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Purpose Orthorexia Nervosa (ON) may belong on the eating disorder (ED) or obsessive-compulsive (OC) spectrum. We sought to provide additional evidence regarding the working classification of ON as an ED. Methods 512 individuals completed a measure of ON symptoms (rBOT), ED symptoms (Eating Disorder Examination Questionnaire), OC symptoms (Obsessive-Compulsive Inventory Revised), food choice motives (Food Choice Questionnaire), and perfectionism (Multidimensional Perfectionism Scale). Results ON symptoms were more strongly linked to ED symptoms than to OC symptoms. ON symptoms were related to body weight and shape concerns, and with prioritizing weight above health with respect to food selection. Both ED and ON symptoms were moderately related to perfectionism, while OC symptoms were strongly related to perfectionism. Conclusion Our results support ON being classified on the ED spectrum; however, whether ON represents a precursor to an ED, an ED with added health concerns, or a disorder that evolves from an ED is not certain. Future longitudinal research is necessary to test these alternate possibilities.

Perfectionism has long been known to correlate with eating disturbance (ED). One mechanism through which this personality tendency may lead to ED is through increasing one's daily perfectionistic thoughts. This study examined the mediating role of perfectionistic thinking in the personality perfectionism-ED relationship among both male and female college students, and included measures assessing both typically-male and typically-female ED symptoms.A majority-White sample of 140 males and 329 females completed online versions of the Multidimensional Perfectionism Scale (HewittFlett, 1991), Perfectionism Cognitions Inventory (Flett, Hewitt, Blankstein,Gray, 1998), Drive for Muscularity Scale (McCreary, Sasse, Saucier,Dorsch, 2004), items from the Eating Disorder Examination Questionnaire (Fairburn, 2008), and other measures. Regression tests examined the hypothesized role of perfectionistic cognitions as a mediator, including participant age, BMI, and positive and negative affect as covariates.Among women, relationships between both self-oriented (Sobel's statistic=-4.63, p.001) and socially prescribed perfectionism (Sobel's statistic=-5.77, p.001) and dieting behavior were fully mediated by increased perfectionistic thinking. Among men, however, the relationship between only self-oriented perfectionism and bulimic (but not dieting) behavior, was fully mediated by increased perfectionistic thinking (Sobel's statistic=-2.53, p=.01).Perfectionistic cognitions play an important linking role between personality perfectionism and ED, and can illuminate important differences by gender in eating disturbance. Such findings can improve validity of ED assessment in both genders, and provide a clear pathway to interventions to decrease ED in both genders.

Although both perfectionism (i.e. personal standards perfectionism and evaluative concerns perfectionism) and impulsivity have been shown to be implicated in eating disorders, no previous studies have examined the interplay between both personality dimensions in their association with eating disorder symptoms. This is the first study to investigate the relationship between empirically derived personality subtypes based on perfectionism and impulsivity and eating disorder symptoms (i.e., dietary restraint, and concerns over eating, weight and shape). Cluster analysis was used to establish naturally occurring combinations of perfectionism and impulsivity in adolescent boys and girls (N=460; M age=14.2 years, SD=.90). Evidence was obtained for four personality profiles: (1) a resilient subtype (low on perfectionism and impulsivity), (2) pure impulsivity subtype (high on impulsivity only), (3) pure perfectionism subtype (high on perfectionism only), and (4) combined perfectionism/impulsivity subtype (high on both perfectionism and impulsivity). Participants in these four clusters showed differences in terms of eating disorder symptoms in that participants with a combination of high perfectionism and high impulsivity (rather than the presence of one of these two characteristics alone) had the highest levels of ED symptoms. These findings shed new light on extant theories concerning ED.