Health beliefs, behaviors, and symptoms associated with orthorexia nervosa
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.
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.
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.
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.
KeywordsOrthorexia Supplement use Complementary and alternative medicine Health locus of control Health symptoms
Compliance with ethical standards
Conflict of interest
The authors declare no conflict of interest.
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 was obtained from all individual participants included in the study.
- 1.Bratman S, Knight D (2000) Health food junkies: overcoming the obsession with healthful eating. Broadway Books, New YorkGoogle Scholar
- 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
- 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
- 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.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
- 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.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
- 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
- 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
- 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
- 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
- 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.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