Psychometric properties of EDE 12.0D in obese adult patients without binge eating disorder

Parent version of the Eating Disorder Examination: Reliability and validity in a treatment-seeking sample

BACKGROUND

Assessment of eating disorders (ED) in youth relies heavily on self-report, yet persistent lack of recognition of the presence and/or seriousness of symptoms can be intrinsic to ED. This study examines the psychometric properties of a semi-structured interview, the parent version of the Eating Disorder Examination (PEDE), developed to systematically assess caregiver report of symptoms.

METHODS

A multi-site, clinical sample of youth (N = 522; age range: 12 to 18 years) seeking treatment for anorexia nervosa (AN) and subsyndromal AN were assessed using the Eating Disorder Examination (EDE) for youth and the PEDE for collateral caregiver report.

RESULTS

Internal consistencies of the four PEDE subscales were on par with established ranges for the EDE. Significant medium-sized correlations and poor to moderate levels of agreement were found between the corresponding subscales on each measure. For the PEDE, confirmatory factor analysis of the EDE four-factor model provided a poor fit; an exploratory factor analysis indicated that a 3-factor model better fits the PEDE.

CONCLUSIONS

Findings suggest that the PEDE has psychometric properties on par with the original EDE. The addition of the caregiver perspective may provide incremental information that can aid in the assessment of AN in youth. Future research is warranted to establish psychometric properties of the PEDE in broader transdiagnostic ED samples.

Some hope for a dimensional assessment? A critical review of psychometric validated (semi-)structured interview to assess eating disorders

OBJECTIVE

Given that eating disorders (EDs) are considered one of the deadliest mental illnesses, the development of appropriate assessment instruments is a necessity. Despite the extensive literature on assessing EDs, there has been a lack of focus on semi-structured interviews. The purpose of this article is to provide a comprehensive review of psychometrically validated semi-structured interviews for EDs.

METHODS

Included studies (N = 24) were required to present a semi-structured interview for EDs that has been validated through a psychometric process. The APA PsycNet, MEDLINE, APA Psycinfo, Pubmed, and Health & Psychosocial Instruments databases were searched. The literature search included publications through May 2024, with no earliest year restriction.

RESULTS

A total of six instruments were identified and reviewed in terms of conceptual design, purpose and content, psychometric characteristics, and strengths and limitations. Three main findings were highlighted: (a) only half of the instruments are up to date; (b) the instruments are based on either a categorical or a mixed categorical-dimensional approach; and (c) the predominance of the categorical approach.

CONCLUSIONS

The results are discussed regarding the conceptual approaches of the instrument to provide clinical and research implications. Despite the many strengths of the instrument, additional psychometric research is needed.

Furthering development of the Eating Disorder Examination-Pregnancy Version (EDE-PV): Exploratory factor analysis and psychometric performance among a community sample of pregnant individuals with body mass index ≥ 25

Psychometrically sound measures of disordered eating during pregnancy are needed, particularly for pregnant individuals with body mass index (BMI) ≥ 25, who are at high risk for disordered eating attitudes/behaviors. We previously adapted the Eating Disorder Examination (EDE) for use among pregnant individuals with BMI ≥ 25. This study examined the factor structure of the EDE-Pregnancy Version (EDE-PV) in a community sample of pregnant individuals with BMI ≥ 25. The EDE-PV was administered to 257 pregnant individuals with pre-pregnancy BMI ≥ 25 between 12 and 20 weeks gestation. The EDE-PV factor structure was determined using an exploratory factor analysis with oblique geomin rotation, internal consistency coefficients were calculated, and convergent and discriminant validity of the EDE-PV factors were assessed. An 11-item, two-factor solution produced an acceptable model fit. The subscales did not replicate those of the EDE and were interpreted as Pregnancy Eating and Weight Change Concerns and Pregnancy Shape and Weight Concerns (αs=.67 and .85; ωs=.70 and .85, respectively). These subscales showed small-to-moderate, positive correlations with weight and psychosocial distress measures and differentiated between participants with and without lifetime histories of any eating disorder diagnosis, demonstrating adequate convergent and discriminant validity. The results indicate that the EDE-PV can more reliably identify factors associated with disordered eating attitudes/behaviors among pregnant individuals with BMI ≥ 25 compared to the EDE and support our call for the development and use of new and/or adapted measures to appropriately assess disordered eating during pregnancy.

Factor analysis of the eating disorder examination in a sample of female adolescents and adults with eating disorders

OBJECTIVE

Studies of the construct validity of the Eating Disorder Examination (EDE) show mixed results and none have included samples of adults with a sole diagnosis of either anorexia nervosa or bulimia nervosa. Thus, we examine the EDE's construct validity in a Danish clinical sample of adolescents and adults with eating disorders.

METHOD

Confirmatory factor analyses of the four-factor model indicated by the original four subscales and subsequent ad hoc exploratory factor analyses were performed in a sample of patients with eating disorders (N = 1,586) divided into five subsamples based on age and diagnosis: (a) adolescents with anorexia nervosa, (b) women with anorexia nervosa, (c) women with bulimia nervosa, and women with atypical versions of (d) anorexia nervosa, and (e) bulimia nervosa.

RESULTS

The four-factor model was not confirmed in these five subsamples. Subsequent exploratory factor analyses did not reveal a single model fit for all five groups. Rather, eating-disorder symptoms can be understood through a one-, two-, or three-factor model depending on the subsample.

DISCUSSION

The four-factor model indicated by the original EDE subscales cannot be supported. The four subscales should be used with great care, if used at all, in trying to understand specific symptoms of eating disorders.

Development and validation of the Croatian version of the Eating Disorder Examination Questionnaire in a community sample

PURPOSE

The Eating Disorder Examination Questionnaire (EDE-Q) is one of the most commonly used tools for identification of eating disorder (ED) symptoms. The purpose of this study was to develop and validate the Croatian version of the EDE-Q 6.0.

METHODS

Participants were 279 individuals from a community sample (215 females; 64 males) with an average age of 24.61 ± 5.68 years. The Eating Attitudes Test-26 and Body Image Satisfaction Scale were used to determine the convergent validity of the EDE-Q. Four-, three-, two-, and single-factor models were tested, together with a brief 8-item version of the EDE-Q.

RESULTS

Confirmatory factor analysis yielded a better fit of the original four-factor model when compared to other models, although the best model-data fit was obtained when testing subscales individually with correlations between factors ranging from 0.30 to 0.99. However, item 10 had to be excluded from the shape concern subscale to reach an acceptable fit. Correlation analyses showed that the EDE-Q has good convergent validity, but additional calculations discovered its tendency to overestimate ED symptomatology.

CONCLUSIONS

This study is the first to show satisfactory psychometric properties of the Croatian version of the EDE-Q with minor modifications of the original questionnaire. The Croatian translation and validation of the EDE-Q enables researchers and clinicians in Croatia to employ the most widely and commonly used instrument for the assessment of core ED features.

LEVEL OF EVIDENCE

Descriptive cross-sectional study, Level V.

Confirmatory Factor Analysis of the Acceptance and Action Questionnaire for Weight-Related Difficulties-Revised (AAQW-R) in a United States Sample of Adults with Overweight and Obesity

OBJECTIVE

To examine the psychometric properties of the English language version of the 10-item Acceptance and Action Questionnaire for Weight-Related Difficulties-Revised (AAQW-R) in a United States (U.S.) sample of women and men with overweight/obesity (OW/OB).

METHOD

Adults with OW/OB seeking weight loss (N = 283; 59% women) completed the AAQW-R and other weight-related and psychosocial measures. Confirmatory factor analysis was used to examine single-factor, three-factor, and second-order factor structures of the AAQW-R, which were previously examined in a sample of Portuguese women. A chi-square difference test was used to compare the fit of a single-factor structure with three-factor and second-order factor structures. Internal reliability and convergent validity were examined for the total and three-factor subscale scores.

RESULTS

The single-factor structure evidenced poor fit to the data whereas the three-factor structure evidenced acceptable fit. The second-order structure was assessed qualitatively due to limitations to statistical model specification. The internal reliability of the AAQW-R total score and each of the three subscales were in the good and acceptable ranges, respectively. Total and subscale scores demonstrated good convergent validity.

DISCUSSION

Findings suggest that the English language version of the AAQW-R can be used to assess weight-related experiential avoidance in U.S. adult samples with OW/OB as a three-factor construct (food as control, weight as a barrier to living, weight stigma), with or without a total score. Additional research should confirm measurement invariance among various sociodemographic groups.

Spanish validation of the Eating Disorder Examination Questionnaire for Adolescents (EDE-Q-A): confirmatory factor analyses among a clinical sample

Most studies of eating disorders (ED) among adolescents have relied on the use of self-report questionnaires given its cost-effectiveness compared to interviews approaches. The Eating Disorders Examination Questionnaire (EDE-Q) is one of the most commonly used self-report measures of eating psychopathology, despite issues regarding the underlying latent structure and its validity in this population. Given the lack of validated measures among Hispanic clinical samples, the current study aimed to validate previously suggested models for the adolescent version (EDE-Q-A) among female teenage patients with ED in Spain (M_age = 15.45, SD = 1.59). Results failed to replicate the theoretical 4-factor structure, and a 2-factor model previously validated in a Hispanic-American community sample showed best fit over a 3-factor and a single-factor model. Excellent levels of internal consistency were observed for the two dimensions of the retained model and for the Global Score of the EDE-Q-A. Significant correlations with well-established measures of ED (Eating Disorders Inventory; EDI-2) and self-esteem are presented as evidence for convergent and concurrent validity. Sensitivity analyses showed a similar pattern of association between the retained model of the EDE-Q-A and the EDI-2. Current findings may contribute to development of evidence-based knowledge on ED among Hispanic clinical populations.

Replication of a Modified Factor Structure for the Eating Disorder Examination-Questionnaire: Extension to Clinical Eating Disorder and Non-clinical Samples in Portugal

Psychometric investigations of the Eating Disorder Examination-Questionnaire (EDE-Q) have generally not supported the original scale structure. The present study tested an alternative brief factor structure in two large Portuguese samples: (1) a non-clinical sample of N = 4117 female students and (2) a treatment-seeking sample of N = 609 patients diagnosed with eating disorders. Confirmatory factor analysis revealed a poor fit for the original EDE-Q structure in both the non-clinical and the clinical samples but revealed a good fit for the alternative 7-item 3-factor structure (dietary restraint, shape/weight overvaluation and body dissatisfaction). Factor loadings were invariant across samples and across the different specific eating disorder diagnoses in the clinical sample. These confirmatory factor analysis findings, which replicate findings from studies with diverse predominately overweight/obese samples, supported a modified 7-item, 3-factor structure for the EDE-Q. The reliable findings across different non-clinical and clinical eating disorder groups provide confidence regarding the potential utility of this brief version. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Measurement invariance of the Eating Disorder Examination in black and white children and adolescents

OBJECTIVE

The Eating Disorder Examination (EDE) was originally developed and validated in primarily white female samples. Since data indicate that eating pathology impacts black youth, elucidating the psychometric appropriateness of the EDE for black youth is crucial.

METHODS

A convenience sample was assembled from seven pediatric obesity studies. The EDE was administered to all youth. Confirmatory factor analyses (CFA) were conducted to examine the original four-factor model fit and two alternative factor structures for black and white youth. With acceptable fit, multiple-group CFAs were conducted. For measurement invariant structures, the interactive effects of race with sex, BMIz, adiposity, and age were explored (all significance levels p < .05).

RESULTS

For both black and white youth (N = 820; 41% black; 37% male; 6-18 years; BMIz -3.11 to 3.40), the original four-factor EDE structure and alternative eight-item one-factor structure had mixed fit via CFA. However, a seven-item, three-factor structure reflecting Dietary Restraint, Shape/Weight Overvaluation, and Body Dissatisfaction had good fit and held at the level of strict invariance. Girls reported higher factor scores than boys. BMIz and adiposity were positively associated with each subscale. Age was associated with Dietary Restraint and Body Dissatisfaction. The interactional effects between sex, BMIz, and age with race were not significant; however, the interaction between adiposity and race was significant. At higher adiposity, white youth reported greater pathology than black youth.

CONCLUSION

An abbreviated seven-item, three-factor version of the EDE captures eating pathology equivalently across black and white youth. Full psychometric testing of the modified EDE factor structure in black youth is warranted.

Psychometric Evaluation of Disordered Eating Measures in Bariatric Surgery Candidates

INTRODUCTION

Assessment of disordered eating is common in bariatric surgery candidates, yet psychometric properties of disordered eating measures in this population are largely unknown.

METHODS

Measures were completed by 405 adult bariatric surgery candidates at pre-surgical consultation. Fit of the original scale structures was tested using confirmatory factor analysis (CFA) and alternative factor solutions were generated using exploratory factor analysis (EFA). Reliability (internal consistency), construct validity (convergent and divergent) and criterion validity (with the EDE as criterion) were assessed.

MATERIALS

The measures prioritised for evaluation are the following: Eating Disorder Examination Questionnaire (EDE-Q; n = 405), Three-Factor Eating Questionnaire (TFEQ; n = 405), Questionnaire of Eating and Weight Patterns Revised (QEWP-R; n = 204), Clinical Impairment Assessment (CIA; n = 204) and the Eating Disorder Examination clinical interview (EDE; n = 131).

RESULTS

CFA revealed adequate fit for only the CIA in its current form (CFI = 0.925, RMSEA = 0.096). EFA produced revised scales with improved reliability for the EDE, EDE-Q and TFEQ. Reliability of revised subscales was improved (original scales α = 0.43-0.82; revised scales α = 0.67-0.93). Correlational analyses of the CIA and revised versions of remaining scales with measures of psychological wellbeing and impairment revealed adequate convergent validity. All measures differentiated an EDE-classified disordered eating group from a non-disordered eating group (criterion validity). Diagnostic concordance between the EDE, EDE-Q and QEWP-R was low, and identification of disordered eating behaviours was inconsistent across measures.

CONCLUSIONS

Findings highlight the limitations of existing disordered eating questionnaires in bariatric surgery candidates. Results suggest revised assessments are required to overcome these limitations and ensure that measures informing clinical recommendations regarding patient care are reliable and valid.

Eating disorder examination: Factor structure and norms in a clinical female pediatric eating disorder sample

OBJECTIVE

The factor structure of the eating disorder examination (EDE) has never been tested in a clinical pediatric sample, and no normative data exist.

METHOD

The factor structure of an adapted EDE was examined in a clinical sample of 665 females aged 9-17 years with anorexia nervosa spectrum (70%), bulimia nervosa spectrum (12%), purging disorder (3%), and unspecified feeding and eating disorders (15%).

RESULTS

The original four-factor model was a good fit in a confirmatory factor analysis as well a higher order model with three dimensions of restraint, eating concern, and combined weight concern/shape concern. Normative data are reported for clinicians to identify the percentiles in which their patients' score.

DISCUSSION

The findings support dimensions of restraint, eating concern, weight concern, and shape concern in a clinical pediatric sample. This supports the factorial validity of the EDE, and the norms may assist clinicians to evaluate symptoms in females under 18 years.

Development and validation of the Chinese-language version of the eating pathology symptoms inventory

OBJECTIVE

Eating disorders are becoming increasingly prevalent among individuals from non-Western countries, yet few non-English-language measures of eating pathology exist. The current study sought to develop and validate a Chinese version of the Eating Pathology Symptoms Inventory(1) with cross-cultural equivalence.

METHOD

The Chinese version of the Eating Pathology Symptoms Inventory (CEPSI) was translated and back-translated by native Chinese speakers, and administered to a pilot sample of native Chinese speaking students (N = 45) from a Midwestern university in the United States. The measure was revised based on participant's feedback, and administrated to a large sample of native Chinese speakers recruited from a Midwestern community (N = 195; 49.2% women) to test the factor structure and convergent and discriminant validity of the measure.

RESULTS

As hypothesized, the CEPSI had a robust eight-factor structure, and demonstrated evidence for acceptable internal consistency (median coefficient alphas were 0.80 for men and 0.79 for women, and alpha values ranged from 0.36 to 0.85 in men and 0.70 to 0.89 in women), and good convergent validity (correlations with relevant translated scales from the Eating Disorder Examination-Questionnaire and the Eating Attitudes Test-26 ranged from 0.22 to 0.58) and discriminate validity (correlations with a translated version of the Center for Epidemiological Studies - Depression Scale ranged from .12 to .30).

DISCUSSION

Results indicate that the CEPSI has high potential value as a new self-report measure of eating pathology that can be used in future research and clinical settings to assess eating disorder-related psychopathology among Chinese speaking individuals.

Factor structure and construct validity of the Eating Disorder Examination-Questionnaire in college students: further support for a modified brief version

OBJECTIVE

The Eating Disorder Examination-Questionnaire (EDE-Q) is widely used in research studies across clinical and nonclinical groups. Relatively little is known about psychometric properties of this measure and the available literature has not supported the proposed scale structure. This study evaluated the factor structure and construct validity of the EDE-Q in a nonclinical study group of young adults.

METHOD

Participants were 801 young adults (573 females and 228 males) enrolled at a large public university in the Midwestern United States who completed the EDE-Q and a battery of behavioral and psychological measures.

RESULTS

Confirmatory factor analysis (CFA) revealed an inadequate fit for the original EDE-Q structure but revealed a good fit for an alternative structure suggested by recent research with predominately overweight/obese samples. CFA supported a modified seven-item, three-factor structure; the three factors were interpreted as dietary restraint, shape/weight overvaluation, and body dissatisfaction. Factor loadings and item intercepts were invariant across sex and overweight status. The three factors had less redundancy than the original EDE-Q scales and demonstrated improved convergent and discriminant validity in relation to relevant other measures.

DISCUSSION

These factor-analytic findings, which replicate findings from studies with diverse predominately overweight/obese samples, supported a modified seven-item, three-factor structure for the EDE-Q with improved psychometric characteristics. The findings provide further empirical support for the distinction between body dissatisfaction and overvaluation and have implications for assessment and research. These findings need to be replicated in samples of persons with eating-disorder psychopathology including those with anorexia nervosa, bulimia nervosa, and allied states.

Factor structure of a French version of the Eating Disorder Examination-Questionnaire among women with and without binge eating disorder symptoms

The Eating Disorder Examination-Questionnaire (EDE-Q) is a self-report questionnaire that is widely used to investigate the core features of eating disorders. The EDE-Q is derived from the Eating Disorder Examination, a semi-structured interview considered as the "gold standard" in the assessment of eating disorders. To verify the factor structure of both instruments, originally composed of four subscales, factor analyses have been conducted with various samples. Heterogeneous results were found. Because no study had investigated the factor structure of the EDE-Q in individuals with binge eating disorder, the goal of our study was to fill this gap. We started with a review of the studies on the EDE and EDE-Q factor structure to decide which models to compare. Among 21 studies that were identified, three models had been replicated several times. We compared these three models-a 22-item, 3-factor model, a brief 7-item, 3-factor model and a brief 8-item, 1-factor model-in two samples of participants, one with threshold and subthreshold criteria for binge eating disorder (N = 116) and one without eating disorders (N = 161). Confirmatory factor analysis revealed a good fit for the brief 7-item, 3-factor model for both populations, whereas other solutions were not acceptable. Cronbach's alpha coefficients of the three factors were acceptable to good, ranging between 0.714 and 0.953. The group with binge eating disorder symptoms had significantly higher scores for each factor. This brief 7-item instrument might be useful for screening or short interventions.

Depression and treatment outcome in anorexia nervosa

The aim of this study was to compare the immediate and long-term effect of a cognitive-behavior therapy program for anorexia nervosa inpatients with and without concomitant Major Depressive Episodes (MDE). The program has been adapted from the "enhanced" form of Cognitive Behavior Therapy (CBT) for eating disorders. Sixty-three consecutive underweight adult patients with severe eating disorder were treated with inpatient CBT. MDE was assessed with the structured clinical interview for DSM-IV. The Eating Disorder Examination, and the Brief Symptom Inventory were recorded at entry, at the end of treatment, and 6 and 12 months later. MDE was present in 60.3% of participants. No significant differences were observed in the demographic and baseline clinical variables between patients with and without MDE. Significant improvements in weight, and in eating disorder and general psychopathology were showed. There were no differences between participants with and without MDE in terms of treatment outcome, and the severity of depression was not associated with changes in global Eating Disorder Examination score. These findings suggest that a diagnosis of MDE does not influence the outcome of inpatient treatment for anorexia nervosa patients, and that the severity of depression cannot be used to predict the success or failure of such treatment.

Assessment of physical activity in anorexia nervosa and treatment outcome

PURPOSE

The aim of this study was to compare objective and subjective assessments of physical activity (PA) in patients with anorexia nervosa and its effect on treatment outcome.

METHODS

Both Actiheart (AH) and International Physical Activity Questionnaire (IPAQ) were used to assess PA in 52 female patients with anorexia nervosa during the first week of inpatient treatment.

RESULTS

No correspondence between PA estimated by IPAQ, which had a tendency to underestimate PA, and that measured using AH emerged. However, a significant association was found between the change in Eating Disorder Examination global score at the end of the treatment and light PA measured by AH (beta = -0.12, t = -2.44, P = 0.019), but not that estimated by IPAQ.

CONCLUSIONS

PA in patients with anorexia nervosa is underestimated by subjective assessment when compared with objective measurement. Only time spent in light PA, assessed objectively with AH, showed a negative association with improvement in eating disorder psychopathology.

Eating disorder examination-questionnaire factor structure and construct validity in bariatric surgery candidates

BACKGROUND

The Eating Disorder Examination-Questionnaire (EDE-Q) is increasingly used in studies with bariatric surgery patients although little is known about psychometric properties of this self-report measure in this clinical group. The current study evaluated the factor structure and construct validity of the EDE-Q in bariatric surgery candidates.

METHODS

Participants were a consecutive series of 174 obese bariatric surgery candidates who completed the EDE-Q and a battery of behavioral and psychological measures.

RESULTS

Confirmatory factor analysis (CFA) revealed an inadequate fit for the original EDE-Q structure but revealed a good fit for an alternative structure suggested by recent research with obese samples. CFA supported a seven-item, three-factor structure; the three factors were interpreted as dietary restraint, shape/weight overvaluation, and body dissatisfaction. The three factors converged with other relevant collateral measures.

CONCLUSIONS

These factor analytic findings, which replicate recent findings from studies with diverse obese samples, demonstrated convergent validity. Implications of these findings for clinical assessment and research with bariatric surgery patients are discussed.

Measured physical activity in anorexia nervosa: features and treatment outcome

OBJECTIVE

To assess the role of measured physical activity (PA) in anorexia nervosa treatment outcome, and to compare the PA of patients with anorexia nervosa with age-matched controls.

METHOD

PA was assessed by means of Sense Wear Armband before and after a cognitive-behavioral inpatient treatment in 53 consecutive females with anorexia nervosa, and in 53 healthy age-matched controls.

RESULTS

At baseline, patients with anorexia nervosa exhibited a higher duration of moderate-vigorous PA (MVPA≥3 Metabolic Equivalent Tasks (METs)) than controls (t = 2.91; p = .004). Dropouts had higher duration (sec) and expenditure (kcal·day(-1)) of MVPA than completers. At the end of treatment, completers had a higher number of daily steps, MVPA duration, and expenditure than controls. However, PA was not correlated to eating disorder psychopathology either before or after treatment.

DISCUSSION

PA is higher in patients with anorexia nervosa than age-matched controls both before and after treatment, and is associated with treatment dropout.

Factor structure of the Eating Disorder Examination Questionnaire (EDE-Q) in male and female college athletes

The study explored the psychometric properties of the Eating Disorder Examination Questionnaire (EDE-Q) among 1637 university students. Participants were divided into male (n=432) and female (n=544) competitive athletes, and male (n=229) and female (n=429) comparison groups comprised of individuals who had not engaged in competitive sports for at least one year. All groups were subjected to confirmatory factor analysis (CFA) to test the fit of the published factor structure in this population, and then exploratory FA (EFA). A three-factor solution was the best fit for three out of four groups, with a two-factor solution providing best fit for the male comparison group. The first factor for all groups resembled a combined Shape and Weight Concern subscale. The factor structure among male and female competitive athletes was remarkably similar; however, non-competitive athletic/low activity males appear qualitatively different from other groups.

Spanish-language Eating Disorder Examination interview: factor structure in Latino/as

Latino/as face health care disparities in eating/weight disorders but are under-represented in treatment research and this is especially the case for Spanish-speaking-only persons. The development of psychometrically-sound assessment methods for Latino/as is needed to facilitate eating/weight research. The current study aimed to evaluate the factor structure of the Spanish-language version of the Eating Disorder Examination (S-EDE) interview, one of the primary assessment methods in studies of eating/weight despite limited data regarding psychometric aspects of this measure. Participants were 156 Spanish-speaking-only Latino/as (mean BMI 33.2; 84.6% classified as overweight) who were reliably administered the S-EDE interview by trained bi-lingual doctoral research-clinicians. Confirmatory factor analysis revealed an inadequate fit for the original EDE structure but revealed a good fit for an alternative structure suggested by recent research. CFA supported an 8-item 3-factor structure; the three factors were interpreted as dietary restraint, shape/weight overvaluation, and body dissatisfaction. These factor analytic findings of the Spanish EDE interview are comparable to recent findings reported for English-speaking obese patient groups and have implications for clinical assessment and research with Latino/as.

Psychometric evaluation of the eating disorder examination and eating disorder examination-questionnaire: a systematic review of the literature

OBJECTIVE

The purpose of this study was to systematically review the reliability of scores on the Eating Disorder Examination (EDE) and the Eating Disorder Examination-Questionnaire (EDE-Q) and to examine the validity of their use as measures of eating disorder symptoms.

METHOD

Articles describing the psychometric properties of the EDE and EDE-Q were identified in a systematic search of major computer databases and a review of reference lists. Articles were selected based on a priori inclusion and exclusion criteria.

RESULTS

Fifteen studies were identified that examined the psychometrics of the EDE, whereas 10 studies were found that examined the psychometrics of the EDE-Q.

DISCUSSION

Both instruments demonstrated reliability of scores. There is evidence that scores on the EDE and EDE-Q correlate with scores on measures of similar constructs and support for using the instruments to distinguish between cases and non-cases. Additional research is needed to broaden the generalizability of the findings.

Confirmatory factor analysis of the Eating Disorder Examination-Questionnaire (EDE-Q)

OBJECTIVE

To compare the goodness-of-fit of five models of Eating Disorder Examination-Questionnaire (EDE-Q) data, in clinical and community samples.

METHOD

The EDE-Q was administered to 228 eating disorder patients and 211 non-eating disordered university students. Confirmatory factor analysis was used to compare the validity of the original four EDE-Q subscales with that of brief one-factor, extended one-factor, two-factor, and three-factor models. Measurement invariance across the two samples was considered.

RESULTS

The only model to provide an acceptable fit to the data was the brief one-factor model consisting of eight Weight and Shape Concern items. Scores on this scale correlated highly with the original EDE-Q subscales.

CONCLUSION

The reliability of the EDE-Q may be increased if a modified scoring system is used. This complements findings from recent research with the Eating Disorder Examination (EDE).

Factor structure of the eating disorder examination interview in patients with binge-eating disorder

Despite the widespread use of the Eating Disorder Examination (EDE) as a primary assessment instrument in studies of eating and weight disorders, little is known about the psychometric aspects of this interview measure. The primary purpose of this study was to evaluate the factor structure of the EDE interview in a large series of patients with binge-eating disorder (BED). Participants were 688 treatment-seeking patients with BED who were reliably administered the EDE interview by trained research clinicians at three research centers. Exploratory factor analysis (EFA) performed on EDE interview data from a random split-half of the study group suggested a brief 7-item 3-factor structure. Confirmatory factor analysis (CFA) performed on the second randomly selected half of the study group supported this brief 3-factor structure of the EDE interview. The three factors were interpreted as Dietary Restraint, Shape/Weight Overvaluation, and Body Dissatisfaction. In this series of patients with BED, factor analysis of the EDE interview 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 interview in this and other eating-disordered groups. The implications of these factor analytic findings for understanding and assessing the specific psychopathology of patients with BED are discussed.

The factor structure of the eating disorder examination in clinical and community samples

OBJECTIVE

To assess the factor structure of the Eating Disorder Examination (EDE) in three different samples and to compare the goodness-of-fit of five models of EDE data.

METHOD

The EDE was administered to eating disordered (n = 158), treatment-seeking obese (n = 170) and non-eating disordered community-based (n = 329) participants. Confirmatory factor analysis was used to compare the validity of the original four-factor EDE model with that of three-, two-, and one-factor models.

RESULTS

None of the tested models provided a "good fit" to the data in any sample, with the exception of a brief one-factor model in the eating disorder group. Estimations of internal consistency, reliability, and validity were superior for the one-, two-, and three-factor models compared to the four-factor model in all samples.

DISCUSSION

Overall, there was more support for a one-factor model of EDE data than for a multi-factorial model. It may be more appropriate to use Global EDE scores than individual subscale scores for research purposes.

Validity and reliability of a Fijian translation and adaptation of the Eating Disorder Examination Questionnaire

OBJECTIVE

Assessment of disordered eating has uncertain validity across culturally diverse populations. This study evaluated Eating Disorder Examination Questionnaire (EDE-Q) performance in an ethnic Fijian study population.

METHOD

The EDE-Q was translated, adapted, and administered to school-going Fijian adolescent females (N = 523). A subsample (n = 81) completed it again within approximately 1 week. We assessed feasibility, internal consistency, and test-retest reliability; evaluated construct validity through factor analysis and correlation with similar constructs; and examined the marginal utility of an additional question on traditional purgative use.

RESULTS

Internal consistency reliability was adequate for the global scale and subscales (Cronbach's alpha = 0.66-0.91); retest reliability was adequate for both the languages (range of ICCs, 0.50-0.79, and of kappas, 0.46-0.81, excluding purging items). Construct validity was supported by significant correlations with measures of similar constructs. Factor analysis confirms multiple dimensions of eating disorder symptoms but suggests possible culture-specific variation in this population. The majority of respondents endorsing traditional purgative use (58%) did not endorse conventional EDE-Q items assessing purging.

DISCUSSION

The EDE-Q is a valid measure of eating disorder pathology for ethnic Fijian adolescent females and measures a unitary underlying construct.

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.

Psychometric properties of the eating disorder examination-questionnaire: factor structure and internal consistency

OBJECTIVE

The purpose of this investigation was to evaluate the factor structure and the internal consistency of the Eating Disorder Examination-Questionnaire (EDE-Q).

METHOD

The EDE-Q was administered to 203 women with bulimic symptoms, who were recruited from five Midwestern communities.

RESULTS

Acceptable levels of internal consistency were observed for the EDE-Q total score (alpha = .90) and subscales: Restraint (alpha = .70), Eating Concern (alpha = 0.73), Shape Concern (alpha = 0.83) and Weight Concern (alpha = 0.72). Exploratory factor loadings using Principal Axis Analysis supported the Eating Concern and Restraint subscales. Most of the Shape Concern and Weight Concern items loaded on one factor, with the exception of the items focusing on the importance of weight and shape in self-evaluation and preoccupation with shape and weight.

CONCLUSION

The results of this study provide support for the internal consistency of the EDE-Q and indicate a need for further examination of the factor structure of this instrument.

Eating behavior in obese patients with and without type 2 diabetes mellitus

OBJECTIVE

Aim of this study was the assessment of the prevalence of eating disorders, and of eating disorder symptoms, in obese patients with type 2 diabetes, compared to non-diabetic subjects.

DESIGN

Three samples of individuals were studied: a series of 156 (76 male, 80 female) overweight and obese type 2 diabetic patients, aged 30-65 y, with a body mass index (BMI)>28 kg/m(2) (DM); a series of 192 (20 male, 172 female) obese (BMI>30 kg/m(2)) non-diabetic patients aged 30-65 y seeking treatment for weight loss (OC); and a non-clinical sample of 48 (22 male, 26 female) obese (BMI>30 kg/m(2)) subjects aged 30-65 y selected from the lists of two general practices (OP). Eating behavior was assessed using the Eating Disorder Examination (EDE 12.0D).

RESULTS

The prevalence of Binge Eating Disorder was lower than 5% in all the three samples. Median EDE scores in females were significantly higher in OC (3.0) and OP (3.4) than in DM (1.7), while diabetic patients showed higher scores on Restraint than both non-diabetic samples. Among diabetic patients, a significant correlation of EDE scores with HbA(1)c was observed.

CONCLUSIONS

Type 2 diabetes is unlikely to induce relevant eating disturbances in obese patients, apart from an increase in restraint. Abnormalities of eating attitudes and behavior are associated with an impairment of metabolic control.

The structured interview for anorexic and bulimic disorders for DSM-IV and ICD-10 (SIAB-EX): reliability and validity

OBJECTIVE

For reliable and valid assessment and diagnostic categorization of eating disorders, self-report measures have considerable limitations. A semi-structured interview - the SIAB-EX - was developed for a more reliable and valid assessment of eating disorders.

METHODS

One study (videotapes of 31 inpatients, seven raters) was made to establish inter-rater reliability; in another study with 80 patients the SIAB-EX was compared to another semi-structured interview designed for comparable purposes (EDE). In a third study data was obtained on 377 eating disorder patients seeking treatment to explore discriminant and convergent (construct) validity using the following self-rating scales: EDI, TFEQ, SCL-90, BDI, and the PERI Demoralization Scale.

RESULTS

Inter-rater reliability of dichotomous ratings was good with mean kappa values of.81 (current) and.85 (past). Comparison of the SIAB-EX with the EDE generally showed quite similar results and higher intercorrelation of the total scale (.77). There are, however, a number of differences between the two scales, which are discussed in detail. Construct validity of the SIAB-EX was established.

CONCLUSION

Inter-rater reliability was good. Convergent and discriminant (construct) validity of the SIAB-EX was demonstrated. The constructs assessed by the SIAB and its subscales and items are discussed in the context of their correlations with other well-known scales.