Eating Disorder Examination-Questionnaire as a measure of change in patients with bulimia nervosa

OBJECTIVE: The current study evaluated the agreement between the Eating Disorder Examination and the Eating Disorder Examination-Questionnaire in assessing eating disorder pathology in a sample of women with bulimia nervosa. METHOD: Patients with broadly defined bulimia nervosa were enrolled in a double-blind, placebo-controlled treatment study of fluoxetine, with and without guided self-help. The current study presents information from 50 patients with data from both the EDE and EDE-Q at study entry and treatment termination. RESULTS: The EDE and EDE-Q produced more similar scores for compensatory behaviors (vomiting/laxative use) than complex eating-disordered features (binge eating/importance of shape and weight) at the pretreatment and posttreatment assessments, and for change during the study. DISCUSSION: The EDE and EDE-Q are highly correlated for many of the behavioral and attitudinal features of bulimia nervosa. There is substantial variability in agreement for individual patients, but on average, the EDE and EDE-Q will yield similar assessments of eating disorder symptoms and change in symptoms over time.     

Eating Disorders Examination versus Eating Disorders Examination-Questionnaire in adolescents with full and partial-syndrome bulimia nervosa and anorexia nervosa

OBJECTIVE: The current study compared the Eating Disorders Examination (EDE) and the Eating Disorders Examination-Questionnaire (EDE-Q) in adolescents with eating disorders. METHOD: Adolescents (N = 70) with bulimia nervosa (BN; n = 21), partial-syndrome BN (PBN; n = 25), and anorexia nervosa (AN; n = 24) were assessed with the EDE and EDE-Q. RESULTS: Moderate to high correlations were found on all four subscales within and between diagnostic groups. The discrepancy between the EDE and EDE-Q was significantly greater in BN relative to PBN and AN for the Eating Concern subscale. Objective binge episode (OBE) frequency in BN and subjective binge episode (SBE) frequency in BN and PBN were higher with the EDE compared with the EDE-Q. Self-induced vomiting was highly correlated between the two measures. DISCUSSION: Adolescents with BN, PBN, and AN exhibited strong correspondence between the EDE interview and questionnaire formats. However, this consistency was not as pronounced for BN as it was for PBN and AN. The current study lends preliminary credibility to the use of the EDE-Q in adolescent eating disorder samples.     

General population-based epidemiological study of eating disorders in Norway

In a questionnaire-based study of eating disorders in a representative sample of the general female population of Norway, the lifetime prevalence of eating disorders was 8.7% with a point prevalence of 3.8%. The lifetime prevalence of binge eating disorder (BED) was 3.2%, bulimia nervosa (BN) 1.6%, and anorexia nervosa (AN) 0.4%. Eating disorders not otherwise specified (EDNOS) had a lifetime prevalence of 3.0%. Point prevalence of BED was 1.5%, BN 0.7%, AN 0.3%, and EDNOS 1.3%. © 1995 by John Wiley & Sons, Inc.     

State and trait food craving in people with bulimic eating disorders

In two studies, we examined trait and state food craving levels in people with a bulimic disorder (BD) (bulimia nervosa and related disorders) and healthy controls (HC) using multidimensional self-report assessments. In study 1, trait food craving was assessed in 70 people with a BD and 69 HC using the Food Craving Questionnaire — Trait. Participants also completed the Eating Disorder Examination — Questionnaire (EDE-Q). In study 2, 45 people with a BD and 29 HC completed the Food Craving Questionnaire — State and the EDE-Q following exposure to visual and real high-caloric food cues. The results showed that both trait and state food cravings were significantly higher in people with a BD, compared to HC. Trait food craving was associated with eating disorder symptomatology in both the HC and BD groups. State food craving was associated with eating disorder psychopathology, but only in the BD group. This research underscores the importance of food craving in the study and conceptualization of BD.     

Eating disorders and alcohol use: group differences in consumption rates and drinking motives

Alcohol use and drinking motives were investigated among college women divided into four probable eating disorder groups: Bulimia Nervosa, purging subtype (BN n=16) Binge Eating Disorder (BED n=30) Eating Disorder, Not Otherwise Specified (EDNOS n=85) and Non-Eating Disordered Controls (NEDC n=252). Participants completed questionnaires that assessed eating behaviors and attitudes, motives for drinking alcohol, quantity and frequency of alcohol use, and binge drinking. The BED group reported greater weekend alcohol consumption and binge drinking than the EDNOS and NEDC groups. The BN and BED groups were significantly more likely to endorse Coping as a drinking motive than the EDNOS and NEDC groups. The NEDC group was more likely to endorse Mood Enhancement than the EDNOS group. These results offer one explanation for the relationship between eating and alcohol use disorders. Women with eating disorders may use alcohol to cope with negative affect, analogous to findings that women with eating disorders report binge eating to regulate negative affect [Mizes, J. S. (1985). Bulimia: A review of its symptomatology and treatment. Advances in Behavior Research and Therapy, 7, 91-142].     

Temporal stability of the Eating Disorder Examination Questionnaire

OBJECTIVES: The current study examined the stability and internal consistency of the Eating Disorder Examination Questionnaire (EDE-Q) in a general population sample. METHODS: The EDE-Q was administered to a community sample of women aged 18-45 on two occasions, with a median test-retest interval of 315.0 days. RESULTS: Pearson correlations between items of the EDE-Q assessing attitudinal features of eating disorder psychopathology ranged from 0.57 for the Restraint subscale to 0.77 for the Eating Concern subscale. The stability of items addressing eating disorder behaviors was much lower, with phi coefficients for the occurrence of objective bulimic episodes, subjective bulimic episodes, and use of exercise as a compensatory behavior of 0.44, 0.24, and 0.31, respectively, and Kendall's tau b correlations of 0.44, 0.28, and 0.31, respectively, for the frequency of these behaviors, across occasions. The internal consistency of the EDE-Q was high, with a Cronbach alpha coefficient for the global scale of 0.93, compared with a value of 0.90 for the Eating Disorder Examination interview. DISCUSSION: Items of the EDE-Q assessing attitudinal features of eating disorder psychopathology demonstrate a high degree of temporal stability, whereas the stability of items addressing eating disorder behaviors is much lower. In the case of compensatory eating disorder behaviors, low stability is likely to reflect actual trait variation, whereas the low stability of binge eating behaviors, in particular subjective bulimic episodes, is likely to reflect both trait variation and measurement error. The high internal consistency of EDE-Q items supports its use as a screening instrument in two-phase epidemiologic studies.     

The reliability of the Eating Disorder Examination-Self-Report Questionnaire Version (EDE-Q)

OBJECTIVE: This research investigated the internal consistency and test-retest reliability of the Eating Disorder Examination-Self-Report Questionnaire Version (EDE-Q), a 41-item measure adapted from the Eating Disorder Examination (EDE). The EDE is a structured clinical interview assessing the key behavioral features and associated psychopathology of eating disorders. RESULTS: Results indicated excellent internal consistency and 2-week test-retest reliability for the four subscales of the EDE-Q: Restraint, Weight Concern, Shape Concern, and Eating Concern. There was somewhat less stability in the items measuring the occurrence and frequency of the key behavioral features of eating disorders. CONCLUSIONS: Overall, results support the psychometric adequacy of the EDE-Q.     

Eating disorder symptomatology among ballet dancers

OBJECTIVE: The current study sought to compare eating disorder symptomatology among ballet dancers and individuals with restricting anorexia nervosa (RAN), bulimia nervosa (BN), and no eating pathology. METHOD: Twenty-nine female ballet dancers completed assessments and were compared with an archival dataset of 26 women with RAN, 47 women with BN, and 44 women with no eating pathology. Eating disorder diagnoses and behaviors were assessed with a semi-structured clinical interview, the Eating Disorder Inventory (EDI), and a weight history interview. RESULTS: Eighty-three percent of dancers met lifetime criteria for AN (6.9%), BN (10.3%), AN+BN (10.3%), or EDNOS (55.0%). Moreover, dancers looked more similar to eating-disordered individuals than to control individuals on measures of eating pathology. CONCLUSION: Despite previous emphasis on the pathology AN, the current findings suggest that dancers frequently engage in binge eating and purging behaviors. Moreover, it appears that their pathology is as severe as that of non-dancing women with eating disorders.     

The clinical features of EDNOS: Relationship to mood,health status and general functioning

Study purposeEating disorder not otherwise specified (EDNOS) remains poorly evaluated in terms of eating disorder features and relationship to mood, health status and general functioning. This study investigated the clinical profiles of a sample of EDNOS patients, and how they compared to patients with anorexia nervosa (AN) and bulimia nervosa (BN).MethodThe sample consisted of 178 patients. All completed the Eating Disorder Examination, Beck Depression Inventory, Work and Social Adjustment Scale and Sf-36. ANOVAs were conducted to explore group differences.ResultsNo differences were found for depression. No differences were found between BN and EDNOS on measures of health status and general functioning. AN patients reported greater role limitations due to physical health and experienced greater physical pain compared with BN or EDNOS patients, and reported poorer social functioning, lower vitality and higher functional impairment compared with EDNOS patients.ConclusionEDNOS patients are generally no less clinically impaired than those with BN. However AN patients may be more impaired in some aspects of general functioning compared with BN or EDNOS patients.     

Assessment of patients with anorexia nervosa: interview versus self-report

OBJECTIVE: The current study compared the agreement between the Eating Disorders Examination (EDE) and the Eating Disorders Examination-Questionnaire (EDE-Q) in the diagnosis and assessment of eating disorder pathology in a sample of women with anorexia nervosa. METHOD: First, a physician administered a clinical interview to each patient. Then, before hospital admission, all subjects were given the EDE-Q and the EDE interview. RESULTS: Results indicate that agreement between the EDE and the EDE-Q on the individual items informing the overall diagnosis of anorexia nervosa ranges from low to moderate. Agreement for the overall diagnosis of anorexia nervosa and for the binge/purge subtype was more impressive. Although correlations between subscale scores as well as eating disorder behaviors were strong, higher levels of disturbance were consistently reported on the EDE-Q than on the EDE interview. DISCUSSION: The pattern of findings suggests that the EDE-Q may be used in place of the interviewer-based measure when assessing overall diagnosis and subtype, as well as specific, well-defined features (vomiting/laxative use). However, there was a low level of agreement with respect to less-defined features, like binge eating, for which significantly higher frequencies were generated by the self-report questionnaire.     

Eating Disorder Examination Questionnaire (EDE-Q): Norms for undergraduate men

Normative data on the Eating Disorder Examination Questionnaire for samples of undergraduate men in the United States are presented. Participants were 404 undergraduate men aged 18–26 who completed the EDE-Q as part of two larger survey studies. Mean scores, standard deviations, and percentile ranks for the Global score and four subscale scores are provided. Data regarding the frequency of objective binge eating episodes and compensatory behaviors also are reported. Although the overall prevalence of full threshold eating disorders remains lower in men than in women, body dissatisfaction and disordered eating behaviors are fairly common among young men. These results will help researchers and clinicians interpret the EDE-Q scores of undergraduate men.     

Comparison of DSM-IV versus proposed DSM-5 diagnostic criteria for eating disorders: reduction of eating disorder not otherwise specified and validity

Objective:

Revised Eating Disorder (ED) diagnostic criteria have been proposed for the Diagnostic and Statistical Manual (DSM)‐5 to reduce the preponderance of eating disorder not otherwise specified (EDNOS) and increase the validity of diagnostic groups. This article compares DSM‐IV and proposed DSM‐5 diagnostic criteria on number of EDNOS cases and validity.

Method:

Participants (N = 397; 91% female) completed structured clinical interviews in a two‐stage epidemiological study of EDs. Interviewers did not follow standard skip rules, making it possible to evaluate alternative ED diagnostic criteria.

Results:

Using DSM‐IV versus DSM‐5 criteria, 34 (14%) versus 48 (20%) had anorexia nervosa, 43 (18%) versus 44 (18%) had bulimia nervosa, and 163 (68%) had EDNOS versus 20 (8%) had binge eating disorder (BED), and 128 (53%) had EDNOS, respectively, reflecting a significant decrease in EDNOS. Validation analyses supported significant differences among groups with some improvement associated with delineation of BED.

Discussion:

Proposed revisions to EDs in the DSM‐5 significantly reduced reliance on EDNOS without loss of information. © 2011 by Wiley Periodicals, Inc.     

Prevalence of eating disorders in female and male adolescents (14-15 years)

OBJECTIVE: The main aim of the present study is to establish the prevalence of eating disorders (ED) in adolescents of both genders. To our knowledge, such data have not previously been published using both DSM-IV and DSM-III-R criteria. METHOD: The study sample consisted of 1960 adolescents (1026 girls and 934 boys), 14-15 years of age. The participants completed the Survey for Eating Disorders (SEDs), including DSM-III-R and DSM-IV diagnoses for all subcategories of ED. RESULTS: Lifetime prevalence of any ED among girls was 17.9% anorexia nervosa (AN) 0.7%, bulimia nervosa (BN) 1.2%, binge eating disorder (BED) 1.5%, and EDs not otherwise specified (EDNOS) 14.6%. Corresponding numbers for boys for any ED is 6.5%, AN 0.2%, BN 0.4%, BED 0.9%, and EDNOS 5.0%. DISCUSSION: Our prevalence rates on AN, BN, and BED largely support previous school/community-based studies, while our figures on EDNOS were rather high. Generally, we found high numbers for boys with ED.     

Different methods for assessing the features of eating disorders in patients with binge eating disorder: a replication.

OBJECTIVE: To compare different methods for assessing the features of eating disorders in patients with binge eating disorder (BED). RESEARCH METHODS AND PROCEDURES: A total of 47 participants with BED were administered the Eating Disorder Examination (EDE) Interview and completed the EDE-Questionnaire (EDE-Q) at baseline. A total of 37 participants prospectively self-monitored their eating behaviors daily for 4 weeks and then completed another EDE-Q. RESULTS: At baseline, the EDE and the EDE-Q were significantly correlated on frequencies of objective bulimic episodes (binge eating), overeating episodes, and on the dietary restraint, eating concern, weight concern, and shape concern subscales. Mean differences in the EDE and EDE-Q frequencies of objective bulimic episodes and overeating were not significant but scores on the four subscales differed significantly, with the EDE-Q yielding higher scores. At the 4-week point, the EDE-Q retrospective 28-day assessment was significantly correlated with the prospective daily self-monitoring records for frequency of objective bulimic episodes and the mean difference between the methods was not significant. The EDE-Q and self-monitoring findings for subjective bulimic episodes and objective overeating differed significantly. DISCUSSION: In patients with BED, the three assessment methods showed some areas of acceptable convergence.     

Individual and family eating patterns during childhood and early adolescence: an analysis of associated eating disorder factors

To examine whether there is an association between individual and family eating patterns during childhood and the likelihood of developing an eating disorder (ED) later in life. The sample comprised 261 eating disorder patients [33.5% [N=88] anorexia nervosa (AN), 47.2% [N=123] with bulimia nervosa (BN) and 19.3% [N=50] with Eating Disorders Not Otherwise Specified (EDNOS)] and 160 healthy controls from the Province of Catalonia, Spain, who were matched for age and education. All patients were consecutively admitted to our Psychiatry Department and were diagnosed according to DSM-IV criteria. Participants completed the Early Eating Environmental Subscale of the Cross-Cultural (Environmental) Questionnaire (CCQ), a retrospective measure of childhood eating attitudes and behaviours. In the control group, also the General Health Questionnaire-28 (GHQ-28) was used. During childhood and early adolescence, the following main factors were identified to be linked to eating disorders: eating excessive sweets and snacks and consuming food specially prepared for the respondent. Conversely, regular breakfast consumption was negatively associated with an eating disorder. Compared to healthy controls, eating disorder patients report unfavourable eating patterns early in life, which in conjunction with an excessive importance given to food by the individual and the family may increase the likelihood for developing a subsequent eating disorder.     

Eating Disorder Examination Questionnaire (EDE-Q): Norms for Black women

The current study provides Eating Disorder Examination Questionnaire (EDE-Q) norms for Black undergraduate women (N = 395). EDE-Q subscale scores, clinical cutoffs, and disordered eating behavior were compared with previously published norms for primarily White undergraduate and community samples. The current sample endorsed mean EDE-Q scores similar to those of White females recruited from the community. Regarding clinical cutoffs, Black women in the current sample were most similar to White college women. Despite similar EDE-Q scores, the current sample endorsed significantly less binge eating and compensatory behaviors than White undergraduate or community women. Outcomes suggest that increased eating- and weight-related concerns among Black undergraduate women might not be associated with disordered eating behavior. Similarly, results suggest that the validity of EDE-Q cutoffs is lower in samples of Black women compared with samples of White women. Additional research is needed to enhance understanding of eating disorder risk factors for Black college women.     

The EDE-Q, BULIT-R, and BEDT as self-report measures of binge eating disorder

Binge eating disorder, currently classified as an eating disorder not otherwise specified, is a valid and clinically useful psychiatric diagnosis. Given its probable inclusion in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), identification of self-report measures with high levels of diagnostic utility should improve the likelihood and accuracy of screening. The aim of the current study was to assess the diagnostic utility of two widely used measures of eating disorder symptoms, namely the Eating Disorder Examination-Questionnaire (EDEQ) and the Bulimia Test-Revised (BULIT-R), as well as a factor of the BULIT-R (coined the Binge Eating Disorder Test or BEDT), newly created specifically for the assessment of BED. Participants included 15 individuals with BED and 26 non-BED controls, as determined via the diagnostic section of the Eating Disorder Examination, who met criteria for being overweight or obese. Results showed that the BEDT achieved 100% sensitivity, specificity, positive and negative predictive values. The BULIT-R and Eating Concern subscale of the EDE-Q evidenced strong sensitivity (100 vs 87), specificity (96 vs 100), positive predictive values (94 vs 100), and negative predictive values (100 vs 93), respectively. Results suggest that the BEDT is an excellent overall measure of BED in obese populations. The BULIT-R affords the advantage of ruling out compensatory behaviors, particularly of the non-purging variety (e.g., severe restriction outside of binges), while the brevity of the Eating Concern subscale of the EDE-Q makes it optimal for use in brief screening situations.     

Assessment of eating disorders in adolescents with anorexia nervosa: self-report questionnaire versus interview

OBJECTIVE: To compare the Eating Disorder Examination (EDE) with the self-report version (EDE-Q) in a population of adolescents with anorexia nervosa. METHOD: Twenty-eight adolescent women meeting criteria for anorexia nervosa were assessed using both measures. The self-report version (EDE-Q) was given both before and (Time 1) after (Time 2) administration of the interview-based version (EDE). RESULTS: The results comparing the EDE with the EDE-Q at Time 1 were consistent with previous studies. Specifically, high correlations were generated on each of the four subscales (Dietary Restraint, Eating Concern, Shape Concern, Weight Concern) where the EDE-Q consistently overestimated the EDE. However, significant differences between the two measures were found on all subscales except Dietary Restraint. Agreement was best for the Weight Concern subscale and worst for the Eating Concern subscales. Comparing the EDE with the EDE-Q at Time 2, agreement improved for all subscales whereas significant differences were found on only two of the four subscales (Eating Concern and Shape Concern). DISCUSSION: Adolescents with anorexia nervosa report information on the EDE-Q as well as any of the other populations that have been studied. The results suggest that providing information to participants before they complete the self-report measure could improve scores on the EDE-Q.     

Eating disorders and health in elite women distance runners.

OBJECTIVES: To examine the presence of eating disorder syndromes in elite women distance runners in the United Kingdom and any associated differences in training, dieting, general health, and well-being. METHOD: Athletes were selected from the top of their respective ranking lists for all middle and long-distance races in 1996/1997. All running disciplines were included (track, road, cross-country, and fell/mountain running). Athletes were sent the Eating Disorders Examination Questionnaire and a questionnaire on demographics, athletic training, diet, and health. Of the 226 athletes identified, 181 (81%) completed and returned the questionnaires. RESULTS: Twenty-nine athletes (16%) had an eating disorder at the time of the study (7 had anorexia nervosa [AN], 2 had bulimia nervosa [BN], and 20 had eating disorders not otherwise specified [EDNOS]) and a further 6 had received previous treatment. Comparing the eating disorder group with the rest of the sample showed no difference in age, height, preferred race distance, or the number of hours/week spent training. However, they had a significantly lower body mass index (BMI), lower self-esteem, and poorer mental health. Current and past dieting were significantly more common in the eating disorder group. DISCUSSION: The levels of AN and EDNOS are higher than would be expected in similarly aged, nonathletic women. The demands for leanness rather than exercise intensity appear to be the main risk in these elite runners. The early detection and prevention of eating disorders in women athletes should have high priority.     

Relationship between EDNOS and its subtypes and borderline personality disorder

OBJECTIVE: The purpose of this study was to assess the prevalence of eating disorder not otherwise specified (EDNOS) and four well-defined subtypes of this disorder found in a sample of female borderline patients. METHOD: The lifetime prevalence of EDNOS and its various subtypes among 233 female borderline patients and 46 female Axis II comparison subjects was assessed using the Structured Clinical Interview for DSM-III-R Axis I disorders. RESULTS: Thirty-three percent of female borderline patients met DSM-III-R criteria for EDNOS at some point in their lives. Of these 76 women, 20% reported a pattern of restricting without low weight, 37% reported a pattern of binging without purging, 37% reported a pattern of purging without binging, and 33% reported a pattern of low weight without loss of menses. However, less than 25% of these 76 borderline women had ever met criteria for anorexia nervosa or bulimia nervosa. CONCLUSIONS: The results of this study suggest that EDNOS is a separate cluster of eating disorders among borderline women, rather than a prodromal or residual form of a more clear-cut case of anorexia or bulimia nervosa.