Orthorexia Nervosa and Perfectionism: A Systematic Review

Year 2024, Volume: 16 Issue: 4, 707 - 722, 25.12.2024

Ahmet Dönmez

https://doi.org/10.18863/pgy.1421245

Abstract

Orthorexia nervosa is described as a pathological fixation with healthy eating. Many risk factors contribute to the development of orthorexia nervosa. This study aimed to better understand the role of perfectionism in the development of orthorexia nervosa. In this context, studies on the relationship between orthorexia nervosa and perfectionism were reviewed. In the databases of PubMed, Wiley Online Library and Sage Journals and were searched. The keywords “orthorexia”, “orthorexia nervosa”, “pathologically healthy eating” and “perfectionism” were used in the search. As a result of the scanning, 17 articles on the relationship between orthorexia nervosa and perfectionism were examined. Studies were evaluated in terms of sample characteristics, study design, orthorexia nervosa measurement tools and study results. The results indicate that orthorexia nervosa and perfectionism are related. In addition, only one study found a weak relationship between ON and perfectionism. However, for more comprehensive findings on the relationship between orthorexia nervosa and perfectionism, cross-cultural studies are needed. Finally, the concept of perfectionism, which is effective in the development of orthorexia nervosa, may be a guide for effective treatment techniques.

Keywords

Eating disorders, orthorexia, orthorexia nervosa, perfectionism, systematic review

Ortoreksiya Nervoza ve Mükemmeliyetçilik: Sistematik Bir Gözden Geçirme

Abstract

Ortoreksiya nervoza, sağlıklı beslenmeye yönelik patolojik bir saplantı şeklinde tanımlanmaktadır. Ortoreksiya nervozanın gelişiminde birçok risk faktörünün etkili olduğu bilinmektedir. Bu çalışmada, ortoreksiya nervozanın gelişiminde etkisi olduğu düşünülen mükemmeliyetçiliğin rolünün daha iyi anlaşılması amaçlanmıştır. Bu bağlamda, ortoreksiya nervoza ile mükemmeliyetçilik ilişkisini ele alan çalışmalar gözden geçirilmiştir. PubMed, Wiley Online Library ve SageJournals veri tabanlarında arama yapılmıştır. Taramada “orthorexia”, “orthorexia nervosa”, “pathologically healthy eating” ve “perfectionism” anahtar sözcükleri kullanılmıştır. Tarama sonucunda, ortoreksiya nervoza ile mükemmeliyetçilik arasındaki ilişkiyi ele alan 17 çalışma incelenmiştir. Çalışmalar örneklem özellikleri, çalışma deseni, ortoreksiya nervoza ölçüm araçları ve çalışma sonuçları açısından değerlendirilmiştir. Çalışmaların sonuçlarına bakıldığında ortoreksiya nervoza ve mükemmeliyetçiliğin ilişkili olduğu görülmektedir. Ayrıca incelenen çalışmalardan yalnızca bir çalışmada ortoreksiya nervoza ile mükemmeliyetçilik arasında zayıf düzeyde bir ilişki olduğu belirlenmiştir. Bununla birlikte, ortoreksiya nervoza ve mükemmeliyetçilik ilişkisine dair daha kapsamlı sonuçlar elde etmek için kültürlerarası yürütülen çalışmalara ihtiyaç olduğu görülmektedir. Son olarak ortoreksiya nervozanın gelişiminde etkili olduğu düşünülen mükemmeliyetçilik kavramının etkili tedavi stratejileri izlenmesinde yol gösterici olabileceği düşünülmektedir.

Keywords

Yeme bozuklukları, ortoreksiya, ortoreksiya nervoza, mükemmeliyetçilik, sistematik gözden geçirme

References

• Afshin A, Micha R, Khatibzadeh S, Mozaffarian D (2014) Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis. Am J Clin Nutr, 100:278-288.
• Almeida C, Vieira Borba V, Santos L (2018) Orthorexia nervosa in a sample of Portuguese fitness participants. Eat Weight Disord, 23:443-451.
• Alvarenga MS, Martins MCT, Sato KSCJ, 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, 17:29-35.
• APA (2013) Diagnostic and Statistical Manual of Mental Disordersi Fifthe edition (DSM-5). Washington, DC, American Psychiatric Association.
• Anil C, Aritici G, Ari H, Tutuncu NB (2015) Prevalence of orthorexia in diabetic patients. In Endocr Abstr, 37:327.
• Arusoğlu G, Kabakçi E, Köksal G, Merdol TK (2008) Orthorexia nervosa and adaptation of ORTO-11 into Turkish. Turk Psikiyatri Derg, 19:283-291.
• Bardone-Cone AM, Wonderlich SA, Frost RO, Bulik CM, Mitchell JE, Uppala S et al. (2007) Perfectionism and eating disorders: Current status and future directions. Clin Psychol Rev, 27:384-405.
• Barnes MA, Caltabiano ML (2017) The interrelationship between orthorexia nervosa, perfectionism, body image and attachment style. Eat Weight Disord, 22:177-184.
• 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.
• Bartel SJ, Sherry SB, Farthing GR, Stewart SH (2020) Classification of orthorexia nervosa: further evidence for placement within the eating disorders spectrum. Eat Behav, 38:101406.
• Barthels F, Barrada, J. R, Roncero M (2019) Orthorexia nervosa and healthy orthorexia as new eating styles. PloS One, 14: e0219609.
• Bona E, Tury F, Forgacs A (2019) Evolutionary aspects of a new eating disorder: orthorexia nervosa in the 21st century. Psychological Thoughts, 12:152–161.
• Bosi ATB, Camur D, Güler C (2007) Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine (Ankara, Turkey). Appetite, 49:661-666.
• Botchlett R, Woo, SL, Liu M, Pei Y, Guo X, Li H et al. (2017) Nutritional approaches for managing obesity-associated metabolic diseases. J Endocrinol, 233:145-171.
• Bratman S (1997) Health Food Junkie: Obsession with dietary perfection can sometimes do more harm than good, says one who has been there. Yoga Journal, 136:42-50.
• Bratman S, Knight D (2000) Health Food Junkies: Overcoming the Obsession with Healthful Eating. New York, Broadway Books.
• Bratman S (2017) Orthorexia vs. theories of healthy eating. Eat Weight Disord, 22:381-385.
• Brown AJ, Parman KM, Rudat DA, Craighead LW (2012) Disordered eating, perfectionism, and food rules. Eat Behav, 13:347-353.
• Brug J (2008) Determinants of healthy eating: motivation, abilities and environmental opportunities. Fam Pract, 25:50-55.
• Brustein M (2013) Perfectionism: A guide for mental health professionals. Cham, Springer.
• Brytek-Matera A (2012) Orthorexia nervosa–an eating disorder, obsessive-compulsive disorder or disturbed eating habit. Arch Psychiatry Psychother, 1:55-60.
• Brytek-Matera A, Staniszewska A, Hallit S (2020a) Identifying the profile of orthorexic behavior and “normal” eating behavior with cluster analysis: A cross-sectional study among polish adults. Nutrients, 12:3490.
• Brytek-Matera A, Onieva-Zafra, MD, Parra-Fernández ML, Staniszewska, A. Modrzejewska, J, Fernández-Martínez E (2020b) Evaluation of orthorexia nervosa and symptomatology associated with eating disorders among European university students: a multicentre cross-sectional study. Nutrients, 12:3716.
• Brytek-Matera A, Pardini S, Modrzejewska J, Modrzejewska A, Szymańska P, Czepczor-Bernat et al. (2022) Orthorexia nervosa and its association with obsessive–compulsive disorder symptoms: initial cross-cultural comparison between Polish and Italian university students. Eat Weight Disord, 27:913-927.
• Bulik CM, Tozzi F, Anderson C, Mazzeo SE, Aggen S, Sullivan PF (2003) The relation between eating disorders and components of perfectionism. Am J Psychiatry, 160:366-368.
• Cassin SE, von Ranson KM (2005) Personality and eating disorders: a decade in review. Clin Psychol Rev, 25:895-916.
• Catalina Zamora ML, Bonaechea BB, Sánchez FG, Rial BR (2005) Orthorexia nervosa. A new eating behavior disorder? Actas Esp Psiquiatr, 33:66-68.
• Cena H, Barthels F, Cuzzolaro M, Bratman S, Brytek-Matera A, Dunn T et al. (2019) Definition and diagnostic criteria for orthorexia nervosa: a narrative review of the literature. Eat Weight Disord, 24:209-246.
• Costa CB, Hardan-Khalil K, Gibbs K (2017) Orthorexia nervosa: a review of the literature. Issues Ment Health Nurs, 38:980-988.
• Dell’Osso L, Abelli M, Carpita B, Pini S, Castellini G, Carmassi C et al. (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.
• 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, 22:193-199.
• DiBartolo PM, Rendón MJ (2012) A critical examination of the construct of perfectionism and its relationship to mental health in Asian and African Americans using a cross-cultural framework. Clin Psychol Rev, 32:139-152.
• Domingues RB, Carmo C (2021) Orthorexia nervosa in yoga practitioners: relationship with personality, attitudes about appearance, and yoga engagement. Eat Weight Disord, 26:789-795.
• Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C (2005) Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord, 10:28-32.
• Dunn TM, Bratman S (2016) On orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eat Behav, 21:11-17.
• 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, 22:185-192.
• Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F et al (2013) Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med, 368:1279-1290.
• Fairburn CG, Cooper Z, Shafran R (2003) Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behav Res Ther, 41:509-528.
• Farstad SM, McGeown LM, von Ranson KM (2016) Eating disorders and personality, 2004–2016: A systematic review and meta-analysis. Clin Psychol Rev, 46:91-105.
• Fidan T, Ertekin V, Işikay S, Kırpınar I (2010) Prevalence of orthorexia among medical students in Erzurum, Turkey. Compr Psychiatry, 51:49-54.
• Flett GL, Nepon T, Hewitt PL, Fitzgerald K (2016) Perfectionism, components of stress reactivity, and depressive symptoms. J Psychopathol Behav Assess, 38:645-654.
• Frost RO, Marten PA (1990) Perfectionism and evaluative threat. Cognitive therapy and research, 14:559-572.
• Gonzalez CA, Riboli E (2010) Diet and cancer prevention: Contributions from the European prospective investigation into cancer and nutrition (EPIC) study. Eur J Cancer, 46:2555-2562.
• 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 Cogn Psychother, 31:124-135.
• Hessler-Kaufmann JB, Meule A, Holzapfel C, Brandl B, Greetfeld M, Skurk, T et al. (2021) Orthorexic tendencies moderate the relationship between semi-vegetarianism and depressive symptoms. Eat Weight Disord, 26:623-628.
• Keller MF, Konradsen H (2013) Ortoreksi blandt unge fitness-medlemmer. Klin Sygepleje, 27:63-71.
• Koven N, Senbonmatsu R (2013) A neuropsychological evaluation of orthorexia nervosa. Open J Psychiatry, 3:214-222.
• Koven NS, Abry AW (2015) The clinical basis of orthorexia nervosa: Emerging perspectives. Neuropsychiatr Dis Treat, 11:385–394.
• Lanigan J, Singhal A (2009) Early nutrition and long-term health: A practical approach: Symposium on ‘Early nutrition and later disease: Current concepts, research and implications’. Proc Nutr Soc, 68:422-429.
• Levinson CA, Zerwas S, Calebs B, Forbush K, Kordy H, Watson H et al. (2017) The core symptoms of bulimia nervosa, anxiety, and depression: a network analysis. J Abnorm Psychol, 126:340-354.
• Limburg K, Watson HJ, Hagger MS, Egan SJ (2017) The relationship between perfectionism and psychopathology: A meta‐analysis. J Clin Psychol, 73:1301-1326.
• Lilenfeld LR, Wonderlich S, Riso LP, Crosby R, Mitchell J (2006) Eating disorders and personality: a methodological and empirical review. Clin Psychol Rev, 26:299-320.
• 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.
• Mavrandrea P, Gonidakis F (2023) Exercise dependence and orthorexia nervosa in Crossfit: exploring the role of perfectionism. Curr Psychol, 42:25151-25159.
• McComb SE, Mills JS (2019) Orthorexia nervosa: A review of psychosocial risk factors. Appetite, 140:50-75.
• Mente A, de Koning L, Shannon HS, Anand SS (2009) A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med, 169:659-669.
• Miley M, Egan H, Wallis D, Mantzios M (2022) Orthorexia nervosa, mindful eating, and perfectionism: An exploratory investigation. Eat Weight Disord, 27:2869-2878.
• Moroze RM, Dunn TM, Holland JC, 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, 56:397-403.
• Nosrati N, Bakovic M, Paliyath G (2017) Molecular mechanisms and pathways as targets for cancer prevention and progression with dietary compounds. Int J Mol Sci, 18:20-50.
• Novara C, Maggio E, Piasentin S, Pardini S, Mattioli S (2021) Orthorexia nervosa: differences between clinical and non-clinical samples. BMC Psychiatry, 21:341.
• Novara C, Mattioli S, Piasentin S, Pardini S, Maggio E (2022) The role of dieting, psychopathological characteristics and maladaptive personality traits in orthorexia nervosa. BMC Psychiatry, 22:290.
• Novara C, Piasentin S, Mattioli S, Pardini S, Maggio E (2023) Perfectionism or perfectionisms in orthorexia nervosa. Nutrients, 15:3289.
• Oberle CD, Samaghabadi RO, Hughes EM (2017) Orthorexia nervosa: Assessment and correlates with gender, BMI, and personality. Appetite, 108:303-310.
• Plichta M, Jezewska-Zychowicz M (2019) Eating behaviors, attitudes toward health and eating, and symptoms of orthorexia nervosa among students. Appetite, 137:114-123.
• Pratt VB, Madigan DJ, Hill AP (2022) Perfectionistic self-presentation and orthorexia in exercisers. Eat Weight Disord, 27:1217-1221.
• Schwingshackl L, Missbach B, König J, Hoffmann G (2015) Adherence to a Mediterranean diet and risk of diabetes: A systematic review and meta-analysis. Public Health Nutr, 18:1292-1299.
• Stice E (2002) Risk and maintenance factors for eating pathology: A meta-analytic review. Psychol Bull, 128:825-848
• Stoeber J. Madigan DJ, Damian LE, Esposito RM, Lombardo C (2017) Perfectionism and eating disorder symptoms in female university students: The central role of perfectionistic self-presentation. Eat Weight Disord, 22:641-648.
• Strahler J, Hermann A, Walter B, Stark R (2018) Orthorexia nervosa: A behavioral complex or a psychological condition?. J Behav Addict, 7:1143-1156.
• Strahler J, Haddad C, Salameh P, Sacre H, Obeid S, Hallit S (2020) Cross-cultural differences in orthorexic eating behaviors: Associations with personality traits. Nutrition, 77:110811.
• Turner PG, Lefevre CE (2017) Instagram use is linked to increased symptoms of orthorexia nervosa. Eat Weight Disord, 22:277-284.
• Vaillancourt C, Bédard A, Bélanger-Gravel A, Provencher V, Bégin, C, Desroches, S et al. (2019) Promoting healthy eating in adults: An evaluation of pleasure-oriented versus health-oriented messages. Curr Dev Nutr, 3:12.
• Valente M, Syurina EV, Donini LM (2019) Shedding light upon various tools to assess orthorexia nervosa: A critical literature review with a systematic search. Eat Weight Disord, 24:671-682.
• 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, 19:469-472.
• Varga M, Dukay-Szabó S, Túry F, van Furth Eric F (2013) Evidence and gaps in the literature on orthorexia nervosa. Eat Weight Disord, 18:103-111.