Mitrofanova, Elina ORCID: https://orcid.org/0000-0002-2907-6178, Pummell, Elizabeth, Martinelli, Laura and Petróczi, Andrea (2020) Does ORTO‑15 produce valid data for ‘Orthorexia Nervosa’? A mixed‑method examination of participants’ interpretations of the fifteen test items. Eating and Weight Disorders, 26. pp. 897-909. ISSN 1124-4909 (Print), 1590-1262 (Online) (doi:10.1007/s40519-020-00919-2)

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Abstract

Purpose Orthorexia Nervosa (ON) is defned as a pathological eating behaviour stemming from being “healthy” or “pure”.
Survey-based studies typically rely on the ORTO-15 questionnaire or its variations to detect orthorexia. However, frequent
post-hoc adjustments to the ORTO-15 suggest psychometric problems. In this study, we explored people’s cognitions about
the ORTO-15 items to (1) identify problems specifc to ORTO-15 items and (2) explore participants’ understanding of ON
symptoms.
Methods Fifty adult participants (40% male, mean age=34.0±14.4 years) completed the ORTO-15, the Eating Attitudes
Test (EAT-26) and the Obsessive–Compulsive Inventory–Revised edition (OCI-R). Qualitative data were collected using
the modifed “think aloud” protocol, which asked participants to ‘verbalise’ their responses to the ORTO-15 items. These
qualitative responses were frst analysed conjunctively with the quantitative responses; then subjected to thematic analysis.
Results ORTO-15 identifed 64% of the participants for orthorexic tendencies. In most cases (76%), participants reported
no issues completing the ORTO-15. However, in some cases, qualitative responses difered from quantitative ones. When
people encountered problems, it was because of poor psychometric construction: lack of clarity, ambiguous wording and
multiple statements in a single item. Elaborations around the ORTO-15 items formed four major themes: “preoccupation
with physical appearance”, “control”, “food is fuel” and “alone, not isolated”.
Conclusion Even though in the majority of cases there were no issues with completing ORTO-15, thematic analysis revealed
several discrepancies between our participants’ perceptions of the ORTO-15 items and the previously proposed diagnostic
criteria for ON. The results suggest that ORTO-15 is, at best, a mediocre screening tool for ON, which is sensitive to diet but
fails to have sufcient level of specifcity to detect the pathological stage. More accurate instruments are needed to further
research on ON.

Item Type:	Article
Uncontrolled Keywords:	orthorexia; clean eating; ORTO-15; psychometrics; eating disorder; pathological eating
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Mental Health Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM)
Related URLs:	Publisher
Last Modified:	05 May 2023 09:45
URI:	http://gala.gre.ac.uk/id/eprint/42432

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