Advertisement

Prevalence and predictors of orthorexia nervosa among German students using the 21-item-DOS

  • Julia DepaEmail author
  • Jenny Schweizer
  • Sandra-Kristin Bekers
  • Carolin Hilzendegen
  • Nanette Stroebele-Benschop
Original Article

Abstract

Purpose

Orthorexia nervosa (ON) describes the constant pathological preoccupation with “healthy” nutrition. The current results regarding the prevalence of ON differ widely possibly because of invalid measurement tools. This study aimed to investigate ON prevalence in a sample of German students and to examine age, gender, semester, and nutritional knowledge as potential predictors of ON by comparing nutrition science (NS) with economics (ES) students.

Methods

A total of 446 university students participated in the survey (NS 188, ES 268). ON was determined using the 21-item-DOS, which is a well-constructed, validated, and reliability-tested questionnaire. Age, gender, and semester were also assessed.

Results

Of the total sample, 3.3 % were classified as having ON and 9.0 % were at risk of developing ON. Older students scored significantly higher on the subscale “avoidance of additives” compared with younger students and students of lower semester suffered significantly more often from ON than students of higher semester. In addition, comparing field of study showed no significant difference in the prevalence of ON or the risk of developing ON between female NS and ES students. However, mean values for the three DOS subscales were higher among female NS students, albeit far below values indicating pathological behavior.

Conclusions

The prevalence of ON appears to be low in this sample of German university students. Female NS students do not seem to have higher prevalence of ON or risk of developing ON.

Keywords

Orthorexia nervosa Prevalence Nutrition knowledge Eating behavior 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

Informed consent

Written informed consent was not obtained due to the anonymous nature of the study design and inability to identify study subjects based on the collected data.

References

  1. 1.
    Bratman S, Knight D (2000) Health food junkies. Overcoming the obsession with healthful eating, 1st ed. Broadway Books, New YorkGoogle Scholar
  2. 2.
    Dunn TM, Bratman S (2016) On orthorexia nervosa: a review of the literature and proposed diagnostic criteria. Eat Behav 21:11–17. doi: 10.1016/j.eatbeh.2015.12.006 CrossRefPubMedGoogle Scholar
  3. 3.
    Brytek-Matera A (2012) Orthorexia nervosa—an eating disorder, obsessive-compulsive disorder or disturbed eating habit? Arch Psychiatr Psychother 1:55–60Google Scholar
  4. 4.
    Cartwright MM (2004) Eating disorder emergencies: understanding the medical complexities of the hospitalized eating disordered patient. Crit Care Nurs Clin North Am 16:515–530. doi: 10.1016/j.ccell.2004.07.002 CrossRefPubMedGoogle Scholar
  5. 5.
    Chaki B, Pal S, Bandyopadhyay A (2013) Exploring scientific legitimacy of orthorexia nervosa: a newly emerging eating disorder. JHSE 8:1045–1053. doi: 10.4100/jhse.2013.84.14 CrossRefGoogle Scholar
  6. 6.
    Klotter C, Depa J, Humme S (2015) Gesund, gesünder, Orthorexia nervosa. Modekrankheit oder Störungsbild? Eine wissenschaftliche Diskussion. Springer Fachmedien, WiesbadenGoogle Scholar
  7. 7.
    Håman L, Barker-Ruchti N, Patriksson G et al (2015) Orthorexia nervosa: an integrative literature review of a lifestyle syndrome. Int J Qual Stud Health Well-Being 10(10):26799. doi: 10.3402/qhw.v10.26799 CrossRefPubMedGoogle Scholar
  8. 8.
    Koven NS, Abry AW (2015) The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatr Dis Treat 11:385–394. doi: 10.2147/NDT.S61665 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Barthels F, Pietrowsky R (2012) Orthorectic eating behaviour—nosology and prevalence rates. Psychother Psychosom Med Psychol 62:445–449. doi: 10.1055/s-0032-1312630 CrossRefPubMedGoogle Scholar
  10. 10.
    Donini LM, Marsili D, Graziani 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. doi: 10.1007/BF03325060 CrossRefPubMedGoogle Scholar
  11. 11.
    Ramacciotti CE, Perrone P, Coli E et al (2011) Orthorexia nervosa in the general population: a preliminary screening using a self-administered questionnaire (ORTO-15). Eat Weight Disord 16:e127–e130. doi: 10.1007/BF03325318 CrossRefPubMedGoogle Scholar
  12. 12.
    Schnyder U, Milos G, Mohler-Kuo M et al (2012) Prävalenz von Essstörungen in der Schweiz. Im Auftrag des Bundesamtes für Gesundheit (BAG). BAG, ZürichGoogle Scholar
  13. 13.
    Dunn TM, Gibbs J, Whitney N et al (2016) Prevalence of orthorexia nervosa is less than 1%: data from a US sample. Eat Weight Disord. doi: 10.1007/s40519-016-0258-8 CrossRefPubMedGoogle Scholar
  14. 14.
    Donini LM, Marsili D, Graziani MP et al (2005) Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord 10:e28–e32. doi: 10.1007/BF03327537 CrossRefPubMedGoogle Scholar
  15. 15.
    Alvarenga MS, Martins MC, Sato KS et al (2012) Orthorexia nervosa behavior in a sample of Brazilian dietitians assessed by the Portuguese version of ORTO-15. Eat Weight Disord 17:29–35. doi: 10.1007/BF03325325 CrossRefGoogle Scholar
  16. 16.
    Arusoglu G, Kabakci E, Koksal G et al (2008) Orthorexia nervosa and adaptation of ORTO-11 into Turkish. Turk Psikiyatri Derg 19:283–291PubMedGoogle Scholar
  17. 17.
    Brytek-Matera A, Krupa M, Poggiogalle E et al (2014) Adaptation of the ORTHO-15 test to polish women and men. Eat Weight Disord 19:69–76. doi: 10.1007/s40519-014-0100-0 CrossRefPubMedGoogle Scholar
  18. 18.
    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:e0135772. doi: 10.1371/journal.pone.0135772 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    McInerney-Ernst EM (2011) Orthorexia nervosa: real construct or newest social trend? Dissertation, University of Missouri-Kansas CityGoogle Scholar
  20. 20.
    Segura-Garcia C, Papaianni MC, Caglioti F et al (2012) Orthorexia nervosa: a frequent eating disordered behavior in athletes. Eat Weight Disord 17:e226–e233. doi: 10.3275/8272 CrossRefPubMedGoogle Scholar
  21. 21.
    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. doi: 10.1186/1471-244X-14-59 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Barthels F, Meyer F, Pietrowsky R (2015) Duesseldorf orthorexia scale–construction and evaluation of a questionnaire measuring orthorexic eating behavior. Zeitschrift für Klinische Psychologie und Psychother 44:97–105. doi: 10.1026/1616-3443/a000310 CrossRefGoogle Scholar
  23. 23.
    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. doi: 10.1016/j.appet.2016.02.144 CrossRefPubMedGoogle Scholar
  24. 24.
    Fidan T, Ertekin V, Isikay S et al (2010) Prevalence of orthorexia among medical students in Erzurum, Turkey. Compr Psychiatr 51:49–54. doi: 10.1016/j.comppsych.2009.03.001 CrossRefGoogle Scholar
  25. 25.
    Korinth A, Schiess S, Westenhoefer J (2010) Eating behaviour and eating disorders in students of nutrition sciences. Public Health Nutr 13:32. doi: 10.1017/S1368980009005709 CrossRefPubMedGoogle Scholar
  26. 26.
    Nowak U (2011) Fragebogenerhebung über den möglichen Einfluss der Studienrichtung auf das Auftreten von Orthorexia nervosa. Diplomarbeit, WienGoogle Scholar
  27. 27.
    Robinson K (2011) Is the Fixation on “healthy” unhealthy? A study on orthorexia nervosa. Electronic Thesis, Kent State UniversityGoogle Scholar
  28. 28.
    Sanlier N, Yassibas E, Bilici S et al (2016) Does the rise in eating disorders lead to increasing risk of orthorexia nervosa? Correlations with gender, education, and body mass index. Ecol Food Nutr 55:266–278. doi: 10.1080/03670244.2016.1150276 CrossRefPubMedGoogle Scholar
  29. 29.
    Barth A (2015) Students’ nutrition orientations: differences according to gender and subject of study. Ernährungs Umschau Int 62:120–127. doi: 10.4455/eu.2015.022 CrossRefGoogle Scholar
  30. 30.
    Bo S, Zoccali R, Ponzo V et al (2014) University courses, eating problems and muscle dysmorphia: are there any associations? J Transl Med 12:221. doi: 10.1186/s12967-014-0221-2 CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Gleaves DH, Graham EC, Ambwani S (2013) Measuring “Orthorexia”: development of the eating habits questionnaire. Int J Educ Psychol Assess 12:1–18Google Scholar
  32. 32.
    Varga M, Mate G (2010) Eating disturbances in orthorexia nervosa. EACLPP Abstracts. J Psychosom Res 68:672–673Google Scholar
  33. 33.
    Barzegari A, Ebrahimi M, Azizi M et al (2011) Study of nutrition knowledge, attitudes and food habits of College students. World Appl Sci J 15:1012–1017Google Scholar
  34. 34.
    Barthels F (2014) Orthorektisches Ernährungsverhalten. Psychologische Untersuchungen zu einem neuen Störungsbild. Dissertation, Heinrich Heine University of DuesseldorfGoogle Scholar
  35. 35.
    Pietrowsky R (2012) Das Leiden am gesunden Essen—Untersuchungen zu Orthorexie. In: Siegl, Judith (ed) Horizonte der Klinischen Psychologie und Psychotherapie. Festschrift für Hans Reinecker. Pabst Science, Lengerich, pp 245–253Google Scholar
  36. 36.
    Aksoydan E, Camci N (2009) Prevalence of orthorexia nervosa among Turkish performance artists. Eat Weight Disord 14:33–37. doi: 10.1007/BF03327792 CrossRefPubMedGoogle Scholar
  37. 37.
    Bagci Bosi A, Tulay Camur D, Guler C (2007) Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine (Ankara, Turkey). Appetite 49:661–666. doi: 10.1016/j.appet.2007.04.007 CrossRefPubMedGoogle Scholar
  38. 38.
    Barnes MA, Caltabiano ML (2016) The interrelationship between orthorexia nervosa, perfectionism, body image and attachment style. Eat Weight Disord. doi: 10.1007/s40519-016-0280-x CrossRefPubMedGoogle Scholar
  39. 39.
    Herranz Valera J, Acuna Ruiz P, Romero Valdespino B et al (2014) Prevalence of orthorexia nervosa among ashtanga yoga practitioners: a pilot study. Eat Weight Disord 19:469–472. doi: 10.1007/s40519-014-0131-6 CrossRefPubMedGoogle Scholar
  40. 40.
    IfD Allensbach (2016) Gesunde Ernährung und Lebensweise: In welchem Alter besteht ein besonderes Interesse daran? (Deutschland im Jahr 2008). http://de.statista.com/statistik/daten/studie/13439/umfrage/gesundheitsbewusstsein-interesse-fuer-gesunde-ernaehrung/. Accessed 02 Aug 2016
  41. 41.
    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 56:397–403. doi: 10.1016/j.psym.2014.03.003 CrossRefPubMedGoogle Scholar
  42. 42.
    US Department of Health and Human Services and US Department of Agriculture (2015) Dietary Guidelines for Americans 2015–2020. 8th Edition. http://health.gov/dietaryguidelines/2015/guidelines/. Accessed 02 Aug 2016
  43. 43.
    WHO (2015) Healthy diet. Fact sheet N 394. Updated September 2015. http://www.who.int/mediacentre/factsheets/fs394/en/. Accessed 02 Aug 2016

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Nutritional PsychologyInstitute of Nutritional Medicine, University of HohenheimStuttgartGermany

Personalised recommendations