Orthorexia nervosa: A frequent eating disordered behavior in athletes

  • C. Segura-García
  • M. C. Papaianni
  • F. Caglioti
  • L. Procopio
  • C. G. Nisticò
  • L. Bombardiere
  • A. Ammendolia
  • P. Rizza
  • P. De Fazio
  • L. Capranica
Original Research Paper


Striving for enhancing athletic performance, many sportsmen undergo rigid dietary habits, which could lead to eating disorders (EDs) or Orthorexia Nervosa (ON), a psychopathological condition characterized by the obsession for high quality food. The aim of the study was to examine the occurrence of ON in athletes and to verify the relationship between ON and EDs. Five-hundred-seventy-seven athletes and 217 matched controls were administered the following tests: ORTO-15, Eating Attitude Test 26 (EAT-26), Body Uneasiness Test (BUT) and Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS). High positivity to ORTO-15 (28%) and EAT-26 (14%) emerged in athletes, whereas a high rate of BUT positivity was evident among controls (21%). Multivariate logistic regression analysis revealed that independent predictors of ON are previous dieting, age, positivity to YBC-EDS, positivity to EAT-26, competition level, and number of YBC-EDS preoccupations and rituals. Sharing many features with both EDs and Obsessive-Compulsive Spectrum, ON represents a crossroad between these pathologic conditions and might compromise the health state of an athlete. Therefore, coaches should consider important to detect symptoms of EDs and ON in their athletes.

Key words

Diet eating disorders obsessive-compulsive spectrum orthorexia nervosa sport 


  1. 1.
    World Health Organization. Global Strategy on Diet, Physical Activity and Health 2010. Available at: ml. Retrieved June 20, 2011.Google Scholar
  2. 2.
    European Commission. Special Eurobarometer: Sport and Physical Activity 2010. Retrieved June 20, 2011. 34_en.pdf.Google Scholar
  3. 3.
    Bonci CM, Bonci LJ, Granger LR, et al. National Athletic Trainers’ Association Position Statement: Preventing, Detecting, and Managing Disordered Eating in Athletes. J Athl Train 2008; 43: 80–108.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Greenleaf C, Petrie TA, Carter J, et al. Female collegiate athletes: prevalence of Eating disorders and Disordered Eating Behaviors. J Am Coll Health 2009; 57: 489–95.PubMedCrossRefGoogle Scholar
  5. 5.
    Kirk G, Singh K, Getz H. Risk of eating disorders among female college athletes and non-athletes. J Coll Couns 2001; 4: 122–32.CrossRefGoogle Scholar
  6. 6.
    Segura-García C, Ammendolia A, Procopio L, et al. Body uneasiness, eating disorders, and muscle dysmorphia in individuals who overexercise. J Strength Cond Res 2010; 24: 3098–104.PubMedCrossRefGoogle Scholar
  7. 7.
    Holm-Denoma JM, Scaringi V, Gordon KH, et al. Eating disorder symptoms among undergraduate varsity athletes, club athletes, independent exercisers, and nonexercisers. Int J Eat Disord 2009; 42: 47–53.PubMedCrossRefGoogle Scholar
  8. 8.
    Schwarz HC, Gairrett RL, Aruguete MS, et al. Eating Attitudes, Body Dissatisfaction, and Perfectionism in Female College Athletes. North Am J Psychol 2005; 7: 345–52.Google Scholar
  9. 9.
    Martinsen M, Bratland-Sanda S, Eriksson AK, et al. Dieting to win or to be thin? A study of dieting and disordered eating among adolescent elite athletes and non-athlete controls. Br J Sports Med 2010; 44: 70–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Hausenblas HA, Fallon EA. Exercise and body image. A meta-analysis. Psychol Health 2006; 21: 33–47.CrossRefGoogle Scholar
  11. 11.
    Haase AM. Weight perception in female athletes: Associations with disordered eating correlates and behavior. Eat Behav 2011; 12: 64–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Petrie TA, Greenleaf C, Reel J, et al. Personality and psychological factors as predictors of disordered eating among female collegiate athletes. Eat Disord 2009; 17: 302–21.PubMedCrossRefGoogle Scholar
  13. 13.
    Kummer A, Dias FM, Teixeira AL. On the concept of orthorexia nervosa. Scand J Med Sci Sports 2008; 18: 395–6.PubMedCrossRefGoogle Scholar
  14. 14.
    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Ed, Text Revision (DSM-IV-TR). Washington DC, APA, 2000.Google Scholar
  15. 15.
    Bratman SMD, Knight D. Orthorexia Nervosa: Overcoming the obsession with healthful eating. Health food junkies. New York, Broadway Books, 2000.Google Scholar
  16. 16.
    Maine M, Kelly J. The Body Myth: Adult Women and the Pressure to Be Perfect. Hoboken, New Jersey, John Wiley and Sons Inc., 2005.Google Scholar
  17. 17.
    Aksoydan E, Camci N. Prevalence of orthorexia nervosa among Turkish performance artists. Eat Weight Disord 2009; 14: 33–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Eriksson L, Baigi A, Marklund B, et al. Social physique anxiety and sociocultural attitudes toward appearance impact on orthorexia test in fitness participants. Scand J Med Sci Sports 2008; 18: 389–94.PubMedCrossRefGoogle Scholar
  19. 19.
    Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 2011; 43: 1334–59.PubMedCrossRefGoogle Scholar
  20. 20.
    World Health Organization. BMI classification (2006). Available at: ml. Retrieved June 20, 2011.Google Scholar
  21. 21.
    Dotti A, Lazzari S. Validation and reliability of the Italian EAT-26. EatWeight Disord 1998; 3: 188–98.Google Scholar
  22. 22.
    Garner DM, Olmsted MP, Bohr Y, et al. The eating attitudes test: psychometric features and clinical correlates. Psychol Med 1982; 12: 871–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Cuzzolaro M, Vetrone G, Marano G, et al. The Body Uneasiness Test (BUT): development and validation of a new body image assessment scale. Eat Weight Disord 2006; 11: 1–13.PubMedCrossRefGoogle Scholar
  24. 24.
    Donini LM, Marsili D, Graziani MP, et al. Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord 2005; 10: e28–32.PubMedCrossRefGoogle Scholar
  25. 25.
    Mazure C, Halmi KA, Sunday SR, et al. Yale-Brown-Cornell Eating Disorder Scale: development, use, reliability, and validity. J Psychiatr Res 1994; 28: 425–45.PubMedCrossRefGoogle Scholar
  26. 26.
    Jordan J, Joyce PR, Carter FA, et al. The Yale-Brown-Cornell Eating Disorder Scale in Women with Anorexia Nervosa: What Is It Measuring? Int J Eat Disord 2009; 42: 267–74.PubMedCrossRefGoogle Scholar
  27. 27.
    Hosmer D, Lemeshow S. Applied Logistic Regression. New York, Wiley Interscience, 1989Google Scholar
  28. 28.
    Fidan T, Ertekin V, Isikay S, et al. Prevalence of orthorexia among medical students in Erzurum, Turkey. Comprehen Psychiatry 2010; 51: 49–54.CrossRefGoogle Scholar
  29. 29.
    Bartrina JA. Orthorexia or when a healthy diet becomes an obsession. Arch Latinoam Nutr 2007; 57: 313–5.PubMedGoogle Scholar
  30. 30.
    Jonnalagadda SS, Skinner R, Moore L. Overweight athlete: fact or fiction? Curr Sports Med Rep 2004; 3: 198–205.PubMedCrossRefGoogle Scholar
  31. 31.
    Fairburn CG, Harrison PJ. Eating disorders. Lancet 2003; 361: 407–16.PubMedCrossRefGoogle Scholar
  32. 32.
    Kamm RL. Interviewing principles for the psychiatrically aware sports medicine physician. Clin Sports Med 2005; 24: 745–69.PubMedCrossRefGoogle Scholar
  33. 33.
    Kaye WH, Bulik CM, Thornton L, et al. Comorbidity of anxiety disorders with anorexia and bulimia nervosa. Am J Psychiatry 2004; 161: 2215–21.PubMedCrossRefGoogle Scholar
  34. 34.
    Jiménez-Murcia S, Fernández-Aranda F, Raich RM, et al. Obsessive-compulsive and eating disorders: comparison of clinical and personality features. Psychiatry Clin Neurosci 2007; 61: 385–91.PubMedCrossRefGoogle Scholar
  35. 35.
    Sallet PC, de Alvarenga PG, Ferrão Y, et al. Eating disorders in patients with obsessive-compulsive disorder: Prevalence and clinical correlates. Int J Eat Disorder 2010; 43: 315–25.Google Scholar
  36. 36.
    Wu KD. Eating disorders and obsessive-compulsive disorder: A dimensional approach to purported relations. J Anxiety Disord 2008; 22: 1412–20.PubMedCrossRefGoogle Scholar
  37. 37.
    Sherman BJ, Savage CR, Eddy KT, et al. Strategic memory in adults with anorexia nervosa: Are there similarities to obsessive compulsive spectrum disorders? Int J Eat Disord 2006; 39: 468–76.PubMedCrossRefGoogle Scholar
  38. 38.
    Altman SE, Shankman SA. What is the association between obsessive-compulsive disorder and eating disorders? Clin Psychol Rev 2009; 29: 638–46.PubMedCrossRefGoogle Scholar
  39. 39.
    Bento C, Pereira AT, Maia B, et al. Perfectionism and eating behaviour in Portuguese adolescents. Eur Eat Disord Rev 2010; 18: 328–37.PubMedCrossRefGoogle Scholar
  40. 40.
    Serpell L, Livingstone A, Neiderman M, et al. Anorexia nervosa: obsessive-compulsive disorder, obsessivecompulsive personality disorder, or neither? Clin Psychol Rev 2002; 22: 647–69.PubMedCrossRefGoogle Scholar
  41. 41.
    Halmi KA, Tozzi F, Thornton LM, et al. The relation among perfectionism, obsessive-compulsive personality disorder and obsessive-compulsive disorder in individuals with eating disorders. Int J Eat Disord 2005; 38: 371–4.PubMedCrossRefGoogle Scholar
  42. 42.
    Cassin SE, von Ranson KM. Personality and eating disorders: a decade in review. Clin Psychol Rev 2005; 25: 895–916.PubMedCrossRefGoogle Scholar

Copyright information

© Editrice Kurtis 2012

Authors and Affiliations

  • C. Segura-García
    • 1
  • M. C. Papaianni
    • 1
  • F. Caglioti
    • 1
  • L. Procopio
    • 1
  • C. G. Nisticò
    • 1
  • L. Bombardiere
    • 1
  • A. Ammendolia
    • 2
  • P. Rizza
    • 1
  • P. De Fazio
    • 1
  • L. Capranica
    • 3
  1. 1.Dept. Health SciencesUniversity Magna Graecia of CatanzaroCatanzaroItaly
  2. 2.Department of Medical and Surgical SciencesUniversity Magna Graecia of CatanzaroItaly
  3. 3.Department of Human Movement and Sport ScienceUniversity of Rome Foro ItalicoRomeItaly

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