Effect of response format on endorsement of eating disordered attitudes and behaviors

OBJECTIVE: The present study was designed to compare response rates on a standard self-report questionnaire that was nominally anonymous to an unmatched count questionnaire that allowed for true anonymity in responding. METHOD: Four hundred and fifty-four college students were asked about several topics, including attitudes towards weight and shape, dieting, and eating disordered behavior using one of two response formats; either a standard questionnaire in true-false format or an unmatched count questionnaire that did not require participants to directly answer sensitive questions. RESULTS: Both males and females had significantly different rates of endorsement between the two methods of assessment on the majority of the eating-related questions. CONCLUSION: Response format and degree of anonymity affect endorsement of eating-related thoughts and behaviors. Understanding response bias is critical to determining accurate rates of eating disordered thoughts and behaviors.     

Developmental considerations in measuring children's disordered eating attitudes and behaviors

This study examined the discriminant ability of the Children's version of the Eating Attitudes Test (ChEAT) clinical cut-off in a low/low-middle socioeconomic status, non-clinical sample of primarily Hispanic and non-Hispanic white (Caucasian) girls aged 8 to 12. We investigated how age, age-standardized body mass index (z-BMI), body dissatisfaction, body esteem, self-esteem, and depressive symptoms contributed to disordered eating status in 152 girls. Girls scoring at/above the ChEAT clinical cut-off reported significantly greater body dissatisfaction and depressive symptoms and lower body esteem than did girls who scored below the cut-off. We then investigated whether age moderated the discriminant ability of the ChEAT threshold and found that the ChEAT was significantly more sensitive when our sample was limited to 10- to 12-year-olds. An abbreviated 6-item ChEAT scale, based on marker items distinguishing at-risk and non-clinical status, was subsequently developed. Findings indicate that this abbreviated ChEAT scale has improved sensitivity with older girls (10- to 12-year-olds). However, sensitivity was unacceptable for younger girls (8- and 9-year-olds) for both the ChEAT and abbreviated ChEAT scale, regardless of cut-off.     

Dieting history in obese youngsters with and without disordered eating

OBJECTIVE: This article examines the relationship between the emergence of disordered eating and the history of weight and dieting in obese youngsters. METHOD: Both child and parent reports were obtained from 40 obese disordered eaters (objective bulimic episodes, n = 20; objective overeating episodes, n = 20) and 40 obese matched controls aged 10-16 years. RESULTS: No significant differences between subsamples with regard to weight and dieting history were found. In dieters, it was shown that overweight onset preceded dieting onset, which in turn preceded dietary restraint onset. Despite some discordance regarding precise onset ages of different behaviors, parent and child re ports revealed the same temporal sequences. CONCLUSION: A developmental pathway from weight problems through dieting to binge eating is plausible for a subgroup of obese children. Convergence between parent and child reports supports the assumption that children's reports are a viable means of monitoring dieting and weight behaviors.     

Influence of sexual orientation and age on disordered eating attitudes and behaviors in women

OBJECTIVE: We evaluated the influence of age on the association between sexual orientation and disordered eating attitudes and behaviors in women. METHOD: Heterosexual (n=47) and homosexual (n=45) women recruited from the community completed self-report questionnaires including the Body Esteem Scale, the Eating Disorders Inventory-2, the Reasons for Exercise Inventory, and the Self Esteem Scale. RESULTS: A multivariate analysis of variance of eating disorder variables revealed a main effect for sexual orientation on drive for thinness and exercise to control weight and a main effect for age on body mass index (BMI) and body dissatisfaction, but it did not reveal a significant interaction between sexual orientation and age. DISCUSSION: Sexual orientation may influence certain types of disordered eating attitudes and behaviors in women such as endorsing an extreme ideal of thinness. However, homosexual and heterosexual women reported more similarities than differences.     

Natural history of disordered eating attitudes and behaviors over a 6-year period.

OBJECTIVE: This study investigated the course of eating attitudes and eating-disordered behaviors in a community sample of adult women. METHOD: Participants (N = 166; mean age = 32.8 years) completed the Eating Disorder Inventory (EDI), the Three-Factor Eating Questionnaire (TFEQ), and a questionnaire assessing bulimic behaviors at two time points, 6 years apart. RESULTS: Correlations for rank ordering of scores on these measures were all significant, indicating high rank stability over time. Although rates of specific bulimic behaviors decreased over time, mean scores on eating disorder attitude scales tended to increase. DISCUSSION: Findings challenge the commonly held belief that disturbed eating attitudes decline with age.     

Development of the eating disorder recovery self-efficacy questionnaire

OBJECTIVE: The purpose of the current investigation was to develop and validate the Eating Disorder Recovery Self-Efficacy Questionnaire (EDRSQ), a self-report measure of self-efficacy to recover from an eating disorder. METHOD: Participants were 116 female patients with anorexia nervosa, bulimia nervosa, or a subthreshold eating disorder treated at an eating disorder clinic. Patients completed the EDRSQ and measures of eating disorder symptoms and depression. RESULTS: The EDRSQ contains two internally consistent factors, Normative Eating Self-Efficacy and Body Image Self-Efficacy. Moderate to large correlations between EDRSQ subscales and measures of eating disorder pathology support the convergent validity of the EDRSQ. The EDRSQ demonstrates theoretically consistent relations with constructs that are related to but distinct from self-efficacy. Discriminant validity is reflected in small correlations between EDRSQ subscales and measures of general psychological correlates of disordered eating. CONCLUSION: The EDRSQ is a psychometrically sound measure to assess self-efficacy in patients with a range of eating disorder diagnoses.     

The Minnesota Eating Behavior Survey: a brief measure of disordered eating attitudes and behaviors

This article describes details of the development and psychometric characteristics of a brief self-report inventory for assessing attitudes and behaviors symptomatic of eating disorders that is currently in use in a longitudinal study of over 700 families with 11-year-old or 17-year-old twin girls. The Minnesota Eating Behavior Survey (MEBS), formerly the Minnesota Eating Disorder Inventory, is a 30-item measure developed for use with children as young as 10 years as well as adults. An examination of the MEBS's psychometric properties in a large, community sample of girls, women, and men demonstrated good factor congruence, internal consistency reliability, three-year stability, as well as evidence of concurrent and criterion validity. This questionnaire has promise as a screening and assessment measure for eating disturbance in cross-sectional and longitudinal research involving individuals of a wide range of ages.     

Effects of a reality TV cosmetic surgery makeover program on eating disordered attitudes and behaviors

OBJECTIVE: To evaluate the effects of a reality TV cosmetic surgery program on eating disordered attitudes, behaviors, mood, anxiety, and self-esteem. METHOD: Participants (N=147 women) completed baseline surveys and were subsequently randomly assigned to one of two conditions: one in which they watched a reality TV cosmetic surgery program (The Swan) and one in which they watched a reality TV home improvement program (Clean Sweep). Assessments were conducted immediately post-video and two weeks later. RESULTS: Women in the cosmetic surgery program group who reported higher internalization of the thin-ideal at baseline manifested lower self-esteem at posttesting. Among White women, those who watched the cosmetic surgery program reported greater perceptions of media pressures to be thin and stronger endorsement of their ability to control their body's appearance after watching the video. These differences persisted over a two-week follow-up period. DISCUSSION: Reality TV cosmetic surgery makeover programs may contribute to eating disordered attitudes and behaviors among young women, particularly those who have internalized the thin body-ideal. These findings seem to be especially applicable for White women; however, they should be further investigated with more diverse and international samples.     

Purging using the Heimlich maneuver among children and adolescents with eating disorders

This case report describes five independent cases of children and adolescents assessed for eating disorders who disclosed using the Heimlich maneuver as a purging technique. The maneuver is meant to be used only in life or death situations, likely once or less in any person's lifetime. A child or adolescent with an eating disorder may be using it to self‐induce vomiting on a daily basis, increasing the risk of complications, including potential damage to major organs of the body. Asking patients who purge to elaborate on the methods with which they purge can provide clinicians with fuller information, improving their ability to select appropriate medical tests and interventions. Thorough investigations of physical complaints during the patient assessment may be warranted, including examining patients for possible rib fractures, hemorrhages, perforations of the hollow viscous, and other forms of blunt abdominal traumas. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:795–797)     

Nasogastric feeding in children and adolescents with eating disorders: toward good practice

OBJECTIVE: This study aimed to provide an insight into the subjective experiences of nasogastric feeding from the perspective of patients with eating disorders and their parents. METHOD: A semistructured self-report questionnaire was completed by patients from two specialist eating disorders units who had received nasogastric feeding. Parents' views were also assessed via a similar self-report questionnaire. RESULTS: Diverse views were expressed by both patients and parents. Some regarded the experience of nasogastric feeding as wholly negative, but acknowledged the lack of suitable alternatives. Others had a more positive view and identified several helpful aspects. CONCLUSION: Reactions were generally more positive than had been anticipated. A number of useful suggestions were made regarding how to improve the procedure. These have informed the development of guidelines for good practice.     

Comparison of self-report to interview assessment of bulimic behaviors among preadolescent and adolescent girls and boys

OBJECTIVE: To compare self-report to interview assessment of bulimic behaviors among adolescents. METHOD: A sample of children in an ongoing study were recruited to complete in-depth telephone interviews in 1998 on bulimic behaviors (i.e., binge eating and purging). The sample comprised 449 girls and 50 boys. RESULTS: There was some over-reporting of bulimic behaviors on the 1998 questionnaire (asking about 1997-1998) compared with the interview that may have been due to the shorter and nonoverlapping time frame in the interview compared with the questionnaire. Despite the overestimation, the questionnaire did an excellent job at classifying girls who did not purge (negative predictive values [NPV]: 0.99) or binge eat (NPV = 0.98). When purging on the interview was compared with purging on either the 1998 or 1999 questionnaires, the sensitivity increased substantially from 0.73 to 0.93. DISCUSSION: These findings suggest that a short self-report assessment can be used to screen children engaging in, or at risk of beginning to engage in, binge eating and purging.     

Does perfectionism mediate or moderate the relation between body dissatisfaction and disordered eating attitudes and behaviors?

A link between perfectionism and disordered eating has been documented in previous studies. The purpose of the current study was to expand our knowledge of the specific role of perfectionism in disordered eating by examining perfectionism as a mediator or a moderator in the relation between body dissatisfaction and disordered eating (assessed using the EAT-26 and its subscales, and the Binge Scale). We sampled a large ethnically diverse sample of university women (N = 520) using two measures of perfectionism: the Eating Disorder Inventory Perfectionism subscale (EDI-P) and the Multidimensional Perfectionism Scale (H-MPS). In general, socially prescribed and self-oriented perfectionism, but not other-oriented perfectionism, were correlated with disordered eating attitudes and behaviors, except binge eating. Furthermore, perfectionism was found to partially mediate and moderate the relation between body dissatisfaction and disordered eating, however the strength of these associations differed depending on both the particular measure of perfectionism (EDI-P versus H-MPS) and the specific dimension of perfectionism (self-oriented, socially prescribed, other-oriented) used in the analyses. The findings are discussed in relation to the need for more informed and theoretically sound models of the development and maintenance of disordered eating.