Too Healthy for Their Own Good: Orthorexia Nervosa and Compulsive Exercise in the Community

Overview

Journal Eat Weight Disord

Publisher Springer

Date 2023 Jun 27

PMID 37368169

Authors

Ada H Zohar

Merav Zamir

Lilac Lev-Ari

Rachel Bachner-Melman

Affiliations

Soon will be listed here.

Abstract

Background: The similarities and differences between orthorexia nervosa symptoms (ONs) and the symptoms and correlates of eating disorders listed in the DSM-5 need to be elucidated. ONs were examined in a volunteer community sample in conjunction with compulsive exercise, disordered eating, as well as emotional and behavioral correlates of eating disorders.

Methods: Participants were 561 adult volunteers (93 men, 17.09%) aged 19-72 (M = 32.7 ± 11), recruited via social media networks. Participants self-reported on the following measures online: Düsseldorf Orthorexia Scale, Compulsive Exercise Test, Retrospective Child Feeding Questionnaire, Experiences in Close Relationships, Difficulties in Emotional Regulation Scale, Toronto Alexithymia Scale, and Eating Disorder Examination Questionnaire 13. Data were downloaded and analyzed in SPSS26 and Amos26.

Results: A theoretical model of the connections between the study variables was tested via SEM and confirmed. The profiles of participants with high, average and low levels of ONs were compared. Participants with the highest levels also scored highest for compulsive exercise, insecure attachment, alexithymia, emotion regulation difficulties, weight and shape concerns, body dissatisfaction, restriction, bingeing, purging and parental feeding practices of concern about child's weight and restricting and monitoring the child's intake of calorie-rich foods.

Discussion: High levels of ONs are related to disordered eating attitudes and behaviors, as well as to emotional and behavioral correlates of eating disorders. It is unclear to what extent these ONs are distinguishable from symptoms of other eating disorders listed in the DSM-5. Longitudinal studies may help to elucidate distinct trajectories and risk factors for ON.

Level Of Evidence: Level III, case-control analytic study.

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References

Fairburn C, Beglin S . Assessment of eating disorders: interview or self-report questionnaire?. Int J Eat Disord. 1994; 16(4):363-70. View

Zohar A, Lev-Ari L, Bachner-Melman R . Two to Tango? The Dance of Maternal Authority and Feeding Practices with Child Eating Behavior. Int J Environ Res Public Health. 2021; 18(4). PMC: 7915551. DOI: 10.3390/ijerph18041650. View

Meneguzzo P, Garolla A, Bonello E, Todisco P . Alexithymia, dissociation and emotional regulation in eating disorders: Evidence of improvement through specialized inpatient treatment. Clin Psychol Psychother. 2021; 29(2):718-724. PMC: 9291290. DOI: 10.1002/cpp.2665. View

Zohar A, Pick S, Lev-Ari L, Bachner-Melman R . A longitudinal study of maternal feeding and children's picky eating. Appetite. 2020; 154:104804. DOI: 10.1016/j.appet.2020.104804. View

Lev-Ari L, Bachner-Melman R, Zohar A . Eating Disorder Examination Questionnaire (EDE-Q-13): expanding on the short form. J Eat Disord. 2021; 9(1):57. PMC: 8082853. DOI: 10.1186/s40337-021-00403-x. View

Taranis L, Touyz S, Meyer C . Disordered eating and exercise: development and preliminary validation of the compulsive exercise test (CET). Eur Eat Disord Rev. 2011; 19(3):256-68. DOI: 10.1002/erv.1108. View

Chard C, Hilzendegen C, Barthels F, Stroebele-Benschop N . Psychometric evaluation of the English version of the Düsseldorf Orthorexie Scale (DOS) and the prevalence of orthorexia nervosa among a U.S. student sample. Eat Weight Disord. 2018; 24(2):275-281. DOI: 10.1007/s40519-018-0570-6. View

Barthels F, Barrada J, Roncero M . Orthorexia nervosa and healthy orthorexia as new eating styles. PLoS One. 2019; 14(7):e0219609. PMC: 6619829. DOI: 10.1371/journal.pone.0219609. View

Hessler-Kaufmann J, Meule A, Greetfeld M, Schlegl S, Voderholzer U . Orthorexic tendencies in inpatients with mental disorders. J Psychosom Res. 2020; 140:110317. DOI: 10.1016/j.jpsychores.2020.110317. View

10.

Hazzard V, Loth K, Berge J, Larson N, Fulkerson J, Neumark-Sztainer D . Does exposure to controlling parental feeding practices during adolescence predict disordered eating behaviors 8 years later in emerging adulthood?. Pediatr Obes. 2020; 15(10):e12709. PMC: 7501224. DOI: 10.1111/ijpo.12709. View

11.

Parra-Fernandez M, Onieva-Zafra M, Fernandez-Martinez E, Abreu-Sanchez A, Fernandez-Munoz J . Assessing the Prevalence of Orthorexia Nervosa in a Sample of University Students Using Two Different Self-Report Measures. Int J Environ Res Public Health. 2019; 16(14). PMC: 6678205. DOI: 10.3390/ijerph16142459. View

12.

Greetfeld M, Hessler-Kaufmann J, Brandl B, Skurk T, Holzapfel C, Quadflieg N . Orthorexic tendencies in the general population: association with demographic data, psychiatric symptoms, and utilization of mental health services. Eat Weight Disord. 2020; 26(5):1511-1519. PMC: 8128806. DOI: 10.1007/s40519-020-00961-0. View

13.

Lev-Ari L, Zohar A, Bachner-Melman R, Totah Hanhart A . Intergenerational Transmission of Child Feeding Practices. Int J Environ Res Public Health. 2021; 18(15). PMC: 8346001. DOI: 10.3390/ijerph18158183. View

14.

Zohar A, Lev-Ari L, Bachner-Melman R . The EDE-Q in Hebrew: Structural and Convergent/Divergent Validity in a Population Sample. Isr J Psychiatry. 2018; 54(3):15-20. View

15.

Oberle C, Watkins R, Burkot A . Orthorexic eating behaviors related to exercise addiction and internal motivations in a sample of university students. Eat Weight Disord. 2017; 23(1):67-74. DOI: 10.1007/s40519-017-0470-1. View

16.

Novara C, Maggio E, Piasentin S, Pardini S, Mattioli S . Orthorexia Nervosa: differences between clinical and non-clinical samples. BMC Psychiatry. 2021; 21(1):341. PMC: 8265101. DOI: 10.1186/s12888-021-03348-2. View

17.

Bona E, Szel Z, Kiss D, Gyarmathy V . An unhealthy health behavior: analysis of orthorexic tendencies among Hungarian gym attendees. Eat Weight Disord. 2018; 24(1):13-20. DOI: 10.1007/s40519-018-0592-0. View

18.

Dunn T, Bratman S . On orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eat Behav. 2016; 21:11-7. DOI: 10.1016/j.eatbeh.2015.12.006. View

19.

Yakin E, Raynal P, Chabrol H . Not all personal definitions of healthy eating are linked to orthorexic behaviors among French college women. A cluster analysis study. Appetite. 2021; 162:105164. DOI: 10.1016/j.appet.2021.105164. View

20.

Brytek-Matera A . The Polish version of the Düsseldorf Orthorexia Scale (PL-DOS) and its comparison with the English version of the DOS (E-DOS). Eat Weight Disord. 2020; 26(4):1223-1232. PMC: 8062342. DOI: 10.1007/s40519-020-01025-z. View