Orthorexia Nervosa: Disorder or Not? Opinions of Dutch Health Professionals

Abstract

Introduction: Orthorexia nervosa (ON) is a condition that is characterized by a pathological obsession with eating foods one considers healthy and has recently been suggested as a new possible diagnosis. However, there is limited published research on health professionals’ recognition, ideas and opinions regarding the diagnosis and classification of ON.Purpose: The aim of this mixed-methods study was to gain insight into the perspectives of clinically active health professionals on ON, and into their opinions on if and how the disorder should be classified.Results: Psychologists, psychiatrists, dietitians and physiotherapists in the Netherlands (n = 160) participated by responding to a self-administered questionnaire. Most health professionals (78%) reported that they thought that ON should have its own diagnosis. This opinion was more common in physical health professionals than in mental health professionals. A majority (74%) agreed that ON fits within the Diagnostic and Statistical Manual of Mental Disorders (DSM) category Eating and Feeding Disorders. Interviews with 15 mental health professionals were analyzed using code frequencies and continuous comparisons. Mental health professionals reported believing that ON is prevalent in the general population and that a separate diagnosis would have both advantages and disadvantages for health professionals and patients. Interview participants described the typical ON patient as being young, female, and highly educated; characteristics that overlap with typical anorexia nervosa and obsessive compulsive disorder cases.Conclusion: The results suggest that some health professionals from a heterogenous sample in the Netherlands think ON should have a separate diagnosis in the DSM, however, the study needs to be replicated to allow for further generalization. Methodological design of this study may be utilized in future research with similar aims. The findings can serve as a foundation for investigation of individuals’ experiences of distress caused by ON, and further refinement of the diagnostic criteria.

Characteristics and nosological separation of orthorexia nervosa

“…In the above case, two mechanisms would contribute to the development of ON: food restriction (from the ED spectrum) and the symptoms of OCD. This relationship was also confirmed by other studies and specialist opinions linking ON behaviours with ED and OCD (Arusoğlu et al, 2008;Asil and Sürücüoğlu, 2015;Bundros et al, 2016;Hayes et al, 2017;Poyraz et al, 2015;Ryman et al, 2019). At the same time, it is worth considering investigating the causal relationship between these classes of disorders as well as to determine the relationship between orthorexic behaviours and obsessive-compulsive personality traits, which are common in individuals with AN (Crane et al, 2007).…”

“…Choć zważanie na aspekty zdrowotne podczas dokonywania wyborów żywieniowych przez grupę HON i brak związku nasilenia cech ON z BMI są argumentami za różnicowaniem omawianego zaburzenia od AN, zasadne wydaje się zakwestionowanie odrębności psychopatologicznej ON i uznanie miejsca ortoreksji w spektrum ED. Stanowisko to podzielają inni badacze (Barthels, 2013, za: Cena et al, 2019Barthels et al, 2015;Dell'Osso et al, 2016;Łucka et al, 2019;Pietrowsky i Barthels, 2016 (Arusoğlu et al, 2008;Asil i Sürücüoğlu, 2015;Bundros et al, 2016;Hayes et al, 2017;Poyraz et al, 2015;Ryman et al, 2019). Jednocześnie warto rozważyć zbadanie zależności przyczynowo-skutkowych między wymienionymi klasami zaburzeń i określenie związku między cechami ortoreksji a obsesyjno-kompulsyjnymi cechami osobowości, częstymi u osób z AN (Crane et al, 2007).…”

Orthorexia nervosa and Instagram: exploring the Russian-speaking conversation around #opтopeкcия

“…At present, ON is a growing topic of interest predominantly in the global north with the vast majority of research focused on English-speaking populations [15,[21][22][23][24]. This represents a research gap in our understanding of the intercultural differences in the way ON manifests, is experienced, and understood.…”

Orthorexic tendencies are linked with difficulties with emotion identification and regulation

“…In one study, approximately two thirds of Dutch-speaking eating disorder professionals surveyed (n = 111), reported that they had seen ON cases in their work and thought that ON warranted more attention both clinically and in research [18]. In a more recent study, 95.6% of eating disorder specialists surveyed in the Netherlands (n = 160) stated that ON was prevalent to some extent in the general population, with the majority reporting that ON should be categorised under the Eating and Feeding Disorders category in the DSM-5 [19] 2 . At present, ON would perhaps be diagnosed as a subtype of AN, due to overlapping features between ON and AN, such as perfectionism, guilt over food transgression, trait anxiety, cognitive rigidity [20].…”