Identifying psychological processes involved in orthorexia nervosa : a processual transdiagnostic approach
Résumé
Introduction : Orthorexia nervosa (OrNe) is a strong preoccupation with healthy diet with negative emotional, cognitive, and/or social consequences while trying to approach this goal and when the eating behavior deviates from it. Barrada and Roncero (2018) proposed to consider orthorexia as a bidimensional construct composed not only by a pathological dimension (OrNe), but also by a healthy dimension (“Healthy orthorexia”, HeOr, i.e., interest in and tendency to eat healthily). Research has shown that OrNe is positively associated with indicators of psychopathology, while HeOr was not associated or inversely associated with these indicators. Overlaps between OrNe and eating disorders (EDs) have been observed in the literature. Moreover, studies suggest that OrNe can be an antecedent or comorbid with an ED; similarly, OrNe can occur and/or intensify after treatment of EDs. Based on a transdiagnostic processual approach, it is likely that biological, social, and circumstantial factors, as well as psychopathological processes, are common and transdiagnostic elements across EDs and OrNe. This approach, illustrated by the mediating psychological processes model (Kinderman and Tai, 2007), stipulates that the influence of biological, social, and circumstantial factors on psychopathological disorders is not direct but mediated by transdiagnostic psychological processes. The aim of the current study is to investigate the role of the following psychological processes that could be common across OrNe and EDs: mental ruminations, intolerance of uncertainty, and perfectionism, using a bidimensional orthorexia scale. The contributive role as distal causes in OrNe of the following factors will also be investigated: biological factors (body mass index, gender, age, educational level), social factors (appearance-related pressure from family, media, peers, and significant others), and circumstantial factors (history of dieting, physical activity, history of traumatic experiences). Method: A sample of 511 participants (81.8% women) aged between 18 and 72 years (M=37.2, SD=14.6) responded to self-reported questionnaires: the Teruel Orthorexia Scale, the Eating Disorders Examination-Questionnaire, the Sociocultural Attitudes Towards Appearance Questionnaire, the Ruminative Response Scale for Eating Disorders, the Intolerance of Uncertainty Scale, the Multidimensionnal Perfectionism Scale, the Godin Shephard Leisure Time Physical Activity Questionnaire, as well as a socio-demographic questionnaire. Results: Results are currently being analyzed using exploratory structural equation modeling. Based on the literature on eating disorders, we expect that all factors and psychological processes correlate with OrNe (the latter to a larger degree) and that the association of distal factors to be mediated by psychological processes. Discussion: Results of this study will contribute to the identification and the understanding of risk factors associated with OrNe. Additionally, it is expected that the results will clarify similarities which could exist between OrNe and EDs, as well as contributing to the development of specific interventions for screening and prevention purposes. Conclusion: The results of this study could provide new clinical perspectives for the treatment of OrNe and EDs. This could contribute to creating clinical interventions based on common processes, rather on disorder, aiming towards a flexibility improvement of these processes. This type of approach may also help prevent relapses of these disorders.