Food perception in Orthorexia nervosa: Craving or avoidance?

Orthorexia nervosa (ON) is characterised by an excessive preoccupation with eating healthy foods. This disorder shares similarities with various pathological conditions, including anorexia nervosa and addictive behaviours. This research aimed to determine whether ON is primarily driven by a fear of unhealthy foods, similar to anorexia nervosa, or craving for healthy foods, akin to the patterns observed in addictive disorders. In an online study (Study 1), participants (n = 166 adults, mean age = 24.8 years, SD = 7.6 years, 48.8% female) reported their liking, wanting, and frequency of consumption of 20 healthy and 20 unhealthy foods. Additionally, they completed the Düsseldorf Orthorexia Scale, while BMI, hunger level, and risk of eating disorders were collected. In Study 2, participants (n = 73 adults, mean age = 23.4 years, SD = 3.5 years, 37% female) completed questionnaires on ON and the risk of eating disorders, as well as a visual probe task with images of healthy and unhealthy foods. Eye movements were also recorded for a subset of participants in the laboratory. The results suggest that individuals with more pronounced levels of orthorexic features exhibit decreased sensitivity to food rewards and an attentional avoidance of unhealthy foods. This indicates that ON behaviours may be driven by a fear of unhealthy foods. These results underscore the importance of elucidating the role of attentional and motivational mechanisms in ON and their clinical implications.