The relation of orthorexia with lifestyle habits: Arabic versions of the Eating Habits Questionnaire and the Dusseldorf Orthorexia Scale

Abstract

Background Some of the commonly used tools to assess orthorexia nervosa (OrNe) do not allow a meaningful interpretation of the scores or yield mixed results about the dimensions needed to represent orthorexia. Since no advancement in the theoretical knowledge can be made without a thorough examination of the measurement aspects, this study aimed to evaluate the correlation between orthorexia nervosa (OrNe) and lifestyle habits, notably alcohol drinking, cigarette and waterpipe smoking, and physical exercise, and to validate and assess the psychometric properties of the Arabic versions of the Eating Habits Questionnaire (EHQ) and Düsseldorf Orthorexia Scale (DOS). Methods A total of 456 adult participants completed a self-administered questionnaire. Exploratory structural equation models were used to test the internal structure of the instruments. Shorter and more explicit versions were proposed for instruments. Pearson and partial correlations were computed between orthorexia scores and healthy behaviors scores. Results Regarding the internal structure of both EHQ and DOS, evidence favored the bi-dimensional construct of orthorexia. Both tools presented two theoretically clearly interpretable factors (OrNe and Healthy Orthorexia—HeOr—). The two questionnaires presented a high convergent validity, as dimensions with the same interpretation were correlated around 0.80. While OrNe was positively correlated with the use of unhealthy substances (higher alcohol use disorder, cigarette, and waterpipe dependence), HeOr was negatively associated with these behaviors. Conclusion Our results emphasize the idea that further attention should be paid to the multidimensional structure of orthorexia, as OrNe and HeOr present an opposite pattern of associations with healthy behaviors. An OrNe etiopathogenesis common to eating disorders can explain these differences.

Disordered eating and the meat-avoidance spectrum: a systematic review and clinical implications

“…The positive results of the systematic review must be considered with limitations of orthorexia nervosa scales in mind. For example, the most widely used scale, the ORTO, is broadly criticized for having inconsistent psychometric properties [ 72 ], and other scales, such as the DOS and EHQ, have been shown to detect both orthorexia nervosa and healthy orthorexia [ 73 ]. As veg*ism is associated with greater health consciousness (i.e., consume alcohol less frequently, exercise more often, have a higher daily intake of fruit and vegetables) [ 10 , 39 ], it may be the case that veg*ans are high in healthy orthorexia, rather than orthorexia nervosa itself, but commonly used orthorexia tools are unable to disentangle these distinct constructs [ 74 ].…”

Eating disorders and their relationship with menopausal phases among a sample of middle-aged Lebanese women

“…The Dusseldorf Orthorexia Scale (DOS) [ 39 ], validated in Lebanon [ 40 , 41 ], is a 10-item self-reported questionnaire to measure orthorexic eating behavior. Answers are scored on a 4-point Likert scale from 1 (this does not apply to me) to 4 (this applies to me), with higher points indicating a more pronounced orthorexic behavior.…”

“…Three different scales were used to assess orthorexia nervosa because different interpretations of results and mixed ones were obtained following the use of different tools used for the screening of OrNe tendencies and behaviors [ 40 ].…”

Any overlap between orthorexia nervosa and obsessive–compulsive disorder in Lebanese adults? Results of a cross-sectional study and validation of the 12-item and 4-item obsessive–compulsive inventory (OCI-12 and OCI-4)

“…It is a 10-item validated tool in Lebanon where higher scores indicate more tendencies towards ON behaviors [30,31]. Scores between 25 and 29 indicate probable ON, whereas scores ≥ 30 reflect the presence of ON behaviors [32] (Cronbach's alpha = 0.90).…”