Individuals who self-identify as having “orthorexia nervosa” score in the clinical range on the Eating Attitudes Test-26
In recent years, there has been growing interest in pathologically healthful eating, often called orthorexia nervosa (ON). Much of the literature in this area has been about point prevalence of ON in particular populations, which range from less than 1% to nearly 90% depending on the study. Despite this interest, there has been no extensive examination of whether those with pathologically healthful eating are detected by screening instruments that identify disordered eating. This study examines whether individuals who self-report suffering from ON score in the clinical range on the 26-item Eating Attitudes Test (EAT-26).
Individuals (n = 354) sampled from both clinical and non-clinical settings were administered the EAT-26 to determine whether those who self-identify as having ON scored in a range that suggests disordered eating.
Participants who self-report suffering from ON had a mean EAT-26 score of 30.89 (SD 12.60) scoring in a range that urges individuals to seek additional advice on whether there is an eating disorder present (scores of 20 and higher fall in a range suggesting a possible eating disorder). Furthermore, those in the ON group scored no differently than those reporting other eating disorders, but significantly higher than a non-clinical control group.
Our findings indicate that a screening instrument for a possible eating disorder is sensitive to pathologically healthful eating (but has no specificity).
Level of evidence
Level III, case control analytic study.
KeywordsOrthorexia nervosa Pathologically healthful eating EAT-26
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individuals included in the study.
- 2.Moroze RM, Dunn TM, Holland JC, Yager J, Weintraub P (2015) Microthinking about micronutrients: a case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria. Psychosomatics 56:397–403. https://doi.org/10.1016/j.psym.2014.03.003 CrossRefPubMedGoogle Scholar
- 4.Yen LH (2011) Case report when healhty eating becomes unhealhty—atypical eating disorder in a male patient. ASEAN J Psychiatry 12:194–197Google Scholar
- 16.Missbach B, Dunn TM, König JS (2016) 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 108:521–525. https://doi.org/10.1016/j.appet.2016.07.010 CrossRefPubMedGoogle Scholar
- 17.McElroy SL, Crow S, Blom TJ, Biernacka JM, Winham SJ, Geske J, Cuellar-Barboza AB, Bobo WV, Prieto ML, Veldic M (2016) Prevalence and correlates of DSM-5 eating disorders in patients with bipolar disorder. J Affect Disord 191:216–221. https://doi.org/10.1016/j.jad.2015.11.010 CrossRefPubMedGoogle Scholar
- 18.Fernandez-Aranda F, Poyastro Pinheiro A, Tozzi F, La Via M, Thornton LM, Plotnicov KH, Kaye WH, Fichter MM, Halmi KA, Kaplan AS (2007) Symptom profile of major depressive disorder in women with eating disorders. Aust N Z J Psychiatry 41:24–31. https://doi.org/10.1080/00048670601057718 CrossRefPubMedPubMedCentralGoogle Scholar
- 31.Katz MG, Vollenhoven B (2000) The reproductive endocrine consequences of anorexia nervosa. BJOG 107:707–713. https://doi.org/10.1111/j.1471-0528.2000.tb13329.x CrossRefPubMedGoogle Scholar
- 32.Grinspoon S, Thomas E, Pitts S, Gross E, Mickley D, Miller K, Herzog D, Klibanski A (2000) Prevalence and predictive factors for regional osteopenia in women with anorexia nervosa. Ann Intern Med 133:790–794. https://doi.org/10.7326/0003-4819-133-10-200011210-00011 CrossRefPubMedPubMedCentralGoogle Scholar
- 37.Peebles R, Lesser A, Park CC, Heckert K, Timko CA, Lantzouni E, Liebman R, Weaver L (2017) Outcomes of an inpatient medical nutritional rehabilitation protocol in children and adolescents with eating disorders. J Eat Disord 5:7. https://doi.org/10.1186/s40337-017-0134-6 CrossRefPubMedPubMedCentralGoogle Scholar
- 54.Cooney M, Lieberman M, Guimond T, Katzman DK (2018) Clinical and psychological features of children and adolescents diagnosed with avoidant/restrictive food intake disorder in a pediatric tertiary care eating disorder program: a descriptive study. J Eat Disord 6:1–7. https://doi.org/10.1186/s40337-018-0193-3 CrossRefGoogle Scholar