Advertisement

Health beliefs, behaviors, and symptoms associated with orthorexia nervosa

  • Crystal D. OberleEmail author
  • Dalton L. Klare
  • Kevin C. Patyk
Original Article
Part of the following topical collections:
  1. Orthorexia Nervosa

Abstract

Purpose

This research explored whether symptoms of orthorexia nervosa (ON), a condition involving obsessive thoughts and compulsive behaviors regarding healthy eating, are associated with differences pertaining to use of nutritional supplements and complementary and alternative medicine (CAM) techniques, to health locus of control, and to symptoms of poor physical health.

Method

An anonymous online survey assessing the variables above was completed by college students at a university in the southern United States: 47 in the ON symptoms group, 50 in the healthy-eating control group, and 83 in the normal-eating control group.

Results

Compared to both control groups, the ON symptoms group reported greater supplement use and CAM participation, more reasons for these behaviors for the purpose of improving psychological health (i.e., to increase energy, enhance focus, and improve mood), and greater symptoms associated with poor physical health. None of the groups differed on internal or external health locus of control.

Conclusion

For those with ON, “healthy” eating behaviors are accompanied by other health behaviors that include supplement use and CAM activities. However, despite their goal of achieving perfect health, these individuals experience diminished physical health with symptoms that may be related to their severe dietary restrictions.

Level of evidence

Level V, descriptive cross-sectional study.

Keywords

Orthorexia Supplement use Complementary and alternative medicine Health locus of control Health symptoms 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the Texas State University Institutional Review Board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Bratman S, Knight D (2000) Health food junkies: overcoming the obsession with healthful eating. Broadway Books, New YorkGoogle 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.
    Moroze RM, Dunn TM, Holland JC, Yager J, Weintraub P (2015) Microthinking about micronutrients: a case of transition from obsessions about health 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. 4.
    Missbach B, Barthels F (2017) Orthorexia nervosa: moving forward in the field. Eat Weight Disord 22:1.  https://doi.org/10.1007/s40519-017-0365-1 CrossRefPubMedGoogle Scholar
  5. 5.
    American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. Author, Washington, DCCrossRefGoogle Scholar
  6. 6.
    Segura-Garcia C, Papaianni MC, Caglioti F, Procopio L, Nistico CG, Bombardiere L et al (2012) Orthorexia nervosa: a frequent eating disorder behavior in athletes. Eat Weight Disord 17:223–233.  https://doi.org/10.3275/8272 CrossRefGoogle Scholar
  7. 7.
    Segura-Garcia C, Ramacciotti C, Rania M, Aloi M, Caroleo M, Bruni A et al (2015) The prevalence of orthorexia nervosa among eating disorder patients after treatment. Eat Weight Disord 20:161–166.  https://doi.org/10.1007/s40519-014-0171-y CrossRefPubMedGoogle Scholar
  8. 8.
    Bo S, Zoccali R, Ponzo V, Soldati L, De Carli L, Benso A et al (2014) University courses, eating problems and muscle dysmorphia: are there any associations? J Transl Med 12:221.  https://doi.org/10.1186/s12967-014-0221-2 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Fidan T, Ertekin V, Isikay S, Kirpinar I (2010) Prevalence of orthorexia among medical students in Erzurum, Turkey. Compr Psychiatry 51:49–54.  https://doi.org/10.1016/j.comppsych.2009.03.001 CrossRefPubMedGoogle Scholar
  10. 10.
    Bundros J, Clifford D, Silliman K, Morris MN (2016) Prevalence of orthorexia nervosa among college students based on Bratman’s test and associated tendencies. Appetite 101:86–94.  https://doi.org/10.1016/j.appet.2016.02.144 CrossRefPubMedGoogle Scholar
  11. 11.
    Asil E, Surucuoglu MS (2015) Orthorexia nervosa in Turkish dieticians. Ecol Food Nutr 54:303–313.  https://doi.org/10.1080/03670244.2014.987920 CrossRefPubMedGoogle Scholar
  12. 12.
    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
  13. 13.
    Hayes O, Wu MS, De Nadai AS, Storch EA (2017) Orthorexia nervosa: an examination of the prevalence, correlates, and associated impairment in a university sample. J Cogn Psychother 31:124–135.  https://doi.org/10.1891/0889-8391.31.2.124 CrossRefGoogle Scholar
  14. 14.
    Arusoglu G, Kabakci E, Koksal G, Merdol TK (2008) Orthorexia nervosa and adaptation of ORTO-11 into Turkish. Turk J Psychiatry 19:283–291Google Scholar
  15. 15.
    Gezer C, Kabaran S (2013) The risk of orthorexia nervosa for female students studying nutrition and dietetics. SDU J Health Sci Inst 4:14–22Google Scholar
  16. 16.
    Koven NS, Senbonmatsu R (2013) A neuropsychological evaluation of orthorexia nervosa. Open J Psychiatry 3:214–222.  https://doi.org/10.4236/ojpsych.2013.32019 CrossRefGoogle Scholar
  17. 17.
    Fisher MM, Rosen DS, Ornstein RM, Mammel KA, Katzman DK, Rome ES et al (2014) Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a “new disorder” in DSM-5. J Adolesc Health 55:49–52.  https://doi.org/10.1016/j.jadohealth.2013.11.013 CrossRefPubMedGoogle Scholar
  18. 18.
    Forman SF, McKenzie N, Hehn R, Monge MC, Kapphahn CJ, Mammel KA et al (2014) Predictors of outcome at 1 year in adolescents with DSM-5 restrictive eating disorders: report of the National Eating Disorders Quality Improvement Collaborative. J Adolesc Health 55:750–756.  https://doi.org/10.1016/j.jadohealth.2014.06.014 CrossRefPubMedGoogle Scholar
  19. 19.
    Nicely TA, Lane-Loney S, Masciulli E, Hollenbeak CS, Ornstein RM (2014) Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders. J Eat Disord 2:21.  https://doi.org/10.1186/s40337-014-0021-3 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Norris ML, Robinson A, Obeid N, Harrison M, Spettigue W, Henderson K (2014) Exploring avoidant/restrictive food intake disorder in eating disordered patients: a descriptive study. Int J Eat Disord 47:495–499.  https://doi.org/10.1002/eat.22217 CrossRefPubMedGoogle Scholar
  21. 21.
    Aksoydan E, Camci N (2009) Prevalence of orthorexia nervosa among Turkish performance artists. Eat Weight Disord 14:33–37.  https://doi.org/10.1007/BF03327792 CrossRefPubMedGoogle Scholar
  22. 22.
    Donini LM, Marsili D, Graziani MP, 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 9:151–157.  https://doi.org/10.1007/BF03325060 CrossRefPubMedGoogle Scholar
  23. 23.
    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
  24. 24.
    Ramacciotti CE, 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 16:127–130.  https://doi.org/10.1007/BF03325318 CrossRefGoogle Scholar
  25. 25.
    Varga M, Thege BK, Dukay-Szabo S, Tury F, van Furth EF (2014) When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry 14:59.  https://doi.org/10.1186/1471-244X-14-59 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Bosi ATB, Gamur D, Guler G (2007) Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine. Appetite 49:661–666.  https://doi.org/10.1016/j.appet.2007.04.007 CrossRefGoogle Scholar
  27. 27.
    Brytek-Matera A, Donini LM, Krupa M, Poggiogalle E, Hay P (2015) Orthorexia nervosa and self-attitudinal aspects of body image. J Eat Disord 3:1–8.  https://doi.org/10.1186/s40337-015-0038-2 CrossRefGoogle Scholar
  28. 28.
    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 22:185–192.  https://doi.org/10.1007/s40519-016-0258-8 CrossRefPubMedGoogle Scholar
  29. 29.
    Maghetti A, Cicero AFG, D’Ignazio E, Vincenzi M, Paolini B, Lucchin L (2015) Orthorexia prevalence among health care professionals involved in nutrition education: the ADI-O study. Mediterr J Nutr Metab 8:199–204.  https://doi.org/10.3233/MNM-140039 CrossRefGoogle Scholar
  30. 30.
    Valera JH, Ruiz PA, Valdespino BR, Visioli F (2014) Prevalence of orthorexia nervosa among ashtanga yoga practitioners: a pilot study. Eat Weight Disord 19:469–472.  https://doi.org/10.1007/s40519-014-0131-6 CrossRefGoogle Scholar
  31. 31.
    Malmborg J, Bremander A, Olsson MC, Bergman S (2017) Health status, physical activity, and orthorexia nervosa: a comparison between exercise science students and business students. Appetite 109:137–143.  https://doi.org/10.1016/j.appet.2016.11.028 CrossRefPubMedGoogle Scholar
  32. 32.
    Eriksson L, Baigi A, Marklund B, Lindgren EC (2008) Social physique anxiety and sociocultural attitudes toward appearance impact on orthorexia test in fitness participants. Scand J Med Sci Sports 18:389–394.  https://doi.org/10.1111/j.1600-0838.2007.00723.x CrossRefPubMedGoogle Scholar
  33. 33.
    Hyrnik J, Janas-Kozik M, Stochel M, Jelonek I, Siwiec A, Rybakowski JK (2016) The assessment of orthorexia nervosa among 1899 Polish adolescents using the ORTO-15 questionnaire. Int J Psychiatry Clin Pract 20:199–203.  https://doi.org/10.1080/13651501.2016.1197271 CrossRefPubMedGoogle Scholar
  34. 34.
    Oberle CD, Watkins RS, Burkot AJ (2018) Orthorexic eating behaviors related to exercise addiction and internal motivations in a sample of university students. Eat Weight Disord 23:67–74.  https://doi.org/10.1007/s40519-017-0470-1 CrossRefPubMedGoogle Scholar
  35. 35.
    Rudolph S (2018) The connection between exercise addiction and orthorexia nervosa in German fitness sports. Eat Weight Disord 23:581–586.  https://doi.org/10.1007/s40519-017-0437-2 CrossRefPubMedGoogle Scholar
  36. 36.
    Haman L, Lindgren EC, Prell H (2017) “If it’s not Iron it’s Iron f*cking biggest Ironmen”: personal trainers’ views on health norms, orthorexia and deviant behaviors. Int J Qual Stud Health Well-Being 12:1364602.  https://doi.org/10.1080/17482631.2017.1364602 CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Steptoe A, Wardle J (2001) Locus of control and health behaviour revisited: a multivariate analysis of young adults from 18 countries. Br J Psychol 92:659–672.  https://doi.org/10.1348/000712601162400 CrossRefPubMedGoogle Scholar
  38. 38.
    Brytek-Matera A (2008) Dimensions of locus of control and the role of anger expression and anger control in women diagnosed with eating disorders: a pilot study. Arch Psychiatry Psychother 1:49–53Google Scholar
  39. 39.
    Dalgleish T, Tchanturia K, Serpell L, Hems S, de Silva P, Treasure J (2001) Perceived control over events in the world in patients with eating disorders: a preliminary study. Personal Individ Differ 31:453–460.  https://doi.org/10.1016/S0191-8869(00)00150-1 CrossRefGoogle Scholar
  40. 40.
    Fouts G, Vaughan K (2002) Locus of control, television viewing, and eating disorder symptomatology in young females. J Adolesc 25:307–311.  https://doi.org/10.1006/yjado.472 CrossRefPubMedGoogle Scholar
  41. 41.
    Sassaroli S, Gallucci M, Ruggiero GM (2008) Low perception of control as a cognitive factor of eating disorders: its independent effects on measures of eating disorders and its interactive effects with perfectionism and self-esteem. J Behav Ther 39:467–488.  https://doi.org/10.1016/j.jbtep.2007.11.005 CrossRefGoogle Scholar
  42. 42.
    Surgenor LJ, Horn J, Hudson SM (2003) Empirical scrutiny of a familiar narrative: sense of control in anorexia nervosa. Eur Eat Disord Rev 11:291–305.  https://doi.org/10.1002/erv.499 CrossRefGoogle Scholar
  43. 43.
    Akbarikia H, Gasparyan K (2012) Schema and locus of control as predictors of obsessive compulsive disorder. Iran J Psychiatry 7:170–175PubMedPubMedCentralGoogle Scholar
  44. 44.
    Altin M, Karanci N (2008) How does locus of control and inflated sense of responsibility relate to obsessive-compulsive symptoms in Turkish adolescents? J Anxiety Disord 22:1303–1315.  https://doi.org/10.1016/j.janxdis.2008.01.010 CrossRefPubMedGoogle Scholar
  45. 45.
    Moulding R, Kyrios M (2007) Desire for control, sense of control and obsessive-compulsive symptoms. Cogn Ther Res 31:759–772.  https://doi.org/10.1007/s10608-006-9086-x CrossRefGoogle Scholar
  46. 46.
    Bazzano LA (2006) The high cost of not consuming fruits and vegetables. J Am Diet Assoc 106:1364–1368.  https://doi.org/10.1016/j.jada.2006.06.021 CrossRefPubMedGoogle Scholar
  47. 47.
    Trichopoulou A, Naska A, Antoniou A, Friel S, Trygg K, Turrini A (2003) Vegetable and fruit: the evidence in their favour and the public health perspective. J Vitam Nutr Res 73:63–69.  https://doi.org/10.1024/0300-9831.73.2.63 CrossRefGoogle Scholar
  48. 48.
    Van Duyn MAS, Pivonka E (2000) Overview of the health benefits of fruit and vegetable consumption for the dietetics professional: selected literature. J Am Diet Assoc 100:1511–1521.  https://doi.org/10.1016/S0002-8223(00)00420-X CrossRefPubMedGoogle Scholar
  49. 49.
    Ansari WE, Suominen S, Berg-Beckhoff G (2015) Is healthier nutrition behavior associated with better self-reported health and less health complaints? Evidence from Turku. Finland Nutrients 7:8478–8490.  https://doi.org/10.3390/nu7105409 CrossRefPubMedGoogle Scholar
  50. 50.
    Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C (2005) Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord 10:28–32.  https://doi.org/10.1007/BF03327537 CrossRefGoogle Scholar
  51. 51.
    Wallston KA, Wallston BS, DeVellis R (1978) Development of the multidimensional health locus of control (MHLC) scales. Health Educ Monogr 6:160–170.  https://doi.org/10.1177/109019817800600107 CrossRefPubMedGoogle Scholar
  52. 52.
    Cohen S, Hoberman H (1983) Positive events and social supports as buffers of life change stress. J Appl Soc Psychol 13:99–125.  https://doi.org/10.1111/j.1559-1816.1983.tb02325.x CrossRefGoogle Scholar
  53. 53.
    Zickgraf HF, Ellis JM, Essayli JH (2019) Disentangling orthorexia nervosa from healthy eating and other eating disorder symptoms: relationships with clinical impairment, comorbidity, and self-reported food choices. Appetite 134:40–49.  https://doi.org/10.1016/jappet.2018.12.006 CrossRefPubMedGoogle Scholar
  54. 54.
    Hayatbini N, Oberle CD (2019) Are orthorexia nervosa symptoms associated with cognitive inflexibility? Psychiatry Res 271:464–468.  https://doi.org/10.1016/j.psychres.2018.12.017 CrossRefPubMedGoogle Scholar
  55. 55.
    Cena H, Barthels F, Cuzzolaro M, Bratman S, Brytek-Matera A, Dunn T et al (2018) Definition and diagnostic criteria for orthorexia nervosa: a narrative review of the literature. Eat Weight Disord.  https://doi.org/10.1007/s40519-018-0606-y CrossRefPubMedGoogle Scholar
  56. 56.
    Hubley AM, Wagner S (2004) Using alternate forms of the multidimensional health locus of control scale: caveat emptor. Soc Indicators Res 65:167–186.  https://doi.org/10.1023/A:1025809921592 CrossRefGoogle Scholar
  57. 57.
    Levenson H (1974) Activism and powerful others: distinctions within the concept of internal-external locus of control. J Personal Assess 38:377–404.  https://doi.org/10.1080/00223891.1974.10119988 CrossRefGoogle Scholar
  58. 58.
    Allen SF, Wetherell MA, Smith MA (2017) The Cohen-Hoberman inventory of physical symptoms: factor structure, and preliminary tests of reliability and validity in the general population. Psychol Health 32:567–587.  https://doi.org/10.1080/08870446.2017.1290237 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of PsychologyTexas State UniversitySan MarcosUSA

Personalised recommendations