SOME PSYCHOANALYTIC OBSERVATIONS ON ANOREXIA NERVOSA

Prevalence and characteristics of orthorexia nervosa in a sample of university students in Italy

AIMS

Orthorexia nervosa (ON) has been recently defined as a pathological approach to feeding related to healthiness concerns and purity of food and/or feeding habits. This condition recently showed an increasing prevalence particularly among young adults. In order to investigate the prevalence of ON and its relationship with gender and nutritional style among young adults, we explored a sample of students from the University of Pisa, Italy.

METHODS

Assessments included the ORTO-15 questionnaire and a socio-demographic and eating habits form. Subjects were dichotomized for eating habits (i.e. standard vs vegetarian/vegan diet), gender, parents' educational level, type of high school attended, BMI (low vs high vs normal BMI). Chi square tests were performed to compare rates of subjects with overthreshold ORTO-15 scores, and Student's unpaired t test to compare mean scores between groups. Two Classification tree analyses with CHAID growing method were employed to identify the variables best predicting ON and ORTO-15 total score.

RESULTS

more than one-third of the sample showed ON symptoms (ORTO-15 ≥ 35), with higher rates among females. Tree analyses showed diet type to predict ON and ORTO-15 total score more than gender.

CONCLUSIONS

Our results seem to corroborate recent data highlighting similarities between ON and anorexia nervosa (AN). We propose an interpretation of ON as a phenotype of AN in the broader context of Feeding and eating disorders (FEDs) spectrum.

Historical evolution of the concept of anorexia nervosa and relationships with orthorexia nervosa, autism, and obsessive-compulsive spectrum

Eating disorders have been defined as "characterized by persistence disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs health or psychosocial functioning". The psychopathology of eating disorders changed across time under the influence of environmental factors, determining the emergence of new phenotypes. Some of these conditions are still under investigation and are not clearly identified as independent diagnostic entities. In this review, the historic evolution of the eating disorder concept up to the recent Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, has been evaluated. We also examined literature supporting the inclusion of new emergent eating behaviors within the eating disorder spectrum, and their relationship with anorexia, autism, and obsessive-compulsive disorder. In particular, we focused on what is known about the symptoms, epidemiology, assessment, and diagnostic boundaries of a new problematic eating pattern called orthorexia nervosa that could be accepted as a new psychological syndrome, as emphasized by an increasing number of scientific articles in the last few years.

Anorexia, psychoanalysis, and feminism: fantasy and reality

Two distinct trends inform current psychoanalytic and feminist approaches to anorexia: one focuses on its roots in the fantasy, the other in the reality of childhood and adolescent deprivation and abuse. In outlining these two approaches, this article shows how both increasingly attend to the place of the mother to the neglect of the father in the genesis of anorexia--a shift of perspective somewhat redressed by systemic family therapy.

The body owning process in the treatment of anorexia nervosa

After pointing out that over anorexia nervosa too much attention focused on the severity of developmental pathology in infancy and on current family problems seem to blur the developmental perspectives in adolescence, the author examined the course of treatment of an anorexia nervosa patient, a 17-year-old senior high school girl. He showed that with the development of object-relationships, there occurred a disturbance in the sense of body-ownership: the lower half of the body felt fatty, some change occurred that could not be put into words, and a flesh-mantle was seen in a homosexual partner. It was emphasized that the projective cross-identification (the author's term) played an important role in this process.