Turkish ORTO-R shows promising psychometrics in adolescent psychiatry outpatients

A Turkish-language version of the ORTO-R Scale, a questionnaire designed to measure orthorexic tendencies, has shown promising preliminary psychometric properties in a clinical sample of adolescents. The validation study, published in Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, recruited 132 participants aged 12 to 17 years from a child and adolescent psychiatry outpatient clinic and found that the scale displayed acceptable internal consistency and a coherent factor structure, while also correlating with measures of eating disorder and anxiety symptoms as expected.

Orthorexia nervosa, the construct the ORTO-R is intended to capture, refers to a pathological preoccupation with healthy eating. It is characterized by rigid dietary rules, excessive concern about the purity of food, and distress when those rules are violated. Although the concept has attracted growing clinical interest, validated instruments for assessing orthorexic tendencies in children and adolescents remain limited, which is precisely the gap the authors set out to address by adapting the scale for Turkish-speaking youth and testing it in a psychiatric outpatient population rather than a general community sample.

Participants in the study completed a battery of measures: the ORTO-R Scale itself, the Eating Attitudes Test-26, the Orthorexia Nervosa Inventory, and the Revised Child Anxiety and Depression Scale. In addition, psychiatric diagnoses were assessed using a semi-structured clinical interview, allowing the researchers to situate the questionnaire scores within a clinically characterized sample. This combination of self-report instruments and diagnostic interviewing is central to the validation strategy, because a new scale must not only be internally coherent but also relate meaningfully to established measures of related constructs.

The reliability results were straightforward. The ORTO-R demonstrated good internal consistency, with both Cronbach’s alpha and McDonald’s omega coefficients reaching 0.77. These two statistics approach reliability from slightly different directions: Cronbach’s alpha reflects how consistently respondents answer across the scale’s items under classical test theory assumptions, while McDonald’s omega is based on a factor model and is often considered a more flexible indicator of how much of the observed score variance is attributable to the underlying common factor. Agreement between the two coefficients at the same value strengthens confidence that the Turkish items hang together as a single total score.

The structural validity findings were also encouraging. Confirmatory factor analysis identified a three-factor structure with favorable overall model fit. Confirmatory factor analysis is a technique in which researchers specify in advance how many latent factors they expect and which items should load on each, then test statistically whether the observed pattern of responses is compatible with that specification. A favorable fit means the data did not contradict the proposed three-dimensional organization of the scale, supporting the use of the instrument in the way its structure implies.

Beyond internal structure, the study examined convergent and discriminant relationships. Total ORTO-R scores showed moderate positive correlations with orthorexic and eating disorder symptoms, and low-to-moderate correlations with anxiety symptoms. In measurement terms, this pattern is what a valid orthorexia instrument should produce: it should align substantially with other measures of orthorexic preoccupation and disordered eating, since these constructs overlap conceptually, while showing a weaker but still detectable association with anxiety, which is related to the distress component of orthorexia but is not the same construct. The graded pattern of correlations, stronger for eating-related measures and weaker for anxiety, is consistent with the scale measuring something distinct rather than simply duplicating general distress.

The clinical sample is a notable feature of the work. Many validation studies of orthorexia questionnaires have relied on convenience or community samples, in which true orthorexic pathology may be rare and score distributions can be skewed. By recruiting adolescents attending a child and adolescent psychiatry outpatient clinic, the researchers tested the instrument in a population where eating-related and anxiety psychopathology is enriched, providing a stricter test of whether the scale can distinguish and quantify orthorexic tendencies where they are most likely to matter clinically. The semi-structured diagnostic interview adds further value, since it anchors the sample in documented psychiatric diagnoses rather than self-report alone.

The authors themselves frame the findings cautiously. In their abstract, they conclude that the Turkish version of the ORTO-R showed promising preliminary psychometric properties in this psychiatric outpatient sample, including acceptable internal consistency and meaningful associations with related measures. Crucially, they also state that further studies in larger, more diverse, and community-based samples are needed to confirm the scale’s validity, reliability, and clinical utility. This is an appropriate limitation to keep in view: a single validation study in 132 adolescents from one outpatient clinic cannot establish that the instrument performs equally well in the general adolescent population, in other age groups, or in different clinical settings.

For researchers and clinicians working with Turkish-speaking adolescents, the study offers a preliminary answer to a practical question: whether a brief, structured questionnaire can help identify orthorexic tendencies in young patients. The evidence so far suggests the Turkish ORTO-R is internally reliable, structurally coherent, and behaves as theory predicts in relation to eating and anxiety symptoms. Whether it can ultimately support screening, case identification, or treatment monitoring will depend on the replication studies the authors call for, particularly those extending the instrument to larger and more diverse community samples where the full range of orthorexic tendencies, from absent to severe, can be observed.

Subject of Research: Validation of the Turkish ORTO-R Scale for measuring orthorexic tendencies in adolescents attending a child and adolescent psychiatry outpatient clinic

Article Title: Validity and reliability of the Turkish version of the ORTO-R in an adolescent clinical sample

Article References: Kasar, N., Guney, O., Kinay Ermis, D., Akbas, I. H., & Yildirim, S. (2026). Validity and reliability of the Turkish version of the ORTO-R in an adolescent clinical sample. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity. https://doi.org/10.1007/s40519-026-01901-0

Image Credits: AI Generated

DOI: 10.1007/s40519-026-01901-0

Keywords: orthorexia nervosa, ORTO-R Scale, Turkish validation, adolescents, psychometric properties, internal consistency, confirmatory factor analysis, eating disorder symptoms, anxiety symptoms, psychiatric outpatient sample, Validity, reliability