Clinical Impairment Assessment Questionnaire Research Articles

A multi-center, randomized, parallel-group study to compare the efficacy of enhanced cognitive behavior therapy (CBT-E) with treatment as usual (TAU) for anorexia nervosa: study protocol

BackgroundThe superiority of Enhanced Cognitive Behavior Therapy (CBT-E) with regard to weight gain and improvement of psychopathology of eating disorders for patients with anorexia nervosa (AN) over other psychotherapies and treatment as usual (TAU) has not been demonstrated in randomized controlled trials (RCTs). However, a previous RCT showed that patients with AN whose baseline body mass index (BMI) was less than 17.5 kg/m2 gained more weight when treated with CBT-E than with other psychotherapies. The aim of the study is to compare the efficacy of CBT-E and TAU for patients with AN. It was hypothesized that CBT-E would be superior to TAU, at least in terms of weight gain, as most patients with AN are likely to have a BMI lower than 17.5 kg/m2.Methods/designA randomized parallel-group multicenter trial will be conducted in three teaching hospitals in Japan between January 2023 and March 2026. Patients with DSM-5 AN, aged 16 years and older, with a BMI equal to or above 14.0 and below 18.5 will be eligible to participate. 56 patients will be randomly and evenly assigned to two intervention groups (CBT-E and TAU). Those assigned to CBT-E will be offered 25–40 sessions in accordance with their initial BMI. Patients assigned to TAU will have at least one session every 2 weeks, with the number of sessions and treatment period not fixed in advance. The primary outcome is BMI at 40 weeks after treatment initiation. The secondary outcomes are the results from the Japanese version of the Eating Disorder Examination Questionnaire and Clinical Impairment Assessment questionnaire to measure eating disorder psychopathology and psychological impairment. The follow-up assessment will be performed 6 months after the 40-week assessment.DiscussionThis multi-center randomized controlled study will probably evaluate the efficacy of CBT-E compared with TAU for patients with more severe AN than in previous studies since Japanese patients are likely to have a lower BMI than those in Western countries. While it may be difficult to generalize the results of a study conducted in Japan, it would be valuable to clarify the efficacy of CBT-E as a treatment package.Trial registrationUMIN, UMIN000048847. Registered 12 Sep 2022.

Exploring the use of individualised patient-reported outcome measures in eating disorders: Validation of the Psychological Outcome Profiles.

Psychotherapies for eating disorders (EDs) are routinely assessed using standardised patient-reported outcome measures (PROMs). PROMs have been criticised for their lack of patient centeredness and clinical utility. The Psychological Outcome Profiles (PSYCHLOPS) is an individualised PROM that allows patients to specify their own outcomes. (1) To validate the use of the PSYCHLOPS in ED treatment, and (2) to identify patient concerns beyond those measured by common ED PROMs. Two hundred and seventy-eight emerging adult patients, presenting with a first-episode ED (aged 16-25, illness duration <3 years) completed the PSYCHLOPS and two standardised ED PROMs (the EatingDisorder Examination Questionnaire [EDE-Q] and the Clinical Impairment Assessment Questionnaire [CIA]) at four time points across 12 months. Psychometrics of the PSYCHLOPS were assessed quantitatively against the EDE-Q and CIA. Content analysis assessed unique patient concerns identified by PSYCHLOPS. The PSYCHLOPS had adequate to good psychometric properties. A total of 53.3% of participants reported a concern not addressed by the EDE-Q or the CIA, the most common being depression/anxiety, academic problems, treatment concerns and disturbed sleep. PROMs can be complemented by the PSYCHLOPS to identify problems specific to an individual's context. As ED patients are typically ambivalent about change, understanding their concerns is vital in building motivation for change.

Cross-cultural adaptation and translation into Brazilian Portuguese of the instruments Sick Control One Stone Fat Food Questionnaire (SCOFF), Eating Disorder Examination Questionnaire (EDE-Q) and Clinical Impairment Assessment Questionnaire (CIA).

Introduction Eating disorders (EDs) affect up to 13% of young people and are associated with significant morbidity and mortality. Nevertheless, important, internationally recognized instruments for brief ED screening (Sick Control One Stone Fat Food Questionnaire [SCOFF]), symptom severity assessment and diagnosis (Eating Disorder Examination Questionnaire [EDE-Q]) and assessment of ED-associated psychosocial impairment (Clinical Impairment Assessment Questionnaire [CIA]) were not yet available in Brazilian Portuguese. Our objective was to perform the cross-cultural adaptation and translation into Brazilian Portuguese of the instruments SCOFF, EDE-Q and CIA.Method The process involved a series of standardized steps, as well as discussions with experts. First, the relevance and adequacy of the scales’ items to our culture and population were extensively discussed. Then, two independent groups translated the original documents, creating versions that were compared. With the participation of external ED experts (i.e., who did not take part in the translation process), synthesized versions were produced. The syntheses were then applied to a focal group of patients with ED (n = 8). After that step, a preliminary version of the three scales in Brazilian Portuguese was produced and sent for back-translation by two English native speakers, who worked independently. A synthesis of the back-translations, along with the preliminary versions in Brazilian Portuguese, were sent to the original authors.Results The Brazilian Portuguese versions of SCOFF, EDE-Q and CIA were approved by the original authors and are now available for use.Conclusion This study provides important tools for the ED research field in Brazil.

Development of a new Japanese version of the Clinical Impairment Assessment Questionnaire

BackgroundThe Clinical Impairment Assessment questionnaire (CIA) is used to measure the severity of psychosocial impairment in patients with eating disorders. The purpose of the present study was to develop a new Japanese version of the CIA (CIA-J) and to evaluate its reliability and validity.MethodsWe translated the sixteen items of the CIA into Japanese, back-translated them into English, and had them verified by a native English speaking professional editor. Participants were 152 Japanese-speaking patients (30.4 ± 10.6 years) under treatment for eating disorders and 173 healthy controls (29.5 ± 8.3 years). In addition to the CIA-J, the participants were asked to answer the Eating Attitudes Test (EAT26), The Positive and Negative Affect Schedule (PANAS), and the Hospital Anxiety and Depression Scale (HADS). We performed confirmatory factor analyses to evaluate the factor structure, calculated the Cronbach’s alphas of the CIA-J to assess the reliability, and calculated the correlation coefficients between the CIA-J score and those of EAT26, PANAS, and HADS to assess concurrent validity. We also used a Kruskal-Wallis test followed by Steel-Dwass test to compare the scores of the subtypes of eating disorders and the healthy control group.ResultsA three-factor structure was obtained, similar to the original version. The Cronbach’s alphas of both the global and subscale scores of the CIA-J were high. The CIA-J had significant positive correlations with the EAT26, the negative affect subscale of the PANAS, and the HADS. The global and subscale scores for all subtypes of eating disorders were significantly higher than those of the healthy control group.ConclusionsThe CIA-J was determined to be reliable and valid for assessing the severity of psychosocial impairment in patients with eating disorders.

Association between gastrointestinal complaints and psychopathology in patients with anorexia nervosa.

Gastrointestinal (GI) symptoms appear frequently in patients with anorexia nervosa (AN), but the associations between psychopathological, GI, and eating disorder (ED) symptoms remain unclear. This study aimed to determine the relationships of GI complaints with psychopathological measures, ED symptoms, and body mass index (BMI) in patients with AN. Thirty outpatients with AN aged >16 years were included. Psychopathological measures (Symptom Checklist-90-Revised, Beck Depression Inventory-II, and Beck Anxiety Inventory), ED symptoms (Eating Disorder Examination Questionnaire), ED-associated impairment (Clinical Impairment Assessment Questionnaire), GI complaints (Irritable Bowel Syndrome Severity Scoring System [IBS-SSS]), and BMI were assessed prior to starting treatment, and correlation and multiple regression analyses were applied to data from 19 patients. IBS-symptoms were significantly correlated only with ED symptoms (r = 0.583, p = .009) and somatization (r = 0.666, p = .002). Multiple regression analysis revealed that somatization significantly predicted worse IBS symptoms (beta = 0.5, p = .04), while ED symptoms did not. Higher IBS-SSS scores were associated with higher severities of other somatic complaints. GI complaints and somatization should be addressed in treatments for AN in order to prevent these factors impeding the establishment of healthy eating patterns. ClinicalTrials.gov Identifier: NCT02745067.

The clinical impairment assessment questionnaire: validation in Italian patients with eating disorders.

The Clinical Impairment Assessment (CIA) is a measure of functional impairment secondary to eating disorder symptoms. The aim of this study was to examine the psychometric proprieties of the Italian-language version of the CIA. The tool was translated into Italian and administered to 259 Italian-speaking in- and outpatients with eating disorders and 102 healthy controls. The clinical group also completed the Eating Disorder Examination Questionnaire (EDE-Q) and the Brief Symptom Inventory (BSI). Confirmatory factor analysis revealed a good fit for the original three-factor structure. Internal consistency was high for both the global CIA and all subscale scores, and test-retest reliability was acceptable. The high correlation between CIA and EDE-Q and BSI confirmed the convergent validity of the instrument. T test indicated higher raw scores on CIA in patients with eating disorders than healthy controls, and a cut-off score of 16 on the CIA discriminated between eating disorder and general psychopathology scores. Finally, global CIA and subscale scores were significantly higher in patients who reported objective bulimic episodes, purging behaviours, and excessive exercising than in those who did not; in underweight than in not-underweight patients, and in inpatients than outpatients, confirming the good known-groups validity of the tool. Overall, the study showed the good psychometric properties of the Italian version of the CIA, and validated its use in Italian-speaking eating disorder patients. Level V, Descriptive study.

Eating psychopathology and psychosocial impairment in patients treated at a Singapore eating disorders treatment programme.

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.

Eating Disorder Examination Questionnaire (EDE-Q) and Clinical Impairment Assessment (CIA): clinical norms and functional impairment in male and female adults with eating disorders

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.

Measures of eating disorder symptoms, drive for muscularity, and muscle dysmorphia: Norms and typologies of Australian men

ObjectiveThe study aimed to provide normative data on measures of eating disorder symptoms, drive for muscularity, and muscle dysmorphia in men, and to identify typologies based on these measures.MethodA community sample of 284 Australian men (19–84 years) completed the Eating Attitudes Test‐26, Eating Disorder Examination‐questionnaire, Clinical Impairment Assessment Questionnaire, Drive for Muscularity Scale, and Muscle Dysmorphia Inventory. Internal consistency, means, standard deviations, and percentile ranks were calculated for each measure, and results were compared with published findings on men from North America and Germany. A cluster analysis was also conducted.ResultsInternal consistency was adequate to excellent across most measures, and scores were similar to those of men in other countries. Cluster analysis identified three typologies: men with high muscularity, shape, and weight concerns as well as high dieting and exercise dependence; men with moderate shape and weight concerns, moderate muscularity concerns, and high dieting; and men with low to moderate scores across all measures.ConclusionsThe normative data provided will be an important resource for researchers and clinicians needing to utilise and interpret measures of eating disorder, muscle dysmorphia, and drive for muscularity with men. In addition, the typologies identified suggest that when assessing men attention should be paid to attitudes and behaviours related to both drive for muscularity and drive for thinness.

Psychological and behavioural characteristics of females with anorexia nervosa in Singapore.

This study aimed to compare a sample of females with anorexia nervosa in Singapore with international clinical and population samples from published data in terms of endorsement of risk factors related to anorexia nervosa, severity of eating pathology and levels of psychosocial impairment and to explore the nature of the relationships between the anorexia nervosa risk factors and adherence to Asian cultural values. Data from the Eating Disorder Inventory-3 (EDI-3), the Eating Attitudes Test (EAT-26), the Perceived Sociocultural Pressure Scale (PSPS), the Ideal Body Stereotype Scale (IBSS), the Eating Disorder Examination Questionnaire (EDE-Q), the Clinical Impairment Assessment Questionnaire, and the Asian American Values Scale-Multidimensional (AAVS-M) were collected from 41 female patients (13-31years old) who presented for treatment of anorexia nervosa at the Singapore General Hospital. The profile and presentation of anorexia nervosa in Singapore was comparable to that observed in the Western clinical samples in terms of levels of endorsement of the risk factors for anorexia nervosa. No protective benefit of orientation to Asian culture was found. The observed pattern of general similarity of presentation between Western data and Singaporean data, together with the finding that no protective benefit of orientation to Asian culture was observed, suggests that it may be appropriate to directly apply evidence-based Western models of intervention to the treatment of anorexia nervosa in Singapore.

Adaptation and validation of the Spanish version of the Clinical Impairment Assessment Questionnaire

The Clinical Impairment Assessment (CIA) assesses psychosocial impairment secondary to an eating disorder. The aim of this study was to create and validate a Spanish-language version of the CIA. Using a forward–backward translation methodology, we translated the CIA into Spanish and evaluated its psychometric characteristics in a clinical sample of 178 ED patients. Cronbach's alpha values, confirmatory factor analysis (CFA), and correlations between the CIA and the Eating Attitudes Test-12 and the Health-Related Quality of Life in ED-short form questionnaires evaluated the reliability, construct validity, and convergent validity, respectively. Known-groups validity was also studied comparing the CIA according to different groups; responsiveness was assessed by means of effect sizes. Data revealed a three-factor structure similar to that of the original CIA. Cronbach alpha coefficient of 0.91 for the total CIA score supported its internal consistency and correlations with other instruments demonstrated convergent validity. The total CIA score and factor scores also significantly discriminated between employment status, evidencing known-groups validity. Responsiveness parameters showed moderate changes for patients with restrictive eating disorders. These findings suggest that the CIA can be reliably and validly used in Spain in a number of different clinical contexts, by researchers and clinicians alike.

Eating disorder examination questionnaire and clinical impairment assessment questionnaire: General population and clinical norms for young adult women in Sweden

Optimal use of assessment instruments for the detection and diagnosis of eating disorders (ED) depends on the availability of normative data. The aim of this work was to, for the first time, collect norms for both the Eating Disorder Examination Questionnaire (EDE-Q) and the newly developed Clinical Impairment Assessment (CIA) Scale from a general population of young women in Sweden, as well as from a clinical population of ED patients in Sweden. Participants were composed of both a randomized sample from the general population of women aged 18–30 years (N = 760) as well as from a clinical population aged 18–66 years (N = 2383). Data for the clinical population was extracted from the Stepwise database. Mean scores, standard deviations and percentile ranks for the global for the EDE-Q (as well as its subscales) and the CIA are presented. Prevalence figures of key eating disorder behaviors are also reported. Comparisons are made between the results in the present study with other existing normative studies on the EDE-Q and the CIA. The present study contributes to improving the accuracy of the interpretation of scores of the widely used self-report measure of ED, the EDE-Q, and the CIA, both of which play important roles in for diagnosis, prevention and intervention of ED.