Prevalence and determinants of orthorexia nervosa among adolescents

Objective: Considering the frequency and variety of eating problems in adolescents, it is important both clinically and scientifically to know the epidemiological features of orthorexia nervosa in this group and to determine the sociodemographic characteristics and parental attitudes that may be associated with this clinical condition. In this study, it was aimed to calculate the frequency of orthorexia nervosa in adolescents aged 14-18 attending high schools and to examine various factors that may be associated with this clinic condition. Method: The research was carried out by Karadeniz Technical University Faculty of Medicine, Department of Child-Adolescent Psychiatry between September 2022 and March 2023. In the 2022-2023 academic year, 17 high schools were randomly selected from 145 high schools in Trabzon, the most populous province of the Eastern Black Sea Region of Turkey. Questionnaire forms were distributed to 3450 students in selected high schools using the clustering type sampling method. Of these, 1784 participants who both themselves and their families gave consent to participate in the study and who completed the questionnaires were included in the study. In the first stage of the study, the participants and their parents completed the Sociodemographic Data Form, Orthorexia Nervosa Inventory (ONI), the parent form of the revised child anxiety and depression scale (RCADS), the parent attitude scale. In the second phase of the study, a clinical interview was conducted with 9 adolescents who were found to be at risk of orthorexia nervosa by evaluating the ONI data, to determine the comorbidities. Results: A total of 1784 high school students, 1104 (61.9%) girls and 680 (38.1%) boys, participated in the study. The mean age of the participants was 15.31±1.10 and the mean body mass index was 21.33±3.62. The total prevalence of ON was 0.5% in this study. Those living in rural areas (p=0.022), those with a family history of receiving psychiatric treatment (p=0.006), those with a history of psychiatric disorders (p<0.001), those who do sports more than 2 days a week (p<0.001), those who follow a diet programme (p<0.001), those who prefer a dietary style such as vegan or vegetarianism (p<0. 001), those who use nutritional supplements (p=0.002), those who consume 1 or 2 meals per day (p<0.001), those who consume meals alone (p=0.026) and those who have pets (p=0.042) had higher ONE total scores. It was found that the increase in body mass index (B=0.449, p<0.001) and the total score of anxiety (B=0.132, p<0.001) were predictive of ONE total score. It was also found that authoritarian parenting type predicted ONE total score more than other parenting types (B=1.69, p=0.018). Conclusion: Our study makes an important contribution to the literature in terms of revealing the prevalence of ON in adolescents, risk factors that may be associated with ON, various psychopathologies predicting orthorexic symptom severity, and the relationship between parenting types and ON with a strong methodology. It is thought that increasing the awareness of mental health professionals about possible risk factors and mental pathologies that play a role in the emergence of ON and developing family-based interventions for the authoritarian parenting type, which has been shown to predict the increase in orthorexic symptom severity, will contribute to preventive mental health services. Keywords: Orthorexia Nervosa, Prevalance, Comorbidity, Adolescent Mental Health