Orthorexic tendencies in the general population: association with demographic data, psychiatric symptoms, and utilization of mental health services.

PURPOSE: Orthorexia nervosa (ON) is characterized by a preoccupation to eat healthily and restrictive eating habits despite negative psychosocial and physical consequences. As a relatively new construct, its prevalence and correlates in the general population and the associated utilization of mental health services are unclear. METHODS: Adults from the general population completed the Düsseldorf Orthorexia Scale (DOS), the Patient Health Questionnaire (PHQ), the Short Eating Disorder Examination (SEED). RESULTS: Five-hundred eleven (63.4% female) participants with a mean age of 43.39 (SD = 18.06) completed the questionnaires. The prevalence of ON according to the DOS was 2.3%. Considering only effects of at least intermediate size, independent samples t-tests suggested higher DOS scores for persons with bulimia nervosa (p < .001, Cohen's d = 1.14), somatoform syndrome (p = .012, d = .60), and major depressive syndrome (compared p < .001, d = 1.78) according to PHQ as well as those who reported to always experience fear of gaining weight (p < .001, d = 1.78). The DOS score correlated moderately strong and positively with the PHQ depression (r = .37, p < .001) and stress (r = .33, p < .001) scores as well as the SEED bulimia score (r = .32, p < .001). In multivariate logistic regression analyses, only PHQ depression scores were associated with past psychotherapeutic or psychiatric treatment (OR = 1.20, p = .002) and intake of psychotropic medication in the last year (OR = 1.22, p = .013). CONCLUSIONS: The prevalence of ON was low compared to international studies but is in line with other non-representative German studies. Orthorexic tendencies related to general mental distress and eating disorder symptoms but were no independent reason for seeking treatment. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Orthorexic tendencies moderate the relationship between semi-vegetarianism and depressive symptoms.

PURPOSE: Vegetarianism and semi-vegetarianism (i.e., overly vegetarian diet with rare consumption of meat) have been repeatedly linked with depression. As the nature of this association is unclear, we explored whether orthorexic (i.e., pathologically healthful eating) tendencies and ecological/ethical motives to follow a vegetarian diet may moderate the relationship between (semi-)vegetarian diets and depressive symptoms. METHODS: Five-hundred eleven adults (63.4% females; 71.2% omnivores, 19.2% semi-vegetarians, 9.6% vegetarians) completed the Patient Health Questionnaire (PHQ-9) questionnaire-measuring depressive symptoms-and the Düsseldorf Orthorexia Scale (DOS)-measuring orthorexic tendencies. Based on respective questions, participants were categorized as omnivores, semi-vegetarians, and vegetarians (including vegans) and were asked to indicate whether they chose their diet based on ecological/ethical motives. Moderation analyses were carried out with PROCESS. RESULTS: Adjusted for age, sex, and body mass index, there was a statistically significant interaction effect between diet (omnivore vs. semi-vegetarianism vs. vegetarianism) and DOS scores when predicting PHQ depression scores. At low or medium DOS scores, diets did not differ in PHQ depression scores (all ps > 0.05). At high DOS scores, however, semi-vegetarians had higher PHQ depression scores than both omnivores (p = 0.002) and vegetarians (p < 0.001). The interaction between diet and ecological/ethical eating motives when predicting PHQ depression scores was not statistically significant (p = 0.41). CONCLUSION: Semi-vegetarians with strong orthorexic tendencies show more depressive symptoms than omnivores and vegetarians. The complex nature of the relationship between vegetarianism and depression requires further investigation. LEVEL OF EVIDENCE: III, case-control analytic studies.

Orthorexic tendencies in inpatients with mental disorders.

OBJECTIVE: Most research on orthorexia nervosa (ON)-the tendency to only eat foods that are perceived as healthy-has been based on non-clinical samples. Thus, we examined prevalence of and changes in orthorexic tendencies in a large sample of inpatients with mental disorders. Cross-sectional and longitudinal associations with body weight and eating disorder (ED) symptoms were tested in subgroups of inpatients with anorexia nervosa (AN) and bulimia nervosa (BN). METHODS: Inpatients (N = 1167) receiving disorder-specific treatment for disorders classified in the ICD-10 in F3, F4, or F5 completed the Düsseldorf Orthorexia Scale (DOS) at admission and a subset (N = 647) at discharge. ED patients completed the Eating Disorder Inventory-2 and their body weight and height was measured. RESULTS: Prevalence of ON was higher in ED patients than in all other groups, in which prevalence rates were similar to findings from the general population. Across ED groups, DOS scores decreased from admission to discharge, while there was no change in the other groups. In patients with BN, higher DOS scores related to lower BMI and predicted larger decreases in body dissatisfaction. Across ED groups, higher DOS scores related to higher body dissatisfaction and drive for thinness and predicted larger decreases in drive for thinness. CONCLUSION: Our results highlight that ON is part of the ED spectrum. Associations with core ED symptoms question the suggested exclusive health focus on eating in ON and its potential as a distinct diagnosis. Rather, ON may represent a phenomenological subtype of restrictive EDs.

Correction to: Dimensions within 24 weight history indices and their association with inpatient treatment outcome in adults with anorexia nervosa: analysis of routine data.

[This corrects the article DOI: 10.1186/s40337-019-0249-z.].

Measuring orthorexia nervosa: A comparison of four self-report questionnaires.

Orthorexia nervosa is characterized by a preoccupation to eat healthily. However, reliability and validity of some of the existing measures of orthorexic symptomatology are questionable. Therefore, the aim of the current study was to examine internal reliability of and intercorrelations between four of the most popular self-report scales for measuring orthorexia nervosa: Bratman's Orthorexia Test (BOT), the ORTO-15, the Eating Habits Questionnaire (EHQ), and the Düsseldorf Orthorexia Scale (DOS). Five-hundred and eleven adults (63% female) completed all four instruments. Model fit of the originally proposed factor structures of the BOT, DOS, and EHQ was good but was unacceptable for the ORTO-15. Similarly, internal reliability was good for the BOT, EHQ, and DOS, but was unacceptable for the ORTO-15. The BOT, EHQ, and DOS were highly correlated with each other while correlations with the ORTO-15 were of medium size. A subsequent exploratory item analysis suggested that the poor psychometric properties of the ORTO-15 are largely due to the originally proposed scoring procedure. In conclusion, the BOT, EHQ, and DOS are internally reliable instruments that seem to measure the same construct-orthorexic eating behavior. In line with previous suggestions, we conclude that the ORTO-15 cannot be recommended for the measurement of orthorexia nervosa, at least not when the originally proposed scoring procedure is used.

Dimensions within 24 weight history indices and their association with inpatient treatment outcome in adults with anorexia nervosa: analysis of routine data.

OBJECTIVE: Next to weight suppression (WS), there are a range of less often examined weight history indices, and improvements to the WS construct have been proposed. We aimed to examine redundancy and overlap between 24 weight history indices in order to identify suitable constructs for further investigation. METHOD: Analysis of routine data of 770 female adult inpatients treated for AN. Twenty-four indices based on highest, lowest, and current weight, as well as developmental aspects were calculated and employed in correlational and factor analyses. The indices' ability to predict core outcomes of inpatient treatment was investigated with regression analyses. RESULTS: Five factors emerged: "WS and highest weight", "weight elevation (i.e., difference between current and lowest weight since puberty)", "lowest weight", "age at past highest or lowest weight", and "years since past highest or lowest weight". The constructs within these factors showed high correlations. Most indices related to change in weight, ED psychopathology, as well as behavioral aspect of AN. While measures of WE related more to weight gain and general ED Psychopathology, indices including lowest weight were stronger predictors of changes in slimness ideal and inappropriate compensatory behaviors. CONCLUSION: Many proposed weight history indices are closely related and the amount of additional information in complex indices appears questionable. While highest weight seems to dominate indices of WS, WE may rely on current weight. These findings highlight that different aspects of weight history may relate to different aspects of current ED symptoms and their amenability to change under specialized treatment.

Impact of comorbid borderline personality disorder on inpatient treatment for bulimia nervosa: analysis of routine data.

BACKGROUND: A substantial rate of patients with bulimia nervosa (BN) also suffer from Borderline personality disorder (BN + BPD). It is widely unknown how these comorbid patients with BN + BPD present and respond to inpatient treatment. Aims of the study were to examine (1) specific characteristics of patients with BN + BPD at admission, discharge, and during treatment, and (2) differential effects of inpatient treatment for BN vs. BN + BPD. METHOD: We analyzed routine data of inpatients admitted for the treatment of BN between 2013 and 2017 in a specialized hospital for eating disorders. (1) Cross-sectional differences were examined with independent t-tests and χ2-tests; and (2) treatment effects pertaining to eating disorders symptoms, depression, psychosocial functioning and general psychopathology with repeated measures analysis of variance. RESULTS: Of 1298 inpatients (96% female), 13.2% also had a diagnosis of BPD. (1) Patients with BN + BPD had more previous inpatient treatments (p = 0.001), had a longer length of stay (p = 0.003), gained more weight during treatment (p = 0.006), and were more often irregularly discharged (p = 0.018) as well as rated as unfit to work at discharge (p = 0.003). (2) Both groups improved in all examined variables (all main effects treatment p <  0.001). Patients with BN + BPD showed worse symptoms aggregated across admission and discharge (all main effects diagnosis p <  0.05). Patients with BN + BPD showed smaller improvements (interaction treatment×discharge) in depressive symptoms (p = 0.018), perfectionism (p = 0.009), and asceticism (p = 0.035) and discharge scores mostly lay in the range of the admission scores of the BN-only group. CONCLUSION: Patients with BN + BPD improve during intense and specialized inpatient treatment, yet, retain pronounced impairment at discharge despite longer treatment. Treatment needs to be improved and should focus on transdiagnostic symptoms of BN and BPD.

[Exposure Therapy with the Help of a Wearable Defibrillator Device used in the Treatment of Severe Obsessive-Compulsive Disorder and Congenital LQTS - An Example for Interdisciplinary Treatment]. / Expositionsbehandlung mithilfe einer Defibrillatorweste bei schwerer Zwangsstörung und angeborenem Long-QT-Syndrom.

We report on a case of a young female suffering from both obsessive-compulsive disorder (OCD) and a severe underlying cardiac disease. Due to the somatic comorbidity, treatment according to guidelines with exposure and reaction prevention was not initially conducted, due to potentially fatal risks to the patient. However, through collaboration with a cardiology clinic, we were able to find an innovative solution which allowed for the continuation of the exposure therapy. This case report demonstrates a successful interdisciplinary collaboration and is intended to sensitize the reader to the need for checking for somatic contraindications before conducting exposure therapy.

Are there differences between men and women in outcome of intensive inpatient treatment for anorexia nervosa? An analysis of routine data.

OBJECTIVE: Anorexia nervosa (AN) in men is rare and understudied. We compared admission characteristics and response to specialized inpatient treatment between men and women with AN. METHOD: One hundred sixteen consecutive male patients with AN were matched to 116 female patients. Patients completed the self-rating Structured Inventory for Anorexic and Bulimic Syndromes (SIAB-S) at admission and discharge. Differences at admission and in treatment response were examined with independent samples t-tests and ANOVA for repeated measures, respectively. RESULTS: Men had lower body mass index (BMI)-percentiles (Cohen's d = -0.55), higher levels of weight suppression (d = 0.65), and higher scores in the SIAB-S general psychopathology and social integration scale (d = 0.47) at admission. There were no differences in response to treatment except for changes in BMI-percentile (F = 4.49, p = 0.035). CONCLUSIONS: There were more similarities than differences between genders in AN. Because this similarity might be confounded with traditionally "feminine" conceptualizations of AN, further studies of male AN are needed.

Intensive inpatient treatment for bulimia nervosa: Statistical and clinical significance of symptom changes.

OBJECTIVE: This study examines the statistical and clinical significance of symptom changes during an intensive inpatient treatment program with a strong psychotherapeutic focus for individuals with severe bulimia nervosa. METHOD: 295 consecutively admitted bulimic patients were administered the Structured Interview for Anorexic and Bulimic Syndromes-Self-Rating (SIAB-S), the Eating Disorder Inventory-2 (EDI-2), the Brief Symptom Inventory (BSI), and the Beck Depression Inventory-II (BDI-II) at treatment intake and discharge. RESULTS: Results indicated statistically significant symptom reductions with large effect sizes regarding severity of binge eating and compensatory behavior (SIAB-S), overall eating disorder symptom severity (EDI-2), overall psychopathology (BSI), and depressive symptom severity (BDI-II) even when controlling for antidepressant medication. The majority of patients showed either reliable (EDI-2: 33.7%, BSI: 34.8%, BDI-II: 18.1%) or even clinically significant symptom changes (EDI-2: 43.2%, BSI: 33.9%, BDI-II: 56.9%). Patients with clinically significant improvement were less distressed at intake and less likely to suffer from a comorbid borderline personality disorder when compared with those who did not improve to a clinically significant extent. CONCLUSIONS: Findings indicate that intensive psychotherapeutic inpatient treatment may be effective in about 75% of severely affected bulimic patients. For the remaining non-responding patients, inpatient treatment might be improved through an even stronger focus on the reduction of comorbid borderline personality traits.

Weight Suppression But Not Symptom Improvement Predicts Weight Gain During Inpatient Treatment for Bulimia Nervosa.

OBJECTIVE: Fear of gaining weight is a common obstacle to seeking treatment for bulimia nervosa (BN). We investigated changes in body mass index (BMI) during inpatient treatment for BN in relation to treatment outcome and weight suppression (WS). METHODS: Female inpatients of a specialized eating disorders clinic were grouped as deteriorated/unchanged, reliably improved, and clinically significantly improved based on Eating Disorder Inventory-2 scores. Repeated measures ANOVA was employed to examine changes in BMI between admission and discharge depending on treatment outcome and WS. RESULTS: One-hundred seventy-nine patients were included. Overall, the average BMI significantly increased by 0.54 kg/m2 (SD = 1.24). Repeated measures ANOVA revealed no association of change in BMI with treatment outcome [F(df) = 1.13 (2166), p = 0.327] but with WS [F(df) = 2.76 (3166), p < 0.044]. DISCUSSION: Bulimia nervosa can be successfully treated without causing excessive weight gain. Patients with higher WS might expect somewhat more weight gain. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

[Diuretic-Abuse in Chronic Bulimia Nervosa--Case Report and Clinical Management]. / Diuretika-Missbrauch bei chronifizierter Bulimia nervosa--Fallbericht und klinisches Management.

We give account of a patient, who works in health care, with bulimia nervosa (BN) and a long term abuse of Furosemide. Due to patients' tendency to conceal addictive behavior and symptoms of BN, the prevalence of purging behavior caused by the intake of diuretics is difficult to quantify 10% of BN patients exhibit a long-term harmful abuse. Discontinuation of diuretics causes the development of edema, attributable to pathophysiological changes with hyperaldosteronism. These can lead to renewed escalation of purging behaviour, provoked either by phobia of weight gain or by unbearable feelings of tension in the facial area or in the legs. For an adequate clinical management, it is vital to have thorough knowledge of the pathophysiological context which consists of psychoeducation, provision of information, treatment of water-electrolyte imbalance and, in individual cases, the administration of aldosterone antagonists.