Depression, Anxiety, and Stress Effects in Orthorexic Eating Behaviors

Shot of a young woman eating a healthy salad at home.She dosen’t like to eating green
With a lack of studies exploring the possible mediating role of psychological factors, such as depression, anxiety and stress on orthorexic eating behaviors, researchers investigated the mediating effect of depression, anxiety, and stress, on impulsivity and orthorexia nervosa, and healthy orthorexia.

Impulsivity may be mediated by depression, anxiety, and stress among patients with orthorexic eating behaviors. These findings, from a cross-sectional study, were published in BMC Psychiatry.

In 2019, adults were recruited from pharmacies located in 7 communities in Lebanon. A total of 519 adults completed questionnaires which included the Teruel Orthorexia Scale (TOS), the Hamilton Rating Scale for Depression, the Hamilton Anxiety Rating Scale, the I-8 scale for urgency, and the Beirut Distress Scale.

Study participants were 56.0% women, 48.3% were married, 45.4% were single, and 53.1% had completed a university education.

Mean TOS orthorexia nervosa (ON) score was 7.75±5.62 points, TOS healthy orthorexia score was 10.57±6.04, depression score was 6.09±7.27 points, anxiety score was 12.86±10.52 points, and stress score was 17.34±4.60 points.

Women had higher TOS healthy orthorexia scores than men (P =.006) and married individuals had higher scores than single, divorced, or widowed individuals (P =.003).

Higher TOS ON scores were associated with increased age, BMI, anxiety, stress, urgency, and perseverance. Increased TOS healthy orthorexia were associated with anxiety and lower TOS healthy orthorexia scores associated with BMI and perseverance.

Depression and anxiety were significant predictors of TOS ON scores in all models taking urgency, premeditation, perseverance, and sensation seeking as independent variables (all P .006).

For TOS healthy orthorexia scores, depression and anxiety were significant in all models (all P .018). Stress was found to be significant in models which had urgency (P =.007) and perseverance (P =.023) as independent variables. Gender was significant in models which took urgency, premeditation, and sensation seeking as independent variables (all P .025). For the model with perseverance as an independent variable, marital status was significant (P =.029).

Depression (8.08%) and anxiety (14.65%) partially mediated the association between perseverance and ON. Anxiety (14.96%) and stress (15.12%) partially mediated the association between urgency and healthy orthorexia.

This study was limited by its cross-sectional design. It remains unclear whether there are any causal relationships between depression, anxiety, and stress with orthorexia nervosa behaviors.

This study found significant correlations between impulsivity and mental health traits with orthorexia nervosa. Additional study is needed to better understand the role of depression, anxiety, and stress in orthorexic eating behaviors.


Awad E, Salameh P, Sacre H, Malaeb D, Hallit S, Obeid S. Association between impulsivity and orthorexia nervosa / healthy orthorexia: any mediating effect of depression, anxiety, and stress? BMC Psychiatry. 2021;21(1):604. doi:10.1186/s12888-021-03594-4