Orthorexia nervosa (ON) is characterized by the pursuit of extreme dietary purity due to an exaggerated focus on food quality that could ultimately lead to a new kind of eating disorder. Even though researchers have tried to reach a univocal description of ON, to this date, there is no consensus on its diagnostic criteria, making it considerably more difficult to develop a valid questionnaire for assessing the symptoms of ON and to assess its actual prevalence. The aim of this review was to evaluate and gather scientific evidence about the prevalence of ON in both clinical and non-clinical adult populations, using the main validated scale for ON evaluation.

Electronic databases (PubMed, Scopus, and Web of Science) were reviewed to identify studies in accordance with PRISMA guidelines; at the end of the selection process, 62 studies were included.

Prevalence rates of ON vary greatly due to the differences in psychometric qualities of the tools used and the socio-cultural norms of the countries, with the lowest being obtained with the Dusseldorf orthorexic scale (DOS) (2.6% up to 36.7% in cancer survivor women) and the BOS-T (12.8% up to 34.7%), the greatest variability concerning the two thresholds of the ORTO-15 (14.6% with the >35 threshold and up to 86% with the >40 threshold) and the higher score being reported with the ORTO-11 in post-partum women (87.7%).

Additional research is necessary to support the development of a thorough, sensitive, and valid questionnaire for assessing the symptoms of ON.

Orthorexia has been widely studied, but recently, a new conceptualisation was proposed to distinguish its healthy characteristics from its pathological ones. The objective of this study was to differentiate healthy orthorexia (HeOr) from orthorexia nervosa (OrNe) by exploring their sociodemographic, psychological, health, and dietary characteristics using comparative and correlational statistical methods.

Cross-sectional analysis. Participants completed an online, self-administered questionnaire assessing their sociodemographic characteristics, orthorexia, exercise dependence, personality, health anxiety, food choice motives, emotional competences, and eating disorders.

Data were collected between May 2021 and September 2022.

1,515 French females (meanage = 37.67). Responses from men were excluded.

While OrNe was mainly associated with weight control motives in food choices (r = .42), HeOr was more strongly correlated with natural content (r=.60) and health motives (r = .49). In relation to exercising, OrNe showed its highest association with weight control (r = 41). Health anxiety was more strongly associated with OrNe than with HeOr. Both OrNe and HeOr were related to diet adherence and regular exercise, but the association was stronger for the latter. Orthorexia scores, mainly OrNe, were higher in participants at the risk of eating disorders. Participants who were afraid to gain weight showed higher OrNe scores.

HeOr seems to be part of a healthy lifestyle in general. In contrast, OrNe falls into the category of an eating disorder and is associated with more problematic psychological functioning. Particular attention should be given to individuals who are beginning to control and reduce their food intake to prevent them from developing OrNe.

Orthorexia nervosa (ON) is an emerging condition featuring restrictive eating behaviors on the basis of subjective beliefs about food healthiness. Many authors have stressed the similarities between ON and anorexia nervosa (AN) in both cognitive and behavioral patterns. Despite that, while the link between AN and female autism presentations is well known in the literature, no study has yet investigated the relationship between ON and autism spectrum. This work aims to investigate the relationship between ON and autistic traits in a university population.

An e-mail invitation was sent to all the students and University workers of University of Pisa. Subjects were asked to fulfill the ORTO-15 and the Adult Autism Subthreshold spectrum (AdAS spectrum) questionnaires.

A total of 2426 subjects joined the survey: 623 subjects (26.3%) reported a score associated with significant orthorexic symptoms according to ORTO-15 (ON group), while 1789 subjects (73.7%) did not report ON symptomatology and were considered as healthy controls (HC). The ON group scored significantly higher on almost all AdAS spectrum domains. Moreover, being female and scoring higher on AdAS spectrum were statistically predictive factors for the presence of ON symptomatology. Among AdAS spectrum domains, higher scores on AdAS spectrum inflexibility and adherence to routine and restricted interests and rumination domains, as well as lower scores on verbal communication domain, were statistically predictive of orthorexic symptoms.

Our findings highlight an overlap between ON and autism spectrum psychopathology. Further studies are needed to clarify the relationship between restrictive eating disorders and female autism phenotypes.