[{"data":1,"prerenderedAt":432},["ShallowReactive",2],{"assessment-orthorexia-test":3,"assessments-related-orthorexia-test":412},{"id":4,"title":5,"body":6,"category":325,"categoryTitle":326,"clinicalCitations":327,"copyright":358,"description":359,"downloadLink":325,"extension":360,"faqs":361,"featured":377,"firstPublished":378,"i18nReady":377,"icon":325,"inHiBoop":325,"interpreter":379,"interpreterExempt":325,"lastReviewed":401,"meta":402,"navigation":403,"path":404,"permissionsNote":325,"published":403,"recommendedFrequency":325,"relatedCodes":325,"relatedConditions":325,"relevantSpecialty":325,"reviewedBy":325,"seo":405,"slug":406,"status":407,"stem":408,"summary":409,"takeaways":325,"timeline":325,"type":410,"usedToDiagnose":325,"__hash__":411},"assessments\u002Fassessments\u002Forthorexia-test.md","Orthorexia Test: Düsseldorf Orthorexia Scale (DOS) and ORTO-15 Scoring",{"type":7,"value":8,"toc":314},"minimark",[9,18,23,32,49,66,70,110,114,153,157,163,202,206,240,244],[10,11,12,13,17],"p",{},"The DOS (Düsseldorf Orthorexia Scale) is a 10-item self-report questionnaire that measures orthorexic eating behaviour; totals of 10 to 40 are read against a proposed risk range of 25 to 29 and a cutoff of 30 ",[14,15],"cite-ref",{"n":16},"2",".",[19,20,22],"h2",{"id":21},"what-does-the-dos-measure","What does the DOS measure?",[10,24,25,26,29,30,17],{},"The DOS measures orthorexic eating behaviour: a pattern of rigid, preoccupying focus on eating foods a person judges healthy, to the point that it can restrict diet and affect daily life ",[14,27],{"n":28},"10"," ",[14,31],{"n":16},[10,33,34,38,39,42,43,45,46,48],{},[35,36,37],"strong",{},"Orthorexia nervosa is not a DSM-5-TR diagnosis."," No consensus definition existed for years after the term was coined in 1997 ",[14,40],{"n":41},"9",". Dunn and Bratman proposed diagnostic criteria in 2016 ",[14,44],{"n":28},", and a 2022 consensus of 47 eating disorder experts from 14 countries proposed tentative criteria for research and clinical use ",[14,47],{"n":41},". These proposals are not official diagnoses.",[10,50,51,52,29,55,58,59,29,62,65],{},"Why this page leads with the DOS: the ORTO-15 is used far more often, but its factor structure has proved unstable and its developers have since revised it ",[14,53],{"n":54},"7",[14,56],{"n":57},"8",". The DOS has shown better internal consistency in validation studies ",[14,60],{"n":61},"3",[14,63],{"n":64},"4",". Both are covered below.",[19,67,69],{"id":68},"how-do-you-give-the-dos","How do you give the DOS?",[71,72,73,82,88,104],"ul",{},[74,75,76,79,80,17],"li",{},[35,77,78],{},"Format."," 10 statements, each rated on a 4-point scale from 1 (does not apply to me) to 4 (applies to me) ",[14,81],{"n":16},[74,83,84,87],{},[35,85,86],{},"Who completes it."," The client, on paper or on screen.",[74,89,90,93,94,97,98,100,101,103],{},[35,91,92],{},"Languages."," Developed in German ",[14,95],{"n":96},"1",", with validated English ",[14,99],{"n":61}," and Chinese ",[14,102],{"n":64}," versions.",[74,105,106,109],{},[35,107,108],{},"Approach."," Talk about eating without praising or criticizing particular diets or bodies. Ask how food rules affect the client's health, mood and relationships.",[19,111,113],{"id":112},"how-do-you-score-and-interpret-the-dos","How do you score and interpret the DOS?",[115,116,117,122,150],"ol",{},[74,118,119,120,17],{},"Add the 10 ratings for a total from 10 to 40. Higher totals mean more orthorexic eating behaviour ",[14,121],{"n":16},[74,123,124,125,29,127,129,130],{},"Read the total against the proposed cutoffs ",[14,126],{"n":16},[14,128],{"n":64},":\n",[71,131,132,138,144],{},[74,133,134,137],{},[35,135,136],{},"30 or more:"," proposed cutoff for orthorexic eating behaviour.",[74,139,140,143],{},[35,141,142],{},"25 to 29:"," proposed range for risk of developing orthorexic eating behaviour.",[74,145,146,149],{},[35,147,148],{},"10 to 24:"," below the risk range.",[74,151,152],{},"Treat a high total as a reason for a clinical conversation about rigidity, distress and impact, not as a diagnosis. The scorer at the top of this page shows each range with its note.",[19,154,156],{"id":155},"orto-15-and-orto-r","ORTO-15 and ORTO-R",[10,158,159,160,17],{},"The ORTO-15 is a 15-item multiple-choice questionnaire published by Donini and colleagues in 2005 ",[14,161],{"n":162},"5",[71,164,165,173,185,193],{},[74,166,167,170,171,17],{},[35,168,169],{},"Scoring direction."," Lower totals indicate more orthorexic tendencies. The developers proposed a threshold of 40, which gave efficacy 73.8%, sensitivity 55.6% and specificity 75.8% in their validation sample ",[14,172],{"n":162},[74,174,175,178,179,181,182,17],{},[35,176,177],{},"Known problems."," The developers noted it was limited in identifying the obsessive component ",[14,180],{"n":162},". A German validation kept only 9 items and still reached Cronbach's α of only 0.67, and 69.1% of participants were classed as having orthorectic tendencies ",[14,183],{"n":184},"6",[74,186,187,190,191,17],{},[35,188,189],{},"Revision."," Re-analysing the original 525-person data, Rogoza and Donini found the ORTO-15 did not capture orthorexia's structure adequately and proposed the 6-item ORTO-R ",[14,192],{"n":54},[74,194,195,198,199,201],{},[35,196,197],{},"Use today."," Half of the studies in a 2020 systematic review used a version of the ORTO-15 ",[14,200],{"n":57},", so it remains common in research. Read older ORTO-15 prevalence figures with caution.",[19,203,205],{"id":204},"psychometric-properties","Psychometric properties",[71,207,208,216,224,232],{},[74,209,210,213,214,17],{},[35,211,212],{},"English DOS."," In 384 U.S. university students, Cronbach's α was 0.88 and the DOS correlated 0.76 with the Eating Habits Questionnaire. A one-factor model fitted poorly, though all 10 items loaded 0.52 to 0.82 ",[14,215],{"n":61},[74,217,218,221,222,17],{},[35,219,220],{},"Chinese DOS."," In 1,075 Chinese university students, ordinal α was 0.80 and test-retest reliability 0.77; a three-factor structure emerged, and measurement was invariant across genders ",[14,223],{"n":64},[74,225,226,229,230,17],{},[35,227,228],{},"Young women."," In 197 young women, Cronbach's α was 0.863 ",[14,231],{"n":16},[74,233,234,237,238,17],{},[35,235,236],{},"Field-wide."," A systematic review of 68 studies found ten orthorexia scales, most needing further validation, and unresolved questions about orthorexia's dimensions and definition ",[14,239],{"n":57},[19,241,243],{"id":242},"limitations","Limitations",[71,245,246,254,262,277,283],{},[74,247,248,251,252,17],{},[35,249,250],{},"Not a diagnosis."," Orthorexia nervosa has no DSM-5-TR criteria; cutoffs describe scores, not a disorder ",[14,253],{"n":41},[74,255,256,259,260,17],{},[35,257,258],{},"Cutoffs are preliminary."," The DOS cutoffs were proposed by the developers and have not been checked against clinical interviews ",[14,261],{"n":61},[74,263,264,267,268,29,270,272,273,29,275,17],{},[35,265,266],{},"Structure varies."," Factor results differ between languages for the DOS ",[14,269],{"n":61},[14,271],{"n":64},", and markedly for the ORTO-15 ",[14,274],{"n":184},[14,276],{"n":54},[74,278,279,282],{},[35,280,281],{},"Healthy interest vs problem."," A high score cannot by itself separate an interest in healthy eating from a harmful pattern.",[74,284,285,288,289,294,295,299,300,299,304,308,309,313],{},[35,286,287],{},"Overlap."," Restrictive eating can also reflect ",[290,291,293],"a",{"href":292},"\u002Ficd-10\u002Ff50-0-anorexia-nervosa\u002F","anorexia nervosa"," or ARFID. Consider the ",[290,296,298],{"href":297},"\u002Fassessments\u002Fede-q\u002F","EDE-Q",", ",[290,301,303],{"href":302},"\u002Fassessments\u002Fnias\u002F","NIAS",[290,305,307],{"href":306},"\u002Fassessments\u002Feat-26\u002F","EAT-26"," or ",[290,310,312],{"href":311},"\u002Fassessments\u002Fscoff\u002F","SCOFF"," alongside an orthorexia scale.",{"title":315,"searchDepth":316,"depth":316,"links":317},"",3,[318,320,321,322,323,324],{"id":21,"depth":319,"text":22},2,{"id":68,"depth":319,"text":69},{"id":112,"depth":319,"text":113},{"id":155,"depth":319,"text":156},{"id":204,"depth":319,"text":205},{"id":242,"depth":319,"text":243},null,"Eating Disorders",[328,331,334,337,340,343,346,349,352,355],{"text":329,"link":330},"Barthels F, Meyer F, Pietrowsky R. Die Düsseldorfer Orthorexie Skala: Konstruktion und Evaluation eines Fragebogens zur Erfassung orthorektischen Ernährungsverhaltens. Z Klin Psychol Psychother. 2015;44(2):97-105.","https:\u002F\u002Fdoi.org\u002F10.1026\u002F1616-3443\u002Fa000310",{"text":332,"link":333},"Barthels F, Kisser J, Pietrowsky R. Orthorexic eating behavior and body dissatisfaction in a sample of young females. Eat Weight Disord. 2021;26(6):2059-2063.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F32803647\u002F",{"text":335,"link":336},"Chard CA, Hilzendegen C, Barthels F, Stroebele-Benschop N. Psychometric evaluation of the English version of the Düsseldorf Orthorexie Scale (DOS) and the prevalence of orthorexia nervosa among a U.S. student sample. Eat Weight Disord. 2019;24(2):275-281.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F30196526\u002F",{"text":338,"link":339},"He J, Ma H, Barthels F, Fan X. Psychometric properties of the Chinese version of the Düsseldorf Orthorexia Scale: prevalence and demographic correlates of orthorexia nervosa among Chinese university students. Eat Weight Disord. 2019;24(3):453-463.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F30796740\u002F",{"text":341,"link":342},"Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C. Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord. 2005;10(2):e28-32.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F16682853\u002F",{"text":344,"link":345},"Missbach B, Hinterbuchinger B, Dreiseitl V, Zellhofer S, Kurz C, König J. When Eating Right, Is Measured Wrong! A Validation and Critical Examination of the ORTO-15 Questionnaire in German. PLoS One. 2015;10(8):e0135772.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F26280449\u002F",{"text":347,"link":348},"Rogoza R, Donini LM. Introducing ORTO-R: a revision of ORTO-15. Eat Weight Disord. 2021;26(3):887-895.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F32436165\u002F",{"text":350,"link":351},"Opitz MC, Newman E, Alvarado Vázquez Mellado AS, Robertson MDA, Sharpe H. The psychometric properties of Orthorexia Nervosa assessment scales: A systematic review and reliability generalization. Appetite. 2020;155:104797.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F32652100\u002F",{"text":353,"link":354},"Donini LM, Barrada JR, Barthels F, et al. A consensus document on definition and diagnostic criteria for orthorexia nervosa. Eat Weight Disord. 2022;27(8):3695-3711.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F36436144\u002F",{"text":356,"link":357},"Dunn TM, Bratman S. On orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eat Behav. 2016;21:11-17.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F26724459\u002F","DOS © Friederike Barthels, Frank Meyer and Reinhard Pietrowsky, first published in Zeitschrift für Klinische Psychologie und Psychotherapie (Hogrefe, 2015). ORTO-15 © Lorenzo M. Donini and colleagues, first published in Eating and Weight Disorders (2005). Neither set of authors has published terms of use.","Orthorexia test guide: the 10-item Düsseldorf Orthorexia Scale (DOS) scores 10 to 40, with 25 to 29 at risk and 30 or more elevated, plus the ORTO-15.","md",[362,365,368,371,374],{"question":363,"answer":364},"Is there a test for orthorexia?","There is no diagnostic test, because orthorexia nervosa is not a recognized diagnosis in DSM-5-TR. Self-report scales measure orthorexic eating behaviour instead. The 10-item Düsseldorf Orthorexia Scale (DOS) and the 15-item ORTO-15 are the most studied; the DOS has the stronger psychometric support.",{"question":366,"answer":367},"How is the DOS scored?","Each of the 10 statements is rated from 1 (does not apply to me) to 4 (applies to me), and the ratings are added for a total from 10 to 40. Higher totals mean more orthorexic eating behaviour. A total of 30 or more is the proposed cutoff for orthorexic eating behaviour, and 25 to 29 is proposed as a risk range.",{"question":369,"answer":370},"Is orthorexia an eating disorder?","Orthorexia nervosa is not a standardized diagnosis. It is not in DSM-5-TR, and researchers have not agreed on one definition. A 2022 international expert consensus proposed tentative diagnostic criteria to guide research and clinical work, but these are not official.",{"question":372,"answer":373},"What is the ORTO-15?","The ORTO-15 is a 15-item multiple-choice questionnaire published by Donini and colleagues in 2005, where lower totals indicate more orthorexic tendencies and 40 was proposed as the threshold. It is the most widely used orthorexia measure, but later studies found an unstable factor structure and high rates of positive results, and its developers proposed a 6-item revision, the ORTO-R.",{"question":375,"answer":376},"Can a high orthorexia score mean healthy eating?","A high score alone cannot separate a strong interest in healthy eating from a problem. What matters clinically is rigidity, distress and impact on health, relationships and daily life, which needs a clinical conversation rather than a score.",false,"2015",{"heading":380,"scaleLabel":381,"min":382,"max":383,"note":384,"source":385,"bands":386},"DOS Score Interpreter","DOS total",10,40,"10 items, each rated 1 (does not apply to me) to 4 (applies to me). Sum for a total of 10 to 40. Higher totals mean more orthorexic eating behaviour. Orthorexia nervosa is not a DSM-5-TR diagnosis.","Barthels, Meyer and Pietrowsky (2015), as reported by Barthels, Kisser and Pietrowsky (2021): 30 or more proposed cutoff for orthorexic eating behaviour, 25 or more proposed risk range.",[387,392,397],{"min":388,"label":389,"level":390,"note":391},30,"Marked orthorexic eating behaviour","warning","A total of 30 or more is the proposed cutoff. Explore rigidity, distress and impact on health and daily life in a clinical conversation; this is not a diagnosis.",{"min":393,"label":394,"level":395,"note":396},25,"At risk","info","Totals of 25 to 29 are the proposed range for risk of developing orthorexic eating behaviour.",{"min":382,"label":398,"level":399,"note":400},"Below the risk range","success","Totals of 10 to 24 fall below the proposed risk range.","2026-10-30",{},true,"\u002Fassessments\u002Forthorexia-test",{"title":5,"description":359},"orthorexia-test","published","assessments\u002Forthorexia-test","The DOS (Düsseldorf Orthorexia Scale) is a 10-item self-report questionnaire that measures orthorexic eating behaviour: a rigid, preoccupying focus on eating only foods judged to be healthy. Items are rated 1 to 4 for a total of 10 to 40; 25 to 29 suggests risk and 30 or more marked orthorexic eating behaviour. Orthorexia nervosa is not a DSM-5-TR diagnosis.","assessment","U1rAllMAbDNliIKKxc1leC_diNiAT8yE_iAA3nX7Oj8",[413,418,421,424,429],{"slug":414,"title":415,"tier":416,"weight":417},"nias","ARFID Test: NIAS (Nine Item ARFID Screen) Scoring and Cutoffs","same",100,{"slug":419,"title":420,"tier":416,"weight":417},"bes","BES Scoring · Binge Eating Scale (16-Item)",{"slug":422,"title":423,"tier":416,"weight":417},"eat-26","EAT-26 Scoring: Eating Attitudes Test (26-Item), Cutoff 20",{"slug":425,"title":426,"tier":427,"weight":428},"mdq","MDQ: Mood Disorder Questionnaire","weaker",15,{"slug":430,"title":431,"tier":427,"weight":428},"ymrs","Young Mania Rating Scale (YMRS): Scoring and Cutoffs",1794129720230]