Psychometric evaluation of the English version of the Düsseldorf Orthorexie Scale (DOS) and the prevalence of orthorexia nervosa among a U.S. student sample

  • Chrissy A. ChardEmail author
  • Carolin Hilzendegen
  • Friederike Barthels
  • Nanette Stroebele-BenschopEmail author
Original Article
Part of the following topical collections:
  1. Orthorexia Nervosa



Recently, the concept of orthorexia nervosa (ON) as a potential new variant of disordered eating behavior has gained popularity. However, published prevalence rates appear to be questionable given the lack of validity of the available questionnaires. The Düsseldorf Orthorexie Scale (DOS) is a validated questionnaire only available in German to measure orthorexic behavior.


The DOS was translated into English using the back-translation process. Cronbach’s alpha was used to establish internal consistency and an intra-class correlation coefficient was calculated to assess reliability. The Eating Habits Questionnaire (EHQ) was used to test construct validity and the Eating Disorders Inventory was used to test discriminant validity. Principal and confirmatory factor analyses were carried out to test the factor structure. The sample consists of 384 university students in the U.S.


English (E)-DOS and EHQ were highly correlated (r = 0.76, p < .001) indicating very good construct validity. Cronbach’s alpha coefficient reached 0.88, indicating very good internal consistency. Confirmatory factor analyses revealed a poorly fitted one-factor model, but good results for the standardized coefficients for the 10 items ranging between 0.52 and 0.82 were found. According to the E-DOS, 8.0% of the students exceeded the preliminary cut-off score, while an additional 12.4% would be considered being at risk of developing ON.


The E-DOS appears to be a valid, reliable measure for assessing ON. The results revealed higher prevalence rates for orthorexic behavior among U.S. students compared to German students. Cultural aspects could play a role in those differences.

Level of evidence

Descriptive study, Level V.


Orthorexia nervosa Validation study College students Disordered eating 



No funding was provided for this study.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Colorado School of Public Health at Colorado State UniversityFort CollinsUSA
  2. 2.University of HohenheimStuttgartGermany
  3. 3.Heinrich-Heine-UniversityDüsseldorfGermany

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