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Misinformation, thin-ideal internalization, and resistance to treatment: an interpretive phenomenological analysis of the experience of orthorexia nervosa

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

Abstract

Purpose

Orthorexia nervosa (ON) is an emerging pattern of disordered eating which may be driven by a pathological desire to consume only highly nutritious foods, absent concern over body weight, as is noted in anorexia nervosa (AN). This study seeks to clarify the development and progression of ON and add to researchers’ understanding of this potential disorder.

Method

Utilizing Interpretive Phenomenological Analysis to guide data collection and analysis, interviews were conducted with 18 individuals who self-identified as having ON.

Results

Participants described a clear distinction between orthorexia nervosa and clinically recognized eating disorders, with which they had prior experience. In addition, they demonstrated patterns of inflexible thinking that guided their perceptions of themselves and others. As a result, participants rapidly integrated newly acquired nutritional information, which led to escalations in restriction, social isolation, and physical symptoms of malnutrition. While prior findings on the relationship between ON and weight are conflicting, previously proposed criteria for ON emphasize an absence of weight-related concerns. The results of the present study suggest that weight control is a primary motivating factor in the escalating pattern of restriction.

Conclusion

The nuanced results from this work evidence the value of interpretive qualitative approaches to improve understanding of ON. In particular, participants’ described inflexible thinking with respect to eating behaviors may help inform or revise screening instruments and provide important insights for treatment of ON.

Level of evidence

Level V, qualitative descriptive research.

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Data availability

Additional information about analysis, including access to data, is available upon request from the corresponding author. The data that support the findings of this study are not publicly available due to privacy or ethical restrictions.

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Authors and Affiliations

  1. Kent State University College of Public Health, Moulton Hall, 800 Hilltop Drive, Kent, OH, 44242, USA

    Kristen DeBois & Sheryl L. Chatfield

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Contributions

KD transcribed all audio recorded interviews, completed stages of commenting and thematic development for each case, and created an audit trail that included documentation of the stages of data collection and analysis. SLC reviewed initial analysis and the audit trail documentation and assisted with development of the final thematic structure. KD developed the first draft of the manuscript with comments and revisions provided by the second author. KD and SLC approved the final manuscript.

Corresponding author

Correspondence to Kristen DeBois.

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Conflicts of interest

The authors declare no conflicts of interest.

Ethics approval

This study was approved by the Kent State University Institutional Review Board.

Consent to participate

Each participant was provided an electronic copy of an informed consent letter which contained the standard wording regarding audio-recorded interview research provided by our institution’s research compliance office (approved under #18-259), which states “Identifying information will not be included in the data that you provide. Your anonymity is further protected by not asking you to sign and return the informed consent form”. Prior to audio recording, the interviewer read the consent verbiage to each participant; each participant then verified verbally their consent to be interviewed and audio-recorded.

Consent for publication

Participants were informed during recruitment and consent that analysis of their data would be used to inform a research report.

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This article is part of the topical collection on orthorexia nervosa.

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DeBois, K., Chatfield, S.L. Misinformation, thin-ideal internalization, and resistance to treatment: an interpretive phenomenological analysis of the experience of orthorexia nervosa. Eat Weight Disord 26, 1963–1973 (2021). https://doi.org/10.1007/s40519-020-01049-5

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