Convergent validity of the eating disorder inventory and the anorexia nervosa inventory for self-rating in an Austrian nonclinical population

Validation of an Arabic version of the eating disorder inventory's body dissatisfaction subscale among adolescents, adults, and pregnant women

INTRODUCTION

The 9-item Body Dissatisfaction Subscale (BDS) of the Eating Disorder Inventory is one of the most used tools for assessing thinness-oriented body dissatisfaction in research and clinical practice. However, no validated Arabic version of this scale exists to date. In this study, we sought to validate this instrument in three samples of native Arabic-speaking adolescents, adults, and pregnant women from Lebanon.

METHODS

A total of 826 adults, 555 adolescents, and 433 pregnant women were included. To examine the factor structure of the BDS, we performed an exploratory factor analysis (EFA), using a principal component analysis via the FACTOR software on the first split-half subsample among Lebanese adults. We used data from the second split-half in the adult sample to conduct a Confirmatory Factor Analysis (CFA) through the SPSS AMOS v.29 software. That verified model was tested via CFA on adolescents and pregnant women.

RESULTS

The EFA showed a bidimensional structure for the BDS, with all 9 items retained and divided into Factor 1 = Body Satisfaction (negatively-worded items) and Factor 2 = Body Dissatisfaction (positively-worded items). The CFA demonstrated invariable goodness-of-fit of the instrument in the three studied populations. McDonald's omega values were also adequate in the three samples, demonstrating its reliability. Moreover, the BDS showed invariance across sex among both adolescents and adults. Finally, higher BDS scores were correlated with more disordered eating, less body appreciation and less functionality appreciation, thus attesting to convergent validity of the scale. In addition, BDS scores correlated positively with depression and anxiety scores, indicating adequate patterns of divergent validity.

CONCLUSION

In light of our findings, we endorse the use of the BDS by healthcare professionals in Arabic-speaking countries, in order to assess thinness-oriented body dissatisfaction in an appropriate and timely manner and ease early referral to a specialist, thereby preventing the deleterious health-related risks associated with this condition.

The prevalence and risk factors of screen-based disordered eating among university students: a global systematic review, meta-analysis, and meta-regression

PURPOSE

The purpose of this review was to estimate the prevalence of screen-based disordered eating (SBDE) and several potential risk factors in university undergraduate students around the world.

METHODS

An electronic search of nine data bases was conducted from the inception of the databases until 1st October 2021. Disordered eating was defined as the percentage of students scoring at or above established cut-offs on validated screening measures. Global data were also analyzed by country, research measure, and culture. Other confounders in this review were age, BMI, and sex.

RESULTS

Using random-effects meta-analysis, the mean estimate of the distribution of effects for the prevalence of SBDE among university students (K = 105, N = 145,629) was [95% CI] = 19.7% [17.9%; 21.6%], I2 = 98.2%, Cochran's Q p value = 0.001. Bayesian meta-analysis produced an estimate of 0.24, 95% credible intervals [0.20, 0.30], τ = 92%. Whether the country in which the students were studying was Western or non-Western did not moderate these effects, but as either the mean BMI of the sample or the percentage of the sample that was female increased, the prevalence of SBDE increased.

CONCLUSIONS

These findings support previous studies indicating that many undergraduate students are struggling with disordered eating or a diagnosable eating disorder, but are neither receiver effective prevention nor accessing accurate diagnosis and available treatment. It is particularly important to develop ever more valid ways of identifying students with high levels of disordered eating and offering them original or culturally appropriate and effective prevention or early treatment.

LEVEL OF EVIDENCE

I, systematic review and meta-analysis.

The prevalence of feeding and eating disorders symptomology in medical students: an updated systematic review, meta-analysis, and meta-regression

PURPOSE

Medical students have a higher risk of developing psychological issues, such as feeding and eating disorders (FEDs). In the past few years, a major increase was observed in the number of studies on the topic. The goal of this review was to estimate the prevalence risk of FEDs and its associated risk factors in medical students.

METHODS

Nine electronic databases were used to conduct an electronic search from the inception of the databases until 15th September 2021. The DerSimonian-Laird technique was used to pool the estimates using random-effects meta-analysis. The prevalence of FEDs risk in medical students was the major outcome of interest. Data were analyzed globally, by country, by research measure and by culture. Sex, age, and body mass index were examined as potential confounders using meta-regression analysis.

RESULTS

A random-effects meta-analysis evaluating the prevalence of FEDs in medical students (K = 35, N = 21,383) generated a pooled prevalence rate of 17.35% (95% CI 14.15-21.10%), heterogeneity [Q = 1528 (34), P = 0.001], τ2 = 0.51 (95% CI 0.36-1.05), τ = 0.71 (95% CI 0.59-1.02), I2 = 97.8%; H = 6.70 (95% CI 6.19-7.26). Age and sex were not significant predictors. Body mass index, culture and used research tool were significant confounders.

CONCLUSION

The prevalence of FEDs symptoms in medical students was estimated to be 17.35%. Future prospective studies are urgently needed to construct prevention and treatment programs to provide better outcomes for students at risk of or suffering from FEDs.

LEVEL OF EVIDENCE

Level I, systematic review and meta-analysis.

The applicability of the Eating Disorder Inventory in pregnancy

PURPOSE

The aim of our study was validating Eating Disorder Inventory (EDI) among pregnant women, who are vulnerable to eating disorders (EDs).

METHODS

In 2012-2013, 1146 women (aged 18-47 years) completed a questionnaire including EDI during the first 3 days after delivery. We checked factorial validity of three diagnostic subscales of EDI with confirmative factor analysis and internal validity by Cronbach's alpha and item-total correlation. We also tested discriminative validity by comparing average of the three subscale of EDI in case of ED and non-ED groups.

RESULTS

When applying the EDI to pregnant women, it seems necessary to exclude five items on three diagnostic subscales: on the Drive for Thinness subscale, 4 items remain (out of 7); on the Bulimia subscale, 6 items remain (out of 7); the Body Dissatisfaction subscale decreases from 9 to 8 items. Cronbach's alpha and item-total correlation values meet the requirements defined by Garner et al. The internal consistency of the EDI has proved to be appropriate, indicating that it is a reliable screening tool.

CONCLUSIONS

Thinking, attitudes, and behaviors connected to eating, along with the relation to altering body weight change during pregnancy. Vomiting usually accompanies pregnancy; body weight gain within wide limits is also regarded as normal during pregnancy. These behaviors and changes are not feasible to use for measuring ED symptoms. These aspects cannot be neglected when screening eating disorders in pregnant women.

LEVEL OF EVIDENCE

Level IV evidence obtained from multiple time series with or without an intervention.

Disordered eating and sexual insecurities in young women

There has long been a proposed clinical link between sexuality and eating disorders; however, little empirical evidence exists regarding this relationship. The limited body of research on sexuality in eating disorders supports the occurrence of considerable sexual concerns. The aim of the present study was to expand on the dearth of empirical literature exploring altered sexuality in relation to disordered eating. This research examines disordered eating in relation to sexual insecurities. Undergraduate female UBC students (n=789) completed a series of online questionnaires assessing sexual insecurities and eating habits. Several domains of sexual insecurities were associated with disordered eating symptom severity. Mean differences in sexual self-efficacy, as well as body- and performance-based cognitive distractions during sexual activity emerged among women categorized as being at elevated, typical, or low eating disorder risk, with those at greater risk reporting greater sexual difficulties. Sexuality is rarely considered in the context of eating disorder treatment unless a history of sexual abuse is present. The results of this study suggest that sexual insecurities should be addressed during eating disorder care.

Comparability of the Eating Disorder Inventory-2 Between Women and Men

Researchers studying eating disorders in men often use eating-disorder risk and symptom measures that have been validated only on women. Using a sample of 215 college women and 214 college men, this article reports on the validity the Eating Disorder Inventory–2 (EDI-2), one of the best-validated among women and the most widely used risk and symptom measure for women. The EDI-2 had the same, standard eight-factor structure for both genders, and tests of invariance showed that factor loadings, factor variances, and factor intercorrelations were equivalent across gender. The EDI-2 scales correlated with questionnaire measures of bulimic and anorexic symptomatology equivalently across gender. However, the EDI-2 scales were generally less reliable for men, leading to slightly lower Pearson-based estimates of correlations among the measures for men.

In control of weight: the relationship between facets of control and weight restriction

This study explored the moderating effects of body dissatisfaction (BD) on the relationships between various constructs of control and weight restricting and control behaviours (WRCBs). Participants were 167 female undergraduates who completed self-report measures of control, BD and WRCBs. It was found that higher external locus of control (LOC) was related to less dieting and exercise and that LOC was unrelated to purging. In addition, higher levels of general self-control were found to be related to higher levels of purging when BD was high but not low, and higher general self-control was associated with greater dieting and exercise behaviour. Finally, higher 'self-control as self-esteem' was strongly associated with greater dieting and exercise behaviour at both high and low levels of BD, whilst 'self-control as self-esteem' was related to purging only when BD was high. The results of this research suggest that different constructs of control have differential effects on WRCBs. The clinical implications of the findings are discussed.

Is technology assisted guided self-help successful in treating female adolescents with bulimia nervosa?

OBJECTIVE

This study aims to evaluate the long-term outcome of new technology assisted guided self-help in adolescents with bulimia nervosa (BN).

METHOD

One hundred and twenty-six patients with BN (29 adolescents and 97 adults) were randomly allocated to a cognitive behavioural therapy-based self-help program delivered by the Internet or bibliotherapy, both accompanied by e-mail guidance. Outcomes were assessed at baseline, month 4, 7 and 18 including remission rates and eating disorder associated psychopathology.

RESULTS

In all, 44% of adolescents vs. 38.7% of adults were in remission at month 7, and 55% of adolescents vs. 62.5% of adults were in remission at follow-up. Objective binge eating and compensatory behaviour improved significantly over time in both groups, with the highest decrease during the first 4 months. A significant decrease over time and no group differences have been found in almost all EDI-2 subscales.

CONCLUSIONS

E-mail guided self-help (delivered via the Internet or bibliotherapy) is equally effective for adolescents as for adults with BN, and can be recommended as an initial step of treatment for this younger age group.

Internet-delivered cognitive-behavioural therapy v. conventional guided self-help for bulimia nervosa: long-term evaluation of a randomised controlled trial

BACKGROUND

Cognitive-behavioural therapy (CBT)-based guided self-help is recommended as a first step in the treatment of bulimia nervosa.

AIMS

To evaluate in a randomised controlled trial (Clinicaltrials.gov registration number: NCT00461071) the long-term effectiveness of internet-based guided self-help (INT-GSH) compared with conventional guided bibliotherapy (BIB-GSH) in females with bulimia nervosa.

METHOD

A total of 155 participants were randomly assigned to INT-GSH or BIB-GSH for 7 months. Outcomes were assessed at baseline, month 4, month 7 and month 18.

RESULTS

The greatest improvement was reported after 4 months with a continued reduction in eating disorder symptomatology reported at month 7 and 18. After 18 months, 14.6% (n = 7/48) of the participants in the INT-GSH group and 25% (n = 7/28) in the BIB-GSH group were abstinent from binge eating and compensatory measures, 43.8% (n = 21/48) and 39.2% (n = 11/28) respectively were in remission. No differences regarding outcome between the two groups were found.

CONCLUSIONS

Internet-based guided self-help for bulimia nervosa was not superior compared with bibliotherapy, the gold standard of self-help. Improvements remain stable in the long term.

A clinical comparison of men and women on the eating disorder inventory-3 (EDI-3) and the eating disorder assessment for men (EDAM)

This study focused on the most commonly used eating disorder assessment tool, the Eating Disorder Inventory-3 (EDI-3), and the preliminary Eating Disorder Assessment for Men (EDAM). These assessment tools were examined to investigate predictability in males and the extent they differentiated between men and women. Specific scales of the EDI-3 and total scores for each instrument were assessed using a sample of 108 males and females from residential treatment facilities. Overall, the EDI-3 scales were shown to be significantly different between genders on a MANOVA, with men scoring significantly lower in body dissatisfaction, drive for thinness, and bulimia. Both instruments showed the ability to predict eating disorders when using a logistical regression analysis. Results support the hypothesis that eating disorders are significantly different in men and women, providing evidence that there is a need to develop a valid and reliable eating disorder assessment tool specifically for men.

Trait anxiety in children and adolescents with anorexia nervosa

In this study of trait anxiety in children and adolescents with anorexia nervosa, a consecutive series of 23 newly admitted children and adolescents with anorexia nervosa was studied by use of the State-Trait-Anxiety-Inventory, the Eating Disorders Inventory (EDI), the Social Phobia and Anxiety Inventory for Children (SPAI-C), and a structured psychiatric interview (DIPS: Diagnostisches Interview bei psychischen Störungen). In addition, clinical diagnoses were taken from the files. Trait anxiety was significantly increased at the time of admission and social phobia was present in a large proportion of the patients. Specific eating disorder psychopathology as measured by the EDI was significantly associated with trait anxiety. There were no clinical diagnoses (according to the International Classification of Diseases - Tenth Revision) of anxiety disorders. Features of anxiety are very common in young patients with anorexia nervosa and closely linked to specific psychopathology. Anxiety disorders need careful evaluation in these patients.

A cross-cultural comparison of the Eating Disorder Inventory

OBJECTIVE

A systematic analysis of data collected with the Eating Disorder Inventory (EDI) was made.

METHOD

A literature search identified 94 sources in which the mean values of the EDI or EDI-2 subscales were reported, comprising 310 samples differing by sex, age, diagnosis, language, ethnicity, or some other relevant attribute. The total number of respondents was 43,722, from 25 different countries, having used the EDI in one of the 16 languages (1-94).

RESULTS

The factorial structure of the aggregate means of the EDI subscales, for both clinical versus nonclinical and Western versus non-Western samples, was almost identical suggesting generalizability across languages and cultures. Non-Western participants scored higher than Western participants on virtually all EDI subscales, both in normal and eating-disordered samples. It was shown that age is a risk factor when someone is already diagnosed with an eating disorder but, in the general population, increasing age reduces the likelihood of being afflicted by eating disorders.

DISCUSSION

Symptoms of eating disorders are more pronounced in non-Western than in Western samples.

Comparison of the eating disorder inventory (EDI) in the Netherlands, Austria and Italy

OBJECTIVE

Comparison of scores of the Eating Disorder Inventory (EDI) in non-clinical females aged 15-35 years (total n = 2402) in three European countries with North-South variation.

METHODS

Participants were high school girls from the Netherlands (n = 642), Austria (n = 544) and Italy (n = 359), and college students from the Netherlands (n = 348), Austria (n = 114) and Italy (n = 395).

RESULTS

Age-dependent differences of EDI subscale scores were observed. Whereas in Dutch females weight and body shape concerns had a peak between 16 and 19 years, these concerns remained relatively constant in Italy and Austria. The Italian scores were significantly higher than the Dutch scores on almost all EDI subscales whereby effects were small or medium.

CONCLUSIONS

The scores may be influenced by socio-cultural factors, cultural traits, culture-specific social demands on young adults and differences in maturation between North and South Europe. National norms are necessary for different age, weight and sex groups.

Factor structure of Eating Disorders Inventory-2 in a Spanish sample

OBJECTIVE

To present basic statistics and analyze factor structure of EDI-2 in an adolescent non-clinical sample from Spain.

METHOD

An Exploratory Factor Analysis (EFA) was carried out with Principal Axis Factoring (PAF) and oblimin rotation, using raw scores.

RESULTS

EFA presented a 21-factor structure with eigenvalues greater than 1. It was then forced into 11 and 5-factor solutions.

DISCUSSION

The eleven-factor structure does not correspond with the 11 scales. A five-factor structure seems to be better suited than other factor solutions and presented higher reliability coefficients.

Psychotropic substance abuse among adolescents: a structural equation model on risk and protective factors

The use of psychotropic substances in adolescents represents a serious public health problem. In this study a representative sample of 485 Austrian students between 14 and 18 years of age were investigated with a semistructured interview about substance-related issues and completed the general health questionnaire. The following rates of regular psychotropic substance use were found: cigarettes 41.4%, alcohol 44.5%, cannabis 10.1%, and other illicit substances 3%. Logistic regression analyses and structural equation modeling revealed the following major risk factors for substance use: peer pressure, negative family atmosphere, school difficulties, and psychopathology. Knowledge about substance use acted as a protective factor. Prevention of adolescent substance use and misuse should aim at these different targets. Information about coping with peer pressure may be a particularly promising route of intervention.

Time trends in eating disturbances in young Greek migrants

OBJECTIVE

The study intends to measure time trends in eating disorder psychopathology in Greek adolescents in Veria (Greece) and migrant Greek adolescents in Munich (Germany). For this purpose, large samples of students were assessed at both locations in the 1980s and about two decades later. Our research question was whether the frequency of eating disorder-related psychopathology had changed over time and that there were differences between migrants and nonmigrants. The present-day prevalence of eating disorders in the Greek population was established.

METHOD

Greek adolescents were assessed in Munich and Veria in the 1980s (N = 2,631) and almost two decades later (N = 2,920). At both times, the Anorexia Nervosa Inventory for Self-Rating (ANIS) was used to assess eating disorder pathology and the General Health Questionnaire (GHQ-28) was used to assess mental health status. In the second wave, persons at risk for an eating disorder were interviewed using the Structured Interview for Anorexic and Bulimic Syndromes (SIAB-EX).

RESULTS

At both times and both locations, adolescent girls in comparison to boys had higher, more pathologic scores on the GHQ-28 and on all ANIS self-rating subscales. Females in Munich reported an increase over time in figure consciousness and their fear of negative effects of meals. In the 1980s, significantly higher scores of bulimic behavior were found in Veria as compared with Munich. In the second wave, bulimic behavior was considerably decreased in Veria for both girls and boys, and for bulimic behavior no significant differences were found between locations. The percentage of girls with a low body weight (<5th percentile) increased significantly over time in Veria and Munich. In the second wave, the current prevalence for girls with anorexia nervosa was 0.00% in Munich and 0.59% in Veria (lifetime 1.26% and 1.18%, respectively). For bulimia nervosa, current prevalence was 1.89% in Munich and 1.18% in Veria.

CONCLUSION

Differences between locations diminished over time. Bulimic syndromes are prevalent in both locations.

Fear of negative evaluation and eating attitudes: a replication and extension study

OBJECTIVE

Preliminary research has found a link between restrictive eating attitudes and a fear of negative evaluation (FNE). However, such work has focused exclusively on these fears in relation to people in general. The current study sought to replicate and extend these findings by exploring links between restriction and FNE in relation to close friends and relatives.

METHOD

Ninety-one young women completed two versions of the short Fear of Negative Evaluation Scale (FNE). First, they completed the standard scale (in relation to people in general), and then an amended version (in relation to close friends and relatives). Next, they completed the three eating-related subscales of the Eating Disorders Inventory (EDI).

RESULTS

For the whole group, both general and close FNE were significantly and positively correlated with restrictive (drive for thinness and body dissatisfaction), but not with bulimic attitudes. However, only general FNE had significant individual predictive power on restrictive attitudes when these two forms of FNE were entered into a regression analysis.

DISCUSSION

Among nonclinical populations, negative evaluation fears regarding people in general are linked with restrictive but not with bulimic psychopathology.

Prevalence and psychosocial correlates of disordered eating among Chinese pregnant women in Hong Kong

Three-hundred-and-fifty-nine Chinese pregnant women were surveyed to determine prevalence and psychosocial correlates of eating disturbance in pregnancy. About 9.8% of participants reported disordered eating symptoms. Prevalence of these symptoms was related to general factors of drive for thinness, body image dissatisfaction, and traditional gender role attitudes. These general factors were, in turn, associated with factors specific to pregnant women. In particular, drive for thinness was related to poor spousal support; body image dissatisfaction was related to poor maternal-fetal attachment; and traditional gender role attitudes were related to strong maternal-fetal attachment and spousal support. Limitations and implications of these findings are discussed.

Similarity in young women's eating attitudes: self-selected versus artificially constructed groups

OBJECTIVE

The current study explored similarity (in terms of eating attitudes, depression, and anxiety) among new versus established groups of young women.

METHOD

Three hundred and thirty-two female students (living in 80 apartments) participated in the study. They were either living in a newly formed "no-choice" apartment or a "choice" apartment where they had chosen their housemates. All participants completed the Eating Disorders Inventory and the Hospital Anxiety and Depression Scale. The groups were compared using similarity indices (showing attitude spread per apartment).

RESULTS

Consistent with our hypothesis, the choice groups held more similar eating-related attitudes and depression levels than the no-choice groups. Specifically, the choice groups were significantly more similar in their levels of ineffectiveness, interpersonal distrust, and social insecurity.

DISCUSSION

In a similar way to depression, eating attitudes may be shared among relatively close groups of women.

Prädiktoren des Überweisungserfolgs einer psychotherapeutischen Klinikambulanz und des späteren Therapieverlaufs

OBJECTIVES

Many patients are referred to psychotherapy by outpatient units of psychiatric hospital departments. This study investigates predictors of success and outcome of subsequent psychotherapy in this group of patients.

METHODS

Two years after referral, 140 out of an initial sample of 215 patients of a psychotherapy outpatient unit were followed up by means of a telephone interview and questionnaires (GHQ, IIP). In addition, their therapists were interviewed.

RESULTS

57.1% of the patients actually began psychotherapy; of these, 67.5% completed or were continuing the treatment. Predictors of referral success were younger age, female gender, higher levels of depression, a less competitive, subassertive, nurturant, and expressive personality style, and a preexisting high motivation for psychotherapy. In the total sample of 140 patients there was a significant improvement of psychopathology (0.54 < d < 0.99), interpersonal problems (0.25 < d < 0.33), and subjective experience of symptoms (d = 0.26). Patients who began psychotherapy did not show a significantly better outcome after two years compared to those who were non-compliant.

CONCLUSIONS

Randomized-controlled studies are not comparable to regular outpatient treatment. Patients who did not begin psychotherapy despite referral might have been stabilized by the initial brief intervention they received at the psychotherapy outpatient unit, and consequently did not feel the need for any additional psychotherapy. This group of patients should be identified before being referred and offered a short-term psychotherapy at the outpatient unit.

Sexuality, personality, and eating disorders

To assess sexuality, personality, and eating pathology in women with eating disorders (EDs), we asked a random sample of 234 clinicians to describe an ED patient (age 16-65). Restricting AN patients tended to be childlike and prim/proper, while BN patients tended to be flirtatious and promiscuous. A constricted/overcontrolled personality predicted a childlike sexuality independent of AN diagnosis, and an undercontrolled, emotionally dysregulated personality predicted impulsive sexuality above and beyond BN diagnosis. Constraint and impulsivity are not isolated to the domain of eating in women with EDs. Personality provides a link between eating and sexuality in at least a subset of women with EDs.

Comparison of patients with bulimia nervosa, obese patients with binge eating disorder, and nonobese patients with binge eating disorder

This study compared patients with bulimia nervosa (BN), obese patients with binge eating disorder (BED), and nonobese patients with BED. One hundred sixty-two adult women consecutively evaluated for outpatient clinical trials who met DSM-IV criteria for BN, purging type (N = 46) or for BED (N = 79 obese and N = 37 nonobese) were compared using the Eating Disorder Inventory (EDI). The three groups differed significantly on two (drive for thinness and body dissatisfaction) of the three eating-related scales and on all five of the general personality scales of the EDI. When age and depression level were controlled, findings for the eating-related scales did not change, whereas four of the five general personality scales were no longer significant. Post hoc analyses revealed that the BN group and the nonobese BED group had significantly higher drive for thinness than the obese BED group. The nonobese and the obese BED groups did not differ from each other in any area (other than drive for thinness), including body dissatisfaction. The nonobese and the obese BED groups had significantly lower maturity features than the BN group. Our findings suggest that when the effects of age and depression levels are controlled, treatment-seeking women with BN and BED are generally similar. Certain differences that do exist between women with BN and BED are associated with obesity status (drive for thinness), whereas others are associated with diagnosis (body dissatisfaction, maturity fears).

Social anxiety and social comparison: differential links with restrictive and bulimic attitudes among nonclinical women

This study investigated the relationship of two social psychological constructs (social anxiety and social comparison) with bulimic and restrictive eating attitudes among nonclinical women. Eighty young women completed a measure of social anxiety (the Fear of Negative Evaluation Scale, FNE), a measure of social comparison (the Iowa-Netherlands Comparison Orientation Measure, INCOM), the Beck Depression Inventory (BDI), and the Eating Disorders Inventory (EDI). The results indicate a differential link between the two different social processes and the nature of eating psychopathology. Specifically, heightened social anxiety predicted drive for thinness, while levels of social comparison predicted bulimic attitudes. The findings support a model where the two social processes are each associated with different patterns of eating pathology.

Gender differences in patients with binge eating disorder

OBJECTIVE

This study examined gender differences in patients with binge eating disorder (BED).

METHOD

Participants were 182 adults (35 male, 147 female) who were consecutively evaluated for outpatient clinical trials and met criteria for BED as outlined in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders. They were administered a battery of measures to examine developmental, eating and weight-related disturbances, and psychological features associated with BED.

RESULTS

Men and women did not differ significantly on several developmental variables (age at first overweight, age at first diet, age at onset of regular binge eating, or number of weight cycles). Men had significantly higher current body mass index (BMI), highest adult BMI, and were significantly more likely to be classified as obese. Men and women did not differ significantly on measures of current eating disorder features (binge eating, eating concerns, weight or shape concerns) but women reported significantly greater body image dissatisfaction and drive for thinness. Men and women did not differ significantly on current depression or self-esteem but men reported a greater frequency of past drug abuse problems.

DISCUSSION

Although men and women who present for treatment for BED show many similarities in current eating disorder features, we observed a number of gender differences on important developmental and physical variables as well as associated psychological features.

The Eating Disorder Inventory in evaluation of impaired eating behaviour in subjects requesting nutritional consultation

The present study evaluated impaired eating behaviour in women seeking participation in a diet-based programme of weight reduction or achievement of ideal body weight. Forty-seven obese, 42 overweight and 14 normal-weight subjects, attending an Italian university outpatient clinic completed the Eating Disorder Inventory (EDI). Forty-eight mothers of primary school children (25 normal-weight and 23 overweight) were used as controls. The EDI consists of 8 subscales, 3 evaluating psychopathology related to eating disorders (drive for thinness, bulimia, body dissatisfaction) and 5 evaluating general psychopathology (intereoceptive awareness, ineffectiveness, maturity fears, perfectionism, interpersonal distrust). Significantly altered scores in the first three subscales were observed both in normal-weight and overweight outpatients compared to the controls. The overweight outpatients scored higher than the obese patients in terms of drive for thinness and bulimia and higher than the normal-weight women for terms of bulimia, body dissatisfaction and drive for thinness. The overweight controls scored significantly higher than the normal-weight controls in the first three subscales in the remaining subscales, mean values were also higher in the overweight group, though significance was only reached in the interpersonal distrust and interoceptive awareness subscales. Impaired eating behaviour is frequent in subjects seeking participation in weight reduction or ideal body weight achievement programmes.

Psychometric properties of the General Health Questionnaire (GHQ-12) in a German primary care sample

OBJECTIVE

The aim of this investigation was to examine the psychometric properties of the German 12-item General Health Questionnaire (GHQ-12) in a primary care sample.

METHOD

A sample (n = 421) of adult out-patients was screened using the GHQ-12. A standardized clinical interview (SCID) was conducted with all screened patients. Reliability, validity and factor analysis of the GHQ-12 were evaluated. Item characteristics were examined using item characteristics curves. Item bias analysis was performed using contingency tables.

RESULTS

The German version of the GHQ-12 is a reliable instrument and performed well in detecting cases of psychological disorders. Factor analysis replicated the findings of earlier studies. Item characteristics curves and item bias analysis indicated that the individual items should be assessed carefully. One item was biased in relation to age, while another item showed a low positive response rate.

CONCLUSION

The GHQ-12 as a whole is a reliable questionnaire and can be a useful screening tool in primary care.