{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:39:04Z","timestamp":1790807944944,"version":"4.1.0"},"reference-count":54,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T00:00:00Z","timestamp":1736985600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: The research on orthorexia nervosa (ON) has thoroughly outlined the connection between it and various mental disorders, including obsessive-compulsive disorders and eating disorders, in addition to stress. However, research has not considered psychophysical stress and other measures of psychophysical health, such as adherence to the Mediterranean diet. Methods: This cross-sectional and case-control research involved 63 students from the University of Parma, aged between 18 and 49 years. The ORTO-15 questionnaire was utilized to categorize the entire sample into two groups: one without orthorexia (score &gt; 35) and another with orthorexia (score &lt; 35). All subjects were assessed with the Psychophysiological Stress Profile (PSP) and completed the Eating Disorder Inventory-3 (EDI-3) and the Symptom Checklist-90-Revised (SCL-90-R). In addition, they were interviewed using the PREDIMED questionnaire to assess adherence to the Mediterranean Diet, and their body mass index (BMI) was calculated. Results: Subjects with orthorexia represented 38.10% of the total sample and reported a higher BMI than controls, although the PREDIMED score did not show a difference in adherence to the Mediterranean diet. The EDI-3 highlighted emotional dysregulation and hypercontrol in students with orthorexia, and a dissociation between subjective and objective measures of stress emerged. Particularly, the psychophysiological parameters of skin conductance, heart rate, and heart rate variability showed greater reactivity to stressful stimuli, but no difference was noted in psychological symptoms. Conclusions: These findings confirmed the presence of alterations in eating behavior in people with orthorexia as well as a higher BMI. It was hypothesized that hypercontrol might favor the perception of psychological well-being at a subjective level, although inadequate management of stress emerged at an objective psychophysiological level. Further studies are needed to highlight the causality between ON, hypercontrol, diet, and psychophysical stress, given that students with orthorexia present a dysregulation of emotions associated with greater autonomic arousal.<\/jats:p>","DOI":"10.3390\/nu17020317","type":"journal-article","created":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T10:44:23Z","timestamp":1737024263000},"page":"317","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Multidimensional Assessment of Orthorexia Nervosa: A Case-Control Study Comparing Eating Behavior, Adherence to the Mediterranean Diet, Body Mass Index, Psychological Symptoms, and Autonomic Arousal"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4607-4438","authenticated-orcid":false,"given":"Sara","family":"Guidotti","sequence":"first","affiliation":[{"name":"Clinical Psychology, Clinical Psychophysiology and Clinical Neuropsychology Laboratory, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Fiduccia","sequence":"additional","affiliation":[{"name":"Clinical Psychology, Clinical Psychophysiology and Clinical Neuropsychology Laboratory, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7335-2332","authenticated-orcid":false,"given":"Rosanna","family":"Sanseverino","sequence":"additional","affiliation":[{"name":"Clinical Psychology, Clinical Psychophysiology and Clinical Neuropsychology Laboratory, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7686-0766","authenticated-orcid":false,"given":"Carlo","family":"Pruneti","sequence":"additional","affiliation":[{"name":"Clinical Psychology, Clinical Psychophysiology and Clinical Neuropsychology Laboratory, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1016\/j.jand.2023.05.015","article-title":"Healthy Eating Index-2020: Review and Update Process to Reflect the Dietary Guidelines for Americans, 2020\u20132025","volume":"123","author":"Pannucci","year":"2023","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.addbeh.2013.09.003","article-title":"Relationships between problematic internet use and problem-gambling severity: Findings from a high-school survey","volume":"39","author":"Yau","year":"2014","journal-title":"Addict. Behav."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1006\/appe.2001.0390","article-title":"Mood and carbohydrate cravings","volume":"36","author":"Christensen","year":"2001","journal-title":"Appetite"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Ljubi\u010di\u0107, M., Matek Sari\u0107, M., Klarin, I., Rumbak, I., Coli\u0107 Bari\u0107, I., Ranilovi\u0107, J., D\u017eelalija, B., Sari\u0107, A., Naki\u0107, D., and Djekic, I. (2023). Emotions and Food Consumption: Emotional Eating Behavior in a European Population. Foods, 12.","DOI":"10.3390\/foods12040872"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.appet.2012.09.023","article-title":"Perceptions of emotional eating behavior. A qualitative study of college students","volume":"60","author":"Bennett","year":"2013","journal-title":"Appetite"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Dakanalis, A., Mentzelou, M., Papadopoulou, S.K., Papandreou, D., Spanoudaki, M., Vasios, G.K., Pavlidou, E., Mantzorou, M., and Giaginis, C. (2023). The Association of Emotional Eating with Overweight\/Obesity, Depression, Anxiety\/Stress, and Dietary Patterns: A Review of the Current Clinical Evidence. Nutrients, 15.","DOI":"10.3390\/nu15051173"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0005-7967(98)00102-8","article-title":"A cognitive behavioural theory of anorexia nervosa","volume":"37","author":"Fairburn","year":"1999","journal-title":"Behav. Res. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Pontillo, M., Zanna, V., Demaria, F., Averna, R., Di Vincenzo, C., De Biase, M., Di Luzio, M., Foti, B., Tata, M.C., and Vicari, S. (2022). Orthorexia Nervosa, Eating Disorders, and Obsessive-Compulsive Disorder: A Selective Review of the Last Seven Years. J. Clin. Med., 11.","DOI":"10.3390\/jcm11206134"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3695","DOI":"10.1007\/s40519-022-01512-5","article-title":"A consensus document on definition and diagnostic criteria for orthorexia nervosa","volume":"27","author":"Donini","year":"2022","journal-title":"Eat. Weight Disord."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Depa, J., Barrada, J.R., and Roncero, M. (2019). Are the Motives for Food Choices Different in Orthorexia Nervosa and Healthy Orthorexia?. Nutrients, 11.","DOI":"10.3390\/nu11030697"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1556\/2006.7.2018.129","article-title":"Orthorexia nervosa: A behavioral complex or a psychological condition?","volume":"7","author":"Strahler","year":"2018","journal-title":"J. Behav. Addict."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e28","DOI":"10.1007\/BF03327537","article-title":"Orthorexia nervosa: Validation of a diagnosis questionnaire","volume":"10","author":"Donini","year":"2005","journal-title":"Eat. Weight Disord."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e34","DOI":"10.1056\/NEJMoa1800389","article-title":"Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts","volume":"378","author":"Estruch","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1016\/j.clnu.2018.03.012","article-title":"Association between Mediterranean diet and hand grip strength in older adult women","volume":"38","author":"Barrea","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez-Gonz\u00e1lez, M.A., Garc\u00eda-Arellano, A., Toledo, E., Salas-Salvad\u00f3, J., Buil-Cosiales, P., Corella, D., Covas, M.I., Schr\u00f6der, H., Ar\u00f3s, F., and G\u00f3mez-Gracia, E. (2012). A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: The PREDIMED trial. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0043134"},{"key":"ref_16","unstructured":"Weir, C.B., and Jan, A. (2023). BMI Classification Percentile and Cut Off Points. StatPearls, StatPearls Publishing."},{"key":"ref_17","unstructured":"Garner, D.M. (2004). The Eating Disorder Inventory-3: Professional Manual, Psychological Assessment Resources Inc."},{"key":"ref_18","unstructured":"Maruish, M.E. (1999). The SCL-90-R, Brief Symptom Inventory, and Matching Clinical Rating Scales. The Use of Psychological Testing for Treatment Planning and Outcomes Assessment, Lawrence Erlbaum Associates Publishers."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/j.eurpsy.2010.12.006","article-title":"Psychometric properties of the Italian version of the SCL-90-R: A study on a large community sample","volume":"27","author":"Prunas","year":"2012","journal-title":"Eur. Psychiatry"},{"key":"ref_20","unstructured":"Fuller, G.D. (1979). Biofeedback Methods and Procedures in Clinical Practice, Biofeedback Press."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1007\/s10484-023-09582-6","article-title":"Methods for Heart Rate Variability Biofeedback [HRVB): A Systematic Review and Guidelines","volume":"48","author":"Lalanza","year":"2023","journal-title":"Appl. Psychophysiol. Biofeedback"},{"key":"ref_22","first-page":"H2233","article-title":"Effect of aging on gender differences in neural control of heart rate","volume":"277","author":"Kuo","year":"1999","journal-title":"Am. J. Physiol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Laborde, S., Mosley, E., and Thayer, J.F. (2017). Heart Rate Variability and Cardiac Vagal Tone in Psychophysiological Research\u2014Recommendations for Experiment Planning, Data Analysis, and Data Reporting. Front. Psychol., 8.","DOI":"10.3389\/fpsyg.2017.00213"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.comppsych.2009.03.001","article-title":"Prevalence of orthorexia among medical students in Erzurum, Turkey","volume":"51","author":"Fidan","year":"2010","journal-title":"Compr. Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Missbach, B., Hinterbuchinger, B., Dreiseitl, V., Zellhofer, S., Kurz, C., and K\u00f6nig, J. (2015). When Eating Right, Is Measured Wrong! A Validation and Critical Examination of the ORTO-15 Questionnaire in German. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0135772"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1080\/03670244.2016.1150276","article-title":"Does the rise in eating disorders lead to increasing risk of orthorexia nervosa? Correlations with gender, education, and body mass index","volume":"55","author":"Sanlier","year":"2016","journal-title":"Ecol. Food Nutr."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Varga, M., Thege, B.K., Dukay-Szab\u00f3, S., T\u00fary, F., and van Furth, E.F. (2014). When eating healthy is not healthy: Orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry, 14.","DOI":"10.1186\/1471-244X-14-59"},{"key":"ref_28","first-page":"190","article-title":"Orthorexia nervosa in a sample of Italian university population","volume":"51","author":"Abelli","year":"2016","journal-title":"Riv Psichiatr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1007\/s40519-018-0517-y","article-title":"Orthorexia nervosa in a sample of Portuguese fitness participants","volume":"23","author":"Almeida","year":"2018","journal-title":"Eat. Weight Disord."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/BF03325060","article-title":"Orthorexia Nervosa: A preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon","volume":"9","author":"Donini","year":"2004","journal-title":"Eat. Weight Disord."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1007\/s40519-016-0334-0","article-title":"Prevalence and predictors of Orthorexia Nervosa among germane students using the 21-item-DOS","volume":"22","author":"Depa","year":"2017","journal-title":"Eat. Weight Disord."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.appet.2016.11.028","article-title":"Health status, physical activity, and orthorexia nervosa: A comparison between exercise science students and business students","volume":"109","author":"Malmborg","year":"2017","journal-title":"Appetite"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/j.appet.2007.04.007","article-title":"Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine (Ankara, Turkey)","volume":"49","author":"Camur","year":"2007","journal-title":"Appetite"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.appet.2016.02.144","article-title":"Prevalence of Orthorexia Nervosa among college students based on Bratman\u2019s test and associated tendencies","volume":"101","author":"Bundros","year":"2016","journal-title":"Appetite"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.appet.2016.10.021","article-title":"Orthorexia Nervosa: Assessment and correlates with gender, BMI, and personality","volume":"108","author":"Oberle","year":"2017","journal-title":"Appetite"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.ijpsycho.2023.08.001","article-title":"Heart rate variability (HRV) as a way to understand associations between the autonomic nervous system (ANS) and affective states: A critical review of the literature","volume":"192","author":"Gullett","year":"2023","journal-title":"Int. J. Psychophysiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s11892-018-1000-x","article-title":"Causes of Emotional Eating and Matched Treatment of Obesity","volume":"18","year":"2018","journal-title":"Curr. Diabetes Rep."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Shriver, L.H., Dollr, J.M., Calkins, S.D., Keane, S.P., Shanahan, L., and Wideman, L. (2020). Emotional Eating in Adolescence: Effects of Emotion Regulation, Weight Status and Negative Body Image. Nutrients, 13.","DOI":"10.3390\/nu13010079"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Guidotti, S., Fiduccia, A., Murgolo, M., and Pruneti, C. (2024). Comparison between Physical Activity and Stress-Related Lifestyle between Orthorexic and Non-Orthorexic University Students: A Case-Control Study. Nutrients, 16.","DOI":"10.3390\/nu16091340"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.eatbeh.2015.12.006","article-title":"On orthorexia nervosa: A review of the literature and proposed diagnostic criteria","volume":"21","author":"Dunn","year":"2016","journal-title":"Eat. Behav."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"421","DOI":"10.12740\/PP\/125387","article-title":"Orthorexia nervosa\u2014A distorted approach to healthy eating","volume":"55","author":"Gortat","year":"2021","journal-title":"Psychiatr. Pol."},{"key":"ref_42","first-page":"55","article-title":"Orthorexia nervosa\u2014An eating disorder, obsessive-compulsive disorder or disturbed eating habit?","volume":"14","year":"2012","journal-title":"Arch. Psychiatry Psychother."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2387","DOI":"10.1007\/s40519-020-01091-3","article-title":"Orthorexic eating behaviour, illness anxiety and dysfunctional cognitions characteristic of somatic symptom disorders in a non-clinical sample","volume":"26","author":"Barthels","year":"2021","journal-title":"Eat. Weight Disord."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s40519-019-00829-y","article-title":"Orthorexic eating behavior in patients with somatoform disorders","volume":"26","author":"Barthels","year":"2021","journal-title":"Eat. Weight Disord."},{"key":"ref_45","first-page":"1282","article-title":"Orthorexia nervosa","volume":"70","author":"Kalra","year":"2020","journal-title":"JPMA J. Pak. Med. Assoc."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.tics.2011.11.009","article-title":"Neurocognitive endophenotypes of impulsivity and compulsivity: Towards dimensional psychiatry","volume":"16","author":"Robbins","year":"2012","journal-title":"Trends Cogn. Sci."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1001\/archpsyc.63.11.1225","article-title":"Reduced orbitofrontalstriatal activity on a reversal-learning task in obsessive-compulsive disorder","volume":"63","author":"Remijnse","year":"2006","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_48","first-page":"201","article-title":"L\u2019ortoressia nervosa tra attenzione per la qualit\u00e0 dell\u2019alimentazione e disturbi alimentari: Criteri diagnostici e strumenti di valutazione","volume":"55","author":"Atzeni","year":"2020","journal-title":"Rivista di Psichiatria"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1017\/S0033291718001988","article-title":"Heart rate and high-frequency heart rate variability during stress as biomarker for clinical depression. A systematic review","volume":"49","author":"Schiweck","year":"2019","journal-title":"Psychol. Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s40337-018-0210-6","article-title":"Emotional eating and weight regulation: A qualitative study of compensatory behaviors and concerns","volume":"6","author":"Frayn","year":"2018","journal-title":"J. Eat. Disord."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1037\/a0020909","article-title":"Developing constructs for psychopathology research: Research domain criteria","volume":"119","author":"Sanislow","year":"2010","journal-title":"J. Abnorm. Psychol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"100196","DOI":"10.1016\/j.ijchp.2020.07.007","article-title":"Prevalence of depression during the COVID-19 outbreak: A meta-analysis of community-based studies","volume":"21","author":"Olaya","year":"2021","journal-title":"Int. J. Clin. Health Psychol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"113706","DOI":"10.1016\/j.psychres.2021.113706","article-title":"Increased mood disorder symptoms, perceived stress, and alcohol use among college students during the COVID-19 pandemic","volume":"296","author":"Charles","year":"2021","journal-title":"Psychiatry Res."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1037\/0022-3514.80.1.53","article-title":"Emotional distress regulation takes precedence over impulse control: If you feel bad, do it!","volume":"80","author":"Tice","year":"2001","journal-title":"J. Pers. Soc. Psychol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/2\/317\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:30:06Z","timestamp":1759919406000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/2\/317"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,16]]},"references-count":54,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["nu17020317"],"URL":"https:\/\/doi.org\/10.3390\/nu17020317","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,16]]}}}