The psychometric properties of Orthorexia Nervosa assessment scales: A systematic review and reliability generalization

Abstract

The main objective of this systematic review was to provide a comprehensive overview of the psychometric properties of all available Orthorexia Nervosa (ON) assessment tools, in order to evaluate their scope of application for research and practice. Ten databases were searched for studies quantitatively assessing ON. The psychometric properties were evaluated according to specified quality criteria, focusing on the reliability, structural validity and construct validity of the scales. A meta-analytic approach was used to summarize eligible Cronbach's alpha coefficients between studies. Sixty-eight unique studies fulfilled the inclusion criteria for this systematic review. Ten discrete ON scales were identified. Half of the included studies exclusively utilized a version of the ORTO-15. The evaluation of all available ON measures raise issues regarding ON's dimensionality and conceptualization.Most of the identified scales require further validation. Based on the reported psychometric properties it is advised to re-evaluate existing tools and to focus on establishing consensus regarding the conceptualization of ON to establish a measure with sound psychometric properties.

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

“…Orthorexia nervosa (ON) is defined as “a pathological obsession, fixation or preoccupation with healthy food” [ 1 ] (p. 1). Although many researchers agree with the above definition, particular approaches to ON vary, highlighting different diagnosis criteria [ 2 ], such as weight loss [ 3 ], phobic avoidances [ 4 ], and the exclusion of food allergies or medical conditions that require restrictive diets [ 5 , 6 ].…”

“…Although many researchers agree with the above definition, particular approaches to ON vary, highlighting different diagnosis criteria [ 2 ], such as weight loss [ 3 ], phobic avoidances [ 4 ], and the exclusion of food allergies or medical conditions that require restrictive diets [ 5 , 6 ]. Differences in the conceptualization of ON are reflected in the measurement methods, as has been shown in a recent review [ 1 ]. So far, ON has not been recognized as a separate disorder in either the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Statistical Classification of Diseases and Related Health Problems (ICD-10).…”

“…Although several assessment tools have been developed to date, criticism regarding the reliability and validity of existing questionnaires has led to the conclusion that there is a continuous need to create new tools to investigate ON [ 1 , 12 , 13 , 18 , 41 , 44 ]. A recent systematic review and reliability generalization [ 1 ] identified ten scales measuring ON: Body Image Screening Questionnaire (BISQ), Burda Orthorexia Risk Assessment (B-ORA), Bratman Orthorexia Test (BOT), Düsseldorf Orthorexia Scale (DOS), Eating Habits Questionnaire (EHQ), Eating Habits Questionnaire-Revised (EHQ-R), Orthorexia Nervosa Scale (ONS), ORTO-15, Scale to Measure Orthorexia in Puerto Rican Men and Women, and Teruel Orthorexia Scale (TOS). These Orthorexia Nervosa scales’ psychometric properties indicated that the main issues are related to dimensionality and conceptualization [ 1 , 2 , 41 ].…”

“…A recent systematic review and reliability generalization [ 1 ] identified ten scales measuring ON: Body Image Screening Questionnaire (BISQ), Burda Orthorexia Risk Assessment (B-ORA), Bratman Orthorexia Test (BOT), Düsseldorf Orthorexia Scale (DOS), Eating Habits Questionnaire (EHQ), Eating Habits Questionnaire-Revised (EHQ-R), Orthorexia Nervosa Scale (ONS), ORTO-15, Scale to Measure Orthorexia in Puerto Rican Men and Women, and Teruel Orthorexia Scale (TOS). These Orthorexia Nervosa scales’ psychometric properties indicated that the main issues are related to dimensionality and conceptualization [ 1 , 2 , 41 ]. For example, unstable factor structure and/or item-allocation in particular factors were shown for ORTO-15, EHQ, and DOS [ 1 ].…”

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

“…While using the DOS, ON incidence ranges from 1% to 8% [31]. Such diversity of ON prevalence could result from the difference in the psychometric quality of the questionnaires [32,33] and lack of an optimal cut-off value (e.g., a cutoff score of 35 based on the ORTO-15 [27]; a cutoff score of 30 or higher based on the DOS [29]; a cuttoff score of 72 based on the ONI [31]). Although the ORTO-15 has good predictive validity [27], the lack of basic psychometric properties and the internal consistency has been criticized [32].…”