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Open Access 01-12-2021 | Mood Disorders | Research

Association between impulsivity and orthorexia nervosa / healthy orthorexia: any mediating effect of depression, anxiety, and stress?

Authors: Emmanuelle Awad, Pascale Salameh, Hala Sacre, Diana Malaeb, Souheil Hallit, Sahar Obeid

Published in: BMC Psychiatry | Issue 1/2021

Abstract

Background

There is a lack of studies investigating the possible mediating role of psychological factors, such as depression, anxiety and stress on orthorexic eating behaviors. Given that personality attributes might affect the manifestation of psychological disorders, it was hypothesized that depression, anxiety and stress mediate the relationship between impulsivity-related traits and orthorexic eating, noting that previous research had evaluated the role of depression as a mediator between impulsivity and other pathological eating behaviors. The study objectives were to explore the mediating effect of depression, anxiety, and stress, on impulsivity and orthorexia nervosa, and healthy orthorexia.

Methods

This cross-sectional study conducted between July and December 2019 recruited 519 Lebanese adults from seven community pharmacies randomly selected from a list provided by the Lebanese Order of Pharmacists.

Results

Our results showed that depression and anxiety were positively correlated with ON. We also found a notable gender difference in findings: higher anxiety and female gender were significantly associated with higher TOS healthy orthorexia, while higher stress was associated with lower TOS healthy orthorexia. Finally, higher urgency was associated with lower TOS healthy orthorexia, while higher perseverance was significantly associated with higher TOS healthy orthorexia. Depression and anxiety partially mediated the association between perseverance and ON while anxiety and stress partially mediated the association between urgency and healthy orthorexia.

Conclusion

Our study suggests that depression, anxiety and stress play a mediating role between impulsivity and orthorexia nervosa/healthy orthorexia. Our findings provide a ground for future investigations of impulsive behaviors, psychopathology, and orthorexia in different populations.

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Obeid S, Hallit S, Akel M, et al. Orthorexia nervosa and its association with alexithymia, emotion dysregulation and disordered eating attitudes among Lebanese adults. Eat Weight Disord. 2021. https://doi.org/10.1007/s40519-021-01112-9.

Cena H, Barthels F, Cuzzolaro M, Bratman S, Brytek-Matera A, Dunn T, et al. Definition and diagnostic criteria for orthorexia nervosa: a narrative review of the literature. Eat Weight Disord. 2019;24(2):209–46. https://doi.org/10.1007/s40519-018-0606-y.CrossRefPubMed

Dunn TM, Bratman S. On orthorexia nervosa: a review of the literature and proposed diagnostic criteria. Eat Behav. 2016;21:11–7. https://doi.org/10.1016/j.eatbeh.2015.12.006.CrossRefPubMed

Simpson CC, Mazzeo SE. Attitudes toward orthorexia nervosa relative to DSM-5 eating disorders. Int J Eat Disord. 2017;50(7):781–92. https://doi.org/10.1002/eat.22710.CrossRefPubMed

McComb SE, Mills JS. Orthorexia nervosa: a review of psychosocial risk factors. Appetite. 2019;140:50–75. https://doi.org/10.1016/j.appet.2019.05.005.CrossRefPubMed

Brytek-Matera A, Staniszewska A, Hallit S. Identifying the profile of orthorexic behavior and “normal” eating behavior with cluster analysis: a cross-sectional study among polish adults. Nutrients. 2020;12(11). https://doi.org/10.3390/nu12113490.

Awad E, Salameh P, Sacre H, Malaeb D, Hallit S, Obeid S. Association between impulsivity and healthy orthorexia: any moderating role of personality traits? Psychol Health Med. 2021;1-10:1–10. https://doi.org/10.1080/13548506.2021.1954673.CrossRef

Strahler J, Stark R. Perspective: classifying orthorexia nervosa as a new mental illness-much discussion, little evidence. Adv Nutr. 2020;11(4):784–789.

Depa J, Barrada JR, Roncero M. Are the motives for food choices different in orthorexia nervosa and healthy orthorexia? Nutrients. 2019;11(3). https://doi.org/10.3390/nu11030697.

10.

Roncero M, Barrada JR, Perpiñá C. Measuring orthorexia nervosa: psychometric limitations of the ORTO-15. Span J Psychol. 2017;20:E41. https://doi.org/10.1017/sjp.2017.36.CrossRefPubMed

11.

Barrada J, Roncero M. Bidimensional structure of the orthorexia: development and initial validation of a new instrument. Anal Psicol. 2018;34(2):282–90. https://doi.org/10.6018/analesps.34.2.299671.CrossRef

12.

Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C. Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eat Weight Disord. 2004;9(2):151–7. https://doi.org/10.1007/BF03325060.CrossRefPubMed

13.

Mathieu J. What is orthorexia? J Am Diet Assoc. 2005;105(10):1510–2. https://doi.org/10.1016/j.jada.2005.08.021.CrossRefPubMed

14.

Depa J, Schweizer J, Bekers SK, Hilzendegen C, Stroebele-Benschop N. Prevalence and predictors of orthorexia nervosa among German students using the 21-item-DOS. Eat Weight Disord. 2017;22(1):193–9. https://doi.org/10.1007/s40519-016-0334-0.CrossRefPubMed

15.

Brytek-Matera A, Sacre H, Staniszewska A, Hallit S. The prevalence of orthorexia nervosa in polish and Lebanese adults and its relationship with sociodemographic variables and BMI ranges: a cross-cultural perspective. Nutrients. 2020;12(12). https://doi.org/10.3390/nu12123865.

16.

Claes L, Vandereycken W, Vertommen H. Impulsivity-related traits in eating disorder patients. Personal Individ Differ. 2005;39(4):739–49. https://doi.org/10.1016/j.paid.2005.02.022.CrossRef

17.

Striegel Moore RH, Rosselli F, Perrin N, DeBar L, Wilson GT, May, A, Kraemer, HC. Gender difference in the prevalence of eating disorder symptoms. Int J Eat Disord. 2009;42(5):471–474.

18.

Strahler J. Sex differences in orthorexic eating behaviors: A systematic review and meta-analytical integration. Nutrition. 2019;67:110534.

19.

Mikhail ME, Culbert KM, Sisk CL, Klump KL. Gonadal hormone contributions to individual differences in eating disorder risk. Curr Opin Psychiatry. 2019;32(6):484.

20.

Maxwell M, Thornton LM, Root TL, Pinheiro AP, Strober M, Brandt H,...Bulik CM. Life beyond the eating disorder: Education, relationships, and reproduction. Int J Eat Disord. 2011;44(3):225–232.

21.

Poínhos R, Oliveira BM, Correia F. Eating behaviour patterns and BMI in Portuguese higher education students. Appetite. 2013;71:314–320.

22.

Bland AR, Roiser JP, Mehta MA, Schei T, Boland H, Campbell-Meiklejohn DK, et al. EMOTICOM: a neuropsychological test battery to evaluate emotion, motivation, impulsivity, and social cognition. Front Behav Neurosci. 2016;10:25.CrossRef

23.

Robbins TW, Gillan CM, Smith DG, de Wit S, Ersche KD. Neurocognitive endophenotypes of impulsivity and compulsivity: towards dimensional psychiatry. Trends Cogn Sci. 2012;16(1):81–91. https://doi.org/10.1016/j.tics.2011.11.009.CrossRefPubMed

24.

Chamberlain SR, Stochl J, Redden SA, Grant JE. Latent traits of impulsivity and compulsivity: toward dimensional psychiatry. Psychol Med. 2018;48(5):810–21. https://doi.org/10.1017/S0033291717002185.CrossRefPubMed

25.

Caspi A, Houts RM, Belsky DW, Goldman-Mellor SJ, Harrington H, Israel S, et al. The p factor: one general psychopathology factor in the structure of psychiatric disorders? Clin Psychol Sci. 2014;2(2):119–37. https://doi.org/10.1177/2167702613497473.CrossRefPubMedPubMedCentral

26.

Lovallo WR. Early life adversity reduces stress reactivity and enhances impulsive behavior: implications for health behaviors. Int J Psychophysiol. 2013;90(1):8–16. https://doi.org/10.1016/j.ijpsycho.2012.10.006.CrossRefPubMed

27.

McCarty KN, Morris DH, Hatz LE, McCarthy DM. Differential associations of UPPS-P impulsivity traits with alcohol problems. J Stud Alcohol Drugs. 2017;78(4):617–22. https://doi.org/10.15288/jsad.2017.78.617.CrossRefPubMedPubMedCentral

28.

Waxman SE. A systematic review of impulsivity in eating disorders. Eur Eat Disord Rev. 2009;17(6):408–25. https://doi.org/10.1002/erv.952.CrossRefPubMed

29.

Wolz I, Hilker I, Granero R, Jiménez-Murcia S, Gearhardt AN, Dieguez C, et al. “Food addiction” in patients with eating disorders is associated with negative urgency and difficulties to focus on long-term goals. Front Psychol. 2016;7:61.CrossRef

30.

Kleifield EI, Sunday S, Hurt S, Halmi KA. The tridimensional personality questionnaire: an exploration of personality traits in eating disorders. J Psychiatr Res. 1994;28(5):413–23. https://doi.org/10.1016/0022-3956(94)90001-9.CrossRefPubMed

31.

Lichtenstein MB, Christiansen E, Elklit A, Bilenberg N, Klinky SR. Exercise addiction: a study of eating disorder symptoms, quality of life, personality traits and attachment styles. Psychiatry Res. 2014;250(2):410–6. https://doi.org/10.1016/j.psychres.2013.11.010.CrossRef

32.

Pearson CM, Zapolski TC, Smith GT. A longitudinal test of impulsivity and depression pathways to early binge eating onset. Int J Eat Disord. 2015;48(2):230–7. https://doi.org/10.1002/eat.22277.CrossRefPubMed

33.

Benard M, Bellisle F, Kesse-Guyot E, Julia C, Andreeva VA, Etile F, et al. Impulsivity is associated with food intake, snacking, and eating disorders in a general population. Am J Clin Nutr. 2019;109(1):117–26. https://doi.org/10.1093/ajcn/nqy255.CrossRefPubMed

34.

Pallister E, Waller G. Anxiety in the eating disorders: understanding the overlap. Clin Psychol Rev. 2008;28(3):366–86. https://doi.org/10.1016/j.cpr.2007.07.001.CrossRefPubMed

35.

Koven NS, Abry AW. The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatr Dis Treat. 2015;11:385–94. https://doi.org/10.2147/NDT.S61665.CrossRefPubMedPubMedCentral

36.

Lai JS, Hiles S, Bisquera A, Hure AJ, McEvoy M, Attia J. A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults. Am J Clin Nutr. 2014;99(1):181–97. https://doi.org/10.3945/ajcn.113.069880.CrossRefPubMed

37.

Strahler J, Hermann A, Schmidt NM, Stark R, Hennig J, Munk AJ. Food cue-elicited brain potentials change throughout menstrual cycle: modulation by eating styles, negative affect, and premenstrual complaints. Horm Behav. 2020:104811. https://doi.org/10.1016/j.yhbeh.2020.104811.

38.

Obeid S, Lahoud N, Haddad C, Sacre H, Akel M, Fares K, et al. Factors associated with depression among the Lebanese population: results of a cross-sectional study. Perspect Psychiatr Care. 2020;56(4):956–67. https://doi.org/10.1111/ppc.12518.CrossRefPubMed

39.

Obeid S, Lahoud N, Haddad C, Sacre H, Fares K, Akel M, et al. Factors associated with anxiety among the Lebanese population: the role of alexithymia, self-esteem, alcohol use disorders, emotional intelligence and stress and burnout. Int J Psychiatry Clin Pract. 2020;24(2):151–62. https://doi.org/10.1080/13651501.2020.1723641.CrossRefPubMed

40.

Obeid S, Akel M, Haddad C, Fares K, Sacre H, Salameh P, et al. Factors associated with alexithymia among the Lebanese population: results of a cross-sectional study. BMC Psychol. 2019;7(1):80. https://doi.org/10.1186/s40359-019-0353-5.CrossRefPubMedPubMedCentral

41.

Abou Rizk T. Lebanese Pound’s crisis, an opportunity in disguise? 2020. Available from: https://www.bytheeast.com/2020/07/17/lebanese-pounds-crisis-an-opportunity-in-disguise/#:~:text=Depreciating%20currency,at%201%2C50020against20the%20greenback.

42.

Haddad C, Obeid S, Akel M, Honein K, Akiki M, Azar J, et al. Correlates of orthorexia nervosa among a representative sample of the Lebanese population. Eat Weight Disord. 2019;24(3):481–93. https://doi.org/10.1007/s40519-018-0631-x.CrossRefPubMed

43.

Haddad C, Hallit R, Akel M, Honein K, Akiki M, Kheir N, et al. Validation of the Arabic version of the ORTO-15 questionnaire in a sample of the Lebanese population. Eat Weight Disord. 2019;25(4):951–60. https://doi.org/10.1007/s40519-019-00710-y.CrossRefPubMed

44.

Farchakh Y, Hallit S, Soufia M. Association between orthorexia nervosa, eating attitudes and anxiety among medical students in Lebanese universities: results of a cross-sectional study. Eat Weight Disord. 2019;24(4):683–91. https://doi.org/10.1007/s40519-019-00724-6.CrossRefPubMed

45.

Aoun C, Nassar L, Soumi S, El Osta N, Papazian T, Rabbaa KL. The cognitive, behavioral, and emotional aspects of eating habits and association with impulsivity, chronotype, anxiety, and depression: a cross-sectional study. Front Behav Neurosci. 2019;13. https://doi.org/10.3389/fnbeh.2019.00204.

46.

Merz EC, He X, Noble KG. Anxiety, depression, impulsivity, and brain structure in children and adolescents. NeuroImage. 2018;20:243–51. https://doi.org/10.1016/j.nicl.2018.07.020.CrossRefPubMedPubMedCentral

47.

Awad E, Obeid S, Sacre H, Salameh P, Strahler J, Hallit S. Association between impulsivity and orthorexia nervosa: any moderating role of maladaptive personality traits? Eat Weight Disord. 2021. https://doi.org/10.1007/s40519-021-01186-5.

48.

Mhanna M, Azzi R, Hallit S, Obeid S, Soufia M. Validation of the Arabic version of the Teruel Orthorexia Scale (TOS) among Lebanese adolescents. Eat Weight Disord. 2021. https://doi.org/10.1007/s40519-021-01200-w.

49.

Kovaleva A, Beierlein C, Kemper CJ, Rammstedt B. Eine Kurzskala zur Messung von Impulsivität nach dem UPPS-Ansatz: Die Skala Impulsives-Verhalten-8 (I-8). GESIS-Working Papers, 20; 2012.

50.

Obeid S, Abi Elias Hallit C, Haddad C, Hany Z, Hallit S. Validation of the Hamilton Depression Rating Scale (HDRS) and sociodemographic factors associated with Lebanese depressed patients. Encephale. 2018;44(5):397–402. https://doi.org/10.1016/j.encep.2017.10.010.CrossRefPubMed

51.

Hallit S, Haddad C, Hallit R, Akel M, Obeid S, Haddad G, et al. Validation of the Hamilton anxiety rating scale and state trait anxiety inventory a and B in Arabic among the Lebanese population. Clin Epidemiol Glob Health. 2020;8(4):1104–1109.

52.

Malaeb D, Farchakh Y, Haddad C, Sacre H, Obeid S, Hallit S, et al. Validation of the Beirut Distress Scale (BDS-10), a short version of BDS-22, to assess psychological distress among the Lebanese population. Perspect Psychiatr Care. 2021. https://doi.org/10.1111/ppc.12787.

53.

Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000;25(24):3186–91. https://doi.org/10.1097/00007632-200012150-00014.CrossRef

54.

Beaton D., Bombardier C., Guillemin F., Ferraz B.. Recommendations for the cross-cultural adaptation of health status measures - supported by the American Academy of Orthopaedic Surgeons, Institute of Work & Health. 1998. Available from: https://pdfs.semanticscholar.org/729b/fa6c68a48aafdf61e39e5f999.

55.

Al-Bannay H, Jarus T, Jongbloed L, Yazigi M, Dean E. Culture as a variable in health research: perspectives and caveats. Health Promot Int. 2014;29(3):549–57. https://doi.org/10.1093/heapro/dat002.CrossRefPubMed

56.

George D. SPSS for windows step by step: a simple study guide and reference, 17.0 update, 10/e, Pearson Education India; 2011.

57.

Mishra P, Pandey CM, Singh U, Gupta A, Sahu C, Keshri A. Descriptive statistics and normality tests for statistical data. Ann Card Anaesth. 2019;22(1):67–72. https://doi.org/10.4103/aca.ACA_157_18.CrossRefPubMedPubMedCentral

58.

Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach, Guilford publications; 2017.

59.

Barthels F, Barrada JR, Roncero M. Orthorexia nervosa and healthy orthorexia as new eating styles. PLoS One. 2019;14(7):e0219609. https://doi.org/10.1371/journal.pone.0219609.CrossRefPubMedPubMedCentral

60.

Gramaglia C, Brytek-Matera A, Rogoza R, Zeppegno P. Orthorexia and anorexia nervosa: two distinct phenomena? A cross-cultural comparison of orthorexic behaviours in clinical and non-clinical samples. BMC Psychiatry. 2017;17(1):75. https://doi.org/10.1186/s12888-017-1241-2.CrossRefPubMedPubMedCentral

61.

Heise L, Greene ME, Opper N, Stavropoulou M, Harper C, Nascimento M, et al. Gender inequality and restrictive gender norms: framing the challenges to health. Lancet. 2019;393(10189):2440–54. https://doi.org/10.1016/S0140-6736(19)30652-X.CrossRefPubMed

62.

Allen KJD, Sammon MM, Fox KR, Stewart JG. Emotional response inhibition: a shared neurocognitive deficit in eating disorder symptoms and nonsuicidal self-injury. Brain Sci. 2020;10(2). https://doi.org/10.3390/brainsci10020104.

63.

Claes L, Vandereycken W, Vertommen H. Impulsivity-related traits in eat-ing disorder patients. Pers Individ Differ. 2005;39(4):739–49. https://doi.org/10.1016/j.paid.2005.02.022.CrossRef

64.

Luck-Sikorski C, Jung F, Schlosser K, Riedel-Heller SG. Is orthorexic behavior common in the general public? A large representative study in Germany. Eat Weight Disord. 2019;24(2):267–73. https://doi.org/10.1007/s40519-018-0502-5.CrossRefPubMed

65.

American Psychiatric Associaiton. Statistical manual of mental disorders. Arlington: DSM-V; 2013.CrossRef

66.

Kiss-Leizer M, Toth-Kiraly I, Rigo A. How the obsession to eat healthy food meets with the willingness to do sports: the motivational background of orthorexia nervosa. Eat Weight Disord. 2019;24(3):465–72. https://doi.org/10.1007/s40519-019-00642-7.CrossRefPubMedPubMedCentral

67.

Kesby A, Maguire S, Vartanian LR, Grisham JR. Intolerance of uncertainty and eating disorder behaviour: piloting a consumption task in a non-clinical sample. J Behav Ther Exp Psychiatry. 2019;65:101492. https://doi.org/10.1016/j.jbtep.2019.101492.CrossRefPubMed

68.

Eriksson L, Baigi A, Marklund B, Lindgren EC. Social physique anxiety and sociocultural attitudes toward appearance impact on orthorexia test in fitness participants. Scand J Med Sci Sports. 2007;18(3):389–94. https://doi.org/10.1111/j.1600-0838.2007.00723.x.CrossRefPubMed

69.

Tóth-Király I, Gajdos P, Román N, Vass N, Rigó A. The associations between orthorexia nervosa and the sociocultural attitudes: the mediating role of basic psychological needs and health anxiety. Eat Weight Disord. 2021;26:125–134. https://doi.org/10.1007/s40519-019-00826-1.

70.

Strahler J, Hermann A, Walter B, Stark R. Orthorexia nervosa: a behavioral complex or a psychological condition? J Behav Addict. 2018;7(4):1143–56. https://doi.org/10.1556/2006.7.2018.129.CrossRefPubMedPubMedCentral

71.

Zhunissova M, Shalkarova ZS, Shalkarova ZN, Nuskabayeva G, Sadykova KZ, Madenbay K, et al. Psychoemotional stress and eating behavior in Kazakhstan. Ekologiya Cheloveka. 2015:36–45. https://doi.org/10.33396/1728-0869-2015-5-36-45.

Title: Association between impulsivity and orthorexia nervosa / healthy orthorexia: any mediating effect of depression, anxiety, and stress?
Authors: Emmanuelle Awad
Pascale Salameh
Hala Sacre
Diana Malaeb
Souheil Hallit
Sahar Obeid
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Mood Disorders
Eating Disorder
Eating Disorder
Affective Disorder
Anxiety
Published in: BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-021-03594-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Association between impulsivity and orthorexia nervosa / healthy orthorexia: any mediating effect of depression, anxiety, and stress?

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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