Gercek Hacer Gizem, İpek Bas Selin Ayse, Kara Aziz, Bukulmez Aysegul
Department of Child and Adolescent Psychiatry, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey.
Private Physician, Antalya, Turkey.
J Eat Disord. 2025 Jun 4;13(1):102. doi: 10.1186/s40337-025-01294-y.
Celiac disease (CD) is an autoimmune disorder triggered by gluten, leading to digestive issues, malabsorption, nutritional deficiencies, mental health effects, and long-term health risks. Previous studies have indicated that increased attention directed to food in CD treated with a gluten-free diet may increase the risk of eating disorders (ED). Although Orthorexia Nervosa (ON), defined as an obsession with healthy eating, is not yet considered an ED in an official diagnostic system, it is similar to ED in some of its features. ON in adolescents with CD has not been explored in the existing literature. We aimed to compare ON symptoms, eating attitudes, anxiety, depression, and obsessive-compulsive disorder (OCD) symptoms between adolescents with and without CD in this study.
The study involved 30 adolescents with CD and 30 healthy controls. Participants were assessed using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL) in a semi-structured clinical interview. The risk of ON was evaluated with the ORTO-11 questionnaire while eating attitudes were measured using the Eating Attitudes Test (EAT-40). Anxiety, depression, and OCD symptoms were compared between the adolescents with and without CD using the parent and child forms of the Revised Child Anxiety and Depression Scale (RCADS).
ON symptoms and impaired eating attitudes were higher in adolescents with CD than in the healthy control group. No significant differences were found between the groups in terms of anxiety, depression, and OCD symptoms. In the correlation analysis of the RCADS-child form with other scales, there was a positive correlation between ON symptoms, impaired eating attitudes, and OCD symptoms. When the correlation analysis of the RCADS-parent form with other scales was examined, no significant correlation was found.
To the best of our knowledge, our study is the first to evaluate ON in adolescents diagnosed with CD, and our results show that there is an increase in the frequency of ON and impaired eating attitudes in CD. Additionally, we found that the increase in OCD symptoms in adolescents with CD was associated with ON and impaired eating attitudes.
乳糜泻（CD）是一种由麸质引发的自身免疫性疾病，会导致消化问题、吸收不良、营养缺乏、心理健康问题以及长期健康风险。先前的研究表明，在采用无麸质饮食治疗的CD患者中，对食物的关注度增加可能会增加饮食失调（ED）的风险。尽管“健康饮食强迫症”（ON）被定义为对健康饮食的痴迷，在官方诊断系统中尚未被视为一种饮食失调，但它在某些特征上与饮食失调相似。现有文献中尚未对患有CD的青少年中的“健康饮食强迫症”进行探讨。在本研究中，我们旨在比较患有和未患有CD的青少年之间的“健康饮食强迫症”症状、饮食态度、焦虑、抑郁和强迫症（OCD）症状。
该研究纳入了30名患有CD的青少年和30名健康对照者。通过学龄儿童情感障碍和精神分裂症量表（K-SADS-PL）在半结构化临床访谈中对参与者进行评估。使用ORTO-11问卷评估“健康饮食强迫症”风险，同时使用饮食态度测试（EAT-40）测量饮食态度。使用修订后的儿童焦虑和抑郁量表（RCADS）的家长版和儿童版，比较患有和未患有CD的青少年之间的焦虑、抑郁和强迫症症状。
患有CD的青少年的“健康饮食强迫症”症状和受损的饮食态度高于健康对照组。两组在焦虑、抑郁和强迫症症状方面未发现显著差异。在RCADS儿童版与其他量表的相关性分析中，“健康饮食强迫症”症状、受损的饮食态度和强迫症症状之间存在正相关。当检查RCADS家长版与其他量表之间时，未发现显著相关性。
据我们所知，我们的研究是首次评估被诊断患有CD的青少年中的“健康饮食强迫症”，我们的结果表明，CD患者中“健康饮食强迫症”的频率和受损的饮食态度有所增加。此外，我们发现患有CD的青少年中强迫症症状的增加与“健康饮食强迫症”和受损的饮食态度有关。
