Adaptation and evaluation of the Clinical Impairment Assessment to assess disordered eating related distress in an adolescent female ethnic Fijian population

Abstract

Objective:Measurement of disease-related impairment and distress is central to diagnostic, therapeutic, and health policy considerations for eating disorders across diverse populations. This study evaluates psychometric properties of a translated and adapted version of the Clinical Impairment Assessment (CIA) in an ethnic Fijian population.Method:The adapted CIA was administered to ethnic Fijian adolescent schoolgirls (N = 215). We calculated Cronbach's α to assess the internal consistency, examined the association between indicators of eating disorder symptom severity and the CIA to assess construct and criterion validity, and compared the strength of relation between the CIA and measures of disordered eating versus with measures of generalized distress.Results:The Fijian version of the CIA is feasible to administer as an investigator-based interview. It has excellent internal consistency (α = 0.93). Both construct and criterion validity were supported by the data, and regression models indicated that the CIA predicts eating disorder severity, even when controlling for generalized distress and psychopathology.Discussion:The adapted CIA has excellent psychometric properties in this Fijian study population. Findings suggest that the CIA can be successfully adapted for use in a non-Western study population and that at least some associated distress and impairment transcends cultural differences. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord, 2010

A latent profile analysis of the typology of bulimic symptoms in an indigenous Pacific population: evidence of cross-cultural variation in phenomenology

“…We evaluated herbal purgative use as a potential LPA indicator with the following item incorporated into the EDE-Q: “Over the past 28 days, how many times have you taken traditional Fijian dranu to cause diarrhea, clean out your stomach, or suppress your appetite as a means of controlling your shape or weight?” We have previously reported that self-reported herbal purgative use was prevalent in our sample, and significantly associated with both eating pathology (Becker et al , 2009c) and eating-related clinical impairment (Becker et al , 2009b). …”

“…The study utilized data originally collected as part of a two-stage design described previously (Becker et al , 2009b; Becker et al , 2009c). Briefly, all participants completed a self-report battery at Stage 1.…”

“…For LPA indicators, we drew from Stage 1 self-report and anthropometric data available for the full sample ( n = 523). Stage 2 interview data were available for a subsample ( n = 215) selected by eligibility criteria specified in a related study identifying symptomatic ( n = 178) and asymptomatic ( n = 37) groups (described in Becker et al , 2009b; Becker et al , 2009c). The Partners Human Research Committee (PHRC), Harvard Medical School Human Subjects Committee, and Fiji National Research Ethical Review Committee approved the data collection.…”

“…However, in the setting of globalizing economic and cultural influences on the nutritional environment (Hughes & Lawrence, 2005), urban migration, and social norms for appearance, eating pathology (Becker et al , 2002) and obesity (Becker et al , 2005; Mavoa & McCabe, 2008) have become more common in ethnic Fijian females. Weight management strategies include use of an extensive traditional herbal pharmacopoeia ( dranu ) both to prevent weight loss (Becker, 1995) and also to prevent weight gain (Becker et al , 2009b), and suggest the potential for cross-cultural plasticity in eating disorder presentation.…”

The validity and clinical utility of purging disorder

“…In addition to these recognizable features as potential consequences of globalization, Becker et al recently found that 35% of Fijian school girls ages 15 to 20 years endorsed traditional herbal purgative use. 56 Follow-up analyses indicated that traditional herbal purgative use was associated with significantly elevated impairment and distress in these girls, 57 supporting the value of culture-specific assessments to enhance detection of eating disorder symptoms in non-Western contexts. 56 However, Becker 54 cautioned that syndromes identified within a Western context may not be represented in a comparable indigenous illness category.…”