The Eating Disorder Examination Questionnaire (EDE-Q) is a widely used assessment of eating disorder psychopathology; however, EDE-Q norms are yet to be provided within a nonclinical UK adult sample. Secondly, there is considerable disagreement regarding the psychometric properties of this measure. Several alternative factor structures have been previously proposed, but very few have subsequently validated their new structure in independent samples and many are often confined to specific sub-populations. Therefore, in the current study, we provide norms of the original four-factor EDE-Q structure, and subsequently assess the psychometric properties of the EDE-Q in females and males using a large non-clinical UK sample (total N=2459). EDE-Q norms were consistently higher in females compared with males across all samples. Initial Confirmatory Factor Analyses (CFA) did not support the original four-factor structure for females or males (Phase 1). However, subsequent Exploratory Factor Analyses (EFA) revealed a three-factor structure as being the optimal fit for both females and males, using an 18-item and 16-item model, respectively (Phase 2). For females, the newly-proposed 18-item structure was validated within an independent student sample and further validated in an additional non-student sample. The 16item three-factor male structure was also validated within an independent non-student sample, but was marginally below accepted fit indices within an independent student sample (Phase 3).Taken together, the above findings suggest that the EDE-Q factor structure may require further reassessment, with greater focus on the qualitative differences in interpretation of EDE-Q items between females and males. Public Significance StatementThe present study suggests that the measures used to investigate eating disorder psychopathology in the non-clinical population may require reassessment in accordance with updated eating disorder symptomology. Additionally, given that this measure was originally developed using female populations, the utility of the EDE-Q measuring male eating disorder symptomology must be further considered.

Neuroimaging research has independently implicated the extrastriate body area (EBA) in distinguishing between different visual perspectives and morphologies of bodies within visual processing. However, the combined processing of these physical attributes towards neural EBA response remains unclear, and may be crucial in influencing higher-order, aesthetic evaluation of bodies. Indeed, EBA alterations amongst eating disorder patients have been associated with disturbances in body image, and disruption 8 to EBA activity amongst healthy individuals shown to influence aesthetic evaluations made towards 9 bodies. Therefore, the present study used images of slim and large female bodies viewed from 10 egocentric and allocentric perspectives, to investigate neural EBA response in healthy females (N=30). 11 In addition, participants provided behavioural aesthetic and weight evaluations of all model stimuli. 12 Results revealed an interaction, bilaterally, between visual perspective and body size in EBA activity, 13 with multi-voxel pattern analysis revealing distinct neural patterns between the four conditions. 14 However, EBA activity did not relate to non-clinical eating disorder psychopathology. No direct 15 relationship was found between EBA activity and behavioural evaluations of model stimuli; however, 16 a whole brain analysis revealed that higher-order, prefrontal regions were associated with cognitive 17 evaluations of large bodies. Taken together, our results suggest that the EBA is an integral core region in discriminating between multiple physical attributes of the body, which is likely to provide important information to higher-order brain regions which make aesthetic evaluations towards bodies.

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Several problems limit our understanding of the ways that gender and sexual orientation influence disordered eating. These include the reliance on measures that have been developed and validated in samples of cisgender heterosexual women, and the lack of confirmed measurement invariance that allows us to meaningfully compare these experiences between groups. This study was an EFA to CFA exploration of the Eating Disorder Examination Questionnaire in a group of heterosexual, bisexual, gay, and lesbian men and women. In total 1638 participants were recruited via adverts in traditional and social media to complete an online survey. A 14-item, three-factor model of the EDE-Q was confirmed as best fitting the data and measurement invariance between groups was ascertained. Sexual orientation influenced disordered eating and muscularity-related thoughts and behaviours in men but not women. Heterosexual men reported more muscularity-related concerns and behaviours, whereas gay men showed more thinness-related concerns and behaviours. Bisexual participants showed a different pattern, highlighting the importance of treating this group individually and not collating all non-heterosexual participants together. Small but significant effects of sexual orientation and gender have an impact on the kinds of disordered eating thoughts and behaviours one might experience, and could influence prevention and treatment. Clinicians may be able to provide more effective and tailored interventions by taking into account gender and sexual orientation in sensitive ways.