Orthorexic tendencies are linked with difficulties with emotion identification and regulation

The risk of believing that emotions are bad and uncontrollable: association with orthorexia nervosa

PURPOSE

This study aimed to explore emotional functioning in individuals with varying levels of orthorexia nervosa (ON) symptoms. Given the established links between emotion dysregulation and other eating disorders (EDs), and the conceptualization of ON within the ED spectrum, this research sought to examine the relationships between ON symptomatology and emotion regulation strategies, alexithymia, and beliefs about emotions.

METHODS

A large sample (N = 562) completed self-report measures with high psychometric properties, assessing ON traits (E-DOS), emotion regulation strategies (DERS-SF and ERQ), alexithymia (TAS-20), and beliefs about emotions (ERQ). The study used well-validated measures to address limitations of previous research.

RESULTS

Individuals with high ON traits demonstrated difficulties in most aspects of emotional functioning compared to those with low ON traits. Suppression, but not reappraisal, partially mediated the relationship between beliefs about emotions and ON symptoms. Believing emotions are bad or useless, difficulty controlling impulses, and relying on suppression to regulate emotions were most strongly associated with ON symptoms.

CONCLUSION

This study provides evidence that emotion dysregulation plays an important role in ON symptomatology. The findings suggest that when emotions feel unhelpful or uncontrollable, and maladaptive strategies like suppression are employed, individuals may seek perceived control through pathologically 'healthy' eating. There is currently no diagnosis criteria for ON, and consequently no clear treatment pathway. Our research suggests that specific aspects of emotional functioning such as beliefs about the usefulness of emotions or difficulties with feeling out of control when upset may be a useful treatment target to help individuals with ON develop healthier coping mechanisms and reduce reliance on rigid dietary rules as a means of emotional regulation.

LEVEL OF EVIDENCE

LEVEL III

Evidence obtained from well-designed cohort or case-control analytic studies.

Food Neophobia and Two Facets of Orthorexia Among Women: Cross-Sectional Study

The purpose of this study was to investigate the link between food neophobia and two dimensions of orthorexia in women. This cross-sectional study of 985 women aged 18 years and over was conducted using face-to-face questionnaires. Women who had a disability, had a chronic disease, or were pregnant or breastfeeding were excluded. Participants provided information on their sociodemographic details (age and educational level) and frequency of physical activity. Orthorexic tendencies were assessed using the Teruel Orthorexia Scale. The women's attitude towards trying new foods was assessed using the Food Neophobia Scale. A total of 337 participants (34.2%) were neophilic, 322 participants (32.7%) were neutral, and 326 participants (33.1%) were neophobic. There was no correlation between food neophobia scores and either age or body mass index. However, food neophobia was positively correlated with healthy orthorexia and orthorexia nervosa (p < 0.05). The mean individual scores for orthorexia nervosa and healthy orthorexia according to the Teruel Orthorexia Scale were 11.45 ± 3.91 and 20.04 ± 4.31, respectively. The results indicate that individuals with orthorexia nervosa have higher food neophobia scores, reflecting a greater reluctance to try unfamiliar foods, whereas individuals with healthy orthorexia do not show significant differences in food neophobia tendencies. This distinction highlights the importance of distinguishing between pathological and non-pathological eating behaviors when addressing dietary concerns.

Orthorexia as an Eating Disorder Spectrum-A Review of the Literature

BACKGROUND

The purpose of this study is to compare and analyze research studies focused on orthorexia nervosa (ON) as a spectrum of eating disorders, and to summarize potential risk factors in different age and social groups. ON is characterized by an obsession with healthy eating, which leads to a restrictive diet and health problems.

METHODS

Due to a lack of comprehensive analyses, this review re-examined studies from 2006 to 2023, initially retrieving 53,134 articles. Upon refining the criteria and risk factors for eating disorders, 34 notable records were identified. These studies employed diagnostic tools such as ORTO and BOT, focusing on risk factors for ON.

RESULTS

Results indicate that individuals suffering from eating disorders, losing weight, exercising heavily, developing relationship problems, and suffering from body dysmorphic disorder are at high risk of developing ON. A significant correlation was found between ON, BMI, and gender, but not between ON and OCD. Interestingly, ON symptoms appear to overlap with those of other eating disorders, such as anorexia and bulimia, especially in terms of obsessive control over dieting and fear of gaining weight, indicating a close relationship between the two.

CONCLUSIONS

Interestingly, orthorexia nervosa may serve as a coping mechanism for anorexia, providing a sense of control. However, further research on its long-term effects is required.

Reliability generalization meta-analysis of orthorexia nervosa using the ORTO-11/12/15/R scale in all populations and language versions

BACKGROUND

The ORTO scale was developed in 2004 as a self-report questionnaire to assess symptoms of orthorexia nervosa (ON). ON is an unhealthy preoccupation with eating healthy food. The scale aims to measure obsessive attitudes and behaviors related to the selection, purchase, preparation, and consumption of pure, healthy food. Since its development, the ORTO-15 has been adapted into several shorter versions. The objective was to conduct a reliability generalization meta-analysis of the ORTO scale and its variant versions in all populations and languages.

METHODS

A systematic literature search was conducted to identify studies reporting the internal consistency of ORTO. Random-effect models were used to evaluate summary statistics of reliability coefficients, weighting the coefficients by the inverse variance using the restricted maximum likelihood method. The heterogeneity among the reliability coefficients was evaluated and assessed using numerous statistical metrics. The tau (τ), tau2 (τ2), I2, H2, R2, df, and the Q-statistic are among those obtained. Meta-regression analyses were used to examine moderators such as age and sex.

RESULTS

Twenty-one studies (k = 21) involving 11,167 participants (n = 11,167) were analyzed. The overall effect estimate on internal consistency was 0.59 (95% CI 0.49-0.68), with a minimum reliability coefficient of 0.23 and a maximum reliability coefficient of 0.83. The heterogeneity statistics were found to have an I2 of 99.31%, which suggested high heterogeneity owing to a decrease in the confidence interval (95% CI) and an increase in variability. Sensitivity analysis revealed that a few studies strongly influenced the overall estimate. Egger's test suggested possible publication bias. Neither age nor sex significantly moderated reliability via meta-regression.

CONCLUSIONS

The ORTO scale has a relatively low pooled reliability coefficient. Alternative ON assessment tools with enhanced psychometric properties are needed. Clinicians should not base diagnoses or treatment decisions on ORTO alone. Comprehensive psychiatric assessment is essential for accurate ON evaluation.

Too healthy for their own good: orthorexia nervosa and compulsive exercise in the community

BACKGROUND

The similarities and differences between 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 on the following measures online: 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 were 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 parental feeding practices of concern about child's weight and restricting and monitoring the child's intake of calorie-rich foods.

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 for ON.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

The role of eating disorders features, psychopathology, and defense mechanisms in the comprehension of orthorexic tendencies

PURPOSE

Recent studies pointed out the importance to distinguish orthorexia nervosa (ON) from non-problematic forms of interest with healthy eating. This distinction needs to be further explored since it may favor a better comprehension of the relationship between orthorexic behaviors and psychopathology and lead to an improved understanding of the psychological processes implicated in ON. Therefore, the aim of the current study was to investigate the associations between ON and the core features of eating disorders (EDs), psychopathological symptoms and defense mechanisms, by differentiating three groups of individuals: an ON symptoms group, a healthy-eating control group, and a normal-eating control group.

METHODS

College students (n = 270, M_age = 21.57, SD = 2.16) were recruited from Palermo's University, in the south of Italy, and were assigned to three groups: 52 in the ON symptoms group, 157 in the healthy-eating control group and 61 in the normal-eating control group. Participants completed four questionnaires assessing ON (EHQ-21), eating psychopathology (EDI-3), psychopathological symptoms (BSI) and defense mechanisms (DSQ-40).

RESULTS

Compared to the control groups, the ON symptoms group reported greater EDs' features, higher psychopathological symptoms and greater employment of different neurotic and immature defense mechanisms. No differences were found between groups with regard to obsessive-compulsive symptoms.

CONCLUSION

Our findings support the notion that ON behaviors should be carefully distinguished from non-problematic forms of interest with healthy eating. Indeed, results suggest that ON individuals are characterized by similar clinical features and defensive functioning as those observed in traditional EDs, indicating the importance of deepening our understanding of the relationship between these conditions.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional study.

Orthorexia nervosa: replication and validation of the ORTO questionnaires translated into Greek in a survey of 848 Greek individuals

PURPOSE

The present study aimed to validate the ORTO-15 questionnaire for orthorexia nervosa (ON), translated by our group into the Greek language, and replicate the findings of the recently proposed 6-item ORTO-R.

METHODS

The tool was translated into the Greek language (ORTO-15-GR) using the forward-backward-forward method. A total of 848 adults participated in the validation study by filling in the questionnaires and providing general characteristics (age, gender, educational level, body weight, and height). The internal consistency of the tool was assessed by the omega (ω) coefficient, and confirmatory factor analyses (CFA) examined its factorial structure. Using the original six items of the ORTO-15 tool, a separate CFA model examined the factorial structure of the proposed ORTO-R tool. Furthermore, regression models tested the association of ORTO-R with study variables.

RESULTS

For ORTO-15-GR, the omega coefficient was 0.70 and for the ORTO-R 0.65. For the latter, the CFA revealed acceptable goodness-of-fit (standardized factor loadings from 0.36 to 0.64); however, all ORTO-15 models were characterized by a poor fit. In addition, there was a negative association between ORTO-R score and female gender, body mass index (BMI), and having a nutrition-related health problem.

CONCLUSION

The replication of ORTO-R indicates that it is a reliable tool in the field of ON. Therefore, the use of a 6-item questionnaire for ON assessment appears promising in research and clinical settings.

Orthorexia Nervosa and its association with obsessive-compulsive disorder symptoms: initial cross-cultural comparison between Polish and Italian university students

There is limited evidence of a link between Orthorexia Nervosa (ON) and Obsessive-Compulsive Disorder (OCD), and no definitive conclusions can be drawn. The interplay between socio-cultural context and ON has been poorly investigated as well. Therefore, the objectives of the present study were: (1) to investigate the differences in ON and OCD symptoms and (2) to assess the relationship between ON and OCD symptoms among university students. Six hundred and sixty-six university students participated in the present study: 286 from Poland and 320 from Italy. No age, gender and marital status differences were identified between two samples of university students. However, on average, Polish university students had a higher Body Mass Index than Italian ones. Our findings showed that Polish students present more problems related to obsessive symptomatology, core beliefs of OCD, perfectionism traits, and a major ON symptomatology than Italian ones. Also, Polish students with a higher level of ON exhibited higher levels of OCD symptoms and parental expectations/parental criticism. While Italian students with a higher level of ON showed higher levels of perfectionism features (organization and concern over mistakes). In general, correlations were low as confirmation of partial independence ON from OCD symptoms and core beliefs of OCD in both Polish and Italian university students. The present results highlight a need for further investigation of the correlates of ON across different cultural groups. Future research may screen individuals with ON to determine the comorbidity between ON and OCD symptomology to facilitate appropriate treatment choices. LEVEL OF EVIDENCE: Level V, Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Psychological Correlates of Excessive Healthy and Orthorexic Eating: Emotion Regulation, Attachment, and Anxious-Depressive-Stress Symptomatology

Orthorexia nervosa, the pathological obsession with eating healthy, shares risks and significant comorbidity with other mental disorders. Based on a behavioral conceptualization of the overlap, emotion regulation, attachment style, and anxious-depressive-stress symptomatology are prominent but insufficiently researched endophenotypes for orthorexia nervosa. This study aimed at identifying ways in which difficulties in emotion regulation and attachment-related anxiety and avoidance become apparent in orthorexia nervosa and healthy orthorexia. Additionally, the moderating role of anxious, depressive, and stress symptoms was explored. A convenience sample of 399 adults (266 women) completed questionnaires to measure orthorexia nervosa and healthy orthorexia, difficulties in emotion regulation, partnership-related bond, and anxious-depressive-stress symptomatology. The healthy orthorexia subscale was negatively associated with lack of emotional awareness but no other subscale of difficulties in emotion regulation or attachment-related anxiety and avoidance. Orthorexia nervosa scores were positively linked to difficulties in emotion regulation as well as attachment-related anxiety and avoidance. Multiple linear regression indicated non-acceptance of emotional responses and impulse control difficulties to be the strongest predictors for orthorexia nervosa. Both subscales also mediated the effects of attachment style on orthorexia nervosa with anxious-depressive-stress symptomatology moderating some of these effects. Individuals with higher orthorexia nervosa tendencies showed difficulties in emotion regulation, a common feature also of affective and eating disorders. Improvement in understanding the psychological features of orthorexia nervosa can enable a better differentiation from other disorders, advances in the development of treatment approaches and treatment planning, and outlines directions for future research on mechanisms.

Associations between orthorexia, disordered eating, and obsessive-compulsive symptoms: A systematic review and meta-analysis

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.

Association between impulsivity and orthorexia nervosa: any moderating role of maladaptive personality traits?

OBJECTIVES

To explore the possible moderating relation between impulsive behavior and maladaptive personality traits in regards to orthorexia nervosa (ON).

METHODS

This cross-sectional study was conducted between July and December 2019 and recruited 519 Lebanese adults from seven community pharmacies randomly selected from a list provided by the Lebanese Order of Pharmacists. The Teruel Orthorexia Scale (TOS) was employed to assess orthorexic eating tendencies, the I-8 measured impulsivity and the Personality Inventory for DSM-5 (PID) evaluated maladaptive personality traits.

RESULTS

Our results showed that, for I-8 subscales, only higher perseverance (B = 0.31) was significantly associated with higher ON. In regard to PID-5 subscales, only higher negative affect (B = - 0.34) was significantly associated with lower ON. Furthermore, significant interactions were found between personality traits and impulsivity to predict TOS-ON.

CONCLUSION

The current results show that female gender, maladaptive personality traits and impulsivity present contributing factors regarding orthorexic eating. Certain impulsivity dimensions were confirmed to interact with personality traits in the prediction of orthorexic eating thereby highlighting possible risk factors and psychopathological mechanisms.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Coping Using Sex, Health-Related Behaviors, and Mental Health During COVID-19 Lockdown in the UK

BACKGROUND

Peoples' sexual behaviors have changed during the period of enforced COVID-19 social distancing, in some cases, to cope with negative feelings during lockdown. Research on coping using sex is relatively restricted to samples of men with a history of sexual offending, and it is unknown whether coping using sex is associated with health-related behaviors and mental health in the general population.

AIM

We examined if coping using sex before and during lockdown was associated with adverse outcomes (i.e., self-perceived reduction in health-related behaviors and mental health) in a community sample.

HYPOTHESES

We hypothesized that participants who reported greater use of sex to cope in the weeks preceding lockdown would show a greater decline in health-related behaviors and mental health during lockdown. Furthermore, that changes in coping using sex resulting from lockdown would account for further variance in the worsening of health-related behaviors and mental health.

METHODS

Participants were UK residents, aged 18-60 years, and fluent in English. 789 participants completed an online survey, providing demographic information, self-reported social distancing, loneliness, and coping using sex over a 14-day period during lockdown, and retrospectively preceding lockdown.

OUTCOMES

Participants reported perceived changes in health-related behaviors and mental health symptomatology during lockdown compared to before the pandemic. They also self-reported levels of stress, anxiety and depression during lockdown.

RESULTS

Greater coping using sex prior to lockdown predicted positive change in health-related behaviors, for example, higher scores were associated with participants reporting having exercised and slept more. It was also associated with higher trait levels of anxiety, stress and depression during lockdown. Changes in coping using sex from before to during lockdown did not predict perceived changes in health related behaviors or mental health symptomatology.

CONCLUSIONS

Overall, greater coping using sex prior to lockdown was associated with worse mental health symptomatology during lockdown (anxiety, depression and stress), however, it was also associated with perceived positive change in health-related behaviors compared with before lockdown. This suggests that coping using sex may be associated with negative emotional reactions during lockdown, but may also be linked with positive change in health-promoting behaviors.

Orthorexia nervosa and its association with alexithymia, emotion dysregulation and disordered eating attitudes among Lebanese adults

OBJECTIVE

This study aims to explore whether orthorexia nervosa, like other eating disorders, is associated with difficulties identifying, describing, and regulating one's own emotions among a sample of Lebanese adults.

METHODS

A cross-sectional study was conducted during October 2020, during the lockdown period imposed by the government for the COVID-19 pandemic. All participants above 18 years of age were allowed to participate in this study. A total of 787 Lebanese adults out of 920 (85.54%) completed an online survey including Arabic versions of the ORTO-R measure of orthorexia, the Toronto Alexithymia Scale, the Difficulty in Emotion Regulation Scale, and the Eating Attitudes Test.

RESULTS

After making sure that all norms are verified, hierarchical linear regressions were conducted to evaluate the association between disordered eating attitudes (EAT scores) and ON (model 1), and after controlling for difficulties in emotion regulation (DERS score) (model 2). Model 1 accounted for 15.1% of the variance of ON (adj. R2 = 0.151, F(1, 786) = 140.06, p < 0.001) and showed that higher levels of disordered eating (higher EAT scores) (β = 0.15) were significantly associated with more ON tendencies and behaviors. When adding the DERS total score to the model, Model 2 was a much better fit with 17.7% of the variance of ON (adj. R2 = 0.177, F(2, 786) = 84.44, p < 0.001), with higher levels of emotion dysregulation (higher DERS scores) (β = 0.06) and more disordered eating attitudes (higher EAT scores) (β = 0.13) were associated with higher levels of ON (Table 5).

CONCLUSION

The present research suggests that people with high ON tendencies experience troubles recognizing, regulating, and describing their emotions, similarly to other disordered eating.

LEVEL OF EVIDENCE

5.

Transformative eating disorder research: qualitative research considerations

This letter identifies the potential of qualitative eating disorder research to work within a transformative paradigm that naturalizes the state of living with an eating disorder. The number of qualitative research publications with persons living with eating disorders have increased, however, a substantive proportion of this qualitative research follows traditional research paradigms that are built upon the assumption that eating disorders signify a personal deficit. Transformative qualitative eating disorder research has potential to include those living with eating disorders in all stages of the research process to ensure that research leads to the de-stigmatization of eating disorders promoting health, wellbeing, and quality of life for persons living with eating disorders.

Development and Validation of the Test of Orthorexia Nervosa (TON-17)

This study aims to develop and validate a new self-report questionnaire to measure orthorexia nervosa (ON). Based on a current review of the scientific literature and interviews with people at risk of orthorexia, 40 items were selected to test orthorexia nervosa (TON-40). A total sample of 767 individuals (M = 26.49, SD = 9.66, 56.98% women) participated in the study. The exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and composite construct analysis (CCA) were performed to find an appropriate model of sufficient reliability and validity and stable construction. Convergent validation was performed regarding the correlation of the TON-17 with another measure of ON (ORTO-15), eating disorders (the EAT-26 and DEAS), healthy behavior (the HBI), quality of life (the Brief WHOQOL), physical health (the GRSH), anxiety (the GAD-7), depression (the PHQ-9), and obsessive-compulsive disorder (the OCI-R). Gender, Body Mass Index (BMI), and the medical reasons for a restrictive diet were also examined. As a result of the structural analyses, the number of items was reduced from 40 to 17. The best fit indices of the TON-17 were found for the hierarchical bi-factor model, with three lower-order factors (Control of food quality, Fixation of health and healthy diet, and Disorder symptoms) and one general higher-order factor (Orthorexia). According to the 95th percentile method of estimation, the prevalence of ON was 5.5% for the TON-17 total score. The TON-17 scale and subscales showed good psychometric properties, stability, reliability, and construct validity. The TON-17 indicated a positive relationship with the ORTO-15, EAT-26, DEAS, HBI, OCI-R, GAD-7, and PHQ-9. TON-17 can be considered as a useful tool for assessing the risk of ON.

Evaluation of Orthorexia Nervosa and Symptomatology Associated with Eating Disorders among European University Students: A Multicentre Cross-Sectional Study

The objectives of the present study were to (1) evaluate prevalence of orthorexia nervosa (ON) in university students in Spain and Poland, (2) assess differences in ON and eating disorder (ED) pathology in both samples and (3) examine the relationship between ON and ED symptoms among Spanish and Polish university students. Eight hundred and sixty university students participated in the present study (M_age = 21.17 ± 3.38; M_BMI = 22.57 ± 3.76). The Spanish and Polish samples comprised 485 and 375 students, respectively. The Düsseldorf Orthorexia Scale and the Eating Disorder Inventory were used in the present study. ON prevalence rates of 2.3% and 2.9%, respectively, are found in the Spanish and Polish samples. Compared to Polish students, Spanish university students reported increased drive for thinness and lower body dissatisfaction, lower level of ineffectiveness and lower level of interpersonal distrust. ON was positively related to drive for thinness, bulimia, body dissatisfaction, perfectionism interoceptive awareness (in both Spanish and Polish students) and ineffectiveness (in Spanish students). Our findings suggest that ON significantly overlaps with ED symptoms, which is in line with recent studies. Longitudinal studies are needed to assess how ON develops in a sample of young adults and whether it develops in isolation of or in parallel with ED pathology.

Identifying the Profile of Orthorexic Behavior and "Normal" Eating Behavior with Cluster Analysis: A Cross-Sectional Study among Polish Adults

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.

Developmental pathway of orthorexia nervosa: Factors contributing to progression from healthy eating to excessive preoccupation with healthy eating. Experiences of Dutch health professionals

Orthorexia nervosa (ON) has in recent years attracted attention, but the scarcity of empirical research on the matter generates uncertainty about its progression. This study aims to gain insight into the developmental pathway of ON and factors contributing to it, to establish its etiology. In order to gain insights into health professionals' experience with patients that they identified as suffering from ON, this study adopted mixed methods, with a sequential exploratory design: first, semi-structured interviews (n = 10) were conducted; following, a questionnaire (n = 101) was administered online. Nutritionists, psychologists, psychotherapists, and support workers with experience in treating eating disorders in the Netherlands were the study's target group. Results shed light on environmental factors influencing the development of ON (e.g. pseudoscientific nutritional experts on social media), baseline risks (e.g. high level of education), initiating events (e.g. experiencing a break up), symptoms (e.g. feelings of depression and anxiety), diagnosis and type of treatment administered (e.g. cognitive-behavioral therapy). The current study is unique in its use of health professionals' experiential knowledge to assess how ON develops and who typically develops it. Furthermore, it contributes to the sparse literature on potential ways to treat ON. More top-down investigations into health professionals' experiences are encouraged as the literature on ON thickens.

"And it snowballed from there": The development of orthorexia nervosa from the perspective of people who self-diagnose

This study aims to include the perspective of those who share content about Orthorexia Nervosa (ON) on Instagram and self-diagnose with ON (SD-ON) to trace their development of ON, gain insights into risk factors, symptoms and recovery, and explore differences with those who do not SD-ON. This research used mixed methods, with a sequential explanatory design. The quantitative component (n = 185) aimed to identify biological, psychological, interpersonal, and contextual factors that play a role in each phase of ON development. The qualitative component (n = 10) aimed to probe how and why individuals who SD-ON feel that certain experiences have shaped their development of ON. Respondents defined ON an obsession with healthy eating and clean or pure foods, with unhealthy effects on physical, mental or social wellbeing. A minority of participants did not view ON as problematic, but as a "salvation" from chronic diseases. Three phases characterizing the development of ON were identified: onset, progression and help seeking. Regarding the onset, two routes were identified, both characterized by a snowball effect of interacting factors. Regarding the progression of ON, several symptoms were identified, with obsession with healthy eating being the most frequent one. The majority of participants were trying to lose weight during ON, but their rationale was health rather than appearance. Regarding the help-seeking phase, reasons for problem realization were identified. ON was not noticed by loved ones until major health problems occurred, this being a barrier for recovery. While most believed that recovery is possible, respondents agreed that ON is a condition that will always linger in the back of the mind. This study contributes to addressing the shortage of qualitative studies investigating ON from insiders' perspective.