Background
To achieve a better differential diagnosis of eating disorders, investigating the various subtypes and developing specific assessment tools to measure specific symptoms is necessary. Orthorexia nervosa (ON) is an alleged eating disorder in which the person is excessively preoccupied with healthy food. First described by Bratman in 1997, ON entails a fixation on healthy food or a health food dependence. The term orthorexia nervosa arises from the words orthos (=accurate) and orexis (=hunger) meaning obsession with healthy food and proper nutrition. Fears and worries about health, eating, and the quality of food are significant.
In extreme cases, the obsessive and compulsive characteristics of ON become pathological and dominate a person's life. The preoccupation with quality of food and eating healthy comprise the principal elements of this disorder. The pathological obsession with biologically pure food and shops which sell it leads to a special lifestyle. Stringent dietary restrictions and eating plans, combined with a personality and attitude of superiority and obsessive-phobic behavioral characteristics define the core of ON. Transgressing the dietary rules leads to intense anxiety, feelings of guilt and shame and is followed by even more stringent dietary restrictions.
At present, ON is not a formal disorder, but more and more clinical reports related to it have appeared as it becomes more and more familiar to health care professionals. There is no consensus on the categorization of ON among mental disorders or even if it is a mental disorder. ON was debated on whether or not it should have a place in the recently published DSM-5. In sum, ON is a new and controversial concept.
Two instruments have been developed to assess ON. The Bratman test is based mostly on clinical experience, and its validity has not been investigated by the author himself or by others. In 2005, Donini and colleagues developed the ORTO-15 based on Bratman's test. However, this instrument also includes items not specifically characteristic of ON making the face validity of the test doubtful. The ORTO-11 scale, the only foreign language (Turkish) adaptation of the ORTO-15 to date, was designed after omitting four non-ON-specific items based on statistical considerations. In addition, the psychometric properties of the ORTO-15 have only been partially examined by the original test authors. Due to not having a well-defined group of individuals with ON for this purpose, Donini and colleagues proposed a cutoff point to distinguish between individuals with or without ON based on the interrelationship of ORTO-15 scores with obsessive-phobic personality traits as measured by the Minnesota Multiphasic Personality Inventory. A further limitation of the documentation is the inadequate description of the scoring method.
Some clinical studies have also been carried out to better understand the characteristics of ON. These suggest that the difference between an ON sufferer and a health-conscious person include the extreme preoccupation with and the judging attitude towards others who do not follow a healthy diet. These studies also provide recommendations for distinguishing ON from anorexia nervosa, psychosis, and poisoning fears.
The aim of the present study was to describe the adaptation process of the ORTO-15 into Hungarian and to investigate the psychometric properties of this version in a large Hungarian sample. We investigated the relationship between the ORTO-15 and ON features such as food choices and nutritional supplement use, alcohol, drug, and cigarette use, and some demographic variables, and added supplemental ON specific questions to examine external criteria for ON. We hypothesized that individuals who have a tendency for ON, in addition to making healthier food choices, refuse to use drugs, alcohol, cigarettes, and take more nutritional supplements, engage in more sports activity and have more dietary restrictions than those without a tendency for ON. Beyond the psychometric aspects, we also intended to improve the knowledge in the field concerning cultural differences, the investigating of which is largely missing from the literature on ON.