Bidimensional Structure of the Orthorexia: Development and Initial Validation of a New Instrument

Keywords: orthorexia nervosa, eating disorder, validation, questionnaire


Orthorexia nervosa could be conceptualized as extreme or excessive preoccupation with eating food believed to be healthy. Up to now, there is no available instrument evaluating every aspect of orthorexia with sufficient psychometric guarantees. The objective of the present study was two-fold. First, to develop and validate a new questionnaire of orthorexia –the Teruel Orthorexia Scale– and, second, to analyze the association with other psychological constructs and disorders theoretically related to orthorexia nervosa: eating disorder symptoms, obsessive-compulsive disorder symptoms, negative affect, and perfectionism. Participants were 942 mainly university students who completed a battery of online questionnaires. Starting with an initial item bank of 31 items, we proposed a bidimensional test of orthorexia. This final version, with 17 items, encompassed two related, although differentiable (r = .43), aspects of orthorexia. First, Orthorectic Efforts, which evaluates the “healthy” preoccupation with diet, which is independent of psychopathology, and even inversely associated with it. Second, Orthorectic Concerns, which assesses the negative social and emotional impact of trying to achieve a rigid way of eating. This dimension represents a pathological preoccupation with a healthy diet. This study presents a new instrument that offers promising possibilities in the study of orthorexia.


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Arusoğlu, G., Kabakçi, E., Köksal, G., & Kutluay Merdol, T. (2008). Orthorexia nervosa and adaptation of ORTO-11 into Turkish. Turkish Journal of Psychiatry, 19, 1-9.

Alvarenga, M. S., Martins, M. C. T., Sato, K. S. C. J., Vargas, S. V. A., Philippi, S. T., & Scagliusi, F. B. (2012). Orthorexia nervosa behavior in a sample of Brazilian dietitians assessed by the Portuguese version of ORTO-15. Eating and Weight Disorders, 17, 29-35. doi: 10.1007/BF03325325

Bratman, S., & Knight, D. (2000). Health food junkies. New York: Broadway Books.

Brytek-Matera, A. (2012). Orthorexia nervosa—an eating disorder, obsessive-compulsive disorder or disturbed eating habit? Archives Psychiatry and Psychotherapy 14, 55–60.

Brytek-Matera, A., Krupa, M., Poggiogalle, E., & Donini, L. M. (2014). Adaptation of the ORTHO-15 test to Polish women and men. Eating and Weight Disorders, 19, 69-76. doi: 10.1007/s40519-014-0100-0

Bundros, J., Clifford, D., Silliman, K., & Neyman Morris, M. (2016). Prevalence of orthorexia nervosa among college students based on Bratman’s test and associated tendencies. Appetite, 101, 86–94. doi: 10.1016/j.appet.2016.02.144

Cash, T. F. (2000). The MBSRQ users’ manual (3rd ed.). Available from the author at

Cartwright, M. M. (2004). Eating disorder emergencies: Understanding the medical complexities of the hospitalized eating disordered patient. Critical Care Nursing Clinics of North America, 16(4), 515-530. doi: 10.1016/j.ccell.2004.07.002

Castro, J., Toro, J., Salamero, M., & Guimerá, E. (1991). The Eating Attitudes Test: Validation of the Spanish version. Evaluación Psicológica, 7, 175-189.

Catalina, M. L., Bote, B., García, F., & Ríos, B. (2005). Orthorexia nervosa. A new eating behavior disorder? Actas Españolas de Psiquiatría, 33, 66-68.

Donini, L. M., Marsili, D., Graziani, M. P., Imbriale, M., & Cannella, C. (2005). Orthorexia nervosa: A preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eating and Weight Disorders, 9, 151-157. doi: 10.1007/BF03325060

Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., & Salkovskis, P. M. (2002). The Obsessive-Compulsive Inventory: Development and validation of a short version. Psychological Assessment, 14, 485-496. doi: 10.1037/1040-3590.14.4.485

Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14, 449-468. doi: 10.1007/BF01172967

Fullana, M. A., Tortella-Feliu, M., Caseras, X., Andión, Ó., Torrubia, R., & Mataix-Cols, D. (2005). Psychometric properties of the Spanish version of the Obsessive–Compulsive Inventory-Revised in a non-clinical sample. Journal of Anxiety Disorders, 19, 893-903. doi: 10.1016/j.janxdis.2004.10.004

Garner, D. M., Olmsted, M. P., Bohr, Y., & Garfinkel, P. E. (1982). The Eating Attitudes Test: Psychometric features and clinical correlates. Psycholological Medicine, 12, 871–878. doi: 10.1017/S0033291700049163

Garrido, L. E., Abad, F. J., & Ponsoda, V. (2013). A new look at Horn’s parallel analysis with ordinal variables. Psychological Methods, 18, 454-474. doi: 10.1037/a0030005

Gelabert, E., García-Esteve, L., Martín-Santos, R., Gutiérrez, F., Torres, A., & Subirà, S. (2011). Psychometric properties of the Spanish version of the Frost Multidimensional Perfectionism Scale in women. Psicothema, 23, 133-139.

Gleaves, D. H., Graham, E. C., & Ambwani, S. (2013). Measuring 'orthorexia': Development of the Eating Habits Questionnaire. The International Journal of Educational and Psychological Assessment, 12, 1-18.

Hallquist, M. & Wiley, J. (2016). Package ‘MplusAutomation’. Available at

Herranz, J., Acuña, P, Romero, B., & Visioli, F. (2014). Prevalence of orthorexia nervosa among ashtanga yoga practitioners: A pilot study. Eating and Weight Disorders, 19, 469-472. doi: 10.1007/s40519-014-0131-6

Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1-55. doi: 10.1080/10705519909540118

Koven, N. S., & Abry, A. W. (2015). The clinical basis of orthorexia nervosa: Emerging perspectives. Journal of Neuropsychiatric Disease and Treatment, 18, 385-394. doi: 10.2147/NDT.S61665

Mac Evilly, C. (2001). The price of perfection. Nutrition Bulletin, 26, 275-276. doi: 10.1046/j.1467-3010.2001.00182.x

Missbach, B., Dunn, T. M., & König, J. S. (2017). We need new tools to assess orthorexia nervosa. A commentary on “Prevalence of orthorexia nervosa among college students based on Bratman’s test and associated tendencies”. Appetite, 108, 521-524. doi: 10.1016/j.appet.2016.07.010

Missbach, B., Hinterbuchinger, B., Dreiseitl, V., Zellhofer, S., Kurz, C., & König, J. (2015). When eating right, is measured wrong! A validation and critical examination of the ORTO-15 questionnaire in German. PLoS ONE, 10(8), 1–15. doi: 10.1371/journal.pone.0135772

Moroze, R. M., Dunn, T. M., Holland, J. C., Yager, J., & Weintraub, P. (2015). Microthinking about micronutrients: A case of transition from obsessions about healthy eating to near-fatal ‘‘orthorexia nervosa’’ and proposed diagnostic criteria. Psychosomatics, 56, 397-403. doi: 10.1016/j.psym.2014.03.003

Muthén, L.K. and Muthén, B.O. (1998-2015). Mplus User’s Guide. Seventh Edition. Los Angeles, CA: Muthén & Muthén.

Revelle, W. (2017). Package ‘psych’. Available at packages/psych/psych.pdf

Rogoza, R., Brytek-Matera, A., & Garner, D. (2016). Analysis of the EAT-26 in a non-clinical sample. Archives of Psychiatry and Psychotherapy, 18, 54–58. doi: 10.12740/APP/6364

Roncero, M., Barrada, J. R., & Perpiñá. (In press). Measuring orthorexia nervosa: Psychometric limitations of the ORTO-15. Spanish Journal of Psychology.

Roncero, M., Perpiñá, C., Marco, J. H., & Sánchez-Reales, S. (2015). Confirmatory factor analysis and psychometric properties of the Spanish version of the Multidimensional Body-Self Relations Questionnaire-Appearance Scales. Body Image, 14, 47-53. doi: 10.1016/j.bodyim.2015.03.005

Sandín, B., Chorot, P., Lostao, L., Joiner, T. E., Santed, M. A., & Valiente, R. M. (1999). Escalas PANAS de afecto positivo y negativo: Validación factorial y convergencia transcultural [Positive and Negative Affect Schedule: Factorial validation and transcultural convergence]. Psicothema, 11, 37-51.

Souza, Q. J. O. V., & Rodrigues, A. M. (2014). Risk behavior for orthorexia nervosa in nutrition students. Jornal Brasileiro de Psiquiatria, 63, 200-204. doi: 10.1590/0047-2085000000026

Stochel, M., Janas-Kozik, M., Zejda, J. E., Hyrnik, J., Jelonek, I., & Siwiec, A. (2015). Validation of ORTO-15 questionnaire in the group of urban youth aged 15-21. Psychiatria Polska, 49, 119-134. doi: 10.12740/PP/25962

Vandereycken, W. (2011). Media hype, diagnostic fad or genuine disorder? Professionals' opinions about night eating syndrome, orthorexia, muscle dysmorphia, and emetophobia. Eating Disorders, 19, 145-155. doi: 10.1080/10640266.2011.551634

Varga, M., Dukay-Szabó, S., Túry, F., & van Furth, E. F. (2013). Evidence and gaps in the literatura on orthorexia nervosa. Eating and Weight Disorders, 18, 103–111. doi: 10.1007/s40519-013-0026-y

Varga, M., Thege, B. K., Dukay-Szabó, S., Túry, F., & van Furth, E. F. (2014). When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry, 14(1), 1. doi: 10.1186/1471-244X-14-59

Watson, D., Clark, L.A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063-1070. doi: 10.1037/0022-3514.54.6.1063

How to Cite
Barrada, J. R., & Roncero, M. (2018). Bidimensional Structure of the Orthorexia: Development and Initial Validation of a New Instrument. Anales De Psicología / Annals of Psychology, 34(2), 283-291.
Clinical and Health Psychology