Disentangling orthorexia nervosa from healthy eating and other eating disorder symptoms: Relationships with clinical impairment, comorbidity, and self-reported food choices

Zickgraf, Hana F.; Ellis, Jordan M.; Essayli, Jamal H.

doi:10.1016/j.appet.2018.12.006

Cited by 76 publications

(89 citation statements)

References 41 publications

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“…Note: 2 Whilst many papers suggest a similarity between ON and other eating disorders, some also suggest links with obsessive compulsive disorders (OCD). Please see [6,20,25] for a discussion of the relationship between ON and OCD.…”

Section: Diagnosismentioning

confidence: 99%

“…Research surrounding ON is notably limited [3], and while there are conflicting opinions surrounding the definitive diagnostic criteria for ON, making identifying the prevalence an on-going challenge, it seems that around 1% of the general population may be affected [4]. While ON is thought to be different from avoidance/restrictive food intake disorder (ARFID) [5] in that it is an obsession around eating clean food, rather than food that have certain sensory properties 1 , it has been found to have similarities with anorexia nervosa (AN) and bulimia nervosa (BN) [6], and has even been suggested to develop in the recovery phase of an eating disorder [7]. However, more research is needed to identify whether ON is similar to, or different from, other disorders so we can best understand and eventually treat it.…”

Section: Introductionmentioning

confidence: 99%

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Orthorexic tendencies are linked with difficulties with emotion identification and regulation

2020

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Background: Orthorexia nervosa (ON) is characterised by an unhealthy obsession with healthy eating and while it is not recognised as an eating disorder (or any disorder), current research is exploring similarities and differences with such disorders. The literature has shown that individuals with eating disorders have difficulties identifying and describing emotions (known as alexithymia) as well as regulating them. However no research to date has looked at whether people with orthorexic tendencies also suffer from difficulties with emotions. In this paper, we refer to people with orthorexic tendencies but do not assume that their healthy eating is at a pathological level needing clinical attention. Methods: The current study examined this by asking 196 healthy adults with an interest in healthy eating to complete four questionnaires to measure ON (ORTO-15reduced to ORTO-7CS), eating psychopathology (EAT-26), alexithymia (TAS-20) and emotion dysregulation (DERS-16). Results: We found that difficulties identifying and regulating emotions was associated with symptoms of ON, similar to what is found in other eating disorders. We suggest that ON behaviours may be used as a coping strategy in order to feel in control in these participants who have poor emotion regulation abilities. Conclusions: Our results show that individuals with ON tendencies may share similar difficulties with emotions compared to other eating disorders. While important, our results are limited by the way we measured ON behaviours and we recommend that further research replicate our findings once a better and more specific tool is developed and validated to screen for ON characteristics more accurately.

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Section: Diagnosismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Orthorexic tendencies are linked with difficulties with emotion identification and regulation

2020

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“…Whilst it has been argued that ON is a unique and specific eating disorder [12,15,16], a number of studies have identified common affective and cognitive agents operating in ON, obsessive-compulsive disorder (OCD) and other eating disorders [17,18]. More specifically, it has been suggested that anxious states similar to those reported by people with anorexia nervosa (AN) and OCD (strong beliefs about food and obsessive eating habits) may be characteristic of ON [19,20] and lead to "health anxiety" [21].…”

Section: Introductionmentioning

confidence: 99%

Selective attentional bias to food-related stimuli in healthy individuals with characteristics towards orthorexia nervosa

et al. 2019

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Purpose It has been argued that orthorexia nervosa (ON) is a unique type of disordered eating of food considered by the individual to be healthy. Given that in other eating disorder populations attentional preference for food-related cues influences eating behaviours, is it also likely that these biases may be a characteristic of ON tendency. Methods Eighty healthy individuals completed the ORTO-15 questionnaire (ON tendency), a modified Stroop task containing words related to healthy and unhealthy foods and perceived hunger levels pre-and post-testing. The ORTO-15 was used to identify participants within this sample who demonstrated more or less of the characteristics of ON. Results Results suggest that the presence of attentional bias to healthy, but not for unhealthy food-related stimuli independently predict increased ON tendency. Increased attentional bias towards healthy food-related stimuli is associated with increased scores on the ORTO-15. Conclusion Attentional bias, as a deficit in information processing, towards healthy food-related stimuli accounts for variability in ON characteristics. Level of evidence Level I, experimental study.

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“…Moreover, many authors have confirmed that ED is a significant determinant of psychosocial impairment [24,37,38]. In the study that indicated no correlation between ON symptoms and the global CIA score [39], the CIA questionnaire was modified to assess the impairment solely on the basis of eating habits. However, in the original version of CIA, exercises and nutritional considerations, figure, and body weight are included as factors affecting daily functioning, in addition to eating habits [40].…”

Section: Discussionmentioning

confidence: 99%

“…Until now no correlation was found between the ON and BMI, which was the main factor used to differentiate the orthorexic behaviors from AN [43][44][45]. Nevertheless, distinguishing orthorexic behaviors from AN or BN may be more difficult in practice than in theory [39]. What is more, this belief may change in the future, as the latest studies showed that the motive for choosing food, which is weight control, was positively correlated with ON [9].…”

Section: Discussionmentioning

confidence: 99%

Relationship between Psychosocial Impairment, Food Choice Motives, and Orthorexic Behaviors among Polish Adults

2020

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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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Disentangling orthorexia nervosa from healthy eating and other eating disorder symptoms: Relationships with clinical impairment, comorbidity, and self-reported food choices

Cited by 76 publications

References 41 publications

Orthorexic tendencies are linked with difficulties with emotion identification and regulation

Orthorexic tendencies are linked with difficulties with emotion identification and regulation

Selective attentional bias to food-related stimuli in healthy individuals with characteristics towards orthorexia nervosa

Relationship between Psychosocial Impairment, Food Choice Motives, and Orthorexic Behaviors among Polish Adults

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