Orthorexia nervosa through the eyes of psychiatrists: A large population study

Orthorexia nervosa (ON), characterized by an obsessive focus on healthy eating and rigid dietary rules, is not yet recognized in major diagnostic systems such as the DSM-5-TR or ICD-11. Although healthcare professionals-especially those in dietetics-show elevated rates of orthorexic tendencies, the perspectives of psychiatrists, who play a key role in diagnosis and treatment, remain largely unexplored. This study aimed to assess Turkish psychiatrists' knowledge, attitudes, and clinical experiences regarding ON, as well as their own orthorexic tendencies. A cross-sectional online survey was conducted among adult and child-adolescent psychiatrists in Türkiye. The survey included demographic questions, items on knowledge and attitudes toward ON, clinical experience with ON symptoms, and the Orthorexia Nervosa Inventory (ONI). A total of 1067 psychiatrists completed the questionnaire. Although 84.5% of participants had heard of ON, only 13% rated their knowledge as "good" or "very good." The prevalence of ON symptomatology (ONI ≥72) was 0.28%. Psychiatrists commonly associated ON with obsessive-compulsive and eating disorders, but only half supported its inclusion in diagnostic manuals. Key challenges in clinical recognition included a lack of clear criteria and significant symptom overlap with other disorders. Psychotherapy was the most recommended treatment, though difficulties with patient adherence were frequently reported. Despite growing awareness, ON remains poorly understood and inconsistently conceptualized among Turkish psychiatrists. The findings underscore a critical need for standardised diagnostic criteria, clearer clinical definitions, and the integration of ON into psychiatric education and training. Developing consensus-based guidelines may improve recognition, diagnosis, and management of ON in clinical settings.