Relationship Between Orthorexia Nervosa, Eating Attitudes and Obsessive-Compulsive Disorder Among Nursing Students: A Cross-Sectional Study
Methods: The study was designed as a descriptive, cross-sectional study. Participants were selected using purposive sampling. Descriptive Characteristics Information Form, Orthorexia-11 Scale, Eating Attitudes Test (EAT) and Padua Inventory-Washington State University Revision (PI-WSUR) scales were used. This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology checklist for cross-sectional studies.
Results: The mean score was 19.11±11.53 in the EAT participants, 28.30±4.16 in the Orthorexia-11 Scale and 56.35±23.85 in the PI-WSUR. A positive correlation was found between the participants’ orthorexia nervosa tendencies and obsessive-compulsive symptoms. It was observed that as the participants' EAT mean scores increased, their obsessive-compulsive symptoms also increased. In the regression analysis, it was seen that orthorexia nervosa tendencies and eating attitudes were significant predictors of obsessive-compulsive symptoms.
Conclusions: The findings obtained from the study are important in terms of shedding light on the relationship between orthorexia nervosa, eating attitudes and obsessive-compulsive symptoms in nursing students. Given that health sciences students are a high-risk group for eating disorders, it is essential to include courses on eating disorders in the curriculum and implement regular psychological screenings in universities.
1. Segura-Garcia C, Ramacciotti C, Rania M, et al. The prevalence of orthorexia nervosa among eating disorder patients after treatment. Eat Weight Disord. 2015;20(2):161-166. doi: 10.1007/s40519-014-0171-y.
2. Novara C, Pardini S, Maggio E, Mattioli S, Piasentin S. Orthorexia Nervosa: over concern or obsession about healthy food? Eat Weight Disord. 2021;26(8):2577-2588. doi: 10.1007/s40519-021-01110-x.
3. Depa J, Barrada JR, Roncero M. Are the Motives for Food Choices Different in Orthorexia Nervosa and Healthy Orthorexia? Nutrients. 2019;11(3):697. doi: 10.3390/nu11030697.
4. Zickgraf HF, Barrada JR. Orthorexia nervosa vs. healthy orthorexia: relationships with disordered eating, eating behavior, and healthy lifestyle choices. Eat Weight Disord. 2022;27(4):1313-1325. doi: 10.1007/s40519-021-01263-9.
5. Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C. Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord. 2005;10(2):e28-32. doi: 10.1007/BF03327537.
6. Dolapoglu N, Ozcan D, Tulaci RG. Is Orthorexia Nervosa a Non-specific Eating Disorder or a Disease in the Spectrum of Obsessive-Compulsive Disorder? Cureus. 2023;15(5):e38451. doi: 10.7759/cureus.38451.
7. Barlow IU, Lee E, Saling L. Orthorexia nervosa versus healthy orthorexia: Anxiety, perfectionism, and mindfulness as risk and preventative factors of distress. Eur Eat Disord Rev. 2024;32(1):130-147. doi: 10.1002/erv.3032.
8. Yakın E, Raynal P, Chabrol H. Distinguishing orthorexic behaviors from eating disordered and obsessive-compulsive behaviors: a typological study. Eat Weight Disord. 2021;26(6):2011-2019. doi: 10.1007/s40519-020-01037-9.
9. Gajdos P, Román N, Tóth-Király I, Rigó A. Functional gastrointestinal symptoms and increased risk for orthorexia nervosa. Eat Weight Disord. 2022;27(3):1113-1121. doi: 10.1007/s40519-021-01242-0.
10. Meule A, Voderholzer U. Orthorexia Nervosa-It Is Time to Think About Abandoning the Concept of a Distinct Diagnosis. Front Psychiatry. 2021;12:640401. doi: 10.3389/fpsyt.2021.640401.
11. Gerges S, Azzi V, Bianchi D, et al. Exploring the relationship between dysfunctional metacognitive processes and orthorexia nervosa: the moderating role of emotion regulation strategies. BMC Psychiatry. 2023;23(1):674. doi: 10.1186/s12888-023-05183-z.
12. Sezer Katar K, Şahin B, Kurtoğlu MB. Healthy orthorexia, orthorexia nervosa, and personality traits in a community sample in Turkey. Int J Psychiatry Med. 2024;59(1):83-100. doi: 10.1177/00912174231194745.
13. Das A, Malakar C. Psychiatric Co-morbidity with Obsessive Compulsive Disorder. KYAMC Journal. 2024;14(4):206-209. doi: 10.3329/kyamcj.v14i04.69239.
14. Niewęgłowski K, Wilczek N, Rycharski M, Niewęgłowska J. Impact of gut microbiota on severity of obsessive-compulsive disorder (OCD)-a short review. Journal of Education, Health and Sport. 2022;12(8):283-288. doi: 10.12775/JEHS.2022.12.08.028.
15. Nazeer A, Latif F, Mondal A, Azeem MW, Greydanus DE. Obsessive-compulsive disorder in children and adolescents: epidemiology, diagnosis and management. Transl Pediatr. 2020;9(Suppl 1):S76-S93. doi: 10.21037/tp.2019.10.02.
16. Cosh SM, Olson J, Tully PJ. Exploration of orthorexia nervosa and diagnostic overlap with eating disorders, anorexia nervosa and obsessive-compulsive disorder. Int J Eat Disord. 2023;56(11):2155-2161. doi: 10.1002/eat.24051.
17. Vaccari G, Cutino A, Luisi F, et al. Is orthorexia nervosa a feature of obsessive-compulsive disorder? A multicentric, controlled study. Eat Weight Disord. 2021;26(8):2531-2544. doi: 10.1007/s40519-021-01114-7.
18. Turner PG, Lefevre CE. Instagram use is linked to increased symptoms of orthorexia nervosa. Eat Weight Disord. 2017;22(2):277-284. doi: 10.1007/s40519-017-0364-2.
19. Koven NS, Abry AW. The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatr Dis Treat. 2015;11:385-394. doi: 10.2147/NDT.S61665.
20. Zagaria A, Vacca M, Cerolini S, Ballesio A, Lombardo C. Associations between orthorexia, disordered eating, and obsessive-compulsive symptoms: A systematic review and meta-analysis. Int J Eat Disord. 2022;55(3):295-312. doi: 10.1002/eat.23654.
21. Łucka I, Mazur A, Łucka A, Sarzyńska I, Trojniak J, Kopańska M. Orthorexia as an Eating Disorder Spectrum-A Review of the Literature. Nutrients. 2024;16(19):3304. doi: 10.3390/nu16193304.
22. Dokumacioglu E, Badem K, Kucuk U. Determining Orthorexia Nervosa Tendency among the Students of Health Sciences Faculty: The Case of Artvin Coruh University. Archives of Current Research International. 2019;17(2):1-7. doi: 10.9734/acri/2019/v17i230105.
23. Brytek-Matera A, Donini LM, Krupa M, Poggiogalle E, Hay P. Orthorexia nervosa and self-attitudinal aspects of body image in female and male university students. J Eat Disord. 2015;3:2. doi: 10.1186/s40337-015-0038-2.
24. Christodoulou E, Markopoulou V, Koutelidakis AE. Exploring the link between mindful eating, instagram engagement, and eating disorders: a focus on orthorexia nervosa. Psychiatry Int. 2024;5(1):27-38. doi: 10.3390/psychiatryint5010003.
25. Ergin G. Orthorexia nervosa prevalence study in health-care and non-health care individuals. Master's thesis, Başkent University, Institute of Health Sciences. 2014.
26. Yılmaz H, Karakuş G, Tamam L, Demirkol ME, Namlı Z, Yeşiloğlu C. Association of Orthorexic Tendencies with Obsessive-Compulsive Symptoms, Eating Attitudes and Exercise. Neuropsychiatr Dis Treat. 2020;16:3035-3044. doi: 10.2147/NDT.S280047.
27. Pearce T, Maple M, Shakeshaft A, Wayland S, McKay K. What Is the Co-Creation of New Knowledge? A Content Analysis and Proposed Definition for Health Interventions. Int J Environ Res Public Health. 2020;17(7):2229. doi: 10.3390/ijerph17072229.
28. Kobelev OM. Information analytics in the organizational structure of libraries of top-rated universities in Ukraine. In: University Library at a New Stage of Social Communications Development. Conference Proceedings. 2019. p. 117-121. doi: 10.15802/unilib/2019_186985.
29. Arusoğlu G, Kabakçi E, Köksal G, Merdol TK. Ortoreksiya nervoza ve Orto-11'in Türkçeye uyarlama çalişmasi [Orthorexia nervosa and adaptation of ORTO-11 into Turkish]. Turk Psikiyatri Derg. 2008;19(3):283-291. [Article in Turkish]
30. Garner DM, Garfinkel PE. The Eating Attitudes Test: an index of the symptoms of anorexia nervosa. Psychol Med. 1979;9(2):273-279. doi: 10.1017/s0033291700030762.
31. Savaşır I. Erol N. Yeme Tutum Testi: Anoreksiya Nervoza Belirtileri İndeksi [Eating Attitudes Test: Anorexia Nervosa Symptom Index]. Psikoloji Dergisi. 1989;7(23):19-25. doi: 10.31828/tpd1300443319890000m000360. [Article in Turkish]
32. Sanavio E. Obsessions and compulsions: the Padua Inventory. Behav Res Ther. 1988;26(2):169-77. doi: 10.1016/0005-7967(88)90116-7.
33. Burns GL, Keortge SG, Formea GM, Sternberger LG. Revision of the Padua Inventory of obsessive compulsive disorder symptoms: distinctions between worry, obsessions, and compulsions. Behav Res Ther. 1996;34(2):163-173. doi: 10.1016/0005-7967(95)00035-6.
34. Yorulmaz O, Karancı AN, Dirik G, et al. Padua Envanteri--Washington Eyalet Üniversitesi Revizyonu: Türkçe versiyonunun psikometrik özellikleri [Padua Inventory--Washington State University Revision: Psychometric properties of the Turkish version]. Türk Psikoloji Yazilari. 2007;10:75-85. doi: 10.31828/tpy1301996120070000m000162.
35. Tabachnick BG, Fidell LS. Using multivariate statistics. 5th ed. Boston: Allyn & Bacon; 2007.
36. Arslantaş H, Adana F, Öğüt S, Ayakdaş D, Korkmaz A. Hemşirelik Öğrencilerinin Yeme Davranışları ve Ortoreksiya Nervoza (Sağlıklı Beslenme Takıntısı) İlişkisi: Kesitsel Bir Çalışma [Relationship between eating behaviors of nursing students and orthorexia nervosa (obsession with healthy eating): a cross-sectional study]. Psikiyatri Hemşireliği Dergisi. 2017;8(3):137-144. doi: 10.14744/phd.2016.36854. [Article in Turkish]
37. Bağci Bosi AT, Camur D, Güler C. Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine (Ankara, Turkey). Appetite. 2007;49(3):661-666. doi: 10.1016/j.appet.2007.04.007.
38. Fidan T, Ertekin V, Işikay S, Kirpinar I. Prevalence of orthorexia among medical students in Erzurum, Turkey. Compr Psychiatry. 2010;51(1):49-54. doi: 10.1016/j.comppsych.2009.03.001.
39. Ramacciotti CE, Perrone P, Coli E, Burgalassi A, Conversano C, Massimetti G, Dell'Osso L. Orthorexia nervosa in the general population: a preliminary screening using a self-administered questionnaire (ORTO-15). Eat Weight Disord. 2011;16(2):e127-130. doi: 10.1007/BF03325318.
40. Alvarenga MS, Martins MC, Sato KS, Vargas SV, Philippi ST, Scagliusi FB. Orthorexia nervosa behavior in a sample of Brazilian dietitians assessed by the Portuguese version of ORTO-15. Eat Weight Disord. 2012;17(1):e29-35. doi: 10.1007/BF03325325.
41. Evcimen H, Ayyildiz NI. Üniversite Öğrencilerinin Ortoreksiya Nervosaya Olan Eğilimlerinin Obsesyonla İlişkisinin Belirlenmesi [Determination of the tendencies of university students to orthorexia nervosa of the relationship with obsession]. ESTUDAM Public Health Journal. 2020;5(3):391-400. doi: 10.35232/estudamhsd.691686. [Article in Turkish]
42. Neyman Morris M, Clark C, Silliman K. Prevalence of orthorexia nervosa among students at a rural university (1021.10). The FASEB Journal. 2014;28(S1):1010-21. doi: 10.1096/fasebj.28.1_supplement.1021.10.
43. Oberle CD, Samaghabadi RO, Hughes EM. Orthorexia nervosa: Assessment and correlates with gender, BMI, and personality. Appetite. 2017;108:303-310. doi: 10.1016/j.appet.2016.10.021.
44. Oğur S, Aksoy A, Güngör Ş. Üniversite Öğrencilerinde Ortoreksiya Nervoza Eğiliminin Belirlenmesi [Determination of the orthorexia nervosa tendency in university students]. BEU Fen Bilimleri Dergisi. 2015;4(2):93-102. doi: 10.17798/beufen.95626. [Article in Turkish]
45. Duran S. Sağlık Yüksekokulu öğrencilerinde ortoreksiya nervoza (sağlıklı beslenme takıntısı) riski ve etkileyen faktörler [The risk of orthorexia nervosa (healthy eating obsession) symptoms for health high school students’ and affecting factors]. Pamukkale Tıp Derg.. 2016;9(3):220-226. doi: 10.5505/ptd.2016.03880. [Article in Turkish]
46. Alfalahi M, Mahadevan S, Balushi RA, et al. Prevalence of eating disorders and disordered eating in Western Asia: a systematic review and meta-Analysis. Eat Disord. 2022;30(5):556-585. doi: 10.1080/10640266.2021.1969495.
47. Liu KSN, Chen JY, Ng MYC, Yeung MHY, Bedford LE, Lam CLK. How Does the Family Influence Adolescent Eating Habits in Terms of Knowledge, Attitudes and Practices? A Global Systematic Review of Qualitative Studies. Nutrients. 2021;13(11):3717. doi: 10.3390/nu13113717.
48. Pontillo M, Zanna V, Demaria F, et al. Orthorexia Nervosa, Eating Disorders, and Obsessive-Compulsive Disorder: A Selective Review of the Last Seven Years. J Clin Med. 2022;11(20):6134. doi: 10.3390/jcm11206134.
49. Torresan RC, Ramos-Cerqueira AT, de Mathis MA, et al. Sex differences in the phenotypic expression of obsessive-compulsive disorder: an exploratory study from Brazil. Compr Psychiatry. 2009;50(1):63-69. doi: 10.1016/j.comppsych.2008.05.005.
50. Karadaĝ F, Oguzhanoglu NK, Ozdel O, Ateşci FC, Amuk T. OCD symptoms in a sample of Turkish patients: a phenomenological picture. Depress Anxiety. 2006;23(3):145-52. doi: 10.1002/da.20148.
51. Labad J, Menchon JM, Alonso P, et al. Gender differences in obsessive-compulsive symptom dimensions. Depress Anxiety. 2008;25(10):832-838. doi: 10.1002/da.20332.
52. Fawcett EJ, Power H, Fawcett JM. Women Are at Greater Risk of OCD Than Men: A Meta-Analytic Review of OCD Prevalence Worldwide. J Clin Psychiatry. 2020;81(4):19r13085. doi: 10.4088/JCP.19r13085.
53. Chaturvedi A, Murdick NL, Gartin BC. Obsessive compulsive disorder: what an educator needs to know. Physical Disabilities: Education and Related Services. 2014;33(2):71-83. doi: 10.14434/pders.v33i2.13134.
54. Kazkondu I. Investigation of the orthorexia nervosa (healthy nutrition obsession) symptoms among university students. Master Thesis. Gazi University, Institute of Educational Sciences. 2010.
55. Gezer C, Kabaran S. Beslenme ve diyetetik bölümü kız öğrencileri arasında görülen ortoreksiya nervosa riski [The risk of orthorexia nervosa for female students studying nutrition and dietetics]. S.D.Ü Sağlık Bilimleri Dergisi. 2013;4(1):14-22. [Article in Turkish]
56. Duradoni M, Gursesli MC, Fiorenza M, Guazzini A. The Relationship between Orthorexia Nervosa and Obsessive Compulsive Disorder. Eur J Investig Health Psychol Educ. 2023;13(5):861-869. doi: 10.3390/ejihpe13050065.
57. Aksoy Poyraz C, Tüfekçioğlu E, Özdemir A, et al. Yaygın Anksiyete Bozukluğu, Panik Bozukluk ve Obsesif Kompulsif Bozukluk Hastalarında Ortoreksi ile Obsesif Kompulsif Semptomlar Arasındaki İlişkininAraştırılması [Relationship Between Orthorexia and Obsessive-Compulsive Symptoms in Patients with Generalised Anxiety Disorder, Panic Disorder and Obsessive Compulsive Disorder]. Yeni Symposium. 2015;53(4):22-26. doi: 10.5455/nys.20160324065040. [Article in Turkish]

Copyright (c) 2026 The European Research Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Downloads
Article Information
- Article Type Research Article
- Submitted February 21, 2026
- Published March 14, 2026
- Issue 2026: Online First
- Section Research Article