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PubMed2004

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.

Adolescent↗

PubMed2006

Comorbidity of body dysmorphic disorder and eating disorders: severity of psychopathology and body image disturbance.

OBJECTIVE: The current study examined comorbidity and clinical correlates of eating disorders in a large sample of individuals with body dysmorphic disorder (BDD). METHOD: Two hundred individuals with DSM-IV (4th ed. of the Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association; 1994) BDD completed reliable interviewer-administered and self-report measures, including diagnostic assessments and measures of body image, symptom severity, delusionality, psychosocial functioning, quality of life (QOL), and history of psychiatric treatment. RESULTS: A total of 32.5% of BDD subjects had a comorbid lifetime eating disorder: 9.0% had anorexia nervosa, 6.5% had bulimia nervosa, and 17.5% had an eating disorder not otherwise specified. Comparisons of subjects with a comorbid lifetime eating disorder (n = 65) and subjects without an eating disorder (n = 135) indicated that the comorbid group was more likely to be female, less likely to be African American, had more comorbidity, and had significantly greater body image disturbance and dissatisfaction. There were no significant group differences in BDD symptom severity, degree of delusionality, or suicidal ideation or attempts. Functioning and QOL were notably poor in both groups, with no significant between-group differences. However, a higher proportion of the comorbid eating disorder group had been hospitalized for psychiatric problems. This group had also received a greater number of psychotherapy sessions and psychotropic medications. CONCLUSION: Eating disorders appear relatively common in individuals with BDD. BDD subjects with a comorbid eating disorder differed on several demographic variables, had greater comorbidity and body image disturbance, and had received more mental health treatment than subjects without a comorbid eating disorder. These findings have important implications for the assessment and treatment of these comorbid body image disorders.

Adolescent↗

PubMed2006

Trans-cultural comparison of disordered eating in Korean women.

OBJECTIVE: The presence of eating disorders in non-Western cultures is often attributed to the export of Western ideals. This study examines this hypothesis by comparing disordered eating attitudes and behaviors in Korean women with differing levels of exposure to Western culture. METHOD: Second-generation Korean-Americans (n=167) and Korean immigrants (n=37) completed the Eating Attitudes Test (EAT-26), and data from native Koreans (n=937) were obtained from a previous epidemiological study, using a Korean-translated version of the EAT-26 (K-EAT-26). Korean-American and immigrant women completed the Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA). RESULTS: Korean-American women scored significantly lower on the EAT-26 than Korean immigrants and native Koreans, who did not differ from each other. Korean-Americans were more Western-oriented than Korean immigrants, and acculturation levels were not correlated with EAT-26 scores in either group. CONCLUSION: This study supports the importance of native cultural factors in the development of eating disorders in non-Western contexts.

Acculturation↗

PubMed2006

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.

Adult↗

PubMed2007

Narcissism and narcissistic defences in the eating disorders.

OBJECTIVE: This study examined the associations between eating pathology and narcissism in an eating-disordered group. Narcissism was conceptualized in terms of both its core element (entitlement, grandiosity) and the narcissistic defenses that are used to maintain self-esteem. METHOD: Seventy non-clinical and 84 eating-disordered patients completed a measure of the different elements of narcissism, and a standardized measure of eating pathology. RESULTS: The eating-disordered group scored higher than the non-clinical women on the measures of core narcissism and of the narcissistically abused style ("poor me" defense). The pattern of dimensional associations between narcissism and eating pathology was highly similar across the clinical and nonclinical groups, with the narcissistic defenses playing the strongest role. The poisonous pedagogy style ("bad you" defense) was positively associated with restrictive attitudes toward eating, while the narcissistically abused style was positively associated with restraint, eating concern, body shape concern, and body weight concern. CONCLUSION: The narcissistic defenses are particularly relevant in understanding the eating disorders. Implications for future research are outlined, and suggestions are made about the need to assess and respond to these associations in treatment.

Adolescent↗

PubMed2007

The prevalence of eating disorders not otherwise specified.

OBJECTIVE: Eating Disorders Not Otherwise Specified (EDNOS) represent the most common eating disorder diagnosed in specialized treatment settings. The purpose of the current study is to assess the prevalence of EDNOS in a nationwide community sample. METHOD: Participants were 2,028 female students, aged 12-23, attending public schools in the 9th to 12th grades in Portugal. Participants completed the Eating Disorder Examination Questionnaire in Stage 1 of the study. In Stage 2, we selected all the participants who met any of these criteria: (1) BMI < or =17.5, (2) scores > or =4 on any of the four EDE-Q Subscales, (3) a total EDE-Q score > or =4, or (4) the presence of dysfunctional eating behaviors. In Stage 2, eating disorder experts interviewed 901 participants using the Eating Disorder Examination. RESULTS: The prevalence of all eating disorders was 3.06% among young females. Prevalence for anorexia nervosa was 0.39%, for bulimia nervosa 0.30%, EDNOS 2.37%. CONCLUSION: EDNOS is a very common eating disorder and accounts for three-quarters of all community cases with eating disorders.

Adolescent↗

PubMed2004

Athletics, perfectionism, and disordered eating.

OBJECTIVES: To determine the effects of sex, perfectionism, level of athletic participation (varsity vs. recreational), and type of sport (swimming, running, or soccer) on disordered eating. METHOD: Male and female swimmers, runners, and soccer players at Stanford University were recruited at both the recreational and varsity level. Athletes were given the Multidimensional Perfectionism Scale (MPS), the Eating Attitudes Test-26 (EAT-26), the Eating Disorders Examination Questionnaire (EDE-Q), and a survey on demographics and level of athletic competition. Of 257 athletes identified, 250 (97.3%) returned the questionnaires. RESULTS: A Multivariate Analysis of Variance (MANOVA) was used to assess the variables' effects on disordered eating attitudes. Significant main effects were found for Sex (F5,199=25.7, p<0.001), Level (F5,199=2.5, p<0.05), and Perfectionism (F10,400=3.0, p<0.001). Only two of the ten interaction terms were significant: Sex by Level of athletic participation (F5,199=3.2, p<0.01) and Sex by Perfectionism (F10,400=2.1, p<0.05). Females displayed higher disordered eating than males. Disordered eating attitudes increased with perfectionism and were greater for recreational athletes than varsity, but this trend was significant for females only. Type of sport showed no significant effects. When examining physiological data a higher percentage of varsity females had irregular periods (42.9%) or amenorrhea (14.3%) than recreational females (13.4% and 2.9%, respectively). DISCUSSION: Males showed little variability in their data due to low disordered eating scores overall, thus demonstrated few significant results. The greatest risk factor for disordered eating attitudes for females was perfectionism, which crossed all athletic divisions. Although recreational athletes seemed more at risk psychologically, the varsity athletes had more physiological risk.

Adolescent↗

PubMed2004

Disordered eating attitudes: an emerging health problem among Mediterranean adolescents.

Aim of the present study was to investigate eating attitudes in a group of Mediterranean high school students. One hundred and twenty high school students participated in this survey. The Eating Attitudes Test (EAT-26) was used for evaluating symptoms and attitudes associated with disordered eating. Body composition and dietary intake were also assessed. Using the cut-off point of 20 in the total EAT, 13 females (20.3%) and 4 males (7.3%) exhibited disordered eating behavior. Overweight students had significantly higher scores in the dieting scale than those in the normal BMI range. Percent fat mass was positively related to the total EAT (r=0.326, p<0.001) and the dieting scale (r=0.489, p<0.001). Waist/hip ratio was negatively related to total EAT and its scales. In conclusion, a significant percentage of students in this urban Mediterranean adolescent population found to have abnormal eating attitudes. This finding may be partly explained by the effect of cultural transition.

Adolescent↗

PubMed2002

Eating attitudes in high school students in the Philippines: a preliminary study.

PURPOSE: The purpose of this study was to examine the prevalence of abnormal eating attitudes among high school students from Pasig Catholic College in the Philippines. METHODS: Two survey questionnaires, the Eating Attitudes Test (EAT) and Beck's Depression Inventory (BDI), were administered to 932 high school students. The height and weight of the subjects were measured, and their body mass indices (BMI) calculated. RESULTS: The prevalence of abnormal eating attitudes according to the EAT scores was 14.5 +/- 3.2% among males and 15.0 +/- 3.5% among females, comparable to the 7-22% found in Western countries. There was a weak correlation between the EAT scores and BMI (r=0.180, p=0.01), and between the EAT scores and Beck's Depression Inventory (r=0.187, p=0.01). CONCLUSIONS: The results indicate the presence of abnormal eating attitudes among Filipino high school students from Pasig Catholic College, which suggests that further study of eating disorders and their associated risks is warranted.

Adolescent↗

PubMed2000

Prevalence and dimensionality in adolescent eating problems.

Prevalence of three eating problem dimensions (body concerns, dieting, and loss of control over eating) was studied in a Norwegian sample consisting of 4129 normal adolescents aged 12-16. The existence of eating problem dimensionality had been demonstrated in an earlier study of the same sample, and is in line with the reasoning presented in both restraint theory and the continuum hypothesis for eating disorders. Body concern was the most dominant dimension in both genders in the present study, whereas loss of control over eating was the least dominant for girls. For boys, both the dieting and the loss of control over eating dimension showed a low dominance. Older girls reported significantly more eating problems than younger girls, but this difference was not found for boys. The results are discussed and taken to support restraint theory and the continuum hypothesis. It is concluded that the study gives support to the view of the relationship between the three dimensions as cumulative and developmental, and that longitudinal research should be conducted to examine how these eating problems are related to later eating disorders.

Adolescent↗

PubMed2006

A comparison of disordered eating attitudes and behaviors among Filipino and American college students.

OBJECTIVE: The purpose of this study was to compare the levels of eating disordered attitudes and behaviors among college students in the United States and the Philippines. DESIGN: A convenience-based cross-sectional survey. SETTING: General education classes in one college in Manila and another in the Western US. PARTICIPANTS: 340 college students. INTERVENTIONS: A paper-pencil survey was given to the students in the classroom consisting of Eating Attitudes Test (EAT-26) and demographic variables. MAIN OUTCOME MEASURES: Eating disordered attitudes and behaviors (scoring 20 or more on EAT-26) was the dependent variable, while gender and country of residence were the two main independent variables. ANALYSIS: Frequency distributions, chi-squares, and logistic regression analysis were employed to summarize and analyze the data. RESULTS: Filipino students were 10.9 times (p-value <0.0001) more likely to have eating disordered attitudes and behaviors than their American counterparts controlling for the demographics collected. This relationship remained significant when regression models were done for each gender separately. In addition, married students and more specifically married female students were more likely to have eating disordered attitudes and behaviors than single students or single females. CONCLUSIONS AND IMPLICATIONS: Arguments are made as to why higher levels of eating disordered attitudes and behaviors are observed among Filipino college students. These results provide important information about the levels of eating disordered attitudes and behaviors in the Philippines and may be useful for developing future education programs.

Adult↗

PubMed2005

Attitudes towards change and treatment outcome in eating disorders.

OBJECTIVE: To investigate the influence of the stage of change on treatment outcome among patients suffering from eating disorders. METHOD: Sixty-seven women receiving free outpatient treatment for eating disorders initially participated in this study. Their demographic, lifetime and clinical characteristics, eating disorder symptoms and general distress were assesssed at baseline and after one year, together with the results of self-report questionnaire on Attitudes towards Change in Eating Disorders (ACTA). RESULTS: High scores on the Maintenance subscale were protective for eating psychopathology as measured by the Eating Attitudes Test (EAT-40), Eating Disorders Inventory (EDI-2) and the frequency of purging. Action was predictive of weight changes. Precontemplation and Relapse respectively predicted little change in EAT and the Bulimic Inventory Test Edinburgh (BITE). High Preparation scores were predictive of the level of EDI-2 Interoceptive Awareness, Maturity Fears, and Ascetism. DISCUSSION: Our results suggest considering the stage of change as a useful outcome predictor.

Adolescent↗

PubMed1987

Correlates of eating related difficulties among college students: a preliminary investigation.

In this preliminary correlational study, sex, dieting, and rigorous eating were compared to three types of eating related difficulties (binge eating, general symptoms of anorexia nervosa, and more specific obsessions about food and weight). As predicted, significant correlations were obtained between being female, dieting, and more rigorous styles of eating and scoring higher on measures of these eating related difficulties. In addition, there were significant correlations between predictor variables. Females reported more dieting and more rigorous eating. Dieting and rigorous eating also were somewhat related. When extent of dieting and rigorous eating was controlled, the association between being female and scoring higher on these measures was somewhat reduced. The association between being female and binge eating no longer retained significance.

Adult↗

PubMed2004

Interpretations and attitudes toward healthy eating among Japanese workers.

Japanese interpretations of 'healthy eating' may differ from those of people in other industrialized countries; however, no studies have addressed this question. Thus, we examined how Japanese people interpret healthy eating and investigated the factors relevant to that interpretation. In the first study, in order to investigate lay interpretations of the meaning of healthy eating, 34 adults were interviewed, and the results were analyzed as a basis for the second study. In the second study, a sample of city workers (n=1155) in Japan responded to a questionnaire concerning attitudes toward healthy eating, and relevant factors were assessed by a factor analysis. We made three findings. (1) Japanese adults interpreted 'eating a nutritionally balanced diet' and 'eating plenty of vegetables' as the most important definitions of healthy eating. (2) Healthy eating included two factors according to the factor analysis of questionnaire responses: 'eating styles and habits' and 'foods and nutrition.' (3) The relevant characteristics of the subjects regarding the two factors differed. Although these findings are unique, the external validity of this study is limited. More research is necessary to verify the present results.

Adult↗

PubMed2006

Measuring behavioural susceptibility to obesity: validation of the child eating behaviour questionnaire.

The Child Eating Behaviour Questionnaire (CEBQ; [Wardle, J., Guthrie, C.A., Sanderson, S., & Rapoport, L. (2001). Development of the children's eating behaviour questionnaire. Journal of Child Psychology and Psychiatry, 42, 963-970]) is a parent-report questionnaire designed to assess eating styles related to obesity risk. It has been shown to have a robust factor structure and good internal reliability, but has not been validated against behavioural measures of eating. In the present study, associations were examined between three CEBQ scales (Satiety Responsiveness, SR; Food Responsiveness, FR; Enjoyment of Food, EF) and four aspects of eating behaviour (eating without hunger, caloric compensation, eating rate and energy intake at a meal) aggregated across up to five occasions, in a sample of 4-5-year olds. In multiple regression, the aggregated behavioural measures of eating explained 56% of the variance in SR, 33% of the variance in FR and 40% of the variance in EF. These findings support the validity of the CEBQ as a parent-report instrument to assess 'obesogenic' eating behaviours in children. An easily-administered measure such as the CEBQ will be valuable in gathering data on the scale required to study the behavioural phenotype associated with obesity risk.

Child, Preschool↗

PubMed2004

Relations among exercise, coping, disordered eating, and psychological health among college students.

Researchers have long been interested in the coping styles of individuals who display disordered eating characteristics. Recently, exercise has been recognized as both a behavior and coping strategy that might be present among individuals with disordered eating. The present study evaluates the role of exercise as both a coping mechanism and as a health behavior in relation to eating pathology and other measures of psychological health in a nonclinical university population. Female (n=235) and male (n=86) undergraduate students completed questionnaires that assessed exercise behavior, coping strategies, eating attitudes, self-esteem, life satisfaction, affect, depression, and anxiety. The results indicate that the relations among exercise, coping, and eating pathology is complex. Exercise was related to positive psychological health in males, whereas exercise in females was associated with both positive and negative psychological health. For women with high Eating Attitudes Test (EAT-26) scores, exercise was significantly associated with negative affect, and a trend existed in this group such that exercise was associated with higher levels of depression and anxiety. Conversely, for women with low EAT scores, exercise was associated with positive affect. This suggests that exercise might be differentially associated with mental health based on the presence or absence of eating pathology.

Adaptation, Psychological↗

PubMed2005

Acculturation and eating disorders in Asian and Caucasian Australian university students.

This study aimed to compare the attitudes and psychopathology of eating disorders of Asian and Caucasian university students using a survey method. The study also investigated the relationship between acculturation, attitudes and psychopathology of eating disorders in sub-groups of Asian girls. There were 130 Asian and 110 Caucasian adolescent girls, aged 18-24 who were screened using the Eating Attitudes Test (EAT-26), the Eating Disorders Inventory (EDI-2) and an Acculturation Index. The Asian group did not have higher mean EAT score than the Caucasian group, but had higher mean score in some sub-scales of the EDI-2. Eating disordered attitudes and psychopathology was not significantly different in the low compared to the high accultured Asian girls. This study suggests that Asian and Caucasian university students in Western Australia are equally susceptible to eating disorders, and that the level of acculturation does not modify the susceptibility of Asian students for eating disorders.

Acculturation↗

PubMed2005

Development and preliminary validation of the testable assumptions questionnaire--eating disorders (TAQ-ED).

BACKGROUND: While cognitive formulations of eating disorders emphasise the role of dysfunctional assumptions regarding eating, weight and shape (EWS), less is known about the role of dysfunctional assumptions that are unrelated to EWS and those linking beliefs about EWS with negative beliefs about the self or the world. The present study aimed to develop a brief measure of dysfunctional assumptions in the eating disorders and to validate it clinically. Given that cognitive-behavioural therapy frequently involves the testing of patients' assumptions with the help of behavioural experiments, the measure was designed specifically to assess assumptions that can be addressed using such techniques. METHOD: The sample consisted of 79 women with DSM-IV eating disorder diagnoses. Each participant completed the measure of testable assumptions in the eating disorders (TAQ-ED), the Eating Disorders Inventory (EDI) and the Brief Fear of Negative Evaluation scale (Brief FNE). RESULTS: The TAQ-ED was made up of three scales, each of which had acceptable psychometric properties. High scores on the eating attitudes/behaviours scales of the EDI and on the Brief FNE were broadly associated with dysfunctional assumptions about the world and one's body. In contrast, high scores on ego-dysfunction scales of the EDI were associated with dysfunctional assumptions about feelings. CONCLUSIONS: Different aspects of eating disorder pathology appear to be linked to different types of dysfunctional assumptions in the eating disorders. The clinical value of the proposed new measure of dysfunctional assumptions is discussed, and ideas are provided for behavioural experiments testing such assumptions.

Adolescent↗