Abstract
Purpose
In recent years, a new term—orthorexia nervosa (ON)—has been introduced in the field of clinical assessment and psychotherapy. Orthorexia nervosa is defined as a fixation on healthy food and a pathological obsession to eat food with more natural, higher quality ingredients. Although instruments to measure ON are available, no study on the psychometric properties of the original developed instrument by Bratman (Orthorexia nervosa: Overcoming the obsession with healthful eating, Broadway Books, New York, 2000) in a large clinical sample exists until now.
Methods
The study was conducted in a large clinic in Germany. The study sample consisted of N = 1122 inpatients, 70% were female, and the mean age was 41 years (SD = 14 years). The main diagnoses at the end of treatment were affective disorders (46%), followed by eating disorders (13%), anxiety disorders (10%), and personality disorders (10%). The patients filled out several instruments, like the Ortho-10, the 10-item version of the orthorexia nervosa instrument, and other construct-related, disorder-specific and construct-distant instruments.
Results
The exploratory factor analysis revealed a two-factor structure: an eating disorder-specific factor and an orthorexia-nervosa specific factor. The eating disorder factor showed good convergent and discriminative validity in which patients with eating disorders and those without could correctly be classified. However, the orthorexia-nervosa specific factor revealed no informational gain compared to the eating disorder-specific factor in this clinical sample.
Conclusions
Further investigation is necessary to approach the concept of ON and its sense in clinical samples.
Level of evidence
Level II: evidence obtained from well-designed controlled trials without randomization.
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References
American Psychiatric Association., American Psychiatric Association. DSM-5 Task Force (2013) Diagnostic and statistical manual of mental disorders: DSM-5, 5th. American Psychiatric Association, Washington, D.C.
Bratman S (2000) Orthorexia nervosa: overcoming the obsession with healthful eating. Broadway Books, New York
Donini LM, Marsili D, Granziani MP et al (2004) Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eat Weight Disord 9:151–157
Kinzl JF, Hauer K, Traweger C et al (2006) Orthorexia nervosa in dieticians. Psychother Psychosom 75:395–396. https://doi.org/10.1159/000095447
Moroze RM, Dunn TM, Craig Holland J et al (2015) Microthinking about micronutrients: a case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria. Psychosomatics 56(4):397–403. https://doi.org/10.1016/j.psym.2014.03.003
Bagci Bosi AT, Camur D, Guler C (2007) Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine (Ankara, Turkey). Appetite 49(3):661–666. https://doi.org/10.1016/j.appet.2007.04.007
Kummer A, Dias F, Teixeira AL (2007) Orthorexia nervosa: who cares? Brit J Psychiat 190:81
Mathieu J (2005) What is orthorexia? J Am Diet Assoc 105(10):1510–1512. https://doi.org/10.1016/j.jada.2005.08.021
Koven NS, Abry AW (2015) The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatr Dis Treat 11:385–394. https://doi.org/10.2147/NDT.S61665
Halmi KA, Sunday SR, Klump KL et al (2003) Obsessions and compulsions in anorexia nervosa subtypes. Int J Eat Disord 33(3):308–319. https://doi.org/10.1002/eat.10138
Kinzl JF, Hauer K, Traweger C et al (2005) Orthorexia nervosa: Eine häufige Essstörung bei Diätassistentinnen? Ernährungs-Umschau 52:436–439
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
Donini LM, Marsili D, Graziani MP et al (2005) Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord 10:e28–e32
Arusoglu G, Kabakci E, Koksal G et al (2008) [Orthorexia nervosa and adaptation of ORTO-11 into Turkish]. Turk Psikiyatri Derg 19(3):283–291
Varga M, Thege BK, Dukay-Szabo S et al (2014) When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry 14:59. https://doi.org/10.1186/1471-244X-14-59
Brytek-Matera A, Krupa M, Poggiogalle E et al (2014) Adaptation of the ORTHO-15 test to Polish women and men. Eat Weight Disord 19(1):69–76. https://doi.org/10.1007/s40519-014-0100-0
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(8):e0135772. https://doi.org/10.1371/journal.pone.0135772
Robinson K (2011) Is the fixation on “healthy” unhealthy?: A study on orthorexia nervosa
Gleaves DH, Graham EC, Ambwani S (2013) Measuring “Orthorexia”: development of the eating habits questionnaire. Int J Educ Psychol Assess 2:1–18
Liebherz S, Rabung S (2013) Wirksamkeit psychotherapeutischer Krankenhausbehandlung im deutschsprachigen Raum: Eine Meta-Analyse (effectiveness of psychotherapeutic hospital treatment in German speaking countries: a meta-analysis). Psychother Psychosom Med Psychol 63(9–10):355–364. https://doi.org/10.1055/s-0033-1337909
Garner DM (1991) EDI-2. Eating disorder inventory-2. Professional manual
Garner DM, Olmstead MP, Polivy J (1983) Development and validation of a multidimensional eating disorder inventory of anorexia nervosa and bulimia. Int J Eat Disord 2:14–34
Derogatis LR (1993) The brief symptom inventory (BSI): administration, scoring, and procedures manual. National Computer Services, Minneapolis
Goodman WK, Price LH, Rasmussen SA et al (1989) The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry 46(11):1006–1011
Goodman WK, Price LH, Rasmussen SA et al (1989) The Yale-Brown obsessive compulsive scale II validity. Arch Gen Psychiatry 46(11):1012–1016
Frost RO, Marten P, Lahart C et al (1990) The dimensions of perfectionism. Cogn Ther Res 14:449–468
Ware JE, Raczek AE, McHorney CA (1993) The MOS 36-item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 31(3):247–263
Beck AT, Ward CH, Mendelson M et al (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571
Patton JH, Stanford MS, Barratt ES (1995) Factor structure of the Barratt Impulsiveness Scale. J Clin Psychol 51(6):768–774
Thiel A, Jacobi C, Horstmann S et al (1997) Eine deutschsprachige Version des eating Disorder Inventory EDI-2. Psychotherapie Psychosomatik Medizinische Psychologie 47(9–10):365–376
Derogatis LR (ed) (1977) SCL-90-R: administration, scoring and procedures manual-I for the R(evised) version. John Hopkins University School Medicine, Baltimore
Rief W, M G, Fichter MM (1991) Kurzberichte über neue diagnostische Verfahren. Die Symptom-Checkliste SCL-90-R: Überprüfung an 900 psychosomatischen Patienten. Diagnostica 37:58–65
Schmitz N, Hartkamp N, Kruse J et al (2002) The Symptom Check-List-90-R (SCL-90-R): A German validation study. Qual Life Res 9:185–193
Stöber J (1998) The frost multidimensional perfectionism scale: more perfect with four (instead of six) dimensions. Personal Individ Differ 24:481–491
American Psychiatric Association (1987) DSM-III-R: diagnostic and statistical manual of mental disorders. APA, Washington, DC
Moritz S, Meier B, Kloss M et al (2002) Dimensional structure of the Yale-Brown obsessive compulsive scale (Y-BOCS). Psychiatry Res 109:193–199
Baer L (1993) Alles unter Kontrolle—Zwangsgedanken und Zwangshandlungen überwinden. Huber, Bern
Schaible R, Armbrust M, Nutzinger DO (2001) Yale-Brown obsessive compulsive scale: Sind Selbst-und Fremdrating äquivalent? Verhaltenstherapie 11:298–303
Bullinger M, Kirchberger I (1998) SF-36. Fragebogen zum Gesundheitszustand. Hogrefe, Göttingen
Ware JE (2000) SF-36 Health survey update. Spine 25(24):3130–3139
Hautzinger M, Bailer M, Worrall H et al (1995) Das Beck Depressionsinventar (BDI). Huber, Bern
Arbuckle JL (2017) Amos (Version 25.0) [Computer Program]. SPSS, Chicago
Hu L, Bentler PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model 6:1–55
Kriston L, Günzler C, Harms A et al (2008) Confirmatory factor analysis of the German version of the international index of erectile function (IIEF): a comparison of four models. J Sex Med 5(1):92–99. https://doi.org/10.1111/j.1743-6109.2007.00474.x
Dilling H, Mombour W, Schmidt MH (1993) Internationale Klassifikation psychischer Störungen: ICD-10 Kapitel V (F)—Klinisch-diagnostische Leitlinien. Verlag Hans Huber, Bern
Bundros J, Clifford D, Silliman K et al (2016) Prevalence of Orthorexia nervosa among college students based on Bratman’s test and associated tendencies. Appetite 101:86–94. https://doi.org/10.1016/j.appet.2016.02.144
Gramaglia C, Brytek-Matera A, Rogoza R et al (2017) Orthorexia and anorexia nervosa: two distinct phenomena? A cross-cultural comparison of orthorexic behaviours in clinical and non-clinical samples. BMC Psychiatry 17(1):75. https://doi.org/10.1186/s12888-017-1241-2
Acknowledgements
We would like to thank the patients of the Klinik Bad Bramsted for their willing participation. Finally, we thank the anonymous reviewers for their valuable comments.
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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study has been approved by the ethic committee of the University of Luebeck, Germany.
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This article is part of topical collection on Orthorexia Nervosa.
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Andreas, S., Schedler, K., Schulz, H. et al. Evaluation of a German version of a brief diagnosis questionnaire of symptoms of orthorexia nervosa in patients with mental disorders (Ortho-10). Eat Weight Disord 23, 75–85 (2018). https://doi.org/10.1007/s40519-017-0473-y
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DOI: https://doi.org/10.1007/s40519-017-0473-y