A consensus document on definition and diagnostic criteria for orthorexia nervosa

• Type of Material: Article
• Authors: Lorenzo M Donini, Sapienza Univ; Juan Ramón Barrada, University of Zaragoza; Friederike Barthels, Heinrich Heine University Dusseldorf; Thomas M Dunn, University of Northern Colorado; Camille Babeau, Ecole Psychologues Praticiens; Anna Brytek-Matera, University of Wroclaw; Hellas Cena, University of Pavia; Silvia Cerolini, Sapienza University; Hye-Hun Cho, Chung Ang University; Maria Coimbra, University of Coimbra; Massimo Cuzzolaro, Sapienza University; Claudia Ferreira, University of Coimbra; Valeria Galfano, Sapienza University; Maria G Grammatikopoulou, University of Thessaly; Souheil Hallit, Holy Spirit Univ Kaslik; Linn Håman, Halmstad University; Phillipa Hay, Western Sydney University; Masahito Jimbo, University of Michigan; Clotilde Lasson, University of Toulouse-Jean Jaures; Eva-Carin Lindgren, Halmstad University; Renee McGregor, The EN:SPIRE Clinic; Mariannna Minnetti, Sapienza University; Edoardo Mocini, Sapienza University; Sahar Obeid, Lebanese American University; Crystal D Oberle, Texas State University; Maria-Dolores Onieva-Zafra, University of Castilla-La Mancha; Marie-Christine Opitz, University of Edinburgh; María-Laura Parra-Fernández, University of Castilla-La Mancha; Reinhard Pietrowsky, Heinrich Heine University Dusseldorf; Natalija Plasonja, University of Bordeaux; Eleonora Poggiogalle, Sapienza University; Adrien Rigó, Eotvos Lorand University; Rachel F Rodgers, Northeastern University; Maria Roncero, University of Valencia; Carmina Saldaña, University of Barcelona; Cristina Segura-Garcia, University of Catanzaro; Jessica Setnick, nternational Federation of Eating Disorder Dietitians, Dallas; Ji-Yeon Shin, Chung-Ang University; Grazia Spitoni, Sapienza University; Jana Strahler, University of Freiburg; Nanette Stroebele-Benschop, University Hohenheim; Patrizia Todisco, Casa Cura Villa Margherita; Mariacarolina Vacca, Sapienza University; Martina Valente, Amedeo Avogadro Univ Eastern Piedmont; Màrta Varga, Semmelweis University; Andrea Zagaria, Sapienza Univ; Hannah Zickgraf, Emory University; Rebecca Reynolds, UNSW Sydney; Caterina Lombardo, Sapienza University
• Language: English
• Date: 2022-11-27
• Publisher: SPRINGER
• Publication Version: Final Published Version
• Copyright Statement: © Springer Nature Switzerland AG 2023
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1007/s40519-022-01512-5
• Title of Journal or Parent Work: EATING AND WEIGHT DISORDERS-STUDIES ON ANOREXIA BULIMIA AND OBESITY
• Volume: 27
• Issue: 8
• Start Page: 3695
• End Page: 3711
• Keywords: Orthorexia nervosa (ON); Science & Technology; BODY-IMAGE; Feeding and eating disorders (F&ED); Psychiatry; Avoidant restrictive food intake disorder (ARFID); Obsessive-compulsive disorder (OCD); EATING-DISORDER; Eating disorder; Life Sciences & Biomedicine; Anorexia nervosa (AN); PREVALENCE
• Research Categories: Health Sciences, Medicine and Surgery; Psychology, General

Abstract

Purpose: Since the term orthorexia nervosa (ON) was coined from the Greek (ὀρθός, right and ὄρεξις, appetite) in 1997 to describe an obsession with “correct” eating, it has been used worldwide without a consistent definition. Although multiple authors have proposed diagnostic criteria, and many theoretical papers have been published, no consensus definition of ON exists, empirical primary evidence is limited, and ON is not a standardized diagnosis. These gaps prevent research to identify risk and protective factors, pathophysiology, functional consequences, and evidence-based therapeutic treatments. The aims of the current study are to categorize the common observations and presentations of ON pathology among experts in the eating disorder field, propose tentative diagnostic criteria, and consider which DSM chapter and category would be most appropriate for ON should it be included. Methods: 47 eating disorder researchers and multidisciplinary treatment specialists from 14 different countries across four continents completed a three-phase modified Delphi process, with 75% agreement determined as the threshold for a statement to be included in the final consensus document. In phase I, participants were asked via online survey to agree or disagree with 67 statements about ON in four categories: A–Definition, Clinical Aspects, Duration; B–Consequences; C–Onset; D–Exclusion Criteria, and comment on their rationale. Responses were used to modify the statements which were then provided to the same participants for phase II, a second round of feedback, again in online survey form. Responses to phase II were used to modify and improve the statements for phase III, in which statements that met the predetermined 75% of agreement threshold were provided for review and commentary by all participants. Results: 27 statements met or exceeded the consensus threshold and were compiled into proposed diagnostic criteria for ON. Conclusions: This is the first time a standardized definition of ON has been developed from a worldwide, multidisciplinary cohort of experts. It represents a summary of observations, clinical expertise, and research findings from a wide base of knowledge. It may be used as a base for diagnosis, treatment protocols, and further research to answer the open questions that remain, particularly the functional consequences of ON and how it might be prevented or identified and intervened upon in its early stages. Although the participants encompass many countries and disciplines, further research will be needed to determine if these diagnostic criteria are applicable to the experience of ON in geographic areas not represented in the current expert panel. Level of evidence: Level V: opinions of expert committees.