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When “Healthy” Is Taken Too Far: Orthorexia Nervosa—Current State, Controversies and Future Directions

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Hidden and Lesser-known Disordered Eating Behaviors in Medical and Psychiatric Conditions

Abstract

Orthorexia nervosa (ON) is an emerging eating disorder characterized by an obsession with healthy food that may lead to malnourishment, medical complications, loss of social and personal relationships and poor quality of life.

In recent decades, this eating disorder has increased presence in society; at the same time, researchers have increased interest in studying its critical aspects with the aim to filling the gaps in the literature.

The aims of this chapter were to summarize the current scientific knowledge, highlight the most recent controversies in the field of ON research and suggest instructions for further study through the use of the transdisciplinary approach.

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References

  1. Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C. Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eat Weight Disord. 2004;9(2):151–7. https://doi.org/10.1007/BF03325060.

    Article  CAS  PubMed  Google Scholar 

  2. Dunn TM, Bratman S. On orthorexia nervosa: a review of the literature and proposed diagnostic criteria. Eat Behav. 2016;21:11–7. https://doi.org/10.1016/j.eatbeh.2015.12.006.

    Article  PubMed  Google Scholar 

  3. Ryman FVM, Cesuroglu T, Bood ZM, Syurina EV. Orthorexia nervosa: disorder or not? Opinions of Dutch health professionals. Front Psychol. 2019;10:555. https://doi.org/10.3389/fpsyg.2019.00555.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Harris JL, Bargh JA, Brownell KD. Priming effects of television food advertising on eating behavior. Health Psychol. 2009;28(4):404–13. https://doi.org/10.1037/a0014399.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bratman, S. Original essay on orthorexia; 1997. www.orthorexia.comS. Accessed April 2006.

  6. Cena H, Barthels F, Cuzzolaro M, Bratman S, Brytek-Matera A, Dunn T, Varga M, Missbach B, Donini LM. Definition and diagnostic criteria for orthorexia nervosa: a narrative review of the literature. Eat Weight Disord. 2018;24 https://doi.org/10.1007/s40519-018-0606-y.

  7. ANRED. Less-well-known eating disorders and related problems. http://www.anred.com/defslesser.htmlS. Accessed April 2006.

  8. Vandereycken W. Media hype, diagnostic fad or genuine disorder? Professionals’ opinions about night eating syndrome, orthorexia, muscle dysmorphia, and emetophobia. Eat Disord. 2011;19(2):145–55. https://doi.org/10.1080/10640266.2011.551634.

    Article  PubMed  Google Scholar 

  9. Dunn TM, Gibbs J, Whitney N, Starosta A. Prevalence of orthorexia nervosa is less than 1%: data from a US sample. Eat Weight Disord. 2017;22(1):185–92. https://doi.org/10.1007/s40519-016-0258-8.

    Article  PubMed  Google Scholar 

  10. Brytek-Matera A. Orthorexia nervosa–an eating disorder, obsessive-compulsive disorder or disturbed eating habit. Arch Psychiatry Psychother. 2012;1:55–60.

    Google Scholar 

  11. Mathieu J. What is orthorexia? J Am Diet Assoc. 2005;105(10):1510–2. https://doi.org/10.1016/j.jada.2005.08.021.

    Article  PubMed  Google Scholar 

  12. Brytek-Matera A, Donini LM, Krupa M, Poggiogalle E, Hay P. Erratum to: Orthorexia nervosa and self-attitudinal aspects of body image in female and male university students. J Eat Disord. 2016;4(16) https://doi.org/10.1186/s40337-016-0105-3.

  13. Barnes MA, Caltabiano ML. The interrelationship between orthorexia nervosa, perfectionism, body image and attachment style. Eat Weight Disord. 2017;22(1):177–84. https://doi.org/10.1007/s40519-016-0280-x.

    Article  PubMed  Google Scholar 

  14. Depa J, Barrada JR, Roncero M. Are the motives for food choices different in orthorexia nervosa and healthy orthorexia? Nutrients. 2019;11(3):697. https://doi.org/10.3390/nu11030697.

    Article  PubMed Central  Google Scholar 

  15. Bratman S, Knight D. Health food junkies: orthorexia nervosa–overcoming the obsession with healthful eating. New York, NY: Broadway; 2000.

    Google Scholar 

  16. Moroze RM, Dunn TM, Craig Holland J, Yager J, Weintraub P. Microthinking about micronutrients: a case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria. Psychosomatics. 2015;56(4):397–403. https://doi.org/10.1016/j.psym.2014.03.003.

    Article  PubMed  Google Scholar 

  17. Park SW, Kim JY, Go GJ, et al. Orthorexia nervosa with hyponatremia, subcutaneous emphysema, pneumomediastinum, pneumothorax, and pancytopenia. Electrolyte Blood Press. 2011;9(1):32–7.

    Article  Google Scholar 

  18. McComb SE, Mills JS. Orthorexia nervosa: a review of psychosocial risk factors. Appetite. 2019;140:50–75. https://doi.org/10.1016/j.appet.2019.05.005.

    Article  PubMed  Google Scholar 

  19. Koven NS, Abry AW. The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatr Dis Treat. 2015;11:385–94. https://doi.org/10.2147/NDT.S61665.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Valente M, Syurina EV, Muftugil-Yalcin S, Cesuroglu T. “Keep Yourself Alive”: from healthy eating to progression to orthorexia nervosa a mixed methods study among young women in the Netherlands. Ecol Food Nutr. 2020:1–20. https://doi.org/10.1080/03670244.2020.1755279.

  21. Syurina EV, Bood ZM, Ryman FVM, Muftugil-Yalcin S. Cultural phenomena believed to be associated with orthorexia nervosa—opinion study in dutch health professionals. Front Psychol. 2018;9:1419. https://doi.org/10.3389/fpsyg.2018.01419.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Turner PG, Lefevre CE. Instagram use is linked to increased symptoms of orthorexia nervosa. Eat Weight Disord. 2017;22(2):277–84. https://doi.org/10.1007/s40519-017-0364-2.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Santarossa S, Lacasse J, Larocque J, Woodruff SJ. #Orthorexia on Instagram: a descriptive study exploring the online conversation and community using the Netlytic software. Eat Weight Disord. 2019;24(2):283–90. https://doi.org/10.1007/s40519-018-0594-y.

    Article  PubMed  Google Scholar 

  24. Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C. Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord. 2005;10:e28–32.

    Article  CAS  Google Scholar 

  25. Rogoza R, Donini LM. Introducing ORTO-R: a revision of ORTO-15: based on the re-assessment of original data. Eat Weight Disord. 2020; https://doi.org/10.1007/s40519-020-00924-5.

  26. Missbach B, Dunn TM, König JS. We need new tools to assess Orthorexia Nervosa. A commentary on “Prevalence of Orthorexia Nervosa among College Students Based on Bratman’s Test and Associated Tendencies”. Appetite. 2017;108:521–4.

    Article  Google Scholar 

  27. Roncero M, Barrada JR, Perpiñá C. Measuring orthorexia nervosa: psychometric limitations of the ORTO-15. Span J Psychol. 2017;20:41.

    Article  Google Scholar 

  28. Gleaves DH, Graham EC, Ambwani S. Measuring “orthorexia”: development of the Eating Habits Questionnaire. Int J Educ Psychol Assess. 2013;12(2):1–18.

    Google Scholar 

  29. Barthels F, Meyer F, Pietrowsky R. Die Düsseldorfer Orthorexie Skala-Konstruktion und Evaluation eines Fragebogens zur Erfassung ortho-rektischen Ernährungsverhaltens. Z Klin Psychol Psychother. 2015;44(2):97–105. https://doi.org/10.1026/1616-3443/a000310.

    Article  Google Scholar 

  30. Bauer SM, Fusté A, Andrés A, Saldaña C. The Barcelona Orthorexia Scale (BOS): development process using the Delphi method. Eat Weight Disord. 2018;24:247. https://doi.org/10.1007/s40519-018-0556-4.

    Article  PubMed  Google Scholar 

  31. Roncero M, Barrada JR, Perpiñá C. Measuring orthorexia nervosa: psychometric limitations of the ORTO-15. Span J Psychol. 2017;20:E41. https://doi.org/10.1017/sjp.2017.36.

    Article  PubMed  Google Scholar 

  32. Oberle CD, De Nadai AS, Madrid AL. Orthorexia Nervosa Inventory (ONI): development and validation of a new measure of orthorexic symptomatology. Eat Weight Disord. 2020; https://doi.org/10.1007/s40519-020-00896-6.

  33. Kinzl JF, Hauer K, Traweger C, Kiefer I. Orthorexia nervosa: eine häufige essstörung bei diätassistentinnen. Ern Umschau. 2005;52(11):436–9.

    Google Scholar 

  34. Eriksson L, Baigi A, Marklund B, Lindgren EC. Social physique anxiety and sociocultural attitudes toward appearance impact on orthorexia test in fitness participants. Scand J Med Sci Sports. 2008;18(3):389–94. https://doi.org/10.1111/J.1600-0838.2007.00723.x.

    Article  CAS  PubMed  Google Scholar 

  35. Bosi ATB, Çamur D, Güler Ç. Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine (Ankara, Turkey). Appetite. 2007;49(3):661–6. https://doi.org/10.1016/j.appet.2007.04.007.

    Article  Google Scholar 

  36. Arusoğlu G, Kabakçi E, Köksal G, Merdol TK. Ortoreksiya nervoza ve Orto-11’in türkçeye uyarlama çalişmasi [Orthorexia nervosa and adaptation of ORTO-11 into Turkish]. Turk Psikiyatri Derg. 2008;19(3):283–91.

    PubMed  Google Scholar 

  37. Alvarenga MS, Martins MC, Sato KS, Vargas SV, Philippi ST, Scagliusi FB. Orthorexia nervosa behavior in a sample of Brazilian dietitians assessed by the Portuguese version of ORTO-15. Eat Weight Disord. 2012;17(1):e29–35. https://doi.org/10.1007/BF03325325.

    Article  CAS  PubMed  Google Scholar 

  38. Varga M, Thege BK, Dukay-Szabó S, Túry F, van Furth EF. When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry. 2014;14(59) https://doi.org/10.1186/1471-244X-14-59.

  39. Brytek-Matera A, Krupa M, Poggiogalle E, Donini LM. Adaptation of the ORTHO-15 test to Polish women and men [published correction appears in Eat Weight Disord. 2014 Jun;19(2):271]. Eat Weight Disord. 2014;19(1):69–76. https://doi.org/10.1007/s40519-014-0100-0.

    Article  PubMed  Google Scholar 

Fine Modulo

  1. Stochel M, Janas-Kozik M, Zejda JE, Hyrnik J, Jelonek I, Siwiec A. Validation of ORTO-15 questionnaire in the group of urban youth aged 15–21. Psychiatr Pol. 2015;49(1):119–34. https://doi.org/10.12740/PP/25962.

    Article  PubMed  Google Scholar 

  2. Missbach B, Hinterbuchinger B, Dreiseitl V, Zellhofer S, Kurz C, König J. When eating right, is measured wrong! A validation and critical examination of the ORTO-15 questionnaire in German. PLoS One. 2015;10(8):e0135772. https://doi.org/10.1371/journal.pone.0135772.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Moller S, Apputhurai P, Knowles SR. Confirmatory factor analyses of the ORTO 15-, 11- and 9-item scales and recommendations for suggested cut-off scores [published correction appears in Eat Weight Disord. 2019;24(5):981]. Eat Weight Disord. 2019;24(1):21–8. https://doi.org/10.1007/s40519-018-0515-0.

    Article  PubMed  Google Scholar 

  4. Parra-Fernandez ML, Rodríguez-Cano T, Perez-Haro MJ, Onieva-Zafra MD, Fernandez-Martinez E, Notario-Pacheco B. Structural validation of ORTO-11-ES for the diagnosis of orthorexia nervosa, Spanish version. Eat Weight Disord. 2018;23(6):745–52. https://doi.org/10.1007/s40519-018-0573-3.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Parra-Fernandez ML, Rodríguez-Cano T, Onieva-Zafra MD, Perez-Haro MJ, Casero-Alonso V, Camargo JCM, Notario-Pacheco B. Adaptation and validation of the Spanish version of the ORTO-15 questionnaire for the diagnosis of orthorexia nervosa. PLoS One. 2018;13(1):e0190722. https://doi.org/10.1371/journal.pone.0190722.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Haddad C, Hallit R, Akel M. Validation of the Arabic version of the ORTO-15 questionnaire in a sample of the Lebanese population. Eat Weight Disord. 2019; https://doi.org/10.1007/s40519-019-00710-y.

  7. Babeau C, Le Chevanton T, Julien-Sweerts S, Brochenin A, Donini LM, Fouques D. Structural validation of the ORTO-12-FR questionnaire among a French sample as a first attempt to assess orthorexia nervosa in France. Eat Weight Disord. 2019; https://doi.org/10.1007/s40519-019-00835-0.

  8. Meule A, Holzapfel C, Brandl B, et al. Measuring orthorexia nervosa: a comparison of four self-report questionnaires. Appetite. 2020:146, 104512. https://doi.org/10.1016/j.appet.2019.104512.

  9. Moller S, Apputhurai P, Knowles SR. Confirmatory factor analyses of the ORTO 15-, 11- and 9-item scales and recommendations for suggested cut-off scores [published correction appears in Eat Weight Disord. 2019 Oct;24(5):981]. Eat Weight Disord. 2019;24(1):21–8. https://doi.org/10.1007/s40519-018-0515-0.

    Article  PubMed  Google Scholar 

  10. Chard CA, Hilzendegen C, Barthels F, Stroebele-Benschop N. Psychometric evaluation of the English version of the Düsseldorf orthorexie scale (DOS) and the prevalence of orthorexia nervosa among a US student sample. Eat Weight Disord. 2018;24(2):275–81. https://doi.org/10.1007/s40519-018-0570-6.

    Article  PubMed  Google Scholar 

  11. He J, Ma H, Barthels F, Fan X. Psychometric properties of the Chinese version of the Düsseldorf Orthorexia Scale: prevalence and demographic correlates of orthorexia nervosa among Chinese university students. Eat Weight Disord. 2019;24(3):453–63. https://doi.org/10.1007/s40519-019-00656-1.

    Article  PubMed  Google Scholar 

  12. Parra-Fernández ML, Onieva-Zafra MD, Fernández-Muñoz JJ, Fernández-Martínez E. Adaptation and validation of the Spanish version of the DOS questionnaire for the detection of orthorexic nervosa behavior. PLoS One. 2019;14(5):e0216583. https://doi.org/10.1371/journal.pone.0216583.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Fidan T, Ertekin V, Sikay S, Kirpinar I. Prevalence of orthorexia among medical students in Erzurum, Turkey. Compr Psychiatry. 2010;51:49–54. https://doi.org/10.1016/j.comppsych.2009.03.001.

    Article  PubMed  Google Scholar 

  14. Valera JH, Ruiz PA, Valdespino BR, Visioli F. Prevalence of orthorexia nervosa among ashtanga yoga practitioners: a pilot study. Eat Weight Disord. 2014;19:469–72. https://doi.org/10.1007/s40519-014-0131-6.

    Article  Google Scholar 

  15. Segura-Garcia C, Ramacciotti C, Rania M, Aloi M, Caroleo M, Bruni A. The prevalence of orthorexia nervosa among eating disorder patients after treatment. Eat Weight Disord. 2015;20:161–6. https://doi.org/10.1007/s40519-014-0171-y.

    Article  PubMed  Google Scholar 

  16. Gramaglia C, Gambaro E, Delicato C, et al. Pathways to and results of psychiatric consultation for patients referred from the emergency department. Are there differences between migrant and native patients? Transcult Psychiatry. 2019;56(1):167–86. https://doi.org/10.1177/1363461518798844.

    Article  PubMed  Google Scholar 

  17. Agopyan A, Kenger EB, Kermen S. The relationship between orthorexia nervosa and body composition in female students of the nutrition and dietetics department. Eat Weight Disord. 2019;24:257–66. https://doi.org/10.1007/s40519-018-0565-3.

    Article  PubMed  Google Scholar 

  18. Farchakh Y, Hallit S, Soufia M. Association between orthorexia nervosa, eating attitudes and anxiety among medical students in Lebanese universities: results of a cross-sectional study. Eat Weight Disord. 2019;24:683–91. https://doi.org/10.1007/s40519-019-00724-6.

    Article  PubMed  Google Scholar 

  19. Erkin Ö, Göl I. Determination of health status perception and orthorexia nervosa tendencies of Turkish yoga practitioners: a cross-sectional descriptive study. Progr Nutr. 2019;21(1):105–12.

    Google Scholar 

  20. Bóna E, Szél Z, Kiss D. An unhealthy health behavior: analysis of orthorexic tendencies among Hungarian gym attendees. Eat Weight Disord. 2019;24:13–20.

    Article  Google Scholar 

  21. Asil E, Sürücüoğlu MS. Orthorexia nervosa in Turkish dietitians. Ecol Food Nutr. 2015;54(4):303–13.

    Article  Google Scholar 

  22. Malmborg J, Bremander A, Olsson MC, Bergman S. Health status, physical activity, and orthorexia nervosa: a comparison between exercise science students and business students. Appetite. 2017;109:137–43.

    Article  Google Scholar 

  23. Bo S, Zoccali R, Ponzo V, Soldati L, De Carli L, Benso A, Fea E, Rainoldi A, Durazzo M, Fassino S. University courses, eating problems and muscle dysmorphia: are there any associations? J Transl Med. 2014;12:221. https://doi.org/10.1186/s12967-014-0221-2.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Aksoydan E, Camci N. Prevalence of orthorexia nervosa among Turkish performance artists. Eat Weight Disord. 2009;14:33–7.

    Article  CAS  Google Scholar 

  25. Bartrina JA. Ortorexia o la obsesión por la dieta saludable [Orthorexia or when a healthy diet becomes an obsession]. Arch Latinoam Nutr. 2007;57(4):313–5. Spanish.

    PubMed  Google Scholar 

  26. Borgida A. In sickness and in health: orthorexia nervosa, the study of obsessive healthy eating [dissertation]. USA: ProQuest Information and Learning; 2012, pp/ 6376–6376. http://gradworks.umi.com/34/67/3467161.html. Accessed 15 Dec 2014.

  27. Simpson HB, Wetterneck CT, Cahill SP, et al. Treatment of obsessive-compulsive disorder complicated by comorbid eating disorders. Cogn Behav Ther. 2013;42(1):64–76.

    Article  Google Scholar 

  28. Schröder A, Heider J, Zaby A, et al. Cognitive behavioral therapy versus progressive muscle relaxation training for multiple somatoform symptoms: results of a randomized controlled trial. Cogn Ther Res. 2013;37(2):296–306.

    Article  Google Scholar 

  29. Barsky AJ, Ahern DK, Bauer MR, et al. A randomized trial of treatments for high-utilizing somatizing patients. J Gen Intern Med. 2013;28(11):1396–404.

    Article  Google Scholar 

  30. Freeman J, Sapyta J, Garcia A, Compton S, Khanna M, Flessner C, et al. Family-based treatment of early childhood obsessive-compulsive disorder: The pediatric obsessive-compulsive disorder treatment study for young children (POTS Jr)da randomized clinical trial. JAMA Psychiat. 2014;71(6):689–98.

    Article  Google Scholar 

  31. Torp NC, Dahl K, Skarphedinsson G, Thomsen PH, Valderhaug R, Weidle B, Wentzel-Larsen T. Effectiveness of cognitive behavior treatment for pediatric obsessive-compulsive disorder: acute outcomes from the Nordic Long-term OCD Treatment Study (NordLOTS). Behav Res Ther. 2015;64:15–23.

    Article  Google Scholar 

  32. Fairburn CG. Cognitive behavior therapy and eating disorders. New York: Guilford Press; 2008.

    Google Scholar 

  33. Zickgraf HF, Ellis JM, Essayli JH. Disentangling orthorexia nervosa from healthy eating and other eating disorder symptoms: relationships with clinical impairment, comorbidity, and self-reported food choices. Appetite. 2019;134:134–40. https://doi.org/10.1016/j.appet.2018.12.006.

    Article  Google Scholar 

  34. Barthels F, Barrada JR, Roncero M. Orthorexia nervosa and healthy orthorexia as new eating styles. PLoS One. 2019;14(7):e0219609. https://doi.org/10.1371/journal.pone.0219609.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Scarff JR. Orthorexia nervosa: an obsession with healthy eating. Federal Practitioner. 2017;34(6):36–9.

    PubMed  PubMed Central  Google Scholar 

  36. Koven NS, Senbonmatsu N. A neuropsychological evaluation of orthorexia nervosa. Open J Psychiatry. 2013;3:214–22. https://doi.org/10.4236/ojpsych.2013.32019.

    Article  Google Scholar 

  37. Dell’Osso L, Abelli M, Carpita B, et al. Historical evolution of the concept of anorexia nervosa and relationships with orthorexia nervosa, autism, and obsessive-compulsive spectrum. Neuropsychiatr Dis Treat. 2016;12:1651–60. https://doi.org/10.2147/NDT.S108912.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Hayatbini N, Oberle CD. Are orthorexia nervosa symptoms associated with cognitive Inflexibility? Psychiatry Res. 2019;271:464–8. https://doi.org/10.1016/j.psychres.2018.12.017.

    Article  PubMed  Google Scholar 

  39. Reynolds R, McMahon S. Views of health professionals on the clinical recognition of orthorexia nervosa: a pilot study. Eat Weight Disord. 2019; https://doi.org/10.1007/s40519-019-00701-z.

  40. Reynolds R. Is the prevalence of orthorexia nervosa in an Australian university population 6.5%? Eat Weight Disord. 2018;23(4):453–8.

    Article  Google Scholar 

  41. Gramaglia C, Brytek-Matera A, Rogoza R, Zeppegno P. Orthorexia and anorexia nervosa: two distinct phenomena? A cross-cultural comparison of orthorexic behaviours in clinical and non-clinical samples. BMC Psychiatry. 2017;17(1):75. https://doi.org/10.1186/s12888-017-1241-2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Barrada R, Roncero M. Bidimensional structure of the orthorexia: development and initial validation of a new instrument. Anales De Psicología/Annals of Psychology. 2018;34(2):283–91.

    Article  Google Scholar 

  43. Varga M, Dukay-Szabó S, Túry F, van Furth EF. Evidence and gaps in the literature on orthorexia nervosa [published correction appears in Eat Weight Disord. 2013;18(2):113. van Furth Eric, F [corrected to van Furth, Eric F]]. Eat Weight Disord. 2013;18(2):103–11. https://doi.org/10.1007/s40519-013-0026-y.

    Article  PubMed  Google Scholar 

  44. Oberle CD, Samaghabadi RO, Hughes EM. Orthorexia nervosa: assessment and correlates with gender, BMI, and personality. Appetite. 2017;108:303–10. https://doi.org/10.1016/j.appet.2016.10.021.

    Article  PubMed  Google Scholar 

  45. Eckersley R. Is modern Western culture a health hazard. Int J Epidemiol. 2006;35:252–8. https://doi.org/10.1093/ije/dyi235.

    Article  PubMed  Google Scholar 

  46. Hesse-Biber S, Leavy P, Quinn CE, Zoino J. The mass marketing of disordered eating and eating disorders: the social psychology of women, thinness and culture. Paper Presented at the Women’s Studies International Forum, New York, NY; 2006, pp. 208–224. https://doi.org/10.1016/j.wsif.2006.03.007.

  47. Domingues RB, Carmo C. Orthorexia nervosa in yoga practitioners: relationship with personality, attitudes about appearance, and yoga engagement. Eat Weight Disord. 2020; https://doi.org/10.1007/s40519-020-00911-w.

  48. Tóth-Király I, Gajdos P, Román N, Vass N, Rigó A. The associations between orthorexia nervosa and the sociocultural attitudes: the mediating role of basic psychological needs and health anxiety. Eat Weight Disord. 2019; https://doi.org/10.1007/s40519-019-00826-1.

  49. Strahler J, Haddad C, Salameh P, Sacre H, Obeid S, Hallit S. Cross-cultural differences in orthorexic eating behaviors: associations with personality traits. Nutrition. 2020;110811:77. https://doi.org/10.1016/j.nut.2020.110811.

    Article  Google Scholar 

  50. Swaans K, Broerse J, Meincke M, Mudhara M, Bunders J. Promoting food security and well-being among poor and HIV/AIDS affected households: lessons from an interactive and integrated approach. Eval Program Plann. 2009;32(1):31–42. https://doi.org/10.1016/j.evalprogplan.2008.09.002.

    Article  PubMed  Google Scholar 

  51. Stock P, Burton RJF. Defining terms for integrated (multi-inter-trans-disciplinary) sustainability research. Sustainability. 2011;3(8):1090–113.

    Article  Google Scholar 

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Author notes

  1. Valeria Galfano and Elena V. Syurina contributed equally to this work.

Authors and Affiliations

  1. Department of Experimental Medicine, Sapienza University, Rome, Italy

    Valeria Galfano & Lorenzo M. Donini

  2. Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

    Elena V. Syurina & Martina Valente

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  1. Valeria Galfano
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  2. Elena V. Syurina
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  3. Martina Valente
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  4. Lorenzo M. Donini
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Correspondence to Lorenzo M. Donini .

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Editors and Affiliations

  1. Private Hospital "Salus" of Ferrara, University of Ferrara, Ferrara, Italy

    Emilia Manzato

  2. Formerly Sapienza University of Rome, Founding Editor of Eating and Weight Disorders, Campiglia Marittima, Livorno, Italy

    Massimo Cuzzolaro

  3. Experimental Medicine Department, Sapienza University of Rome, Editor-in-Chief of Eating and Weight Disorders, Roma, Roma, Italy

    Lorenzo Maria Donini

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Galfano, V., Syurina, E.V., Valente, M., Donini, L.M. (2022). When “Healthy” Is Taken Too Far: Orthorexia Nervosa—Current State, Controversies and Future Directions . In: Manzato, E., Cuzzolaro, M., Donini, L.M. (eds) Hidden and Lesser-known Disordered Eating Behaviors in Medical and Psychiatric Conditions . Springer, Cham. https://doi.org/10.1007/978-3-030-81174-7_14

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  • DOI: https://doi.org/10.1007/978-3-030-81174-7_14

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  • Online ISBN: 978-3-030-81174-7

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