Is dieting a double-edged sword? Orthorexia in celiac disease

OBJECTIVE: Celiac disease (CD) is a systemic autoimmune disorder requiring lifelong gluten exclusion, which may inadvertently foster disordered eating patterns. This study examined orthorexic traits in patients with CD and explored its association with anxiety and depressive symptoms. METHODS AND MEASURES: A cross-sectional study included 156 biopsy-confirmed patients with CD and 182 controls. Assessments included the Orthorexia Nervosa Inventory (ONI), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). RESULTS: Of the 338 participants, 255 were female (75.4%). ONI total score and all ONI subscale scores (behaviors, emotions, and impairments) were significantly higher in the CD group. Similarly, BDI and BAI scores were significantly higher in the CD group. ONI total scores showed a significant positive correlation with BDI (r = 0.38; p < 0.001) and BAI scores (r = 0.42; p < 0.001). In hierarchical regression analyses, CD status emerged as the strongest predictor of orthorexic traits, while anxiety symptoms and age remained significant independent predictors. CONCLUSION: Orthorexic traits were significantly higher in individuals with CD and were associated with increased psychological distress. These findings suggest that the rigid dietary requirements of CD management may be associated with orthorexic tendencies in some individuals, highlighting the importance of integrating nutritional and psychological support into routine clinical follow-up.