In recent years, the intersection between personality disorders and eating behaviors has gained increasing attention among mental health researchers. A groundbreaking study published in BMC Psychiatry delves into this nexus by exploring orthorexia nervosa within the context of obsessive–compulsive personality disorder (OCPD). This research uniquely addresses how perfectionism and metacognitive processes contribute to the development and intensification of orthorexic tendencies, shedding light on complex psychological mechanisms that might pave the way for targeted interventions.
Obsessive–compulsive personality disorder is clinically defined by relentless rigidity, excessive control, and an unwavering pursuit of orderliness. Patients with OCPD often experience impairments in daily functioning due to these inflexible cognitive and behavioral patterns. Among the defining traits, perfectionism stands out as a key driver that perpetuates maladaptive behaviors. Notably, the desire for an ‘ideal’ state extends beyond general life domains, infiltrating areas such as body image and dietary habits. Orthorexia nervosa, characterized by an obsessive preoccupation with healthy or “pure” eating, increasingly appears as a manifestation of this perfectionistic drive in OCPD patients.
The study conducted by A.K. Kılıçaslan and colleagues involved a methodologically rigorous approach, recruiting 73 individuals clinically diagnosed with OCPD using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Structured Clinical Interview. In parallel, a control cohort of 73 healthy participants matched for age, sex, and education level was included to establish comparative baselines. Such careful matching is vital to isolate the psychological phenomena inherent to OCPD rather than confounding demographic factors.
Assessment tools employed in the study were comprehensive and validated. The Frost Multidimensional Perfectionism Scale (FMPS) quantified perfectionistic traits, while the Meta-Cognition Questionnaire-30 (MCQ-30) measured participants’ metacognitive beliefs and processes—essentially, how they think about thinking. Orthorexic tendencies were quantified using the ORTO-11 scale, a widely recognized instrument capturing obsessive healthy eating behaviors. Through these measures, the research team mapped intricate correlations between perfectionism, metacognition, and orthorexic symptoms.
Results from the analysis were compelling. Patients with OCPD showed statistically significant higher scores in perfectionism and metacognitive activity compared to controls. Particularly, the negative correlation between FMPS and ORTO-11 scores highlighted that heightened perfectionism was associated with stronger orthorexic tendencies. In other words, those who strive more intensely for flawlessness in various life domains also exhibit a more obsessional fixation on dietary purity and health.
Crucially, metacognition emerged as a central mediator in this psychological landscape. The positive associations between metacognitive activity and perfectionism, coupled with the negative correlation between metacognition and orthorexic behaviors, suggested that dysfunctional metacognitive processes facilitate the transition from perfectionistic traits to orthorexic attitudes. This partial mediation indicates that it is not perfectionism alone but also how individuals regulate and appraise their own thoughts that catalyzes the emergence of orthorexic behaviors in OCPD.
Orthorexia nervosa, although not officially recognized in the main psychiatric diagnostic manuals, is gaining recognition as a significant psychiatric concern due to its potential to cause marked social, psychological, and physical impairments. The findings of this study emphasize that in OCPD patients, the pathological cognitive regulation of perfectionism through metacognitive dysfunction contributes to the development of dangerously restrictive and obsessive eating patterns.
Lower body mass indices (BMIs) observed in the OCPD group further reinforce the clinical significance of the findings. These physical markers align with the hypothesis that orthorexic behaviors often translate into real-world consequences, including nutritionally inadequate diets and potential malnutrition. The co-occurrence of these psychological and physiological markers mandates an integrated therapeutic approach.
Metacognitive therapy, emerging from cognitive-behavioral traditions but focusing distinctly on metacognitive beliefs and thought regulation strategies, appears promising based on these results. By addressing dysfunctional metacognition, clinicians may effectively disrupt the reinforcing feedback loops between perfectionism and orthorexic tendencies, thereby alleviating symptoms and improving overall clinical outcomes in OCPD populations.
This research not only advances our understanding of the psychopathological substrates underlying orthorexia nervosa but also expands the conceptual framework of personality disorders interacting dynamically with eating-related pathologies. The partial mediation model proposed offers a nuanced view that can inform both future empirical investigations and clinical practice innovations.
Given the growing prevalence of disordered eating and its association with personality traits, these findings also spur broader public health considerations. Screening for perfectionism and metacognitive dysfunctions in populations at risk for OCPD could facilitate early identification of orthorexic symptoms, preventing progression to more severe physical and psychological sequelae.
The study’s combination of quantitative assessments and rigorous statistical analyses such as Pearson correlation, linear regression, and mediation analyses exemplifies the high methodological standards necessary for advancing psychiatric research. These approaches elucidate not merely correlations but directional influences, enhancing the sophistication of causal inference.
In conclusion, the intersection of perfectionism and metacognition articulates a critical pathway to orthorexic behaviors within obsessive–compulsive personality disorder. The clinical implications call for an integrated, metacognitively informed therapeutic approach that targets both the rigid perfectionistic standards and the maladaptive cognitive monitoring processes. Mental health practitioners should be attuned to the early signs of orthorexia in OCPD patients to mitigate adverse developmental trajectories.
Subject of Research:
The study investigates the role of perfectionism and metacognition in orthorexic tendencies among individuals diagnosed with obsessive–compulsive personality disorder.
Article Title:
Orthorexia in obsessive–compulsive personality disorder: the impact of perfectionism and metacognition
Article References:
Kılıçaslan, A.K. Orthorexia in obsessive–compulsive personality disorder: the impact of perfectionism and metacognition. BMC Psychiatry 25, 448 (2025). https://doi.org/10.1186/s12888-025-06799-z
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