Skip to main content

Advertisement

SpringerLink
Log in

Definition and diagnostic criteria for orthorexia nervosa: a narrative review of the literature

  • Review Article
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Aim

In some cases, detrimental consequences on health are generated by self-imposed dietary rules intended to promote health. The pursuit of an “extreme dietary purity” due to an exaggerated focus on food may lead to a disordered eating behavior called “orthorexia nervosa” (ON). ON raises a growing interest, but at present there is no universally shared definition of ON, the diagnostic criteria are under debate, and the psychometric instruments used in the literature revealed some flaws. This narrative review of the literature aims at assessing state of the art in ON definition, diagnostic criteria and related psychometric instruments and provides research propositions and framework for future analysis.

Methods

The authors collected articles through a search into Pubmed/Medline, Scopus, Embase and Google Scholar (last access on 07 August 2018), using “orthorexia”, “orthorexia nervosa” and “obsessive healthy eating” as search terms, and filled three tables including narrative articles (English), clinical trials (English), and articles in languages different from English. The data extrapolated from the revised studies were collected and compared. In particular, for each study, the diagnostic criteria considered, the specific psychometric instrument used, the results and the conclusions of the survey were analyzed.

Results

The terms employed by the different authors to define ON were fixation, obsession and concern/preoccupation. Several adjectives emphasized these expressions (e.g. exaggerated/excessive, unhealthy, compulsive, pathological, rigid, extreme, maniacal). The suitable food and the diet were defined in different ways. Most of the papers did not set the diagnostic criteria. In some cases, an attempt to use DSM (edition IV or 5) criteria for anorexia nervosa, or avoidant/restrictive food intake disorder, or body dysmorphic disorder, was done. Specific diagnostic criteria proposed by the authors were used in few studies. All these studies indicated as primary diagnostic criteria: (a) obsessional or pathological preoccupation with healthy nutrition; (b) emotional consequences (e.g. distress, anxieties) of non-adherence to self-imposed nutritional rules; (c) psychosocial impairments in relevant areas of life as well as malnutrition and weight loss. The ORTO-15 and the Orthorexia Self-Test developed by Bratman were the most used psychometric tools.

Conclusions

The present review synopsizes the literature on the definition of ON, proposed diagnostic criteria and psychometric instruments used to assess ON attitudes and behaviors. This work represents a necessary starting point to allow a further progression of the studies on the possible new syndrome and to overcome the criticisms that have affected both research and clinical activity until now.

Level of Evidence

Level V, narrative review.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. The ON-TF is composed of the authors of the present review article and (alphabetical order): Stefan Michael Bauer (Universidad de Barcelona); Daniela Converso (University of Turin, Italy); Julia Depa (Universität Hohenheim, Stuttgart, Germany); Barbara Loera (University of Turin, Italy); Cristina Segura-Garcia (University of Catanzaro, Italy); Jessica Setnick, (USA); Jiyeon Shin, (Korea).

References

  1. Bratman S (1997) Health food junkie. Yoga (September/October). http://www.beyondveg.com/bratman-s/hfj/hf-junkie-1a.shtml. Accessed August 18, 2018

  2. Bratman S, Knight D (2000) Health food junkies. Orthorexia nervosa. Overcoming the obsession with healthful eating. Broadway Books, New York

    Google Scholar 

  3. Cuzzolaro M, Donini LM (2016) Orthorexia nervosa by proxy? Eat Weight Disord 21(4):549–551

    Article  PubMed  Google Scholar 

  4. Kinzl JF, Hauer K, Traweger C, Kiefer I (2006) Orthorexia nervosa in dieticians. Psychother Psychosom 75(6):395–396

    Article  PubMed  Google Scholar 

  5. Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C (2005) Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord 10(2):e28–e32

    Article  CAS  PubMed  Google Scholar 

  6. Missbach B, Hinterbuchinger B, Dreiseitl V, Zellhofer S, Kurz C, König J (2015) When eating right, is measured wrong! A validation and critical examination of the ORTO-15 Questionnaire in German. PLoS One 10(8):e0135772. https://doi.org/10.1371/journal.pone.0135772 (eCollection 2015)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Dunn TM, Bratman S (2016) On orthorexia nervosa: a review of the literature and proposed diagnostic criteria. Eat Behav 21:11–17. https://doi.org/10.1016/j.eatbeh.2015.12.006

    Article  PubMed  Google Scholar 

  8. Missbach B, Dunn TM, König JS (2017) 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 108:521–524. https://doi.org/10.1016/j.appet.2016.07.010

    Article  PubMed  Google Scholar 

  9. Acar Tek N, Karacil Ermumcu M, Cakir Y (2016) Orthorexia nervosa in healthcare professionals obesity facts 9(SUPPL. 1):261

    Google Scholar 

  10. Adriana García J, Israel Ramírez S, Ceballos G, Méndez R Enrique B (2014) What do you know about Orthorexia? [¿Qué sabe ud. acerca de… ortorexia?]. Revista Mexicana de Ciencias Farmaceuticas 45(2):84–87

  11. Aksoydan E, Camci N (2009) Prevalence of orthorexia nervosa among Turkish performance artists. Eat Weight Disord 14(1):33–37

    Article  CAS  PubMed  Google Scholar 

  12. Almeida C, Vieira Borba V, Santos L (2018) Orthorexia nervosa in a sample of Portuguese fitness participants. Eat Weight Disord 23(4):443–451. https://doi.org/10.1007/s40519-018-0517-y

    Article  PubMed  Google Scholar 

  13. Alvarenga MS, Martins MC, Sato KS, Vargas SV, Philippi ST, Scagliusi FB (2012) Orthorexia nervosa behavior in a sample of Brazilian dietitians assessed by the Portuguese version of ORTO-15. Eat Weight Disord 17(1):e29–e35

    Article  CAS  PubMed  Google Scholar 

  14. Andreas S, Schedler K, Schulz H, Nutzinger DO (2018) Evaluation of a German version of a brief diagnosis questionnaire of symptoms of orthorexia nervosa in patients with mental disorders (Ortho-10). Eat Weight Disord 23(1):75–85. https://doi.org/10.1007/s40519-017-0473-y

    Article  PubMed  Google Scholar 

  15. Arusoğlu G, Kabakçi E, Köksal G, Merdol TK (2008) Orthorexia nervosa and adaptation of ORTO-11 into Turkish. Turk Psikiyatri Derg 19(3):283–291 (Turkish)

    PubMed  Google Scholar 

  16. Asil E, Sürücüoğlu MS (2015) Orthorexia nervosa in Turkish Dietitians. Ecol Food Nutr 54(4):303–313. https://doi.org/10.1080/03670244.2014.987920

    Article  PubMed  Google Scholar 

  17. Bağci Bosi AT, Camur D, Güler C (2007) Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine (Ankara, Turkey). Appetite 49(3):661–666

    Article  PubMed  Google Scholar 

  18. Barnes MA, Caltabiano ML (2017) The interrelationship between orthorexia nervosa, perfectionism, body image and attachment style. Eat Weight Disord 22(1):177–184. https://doi.org/10.1007/s40519-016-0280-x

    Article  PubMed  Google Scholar 

  19. Barnett MJ, Dripps WR, Blomquist KK (2016) Organivore or organorexic? Examining the relationship between alternative food network engagement, disordered eating, and special diets. Appetite 105:713–720. https://doi.org/10.1016/j.appet.2016.07.008

    Article  PubMed  Google Scholar 

  20. Barrada JR, Roncero M (2018) Bidimensional structure of the orthorexia: development and initial validation of a new instrument [Estructura Bidimensional de la Ortorexia: Desarrollo y Validación Inicial de un Nuevo Instrumento]. Anales de Psicologia 34(2):283–291

    Article  Google Scholar 

  21. Barthels F, Meyer F, Huber T, Pietrowsky R (2017) Orthorexic eating behaviour as a coping strategy in patients with anorexia nervosa. Eat Weight Disord 22(2):269–276. https://doi.org/10.1007/s40519-016-0329-x

    Article  PubMed  Google Scholar 

  22. Barthels F, Meyer F, Pietrowsky R (2018) Orthorexic and restrained eating behaviour in vegans, vegetarians, and individuals on a diet. Eat Weight Disord 23(2):159–166. https://doi.org/10.1007/s40519-018-0479-0

    Article  PubMed  Google Scholar 

  23. Barthels F, Pietrowsky R (2012) Orthorectic eating behaviour—nosology and prevalence rates. Psychother Psychosom Med Psychol 62(12):445–449. https://doi.org/10.1055/s-0032-1312630

    Article  PubMed  Google Scholar 

  24. Barthels F (2013) Can healthy eating be a illness? (interview by Dr. Beate Schumacher)]. MMW Fortschr Med 155(5):6 (German)

    Article  PubMed  Google Scholar 

  25. Barthels F, Meyer F, Huber T, Pietrowsky R (2017) Analysis of orthorexic eating behavior in patients with eating disorder and obsessive-compulsive disorder [Analyse des orthorektischen ernährungsverhaltens von Patienten mit Essstörungen und mit Zwangsstörungen]. Zeitschrift fur Klinische Psychologie Psychotherapie 46(1):32–41

    Article  Google Scholar 

  26. Barthels F, Meyer F, Pietrowsky R (2015) Duesseldorf orthorexia scale—Construction and evaluation of a questionnaire measuring orthorexic eating behavior [Die düsseldorfer orthorexie skala—construktion und evaluation eines fragebogens zur erfassung orthorektischen ernährungsverhaltens]. Zeitschrift fur Klinische Psychologie Psychotherapie 44(2):97–105

    Article  Google Scholar 

  27. Barthels F, Meyer F, Pietrowsky R (2015) Orthorexic eating behavior. Ernahrungs Umschau 62(10):156–161

    Google Scholar 

  28. Bartrina JA (2007) Orthorexia or when a healthy diet becomes an obsession. Arch Latinoam Nutr 57(4):313–315 (Spanish)

    PubMed  Google Scholar 

  29. Bo S, Zoccali R, Ponzo V, Soldati L, De Carli L, Benso A, Fea E, Rainoldi A, Durazzo M, Fassino S, Abbate-Daga G (2014) University courses, eating problems and muscle dysmorphia: are there any associations? J Transl Med 12:221. https://doi.org/10.1186/s12967-014-0221-2

    Article  PubMed  PubMed Central  Google Scholar 

  30. Bratman S (2017) Orthorexia vs. theories of healthy eating. Eat Weight Disord 22(3):381–385. https://doi.org/10.1007/s40519-017-0417-6

    Article  PubMed  Google Scholar 

  31. Brytek-Matera A, Donini LM, Krupa M, Poggiogalle E, Hay P (2016) Erratum to: Orthorexia nervosa and self-attitudinal aspects of body image in female and male university students. J Eat Disord. https://doi.org/10.1186/s40337-016-0105-3. (eCollection 2016)

    Article  PubMed  PubMed Central  Google Scholar 

  32. Brytek-Matera A, Donini LM, Krupa M, Poggiogalle E, Hay P (2015) Orthorexia nervosa and self-attitudinal aspects of body image in female and male university students. J Eat Disord 3:2. https://doi.org/10.1186/s40337-015-0038-2 (eCollection 2015. Erratum in J Eat Disord. 2016;4:16).

  33. Brytek-Matera A, Fonte ML, Poggiogalle E, Donini LM, Cena H (2017) Orthorexia nervosa: relationship with obsessive-compulsive symptoms, disordered eating patterns and body uneasiness among Italian university students. Eat Weight Disord 22(4):609–617. https://doi.org/10.1007/s40519-017-0427-4 (Epub 2017 Aug 24)

    Article  PubMed  Google Scholar 

  34. Brytek-Matera A, Krupa M, Poggiogalle E, Donini LM (2014) Adaptation of the ORTHO-15 test to Polish women and men. Eat Weight Disord 19(1):69–76. https://doi.org/10.1007/s40519-014-0100-0 (Epub 2014 Jan 22) (Erratum in Eat Weight Disord. 2014 Jun; 19(2):271)

    Article  PubMed  Google Scholar 

  35. Brytek-Matera A, Rogoza R, Gramaglia C, Zeppegno P (2015) Predictors of orthorexic behaviours in patients with eating disorders: a preliminary study. BMC Psychiatry 15:252. https://doi.org/10.1186/s12888-015-0628-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Brytek-Matera A (2012) Orthorexia nervosa—an eating disorder, obsessive-compulsive disorder or disturbed eating habit? Arch Psychiatry Psychother 14(1):55–60

    Google Scholar 

  37. Brytek-Matera A (2017) Does emotional eating mediate the relationship between body image-related distress and orthorexic behaviours in overweight/obese women? Eat Weight Disord 3:563 (Date of Publication: 2017)

    Google Scholar 

  38. Brytek-Matera A (2014) Healthy eating obsession in women with anorexia nervosa: a case control study. In: Gramaglia C, Zeppegno P (eds) New developments in anorexia nervosa research. Nova Science Publishers, New York, pp 39–50

    Google Scholar 

  39. Bundros J, Clifford D, Silliman K, Neyman Morris M (2016) Prevalence of orthorexia nervosa among college students based on Bratman’s test and associated tendencies. Appetite 101:86–94. https://doi.org/10.1016/j.appet.2016.02.144

  40. Cartwright MM (2004) Eating disorder emergencies: understanding the medical complexities of the hospitalized eating disordered patient. Crit Care Nurs Clin North Am 16(4):515–530

    Article  PubMed  Google Scholar 

  41. Catalina Zamora ML, Bote Bonaechea B, García Sánchez F, Ríos Rial B (2005) [Orthorexia nervosa. A new eating behavior disorder?]. Actas Esp Psiquiatr 33(1):66–68. (Spanish)

    CAS  PubMed  Google Scholar 

  42. Chaki B, Pal S, Bandyopadhyay A (2013) Exploring scientific legitimacy of orthorexia nervosa: a newly emerging eating disorder. J Hum Sport Exerc 8(4):1045–1053

    Article  Google Scholar 

  43. Çiçekoğlu P, Tunçay GY (2018) A comparison of eating attitudes between vegans/vegetarians and nonvegans/nonvegetarians in terms of orthorexia nervosa. Arch Psychiatr Nurs 32(2):200–205. https://doi.org/10.1016/j.apnu.2017.11.002

    Article  PubMed  Google Scholar 

  44. Cinosi E, Matarazzo I, Marini S, Acciavatti T, Lupi M, Corbo M, Santacroce R, Vellante F, Sarchione F, De Berardis D, Carano A, Di Iorio G, Martinotti G, Di Giannantonio M (2015) Prevalence of orthorexia nervosa in a population of young Italian adults European Psychiatry 30(SUPPL. 1):1330

  45. Cinquegrani C, Brown DHK (2018) ‘Wellness’ lifts us above the Food Chaos’: a narrative exploration of the experiences and conceptualisations of Orthorexia Nervosa through online social media forums. Qualitative Research in Sport, Exercise and Health, pp 1–19

  46. Costa CB, Hardan-Khalil K, Gibbs K (2017) Orthorexia nervosa: a review of the literature. Issues Ment Health Nurs 38(12):980–988. https://doi.org/10.1080/01612840.2017.1371816

    Article  PubMed  Google Scholar 

  47. de Souza QJOV, Rodrigues AM (2014) Risk behavior for orthorexia nervosa in nutrition students Comportamento de risco para ortorexia nervosa em estudantes de nutrição Jornal Brasileiro de Psiquiatria 63(3):201–204

  48. Dell’Osso L, Abelli M, Carpita B, Massimetti G, Pini S, Rivetti L, Gorrasi F, Tognetti R, Ricca V, Carmassi C (2016) Orthorexia nervosa in a sample of Italian university population. Riv Psichiatr 51(5):190–196. https://doi.org/10.1708/2476.25888

    Article  PubMed  Google Scholar 

  49. Dell’Osso L, Abelli M, Carpita B, Pini S, Castellini G, Carmassi C, Ricca V (2016) Historical evolution of the concept of anorexia nervosa and relationships with orthorexia nervosa, autism, and obsessive-compulsive spectrum. Neuropsychiatr Dis Treat 12:1651–1660. https://doi.org/10.2147/NDT.S108912 (eCollection 2016)

    Article  PubMed  PubMed Central  Google Scholar 

  50. Dell’Osso L, Carpita B, Muti D, Cremone IM, Massimetti G, Diadema E, Gesi C, Carmassi C (2018 Feb) Prevalence and characteristics of orthorexia nervosa in a sample of university students in Italy. Eat Weight Disord 23(1):55–65. https://doi.org/10.1007/s40519-017-0460-3

    Article  PubMed  Google Scholar 

  51. Depa J, Schweizer J, Bekers SK, Hilzendegen C, Stroebele-Benschop N (2017) Prevalence and predictors of orthorexia nervosa among German students using the 21-item-DOS. Eat Weight Disord 22(1):193–199. https://doi.org/10.1007/s40519-016-0334-0

    Article  PubMed  Google Scholar 

  52. Dittfeld A, Gwizdek K, Jagielski P, Brzęk J, Ziora K (2017) A study on the relationship between orthorexia and vegetarianism using the BOT (Bratman Test for Orthorexia). Psychiatr Pol 51(6):1133–1144. https://doi.org/10.12740/PP/75739

    Article  PubMed  Google Scholar 

  53. Dittfeld A, Gwizdek K, Koszowska A, Nowak J, Brończyk-Puzoń A, Jagielski P, Oświęcimska J, Ziora K (2016) Assessing the risk of orthorexia in dietetic and physiotherapy students using the BOT (Bratman Test for Orthorexia). Pediatr Endocrinol Diabetes Metab 22(1):6–14. https://doi.org/10.18544/PEDM-22.01.0044

    Article  PubMed  Google Scholar 

  54. Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C (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(2):151–157

    Article  CAS  PubMed  Google Scholar 

  55. Dunn TM, Gibbs J, Whitney N, Starosta A (2017) Prevalence of orthorexia nervosa is less than 1%: data from a US sample. Eat Weight Disord 22(1):185–192. https://doi.org/10.1007/s40519-016-0258-8

    Article  PubMed  Google Scholar 

  56. Duyar Ş, Ertaş Y, Gezmen Karadaǧ M (2016) Eating disorder score is associated with orthorexia in female. Obes Facts 9(SUPPL. 1):150

    Google Scholar 

  57. Ercan A, Altun S, Özkahya D, Güler S (2013) Prevalance of orthorexia nervosa among adolescents and young adults. Ann Nutr Metab 63(SUPPL. 1):563

    Google Scholar 

  58. Eriksson L, Baigi A, Marklund B, Lindgren EC (2008) Social physique anxiety and sociocultural attitudes toward appearance impact on orthorexia test in fitness participants. Scand J Med Sci Sports 18(3):389–394

    Article  CAS  PubMed  Google Scholar 

  59. Ewers SM, Halioua R, Jäger M, Seifritz E, Claussen MC (2017) Sports psychiatry and psychotherapy-disturbed eating behavior and eating disorders in high-performance sport [Sportpsychiatrie und-psychotherapie-gestörtes essverhalten und essstörungen im leistungssport]. Dtsch Z Sportmed 68(11):261–268

    Article  Google Scholar 

  60. Farooq A, Bradbury J (2016) Orthorexia nervosa in university athletes. Proc Nutr Soc 75:OCE3 (E263)

    Article  Google Scholar 

  61. Fidan T, Ertekin V, Işikay S, Kirpinar I (2010) Prevalence of orthorexia among medical students in Erzurum, Turkey. Compr Psychiatry 51(1):49–54. https://doi.org/10.1016/j.comppsych.2009.03.001

    Article  PubMed  Google Scholar 

  62. Fidan T., Ertekin V., Isikay S., Kaya D., Esin I., Asfuroglu B (2014) Orthorexia nervosa and education. European Neuropsychopharmacol 24(SUPPL. 2):S731.

    Article  Google Scholar 

  63. Gezmen Karadaǧ M, Duyar Ş, Ertaş Y (2016) Orthorexia risk were higher in female with lower body mass index. Obes Facts 9(SUPPL. 1):136

    Google Scholar 

  64. Gkiouras K, Mavridis P, Tsakiri V, Theodoridis X, Gerontidis A, Grammatikopoulou MG, Chourdakis M (2018) Evaluation of orthorexia among dietetics students. Clin Nutr ESPEN 24:179. https://doi.org/10.1016/j.clnesp.2018.01.031

    Article  Google Scholar 

  65. Gleaves DH, Graham EC, Ambwani S (2013) Measuring “Orthorexia”: development of the eating habits Questionnaire. Int J Educ Psychol Assess 12(2):1–18

    Google Scholar 

  66. Glogowski S (2015) Eating disorders: orthorexia in the consulting practice [Essstörungen: Orthorexie in der Beratungspraxis]. Ernahrungs Umschau 62(10):1

    Google Scholar 

  67. Gramaglia C, Brytek-Matera A, Rogoza R, Zeppegno P (2017) Orthorexia and anorexia nervosa: two distinct phenomena? A cross-cultural comparison of orthorexic behaviours in clinical and non-clinical samples. BMC Psychiatry 17(1):75. https://doi.org/10.1186/s12888-017-1241-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Grammatikopoulou MG, Gkiouras K, Markaki A, Theodoridis X, Tsakiri V, Mavridis P, Dardavessis T, Chourdakis M (2018) Food addiction, orthorexia, and food-related stress among dietetics students. Eat Weight Disord 23(4):459–467. https://doi.org/10.1007/s40519-018-0514-1

    Article  PubMed  Google Scholar 

  69. Håman L, Barker-Ruchti N, Patriksson G, Lindgren EC (2015) Orthorexia nervosa: an integrative literature review of a lifestyle syndrome. Int J Qual Stud Health Well-being 10:26799. https://doi.org/10.3402/qhw.v10.26799 (eCollection 2015)

    Article  PubMed  Google Scholar 

  70. Håman L, Lindgren EC, Prell H (2017) “If it’s not Iron it’s Iron f*cking biggest Ironman”: personal trainers’s views on health norms, orthorexia and deviant behaviours. Int J Qual Stud Health Well-being 12(1):1364602. https://doi.org/10.1080/17482631.2017.1364602

    Article  PubMed  PubMed Central  Google Scholar 

  71. Hayes O, Wu MS, De Nadai AS, Storch EA (2017) Orthorexia nervosa: an examination of the prevalence, correlates, and associated impairment in a university sample. J Cognit Psychother 31(2):124–135

    Article  Google Scholar 

  72. Hepworth K (2010) Eating disorders today—not just a girl thing. J Christ Nurs 27(3):236–241 (quiz 242–243)

    Article  PubMed  Google Scholar 

  73. Herranz Valera J, Acuña Ruiz P, Romero Valdespino B, Visioli F (2014) Prevalence of orthorexia nervosa among ashtanga yoga practitioners: a pilot study. Eat Weight Disord 19(4):469–472. https://doi.org/10.1007/s40519-014-0131-6

    Article  PubMed  Google Scholar 

  74. Hyrnik J, Janas-Kozik M, Stochel M, Jelonek I, Siwiec A, Rybakowski JK (2016) The assessment of orthorexia nervosa among 1899 Polish adolescents using the ORTO-15 questionnaire. Int J Psychiatry Clin Pract 20(3):199–203. https://doi.org/10.1080/13651501.2016.1197271

    Article  PubMed  Google Scholar 

  75. Janas-Kozik M, Zejda J, Stochel M, Brozek G, Janas A, Jelonek I (2012) Orthorexia—a new diagnosis?. Psychiatr Pol 46(3):441–450 (Review. Polish)

    PubMed  Google Scholar 

  76. Jerez FT, Lagos HR, Valdés-Badilla P, Pacheco PE, Pérez CC (2015) Prevalence of orthorexic behaviour in high school students of Temuco [Prevalencia de conducta ortoréxica en estudiantes de educación media de Temuco]. Revista Chilena de Nutricion 42(1):41–44

    Article  Google Scholar 

  77. Kaluaratchige E (2013) Orthorexia—psychopathological questionings [Orthorexie: Un questionnement psychopathologique]. Topique 123(2):175–188

    Article  Google Scholar 

  78. Kamarli H, Keser I, Seremet Kürklü N (2016) Prevalence of orthorexia Nervosa of University students attending in social sciences. Clin Nutr 35(Supplement 1):S207–S208

    Article  Google Scholar 

  79. Karadag MG, Elibol E, Yildiran H, Akbulut G, Çelik MG, Degirmenci M, Sögüt M, Günes M, Dinler MF (2016) Evaluation of the relationship between obesity with eating attitudes and orthorexic behavior in healthy adults Saglikli yetiskin bireylerde yeme tutum ve ortorektik davranislar ile obezite arasindaki iliskinin degerlendirilmesi. Gazi Med J 27(3):107–114

    Google Scholar 

  80. Kata D, Túry F (2008) Orthorexia nervosa: Dependence on healthy food, as one of the newest eating disorders [Orthorexia nervosa: Az egészségesétel- függoség mint a legújabb evészavarok egyike]. Mentalhigiene es Pszichoszomatika 9(2):125–137

    Article  Google Scholar 

  81. Korinth A, Schiess S, Westenhoefer J (2010) Eating behaviour and eating disorders in students of nutrition sciences. Public Health Nutr 13(1):32–37. https://doi.org/10.1017/S1368980009005709

    Article  PubMed  Google Scholar 

  82. Koven NS, Abry AW (2015 Feb) The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatr Dis Treat 11:385–394. https://doi.org/10.2147/NDT.S61665 (eCollection 2015)

    Article  PubMed  PubMed Central  Google Scholar 

  83. Krzywdzińska A, Hozyasz KK (2014) Orthorexia—pathological control over nutrition. Threat to children and adolescents Ortoreksja—patologiczna kontrola nad odzywianiem. Zagrozenie dla dzieci i młodziezy Pediatria Polska 89(2):119–124

    Article  Google Scholar 

  84. Kummer A, Dias FM, Teixeira AL (2008) On the concept of orthorexia nervosa. Scand J Med Sci Sports 18(3):395–396. https://doi.org/10.1111/j.1600-0838.2008.00809.x (author reply 397)

    Article  CAS  PubMed  Google Scholar 

  85. Lisle R (2016) Orthorexia—slipping through the net? Psychologist 29(12):890

    Google Scholar 

  86. Luck-Sikorski C, Jung F, Schlosser K, Riedel-Heller SG (2018) Is orthorexic behavior common in the general public? A large representative study in Germany. Eat Weight Disord. https://doi.org/10.1007/s40519-018-0502-5

    Article  PubMed  Google Scholar 

  87. Mac Evilly C (2001) The price of perfection. Nutr Bull 26(4):275–276

    Article  Google Scholar 

  88. Mader U (2004) [Othorexia—the addiction to nourishing oneself “healthfully”]. Dtsch Med Wochenschr 129(14):728 (German)

    PubMed  Google Scholar 

  89. Maghetti A, Cicero AFG, D’Ignazio E, Vincenzi M, Paolini B, Lucchin L, Malvaldi F, Maghetti A, Culicchi V, Del Ciondolo I, D’Ignazio E, Paolini B, Malfi G, Vassallo D, De Donà F, Caregaro L, Situlin R, Vinci P, Marucci S, Vincenzi M (2015) Orthorexia prevalence among health care professionals involved in nutrition education: the ADI-O study Mediterranean. J Nutr Metab 8(2):199–204

    Google Scholar 

  90. Malmborg J, Bremander A, Olsson MC, Bergman S (2017) Health status, physical activity, and orthorexia nervosa: a comparison between exercise science students and business students. Appetite. 109:137–143. https://doi.org/10.1016/j.appet.2016.11.028

    Article  PubMed  Google Scholar 

  91. Marazziti D, Presta S, Baroni S, Silvestri S, Dell’Osso L (2014) Behavioral addictions: a novel challenge for psychopharmacology. CNS Spectr 19(6):486–495. https://doi.org/10.1017/S1092852913001041

    Article  PubMed  Google Scholar 

  92. Mathieu J (2005) What is orthorexia? J Am Diet Assoc 105(10):1510–1512

    Article  PubMed  Google Scholar 

  93. Michalska A, Szejko N, Jakubczyk A, Wojnar M (2016) Nonspecific eating disorders—a subjective review. Psychiatr Pol 50(3):497–507. https://doi.org/10.12740/PP/59217 (Review. English, Polish)

    Article  Google Scholar 

  94. Missbach B, Barthels F (2017) Orthorexia nervosa: moving forward in the field. Eat Weight Disord 22(1):1. https://doi.org/10.1007/s40519-017-0365-1

    Article  PubMed  Google Scholar 

  95. Moller S, Apputhurai P, Knowles SR (2018) Confirmatory factor analyses of the ORTO 15-, 11- and 9-item scales and recommendations for suggested cut-off scores. Eat Weight Disord. https://doi.org/10.1007/s40519-018-0515-0

    Article  PubMed  Google Scholar 

  96. Moroze RM, Dunn TM, Craig Holland J, Yager J, Weintraub P (2015) Microthinking about micronutrients: a case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria. Psychosomatics 56(4):397–403. https://doi.org/10.1016/j.psym.2014.03.003

    Article  PubMed  Google Scholar 

  97. Musolino C, Warin M, Wade T, Gilchrist P (2015) ‘Healthy anorexia’: the complexity of care in disordered eating. Soc Sci Med 139:18–25. https://doi.org/10.1016/j.socscimed.2015.06.030

    Article  PubMed  Google Scholar 

  98. Nauta K, Toxopeus K, Eekhoff EM (2016) Malnutrition due to an extremely ‘healthy’ diet; a new eating disorder?. Ned Tijdschr Geneeskd 160:A9164 (Dutch)

    CAS  PubMed  Google Scholar 

  99. Nevin SM, Vartanian LR (eCollection 2017) The stigma of clean dieting and orthorexia nervosa. J Eat Disord 5:37. https://doi.org/10.1186/s40337-017-0168-9 (eCollection 2017)

    Article  PubMed  PubMed Central  Google Scholar 

  100. Nyman H (2002) A direct question: is orthorexia a correct word for a wrong concept?. Lakartidningen 99(5):423–424 (Swedish)

    PubMed  Google Scholar 

  101. Oberle CD, Lipschuetz SL (2018) Orthorexia symptoms correlate with perceived muscularity and body fat, not BMI. Eat Weight Disord. https://doi.org/10.1007/s40519-018-0508-z

    Article  PubMed  Google Scholar 

  102. Oberle CD, Samaghabadi RO, Hughes EM (2017) Orthorexia nervosa: assessment And correlates with gender, BMI, and personality. Appetite 108:303–310. https://doi.org/10.1016/j.appet.2016.10.021

    Article  PubMed  Google Scholar 

  103. Oberle CD, Watkins RS, Burkot AJ (2018) Orthorexic eating behaviors related to exercise addiction and internal motivations in a sample of university students. Eat Weight Disord 23(1):67–74. https://doi.org/10.1007/s40519-017-0470-1

    Article  PubMed  Google Scholar 

  104. Olejniczak D, Bugajec D, Panczyk M, Brytek-Matera A, Religioni U, Czerw A, Grąbczewska A, Juszczyk G, Jabłkowska-Górecka K, Staniszewska A (2017) Analysis concerning nutritional behaviors in the context of the risk of orthorexia. Neuropsychiatr Dis Treat 13:543–550. https://doi.org/10.2147/NDT.S129660 (eCollection 2017)

    Article  PubMed  PubMed Central  Google Scholar 

  105. Park SW, Kim JY, Go GJ, Jeon ES, Pyo HJ, Kwon YJ (2011) Orthorexia nervosa with hyponatremia, subcutaneous emphysema, pneumomediastimum, pneumothorax, and pancytopenia. Electrolyte Blood Press 9(1):32–37. https://doi.org/10.5049/EBP.2011.9.1.32

    Article  PubMed  PubMed Central  Google Scholar 

  106. Parra-Fernandez ML, Rodríguez-Cano T, Onieva-Zafra MD, Perez-Haro MJ, Casero-Alonso V, Muñoz Camargo JC, Notario-Pacheco B (2018) Adaptation and validation of the Spanish version of the ORTO-15 questionnaire for the diagnosis of orthorexia nervosa. PLoS One 13(1):e0190722. https://doi.org/10.1371/journal.pone.0190722 (eCollection 2018)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  107. Peat CM (2016) When ‘eating healthy’ becomes disordered, you can return patients to genuine health. Curr Psychiatry 15(5):76–77

    Google Scholar 

  108. Pietrowsky R, Barthels F (2016) Orthorexia nervosa—lifestyle or socially relevant disorder? Orthorexia nervosa—Lebensstil oder gesellschaftlich relevantes Krankheitsbild? Public Health Forum 24(3):189–190

    Article  Google Scholar 

  109. Poyraz CA, Tüfekçioğlu EY, Özdemir A, Baş A, Kani AS, Erginöz E, Duran A (2015) Relationship between orthorexia and obsessive-compulsive symptoms in patients with generalised anxiety disorder, panic disorder and obsessive compulsive disorder. Yaygın anksiyete bozukluğu, panik bozukluk ve obsesif kompulsif bozukluk hastalarında ortoreksi ile obsesif kompulsif semptomlar arasındaki ılişkinin araştırılması Yeni Symposium 53(4):22–26

  110. Ramacciotti CE, Perrone P, Coli E, Burgalassi A, Conversano C, Massimetti G, Dell’Osso L (2011) Orthorexia nervosa in the general population: a preliminary screening using a self-administered questionnaire (ORTO-15). Eat Weight Disord 16(2):e127–e130

    Article  CAS  PubMed  Google Scholar 

  111. Rangel C, Dukeshire S, MacDonald L (2012) Diet and anxiety. An exploration into the Orthorexic Society. Appetite 58(1):124–132

    Article  PubMed  Google Scholar 

  112. Roncero M, Barrada JR, Perpiñá C (2017 Sep) Measuring orthorexia nervosa: psychometric limitations of the ORTO-15. Span J Psychol 20:E41. https://doi.org/10.1017/sjp.2017.36

    Article  PubMed  Google Scholar 

  113. Rössner S (2004) Orthorexia nervosa—a new disease? Lakartidningen 101(37):2835 (Swedish)

    PubMed  Google Scholar 

  114. Rudolph S (2017) The connection between exercise addiction and orthorexia nervosa in German fitness sports. Eat Weight Disord. https://doi.org/10.1007/s40519-017-0437-2

    Article  PubMed  Google Scholar 

  115. Rudolph S, Göring A, Jetzke M, Großarth D, Rudolph H (2017) The prevalence of orthorectic eating behavior of student athletes [Zur Prävalenz von orthorektischem Ernährungsverhalten bei sportlich aktiven Studierenden]. Dtsch Z Sportmed 68(1):10–13

    Article  Google Scholar 

  116. Saddichha S, Babu GN, Chandra P (2012) Orthorexia nervosa presenting as prodrome of schizophrenia. Schizophr Res 134(1):110. https://doi.org/10.1016/j.schres.2011.10.017

    Article  PubMed  Google Scholar 

  117. Saljoughian M (2017) Orthorexia: an eating disorder emerges. U.S. Pharm 42(12):9

    Google Scholar 

  118. San Mauro Martín I, Garicano Vilar E, González Fernández M, Villacorta Pérez P, Megias Gamarra A, Miralles Rivera B, Figueroa Borque M, Andrés Sánchez N, Bonilla Navarro M, Arranz Poza P, Bernal Maurandi MD Ruiz León AM, Moraleda Ponzol E, de la Calle de la Rosa L (2014) Nutritional and psychological habits in people who practice exercise]. Nutr Hosp ;30(6):1324–1332. https://doi.org/10.3305/nh.2014.30.6.7838 (Spanish)

    Article  PubMed  Google Scholar 

  119. Sanlier N, Yassibas E, Bilici S, Sahin G, Celik B (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(3):266–278. https://doi.org/10.1080/03670244.2016.1150276

    Article  PubMed  Google Scholar 

  120. Segura-García C, Papaianni MC, Caglioti F, Procopio L, Nisticò CG, Bombardiere L, Ammendolia A, Rizza P, De Fazio P, Capranica L (2012) Orthorexia nervosa: a frequent eating disordered behavior in athletes. Eat Weight Disord 17(4):e226–e233. https://doi.org/10.3275/8272

    Article  PubMed  Google Scholar 

  121. Segura-Garcia C, Ramacciotti C, Rania M, Aloi M, Caroleo M, Bruni A, Gazzarrini D, Sinopoli F, De Fazio P (2015) The prevalence of orthorexia nervosa among eating disorder patients after treatment. Eat Weight Disord 20(2):161–166. https://doi.org/10.1007/s40519-014-0171-y

    Article  PubMed  Google Scholar 

  122. Simpson CC, Mazzeo SE (2017) Attitudes toward orthorexia nervosa relative to DSM-5 eating disorders. Int J Eat Disord 50(7):781–792. https://doi.org/10.1002/eat.22710

    Article  PubMed  Google Scholar 

  123. Slof-Op’t Landt MC, Claes L, van Furth EF (2016) Classifying eating disorders based on “healthy” and “unhealthy” perfectionism and impulsivity. Int J Eat Disord 49(7):673–680. https://doi.org/10.1002/eat.22557

    Article  Google Scholar 

  124. Stochel M, Joanna Hyrnik JH, Ireneusz Jelonek IJ, Jan Zejda JZ, Malgorzata Janas-Kozik MJK (2013) Orthorexia among Polish urban youth. Eur Neuropsychopharmacol 23(SUPPL. 2):S527–S528

    Google Scholar 

  125. Tremelling K, Sandon L, Vega GL, McAdams CJ (2017) Orthorexia nervosa and eating disorder symptoms in registered dietitian nutritionists in the United States. J Acad Nutr Diet 117(10):1612–1617. https://doi.org/10.1016/j.jand.2017.05.001

    Article  PubMed  PubMed Central  Google Scholar 

  126. Turner PG, Lefevre CE (2017) Instagram use is linked to increased symptoms of orthorexia nervosa. Eat Weight Disord 22(2):277–284. https://doi.org/10.1007/s40519-017-0364-2

    Article  PubMed  PubMed Central  Google Scholar 

  127. Vandereycken W (2011) Media hype, diagnostic fad or genuine disorder? Professionals’ opinions about night eating syndrome, orthorexia, muscle dysmorphia, and emetophobia. Eat Disord 19(2):145–155. https://doi.org/10.1080/10640266.2011.551634

    Article  PubMed  Google Scholar 

  128. Varga M, Dukay-Szabó S, Túry F, van Furth EF (2013) Evidence and gaps in the literature on orthorexia nervosa. Eat Weight Disord 18(2):103–111. https://doi.org/10.1007/s40519-013-0026-y (Epub 2013 Apr 12. Review)

    Article  PubMed  Google Scholar 

  129. Varga M, Dukay-Szabo S, Túry F (2013) Orthorexia nervosa and it’s background factors. Ideggyogy Sz 66(7–8):220–227 (Review. Hungarian)

    PubMed  Google Scholar 

  130. Varga M, Thege BK, Dukay-Szabó S, Túry F, van Furth EF (2014) When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry 14:59. https://doi.org/10.1186/1471-244X-14-59

    Article  PubMed  PubMed Central  Google Scholar 

  131. Varga M, Máté G (2010) Eating disturbances in orthorexia nervosa. J Psychosomat Res 68(6):672–673

    Google Scholar 

  132. Volpe U, Atti AR, Cimino M, Monteleone AM, De Ronchi D, Fernández-Aranda F, Monteleone P (2015) Beyond anorexia and bulimia nervosa: What’s “new” in eating disorders? J Psychopathol 21(4):415–423

    Google Scholar 

  133. Von Rosenstiel I, Stam J, Schats W (2012) Safety issues and orthorexia in paediatrics BMC Complementary and Alternative Medicine 12 SUPPL. 1. Date of Publication: 12 Jun 2012

  134. Setnick J (2013) The eating disorders clinical pocket guide, second edition: quick reference for healthcare providers. Understanding Nutrition, Dallas

    Google Scholar 

  135. Kendell R, Jablensky A (2003) Distinguishing between the validity and utility of psychiatric diagnoses. Am J Psychiatry 160(1):4–12

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Pavia, Pavia, Italy

    Hellas Cena

  2. Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany

    Friederike Barthels

  3. Formerly Sapienza University of Rome, Rome, Italy

    Massimo Cuzzolaro

  4. Vallejo, CA, USA

    Steven Bratman

  5. SWPS University of Social Sciences and Humanities, Katowice, Poland

    Anna Brytek-Matera

  6. University of Northern Colorado, Greeley, USA

    Thomas Dunn

  7. Semmelweis University, Budapest, Hungary

    Marta Varga

  8. Open Innovation in Science Research and Competence Center, Ludwig Boltzmann Gesellschaft, Vienna, Austria

    Benjamin Missbach

  9. Food Science and Human Nutrition Research Unit, Medical Pathophysiology, Food Science and Endocrinology Section, Experimental Medicine Department, Sapienza University of Rome, Rome, Italy

    Lorenzo M. Donini

Authors
  1. Hellas Cena
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Friederike Barthels
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Massimo Cuzzolaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Steven Bratman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anna Brytek-Matera
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Thomas Dunn
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marta Varga
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Benjamin Missbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Lorenzo M. Donini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lorenzo M. Donini.

Ethics declarations

Conflict of interest

All the authors declare that they have no conflict of interest regarding this publication.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

Additional information

Hellas Cena and Friederike Barthels contributed equally.

This article is part of topical collection on Orthorexia Nervosa

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cena, H., Barthels, F., Cuzzolaro, M. et al. Definition and diagnostic criteria for orthorexia nervosa: a narrative review of the literature. Eat Weight Disord 24, 209–246 (2019). https://doi.org/10.1007/s40519-018-0606-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-018-0606-y

Keyword

Search

Navigation