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Psychometric properties of the Chinese version of the Düsseldorf Orthorexia Scale: prevalence and demographic correlates of orthorexia nervosa among Chinese university students

  • Jinbo HeEmail author
  • Hongzhi Ma
  • Friederike Barthels
  • Xitao Fan
Original Article
Part of the following topical collections:
  1. Orthorexia Nervosa

Abstract

Purpose

As there is no measure available in Chinese for assessing orthorexia nervosa (ON), and as the Düsseldorf Orthorexia Scale (DOS) has demonstrated to be a valid measure for such a purpose, the current study aimed to obtain a Chinese version of the DOS (C-DOS), to evaluate psychometric properties of the C-DOS in a sample of Chinese university students, and to explore the prevalence of ON among the participants.

Methods

According to standard procedures, the C-DOS was obtained and administered to 1075 mainland Chinese university students (52.7% female) recruited from two provinces in mainland China. To examine the factor structure of the C-DOS, the total sample was split into two halves, one for exploratory factor analysis, and the other for confirmatory factor analysis. The ordinal alpha and test–retest reliability were examined. Convergent and divergent validity was assessed by conducting Pearson correlation analyses between the C-DOS and other theoretically related/unrelated measures. Prevalence of ON was estimated based on the total score of the C-DOS with the cutoff value of 30.

Results

A three-factor structure was revealed for the C-DOS. The C-DOS showed good internal consistency with an ordinal alpha of 0.80, and it also had good test–retest reliability of 0.77. The total scores of the C-DOS had strong and statistically significant positive correlations with eating inflexibility, while the total scores had weak correlations with other eating disturbances. Strong measurement invariance across gender groups was also supported. The prevalence of ON was 7.8% with males showing higher rates of ON than females (10.6% vs. 5.3%).

Conclusions

The Chinese version of the DOS (C-DOS) was psychometrically adequate for the sample of Chinese students. Given the high prevalence of ON found in the current study, more attention to ON, as well as further research and potential interventions, are warranted in China.

Level of evidence

Descriptive (cross-sectional) study, Level V.

Keywords

Orthorexia nervosa Düsseldorf Orthorexia Scale Validation Simplified Chinese Prevalence 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the research committee of Hunan University and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from all the surveyed participants.

References

  1. 1.
    Bratman S (1997) Original orthorexia essay. Yoga JGoogle Scholar
  2. 2.
    Dunn TM, Bratman S (2016) On orthorexia nervosa: a review of the literature and proposed diagnostic criteria. Eat Behav 21:11–17.  https://doi.org/10.1016/j.eatbeh.2015.12.006 CrossRefPubMedGoogle Scholar
  3. 3.
    Depa J, Schweizer J, Bekers S-K, Hilzendegen C, Stroebele-Benschop N (2017) Prevalence and predictors of orthorexia nervosa among German students using the 21-item-DOS. Eat Weight Disord 22(1):193–199.  https://doi.org/10.1007/s40519-016-0334-0 CrossRefPubMedGoogle Scholar
  4. 4.
    Chaki B, Pal S, Bandyopadhyay A (2013) Exploring scientific legitimacy of orthorexia nervosa: a newly emerging eating disorder. J Hum Sport Exerc 8(4):1045–1053CrossRefGoogle Scholar
  5. 5.
    Dunn TM, Gibbs J, Whitney N, Starosta A (2017) Prevalence of orthorexia nervosa is less than 1%: data from a US sample. Eat Weight Disord 22(1):185–192.  https://doi.org/10.1007/s40519-016-0258-8 CrossRefPubMedGoogle Scholar
  6. 6.
    Koven NS, Abry AW (2015) The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatr Dis Treat 11:385CrossRefGoogle Scholar
  7. 7.
    Sánchez FG, Rial BR (2005) Orthorexia nervosa. A new eating behavior disorder? Actas Esp Psiquiatr 33(1):66–68Google Scholar
  8. 8.
    Donini LM, Marsili D, Graziani M, Imbriale M, Cannella C (2004) Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eat Weight Disord 9(2):151–157.  https://doi.org/10.1007/BF03325060 CrossRefPubMedGoogle Scholar
  9. 9.
    National Eating Disorders Association (2018) https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia. Accessed May 17 2018
  10. 10.
    Bosi ATB, Çamur D, Güler Ç (2007) Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine (Ankara, Turkey). Appetite 49(3):661–666.  https://doi.org/10.1016/j.appet.2007.04.007 CrossRefGoogle Scholar
  11. 11.
    Dell’Osso L, Carpita B, Muti D, Cremone I, Massimetti G, Diadema E, Gesi C, Carmassi C (2018) Prevalence and characteristics of orthorexia nervosa in a sample of university students in Italy. Eat Weight Disord 23(1):55–65.  https://doi.org/10.1007/s40519-017-0460-3 CrossRefPubMedGoogle Scholar
  12. 12.
    Varga M, Thege BK, Dukay-Szabó S, Túry F, van Furth EF (2014) When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry 14(1):59.  https://doi.org/10.1186/1471-244X-14-59 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Parra-Fernandez ML, Rodríguez-Cano T, Onieva-Zafra MD, Perez-Haro MJ, Casero-Alonso V, Camargo JCM, Notario-Pacheco B (2018) Adaptation and validation of the Spanish version of the ORTO-15 questionnaire for the diagnosis of orthorexia nervosa. PLoS One 13(1):e0190722.  https://doi.org/10.1371/journal.pone.0190722 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Reynolds R (2018) Is the prevalence of orthorexia nervosa in an Australian university population 6.5%? Eat Weight Disord 23(4):453–458.  https://doi.org/10.1007/s40519-018-0535-9 CrossRefPubMedGoogle Scholar
  15. 15.
    Pike KM, Dunne PE (2015) The rise of eating disorders in Asia: a review. J Eating Disord 3(1):33.  https://doi.org/10.1186/s40337-015-0070-2 CrossRefGoogle Scholar
  16. 16.
    Tong J, Miao S, Wang J, Yang F, Lai H, Zhang C, Zhang Y, Hsu LG (2014) A two-stage epidemiologic study on prevalence of eating disorders in female university students in Wuhan, China. Soc Psychiatry Psychiatr Epidemiol 49(3):499–505.  https://doi.org/10.1007/s00127-013-0694-y CrossRefPubMedGoogle Scholar
  17. 17.
    Kadish YA (2012) The role of culture in eating disorders. Br J Psychother 28(4):435–453.  https://doi.org/10.1111/j.1752-0118.2012.01311.x CrossRefGoogle Scholar
  18. 18.
    Bratman S, Knight D (2000) Health food junkies: overcoming the obsession with healthful eating. Broadway Books, New YorkGoogle Scholar
  19. 19.
    Donini LM, Marsili D, Graziani M, Imbriale M, Cannella C (2005) Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord 10(2):e28–e32.  https://doi.org/10.1007/BF03327537 CrossRefPubMedGoogle Scholar
  20. 20.
    Robinson KM (2011) Is the fixation on “healthy” unhealthy? A study on orthorexia nervosa. Kent State University, KentGoogle Scholar
  21. 21.
    Gleaves DH, Graham EC, Ambwani S (2013) Measuring’orthorexia’: development of the eating habits questionnaire. Int J Educ Psychol Assess 12(2):1–18Google Scholar
  22. 22.
    Barthels F, Meyer F, Pietrowsky R (2015) Die Düsseldorfer Orthorexie Skala–Konstruktion und evaluation eines Fragebogens zur Erfassung ortho-rektischen Ernährungsverhaltens. Z Klin Psychol Psychother 44:97–105CrossRefGoogle Scholar
  23. 23.
    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 108:521–524.  https://doi.org/10.1016/j.appet.2016.07.010 CrossRefPubMedGoogle Scholar
  24. 24.
    Costa CB, Hardan-Khalil K, Gibbs K (2017) Orthorexia nervosa: a review of the literature. Issues Mental Health Nurs 38(12):980–988.  https://doi.org/10.1080/01612840.2017.1371816 CrossRefGoogle Scholar
  25. 25.
    Missbach B, Hinterbuchinger B, Dreiseitl V, Zellhofer S, Kurz C, König J (2015) When eating right, is measured wrong! A validation and critical examination of the ORTO-15 questionnaire in German. PLoS One 10(8):e0135772.  https://doi.org/10.1371/journal.pone.0135772 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Roncero M, Barrada JR, Perpiñá C (2017) Measuring orthorexia nervosa: psychometric limitations of the ORTO-15. Span J Psychol 20:e41.  https://doi.org/10.1017/sjp.2017.36 CrossRefPubMedGoogle Scholar
  27. 27.
    Chard CA, Hilzendegen C, Barthels F, Stroebele-Benschop N (2018) 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.  https://doi.org/10.1007/s40519-018-0570-6 CrossRefPubMedGoogle Scholar
  28. 28.
    Faul F, Erdfelder E, Lang A-G, Buchner A (2007) G* Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39(2):175–191.  https://doi.org/10.3758/BF03193146 CrossRefGoogle Scholar
  29. 29.
    Zhou B-F (2002) Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults—study on optimal cut-off points of body mass index and waist circumference in Chinese adults. Biomed Environ Sci 15(1):83–96PubMedGoogle Scholar
  30. 30.
    Brislin RW (1970) Back-translation for cross-cultural research. J Cross Cultur Psychol 1(3):185–216CrossRefGoogle Scholar
  31. 31.
    Duarte C, Ferreira C, Pinto-Gouveia J, Trindade I, Martinho A (2017) What makes dietary restraint problematic? Development and validation of the inflexible eating questionnaire. Appetite 114:146–154.  https://doi.org/10.1016/j.appet.2017.03.034 CrossRefPubMedGoogle Scholar
  32. 32.
    Cappelleri J, Bushmakin A, Gerber R, Leidy N, Sexton C, Lowe M, Karlsson J (2009) Psychometric analysis of the Three-Factor Eating Questionnaire-R21: results from a large diverse sample of obese and non-obese participants. Int J Obes 33(6):611–620CrossRefGoogle Scholar
  33. 33.
    Shi M, Kong F, Chen H, Cheng D (2011) Applicability of Three-Factor Eating Questionnaire among Chinese women undergraduates. Chin J Clin Psychol 19(6):737–739Google Scholar
  34. 34.
    Garner DM, Olmstead MP, Polivy J (1983) Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J Eat Disord 2(2):15–34CrossRefGoogle Scholar
  35. 35.
    R Core Team (2018) A language and environment for statistical computing. R Foundation for Statistical Computing, Austria, 2015. ISBN 3-900051-07-0. http://www.R-project.org
  36. 36.
    Revelle W (2014) Psych: Procedures for psychological, psychometric, and personality research. Northwestern University, Evanston, p 165Google Scholar
  37. 37.
    Rosseel Y (2012) Lavaan: an R package for structural equation modeling and more. Version 0.5–12 (BETA). J Stat Softw 48(2):1–36CrossRefGoogle Scholar
  38. 38.
    Jorgensen T, Pornprasertmanit S, Schoemann A, Rosseel Y (2018) semTools: useful tools for structural equation modeling. R Package Version 0.5-1Google Scholar
  39. 39.
    Hayton JC, Allen DG, Scarpello V (2004) Factor retention decisions in exploratory factor analysis: a tutorial on parallel analysis. Organ Res Methods 7(2):191–205.  https://doi.org/10.1177/1094428104263675 CrossRefGoogle Scholar
  40. 40.
    Tabachnick BG, Fidell LS (2007) Using multivariate statistics, 5th edn. Allyn & Bacon/Pearson Education, BostonGoogle Scholar
  41. 41.
    Satorra A, Bentler PM (2001) A scaled difference chi-square test statistic for moment structure analysis. Psychometrika 66(4):507–514.  https://doi.org/10.1007/BF02296192 CrossRefGoogle Scholar
  42. 42.
    Lt Hu, Bentler PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model Multidiscip J 6(1):1–55.  https://doi.org/10.1080/10705519909540118 CrossRefGoogle Scholar
  43. 43.
    Hair JF, Black WC, Babin BJ, Anderson RE, Tatham RL (1998) Multivariate data analysis, vol 5. Prentice Hall, Upper Saddle RiverGoogle Scholar
  44. 44.
    Van de Schoot R, Lugtig P, Hox J (2012) A checklist for testing measurement invariance. Eur J Dev Psychol 9(4):486–492.  https://doi.org/10.1080/17405629.2012.686740 CrossRefGoogle Scholar
  45. 45.
    Chen FF (2007) Sensitivity of goodness of fit indexes to lack of measurement invariance. Struct Equ Model 14(3):464–504.  https://doi.org/10.1080/10705510701301834 CrossRefGoogle Scholar
  46. 46.
    Cheung GW, Rensvold RB (2002) Evaluating goodness-of-fit indexes for testing measurement invariance. Struct Equ Model 9(2):233–255.  https://doi.org/10.1207/S15328007SEM0902_5 CrossRefGoogle Scholar
  47. 47.
    Enders CK (2006) A primer on the use of modern missing-data methods in psychosomatic medicine research. Psychosom Med 68(3):427–436.  https://doi.org/10.1097/01.psy.0000221275.75056.d8 CrossRefPubMedGoogle Scholar
  48. 48.
    Field A (2013) Discovering statistics using IBM SPSS statistics. Sage Publications, Thousand OaksGoogle Scholar
  49. 49.
    Barrada JR, Roncero M (2018) Bidimensional structure of the orthorexia: development and initial validation of a new instrument. Ann Psychol 34(2):283–291Google Scholar
  50. 50.
    Aksoydan E, Camci N (2009) Prevalence of orthorexia nervosa among Turkish performance artists. Eat Weight Disord 14(1):33–37.  https://doi.org/10.1007/BF03327792 CrossRefPubMedGoogle Scholar
  51. 51.
    Kinzl JF, Hauer K, Traweger C, Kiefer I (2006) Orthorexia nervosa in dieticians. Psychother Psychosom 75(6):395–396.  https://doi.org/10.1159/000095447 CrossRefPubMedGoogle Scholar
  52. 52.
    Ab Hamid MR, Azman NN, Said N, Rahman ANA (2018) Orthorexia nervosa and the quality of life among health sciences students in Universiti Teknologi MARA, Selangor. Environ Behav Proc J 3(7):121–126CrossRefGoogle Scholar
  53. 53.
    Fidan T, Ertekin V, Isikay S, Kaya D, Esin I, Asfuroglu B (2014) Orthorexia nervosa and education. Eur Neuropsychopharmacol 24(SUPPL. 2):S731CrossRefGoogle Scholar
  54. 54.
    Liu Z (2011) The culture of Chinese healthcare and its contemporary significance. J Educ Coll Jilin Prov 27:26–27Google Scholar
  55. 55.
    Flaws B (2000) The TAO of Healthy eating: dietary wisdom according to chinese medicine. BukupediaGoogle Scholar
  56. 56.
    Brytek-Matera A, Donini LM, Krupa M, Poggiogalle E, Hay P (2015) Orthorexia nervosa and self-attitudinal aspects of body image in female and male university students. J Eat Disord 3(1):2.  https://doi.org/10.1186/s40337-016-0105-3 CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Oberle CD, Samaghabadi RO, Hughes EM (2017) Orthorexia nervosa: assessment and correlates with gender, BMI, and personality. Appetite 108:303–310.  https://doi.org/10.1016/j.appet.2016.10.021 CrossRefPubMedGoogle Scholar
  58. 58.
    Ramacciotti C, Perrone P, Coli E, Burgalassi A, Conversano C, Massimetti G, Dell’Osso L (2011) Orthorexia nervosa in the general population: a preliminary screening using a self-administered questionnaire (ORTO-15). Eat Weight Disord 16(2):e127–e130.  https://doi.org/10.1007/BF03325318 CrossRefPubMedGoogle Scholar
  59. 59.
    Valera JH, Ruiz PA, Valdespino BR, Visioli F (2014) Prevalence of orthorexia nervosa among ashtanga yoga practitioners: a pilot study. Eat Weight Disord 19(4):469–472.  https://doi.org/10.1007/s40519-014-0131-6 CrossRefGoogle Scholar
  60. 60.
    Arusoğlu G, Kabakçi E, Köksal G, Merdol TK (2008) Orthorexia nervosa and adaptation of ORTO-11 into Turkish. Turk J Psychiatry 19(3):283–291Google Scholar
  61. 61.
    Koven NS, Senbonmatsu R (2013) A neuropsychological evaluation of orthorexia nervosa. Open J Psychiatry 3(02):214CrossRefGoogle Scholar
  62. 62.
    Fidan T, Ertekin V, Işikay S, Kırpınar I (2010) Prevalence of orthorexia among medical students in Erzurum, Turkey. Compr Psychiatry 51(1):49–54.  https://doi.org/10.1016/j.comppsych.2009.03.001 CrossRefPubMedGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Educational Science Research InstituteHunan UniversityChangshaChina
  2. 2.School of Humanities and Social ScienceChinese University of Hong Kong (Shenzhen)ShenzhenChina
  3. 3.Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South UniversityChangshaChina
  4. 4.Heinrich-Heine-Universität, DüsseldorfDüsseldorfGermany

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