Skip to main content

Advertisement

SpringerLink
Log in

Orthorexia nervosa and substance use for the purposes of weight control, conformity, and emotional coping

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

Abstract

Purpose

Orthorexia nervosa (ON), characterized by extreme behaviors driven by the goal of eating only healthy and pure foods, could plausibly be associated with avoidance of nicotine, alcohol, and illicit drugs. However, findings from the limited research on these relationships are mixed, and other eating disorders are associated with greater substance abuse.

Method

An online survey was completed by 471 participants (86% women, mean age = 20) recruited from undergraduate courses and through an Instagram advertisement. The questionnaires assessed ON symptomatology; frequency of smoking, alcohol consumption, and illicit drug use; abuse of these substances; and motivations for using these substances.

Results

ON scores were not significantly related to the level of use or abuse of nicotine, alcohol, or most illicit drugs. Yet, ON scores were positively correlated with frequency of using illicit depressant drugs. Further, among substance users, ON scores were positively associated with smoking or vaping for the purpose of weight control, and with consuming alcohol and using illicit drugs for the purposes of conformity and coping with such negative emotions as anxiety and depression.

Conclusion

Although people who are high in ON symptomatology may be at least partly driven by a strong desire to be as healthy as possible, they are not less likely to use potentially harmful drugs. Instead, many of them may even turn to certain drugs for the same weight control and emotional-coping motives that guide the behaviors of individuals with other eating disorders.

Level of evidence

Level V, descriptive cross-sectional study.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Barthels F, Meyer F, Pietrowsky R (2015) Duesseldorf orthorexia scale–construction and evaluation of a questionnaire measuring orthorexic eating behavior. Z Klin Psychol Psychother 44:97–105. https://doi.org/10.1026/1616-3443/a000310

    Article  Google Scholar 

  2. Cena H, Barthels F, Cuzzolaro M, Bratman S, Brytek-Matera A, Dunn T et al (2019) Definition and diagnostic criteria for orthorexia nervosa: a narrative review of the literature. Eat Weight Disord 24:209–246. https://doi.org/10.1007/s40519-018-0606-y

    Article  PubMed  Google Scholar 

  3. 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

    Article  PubMed  Google Scholar 

  4. 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

    Article  PubMed  Google Scholar 

  5. Setnick J (2013) The eating disorders clinical pocket guide: quick reference for healthcare providers, 2nd edn. Understanding Nutrition, Dallas

    Google Scholar 

  6. 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

    Article  PubMed  Google Scholar 

  7. 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

    Article  PubMed  Google Scholar 

  8. 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

    Article  Google Scholar 

  9. Karakus B, Hidiroglu S, Keskin N, Karavus M (2017) Orthorexia nervosa tendency among students of the department of nutrition and dietetics at a university in Instanbul. North Clin Istanb 4:117–123. https://doi.org/10.14744/nci.2017.20082

    Article  PubMed Central  PubMed  Google Scholar 

  10. Almeida C, Vieira Borba V, Santos L (2018) Orthorexia nervosa in a sample of Portuguese fitness participants. Eat Weight Disord 23:443–451. https://doi.org/10.1007/s40519-018-0517-y

    Article  PubMed  Google Scholar 

  11. 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

    Article  CAS  PubMed  Google Scholar 

  12. Oberle CD, De Nadai AS, Madrid AL (2021) Orthorexia Nervosa Inventory (ONI): development and validation of a new measure of orthorexic symptomatology. Eat Weight Disord 26:609–622. https://doi.org/10.1007/s40519-020-00896-6

    Article  PubMed  Google Scholar 

  13. Strahler J, Hermann A, Walter B, Stark R (2018) Orthorexia nervosa: a behavioral complex or psychological condition? J Behav Addict 7:1143–1156. https://doi.org/10.1556/2006.7.2018.129

    Article  PubMed Central  PubMed  Google Scholar 

  14. Parra-Fernandez ML, Rodriguez-Cano T, Onieva-Zafra MD, Perez-Haro MJ, Casero-Alonso V, Fernandez-Martinez E, Notario-Pacheco B (2018) Prevalence of orthorexia nervosa in university students and its relationship with psychopathological aspects of eating behaviour disorders. BMC Psychiatry 18:364. https://doi.org/10.1186/s12888-018-1943-0

    Article  PubMed Central  PubMed  Google Scholar 

  15. 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

    Article  PubMed Central  PubMed  Google Scholar 

  16. Alvarenga MS, Martins MCT, Sato KSCJ, Vargas SVA, 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 17:29–35. https://doi.org/10.1007/BF03325325

    Article  Google Scholar 

  17. Arusoglu G, Kabakci E, Koksal G, Merdol TK (2008) Orthorexia nervosa and adaptation of ORTO-11 into Turkish. Turk J Psychiatry 19:283–291

    Google Scholar 

  18. 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. https://doi.org/10.1007/s40519-014-0100-0

    Article  PubMed  Google Scholar 

  19. Haddad C, Obeid S, Akel M, Honein K, Akiki M, Azar J, Hallit S (2019) Correlates of orthorexia nervosa among a representative sample of the Lebanese population. Eat Weight Disord 24:481–493. https://doi.org/10.1007/s40519-018-0631-x

    Article  PubMed  Google Scholar 

  20. Missbach B, Dunn TM, König JS (2017) We need new tools to assess orthorexia nervosa: a commentary on 'Prevalence of orthorexia nervosa among college students based on Bratman’s test and associated tendencies’. Appetite 108:521–524. https://doi.org/10.1016/j.appet.2016.07.010

    Article  PubMed  Google Scholar 

  21. 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

    Article  PubMed  Google Scholar 

  22. Parra-Fernández ML, Rodríguez-Cano T, Perez-Haro MJ, Onieva-Zafra MD, Fernández-Martinez E, Notario-Pacheco B (2018) Structural validation of ORTO-11-ES for the diagnosis of orthorexia nervosa, Spanish version. Eat Weight Disord 23:745–752. https://doi.org/10.1007/s40519-018-0573-3

    Article  PubMed Central  PubMed  Google Scholar 

  23. Copeland AL, Spears CA, Baillie LE, McVay MA (2016) Fear of fatness and drive for thinness in predicting smoking status in college women. Addict Behav 54:1–6. https://doi.org/10.1016/j.addbeh.2015.11.010

    Article  PubMed  Google Scholar 

  24. Saules KK, Collings AS, Hoodin F, Angelella NE, Alschuler K, Ivezaj V et al (2009) The contributions of weight problem perception, BMI, gender, mood, and smoking status to binge eating among college students. Eat Behav 10:1–9. https://doi.org/10.1016/j.eatbeh.2008.07.010

    Article  PubMed  Google Scholar 

  25. Lowry R, Galuska DA, Fulton JE, Wechsler H, Kann L (2002) Weight management goals and practices among US high school students: associations with physical activity, diet, and smoking. J Adolesc Health 31:133–144. https://doi.org/10.1016/S1054-139X(01)00408-6

    Article  PubMed  Google Scholar 

  26. Saarni SE, Silventoinen K, Rissanen A, Sarlio-Lähteenkorva S, Kaprio J (2004) Intentional weight loss and smoking in young adults. Int J Obes 28:796–802. https://doi.org/10.1038/sj.ijo.0802627

    Article  CAS  Google Scholar 

  27. Strauss RS, Mir HM (2001) Smoking and weight loss attempts in overweight and normal-weight adolescents. Int J Obes 25:1381–1385. https://doi.org/10.1038/sj.ijo.0801683

    Article  CAS  Google Scholar 

  28. Barnes MA, Caltabiano ML (2017) The interrelationship between orthorexia nervosa, perfectionism, body image and attachment style. Eat Weight Disord 22:177–184. https://doi.org/10.1007/s40519-016-0280-x

    Article  PubMed  Google Scholar 

  29. Brytek-Matera A, Donini LM, Krupa M, Poggiogalle E, Hay P (2015) Orthorexia nervosa and self-attitudinal aspects of body image in female and male university students. J Eat Disord 3:2. https://doi.org/10.1186/s40337-015-0038-2

    Article  PubMed Central  PubMed  Google Scholar 

  30. Valente M, Brenner R, Cesuroglu T, Bunders-Aelen J, Syurina EV (2020) “And it snowballed from there”: the development of orthorexia nervosa from the perspective of people who self-diagnose. Appetite 155:104840. https://doi.org/10.1016/j.appet.2020.104840

    Article  PubMed  Google Scholar 

  31. Anzengruber D, Klump KL, Thornton L, Brandt H, Crawford S, Fichter MM et al (2006) Smoking in eating disorders. Eat Behav 7:291–299. https://doi.org/10.1016/j.eatbeh.2006.06.005

    Article  PubMed  Google Scholar 

  32. George A, Waller G (2005) Motivators for smoking in women with eating disorders. Eur Eat Disord Rev 13:417–423. https://doi.org/10.1002/erv.623

    Article  Google Scholar 

  33. King L, Saules KK, Irish J (2007) Weight concerns and cognitive style: Which carries more “weight” in the prediction of smoking among college women? Nicotine Tob Res 9:535–543. https://doi.org/10.1080/14622200701188935

    Article  PubMed  Google Scholar 

  34. Solmi M, Veronese N, Sergi G, Luchini C, Favaro A, Santonastaso P et al (2016) The association between smoking prevalence and eating disorders: a systematic review and meta-analysis. Addict 111:1914–1922. https://doi.org/10.1111/add.13457

    Article  Google Scholar 

  35. Baker JH, Mitchell KS, Neale MC, Kendler KS (2010) Eating disorder symptomatology and substance use disorders: prevalence and shared risk in a population based twin sample. Int J Eat Disord 43:648–658. https://doi.org/10.1002/eat.20856

    Article  PubMed Central  PubMed  Google Scholar 

  36. Nøkleby H (2012) Comorbid drug use disorders and eating disorders—a review of prevalence studies. Nord Stud Alcohol Drug 29:303–314. https://doi.org/10.2478/V10199-012-0024-9

    Article  Google Scholar 

  37. Root TL, Pisetsky EM, Thorton L, Lichtenstein P, Pedersen NL, Bulik CM (2010) Patterns of co-morbidity of eating disorders and substance use in Swedish females. Psychol Med 40:105–115. https://doi.org/10.1017/S0033291709005662

    Article  CAS  PubMed  Google Scholar 

  38. Baker JH, Thornton LM, Strober M, Brandt H, Crawford S, Fichter MM et al (2013) Temporal sequence of comorbid alcohol use disorder and anorexia nervosa. Addict Behav 38:1704–1709. https://doi.org/10.1016/j.addbeh.2012.10.005

    Article  PubMed  Google Scholar 

  39. Harrop EN, Marlatt GA (2010) The comorbidity of substance use disorders and eating disorders in women: prevalence, etiology, and treatment. Addict Behav 35:392–398. https://doi.org/10.1016/j.addbeh.2009.12.016

    Article  PubMed  Google Scholar 

  40. Raney TJ, Thornton LM, Berrettini WH, Brandt H, Crawford S, Fichter MM et al (2008) Influence of overanxious disorder of childhood on the expression of anorexia nervosa. Int J Eat Disord 41:326–332. https://doi.org/10.1002/eat.20508

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Gleaves DH, Graham EC, Ambwani S (2013) Measuring “orthorexia:” development of the Eating Habits Questionnaire. Int J Educ Psychol Assess 12(2):1–18

    Google Scholar 

  42. Luck-Sikorski C, Jung F, Schlosser K, Riedel-Heller SG (2018) Is orthorexic behavior common in the general public? A large representative study in Germany. Eat Weight Disord 24:267–273. https://doi.org/10.1007/s40519-018-0502-5

    Article  PubMed  Google Scholar 

  43. Zhou X, Schneider SC, Cepeda SL, Storch EA (2020) Orthorexia nervosa in China: an exploration of phenomenology and clinical correlates among university students. J Cogn Psychother 34:225–241. https://doi.org/10.1891/JCPSY-D-19-00027

    Article  CAS  PubMed  Google Scholar 

  44. Root TL, Pinheiro AP, Thornton L, Strober M, Fernandez-Aranda F, Brandt H et al (2010) Substance use disorders in women with anorexia nervosa. Int J Eat Disord 43:14–21. https://doi.org/10.1002/eat.20670

    Article  PubMed Central  PubMed  Google Scholar 

  45. Etter JF, Le Houezec J, Perneger TV (2003) A self-administered questionnaire to measure dependence on cigarettes: the cigarette dependence scale. Neuropsychopharmacol 28:359–370. https://doi.org/10.1038/sj.npp.1300030

    Article  Google Scholar 

  46. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M (1993) Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption—II. Addict 88:791–804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x

    Article  CAS  Google Scholar 

  47. Proctor SL, Hoffmann NG (2016) The UNCOPE: an effective brief screen for DSM–5 substance use disorders in correctional settings. Psychol Addict Behav 30:613–618. https://doi.org/10.1037/adb0000170

    Article  PubMed  Google Scholar 

  48. Souza ES, Crippa JA, Pasian SR, Martinez JA (2010) University of São Paulo reasons for smoking scale: a new tool for the evaluation of smoking motivation. J Bras Pneumol 36:768–778. https://doi.org/10.1590/s1806-37132010000600015

    Article  PubMed  Google Scholar 

  49. Cooper ML (1994) Motivations for alcohol use among adolescents: development and validation of a four-factor model. Psychol Assess 6:117–128. https://doi.org/10.1037/1040-3590.6.2.117

    Article  Google Scholar 

  50. Pew Research Center (2019) Social media fact sheet. https://www.pewresearch.org/internet/fact-sheet/social-media/

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, Texas State University, 601 University Dr., San Marcos, TX, 78666, USA

    Crystal D. Oberle, Haley S. Marcell & Natalie A. Noebel

Authors
  1. Crystal D. Oberle
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Haley S. Marcell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Natalie A. Noebel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Crystal D. Oberle.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Ethical approval

All the 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.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Oberle, C.D., Marcell, H.S. & Noebel, N.A. Orthorexia nervosa and substance use for the purposes of weight control, conformity, and emotional coping. Eat Weight Disord 27, 553–561 (2022). https://doi.org/10.1007/s40519-021-01190-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-021-01190-9

Keywords

Search

Navigation