DEVELOPMENT AND VALIDATION OF AN INVENTORY MEASURING DIETARY ATTITUDES OF HEALTHY EATING AND ORTHOREXIA NERVOSA A Dissertation by LILO BURDA *This is only for degrees previously earned! Please do not include your major with the degree name, and list the degree simply as BA, BS, MA, etc. For example: BS, University Name, Year MS, University Name, Year *International Students must include the name of the country between the school and BS, Texas A&M University-Corpus Christi, 2002 the date the degree was received, if it was received outside of the US. MS, Texas A&M University-Corpus Christi, 2014 *Delete this box before typing in your information. Submitted in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF PHILOSOPHY in COUNSELOR EDUCATION Texas A&M University-Corpus Christi Corpus Christi, Texas May 2018 © Lilo Maria Burda All Rights Reserved May 2018 DEVELOPMENT AND VALIDATION OF AN INVENTORY MEASURING DIETARY ATTITUDES OF HEALTHY EATING AND ORTHOREXIA NERVOSA A Dissertation by LILO BURDA This dissertation meets the standards for scope and quality of Texas A&M University-Corpus Christi and is hereby approved. Joshua Watson, PhD Marvarene Oliver, PhD Chair Committee Member Michelle Hollenbaugh, PhD Rich Gere, M.F.A. Committee Member Graduate Faculty Representative May 2018 ABSTRACT The obesity epidemic in the United States today has facilitated increased public discussion of healthy eating (Chaki, Pal, & Bandyopadhyay, 2013). Researchers suggest that as eating healthy continues to be emphasized, individuals will become increasingly more aware of how their eating habits impact their overall health, and many will strive to adjust their food choices accordingly (Bosi, Çamur, & Güler, 2007). ). As individuals begin making more health- conscious lifestyle choices, a growing number will develop problems resulting in healthy eating- related pathology, which can severely interfere with daily functioning, resulting in malnutrition, and, in extreme cases, lead to death. Bratman and Knight (2000) initially observed the phenomenon of pathology connected to healthy eating, naming it orthorexia nervosa (ON). The intention of this research study will be to explore the epidemiological composition of ON in an American college student sample and to create a valid survey instrument exploring ON as a psychological construct. With the need for additional research concerning ON, there is a necessity for an instrument exploring ON’s latent construct. An instrument exploring cognitive, emotional, and behavioral themes leading to problematic eating can aid health professionals in recognizing possible signs and symptoms of ON. Unhealthy eating habits lead to deteriorations in physical and mental health and may impact an individual’s ability to function effectively in daily life (O'Neil, et al., 2014). Therefore, the aim of this research is to develop an instrument designed to identify cognitions, emotions, and behaviors underlying disordered eating pathology related to ON. v DEDICATION I am dedicating my work to my parents, who always encouraged me to follow my dreams and taught me to extend the respect, loyalty, and goodwill I received under their care to the people that cross my path through life. They inspired me to ask questions, be curious, and keep on learning and growing. I love you so very much. vi ACKNOWLEDGEMENTS I would like to thank my committee chair, Dr. Joshua Watson, and my committee members, Dr. Marvarene Oliver and Dr. Michelle Hollenbaugh, for their guidance and support throughout the course of this research. A special thank you goes to Dr. Samantha Klassen and Sherrye Garrett for daring to edit grammar and flow for which I am grateful beyond words. Thanks also go to my friends and colleagues and the department faculty and staff for making my time at Texas A&M University-Corpus Christi a unique experience. I also want to extend my gratitude to my friends, who did not give up on me, did not report me missing, and encouraged me when the going was tough while I was finishing my dissertation. To Brenda Miles for supplying moral support at my defense presentation I extend my unending gratitude and love. vii TABLE OF CONTENTS CONTENTS PAGE ABSTRACT .................................................................................................................................... v DEDICATION .............................................................................................................................. vii ACKNOWLEDGEMENTS .......................................................................................................... vii TABLE OF CONTENTS ............................................................................................................. viii SECTION I: CHAPTER I, II, and III ............................................................................................. 1 CHAPTER I: Introduction .............................................................................................................. 1 General Prevalance Rates for Eating Disorders .................................................................. 3 Adolescent and Young Adults Prevalence Rates for Eating Disorders .............................. 4 Characteristics of ON, AN, and BN............................................................................................. 5 Orthorexia Nervosa ............................................................................................................. 8 Anorexia Nervosa ............................................................................................................... 8 Bulimia Nervosa ................................................................................................................. 9 Differences between ON, AN, and BN ............................................................................... 9 Statement of the Problem ......................................................................................................... 12 Purpose of the Study ................................................................................................................ 13 Research Questions .................................................................................................................. 13 Significance of the Study ......................................................................................................... 14 Conceptual Framework ............................................................................................................ 15 viii Definition of Key Terms .......................................................................................................... 17 CHAPTER II: Literature Review .................................................................................................. 17 Societal Impact on Food Consumption Patterns ............................................................... 17 Eating Disorders....................................................................................................................... 18 Diagnosis........................................................................................................................... 21 Treatment .......................................................................................................................... 22 Eating Disorders on College Campuses ................................................................................... 22 Orthorexia Nervosa .................................................................................................................. 26 Possible Orthorexia Nervosa Co-Variate Characteristics in Individuals ................................. 31 Socioeconomic Status ....................................................................................................... 31 Age .................................................................................................................................... 32 Gender ............................................................................................................................... 32 Education and Occupation ................................................................................................ 33 Body Mass Index .............................................................................................................. 34 CHAPTER III: Methodology ........................................................................................................ 34 Participants and Sample ........................................................................................................... 35 Instruments .............................................................................................................................. 35 Conceptualization of the Purpose, Function, and Design of the B-ORA ................................ 36 Congegation of the Initial Item Consortium ..................................................................... 37 Administration of the Instrument to Experts and General Public ........................................... 38 ix Determining the Quaity of the Question Pool................................................................... 38 Scoring and Interpreting the Ortho-15 and EAT-26 ................................................................ 39 Ortho-15 ............................................................................................................................ 39 EAT-26 ............................................................................................................................