Internal consistency, convergent validity and reliability of a brief questionnaire on disordered eating (DEQ)

Body shaming and internalized weight bias as potential precursors of eating disorders in adolescents

Introduction

Body shaming (BS) is a growing phenomenon within the school context, especially among adolescents. Recently, it has been described as an unrepeated act in which a person expresses unsolicited, mostly negative comments about an individual's body. The targeted person perceives these comments as negative, offensive or body shame-inducing. Empirical evidence also suggests that body weight is the most common reason that youths are teased and bullied. Indeed, weight stigma, described as bias or discriminatory behaviors, attitudes, feelings, and thinking about individuals, because of their weight, can lead to weight-based discrimination and victimization. Preliminary evidence suggests that BS and weight stigma have negative effects on psychological health both in the short and long term. In the delicate stage of adolescence development and pubertal maturation, BS experiences can be highly prevalent and it can lead to adverse outcomes such as eating disorders (ED). However, prevalence data in the Italian context are still lacking.

Methods

The study aims to estimate weight-related BS perceived by different sources (i.e., peers and family members) and their associations with public and internalized weight bias, body mass index (BMI), body dissatisfaction, and ED symptoms. A sample of 919 high school students (Mage = 15.97, SD = 1.58; 57.1% boys) completed a battery of self-report questionnaires assessing these variables.

Results

One in four students reported experiences of weight-related BS by peers or family members. A total of 37% reported having at least one BS experience in a lifetime. Higher scores of ED symptoms, body dissatisfaction, and weight bias were reported by adolescents who experienced BS, especially females. Among overweight participants, results showed that internalized weight bias partially mediated the relationship between BS by family members and ED symptoms and fully mediated the relationship between BS by peers and ED symptoms, after controlling for age, sex and BMI.

Discussion

These findings, despite their cross-sectional nature, add an important contribution to the creation of quantitative empirical evidence on the phenomenon of BS. Its role in explaining eating disorders, both alone and with the mediation of internalized weight stigma has been first proved and needs to be confirmed by longitudinal results.

Italian adaptation of the Düsseldorf Orthorexia Scale (I-DOS): psychometric properties and prevalence of orthorexia nervosa among an Italian sample

PURPOSE

Orthorexia Nervosa (ON) is described as an extreme level of preoccupation around healthy eating, accompanied by restrictive eating behaviors. During the years, different assessment instruments have been developed. The aim of the study is to adapt into Italian the Düsseldorf Orthorexia Scale (I-DOS) and to test its psychometric properties.

METHOD

A total sample of 422 volunteer university students (mean age = 20.70 ± 3.44, women 71.8%) completed a group of self-report questionnaires in large group sessions during their lecture time. The scales assessed ON (the I-DOS and the Orhto-15), disordered eating (Disordered Eating Questionnaire, DEQ), depressive symptoms (Beck Depression Inventory-II, BDI-II), obsessive and compulsive symptoms (Obsessive Compulsive Inventory-Revised, OCI-R), and self-reported height and weight.

RESULTS

The fit of the unidimensional structure and reliability of the I-DOS was tested trough Confirmatory Factor Analysis (CFA) as well as its criterion validity computing correlation coefficients among Ortho-15, DEQ, BDI-II, OCI-R, BMI. Analyses confirmed the unidimensional structure of the I-DOS with acceptable or great fit indices (CFI = 0.984; TLI = 0.978; SRMR = 0.043; RMSEA = 0.076) and the strong internal consistency (α = 0.888). The correlations path supported the criterion validity of the scale. The estimated total prevalence of both ON and ON risk was 8.1%.

CONCLUSIONS

This 10-item scale appears to be a valid and reliable measure to assess orthorexic behaviors and attitudes.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional study.

Psychometric properties of a Silhouette Rating Scale assessing current and ideal body size and body dissatisfaction in adults

PURPOSE

The study aims at validating a new pictorial tool, the Silhouette Rating Scale (SRS). It consists of a series of nine female or male silhouettes. It was created to assess current and ideal body size evaluation, and body dissatisfaction. Our aims were to test the concurrent, convergent and discriminant validity of the scale, evaluating possible gender differences.

METHOD

A first sample of 754 young adults (age M = 26.10 ± 8.50, males N = 218) and a second sample of 210 young adults (age M = 21.19 ± 3.22, males = 43) completed the SRS, and other self-report measures assessing body size evaluation, disordered eating, body satisfaction, depression, emotion regulation and insomnia.

RESULTS

Statistical analyses performed on the first sample largely support the concurrent validity of the scale. Results obtained from the second sample confirm its convergent validity, showing strong correlations with the Contour Drawing Rating Scale. In addition, the correlations performed between the three responses of the SRS and other measures of eating disorders, depression, insomnia and emotion regulation indicated a good discriminant validity, though some of the variables measured seem to be significantly correlated.

CONCLUSIONS

The SRS is a reliable and valid tool for assessing current body size, body ideal and body dissatisfaction as compared to other widely used scales. It guarantees the universality of use thanks to the absence of details related to ethnicity or culture and at the same time, maintaining a right level of realism. Future studies will evaluate test-retest validity and its potential within clinical populations.

LEVE OF EVIDENCE

V, descriptive cross sectional study.

Dissociation and Suicidality in Eating Disorders: The Mediating Function of Body Image Disturbances, and the Moderating Role of Depression and Anxiety

In patients with eating disorders (EDs), elevated dissociation may increase the risk of suicide. Bodily related disturbances, depression, and anxiety may intervene in the association between dissociation and suicidality. In this study we aimed to examine the influence of bodily related disturbances, depression, anxiety, severity of ED symptoms, body mass index (BMI), and type and duration of the ED on the relationship between elevated dissociation and elevated suicidality. The study included 172 inpatients: 65 with anorexia nervosa restricting type, 60 with anorexia nervosa binge/purge type, and 37 with bulimia nervosa. Participants were assessed using self-rating questionnaires for dissociation, suicidality, bodily related parameters, and severity of ED symptomatology, depression, and anxiety. We found that dissociation and suicidality were directly associated. In addition, depression and anxiety moderated the mediating role of body image parameters in the association between increased dissociation and increased suicidality. Thus, only in inpatients with high depression and anxiety, i.e., above the median range, body image disturbances were found to mediate the association between dissociation and suicidality. ED-related parameters did not moderate these relationships. Our study demonstrates that in inpatients with EDs, increased dissociation may be significantly associated with increased suicidality, both directly and via the intervening influence of body image, depression, and anxiety.

Eating self-efficacy: validation of a new brief scale

PURPOSE

Eating self-efficacy (ESE) is the belief in one's ability to self-regulate eating. Social and emotional situations may be differently challenging depending on the individual eating habits, body mass index and affects. Several ESE scales have been developed but most of them focus on weight management, dieting or healthy eating. The aim of the study was to validate a new brief scale assessing ESE in situations in which people face social or emotional pressures for excessive food intake.

METHODS

Study 1: A sample of 412 volunteer females (age M = 25.44 ± 5.03) completed a first 25-item version of the scale. Exploratory factor analysis (EFA) was conducted for selecting a subgroup of items composing the ESE brief scale (ESEBS). Study 2 assessed its psychometric properties through a Confirmatory Factor Analysis (CFA), analyzing the responses of 410 volunteer adults (273 females, 137 males).

RESULTS

EFA of Study 1 evidenced a bifactorial structure. Four items for each factor were selected, explaining 63% of the variance. Study 2 confirmed the good fit of the bifactorial model (CFI = 0.9589; χ² (19) = 62.852, p < 0.001; RMSEA = 0.075; SRMR = 0.040) and provided support for the measurement invariance of the scale across gender. The internal consistency was as follows: Social (α = 0.786), Emotional (α = 0.820). The concurrent validity of the subscales was demonstrated by significant latent negative correlations with measures of eating disorders and emotional eating.

CONCLUSIONS

The 8-items ESEBS appears as a valid and reliable instrument to assess eating self-efficacy related to social and emotional situations. Future studies should evaluate its potential use in non-clinical and clinical research and interventions.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional study.

A single summative global scale of disordered eating attitudes and behaviors: Findings from Project EAT, a 15-year longitudinal population-based study

OBJECTIVE

The Project EAT Disordered Eating Attitudes and Behaviors (DEAB) scale was created from disordered eating attitudes and behaviors that tend to interrelate. To examine the appropriateness of the scale, we assessed the fit (i.e., how well a single latent factor fits a set of interrelated disordered eating attitudes and behaviors) and the convergent validity over time.

METHOD

Five interrelated disordered eating attitudes and behaviors were assessed in a longitudinal cohort (Project EAT, age 11 to 18 in 1998-1999, N = 1492). Confirmatory factor analysis examined the appropriateness of the DEAB scale. To examine whether individual variables function differently in relation to the latent construct across time, two models were compared: one requiring indicator-level factor loadings to remain equivalent across three time points (baseline [EAT-I], five-year follow-up [EAT-II], and 15-year follow-up [EAT-IV]), and the second allowing the factor loadings to vary over time. To examine the convergent validity, Pearson correlation with body satisfaction, self-esteem, depressive symptoms, and BMI was compared across time.

RESULTS

The fit indices for a single factor structure supported the use of the DEAB scale over time (standardized loadings: 0.60-0.87, 0.67-0.89, 0.59-0.77 at EAT-I, II, and IV respectively). As hypothesized, compared to fewer number of disordered eating attitudes and behaviors, greater number of attitudes and behaviors was associated with lower body satisfaction and self-esteem, and greater depressive symptoms and BMI (p < .01).

DISCUSSION

The Project EAT DEAB scale can be used as a proxy to measure the severity of disordered eating attitudes and behaviors over time in population-based studies.

Decreased inhibitory control after partial sleep deprivation in individuals reporting binge eating: preliminary findings

Background

Poor executive functions are associated with dysregulated eating and greater caloric intake in healthy samples. In parallel, findings suggested that sleep deprivation impairs executive functions.

Methods

We investigated whether partial sleep deprivation impairs executive functions in individuals reporting binge eating (BE, N = 14) and healthy controls (C, N = 13). Switch cost and backward inhibition were measured using the Task Switching Paradigm after a habitual night of sleep and after a night of partial sleep deprivation.

Results

Results showed a Night by Group interaction on the backward inhibition. The two groups differed in the habitual night, evidencing higher inhibitory control in BE compared to C. Additionally, after partial sleep deprivation, compared to the habitual night, backward inhibition decreased in BE group. This preliminary study was the first to explore the impact of sleep deprivation on executive functions in participants reporting binge eating and healthy controls, thus highlighting their potential role in influencing eating behavior.

Eating disorder symptoms and the 2 × 2 model of perfectionism: mixed perfectionism is the most maladaptive combination

PURPOSE

The 2 × 2 model of perfectionism (Gaudreau and Thompson in Personal Individ Diff 48:532-537, 2010) represents an important addition to the perfectionism literature, but so far has not been studied in relation with disordered eating.

METHOD

Using the 2 × 2 model as analytic framework, this study examined responses from a convenience sample of 716 participants aged 19-68 years (71% female) investigating how self-oriented perfectionism (SOP) and socially prescribed perfectionism (SPP) predicted individual differences in eating disorder symptoms, additionally controlling for body mass index, gender, and age.

RESULTS

Results showed a significant SOP × SPP interaction indicating that the combination of high SOP and high SPP-called "mixed perfectionism"-was associated with the highest levels of eating disorder symptoms.

CONCLUSIONS

The findings demonstrate the utility of the 2 × 2 model of perfectionism as an analytic framework for examining perfectionism and disordered eating. Moreover, they suggest that mixed perfectionism is the most maladaptive form of perfectionism when it comes to disordered eating, such that having high levels of SPP combined with high levels of SOP represents the most maladaptive combination of perfectionism in terms of risk of eating disorder.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Partial sleep deprivation and food intake in participants reporting binge eating symptoms and emotional eating: preliminary results of a quasi-experimental study

Sleep deprivation consistently increases food intake. This study aimed to evaluate the effect of partial sleep deprivation on food intake in individuals reporting binge eating, controlling for self-reported depressive emotional eating. Fourteen young adults reporting binge eating symptoms and 14 controls denying any eating disorders symptoms were offered a large and varied breakfast after a night of habitual sleep (HN) and after a night of partial sleep deprivation (DN). Food intake was unobtrusively measured while daily food intake was measured via a food diary. Results revealed only a significant effect of the Night on fibre consumed at breakfast and on the amount of daily snacks: both groups consumed less fibre and more snacks after DN compared to after HN. However, when controlling for depressive emotional eating, results showed that individuals reporting low depressive emotional eating ate less after DN than after HN at breakfast, but then they ate more throughout the day. Partial sleep deprivation may decrease fibre consumption and increase daily snacks regardless of binge eating symptoms, while daily food intake may increase only in individuals who do not report emotional eating.

LEVEL OF EVIDENCE

Experimental study, Level 1.

Computerized assessment of body image in anorexia nervosa and bulimia nervosa: comparison with standardized body image assessment tool

Body image disturbances are a prominent feature of eating disorders (EDs). Our aim was to test and evaluate a computerized assessment of body image (CABI), to compare the body image disturbances in different ED types, and to assess the factors affecting body image. The body image of 22 individuals undergoing inpatient treatment with restricting anorexia nervosa (AN-R), 22 with binge/purge AN (AN-B/P), 20 with bulimia nervosa (BN), and 41 healthy controls was assessed using the Contour Drawing Rating Scale (CDRS), the CABI, which simulated the participants' self-image in different levels of weight changes, and the Eating Disorder Inventory-2-Body Dissatisfaction (EDI-2-BD) scale. Severity of depression and anxiety was also assessed. Significant differences were found among the three scales assessing body image, although most of their dimensions differentiated between patients with EDs and controls. Our findings support the use of the CABI in the comparison of body image disturbances in patients with EDs vs.

CONTROLS

Moreover, the use of different assessment tools allows for a better understanding of the differences in body image disturbances in different ED types.

Validation of an Italian version of the Food Craving Questionnaire-State: Factor structure and sensitivity to manipulation

OBJECTIVE

The present paper describes two studies designed to evaluate the construct and the predictive validity of an Italian version of the Food Craving Questionnaire-State (FCQ-S).

METHODS

In the first study 368 volunteers aged 18-65years completed the FCQ-S and the Disordered Eating Questionnaire (DEQ). In the second study 41 females with eating disorders symptoms (mean age: 24.4yrs., DEQ≥30; Body Mass Index (BMI) in the range 17 to 30.9kg/m(2), 87.5% in the normal range) and 43 female healthy controls (mean age: 25.6yrs., DEQ<30; BMI in the normal range) took part in an experiment aimed at assessing changes in FCQ-S after exposure to words or images of highly palatable foods.

RESULTS

The results of Study 1 showed that the five-factor model had acceptable fit indices. All subscales of the FCQ-S (but Desire) significantly correlated with the disordered eating measure. The strongest relationship was found between disordered eating and fear of losing control over food intake. The results of Study 2 revealed that four out of five FCQ-S subscales significantly increased after exposure to food stimuli. Participants with eating disorders symptoms, as compared to controls, also showed higher fear of losing control over food and higher negative reinforcement, although this difference was only marginally significant.

CONCLUSIONS

The Italian version of the FCQ-S has good construct and concurrent validity, and it seems sensitive in detecting changes induced by stimuli related to highly palatable foods.

Cross-validation of the reduced form of the Food Craving Questionnaire-Trait using confirmatory factor analysis

Objective: The Food Craving Questionnaire-Trait (FCQ-T) is commonly used to assess habitual food cravings among individuals. Previous studies have shown that a brief version of this instrument (FCQ-T-r) has good reliability and validity. This article is the first to use Confirmatory factor analysis to examine the psychometric properties of the FCQ-T-r in a cross-validation study.

Method: Habitual food cravings, as well as emotion regulation strategies, affective states, and disordered eating behaviors, were investigated in two independent samples of non-clinical adult volunteers (Sample 1: N = 368; Sample 2: N = 246). Confirmatory factor analyses were conducted to simultaneously test model fit statistics and dimensionality of the instrument. FCQ-T-r reliability was assessed by computing the composite reliability coefficient.

Results: Analysis supported the unidimensional structure of the scale and fit indices were acceptable for both samples. The FCQ-T-r showed excellent reliability and moderate to high correlations with negative affect and disordered eating.

Conclusion: Our results indicate that the FCQ-T-r scores can be reliably used to assess habitual cravings in an Italian non-clinical sample of adults. The robustness of these results is tested by a cross-validation of the model using two independent samples. Further research is required to expand on these findings, particularly in children and adolescents.

Body dissatisfaction among pre-adolescent girls is predicted by their involvement in aesthetic sports and by personal characteristics of their mothers

Empirical evidence indicates that the dissatisfaction with one's body is widely present in the general population even at very early ages, and that it is predictive of future eating disorders. The family seem particularly influent for the development of body dissatisfaction while sports practice is associated to a higher prevalence of disordered eating. However the role of sports practice in the development of body dissatisfaction is still under debate and only few studies have evaluated together the influences of family and sport practice on body dissatisfaction. The present study aimed at evaluating both the singular and conjoint role of the type of sport and maternal influences in young female children. The sport influence was assessed comparing aesthetic and non-aesthetic disciplines; the mother's influence was evaluated considering her personal characteristics and her desire to have a thinner child. Results evidence that children involved in aesthetic sports, although thinner than those involved in non-aesthetic sports, report higher desire to be much thinner and have mothers who pressure them toward a greater thinness. Furthermore, children's body dissatisfaction in the sport groups is predicted by maternal characteristic like her habit to restrict her own eating and her perfectionism.

Concurrent validity of the Disordered Eating Questionnaire (DEQ) with the Eating Disorder Examination (EDE) clinical interview in clinical and non clinical samples

OBJECTIVES

The aim of the present study was to evaluate the concurrent validity, specificity and sensitivity of the Disordered Eating Questionnaire (DEQ). The DEQ is a brief questionnaire (24 items), that can be used for epidemiological screenings. It addresses face valid questions to evaluate frequency and intensity of disordered eating attitudes and behaviors over a time frame of three months.

DESIGN

The study was conducted using a cross-sectional design.

METHODS

The DEQ was completed by 190 eating disordered patients (73 patients with Anorexia, 48 with Bulimia, 11 with Binge Eating Disorder, 48 with Eating Disorders Not Otherwise Specified, 10 recovered patients) and 88 healthy controls.

RESULTS

In the whole group, DEQ scores were highly correlated with the scores of the Eating Disorder Examination (EDE 12.0D). Sensitivity and specificity were evaluated. In the female subsample, the ROC curves indicate that a cut-off score of 30 allows to obtain a sensitivity of 82% and a specificity of 68%. A formative approach of Structural Equationing Model confirm the construct validity of the instrument.

CONCLUSIONS

The DEQ confirm to be a valid and reliable instrument, whose sensitivity and specificity is comparable to that of the EAT-40 even though it has fewer items.