Orthorexia Nervosa and Substance Use for the Purposes of Weight Control, Conformity, and Emotional Coping

Abstract Purpose: Orthorexia nervosa (ON), characterized by extreme behaviors driven by the goal of eating only healthy and pure foods, could plausibly be associated with avoidance of nicotine, alcohol, and illicit drugs. However, findings from the limited research on these relationships are mixed, and other eating disorders are associated with greater substance abuse. Method: An online survey was completed by 471 participants (86% women, mean age = 20) recruited from undergraduate courses and through an Instagram advertisement. The questionnaires assessed ON symptomatology; frequency of smoking, alcohol consumption, and illicit drug use; abuse of these substances; and motivations for using these substances. Results: ON scores were not significantly related to the level of use or abuse of nicotine, alcohol, or most illicit drugs. Yet, ON scores were positively correlated with frequency of using illicit depressant drugs. Further, among substance users, ON scores were positively associated with smoking or vaping for the purpose of weight control, and with consuming alcohol and using illicit drugs for the purposes of conformity and coping with such negative emotions as anxiety and depression. Conclusion: Although people who are high in ON symptomatology may be at least partly driven by a strong desire to be as healthy as possible, they are not less likely to use potentially harmful drugs. Instead, many of them may even turn to certain drugs for the same weight-control and emotional-coping motives that guide the behaviors of individuals with other eating disorders.Level of evidence: Level V, descriptive cross-sectional study