Abstract
Orthorexia nervosa, the pathological obsession with eating healthy, shares risks and significant comorbidity with other mental disorders. Based on a behavioral conceptualization of the overlap, emotion regulation, attachment style, and anxious-depressive-stress symptomatology are prominent but insufficiently researched endophenotypes for orthorexia nervosa. This study aimed at identifying ways in which difficulties in emotion regulation and attachment-related anxiety and avoidance become apparent in orthorexia nervosa and healthy orthorexia. Additionally, the moderating role of anxious, depressive, and stress symptoms was explored. A convenience sample of 399 adults (266 women) completed questionnaires to measure orthorexia nervosa and healthy orthorexia, difficulties in emotion regulation, partnership-related bond, and anxious-depressive-stress symptomatology. The healthy orthorexia subscale was negatively associated with lack of emotional awareness but no other subscale of difficulties in emotion regulation or attachment-related anxiety and avoidance. Orthorexia nervosa scores were positively linked to difficulties in emotion regulation as well as attachment-related anxiety and avoidance. Multiple linear regression indicated non-acceptance of emotional responses and impulse control difficulties to be the strongest predictors for orthorexia nervosa. Both subscales also mediated the effects of attachment style on orthorexia nervosa with anxious-depressive-stress symptomatology moderating some of these effects. Individuals with higher orthorexia nervosa tendencies showed difficulties in emotion regulation, a common feature also of affective and eating disorders. Improvement in understanding the psychological features of orthorexia nervosa can enable a better differentiation from other disorders, advances in the development of treatment approaches and treatment planning, and outlines directions for future research on mechanisms.
Highlights
Orthorexia nervosa (OrNe) describes the pathological obsession with healthy eating
The findings of this study with a convenience sample showed that specific dimensions of emotion regulation difficulties correlated with pathological orthorexic behaviors while there was no relation to the healthy aspects of orthorexic eating
Mediation models implicated that non-acceptance of emotions and impulse control difficulties fully mediated the relationship between attachment style and pathological orthorexic behaviors
Summary
Orthorexia nervosa (OrNe) describes the pathological obsession with healthy eating. not officially recognized as a mental disorder, obsession over nutrition, severely restricting types of food one eats, and trying to achieve the “perfect” diet can result in severe malnutrition, weight loss, emotional distress and other health issues [1]. It has been suggested that OrNe should be distinguished from healthy orthorexia (HeOr), defined as a healthy interest in diet and nutrition, and as having a healthy eating identity [3]. This proposed two-factor structure has been replicated in follow-up studies showing opposite associations of OrNe and HeOr with disordered eating attitudes, food choices and affective measures [4]. Orthorexic eating is often accompanied by other disorders, such as eating disorders, obsessive-compulsive as well as affective psychopathology [5–7] These comorbidities substantiate the debate whether OrNe is a diagnostic entity that is distinct from established mental disorders [8]. Based on commonalities in risk factors, psychological profiles, and clinical symptoms classification of OrNe within the eating disorder spectrum is most popular [10]
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