ArticleEating and weight disorders : EWD2021
Does ORTO-15 produce valid data for 'Orthorexia Nervosa'? A mixed-method examination of participants' interpretations of the fifteen test items.
Article in Eating and weight disorders : EWD, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Overall proportion of orthorexia nervosa symptoms: A systematic review and meta-analysis including 30 476 individuals from 18 countries.Journal of global health · 2023Pooled it
- Problematic usage of the internet is associated with orthorexia nervosa tendency in adults.CNS spectrums · 2025Article
- Orthorexia Nervosa Tendencies in Two Cohorts of Polish Young Adults: A Comparative Analysis of Prevalence, Correlates, and Comorbidity.Nutrients · 2025Article
- The need for research on orthorexia nervosa: looking back, looking forward.Eating and weight disorders : EWD · 2025Article
- Patterns of implicit and explicit identity as a vegan or vegetarian in predicting healthy orthorexia and orthorexia nervosa.Eating and weight disorders : EWD · 2025Article
- Reliability generalization meta-analysis of orthorexia nervosa using the ORTO-11/12/15/R scale in all populations and language versions.Journal of eating disorders · 2024Article
- Perfectionism as a moderator of the relationship between orthorexia nervosa and obsessive-compulsive symptoms.Eating and weight disorders : EWD · 2024Article
- Maternal Bonding as a Protective Factor for Orthorexia Nervosa Risk in Dietetics Students.Nutrients · 2023Article
- Associations between Orthorexia Nervosa, Body Self-Image, Nutritional Beliefs, and Behavioral Rigidity.Nutrients · 2022Article
- Orthorexia nervosa is a concern in gastroenterology: A scoping review.Neurogastroenterology and motility · 2022Article
- Orthorexia nervosa: replication and validation of the ORTO questionnaires translated into Greek in a survey of 848 Greek individuals.Hormones (Athens, Greece) · 2022Article
- The #orthorexia community on Instagram.Eating and weight disorders : EWD · 2022Article
- Association between impulsivity and orthorexia nervosa: any moderating role of maladaptive personality traits?Eating and weight disorders : EWD · 2022Article
- Article
- The relation of orthorexia with lifestyle habits: Arabic versions of the Eating Habits Questionnaire and the Dusseldorf Orthorexia Scale.Journal of eating disorders · 2021Article
- Article
- Personality Profile in Orthorexia Nervosa and Healthy Orthorexia.Frontiers in psychology · 2021Article
- Assessing Orthorexia Nervosa: Validation of the Polish Version of the Eating Habits Questionnaire in a General Population Sample.Nutrients · 2020Article
- Article
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4 authors.
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No grant is acknowledged in the PubMed record.
Abstract
purposeOrthorexia Nervosa (ON) is defined as a pathological eating behaviour stemming from being "healthy" or "pure". Survey-based studies typically rely on the ORTO-15 questionnaire or its variations to detect orthorexia. However, frequent post-hoc adjustments to the ORTO-15 suggest psychometric problems. In this study, we explored people's cognitions about the ORTO-15 items to (1) identify problems specific to ORTO-15 items and (2) explore participants' understanding of ON symptoms.
methodsFifty adult participants (40% male, mean age = 34.0 ± 14.4 years) completed the ORTO-15, the Eating Attitudes Test (EAT-26) and the Obsessive-Compulsive Inventory-Revised edition (OCI-R). Qualitative data were collected using the modified "think aloud" protocol, which asked participants to 'verbalise' their responses to the ORTO-15 items. These qualitative responses were first analysed conjunctively with the quantitative responses; then subjected to thematic analysis.
resultsORTO-15 identified 64% of the participants for orthorexic tendencies. In most cases (76%), participants reported no issues completing the ORTO-15. However, in some cases, qualitative responses differed from quantitative ones. When people encountered problems, it was because of poor psychometric construction: lack of clarity, ambiguous wording and multiple statements in a single item. Elaborations around the ORTO-15 items formed four major themes: "preoccupation with physical appearance", "control", "food is fuel" and "alone, not isolated".
conclusionEven though in the majority of cases there were no issues with completing ORTO-15, thematic analysis revealed several discrepancies between our participants' perceptions of the ORTO-15 items and the previously proposed diagnostic criteria for ON. The results suggest that ORTO-15 is, at best, a mediocre screening tool for ON, which is sensitive to diet but fails to have sufficient level of specificity to detect the pathological stage. More accurate instruments are needed to further research on ON. LEVEL OF EVIDENCE: V (cross-sectional descriptive study with qualitative analysis).
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