Confirmatory factor analyses of the ORTO 15-, 11- and 9-item scales and recommendations for suggested cut-off scores
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To explore the validity and recommend cut-off scores in an English-speaking sample for 9, 11, and 15-item versions of the ORTO measure for orthorexia, a proposed eating disorder characterised by a pathological obsession with consuming only ‘healthy’ foods.
Materials and methods
The sample comprised of 585 participants (82.4% female) who completed an online questionnaire containing the ORTO-15, Eating Attitudes test, Obsessive Compulsive Inventory Revised. A series of Confirmatory Factor Analyses were conducted to test model fit. Binary logistic linear regression and receiver-operating-characteristics (ROC) analyses were used to obtain cut-offs.
Results and conclusion
Results showed that none of the three published versions (9, 11, and 15-item) of the ORTO produced an acceptable model. Subsequent exploratory and confirmatory factor analyses yielded a seven-item version of the ORTO (ORTO-7) with a strong and stable factor structure. Analysis of cut-offs revealed that a cut-off score of equal or greater than 19 on the ORTO-7 represents probable orthorexia.
Level of evidence
Level V, descriptive study.
KeywordsOrthorexia Scale validation Confirmatory factor analysis Disordered eating
All authors identified on this manuscript have contributed equally to the study and provide approval for the final version of this manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that this research was conducted in the absence of any conflict of interest.
All procedures performed in studies 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 was obtained from all individual participants included in the study.
- 2.Kaplan S (2015) Psychiatry doesn’t recognize “orthorexia”—an obsession with healthy eating. But the Internet does. [online] Washington Post. https://www.washingtonpost.com/news/morningmix/wp/2015/11/05/psychiatry-doesnt-recognize-orthorexia-an-obsession-with-healthy-eating-but-theinternet-does/?noredirect=on&utm_term=.9e9d22a59701. Accessed 15 Jan 2016
- 3.Oksman O (2015) Orthorexia: when healthy eating turns against you. [online] The Guardian. https://www.theguardian.com/lifeandstyle/2015/sep/26/orthorexia-eating-disorder-clean-eating-dsmmiracle-foods. Accessed 3 Mar 2016
- 4.Jones R (2016) Orthorexia: the dangerous trend behind #cleaneating. [online] Triple J Hack. http://www.abc.net.au/triplej/programs/hack/orthorexia-the-dangerous-trend-behind-clean-eating/7251952. Accessed 1 Apr 2016
- 5.American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. https://doi.org/10.1176/appi.books.9780890425596.744053
- 9.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. https://doi.org/10.1016/j.psym.2014.03.003 CrossRefPubMedGoogle Scholar
- 11.Mosticoni R, Chiari G (1985) Una descrizione obiettiva della personalità. Il Minnesota Multiphasic Personalità Inventory. Organizzazioni Speciali, FirenzeGoogle Scholar
- 23.Arusoǧlu G, Kabakçi E, Köksal G, Kutluay Merdol T (2008) Orhorexia nervosa and adaptation of ORTO-11 into Turkish. Turk Psikiyatr Derg 19:283–291Google Scholar
- 30.McInerney-Ernst EM (2011) Orthorexia nervosa: real construct or newest social trend? Faculty of the University of Missouri-Kansas City, Kansas CityGoogle Scholar
- 31.Forester DS (2014) Examining the relationship between orthorexia nervosa and personality traits. California State University, StanislausGoogle Scholar
- 32.Koven NS, Senbonmatsu R (2013) A neuropsychological evaluation of orthorexia nervosa. Open J Psychiatry 214–222. https://doi.org/10.4236/ojpsych.2013.32019
- 38.Byrne BM (2009) Structural equation modeling with AMOS: basic concepts, applications, and programming, 2nd edn. Routledge, LondonGoogle Scholar
- 39.Westin LK (2001) Receiver operating characteristic (ROC) analysis: evaluating discriminance effects among decision support systems. https://www.semanticscholar.org/paper/Receiver-operating-characteristic-(ROC)-analysis-Westin/dfc1e148b1d08500954f5c78f0a1001affbfc041. Accessed 27 Apr 2018