Structural validity of the Eating Disorder Examination—Questionnaire: A systematic review

Abstract

Objective: The main aim was to perform a systematic literature review of studies investigating the factor structure of the Eating Disorder Examination-Questionnaire (EDE-Q), a widely used measure of eating pathology. Secondary aims were to summarize the quality of reporting of latent variable (factor) analyses in these studies and review support for different factor solutions.Method: Literature was identified through Scopus, Medline, PsycInfo, and ProQuest databases published up to February 23, 2022 and outreach via an international listserv. All studies published in English reporting factor analysis of the EDE-Q were included with few restrictions. Sixty studies including 63,389 participants met inclusion criteria. Results:The originally proposed four-factor solution received little empirical support, although few alternative models have been robustly evaluated. Items assessing shape and weight concerns frequently coalesce in factor solutions, suggesting that these constructs are closely related. Investigations of brief versions of the EDE-Q have produced more consistent findings, suggesting that these measures, particularly a sevenitem version, might be useful alternatives to the full version. Quality of studies was reasonable, with important methodological elements of factor analysis often reported.Discussion: The findings are of relevance to practitioners and researchers, suggesting that the "original" factor structure of the EDE-Q should be reconsidered and that use of a seven-item version is to be encouraged.Public Significance: Self-report questionnaires are widely used in the assessment of disordered eating. The current study found that there is little consensus about the structure of a common measure of eating psychopathology. There is more consistent support for a brief, seven-item, version assessing dietary restraint, body dissatisfaction, and overvaluation of weight and shape. ResumenObjetivo: El objetivo principal fue realizar una revisión sistemática de la literatura de los estudios que investigan la estructura factorial del Cuestionario de Eating Disorders Examination (EDE-Q), una medida ampliamente utilizada en la patología

Co-occurring psychotic and eating disorders in England: findings from the 2014 Adult Psychiatric Morbidity Survey

“…The EDE-Q has been shown to have good internal consistency and other psychometric properties [ 55 ]. Yet, a short version known as the EDE-Q7 [ 56 , 57 ] is described as offering more robust psychometric properties than the original version [ 58 ].…”

Factor structure of the Eating Disorder Examination-Questionnaire (EDE-Q) in adult men with eating disorders

“…Gender differences in ED pathology may play a central role in lowered recognition and underrepresentation of men in ED research, as standard assessments were developed based on ED presentation in adolescents and young women [ 17 , 18 ]. Consequently, there have already been initial attempts to develop men-specific assessment instruments [ 19 – 21 ] as well as to validate existing ED assessments in men [ 22 – 24 ]. For example, the widely used Eating Disorder Examination-Questionnaire (EDE-Q; [ 25 ]), designed to capture the variation and severity in eating-related psychopathology [ 26 ], is based on common cognitive behavioral models of ED.…”

“…These and similar findings question the validity of using the EDE-Q subscales for measuring ED pathology in men. Indeed, several studies have shown difficulties reproducing the original EDE-Q factor structure, including in cohorts of men [ 24 , 33 ]. This indicates that the original factor model may not be sensitive to different ED manifestations in adult men [ 23 , 24 ].…”

“…Indeed, several studies have shown difficulties reproducing the original EDE-Q factor structure, including in cohorts of men [ 24 , 33 ]. This indicates that the original factor model may not be sensitive to different ED manifestations in adult men [ 23 , 24 ]. For example, Klimek et al [ 34 ] showed that in men who identify as gay, bisexual, or otherwise non-heterosexual ( n = 479), the original four-factor solution could not be applied, similar to a male Argentine sample consisting of university students and athletes ( n = 986; [ 35 ]).…”

“…Thus far, however, previous investigations on EDE-Q factor structures in men have been limited to non-clinical settings [ 36 , 37 ], severely limiting conclusions about the EDE-Q’s factorial validity among men with diagnosed ED. For example, it is currently unknown whether and which subscale scores should be reported for men with ED, or which subscale could be used to compare men with ED to other samples, or for tracking treatment response [ 24 ]. Hence, analysis and, if necessary, adaptation of the factor structure to specific patient groups are elementary for valid ED assessment.…”