Skip to main content
Erschienen in: BMC Psychiatry 1/2017

Open Access 01.12.2017 | Research article

Orthorexia and anorexia nervosa: two distinct phenomena? A cross-cultural comparison of orthorexic behaviours in clinical and non-clinical samples

verfasst von: C. Gramaglia, A. Brytek-Matera, R. Rogoza, P. Zeppegno

Erschienen in: BMC Psychiatry | Ausgabe 1/2017

Abstract

Background

Orthorexia nervosa (ON) is defined as pathological healthful eating. The aim of this study was to investigate whether there is any difference in orthorexic behaviours between clinical and non-clinical groups, and in different cultural contexts. .

Methods

Recruitment involved both female patients with anorexia nervosa (AN) and healthy controls (HC) from Italy and Poland (N = 23 and N = 35 AN patients; and N = 39 and N = 39 HCs, in Italy and Poland, respectively). Assessment of orthorexic behaviours was performed with the ORTO-15 test.

Results

Statistically significant differences were found between Italian women in the AN and HC group, whereas no difference between Polish women in the AN and HC group was found. Both Italian groups scored significantly higher than the Polish ones on the ORTO-15.

Conclusions

Differences have been found between the Italian and Polish samples, both in the percentage of individuals with orthorexic behaviours as suggested by an ORTO 15 score below the cutoff, and in the mean ORTO 15 scores in the AN and HC groups, suggesting cross-cultural differences in orthorexic behaviours, whose meaning is currently difficult to understand.
Abkürzungen
AFN
Alternative Food Networks
AN
Anorexia nervosa
BN
Bulimia nervosa
ED
Eating disorder
HCs/HC
Healthy controls
ON
Orthorexia nervosa

Background

Orthorexia nervosa (ON) is defined as an exaggerated, obsessive, pathological fixation on healthy food, eating healthy, or rather health-conscious eating behaviours [13]. The literature is not unequivocal about whether ON is an eating disorder (at all), a variant of a currently recognized eating disorder (ED), such as the avoidant/restrictive food intake disorder, or a different disorder [46]. Similarities and possible overlaps have been suggested with the spectrum of obsessive-compulsive, eating, or somatoform disorders [5, 7, 8]. Orthorexia shares issues with disturbed eating/nutrition attitudes as shown by excessive focus on food-related topics [9, 10], strict diet [11], perfectionism [12], co-occurrence of anxiety, need of control [13], stiffness of behaviour and rituals related to preparation of meals [14, 15]. In individuals with ON, the most characteristic features of anorexia nervosa (AN) and bulimia nervosa (BN) are absent, namely excessive preoccupation with losing weight, extreme fear of gaining weight and body size overestimation [12, 16]. Reports from the literature are far from being consistent, nonetheless a high frequency of occurrence of orthorexic behaviours in patients with EDs has been described, and eating related disturbances may play the role of risk factors for orthorexia, although the reverse is also possible [1723]. Overall, despite increasing research efforts, there is still a dearth of empirical data regarding the relation between AN and orthorexia.
Reports are not unequivocal also as far as the correlation between eating pathology (as measured for instance with the Eating Attitudes Test) and orthorexia (as measured with the ORTO-15 test) is concerned [17, 2428]. Moreover, while orthorexia entails both a fixation, i.e. a mental process, and specific behaviours, the ORTO-15 test, especially when using a score of 40 as threshold value, likely measures the latter (healthy eating behaviours) rather than the first (fixations and obsessive traits) [3, 29].
The aim of the present research was to assess the possible overlap between orthorexia, measured with the ORTO-15 test, and AN. For this purpose, we assessed a sample of female patients under treatment for a diagnosis of AN, and a sample of female healthy controls (HCs) from the general population. The second aim was to assess the possible cross-cultural differences in orthorexic behaviours between Italian and Polish women, both with and without a diagnosis of AN. For this purpose, the same research procedure was carried on in two culturally different countries – Italy and Poland.

Methods

Patients with a diagnosis of AN according to DSM-5 criteria [30] were recruited both in Italy (Psychiatry Institute, Università del Piemonte Orientale, AOU Maggiore della Carità, Novara), and in Poland (the Polish National Center for Eating Disorders, Wroclaw) (N = 23 and N = 35, respectively), as well as HCs from the general population (N = 39, both in Italy and Poland). All groups included individuals aged > 18 years, who voluntarily took part in the study after informed consent was obtained. The need for approval from the local ethics committee was waived since the study did not entail anything beyond standard and everyday clinical practice.
The ORTO-15 test [3, 29] was used as a measure of orthorexic behaviours. The ORTO-15 is composed of 15 items with closed multiple-choice answers (“always”, “often”, “sometimes”, “never”). Items investigate the obsessive attitude of the individuals in choosing, buying, preparing and consuming food they consider to be healthy. A score equal to 1 for each item corresponds to an orthorexic tendency in the eating behaviour, while a score equal to 4 points indicates normal eating habits. Higher scores suggest normal eating habits; a cutoff of 40 or 35 points has been suggested. We used the 40-points cutoff, which according to Donini and coworkers [29] allows the identification of symptoms consistent with orthorexia nervosa with a sensitivity of 100.0%, a specificity value of 73.6%, a positive predictive value of 17.6% and a negative predictive value of 100%. In our study we used both the Italian and Polish [31] validated versions of the questionnaire.
Statistical analyses were performed using Chi-square test and parametric t tests for independent sample to test the study hypotheses; statistical significance level was set at p-value <0.05. All analyses were performed with SPSS v.22 [32].

Results

Mean age and BMI of AN and HCs from both countries are reported in Table 1, as well as the percentage of individuals scoring under the ORTO-15 cutoff (i.e. with orthorexic tendencies). No difference was found with the Chi-square test in the percentage of subjects scoring under the ORTO-15 cutoff when comparing Italian AN and Italian HC (p = .263), or when comparing Polish AN and Polish HC (p = .670). On the contrary, the percentage of individuals with orthorexic behaviours as described by an ORTO-15 score below the cutoff was different between Italian AN and Polish AN (p = .031) and between Italian and Polish HC (p = .001). Descriptive statistics and normality distribution test of ORTO-15 scores in the AN and HC groups are presented in Table 2. Data in all studied samples as divided by country were normally distributed, except for the Italian AN group, likely due to the small number of patients included. Nonetheless, since both kurtosis and skewness in all samples did not exceed 1, parametric statistics were used for the analyses.
Table 1
Mean age, mean BMI, and % of individuals scoring under the ORTO-15 40-points cutoff
Sample
Mean age (years)
Mean BMI (Kg/m2)
% scoring under the ORTO-15 40-points cutoff
Italian AN
30.39
16.36
60.9%
Italian HC
34.41
22.69
46%
Polish AN
22.97
17.21
85.6%
Polish HC
23.00
21.69
82%
Table 2
Descriptive statistics and normality distribution test of ORTO-15 scores in the AN and HC groups (bold is for statistically significant results)
Sample
N
M
SD
Kurtosis
Skewness
Kolmogorov-Smirnov normality test
p
Italian AN
23
37.21
1.15
–0.97
–0.07
0.20
.024
Italian HC
39
39.41
0.50
0.61
0.31
0.12
.191
Polish AN
35
34.37
0.83
–0.88
–0.20
0.13
.166
Polish HC
39
35.36
0.58
–0.74
–0.21
0.10
.200
The results of the t-tests are presented in Table 3. First, groups recruited in the same nation were compared. The statistical difference between Italian AN and HC groups was found at the boundary of the accepted threshold, whereas no differences between Polish women in the AN and HC group was found. Second, women in the AN and HC groups were compared, independently. The Italian groups scored significantly higher than the Polish ones, both for AN and HC group.
Table 3
Comparison of the mean ORTO-15 score in AN and HC groups divided by country (bold is for statistically significant results)
Group 1
Group 2
t (df)
p
Italian AN
Italian HC
–2.00(60)
.049
Polish AN
Polish HC
–0.98(72)
.325
Polish AN
Italian AN
–2.06(56)
.044
Polish HC
Italian HC
5.31(76)
.001

Discussion

Italian patients were older than Polish ones; regrettably data about illness duration were not available, although it is likely that the Italian AN group included patients with a more severe and enduring ED, as suggested also by the lower BMI values.
In the current Italian HC sample, 54% scored 40 or above at the ORTO-15, suggesting the presence of orthorexic behaviours in 46% of the sample, consistent with a previous study performed in Italy and reporting a prevalence of orthorexia nervosa of 57.6% (40-point threshold, ORTO-15), or 21% (35-point threshold, ORTO-15) [19].
Surprisingly, in the Polish HC sample the percentage of those scoring 40 or above (i.e. those with no orthorexic tendencies) was only 18%, with 82% of the sample self-reporting orthorexic behaviours as described by the ORTO-15 test. Mean scores under the 40-points cutoff [33], and percentages up to 68.55% of orthorexic behaviours measured with the ORTO-15 [34] have been described in Poland.
Differences in the mean score at the ORTO-15 were found between AN and HC groups in Italy, but not in Poland. Whether there is an overlap or not between AN and orthorexic behaviours, and whether this is also mediated by cultural factors should be further assessed by studies involving larger samples.
The Chi-square differences in the percentage of orthorexic behaviours suggested by an ORTO-15 score below the cutoff, and the finding of higher ORTO-15 mean scores in Italian women than in Polish ones, independent of belonging to either the AN or the HC group, suggest cross-cultural differences in orthorexic attitudes and behaviours. Their meaning is currently difficult to understand, considering the lack of data about this issue. These differences are likely due to culture-related discrepancies in the approach to food and health concept. Italy has a widely-acknowledged culture about eating and nutrition, and the Mediterranean diet has long been praised for its benefits for overall health [35, 36], but has a strong focus on taste as well. In Poland, in the last ten years, good consumer practices have gained a slightly greater popularity (e.g. checking the composition of foodstuffs). For Poles, healthy eating is the most important among various activities aimed at improving their own state of health; eight out of ten adults report eating healthy, and most Poles assess their diet as balanced [37]. This may explain the high percentage of people scoring under the ORTO-15 cutoff, i.e. self-reporting orthorexic behaviours.
Further studies are warranted to assess whether healthism or Alternative Food Networks (AFN) play a role in the differences between Italian and Poles. Healthism is a concept proposed to discuss and contextualize orthorexia, which would be an advocate for healthy eating to pursue a better health [38]. Orthorexic tendencies have been described in people actively engaged in AFN [39], but while most people are likely to do so for the benefits that this would bring to society, health and environment, currently it cannot be excluded that a small number of individuals may rather try to disguise disordered eating attitudes behind these socially acceptable (and even laudable) habits.
Limitations of this study are the relatively small sample size, which may hinder the generalizability of the current results, and the intrinsic flaws of the ORTO-15. As far as the former is concerned, regrettably it is a shared problem of most studies in the field of orthorexia [18]. As for the latter, recently it has been claimed that new tools are necessary for the assessment of orthorexia, in consideration of the limits of both the ORTO-15 and Bratman’s Test [8, 4042], which tend to overestimate its prevalence. While the ORTO-15 is still the most used instrument by the studies in this field, we cannot exclude the possibility that other assessment tools would yield different results. Moreover, the ORTO-15 alone is not a diagnostic tool, and regrettably in this study neither a measure of personality features was available [3] nor the suggested diagnostic criteria for ON [2, 43] were used.
Last, since this was a naturalistic study based on voluntary participation, the samples in Poland and Italy were not age matched. Therefore, we cannot exclude that some of the differences we found depend on age issues.

Conclusions

In the current sample, orthorexic behaviours did not overlap with AN in the Italian samples, and seemed to be influenced by cultural issues. Further studies are warranted to assess whether orthorexia is just a variant of individuals’ ways of approaching eating and nutrition, or something different, and to disentangle the meaning of cultural differences in its prevalence.

Acknowledgements

not applicable.

Funding

No funding was received for this research.

Availability of data and materials

The datasets used and analysed during the current study available from the corresponding author on reasonable request.

Authors’ contributions

CG. and PZ. designed the study project. CG. and ABM. collected data and drafted the manuscript. RR. performed statistical analyses. PZ. critically revised the manuscript. All the Authors read and approved the final draft of the manuscript.

Competing interests

The authors declare that they have no competing interests.
not applicable.
The need for approval from the local ethics committee (Comitato Etico Interaziendale, Novara, Italy; SWPS University of Social Sciences and Humanities Human Research Ethics Committee, Katowice, Poland) was waived since the study did not entail anything beyond standard and everyday clinical practice; patients’ informed consent was obtained.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://​creativecommons.​org/​publicdomain/​zero/​1.​0/​) applies to the data made available in this article, unless otherwise stated.
Literatur
1.
Zurück zum Zitat Bratman S. Health food junkie. Yoga J. 1997;136:42–50. Bratman S. Health food junkie. Yoga J. 1997;136:42–50.
2.
Zurück zum Zitat Dunn TM, Bratman S. On orthorexia nervosa: a review of the literature and proposed diagnostic criteria. Eat Behav. 2016;21:11–7.CrossRefPubMed Dunn TM, Bratman S. On orthorexia nervosa: a review of the literature and proposed diagnostic criteria. Eat Behav. 2016;21:11–7.CrossRefPubMed
3.
Zurück zum Zitat Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C. Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eat Weight Disord. 2004;9(2):151–7.CrossRefPubMed Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C. Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eat Weight Disord. 2004;9(2):151–7.CrossRefPubMed
4.
Zurück zum Zitat Brytek-Matera A. Healthy eating obsession in women with anorexia nervosa: a case control study. In: Gramaglia C, Zeppegno P, editors. New developments in anorexia nervosa research. New York: Nova; 2014. p. 39–50. Brytek-Matera A. Healthy eating obsession in women with anorexia nervosa: a case control study. In: Gramaglia C, Zeppegno P, editors. New developments in anorexia nervosa research. New York: Nova; 2014. p. 39–50.
5.
Zurück zum Zitat Dell’Osso L, Abelli M, Carpita B, Pini S, Castellini G, Carmassi C, Ricca V. HIstorical evolution of the concept of anorexia nervosa and relationships with orthorexia nervosa, autism and obsessive-compulsive spectrum. Neuropsychiatr Dis Treat. 2016;12:1651–60.CrossRefPubMedPubMedCentral Dell’Osso L, Abelli M, Carpita B, Pini S, Castellini G, Carmassi C, Ricca V. HIstorical evolution of the concept of anorexia nervosa and relationships with orthorexia nervosa, autism and obsessive-compulsive spectrum. Neuropsychiatr Dis Treat. 2016;12:1651–60.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Vandereycken W. Meda hype, diagnostic fad or genuine disorder? Professionals’ opinions about night eating syndrome, orthorexia, muscle dysmorphia, and emethophobia. Eat Disord. 2011;19(2):145–55.CrossRefPubMed Vandereycken W. Meda hype, diagnostic fad or genuine disorder? Professionals’ opinions about night eating syndrome, orthorexia, muscle dysmorphia, and emethophobia. Eat Disord. 2011;19(2):145–55.CrossRefPubMed
7.
Zurück zum Zitat Hadjistavropoulos H, Lawrence B. Does anxiety about health influence eating patterns and shape-related body checking among females? Personal Individ Differ. 2007;43(2):319–28.CrossRef Hadjistavropoulos H, Lawrence B. Does anxiety about health influence eating patterns and shape-related body checking among females? Personal Individ Differ. 2007;43(2):319–28.CrossRef
9.
Zurück zum Zitat Catalina Zamora ML, Bote Bonaechea B, García Sánchez F, Ríos RB. Ortorexia nerviosa. ¿Un nuevo trastorno de la conducta alimentaria? Actas Esp Psiquiatr. 2005;33(1):66–8.PubMed Catalina Zamora ML, Bote Bonaechea B, García Sánchez F, Ríos RB. Ortorexia nerviosa. ¿Un nuevo trastorno de la conducta alimentaria? Actas Esp Psiquiatr. 2005;33(1):66–8.PubMed
10.
Zurück zum Zitat Chaki B, Pal S, Bandyopadhyay A. Exploring scientific legitimacy of orthorexia nervosa: a newly emerging eating disorder. J Hum Sport Exerc. 2013;8(4):1045–53.CrossRef Chaki B, Pal S, Bandyopadhyay A. Exploring scientific legitimacy of orthorexia nervosa: a newly emerging eating disorder. J Hum Sport Exerc. 2013;8(4):1045–53.CrossRef
11.
Zurück zum Zitat Varga M, Thege BK, Dukay-Szabó S, Túry F, van Furth EF. When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry. 2014;14:59.CrossRefPubMedPubMedCentral Varga M, Thege BK, Dukay-Szabó S, Túry F, van Furth EF. When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry. 2014;14:59.CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Brytek-Matera A. Orthorexia nervosa – an eating disorder, obsessive-compulsive disorder or disturbed eating habit? Arch Psychiatr Psychother. 2012;14(1):55–60. Brytek-Matera A. Orthorexia nervosa – an eating disorder, obsessive-compulsive disorder or disturbed eating habit? Arch Psychiatr Psychother. 2012;14(1):55–60.
13.
Zurück zum Zitat Fidan T, Ertekin V, Işikay S, Kirpinar I. Prevalence of orthorexia among medical students in Erzurum. Turkey Compr Psychiatry. 2010;51(1):49–54.CrossRefPubMed Fidan T, Ertekin V, Işikay S, Kirpinar I. Prevalence of orthorexia among medical students in Erzurum. Turkey Compr Psychiatry. 2010;51(1):49–54.CrossRefPubMed
14.
Zurück zum Zitat Bartrina JA. Ortorexia o la obsesión por la dieta saludable. Arch Latinoam Nutr. 2007;57(4):313–5.PubMed Bartrina JA. Ortorexia o la obsesión por la dieta saludable. Arch Latinoam Nutr. 2007;57(4):313–5.PubMed
15.
Zurück zum Zitat Koven NS, Senbonmatsu N. A neuropsychological evaluation of orthorexia nervosa. Open J Psychiatry. 2013;3:214–22.CrossRef Koven NS, Senbonmatsu N. A neuropsychological evaluation of orthorexia nervosa. Open J Psychiatry. 2013;3:214–22.CrossRef
17.
Zurück zum Zitat Brytek-Matera A, Rogoza R, Gramaglia C, Zeppegno P. Predictors of orthorexic behaviours in patients with eating disorders: a preliminary study. BMC Psychiatry. 2015;15:252.CrossRefPubMedPubMedCentral Brytek-Matera A, Rogoza R, Gramaglia C, Zeppegno P. Predictors of orthorexic behaviours in patients with eating disorders: a preliminary study. BMC Psychiatry. 2015;15:252.CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Varga M, Dukay-Szabó S, Túry F, van Furth EF. Evidence and gaps in the literature on orthorexia nervosa. Eat Weight Disord. 2013;18(2):103–11.CrossRefPubMed Varga M, Dukay-Szabó S, Túry F, van Furth EF. Evidence and gaps in the literature on orthorexia nervosa. Eat Weight Disord. 2013;18(2):103–11.CrossRefPubMed
19.
Zurück zum Zitat Ramacciotti CE, Perrone P, Coli E, Burgalassi A, Conversano C, Massimetti G, Dell’Osso L. Orthorexia nervosa in the general population: a preliminary screening using a self-administered questionnaire (ORTO-15). Eat Weight Disord. 2011;16(2):e127–30.CrossRefPubMed Ramacciotti CE, Perrone P, Coli E, Burgalassi A, Conversano C, Massimetti G, Dell’Osso L. Orthorexia nervosa in the general population: a preliminary screening using a self-administered questionnaire (ORTO-15). Eat Weight Disord. 2011;16(2):e127–30.CrossRefPubMed
20.
Zurück zum Zitat Segura-Garcia C, Ramacciotti C, Rania M, Aloi M, Caroleo M, Bruni A, Gazzarrini D, Sinopoli F, De Fazio P. The prevalence of orthorexia nervosa among eating disorder patients after treatment. Eat Weight Disord. 2015;20(2):161–6.CrossRefPubMed Segura-Garcia C, Ramacciotti C, Rania M, Aloi M, Caroleo M, Bruni A, Gazzarrini D, Sinopoli F, De Fazio P. The prevalence of orthorexia nervosa among eating disorder patients after treatment. Eat Weight Disord. 2015;20(2):161–6.CrossRefPubMed
21.
22.
Zurück zum Zitat Cartwright MM. Eating disorder emergencies: understanding the medical complexities of the hospitalized eating disordered patient. Crit Care Nurs Clin North Am. 2004;16(4):515–30.CrossRefPubMed Cartwright MM. Eating disorder emergencies: understanding the medical complexities of the hospitalized eating disordered patient. Crit Care Nurs Clin North Am. 2004;16(4):515–30.CrossRefPubMed
23.
Zurück zum Zitat Kinzl JF, Hauer K, Traweger C, Kiefer I. Orthorexia nervosa in dieticians. Psychother Psychosom. 2006;75(6):395–6.CrossRefPubMed Kinzl JF, Hauer K, Traweger C, Kiefer I. Orthorexia nervosa in dieticians. Psychother Psychosom. 2006;75(6):395–6.CrossRefPubMed
24.
Zurück zum Zitat Sanlier N, Yassibas E, Bilici S, Sahin G, Celik B. Does the rise in eating disorders lead to increasing risk of orthorexia nervosa? correlations with gender, education, and body mass index. Ecol Food Nutr. 2016;55(3):266–78.CrossRefPubMed Sanlier N, Yassibas E, Bilici S, Sahin G, Celik B. Does the rise in eating disorders lead to increasing risk of orthorexia nervosa? correlations with gender, education, and body mass index. Ecol Food Nutr. 2016;55(3):266–78.CrossRefPubMed
25.
Zurück zum Zitat Asil E, Sürücüoğlu MS. Orthorexia nervosa in Turkish dietitians. Ecol Food Nutr. 2015;54(4):303–13.CrossRefPubMed Asil E, Sürücüoğlu MS. Orthorexia nervosa in Turkish dietitians. Ecol Food Nutr. 2015;54(4):303–13.CrossRefPubMed
27.
Zurück zum Zitat Segura-García C, Papaianni MC, Caglioti F, Procopio L, Nisticò CG, Bombardiere L, Ammendolia A, Rizza P, De Fazio P, Capranica L. Orthorexia nervosa: a frequent eating disordered behavior in athletes. Eat Weight Disord. 2012;17(4):e226–33.PubMed Segura-García C, Papaianni MC, Caglioti F, Procopio L, Nisticò CG, Bombardiere L, Ammendolia A, Rizza P, De Fazio P, Capranica L. Orthorexia nervosa: a frequent eating disordered behavior in athletes. Eat Weight Disord. 2012;17(4):e226–33.PubMed
28.
Zurück zum Zitat Bundros J, Clifford D, Silliman K, Neyman MM. Prevalence of orthorexia nervosa among college students based on Bratman’s test and associated tendencies. Appetite. 2016;101:86–94.CrossRefPubMed Bundros J, Clifford D, Silliman K, Neyman MM. Prevalence of orthorexia nervosa among college students based on Bratman’s test and associated tendencies. Appetite. 2016;101:86–94.CrossRefPubMed
29.
Zurück zum Zitat Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C. Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord. 2005;10:e28–32.CrossRefPubMed Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C. Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord. 2005;10:e28–32.CrossRefPubMed
30.
Zurück zum Zitat American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.CrossRef American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.CrossRef
31.
Zurück zum Zitat Brytek-Matera A, Krupa M, Poggiogalle E, Donini LM. Adaptation of the ORTHO-15 test to polish women and men. Eat Weight Disord. 2014;19(1):69–76.CrossRefPubMed Brytek-Matera A, Krupa M, Poggiogalle E, Donini LM. Adaptation of the ORTHO-15 test to polish women and men. Eat Weight Disord. 2014;19(1):69–76.CrossRefPubMed
32.
Zurück zum Zitat Corporation IBM. IBM SPSS statistics for windows, version 22.0. Armonk: IBM Corporation; 2013. Corporation IBM. IBM SPSS statistics for windows, version 22.0. Armonk: IBM Corporation; 2013.
33.
Zurück zum Zitat Hyrnik J, Janas-Kozik M, Stochel M, Jelonek I, Siwiec A, Rybakowski JK. The assessment of orthorexia nervosa among 1899 polish adolescents using the ORTO-15 questionnaire. Int J Psychiatry Clin Pract. 2016;20(3):199–203.CrossRefPubMed Hyrnik J, Janas-Kozik M, Stochel M, Jelonek I, Siwiec A, Rybakowski JK. The assessment of orthorexia nervosa among 1899 polish adolescents using the ORTO-15 questionnaire. Int J Psychiatry Clin Pract. 2016;20(3):199–203.CrossRefPubMed
34.
Zurück zum Zitat Brytek-Matera A, Donini LM, Krupa M, Poggiogalle E, Hay P. Orthorexia nervosa and self-attitudinal aspects of body image in female and male university students. J Eat Disord. 2015;3:2.CrossRefPubMedPubMedCentral Brytek-Matera A, Donini LM, Krupa M, Poggiogalle E, Hay P. Orthorexia nervosa and self-attitudinal aspects of body image in female and male university students. J Eat Disord. 2015;3:2.CrossRefPubMedPubMedCentral
35.
Zurück zum Zitat Sofi F, Abbate R, Gensini GF, Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010;92(5):1189–96.CrossRefPubMed Sofi F, Abbate R, Gensini GF, Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010;92(5):1189–96.CrossRefPubMed
36.
Zurück zum Zitat Schwingshackl L, Missbach B, König J. Hoffmann G adherence to a Mediterranean diet and risk of diabetes: a systematic review and meta-analysis. Public Health Nutr. 2015;18(7):1292–9.CrossRefPubMed Schwingshackl L, Missbach B, König J. Hoffmann G adherence to a Mediterranean diet and risk of diabetes: a systematic review and meta-analysis. Public Health Nutr. 2015;18(7):1292–9.CrossRefPubMed
38.
Zurück zum Zitat Håman L, Barker-Ruchti N, Patriksson G, Lindgren EC. Orthorexia nervosa: an integrative literature review of a lifestyle syndrome. Int J Qual Stud Health Well-being. 2015;10:26799.CrossRefPubMed Håman L, Barker-Ruchti N, Patriksson G, Lindgren EC. Orthorexia nervosa: an integrative literature review of a lifestyle syndrome. Int J Qual Stud Health Well-being. 2015;10:26799.CrossRefPubMed
39.
Zurück zum Zitat Barnett MJ, Dripps WR, Blomquist KK. Organivore or organorexic? examining the relationship between alternative food network engagement, disordered eating, and special diets. Appetite. 2016;105:713–20.CrossRefPubMed Barnett MJ, Dripps WR, Blomquist KK. Organivore or organorexic? examining the relationship between alternative food network engagement, disordered eating, and special diets. Appetite. 2016;105:713–20.CrossRefPubMed
40.
Zurück zum Zitat Missbach B, Dunn TM, König JS. We need new tools to assess orthorexia nervosa. A commentary on “prevalence of orthorexia nervosa among college students based on Bratman’s test and associated tendencies.”. Appetite. 2016. doi:10.1016/j.appet.2016.07.010.PubMed Missbach B, Dunn TM, König JS. We need new tools to assess orthorexia nervosa. A commentary on “prevalence of orthorexia nervosa among college students based on Bratman’s test and associated tendencies.”. Appetite. 2016. doi:10.​1016/​j.​appet.​2016.​07.​010.PubMed
42.
Zurück zum Zitat Missbach B, Hinterbuchinger B, Dreiseitl V, Zellhofer S, Kurz C, König J. When eating right, is measured wrong! a validation and critical examination of the ORTO-15 questionnaire in German. PLoS One. 2015;10(8):e0135772.CrossRefPubMedPubMedCentral Missbach B, Hinterbuchinger B, Dreiseitl V, Zellhofer S, Kurz C, König J. When eating right, is measured wrong! a validation and critical examination of the ORTO-15 questionnaire in German. PLoS One. 2015;10(8):e0135772.CrossRefPubMedPubMedCentral
43.
Zurück zum Zitat Moroze RM, Dunn TM, Craig Holland J, Yager J, Weintraub P. Microthinking about micronutrients: a case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria. Psychosomatics. 2015;56(4):397–403.CrossRefPubMed Moroze RM, Dunn TM, Craig Holland J, Yager J, Weintraub P. Microthinking about micronutrients: a case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria. Psychosomatics. 2015;56(4):397–403.CrossRefPubMed
Metadaten
Titel
Orthorexia and anorexia nervosa: two distinct phenomena? A cross-cultural comparison of orthorexic behaviours in clinical and non-clinical samples
verfasst von
C. Gramaglia
A. Brytek-Matera
R. Rogoza
P. Zeppegno
Publikationsdatum
01.12.2017
Verlag
BioMed Central
Erschienen in
BMC Psychiatry / Ausgabe 1/2017
Elektronische ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-017-1241-2

Weitere Artikel der Ausgabe 1/2017

BMC Psychiatry 1/2017 Zur Ausgabe