A consensus document on definition and diagnostic criteria for orthorexia nervosa
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 m...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Springer
2022-11-01
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| Series: | Eating and Weight Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1007/s40519-022-01512-5 |
| _version_ | 1797682614080897024 |
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| author | Lorenzo M. Donini Juan Ramón Barrada Friederike Barthels Thomas M. Dunn Camille Babeau Anna Brytek-Matera Hellas Cena Silvia Cerolini Hye-hyun Cho Maria Coimbra Massimo Cuzzolaro Claudia Ferreira Valeria Galfano Maria G. Grammatikopoulou Souheil Hallit Linn Håman Phillipa Hay Masahito Jimbo Clotilde Lasson Eva-Carin Lindgren Renee McGregor Marianna Minnetti Edoardo Mocini Sahar Obeid Crystal D. Oberle Maria-Dolores Onieva-Zafra Marie-Christine Opitz María-Laura Parra-Fernández Reinhard Pietrowsky Natalija Plasonja Eleonora Poggiogalle Adrien Rigó Rachel F. Rodgers Maria Roncero Carmina Saldaña Cristina Segura-Garcia Jessica Setnick Ji-Yeon Shin Grazia Spitoni Jana Strahler Nanette Stroebele-Benschop Patrizia Todisco Mariacarolina Vacca Martina Valente Màrta Varga Andrea Zagaria Hana Flynn Zickgraf Rebecca C. Reynolds Caterina Lombardo |
| author_facet | Lorenzo M. Donini Juan Ramón Barrada Friederike Barthels Thomas M. Dunn Camille Babeau Anna Brytek-Matera Hellas Cena Silvia Cerolini Hye-hyun Cho Maria Coimbra Massimo Cuzzolaro Claudia Ferreira Valeria Galfano Maria G. Grammatikopoulou Souheil Hallit Linn Håman Phillipa Hay Masahito Jimbo Clotilde Lasson Eva-Carin Lindgren Renee McGregor Marianna Minnetti Edoardo Mocini Sahar Obeid Crystal D. Oberle Maria-Dolores Onieva-Zafra Marie-Christine Opitz María-Laura Parra-Fernández Reinhard Pietrowsky Natalija Plasonja Eleonora Poggiogalle Adrien Rigó Rachel F. Rodgers Maria Roncero Carmina Saldaña Cristina Segura-Garcia Jessica Setnick Ji-Yeon Shin Grazia Spitoni Jana Strahler Nanette Stroebele-Benschop Patrizia Todisco Mariacarolina Vacca Martina Valente Màrta Varga Andrea Zagaria Hana Flynn Zickgraf Rebecca C. Reynolds Caterina Lombardo |
| author_sort | Lorenzo M. Donini |
| collection | DOAJ |
| description | 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 |
| first_indexed | 2024-03-12T00:03:22Z |
| format | Article |
| id | doaj.art-9e2302ea2a814571bf633fb7ab99b4d9 |
| institution | Directory Open Access Journal |
| issn | 1590-1262 |
| language | English |
| last_indexed | 2024-03-12T00:03:22Z |
| publishDate | 2022-11-01 |
| publisher | Springer |
| record_format | Article |
| series | Eating and Weight Disorders |
| spelling | doaj.art-9e2302ea2a814571bf633fb7ab99b4d92023-09-17T11:04:08ZengSpringerEating and Weight Disorders1590-12622022-11-012783695371110.1007/s40519-022-01512-5A consensus document on definition and diagnostic criteria for orthorexia nervosaLorenzo M. Donini0Juan Ramón Barrada1Friederike Barthels2Thomas M. Dunn3Camille Babeau4Anna Brytek-Matera5Hellas Cena6Silvia Cerolini7Hye-hyun Cho8Maria Coimbra9Massimo Cuzzolaro10Claudia Ferreira11Valeria Galfano12Maria G. Grammatikopoulou13Souheil Hallit14Linn Håman15Phillipa Hay16Masahito Jimbo17Clotilde Lasson18Eva-Carin Lindgren19Renee McGregor20Marianna Minnetti21Edoardo Mocini22Sahar Obeid23Crystal D. Oberle24Maria-Dolores Onieva-Zafra25Marie-Christine Opitz26María-Laura Parra-Fernández27Reinhard Pietrowsky28Natalija Plasonja29Eleonora Poggiogalle30Adrien Rigó31Rachel F. Rodgers32Maria Roncero33Carmina Saldaña34Cristina Segura-Garcia35Jessica Setnick36Ji-Yeon Shin37Grazia Spitoni38Jana Strahler39Nanette Stroebele-Benschop40Patrizia Todisco41Mariacarolina Vacca42Martina Valente43Màrta Varga44Andrea Zagaria45Hana Flynn Zickgraf46Rebecca C. Reynolds47Caterina Lombardo48Sapienza UniversityUniversidad de ZaragozaHeinrich Heine University DüsseldorfUniversity of Northern ColoradoEcole de Psychologues PraticiensUniversity of WroclawUniversity of PaviaSapienza UniversityChung-Ang UniversityUniversity of Coimbra, CINEICCSapienza UniversityUniversity of CoimbraSapienza UniversityUniversity of ThessalyHoly Spirit University of KaslikHalmstad UniversityWestern Sydney UniversityUniversity of MichiganUniversity of Toulouse-Jean JaurèsHalmstad UniversityThe EN:SPIRE ClinicSapienza UniversitySapienza UniversityLebanese American UniversityTexas State UniversityUniversity of Castilla-La ManchaThe University of EdinburghUniversity of Castilla-La ManchaHeinrich Heine University DüsseldorfUniversity of BordeauxSapienza UniversityInstitute of Psychology, ELTE Eötvös Loránd UniversityNortheastern UniversityUniversity of ValenciaUniversitat de BarcelonaUniversity of CatanzaroInternational Federation of Eating Disorder DietitiansChung-Ang UniversitySapienza UniversityUniversity of FreiburgUniversity of HohenheimCasa Di Cura Villa MargheritaSapienza UniversityAmedeo Avogadro University of Eastern PiedmontSemmelweis UniversitySapienza UniversityChildren’s Healthcare of Atlanta, Emory UniversitySchool of Population Health, UNSW SydneySapienza UniversityAbstract 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 committeeshttps://doi.org/10.1007/s40519-022-01512-5Orthorexia nervosa (ON)Feeding and eating disorders (F&ED)Anorexia nervosa (AN)Obsessive–compulsive disorder (OCD)Avoidant restrictive food intake disorder (ARFID)Eating disorder |
| spellingShingle | Lorenzo M. Donini Juan Ramón Barrada Friederike Barthels Thomas M. Dunn Camille Babeau Anna Brytek-Matera Hellas Cena Silvia Cerolini Hye-hyun Cho Maria Coimbra Massimo Cuzzolaro Claudia Ferreira Valeria Galfano Maria G. Grammatikopoulou Souheil Hallit Linn Håman Phillipa Hay Masahito Jimbo Clotilde Lasson Eva-Carin Lindgren Renee McGregor Marianna Minnetti Edoardo Mocini Sahar Obeid Crystal D. Oberle Maria-Dolores Onieva-Zafra Marie-Christine Opitz María-Laura Parra-Fernández Reinhard Pietrowsky Natalija Plasonja Eleonora Poggiogalle Adrien Rigó Rachel F. Rodgers Maria Roncero Carmina Saldaña Cristina Segura-Garcia Jessica Setnick Ji-Yeon Shin Grazia Spitoni Jana Strahler Nanette Stroebele-Benschop Patrizia Todisco Mariacarolina Vacca Martina Valente Màrta Varga Andrea Zagaria Hana Flynn Zickgraf Rebecca C. Reynolds Caterina Lombardo A consensus document on definition and diagnostic criteria for orthorexia nervosa Eating and Weight Disorders Orthorexia nervosa (ON) Feeding and eating disorders (F&ED) Anorexia nervosa (AN) Obsessive–compulsive disorder (OCD) Avoidant restrictive food intake disorder (ARFID) Eating disorder |
| title | A consensus document on definition and diagnostic criteria for orthorexia nervosa |
| title_full | A consensus document on definition and diagnostic criteria for orthorexia nervosa |
| title_fullStr | A consensus document on definition and diagnostic criteria for orthorexia nervosa |
| title_full_unstemmed | A consensus document on definition and diagnostic criteria for orthorexia nervosa |
| title_short | A consensus document on definition and diagnostic criteria for orthorexia nervosa |
| title_sort | consensus document on definition and diagnostic criteria for orthorexia nervosa |
| topic | Orthorexia nervosa (ON) Feeding and eating disorders (F&ED) Anorexia nervosa (AN) Obsessive–compulsive disorder (OCD) Avoidant restrictive food intake disorder (ARFID) Eating disorder |
| url | https://doi.org/10.1007/s40519-022-01512-5 |
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