doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

Purpose Orthorexia Nervosa is characterized by specific behaviors frequently related to other psychopathological conditions, such as Obsessive–Compulsive Disorder (OCD) and Eating Disorders (EDs). Whereas ON can mainly be described as an excessive concern regarding healthy food, the study’s principal aim was to investigate if ON could be considered a condition related and differentiated from worry, other than OCD, EDs, perfectionism, anxiety, and depression. Method To achieve these aims, 302 individuals from the general population were enrolled and were divided into two groups named “High EHQ” and “Low EHQ”, based on their Eating Habits Questionnaire’s score (EHQ-21). Results Correlations of ON with EDs and non-adaptive perfectionism constructs emerged independently from Obsessive-Compulsive (OC) symptoms, and the same pattern was observed when comparing the High and the Low EHQ groups. The two groups also differ in the worry anxiety and depression constructs and are not affected by OC symptoms removal. Discussion Our results confirm a relationship between ON with the typical ED, perfectionistic, anxious, and depressive symptomatology, mainly when the OC features are controlled; moreover, worry constructs could be considered characteristic of the ON phenomenology. This study does not entirely exclude the relationship with obsessive and compulsive characteristics, which could be associated with or serve as a mediator of the orthorexic behavior. Future research could explore the potential mediating or collateral role of OC symptoms. Level of evidence Level III, evidence obtained from well-designed cohort or case–control analytic studies.

Background Orthorexia Nervosa (ON) is a construct characterized by behaviors, emotions, and beliefs on eating healthy food and excessive attention to diet; moreover, dieting has been considered a risk factor in ON symptoms development. The principal aim of this study was to investigate the differences in clinical and non-clinical groups most at risk of ON. Aspects that could be associated with ON (Eating Disorders [EDs], obsessive-compulsive symptomatology, perfectionistic traits, anxiety, depression, Body Mass Index [BMI]) were investigated in all groups. Methods The sample consisted of 329 adults belonging to four different groups. Three were on a diet: Anorexia/Bulimia Nervosa group (N = 90), Obesity/Binge Eating Disorder group (N = 54), Diet group (N = 91). The Control group consisted of people who were not following a diet (N = 94). Participants completed several self-administered questionnaires (EHQ-21, EDI-3, OCI-R, MPS, BAI, BDI-II) to assess ON-related features in different groups. Results Analyses highlighted higher orthorexic tendencies in Anorexia/Bulimia Nervosa, Obesity/BED, and Diet groups than in the Control group. Moreover, results have shown that in the AN/BN group, eating disorders symptomatology and a lower BMI were related to ON and that in Obesity/Binge Eating Disorder and Diet groups, perfectionism traits are associated with ON. Conclusion Individuals who pursue a diet share some similarities with those who have an eating disorder regarding emotions, behaviors, and problems associated with orthorexic tendencies. Moreover, perfectionistic traits seem to predispose to higher ON tendencies. In general, these results confirm the ON as an aspect of the main eating disorders category.

There is limited evidence of a link between Orthorexia Nervosa (ON) and Obsessive–Compulsive Disorder (OCD), and no definitive conclusions can be drawn. The interplay between socio-cultural context and ON has been poorly investigated as well. Therefore, the objectives of the present study were: (1) to investigate the differences in ON and OCD symptoms and (2) to assess the relationship between ON and OCD symptoms among university students. Six hundred and sixty-six university students participated in the present study: 286 from Poland and 320 from Italy. No age, gender and marital status differences were identified between two samples of university students. However, on average, Polish university students had a higher Body Mass Index than Italian ones. Our findings showed that Polish students present more problems related to obsessive symptomatology, core beliefs of OCD, perfectionism traits, and a major ON symptomatology than Italian ones. Also, Polish students with a higher level of ON exhibited higher levels of OCD symptoms and parental expectations/parental criticism. While Italian students with a higher level of ON showed higher levels of perfectionism features (organization and concern over mistakes). In general, correlations were low as confirmation of partial independence ON from OCD symptoms and core beliefs of OCD in both Polish and Italian university students. The present results highlight a need for further investigation of the correlates of ON across different cultural groups. Future research may screen individuals with ON to determine the comorbidity between ON and OCD symptomology to facilitate appropriate treatment choices. Level of evidence Level V, Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Virtual Reality Environments (VREs) are widely deployed in mental health treatments, often associated with relaxation techniques. The personalization of natural VR-based scenarios is a key element that can further facilitate users’ sense of presence and relaxation. This study explored the role of VREs’ personalization in the user experience with an environment supporting relaxation, by deploying mixed methods. Methods: A non-clinical sample of 20 individuals participated in exposure to a supportive body-scan-guided relaxation VRE. In the personalized conditions, the participants had the option of choosing the context (e.g., sea, mountain, or countryside) and including in the scenario different types of sounds, visual elements, and changing the time of day and weather. In the standard conditions, individuals were exposed to a relaxing VRE, but they could choose neither the context nor the auditory and visual elements. The order of presentation of the personalized vs non-personalized environments was randomized. Measures regarding relaxation, state-anxiety perceived levels, VRE-related symptoms, the usability of the Virtual Reality (VR) setting, sense of presence, pleasure, activation, engagement, and level of immersion experienced were collected before and after exposure to the VR environments. Results: Findings showed that personalized VREs were preferred by users. Participants generally preferred to experience a greater immersivity, pleasure, engagement, and relaxation in the personalized virtual settings. Conclusion: The study further confirms the role of personalization as a component positively contributing to relaxation and engagement. Future research may further assess this effect in the context of large-scale controlled studies involving clinical and non-clinical populations.