Skip to main content

Assessing Orthorexia Nervosa by Questionnaires

  • Living reference work entry
  • First Online:
Eating Disorders

Abstract

With a growing research interest directed at orthorexia nervosa (ON), specifically at measuring it accurately, today there are many measurement tools available in the scientific literature. Due to the lack of a consensus on the diagnostic criteria of ON for many years, the early scales, which are the most commonly used ones, lack questioning some key features of the disease, in addition to lacking adequate validity. Researchers who noticed this shortcoming started working on developing new measurement tools. In this chapter, we will review these 10 ON measurement tools and their properties: Bratman Orthorexia Test (BOT), ORTO-15, Body Image Screening Questionnaire (BISQ), Düsseldorf Orthorexia Scale (DOS), Orthorexia Nervosa Scale (ONS), Burda Orthorexia Risk Assessment (B-ORA), Teruel Orthorexia Scale (TOS), The Barcelona Orthorexia Scale (BOS), Orthorexia Nervosa Inventory (ONI), and Test of Orthorexia Nervosa (TON-17). Our aim is to provide researchers and clinicians with the information they require regarding the content, validity, reliability, and other distinct properties of the questionnaires.

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

Access this chapter

Institutional subscriptions

Similar content being viewed by others

Abbreviations

ABOST:

Authorized Bratman Orthorexia Self-Test

BISQ:

Body Image Screening Questionnaire

B-ORA:

Burda Orthorexia Risk Assessment

BOT:

Bratman Orthorexia Test

DOS:

Düsseldorf Orthorexia Scale

DSM-5:

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

ON:

Orthorexia nervosa

ONI:

Orthorexia Nervosa Inventory

ONS:

Orthorexia Nervosa Scale

TON-17:

Test of Orthorexia Nervosa

TOS:

Teruel Orthorexia Scale

References

  • Aksoydan E, Camci N (2009) Prevalence of orthorexia nervosa among Turkish performance artists. Eat Weight Disord Stud Anorexia Bulim Obes 14:33–37

    Article  CAS  Google Scholar 

  • Alvarenga MS, Martins MCT, Sato K et al (2012) Orthorexia nervosa behavior in a sample of Brazilian dietitians assessed by the Portuguese version of ORTO-15. Eat Weight Disord Stud Anorexia Bulim Obes 17:e29–e35

    Article  CAS  Google Scholar 

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

    Book  Google Scholar 

  • 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 

  • Babeau C, le Chevanton T, Julien-Sweerts S et al (2020) Structural validation of the ORTO-12-FR questionnaire among a French sample as a first attempt to assess orthorexia nervosa in France. Eat Weight Disord Stud Anorexia Bulim Obes 25:1771–1778

    Article  Google Scholar 

  • Barrada JR, Roncero M (2018) Bidimensional structure of the orthorexia: development and initial validation of a new instrument. An Psicol 34:282–290. https://doi.org/10.6018/analesps.34.2.299671

    Article  Google Scholar 

  • Barthels F, Meyer F, Pietrowsky R (2015) Orthorexic eating behavior: a new type of disordered eating. Ernaehrungs Umschau Int 62:156–161. https://doi.org/10.4455/eu.2015.029

    Article  Google Scholar 

  • Barthels F, Barrada JR, Roncero M (2019) Orthorexia nervosa and healthy orthorexia as new eating styles. PLoS One 14:e0219609

    Article  CAS  Google Scholar 

  • Bauer SM, Fusté A, Andrés A, Saldaña C (2019) The Barcelona Orthorexia Scale (BOS): development process using the Delphi method. Eat Weight Disord Stud Anorexia Bulim Obes 24:247–255

    Article  Google Scholar 

  • Bozan N, Bas M, Asci FH (2011) Psychometric properties of Turkish version of Dutch Eating Behaviour Questionnaire (DEBQ), A preliminary results. Appetite 56:564–566. https://doi.org/10.1016/j.appet.2011.01.025

    Article  PubMed  Google Scholar 

  • Bratman S (1997) Health food junkie: obsession with dietary perfection can sometimes do more harm than good, says one who has been there. Yoga J (October):42–44

    Google Scholar 

  • Bratman SKD (2000) Orthorexia nervosa: overcoming the obsession with healthful eating, 1st edn. Broadway Books, New York

    Google Scholar 

  • Brytek-Matera A (2021) The polish version of the Düsseldorf Orthorexia Scale (PL-DOS) and its comparison with the English version of the DOS (E-DOS). Eat Weight Disord Stud Anorexia Bulim Obes 26:1223–1232

    Article  Google Scholar 

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

    Article  Google Scholar 

  • Burda L (2018) Development and validation of an inventory measuring dietary attitudes of healthy eating and orthorexia nervosa. Texas A&M University – Corpus Christi

    Google Scholar 

  • Cerolini S, Vacca M, Zagaria A et al (2021) Italian adaptation of the Düsseldorf Orthorexia Scale (I-DOS): psychometric properties and prevalence of orthorexia nervosa among an Italian sample. Eat Weight Disord Stud Anorexia Bulim Obes:1–9

    Google Scholar 

  • Chace S, Kluck AS (2021) Validation of the Teruel Orthorexia Scale and relationship to health anxiety in a US sample. Eat Weight Disord Stud Anorexia Bulim Obes:1–11

    Google Scholar 

  • Chard CA, Hilzendegen C, Barthels F, Stroebele-Benschop N (2019) Psychometric evaluation of the English version of the Düsseldorf Orthorexie Scale (DOS) and the prevalence of orthorexia nervosa among a US student sample. Eat Weight Disord Stud Anorexia Bulim Obes 24:275–281

    Article  Google Scholar 

  • Conrad R (2019) Psychometric properties of a new measure for orthorexia nervosa: the Orthorexia Nervosa Scale (ONS). Electron theses diss

    Google Scholar 

  • de Souza QJOV, Rodrigues AM (2014) Comportamento de risco para ortorexia nervosa em estudantes de nutrição. J Bras Psiquiatr 63:200–204

    Article  Google Scholar 

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

  • 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 

  • Garner DM, Olmstead MP, Polivy J (1983) Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J Eat Disord 2:15–34. https://doi.org/10.1002/1098-108X(198321)2:2<15::AID-EAT2260020203>3.0.CO;2-6

    Article  Google Scholar 

  • Gonidakis F, Poulopoulou C, Michopoulos I, Varsou E (2021) Validation of the Greek ORTO-15 questionnaire for the assessment of orthorexia nervosa and its relation to eating disorders symptomatology. Eat Weight Disord Stud Anorexia Bulim Obes:1–9

    Google Scholar 

  • Haddad C, Hallit R, Akel M et al (2020) Validation of the Arabic version of the ORTO-15 questionnaire in a sample of the Lebanese population. Eat Weight Disord Stud Anorexia Bulim Obes 25:951–960

    Article  Google Scholar 

  • Hallit S, Barrada JR, Salameh P et al (2021a) The relation of orthorexia with lifestyle habits: Arabic versions of the eating habits questionnaire and the Dusseldorf orthorexia scale. J Eat Disord 9:1–12

    Article  Google Scholar 

  • Hallit S, Brytek-Matera A, Obeid S (2021b) Orthorexia nervosa and disordered eating attitudes among Lebanese adults: assessing psychometric proprieties of the ORTO-R in a population-based sample. PLoS One 16:e0254948. https://doi.org/10.1371/journal.pone.0254948

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • He J, Ma H, Barthels F, Fan X (2019) Psychometric properties of the Chinese version of the Düsseldorf Orthorexia Scale: prevalence and demographic correlates of orthorexia nervosa among Chinese university students. Eat Weight Disord Stud Anorexia Bulim Obes 24:453–463

    Article  Google Scholar 

  • Heiss S, Coffino JA, Hormes JM (2019) What does the ORTO-15 measure? Assessing the construct validity of a common orthorexia nervosa questionnaire in a meat avoiding sample. Appetite 135:93–99. https://doi.org/10.1016/j.appet.2018.12.042

    Article  PubMed  Google Scholar 

  • Jenaro C, Flores N, Bermejo BG, Cruz M (2011) Body image questionnaire for early detection of eating disorders. Acción Psicol 8:7–20. https://doi.org/10.5944/AP.8.1.193

    Article  Google Scholar 

  • Kaya S, Uzdil Z, Çakıroğlu FP (2021) Validation of the Turkish version of the Orthorexia Nervosa Inventory (ONI) in an adult population: its association with psychometric properties. Eat Weight Disord Stud Anorexia Bulim Obes:1–7

    Google Scholar 

  • Kinzl JF, Hauer K, Traweger C, Kiefer I (2005) Orthorexia nervosa: Eine häufige Essstörung bei Diätassistentinnen? Einleitung. Ernährungs-Umschau 52:11

    Google Scholar 

  • Kramer ME (2016) The development of a scale to measure orthorexia nervosa. Colorado State University

    Google Scholar 

  • Kramer ME (2019) Orthorexia nervosa scale: updated and tested in a targeted community sample

    Google Scholar 

  • Lasson C, Barthels F, Raynal P (2021) Psychometric evaluation of the French version of the Düsseldorfer Orthorexia Skala (DOS) and prevalence of orthorexia nervosa among university students. Eat Weight Disord Stud Anorexia Bulim Obes:1–8

    Google Scholar 

  • Mandal A, Eaden J, Mayberry MK, Mayberry JF (2000) Questionnaire surveys in medical research. J Eval Clin Pract 6:395–403. https://doi.org/10.1046/J.1365-2753.2000.00263.X

    Article  CAS  PubMed  Google Scholar 

  • Meule A, Holzapfel C, Brandl B et al (2020) Measuring orthorexia nervosa: a comparison of four self-report questionnaires. Appetite 146:104512. https://doi.org/10.1016/J.APPET.2019.104512

    Article  PubMed  Google Scholar 

  • Mhanna M, Azzi R, Hallit S et al (2021) Validation of the Arabic version of the Teruel Orthorexia Scale (TOS) among Lebanese adolescents. Eat Weight Disord Stud Anorexia Bulim Obes:1–9

    Google Scholar 

  • 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

    Article  Google Scholar 

  • Mitrofanova E, Pummell E, Martinelli L, Petróczi A (2021) Does ORTO-15 produce valid data for ‘Orthorexia Nervosa’? A mixed-method examination of participants’ interpretations of the fifteen test items. Eat Weight Disord Stud Anorexia Bulim Obes 26:897–909. https://doi.org/10.1007/s40519-020-00919-2

    Article  Google Scholar 

  • Moller S, Apputhurai P, Knowles SR (2019) Confirmatory factor analyses of the ORTO 15-, 11- and 9-item scales and recommendations for suggested cut-off scores. Eat Weight Disord 24:21–28. https://doi.org/10.1007/s40519-018-0515-0

    Article  PubMed  Google Scholar 

  • Mond JM, Hay PJ, Rodgers B et al (2004) Validity of the Eating Disorder Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples. Behav Res Ther 42:551–567. https://doi.org/10.1016/S0005-7967(03)00161-X

    Article  CAS  PubMed  Google Scholar 

  • Morgan JF, Reid F, Lacey JH (1999) The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ 319:1467–1468. https://doi.org/10.1136/bmj.319.7223.1467

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • 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 

  • Özdengül F, Yargic MP, Solak R et al (2021) Assessment of orthorexia nervosa via ORTO-R scores of Turkish recreational and competitive athletes and sedentary individuals: a cross-sectional questionnaire study. Eat Weight Disord 26:1111–1118. https://doi.org/10.1007/s40519-020-01006-2

    Article  PubMed  Google Scholar 

  • Parra-Fernandez ML, Rodríguez-Cano T, Onieva-Zafra MD et al (2018) Adaptation and validation of the Spanish version of the ORTO-15 questionnaire for the diagnosis of orthorexia nervosa. PLoS One 13:e0190722

    Article  Google Scholar 

  • 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. https://doi.org/10.1007/BF03325318

    Article  CAS  PubMed  Google Scholar 

  • Roberto da Silva W, Cruz Marmol CH, Nogueira Neves A et al (2021) A Portuguese adaptation of the Teruel orthorexia scale and a test of its utility with Brazilian young adults. Percept Mot Skills 128:2052–2074

    Article  Google Scholar 

  • Rodgers RF, White M, Berry R (2021) Orthorexia nervosa, intuitive eating, and eating competence in female and male college students. Eat Weight Disord. https://doi.org/10.1007/s40519-020-01054-8

  • Rogowska AM, Kwaśnicka A, Ochnik D (2021a) Development and validation of the test of orthorexia nervosa (TON-17). J Clin Med 10:1637

    Article  Google Scholar 

  • Rogowska AM, Kwaśnicka A, Ochnik D (2021b) Validation and polish adaptation of the Authorized Bratman Orthorexia Self-Test (ABOST): comparison of dichotomous and continuous Likert-type response scales. Psychol Res Behav Manag 14:921–931. https://doi.org/10.2147/PRBM.S308356

    Article  PubMed  PubMed Central  Google Scholar 

  • Rogoza R, Donini LM (2021) Introducing ORTO-R: a revision of ORTO-15. Eat Weight Disord 26:887–895. https://doi.org/10.1007/s40519-020-00924-5

    Article  PubMed  Google Scholar 

  • Roncero M, Barrada JR, Perpiñá C (2017) Measuring orthorexia nervosa: psychometric limitations of the ORTO-15. Span J Psychol 20. https://doi.org/10.1017/SJP.2017.36

  • Rössner S (2004) Orthorexia nervosa–en ny sjukdom. Lakartidningen 101:2835

    PubMed  Google Scholar 

  • Segura-Garcia C, Ramacciotti C, Rania M et al (2015) The prevalence of orthorexia nervosa among eating disorder patients after treatment. Eat Weight Disord 20:161–166

    Article  Google Scholar 

  • Stochel M, Janas-Kozik M, Zejda JE et al (2015) Validation of ORTO-15 questionnaire in the group of urban youth aged 15–21. Psychiatr Pol 49:119–134

    Article  Google Scholar 

  • Tomsa R, Istfan N, Jenaro C et al (2012) Body image screening questionnaire for eating disorder early detection: a Romanian replication. Procedia Soc Behav Sci 33:423–427. https://doi.org/10.1016/j.sbspro.2012.01.156

    Article  Google Scholar 

  • Valente M, Syurina EV, Donini LM (2019) Shedding light upon various tools to assess orthorexia nervosa: a critical literature review with a systematic search. Eat Weight Disord 24:671–682

    Article  Google Scholar 

  • Vuillier L, Robertson S, Greville-Harris M (2020) Orthorexic tendencies are linked with difficulties with emotion identification and regulation. J Eat Disord 8:15. https://doi.org/10.1186/s40337-020-00291-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wardle J (1987) Eating style: a validation study of the Dutch eating behaviour questionnaire in normal subjects and women with eating disorders. J Psychosom Res 31:161–169. https://doi.org/10.1016/0022-3999(87)90072-9

    Article  CAS  PubMed  Google Scholar 

  • Zemlyanskaya Y, Valente M, Syurina EV (2021) Orthorexia nervosa and Instagram: exploring the Russian-speaking conversation around# opтopeкcия. Eat Weight Disord Anorexia Bulim Obes:1–10

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Melda Pelin Yargic .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Yargic, M.P., Celen, M.C. (2022). Assessing Orthorexia Nervosa by Questionnaires. In: Patel, V., Preedy, V. (eds) Eating Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-67929-3_84-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-67929-3_84-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-67929-3

  • Online ISBN: 978-3-030-67929-3

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics