Exploration of orthorexia nervosa and diagnostic overlap with eating disorders, anorexia nervosa and obsessive-compulsive disorder.

OBJECTIVE: Orthorexia nervosa (ON) is characterized as obsessional healthy eating that results in malnutrition and/or psychosocial impairment. Yet, ON shares theoretical overlap with eating disorders (EDs), especially anorexia nervosa (AN), as well as obsessive-compulsive disorder (OCD). This study aimed to further understand ON and its overlap with related disorders by assessing the ability of ON for detecting the presence/absence of threshold ED, AN, and OCD symptoms. METHOD: An observational survey was completed by 197 participants recruited through eating disorder, dieting, and mental health support groups. Receiver operating characteristic (ROC) curve analyses determined the predictive ability of ON symptoms (assessed by Eating Habits Questionnaire [EHQ] orthorexia nervosa [OrNe] and healthy orthorexia [HeOr] subscales, and the Orthorexia Nervosa Inventory [ONI]) for detecting disordered eating symptoms (determined by Eating Disorder Examination Questionnaire [EDE-Q] global cut-scores), probable AN (determined by EDE-Q cut-scores and body mass index [BMI] <18.5), and OCD symptoms and obsessional thinking (assessed by the Revised Obsessive-Compulsive Inventory [OCI-R]). RESULTS: Results showed both the ONI and EHQ OrNe measures are able to adequately predict ED symptoms and AN; however, both were poor to moderate at detecting OCD symptoms and obsessional thinking. Healthy orthorexia was poor to moderate at detecting outcomes. DISCUSSION: These results suggest that ON, as it is currently operationalized, may be more closely related to EDs than OCD, and that ON may represent a subtype of AN. Results also support healthy orthorexia as a distinct construct to ON. While results are limited by the lack of definitive ON diagnostic criteria, findings suggest that treatments developed for EDs might be most suited to ON. PUBLIC SIGNIFICANCE: ON has been proposed as a psychiatric disorder, and it shares theoretical overlap with several existing disorders. This study adopts a novel approach to assessing and exploring the overlap of ON with EDs, AN and OCD. Results suggest that ON shares more overlap with EDs and might best be understood as a subtype of EDs or AN.

A pilot study of a modification EAT-26 questionnaire for screening pathological eating behavior in competitive athletes.

This study deals with pathological forms of eating behavior and disorders of athletes with the aim to verify a newly created questionnaire method focused on their screening. First, a detailed analysis of one of the most frequently used methods, EAT-26, was carried out, which was subsequently reworked into a newly created questionnaire that should meet the criteria for application to a group of competitive athletes. This new questionnaire was then verified on a group of athletes in risky sports disciplines. It was distributed among athletes of aesthetic sports, specifically among aerobics (gymnastic, sport, and fitness), gymnastics (modern and sport), professional dance, figure skating, and bodybuilding/fitness (classic bodybuilding, bikini fitness, and men's physique). In total, 100 respondents, 79 women and 21 men, with 20 persons from each sport branch, aged 16-26, participated in the research. The main results of the research investigation were determined using factor analysis, which yielded positive results. Five strong factors (dietary control, body weight control, training obsession, appetite, and calorie counting) were identified, which can be defined as common and well-known characteristics in the eating and training regime of competitive athletes. At the same time, the factors found can be defined as essential factors influencing the emergence of disturbed eating behavior or the later development of an eating disorder. Compared to the original EAT-26, the point score was adjusted, and its critical value was determined at 57 points. Of the respondents, 33%, i.e., 33 out of a possible 100, achieved this value or above. Respondents with a point score of 57 and above were found in every sport tested. Of the 33 respondents reaching this point limit, 6% were in aerobics, 24% in gymnastics, 15% in professional dance, 27% in figure skating, and 27% in bodybuilding/fitness. Respondents from the bodybuilding and fitness sports sector achieved the highest number of points on average and those were the only ones who exceeded the threshold of 57 points on average. The results of the work correspond with the opinion of many experts that the sports environment is ideal for covering up disturbed eating behavior or eating disorders, and diagnosis in this environment is difficult.

Emotional and external eating styles associated with obesity.

BACKGROUND: Obesity is related to eating habits. Overeating is the most behavioural trait implicated in obesity; emotional, external and rigid restrained eating are three maladaptive eating habits that are associated to overeating. OBJECTIVES: The current study assesses the eating styles of Algerian adults. It identifies and analyses differences in eating styles in a sample from adults with normal BMI and who have obesity. The study examines the relationship between eating styles and BMI. METHODS: The sample consisted of 200 volunteers aged from 31 to 62 years old, 110 with obesity and 90 having normal BMI. The participants were recruited from hospital and university employees. They were questioned about their eating habits. The participants did not receive any treatment. To assess eating styles, participants completed the DEBQ. RESULTS: The prevalence of women was in the majority, representing 61% (n = 122) in the total sample (63.63% (n = 70) with obesity, and 55.77% (n = 52) with normal BMI). The prevalence of men represents 39% (n = 78) in the total sample (36.36% (n = 40) with obesity, and 42.22% (n = 38) with normal BMI). Participants with obesity showed pathological eating styles. They scored higher on emotional and external eating styles than to normal BMI group. However, restraint eating showed a slight no significant increase. The mean scores ± standard deviations observed in each eating styles were: emotional eating (2.88 ± 0.99** vs. 1.71 ± 0.32), external eating (3.31 ± 0.68** vs. 1.96 ± 0.29), and retrained eating (1.81 ± 0.7ns vs. 1.3 ± 0.30). The linear regression analysis showed an effect of emotional and external eating on BMI. CONCLUSION: These results could be used to provide clinical information at the initial screening for obesity criteria, obesity prevention and treatment.

Emotional, external and rigid restrained eating are three eating habits related to obesity. They are associated to overeating in response to negative emotions, external food-related cues, and body weight control. Obesity treatment necessarily requires the training of medical professionals. The objective of this research is to assess eating styles of people living with obesity and to analyse differences comparing with people with normal body mass index (BMI). We examined the relationship between eating habits and BMI. A total of 200 participants aged from 31 to 62 years old were recruited from hospital and university workers; 110 with obesity and 90 with normal BMI. The Dutch Eating Behaviour Questionnaire was used to assess eating styles (DEBQ). The outcomes of the current study showed that people with obesity exhibit a high emotional and external eating. However, they show a slight restraint eating. BMI was associated to both emotional and external eating. Negatives emotions lead participants to overeat as a response way to cope with, and expose them to obesity. These results are important for the initial screening of obesity criteria. For prevention and treatment of obesity, eating styles must be targeted as factors associated to obesity in order to cope with negative emotions.

Alike and different: Associations between orthorexic eating behaviors and exercise addiction.

OBJECTIVE: Symptoms of exercise addiction, a state of compulsively engaging in intense exercise, and orthorexic eating attitudes, the obsession with eating only healthy foods, often occur together. It is assumed that some more general psychological traits underlie this association. Main aim of this report was to examine similarities and differences between orthorexic eating and addictive exercising. METHOD: Six hundred and eight individuals completed an online survey (mean age: 27.5, SD = 11.0 years; 76.5% women) measuring exercise addiction (Exercise Addiction inventory, EAI), orthorexic eating (Düsseldorfer Orthorexie Skala, DOS), personality domains (Big-Five Inventory-10), anxiety and depression (Hospital Anxiety and Depression Scale). RESULTS: Correlations between the DOS and EAI were .43 in women and .62 in men. Structural equation models identified gender-specific as well as behavior-specific psychological correlates. Among women, anxiety correlated with both EAI and DOS. In addition, the DOS correlated with depression and neuroticism while the EAI correlated with conscientiousness. In men, both scales were associated with conscientiousness and the EAI also correlated with extraversion. Clusterability analysis provided no evidence for clusters based on DOS and EAI. DISCUSSION: Present results showed a substantial correlation between addictive exercising and orthorexic eating, however, coefficients were smaller than expected and appeared higher in men. Both behaviors shared few psychological traits (anxiety in women, conscientiousness in men) thereby questioning the assumption of a similar origin. Additionally, gender-specific psychological correlates point to the need for different disease management approaches in women and men.

Does ORTO-15 produce valid data for 'Orthorexia Nervosa'? A mixed-method examination of participants' interpretations of the fifteen test items.

PURPOSE: Orthorexia Nervosa (ON) is defined as a pathological eating behaviour stemming from being "healthy" or "pure". Survey-based studies typically rely on the ORTO-15 questionnaire or its variations to detect orthorexia. However, frequent post-hoc adjustments to the ORTO-15 suggest psychometric problems. In this study, we explored people's cognitions about the ORTO-15 items to (1) identify problems specific to ORTO-15 items and (2) explore participants' understanding of ON symptoms. METHODS: Fifty adult participants (40% male, mean age = 34.0 ± 14.4 years) completed the ORTO-15, the Eating Attitudes Test (EAT-26) and the Obsessive-Compulsive Inventory-Revised edition (OCI-R). Qualitative data were collected using the modified "think aloud" protocol, which asked participants to 'verbalise' their responses to the ORTO-15 items. These qualitative responses were first analysed conjunctively with the quantitative responses; then subjected to thematic analysis. RESULTS: ORTO-15 identified 64% of the participants for orthorexic tendencies. In most cases (76%), participants reported no issues completing the ORTO-15. However, in some cases, qualitative responses differed from quantitative ones. When people encountered problems, it was because of poor psychometric construction: lack of clarity, ambiguous wording and multiple statements in a single item. Elaborations around the ORTO-15 items formed four major themes: "preoccupation with physical appearance", "control", "food is fuel" and "alone, not isolated". CONCLUSION: Even though in the majority of cases there were no issues with completing ORTO-15, thematic analysis revealed several discrepancies between our participants' perceptions of the ORTO-15 items and the previously proposed diagnostic criteria for ON. The results suggest that ORTO-15 is, at best, a mediocre screening tool for ON, which is sensitive to diet but fails to have sufficient level of specificity to detect the pathological stage. More accurate instruments are needed to further research on ON. LEVEL OF EVIDENCE: V (cross-sectional descriptive study with qualitative analysis).

Perspective: Classifying Orthorexia Nervosa as a New Mental Illness-Much Discussion, Little Evidence.

Significant prevalence rates of pathological healthful eating and its extreme form, orthorexia nervosa (ON), the pathological obsession with healthy eating, have led to increased efforts to understand this phenomenon's clinical relevance. This narrative review qualitatively summarizes existing evidence on the (psycho-)pathology and consequences of ON and offers an interpretation within the frame of existing theories and models of psychiatric disease. Adding to the controversy in the field of ON, this review offers important critiques and identifies gaps in our current understanding of ON as a (distinct) mental illness.