Eating disorder examination questionnaire and clinical impairment assessment questionnaire: general population and clinical norms for young adult women in Sweden

Optimal use of assessment instruments for the detection and diagnosis of eating disorders (ED) depends on the availability of normative data. The aim of this work was to, for the first time, collect norms for both the Eating Disorder Examination Questionnaire (EDE-Q) and the newly developed Clinical Impairment Assessment (CIA) Scale from a general population of young women in Sweden, as well as from a clinical population of ED patients in Sweden. Participants were composed of both a randomized sample from the general population of women aged 18–30 years (N = 760) as well as from a clinical population aged 18–66 years (N = 2383). Data for the clinical population was extracted from the Stepwise database. Mean scores, standard deviations and percentile ranks for the global for the EDE-Q (as well as its subscales) and the CIA are presented. Prevalence figures of key eating disorder behaviors are also reported. Comparisons are made between the results in the present study with other existing normative studies on the EDE-Q and the CIA. The present study contributes to improving the accuracy of the interpretation of scores of the widely used self-report measure of ED, the EDE-Q, and the CIA, both of which play important roles in for diagnosis, prevention and intervention of ED.     

The measurement of impairment due to eating disorder psychopathology

Eating disorders have a profound and highly specific impact on psychosocial functioning. The aim of this research was to develop a measure of such secondary impairment. A 16-item, self-report instrument was developed, the Clinical Impairment Assessment (CIA), which was designed to measure such impairment overall and in three specific domains (personal, cognitive, social). The psychometric properties of the instrument were evaluated using data collected in the context of a transdiagnostic treatment trial. The findings consistently supported the utility of the instrument with the CIA being shown to have high levels of internal consistency, construct and discriminant validity, test-retest reliability, and sensitivity to change. The CIA should be of value to clinicians when assessing patients with eating disorders and their response to treatment. It should also help inform epidemiological research.     

Interoceptive Awareness and Suicidal Ideation in a Clinical Eating Disorder Sample: The Role of Body Trust

Previous research has demonstrated that both suicidal ideation (SI) and eating disorders (EDs) are associated with poor interoceptive awareness (IA). Suicidality research has demonstrated that the IA dimension of lower body trust is associated with SI, suicide plans, and suicide attempts. Similarly, in ED samples, recent research supports that low body trust has been the most robust dimension of IA associated with eating pathology. However, to date, research is lacking in how dimensions of IA may be associated with SI in an ED sample, above and beyond the impact of eating pathology on SI. Thus, in a clinical ED sample, the present study sought to determine which IA dimensions predict the presence and severity of SI, above and beyond ED symptoms. Participants (N = 102) completed a clinical interview assessing SI and self-report assessments including the Multidimensional Assessment of Interoceptive Awareness (MAIA). Results demonstrated that patients with current SI reported greater ED psychopathology, lower MAIA Attention Regulation, MAIA Self-Regulation, and MAIA Trusting scores compared to patients without SI. Higher ED psychopathology and lower MAIA Attention Regulation, Self-Regulation, and Trusting subscale scores were all significantly associated with the presence of SI. However, only low MAIA Trusting scores predicted the presence of SI, above and beyond covariates (age, depression, and eating pathology). No MAIA subscales were correlated with the severity of SI. Consistent with previous research, results suggest low MAIA Trusting scores may be associated with SI in ED samples and highlight the need for future research on mechanisms of these associations.     

An evaluation of the reliability and construct validity of eating disorder measures in White and Black women

Most measures of eating disorder symptoms and risk factors were developed in predominantly White female samples. Yet eating disorders affect individuals of all racial and ethnic backgrounds. Black women appear more vulnerable to certain forms of eating pathology, such as binge eating, and less susceptible to other eating disorder symptoms and risk factors, such as body dissatisfaction, compared with their White peers. Despite concern that extant measures do not adequately assess eating concerns among Black women, the construct validity of scores on most of these measures has not been adequately examined within this population. This study included 2,208 Black and White women who completed the following: the Binge Eating Scale (BES), the Eating Disorder Diagnostic Scale (EDDS), the Eating Attitudes Test-26 (EAT-26), the Eating Disorder Inventory Body Dissatisfaction and Drive for Thinness subscales, the Bulimia Test-Revised (BULIT-R), the Multidimensional Body-Self Relations Questionnaire-Appearance Evaluation subscale (MBSRQ-AE), and the Objectified Body Consciousness Scale (OBCS). Most measures yielded internally consistent scores in both races. Confirmatory factor analyses indicated that loadings for some measures, including the EAT-26 and EDDS, were not invariant across groups and thus do not assess equivalent constructs in White and Black women. However, others, including the BULIT-R, BES, OBCS, and MBSRQ-AE, exhibited factorial invariance in both races. Results suggest scores are likely not equivalent across races for several popular measures of eating disorder symptoms and risk factors. Thus, it is recommended that researchers and clinicians obtain additional information regarding racial/cultural factors when using these instruments with Black women.     

Social Competence and Eating Disorders: Development and Validation of the Anorexia and Bulimia Problem Inventory

Incompetence at solving interpersonal problems is a possible antecedent of anorexic and bulimic behaviors in college-age women. A role-play measure of interpersonal competence, the Anorexia and Bulimia Problem Inventory (ABPI), was developed empirically and then was tested in two validation studies. ABPI scores for two samples of college women were compared: a subclinical sample [extremely high scores on the Eating Attitudes Test (EAT)] and a control sample (extremely low EAT scores). Groups differed as predicted. The second study replicated and extended these findings. The ABPI scores of clinical, subclinical, and control samples of college women differed significantly. Bulimic bingers, purgers, and laxative users were least competent on the ABPI. A lack of group differences on the Helping Situations Inventory supported the ABPI's discriminant validity. A correlation between the ABPI and Beck Depression Inventory supported the ABPI's convergent validity. ABPI competence appears to be related to certain subtypes of eating disorders.     

The Big Five and eating disorders: a prospective study in the general population

The present study assessed the Big‐Five personality dimensions according to the lexical hypothesis among participants with a lifetime history of eating disorders (ED) (n = 84), as well as participants with a first‐time incidence of ED (n = 33) compared to participants with no history of ED (non‐ED, n = 1014). Personality and ED were investigated with self‐report questionnaires among women (n = 1157) randomly selected from the general population. Participants with a lifetime ED reported significantly lower levels of Agreeableness. Conscientious, Emotional Stability, and a significantly higher level of Openness compared to the non‐ED. When Emotional Stability was controlled for, participants with ED scored higher on Openness compared to controls. Participants were followed up after two years. Thirty‐three participants with complete data on all the scales developed an eating disorder for the first time at follow‐up. This first‐time incidence group had a very similar pattern of personality prior to developing any symptoms of ED (i.e. low on Agreeableness and Emotional Stability, and high on Openness) to those with a lifetime history of ED, and significantly different from those who never reported any symptoms of ED (controls, n = 636). This pattern resembles the Type 3 personality according to Caspi and colleagues. It is suggested that the presence of some specific personality traits may be regarded as a risk factor for developing ED. Copyright © 2000 John Wiley & Sons, Ltd.     

The structure and validity of directional measures of appearance social comparison among emerging adults in China

We evaluated the structure and validity of the Upward Appearance Comparison Scale (UPACS) and Downward Appearance Comparison Scale (DACS) (O’Brien et al., 2009) in Chinese samples. In Study 1, principal component analysis on an initial sample (427 women, 123 men) and confirmatory factor analysis on another sample (447 women, 121 men) found that a 15-item, two component model had the best overall fit. Derived components had moderate correlations with most conceptually related measures and low correlations with less conceptually related indices. Study 2 participants (310 women, 201 men) completed the UPACS and DACS as well as measures of disordered eating, fatness concern, and negative affect; they were re-assessed one year later. Baseline UPACS scores predicted changes in disordered eating for women and fatness concerns for men, independent of initial disturbances, but DACS responses were not related to outcomes. Findings highlighted the potential utility of derived UPACS and DACS within a Chinese context.     

Experiences of demand and control during daily life are predictors of carotid atherosclerotic progression among healthy men.

OBJECTIVES: The authors previously reported that individuals who rate their daily life as more demanding or less controllable by momentary electronic diary (ED) reports showed greater intima-medial thickness (IMT) by carotid ultrasonography. They now present prospective findings on this relation. DESIGN: Three hundred thirty-five healthy individuals (ages 50-70 at study onset) completed ongoing ratings of activity and mood over a 6-day period, using ED assessments. MAIN OUTCOME MEASURES: Mean bilateral carotid artery IMT was measured at baseline and 36 months later. RESULTS AND CONCLUSION: Mean ratings of high demand and low control were significantly associated with IMT progression among men but not among women. These associations were not explained by traditional risk factors or by measures of occupational stress. Effects were partially accounted for by elevated ambulatory heart rates among those with low ratings of control. These data support the utility of ED-based measures for examining psychosocial risks in the prediction of cardiovascular disease progression.     

The Eating Attitudes Test: validation with DSM-IV eating disorder criteria

The Eating Attitudes Test (EAT; Garner & Garfinkel, 1979) is one of the most widely used self-report eating disorder instruments. Originally developed to diagnose anorexia nervosa, it is often used in nonclinical samples where it has a high false-positive rate, which is likely due to changes in diagnostic criteria. Because the EAT has not been validated with Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) criteria, we examined its criterion validity for discriminating between nonclinical women with and without an undifferentiated DSM-IV eating disorder diagnosis. We also examined differences in mean EAT scores among eating-disordered, symptomatic, and asymptomatic participants. Results show that the EAT has an accuracy rate of at least 90% when used to differentially diagnose those with and without eating disorders and that mean EAT scores differed among eating-disordered, symptomatic, and asymptomatic participants.     

Testing a Moderated Mediation Model of Objectification Theory among Black Women in the United States: The Role of Protective Factors

Recent studies find that Black women experience rates of eating pathology and body dissatisfaction comparable to those of White women. Abundant research suggests that objectification theory could help explain the development and maintenance of eating disorder (ED) symptoms among diverse women. However, research on the applicability of objectification theory to ED symptoms in Black women is equivocal. Specifically, some have suggested that body surveillance might operate differently for Black women. Thus, the current study examined ethnic-racial identity (ERI) commitment and body appreciation as moderators of the mediated associations among body surveillance, body shame, and ED symptoms. Black women (n?=?175) in the United States completed measures of body image, ERI commitment, and ED symptoms. Consistent with objectification theory, body shame mediated the association between body surveillance and ED symptoms. Contrary to our hypothesis, ERI commitment did not moderate the link between body surveillance and body shame. However, body appreciation was a significant moderator, such that the strength of the relation between body surveillance and ED symptoms via body shame was weakened at high levels of body appreciation. Future work should consider interventions that foster body appreciation in Black women.

     

Effects of an Internet-based intervention for subthreshold eating disorders: a randomized controlled trial

BackgroundWomen reporting initial eating disorder (ED) symptoms are at highest risk for the development of an eating disorder. Preventive interventions should, therefore, be specifically tailored for this subgroup.AimsTo adapt and evaluate the effects of the Internet-based prevention program “Student Bodies?” for women with symptoms of disordered eating and/or subthreshold eating disorder (ED) syndromes.Method126 women, reporting subthreshold ED symptoms (high weight and shape concerns and below threshold bingeing, purging, chronic dieting or several of these symptoms) were randomly assigned to a Student Bodies?+ (SB+) intervention or a wait-list control group and assessed at pre-intervention, post-intervention, and 6-month follow-up. “Student Bodies?” was adapted to be suitable for subthreshold EDs. Main outcome measures were attitudes and symptoms of disordered eating. Pre-follow-up data were analyzed by ANCOVAS with mixed effects.ResultsAt 6-month follow-up, compared to participants in the control group, participants in the intervention group showed significantly greater improvements on ED-related attitudes. Intervention participants also showed 67% (95% CI = 20–87%) greater reductions in combined rates of subjective and objective binges, and 86% (95% CI = 63–95%) greater reduction in purging episodes. Also, the rates of participants abstinent from all symptoms of disordered eating (restrictive eating, binge eating and any compensatory behavior) were significantly higher in the intervention group (45.1% vs. 26.9%). Post-hoc subgroup analyses revealed that for participants with binge eating the effect on EDE-Q scores was larger than in the pure restricting subgroup.ConclusionThe adapted “SB+” program represents an effective intervention for women with subthreshold EDs of the binge eating subtype.     

Avoidance coping style and the risk of developing an eating disorder in adolescents

The first aim of this study was to analyse the relationship between coping styles and strategies in Spanish adolescents of both genders, with high and low eating disorder risk. Secondly, this study aims to examine the relation of coping styles and coping strategies with eating disorder risk. The sample comprised 2142 adolescents (1.130 girls and 1.012 boys), mean age 13,96 years (SD= 1.34). They completed the Adolescent Coping Scale (ACS) and the Eating Attitude Test (EAT-40). The results showed high use of intropunitive avoidance coping in both female and male adolescents with high EAT-40 scores. The regression analysis indicated that, in both girls and boys, the intropunitive avoidance and the tension reduction coping strategy explained a high percentage of variance of eating disorder risk. The results of this study have implications for the prevention of these behaviours in adolescents, because people with a high risk of developing an eating disorder present a maladaptive coping style before the onset of the eating disorder.     

Assessment of Problematic Situations and Coping Strategies in Women with Eating Disorders: Initial Validation of a Situation-Specific Problem Inventory

The current study examined the psychometric properties of the Anorexia and Bulimia Problem Inventory (ABPI; Eason, 1983) in women with and without diagnosed eating disorders. The ABPI was initially constructed in accordance with the Behavior-Analytic model of instrument development (Goldfried & D'Zurilla, 1969). In this investigation, the ABPI was refined to consist of 38 audiotaped problematic situations, including those related to eating and weight, academic, family, and interpersonal relationship issues, and scoring criteria to rate the effectiveness of responses. Convergent and discriminant validity were established between ABPI-R scores and the Eating Disorder Inventory (EDI; Garner, Olmsted, & Polivy, 1983) scales. As evidence of disciminative validity women with eating disorders received less ratings indicating less effective problem-solving on the ABPI-R scales than women without eating disorders. A significant increase in effective coping as measured by the ABPI-R was found for women following an 8-week outpatient eating disorders treatment program. Potential uses of this measure in research and clinical practice are discussed.     

Clustered Patterns of Behavioral and Health-Related Variables Among Young Lesbian Women

Lesbian women are at increased risk for a variety of mental and physical health problems compared to heterosexual women. In order to inform treatment and prevention, the purpose of this study was to examine behavioral and health-related patterns among lesbian women and elucidate how these patterns are associated with general discrimination, sexual minority stress, affect, and social support. A sample of self-identified lesbian women (N = 436) completed an online survey from August 2014–March 2015. A latent profile analysis was conducted using measures of body mass index, hazardous alcohol use, binge eating, eating disorder risk, and exercise as indicators. A 5-class solution best fit the data and included two healthy groups: (a) low health risk, moderate exercise (54%), (b) low health risk + high exercise (22%); and three unhealthy risk groups: (c) obese + binge eating (14%); (d) disordered eating + hazardous alcohol use (5%); (e) disordered eating + high exercise (5%). The three unhealthy classes generally reported more general discrimination, sexual minority stress, social anxiety, negative affect, and lower social support compared to the healthy classes. These findings show that behavioral and health-related variables cluster together in several distinct patterns among lesbian women. In addition, general discrimination and sexual minority stress and associated psychosocial functioning may be related to these maladaptive behavioral and health-related patterns and may be important to consider in behavioral interventions.     

100 midlife women with eating disorders: a phenomenological analysis of etiology

This study analyzed eating disorder (ED) etiological factors for 100 midlife women ED inpatients, grouped by ED onset age: < 40 and > or = 40 years. Interpretative Phenomenological Analysis classified ED etiological influences into background contributors, immediate triggers, or sustainers. Family-of-origin issues, predominantly parental maltreatment, emerged as important background contributors, but not immediate ED triggers, regardless of onset age. Body image issues were also major background contributors regardless of onset age and further served as immediate ED triggers for many of the younger-onset patients, but not the older-onset patients. Family-of-choice and health issues were unimportant for younger-onset patients but were important ED contributors and triggers for older-onset patients. Emergent etiological differences suggest differential assessment and treatment needs for midlife ED patients based on ED onset age.     

Screening for Eating Disorders in Undergraduate Women: Norms and Validity of the Spanish Version of the Eating Disorder Examination Questionnaire (EDE-Q)

The purpose of this investigation was to examine the internal consistency reliability and the convergent validity of the Spanish version of the Eating Disorder Examination Questionnaire (EDE-Q) and to provide EDE-Q norms for Spanish undergraduate women. Seven hundred eight college women, aged 18–30 years, volunteered to complete the EDE-Q, BSQ and EDI-2. Satisfactory internal consistency for the four subscales and the global score of the EDE-Q was obtained (Cronbach’s α ≥ .81). The EDI-2 Drive for Thinness and Body Dissatisfaction subscales and the BSQ global factor score correlated highly and positively with the corresponding EDE-Q subscales (r ≥ .72). Average scores, standard deviations and percentile ranks for the raw EDE-Q subscales and data on the occurrence of binge eating and compensatory behaviors are presented. Most of these values were lower than those found in other non-European developed countries. Results support the satisfactory internal consistency and convergent validity of the Spanish version of the EDE-Q. Lower scores in EDE-Q subscales suggest the need to study a lower cut-off point for clinical significance in Spanish college women. These data will help clinicians and researchers to interpret the EDE-Q scores of college women in Spain.     

Risk factors for onset of eating disorders: Evidence of multiple risk pathways from an 8-year prospective study

Objective

Use classification tree analysis with lagged predictors to determine empirically derived cut-points for identifying adolescent girls at risk for future onset of threshold, subthreshold, and partial eating disorders and test for interactions between risk factors that may implicate qualitatively distinct risk pathways.

Method

Data were drawn from a prospective study of 496 adolescent girls who completed diagnostic interviews and surveys annually for 8 years.

Results

Body dissatisfaction emerged as the most potent predictor; adolescent girls in the upper 24% of body dissatisfaction showed a 4.0-fold increased incidence of eating disorder onset (24% vs. 6%). Among participants in the high body dissatisfaction branch, those in the upper 32% of depressive symptoms showed a 2.9-fold increased incidence of onset (43% vs. 15%). Among participants in the low body dissatisfaction branch, those in the upper 12% of dieting showed a 3.6-fold increased incidence onset (18% vs. 5%).

Conclusion

This three-way interaction suggests a body dissatisfaction pathway to eating disorder onset that is amplified by depressive symptoms, as well as a pathway characterized by self-reported dieting among young women who are more satisfied with their bodies. It may be possible to increase the effectiveness of prevention programs by targeting each of these qualitatively distinct risk groups, rather than only individuals with a single risk factor.     

Psychological characteristics of women with eating disorders: Permanent or transient features?

The purpose of the study was to make a psychological profile of Danish women with Eating Disorders, who were not currently hospitalized. 75 women between the ages of 19 and 46 years participated. 22 participants suffered from a clinical eating disorder (ED). 20 women had previously suffered from a clinical ED, and 33 women had never suffered from ED. The study included sociodemographic data, problems in relation to eating and weight, exposure to stressful life events, and the following questionnaires: The Eating Disorder Inventory, the Rosenberg Self-Esteem Scale, the Coping Styles Questionnaire, the Perceived Stress Scale, the Defense Style Questionnaire, and the Trauma Symptom Checklist. Psychologically, women with ED differed significantly from women without ED by using a more primitive defense style, perceiving themselves as being more exposed to stress, using more inefficient methods of coping and having lower self-esteem. Unexpectedly, the study also showed that recovery from an ED was resulting in normalisation of both behavioral and psychological characteristics. The implications of these findings are discussed.     

Body Image Assessment Software: Psychometric data

The aim of the present study was to analyze the psychometric characteristics of the Body Image Assessment Software (BIAS), an innovative interactive computer program developed to assess body image disturbances. The program was tested on 252 psychology students at the University of Barcelona and 51 patients with an eating disorder (ED). The subjects filled in the Eating Attitudes Test-26, the Body Shape Questionnaire, the body dissatisfaction scale of the Eating Disorders Inventory-2, and the Body Image Assessment-Revised (a test of silhouettes). Results showed good validity and very high reliability. Furthermore, BIAS was able to discriminate between people who were at risk of an ED and those who were not, as well as between people with and without a history of an ED. Those at risk of having an ED and those with a current ED showed more body image distortion (overestimation of body size) and higher levels of body image dissatisfaction.     

Validity of self-efficacy scale scores for a Spanish sample

This study analyzed the validity of the Sherer, et al. Self-efficacy Scale for a Spanish sample of 555 subjects, 257 men and 298 women. 415 were from the general population; 34 schizophrenics and 45 with eating disorders were from a clinic, plus 61 drug addicts from two centers. All met DSM-IV-R criteria. The Eysenck Personality Questionnaire, State-Trait Anxiety Inventory, Assertiveness Inventory, and the Self-control Questionnaire were administered. The reliability for total scores, general factor were high even when social self-efficacy was low. A bidimensional factor structure seemed more acceptable. The Self-efficacy scale scores correlated with those on the Self-control Questionnaire and the Assertiveness Inventory. Extraversion scores on the Sincerity dimension of the Eysenck Personality Questionnaire correlated with scores on the State-Trait Anxiety Inventory and Eysenck's Neuroticism and Psychoticism scales. Significant mean differences appeared between the general population group and the three clinical groups. These analyses support the usefulness of the scale for clinical practice and research with Spanish samples.