The interrelationship between orthorexia nervosa, perfectionism, body image and attachment style

Eat Weight Disord. 2017 Mar;22(1):177-184. doi: 10.1007/s40519-016-0280-x. Epub 2016 Apr 11.


Purpose: We investigated whether perfectionism, body image, attachment style, and self-esteem are predictors of orthorexia nervosa.

Methods: A cohort of 220 participants completed a self-administered, online questionnaire consisting of five measures: ORTO-15, the Multidimensional Perfectionism Scale (MPS), the Multidimensional Body-Self Relations Questionnaire-Appearance Scale (MBSRQ-AS), the Relationship Scales Questionnaire (RSQ), and Rosenberg's Self-Esteem Scale (RSES).

Results: Correlation analysis revealed that higher orthorexic tendencies significantly correlated with higher scores for perfectionism (self-oriented, others-oriented and socially prescribed), appearance orientation, overweight preoccupation, self-classified weight, and fearful and dismissing attachment styles. Higher orthorexic tendencies also correlated with lower scores for body areas satisfaction and a secure attachment style. There was no significant correlation between orthorexia nervosa and self-esteem. Multiple linear regression analysis revealed that overweight preoccupation, appearance orientation and the presence of an eating disorder history were significant predictors of orthorexia nervosa with a history of an eating disorder being the strongest predictor.

Conclusions: Orthorexia nervosa shares similarities with anorexia nervosa and bulimia nervosa with regards to perfectionism, body image attitudes, and attachment style. In addition, a history of an eating disorder strongly predicts orthorexia nervosa. These findings suggest that these disorders might be on the same spectrum of disordered eating.

Keywords: Attachment; Body image; Eating disorder; ORTO-15; Orthorexia nervosa; Perfectionism.

MeSH terms

  • Adolescent
  • Adult
  • Body Image / psychology*
  • Feeding and Eating Disorders / psychology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Object Attachment*
  • Perfectionism*
  • Personal Satisfaction
  • Psychometrics
  • Self Concept
  • Surveys and Questionnaires
  • Young Adult