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

Abstract

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.

Orthorexia Nervosa and Disordered Eating Attitudes, Self-Esteem and Physical Activity among Young Adults

“…These results are in line with other studies showing that greater ON symptomatology is associated with greater disordered eating among adults from the general population [ 11 , 12 , 15 , 16 , 17 ]. It is worth pointing out that the recent systematic review and meta-analysis [ 18 ] on relationship between ON and disordered eating, and obsessive–compulsive (OCD) symptoms have demonstrated a moderate association between ON and EDs symptoms and a small association between ON and OCD symptoms. In addition, ON has been found to be more associated with EDs compared to OCD.…”

Orthorexia Nervosa in Adolescents and Young Adults: A Literature Review

“…ON is not currently recognized as an ED in DSM-5, since the great heterogeneity in its clinical presentations is insufficient to make a more specific diagnosis [21]. A history of EDs has shown positive correlations with ON in various studies [8,27]; accordingly, a recent systematic review and meta-analysis of 36 studies showed a significant, moderate association between ON and symptoms of EDs (pooled effect size = 0.36, 95% CI: 0.30-0.43) [28].…”

“…Having an anxious personality, the need to have complete control, the phobia of food impurity, and a potential tendency to perfectionism are some of their shared characteristics [19,50]. A systematic review and meta-analysis published in 2021 showed a significant association between ON and OCD symptoms (pooled effect size = 0.21, 95% CI: 0.15-0.27) [28].…”

Turkish version of the new instrument for Orthorexia Nervosa -Test of Orthorexia Nervosa (TON-17): a validity and reliability study

“…Speci cally, the authors emphasize rigidity, perfectionism, and other obsessive-compulsive traits as their common features, while the only difference between is that OCD symptoms are related to healthy eating in ON. In their metaanalysis, Zagaria et al [12] have reported that ON symptoms are more associated with eating disorders compared to OCD, and therefore ON can be included in the DSM classi cation as an emerging eating disorder.…”