Skip to main content
Log in

Prevalence and predictors of orthorexia nervosa among German students using the 21-item-DOS

  • Original Article
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Purpose

Orthorexia nervosa (ON) describes the constant pathological preoccupation with “healthy” nutrition. The current results regarding the prevalence of ON differ widely possibly because of invalid measurement tools. This study aimed to investigate ON prevalence in a sample of German students and to examine age, gender, semester, and nutritional knowledge as potential predictors of ON by comparing nutrition science (NS) with economics (ES) students.

Methods

A total of 446 university students participated in the survey (NS 188, ES 268). ON was determined using the 21-item-DOS, which is a well-constructed, validated, and reliability-tested questionnaire. Age, gender, and semester were also assessed.

Results

Of the total sample, 3.3 % were classified as having ON and 9.0 % were at risk of developing ON. Older students scored significantly higher on the subscale “avoidance of additives” compared with younger students and students of lower semester suffered significantly more often from ON than students of higher semester. In addition, comparing field of study showed no significant difference in the prevalence of ON or the risk of developing ON between female NS and ES students. However, mean values for the three DOS subscales were higher among female NS students, albeit far below values indicating pathological behavior.

Conclusions

The prevalence of ON appears to be low in this sample of German university students. Female NS students do not seem to have higher prevalence of ON or risk of developing ON.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Bratman S, Knight D (2000) Health food junkies. Overcoming the obsession with healthful eating, 1st ed. Broadway Books, New York

  2. Dunn TM, Bratman S (2016) On orthorexia nervosa: a review of the literature and proposed diagnostic criteria. Eat Behav 21:11–17. doi:10.1016/j.eatbeh.2015.12.006

    Article  PubMed  Google Scholar 

  3. Brytek-Matera A (2012) Orthorexia nervosa—an eating disorder, obsessive-compulsive disorder or disturbed eating habit? Arch Psychiatr Psychother 1:55–60

    Google Scholar 

  4. Cartwright MM (2004) Eating disorder emergencies: understanding the medical complexities of the hospitalized eating disordered patient. Crit Care Nurs Clin North Am 16:515–530. doi:10.1016/j.ccell.2004.07.002

    Article  PubMed  Google Scholar 

  5. Chaki B, Pal S, Bandyopadhyay A (2013) Exploring scientific legitimacy of orthorexia nervosa: a newly emerging eating disorder. JHSE 8:1045–1053. doi:10.4100/jhse.2013.84.14

    Article  Google Scholar 

  6. Klotter C, Depa J, Humme S (2015) Gesund, gesünder, Orthorexia nervosa. Modekrankheit oder Störungsbild? Eine wissenschaftliche Diskussion. Springer Fachmedien, Wiesbaden

  7. Håman L, Barker-Ruchti N, Patriksson G et al (2015) Orthorexia nervosa: an integrative literature review of a lifestyle syndrome. Int J Qual Stud Health Well-Being 10(10):26799. doi:10.3402/qhw.v10.26799

    Article  PubMed  Google Scholar 

  8. Koven NS, Abry AW (2015) The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatr Dis Treat 11:385–394. doi:10.2147/NDT.S61665

    Article  PubMed  PubMed Central  Google Scholar 

  9. Barthels F, Pietrowsky R (2012) Orthorectic eating behaviour—nosology and prevalence rates. Psychother Psychosom Med Psychol 62:445–449. doi:10.1055/s-0032-1312630

    Article  PubMed  Google Scholar 

  10. Donini LM, Marsili D, Graziani MP et al (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. doi:10.1007/BF03325060

    Article  CAS  PubMed  Google Scholar 

  11. Ramacciotti CE, Perrone P, Coli E et al (2011) Orthorexia nervosa in the general population: a preliminary screening using a self-administered questionnaire (ORTO-15). Eat Weight Disord 16:e127–e130. doi:10.1007/BF03325318

    Article  CAS  PubMed  Google Scholar 

  12. Schnyder U, Milos G, Mohler-Kuo M et al (2012) Prävalenz von Essstörungen in der Schweiz. Im Auftrag des Bundesamtes für Gesundheit (BAG). BAG, Zürich

  13. Dunn TM, Gibbs J, Whitney N et al (2016) Prevalence of orthorexia nervosa is less than 1%: data from a US sample. Eat Weight Disord. doi:10.1007/s40519-016-0258-8

    Article  PubMed  Google Scholar 

  14. Donini LM, Marsili D, Graziani MP et al (2005) Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord 10:e28–e32. doi:10.1007/BF03327537

    Article  CAS  PubMed  Google Scholar 

  15. Alvarenga MS, Martins MC, Sato KS et al (2012) Orthorexia nervosa behavior in a sample of Brazilian dietitians assessed by the Portuguese version of ORTO-15. Eat Weight Disord 17:29–35. doi:10.1007/BF03325325

    Article  Google Scholar 

  16. Arusoglu G, Kabakci E, Koksal G et al (2008) Orthorexia nervosa and adaptation of ORTO-11 into Turkish. Turk Psikiyatri Derg 19:283–291

    PubMed  Google Scholar 

  17. Brytek-Matera A, Krupa M, Poggiogalle E et al (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 

  18. Missbach B, Hinterbuchinger B, Dreiseitl V et al (2015) When eating right, is measured wrong! A validation and critical examination of the ORTO-15 questionnaire in German. PLoS One 10:e0135772. doi:10.1371/journal.pone.0135772

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. McInerney-Ernst EM (2011) Orthorexia nervosa: real construct or newest social trend? Dissertation, University of Missouri-Kansas City

  20. Segura-Garcia C, Papaianni MC, Caglioti F et al (2012) Orthorexia nervosa: a frequent eating disordered behavior in athletes. Eat Weight Disord 17:e226–e233. doi:10.3275/8272

    Article  CAS  PubMed  Google Scholar 

  21. Varga M, Thege BK, Dukay-Szabo S et al (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  PubMed Central  Google Scholar 

  22. Barthels F, Meyer F, Pietrowsky R (2015) Duesseldorf orthorexia scale–construction and evaluation of a questionnaire measuring orthorexic eating behavior. Zeitschrift für Klinische Psychologie und Psychother 44:97–105. doi:10.1026/1616-3443/a000310

    Article  Google Scholar 

  23. Bundros J, Clifford D, Silliman K et al (2016) Prevalence of orthorexia nervosa among college students based on Bratman’s test and associated tendencies. Appetite 101:86–94. doi:10.1016/j.appet.2016.02.144

    Article  PubMed  Google Scholar 

  24. Fidan T, Ertekin V, Isikay S et al (2010) Prevalence of orthorexia among medical students in Erzurum, Turkey. Compr Psychiatr 51:49–54. doi:10.1016/j.comppsych.2009.03.001

    Article  Google Scholar 

  25. Korinth A, Schiess S, Westenhoefer J (2010) Eating behaviour and eating disorders in students of nutrition sciences. Public Health Nutr 13:32. doi:10.1017/S1368980009005709

    Article  PubMed  Google Scholar 

  26. Nowak U (2011) Fragebogenerhebung über den möglichen Einfluss der Studienrichtung auf das Auftreten von Orthorexia nervosa. Diplomarbeit, Wien

    Google Scholar 

  27. Robinson K (2011) Is the Fixation on “healthy” unhealthy? A study on orthorexia nervosa. Electronic Thesis, Kent State University

  28. Sanlier N, Yassibas E, Bilici S et al (2016) Does the rise in eating disorders lead to increasing risk of orthorexia nervosa? Correlations with gender, education, and body mass index. Ecol Food Nutr 55:266–278. doi:10.1080/03670244.2016.1150276

    Article  PubMed  Google Scholar 

  29. Barth A (2015) Students’ nutrition orientations: differences according to gender and subject of study. Ernährungs Umschau Int 62:120–127. doi:10.4455/eu.2015.022

    Article  Google Scholar 

  30. Bo S, Zoccali R, Ponzo V et al (2014) University courses, eating problems and muscle dysmorphia: are there any associations? J Transl Med 12:221. doi:10.1186/s12967-014-0221-2

    Article  PubMed  PubMed Central  Google Scholar 

  31. Gleaves DH, Graham EC, Ambwani S (2013) Measuring “Orthorexia”: development of the eating habits questionnaire. Int J Educ Psychol Assess 12:1–18

    Google Scholar 

  32. Varga M, Mate G (2010) Eating disturbances in orthorexia nervosa. EACLPP Abstracts. J Psychosom Res 68:672–673

    Google Scholar 

  33. Barzegari A, Ebrahimi M, Azizi M et al (2011) Study of nutrition knowledge, attitudes and food habits of College students. World Appl Sci J 15:1012–1017

    Google Scholar 

  34. Barthels F (2014) Orthorektisches Ernährungsverhalten. Psychologische Untersuchungen zu einem neuen Störungsbild. Dissertation, Heinrich Heine University of Duesseldorf

  35. Pietrowsky R (2012) Das Leiden am gesunden Essen—Untersuchungen zu Orthorexie. In: Siegl, Judith (ed) Horizonte der Klinischen Psychologie und Psychotherapie. Festschrift für Hans Reinecker. Pabst Science, Lengerich, pp 245–253

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

    Article  CAS  PubMed  Google Scholar 

  37. Bagci Bosi A, Tulay Camur D, Guler C (2007) Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine (Ankara, Turkey). Appetite 49:661–666. doi:10.1016/j.appet.2007.04.007

    Article  PubMed  Google Scholar 

  38. Barnes MA, Caltabiano ML (2016) The interrelationship between orthorexia nervosa, perfectionism, body image and attachment style. Eat Weight Disord. doi:10.1007/s40519-016-0280-x

    Article  PubMed  Google Scholar 

  39. Herranz Valera J, Acuna Ruiz P, Romero Valdespino B et al (2014) Prevalence of orthorexia nervosa among ashtanga yoga practitioners: a pilot study. Eat Weight Disord 19:469–472. doi:10.1007/s40519-014-0131-6

    Article  PubMed  Google Scholar 

  40. IfD Allensbach (2016) Gesunde Ernährung und Lebensweise: In welchem Alter besteht ein besonderes Interesse daran? (Deutschland im Jahr 2008). http://de.statista.com/statistik/daten/studie/13439/umfrage/gesundheitsbewusstsein-interesse-fuer-gesunde-ernaehrung/. Accessed 02 Aug 2016

  41. Moroze RM, Dunn TM, Craig Holland J et al (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. doi:10.1016/j.psym.2014.03.003

    Article  PubMed  Google Scholar 

  42. US Department of Health and Human Services and US Department of Agriculture (2015) Dietary Guidelines for Americans 2015–2020. 8th Edition. http://health.gov/dietaryguidelines/2015/guidelines/. Accessed 02 Aug 2016

  43. WHO (2015) Healthy diet. Fact sheet N 394. Updated September 2015. http://www.who.int/mediacentre/factsheets/fs394/en/. Accessed 02 Aug 2016

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Julia Depa.

Ethics declarations

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 institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was not obtained due to the anonymous nature of the study design and inability to identify study subjects based on the collected data.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Depa, J., Schweizer, J., Bekers, SK. et al. Prevalence and predictors of orthorexia nervosa among German students using the 21-item-DOS. Eat Weight Disord 22, 193–199 (2017). https://doi.org/10.1007/s40519-016-0334-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-016-0334-0

Keywords

Navigation