Validity of the Eating Disorder Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples

Prevalence of and traits associated with low BMD among female adolescent runners

PURPOSE

Identify the prevalence of and traits that may increase the risk of low bone mineral density (BMD) among 93 female adolescent competitive endurance runners.

METHODS

Participants were 93 high school runners, ages 13-18 yr, from southern California. Eating attitudes and behaviors were assessed using the Eating Disorder Examination Questionnaire (EDE-Q). Menstrual and sports participation history were evaluated using an interviewer-assisted, self-report questionnaire. Bone mineral density (BMD) of the spine (L1-L4), total hip, and total body were measured by dual-energy x-ray absorptiometry. The -2 and -1 BMD age-matched, gender-specific z-score cutoffs were used to categorize girls as having low bone mass for age.

RESULTS

Among the female runners, 11.8% and 28% met the -2 and -1 BMD z-score cutoffs, respectively, whereas 25.8% reported menstrual irregularity (MI). Total hip BMD, lumbar spine BMD, and lumbar spine BMD z-score were significantly lower in runners with MI after adjusting for body mass index (BMI) and lean tissue mass. Runners that participated in five or more compared with three seasons of endurance running exhibited a significantly lower total body and lumbar spine BMD z-score after adjusting for BMI, lean tissue mass, and number of menstrual cycles in the past year. Multiple regression analysis indicated that MI, participation in five or more seasons of endurance running, BMI, and lean tissue mass were independent predictors of low BMD.

CONCLUSION

Female adolescent endurance runners may represent a population with an increased risk of low bone mass. Future studies are necessary to further understand the factors contributing to low bone mass in young runners and to identify behavioral strategies that will promote optimal bone mineral accumulation during the adolescent years.

Eating-disorder symptoms and syndromes in a sample of urban-dwelling Canadian women: contributions toward a population health perspective

OBJECTIVE

We estimated the prevalence of eating disorders and maladaptive eating behaviors in a population-based sample and examined the association of maladaptive eating with self-rated physical and mental health.

METHOD

A sample of 1,501 women (mean age = 31.2 years, SD = 6.2) were recruited using random-digit dialing to participate in a 20-min telephone interview about eating behaviors.

RESULTS

Weighted frequency analysis showed the prevalence of frequent binge-eating to be 4.1%, that of regular purging to be 1.1%, and that of frequent compensation to be 8.7%. Although we found none of the women to meet full criteria for anorexia nervosa, 0.6% met criteria for bulimia nervosa, 3.8% provisional criteria for binge eating disorder, and 0.6% criteria for a newly proposed entity, purging disorder. As many as 14.9% fell into a residual category representing subthreshold, but potentially problematic variants of eating disturbances. Logistic regression analyses showed that clinical-level maladaptive eating attitudes and behaviors predicted self-rated physical- and mental-health problems after sociodemographic factors were controlled.

DISCUSSION

This population-based survey provides prevalence estimates of BN, BED, and purging disorder that are compatible with those of recent epidemiological studies and shows that maladaptive eating attitudes and behaviors represent a substantial population burden.

Better psychological health is associated with weight stability in women with eating disorders

AIM

To explore the associations between changes in weight, eating disorder psychopathology and psychological distress in a community sample of women with eating disorders over two years.

METHOD

One hundred and twenty two women identified with disordered eating in a baseline population survey agreed to participate in a follow-up study, of whom 87 (71%), mean age 28+/-6.2, completed the two-year follow-up. Body mass index, eating disorder psychopathology, psychological distress, and demographic details were assessed at both time points.

RESULTS

Over the two years there was a mean weight gain of 1.76 kg (SD=7.03), 11 (13%) women lost > or =5 kg, 25 (29%) gained > or =5 kg, and 49 (58%) remained weight stable (i.e., within 5 kg of baseline weight). Comparisons between those who had lost, gained and remained weight stable showed few significant differences, however, women who remained weight stable were the least psychologically distressed at baseline and those who lost weight had the greatest reduction in shape concern. Body mass index at baseline, and change in level of binge eating episodes were not associated with weight change.

CONCLUSIONS

Disordered eating behaviours have little influence on weight change over two years in community women with disordered eating. Low levels of psychological distress at baseline may promote weight stability. Concerns about shape are likely to increase with increased weight.

Excessive exercise in eating disorder patients and in healthy women

OBJECTIVE

In order to elucidate the nature of excessive exercise among individuals with eating disorders, exercise behaviours were compared between eating disorder patients receiving specialist treatment and healthy women, and between subgroups of patients.

METHODS

Self-report measures of obligatory exercise, motivation for exercise and frequency of hard exercise for weight or shape reasons were completed by eating disorder patients (n=102) and healthy women (n=184).

RESULTS

The experience of intense guilt when exercise is missed and exercising solely or primarily for reasons of weight, shape or physical attractiveness, were the exercise behaviours that most clearly differentiated between women with eating disorders and healthy women. Patients with the purging form of anorexia nervosa (n=13) and those with bulimia nervosa (n=41) tended to have higher scores on measures of these behaviours than those with the restricting form of anorexia nervosa (n=15).

CONCLUSIONS

Research addressing the prevalence and correlates of excessive exercise in eating disorder patients would benefit from a broader assessment of exercise behaviour than has typically been used in previous studies. In addition, the findings may indicate specific targets for the clinical management of excessive exercise as well as for community-based health promotion initiatives.

Validation of the Finnish version of the SCOFF questionnaire among young adults aged 20 to 35 years

BACKGROUND

We tested the validity of the SCOFF, a five-question screening instrument for eating disorders, in a general population sample.

METHODS

A random sample of 1863 Finnish young adults was approached with a questionnaire that contained several screens for mental health interview, including the SCOFF. The questionnaire was returned by 1316 persons. All screen positives and a random sample of screen negatives were invited to SCID interview. Altogether 541 subjects participated in the SCID interview and had filled in the SCOFF questionnaire. We investigated the validity of the SCOFF in detecting current eating disorders by calculating sensitivity, specificity, and positive and negative predictive values (PPV and NPV) for different cut-off scores. We also performed a ROC analysis based on these 541 persons, of whom nine had current eating disorder.

RESULTS

The threshold of two positive answers presented the best ability to detect eating disorders, with a sensitivity of 77.8%, a specificity of 87.6%, a PPV of 9.7%, and a NPV of 99.6%. None of the subjects with current eating disorder scored zero points in the SCOFF.

CONCLUSION

Due to its low PPV, there are limitations in using the SCOFF as a screening instrument in unselected population samples. However, it might be used for ruling out the possibility of eating disorders.

Empirical identification and validation of eating disorder phenotypes in a multisite clinical sample

Identified problems with the classification system of eating disorders (EDs), including its imperfect application to clinical samples, challenge its validity and limit its utility. The present study aimed to empirically identify and validate ED phenotypes in a multisite clinical sample using latent profile analysis (LPA). ED symptom data collected from 687 individuals were included in LPA. Identified latent profiles (LPs) were compared on clinical validators. Five LPs were identified: LP1 (n = 178), objective bingeing and multiple purging methods; LP2 (n = 172), objective bingeing without purging; LP3 (n = 130), objective bingeing and vomiting; LP4 (n = 108), low/normal weight and excessive exercise; LP5 (n = 99), low/normal weight and absence of ED symptoms. Validation analyses demonstrated the most extreme psychopathology/medical morbidity in LP1 and the least in LP5. LP1 and LP3 were most likely to report medication treatment for EDs. Identified LPs imperfectly resembled diagnostic and statistical manual of mental disorders-IV-TR EDs. Multiple purging methods and the absence of ED cognitions marked differences in severity across groups, whereas low weight did not. Clinical differences in psychopathology, medical morbidity, and treatment utilization validated groups. Future research should examine longitudinal stability of empirically-derived phenotypes and incremental validity of alternative classification schema to inform DSM-V.

A consideration of developmental egocentrism in anorexia nervosa

Recent research has suggested that normal adolescent processes are important in understanding psychosis, and that young adult individuals with psychosis are often struggling to develop an individual and autonomous self (the "fundamental task" of adolescence). The current paper explores the utility of considering normative adolescent developmental processes in understanding anorexia nervosa. Data were collected from 31 female young-adults with symptoms of anorexia nervosa, 26 female comparison young-adults and 71 female adolescents on measures of adolescent egocentrism. A one-way ANOVA indicated that individuals with symptoms of anorexia nervosa scored more highly than both their peers and the adolescents on several dimensions of egocentric developmental beliefs. Correlations also showed that egocentrism was positively associated with eating concern in participants with symptoms of anorexia. The results suggest that young-adult women with symptoms of anorexia nervosa tended to feel physically invulnerable while also feeling both psychologically vulnerable to others and special or different. Together with the finding of excessive self-consciousness, this supports a notion that they may be experiencing exaggerated versions of normal self-developmental phenomena. Clinically, offering alternative ways of feeling unique other than dieting may be important in therapeutic approaches to anorexia nervosa. Similarly, strategies aimed at normalisation, such as facilitating healthy attachment to peers, may be useful for individuals with anorexia nervosa.

Clinical and psychometric validation of an extended version of the Testable Assumptions Questionnaire (TAQ-ED-R)

OBJECTIVE

Testable dysfunctional assumptions are a central aspect of the cognitive profile of patients with eating disorders. These are conditional beliefs that can be challenged directly using techniques such as behavioural experiments and surveys. Recent research has suggested that such assumptions fall into three classes (assumptions about one's body, one's feelings and the world), but the emerging scale had only relatively few items. The present study examines the clinical and psychometric utility of an extended version of that scale--the Testable Assumptions Questionnaire-Eating Disorders-Revised (TAQ-ED-R).

METHOD

The TAQ-ED-R and the Eating Disorders Examination-Questionnaire (EDE-Q) were administered to 200 women--72 with eating disorders, and 128 with no eating disorder. Differences between anorexic, bulimic and non-clinical women were examined, and associations with EDE-Q scores were tested.

RESULTS

The three subscales had adequate to good internal consistency across all three samples. The two clinical groups reported relatively high levels of testable assumptions, but there was no difference between the anorexic and bulimic women on the overall scale. Although all three forms of testable assumption were associated with levels of eating pathology, assumptions relating to one's body were the key correlate.

DISCUSSION

The TAQ-ED-R is a clinically useful measure of dysfunctional assumptions that can be tested with the help of behavioural experiments and surveys. It will be important to test the predictive validity of the new measure, as well as its capacity to drive treatment for comorbid states, such as alexithymia and social anxiety.

The prevalence of eating disorders in infertile women

OBJECTIVE

To determine the prevalence of eating disorders in a sample of infertile women.

DESIGN

A descriptive comparative two-group design in which collected data were compared with a published community sample.

SETTING

Private infertility center.

PATIENT(S)

Eighty-two participants beginning their first gonadotropin/intrauterine insemination (IUI) treatment cycle completed self-report measures that assessed eating disorder pathology and exercise habits. Each subject was telephone-administered the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) Module H (Eating Disorders) and a demographic questionnaire.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Past or current diagnosis of an eating disorder.

RESULT(S)

Seventeen participants (20.7%) met criteria for a past or current eating disorder, which is five times higher than the U.S. lifetime prevalence rate. None of the participants who met the criteria for an eating disorder had disclosed their past or current diagnosis to their reproductive endocrinologist.

CONCLUSION(S)

Infertility clinics are likely to be treating women with a past or current eating disorder history. Therefore, an eating disorder screening tool should be included in the initial intake, because these patients may be at a higher risk for negative maternal and fetal outcomes than non-eating disorder patients. Additionally, patients with a past or current eating disorder may not disclose this information to reproductive health care providers, which may limit providers' ability to provide appropriate medical and psychologic referrals.

Body image disturbance in young North European and East Asian women with and without eating disorders in Australia and in Singapore

OBJECTIVE

To investigate body image disturbance in young women with and without an eating disorder (ED) across two different ethnic groups in Australia and Singapore.

METHOD

The relationship of body image disturbance to cultural orientation and socio-cultural factors was analysed in 154 women with and without an ED. Participants were from the following backgrounds: North European Australian, East Asian Australian, Singaporean Chinese (SC) and North European expatriates in Singapore.

RESULTS

Irrespective of cultural group, women with an ED had similar body dissatisfaction. Among those without an ED, SC women reported greater body dissatisfaction than all other cultural groups. Finally, within each cultural group, ED participants reported significantly higher body dissatisfaction than their non-ED counterparts with the exception of SC women where there was no difference.

DISCUSSION

Socio-cultural factors other than body image may play more important roles in SC women's ED psychopathology.

Public perceptions of binge eating and its treatment

OBJECTIVE

Attitudes and beliefs concerning a binge eating problem were examined in a community sample of men and women (n = 1031) aged 15 to 94 years.

METHOD

A vignette describing a fictional 32-year-old female obese binge eater was presented, followed by a series of questions concerning the nature and treatment of the problem described.

RESULTS

Most participants believed that binge eating is primarily a problem of low self-esteem or depression. Behavioral weight loss treatment and self-help interventions were the treatments considered most helpful, whereas few participants believed that psychotherapy would be helpful. General practitioners and dieticians were the treatment providers considered most helpful. Most participants were ambivalent about prognosis given treatment and pessimistic about outcome in the absence of treatment.

CONCLUSION

The fact that binge eating is viewed primarily as a problem of negative affect, and that specific psychotherapy is not highly regarded as a treatment, may go some way to explaining why most individuals with binge eating-type disorders do not receive appropriate treatment. The benefits of specific psychotherapy in stabilizing eating behavior and improving quality of life for obese binge eaters need to be communicated to sufferers and to the health professionals they are likely to contact.

Femininity and eating disorders

The purpose of this study is to examine conformity to traditional feminine norms as a predictor of eating disorder (ED) symptomatology. Eight subscales of the Conformity to Feminine Norms Inventory (CFNI) were examined as predictors of ED symptomatology as assessed by the Eating Disorder Examination-Questionnaire (EDE-Q). Findings indicate the Thinness subscale of the CFNI predicted significant portions of the variance in ED symptomatology. Contrary to the findings of Mahalik and colleagues (2005), no other CFNI subscales predicted ED symptoms. Implications for the femininity theory of EDs are discussed.

Eating disorder psychopathology does not predict the overweight severity in subjects seeking weight loss treatment

BACKGROUND

Many obese subjects show relevant psychological distress. The aims of this study were to assess the psychopathological and clinical features of a sample of overweight or obese subjects seeking weight loss treatment and to evaluate the possible, significant associations between the levels of overweight and the specific and general eating disorder psychopathology.

METHODS

A total of 397 consecutive overweight (body mass index > or =25 kg/m(2)) patients seeking treatment for weight loss at the Outpatient Clinic for Obesity of the University of Florence were studied. The prevalence of binge eating disorder was assessed using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. All subjects were assessed through the self-report version of the Eating Disorder Examination Questionnaire, the Beck Depression Inventory, and the State-Trait Anxiety Inventory.

RESULTS

The current prevalence of binge eating disorder was 24.2%; 35% of the subjects were overweight during childhood. High prevalence rates of clinical significant depressive (38%) and anxious (71.5%) symptoms were observed. Binge eating disorder, the severity of specific eating disorder psychopathology, and depressive and anxious symptoms were not associated with the severity of overweight.

CONCLUSIONS

The severity of the specific and general eating disorder psychopathology does not predict the levels of overweight. A positive association between severe eating disorder psychopathology and clinical depression was observed.

The reliability and validity of the dichotomous thinking in eating disorders scale

The Dichotomous Thinking in Eating Disorders Scale (DTEDS) is a short, self-report measure that can be used to assess the presence of a rigid, "black-and-white" cognitive thinking style. It was originally developed for use in a study of psychological predictors of weight regain in obesity. The DTEDS consists of two subscales. Items on the Eating subscale assess dichotomous thinking with regards to eating, dieting or weight, and items on the General subscale assess dichotomous thinking more generally. This study aimed to examine the factor structure and psychometric properties of the DTEDS in a sample of treatment-seeking eating disordered (N=87) and overweight/obese (N=111) women. Confirmatory factor analysis demonstrated that a two-factor model provided a better fit to the data than a one-factor model. The psychometric properties of the final scale were excellent, with evidence being provided for the reliability and validity of the two subscales. Overall, the results indicated that the DTEDS is a reliable instrument that can be used to assess eating-specific as well as more general aspects of dichotomous thinking.

Psychometric evaluation of the eating disorder examination-questionnaire for bariatric surgery candidates

OBJECTIVE

Despite increasing use of the Eating Disorder Examination-Questionnaire (EDE-Q) in bariatric surgery patients, little is known about the utility and psychometric performance of this self-report measure in this clinical group. The primary purpose of the current study was to evaluate the factor structure and construct validity of the EDE-Q in a large series of bariatric surgery candidates.

METHODS AND PROCEDURES

Participants were 337 obese bariatric surgery candidates. Participants completed the EDE-Q and a battery of behavioral and psychological measures.

RESULTS

Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) produced a 12-item, 4-factor structure of the EDE-Q. The four factors, interpreted as Dietary Restraint, Eating Disturbance, Appearance Concerns, and Shape/Weight Overvaluation, were found to be internally consistent and converged with other relevant measures of psychopathology.

DISCUSSION

Factor analysis of the EDE-Q in bariatric surgery candidates did not replicate the original subscales but revealed an alternative factor structure. Future research must further evaluate the psychometric properties, including the factor structure, of the EDE-Q in this and other diverse populations and consider means of improving this measure's ability to best assess eating-related pathology in bariatric surgery patients.

Screening for eating disorders in primary care: EDE-Q versus SCOFF

OBJECTIVE AND METHODS

The comparative validity of the Eating Disorder Examination Questionnaire (EDE-Q) (22 items) and SCOFF (five items) in screening for cases of the more commonly occurring eating disorders was examined in a primary care sample of young adult women (n=257). Diagnoses were confirmed in a sub-group of interviewed participants (n=147).

RESULTS

Twenty-five cases, primarily variants of bulimia nervosa (BN) not meeting formal diagnostic criteria, were identified in the interviewed sample. An EDE-Q global score of >or= 2.80 yielded the optimal trade-off between sensitivity (Se) (0.80) and specificity (Sp) (0.80) (positive predictive value (PPV)=0.44), whereas a score of two or more positive responses on the SCOFF was optimal (Se=0.72, Sp=0.73, PPV=0.35). Validity coefficients for both measures varied as a function of participants' age and body weight, although these effects were more pronounced for the SCOFF.

CONCLUSIONS

Both measures performed well in terms of their ability to detect cases and to exclude non-cases of the more commonly occurring eating disorders in a primary care setting. The EDE-Q performed somewhat better than the SCOFF and was more robust to effects on validity of age and weight. These findings need to be weighed against the advantage of the SCOFF in terms of its brevity.

Weight gain, dietary restraint, and disordered eating in the freshman year of college

OBJECTIVE

The aims of the study were to assess whether women during the first year of college experience (1) significant weight gain; (2) a prospective relation between dietary restraint and weight gain; (3) an increase in disordered eating; and (4) a prospective relation between dietary restraint or concern about the Freshmen 15 (i.e., weight gain of 15 lbs during the freshman year of college) and disordered eating.

METHOD

Participants were 336 female students in their first year of college who completed questionnaire measures of Body Mass Index (BMI), eating disorder pathology, dietary restraint, body image, and self-esteem.

RESULTS

Participants' mean weight gain was approximately 3 lbs (1.5 kg), and among those who gained weight, the mean gain was 7.32 lbs (3.3 kg). Dietary restraint in September did not predict weight change in April, but participants who lost weight reported significantly greater dietary restraint than those participants who gained weight. Eating disorder symptoms increased significantly from September to April. Dietary restraint, concern about the "Freshman 15", and self-esteem in September uniquely predicted EDE-Q Weight and Shape Concern subscale scores in April.

DISCUSSION

Female students in their first year of college gain a small but significant amount of weight, and weight gain was mostly unrelated to dietary restraint. Disordered eating increases during the first year of college and, is predicted by prospective dietary restraint and concerns about weight gain.

Emotional responses to food, body dissatisfaction and other eating disorder features in children, adolescents and young adults

We aimed to assess and compare emotional responses to different foods in relationship to eating disorder and associated features, across gender and age groups. We hypothesized that negative emotional responses to images of foods would be higher in (i) those with higher body dissatisfaction and (ii) older females. Five hundred and thirty-six (18% Grade 5, 39% Grade 8 or 9, and 43% Grade 11 or 12) school, and 93 university students participated. Emotive responses to images of foods were assessed with a PowerPoint presentation of 16 differing food and four 'neutral' images shown over 30s intervals. Responses were rated on three 10-cm visual analog scales measuring levels of happiness, fear and disgust. Body image concern was assessed with the nine-item body dissatisfaction subscale of the EDI and eating disorder symptoms with the Eating Disorder Examination Questionnaire. With increasing age all three emotional responses towards food fell and body dissatisfaction increased. Compared to females, males showed significantly higher levels of a 'happy' response to food, and in adult females a fear emotive response correlated positively with eating concern and body dissatisfaction. In men, positive emotive responses to food may be indicative of broader factors that reduce their vulnerability to eating disorders.

The relationship between dissociation and binge eating

Despite research findings demonstrating a relationship between dissociation and binge eating, the psychological processes that may underlie this association remain unclear. The present study examined 2 potential explanations: (a) that dissociation disinhibits behavioral control over eating and (b) that dissociation interferes with self-awareness and undermines body image. A total of 151 female university students completed measures of dissociation, body dissatisfaction, impulsivity, internalization of the thin ideal, body comparison, and binge eating. Correlations confirmed the presence of a relationship between dissociation and binge eating, and regression analyses revealed that this relationship is limited to body-specific (somatic) symptoms of dissociation. Path analyses identified body dissatisfaction, comparison, and impulsivity as significant mediators of this relationship. However, inclusion of all 3 mediated paths in a full model revealed that only body dissatisfaction is a unique mediator. The relevance of somatic symptoms, and the unique contribution of body dissatisfaction as a mediator, are consistent with an explanation of the relationship between dissociation and binge eating that is based on a vulnerability of body image. The results emphasize the need for future research to consider the relation of dissociation to a broader range of disordered eating symptoms than simply binge eating.

Self-report versus interview assessment of purging in a community sample of women

OBJECTIVE AND METHODS

Agreement between self-report and interview assessment of purging behaviours was examined in a community sample of women with a high level of eating disorder symptoms (n = 324) who completed both the Eating Disorder Examination (EDE) and Eating Disorder Examination Questionnaire (EDE-Q).

RESULTS

Of 46 individuals who reported any use of self-induced vomiting or laxative misuse on the questionnaire, 19 (41.7%) denied these behaviours when subsequently questioned in a face-to-face interview. These individuals had lower levels of eating disorder psychopathology, functional impairment and general psychological distress, than participants who reported purging on both the questionnaire and at interview (n = 27).

CONCLUSIONS

The assumption of interview superiority in the assessment of specific aspects of eating disorder psychopathology should not be uncritically accepted. Caution should be exercised in drawing conclusions concerning the level of agreement between self-report and interview assessment of purging based on research in clinical samples.

Obesity and impairment in psychosocial functioning in women: the mediating role of eating disorder features

OBJECTIVE

The objective was to test the hypothesis that, in women, the association between obesity and impairment in psychosocial functioning is mediated by levels of weight and shape concerns and/or binge-eating frequency.

RESEARCH METHODS AND PROCEDURES

Self-report measures of eating disorder psychopathology, mental health functioning, subjective quality of life in the psychological and social domains, and days "out-of-role" associated with any (physical or mental) health problem, were completed by a community sample of women classified as obese (BMI >or=30 kg/m(2), n = 639) or non-obese (BMI <30 kg/m(2), n = 4253). For each of the dependent measures, regression models were used to test the hypothesis of mediation by comparing the strength of the relationship between independent and dependent variables with and without inclusion of the putative mediator in the regression model.

RESULTS

On each measure, the conditions for perfect mediation were satisfied when weight or shape concerns acted as the putative mediator, indicating that there was no association between obesity and functional impairment after controlling for weight or shape concerns. In contrast, associations between obesity and impairment in psychosocial functioning remained highly significant when binge-eating frequency was the putative mediator.

DISCUSSION

The findings suggest that in women, weight and shape concerns are an important mediator of the relationship between obesity and impairment in psychosocial functioning, whereas binge eating may not be of primary importance. A greater focus on body acceptance in obesity treatment may be indicated.

Assessment of binge eating in overweight youth using a questionnaire version of the Child Eating Disorder Examination with Instructions

OBJECTIVE

Existing self-report methods for assessing eating disorder (ED) symptoms in youth do not adequately measure binge eating and lack sufficient psychometric support. The Youth Eating Disorder Examination-Questionnaire (YEDE-Q), a self-report version of the Child Eating Disorder Examination (ChEDE), was designed to assess the spectrum of ED psychopathology in youth.

METHOD

The YEDE-Q was compared to the ChEDE and the Questionnaire for Eating and Weight Patterns-Adolescent version (QEWP-A) in a sample of 35 overweight adolescents aged 12-17.

RESULTS

The YEDE-Q showed significant agreement (ps < .001) with the ChEDE on all four subscale scores, the global score, and measurement of objective bulimic episodes. The YEDE-Q and the QEWP-A showed significant agreement (ps < .001) on the measurement of shape and weight concerns.

CONCLUSION

The YEDE-Q appears promising in the assessment of eating-related pathology in overweight adolescents, but remains in need of validation in children and ED populations.

Eating Disorder Examination-Questionnaire

Zusammenfassung. Der Eating Disorder Examination-Questionnaire von Fairburn und Beglin (EDE-Q; 1994) ist die Fragebogenversion des strukturierten Essstörungsinterviews Eating Disorder Examination (EDE). Der EDE-Q erfasst die spezifische Essstörungspsychopathologie mithilfe von vier Subskalen zum gezügelten Essverhalten, zu Sorgen über das Essen, Gewicht und Figur. Die in diesem Beitrag vorgestellte deutschsprachige Übersetzung des EDE-Q wurde in Stichproben mit Anorexia nervosa, Bulimia nervosa und atypischen Essstörungen, sowie nicht-klinischen, subklinischen und psychiatrischen Vergleichsgruppen teststatistisch untersucht (N = 706). Der EDE-Q erwies sich als intern konsistent und stabil. Seine faktorielle Struktur wurde teilweise reproduziert. Die Kennwerte des EDE-Q waren signifikant mit denen des EDE korreliert, fielen erwartungsgemäß jedoch teilweise höher aus. Weitere Hinweise für die konvergente Validität ergaben sich durch Korrelationen mit konzeptverwandten Fragebögen. Der EDE-Q zeigte eine gute diskriminative Validität und war sensitiv in der Erfolgsmessung therapeutischer und präventiver Maßnahmen.

Health service utilization for eating disorders: findings from a community-based study

BACKGROUND

Prior use of health services was examined in a community sample of women with bulimic-type eating disorders.

METHOD

Participants (n = 159) completed a structured interview for the assessment of eating disorder psychopathology as well as questions concerning treatment-seeking and type of treatment received.

RESULTS

Whereas a minority (40.3%) of participants had received treatment for an eating problem, most had received treatment for a general mental health problem (74.2%) and/or weight loss (72.8%), and all had used one or more self-help treatments. Where treatment was received for an eating or general mental health problem, this was from a primary care practitioner in the vast majority of cases. Only half of those participants who reported marked impairment associated with an eating problem had ever received treatment for such a problem and less than one in five had received such treatment from a mental health professional.

CONCLUSION

Women with bulimic-type eating disorders rarely receive treatment for an eating problem, but frequently receive treatment for a general mental health problem and/or for weight loss. The findings underscore the importance of programs designed to improve the detection and management of eating disorders in primary care.

Prevalence of eating disorders among adolescent and young adult scholastic population in the region of Madrid (Spain)

OBJECTIVE

The prevalence of eating disorders (EDs) in a representative scholastic sample was evaluated, and the demographic factors associated with ED were assessed.

METHOD

The study used a two-stage epidemiological design. The study population was a randomly selected sample of 1545 students (12- to 21-year-old males and females) in the region of Madrid (Spain).

RESULTS

ED prevalence was 3.43%. Prevalence estimations were as follows: 5.34% for females: 2.72% for eating disorders not otherwise specified (EDNOS), 2.29% for bulimia nervosa (BN), and 0.33% for anorexia nervosa (AN); and 0.64% for males: 0.48% for EDNOS, 0.16% for BN, and 0.00% for AN. Some demographic factors that were shown to be associated with ED included the following: sex, age, single child, single-parent families, and father or mother's death.

DISCUSSION

Despite the methodological improvements over previous epidemiological studies developed in Spain, there were no significant differences in the prevalence estimations.

Remote treatment of bulimia nervosa and binge eating disorder: A randomized trial of Internet-assisted cognitive behavioural therapy

The present study investigated the efficacy of self-help based on cognitive behaviour therapy in combination with Internet support in the treatment of bulimia nervosa and binge eating disorder. After confirming the diagnosis with an in-person interview, 73 patients were randomly allocated to treatment or a waiting list control group. Treated individuals showed marked improvement after 12 weeks of self-help compared to the control group on both primary and secondary outcome measures. Intent-to-treat analyses revealed that 37% (46% among completers) had no binge eating or purging at the end of the treatment and a considerable number of patients achieved clinically significant improvement on most of the other measures as well. The results were maintained at the 6-month follow-up, and provide evidence to support the continued use and development of self-help programmes.

Randomized trial of a multifaceted commercial weight loss program

OBJECTIVE

To test whether a commercial weight loss program promotes greater weight loss in overweight or obese women compared with control conditions and to describe the effect on plasma lipids, carotenoids, hormones, and fitness.

RESEARCH METHODS AND PROCEDURES

Overweight or obese women were randomized to commercial weight loss program or control conditions (n=35 each).

RESULTS

At randomization, participants were 41.1 (11.4) (mean [standard deviation]) years, BMI 34.0 (3.5) kg/m2, and weight 92.0 (11.1) kg. At 6 months, change in weight by intent-to-treat (ITT) analysis was -7.2 (6.7) kg and -7.8% (7.2%) in the intervention group vs. -0.3 (3.9) kg and -0.3% (4.5%) in the control group (n=35 for each; p<0.01). One-year ITT analysis revealed significantly greater change in weight, percent weight, BMI, and waist and hip circumferences in the intervention vs. control group. Completers at 1 year exhibited change in weight of -7.3 (10.4) kg for the intervention group (n=32) vs. -0.7 (5.6) kg for controls (n=33) (p<0.01), and -7.8% (11.1%) weight change for the intervention group vs. -0.7% (6.2%) for controls (p<0.01). High-density lipoprotein (HDL) cholesterol concentration increased significantly in the intervention group. Fasting serum insulin decreased in the intervention but increased in the control group at 6 months (p<0.01), remaining different at 1 year (p=0.05).

DISCUSSION

The commercial program successfully facilitated weight loss, which was notably maintained at 1 year, and promoted favorable changes in plasma lipid and hormone concentrations.

Assessment of body image distortion in eating and weight disorders: the validation of a computer-based tool (Q-BID)

Quantification of Body Image Distortion (Q-BID) is a computerized tool developed to quantify body image distortion in eating and weight disorders. This paper presents information on the psychometric properties of this computerized tool. Three samples of adolescents were recruited and completed the Q-BID, paper and pencil questionnaires and anthropometric measurements, namely a group of hospitalized anorectic patients (n=18), girls following outpatient treatment (n=22) for restrictive anorexia nervosa, and control group of 200 teenager girls. Analyses showed that Q-BID is a valid and reliable tool in that test-retest reliability was high and Q-BID accurately discriminates between hospitalized anorexics and control non-anorexic girls. Also, Q-BID contributes to the multivariate classification of subjects into the 3 sampled groups. The possible uses of this tool for clinical and public health research are discussed as are future research directions.

The EAT-26 as screening instrument for clinical nutrition unit attenders

OBJECTIVE

The aim of this study was to use the Eating Attitudes Test-26 (EAT-26) as a screening instrument on a specific population with a marked prevalence of binge eating disorder (BED) and eating disorder not otherwise specified (EDNOS). The EAT-26 questionnaire was used in order to identify the high-risk subjects for referral to clinical evaluation.

METHOD

EAT-26 was administered to 845 subjects who, for the first time, came to the Nutritional Medicine Service looking for a diet between January 1999 and December 2002. From this initial sample, subsequently, 250 subjects were randomly selected and administered a semistructured clinical interview for DSM-IV (SCID I, version 2.0).

RESULTS

Discriminant analysis provided a cutoff value of EAT-26=11. Logistic regression analysis indicated high Dieting (D) or Bulimia (B) subscale scores as a risk factor of EDNOS or bulimia nervosa (BN) cases, respectively; on the other hand, a high Oral Control (O) subscale score represented a protecting factor for BED cases.

CONCLUSION

Our study tried to assess the usefulness of EAT-26 as a screening instrument for obese patients attending a Medical Nutritional Service. Results from this study suggest that a cutoff score of 11, lower than that indicated in the literature, improves the diagnostic accuracy of the EAT-26 in a high-risk setting regarding sensibility level (68.1%) and leading to a reduction of the false negative rate (31.9%).

The patient's view on quality of life and eating disorders

OBJECTIVE

This study investigated the personal views of eating disorder (ED) patients on their quality of life (QOL).

METHOD

The views of 146 current ED patients and 146 former ED patients on their QOL were studied using a self-report questionnaire. Patients were requested to name the most important aspects of their life and they subsequently rated themselves on these aspects. Qualitative analysis clustered items into meaningful categories.

RESULTS

A sense of belonging was mentioned most often (93.0%) by the participants. Work or education, health and well-being were also mentioned frequently. Furthermore, participants stated a sense of self, disease-specific psychopathology, life skills, leisure activities, a sense of purpose, financial situation, living condition, and pets. Current ED patients more frequently mentioned disease-specific psychopathology than former ED patients. Current ED patients reported poor QOL on most domains, particularly on self-image and well-being. Former ED patients reported better QOL than current ED patients, but ratings were just above average.

CONCLUSION

The views on QOL of ED patients broadens the scope of relevant domains of QOL. The assessment of these views may be a useful adjunct to the use of standardized QOL measures.

Body checking in the eating disorders: Associations between cognitions and behaviors

OBJECTIVE

Body checking behaviors appear to be a manifestation of the cognitive distortions that are central to the maintenance of the eating disorders. However, there is little understanding of the cognitions that drive these behaviors. This study validates a novel measure of such cognitions (Body Checking Cognitions Scale [BCCS]) and examines the association between body checking cognitions, body checking behaviors, and general eating pathology.

METHOD

Eighty-four eating-disordered women and 205 non-eating-disordered women each completed measures of body checking behaviors, body checking cognitions and eating pathology. A further 130 nonclinical women completed the measures to provide an independent cross-validation sample for the BCCS.

RESULTS

The BCCS was reliable and valid, and cross-validation with an independent sample confirmed the four-factor structure. Eating-disordered women were significantly more likely to experience body checking cognitions than healthy women. Those cognitions were associated with a significant proportion of variance in eating pathology, over and above the variance explained by checking behaviors.

CONCLUSION

This study provides evidence for a range of beliefs underlying body checking behavior in eating-disordered women, suggesting that interventions addressing those beliefs might be pertinent in some cases.

Evaluating the treatment of eating disorders from the patient's perspective

OBJECTIVE

This study investigated the evaluation of treatment of eating disorders (EDs) from the patient's perspective in a large community based sample in the Netherlands. It investigated perceived helpfulness of different types of treatment. Furthermore it investigated which patient and treatment characteristics contribute to the evaluation of treatment.

METHOD

The Eating Disorder Examination questionnaire was administered to 44 anorexia nervosa (AN), 43 bulimia nervosa (BN), 69 EDNOS (ED not otherwise specified), and 148 former ED patients. A questionnaire specifically designed for the purpose of this study addressing treatment history and patient's evaluation of their treatment was administered.

RESULTS

There is a substantial patient and doctor delay in seeking and finding treatment. Treatment in specialized ED centers, self-help groups, and treatment with a partner were reported to be most helpful. Beneficial components of treatment reported in specialized ED centers refer to the communication skills of professionals, the therapist-patient working alliance, the contact with peers, and the focus of treatment on both ED symptoms as well as underlying issues.

CONCLUSION

The patient's perspective on treatment of EDs does provide recommendations for the improvement of treatment of EDs that will facilitate clinical decision making and treatment planning.

Self-recognition of disordered eating among women with bulimic-type eating disorders: A community-based study

OBJECTIVE

Self-recognition of eating-disordered behavior was examined in a community sample of young adult women (n = 158) with bulimic eating disorders.

METHOD

A vignette was presented describing a fictional person meeting diagnostic criteria for bulimia nervosa. Participants were asked whether they might currently have a problem such as the one described. Scores on measures of eating disorder psychopathology, functional impairment and general psychological distress were compared between participants who recognized a problem with their eating and those who did not.

RESULTS

Participants who recognized a problem with their eating (n = 86, 51.9%) had higher levels of eating disorder psychopathology and general psychological distress, were more likely to engage in self-induced vomiting, and tended to be heavier, than those who did not (n = 72, 48.1%). In addition, participants who recognized a problem were more likely to have received treatment for an eating or weight problem. In multivariate analysis, the occurrence of self-induced vomiting and higher body weight were the only variables significantly associated with recognition.

CONCLUSION

Poor recognition of eating-disordered behavior may be conducive to low or inappropriate treatment seeking among individuals with bulimic- type eating disorders. The perception that only disorders involving self-induced vomiting are pathological may need to be addressed in prevention programs.

Reliability of self-reported eating disorders: Optimizing population screening

OBJECTIVE

The objective of this study was to assess whether short self-report eating disorder screening questions are useful population screening methods.

METHOD

We screened the female participants (N = 2881) from the 1975-1079 birth cohorts of Finnish twins for eating disorders, using several short screening questions and three Eating Disorder Inventory (EDI) subscales. Comparing these measures with clinician-conducted semi-structured diagnostic interviews (N = 549) of Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) anorexia and bulimia, we calculated their sensitivities and specificities and drew receiver operating characteristic curves to further compare these items.

RESULTS

For current and lifetime bulimia, best tradeoffs between sensitivity and specificity were reached by addressing purging behaviors. For current and lifetime anorexia, the questions "Have you ever had anorexia" and "Has anybody ever suspected that you might have an eating disorder?" optimized tradeoffs between sensitivity and specificity. These questions generally outperformed EDI subscales.

CONCLUSION

Simple screening questions, although less than ideal, are at least as good as other available instruments for community screenings.

Disordered eating behaviours and cognitions in young women with obesity: relationship with psychological status

OBJECTIVE

To examine levels of eating disorder behaviours and cognitions of young women with obesity in the Australian Capital Territory, Australia and assess the impact upon psychological status.

DESIGN

General population cross-sectional survey.

SUBJECTS

A total of 4891 young women from the community aged 18-42 years, of which 630 were in the obese weight range.

MEASUREMENTS

Body mass index (BMI), eating disorder psychopathology (eating disorder examination questionnaire), and psychological distress (K-10).

RESULTS

Women with obesity had significantly higher levels of dietary restraint, eating concern, weight concern, shape concern, binge eating, misuse of diuretics, use of diet pills and fasting compared to other women in the community. These eating disorder cognitions and behaviours were associated with increased levels of psychological distress. In women with obesity, eating concern, weight concern, shape concern, dietary restraint and decreased age predicted psychological distress in a multivariate model. Among other women in the community, behaviours such as laxative misuse, 'hard' exercise and subjective bulimic episodes also contributed to the model predicting psychological distress.

CONCLUSION

As disordered eating psychopathology is high in young obese women and negatively impacts upon psychological status, obesity prevention and treatment should consider eating disorder psychopathology and mental health outcomes.

The Spanish language version of the Eating Disorder Examination Questionnaire: comparison with the Spanish language version of the eating disorder examination and test-retest reliability

This study compared the Spanish language questionnaire (S-EDE-Q) and interview (S-EDE) versions of the Eating Disorder Examination and examined the short-term test-retest reliability of the questionnaire version. Seventy-seven monolingual Spanish-speaking Latina women recruited from the community completed the S-EDE-Q and were then administered the S-EDE by fully bilingual doctoral-level research clinicians. The same assessment was repeated after approximately one week (5-14 days). The S-EDE-Q and the S-EDE were significantly correlated on frequencies of binge eating and all four subscales. Mean differences in the frequency of binge eating and the Restraint subscale were not significant, but scores on the Eating Concern, Weight Concern, and Shape Concern subscales differed significantly, with the S-EDE-Q yielding higher scores. Test-retest reliability for the S-EDE-Q was modest for binge eating but was excellent for the subscales (Spearman rho ranged 0.71-0.81), albeit somewhat variable for the individual items. Overall, the acceptable convergence between the S-EDE-Q and the S-EDE for many features of eating disorders and the good short-term test-retest findings provide preliminary support for the use of the S-EDE-Q. These findings, derived using a non-clinical sample of monolingual Spanish-speaking Latina women, require replication and extension. Evaluation with a clinical sample is necessary to further establish the reliability of the S-EDE-Q with an eating disordered group.

Recurrent binge eating with and without the "undue influence of weight or shape on self-evaluation": implications for the diagnosis of binge eating disorder

Levels of eating disorder psychopathology, impairment in psycho-social functioning and use of health services were compared among probable cases of binge eating disorder (BED) with and without extreme weight or shape concerns ("undue influence of weight or shape on self-evaluation") recruited from a large community sample of women. Data for obese non-binge eaters (n=457), also recruited from the community sample, and for a clinical sample of eating disorder patients (n=128), recruited separately, were included for comparative purposes. BED cases who reported extreme weight or shape concerns (n=51, 46.4%) had significantly higher levels of eating disorder psychopathology and functional impairment than those who did not report such concerns (n=59), after controlling for between-group differences in age and body weight. In addition, BED cases who reported extreme weight or shape concerns were more likely to have sought treatment for an eating or weight problem than those who did not. Whereas levels of eating disorder psychopathology and functional impairment were markedly elevated among BED cases with extreme weight or shape concerns, BED cases who did not report extreme weight or shape concerns resembled obese non-binge eaters in most respects. The findings support the inclusion of an undue influence of weight or shape on self-evaluation as a diagnostic criterion for BED. In the absence of this influence, eating disorders that otherwise resemble BED do not appear to be "clinically significant".

Impulsiveness and lack of inhibitory control in eating disorders

Eating disorders are considered to lie on a spectrum of disorders with varying degrees of obsessive-compulsive and impulsive traits. Restrictive anorexia nervosa patients (AN-R) are thought to belong to the obsessive pole of the spectrum, and purging-anorexia (AN-P) and bulimia nervosa (BN) patients to the impulsive pole. In this study we have compared impulsive traits in three groups of eating disordered patients (total N=56) and a control group of 83 female students. Information about impulsive traits and lack of inhibitory control was gathered by means of standardized rating scales (Eysenck's Impulsiveness Scale, Barrett's Impulsiveness Scale, and Carver and White's BIS/BAS scale) and a behavioral measure of impulsiveness (stop-go task). On the questionnaires AN-R patients reported to be less impulsive than controls, AN-P and BN patients. In the stop-go task, we did not find significant differences between the different groups. Correlations between self-reported measures of impulsiveness and behavioral measures were not significant.

IN CONCLUSION

Our results from the self-report measures are at odds with the behavioral measures certainly in the AN-R group. Perhaps the latter patients' distorted self-perception and/or self-description may explain this discrepancy.

Binge eating and weight loss in a self-help behavior modification program

OBJECTIVE

To examine the occurrence of binge eating and its impact on weight loss outcomes among obese participants in the Trevose Behavior Modification Program, a lay-administered, lay-directed self-help weight loss program offering continuing care.

RESEARCH METHODS AND PROCEDURES

Participants completed questionnaires, and weight loss data were recorded prospectively.

RESULTS

Although objective bulimic episodes were reported by 41% of the sample, objective bulimic episodes were not associated with worse weight loss outcomes. Mean weight loss after 12 months was 18.2 kg (18.8% of initial body weight) for the treatment completers and 10.3 kg (10.5% of initial body weight) for the full sample (using intent-to-treat analyses, with baseline scores carried forward).

DISCUSSION

Substantial long-term weight loss, resulting from a continuing care treatment program, occurred in individuals both with and without frequent binge eating.

Reliability of the Eating Disorder Examination-Questionnaire in patients with binge eating disorder

This study examined the test-retest reliability of the Eating Disorder Examination-Questionnaire (EDE-Q) in patients with binge eating disorder (BED). Short-term (mean days = 4.8; SD = 3.6) test-retest reliability of the EDE was examined in a sample of 86 patients with BED. Test-retest reliability was excellent for objective bulimic episodes (correlation = .84), but poor to unacceptable for subjective bulimic episodes and objective overeating episodes (correlations = .51 and .39, respectively). Test-retest reliabilities were good for the EDE-Q scales (correlations = .66 to .77), albeit somewhat variable for the individual EDE-Q items (.54 to .78). These findings support the reliability of the EDE-Q for patients with BED. The EDE-Q has utility for assessing the number of binge eating episodes (objective bulimic episodes) and associated features of eating disorders in patients with BED. The results for subjective bulimic episodes are consistent with previous studies in suggesting that these eating behaviors may not be reliable indicators of eating disorders for patients with BED.

Eating Disorder Examination Questionnaire (EDE-Q): norms for young adult women

In order to establish norms for the Eating Disorder Examination Questionnaire (EDE-Q) among young adult women, the questionnaire was administered to a large general population sample of women aged 18-42 yr in the Australian Capital Territory (ACT) region of Australia. Normative data were derived for EDE-Q subscales and for the occurrence of specific eating disorder behaviours, for each of five age bands (18-22, 23-27, 28-32, 33-37, 38-42 yr). Mean scores (SDs) for the Restraint, Eating Concern, Weight Concern and Shape Concern subscales for the total sample (n = 5,255) were, respectively, 1.30 (1.40), 0.76 (1.06), 1.79 (1.51) and 2.23 (1.65). The mean global score was 1.52 (1.25). The regular occurrence of objective and subjective overeating episodes was reported by 10.6% and 12.7% of participants, respectively. The regular use of self-induced vomiting, laxative misuse, and use of diuretics, was reported by 1.4%, 1.0%, and 0.3%, of participants, respectively, while 2.2% of participants reported regularly using diet pills. "Extreme dietary restraint" and "excessive exercise" were reported by 3.4% and 4.9% of participants, respectively. Both attitudinal and behavioural features of eating disorder psychopathology tended to decrease with increasing age. These data will inform researchers intending to use the EDE-Q in epidemiological studies.

Use of extreme weight control behaviors with and without binge eating in a community sample: implications for the classification of bulimic-type eating disorders

OBJECTIVE AND METHOD

To inform the classification of bulimic-type eating disorders not meeting formal diagnostic criteria for bulimia nervosa (BN), levels of eating disorder psychopathology and functional impairment associated with subjective and objective bulimic episodes (SBEs and OBEs) and purging and nonpurging methods of weight control were examined in a large community-based sample of women (n = 5,232).

RESULTS

Participants who reported recurrent bulimic episodes had significantly higher levels of eating disorder psychopathology and functional impairment than those who did not and this was the case whether the episodes were objective or subjective. Similarly, participants who reported the use of extreme weight control behaviors had higher levels of eating disorder psychopathology and functional impairment than those who did not, and this was the case whether purging or nonpurging behaviors were employed. The combination of bulimic episodes and extreme weight control behaviors was associated with particularly high levels of eating disorder psychopathology and functional impairment.

CONCLUSION

The combination of bulimic episodes, objective or subjective, and extreme weight control behaviors, purging or nonpurging, is significant in terms of impairment in psychosocial functioning among individuals affected by eating disorders not meeting formal diagnostic criteria for BN. The combination of SBEs and extreme weight control behaviors, in particular, warrants further investigation.

Comparison of two self-report instruments for assessing binge eating in bariatric surgery candidates

This study compared two self-report methods for assessing binge eating in severely obese bariatric surgery candidates. Participants were 249 gastric bypass candidates who completed the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) and the Eating Disorder Examination-Questionnaire (EDE-Q) prior to surgery. Participants were classified by binge eating status (i.e., no or recurrent binge eating) with each of the measures. The degree of agreement was examined, as well as the relationship between binge eating and measures of convergent validity. The two measures identified a similar number of patients with recurrent binge eating (i.e., at least 1 binge/week); however, overlap was modest (kappa=.26). Agreement on twice weekly binge eating was poor (kappa=.05). The QEWP-R and EDE-Q both identified clinically meaningful groups of binge eaters. The EDE-Q appeared to differentiate between non/infrequent bingers and recurrent bingers better than the QEWP-R, based on measures of convergent validity. In addition, the EDE-Q demonstrated an advantage because it identified binge eaters with elevated weight and shape overconcern. Using the self-report measures concurrently did not improve identification of binge eating in this study. More work is needed to determine the construct validity and clinical utility of these measures with gastric bypass patients.

Quality of life and eating disorders

OBJECTIVE

Eating disorders (EDs) can have a serious impact on various life domains and may lead to physical, mental and social impairment and consequently to poor quality of life (QOL). This study compared the QOL of ED patients and former ED patients in a large community based sample to the QOL of a normal reference group and to the QOL of patients with mood disorders. Differences between ED diagnostic groups were examined. The study investigated what factors contribute to QOL.

METHODS

A generic health-related quality of life questionnaire, the Short Form-36 (SF-36), and the Eating Disorder Examination-Questionnaire were administered to 156 ED patients--44 anorexia nervosa patients, 43 bulimia nervosa patients, 69 eating disorder not otherwise specified patients--and 148 former ED patients.

RESULTS

ED patients reported significantly poorer QOL than a normal reference group. No differences were found between the diagnostic groups. Former ED patients still had poorer QOL than a normal reference group. ED patients reported significantly poorer QOL than patients with mood disorders. Self esteem contributed most to QOL.

CONCLUSION

EDs have a severe impact on many domains of QOL. Therefore QOL needs to be addressed in effectiveness research and clinical practice.