Cross-cultural adaptation and psychometric validation of the Turkish Düsseldorf Orthorexia Scale in adolescents

Orthorexia nervosa (ON) is characterized by an excessive preoccupation with healthy eating that may lead to rigidity, distress, and functional impairment. Validated instruments for assessing orthorexic tendencies in adolescent psychiatric settings remain limited. This study aimed to examine the psychometric properties of the Turkish version of the Düsseldorf Orthorexia Scale (TR-DOS) in a clinically referred adolescent sample.

Adolescents aged 12-18 years presenting to a child and adolescent psychiatry outpatient clinic completed the TR-DOS, Orthorexia Nervosa Inventory (ONI), Eating Attitudes Test-26 (EAT-26), and Revised Child Anxiety and Depression Scale-Child Version (RCADS-CV). Psychiatric diagnoses were established through clinician-administered DSM-5 interviews. Construct validity was examined using exploratory and confirmatory factor analyses, internal consistency using Cronbach's alpha and McDonald's omega, and convergent validity through correlations with related measures.

The sample comprised 209 adolescents (61.2% female; mean age = 15.7 ± 1.72 years). Exploratory factor analysis supported a single-factor solution. Confirmatory factor ana`lysis also supported a one-factor structure, with good model fit (χ²/df = 1.51, CFI = 0.977, TLI = 0.967, RMSEA = 0.049, SRMR = 0.039). All factor loadings were statistically significant, with standardized loadings ranging from 0.335 to 0.725. Internal consistency was high (Cronbach's alpha = 0.868; McDonald's omega = 0.871). TR-DOS scores were positively correlated with ONI and EAT-26, but not with BMI or RCADS-CV total anxiety. Adolescents with obsessive-compulsive disorder had significantly higher TR-DOS scores than those without this diagnosis.

The TR-DOS demonstrated satisfactory validity and reliability in a clinically referred Turkish adolescent sample. Level of evidence Level V, descriptive study.