Exploration of orthorexia nervosa and diagnostic overlap with eating disorders, anorexia nervosa and obsessive-compulsive disorder

The need for research on orthorexia nervosa: looking back, looking forward

One of the sustainable development goals (SDGs) of the United Nations is to enhance scientific research and substantially increase the number of public and private research and development spending (SDG Target 9.5). What types of research should be carried out in the field of orthorexia nervosa (ON)? Fundamental, applied, comparative, exploratory, laboratory, longitudinal or mixed research? How can we utilize our previous misinterpretations to develop a more accurate understanding of ON? Do we need more research in this field? These and other questions encourage us to publicly debate on ON, which is why we would like to express our position on this issue.Level of evidence: Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Orthorexic Tendencies Are Associated with Autistic Traits in Patients with Borderline Personality Disorder

Background/Objectives: Orthorexia Nervosa (ON), a condition marked by an obsessive focus on eating healthily, has drawn increasing clinical attention due to its rigid dietary patterns and social impairment. Borderline Personality Disorder (BPD), characterized by emotional dysregulation, impulsivity, and unstable interpersonal relationships, frequently co-occurs with eating disorders. Recent research suggests that autistic traits-such as cognitive rigidity and restricted interests-may underlie both ON and BPD, especially in female populations. This study aimed to assess the prevalence of orthorexic tendencies in patients with BPD compared to healthy controls (HCs) and to explore their associations with autistic traits and disordered eating behaviors. Methods: This study involved 73 BPD patients and 52 HCs. Participants completed the Adult Autism Subthreshold (AdAS) Spectrum, Eating Disorder Inventory-2 (EDI-2), and the ORTO-15 questionnaire. Results: BPD patients scored significantly higher than HCs on AdAS Spectrum and EDI-2, and significantly lower on ORTO-15, indicating more pronounced autistic traits, disordered eating behavior, and orthorexic tendencies. A greater proportion of BPD individuals reported clinically relevant ON symptoms according to the ORTO-15 threshold. Orthorexic symptoms were significantly correlated with most EDI-2 and all AdAS Spectrum domains. Regression analysis revealed that autistic traits, but not feeding and eating disorder symptoms, significantly predicted orthorexic tendencies. Conclusions: Orthorexic tendencies are more prevalent in individuals with BPD and are significantly associated with autistic traits. These findings suggest that ON may represent a manifestation of the autism spectrum, particularly in individuals with BPD, and support a reconceptualization of ON within a neurodevelopmental framework. Recommendation: Future research is needed in order to clarify the temporal and causal relationships among autistic traits, BPD symptomatology, and the emergence of orthorexic behaviors.

Prevalence and determinants of orthorexia nervosa among Turkish adolescents

PURPOSE

Given the prevalence and diversity of eating issues among adolescents, understanding the epidemiological aspects of orthorexia nervosa (ON) in this demographic, along with identifying associated clinical factors, sociodemographic traits, eating habits and parental attitudes, holds paramount importance both clinically and scientifically. This study aimed to ascertain the prevalence of ON among Turkish high school adolescents aged 14-18 and explore potential correlates of this clinical condition.

METHOD

In the initial phase, 1784 adolescents completed the Data Form, Orthorexia Nervosa Inventory (ONI) and Parent Style Scale (PSS), while their parents filled out the the parental version of the revised Child Anxiety and Depression Scale (RCADS). Subsequently, clinical interview and The Kiddie-Schedule for Affective Disorders and Schizophrenia for School Aged Children, Present and Lifetime Version (KD-SADS-PL) were conducted with 9 adolescents with high risk for ON to assess comorbidities.

RESULTS

The study revealed ON prevalence of 0.5%, with 0.3% in boys and 0.6% in girls. Rural residency, dietary supplement use, and pet ownership correlated with higher ONI scores (p = 0.022, p = 0.002, p = 0.042 respectively). OCD and panic disorder symptoms (B = 0.307, p < 0.001 and B = 0.165, p = 0.018 respectively), increased BMI, and anxiety scores were associated with elevated ONI scores. Authoritarian parenting was significantly related to ONI total scores (B = 1.69, p = 0.018).

CONCLUSION

This study significantly contributes to the literature by delineating the prevalence of ON in adolescents, identifying associated risk factors, elucidating psychopathological associations of orthorexic symptoms, and identifying the relationship between parenting styles and ON. Such insights into the factors influencing ON can aid in demystifying its nature.

The Mediating Role of Social Camouflaging on the Relationship Between Autistic Traits and Orthorexic Symptoms

Background/Objectives: Recent lifestyle and dietary changes, driven by health awareness and ecological concerns, have led to the rise in numerous type of diets, which can promote well-being but may also contribute to Orthorexia Nervosa (ON), which have been suggested to be linked to autism spectrum disorder. This study aimed to explore the relationship between autistic traits, social camouflaging, and orthorexic tendencies in female university students, focusing on how these factors intersect with specific dietary habits. Methods: 554 female students were recruited via an online survey and assessed with the Adult Autism Subthreshold (AdAS) Spectrum, the Camouflaging Autistic Traits Questionnaire (CAT-Q), and the ORTO-R. Participants were categorized into four groups based on AdAS Spectrum and CAT-Q quartiles. Results: Vegans and vegetarians exhibited higher orthorexic tendencies and specific autistic traits. High scorers on the AdAS Spectrum and CAT-Q also showed higher ORTO-R scores, with both AdAS Spectrum and CAT-Q total scores, as well as certain domains, serving as significant positive predictors of higher ORTO-R scores. Notably, the AdAS Spectrum total score had a significant direct and indirect effect (through the CAT-Q) on the ORTO-R total score. Conclusions: The study found significant associations between autistic traits, social camouflaging behaviors, and orthorexic tendencies in female university students. These findings suggest that the strict dietary behaviors and rigid thinking characteristic of orthorexia may be influenced by underlying autistic features, highlighting the need for further research into the intersection of autism and eating disorders.

Examining Associations Between Fasting Behavior, Orthorexia Nervosa, and Eating Disorders

BACKGROUND/OBJECTIVES

Fasting, orthorexia nervosa, and eating disorders are increasingly prevalent and interconnected. Understanding their relationship is essential for identifying potential risks and developing effective prevention and intervention strategies. This study investigated these associations to enhance our knowledge of their interplay and implications for mental health.

METHODS

A cross-sectional online survey was conducted in Poland in 2023. A sample of 214 participants aged 16 to 65 (M = 27.95, SD = 9.44) participated in this study. Fasting behavior was the predictor (independent) variable, orthorexia nervosa (measured using the Authorized Bratman Orthorexia Self-Test) was the mediator, and an eating disorder was the dependent variable (assessed using the Eating Attitude Test).

RESULTS

The Mann-Whitney U-test indicated that the fasting group scored higher in orthorexia and eating disorder symptoms than the non-fasting sample. Positive associations emerged between the fasting, orthorexia, and eating disorder scales. Linear regression analysis identified significant predictors of eating disorder symptoms, such as age, fasting, dieting, overweight status, and orthorexia. A path analysis revealed that fasting affected eating disorders directly and indirectly through orthorexia.

CONCLUSIONS

This study identified fasting as a risk factor for orthorexia and other eating disorders, with orthorexia fully mediating the fasting-eating disorder relationship. Clinicians should consider both fasting and orthorexia when assessing patients at risk for eating disorders. This paper also proposes possible intervention and treatment strategies for affected individuals.

Higher orthorexia tendency among female fashion models: an empirical international study

PURPOSE

Female fashion models are more at risk for developing eating disorders than non-models due to the intense occupational pressure they face. The present study focuses on assessing whether female models are more prone to report orthorexia nervosa signs and symptoms than non-models.

METHODS

Female fashion models (n = 179, mean age: 25.9 SD = 4.40 years) and an age adjusted control group (n = 261, mean age: 25.0 SD = 4.97 years) were selected by snowball sampling. Participants filled out an online survey containing anthropometric questions and the 18-item Eating Habits Questionnaire.

RESULTS

According to BMI, fashion models were underweight (mean BMI = 18.1 SD = 1.68) while control participants' BMI was in the normal range (mean = 22.1 SD = 4.23, p < 0.001). On all three of Eating Habits Questionnaire subscales fashion models showed significantly higher average value (Knowledge subscale: M = 2.42 among models versus M = 2.08 in the control group, p < 0.01, Cohen's d = 0.52; Problems subscale: M = 1.93 among models versus M = 2.61 in the control group, p < 0.01, Cohen's d = 0.49; Feelings subscale: M = 3.20 among models versus M = 2.96 in the control group, p < 0.01, Cohen's d = 0.38). Orthorexic tendencies were reported by 35.1% of the models versus 20.2% of controls.

CONCLUSION

Fashion models are at risk for the development of eating disorders. Even though not yet included in the DSM-5, the assessment of orthorexia nervosa among fashion models seems to be important. It is suggested to take appropriate measures to prevent the spread of disordered eating habits among models as they can lead to the development of anorexia nervosa or bulimia nervosa.

LEVEL OF EVIDENCE

Level III, well-designed cohort study.

The association between food neophobia, bi-dimensional aspects of orthorexia, and anxiety among vegetarians and omnivores

Vegetarianism is a growing trend, and food neophobia and orthorexia nervosa could act as barriers to achieving a healthy vegetarian diet. The aim of this study is to compare the levels of food neophobia, anxiety, and both healthy and pathological aspects of orthorexia among vegetarians and omnivores. Additionally, the study aims to identify the relationships between food neophobia, anxiety, and orthorexia. In this cross-sectional online survey, a total of 324 vegetarian and 455 omnivores adults participated. The questionnaire consisted of four sections: sociodemographic, lifestyle, and health-related characteristics, the Food Neophobia Scale (FNS), the Teruel Orthorexia Scale (TOS), and the Generalized Anxiety Disorders-7 Scale. Vegetarians exhibited lower FNS scores (p < 0.001) and had higher healthy orthorexic scores (p < 0.001) than omnivores. There were no differences between groups for anxiety scores (p > 0.05). Regression analysis indicated that higher food neophobia (OR: 0.953, 95% CI:0.937-0.968) and TOS-OrNe scores (OR: 0.946, 95% CI: 0.901-0.993) were associated with lower odds of following a vegetarian diet. Conversely, higher TOS-HeOr scores (OR: 1.135, 95% CI:1.096-1.176) were linked to an increased likelihood of adopting a vegetarian diet. Furthermore, both FNS and GAD-7 scores showed negative correlations with TOS-HeOR (r = -0.124, p < 0.001 and r = -0.129 p < 0.001, respectively), and positive correlations with TOS-OrNe (r = 0.106, p < 0.001 and r = 0.146, p < 0.001). In conclusion, vegetarians exhibit lower levels of food neophobia and a greater interest in healthy eating than omnivores. Additionally, the distinct correlation between two dimensions of orthorexia and food neophobia and anxiety provides support for the two-dimensional nature of orthorexia.