A consensus document on definition and diagnostic criteria for orthorexia nervosa
Lorenzo Donini
(1)
,
Juan Ramón Barrada
(2)
,
Friederike Barthels
(3)
,
Thomas Dunn
(4)
,
Camille Babeau
(5)
,
Anna Brytek-Matera
(6)
,
Hellas Cena
(7, 8)
,
Silvia Cerolini
(9)
,
Hye-Hyun Cho
(10)
,
Maria Coimbra
(11)
,
Massimo Cuzzolaro
(1)
,
Claudia Ferreira
(11)
,
Valeria Galfano
(1)
,
Maria Grammatikopoulou
(12)
,
Souheil Hallit
(13)
,
Linn Håman
(14)
,
Phillipa Hay
(15)
,
Masahito Jimbo
(16)
,
Clotilde Lasson
(17)
,
Eva-Carin Lindgren
(14)
,
Renee Mcgregor
(18)
,
Marianna Minnetti
(1)
,
Edoardo Mocini
(1)
,
Sahar Obeid
(19)
,
Crystal Oberle
(20)
,
Maria-Dolores Onieva-Zafra
(21)
,
Marie-Christine Opitz
(22)
,
María-Laura Parra-Fernández
(21)
,
Reinhard Pietrowsky
(3)
,
Natalija Plasonja
(23)
,
Eleonora Poggiogalle
(1)
,
Adrien Rigó
(24)
,
Rachel Rodgers
(25)
,
Maria Roncero
(26)
,
Carmina Saldaña
(27)
,
Cristina Segura-Garcia
(28)
,
Jessica Setnick
(29)
,
Ji-Yeon Shin
(10)
,
Grazia Spitoni
(1)
,
Jana Strahler
(30)
,
Nanette Stroebele-Benschop
(31)
,
Patrizia Todisco
(32)
,
Mariacarolina Vacca
(1)
,
Martina Valente
(33)
,
Màrta Varga
(34)
,
Andrea Zagaria
(1)
,
Hana Flynn Zickgraf
(35)
,
Rebecca Reynolds
(36)
,
Caterina Lombardo
(1)
1
UNIROMA -
Università degli Studi di Roma "La Sapienza" = Sapienza University [Rome]
2 Universidad de Zaragoza = University of Zaragoza [Saragossa University] = Université de Saragosse
3 Heinrich Heine Universität Düsseldorf = Heinrich Heine University [Düsseldorf]
4 UNCO - University of Northern Colorado
5 Ecole de psychologues praticiens, Lyon
6 UWr - University of Wrocław [Poland]
7 UNIPV - Università degli Studi di Pavia = University of Pavia
8 IRCCS Pavia - ICS Maugeri - Istituti Clinici Scientifici Maugeri [Pavia]
9 Department of Psychology [University of Roma "La Sapienza"]
10 CAU - Chung-Ang University
11 Universidade de Coimbra [Coimbra]
12 University of Thessaly [Larissa]
13 Holy-Spirit University of Kaslik [Jounieh]
14 Halmstad University
15 Western Sydney University
16 University of Michigan [Ann Arbor]
17 CERPPS - Centre d’Etudes et de Recherches en Psychopathologie et Psychologie de la Santé
18 The EN:SPIRE Clinic, Bengaluru
19 AUB - American University of Beirut [Beyrouth]
20 Texas State University
21 UCLM - Universidad de Castilla-La Mancha = University of Castilla-La Mancha
22 Edin. - University of Edinburgh
23 UB - Université de Bordeaux
24 ELTE - Eötvös Loránd University
25 Northeastern University [Boston]
26 UV - Universitat de València
27 UB - Universitat de Barcelona
28 UMG - Università degli Studi "Magna Graecia" di Catanzaro = University of Catanzaro
29 international federation of eating disorders dietitians, Dallas
30 Albert-Ludwigs-Universität Freiburg = University of Freiburg
31 Universität Hohenheim
32 Cassa Di Cura Villa Margherita, Vicenza
33 Amedeo Avogadro University of Eastern Piedmont
34 Semmelweis University [Budapest]
35 Children's Healthcare of Atlanta [Atlanta, GA, USA]
36 School of Population Health, UNSW Sydney, Sydney, NSW 2052
2 Universidad de Zaragoza = University of Zaragoza [Saragossa University] = Université de Saragosse
3 Heinrich Heine Universität Düsseldorf = Heinrich Heine University [Düsseldorf]
4 UNCO - University of Northern Colorado
5 Ecole de psychologues praticiens, Lyon
6 UWr - University of Wrocław [Poland]
7 UNIPV - Università degli Studi di Pavia = University of Pavia
8 IRCCS Pavia - ICS Maugeri - Istituti Clinici Scientifici Maugeri [Pavia]
9 Department of Psychology [University of Roma "La Sapienza"]
10 CAU - Chung-Ang University
11 Universidade de Coimbra [Coimbra]
12 University of Thessaly [Larissa]
13 Holy-Spirit University of Kaslik [Jounieh]
14 Halmstad University
15 Western Sydney University
16 University of Michigan [Ann Arbor]
17 CERPPS - Centre d’Etudes et de Recherches en Psychopathologie et Psychologie de la Santé
18 The EN:SPIRE Clinic, Bengaluru
19 AUB - American University of Beirut [Beyrouth]
20 Texas State University
21 UCLM - Universidad de Castilla-La Mancha = University of Castilla-La Mancha
22 Edin. - University of Edinburgh
23 UB - Université de Bordeaux
24 ELTE - Eötvös Loránd University
25 Northeastern University [Boston]
26 UV - Universitat de València
27 UB - Universitat de Barcelona
28 UMG - Università degli Studi "Magna Graecia" di Catanzaro = University of Catanzaro
29 international federation of eating disorders dietitians, Dallas
30 Albert-Ludwigs-Universität Freiburg = University of Freiburg
31 Universität Hohenheim
32 Cassa Di Cura Villa Margherita, Vicenza
33 Amedeo Avogadro University of Eastern Piedmont
34 Semmelweis University [Budapest]
35 Children's Healthcare of Atlanta [Atlanta, GA, USA]
36 School of Population Health, UNSW Sydney, Sydney, NSW 2052
Résumé
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