Research Article
BibTex RIS Cite

Orthorexia Nervosa as a Disorder of Less Intuition and Emotion Dysregulation

Year 2023, Volume: 15 Issue: Supplement 1, 346 - 354, 29.12.2023
https://doi.org/10.18863/pgy.1316560

Abstract

Emotion regulation difficulties are a significant concern in the realm of eating disorders, serving as either contributing factors or ongoing challenges. While extensive research has explored these issues within prominent eating disorders like anorexia (AN) and bulimia nervosa (BN), there is a noticeable gap when it comes to understanding emotion regulation difficulties (ERD) and intuitive eating (IE) characteristics in the context of orthorexia nervosa (ON). This study aims to bridge this knowledge gap by introducing a quantitative approach to investigate ERD and IE in a Turkish population affected by ON, involving 159 participants. The study's primary findings reveal that ON represents a non-adaptive eating behavior inherently marked by ERD. Notably, a significant gender difference was observed, indicating that men exhibit a higher likelihood of displaying orthorexic tendencies compared to women . Prior research has highlighted the importance of ERD and the absence of IE in the context of AN and BN. This study extends these findings to assert that these emotional factors also constitute critical criteria in the understanding and treatment of ON. Thus, clinicians should be attentive to the emotional aspects when addressing individuals affected by ON.

Supporting Institution

Eötvös Lorand University

Project Number

Grant numbers: KKP126835

References

  • Aksoydan E, Camci N (2009) Prevalence of orthorexia nervosa among Turkish performance artists. Eat Weight Disord, 14:33–37.
  • Almeida C, Santos L (2018) Orthorexia nervosa in a sample of Portuguese fitness participants. Eat Weight Disord, 4:443-451.
  • APA (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM 5). Washington DC, American Psychiatric Association.
  • Anastasiades E, Argyrides M (2022) Healthy orthorexia vs orthorexia nervosa Associations with body appreciation, functionality appreciation, intuitive eating and embodiment. Eat Weight Disord, 27:3197–3206.
  • Artusi R, Verderio P, Marubini E (2002) Bravais-Pearson and Spearman correlation coefficients meaning, test of hypothesis and confidence interval. Int J Biol Markers, 17:148–151.
  • Arusoğlu G, Kabakçi E, Köksal G, Merdol T K (2008) Orthorexia nervosa and adaptation of ORTO-11 into Turkish. Turk Psikiyatri Derg, 19:283-291.
  • Barnes M, Caltabiano M (2017a) The interrelationship between orthorexia nervosa, perfectionism, body image and attachment style. Eat Weight Disord 22:177-184.
  • Barrada R, Roncero M (2018a) Bidimensional structure of the orthorexia Development and initial validation of a new instrument. Anales de Psicología 34:283–291.
  • Barthels F, Meyer F, Pietrowsky R (2015) Duesseldorf Orthorexia Scale–Construction and evaluation of a questionnaire measuring orthorexic eating behavior. Z Klin Psychol Psychother (Gott), 44:97-105.
  • Bosi A, Güler C (2007) Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine. Appetite, 49:661–666.
  • Bratman S, Knight D (2000) Health Food Junkies Overcoming the Obsession With Healthful Eating. New York, Broadway.
  • Brockmeyer T, Holtforth M, Bents H , Kämmerer A, Herzog W, Friederich C (2012a) Starvation and emotion regulation in anorexia nervosa. Compr Psychiatry 53:496-501.
  • Brockmeyer T, Skunde M, Wu M, Bresslein E, Rudofsky G, HerzogW (2014) Difficulties in emotion regulation across the spectrum of eating disorders. Compr Psychiatry, 55:565-571.
  • Brytek Matera A (2012a) Orthorexia nervosa an eating disorder, obsessive compulsive disorder or disturbed eating habit. Archives of Psychiatry and Psychotherapy, 14:55–60.
  • Brytek Matera A, Fonte L, Poggiogalle E, Donini M, Cena H (2017) Orthorexia nervosa: Relationship with obsessive compulsive symptoms disordered eating patterns and body uneasiness among Italian university students. Eat Weight Disord, 22:609-617.
  • Bundros J, Clifford D, Silliman K, Morris M (2016) Prevalence of Orthorexia nervosa among college students based on Bratman test and associated tendencies. Appetite, 101:86-94.
  • Coimbra M, Ferreira C (2021) Making the leap from healthy to disordered eating the role of intuitive and inflexible eating attitudes in orthorexic behaviours among women. Eat Weight Disord, 26:1793-1800.
  • Donini M, Marsili D, Graziani M, Imbriale M, Cannella C (2004a) Orthorexia nervosa: A preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eat Weight Disord, 9:151–157.
  • Dunn T, Bratman S (2016) A review of the literature and proposed diagnostic criteria. Eat Behav, 21:11–17.
  • Dunn T, Gibbs J, Whitney N, Starosta A (2017). Prevalence of orthorexia nervosa is less than 1%: Data from a US sample. Eat Weight Disord, 22:185-192.
  • Engel S, Wonderlich A, Crosby D, Mitchell E, Crow S, Peterson C (2013a) The role of affect in the maintenance of anorexia nervosa: Evidence from a naturalistic assessment of momentary behaviors and emotion. J Abnorm Psychol, 122:709-719.
  • Fairburn C, Cooper Z, Shafran R (2003) Cognitive behaviour therapy for eating disorders Atransdiagnostic theory and treatment. Behav Res Ther, 41:509-528.
  • Fidan T, Ertekin V, Isilay A, Kırpınar I (2010a) Prevalence of orthorexia among medical students in Erzurum, Turkey. Compr Psychiatry, 51:49-54.
  • Gann L (2019) Orthorexia nervosa: The role of social media# cleaneating. (Doctoral thesis). Iowa, University of Iowa
  • Gratz K , Roemer L (2004) Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Behav Modif, 39:431-453.
  • Harrison A, Sullivan S, Tchanturia K, Treasure J (2010a) Emotional functioning in eating disorders Attentional bias, emotion recognition and emotion regulation. Psychol Med, 40:1887-1897.
  • Hawks S, Merrill R, Madanat H (2004) The intuitive eating scale: Development and preliminary validation. Am J Health Educ, 35:90-99.
  • Hayes O, Wu MS, De Nadai S, Storch A (2017) Orthorexia nervosa: An examination of the prevalence, correlates, and associated impairment in a university sample. J J Cogn Psychother, 31:124-135.
  • Karakus B, Hidiroglu S, Keskin N, Karavus M (2017) Orthorexia nervosa tendency among students of the department of nutrition and dietetics at a university in Istanbul. North Clin Istanb, 4:117-123.
  • Keller M, Konradsen H (2013) Ortoreksi blandt unge fitness-medlemmer. Klinisk Sygepleje, 7:63-71.
  • Koven N,Abry A W (2015) The clinical basis of orthorexia nervosa: Emerging perspectives. Neuropsychiatr Dis Treat, 11:385-394.
  • Koven N, Senbonmatsu R (2013) A neuropsychological evaluation of orthorexia nervosa. Open Journal of Psychiatry, 3:214-222.
  • Livazović G, Mudrinić I (2017) Dissatisfaction with physical appearance and behaviors associated with eating disorders in adolescents. Kriminologija Socijalna Integracija, 25:90–109.
  • Madden C, Leong S, Gray A, Horwath C (2012) Eating in response to hunger and satiety signals is related to BMI in a nationwide sample of 1601 mid-age New Zealand women. Public Health Nutr, 15:2272-2279.
  • George, D, Mallery, P. (2003) SPSS for Windows Step By Step: A Simple Guide and Reference 11.0 update 4th ed. Boston, Allyn Bacon.
  • Missbach B, Hinterbuchinger B, Dreiseitl V, Zellhofer S, Kurz C, König J (2015) When eating right, is measured wrong! A validation and critical examination of the ORTO-15 questionnaire in German. PLoS One, 10:e0135772.
  • Obeid S, Hallit S, Akel M, Brytek Matera A (2021a) Orthorexia nervosa and its association with alexithymia, emotion dysregulation and disordered eating attitudes among Lebanese adults. Eat Weight Disord, 26:2607-2616.
  • Oberle C, Samaghabadi R, Hughes E (2017) Orthorexia nervosa Assessment and correlates with gender BMI and personality. Appetite, 108:303–310.
  • Ramacciotti C, Perrone P, Coli E, Burgalassi A, Conversano C, Massimetti G (2018) Is the prevalence of orthorexia nervosa in an Australian university population. Eat Weight Disord, 23:453–458.
  • Rodgers R, White M, Berry R (2021) Orthorexia nervosa, intuitive eating, and eating competence in female and male college students. Eat Weight Disord, 26:2625-2632.
  • Roncero M, Barrada J, Perpiñá C (2017) Measuring orthorexia nervosa Psychometric limitations of the ORTO-15. Span J Psychol, 20:20: 41.
  • Rowsell M, MacDonald D, Carter J (2016) Emotion regulation difficulties in anorexia nervosa: Associations with improvements in eating psychopathology. J Eat Disord, 4:17.
  • Ruscitti C, Rufino K, Goodwin N, Wagner R (2016b) Difficulties in emotion regulation in patients with eating disorders. Borderline Personal Disord Emot Dysregul, 3:3.
  • Strahler J (2021) Trait mindfulness differentiates the interest in healthy diet from orthorexia nervosa. Eat Weight Disord, 26:993-998.
  • Strahler J, Wachten H, Neuhofer S, Zimmermann P (2022) Psychological correlates of excessive healthy and orthorexic eating emotion regulation attachment, and anxious depressive stress symptomatology. Front Nutr, 9:817047.
  • Stutts L A (2020) It’s complicated: The relationship between orthorexia and weight shape concerns eating behaviors and mood. Eat Behav, 39:101444.
  • Tribole E, Resch E (1995) I ntuitive Eating: A Recovery Book for the Chronic Dieterary New York, Broadway.
  • Turner P G, Lefevre C (2017) Instagram use is linked to increased symptoms of orthorexia nervosa. Eat Weight Disord, 22:277–284.
  • TUIK (2022) Hanehalkı Bilişim Teknolojileri Kullanım Araştırması 2022. Anakara, Türkiye İstatistik Kurumu.
  • Tylka T (2006c) Development and psychometric evaluation of a measure of intuitive eating. J Couns Psychol, 53:226-240.
  • Tylka L, Kroon Van Diest A (2013) The Intuitive Eating Scale–2: Item refinement and psychometric evaluation with college women and men. J Couns Psychol, 60:137-153.
  • Valera J, Ruiz P, Valdespino R, Visioli F (2014) Prevalence of orthorexia nervosa among ashtanga yoga practitioners. A pilot studies. Eat Weight Disord, 19:469–472.
  • Van Dyck Z, Herbert B, Happ C, Kleveman G,Vögele C (2016b) German version of the intuitive eating scale. Psychometric evaluation and application to an eating disordered population. Appetite, 105:798–807.
  • Vuillier L, Robertson S, Greville-Harris M (2020b) Orthorexic tendencies are linked with difficulties with emotion identification and regulation. J Eat Disord, 8:15.
  • Wagener A, Much K (2010) Eating disorders as coping mechanisms. J College Stud Psychother, 24:203–212.
  • Westwood H, Kerr-Gaffney J, Stahl D, Tchanturia K (2017) Alexithymia in eating disorders Systematic review and meta-analyses of studies using the Toronto Alexithymia Scale. J Psychosom Res, 99:66–81.
  • WHO (2021) International Classification of Diseases, Eleventh Revision (ICD-11) Geneva, World Health Organization

Sezgi Azlığı ve Duygu Düzenleme Bozukluğu Olarak Ortoreksiya Nervoza

Year 2023, Volume: 15 Issue: Supplement 1, 346 - 354, 29.12.2023
https://doi.org/10.18863/pgy.1316560

Abstract

Duygu düzenleme güçlükleri, yeme bozuklukları alanında önemli bir sorundur ve hem etken faktörler hem de süregelen zorluklar olarak karşımıza çıkmaktadır. Anoreksiya (AN) ve bulimia nervoza (BN) gibi önde gelen yeme bozukluklarında bu konular kapsamlı araştırmalarla incelenmiş olsa da, ortoreksiya nervoza (ON) bağlamında duygu düzenleme güçlükleri ( DDG) ve sezgisel yeme (SY) özelliklerinin anlaşılması söz konusu olduğunda gözle görülür bir boşluk bulunmaktadır. Bu çalışma, 159 katılımcının yer aldığı ON'dan etkilenen bir Türk örnekleminde DDG ve SY'yi araştırmak için nicel bir yaklaşım sunarak bu bilgi boşluğunu doldurmayı amaçlamaktadır. Çalışmanın birincil bulguları, ON'un doğası gereği DDG ile kendini gösteren, uyuma yönelik olmayan bir yeme davranışını temsil ettiğini ortaya koymaktadır. Özellikle, erkeklerin kadınlara kıyasla ortoreksik eğilimler sergileme olasılığının daha yüksek olduğunu gösteren önemli bir cinsiyet farkı gözlemlenmiştir. Önceki araştırmalar, AN ve BN bağlamında DDG'nin önemini ve SY'nin yokluğunu vurgulamıştır. Bu çalışma, bu duygusal faktörlerin ON'nin anlaşılması ve tedavisinde de kritik kriterler oluşturduğunu ileri sürmek için bu bulguları genişletmektedir. Bu nedenle, klinisyenler ON'dan etkilenen bireylere müdahale ederken duygusal yönlere dikkat etmelidir.

Project Number

Grant numbers: KKP126835

References

  • Aksoydan E, Camci N (2009) Prevalence of orthorexia nervosa among Turkish performance artists. Eat Weight Disord, 14:33–37.
  • Almeida C, Santos L (2018) Orthorexia nervosa in a sample of Portuguese fitness participants. Eat Weight Disord, 4:443-451.
  • APA (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM 5). Washington DC, American Psychiatric Association.
  • Anastasiades E, Argyrides M (2022) Healthy orthorexia vs orthorexia nervosa Associations with body appreciation, functionality appreciation, intuitive eating and embodiment. Eat Weight Disord, 27:3197–3206.
  • Artusi R, Verderio P, Marubini E (2002) Bravais-Pearson and Spearman correlation coefficients meaning, test of hypothesis and confidence interval. Int J Biol Markers, 17:148–151.
  • Arusoğlu G, Kabakçi E, Köksal G, Merdol T K (2008) Orthorexia nervosa and adaptation of ORTO-11 into Turkish. Turk Psikiyatri Derg, 19:283-291.
  • Barnes M, Caltabiano M (2017a) The interrelationship between orthorexia nervosa, perfectionism, body image and attachment style. Eat Weight Disord 22:177-184.
  • Barrada R, Roncero M (2018a) Bidimensional structure of the orthorexia Development and initial validation of a new instrument. Anales de Psicología 34:283–291.
  • Barthels F, Meyer F, Pietrowsky R (2015) Duesseldorf Orthorexia Scale–Construction and evaluation of a questionnaire measuring orthorexic eating behavior. Z Klin Psychol Psychother (Gott), 44:97-105.
  • Bosi A, Güler C (2007) Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine. Appetite, 49:661–666.
  • Bratman S, Knight D (2000) Health Food Junkies Overcoming the Obsession With Healthful Eating. New York, Broadway.
  • Brockmeyer T, Holtforth M, Bents H , Kämmerer A, Herzog W, Friederich C (2012a) Starvation and emotion regulation in anorexia nervosa. Compr Psychiatry 53:496-501.
  • Brockmeyer T, Skunde M, Wu M, Bresslein E, Rudofsky G, HerzogW (2014) Difficulties in emotion regulation across the spectrum of eating disorders. Compr Psychiatry, 55:565-571.
  • Brytek Matera A (2012a) Orthorexia nervosa an eating disorder, obsessive compulsive disorder or disturbed eating habit. Archives of Psychiatry and Psychotherapy, 14:55–60.
  • Brytek Matera A, Fonte L, Poggiogalle E, Donini M, Cena H (2017) Orthorexia nervosa: Relationship with obsessive compulsive symptoms disordered eating patterns and body uneasiness among Italian university students. Eat Weight Disord, 22:609-617.
  • Bundros J, Clifford D, Silliman K, Morris M (2016) Prevalence of Orthorexia nervosa among college students based on Bratman test and associated tendencies. Appetite, 101:86-94.
  • Coimbra M, Ferreira C (2021) Making the leap from healthy to disordered eating the role of intuitive and inflexible eating attitudes in orthorexic behaviours among women. Eat Weight Disord, 26:1793-1800.
  • Donini M, Marsili D, Graziani M, Imbriale M, Cannella C (2004a) Orthorexia nervosa: A preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eat Weight Disord, 9:151–157.
  • Dunn T, Bratman S (2016) A review of the literature and proposed diagnostic criteria. Eat Behav, 21:11–17.
  • Dunn T, Gibbs J, Whitney N, Starosta A (2017). Prevalence of orthorexia nervosa is less than 1%: Data from a US sample. Eat Weight Disord, 22:185-192.
  • Engel S, Wonderlich A, Crosby D, Mitchell E, Crow S, Peterson C (2013a) The role of affect in the maintenance of anorexia nervosa: Evidence from a naturalistic assessment of momentary behaviors and emotion. J Abnorm Psychol, 122:709-719.
  • Fairburn C, Cooper Z, Shafran R (2003) Cognitive behaviour therapy for eating disorders Atransdiagnostic theory and treatment. Behav Res Ther, 41:509-528.
  • Fidan T, Ertekin V, Isilay A, Kırpınar I (2010a) Prevalence of orthorexia among medical students in Erzurum, Turkey. Compr Psychiatry, 51:49-54.
  • Gann L (2019) Orthorexia nervosa: The role of social media# cleaneating. (Doctoral thesis). Iowa, University of Iowa
  • Gratz K , Roemer L (2004) Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Behav Modif, 39:431-453.
  • Harrison A, Sullivan S, Tchanturia K, Treasure J (2010a) Emotional functioning in eating disorders Attentional bias, emotion recognition and emotion regulation. Psychol Med, 40:1887-1897.
  • Hawks S, Merrill R, Madanat H (2004) The intuitive eating scale: Development and preliminary validation. Am J Health Educ, 35:90-99.
  • Hayes O, Wu MS, De Nadai S, Storch A (2017) Orthorexia nervosa: An examination of the prevalence, correlates, and associated impairment in a university sample. J J Cogn Psychother, 31:124-135.
  • Karakus B, Hidiroglu S, Keskin N, Karavus M (2017) Orthorexia nervosa tendency among students of the department of nutrition and dietetics at a university in Istanbul. North Clin Istanb, 4:117-123.
  • Keller M, Konradsen H (2013) Ortoreksi blandt unge fitness-medlemmer. Klinisk Sygepleje, 7:63-71.
  • Koven N,Abry A W (2015) The clinical basis of orthorexia nervosa: Emerging perspectives. Neuropsychiatr Dis Treat, 11:385-394.
  • Koven N, Senbonmatsu R (2013) A neuropsychological evaluation of orthorexia nervosa. Open Journal of Psychiatry, 3:214-222.
  • Livazović G, Mudrinić I (2017) Dissatisfaction with physical appearance and behaviors associated with eating disorders in adolescents. Kriminologija Socijalna Integracija, 25:90–109.
  • Madden C, Leong S, Gray A, Horwath C (2012) Eating in response to hunger and satiety signals is related to BMI in a nationwide sample of 1601 mid-age New Zealand women. Public Health Nutr, 15:2272-2279.
  • George, D, Mallery, P. (2003) SPSS for Windows Step By Step: A Simple Guide and Reference 11.0 update 4th ed. Boston, Allyn Bacon.
  • Missbach B, Hinterbuchinger B, Dreiseitl V, Zellhofer S, Kurz C, König J (2015) When eating right, is measured wrong! A validation and critical examination of the ORTO-15 questionnaire in German. PLoS One, 10:e0135772.
  • Obeid S, Hallit S, Akel M, Brytek Matera A (2021a) Orthorexia nervosa and its association with alexithymia, emotion dysregulation and disordered eating attitudes among Lebanese adults. Eat Weight Disord, 26:2607-2616.
  • Oberle C, Samaghabadi R, Hughes E (2017) Orthorexia nervosa Assessment and correlates with gender BMI and personality. Appetite, 108:303–310.
  • Ramacciotti C, Perrone P, Coli E, Burgalassi A, Conversano C, Massimetti G (2018) Is the prevalence of orthorexia nervosa in an Australian university population. Eat Weight Disord, 23:453–458.
  • Rodgers R, White M, Berry R (2021) Orthorexia nervosa, intuitive eating, and eating competence in female and male college students. Eat Weight Disord, 26:2625-2632.
  • Roncero M, Barrada J, Perpiñá C (2017) Measuring orthorexia nervosa Psychometric limitations of the ORTO-15. Span J Psychol, 20:20: 41.
  • Rowsell M, MacDonald D, Carter J (2016) Emotion regulation difficulties in anorexia nervosa: Associations with improvements in eating psychopathology. J Eat Disord, 4:17.
  • Ruscitti C, Rufino K, Goodwin N, Wagner R (2016b) Difficulties in emotion regulation in patients with eating disorders. Borderline Personal Disord Emot Dysregul, 3:3.
  • Strahler J (2021) Trait mindfulness differentiates the interest in healthy diet from orthorexia nervosa. Eat Weight Disord, 26:993-998.
  • Strahler J, Wachten H, Neuhofer S, Zimmermann P (2022) Psychological correlates of excessive healthy and orthorexic eating emotion regulation attachment, and anxious depressive stress symptomatology. Front Nutr, 9:817047.
  • Stutts L A (2020) It’s complicated: The relationship between orthorexia and weight shape concerns eating behaviors and mood. Eat Behav, 39:101444.
  • Tribole E, Resch E (1995) I ntuitive Eating: A Recovery Book for the Chronic Dieterary New York, Broadway.
  • Turner P G, Lefevre C (2017) Instagram use is linked to increased symptoms of orthorexia nervosa. Eat Weight Disord, 22:277–284.
  • TUIK (2022) Hanehalkı Bilişim Teknolojileri Kullanım Araştırması 2022. Anakara, Türkiye İstatistik Kurumu.
  • Tylka T (2006c) Development and psychometric evaluation of a measure of intuitive eating. J Couns Psychol, 53:226-240.
  • Tylka L, Kroon Van Diest A (2013) The Intuitive Eating Scale–2: Item refinement and psychometric evaluation with college women and men. J Couns Psychol, 60:137-153.
  • Valera J, Ruiz P, Valdespino R, Visioli F (2014) Prevalence of orthorexia nervosa among ashtanga yoga practitioners. A pilot studies. Eat Weight Disord, 19:469–472.
  • Van Dyck Z, Herbert B, Happ C, Kleveman G,Vögele C (2016b) German version of the intuitive eating scale. Psychometric evaluation and application to an eating disordered population. Appetite, 105:798–807.
  • Vuillier L, Robertson S, Greville-Harris M (2020b) Orthorexic tendencies are linked with difficulties with emotion identification and regulation. J Eat Disord, 8:15.
  • Wagener A, Much K (2010) Eating disorders as coping mechanisms. J College Stud Psychother, 24:203–212.
  • Westwood H, Kerr-Gaffney J, Stahl D, Tchanturia K (2017) Alexithymia in eating disorders Systematic review and meta-analyses of studies using the Toronto Alexithymia Scale. J Psychosom Res, 99:66–81.
  • WHO (2021) International Classification of Diseases, Eleventh Revision (ICD-11) Geneva, World Health Organization
There are 57 citations in total.

Details

Primary Language English
Subjects Psychopathology, Emotional Development, Clinical Psychology
Journal Section Research
Authors

Süleyman Agah Demirgül 0000-0002-9312-4955

Adrien Rigó This is me 0000-0003-2940-2110

Project Number Grant numbers: KKP126835
Early Pub Date November 5, 2023
Publication Date December 29, 2023
Acceptance Date November 5, 2023
Published in Issue Year 2023 Volume: 15 Issue: Supplement 1

Cite

AMA Demirgül SA, Rigó A. Orthorexia Nervosa as a Disorder of Less Intuition and Emotion Dysregulation. Psikiyatride Güncel Yaklaşımlar - Current Approaches in Psychiatry. December 2023;15(Supplement 1):346-354. doi:10.18863/pgy.1316560

Creative Commons License
Psikiyatride Güncel Yaklaşımlar - Current Approaches in Psychiatry is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.