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Article

When Eating Healthy Becomes Unhealthy: A Cross-Cultural Comparison of the Indirect Effect of Perfectionism on Orthorexia Nervosa Through Obsessive–Compulsive Symptoms

by
Alexandra Cobzeanu
1,*,†,
Ioana-Cătălina Roman
1,† and
Iulia Cristina Roca
2,†
1
Faculty of Psychology and Education Sciences, Department of Education Sciences, Alexandru Ioan Cuza University, 700554 Iasi, Romania
2
Medical I Department, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Psychiatry Int. 2025, 6(1), 16; https://doi.org/10.3390/psychiatryint6010016
Submission received: 24 September 2024 / Revised: 27 January 2025 / Accepted: 5 February 2025 / Published: 12 February 2025
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Abstract

:
Orthorexia nervosa (ON) is a pathological obsession with eating only healthy and biologically pure food. The primary aim of this study was to explore the relationships between ON, perfectionism, and obsessive–compulsive symptoms in two cultural contexts, i.e., Romania and Germany. Our sample included 600 participants aged 18 to 73 (M = 29.04, SD = 10.30, 79.2% females), i.e., 310 from Romania and 290 from Germany. We tested a moderated mediation model, exploring the mediating effect of obsessive–compulsive symptoms on the link between socially prescribed and self-oriented perfectionism and ON symptoms and the moderating effect of culture (i.e., Western and non-Western) while controlling for age, sex, education, and monthly income. Socially prescribed perfectionism and self-oriented perfectionism were positively related to obsessive–compulsive and ON. Both socially prescribed and self-oriented perfectionism predicted ON through obsessive–compulsive symptoms, but only in the case of German participants. The present study’s results suggest a better understanding of orthorexic behaviors in a cross-cultural context, which might significantly contribute to developing tailored strategies for preventive educational programs and nutritional interventions across different nations.

1. Introduction

The idealization of nutrition has gained more interest in the last decades, especially in Western countries [1]. Nevertheless, the aspiration to have a completely unprocessed diet is controversial because it can consume part of our lives [2]. Orthorexia nervosa (ON) derives from two Greek words, ὀρθός (right) and ὄρεξις (appetite), translated as appropriate appetite [3]. The concept was first described by Bratman [4] as a pathological obsession with eating only healthy and biologically pure food. ON implies strict dietary selections and preparation according to well-defined rules and focuses strictly on the quality of food and not on quantity or calorie counting, as in other eating disorders like anorexia and bulimia nervosa [5,6].
It is important to note that ON is not yet formally recognized as a psychiatric disorder either by The American Psychiatric Association’s [7] Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) or by the World Health Organization [8] International Statistical Classification of Diseases and Related Health Problems (11th ed., ICD-11). However, the literature has progressed through the last two decades in an ongoing debate defining this phenomenon. For instance, ON has been described as a possible independent psychiatric disorder [9], a phenomenological subtype of eating disorders [10], or a trend influenced by culture [11].
The interest in exploring ON has grown, especially given its potential maladaptive outcomes. More specifically, in some cases, it was associated with malnutrition, functional impairments, disrupted quality of life, or social isolation [6,12,13]. Regarding the prevalence of ON, Varga et al. [6] reported it as 6.9% for the general population and 35–57.8% for high-risk groups (e.g., dieticians, artists, and healthcare professionals).
Recent findings on potential socioeconomic factors related to ON have generally been incongruent [14,15]. For instance, considering sex differences, some studies suggested a higher prevalence among females [16,17], while others suggested a higher prevalence among males [5,18,19,20] or non-significant sex differences [21,22,23]. Similarly, mixed and contradictory results were found regarding ON concerning education, age, or income [14].

2. Perfectionism and Obsessive–Compulsive Symptoms in Relation to Orthorexia Nervosa

Different models have portrayed perfectionism as aiming for excessively high performance standards, striving for flawlessness, and overly critical evaluation [24,25,26]. In the current research, we conceptualized perfectionism as a tridimensional personality trait, i.e., self-oriented, other-oriented, and socially prescribed perfectionism [27]. However, the other-oriented dimension was excluded from the current investigation since it may be unrelated to eating behavior habits [28,29].
Previous studies highlighted the association between perfectionism and its causal risk with eating disorder pathology [30]. Thus, high levels of perfectionism might have an essential contribution to developing, maintaining [31], and treating eating disorder symptoms [32]. Also, Barnes and Caltabiano [33] suggested that high perfectionism was positively correlated with orthorexic tendencies and obsessive–compulsive symptoms [34]. Moreover, high perfectionism levels seem to be a common factor associated with eating disorders and obsessive–compulsive symptomatology [35,36].
According to the DSM–5, OCD symptoms are characterized by recurrent intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) related to specific activities (e.g., cleaning, washing hands, checking, ordering, repeating, obsessing, and hoarding). OCD generally has a high prevalence and detrimental impact on an individual’s social functioning and life quality [37]. Several cognitive models [38] highlighted a significant association between OCD symptoms and perfectionism. This link has been investigated in various studies that generally highlighted that perfectionism represents a significant risk factor for developing and maintaining OCD symptoms in both clinical and non-clinical samples [39]. Additionally, OCD symptoms were frequently associated with eating disorder manifestations [37].
There are many similarities between ON and OCD. Both concepts are based on a strong need for control, particularly evidenced by recurrent thoughts on food selection, preparation, and contamination [40]. Other similarities include high levels of perfectionism, anxiety, and cognitive rigidity [17]. However, the relationship between perfectionism, ON, and OCD symptoms is still insufficiently investigated. Our study aimed to address this gap and add to the limited evidence by investigating how perfectionism might indirectly affect ON through OCD.

3. Orthorexia Nervosa and the Moderating Role of Culture

Culture plays an essential role in the development and manifestation of eating disorders [41]. It has previously been believed [42] that eating disorders are results shaped by specific characteristics of modern and developed societies (e.g., materialism, individualism, capitalism) and specific healthism standards (e.g., preoccupation with a healthy lifestyle and idealization of the thin body) [43].
In the present paper, we focused on Romania (a post-communist transitional economy) and Germany (a high-income industrialized country) [44,45]. Romania is a middle-income country located on the eastern side of Europe. According to current literature, traditional Eastern European dietary habits consist of the high consumption of high-fat meat and dairy products (e.g., sour cream), lard, bread, and potatoes [46]. This unbalanced diet leads to higher rates of cancer and cardiovascular mortality among Eastern European populations compared to Western Europeans [47,48]. According to the European Cardiovascular Disease (CVD) Statistics, Romania has a significantly higher cardiovascular mortality rate than Germany [49]. Romania also exhibits a higher prevalence of hypertension, obesity, and physical inactivity [50]. Since an excessive preoccupation with healthy eating characterizes ON, exploring its associations in populations with differing health risk profiles and cultural contexts related to health behaviors might be particularly relevant.
After the fall of the communist regime in 1989, Romania experienced many rapid socioeconomic turns, which were deeply reflected in attitudes toward eating habits [51]. During the transition from communism to democracy, the food markets became widely accessible and diversified (compared to the previous communist period), gradually leading to unhealthy nutrition consumption (e.g., high sugar, salt, and saturated fats). Consequently, an alarming increase in obesity along with diabetes and heart disease was observed in the Romanian population [52,53].
Conversely, Germany is considered a high-income industrialized country and one of Europe’s most substantial economic powers [54]. Like many other Western European countries, Germany is characterized by an individualistic orientation and idiocentric values [55]. In contrast to Eastern Europe, Western European cuisine has been heavily influenced by industrialization, which has led to an increase in processed and convenience foods. However, many Western European countries also have a strong tradition of consuming fresh, locally sourced foods and have been at the forefront of promoting sustainable agriculture and healthy eating. In this sense, healthism and its internalization of health consciousness are more pronounced than non-Western countries [56]. Further, Western culture has been described as a potential environmental risk factor for manifesting an obsession with eating healthy [57]. In addition, Western European countries have registered a growing trend and preoccupation with people following a sustainable diet and lifestyle [58,59]. In this sense, the recent literature has described orthorexia as a cultural manifestation of anorexia nervosa [60].

4. The Present Study

This research aimed to explain the relationship between orthorexia nervosa, obsessive–compulsive symptoms, and perfectionism in two samples, i.e., Germany (a high-income industrialized country) and Romania (a post-communist transitional economy), especially since there is limited literature regarding the link between perfectionism and ON. Although previous research shows that the link between self-oriented and socially prescribed perfectionism and eating disorder symptoms is generally significant [29], the indirect effect of perfectionism on ON through OCD symptoms needs further investigation. Furthermore, the moderating role of culture (i.e., Romanian versus German regions) has not been sufficiently explored.
Thus, the present study attempts to address these challenges and fill some related gaps by addressing the following research questions: How is ON related to perfectionism and OCD symptoms? and do cultural differences between Germany and Romania affect the relationship between self-oriented and socially prescribed perfectionism and ON symptoms? To answer these questions, based on the previous documented literature, we formulated the following hypotheses:
H1. 
Self-oriented and socially prescribed perfectionism would be significantly related to OCD symptoms.
H2. 
Obsessive–compulsive symptoms would be significantly related to ON.
H3. 
OCD symptoms would mediate the link between self-oriented, socially prescribed perfectionism and ON.
H4. 
Cultural regions (Romanian and German regions) would moderate the link between self-oriented and socially prescribed perfectionism and ON.
More specifically, the link between self-oriented perfectionism, socially prescribed perfectionism, and ON symptoms would be stronger in the Western sample (i.e., Germans). The proposed research model is detailed in Figure 1.

5. Method

Participants and Procedure

We recruited our study participants using snowball sampling. A total of 600 participants (310 Romanians and 290 Germans) participated in the study, i.e., individuals with no previous eating disorders and who were not dietitians or healthcare professionals. Most participants were female (79.2%) and aged 18–73 (mean age = 29.04; SD = 10.30). The baseline characteristics of the participants are presented in Table 1.
Participation in the study was voluntary, and individuals were informed of the purpose (i.e., eating habits, personal factors) and the study duration, including time to complete the questionnaire (~15 min). In addition, they were assured that the information provided would be kept anonymous and confidential; further, they could withdraw from the study at any point. All participants provided informed consent. Data were collected across two months, in November and December 2022. We used Google Forms to collect the data for each country. The link was available in Romanian and German. Participants were invited to answer the questions using social media platforms (i.e., Facebook, Instagram, LinkedIn), Whatsapp groups, online and offline student groups (i.e., Erasmus groups), and personal e-mail invitations. The Ethics Committee from the university where the authors are affiliated approved the study (IRB approval number: 2293/03.11.2022), which followed the ethical guidelines of the 2013 Helsinki Declaration.

6. Measures

We used the forward-backward translation strategy for the scales, which were translated from English to Romanian and German [61]. The minimal differences between the original and back-translated versions were reconciled, resulting in the final versions of each instrument. Furthermore, we used the validated German versions of the Obsessive–Compulsive Inventory-Revised (OCI-R) [62] and the original version of the Düsseldorf Orthorexia Scale (DOS) [63].
Orthorexia nervosa. Several researchers agreed that DOS is a valid and reliable self-report questionnaire for assessing ON [64]. The scale comprises ten items and uses a 4-point Likert scale ranging from 1 (this does not apply to me) to 4 (this applies to me). Example items include “I can only enjoy eating foods considered healthy” and “I like that I pay more attention to healthy nutrition than others”. According to previous research, a preliminary cut-off score of ≥30 points indicates the presence of ON [63]. Also, a higher score, between 25 and 29, describes a high orthorexic predisposition. In our study, Cronbach’s alpha for DOS indicated good internal consistency: 0.90 for the overall sample, 0.94 for the German sample, and 0.84 for the Romanian sample.
Obsessive–Compulsive Disorder Symptoms. We used the OCI-R for obsessive–compulsive disorder assessment, which comprises six dimensions: (1) checking (e.g., “I check things more often than necessary”), (2) neutralizing (e.g., “I feel I have to repeat certain numbers”), (3) obsessing (e.g., “I find it difficult to control my own thoughts”), (4) ordering (e.g., “I get upset if objects are not arranged properly”), (5) washing (e.g., “I wash my hands more often and longer than necessary”), and (6) hoarding (e.g., “I have saved up so many things that they get in the way”). The instrument consists of 18 self-reported questions using a 4-point Likert scale ranging from 0 (not at all) to 4 (extremely). A cut-off score of ≥21 points was used according to the OCI-R manual instructions. Higher scores on these six dimensions indicated higher levels of these specific obsessive–compulsive dimensions. Cronbach’s alpha for each of the six subscales indicated good internal consistency: 0.82 for checking, 0.84 for neutralizing, 0.86 for obsessing, 0.84 for ordering, 0.83 for washing, and 0.79 for hoarding. Moreover, Cronbach’s alpha was 0.94 for the overall sample, α = 0.95 for the German sample, and α = 0.91 for the Romanian population.
Perfectionism. We used the Multidimensional Perfectionism Scale (MPS) [28], a reliable self-assessment tool designed to measure perfectionism in clinical and non-clinical samples [65]. The participants answered the 45 items using a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). The MPS comprises three dimensions of perfectionism: (1) self-oriented (e.g., “I strive to be as perfect as I can be”), (2) other-oriented (e.g., “I have high expectations for the people who are important to me”), and (3) socially prescribed (e.g., “I find it difficult to meet other’s expectations of me”). As mentioned in the introduction, the other-oriented dimension was excluded from analyses because it is unrelated to eating disorders [29]. A high score indicates high levels of these specific perfectionism dimensions. In our study, Cronbach’s alpha for the overall sample was 0.88; for the German sample, it was 0.890; and for the Romanian sample, it was 0.88. Cronbach’s alpha for each of the three subscales was 0.88 for self-oriented and 0.76 for socially prescribed perfectionism.
Finally, a demographic survey assessed the age, sex, education, and monthly income of our participants. We did not include individuals with specific nutritional needs based on specific disorders (i.e., type 1 and 2 diabetes, Crohn’s disease, or gastritis), dieticians and healthcare professionals, or younger individuals (age < 18), as younger individuals were not considered autonomous enough in terms of food choices. We chose these specific criteria based on similar previous studies [66].

Overview of the Statistical Analyses

We analyzed the data using IBM SPSS Statistics (Version 26) and Macro Process [67]. The initial assumptions assessment was performed using descriptive univariate analysis and missing cases analysis. We computed the Skewness and Kurtosis values to assess the normality of the distributions [68]. Next, we conducted correlation analyses, and finally, we tested the proposed assumptions using Process Model 5, with 95% CI and 5000 bootstrapped samples. We chose this model because it allows for the examination of a conditional indirect effect, a mediation where the relationship between the predictor variable (perfectionism) and the outcome variable (ON) via a mediator (OCD) is moderated by another variable (culture). The descriptive statistics of the main variables are detailed in Table 2.

7. Results

7.1. Associations Among the Primary Variables

The results of the correlational analysis are presented in Table 3. In both the German and Romanian samples, orthorexia nervosa was positively associated with self-oriented and socially prescribed perfectionism and OCD symptoms (all p-s < 0.001). However, these associations were more robust in the case of the German participants. For instance, in the Romanian sample, the associations between orthorexia nervosa symptoms and both forms of perfectionism were medium (r-s < 0.30), while in the German population, they were strong (r-s > 0.50).

7.2. The Mediating Role of OCD Symptoms on the Relationship Between Self-Oriented Perfectionism and Orthorexia Nervosa and the Moderating Role of Cultural Regions

Next, we performed a Model 5 analysis using Process Macro (95% CI) to test the assumptions related to self-oriented perfectionism, controlling for participants’ age, gender, education, and monthly income. The results suggested that OCD symptoms mediated the link between self-oriented perfectionism and orthorexia nervosa (completely standardized indirect effect: B = 0.25, SE = 0.02, p < 0.001, 95% CI [0.20; 0.30]). Furthermore, the interaction effect between self-oriented perfectionism and culture was also significant: b = 0.11, SE = 0.03, p = 0.002, 95% CI [0.05; 0.17]. However, the conditional direct effect of self-oriented perfectionism on orthorexia nervosa was significant only in the case of German participants: b = 0.13, SE = 0.02, p < 0.001, 95% CI [0.08; 0.18] (see Figure 2).

7.3. The Mediating Role of OCD Symptoms on the Relationship Between Socially Prescribed Perfectionism and Orthorexia Nervosa and the Moderating Role of Culture

We performed the same analysis using socially prescribed perfectionism, with similar results. The resulting data suggested that OCD symptoms mediated the link between socially prescribed perfectionism and orthorexia nervosa (completely standardized indirect effect: B = 0.28, SE = 0.02, p < 0.001, 95% CI [0.23; 0.34]). The interaction effect between socially prescribed perfectionism and culture was also significant: b = 0.13, SE = 0.03, p = 0.003, 95% CI [0.06; 0.20]. However, the conditional direct effect of socially prescribed perfectionism on orthorexia nervosa was significant only in the case of German participants: b = 0.13, SE = 0.03, p < 0.001, 95% CI [0.07; 0.19] (see Figure 3).

8. Discussion

The current cross-sectional study aimed to investigate the indirect effect of perfectionism on ON through obsessive–compulsive symptoms in participants from two different cultures. To our knowledge, this is the first study that examines ON in the cross-cultural context of Romania and Germany. We examined the mediating effect of OCD symptoms on the relationship between perfectionism and ON while also examining the moderating role of culture.
In line with previous studies [34], correlation analysis suggested a positive association between ON, self-oriented perfectionism, and socially prescribed perfectionism. Also, the present findings are broadly consistent with research emphasizing the link between perfectionism and eating disorders [69], including ON [35], since high perfectionism is a significant risk factor in this regard [70]. The explanations underlying our findings might be related to the fact that individuals experiencing outcomes related to perfectionism (e.g., intrusive and highly critical thoughts) might be more likely to engage in orthorexic behaviors [71].
The present results also suggested that OCD symptoms were significantly associated with orthorexia nervosa. As previous research suggested [72], this significant association might be explained through the several similarities between ON and OCD symptoms, such as the need to exert control, intrusive thoughts, and the focus on contamination [73]. Although no previous studies have investigated the rates of co-occurrence between orthorexia and obsessive–compulsive personality disorder [73], the comorbidity of obsessive–compulsive symptoms with eating disorders has been previously investigated [36]. Thus, our findings provide a broader understanding of the relationship between orthorexia and OCD symptoms. Moreover, our results suggested that OCD symptoms mediate the link between self-oriented perfectionism and ON in both samples of participants.
The final goal of this study was to investigate the moderating role of culture on the relationship between perfectionism and orthorexia nervosa. The results indicated that self-oriented perfectionism predicted ON only in the case of German participants. One explanation of these results might be related to the prevalence of allocentric values, which—in the case of Romania—are oriented toward relationships, interdependence, and social norms [55]. Therefore, food-related activities represent a proper way to build and maintain relationships by sharing experiences, especially with one’s family [74]. On the other side, individuals from Germany, marked by idiocentric values such as independence, competition, and autonomy [55], may have a better understanding of healthy lifestyle habits (e.g., diet) compared to post-communist countries [75]. Although German diets, for instance, are frequently linked to high levels of processed foods, added sugars, and saturated fats [76], it is also essential to note that high-income industrialized nations have access to a wide variety of foods (e.g., fruits, vegetables, and lean proteins) that can be included in a healthy diet. At the same time, we must also acknowledge the socioeconomic shift in Romania, particularly following the fall of communism, which increased the availability of processed foods and facilitated dietary diversification, which might also have contributed to the emergence of ON. Nevertheless, these potential factors need further exploration in future studies.
Furthermore, it is important to note that a diet’s healthfulness might vary significantly within a single nation or region, depending on socioeconomic level, cultural traditions, and geographic location [77]. Also, a healthy diet consists of nutritionally balanced meals [78], considering each individual’s specific goals and needs [79]. Nevertheless, another significant limitation of this study is that Germany, especially the eastern part of the country, shares socioeconomic and historical similarities with Romania, as they are both post-communist regions. Since our analysis did not account for various potential cultural similarities between the two countries, future studies might consider them when further exploring ON.
Apart from its potential contribution to the existing related literature, our study has several limitations that must be pointed out. First, we used self-reported measures, which might have increased the possibility of desirable answers. Second, we used a convenience sample, and the number of participants was relatively small, reducing the generalizability of our findings. A larger number of participants might offer a more detailed group and subgroup analysis. Next, the Romanian and German samples were unbalanced regarding the sex ratio, which is a significant limitation of the present study. Future studies might benefit from examining the links between ON, perfectionism, OCD, and other potentially related personality and cultural factors in a more sex-balanced sample of participants to have a better understanding of ON. Also, our cross-sectional design limits the generalizability of the present findings and does not allow us to draw any causal relationships between the variables. Next, the age range of the participants in our study is quite heterogeneous and might be a potential limitation of this research. However, given that our primary focus was on perfectionism, OCD symptoms, and ON, we prioritized gathering a large and diverse sample over segmenting the participants into narrower age categories. Nevertheless, future studies might benefit from conducting subgroup analyses based on age to understand better the potential differences and trends within specific age cohorts.
Next, we must also acknowledge the limitations of the scales we used. More specifically, future research needs to address the cross-cultural validity of the Düsseldorf Orthorexia Scale (DOS) and the Obsessive-Compulsive Inventory-Revised (OCI-R). Finally, various other variables might have accounted for variabilities in the present results, such as sampling bias and the online format of questionnaires, which determines limited control over the survey environment. To generalize our results, these concerns should be addressed in further studies using extended and more balanced samples of participants.

9. Conclusions

To conclude, the present study’s results suggest a better understanding of orthorexic behaviors in a cross-cultural context. Individuals who report high perfectionism and OCD symptoms might also report higher orthorexic behaviors. Moreover, the current study represents the first cross-cultural investigation of orthorexia nervosa and its associated factors in German and Romanian samples. Ultimately, orthorexia nervosa is a relatively new and controversial diagnosis that is not yet recognized as an official eating disorder. As a result, it is challenging to establish whether it is more common in one region or another. Therefore, these findings might be significant for their contribution to the research field and their potential to develop tailored strategies for preventive educational programs and nutritional interventions across different nations.

Author Contributions

Conceptualization, A.C.; Formal analysis, A.C.; Investigation, I.-C.R.; Resources, I.C.R.; Data curation, I.-C.R.; Writing—original draft, A.C., I.-C.R. and I.C.R.; Writing—review & editing, A.C., I.-C.R. and I.C.R.; Supervision, A.C. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

This study was conducted in accordance with the Declaration of Helsinki, and was approved by the Ethical Board from the Faculty of Psychology and Education Sciences from the Alexandru Ioan Cuza on 3 November 2022, approval code 2293/03.11.2022.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Dataset available at the following link: https://doi.org/10.5281/zenodo.8221292.

Conflicts of Interest

The authors declare no conflict of interest.

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Psychiatryint 06 00016 g001
Figure 1. The proposed research model.
Figure 1. The proposed research model.
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Figure 2. The mediating role of OCD symptoms on the relationship between self-oriented perfectionism and orthorexia nervosa, and the moderating role of culture, while controlling for participants’ age, gender, education, and monthly income. * p < 0.05; ** p < 0.001.
Figure 2. The mediating role of OCD symptoms on the relationship between self-oriented perfectionism and orthorexia nervosa, and the moderating role of culture, while controlling for participants’ age, gender, education, and monthly income. * p < 0.05; ** p < 0.001.
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Figure 3. The mediating role of OCD symptoms on the relationship between socially prescribed perfectionism and orthorexia nervosa, and the moderating role of culture, while controlling for participants’ age, gender, education, and monthly income. * p < 0.05; ** p < 0.001.
Figure 3. The mediating role of OCD symptoms on the relationship between socially prescribed perfectionism and orthorexia nervosa, and the moderating role of culture, while controlling for participants’ age, gender, education, and monthly income. * p < 0.05; ** p < 0.001.
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Table 1. Descriptive statistics for the participants (N = 600).
Table 1. Descriptive statistics for the participants (N = 600).
Overall sample (N = 600)
Variables
Self-reported genderN%
   male12520.8
   female47579.2
Monthly incomeMSDMinMax
1270 € 3597050,000
EducationN%
   High school14223.7
   University—Bachelor’s30550.8
   University—Master’s12320.5
   University—PhD101.7
   Other203.3
German sample (N = 290)
Variables
Self-reported genderN%
   male10736.9
   female18363.9
Monthly incomeMSDMinMax
1779 €5033050,000
EducationN%
   High school5017.2
   University—Bachelor’s17560.3
   University—Master’s5418.6
   University—PhD62.1
   Other51.7
Romanian sample (N = 310)
Variables
Self-reported genderN%
   male185.8
   female29294.2
Monthly incomeMSDMinMax
797 €1003010,000
EducationN%
   High school9229.7
   University—Bachelor’s13041.9
   University—Master’s6922.3
   University—PhD41.3
   Other154.8
Table 2. Descriptive statistics for the main variables.
Table 2. Descriptive statistics for the main variables.
Overall sample (N = 600)
VariablesMSDMinMaxSkewness (SE)Kurtosis (SE)
Orthorexia nervosa symptoms24.877.7610400.45−0.70
Self-oriented perfectionism71.6016.84241051.16−0.42
Socially prescribed perfectionism58.8113.4621940.28−0.27
OCD symptoms34.7418.040720.27−0.90
German sample (N = 290)
VariablesMSDMinMaxSkewness (SE)Kurtosis (SE)
Orthorexia nervosa symptoms26.498.7510400.2−1.29
Self-oriented perfectionism74.115.5126105−0.13−0.12
Socially prescribed perfectionism59.6413.552191−0.64−0.22
OCD symptoms40.7619.04072−13−1.09
Romanian sample (N = 310)
VariablesMSDMinMaxSkewness (SE)Kurtosis (SE)
Orthorexia nervosa symptoms23.366.3410400.440.01
Self-oriented perfectionism69.2617.70241050.04−0.59
Socially prescribed perfectionism58.0313.3425940.04−0.13
OCD symptoms29.1115.022720.48−0.35
Table 3. Associations between the main variables.
Table 3. Associations between the main variables.
Overall sample (N = 600)
Variables123
1. Orthorexia nervosa symptoms-
2. Self-oriented perfectionism0.40 **-
3. Socially prescribed perfectionism0.42 **0.58 **-
4. OCD symptoms0.61 **0.52 **0.57 **
German sample (N = 290)
Variables123
1. Orthorexia nervosa symptoms-
2. Self-oriented perfectionism0.51 **-
3. Socially prescribed perfectionism0.53 **0.57 **-
4. OCD symptoms0.72 **0.59 **0.66 **
Romanian sample (N = 310)
Variables123
1. Orthorexia nervosa symptoms-
2. Self-oriented perfectionism0.26 **-
3. Socially prescribed perfectionism0.27 **0.59 **-
4. OCD symptoms0.37 **0.44 **0.49 **
Note: ** p < 0.001.
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Cobzeanu, A.; Roman, I.-C.; Roca, I.C. When Eating Healthy Becomes Unhealthy: A Cross-Cultural Comparison of the Indirect Effect of Perfectionism on Orthorexia Nervosa Through Obsessive–Compulsive Symptoms. Psychiatry Int. 2025, 6, 16. https://doi.org/10.3390/psychiatryint6010016

AMA Style

Cobzeanu A, Roman I-C, Roca IC. When Eating Healthy Becomes Unhealthy: A Cross-Cultural Comparison of the Indirect Effect of Perfectionism on Orthorexia Nervosa Through Obsessive–Compulsive Symptoms. Psychiatry International. 2025; 6(1):16. https://doi.org/10.3390/psychiatryint6010016

Chicago/Turabian Style

Cobzeanu, Alexandra, Ioana-Cătălina Roman, and Iulia Cristina Roca. 2025. "When Eating Healthy Becomes Unhealthy: A Cross-Cultural Comparison of the Indirect Effect of Perfectionism on Orthorexia Nervosa Through Obsessive–Compulsive Symptoms" Psychiatry International 6, no. 1: 16. https://doi.org/10.3390/psychiatryint6010016

APA Style

Cobzeanu, A., Roman, I.-C., & Roca, I. C. (2025). When Eating Healthy Becomes Unhealthy: A Cross-Cultural Comparison of the Indirect Effect of Perfectionism on Orthorexia Nervosa Through Obsessive–Compulsive Symptoms. Psychiatry International, 6(1), 16. https://doi.org/10.3390/psychiatryint6010016

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