How do adult inpatients with ARFID or AN-R compare on self-report eating disorder assessments?

Aim: The aim of the current study was to collect clinical normative data for the Clinical Impairment Assessment questionnaire (CIA) and the Eating Disorder Examination Questionnaire (EDE-Q) from adult patients with eating disorders (EDs). This study also examined unique contributions of eating disorder (ED) symptoms on levels of ED-related impairment.Methods: A sample of 667 patients, 620 females and 47 males, was recruited from six specialist centres across Norway. The majority of the sample (40.3%) was diagnosed with eating disorder not otherwise specified (EDNOS), 34.5% had bulimia nervosa (BN), and 25.2% were diagnosed with anorexia nervosa (AN).Results: There were significant differences for global EDE-Q and CIA scores between females and males. In the female sample, significant differences were found on several EDE-Q sub-scales between the AN and BN group, and between the AN and EDNOS group. No significant differences were found between the diagnostic groups on the CIA. In the male sample, no significant differences were found between diagnostic groups on the EDE-Q or CIA. A multiple regression analysis revealed that 46.8% of the variance in impairment as measured by the CIA was accounted for by ED symptoms.Conclusions: Body mass index, Eating Concern, Shape/Weight Concern, and binge eating served as significant, unique predictors of impairment. The results from the present study contribute to the interpretation of EDE-Q and CIA scores in ED samples.

To examine the psychometric properties of the Parent Eating Disorder Examination Questionnaire (PEDE-Q), developed to improve eating disorder (ED) assessment among youth by including parents as informants. A multi-site, transdiagnostic sample of 355 adolescents with EDs completed the Eating Disorder Examination Questionnaire (EDE-Q) and their parents completed the PEDE-Q. The internal consistencies of the PEDE-Q subscales were on par with established EDE-Q ranges (.73 to .90), both when examined using the original four-factor EDE-Q subscales and the seven-item, three-factor subscales of the brief EDE-Q. Statistically significant medium- to large-sized correlations and poor to moderate levels of agreement were found between the corresponding EDE-Q and PEDE-Q subscales. Receiver-operator characteristic (ROC) curves showed that the PEDE-Q had a statistically significant area under the curve (AUC) to maximize sensitivity and specificity in diagnosing full-syndrome AN, whereas the EDE-Q did not. Based on chi-square analyses, the PEDE-Q identified a statistically significantly greater number of AN cases than the EDE-Q. The EDE-Q yielded a BN diagnosis more frequently than the PEDE-Q, although this difference was not statistically significant. Results suggest that the PEDE-Q has good psychometric properties and provides incremental information that can aid in the assessment and diagnosis of adolescents with EDs, particularly those with AN. There exist complex challenges to identifying clinically significant eating disorders among youth. The PEDE-Q is a questionnaire measure that improves eating disorder assessment among children and adolescents by asking parents to report on the symptoms and behaviors they have observed in their child and that youth may not fully disclose. The PEDE-Q can aid in the diagnosis of adolescents with eating disorders, particularly those with anorexia nervosa.

ObjectiveThis review aimed to examine the validity of self‐report screening questionnaires for identifying eating disorder (ED) risk in adults and adolescents with overweight/obesity.MethodFive databases were searched from inception to September 2020 for studies assessing validation of self‐report ED screening questionnaires against diagnostic interviews in adolescents and adults with overweight/obesity. The review was registered with PROSPERO (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=220013).ResultsTwenty‐seven papers examining 15 questionnaires were included. Most studies validated questionnaires for adults (22 of 27 studies), and most questionnaires (12 of 15) screened for binge eating or binge‐eating disorder (BED). The Eating Disorder Examination Questionnaire (sensitivity = .16–.88, specificity = .62–1.0) and Questionnaire on Eating and Weight Patterns (sensitivity = .07–1.0, specificity = .0–1.0) were most frequently validated (six studies each). Five studies of three questionnaires were in adolescents, with the Adolescent Binge‐Eating Disorder Questionnaire having highest sensitivity (1.0) but lower specificity (.27). Questionnaires designed to screen for BED generally had higher diagnostic accuracy than those screening for EDs in general.DiscussionQuestionnaires have been well validated to identify BED in adults with overweight/obesity. Validated screening tools to identify other EDs in adults and any ED in adolescents with overweight/obesity are lacking. Thus, clinical assessment should inform the identification of patients with co‐morbid EDs and overweight/obesity.Public SignificanceIndividuals with overweight/obesity are at increased risk of EDs. This review highlights literature gaps regarding screening for ED risk in this vulnerable group. This work presents possibilities for improving care of individuals with overweight/obesity by reinventing ED screening tools to be better suited to diverse populations.

Introduction: Changes in self-concept have been considered to play a crucial role in the etiology of eating disorders. In this study, we evaluate the levels of self-concept and severity of the disturbed eating behavior in a clinical population of adolescents with Eating Disorders (ED) and study their correlations. Method: A sample of 50 patients of an Adolescent Psychiatric Service completed two validated self-report scales: the Piers- Harris Children’s Self-concept Scale (PHCSCS) and the Eating Disorder Examination - Questionnaire (EDE-Q). Anthropometric data were also collected. Results:Total self-concept had a negative correlation with disease severity [total EDE-Q (rs= -0.48)], as well as with four subscales of the EDE-Q [Dietary Restraint (rs =-0.30); Weight Concern (rs=-0.44); Shape Concern (rs=-0.56); and Eating Concern (rs=-0.40)]. Four of the PHCSCS subscales showed a negative correlation with the severity of the disease [Behavioral Adjustment (rs=-0.39); Freedom from Anxiety (rs=-0.56); Popularity (PO) (rs=-0.43) and Happiness and Satisfactions (HS) (rs=-0.39)]. Then the sample was divided into two groups: Compulsive / Purgative [5 Bulimia Nervosa (BN) + 3 Unspecified Feeding and Eating Disorder (UFED) with insufficient criteria for BN] and Restrictive (38 Anorexia Nervosa + 4 UFED with insufficient criteria for AN). The Compulsive / Purgative group had lower Self-concept than the Restrictive group (p <0.05). This first group also presented lower values than the Restrictive group in all subscales of the PHCSCS, but with statistical significance only in the Intellectual and School Status and HS. It also presented higher disease severity (p <0.05), with higher values in all four EDE-Q subscales, but with statistical significance only in Weight Concern (p <0.05).Conclusions: These results are in agreement with the literature that the Self-concept is altered in ED. In our study, we report an inverse correlation between self-concept and dysfunctional eating behaviors. The Compulsive/Purgative group reported a lower self-concept and greater severity of the eating behavior pathology, but there were no clinical differences between the two groups. This finding may be explained by the lower morbidity awareness of the Restrictive group.

The current study compared the Eating Disorders Examination (EDE) and the Eating Disorders Examination-Questionnaire (EDE-Q) in adolescents with eating disorders. 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. 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. 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.

Early identification of factors that predict readmission could enhance treatment planning and reduce re-hospitalization. This study evaluated the predictive value of the Eating Disorder Examination-Questionnaire (EDE-Q) for inpatient readmission for adolescents with AN. This retrospective longitudinal study included 226 adolescent participants admitted to an inpatient eating disorder unit. Adolescents completed the EDE-Q within the first 14 days of admission; demographic variables, anxiety and mood comorbidities, and readmission status within 1 year of discharge were obtained through chart review. While higher scores on the EDE-Q global score and subscales for Eating, Shape, and Weight Concerns were significantly associated with readmission, when controlling for demographic variables and length of hospital stay in multivariate regressions, both Eating Concerns and Weight Concerns subscales were trending toward significance (p = .11, p = .06, respectively). Multivariate logistic regression adjusting for demographic variables showed that higher scores on the EDE-Q global score, and Eating Concern, Shape Concern, and Weight Concern subscales were associated with increased odds of comorbid mood or anxiety disorders with an OR of 1.27 (1.03, 1.57), p = .02; OR of 1.47 (CI 1.17, 1.83), p = .001; OR 1.27 (CI 1.05, 1.54), p = .02; and OR 1.22 (CI 1.02, 1.47), p = .03, respectively. These findings underscore how self-report measures like the EDE-Q can highlight more complex psychopathology with regard to comorbidities. Future research with larger sample sizes will be necessary to establish the predictive validity of the EDE-Q for readmissions of adolescents with Anorexia Nervosa.

ObjectivesThe objectives of this study were to (1) validate the Norwegian version of the Compulsive Exercise Test (CET) in adults with longstanding eating disorders, and (2) explore predictors of high CET-score.Methods:Adult inpatients (n = 166) with longstanding DSM-IV Anorexia Nervosa, Bulimia Nervosa (BN) or Eating Disorder not Otherwise Specified (EDNOS) completed the CET instrument, Eating Disorder examination questionnaire (EDE-Q), Beck Depression Inventory-II (BDI-II) and Symptom checklist-90 (SCL-90). A total CET score of 15 or above was defined as high CET-score. ANOVA, Confirmatory factor analysis, Pearson’s correlation, and logistic regression were used to analyze the data.ResultsCronbach’s alpha varied from 0.68 to 0.96 for the CET and its subscales. The confirmatory factor analysis showed adequate fit. Convergent validity of the CET demonstrated correlation between EDE-Q global and subscale scores and CET total score. The same pattern was found for correlation between CET subscales and EDE-Q subscales. EDE-Q global score and frequency of exercise episodes predicted high CET-score, yet 21% of the patients with high CET score had less than one episode of exercise per week.ConclusionThe Norwegian version of CET is valid and useful for assessing compulsive exercise in a sample with longstanding ED. The understanding of compulsive exercise must to a greater extent differ between obsessions and compulsions, as a significant number of patients with high CET score showed no or little exercise behavior.

There is limited data on the psychopathology of eating disorders in Singapore. This study: (a) described levels of eating psychopathology and psychosocial impairment among individuals diagnosed with eating disorders at our hospital; and (b) compared the related psychopathology of these patients. Between 1 August 2010 and 31 July 2012, 257 individuals who met the diagnostic criteria for eating disorders completed the Eating Disorder Examination Questionnaire (EDE-Q) and Clinical Impairment Assessment questionnaire (CIA). A majority of participants were women and of Chinese ethnicity. Diagnoses included anorexia nervosa (AN; 41.6%), bulimia nervosa (BN; 29.6%) and eating disorder not otherwise specified (EDNOS; 28.8%). Mean age at presentation was 20.52 ± 7.14 years and mean body mass index was 17.84 ± 4.18 kg/m2. Individuals with AN were significantly younger at presentation and had shorter duration of untreated illness compared to those with BN and EDNOS. There were no significant differences in the CIA scores of the diagnostic groups. Participants with BN scored higher in all subscales of the EDE-Q than those with AN and EDNOS. Our sample scored lower in most subscales of EDE-Q when compared to treatment centres in Sweden, Australia and the United States. Our clinical sample reported lower scores of psychopathology compared to overseas centres. This could be attributed to the higher percentages of BN and EDNOS diagnosed in overseas populations. Individuals with AN showed higher levels of psychopathology in our study compared to patients from the United States.

Background: There is large variability in the way that outcomes are measured for avoidant/restrictive food intake disorder (ARFID), with many studies focusing solely on weight gain or using measures that are not designed or validated to assess ARFID symptoms, such as the widely used Eating Disorders Examination-Questionnaire (EDE-Q). Objective: The current study compared treatment outcomes for children/adolescents with ARFID to children/adolescents with anorexia nervosa-restricting subtype (AN-R) on weight variables (% of expected body weight (%EBW)), ARFID symptoms as measured using the Eating Disorders in Youth-Questionnaire (EDY-Q), and eating disorder (ED) symptoms (as measured using the EDE-Q). Scores for both groups of patients on each measure were examined to preliminarily determine the appropriateness of each measure for each diagnosis. Method: Participants were 220 children/adolescents aged 9 to 17 receiving treatment at a large multisite treatment facility between November 2020 and June 2023. Self-report questionnaires were completed at intake and discharge, and weight was recorded throughout treatment. Results: EDY-Q, EDE-Q, and %EBW scores changed significantly (p < 0.001) from admission to discharge for both groups of patients. Effect sizes for changes in EDY-Q were similarly large for patients with AN-R (d = 0.91) and ARFID (d = 0.83). Effect sizes for changes in EDE-Q were large for patients with AN-R (d = 0.79) and small-to-medium for patients with ARFID (d = 0.47). Conclusions: Results suggest that the EDY-Q may be assessing symptoms present in both patients with ARFID and patients with AN-R. The study’s findings suggest that the EDE-Q is not an appropriate measure for assessing outcomes among patients with ARFID.

Objective: The aim of this study was to examine the psychometric properties and factorial structure of the Schema Mode Inventory for Eating Disorders (SMI-ED) in a disordered eating population.Method: 573 participants with disordered eating patterns as measured by the Eating Disorder Examination Questionnaire (EDE-Q) completed the 190-item adapted version of the Schema Mode Inventory (SMI). The new SMI-ED was developed by clinicians/researchers specializing in the treatment of eating disorders, through combining items from the original SMI with a set of additional questions specifically representative of the eating disorder population. Psychometric testing included Confirmatory Factor Analysis (CFA) and internal consistency (Cronbach's α). Multivariate Analyses of Covariance (MANCOVA) was also run to test statistical differences between the EDE-Q subscales on the SMI-ED modes, while controlling for possible confounding variables.Results: Factorial analysis confirmed an acceptable 16-related-factors solution for the SMI-ED, thus providing preliminary evidence for the adequate validity of the new measure based on internal structure. Concurrent validity was also established through moderate to high correlations on the modes most relevant to eating disorders with EDE-Q subscales. This study represents the first step in creating a psychometrically sound instrument for measuring schema modes in eating disorders, and provides greater insight into the relevant schema modes within this population.Conclusion: This research represents an important preliminary step toward understanding and labeling the schema mode model for this clinical group. Findings from the psychometric evaluation of SMI-ED suggest that this is a useful tool which may further assist in the measurement and conceptualization of schema modes in this population.

Introduction: Weight management through dieting and rapid weight loss (RWL) is central to performance in weight-classified combat sports but may increase the risk of disordered eating (DE). Perfectionism, a common trait among athletes, can have both adaptive and maladaptive effects and contribute to DE. Objective: To examine the relationship between DE, perfectionism, and weight management practices among striking- and grappling-based combat sport athletes. Methodology: Forty-six active athletes from kickboxing (n = 31; 42% female) and Brazilian jiu-jitsu (BJJ; n = 15; 27% female) completed the Eating Disorder Examination Questionnaire (EDE-Q) 6.0 and the Sport Multidimensional Perfectionism Scale-2 (Sport-MPS-2). Results: Kickboxers reported competing 4.8 ± 5.5 kg below their noncompetition weight, whereas BJJ athletes competed at nearly the same weight. No group differences in EDE-Q or Sport-MPS-2 scores were observed. On average, the athletes exhibited few symptoms of DE, but 15% scored above the cut-off of 2.3 on the EDE-Q global score. Both adaptive and maladaptive perfectionism were associated with EDE-Q subscales, with adaptive perfectionism also being associated with training experience and competition status. Discussion: These findings suggest that combat sport athletes are influenced by both social and psychological factors in their approach to weight management. The results were consistent with existing research showing mixed effects of perfectionism and the influence of peers and coaches on weight management practices. Conclusions: Despite generally low levels of disordered eating, combat sports athletes frequently engage in dieting and RWL practices, highlighting the need for coach- and athlete-focused education on safer weight management.

Objective:The Nine Item ARFID Scale (NIAS) is a widely used measure assessing symptoms of avoidant/restrictive food intake disorder (ARFID). Previous studies suggest that individuals with eating disorders driven by shape/weight concerns also have elevated scores on the NIAS. To further describe NIAS scores among individuals with diverse current and previous eating disorders, we characterized NIAS scores in a large sample of individuals with eating disorders and evaluated overlap in symptoms measured by the NIAS and the Eating Disorder Examination-Questionnaire (EDE-Q) version 6.0.Method:Our sample comprised 9148 participants from the Eating Disorders Genetics Initiative Sweden (EDGI-SE), who completed surveys including NIAS and EDE-Q. NIAS scores were calculated and compared by eating disorder diagnostic group using descriptive statistics and linear models.Results:Participants with current anorexia nervosa demonstrated the highest mean NIAS scores and had the greatest proportion (57.0%) of individuals scoring above a clinical cutoff on at least one of the NIAS subscales. Individuals with bulimia nervosa, binge-eating disorder, and other specified feeding or eating disorder also demonstrated elevated NIAS scores compared to individuals with no lifetime history of an eating disorder (ps < 0.05). All subscales of the NIAS showed small to moderate correlations with all subscales of the EDE-Q (rs = 0.26–0.40).Discussion:Our results substantiate that individuals with eating disorders other than ARFID demonstrate elevated scores on the NIAS, suggesting that this tool is inadequate on its own for differentiating ARFID from shape/weight-motivated eating disorders. Further research is needed to inform clinical interventions addressing the co-occurrence of ARFID-related drivers and shape/weight-related motivation for dietary restriction.

Eating Disorders

"Virtual reality" (VR) has been used effectively in clinical psychology to improve existing treatments and prevention protocols for many psychopathologies, including eating disorders (EDs). However, no VR software was developed to concurrently tackle dysfunctional eating behaviours and three third wave cognitive-behavioural transdiagnostic factors linked to EDs: psychological inflexibility, emotion dysregulation and experiential avoidance. This preliminary study is aimed at evaluating potential effects of a new VR-based preventive intervention (H.O.M.E.-How to Observe and Modify Emotions) in improving selected outcomes of transdiagnostic factors and dysfunctional eating behaviours in the general population (GP) with ED risk compared to a waiting list (WL). N = 40 GP participants with ED risk were screened (using the SCOFF and Eating Disorder Examination Questionnaire (EDE-Q)) and randomised into VR (n = 20) or WL (n = 20) groups. Before and after intervention and at 3- and 6-month follow-up, participants completed EDE-Q, Difficulties in Emotion Regulation Scale-brief version (DERS-16) for emotion dysregulation, Acceptance and Action Questionnaire II (AAQ-II) for psychological inflexibility and Multidimensional Psychological Flexibility Inventory (MPFI) experiential avoidance scale. H.O.M.E. improved scores in all EDE-Q subscales (EDE-Q-total: p = 0.003; EDE-Q-restraint: p = 0.028; EDE-Q-eating concerns: p = 0.035; EDE-Q-shape concerns: p = 0.003; EDE-Q-weight concerns: p = 0.023), AAQ-II (p = 0.005), DERS-16-total (p = 0.006), DERS-16-difficulty in engaging in goal-directed behaviours (p = 0.008), and DERS-16-limited access to emotion regulation strategies (p = 0.001), with results greater than WL and maintained at follow-ups. Results showed potential for H.O.M.E. to represent a feasible tool to prevent EDs. Given the similarity between VR and technologies used in everyday life, H.O.M.E. may help in engaging young individuals with ED risk towards psychological support before ED onset.

BackgroundIndividuals with eating disorders (EDs) have an increased risk of treatment resistant depression (TRD) and treatment resistant bipolar disorder (TRBD) and a higher rate of suicidal ideation and death by suicide than individuals without EDs. Individuals with EDs are less responsive to conventional treatments for mood disorders than individuals without EDs. Ketamine has evidence for treatment of TRD and TRBD and for the treatment of acute suicidality. Ketamine has also been shown to be safe in individuals with EDs who are malnourished. This study is among the first to examine the efficacy of ketamine in TRD and TRBD in patients with co-occurring EDs at higher levels of care.MethodsParticipants were 85 adults admitted to an ED treatment facility who received subanesthetic intranasal generic ketamine compared to a sample of 85 adults matched for age, sex, gender, race, diagnosis, and level of care at admission admitted to the same facilities who did not receive ketamine. Participants completed the Eating Disorder Examination Questionnaire (EDE-Q), Patient Health Questionnaire-9 (PHQ-9), suicidal ideation (PHQ-9 Item 9) and Generalized Anxiety Disorder-7 (GAD-7) at admission and discharge.ResultsPatients receiving ketamine and matched controls were not significantly different on age, sex, gender, race, diagnosis, or level of care at admission. There were no significant differences between groups on admission for all EDE-Q subscales, PHQ-9, suicidal ideation, or GAD. All patients, irrespective of use of ketamine, improved significantly from admission to discharge on all outcomes. There were no significant differences between groups for change in all EDE-Q subscales, change in PHQ-9, change in suicidal ideation, or change in GAD-7. Patients receiving ketamine had significantly longer lengths of stay than controls (b = 0.39, p = .01). The lack of significant differences was maintained irrespective of predicting raw change, controlling for admission scores, or additionally controlling for length of stay.ConclusionsIn a population of individuals seeking higher level of care for an ED and controls matched for age, gender, sex, diagnosis, level of care, and race, treatment with ketamine was associated with significant reductions in depression and ED severity, but not more so than individuals not treated with ketamine. Findings from the study suggest that ketamine may be a viable treatment option for individuals with EDs, however, further research is needed to determine ketamine’s efficacy in treating EDs with comorbid depression.