Psychometric properties of the Stirling Eating Disorder Scales with bulimia nervosa patients

Psychometric properties of self-report measures of eating disorder cognitions: a systematic review

BACKGROUND

Although eating disorder (ED) models display some differences in theory and treatment approach, cognitive-behavioural, schema-focused, and disorder-specific models all highlight the fundamental nature of cognitions as key factors in ED development and maintenance processes. As such, it is vital that ED cognitions continue to be assessed and monitored as therapeutic targets and treatment outcomes as well as being examined as constructs in empirical research. This review aimed to systematically identify and evaluate the psychometric properties of existing self-report measures of ED cognitions.

METHODS

A systematic review protocol was registered using the international prospective register of systematic reviews (PROSPERO; CRD42023440840). Included studies described the development, validation and/or the psychometric evaluation of a measure (or subscale) that was specifically developed to solely assess ED cognitions (that is thoughts, expectations, assumptions, or beliefs), in English-speaking, adult populations. The search was conducted using three electronic databases: PsycINFO, MedLine, and Embase. Two independent reviewers conducted screening, selection and evaluation of the psychometric properties of relevant measures using a standardised, well-established quality appraisal tool.

RESULTS

Of the initial search of 7581 potential studies, 59 met inclusion criteria and described the psychometric evaluation of 31 measures (or subscales) of ED cognitions. The findings from the current review indicate that of the included measures, none currently meet all nine criteria of adequate psychometric properties. The Eating Beliefs Questionnaire (EBQ; and EBQ-18), and the Eating Disorder Inventory Body Dissatisfaction subscale (EDI [BD]) currently possess the most evidence supporting their validity, reliability, and clinical utility.

CONCLUSIONS

The findings of the current systematic review provide guidance for future researchers to focus efforts on improving evidence for the validity, reliability and utility of self-report measures of ED cognitions. Overall, the present study has provided a detailed and systematic evaluation to support researchers and clinicians in future selection of measures of ED cognitions dependent on the specific aims of their research and treatment.

Development, psychometric properties and preliminary clinical validation of a brief, session-by-session measure of eating disorder cognitions and behaviors: The ED-15

OBJECTIVE

In the treatment research literature on other psychological disorders, there is a move towards session-by-session symptom measurement. The necessary measures need to be brief, focused on core features since the last session, and readily available to clinicians. There is no measure in the eating disorders that meets those criteria. This research reports the development and validation of such a self-report questionnaire.

METHOD

The authors generated and refined a brief set of attitudinal and behavioral items. The resulting questionnaire (the ED-15) and an existing measure (Eating Disorders Examination-Questionnaire; EDE-Q) were completed by a large nonclinical adult sample (N = 531), a group of self-reported eating disorder sufferers (N = 63), and a group of women (N = 33) diagnosed with bulimia nervosa or atypical bulimia nervosa and undertaking cognitive-behavioral therapy.

RESULTS

Factor analysis identified two scales (Weight and Shape Concerns; Eating Concerns), with strong internal consistency and test-retest reliability. Correlations with the EDE-Q (r = 0.889) indicates that the ED-15 and EDE-Q measure near-identical constructs. The ED-15 differentiated self-reported eating-disordered and nonclinical groups to the same degree as the longer EDE-Q. Session-by-session analysis of the CBT treatment group demonstrated that the different ED-15 scales changed in different patterns across therapy.

DISCUSSION

The ED-15 is not proposed as an alternative to existing measures, but as a complementary tool, used to measure session-by-session change for clinical and research purposes. Future research will track changes in ED-15 scores across therapy, to determine the importance of very early response to therapy and sudden changes.

Eating disorder beliefs and behaviours across eating disorder diagnoses

OBJECTIVE

To test for differences between diagnostic groups on the severity of eating disorder beliefs and behaviours, evaluate the clinical significance of such differences, and assess the extent to which these beliefs and behaviours may be present at clinically significant levels across eating disorder diagnoses.

METHOD

136 adult women outpatients (aged 18-65, with a BMI over 15) were diagnosed with an eating disorder and completed the Stirling Eating Disorder Scale.

RESULTS

The expected pattern of statistically significant differences was found between diagnostic groups on anorexic dietary beliefs and behaviours and bulimic dietary beliefs and behaviours. A high percentage of participants in each diagnostic group scored above the clinical cut-off on the eating disorder belief and behaviour measures and a very high percentage of participants in each group reported clinically significant levels of restricting beliefs.

CONCLUSIONS

Transdiagnostic or functional analytic approaches to treatment planning may lead to more effective interventions than current, diagnostically-based, care pathways. The high prevalence of restricting beliefs reported suggested that this may need to be a key focus for intervention for the majority of individuals presenting with an eating disorder.

The relation between the lack of control attributional style for indulgent food consumption and bulimic symptoms

OBJECTIVE

The study examined the potential link between the lack of control attributional style for indulgent food consumption and bulimic symptoms.

METHOD

One hundred and 77 undergraduates (145 female; mean age=19 years-2 months) were administered the Eating Attributional Style Questionnaire and the Sterling Eating Disorder Scales across a five-month period.

RESULTS

SEM analyses confirmed that: (1) uncontrollability attributions for indulgent food consumption were concurrently associated with bulimic symptoms, and (2) external locus of control and uncontrollability attributions for indulgent food consumption predicted changes in bulimic symptoms.

CONCLUSIONS

The findings yielded support for the conclusion that the lack of control attributional style for indulgent food consumption is a probable cause of bulimic symptoms.

An investigation into the psychometric properties of the Stirling Eating Disorder Scales

The Stirling Eating Disorder Scales (SEDS) are widely used in clinical practice, however evidence regarding the internal consistency and validity of the measure is limited. The aim of this study was to investigate the psychometric properties of the SEDS in a mixed eating disorder population. The SEDS and the Eating Disorder Examination (EDE) were administered to 241 consecutive patients attending an adult out-patient eating disorder service in the UK. The internal consistency of the overall SEDS was good, but there was variation in the internal consistency of the individual subscales. There were differences across diagnosis for all SEDS subscales, and some significant correlations were found between the EDE and SEDS subscales. It was not possible to replicate the derivation of the original SEDS subscales using a principal components analysis (PCA); further analysis was conducted on the new subscales that were identified. It is suggested that information obtained from the administration of the SEDS should be interpreted with caution, and also that further exploration of the psychometric properties of the SEDS is warranted.