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Open Journal of Psychiatry, 2018, 8, 345-354
http://www.scirp.org/journal/ojpsych
ISSN Online: 2161-7333
ISSN Print: 2161-7325
DOI:
10.4236/ojpsych.2018.83027 Jul. 31, 2018 345 Open Journal of Psychiatry
Agency and Relationship Dissatisfaction
Associated with Orthorexia Symptomatology
Crystal D. Oberle, Shelby L. Lipschuetz
Department of Psychology, Texas State University, San Marcos, TX, USA
Abstract
This study explored whether orthorexia symptomatology is linked to gend-
er-related personality traits and to levels of satisfaction in one’s romantic re-
lationships. Undergraduate students (418 women, 98 men) completed an on-
line survey with measures to assess orthorexia symptomatology, agency, un-
mitigated agency, commun
ion, unmitigated communion, and relationship
satisfaction. Orthorexia symptomatology was positively correlated with levels
of agency (
r
= 0.18;
p
< 0.001), but it was unrelated to unmitigated agency (
p
= 0.51), communion (
p
= 0.76), unmitigated communion (
p
= 0.17), and re-
lationship status (
p
= 0.99). Among the participants who were in a committed
relationship, symptomatology was negatively correlated with relationship sa-
tisfaction (
p
= 0.01), and this correlation was most pronounced for those with
higher levels of unmitigated agency (
p
= 0
.01). Orthorexia is associated with
the agency personality trait, indicative of one’s need to be independent and to
achieve personal accomplishments. However, particularly for those individu-
als whose agency becomes unmitig
ated, characterized by selfishness and
avoidance of others, orthorexia symptomatology predicts significant dissatis-
faction in romantic relationships.
Keywords
Orthorexia, Relationship Satisfaction, Agency, Communion
1. Introduction
Orthorexia nervosa (ON), originally defined by Bratman in 1997, outlines a
condition that results in impaired functioning as a consequence of an obsessive
fixation with eating “healthy” [1] [2] [3]. This obsessive fixation includes mental
preoccupation and compulsive behavior regarding dietary restrictions that typi-
cally become more frequent and severe over time. According to experts in clini-
How to cite this paper:
Oberle, C.D. and
Lipschuetz
, S.L. (2018) Agency and Rela-
tionship Dissatisfaction Associated with
Orthorexia Symptomatology
.
Open Journal
of Psychiatry
,
8
, 345-354.
https://doi.org/10.4236/ojpsych.2018.83027
Received:
July 5, 2018
Accepted:
July 28, 2018
Published:
July 31, 2018
Copyright © 201
8 by authors and
Scientific
Research Publishing Inc.
This work is licensed
under the Creative
Commons Attribution International
License (CC BY
4.0).
http://creativecommons.org/licenses/by/4.0/
Open Access
C. D. Oberle, S. L. Lipschuetz
DOI:
10.4236/ojpsych.2018.83027 346 Open Journal of Psychiatry
cal practice and research on this condition, although the goals behind these re-
strictions are positive and include achieving optimal physical health and purify-
ing the body, the results are often negative and may include malnutrition, in-
tense negative feelings such as shame upon violating any of their dietary rules, or
problems either with their academic or vocational work or with their social rela-
tionships [1] [2] [3].
Although no study has empirically investigated impaired social functioning in
individuals with ON, problems in this area are conceivable based on multiple
factors. First, given their strict and restrictive dietary rules, they likely avoid res-
taurants and social gatherings that involve food, with either the knowledge or
assumption that healthy options will not be available. Eating is a social behavior
in many cultures, and avoidance of gatherings that involve eating may lead to
social isolation from family, friends, and romantic partners. Second, as described
below, ON symptomatology is correlated with several personality traits that
happen to be associated with problematic relationships.
A consistent and established finding in the literature is a positive correlation
between ON symptomatology and obsessive-compulsive tendencies [4] [5] [6]
[7] [8]. This relationship makes sense, considering that the ON individuals’ ob-
sessions and compulsions with eating healthy extend to what, how, and when
they eat, as well as to other domains that include exercise [9]. Unfortunately,
obsessive-compulsive symptoms are also linked to difficulties with interpersonal
relationships that include lower levels of intimacy and relationship satisfaction
[10], as well as rigidity in the context of self-interest, need for excessive control
over their partner, and overall an avoidant attachment style [11] [12].
ON symptomatology has further been positively correlated with the personal-
ity traits of perfectionism, narcissism [13], and neuroticism [7] [14]. The former
research found that people who express ON symptoms have greater feelings of
superiority, both in general and specific to their eating habits and behaviors,
when compared to others. Regarding the latter research, neuroticism is a perso-
nality trait with a tendency toward a negative emotional state that includes feel-
ings of depression, anxiety, and anger. Given that ON entails a time-consuming
obsession that may consequently interfere with academic or vocational work, in
addition to the feelings of guilt and shame that result from dietary lapses, feel-
ings of negativity that include depression are certainly plausible. Unfortunately,
relationship satisfaction is negatively correlated with all of these personality di-
mensions: perfectionism [15] [16], narcissism [17] [18] [19], and neuroticism
[20] [21] [22]. By extension, we may then hypothesize that ON symptomatology
would, likewise, be associated with lower levels of relationship satisfaction.
Also relevant to relationship satisfaction are the gender-related personality
traits of communion and agency. Communion refers to the desire to form and
preserve supportive interpersonal relationships with other people, whereas
agency refers to the desire to be independent of others and to achieve personal
accomplishments for oneself [23] [24]. Not surprisingly, past research reveals
that relationship quality and satisfaction are positively related to communion
C. D. Oberle, S. L. Lipschuetz
DOI:
10.4236/ojpsych.2018.83027 347 Open Journal of Psychiatry
with its emphasis on building supportive relationships [25] [26] [27] [28], but
negatively related to agency with its emphasis on the self [26] [29].
The current study examines whether ON symptomatology is related to com-
munion, agency, and satisfaction in romantic relationships. Regarding the per-
sonality traits, given that people with ON are very independent and focused on
themselves with both their eating and exercise behaviors, we hypothesize that
ON symptomatology would be positively associated with levels of agency. Re-
garding relationship satisfaction, given that ON is associated with other perso-
nality traits that are linked to lower relationship satisfaction (obsessive-compul-
siveness, perfectionism, narcissism, and neuroticism), we hypothesize that ON
symptomatology would be negatively associated with levels of relationship satis-
faction among those who are currently in a committed relationship. Exploratory
analyses will additionally be conducted to determine whether ON symptoma-
tology differs between people who are single or in a committed relationship, and
to determine whether the association between ON symptomatology and rela-
tionship satisfaction is moderated by gender or by the gender-related personality
traits.
2. Method
2.1. Participants
This study’s participants were 516 students (418 women, 98 men) enrolled in
various undergraduate psychology courses at a large university in the southern
region of the United States during the Fall semester. Their ages ranged from 18
to 41 years (
M
= 19.80,
SD
= 2.52). Based on self-reported ethnicity, 40% were
Caucasian, 37% were Hispanic or Latino, 14% were African American, 5% were
Asian American, 3% were biracial or multiracial, and 1% were of another eth-
nicity. The only exclusionary criterion was that participants had to be at least 18
years old.
2.2. Materials and Procedure
This study’s methodology was approved by the Institutional Review Board of
Texas State University. Upon providing informed consent, all participants com-
pleted an anonymous online survey with the scales that are described below, as
well as a demographic questionnaire that included an item asking participants to
indicate whether they were currently single and not dating anyone, casually dat-
ing one or more people, or in a committed relationship.
ON symptomatology was assessed with the Eating Habits Questionnaire
(EHQ), a measure that includes 21 statements to which participants respond
with a Likert rating indicating how well each statement represents their current
eating habits (1 = not at all true, 2 = slightly true, 3 = mainly true, 4 = very true)
[7]. Some of the statements pertain to healthy eating behaviors (e.g., “I follow a
health-food diet rigidly,” “I prepare food in the most healthful way”), some per-
tain to problems that are associated with healthy eating (e.g., “I am constantly
C. D. Oberle, S. L. Lipschuetz
DOI:
10.4236/ojpsych.2018.83027 348 Open Journal of Psychiatry
distracted by thoughts of eating healthily,” “My healthy eating is a significant
source of stress in my relationships”), and some pertain to feeling positively
about healthy eating (e.g., “Eating the way I do gives me a sense of satisfaction,”
“I feel in control when I eat healthy”). This scale has demonstrated excellent in-
ternal consistency with Cronbach’s alpha of 0.90 [13] and good test-retest relia-
bility with coefficients ranging from 0.72 to 0.81 [7]. In addition, the authors of
this questionnaire demonstrated the validity of the EHQ, finding its scores posi-
tively correlated with higher levels of both disordered eating behaviors and ob-
sessive-compulsive tendencies, consistent with past research that found these
same correlations but with a different measure of ON symptomatology [4] [5]
[6] [8] [30] [31] [32].
The personality variables were assessed with the Personal Attributes Ques-
tionnaire (PAQ) [33] and the Revised Unmitigated Communion Scale (RUCS)
[34]. The PAQ includes 24 sets of contradictory statements to which participants
select a response indicating where they fall on 5-point scale between the two ex-
tremes. Eight of the sets pertain to agency (e.g., “Not at all independent … Very
independent,” “Gives up easily … Never gives up”), eight to unmitigated agency
(e.g., “Not at all arrogant … Very arrogant,” “Not at all greedy … Very greedy”),
and eight to communion (e.g., “Not at all helpful to others … Very helpful to
others,” “Very cold in relations with others … Very warm in relations with oth-
ers”). These agency, unmitigated agency, and communion subscales have been
shown to be internally consistent with Cronbach’s alphas of 0.76, 0.72, and 0.76,
respectively [35]. The RUCS includes nine statements to which participants re-
spond on a 4-point Likert rating scale indicating their degree of agreement with
the statements (e.g., “I always place the needs of others above my own,” “For me
to be happy, I need others to be happy”). This scale has been shown to be inter-
nally consistent with Cronbach’s alpha of 0.74 [35].
Finally, relationship satisfaction was assessed with the Relationship Assess-
ment Scale (RAS) [36]. For the RAS, participants use a 5-point Likert rating scale
to answer seven questions about their current romantic relationship. Example
questions are, “In general, how satisfied are you with your relationship?” and
“How well does your partner meet your needs?” This scale has been shown to be
internally consistent with Cronbach’s alpha of 0.86 [36].
2.3. Statistical Analyses
First, Pearson correlation analyses were used to assess the relationships between
ON symptomatology (EHQ scores) and each personality variable: agency
(PAQ-Agency scores), unmitigated agency (PAQ-Unmitigated Agency scores),
communion (PAQ-Communion scores), and unmitigated communion (RUCS
scores). Second, an ANOVA was conducted to determine if ON symptomatology
differed between participants who were single, casually dating, or in a commit-
ted relationship. Finally, for the 212 participants who reported being in a com-
mitted relationship, a regression analysis was conducted to assess the relation-
C. D. Oberle, S. L. Lipschuetz
DOI:
10.4236/ojpsych.2018.83027 349 Open Journal of Psychiatry
ship between ON symptomatology and relationship satisfaction (RAS scores),
and to determine if this relationship was moderated by gender or by any of the
personality variables. For this analysis, the individual predictor variables (ON
symptomatology, agency, unmitigated agency, communion, unmitigated com-
munion, and gender: a dummy variable with men coded 0 and women coded 1)
were first mean-centered, and the following interaction terms were subsequently
computed: ON x gender, ON x agency, ON x unmitigated agency, ON x com-
munion, and ON x unmitigated communion. The mean-centering of the pre-
dictor variables was effective at reducing multicollinearity between the interac-
tion term and the individual predictor variables in the regression analyses (all
tolerance values > 0.5 and all VIF values < 2). Note that this regression analysis
was not used for modeling purposes, but simply as a statistical tool that is equiv-
alent to ANOVA but appropriate in cases of continuous predictor variables and
dummy categorical predictor variables.
3. Results
ON symptomatology was significantly correlated with agency (
r
= 0.18,
p
<
0.001), but not with unmitigated agency (
r
= −0.03,
p
= 0.51), communion (
r
=
0.01,
p
= 0.76), or unmitigated communion (
r
= 0.06,
p
= 0.17). Further, ON
symptomatology did not significantly vary between those who were single (
M
=
38.40,
SD
= 9.31), casually dating (
M
= 38.44,
SD
= 8.18), or in a committed re-
lationship (
M
= 38.40,
SD
= 8.99),
F
(2, 513) = 0.001,
p
= 0.999. Finally, among
the participants in a committed relationship, ON symptomatology was nega-
tively associated with relationship satisfaction, and this relationship was mod-
erated by unmitigated agency, such that the negative ON-relationship satisfac-
tion relationship was most pronounced for those with higher levels of unmiti-
gated agency (see Table 1).
Table 1. Regression analysis predicting relationship satisfaction from ON symptoms,
gender, and personality.
B SE β
t p
ON −0.09 0.03 −0.18 −2.49 0.014*
Gender −0.34 0.89 −0.03 −0.39 0.696
Agency 0.11 0.07 0.12 1.67 0.096
Unmitigated Agency 0.08 0.07 0.08 1.05 0.296
Communion 0.21 0.08 0.23 2.68 0.008**
Unmitigated Communion −0.08 0.09 −0.07 −0.93 0.355
ON x Gender −0.01 0.11 −0.01 −0.10 0.923
ON x Agency −0.01 0.01 −0.11 −1.49 0.138
ON x Unmitigated Agency 0.02 0.01 0.21 2.67 0.008**
ON x Communion 0.02 0.01 0.16 1.85 0.066
ON x Unmitigated Communion 0.01 0.01 0.08 1.07 0.287
*
p
< 0.05. **p < 0.01.
C. D. Oberle, S. L. Lipschuetz
DOI:
10.4236/ojpsych.2018.83027 350 Open Journal of Psychiatry
4. Discussion
The first purpose of the current study was to determine whether ON sympto-
matology is linked to the gender-related personality traits of agency or commu-
nion. According to personality researchers, those who align more with agency
tend to focus more on themselves and maintain separation, while those who
align more with communion are better connected with others, as they focus on
these relationships more readily and see themselves as part of a collective or
whole rather than as an individual unit [37]. As expected, symptomatology was
positively correlated with levels of agency and unrelated to communion. People
with ON are very independent and focused on themselves with both their eating
[1] [2] and exercise behaviors [9], and apparently, these forms of independence
are part of a more inclusive personality trait that encompasses the drive to be
independent of others and to achieve personal goals and accomplishments
across domains.
The second purpose of the current study was to determine whether ON
symptomatology is related to levels of satisfaction in one’s romantic relation-
ships. As expected, symptomatology was negatively correlated with relationship
satisfaction among participants who reported being in a committed relationship,
and this correlation was most notable for those whose agency was unmitigated,
characterized by selfishness and avoidance of others. Extending from the pre-
vious finding, perhaps people with ON are so focused on themselves, including
their own ideals of perfect health, that they do not fully identify as one part of a
whole unit or relationship, which in turn may lead to relatively poor relationship
health and satisfaction. Moreover, past research shows that ON symptomatology
is associated with obsessive-compulsiveness [4] [5] [6] [7] [8], perfectionism and
narcissism [13], and neuroticism [7] [14], and each of these personality traits are
predictive of poor relationship health and satisfaction [10] [11] [12] [15]-[22].
Essentially, with ON, the obsessive desire to maintain unreasonably perfect
standards through rigid behavior seems to take precedence over interpersonal
relationships with partners who do not share the same ideals and behavioral
tendencies toward perfect physical health.
As with any research, this study had its limitations. First, all measures were
self-report surveys that may be susceptible to social desirability bias, particularly
on the eating habits questionnaire, whereby participants could have provided
responses that reflect healthier eating habits than their actual behaviors. Howev-
er, the fact that the survey responses were anonymous should have reduced the
likelihood of any significant bias impacting the study’s results. Second, this study
did not control for levels of key variables beyond agency and communion, such
as narcissism and neuroticism. Although it would be difficult to parse out the
eating thoughts and behaviors of ON from the affect and personality profile that
is associated with ON, measuring these variables would allow for an assessment
of which component of ON is the biggest contributor to relationship dissatisfac-
tion. Third, although the sample was quite large and ethnically diverse, it was
C. D. Oberle, S. L. Lipschuetz
DOI:
10.4236/ojpsych.2018.83027 351 Open Journal of Psychiatry
limited by convenience of available participants enrolled in psychology courses
(for which women comprise the majority of students) at a university in central
Texas. Future research on relationship satisfaction with ON should recruit par-
ticipants from other geographical regions that include those with lower levels of
obesity, from other courses that include nutrition and health profession courses,
from community settings that include health centers and that would offer a wid-
er age range, and from eating disorder clinics. These recruitment measures
would allow for greater generalization across the population, as well as increase
the number of participants who meet the diagnostic criteria for ON [2] [3].
5. Conclusion
According to clinicians and researchers, ON diagnosis necessitates both 1) an
obsessive focus and compulsive behavior regarding what patients deem healthy
eating, and 2) resulting clinical impairment [2] [3]. The proposed criteria for
clinical impairment include malnutrition or other medical complications arising
from their severe dietary restrictions, impairment of social or academic/voca-
tional functioning secondary to their inflexible dietary thoughts and behaviors,
and their self-worth being solely tied to compliance with their rigid diet. The
current study supports the criterion of impaired social functioning, with its
finding that greater ON symptomatology was associated with lower levels of sa-
tisfaction in one’s romantic relationships. Moreover, this impairment was great-
est for individuals scoring high on the trait unmitigated agency, reflecting an ex-
treme focus on oneself to the exclusion of others. When appropriate, couples-
counseling therapists should consider how the mindset of patients with ON may
contribute to poor relationship health and satisfaction, and they should incor-
porate nutrition counseling to help overcome ON alongside making improve-
ments in their interpersonal relationships, the result being better physical, men-
tal, and social health.
Conflicts of Interest
The authors declare no conflicts of interest regarding the publication of this pa-
per.
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