Researchers synthesized data from previous meta-analyses to summarize reported prevalence estimates and identify psychological correlates of Orthorexia Nervosa (ON). Despite growing awareness and increasing recognition in the scientific literature, ON remains unrecognized in major psychiatric diagnostic systems.
Review findings revealed that while prevalence estimates vary widely, around 27.5 percent, ON is significantly linked to perfectionism, obsessive-compulsive traits, and eating disorder symptoms. The review further highlights that although a growing body of literature seeks to elucidate ON, inconsistent diagnostic tools currently limit the conclusiveness of pre-existing evidence.
Study
This umbrella review, defined as a synthesis of existing meta-analyses, aimed to address this gap by clarifying the global prevalence of ON symptoms and identifying the psychological traits that drive them.
Eligible publications were identified through systematic searches of PubMed, Google Scholar, and Scopus from database inception through July 31, 2025. Screening of titles, abstracts, and full texts narrowed 62 candidate publications to five robust meta-analyses for inclusion. These analyses encompassed large datasets, including one meta-analysis drawing on data from more than 30,000 individuals across 18 countries.
Results
The quality of included publications was evaluated using the Risk of Bias in Systematic Review (ROBIS) tool, alongside an evidence-classification framework ranging from Class I, convincing evidence, to Class IV, weak evidence.
Analyses focused on two primary questions. First, how prevalent are reported ON symptoms? Second, which psychological traits are statistically associated with ON?
The review identified substantial variability across prevalence estimates, largely attributable to methodological heterogeneity, including differences in study design and diagnostic instruments. Despite these limitations, several consistent patterns emerged.
The pooled prevalence of ON symptoms was estimated at 27.5 percent, with a 95 percent confidence interval of 23.5 to 31.6 percent. Contrary to earlier assumptions that eating disorders disproportionately affect women, the largest included meta-analysis found no statistically significant difference between females, 34.6 percent, and males, 32.1 percent.
Prevalence varied across subgroups. Individuals focused on sports performance or body composition showed the highest observed prevalence, 34.5 percent, although differences between population types were not statistically significant. A non-significant temporal trend toward higher prevalence was also observed, with studies conducted between 2020 and 2023 generally reporting higher estimates than earlier studies.
Conclusion
This umbrella review indicates that ON symptoms are commonly reported, particularly in fitness-oriented populations. Findings position ON along a psychiatric spectrum, sharing features with obsessive-compulsive disorder and anorexia nervosa while remaining distinct in its emphasis on food purity rather than weight loss.
Most evidence was classified as Class III, suggestive, with some correlates, including obsessive-compulsive traits and perfectionism, reaching Class II, highly suggestive. High statistical heterogeneity across studies limited the ability to draw stronger conclusions. These findings highlight the urgent need for standardized diagnostic criteria, validated screening tools, and longitudinal research designs.
Source:
https://www.news-medical.net/news/20251218/Orthorexia-nervosa-links-strongly-to-perfectionism-and-OCD-traits-review-shows.aspx