the specificity was 90.6%. The positive and negative predictive values (PPV and NPV) at this cutoff value were 24.4% and 88.7% respectively. At the DOS cutoff of 30, sensitivity was 8.8%, whereas the specificity was 94.3%. The PPV and NPV at this cutoff value were 10.6% and 92.5% respectively. The results showed that higher total OCD scores (Beta=0.15) were significantly associated with more ON tendencies. Moreover, higher OCD washing scores (Beta=0.52), physical activity index (Beta=0.06), and Body Mass Index (Beta=0.17) were significantly associated with more ON tendencies. Conclusion: The present results suggest that ON, as measured by the DOS, shares more common features with disordered eating and cannot adequately predict the presence of OCD symptoms.
... Otherwise, it may mean that ON tendencies could evolve into OCD symptomatology at some points of the ED course(Costa & Hardan-Khalil, 2019). Some authors suggest that ON may ultimately result in OCD as the excessive preoccupation with healthy eating may elicit a person to develop repetitive actions and routines(Poyraz et al., 2015). This view of ON and OCD as related but discernible clinical entities is supported in the present study. ...
Objective: Orthorexia nervosa (ON) is defined as an unhealthy obsession with healthy eating, focusing on concerns regarding food quality and composition. Currently, there is still a lack of consensus about a clear definition of the construct. Specifically, it has yet to be clarified whether ON pertains to eating disorders (EDs) or obsessive-compulsive disorder (OCD) spectrum. Hence, we conducted a systematic review and meta-analysis addressing the magnitude of the association between these groups of symptoms. Method: PubMed, Medline, SCOPUS, PsychINFO, CINAHL, and Web of Science were searched from inception up to February 2021. Data from individual studies were pooled using a random-effects model. Pearson's r was used as the effect size metric. Subgroup analyses were conducted exploring the role of ON-related instruments, body mass index, study quality, and cultural context. Results: Thirty-six studies met the eligibility criteria and were included in the meta-analysis. Random-effects model yielded a moderate association between ON and EDs symptoms with an overall effect size of r = .36 (p < .001; 95% confidence interval [CI] = 0.30-0.43). On the other hand, the results showed a small association between ON and OCD symptoms with a mean effect size of r = .21 (p < .001; 95% CI = 0.15-0.27). Discussion: Meta-analytic findings showed that ON symptoms are more associated to EDs compared to OCD. Despite the similarities, the nonhigh magnitude of the pooled correlations suggests that ON might be different from pre-existing EDs and OCD. Hence, ON might be treated as a stand-alone ED and included as an emerging syndrome in the DSM classification.
... Plusieurs recherches ont ré cemment mis en é vidence une possible association entre les symptô mes orthorexiques et les symptômes TCA. En effet, les symptô mes orthorexiques semblent lié s aux symptô mes TCA dans plusieurs types de population : chez des é tudiants turcs en mé decine [18], des dié té ticiens [2,52], des vé gé tariens/vé gé taliens [12], des patients atteints de troubles obsessionnels-compulsifs ou de trouble panique [39], des athlè tes italiens [44], un é chantillon australien [40], un é chantillon espagnol [42], des membres de la communauté allemande [48] et des é tudiants amé ricains [22]. D'autres é tudes utilisant une population clinique ont trouvé une pré valence é levé e des symptômes orthorexiques chez des patients souffrants de TCA : 28 % chez des patients italiens [45], ou encore 82,7 % chez des patients polonais [9]. ...
Résumé Contexte L’orthorexie est un trouble récemment mis en évidence par le médecin Steve Bratman (1997). Il désigne les préoccupations obsessionnelles pour l’alimentation saine qui engendre une altération significative du fonctionnement somato-psychique et social ainsi qu’une souffrance. Objectif Il s’agit dans cette étude d’explorer le profil orthorexique en lien avec les troubles des conduites alimentaires (TCA), l’estime corporelle, les attitudes environnementales et la flexibilité psychologique. Méthode Les participants ont été répartis en trois groupes : « Tout-venant » (n = 110), « TCA actuel » (n = 97) et « TCA passé » (n = 115). Ils ont tous répondu à un ensemble de questionnaires en ligne : l’Échelle Française d’Orthorexie, l’Inventaire des Troubles Alimentaires, l’Échelle d’Estime Corporelle, le Questionnaire d’Acceptation et d’Action, l’Échelle Clinique d’Anxiété et de Dépression et l’Inventaire des Attitudes Environnementales. Résultats Les résultats ont montré des corrélations fortes et significatives entre les symptômes orthorexiques et plusieurs symptômes TCA. Des différences très significatives entre les trois groupes sont présentes concernant les scores d’orthorexie, d’estime corporelle, de flexibilité psychologique et pour tous les symptômes TCA. Le groupe « TCA actuel » possède les scores les plus élevés pour les symptômes orthorexiques du fait d’une approche symptomatique et catégorielle limitée pour réaliser un diagnostic différentiel. Conclusion Le profil orthorexique est très proche du profil des individus ayant des TCA. Il pourrait s’agir d’un réaménagement socialement et culturellement plus acceptable d’un TCA passé. Les autres variables testées ne semblent pas liées aux spécificités du trouble orthorexique. Les études à venir devront prendre en compte une approche en termes de mécanismes et processus psychiques.
... In our sample, a higher level of OCD features (factor 1) and higher perfectionism and behaviors associated with weight maintenance or weight loss (factor 4) were associated with higher odds of being at risk of ON. Previous studies have shown a positive association between ON and OCD [18,19,49], perfectionism [20,50], cognitive restraint [51] and physical activity [14]. ...
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Although the amount of research about orthorexia nervosa (ON) has grown in the last two decades, to date, research on ON remains inconsistent. More is known about some behavioral characteristics of ON and its prevalence but nothing is known about the profile analysis behind this pathological eating behavior maintenance. Therefore, the objective of the present study was to determine the profiles of the participants in terms of eating behaviors, eating disorder psychopathology, obsessive-compulsive disorder symptoms and physical activity as well as check their association with ON. The sample was composed of 229 Polish female and male adults. Our findings showed three clusters and four-related factors (obsessive-compulsive disorder features; inappropriate eating and body-related behaviors; psychological and affective traits of eating disorders; perfectionism and behaviors associated with weight maintenance or weight loss). In our sample, a higher percentage of adults belonging to cluster 1 had no ON, whereas a higher percentage of adults belonging to cluster 3 had ON. Our results emphasize the possibility to target pathological eating behaviors and obsessive-compulsive disorder (OCD) symptoms in ON in psychological intervention.
... The lack of relationship between age and risk of orthorexia is confirmed by similar studies in students (p = 0.151) [14]. Also, in the context of the body weight status in relation to the orthorexia nervosa tendency, no significance was demonstrated [13,15,16], including the Polish study [2]. In the study group of Polish students, variables such as place of residence or level of study were, in percentage, similar to those in the Polish population in the study by Plichta et al. and differ from the current study group from WUR [2]. ...
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Introduction Ortoreksja nervosa is an eating disorder that can affect young people. It is characterized by excessive care for the quality of consumed products, also in terms of their positive effect on the human body. This type of food, both with high nutritional quality and health-promoting properties, includes products called ‘superfood’ (e.g. goji berries, chia seeds). Objectives The aim of the study was to assess the risk of orthorexia and to analyze attitudes towards ‘superfood’ among students from the Warsaw University of Life Sciences (WULS), Poland, and Wageningen University & Research (WUR) in Wageningen, The Netherlands Material and methods 240 students participated in the study. The risk of orthorexia was assessed on the basis of a validated ORTO-15 questionnaire, with a cut-off point of 35 points. Knowledge and attitudes towards ‘superfoods’ were evaluated based on the author’s questionnaire, including also questions about anthropometric and socio-demographic characteristics. Results The examined groups of students were of a similar age (WULS 22.0 ± 3.0 years; WUR 22.8 ± 4.6 years), 75% of the respondents had normal body weight. About 30% of students from WULS and 26% from WUR showed the risk of orthorexia. The best-known products with health-promoting properties were: ginger, ginseng, chia seeds and aloe vera. In contrast, the most frequently consumed were ginger and turmeric. A relationship between orthorexia and superfood consumption was observed for goji berries, amaranth (WULS students) and ginseng (WUR students) Conclusions The relationship between orthorexia and the knowledge and consumption of superfoods products was shown only for 3 products. The obtained results could have been influenced by the small percentage of students with a confirmed risk of orthorexia in the study group. Therefore, to formulate binding conclusions about the relationship between orthoretic behaviour and the knowledge and consumption of superfoods products, further research on a bigger study group is recommended.
Background: The prevalence of eating disorders and orthorexia nervosa has steadily increased and this situation may lead to severe physical, psychological, and social disorders. Aim: The aim of this study was to investigate the prevalence of disordered eating attitudes and orthorexia tendencies among university students studying in various Health Sciences departments in Turkey. Subjects and methods: The study subjects were selected from Health Sciences Faculty students. Among the students who accepted the study, 639 people were reached by simple random sampling method. The EAT-40 and ORTO-15 which are validated instruments for the screening of abnormal eating behaviors and orthorexia nervosa respectively, were used as measurement tools. Results: The majority of the students who participated in the study were found to exhibit orthorexic tendencies, and male students had a higher orthorexic tendency in comparison to female students (p = 0.022). More specifically, the students studying in the Department of Nutrition and Dietetics had lower orthorexic tendencies compared with the students from other departments. There was no significant relationship between BMI values and the mean ORTO-15 scores, whereas the mean EAT-40 score was found to increase statistically significantly with increased BMI (p = 0.038). There was a statistically significant difference between the departments and classes in terms of mean EAT-40 scores, whereas no difference was found regarding gender. Conclusion: Orthorexia nervosa is a common problem for university students studying in health-related departments. Interestingly, the orthorexic tendencies of girls and students studying in the Nutrition and Dietetics department were found to be lower in this study. It was determined that all students except the Nutrition and Dietetics department had orthorexia tendencies. More comprehensive studies are needed to better understand orthorexia nervosa and healthy lifestyle interaction.
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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.
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The purpose of this article was to describe the phenomenon of a new disorder called orthorexia nervosa. This paper proposes a theoretical framework for the definitions, prevalence, diagnostic criteria, method and treatment of orthorexia. This disturbing behaviour concerns the pathologic obsession for healthy nutrition. In contrast to eating disorders, people with orthorexia are obsessed with food quality rather than quantity and they do not care excessively for thin silhouette like in the case of patients with anorexia and bulimia nervosa. Individuals with orthorexia nervosa are obsessive about healthy food, leading to dietary restrictions and to a variety of negative psychological and social outcomes. The results of previous research show that on the one hand orthorexia is related to anorexia and bulimia nervosa, and on the other hand this syndrome is more closely allied with obsessive-compulsive disorders. In view of the studies presented here we could treat orthorexia as a disturbed eating habit which is connected with obsessive-compulsive symptoms.
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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.
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Orthorexia, from the Greek words orthos (straight, proper) and orexis (appetite), is a newly conceptualized disorder characterized by distorted eating habits and cognitions concerning supposedly healthy nutrition. In this article we present preliminary results of a wider research aimed to investigate the diffusion of Orthorexia in the general population and to highlight its characteristics and particularly the relationship with Eating Disorder and Obsessive-Compulsive Disorder. One-hundred and seventy seven adult subjects from the general population, were administered the ORTO-15 test, a selfadministered questionnaire specifically designed to assess orthorexic symptomatology; note that statistical analyses were repeated twice, referring to different diagnostic thresholds (40/35). Orthorexia had a 57.6% prevalence in our sample, using the 40-point threshold, with a female/male ratio 2:1; the figure was sensibly lower with the 35-point threshold (21%). The results of this study highlight the diffusion of Orthorexia which may constitute an important risk factor for mental and physical health, but also the opportunity of more specific diagnostic instruments, so to facilitate a thorough understanding of this disorder.
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Orthorexia is a new term about eating behavior disorder and consists of pathologic obsession for biologically pure foods, free of herbicides, pesticides, and other artificial substances. It is not an independent diagnostic category, but it has some similarities with other eating disorders. This study was conducted to examine the orthorexia among 878 medical students. Of 878 students, 464 (52.8%) were male and 359 (40.9%) were female. The mean age, height, weight, and body mass index were 21.3 +/- 2.1 years, 171.0 +/- 8.5 cm, 65.6 +/- 12.3 kg, 22.4 +/- 2.99, respectively. The rates of the ORTO-11 scores between 0 and 15 was 1.9%; between 16 and 30, 57.5%; and between 31 and higher, 21.1%. There were 17 students with a score of 0 to 15. The mean score for the ORTO-11 test was 27. There were statistically significant differences between age, sex, and smoking habit of the students. In the male students, there was a statistically significantly higher tendency for orthorexia (P = .001), and there was a statistically significant difference between the age groups for tendency for orthorexia (P = .025). In logistic regression analysis, age, sex, Eating Attitude Test-40 (EAT-40), and height affected the ORTO-11 scores.
Because eating disorders (EDs) and obsessive compulsive disorder (OCD) co-occur at high rates and can have functionally similar clinical presentations, it has been suggested that both constructs might be part of a common spectrum of disorders. Identifying the relationship between EDs and OCD may lead to the discovery of important shared core disease processes and/or mechanisms for maintenance. The objective of this paper is to understand the relationship between EDs and OCD by systematically reviewing epidemiological, longitudinal and family studies guided by five models of comorbidity posited by Klein and Riso (1993) and others. Though this literature is relatively small, the preponderance of evidence from these studies largely suggests that OCD/ED co-occur because of a shared etiological relationship. Limitations to extant literature, and suggestions for future research are discussed.