Orthorexic tendencies in the general population: association with demographic data, psychiatric symptoms, and utilization of mental health services

Abstract

Purpose Orthorexia nervosa (ON) is characterized by a preoccupation to eat healthily and restrictive eating habits despite negative psychosocial and physical consequences. As a relatively new construct, its prevalence and correlates in the general population and the associated utilization of mental health services are unclear. Methods Adults from the general population completed the Düsseldorf Orthorexia Scale (DOS), the Patient Health Questionnaire (PHQ), the Short Eating Disorder Examination (SEED). Results Five-hundred eleven (63.4% female) participants with a mean age of 43.39 (SD = 18.06) completed the questionnaires. The prevalence of ON according to the DOS was 2.3%. Considering only effects of at least intermediate size, independent samples t-tests suggested higher DOS scores for persons with bulimia nervosa (p < .001, Cohen's d = 1.14), somatoform syndrome (p = .012, d = .60), and major depressive syndrome (compared p < .001, d = 1.78) according to PHQ as well as those who reported to always experience fear of gaining weight (p < .001, d = 1.78). The DOS score correlated moderately strong and positively with the PHQ depression (r = .37, p < .001) and stress (r = .33, p < .001) scores as well as the SEED bulimia score (r = .32, p < .001). In multivariate logistic regression analyses, only PHQ depression scores were associated with past psychotherapeutic or psychiatric treatment (OR = 1.20, p = .002) and intake of psychotropic medication in the last year (OR = 1.22, p = .013). Conclusions The prevalence of ON was low compared to international studies but is in line with other non-representative German studies. Orthorexic tendencies related to general mental distress and eating disorder symptoms but were no independent reason for seeking treatment. Level of evidence Level V, cross-sectional descriptive study. Keywords Eating behaviors • Eating disorder • Mental health care • Population studies While not being recognized as an official disorder, proposed criteria for orthorexia nervosa (ON) include a preoccupation with food and restrictive eating habits despite negative physiological, emotional, or psychosocial consequences [1]. Partly due to the questionable quality of the respective assessment tools [2-4] and the lack of a well-defined The article is part of the Topical Collection on Orthorexia Nervosa.

Evaluation of Orthorexia Nervosa and Symptomatology Associated with Eating Disorders among European University Students: A Multicentre Cross-Sectional Study

“…Drive for thinness, bulimia, body dissatisfaction, perfectionism, interoceptive awareness (in both Spanish and Polish students) and ineffectiveness (in Spanish students) were found to be related to ON (H3 was confirmed). These results are in line with other studies showing that greater ON symptomatology is associated with greater disordered (pathological) eating among adults from the general population [20,31,32,55], such as body dissatisfaction [47], bulimia [48] or restraint eating, eating concern, weight concern, and shape concern [6]. ON significantly overlapped with ED pathology in both of our samples, suggesting that ON should be consider as disordered eating behaviour closely connected with ED.…”

“…Moreover, in our recent studies 10.5% of Spanish students were classified as having ON [19], while ON was observed in 6.6% of Polish students [23]. To our knowledge, a total of six studies (published in English) used the DOS among adults from the general population [6,17,[47][48][49][50] with ON prevalence ranging from 2.3% [48] to 8.4% [50]. The prevalence of ON appears to be increasing, and more research is needed to elucidate the cultural and social aspects of disordered eating habits in order to provide culturally appropriate psychological treatment.…”

Identifying the Profile of Orthorexic Behavior and “Normal” Eating Behavior with Cluster Analysis: A Cross-Sectional Study among Polish Adults

“…Moreover, the number of participants who meet the criteria for ON or for being at risk of ON is small and represents less than 10% of the total sample. These results are in line with other studies showing that ON prevalence (used the DOS) among a general population sample ranges from 2.3% [58] to 8.4% [59]. Future research using claster analysis should be conducted on a large cohort from different samples (both clinical and non-clinical).…”

Orthorexia Nervosa—It Is Time to Think About Abandoning the Concept of a Distinct Diagnosis

“…In our study in inpatients with mental disorders ( 22), however, we did not find a substantial overlap between ON and mental disorders other than eating disorders. That is, the prevalence of ON (based on DOS scores of ≥30) was similar to prevalence rates reported in the general population [0-3%; e.g., (17,20,21)] in groups of patients with a depressive episode, recurrent depressive disorder, phobic disorders, obsessive-compulsive disorder, trauma-related disorders, and somatoform disorders. Unlike the changes observed in patients with eating disorders, DOS scores did not change from admission to discharge in these groups.…”

“…However, most studies that used the DOS could not demonstrate that orthorexic symptoms are independent from features of disordered eating behavior. For example, positive correlations between DOS scores and eating disorder symptoms such as drive for thinness and body dissatisfaction have been found in both non-clinical and clinical samples [e.g., (18)(19)(20)] and orthorexic symptomatology tends to be higher in females than males [e.g., (21)].…”