Greek adaptation of the Teruel Orthorexia Scale (TOS) in adults from the Republic of Cyprus: A bidimensional model may not be universal.

The Teruel Orthorexia Scale (TOS) is a 17-item instrument designed to assess distinct facets of Orthorexia Nervosa (ON) and Healthy Orthorexia (HO). While a bidimensional model of TOS scores has been supported in diverse national and linguistic groups, the psychometric properties of the TOS have not been previously assessed in Greek-speaking populations. To rectify this, we assessed the psychometric properties of a novel Greek translation of the TOS in a sample of adults from Cyprus. A total of 1248 respondents (710 women, 538 men) completed the Greek TOS, as well as previously validated measures of perfectionism, obsessive-compulsive symptomatology, eating restriction, negative affect, and appearance evaluation. Our results showed that a bidimensional model of the TOS had less-than-adequate fit when modelled using both confirmatory factor analysis and exploratory structural equation modeling (ESEM). Conversely, both exploratory factor analysis and ESEM supported extraction of a 3-factor model consisting of a HO facet and separate components of emotional orthorexia and cognitive-social orthorexia. This 3-factor model showed a lack of measurement bias (measurement invariance across gender identity and lack of differential item functioning as function of age and body mass index), but there were differences in latent factor means as function of respondent age and body mass index. The 3-factor model showed adequate evidence of construct validity, with the latent emotional orthorexia and cognitive-social orthorexia facets showing significant and moderate associations with the additional constructs measured in the survey. Broadly speaking, these findings support the psychometric properties of a 3-factor model of the Greek TOS, but also suggest that the bidimensional model of the TOS may not have universal applicability. We encourage further assessments of factorial validity in other national and linguistic contexts.

Exploring the role of positive body image in healthy orthorexia and orthorexia nervosa: A gender comparison.

Current scholarship on orthorexia nervosa remains undecided about the role of body image in this novel eating disorder. This study aimed to explore the role of positive body image in differentiating between healthy orthorexia and orthorexia nervosa and assess how this might differ for men and women. A total of 814 participants (67.1% women; age M = 40.30, SD = 14.50) completed the Teruel Orthorexia scale, as well as measures of embodiment, intuitive eating, body appreciation and functionality appreciation. A cluster analysis revealed four distinct profiles characterized by high healthy orthorexia and low orthorexia nervosa; low healthy orthorexia and low orthorexia nervosa; low healthy orthorexia and high orthorexia nervosa; and high healthy orthorexia and high orthorexia nervosa. A MANOVA identified significant differences for positive body image between these four clusters, as well as that there were no significant differences between men and women for healthy orthorexia and orthorexia nervosa, despite men scoring significantly higher than women on all measures of positive body image. Cluster × gender interaction effects were found for intuitive eating, functionality appreciation, body appreciation and experience of embodiment. These findings indicate that the role of positive body image in healthy orthorexia and orthorexia nervosa may differ for men and women, making these relationships worthy of further exploration.

Healthy orthorexia vs orthorexia nervosa: associations with body appreciation, functionality appreciation, intuitive eating and embodiment.

PURPOSE: Current conceptualizations and measures of orthorexia nervosa may not be accurately distinguishing between the healthy vs pathological pursuit of a healthy diet, leading to very high prevalence rates and risking the pathologizing and stigmatizing of healthy eating more generally. Recent research has identified healthy orthorexia as a novel construct conceptually distinct from orthorexia nervosa, which represents the non-pathological pursuit of a healthy diet. In light of the strong body of evidence supporting the role of positive body image in eating behavior, the current study aimed to examine the associations between healthy orthorexia, orthorexia nervosa, intuitive eating and indices of positive body image. METHODS: The current study employed a cross-sectional design. An online community sample (N = 835; 62% women; Mage = 40.24, SD = 14.45) completed self-report questionnaires including the Teruel Orthorexia Scale, Body Appreciation Scale-2, Functionality Appreciation Scale, Intuitive Eating Scale-2, and Experience of Embodiment Scale. RESULTS: Intuitive eating and indices of positive body image were significantly positively associated with healthy orthorexia and inversely associated with orthorexia nervosa. A hierarchical multiple regression analysis found that intuitive eating and indices of body image were uniquely associated with 13.3% of the variance of healthy orthorexia above and beyond that accounted for by orthorexia nervosa. Intuitive eating moderated the relationship between healthy orthorexia and orthorexia nervosa. CONCLUSION: The findings of this study provide support for intuitive eating and indices of positive body image as worthy of further exploration as important factors which distinguish between healthy orthorexia and orthorexia nervosa. LEVEL OF EVIDENCE: V, descriptive study.

Associations between body dissatisfaction, importance of appearance, and aging anxiety with depression, and appearance-related behaviors in women in mid-life.

The impacts of body dissatisfaction have been widely studied among adolescent girls, but much less in women in mid-life. In this study, we evaluated the associations between body dissatisfaction, psychological health and behaviors used to manage age-related changes, in an online survey of 331 women aged 45-65. Body dissatisfaction, importance of appearance and aging anxiety were associated with higher depression scores. Moreover, importance of appearance and aging anxiety were associated with the probability of using "anti-aging" behaviors. It seems that with age, for a subgroup of women, the pressure to stay young may be added to that of staying thin.

Openness to help-seeking for mental illness among Greek-Cypriots.

The aim of this study was to test a model of people's willingness to seek help for mental illness whether currently diagnosed or not. A cross-sectional design was used to test this model in a non-clinical convenience sample of Greek-Cypriots. Participants were 196 Greek-Cypriots living in Cyprus (age M = 34.50 years, SD = 14.16). They provided demographic data on their age, gender, SES and whether diagnosed or not with a mental illness, from whom they have/would seek help for a mental illness, and their willingness to seek help. They completed the Inventory of Attitudes towards Seeking Mental Health Services, the Multidimensional Scale of Perceived Support, and the Practical Barriers in Seeking Mental Health Services Scales, translated into Greek for this study. Approximately 24% of the sample reported being diagnosed with a mental illness within the past 12 months, and around a third of these people were taking prescribed medication. Willingness to seek help across all participants was predicted negatively by stigma and positively by openness to help. The findings of the current study extend our previous limited understanding of the factors affecting people's willingness to seek help or their intentions towards the use of mental health services among Greek-Cypriots. Future research should consider whether there are any differences in help-seeking behaviours and motivations across people experiencing different disorders. Despite this limitation in the current data, these results can, in general terms, be used to inform policy in Cyprus for mental health promotions and interventions especially with respect to fostering an open attitude towards mental illness.

Predictive factors of disordered eating and body image satisfaction in cyprus.

OBJECTIVE: This study aimed to assess possible relationships and predictor variables between disordered eating attitudes and behaviors, the internalization of the thin ideal construct, body image satisfaction, body image investment, weight-related anxiety, and body mass index (BMI) among Greek-Cypriot female university students in Cyprus. METHOD: A total of 243 female university students responded to self-report measures assessing disordered eating, internalization of the thin ideal, body satisfaction, body image investment, and weight-related anxiety. RESULTS: Disordered eating was positively correlated to the internalization of the thin ideal, body image investment, weight-related anxiety, and BMI and negatively correlated with body image satisfaction. The internalization of the thin ideal was also positively correlated to weight-related anxiety and body image investment and negatively correlated to body image satisfaction. Furthermore, weight-related anxiety and internalization of the thin ideal have been found to be significant predictors of disordered eating attitudes. DISCUSSION: Possible explanations and vulnerability factors are addressed, as well as implication for prevention strategies and future research.

Validation of the factor structure of the Greek adaptation of the Situational Inventory of Body-Image Dysphoria-Short Form (SIBID-S).

PURPOSE: Body image is a psychological construct that refers to one's perceptions, feelings, and thoughts towards one's body and appearance. The intensity and frequency of dysphoric body-image emotions depend upon situational events (i.e., situations involving body exposure, social comparisons, wearing certain clothing, looking in the mirror, and so forth). The Situational Inventory of Body-Image Dysphoria-Short Form (SIBID-S; Cash, Manual for the situational inventory of body-image dysphoria, 2000) was originally developed to assess one's negative body-image emotions in certain situational events. The current study aimed to confirm the factor structure and reliability of the newly translated Greek version of the SIBID-S. METHODS: Participants consisted of a convenient sample of 2664 high school students (1119 males, 1545 females) who answered the measures of interest. RESULTS: Results indicated that the original one-factor structure of the SIBID-S was retained and fitted very well with the original model for both males and females. In addition, the Greek version had satisfactory reliability and convergent validity coefficients. Gender differences were also noted. CONCLUSION: The Greek SIBID-S has very good validity and reliability data and will serve as a useful measure of body-image dysphoria enabling research with the Greek-speaking population as well as cross-cultural research.

The Experience of Embodiment Scale: An examination of its psychometric properties in women from the Republic of Cyprus.

The Experience of Embodiment Scale (EES) is a recently developed instrument that assesses experiences of living in the body. Here, we prepared a novel Greek translation of the EES and examined its psychometric properties. We initially prepared a Greek translation of the EES using a 5-step procedure recommended for test adaptation studies. Next, in a cross-sectional study, we asked a sample of 933 women from Cyprus to complete the Greek EES, alongside additional, previously validated measures assessing body appreciation, psychological well-being (self-esteem, life satisfaction), eating restriction, perfectionism, and internalisation of appearance ideals. Our analyses showed that EES factorial models based on confirmatory factor analysis (CFA) roundly had poor fit. Conversely, models based on exploratory structural equation modelling (ESEM)-which accounts for the fact that EES items cross-load across factors-had adequate fit to the data. Additionally, we found that both higher-order and bifactor-ESEM models that controlled for the uniqueness of negatively worded items had adequate fit. The bifactor-ESEM model had the best fit of all the models tested, and was invariant across ethnicity (Greeks and Greek-Cypriots) and was unaffected by differential item functioning based on age and body mass index. Additionally, construct validity of the final, optimal model was adequate, especially for its G-factor, as indicated by significant associations with additional constructs in expected directions. These results suggest that a bifactor-ESEM model of the Greek EES has adequate psychometric properties. Our work highlights important psychometric issues relating to the manner in which the EES should (or could) be conceptualised and modelled, which should be considered more fully in future work.

Multidimensional body-self relations questionnaire-appearance scales: psychometric properties of the Greek version.

The psychometric properties of a Greek version of the Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS) were studied. A total of 1,312 high school students (463 boys, 849 girls) were administered the Greek MBSRQ-AS, the Greek Appearance Schemas Inventory-Revised (ASI-R) and the Greek Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3). An exploratory factor analysis revealed that the Greek MBSRQ-AS items significantly loaded with the scale's main factors. Internal consistencies of the subscales ranged from .76 to .86. Test-retest reliabilities ranged from .75 to .93. Convergent validity was also confirmed as the Greek MBSRQ-AS subscales correlated positively with the ASI-R and the SATAQ-3.

Orthorexia and Orthorexia Nervosa: A Comprehensive Examination of Prevalence, Risk Factors, Diagnosis, and Treatment.

Orthorexia nervosa is an emerging and controversial eating disorder characterized by an obsessive preoccupation with healthy eating and an extreme fixation on food purity. Despite growing public interest in orthorexia, its classification as a distinct eating disorder remains a subject of ongoing debate in the mental health community. This paper comprehensively reviews the current literature on orthorexia nervosa, exploring the prevalence rates, risk factors, diagnosis, and treatment options. The paper offers an overview of orthorexia and its historical context and explores the challenges and considerations in diagnosing orthorexia and orthorexia nervosa. Specifically, the distinction between "orthorexia" and "orthorexia nervosa" is a debated issue in eating disorder research due to a lack of clear diagnostic criteria, making it challenging to accurately differentiate between an obsession with healthy eating and a more severe form with potential distress and impairment. Given the absence of formal diagnostic criteria, developing valid and reliable assessment tools is crucial to accurately identify and treat individuals experiencing these disorders. The paper's final section covers the existing treatment approaches for orthorexia nervosa. Overall, the paper highlights the complex and multifaceted nature of orthorexia nervosa. This review contributes to the ongoing discourse surrounding orthorexia and provides valuable insights for clinicians, researchers, and stakeholders in the mental health and eating disorders fields.

Conspiracy Theories, Trust in Science, and Knowledge during the Third Wave of the COVID-19 Pandemic in Cyprus.

Conspiracy theories flourish during periods of crisis. One way to counteract the believability of conspiracy theories is trust in science and knowledge about the "perceived threat", such as the SARS-CoV-2 virus. A total of 363 adults from Cyprus were recruited via convenience and snowball sampling methods. The data were collected via an internet-based questionnaire that examined participants' belief in 17 conspiracy theory statements, trust in science and scientists, knowledge about the symptoms and the spread of the SARS-CoV-2 virus, phobic anxiety, hostility, somatization, and personality traits based on the Big Five. The results suggest (a) the overall belief in conspiracy theories in Cyprus is low, even though a notable percentage holds a neutral stance towards these theories; (b) trust in science and knowledge about the symptoms and the spread of the SARS-CoV-2 virus is negatively related to conspiracy theories, indicating the importance of trusting science and having knowledge as a means to counteract conspiracy theories; (c) young adults, those residing in rural areas, and those with a low education level are more likely to believe in conspiracy theories; (d) there are no significant associations between conspiracy theories and the psychological dimensions of phobic anxiety, hostility, and somatization; (e) there is difficulty in identifying specific traits related to conspiracy ideation. Public health officials could benefit from the findings when communicating information during periods of crisis.

Psychometric properties of a Greek translation of the Functionality Appreciation Scale (FAS) in adults from the Republic of Cyprus.

The Functionality Appreciation Scale is a widely used instrument for the measurement of an individual's appreciation of their body for what it can do and is capable of doing (i.e., functionality appreciation). In the present study, we examined the psychometric properties of a novel Greek translation of the FAS in Cypriot adults. A total of 448 women and 345 men from the Republic of Cyprus completed the FAS, as well as validated measures of body appreciation, appearance evaluation, and symptoms of disordered eating, and self-esteem. Exploratory and confirmatory factor analyses supported a unidimensional model of FAS scores, with all 7 items retained. Scores achieved scalar invariance across gender, with the gender difference in FAS scores not reaching significance. FAS scores were also found to have adequate composite reliability and convergent (significant associations with body appreciation, appearance evaluation, and symptoms of disordered eating) and concurrent validity (significant associations with self-esteem). Finally, functionality appreciation predicted self-esteem once the effects of all other variables had been accounted for, supporting incremental validity. Overall, these results suggest that the Greek FAS is a psychometrically valid tool for the assessment of functionality appreciation in adults from Cyprus.

The Role of Conspiracy Theories, Perceived Risk, and Trust in Science on COVID-19 Vaccination Decisiveness: Evidence from Cyprus.

COVID-19 reminded us of the importance of vaccinating for successfully overcoming health-related crises. Yet, vaccine hesitancy is still present. This study examined the impacts of conspiracy theories, perceived risk, and trust in science on COVID-19 vaccination decisiveness. The study was conducted at the end of the third wave of the pandemic, in July 2021, in Cyprus. Data were collected via an online self-administered anonymous survey using convenience and snowball sampling methods. Participants were 363 adults who completed a set of questionnaires that examined their believability in ten vaccine-related conspiracy theories, their perceived dangerousness of COVID-19, and their level of trust in science and scientists. The results suggest that (a) participants with a high conspiracy theory belief are less likely to be vaccinated, (b) participants who perceive COVID-19 as a dangerous disease are more likely to be vaccinated, and (c) participants with high trust in science are more likely to be vaccinated. The implications of the findings are discussed and can be used by public health officials in their campaigns.

Body Image, Media Influences, and Situational Dysphoria in Individuals with Visible Physical Disabilities.

Body image in individuals with visible physical disabilities appears to be an important area of research and investigation, which has received little attention over the years. The purpose of the current descriptive, cross-sectional study was to investigate relationships between the body image construct, possible media influences on body image satisfaction, self-esteem, and the novel variable of situational body image dysphoria in individuals with visible physical disabilities. One hundred fifty-four men and women responded to the measures of interest. Results indicated that appearance satisfaction, weight-related anxiety, pressures from the media, and the internalization of the thin ideal were significant predictors of situational body image dysphoria. Additionally, when controlling for type of disability, females face more difficulties concerning only some of the variables of interest. These findings have important implications for practice with regards to screening measures, the education of healthcare professionals, as well as intervention and rehabilitation programs.

La imagen corporal en personas con discapacidades físicas visibles parece ser un área importante de investigación y estudio, que ha recibido poca atención a lo largo de los años. El propósito del presente estudio transversal descriptivo fue investigar las relaciones entre la construcción de la imagen corporal, las posibles influencias de los medios en la satisfacción con la imagen corporal, la autoestima y la nueva variable de disforia situacional de la imagen corporal en personas con discapacidades físicas visibles. Ciento cincuenta y cuatro hombres y mujeres respondieron a las medidas de interés. Los resultados indicaron que la satisfacción con la apariencia, la ansiedad relacionada con el peso, las presiones de los medios y la internalización del ideal de delgadez fueron predictores significativos de la disforia situacional de la imagen corporal. Además, cuando se controla por el tipo de discapacidad, las mujeres enfrentan más dificultades con respecto a solo algunas de las variables de interés. Estos hallazgos tienen implicaciones importantes para la práctica con respecto a las medidas de detección, la educación de los profesionales de la salud, así como los programas de intervención y rehabilitación.

Validation of a Greek adaptation of the Anti-Fat Attitudes Questionnaire.

The Anti-Fat Attitudes Questionnaire (AFA) measures prejudicial attitudes that are held about individuals with overweight BMI or obesity. Despite increased interest in research on anti-fat attitudes worldwide, the psychometric properties of the AFA have rarely been examined in non-English speaking populations. The present study aimed to address this gap in the literature by translating and validating the AFA in the Greek language. An online, community-based sample of 642 individuals (364 women) responded to the Greek translation of the AFA and measures of appearance satisfaction and appreciation, disordered eating, self-esteem and depression. Results indicated that the original three-factor solution of the AFA was maintained in both the Principal and Confirmatory Factor Analyses. Additionally, internal consistency, test-retest reliability and convergent validity all showed adequate results. These findings provide support for the use of the AFA in Greek-speaking populations. The availability of the Greek AFA adds to the toolbox of body image scholars working in the Greek context.

The Impact of the COVID-19 Pandemic on Binge Eating Disorder: A Systematic Review.

The aim of this systematic review was to synthesise the impact of the COVID-19 pandemic on binge eating disorder (BED) the new onset and course. Inclusion criteria: original articles and BED diagnosis; and the main outcomes: relationships between the COVID-19 pandemic and the new onset/clinical changes in BED, and specific results for BED. Exclusion criteria: mixed/inaccurate diagnoses and articles not written in English. We searched four databases and one registry until 5 May 2023. The quality appraisal was conducted using the Effective Public Health Practice Project (EPHPP) tool. Twelve studies with 4326 participants were included. All studies were observational with nine cross-sectional and three longitudinal. Four of the included studies investigated new-onset BED, while eight examined the BED clinical course of patients with a previous diagnosis. With the exception of one study, the available literature indicates both an increase in BED diagnoses and a clinical worsening during COVID-19. Major limitations include study quality (weak-to-moderate) and high heterogeneity in terms of pandemic phase, population, geographical areas, and psychometric tools. Our findings indicate that BED patients are particularly vulnerable to events characterised by social distancing and over-worry, and should be, therefore, carefully monitored. Further studies are needed to corroborate our findings, implement preventive strategies, and promote personalised treatments. PROSPERO registration number: CRD42023434106.

Body appreciation around the world: Measurement invariance of the Body Appreciation Scale-2 (BAS-2) across 65 nations, 40 languages, gender identities, and age.

The Body Appreciation Scale-2 (BAS-2) is a widely used measure of a core facet of the positive body image construct. However, extant research concerning measurement invariance of the BAS-2 across a large number of nations remains limited. Here, we utilised the Body Image in Nature (BINS) dataset - with data collected between 2020 and 2022 - to assess measurement invariance of the BAS-2 across 65 nations, 40 languages, gender identities, and age groups. Multi-group confirmatory factor analysis indicated that full scalar invariance was upheld across all nations, languages, gender identities, and age groups, suggesting that the unidimensional BAS-2 model has widespread applicability. There were large differences across nations and languages in latent body appreciation, while differences across gender identities and age groups were negligible-to-small. Additionally, greater body appreciation was significantly associated with higher life satisfaction, being single (versus being married or in a committed relationship), and greater rurality (versus urbanicity). Across a subset of nations where nation-level data were available, greater body appreciation was also significantly associated with greater cultural distance from the United States and greater relative income inequality. These findings suggest that the BAS-2 likely captures a near-universal conceptualisation of the body appreciation construct, which should facilitate further cross-cultural research.

Intuitive eating in Greek-Cypriot adults: Influence of gender and body mass.

Introduction: To date, research on eating behaviors has largely taken a pathological approach. Researchers are increasingly taking a positive approach to explore adaptive eating styles. One such style that has recently received much research attention is intuitive eating. Recent work examining intuitive eating and its relationships with body mass and gender has yielded mixed findings. The current study explored the differential effects of gender and body mass on intuitive eating scores in a sample of Greek-Cypriot adults. Method: A total of 1,312 adult participants (women n = 655; M age = 34.49) completed the Intuitive Eating Scale-2 and provided demographic information. Results: Our analyses revealed that men reported significantly higher intuitive eating scores than women. Body mass was significantly inversely associated with intuitive eating in both men and women. Additionally, a multivariate analysis of variance (MANOVA) indicated significant interaction effects between gender and body mass on intuitive eating. These interaction effects were explored for each of the four subscales of intuitive eating, identifying differential associations for intuitive eating and BMI between men and women. Discussion: Both gender and body mass are important factors which influence intuitive eating levels in Greek-Cypriot adults. Discussions of how these findings can inform future research, theory and practice are presented.

Translation and validation of the Greek version of the Modified Weight Bias Internalization Scale in an adult population.

Weight bias internalization (WBI) has been identified as a global public health concern, which is associated with significant psychological and physical consequences. Despite increased interest in WBI worldwide, cross-cultural research is limited by the lack of availability of validated measures. The aim of the current study was therefore to translate into Greek and validate the Modified Weight Bias Internalization Scale (WBIS-M), the most widely used instrument in the measurement of WBI. An online convenience sample of 642 participants (364 women and 278 men) completed the Greek translation of the WBIS-M and validated the measures of satisfaction with appearance, investment in appearance, weight/appearance anxiety, body appreciation, dysfunctional eating habits and global self-esteem to assess convergent validity. Principal factor and confirmatory analyses revealed that the WBIS-M upheld its one-factor structure. The WBIS-M showed adequate internal consistency, convergent validity and 3-week test-retest reliability. These findings provide support for the cross-cultural equivalence of the WBIS-M and for the utility of this measure in Greek-speaking populations.

Psychometric properties of a Greek translation of the Intuitive Eating Scale-2 (IES-2) in adults from Cyprus.

The construct of intuitive eating is commonly assessed using the 23-item, 4-factor Intuitive Eating Scale-2 (IES-2; Tylka & Kroon Van Diest, 2013). In this study, we assessed the psychometric properties of a novel Greek translation of the IES-2 in adults from Cyprus. In Study 1 (N = 626), an exploratory factor analysis indicated that the IES-2 should be conceptualized as consisting of six factors that showed complete invariance across women and men. Study 2 (N = 793), using exploratory structural equation modelling (ESEM) and beifactor analysis (B-ESEM), indicated that the 6-factor B-ESEM model had adequate fit and evidenced complete invariance across sex once the correlated uniqueness of negatively worded IES-2 items was accounted for. This final model evidenced adequate composite reliability, and a global G-factor evidenced adequate convergent, concurrent, and discriminant validity. In contrast, the IES-2 S-factors showed more equivocal patterns of validity, with some S-factors showing less-than-adequate associations with body image variables, self-esteem, symptoms of disordered eating, and fruit and vegetable intake. In general, these results provide satisfactory evidence of the psychometric properties of the Greek IES-2 in adults from Cyprus, but also suggest that models of IES-2 scores may vary across national or cultural contexts.