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The prevalence of orthorexia nervosa among eating disorder patients after treatment

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Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Background

The pursuit for healthy food consumption is considered a laudable habit. This attitude can turn into pathological when cognitions and worries about healthy nutrition lead to such an accurate food selection that correct diet becomes the most important part of one’s own life leading to important dietary restrictions, stereotyped eating or impairment in important areas of functioning. This behaviour is coined orthorexia nervosa (ON) and can share common characteristics with anorexia nervosa (AN) and bulimia nervosa (BN). The purpose of the present study was to examine the frequency of ON among women with eating disorders (EDs) and to evaluate if it changed after treating the ED.

Methods

Thirty-two patients with AN or BN were evaluated by means of the ORTO-15, the Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS) and the Eating Attitude Test (EAT-26) before (t0) and 3 years after the treatment of their ED (t1), and compared to 32 female healthy controls (HC) matched by gender, age, and BMI at t1.

Results

A significantly higher percentage of patients either at t0 (28 %) or t1 (58 %) resulted positive to ORTO-15 compared to controls (6 %). YBC-EDS and EAT-26 scores were higher among ED patients than in HC, but they decreased from t0 to t1.

Conclusions

Orthorexia nervosa symptoms are highly prevalent among patients with AN and BN, and tend to increase after treatment. ON seems associated both with the clinical improvement of AN and BN and the migration towards less severe forms of EDs. It is necessary to clarify if ON residual symptomatology can be responsible for a greater number of relapses and recurrences of EDs.

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References

  1. Bratman S, Knight D (2000) Health food junkies. Broadway Books, New York

    Google Scholar 

  2. Park SW, Kim JY, Go GJ, Jeon ES, Pyo HJ, Kwon YJ (2011) Orthorexia nervosa with hyponatremia, subcutaneous emphysema, pneumomediastimum, pneumothorax, and pancytopenia. Electrolyte Blood Press 9(1):32–37. doi:10.5049/EBP.2011.9.1.32

    Article  PubMed Central  PubMed  Google Scholar 

  3. Moroze RM, Dunn TM, Craig Holland J, Yager J, Weintraub P (2014) Microthinking about micronutrients: a case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria. Psychosomatics. doi:10.1016/j.psym.2014.03.003

    PubMed  Google Scholar 

  4. Teixeira Martins MC, Dos Santos Alvarenga M, Alves Vargas SV, Cabral De Jesus Sato KS, Baeza Scagliusi F (2011).Ortorexia nervosa: reflexões sobre um novo conceito. Rev Nutr Campinas 24(2):345–357. Retrieved from: http://www.scielo.br/pdf/rn/v24n2/a15v24n2.pdf

  5. 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(2):151–157. doi:10.1007/BF03325060

    Article  CAS  PubMed  Google Scholar 

  6. Varga M, Dukay-Szabó S, Túry F, van Furth EF (2013) Evidence and gaps in the literature on orthorexia nervosa. Eat Weight Disord 18(2):103–111. doi:10.1007/s40519-013-0026-y

    Article  PubMed  Google Scholar 

  7. American Psychiatric Association (2000) DSM-IV-TR: diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington

    Google Scholar 

  8. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, Arlington

    Book  Google Scholar 

  9. Heaner MK, Walsh BT (2013) A history of the identification of the characteristic eating disturbances of bulimia nervosa, binge eating disorder and anorexia nervosa. Appetite 65:185–188. doi:10.1016/j.appet.2013.01.005

    Article  PubMed  Google Scholar 

  10. Kummer A, Dias FM, Teixeira AL (2008) On the concept of orthorexia nervosa. Scand J Med Sci Sports 18(3):395–396. doi:10.1111/j.1600-0838.2008.00809.x author reply 397

    Article  CAS  PubMed  Google Scholar 

  11. Klopp SA, Heiss CJ, Smith HS (2003) Self-reported vegetarianism may be a marker for college women at risk for disordered eating. J Am Diet Assoc 103(6):745–747. doi:10.1053/jada.2003.50139

    Article  PubMed  Google Scholar 

  12. Bardone-Cone AM, Fitzsimmons-Craft EE, Harney MB, Maldonado CR, Lawson MA, Smith R, Robinson DP (2012) The inter-relationships between vegetarianism and eating disorders among females. J Acad Nutr Diet. 112(8):1247–1252. doi:10.1016/j.jand.2012.05.007

    Article  PubMed Central  PubMed  Google Scholar 

  13. Dellava JE, Hamer RM, Kanodia A, Reyes-Rodríguez ML, Bulik CM (2011) Diet and physical activity in women recovered from anorexia nervosa: a pilot study. Int J Eat Disord 44(4):376–382. doi:10.1002/eat.20865

    Article  PubMed  Google Scholar 

  14. Segura-García C, Chiodo D, Sinopoli F, De Fazio P (2013) Temperamental factors predict long-term modifications of eating disorders after treatment. BMC Psychiatry 7(13):288. doi:10.1186/1471-244X-13-288

    Article  Google Scholar 

  15. Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C (2005) Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord 10(2):e28–e32. doi:10.1007/BF03327537

    Article  CAS  PubMed  Google Scholar 

  16. Arusoğlu G, Kabakçi E, Köksal G, Merdol TK (2008) Orthorexia nervosa and adaptation of ORTO-11 into Turkish. Turk Psikiyatri Derg 19:283–291

    PubMed  Google Scholar 

  17. Alvarenga MS, Martins MC, Sato KS, Vargas SV, Philippi ST, Scagliusi FB (2012) Orthorexia nervosa behavior in a sample of Brazilian dietitians assessed by the Portuguese version of ORTO-15. Eat Weight Disord 17:e29–e35. doi:10.1007/BF03325325

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed Central  PubMed  Google Scholar 

  19. Brytek-Matera A, Krupa M, Poggiogalle E, Donini LM (2014) Adaptation of the ORTHO-15 test to Polish women and men. Eat Weight Disord 19:69–76. doi:10.1007/s40519-014-0100-0

    Article  PubMed  Google Scholar 

  20. 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(2):e127–e130. doi:10.1007/BF03325318

    Article  CAS  PubMed  Google Scholar 

  21. Segura-García C, Papaianni MC, Caglioti F, Procopio L, Nisticò CG, Bombardiere L, Ammendolia A, Rizza P, De Fazio P, Capranica L (2012) Orthorexia nervosa: a frequent eating disordered behavior in athletes. Eat Weight Disord 17(4):e226–33. doi: 10.3275/8272. Epub 2012

  22. Mazure C, Halmi KA, Sunday SR et al (1994) Yale-Brown-Cornell Eating Disorder Scale: development, use, reliability, and validity. J Psychiatr Res 28:425–445

    Article  CAS  PubMed  Google Scholar 

  23. Dotti A, Lazzari S (1998) Validation and reliability of the Italian EAT-26. Eat Weight Disord 3:188–198. doi:10.1007/BF03340009

    Article  CAS  PubMed  Google Scholar 

  24. Garner DM, Olmsted MP, Bohr Y et al (1982) The eating attitudes test: psychometric features and clinical correlates. Psychol Med 12:871–878

    Article  CAS  PubMed  Google Scholar 

  25. Cohen J (1988) Statistical power analysis for the behavioral sciences. Lawrence Erlbaum Associates Inc, Hillsdale

    Google Scholar 

  26. Cohen J (1992) A power primer. Psychol Bull 112:155–159

    Article  CAS  PubMed  Google Scholar 

  27. Aksoydan E, Camci N (2009) Prevalence of orthorexia nervosa among Turkish performance artists. Eat Weight Disord 14(1):33–37. doi:10.1007/BF03327792

    Article  CAS  PubMed  Google Scholar 

  28. 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. doi:10.1007/s40519-014-0131-6

    Article  Google Scholar 

  29. Alvarenga MS, Martins MC, Sato KS, Vargas SV, Philippi ST, Scagliusi FB (2012) Orthorexia nervosa behavior in a sample of Brazilian dietitians assessed by the Portuguese version of ORTO-15. Eat Weight Disord. 17(1):e29–e35. doi:10.1007/BF03325325

    Article  CAS  PubMed  Google Scholar 

  30. Ramacciotti CE, Dell’Osso L, Paoli RA, Ciapparelli A, Coli E, Kaplan AS, Garfinkel PE (2002) Characteristics of eating disorders patients without a drive for thinness. Int J Eat Disord 32(2):206–212. doi:10.1002/eat.10067

    Article  PubMed  Google Scholar 

  31. Fairburn CG, Harrison PJ (2003) Eating disorders. Lancet 361(9355):407–416. doi:10.1016/S0140-6736(03)12378-1

    Article  PubMed  Google Scholar 

  32. Fisher M (2003) The course and outcome of eating disorders in adults and in adolescents: a review. Adolesc Med 1:149–158

    Google Scholar 

  33. Steinhausen HC (2009) Outcome of eating disorders. Child Adolesc Psychiatr Clin N Am 1:225–242. doi:10.1016/j.chc.2008.07.013

    Article  Google Scholar 

  34. Keel PK, Brown TA (2010) Update on course and outcome in eating disorders. Int J Eat Disord 3:195–204. doi:10.1002/eat.20810

    Google Scholar 

  35. Garner D, Dalle Grave R (1999) Terapia cognitive comportamentale dei disturbi dell’alimentazione. Positive Press, Verona

    Google Scholar 

  36. Dalle Grave R (2004) Anoressia nervosa. Riv It Medicina Adol 2:5–17

    Google Scholar 

  37. Ohmann S, Popow C, Wurzer M, Karwautz A, Sackl-Pammer P, Schuch B (2013) Emotional aspects of anorexia nervosa: results of prospective naturalistic cognitive behavioral group therapy. Neuropsychiatr 27:119–128. doi:10.1007/s40211-013-0065-7

    Article  PubMed  Google Scholar 

  38. European Commission (2013) EU joint programming initiative a healthy diet for a healthy life. http://www.healthydietforhealthylife.eu Retrieved on May 18, 2014

  39. World Health Organization (2011) Global strategy on diet, physical activity, and health. http://www.who.int/dietphysicalactivity/factsheet_olderadults/en/ retrieved on May 18, 2014

  40. Mathieu J (2005) What is orthorexia? J Am Diet Assoc 105:1510–1512. doi:10.1016/j.jada.2005.08.021

    Article  PubMed  Google Scholar 

Download references

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All authors declare that they have no conflicts of interest.

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Correspondence to Cristina Segura-Garcia.

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Segura-Garcia, C., Ramacciotti, C., Rania, M. et al. The prevalence of orthorexia nervosa among eating disorder patients after treatment. Eat Weight Disord 20, 161–166 (2015). https://doi.org/10.1007/s40519-014-0171-y

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  • DOI: https://doi.org/10.1007/s40519-014-0171-y

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