Emotional exhaustion and traumatic stress among healthcare workers during the COVID-19 pandemic: Longitudinal changes and protective factors.

BACKGROUND: Healthcare workers (HCWs) are at high risk of experiencing work-related stress, burnout syndrome, and depression, especially during infectious disease outbreaks like COVID-19. Contributing factors include increased workload, lack of personal protective equipment, and inadequate support from the healthcare administration. Longitudinal studies have shown that the mental health status of HCWs has deteriorated over time. Social support and compassion satisfaction (CS) are protective factors that can mitigate adverse mental health effects. The present longitudinal study examined the mental health status of HCWs during the COVID-19 outbreak and aimed to identify potential predictors and protective factors. METHODS: The study comprised 386 healthcare workers in Hungary and was conducted in two waves (T1 and T2) from January 2021 to January 2022. Participants completed an online survey including the Professional Quality of Life Scale, Maslach Burnout Inventory, demographic and work-related background factors. Statistical analyses included descriptive statistics, and a cross-lagged panel model (CLPM). RESULTS: Frontline HCWs had higher levels of secondary traumatic stress (STS) and emotional exhaustion (EE) than non-frontline healthcare workers. Both groups experienced significant increases in these measures between T1 and T2. The CLPM indicated that EE had a significant lagged effect on STS among frontline workers, while STS had a significant lagged effect on EE among non-frontline workers. CS had a significant protective effect on both STS and EE in both groups. CONCLUSIONS: The findings suggest that CS protects EE and STS, particularly among frontline HCWs. The study also showed that different causative relationships exist between these factors among frontline and non-frontline HCWs, which underlines the possible cyclical relationship between the two depending on the circumstances. The results provide insights into the protective role of positive work experiences and the importance of considering the needs of both frontline and non-frontline HCWs in preventive intervention programs.

Sensation seeking, drinking motives, and going out mediate the link between eveningness and alcohol use and problems in adolescence.

The present study was aimed at obtaining a more comprehensive understanding of the possible mediating factors in the morningness-eveningness → alcohol consumption relation. We explored the role of mediators such as sensation seeking, the frequency of going out in the evenings, and drinking motives. We tested the proposed mediation model via structural equation modeling based on cross-sectional research conducted among Hungarian adolescents and young adults (N = 1695, 42.5% male, Mage = 18.98, SDage = 1.89). The outcomes included the frequency of alcohol consumption and problematic drinking. Both alcohol consumption and problematic drinking were predicted in similar directions and magnitudes by sensation seeking, "going out," and coping drinking motives. However, eveningness still had a significant direct effect on alcohol consumption and problematic drinking after we controlled for sensation seeking, going out, and drinking motives. For problematic drinking, the possible role of drinking motives seems to be higher and more complex than it is for alcohol consumption. The mediators, such as sensation seeking, the amount of time spent out in the evenings, and drinking motives, can explain the eveningness → alcohol consumption relationship and should be targeted for alcohol prevention programs among evening-type adolescents.

Adaptation and validation of the Hungarian version of Thyroid-Related Patient-Reported Outcome-39 (ThyPro-39) questionnaire: testing factor structure, known-group validity with the comparison of quality of life in Hashimoto's thyroiditis and Graves' disease.

BACKGROUND: Living with autoimmune thyroid disease is a longstanding challenge and can seriously affect the quality of life. We aimed to adapt and validate the Hungarian version of the Thyroid-Related Patient-Reported Outcome-39 (ThyPro-39) questionnaire, test its factor structure, and compare two frequent autoimmune thyroid diseases, Hashimoto's thyroiditis, and Graves' disease. We tested the factor structure of ThyPro-39 with a series of confirmatory factor analyses (CFAs). To examine the validity of ThyPro-39 and to compare the quality of life of the two groups - Hashimoto's thyroiditis (N = 240), Graves' disease (N = 51) - CFA with covariates were used. RESULTS: Our results supported a bifactor model with psychosocial and somatic symptoms as general factors, and 12 symptom-specific factors. Based on the analysis of omega hierarchical indices ranging between 0.22 and 0.66, the specific scales also carry information besides the composite scores and should be used when a more detailed analysis is required. In the multivariate analysis, perceived stress was significantly associated with the general psychosocial factor (ß = 0.80), symptom factors (ß = 0.34), anxiety (ß = 0.43), depressivity (ß = 0.37), and emotional susceptibility (ß = 0.38) specific factors. Graves' patients reported more eye symptoms (d = 0.45) and cosmetic complaints (d = 0.40), while Hashimoto patients had more cognitive problems (d = 0.36) and more severe hypothyroid symptoms (d = 0.35). These group differences confirm the known-group validity of the questionnaire. CONCLUSIONS: The validity of the Hungarian version of ThyPRO-39 is supported. We recommend using two composite scores of psychosocial and somatic symptoms and the specific symptoms scores to measure the quality of life in clinical practice and research.

Who would and who would not become a living kidney donor? / Ki adná a veséjét, és ki nem?

"Introduction: Living donor transplantation is a more and more frequent medical intervention. Beyond the medical issues, living organ donation raises psychosocial questions about the donors and their motivation. Objective: Our aim was to reveal the attitude, knowledge and beliefs regarding living kidney donation. Moreover to reveal the main determining factors of living donation willingness, such as relatedness to the recipient, personality traits, personal values, well-being and purpose in life. Method: The cross-sectional study included 571 Hungarian citizens. The online questionnaire included questions regarding the attitude, knowledge and beliefs, and the Schwartz Value Survey, the Big Five Inventory, the WHO-5 Well-Being Index and the Purpose in Life questionnaire. Results: The majority of the participants would donate their kidney alive to relatives and friends, the fewest people would not donate at all, and 16.8% of the participants would donate even to a stranger. Most participants knew (71.8%) that kidney is the most often transplanted organ and also most often donated alive. Willingness to donate alive showed significant association with the relatedness (r = 0.187), personal values (Self-transcendence) (r = 0.208), and weak association with the knowledge (r = 0.104). The association was significant between knowledge and beliefs about the donors (r = ­0.352, r = 0.136). Based on the multiple linear regression analysis, the personal value (Selftranscendence) (ß = 0.218) and the negative belief that donors have a worse state of health after donation (ß = ­0.207), are weak, significant predictors of willingness to donate kidney alive. Discussion: The intention to become a living kidney donor is associated with the beliefs, which are connected to the knowledge, and the knowledge is associated with the relatedness. Moreover the willingness to become a living donor is associated with the good intention, the desire to help others and social responsibility. Conclusion: The knowledge and the factors of personal values, such as good intention and social responsibility, play a main role in the intention to become a living donor."

A consensus document on definition and diagnostic criteria for orthorexia nervosa.

PURPOSE: Since the term orthorexia nervosa (ON) was coined from the Greek (ὀρθός, right and ὄρεξις, appetite) in 1997 to describe an obsession with "correct" eating, it has been used worldwide without a consistent definition. Although multiple authors have proposed diagnostic criteria, and many theoretical papers have been published, no consensus definition of ON exists, empirical primary evidence is limited, and ON is not a standardized diagnosis. These gaps prevent research to identify risk and protective factors, pathophysiology, functional consequences, and evidence-based therapeutic treatments. The aims of the current study are to categorize the common observations and presentations of ON pathology among experts in the eating disorder field, propose tentative diagnostic criteria, and consider which DSM chapter and category would be most appropriate for ON should it be included. METHODS: 47 eating disorder researchers and multidisciplinary treatment specialists from 14 different countries across four continents completed a three-phase modified Delphi process, with 75% agreement determined as the threshold for a statement to be included in the final consensus document. In phase I, participants were asked via online survey to agree or disagree with 67 statements about ON in four categories: A-Definition, Clinical Aspects, Duration; B-Consequences; C-Onset; D-Exclusion Criteria, and comment on their rationale. Responses were used to modify the statements which were then provided to the same participants for phase II, a second round of feedback, again in online survey form. Responses to phase II were used to modify and improve the statements for phase III, in which statements that met the predetermined 75% of agreement threshold were provided for review and commentary by all participants. RESULTS: 27 statements met or exceeded the consensus threshold and were compiled into proposed diagnostic criteria for ON. CONCLUSIONS: This is the first time a standardized definition of ON has been developed from a worldwide, multidisciplinary cohort of experts. It represents a summary of observations, clinical expertise, and research findings from a wide base of knowledge. It may be used as a base for diagnosis, treatment protocols, and further research to answer the open questions that remain, particularly the functional consequences of ON and how it might be prevented or identified and intervened upon in its early stages. Although the participants encompass many countries and disciplines, further research will be needed to determine if these diagnostic criteria are applicable to the experience of ON in geographic areas not represented in the current expert panel. LEVEL OF EVIDENCE: Level V: opinions of expert committees.

[Invisible barriers - food allergies in children in family context]. / Láthatatlan akadályok ­ súlyos gyermekkori ételallergia a családban.

Childhood food allergy is a chronic immunological condition that affects approximately 6-8% of children. Food protein-induced immune reactions can vary in intensity from mild to fatal. There is a risk of anaphylactic shock in the case of severe food allergies, which requires immediate emergency intervention. In the lack of symptoms, food allergy is invisible to outsiders, which could often cause difficulties in communication and avoidance behavior in involved families. Parents are responsible for representing their child's condition in everyday life. The current study focuses on the caregiver's perspective and draws attention to the challenges of severe childhood food allergies and the complexity of adaptive disease management. The study aims to provide insight into what difficulties the affected parents face, what characteristics they show, and what psychological methods and techniques can help them adapt and cope better, according to the existing recommendations and intervention studies. In this way, adequate adherence to medical treatments is also ensured, contributing to the healthier personality development of children. Orv Hetil. 2022; 163(47): 1855-1861.

Subjective COVID-19-related work factors predict stress, burnout, and depression among healthcare workers during the COVID-19 pandemic but not objective factors.

BACKGROUND: Work-related stress is significantly higher among healthcare workers (HCWs) than in the general population. Elevated occupational stress has been linked to burnout syndrome and depression. Moreover, medical professionals working during infectious disease outbreaks are at especially high risk for these problems. The aim of the present study was to examine the mental health status of HCWs and possible predictors of mental health status related to the COVID-19 outbreak utilizing a complex comprehensive model. METHODS: In a countrywide cross-sectional survey among HCWs (N = 2087), work-related stress, COVID-19 -related objective work factors (displacement, frontline working) and subjective work factors (insecurity, unpredictability, workload), perceived stress, work-related stress, burnout and depression were assessed between the second and third wave of COVID-19 pandemic in Hungary. RESULTS: COVID-19-related objective factors did not predict directly stress, burnout, and depression, whereas feelings of insecurity and unpredictability in relation to the COVID-19 situation at work had a significant medium-sized total effect (also considering the indirect effect via stress) on burnout and depression. CONCLUSIONS: In order to prevent subsequent mental health problems during crisis situations, such as the COVID-19 pandemic, healthcare management should create a more predictable work environment and a safer work experience for healthcare workers and provide mental health support.

Challenges of and possible solutions for living with endometriosis: a qualitative study.

BACKGROUND: Endometriosis as a chronic gynecological disease has several negative effects on women's life, thereby placing a huge burden on the patients and the health system. The negative impact of living with endometriosis (impaired quality of life, diverse medical experiences) is detailed in the literature, however, we know less about patients' self-management, social support, the meaning of life with a chronic disease, and the needs of patients. To implement a proper multidisciplinary approach in practice, we need to have a comprehensive view of the complexity of endometriosis patients' life and disease history. METHODS: Four focus group discussions were conducted between October 2014 and November 2015 by a team consisting of medical and psychological specialists. 21 women (age: 31.57; SD = 4.45) with surgical and histological confirmation of endometriosis were included in the study. Discussions were audiotaped and transcribed verbatim, and a 62,051-word corpus was analyzed using content analysis. RESULTS: Four main themes emerged from the analysis: (1) the impact of endometriosis on quality of life, (2) medical experiences, (3) complementary and alternative treatments, and (4) different coping strategies in disease management. All themes were interrelated and highly affected by a lack of information and uncertainty caused by endometriosis. A supporting doctor-patient relationship, active coping, and social support were identified as advantages over difficulties. Finding the positive meaning of life after accepting endometriosis increased the possibility of posttraumatic growth. Furthermore, women's needs were identified at all levels of the ecological approach to health promotion. CONCLUSIONS: Our results highlight the need for multidisciplinary healthcare programs and interventions to find solutions to the difficulties of women with endometriosis. To achieve this goal, a collaboration of professionals, psychologists, and support organizations is needed in the near future.

Functional gastrointestinal symptoms and increased risk for orthorexia nervosa.

PURPOSE: Recent guidelines point out the possible risk for orthorexia nervosa in functional gastrointestinal disorders, however, to date, no study has investigated this association. The present study aimed to explore the potential relationship between irritable bowel syndrome-related functional gastrointestinal symptoms and certain maladaptive eating behaviours, such as symptoms of orthorexia nervosa and emotional eating. METHODS: A sample of 644 Hungarian volunteers (Mage = 22.37; SDage = 3.95) completed a survey with the following questionnaires: the Rome IV Diagnostic Questionnaire (R4DQ) for adults-Irritable bowel syndrome module for the measurement of functional gastrointestinal symptoms, the Hungarian version of the ORTO-15 questionnaire (ORTO-11-Hu) to assess symptoms of orthorexia nervosa, the Three-Factor Eating Questionnaire (TFEQ) Emotional Eating subscale to measure symptoms of emotional eating and the Short Health Anxiety Inventory (SHAI) for the assessment of health anxiety. Spearman's rank correlation was used to explore the associations between the measured variables, and structural equation modeling was used to test the proposed mediation models. RESULTS: Functional gastrointestinal symptoms were positively related to symptoms of orthorexia nervosa and emotional eating. The relationship between functional gastrointestinal symptoms and symptoms of orthorexia nervosa was partially mediated by health anxiety, while the association between functional gastrointestinal symptoms and symptoms of emotional eating was partially mediated by symptoms of orthorexia nervosa. CONCLUSION: Our findings highlight the possible risk for developing orthorexic symptoms in functional gastrointestinal symptoms, which could lead to other types of disordered eating patterns, such as emotional eating. The results also underscore the potential role of health anxiety in these relationships. LEVEL OF EVIDENCE: Level V (descriptive cross-sectional study).

Intuitive eating in light of other eating styles and motives: Experiences with construct validity and the Hungarian adaptation of the Intuitive Eating Scale-2.

Intuitive eating (IE), an adaptive eating approach, has been identified as a plausible positive determinant of physical and mental well-being. This cross-sectional survey study aimed to examine the construct validity of IE measured by the Intuitive Eating Scale-2 (IES-2). The conceptual network of different adaptive and maladaptive eating behaviors was also explored. Confirmatory factor analysis (CFA), measurement invariance testing, and correlation analyses were applied on the data from a sample of 732 Hungarian university students. Validating variables included several eating behavior styles (i.e., obesogenic eating behaviors, mindful eating [ME], and dieting practices) and motivational factors (i.e., autonomous, controlled, and amotivational sources of healthy eating, and internalization of the thin and muscular body ideals). The results of the CFA supported the original four-factor structure of the IES-2 without a global second-order factor. The scale exhibited measurement invariance on the scalar level across sexes and BMI categories. The IES-2 subscales showed adequate reliability. IE and ME were found to be positively related but conceptually distinct constructs. Autonomous motivation for healthy eating, restrained eating, and current dieting exhibited different yet meaningful associations to IE on the subscale level. Undertaking subscale-level analyses is recommended when using the IES-2.

Cross-cultural comparison of the motivations for healthy eating: investigating the validity and invariance of the motivation for healthy eating scale.

Objective: Applying self-determination theory, the present study examined the different regulatory processes of healthy eating motivations and their determinants in a cross-cultural sample by exploring the factor structure, measurement invariance, and construct validity of the Motivation for Healthy Eating Scale (MHES).Design: 381 Hungarian, 264 Japanese, and 293 Norwegian university students participated in the cross-sectional survey study. The psychometric evaluation was done by applying confirmatory factor analysis (CFA), correlation analysis, and CFA with covariates testing.Main outcome measures: Besides the six factors of MHES (Amotivation, External, Introjected, Integrated, Identified regulation and Intrinsic motivation), validating variables included obesity status, breakfast skipping, wellbeing, and emotional, external and restrained eating styles.Results: The a priori six-factor model of MHES adequately fit the sample data from all three cultures. The questionnaire demonstrated invariance of the factor structure and factor loadings across all of the groups. The different types of regulatory processes showed weak associations with the validating variables in the expected directions, with somewhat varied patterns across cultures.Conclusion: The MHES is a valid tool that measures different types of behavioural regulations of healthy eating. The measure is interpreted similarly across different cultures, which makes further investigations of the factors promoting healthy eating possible.

The association of different interoceptive dimensions with functional gastrointestinal symptoms.

The aim of the current cross-sectional studies was to investigate the association of interoceptive dimensions with irritable bowel syndrome-related functional gastrointestinal symptoms using a multimethod approach. Two studies were conducted in Hungarian volunteers. Study 1 involved questionnaires regarding interoceptive sensibility. In Study 2, an experimental task was additionally used for the measurement of interoceptive accuracy.Reporters of high functional gastrointestinal symptoms were characterised by an increased perception of different somatic sensations together with a reduced trust in bodily signals. Our results support the hypothesis that there are interactions between interoceptive dimensions in the production of functional somatic symptoms. A data accessibility statement is included.

The associations between orthorexia nervosa and the sociocultural attitudes: the mediating role of basic psychological needs and health anxiety.

PURPOSE: Given the range of negative correlates associated with orthorexia nervosa (ON), it is important to identify factors that might contribute to the elevated ON tendencies. Based on the tripartite model of influence, we tested whether sociocultural attitudes towards appearance (i.e., thin and muscular internalization as well as family, peer and media pressure) could contribute to ON. We hypothesized that these attitudes could exert their effect through the intervening processes basic psychological need fulfillment and health anxiety. METHODS: The hypotheses were tested on a sample of 710 young adults (Mage = 21.79, SDage = 2.31). Participants completed validated questionnaires measuring the constructs of interest. RESULTS: According to the structural equation modeling results, ON was predicted by thinness and muscular internalization as well as media pressure. Need fulfillment and health anxiety partially mediated these relationships. Family and peer pressure were not related to ON. DISCUSSION: The present results suggest that internalization of appearance ideas and media pressure contribute to ON through need fulfillment and health anxiety. These findings also provide novel insight into the nature of ON. LEVEL OF EVIDENCE: Level V (descriptive cross-sectional study.

Predictors and outcomes of core and peripheral sport motivation profiles: A person-centered study.

While previous studies highlighted the importance of the different motivations for doing sports as proposed by self-determination theory, less emphasis has been put on the simultaneous presence of multiple motivations within the same individual. Therefore, the present study aimed to investigate the complex interaction of sport motivations and to identify core (common) and peripheral (uncommon) profiles of people engaged in sports based on a combination of motivations. To achieve this goal, latent profile analysis, a person-centered approach, was performed on responses from 506 participants engaged in sports. For better understanding the extracted profiles, basic psychological need fulfillment was included as profile predictor, while subjective vitality and various engagement-related indicators as outcomes. Four core and peripheral profiles were identified: Moderately Motivated, Highly Motivated, Amotivated, and Poorly Motivated. Contrary to theory, introjected regulation clustered more closely with self-determined motivations. Profile membership was significantly predicted by global need fulfillment, autonomy satisfaction as well as, to a smaller extent, autonomy, relatedness, and competence frustration. The four profiles differed along vitality and some, but not all, engagement-related outcomes.

Morningness-eveningness and caffeine consumption: A largescale path-analysis study.

It is still not clear how chronotype influences caffeine consumption (CC) and caffeine use disorder (CUD). The aim of the study was to investigate the relationship between chronotype, CC, CUD, and wellbeing. Participants of an online survey in Hungary (N = 2259) answered the CUD Questionnaire, Morningness-Eveningness Questionnaire and the WHO-5 Well-Being Index. Morningness positively associated with tea consumption, and negatively with cola and energy drink consumption. Severe CUD was more common among evening-type participants. Two significant mediations were found in the path model: Morningness→Tea consumption→Wellbeing and Eveningness→Energy drink consumption→CUD. It is concluded that CUD like other substance use disorders is associated with eveningness. The results indicate that the carrier beverages of the chemical compound of caffeine should be examined separately. Energy drink use can be accompanied by more unfavorable consequences, especially for evening-types, while tea consumption, which was associated with morningness, had more favorable consequences, like higher wellbeing.

[Artificial abortus from the male partner's perspective]. / A muvi abortusz a férfi partner szemszögébol.

Induced abortion is an intervention that scientific research primarily addresses from the concerned women's point of view in terms of either the causes or the consequences of the abortion decision. Nevertheless, each case of abortion involves a man as much as a woman (in the same vein as conception), which calls for the better knowledge of male partners' needs, expectations and experiences related to induced abortion. The present summary addresses male partners' status and importance in abortion care in a practical approach based on professional considerations. Available empirical findings suggest that male partners' involvement in abortion care has importance both in protecting men's emotional balance and in providing support for women in adapting to the abortion process. Male partners' deeper involvement possibly includes roles such as seeing the female partner to the intervention, participation in pre-abortion counselling, presence during the intervention, and participation in post-abortion care. Related findings show that all of these forms of support are related to women's positive abortion-related experiences and thus to their better recovery (provided that the female partner expresses a need for her male partner's personal support). Furthermore, male partners' involvement in abortion care enables health care providers to tailor counselling (information on the intervention, on possible consequences, on contraceptive methods etc.) to men's specific needs. These practices facilitate partners' joint and informed decision making, joint responsibility for conception or contraception, and eventually contribute to reducing the incidence of induced abortion. Orv Hetil. 2019; 160(18): 694-699.

How the obsession to eat healthy food meets with the willingness to do sports: the motivational background of orthorexia nervosa.

PURPOSE: Given its relevance, the present study sought to reveal the motivational background of orthorexia nervosa (ON) and to examine its association to do sports. METHODS: A total number of 739 participants completed a self-administered, online questionnaire including questions related to sports and three scales: Ortho-11-Hu, Motivation for Healthy Behaviors in Orthorexia Nervosa Questionnaire (MHBONQ) and Short Health Anxiety Inventory (SHAI). The age of the respondents ranged from 18 to 72 years (M = 29.67, SD = 10.18) and 79.16% of them were female. The majority of the subjects trained 3-4 times a week (37.2%), usually for 1-2 h per week (25.8%). RESULTS: According to the hierarchical multiple regression analysis, social desirability, guilt over skipping training and health anxiety were the strongest predictors of ON with explaining 46% of the variance of ON. DISCUSSION: The results of the present study suggested that obsessive features of sport activities (guilt over skipping training, counting calories during training) play an important role in ON. People with a higher level of ON tend to reach other people's respect, protect their general health and regulate negative emotional states through healthy eating. LEVEL OF EVIDENCE: Level V, descriptive cross-sectional study.

Psychometric properties of a Japanese version of Composite Scale of Morningness.

This study aimed to assess the factor structure and validity of the Composite Scale of Morningness (CSM) in Japanese samples. A sample of 348 Japanese university students (196 men, 152 women) and 170 adults from the community (50 men, 120 women) completed a questionnaire including the CSM, the Diurnal Type Scale (DTS) and questions regarding sleeping and waking times. Four measurement models were compared, and a two-factor measurement model with Morningness/Time of day preference (α = 0.78) and Morning Affect/Alertness (α = 0.80) factors yielded the closest fit. Both Morningness/Time of day preference and Morning Affect/Alertness were positively correlated with DTS score. Morningness/Ttime of day preference was negatively correlated with the midpoint of sleep on weekdays and free days. The measurement model was invariant across the university and community groups. The community group, which was older, was characterized by greater morningness. The results provide evidence of the validity of the Japanese CSM, thus opening up the possibility of including Japanese samples in cross-cultural research on morningness.

People behind unhealthy obsession to healthy food: the personality profile of tendency to orthorexia nervosa.

PURPOSE: Our aim was to measure the personality profile of people with high orthorexic tendency using an assessment method which is acknowledged in the research of the classical eating disorders (anorexia nervosa, bulimia nervosa) and obsessive-compulsive disorder (OCD). METHODS: In our research, 739 participants completed a self-administered, online questionnaire consisting of two measures: Temperament and Character Inventory-56 (TCI-56) and Ortho-11-Hu. RESULTS: The orthorexia nervosa (ON) grouping variable has a significant effect on three factors of TCI: MANOVA revealed higher harm avoidance (F (2, 736) = 19.01, p < 0.001, η2 = 0.05), lower self-directedness (F (2, 736) = 22.55, p < 0.001, η2 = 0.06), and higher transcendence (F (2, 736) = 3.05, p = 0.048, η2 = 0.01) in the higher ON group, compared to the lower ON group, regardless of the effect of the risk groups. CONCLUSIONS: According to earlier studies, high harm avoidance and low self-directedness are relevant factors of anorexia nervosa, bulimia nervosa, and OCD, but now it also seems to be an important parameter of orthorexia. Nevertheless, higher transcendence may be a unique feature, which suggests that orthorexia seems to be an independent phenomenon. LEVEL OF EVIDENCE: V, descriptive cross-sectional study.