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Pathways to orthorexia nervosa: a case series discussion

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Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Background

Orthorexia nervosa (ON) has gained increasing interest in the last 2 decades. Although a consensus on the diagnostic boundaries of ON has not yet been reached, there is some evidence for an overlap with eating disorders, obsessive–compulsive disorder, and psychotic disorder. Most of the knowledge about ON has emerged from studies of non-clinical and at-risk populations and is focused on differential diagnosis; therefore, further clinical studies are needed to better outline the ON phenomenon in a real-life setting.

Objective

This case series aims at describing clinical cases that developed symptoms suggestive of ON after being diagnosed with a prior psychiatric disorder and then discussing them in light of possible clinical pathways.

Methods

Four women consecutively admitted to an outpatient unit for the treatment of eating disorders were diagnosed with ON through a clinical interview, according to Dunn and Bratman’s criteria and self-administered questionnaire assessment (ORTO-15), and were considered to be eligible for this case series study. Psychiatric anamnestic data were collected retrospectively.

Results

The anamnesis revealed that all patients were previously diagnosed with a psychiatric disorder (i.e. obsessive–compulsive disorder, bulimia nervosa, illness anxiety disorder, and psychotic disorder) before develo** ON.

Conclusion

Past literature focused on differential diagnosis between ON and other psychiatric disorders. This is the first description of clinical cases in a real-life setting that started with different psychiatric disorders and later developed symptoms suggestive of ON. These cases have generated a new research question on the possibility that different psychiatric disorders may associate with a later onset of ON.

Level of evidence

Level V, descriptive study.

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Acknowledgements

Authors are grateful to patients who agreed to collaborate with researchers to this study.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Marianna Rania, Renato de Filippis, and Cristina Segura-Garcia equally contributed to the manuscript.

Authors and Affiliations

  1. Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy

    Marianna Rania, Renato de Filippis, Mariarita Caroleo, Elvira Carbone & Matteo Aloi

  2. Center for Clinical Research and Treatment of Eating Disorders, Azienda Ospedaliera Universitaria Mater Domini, Catanzaro, Italy

    Marianna Rania, Renato de Filippis, Mariarita Caroleo, Elvira Carbone, Matteo Aloi & Cristina Segura-Garcia

  3. Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Viale Europa, 88100, Catanzaro, Italy

    Cristina Segura-Garcia

  4. Northbay Hospital, Fairfield, CA, USA

    Steven Bratman

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  1. Marianna Rania
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  2. Renato de Filippis
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  7. Cristina Segura-Garcia
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Correspondence to Cristina Segura-Garcia.

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Rania, M., de Filippis, R., Caroleo, M. et al. Pathways to orthorexia nervosa: a case series discussion. Eat Weight Disord 26, 1675–1683 (2021). https://doi.org/10.1007/s40519-020-00948-x

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