Attachment styles and orthorexia nervosa among Lebanese adolescents: The indirect effect of self-esteem

Background: Orthorexia nervosa (ON), defined as the pathological obsession for pure foods, remains a novelty in the field of eating disorders. Many studies in the literature have shown that attachment styles correlate with the development of eating disorders. Patients with eating disorders were found to be more avoidant and anxious and less secure than individuals who do not have eating disorders. However, studies on the rela-tionship between attachment styles and ON remain limited, particularly in adolescents. This study assessed the relationship between attachment styles and ON in Lebanese adolescents (15-18 years), along with evalu-ating the indirect effect of self-esteem on this association.Methods: This study used a cross-sectional design and was carried out during May-June 2020 with 555 stu-dents (15-18 years) enrolled. The Dueurosseldorf Orthorexia Scale was utilized to screen for ON tendencies. A lin-ear regression was conducted taking the DOS score as the dependent variable. The PROCESS Macro was used to test the indirect effect of self-esteem between attachment styles and ON. Results: Higher fearful and preoccupied attachment styles, female gender, and more physical activity were significantly associated with more ON tendencies, whereas higher self-esteem was significantly associated with less ON tendencies. When adjusting for all sociodemographic characteristics and other attachment styles, none of the attachment styles remained significantly correlated with ON tendencies. Self-esteem mediated the association between secure attachment style and ON and between dismissive attachment style and ON.Conclusions: The rise in ON warrants further studies and investigations to raise awareness and plan behav-ioral interventions in order to treat it.& COPY; 2023 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.