Investigating the relationship between orthorexia nervosa and autistic traits in a university population

Abstract

Background Orthorexia nervosa (ON) is an emerging condition featuring restrictive eating behaviors on the basis of subjective beliefs about food healthiness. Many authors have stressed the similarities between ON and anorexia nervosa (AN) in both cognitive and behavioral patterns. Despite that, while the link between AN and female autism presentations is well known in the literature, no study has yet investigated the relationship between ON and autism spectrum. This work aims to investigate the relationship between ON and autistic traits in a university population. Methods An e-mail invitation was sent to all the students and University workers of University of Pisa. Subjects were asked to fulfill the ORTO-15 and the Adult Autism Subthreshold spectrum (AdAS spectrum) questionnaires. Results A total of 2426 subjects joined the survey: 623 subjects (26.3%) reported a score associated with significant orthorexic symptoms according to ORTO-15 (ON group), while 1789 subjects (73.7%) did not report ON symptomatology and were considered as healthy controls (HC). The ON group scored significantly higher on almost all AdAS spectrum domains. Moreover, being female and scoring higher on AdAS spectrum were statistically predictive factors for the presence of ON symptomatology. Among AdAS spectrum domains, higher scores on AdAS spectrum inflexibility and adherence to routine and restricted interests and rumination domains, as well as lower scores on verbal communication domain, were statistically predictive of orthorexic symptoms. Conclusions Our findings highlight an overlap between ON and autism spectrum psychopathology. Further studies are needed to clarify the relationship between restrictive eating disorders and female autism phenotypes.

Investigating Orthorexia Nervosa With The ORTO-R in a Sample of University Students With Or Without Subthreshold Autism Spectrum: Focus On Dietary Habits and Sex Differences

“…The distribution of ON in the two sexes is still debated. Several studies reported a higher prevalence among females, although with a lower male/female ratio with respect to AN [3][5][6] [13][14] [15]. However, not all the studies con rmed this result [16] [17].…”

“…To date, several instruments were developed for measuring ON. The most frequently employed questionnaire in this eld is the ORTO-15 [15][18], although this instrument has been increasingly criticized due to the lack of reliability and adherence to the ON symptoms. In particular, the ORTO-15 was developed and validated several years ago, before a more shared agreement on ON de nition and features was reached in the scienti c literature [19].…”

“…In line with the spectrum model, which features a dimensional approach to psychopathology and recognizes the presence of a continuum between full-blown disorders and isolated, atypical or more nuanced symptoms [28], AT seems to be distributed in a continuum from the general to the clinical population, being particularly represented in some speci c high risk groups, including subjects with other kinds of psychiatric disorders [21][29] [30][31] [32][33][34] [35][36] [37]. The similarities between AN and autism spectrum, together with the inverse prevalence of these conditions in the two sexes, led some authors to hypothesize that AN might be re-conceptualized as a female-speci c phenotype of ASD [15]. The possible link between autism spectrum and AN was further supported by studies focused on female presentations of ASD, which reported that autistic-like symptoms may be underrecognized among females due to the presence of different features with respect to those typical of males.…”

“…Moreover, female forms of ASD would feature different kinds of restricted interests, such as spending time with animals, focusing on ctions or celebrities, or also on food and diet [15][38] [39]. Despite this amount of studies about the link between autism spectrum and AN, limited research focused on evaluating the possible association between ON and AT.…”

“…Similarly, the sense of moral superiority and the intolerance towards the eating habits of other people may recall the de cits of the socioemotional reciprocity typically found in autistic patients [20]. A previous study by Carpita et al [15] showed, in a wide University population (students as well as University workers), a greater presence of AT among subjects with ON symptoms, measured by means of the ORTO-15. Moreover, they found that being females and reporting higher AT were statistically predictive factors towards the presence of ON.…”