Psychometric Validation of the Turkish ORTO-11 and Psychological Correlates of Orthorexic Tendencies in Transgender Adults Before Gender-Affirming Treatment

Orthorexic tendencies and their measurement remain understudied in transgender adults. This cross-sectional study conducted a preliminary psychometric evaluation of the Turkish ORTO-11 and examined psychological correlates of orthorexic tendencies in a clinically recruited sample of transgender adults undergoing psychiatric evaluation before gender-affirming hormonal or surgical treatment. Eighty participants completed the ORTO-11, Health Anxiety Inventory, Psychache Scale, Self-Compassion Scale, and Multidimensional Scale of Perceived Social Support. Internal consistency analyses, confirmatory factor analysis, Spearman correlations, robust regression, and indirect-effect analysis were conducted. The ORTO-11 showed good internal consistency (Cronbach’s α = 0.88; McDonald’s ω = 0.89), and confirmatory factor analysis supported a unidimensional structure with acceptable model fit indices. Lower ORTO-11 scores, indicating greater orthorexic tendencies, were associated with higher health anxiety and psychological pain and with lower self-compassion and perceived social support. In multivariable analysis, psychological pain was the only significant independent correlate of ORTO-11 scores. Bootstrap analysis suggested that psychological pain statistically accounted for part of the association between health anxiety and orthorexic tendencies. These findings provide preliminary support for the Turkish ORTO-11 as a self-report measure of orthorexic tendencies in this clinically recruited transgender sample, but the scale should not be interpreted as a diagnostic instrument for orthorexia nervosa.