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Plichta M, Kowalkowska J. Orthorexic tendency and its association with weight control methods and dietary variety in Polish adults: a cross-sectional study. Front Nutr 2024; 11:1355871. [PMID: 38711530 PMCID: PMC11073497 DOI: 10.3389/fnut.2024.1355871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/02/2024] [Indexed: 05/08/2024] Open
Abstract
The methods for controlling weight play a central role in formally diagnosed eating disorders (EDs) and appear to be important in the context of other nonformally recognized disorders, such as orthorexia nervosa (ON). These methods also have an impact on eating behaviors, including dietary variety. Our study aimed to: (i) assess the intensity of ON tendency by sex and BMI groups, (ii) evaluate the associations between ON tendency, weight control methods, and dietary variety, and (iii) determine the extent to which weight control methods and dietary variety contribute to the ON tendency among both females and males. Data were gathered from a sample of 936 Polish adults (463 females and 473 males) through a cross-sectional quantitative study conducted in 2019. Participants were requested to complete the ORTO-6, the Weight Control Methods Scale, and the Food Intake Variety Questionnaire (FIVeQ). Multiple linear regression analysis was employed to evaluate associations between ON tendency, weight control methods, and dietary variety. Females exhibited a higher ON tendency than males (14.4 ± 3.4 vs. 13.5 ± 3.7, p < 0.001, d = 0.25). In the regression model, the higher ON tendency was predicted by more frequent use of weight control methods, such as restricting the amount of food consumed, using laxatives, and physical exercise among both females and males as well as following a starvation diet in females, and drinking teas to aid bowel movements among males. Moreover, the higher ON tendency was predicted by higher dietary variety, lower age in both sexes, and higher level of education among males. However, there were no differences in ON tendency across BMI groups. In conclusion, the findings showed that ON tendency was predicted by a higher frequency of weight control methods commonly used by individuals with anorexia nervosa (AN) and bulimia nervosa (BN). The resemblance to these two EDs is also suggested by the higher intensity of ON tendency among females and younger people. However, the prediction of ON tendency by dietary variety indicates that the obsessive preoccupation with healthy eating may not be advanced enough to observe a decrease in the dietary variety among these individuals.
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Affiliation(s)
- Marta Plichta
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), Warsaw, Poland
| | - Joanna Kowalkowska
- Department of Human Nutrition, Faculty of Food Science, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
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Tayhan F, Doğan G, Yabancı Ayhan N, Sancar C. Assessment of eating disorders and depression in postpartum women. Eur J Clin Nutr 2024; 78:314-319. [PMID: 38093097 DOI: 10.1038/s41430-023-01384-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/15/2023] [Accepted: 11/29/2023] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To determine the prevalence of eating disorders and orthorexia in postpartum women and examine the relationship with postpartum depression. STUDY DESIGN Included in this study were 227 postpartum women. The Eating Attitude Test-26 (EAT-26) was used to determine the risk of eating disorders in the women, followed by the Orthorexia 11 Scale (ORTO-11) to identify orthorexia, and the Edinburgh Postpartum Depression Scale (EPDS) to identify postpartum depression. RESULTS 63 of the women (27.8%) exhibited an orthorexic tendency, which was also related to eating disorders and postpartum depression. Each one-point increase in the EAT-26 score led to a decrease of 0.32 points in the ORTO-11 score. Similarly, each one-point increase in the EPDS score caused a reduction of 0.18 points in the ORTO-11 score. The ORTO-11 score increased by 0.26 points per each live birth. CONCLUSION An obsessive focus on healthful nutrition may result in the impairment of health and numerous adverse psychological and physiological outcomes in the future. Healthy eating habits should be maintained to improve the quality of life without causing an obsession with healthy eating.
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Affiliation(s)
- Fatma Tayhan
- Çankırı Karatekin University, Health Science Faculty, Department of Nutrition and Dietetics, Çankırı, Türkiye.
| | - Gökcen Doğan
- Lokman Hekim University, Health Sciences Faculty, Department of Nutrition and Dietetics, Ankara, Türkiye
| | - Nurcan Yabancı Ayhan
- Ankara University, Health Sciences Faculty, Department of Nutrition and Dietetics, Ankara, Türkiye
| | - Ceren Sancar
- Izmir Private ATA Sağlık Hospital, Department of Gynecology and Obstetrics, Izmir, Türkiye
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Barthels F, Fischer M, Keskini R, Schöl AM, Pietrowsky R. The various facets of orthorexic eating behavior: five case reports of individuals with supposed orthorexia nervosa. J Eat Disord 2024; 12:31. [PMID: 38383470 PMCID: PMC10882829 DOI: 10.1186/s40337-024-00988-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/11/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Orthorexia nervosa, defined as a fixation on eating healthy according to subjective criteria, is recently being discussed as another variant of disordered eating behavior. Further characteristics are rigid adherence to nutritional rules, anxieties and avoidance behavior in the context of eating as well as a focus on health, not on body shape or weight loss, which is supposed to differentiate orthorexic from other disordered eating behavior. Although diagnostic criteria have been suggested, they have rarely been used in case reports published to date. Hence, the aim of this study was to present five individuals with supposed orthorexia nervosa, using preliminary diagnostic criteria to assess their eating behavior. CASE PRESENTATION The five cases (three females, two males) reveal the great variety of disordered eating behavior. Fear of unhealthy overweight (case A), supposed orthorexic eating behavior as a coping strategy for anorexia nervosa (case B), the exclusive consumption of animal products with a total exclusion of fruits and vegetables (case C), the fixation on exercise and athletic goals (case D) as well as a focus on a vegan diet and unprocessed foods (case E) are facets of orthorexia nervosa with varying degrees of impairment. CONCLUSIONS It is concluded that orthorexia nervosa manifests itself in very different ways and that more research is needed in order to determine whether it could be a useful additional category of disordered eating behavior.
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Affiliation(s)
- Friederike Barthels
- Institute of Experimental Psychology, Department of Clinical Psychology, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.
| | - Maren Fischer
- Institute of Experimental Psychology, Department of Clinical Psychology, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Raphaela Keskini
- Institute of Experimental Psychology, Department of Clinical Psychology, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Amelie Marie Schöl
- Institute of Experimental Psychology, Department of Clinical Psychology, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Reinhard Pietrowsky
- Institute of Experimental Psychology, Department of Clinical Psychology, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
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Vasiliu O. An integrative model as a step toward increasing the awareness of eating disorders in the general population. Front Psychiatry 2023; 14:1184932. [PMID: 37205977 PMCID: PMC10188970 DOI: 10.3389/fpsyt.2023.1184932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/18/2023] [Indexed: 05/21/2023] Open
Abstract
Eating disorders (EDs) represent a contradictory chapter of clinical psychiatry, i.e., although they are associated with significant prevalence and risks in the long term (including vital risk, especially for anorexia nervosa), the therapeutic resources are minimal and based on low-quality data. Another contradiction arose in the last few decades, i.e., a variety of new EDs have been described, either by clinicians or signaled by mass media, but their systematic exploration is progressing very slowly. Entities like "food addiction," "orthorexia nervosa," or "emotional eating disorder" still require intensive exploration in order to find the most accurate diagnostic instruments, diagnosis criteria, prevalence data, vulnerability factors, and therapeutic approaches. This article is focused on integrating into a comprehensive model a variety of EDs not specified or loosely defined by the current international classifications of psychiatric disorders. This framework is intended as an instrument for stimulating clinical and epidemiological research, with potential favorable consequences for therapeutic research. The dimensional model suggested here includes four main categories that accommodate the already recognized EDs (i.e., anorexia nervosa, bulimia nervosa, and binge eating disorder) as well as ten EDs that still need intensive research to find their clinical and pathophysiological characteristics. More good-quality studies are urgently required regarding this topic, based on the mental and physical negative impact these EDs may have in the short and long term, especially in vulnerable populations (e.g., pregnant women, athletes, adolescents, etc.).
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Yakın E, Obeid S, Fekih-Romdhane F, Soufia M, Sawma T, Samaha S, Mhanna M, Azzi R, Mina A, Hallit S. "In-between orthorexia" profile: the co-occurrence of pathological and healthy orthorexia among male and female non-clinical adolescents. J Eat Disord 2022; 10:155. [PMID: 36329509 PMCID: PMC9633027 DOI: 10.1186/s40337-022-00673-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The profile of adolescents with orthorexic eating behaviors remains to be explored. This study is the first to explore the typology of Lebanese adolescents from a large non-clinical sample based on orthorexia nervosa (ON) and healthy orthorexia (HO). METHOD A total of 555 adolescents (aged between 15 and 18 years) completed a set of questionnaires assessing orthorexic behaviors, self-esteem, stress, depressive and anxiety symptoms. Cluster analysis based on ON and HO scores was used to identify the typology of the sample. More precisely, this analysis was used to reveal and distinguish between naturally occurring subgroups of individuals with different orthorexic eating profiles, within the studied sample. Further, a series of one-way ANOVA was used to compare observed clusters based on their scores on used questionnaires. This analysis was used to capture the behavioral and psychological differences between previously yielded subgroups of individuals. RESULTS Cluster analysis based on ON and HO scores yielded 3 distinct groups: "Low orthorexia", "Moderate in-between orthorexia" and "High in-between orthorexia". While the first group represented individuals with no particular (healthy or pathological) interest in healthy eating, the two latter groups represented those with respectively moderate and high degrees of an interest in healthy eating that has both pathological and healthy aspects. Significant differences between clusters regarding their levels of stress, depression, anxiety and self-esteem was observed, yet they were found to be negligible due to poor effect sizes. CONCLUSION Findings from this study suggest that ON and HO can indeed co-occur among adolescents, that this co-occurrence can be experienced at different severity levels. Low effect sizes for ANOVA comparisons may suggest the possibility of the co-occurrence of ON and HO reducing the negative effects of ON behavior to some degree. The potential role of confusion around what constitutes "healthy eating" in the emergence of these "in-between orthorexia" profiles is put forward.
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Affiliation(s)
- Ecem Yakın
- Centre d'Études et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse-Jean Jaurès, UT2J, 5 allées Antonio Machado, 31058, Toulouse, France
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, 2010, Manouba, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Michel Soufia
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Toni Sawma
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Serena Samaha
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Mariam Mhanna
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Reine Azzi
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Anthony Mina
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon. .,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
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Dajon M, Sudres JL. Accompagner l’orthorexie dans les troubles des conduites alimentaires : création et évaluation d’un programme psychothérapeutique. L'Évolution Psychiatrique 2022. [DOI: 10.1016/j.evopsy.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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7
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Koning E, Vorstman J, McIntyre RS, Brietzke E. Characterizing eating behavioral phenotypes in mood disorders: a narrative review. Psychol Med 2022; 52:2885-2898. [PMID: 36004528 PMCID: PMC9693712 DOI: 10.1017/s0033291722002446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/06/2022] [Accepted: 07/12/2022] [Indexed: 01/05/2023]
Abstract
Mood disorders, including depressive and bipolar disorders, represent a multidimensional and prevalent group of psychiatric illnesses characterized by disturbances in emotion, cognition and metabolism. Maladaptive eating behaviors in mood disorders are diverse and warrant characterization in order to increase the precision of diagnostic criteria, identify subtypes and improve treatment strategies. The current narrative review synthesizes evidence for Eating Behavioral Phenotypes (EBP) in mood disorders as well as advancements in pathophysiological conceptual frameworks relevant to each phenotype. Phenotypes include maladaptive eating behaviors related to appetite, emotion, reward, impulsivity, diet style and circadian rhythm disruption. Potential treatment strategies for each phenotype are also discussed, including psychotherapeutic, pharmacological and nutritional interventions. Maladaptive eating behaviors related to mood disorders are relevant from both clinical and research perspectives, yet have been somewhat overlooked thus far. A better understanding of this aspect of mood disorders holds promise to improve clinical care in this patient group and contribute to the subtyping of these currently subjectively diagnosed and treated disorders.
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Affiliation(s)
- Elena Koning
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada
| | - Jacob Vorstman
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Elisa Brietzke
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
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Hanras E, Dorard G, Boujut E. Une ou plusieurs orthorexies ? Conceptualisation, évaluation et enjeux sociétaux : une revue critique de la littérature. Psychologie Française 2022. [DOI: 10.1016/j.psfr.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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9
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Gkiouleka M, Stavraki C, Sergentanis TN, Vassilakou T. Orthorexia Nervosa in Adolescents and Young Adults: A Literature Review. Children (Basel) 2022; 9:365. [PMID: 35327737 PMCID: PMC8947656 DOI: 10.3390/children9030365] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/20/2022] [Accepted: 02/26/2022] [Indexed: 01/18/2023]
Abstract
Adolescents are a nutritionally vulnerable population; eating disorders are more common among adolescents and young adults. Orthorexia nervosa (ON) is a non-formally recognized condition characterized by an obsessive preoccupation with eating healthy and "pure" foods; the quality and not the quantity of food is pivotal in ON. ON is a complex entity which can be associated with severe diet restrictions, a negative impact on social relationships, and with physical and mental health conditions, including obsessive-compulsive disorder. In light of this, a literature review regarding the background, diagnosis, features, risk factors, interplay with the social media, and management of ON is presented in this article, with a focus on adolescents and young adults.
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Affiliation(s)
- Maria Gkiouleka
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens University Campus, 11521 Athens, Greece; (M.G.); (C.S.); (T.N.S.)
- Health Centre of Nea Kallikrateia, 63080 Nea Kallikrateia, Greece
| | - Christina Stavraki
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens University Campus, 11521 Athens, Greece; (M.G.); (C.S.); (T.N.S.)
- 2nd Primary School of Nafpaktos, 30300 Nafpaktos, Greece
| | - Theodoros N. Sergentanis
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens University Campus, 11521 Athens, Greece; (M.G.); (C.S.); (T.N.S.)
| | - Tonia Vassilakou
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens University Campus, 11521 Athens, Greece; (M.G.); (C.S.); (T.N.S.)
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Taştekin Ouyaba A, Çiçekoğlu Öztürk P. The effect of the information-motivation-behavioral skills (IMB) model variables on orthorexia nervosa behaviors of pregnant women. Eat Weight Disord 2022; 27:361-372. [PMID: 34097285 DOI: 10.1007/s40519-021-01237-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE This study aims to test the effect of the components of the Information-Motivation-Behavioral Skills Model on Orthorexia Nervosa (ON) behavior of pregnant women and health outcomes using a hypothetical model. METHODS The study is cross-sectional research and was carried out with 350 pregnant women who had the Non-Stress Test in the obstetrics outpatient clinic of a university hospital. The participants were selected using the convenience sampling method. The data were collected with a questionnaire. Data were analyzed using the structural equation model. RESULTS It was found that 26.6% of pregnant women had an ON tendency. High information for obsession with obsession with healthy eating causes more ON behaviors (β = - 0.25, p < 0.001). The higher motivation for obsession with healthy eating obsession (β = 0.73, p < 0.01) and a higher tendency to ON behaviors (β = - 0.16, p < 0.05) are associated with better health outcomes. CONCLUSION Our findings show that high levels of information and motivation about the obsession with healthy eating effect ON tendency and health outcomes. The findings are significant in that they lead and guide the interventions for the detection, prevention, and treatment of ON during pregnancy. LEVEL OF EVIDENCE Level V, cross-sectional study.
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Affiliation(s)
- Ayşe Taştekin Ouyaba
- Obstetrics and Gynecology Nursing, Faculty of Health Sciences, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey.
| | - Pınar Çiçekoğlu Öztürk
- Psychiatric Nursing, Fethiye Faculty of Health Sciences, Muğla Sıtkı Kocman University, Muğla, Turkey
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Bhattacharya A, Cooper M, McAdams C, Peebles R, Timko CA. Cultural shifts in the symptoms of Anorexia Nervosa: The case of Orthorexia Nervosa. Appetite 2021; 170:105869. [PMID: 34910984 DOI: 10.1016/j.appet.2021.105869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/29/2021] [Accepted: 12/11/2021] [Indexed: 12/26/2022]
Abstract
Orthorexia Nervosa (ON) is a term describing a fixation on food purity, involving ritualized eating patterns and a rigid avoidance of "unhealthy foods." Those self-identified as having ON tend to focus on food composition and feel immense guilt after eating food deemed "unhealthy." Although not formally recognized as a psychiatric disorder by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), ON has received increasing attention since its identification in 1997. There is ongoing work to establish diagnostic and empirical tools for measuring ON; embedded in this is the question as to whether or not ON is a new eating disorder. In this paper, we argue ON is not a new psychiatric disorder but rather a new cultural manifestation of anorexia nervosa (AN). We begin by providing an overview of historical representations and classification of eating disorders, with a specific focus on AN. This is followed by discussion of the rise in diet culture and healthism since the 19th century. We conclude by examining the diagnostic validity and utility of ON through a discussion of empirical evidence. Classifying ON under the diagnostic umbrella of AN may improve our understanding of factors underlying restrictive eating behaviors.
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Affiliation(s)
- Anushua Bhattacharya
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19104, USA.
| | - Marita Cooper
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19104, USA.
| | - Carrie McAdams
- Department of Psychiatry, University of Texas Southwestern Medical School, 6363 Forest Park Road, Dallas, TX, 75390, USA.
| | - Rebecka Peebles
- Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, 800 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - C Alix Timko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19104, USA; Department of Psychology in Psychiatry, Perelman School of Medicine at University of Pennsylvania, 800 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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12
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Bóna E, Erdész A, Túry F. Low self-esteem predicts orthorexia nervosa, mediated by spiritual attitudes among frequent exercisers. Eat Weight Disord 2021; 26:2481-9. [PMID: 33502732 DOI: 10.1007/s40519-020-01095-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 12/12/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The aim of this study was to measure how orthorexic tendencies relate to age, self-esteem, and spirituality. We conducted the study on a sample of Hungarian adults performing regular fitness activity. METHOD 175 participants completed a four-part online survey: demographics and training habits, the Rosenberg Self-Esteem Scale, the Eating Habits Questionnaire-Revised (EHQ-R), and one of the Spiritual Awareness questionnaire's subscale. We performed univariate linear regression to assess the predictor role of age on orthorexic tendencies. Mediation analysis was conducted to determine the effect of self-esteem on orthorexic tendencies and the mediator role of spiritual attitudes. RESULTS Age negatively correlated with EHQ-R, and there were no gender differences. Lower self-esteem was a predictor for orthorexic tendencies with the total effect of ß = -0.3046 (p < 0.0001). In part, this is a direct relationship, but it is mediated by spiritual awareness as well. DISCUSSION Among frequent exercisers, strict dieting is likely to originate from a lack of self-esteem due to perfectionist standards, social comparison, and the aspiration of being in control. In case self-esteem is achieved through spiritual approaches, individuals may experience positive changes in their attitudes toward eating and their bodies as well. In the future, it is important to confirm whether the EHQ-R indicates diagnostic boundaries. LEVEL OF EVIDENCE Level V, descriptive cross-sectional study.
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Plasonja N, Décamps G. Validation française de l’échelle de mesure de l’orthorexie ORTO-15 et étude des liens avec les troubles des conduites alimentaires et l’image du corps. Psychologie Française 2021. [DOI: 10.1016/j.psfr.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Lasson C, Barthels F, Raynal P. Psychometric evaluation of the French version of the Düsseldorfer Orthorexia Skala (DOS) and prevalence of orthorexia nervosa among university students. Eat Weight Disord 2021; 26:2589-2596. [PMID: 33565005 DOI: 10.1007/s40519-021-01123-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/20/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study aimed at obtaining a French version of the DOS (F-DOS) and evaluating its psychometric properties in a sample of university students, then assessing the prevalence of orthorexic eating behavior among the participants. METHODS The F-DOS was obtained using back translation, and then administered to 3235 university students (10.32% men, 89.67% women) with a mean age of 21.13 (SD = 2.23). The Eating Habits Questionnaire and Eating Attitudes Test were used to assess convergent and divergent validities, respectively. Confirmatory factor analysis was performed to explore the factor structure. RESULTS Ordinal ⍵ of F-DOS was 0.87, indicating very good internal consistency. F-DOS and EHQ total scores were strongly correlated (rs = 0.74, p < 0.001), indicating very good construct validity. Factor analysis revealed a well-fitted one-factor model. Regarding Orthorexia Nervosa (ON) prevalence, according to DOS cut-off score, 3.28% of participants could be considered having ON, while an additional 11.31% could be at risk of developing ON. CONCLUSIONS The F-DOS appears to be a valid and reliable instrument to assess orthorexic eating behavior. ON prevalence in college students appeared similar to Germany and lower than in the US. LEVEL OF EVIDENCE Descriptive (cross-sectional) study, Level V.
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Affiliation(s)
- Clotilde Lasson
- Laboratoire Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de La Santé, Université Toulouse-Jean Jaurès, UT2J, 5 allées Antonio Machado, 31058, Toulouse, France.
| | - Friederike Barthels
- Heinrich-Heine-University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Patrick Raynal
- Laboratoire Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de La Santé, Université Toulouse-Jean Jaurès, UT2J, 5 allées Antonio Machado, 31058, Toulouse, France
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Rania M, de Filippis R, Caroleo M, Carbone E, Aloi M, Bratman S, Segura-Garcia C. Pathways to orthorexia nervosa: a case series discussion. Eat Weight Disord 2021; 26:1675-83. [PMID: 32666375 DOI: 10.1007/s40519-020-00948-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 06/16/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Orthorexia nervosa (ON) has gained increasing interest in the last 2 decades. Although a consensus on the diagnostic boundaries of ON has not yet been reached, there is some evidence for an overlap with eating disorders, obsessive-compulsive disorder, and psychotic disorder. Most of the knowledge about ON has emerged from studies of non-clinical and at-risk populations and is focused on differential diagnosis; therefore, further clinical studies are needed to better outline the ON phenomenon in a real-life setting. OBJECTIVE This case series aims at describing clinical cases that developed symptoms suggestive of ON after being diagnosed with a prior psychiatric disorder and then discussing them in light of possible clinical pathways. METHODS Four women consecutively admitted to an outpatient unit for the treatment of eating disorders were diagnosed with ON through a clinical interview, according to Dunn and Bratman's criteria and self-administered questionnaire assessment (ORTO-15), and were considered to be eligible for this case series study. Psychiatric anamnestic data were collected retrospectively. RESULTS The anamnesis revealed that all patients were previously diagnosed with a psychiatric disorder (i.e. obsessive-compulsive disorder, bulimia nervosa, illness anxiety disorder, and psychotic disorder) before developing ON. CONCLUSION Past literature focused on differential diagnosis between ON and other psychiatric disorders. This is the first description of clinical cases in a real-life setting that started with different psychiatric disorders and later developed symptoms suggestive of ON. These cases have generated a new research question on the possibility that different psychiatric disorders may associate with a later onset of ON. LEVEL OF EVIDENCE Level V, descriptive study.
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Kaźmierczak-Wojtaś N, Patryn R, Zagaja A, Drozd M, Niedzielski A. Prevalence and Characteristics of Orthorectic Disorders in Adolescence and Young People: Polish Preliminary Studies. Nutrients 2021; 13:1568. [PMID: 34066985 DOI: 10.3390/nu13051568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/25/2021] [Accepted: 05/05/2021] [Indexed: 12/13/2022] Open
Abstract
The aim of this work was to assess orthorectic behaviors among young people and to evaluate their attitudes towards caring for their health. The study was conducted in 2019 on a group of 538 respondents aged 16–35. After analysis, 65 questionnaires were eliminated from further research, and the assessment of orthorectic disorders was performed using a method based on the modified ORTO-15 questionnaire on a group of 473 respondents. A large percentage of them exhibited an increased risk of orthorectic behaviors (32.8), which was higher among women than men (34.7% and 28.2%, respectively). People with higher risks of orthorectic disorders significantly more often reduced their consumption of foods high in fats and sugars. Attitudes of people with orthorectic disorders towards health care proved neutral, with a tendency to be positive. Nutritional behaviors observed in the studied group show some irregularities, which indicates the need for preventive and educational measures aimed at increasing awareness of the role of proper nutrition among young people. The obtained results may be the basis for further research on ON symptoms. One of the major areas of future research would be to create a reliable diagnostic tool which would allow for distinguishing between orthorexia and overdiagnosis.
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Abstract
At the crossroads of social influences and the psychopathology of everyday life, orthorexis is a little-known concept. This obsession with a healthy diet with deleterious consequences raises questions of differential clinical evaluation. Case studies and clinical illustrations provide a better understanding of what some orthorexic people think, feel, do and experience in having these restrictive and deviant relationships to food.
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Affiliation(s)
- Marie Dajon
- Université Toulouse-Jean-Jaurès, centre d'études et de recherches en psychopathologie et psychologie de la santé, UFR de psychologie, 5, allées Antonio-Machado, 31058 Toulouse cedex 9, France
| | - Jean-Pierre Bouchard
- Institut psycho-judiciaire et de psychopathologie (IPJP), Institute of Forensic Psychology and Psychopathology, centre hospitalier de Cadillac, 10, avenue Joseph-Caussil, 33410 Cadillac, France; Unité pour malades difficiles, pôle de psychiatrie médico-légale, centre hospitalier de Cadillac, 10, avenue Joseph-Caussil, 33410 Cadillac, France.
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Brytek-Matera A, Sacre H, Staniszewska A, Hallit S. The Prevalence of Orthorexia Nervosa in Polish and Lebanese Adults and Its Relationship with Sociodemographic Variables and BMI Ranges: A Cross-Cultural Perspective. Nutrients 2020; 12:E3865. [PMID: 33348787 PMCID: PMC7767210 DOI: 10.3390/nu12123865] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023] Open
Abstract
The prevalence of orthorexia nervosa (ON) appears to be increasing, and more research into its cross-cultural aspects is required to provide culturally appropriate psychological treatment. Until now, there has been relatively little research published about ON across cultures. Therefore, the objectives of the present study were to determine: (1) the prevalence of ON in Polish and Lebanese adults and (2) the association between ON and sociodemographic variables and Body Mass Index (BMI) in two culturally different samples. One thousand two hundred and sixty-two adults participated in the present study (NPoland = 743 adults; NLebanon = 519 adults). The Düsseldorf Orthorexia Scale and the Eating Habits Questionnaire were used in the present study. Information about age, sex, anthropometry, and marital status was obtained from all participants as well. The Polish sample had an ON prevalence rate of 2.6%, while the Lebanese sample had an ON prevalence rate of 8.4%. No significant correlation was found between ON and age in both samples. A statistically significant difference was found between marital status and country on ON, with the highest mean score seen among Lebanese singles. In Lebanon, having a low of BMI ≤ 25 kg/m2 compared to a high BMI was significantly associated with lower ON tendencies, while this association was not significant among Polish participants. This study was the second to focus on the prevalence of ON in Western and non-Western countries and its association with sociodemographic characteristics and BMI ranges. Knowledge about ON and its correlates in diverse populations may inform the design of culturally tailored behavior change interventions and the development of culturally appropriate tools in various groups to improve their dietary patterns.
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Affiliation(s)
- Anna Brytek-Matera
- Institute of Psychology, University of Wroclaw, Dawida 1, 50-527 Wroclaw, Poland
| | - Hala Sacre
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon; (H.S.); (S.H.)
| | - Anna Staniszewska
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon; (H.S.); (S.H.)
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon
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Brytek-Matera A, Onieva-Zafra MD, Parra-Fernández ML, Staniszewska A, Modrzejewska J, Fernández-Martínez E. Evaluation of Orthorexia Nervosa and Symptomatology Associated with Eating Disorders among European University Students: A Multicentre Cross-Sectional Study. Nutrients 2020; 12:E3716. [PMID: 33271906 DOI: 10.3390/nu12123716] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/28/2020] [Accepted: 11/30/2020] [Indexed: 12/13/2022] Open
Abstract
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 (Mage = 21.17 ± 3.38; MBMI = 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.
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Strahler J, Stark R. Perspective: Classifying Orthorexia Nervosa as a New Mental Illness-Much Discussion, Little Evidence. Adv Nutr 2020; 11:784-789. [PMID: 32059052 PMCID: PMC7360443 DOI: 10.1093/advances/nmaa012] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/15/2020] [Accepted: 01/31/2020] [Indexed: 12/20/2022] Open
Abstract
Significant prevalence rates of pathological healthful eating and its extreme form, orthorexia nervosa (ON), the pathological obsession with healthy eating, have led to increased efforts to understand this phenomenon's clinical relevance. This narrative review qualitatively summarizes existing evidence on the (psycho-)pathology and consequences of ON and offers an interpretation within the frame of existing theories and models of psychiatric disease. Adding to the controversy in the field of ON, this review offers important critiques and identifies gaps in our current understanding of ON as a (distinct) mental illness.
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Affiliation(s)
- Jana Strahler
- Psychotherapy and Systems Neuroscience, Justus-Liebig-University, Giessen, Germany
| | - Rudolf Stark
- Psychotherapy and Systems Neuroscience, Justus-Liebig-University, Giessen, Germany
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21
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Plichta M, Jezewska-Zychowicz M, Małachowska A. Relationship between Psychosocial Impairment, Food Choice Motives, and Orthorexic Behaviors among Polish Adults. Nutrients 2020; 12:E1218. [PMID: 32357486 DOI: 10.3390/nu12051218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 01/03/2023] Open
Abstract
Orthorexic behaviors correlate not only with health motives when choosing food but may also coexist with psychosocial impairment. The aim of this study was to assess the motives of food choice and psychosocial impairment among adults with orthorexic behaviors through the use of ORTO-15 and ORTO-7. The data for the study were collected from a sample of 1007 Polish adults through a cross-sectional quantitative survey conducted in 2019. The respondents were asked to complete the ORTO-15 questionnaire, the Food Choice Questionnaire (FCQ), and the Clinical Impairment Assessment (CIA). Orthorexic behaviors were measured using both the 15-item and the shorter 7-item version of the ORTO questionnaire. To determine the factors coexisting with the orthorexic behaviors, linear regression models were developed. The scores of both ORTO-15 and ORTO-7 correlated positively with the global CIA scores and the scores of personal, cognitive, and social impairments, but compared to the ORTO-7 scores, the ORTO-15 scores showed weaker correlations with the global CIA score and individual CIA scales. Orthorexic behaviors measured with ORTO-15 correlated positively with such food choice motives as health, natural content, and weight control; whereas orthorexic behaviors measured with ORTO-7 showed positive bivariate correlations only with two food choice motives: health and weight control. In regression models, sensory appeal, age, and education lower than secondary were associated inversely with orthorexic behaviors measured by both the ORTO-15 and the ORTO-7. In conclusion, the obtained results confirm that orthorexic behaviors are associated with a higher score regarding health motivation and cause an increase in psychosocial impairment. In addition, orthorexic behaviors are associated with greater importance of body weight control, which confirms the relationship between orthorexic behaviors and other eating disorders (ED), such as anorexia nervosa (AN) and bulimia nervosa (BN). However, similar motives for food choice displayed by the groups with higher scores of the ORTO-15 and the ORTO-7 and strong correlation between results obtained from both tools confirmed the similarity between these two questionnaires, thus revealing the weak psychometric properties also of the shorter seven-item version of the ORTO. Future studies on food motives, psychosocial impairment, and orthorexic behaviors should consider using other tools for measuring orthorexic behaviors.
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Abstract
In this theoretical study, certain characteristics of orthorexia nervosa (ON) are assessed. As a type of disordered eating, ON is characterized as pathological healthy eating obsession. By reviewing previous literature, four orthorexic traits are investigated whether they meet the conditions of becoming adaptive drivers of human behavior. First, learned neophobia to avoid “improper” foods is considered as an advantageous strategy, secondly, ON being a cohesive force based on common beliefs and its religious, virtuous characteristics is adaptive as well. The third orthorexic trait in the form of physiological consequences (refeeding syndrome, malnutrition) suggests that ON is rather a nonadaptive health behavior, along with the fourth characteristic, namely, the psychological disturbances that health anxiety may induce. To conclude, ON can be viewed as an inherently useful tool to protect one’s health by diet, but also as a phenomenon which has extreme forms causing health problems. The exact etiologies are unexplored, therefore, the psychological, social and cultural drivers of extreme healthy eating are important to understand for future improvements. In order to establish the criteria and therapeutic guidelines, it would be beneficial to collect narrative data and experiences from individuals with orthorexic tendencies.
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Valente M, Syurina EV, Donini LM. Shedding light upon various tools to assess orthorexia nervosa: a critical literature review with a systematic search. Eat Weight Disord 2019; 24:671-682. [PMID: 31228168 PMCID: PMC6647444 DOI: 10.1007/s40519-019-00735-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/07/2019] [Indexed: 12/25/2022] Open
Abstract
AIM The aim of this literature review was to identify the tools developed and used to assess orthorexia nervosa (ON). METHODS A systematic search was executed in PubMed, Biomed Central, and PsycINFO. The final list included 70 articles that were critically analyzed. RESULTS A total of six tools were reported to assess ON: the BOT, the ORTO-15, the EHQ, the DOS, the BOS, and the TOS. The tools were based upon different conceptualizations of ON and of its diagnostic criteria. Although they were different, all the conceptualizations derived from the initial definition of ON provided by Bratman in 1997. None of the methodologies adopted for tool construction considered end users or client perspectives and, when carried out, the validations of the tools were fragmented and often based on specific populations. CONCLUSION This study may be a starting point for the construction of a new diagnostic tool for ON. Starting from the methodological weaknesses identified by this review, it was possible to derive some suggestions for future research: (a) developing a modern re-conceptualization of ON, comprehensive of end-user perspectives; (b) adopting qualitative data collection techniques to gain insights into how to diagnose ON; and (c) actively involving diverse stakeholders for constructing a new tool. LEVEL OF EVIDENCE Level of Evidence: I, systematic review.
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Affiliation(s)
- Martina Valente
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Elena V Syurina
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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24
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Farchakh Y, Hallit S, Soufia M. Association between orthorexia nervosa, eating attitudes and anxiety among medical students in Lebanese universities: results of a cross-sectional study. Eat Weight Disord 2019; 24:683-691. [PMID: 31183627 DOI: 10.1007/s40519-019-00724-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/30/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The objective of the study was to evaluate the association between orthorexia nervosa (ON) tendencies and behaviors, eating attitudes (EAT) and anxiety among a representative sample of medical students in the Lebanese universities. METHODS This cross-sectional study, conducted between May 2018 and January 2019, enrolled 627 medical students using a proportionate random sample from all seven faculties of medicine in Lebanon. The ORTO-15 scale was used to evaluate ON tendencies and behaviors among participants. Scores below 40 indicate the presence of ON. The Eating Attitude Test-26 and the Hamilton Anxiety Rating A (HAM-A) scales (yielding a psychic and a somatic subscale scores) were used to assess eating attitudes and anxiety, respectively. It is noteworthy that the sum of the EAT items 6, 7, 16 and 17 responses yielded the EAT score that would predict ON. RESULTS The results of a linear regression, taking the ORTO-15 score (15 items) as the dependent variable and the EAT total score, the summated score of the EAT items that predict ON and the psychic and somatic anxiety subscales scores as independent variables, showed that a higher EAT score (β = - 0.094) was significantly associated with lower ORTO-15 scores (more orthorexia tendencies and behaviors); whereas, a higher psychic anxiety subscale score (β = 0.117) was significantly associated with higher ORTO-15 scores (lower orthorexia tendencies and behaviors). CONCLUSION This suggests a link between eating disorders and ON which is beyond ON tendencies observed in eating disorders but ON individuals simultaneously have lesser psychological distress and anxiety. LEVEL OF EVIDENCE Level 5, cross-sectional descriptive study.
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Affiliation(s)
- Youssef Farchakh
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.
| | - Michel Soufia
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
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Parra-Fernández ML, Onieva-Zafra MD, Fernández-Martínez E, Abreu-Sánchez A, Fernández-Muñoz JJ. Assessing the Prevalence of Orthorexia Nervosa in a Sample of University Students Using Two Different Self-Report Measures. Int J Environ Res Public Health 2019; 16:ijerph16142459. [PMID: 31373283 PMCID: PMC6678205 DOI: 10.3390/ijerph16142459] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/28/2019] [Accepted: 07/09/2019] [Indexed: 02/01/2023]
Abstract
In recent decades, orthorexia nervosa (ON) has increased presence in society. It is related with beliefs and attitudes towards eating and is characterized by an obsessive behavior toward heathy eating. The prevalence of ON has been reported by numerous researchers, with rates varying considerably according to the tool used to evaluate the same parameter. The aim of this study was to compare the prevalence of ON in a single population using two different questionnaires. The test for the diagnosis of orthorexia (ORTO-11-ES) assessment tool for orthorexia nervosa and the Düsseldorfer Ortorexie Skala (DOS-ES), constitute brief self-report assessment tools which measure the risk of suffering ON. A sample of 492 students from the University of Castilla la Mancha (Spain) participated in this study, of whom 43.1% were male and 56.9% were female. The findings show that, according to the DOS-ES, only 10.5% of students displayed ON whereas, with the ORTO-11-ES, the prevalence of ON increased to 25.2%. The tendency towards orthorexic behavior is more closely associated with the female gender. The Body Mass Index (BMI) had no influence on the tendency for ON. This study provides valuable information on the usefulness of both questionnaires and the possible limitations associated with the use of these tools in the general population.
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Affiliation(s)
- María Laura Parra-Fernández
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing of Ciudad Real, Universidad de Castilla-La-Mancha, 13071 Ciudad Real, Spain
| | - María Dolores Onieva-Zafra
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing of Ciudad Real, Universidad de Castilla-La-Mancha, 13071 Ciudad Real, Spain.
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Haddad C, Obeid S, Akel M, Honein K, Akiki M, Azar J, Hallit S. Correlates of orthorexia nervosa among a representative sample of the Lebanese population. Eat Weight Disord 2019; 24:481-493. [PMID: 30603929 DOI: 10.1007/s40519-018-0631-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 12/14/2018] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Orthorexia nervosa (ON), or the pathological preoccupation and "fixation on healthy food" has been emerging as a new eating disorder. A limited amount of literature exists today on the prevalence of ON. The objective of the current study was to assess factors associated with ON tendencies and behaviors among a representative sample of the Lebanese population. METHODS This was a cross-sectional study, conducted between January and May 2018, which enrolled 811 participants from all Lebanese governorates. The ORTHO-15 scale was used to evaluate ON tendencies and behaviors among participants. Scores below 40 indicate the presence of ON. RESULTS The results showed that 589 (75.2%) participants had ON tendencies and behaviors. The results of the multivariable analysis taking the ORTHO-15 score as the dependent variable, showed that female gender (Beta = - 0.739), starving to lose weight (Beta = - 0.859), convincing others to follow a diet (Beta = - 0.971), thinking that eating out is unhealthy (Beta = - 0.931) and increased EAT (eating attitudes test) scores (Beta = - 0.087) were associated with higher level of orthorexia tendencies and behaviors (lower ORTHO-15 scores). CONCLUSION A highly unexpected prevalence of ON tendencies and behaviors was found in our sample. The Lebanese population might have high preoccupation behavior towards healthy and proper nutrition. Social awareness and behavioral intervention programs are warranted to follow a healthy diet and lifestyle behaviors, and consequently overcome ON. LEVEL OF EVIDENCE Level 5, cross-sectional descriptive study.
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Affiliation(s)
- Chadia Haddad
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Sahar Obeid
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- Faculty of Philosophy and Human Sciences, Holy Spirit University (USEK), Jounieh, Lebanon
- Faculty of Pedagogy, Lebanese University, Beirut, Lebanon
| | - Marwan Akel
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- INSPECT-LB, Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
| | - Karl Honein
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Maria Akiki
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Jocelyne Azar
- Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- Faculty of Medicine, Lebanese American University, Byblos, Lebanon
| | - Souheil Hallit
- INSPECT-LB, Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
- , Building 560, Street 8, 1st floor, Biakout, Lebanon.
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Depa J, Barrada JR, Roncero M. Are the Motives for Food Choices Different in Orthorexia Nervosa and Healthy Orthorexia? Nutrients 2019; 11:E697. [PMID: 30934544 PMCID: PMC6470526 DOI: 10.3390/nu11030697] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/11/2019] [Accepted: 03/21/2019] [Indexed: 12/12/2022] Open
Abstract
Recent research points to the bidimensional nature of orthorexia, with one dimension related to interest in healthy eating (healthy orthorexia) and another dimension related to a pathological preoccupation with eating healthily (orthorexia nervosa). Research was needed to provide further support for this differentiation. We examined the food-choice motives related to both aspects of orthorexia. Participants were 460 students from a Spanish university who completed the Teruel Orthorexia Scale and the Food Choice Questionnaire. By means of structural equation modeling, we analyzed the relationship between orthorexia, food-choice motives, gender, body mass index, and age. The motives predicting food choices in orthorexia nervosa and healthy orthorexia were quite different. In the case of orthorexia nervosa, the main motive was weight control, with sensorial appeal and affect regulation also showing significant associations. For healthy orthorexia, the main motive was health content, with sensorial appeal and price also showing significant associations. This supports the hypothesis that orthorexia nervosa is associated with maladaptive eating behavior motived more by weight control than by health concerns.
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Affiliation(s)
- Julia Depa
- Department of Nutritional, Food and Consumer Sciences, Fulda University of Applied Sciences, 36037 Fulda, Germany.
| | - Juan Ramón Barrada
- Departamento de Psicología y Sociología, Universidad de Zaragoza, 44003 Teruel, Spain.
| | - María Roncero
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de València, 46010 Valencia, Spain.
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