Eating Disorder Scale Research Articles

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.

Posttraumatic Stress Disorder in Anorexia Nervosa

Comorbidity among eating disorders, traumatic events, and posttraumatic stress disorder (PTSD) has been reported in several studies. The main objectives of this study were to describe the nature of traumatic events experienced and to explore the relationship between PTSD and anorexia nervosa (AN) in a sample of women. Eight hundred twenty-four participants from the National Institutes of Health-funded Genetics of Anorexia Nervosa Collaborative Study were assessed for eating disorders, PTSD, and personality characteristics. From a final sample of 753 women with AN, 13.7% (n = 103) met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for PTSD. The sample mean age was 29.5 (standard deviation = 11.1) years. In pairwise comparisons across AN subtypes, the odds of having a PTSD diagnosis were significantly lower in individuals with restricting AN than individuals with purging AN without binge eating (odds ratio = 0.49, 95% confidence interval = 0.30-0.80). Most participants with PTSD reported the first traumatic event before the onset of AN (64.1%, n = 66). The most common traumatic events reported by those with a PTSD diagnosis were sexually related traumas during childhood (40.8%) and during adulthood (35.0%). AN and PTSD do co-occur, and traumatic events tend to occur before the onset of AN. Clinically, these results underscore the importance of assessing trauma history and PTSD in individuals with AN and raise the question of whether specific modifications or augmentations to standard treatment for AN should be considered in a subgroup to address PTSD-related psychopathology.

Reliability and validity of the Conditional Goal Setting in Eating Disorders Scale (CGS-EDS) among adults with eating disorders

The aim of this study was to develop and validate a self-report measure of Conditional Goal Setting (CGS) for use among individuals with eating disorders, the Conditional Goal Setting in Eating Disorders Scale (CGS-EDS). The CGS-EDS assesses the degree to which an individual believes that the achievement of happiness is contingent upon the attainment of body shape and weight goals. Women with a DSM-IV diagnosed eating disorder consecutively referred to a specialist outpatient clinic ( N = 238) completed the CGS-EDS and self-report measures of theoretically related constructs. Exploratory factor analysis indicated a one-factor solution, which accounted for 65% of the variance. The CGS-EDS correlated positively with theoretically related measures of overvaluation of shape and weight, concern with shape and weight, dichotomous thinking, and depression. The alpha reliability of the scale was .92. The CGS-EDS is a valid and reliable measure of CGS in eating disorders and is relevant to cognitive and behavioral models of maintenance and intervention.

Glucagon-like peptide-1 secretion in bulimia nervosa

Blood concentrations of the satiety-inducing glucagon-like peptide-1 (GLP-1) were compared in 20 bulimic patients and 20 healthy controls to examine whether secretory impairment of the peptide could be involved in bulimia nervosa (BN). Basal GLP-1 concentrations were measured by means of an enzyme-linked immunosorbent assay (ELISA) in blood samples taken four times over a 12-h period (08.00h, 12.00h, 16.00h, 20.00h) and seven times over a 3-h period following administration of a test meal. Eating-related and non-eating related patients' psychopathological aspects were measured by the use of a battery of ad hoc rating scales (Eating Disorder Inventory-2 = EDI-2, Bulimic Investigation test-Edinburgh = B.I.T.E., Montgomery–Åsberg Depression Rating Scale = MADRS, Spielberger State-Trait Anxiety Inventory = STAI, Yale–Brown–Cornell Eating Disorder Scale = YBC-EDS). Basal GLP-1 values were higher in patients than in controls only in the blood samples taken at 16.00h, whereas no difference between patients and controls was observed in GLP-1 concentrations in response to the test meal stimulation. GLP-1 levels correlated positively with bingeing–vomiting frequency, with B.I.T.E. scores and the “bulimia” subitem scores of the EDI-2 scale, and negatively with the “ascetism” subitem score of the same scale.

Phobie sociale dans l’anorexie mentale : évolution au cours des soins

The links between anorexia nervosa (AN) and anxiety disorders, and particularly social phobia, are little known. However, social phobia occurs frequently in AN. Some studies have shown reduction in anxious and depressive symptomatology in AN with re-nutrition. But, to our knowledge, no work has examined the evolution of social phobia symptoms during re-nutrition in AN. To specify the links between AN, nutritional state, and social phobia. The population consisted of 2 samples and the analysis was conducted using the SPSS11.5. Sample 1 (N=24 AN) was evaluated on admission and on leaving the hospital. Our evaluation used the body mass index (BMI), the Liebowitz scale, the Mini International Neuropsychiatric Interview (MINI), and the Yale-Brown Obsessive Compulsive Scale for Eating Disorders scale (Y-BOCS-ED) respectively to evaluate or diagnose the state of malnutrition, social anxiety symptomatology, social phobia in Diagnostic and Statistical Manual-4 (DSM-IV) and anorexic symptomatology. Sample 2 (N=60) was assessed at the end of the hospitalization and then 6, 12 and 18 months later. We used the BMI, Liebowitz scale, MINI, and Eating Disorders Inventory (EDI) to assess anorexic symptomatology. In addition, the Morgan-Russell outcome assessment schedule (MR schedule) was used to assess the total clinical state of the patients. Social anxiety symptomatology and actual diagnosis decreased throughout the treatment. However, regardless of the point at which the patient received care, there was no correlation between social phobia and nutritional state, as indicated by BMI. A correlation existed between social phobia and AN symptomatology, and between social phobia and total clinical state, during the out-patient care. A component of AN-social phobia comorbidity is still questionable. Is it linked to the clinical state of the subjects (question of an additional effect of under nutrition and cognition), or even to AN? Others indicators of under nutrition are of interest and warrant further evaluations. We therefore feel that a diagnosis of social phobia can only be confirmed after an acute state of AN, thus allowing for preferential treatments. Others studies must be conducted in order to continue to explore the links between social phobia and AN.

The Role of Depression and Anxiety in Impulsive and Obsessive-Compulsive Behaviors Among Anorexic and Bulimic Patients

Eating disorders are believed to range across a spectrum of varying degrees of obsessive-compulsive and impulsive behavior. Sixty anorexic (mean age = 19.8; sd = 5.9) and 109 bulimic (mean age = 26.9; sd = 11.3) female patients completed self-report questionnaires assessing obsessive-compulsiveness, impulsivity, depression and anxiety, as well as two eating disorder scales. Results yielded significantly higher levels of impulsivity and negative body image in the bulimic compared to the anorexic group. Regression analysis predicting impulsivity showed that bulimia and negative body image were the main contributors. Regression analysis for predicting obsessive-compulsive behavior suggested that depression and anxiety obscure the link between anorexia and obsessive-compulsive behavior, and a high BMI intensifies the association between anxiety and obsessive-compulsive behavior. The high rates of both impulsivity and obsessive-compulsiveness found in both groups, and their association with the severity of the eating disorder, may suggest that impulsivity and obsessive-compulsiveness are not mutually exclusive and can both be found among anorexic and bulimic patients.

The Yale–Brown–Cornell eating disorder scale in women with anorexia nervosa: What is it measuring?

The Yale-Brown-Cornell Eating Disorder Scale (YBC-EDS) assesses eating disorder preoccupations, rituals, and symptom severity. This study examines the YBC-EDS in relation to eating disorder psychopathology, obsessionality, and impulsivity variables in women with anorexia nervosa (AN) and sensitivity of the YBC-EDS to change after psychotherapy. Participants were 56 women with "spectrum" AN (14.5 < BMI < 19). Variables examined in relation to the YBC-EDS were as follows: eating pathology, obsessionality (obsessive compulsive disorder and personality diagnoses, perfectionism), and impulsivity (borderline personality, impulsive traits, and behaviors). YBC-EDS scores were examined pre- and post-treatment. Eating Disorder Examination scores most strongly predicted the YBC-EDS. As expected, perfectionism was significantly associated, but so was impulsivity. YBC-EDS scores were significantly different in those with good versus poor global outcome after therapy. Unexpectedly, maximum lifetime BMI was correlated with the YBC-EDS. The YBC-EDS most strongly measured eating disorder severity and reflected change after psychotherapy for AN.

Validation of the Barcelona Bipolar Eating Disorder Scale for Bipolar Patients with Eating Disturbances

Background: Eating disturbances are frequent in bipolar disorder and are associated with poor outcome. Our objective is to assess the psychometric properties of a specific scale for the evaluation of eating disturbances in bipolar patients. Sampling and Methods: Validation study of 2 groups with a 6-month follow-up (90 patients diagnosed with bipolar and eating disturbances and 40 healthy controls). Results: The scale showed: (1) adequate feasibility (non- response <2.5%); (2) adequate reliability (Cronbach’s α coefficients = 0.79 and 0.57 in groups A and B; intraclass correlation coefficient = 0.79 in group A); (3) adequate discriminant validity between patients and controls [AUC = 0.85; moderate correlations with the Bulimic Investigatory Test Edinburgh (r = 0.32–0.64); low correlations with the Barratt Impulsiveness Scale, Young Mania Rating Scale and Hamilton Depression Rating Scale 17 (r < 0.3)]; (4) adequate sensitivity to changes. Conclusions: The Barcelona Bipolar Eating Disorder Scale showed adequate psychometric properties to assess eating disturbances in bipolar patients in clinical practice and research.

The Family Experience With Eating Disorders Scale: Psychometric Analysis

The role of the family in the development and maintenance of eating disorders is frequently cited in the literature; however, common methodological issues, including the use of diverse family assessment instruments with inadequate psychometric properties, exist. Further, variables specific to families with eating disorder are not being captured in available instruments. The modeling and role-modeling theory (Erickson, H., Kinney, C. (Eds). 1990. Modeling and role-modeling: Theory, practice, and research. Austin, TX: Society for Advancement of Modeling and Role-Modeling; Erickson, H., Tomlin, E., Swain, M. A. 1983. Modeling and role-modeling: A theory and paradigm for nursing. Englewood Cliffs, NJ: Prentice-Hall.) was employed to structure the Family Experience with Eating Disorders Scale (FEEDS), a 53-item instrument that measures variables specific to families with eating disorder. An adequate degree of reliability and validity of the FEEDS was demonstrated with a multisite sample composed of three groups: 146 parents of individuals with eating disorders, 35 parents of adolescents with psychiatric disorders, and 100 parents of college students with no known psychiatric illness. Structural equation modeling supported the construct validity of a reduced 30-item instrument and confirmed three higher order measurement models. A provisional degree of known group validity was established. Tests of internal consistency and test-retest at 2 weeks demonstrated adequate reliability. The FEEDS could be a useful adjunct to clinical assessment and could be instrumental in designing nursing interventions and measuring treatment outcomes for families with eating disorder.

The reliability and validity of the dichotomous thinking in eating disorders scale

The Dichotomous Thinking in Eating Disorders Scale (DTEDS) is a short, self-report measure that can be used to assess the presence of a rigid, “black-and-white” cognitive thinking style. It was originally developed for use in a study of psychological predictors of weight regain in obesity. The DTEDS consists of two subscales. Items on the Eating subscale assess dichotomous thinking with regards to eating, dieting or weight, and items on the General subscale assess dichotomous thinking more generally. This study aimed to examine the factor structure and psychometric properties of the DTEDS in a sample of treatment-seeking eating disordered (N=87) and overweight/obese (N=111) women. Confirmatory factor analysis demonstrated that a two-factor model provided a better fit to the data than a one-factor model. The psychometric properties of the final scale were excellent, with evidence being provided for the reliability and validity of the two subscales. Overall, the results indicated that the DTEDS is a reliable instrument that can be used to assess eating-specific as well as more general aspects of dichotomous thinking.

Mutuality as an Aspect of Family Functioning in Predicting Eating Disorder Symptoms in College Women

We examined mutuality, an aspect of Relational Cultural Theory, in an ethnically diverse sample of 397 college women from Midwestern and Western universities. We hypothesized that mutuality would predict scores on an eating disorder scale after controlling for traditional family variables, such as expressed emotion. As predicted, mutuality, as assessed by the Mutual Psychological Development Questionnaire, was significantly associated with eating disorder symptoms and behaviors, as assessed by the Eating Disorder Inventory 2, even when the variance accounted for by the similar construct of expressed emotion was factored out. Results are discussed in the context of different patterns of association evidenced between college students and their mothers, fathers, and romantic partners.

Evaluating binge eating disorder in children: Development of the children's binge eating disorder scale (C‐BEDS)

Binge eating disorder (BED) may manifest itself differently in children than adults. Recently researchers have proposed provisional criteria for measuring BED in children. The purpose of this study was to develop a brief, simple, structured, interviewer-administered scale (C-BEDS) to measure BED in children according to the provisional criteria and to compare diagnostic results with SCID diagnoses. A total of 55 children between the ages of 5 and 13 were interviewed with both the SCID and the C-BEDS. There was a significant association between the two measures (p = .001). Both measures adequately identified children with binge eating behaviors. Both the provisional criteria and the C-BEDS may be developmentally appropriate for use with children, although the C-BEDS may be a better screening instrument as it quickly identified children with subsyndromal BED. If used by physicians and other health providers, this brief measure may assist with identifying early onset binge eating behaviors and avoiding the associated consequences, including adult BED, obesity, and other comorbidities.

Personality traits after recovery from eating disorders: Do subtypes differ?

We compared individuals recovered from anorexia (AN) and bulimia nervosa (BN) to determine characteristics that are shared by or distinguish eating disorder (ED) subtypes. Sixty women recovered for > or = 1 year from AN or BN were compared with 47 control women (CW). Assessments included the Yale-Brown-Cornell Eating Disorder Scale, the Spielberger State-Trait Anxiety Inventory, the Beck Depression Inventory, the Yale-Brown Obsessive Compulsive Scale, the Temperament and Character Inventory, and Structured Clinical Interviews for DSM-IV. Individuals recovered from an ED had similar scores for mood and personality variables that were significantly higher than the scores for CW. Few recovered subjects had Cluster B personality disorder. Most individuals recovered within 6 years of their ED onset. A latent profile analysis identified an "inhibited" and "disinhibited" cluster based on personality traits. A wide range of symptoms persist after recovery and do not differ between subtypes of ED. These findings may aid in identifying traits that create vulnerabilities for developing an ED.

The pros and cons of change in individuals with eating disorders: A broader perspective

The goals of the current study were to develop a questionnaire measuring the pros and cons of eating disorder symptoms and to explore the themes endorsed by different eating disorder groups. Participants recruited from an eating disorder volunteer register and an outpatient clinic completed the Pros and Cons of Eating Disorders scale (P-CED). Principal components analyses (PCA) were performed to validate the factorial structure of the original items and to explore the factorial structure of the new items. Planned comparisons were used to compare P-CED scores between diagnostic groups. PCA indicated a 10-factor solution for the original Pros and Cons of Anorexia Nervosa scale (P-CAN) items and a 4-factor solution for the new items. Participants with anorexia nervosa (AN) scored significantly higher than participants with bulimia nervosa (BN) on five of the P-CED subscales but there were no significant differences between the two AN subtypes. The P-CED is a useful tool for identifying the positive and negative aspects of eating disorders that can be targeted in treatment or used as an outcome measure in research.

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.

Group cognitive‐behavior therapy for bulimia nervosa: Statistical versus clinical significance of changes in symptoms across treatment

Cognitive-behavior therapy (CBT) is the most effective treatment to date for bulimia nervosa. The current study investigated the effects of group CBT treatment (including some interpersonal elements) for bulimic clients. Twenty-nine patients completed the Stirling Eating Disorder Scales, the Beck Depression Inventory, and the Beck Anxiety Inventory at assessment, pretreatment, end of treatment, and at 6 months follow-up. Symptom change was explored in two ways. Statistically significant change was determined using repeated-measures analyses of variance and clinically significant change was determined using criteria proposed by Jacobson & Truax (1991, Journal of Consulting and Clinical Psychology, 59, 12-19). There was an overall improvement in dimensional measures of bulimic and restrictive attitudes and behaviors (maintained at the 6-month follow-up), which was most closely matched by clinically significant changes in bulimic behaviors. Depression (but not anxiety) was also targeted effectively. Statistically significant improvements in psychological functioning were evident only for assertiveness, but the analysis of clinical significance showed improvement for some participants in self-evaluation (self-directed hostility). Group CBT (including interpersonal elements) is broadly effective when treating bulimia nervosa, but it does not work in all cases (and may lead to enhancement of restrictive characteristics in some cases). Tests of statistical and clinical significance provide different information, which can inform practice and aid in the development of treatments for patients who respond less well to current best practice.

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

Background The Stirling Eating Disorder Scales (SEDS) are described as a well-validated measure of anorexic and bulimic cognitions and behaviors. However, there is little published research that demonstrates or tests the psychometric properties of the SEDS. The aim of this study was to assess the internal consistency of the SEDS with a clinical population at a specialist eating disorders service. Method This study was a cross-sectional component of a larger study (evaluating cognitive behavioural group treatment for bulimia nervosa). At assessment at a specialist eating disorders service, the SEDS was administered to a clinical sample of women with a diagnosis of bulimia nervosa ( N=40). Cronbach's alpha coefficients were used to determine the internal consistency of the scales. Results While the internal consistency of the overall SEDS was good, the existing SEDS subscales lacked internal consistency. Only one of the eight subscales (perceived external control) had an acceptable alpha (>.700). By removing up to three questionnaire items for each subscale that most impaired the alpha, only two further subscales were raised to an acceptable alpha. The sample's scores did not closely reflect the reported norms. Discussion More studies are needed to determine the clinical and psychometric validity of the SEDS. However, the present findings indicate that the preliminary psychometric findings do not generalize to other adult clinical populations. Therefore, caution should be used when interpreting the results of the SEDS when working with adults with eating disorders.

Perception of teasing in underweight persons: a modification of the perception of teasing scale.

The psychometric properties of the Perception of Teasing Scale-Underweight, a modified version of the Perception of Teasing Scale (1), were examined. One hundred eighty-three college students (81 male; 102 female; age range 17-57 years) completed questionnaires about underweight-related and competency-related teasing experiences, eating attitudes, body image, self-esteem, and mood. Factor analysis suggested the Perception of Teasing Scale-Underweight has a two-factor structure, measuring both underweight-related and competency-related teasing experiences. Significant correlations (p<0.05) were found between the Perception of Teasing Scale-Underweight, Beck Depression Inventory, Fear of Negative Appearance Evaluation Scale, Multidimentional Body-Self Relations Questionnaire-Appearance Scales, Multiaxial Eating Disorder Scale, Social Physique Anxiety Scale, and Rosenberg Self-Esteem Scale. The pattern of correlations differed between the entire sample and those with a body mass index <21. One-way analysis of variance analyses found significant differences (p<0.05) between those with body mass index (BMI) <21 and those with BMI >21 for the weight-related event and weight-related impact scales, indicating that the measure discriminates between those individuals most likely to have been underweight as adolescents versus those most likely to have been normal weight or overweight. This measure provides a sound psychometric tool for examining underweight-related and competency-related teasing experiences. The impact of appearance and competence related teasing in underweight persons is less well understood than in overweight samples; therefore, future work should be conducted with a more underweight sample to bridge this gap in the literature.

Persistent amenorrhoea in weight-recovered anorexics: psychological and biological aspects

Demographic, psychopathological and hormonal parameters of 22 women with previous anorexia nervosa (AN) presently recovered, in a state of stabilized nutritional normalization for 3 months to 2 years but with persistent amenorrhoea, and of 20 psychophysically healthy age- and sex-matched normally menstruating controls were studied. Body mass index (BMI) values did not differ in patients and controls. Psychological examination, monitored by Eating Disorder Inventory 1, Bulimic Investigation Test Edinburgh, Yale-Brown-Cornell Eating Disorder Scale, and Tridimensional Personality Questionnaire rating scales, showed the persistence of some of the psychopathological symptoms of AN. Hormonal examinations included basal plasma concentrations of follicle stimulating hormone, luteotropic hormone, estrogens (E), progesterone, thyrotropic hormone, FT 3, FT 4 (immunoradiometric assays), leptin (LEP) (enzymatic-linked-immunosorbent assay) and 24 h urinary free cortisol (immunoradiometric assay). Hormone values were the same in patients and controls, except for E and LEP levels, which were significantly lower in patients than in controls. The concentrations of the two hormones were not correlated with the BMI of the patients, but LEP values were correlated negatively with the difference between the present BMI and the preanorexic one. The values of both hormones correlated negatively with some of the psychopathological aspects typical of AN, in particular with high ‘body dissatisfaction’, ‘ineffectiveness’, and ‘interpersonal distrust’ and with low ‘interoceptive awareness’.

Mothers' and Fathers' Perceptions of Their Adolescent Daughters' Shape, Weight, and Body Esteem: Are They Accurate?

This study examined parents' awareness of their daughters' attitudes, beliefs, and feelings about their bodies. Sixty-six daughters aged 12–15 years completed the Stirling Eating Disorder Scale, a body figure rating scale, and made ratings of their shape and weight. They also completed a more comprehensive measure of body satisfaction, the Body Esteem Scale (BES). Mothers and fathers estimated their daughters' shape and weight, and completed the BES with instructions to complete the measure from their daughters' perspective. While there were few differences between mothers' and fathers' reports, parent–daughter congruence scores varied according to methodology and attribute measured. That is, parents' ratings of objective daughter characteristics on single-item rating scales were more congruent with daughters' self-reports than parents' estimates of daughters' feelings about their bodies using a more comprehensive measure. Greater discrepancies between parents' estimates of daughters' body esteem and daughters' self-reported body esteem were associated with greater body dissatisfaction in daughters.