In a groundbreaking advancement within the domain of eating behaviors and mental health assessment, researchers H.K. Kavsara and I. Kalkan have unveiled the Türkiye Orthorexia Nervosa Scale (TONS-29), a novel psychometric tool tailored to assess orthorexia nervosa specifically in adult populations. This innovative scale marks a significant leap forward in the culturally sensitive evaluation of an increasingly recognized but often misunderstood condition defined by an unhealthy fixation on healthy eating.
The phenomenon of orthorexia nervosa, distinct yet related to other eating disorders, has garnered growing attention over recent years due to its complex manifestations and psychological repercussions. Characterized by an obsessive concern for food quality and purity, orthorexia often results in restrictive eating patterns that impair social functioning and psychological well-being. Despite its relevance, the absence of culturally adapted, psychometrically robust instruments has hampered reliable diagnosis and epidemiological tracking in diverse populations.
Responding to this void, Kavsara and Kalkan embarked on a meticulous scale development process targeting adults within Türkiye. Their work culminated in the TONS-29, a 29-item instrument designed to capture the multifaceted expressions of orthorexia in a way that reflects Turkish cultural nuances while maintaining strong psychometric properties. The scale’s architecture reflects contemporary psychometric theory and was constructed with rigorous item generation, exploratory and confirmatory factor analyses, and validation procedures.
At the conceptual level, the TONS-29 addresses domains such as obsessive preoccupation with healthy eating, emotional distress due to perceived dietary impurity, and behavioral rigidity surrounding food choices. These dimensions collectively map the cognitive, affective, and behavioral components central to orthorexic tendencies. By operationalizing these elements, the scale paves the way for nuanced differentiation from normative health-conscious behaviors as well as from other eating pathologies like anorexia nervosa or bulimia.
The validation study encompassed a substantial adult sample drawn from diverse Turkish regions, ensuring representativeness and cultural relevance. Statistical evaluation revealed excellent internal consistency, with Cronbach’s alpha coefficients demonstrating robust reliability across subscales. Moreover, confirmatory factor analysis corroborated the hypothesized multidimensional structure, enhancing confidence in the scale’s factorial validity.
Beyond psychometric soundness, the TONS-29 exhibited strong convergent validity in relation to established measures of eating disorder symptoms and obsessive-compulsive tendencies, underscoring its clinical relevance. Discriminant validity was also evident, as the scale effectively differentiated orthorexic symptomatology from general psychological distress, minimizing false positives and enhancing diagnostic precision.
The introduction of the TONS-29 holds profound implications for both clinical practice and research contexts within Türkiye and potentially beyond. For clinicians, it offers a culturally attuned and empirically backed tool to facilitate early identification, differential diagnosis, and tailored intervention planning for individuals manifesting orthorexic behaviors. For researchers, it lays a robust foundation for epidemiological studies, cross-cultural comparisons, and longitudinal analyses that can elucidate this disorder’s trajectory and correlates.
Importantly, the scale’s development responds to a broader global call for region-specific instruments that acknowledge cultural, dietary, and social particularities influencing eating behaviors. Orthorexia’s manifestations are invariably shaped by local food cultures, health beliefs, and social norms; hence, tools like the TONS-29 provide enhanced sensitivity and ecological validity compared to generic international instruments.
The scale’s comprehensive item pool, spanning cognitive obsessions, emotional impacts, and behavioral compulsions associated with orthorexia, also enables granular profiling of individuals. Such profiling is invaluable for identifying subgroups with varying severity, comorbidities, and motivational drivers, thereby informing personalized therapeutic approaches and public health initiatives.
Furthermore, the TONS-29’s methodological rigor exemplifies contemporary best practices in psychometric scale construction within mental health. Its iterative item refinement, multi-stage validation, and transparent reporting set a benchmark for subsequent instrument development efforts in orthorexia and other emerging psychiatric phenomena.
Future directions emerging from this work include cross-validation studies in other Turkish-speaking populations and adaptation to diverse cultural milieus to test the scale’s generalizability. Additionally, integrating the TONS-29 into digital health platforms could facilitate large-scale screening and monitoring, particularly relevant in an era of increasing health awareness intersecting with digital media influences.
The introduction of TONS-29 also catalyzes dialogue regarding orthorexia’s nosological status, clinical thresholds, and treatment frameworks. As empirical evidence accrues through widespread utilization, it may inform diagnostic criteria refinements and pave the way for evidence-based psychotherapeutic modalities tailored to orthorexic pathology.
In sum, the Türkiye Orthorexia Nervosa Scale emerges as a seminal contribution advancing the science of eating disorder assessment. By bridging cultural insight with psychometric excellence, it equips mental health professionals and researchers with an indispensable instrument to unravel and address the complexities of orthorexia nervosa, enhancing outcomes and fostering healthier relationships with food in adult populations.
The study published in BMC Psychology not only enriches scientific understanding but also exemplifies the critical intersection of culture, psychology, and health, a nexus increasingly recognized as vital in addressing contemporary mental health challenges worldwide.
Subject of Research: Development and psychometric validation of a culturally adapted scale for assessing orthorexia nervosa in Turkish adult populations.
Article Title: The Türkiye orthorexia nervosa scale (TONS-29): development and psychometric validation for adult populations.
Article References:
Kavsara, H.K., Kalkan, I. The Türkiye orthorexia nervosa scale (TONS-29): development and psychometric validation for adult populations. BMC Psychol 13, 1364 (2025). https://doi.org/10.1186/s40359-025-03634-8
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