Psychological and motivational correlates of orthorexia nervosa: the role of perfectionism, emotion regulation, and health attitudes

BACKGROUND: Orthorexic tendencies are characterized by a rigid preoccupation with healthy eating and have been associated with eating disorder (ED) symptoms, perfectionism, and emotion regulation difficulties. However, the psychological and motivational correlates of the different dimensions of orthorexic symptomatology remain insufficiently understood. METHODS: We conducted a cross-sectional, correlational study in a community sample of 300 Italian adults (mean age = 24.3 years, SD = 4.0). Participants completed an online survey including validated self-report measures of orthorexic tendencies (EHQ-21), ED symptomatology (EAT-26), obsessive-compulsive symptoms (OCI-R), perfectionism (MPS), emotion regulation difficulties (DERS), health and taste attitudes (HTAS), and eating motivations (EATMOT). Pearson's correlations and multiple linear regression analyses were performed using both total scores and theoretically relevant subscales. RESULTS: Orthorexic tendencies were positively associated with ED symptomatology, particularly dieting concerns. They were also positively associated with perfectionism, especially personal standards and concern over mistakes/doubts about actions. Associations with emotion regulation difficulties were generally weak at the total-score level, but the EHQ-21 Problems dimension showed positive correlations with non-acceptance of emotions, lack of confidence, and loss of control. Obsessive-compulsive symptoms were weakly and positively associated with orthorexic tendencies and did not emerge as significant predictors in regression models. Health-related variables showed the strongest pattern of associations: General Health Interest and Health Motivations were positively related to orthorexic dimensions, particularly Knowledge and Problems. In the regression model predicting the EHQ-21 total score, ED symptoms, perfectionism, and eating motivations emerged as significant predictors, explaining 44% of the variance. CONCLUSIONS: These findings suggest that orthorexic tendencies are more closely linked to ED-related features, perfectionism, and health-related motivations than to obsessive-compulsive symptoms. The results support a multidimensional view of orthorexic symptomatology and highlight the importance of distinguishing adaptive interest in healthy eating from more rigid and impairing orthorexic patterns.