Eating Disorder Diagnostic Interview

Abstract

The Eating Disorder Diagnostic Interview (EDDI) is a highly structured, interviewer-administered instrument developed primarily for use in large-scale research and epidemiological settings. Its core function is to systematically quantify the presence, frequency, and severity of key symptoms associated with Eating Disorder pathology over a precise 12-month retrospective period. The EDDI places specific emphasis on behaviors central to diagnoses like Bulimia Nervosa and Binge Eating Disorder, including objective and subjective binge episodes, as well as various compensatory behaviors (e.g., purging, excessive exercise, fasting, laxative misuse). Beyond behaviors, the interview measures crucial cognitive components, such as weight and shape preoccupation and intense fear of weight gain, providing a comprehensive, quantifiable assessment vital for intervention and longitudinal studies.

Keywords

Eating disorder, binge episode, purging, compensatory behavior, body image, weight preoccupation, Bulimia Nervosa, diagnostic interview, psychological assessment.

Authors

Eric Stice, K. Presnell, H. Shaw, P. Rohde, E. Burton

Purpose

The chief objective of the Eating Disorder Diagnostic Interview is to generate detailed, quantitative data concerning the incidence and character of disordered eating behaviors and associated cognitions. This is achieved by segmenting the retrospective inquiry into three distinct, non-overlapping time intervals: the immediate past four weeks, the two months preceding that, and the nine months prior to that, thus capturing a full year’s history of symptoms.

This rigorous, time-bound methodology allows researchers and clinicians to move beyond simple diagnostic presence and instead focus on the quantitative severity and trajectory of symptoms. Specifically, the EDDI enables users to:

• Systematically delineate and quantify objective binge episodes, which are strictly defined by both the consumption of a large quantity of food and a concurrent subjective feeling of loss of control.

• Quantify the frequency of various Compensatory Behaviors, including both purging methods (e.g., self-induced vomiting, misuse of laxatives or diuretics) and non-purging methods (e.g., fasting and excessive exercise performed explicitly to offset caloric intake).

• Assess the intensity of cognitive distortions related to body shape and weight, which are recognized as core criteria for most clinical Eating Disorder diagnoses.

Construct

The EDDI is explicitly structured to measure the specific behavioral and cognitive constructs that form the basis of diagnostic criteria for major eating pathologies, particularly those outlined in the DSM framework. The instrument is designed to isolate and quantify three primary dimensions of eating pathology, ensuring high utility in differential diagnosis and research modeling.

• Binge Eating Pathology: This construct focuses rigorously on episodes characterized by both objective overeating and a profound feeling of loss of control over consumption, thereby differentiating true clinical bingeing from non-pathological overeating. Further questions capture associated features like eating rapidly, eating in isolation due to shame, or experiencing intense guilt afterward.

• Compensatory Behaviors: This dimension quantifies the use of purging behaviors (vomiting, diuretic/laxative misuse) and non-purging behaviors (fasting, excessive exercise) when used specifically and intentionally for the purpose of controlling weight or body shape.

• Weight/Shape Preoccupation: This cognitive construct assesses the degree to which an individual’s self-worth and self-evaluation are unduly influenced by their body weight or shape, alongside measuring the severity and frequency of the fear of gaining weight. These cognitive factors are essential for diagnosing conditions such as Anorexia Nervosa and Bulimia Nervosa.

Validity

As a research-focused Structured Interview, the EDDI demonstrates strong content and face validity due to its close alignment with established clinical diagnostic criteria. The questions and definitions provided to the participant are operationalized precisely to capture core symptoms as defined by major diagnostic manuals.

While formal, dedicated validity coefficients (such as concurrent validity measures against gold-standard interviews) are typically published in the accompanying academic literature rather than within the instrument manual itself, the extensive and repeated utilization of the EDDI in high-impact psychological and epidemiological longitudinal studies confirms its adequate empirical validity when administered by properly trained research staff. The instrument’s unique strength lies in its time-bound quantification, which significantly enhances its utility for accurately measuring symptom change and treatment efficacy over time.

Reliability

The reliability of a structured Diagnostic Interview is primarily dependent on achieving high inter-rater consistency and stability over time. The EDDI is designed with a highly structured questioning sequence and clear, operational definitions (e.g., providing an exact definition of a “binge episode” before querying the participant). This structure is intended to maximize inter-rater reliability among interviewers who have received standardized training.

Furthermore, the EDDI’s focus on collecting specific, quantifiable behavioral frequencies (e.g., number of self-induced vomiting episodes, number of days of excessive exercise) over defined time intervals reduces the reliance on vague, subjective self-reports, thereby supporting the overall reliability and precision of the resulting data, which is crucial for statistical analysis in research.

Factor Analysis

The specific results of factor analytic studies for the EDDI are typically detailed within the academic publications that employ the measure. Nevertheless, the inherent design and structure of the instrument implicitly target factor structures consistent with well-validated models of eating pathology.

The measure effectively separates symptoms into distinct, measurable clusters that mirror dimensional components commonly derived from factor analysis of other comprehensive Eating Disorder symptom measures. These implicitly targeted factors include: 1) Loss-of-Control Binge Episode Frequency, 2) Purging and Non-Purging Compensatory Behaviors Frequency, and 3) Cognitive Preoccupation regarding weight and body shape importance and fear of fatness.

Instrument

Test Type: Structured Clinical Interview/Research Assessment

Format: Interviewer-administered, requiring retrospective self-report and numerical quantification of behaviors across a 12-month period. Physical measurements (height and weight) are mandatory components of the assessment.

Language Available: English (Primary publication language).

Population Group: Individuals screened for eating disorder pathology, predominantly utilized in research settings involving non-clinical and clinical samples.

Age Group: Adolescent and Adult.

Population Details: The EDDI has been used extensively in studies focusing on risk factors, prevention efficacy, and treatment outcomes, particularly involving female adolescents and young adults.

Test Methodology: The interviewer begins by precisely defining key terms, such as “binge episode,” before systematically querying the participant regarding the frequency (days and episodes) of symptomatic behaviors across three fixed periods (4 weeks, 2 prior months, 9 months prior). Cognitive symptoms are assessed using a 0-6 severity rating scale. The original instrument and related documentation can be found online at the research group’s organizational website. The original instrument can be downloaded here: http://www.ori.org/sticemeasures/

Keywords

Adolescent psychology, body weight, disordered eating, self-evaluation, purging behaviors, fasting, diuretics, laxatives, epidemiology, clinical assessment.

Authors

Author ORCID Identifier: Not specified in source content.

Affiliation Email addresses: Not specified in source content.

Correspondence Address: Not specified in source content.

Permissions & Fee and Test Year

The Eating Disorder Diagnostic Interview appears to be accessible primarily for academic and non-commercial research purposes, typically facilitated through the organizational website of the developing research group (ORI). Prospective users should actively consult the source website (http://www.ori.org/sticemeasures/) to obtain the most current and accurate information regarding usage permissions and any associated administrative fees. The principal academic publications documenting the use and validation of this instrument date back to the early to mid-2000s (specifically 2003–2005). The instrument is understood to be a refinement or adaptation of earlier standard diagnostic interviews, optimized for efficiency and quantitative precision in research contexts.

Reference’s

• Presnell‚ K. & Stice‚ E. (2003). An experimental test of the effect of weight-loss dieting on bulimic pathology: Tipping the scales in a different direction. Journal of Abnormal Psychology‚ 112‚ 166-170.

• Stice‚ E.‚ Burton‚ E.‚ & Shaw‚ H. (2004). Prospective relations between bulimic pathology‚ depression‚ and substance abuse: Unpacking comorbidity in adolescent girls. Journal of Consulting and Clinical Psychology‚ 72‚ 62-71.

• Stice‚ E.‚ Presnell‚ K.‚ Shaw‚ H.‚ & Rohde‚ P. (2005). Psychological and behavioral risk factors for obesity onset in adolescent girls: A prospective study. Journal of Consulting and Clinical Psychology‚ 73‚ 195-202.

• Stice‚ E. & Shaw‚ H. (2003). Prospective relations of body image‚ eating‚ and affective disturbances to smoking onset in adolescent girls: How Virginia slims. Journal of Consulting and Clinical Psychology‚ 71‚ 129-135.

Items of the Eating Disorder Diagnostic Interview

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Eating Disorder Diagnostic Interview

I would like to get a general picture of your eating habits over the past 4 weeks. Have your eating habits varied much from day to day? I am interested in any overeating that you may have experienced over the past 4 weeks.

Different people mean different things by overeating. I want to explain the term “binge episode.” This means eating an amount of food that most people would consider very large‚ and feeling like you could not control your eating.

This is different from when you feel your eating is out of control‚ but you don’t eat what most people would consider a large amount of food.

This is also different from simple overeating‚ when you eat a large amount of food‚ but don’t feel like your eating is out of your control. For example‚ at Thanksgiving‚ people tend to eat a lot of food‚ but most people feel as though they are in control during this time. Does that make sense?

Have you ever had a binge episode like that?

If they endorse bingeing‚ ask the following to get a sense of whether it was a true binge episode:

Can you give me an example of what you have eaten at these times? If more than one episode‚ are the other binge episodes similar? Did you feel out of control during those times? Could you have stopped eating once you had started?

1. For the past 4 weeks‚ how many days did you have binge episodesHow many episodes did you have on each of those days? Then for the 2 months before that‚ how many days did you have a binge episode and how many total episodes were there? For the 9 months before that‚ how many days and episodes were there? [Rate best guess as to number of episodes‚ even if number is very large‚ so that data can be analyzed. Capture entire year’s history. Rate 00 if none]

	12	11	10	9	8	7	6	5	4	3	2	Month 1 (Current)
Days
Episodes

(Skip questions 2-7 ONLY if NO binges were endorsed over the past three months)

2. During these episodes did you eat much more rapidly than normal? Yes No

3. Eat until you felt uncomfortably full? Yes No

4. Eat large amounts of food when you didn’t feel physically hungry? Yes No

5. Eat alone because you were embarrassed by how much you were eating? Yes No

6. Feel depressed or very guilty after overeating? Yes No

7. Did you feel upset that you couldn’t control your eating? Yes No

8. Over the past 4 weeks have you made yourself sick as a means of controlling your shape or weightHow many episodes of self-induced vomiting occurred over the last 4 weeks? 2 prior months? 9 months before that? (Make sure that the attempt was successful)

	12	11	10	9	8	7	6	5	4	3	2	Month 1 (Current)
Episodes

 

9. Over the past 4 weeks have you taken laxatives or diuretics (water pills) as a means of controlling your shape or weight? (e.g. medicines such as Ex-Lax‚ Correctol‚ Phenamint‚ Nature’s Remedy‚ Sunril‚ AquaBan‚ Pamprin‚ Midol-PMS.) How many episodes of laxative/diuretic use to control shape or weight occurred over the last 4 weeks? 2 prior months? 9 months before that?

	12	11	10	9	8	7	6	5	4	3	2	Month 1 (Current)
Episodes

 

10. Over the past 4 weeks have you fasted (meaning have you skipped at least 2 meals in a row) as a means of controlling your shape or weightHow many episodes of fasting to control shape or weight occurred over the last 4 weeks? 2 prior months? 9 months before that?

	12	11	10	9	8	7	6	5	4	3	2	Month 1 (Current)
Episodes

 

11. Over the past 4 weeks have you engaged in exercise that was intended to burn calories to compensate for “overconsumption” of eating or drinkingHow many days of compensatory exercise to occurred in the past 4 weeks? 2 prior months? 9 months before that? [Exercise must be excessive to count] Ask about regular exercise (number of days/week‚ duration‚ intensity). Was the exercise compensatory AND in addition to their regular exercise?

	12	11	10	9	8	7	6	5	4	3	2	Month 1 (Current)
Days

 

12. Typically‚ what form of exercise have you done?

(Write the most common form of exercise in the grey box. Write others next to the box.)

13. Typical duration (in minutes) per episode?

(Indicate the total amount of exercise above and beyond the individual’s regular exercise routine.) (Compensatory: general rule is 30+ min of intense exercise (sweating) or 60+ min of moderate-light exercise.)

14. Over the past 4 weeks has your weight and/or shape been important in influencing how you feel about yourself as a person (ie‚ judge‚ think‚ evaluate yourself)? (“On a scale of 0 to 6…”)

0 no importance‚ 1‚ 2 some importance (definitely aspect of self-evaluation)‚ 3‚ 4 moderate importance (definitely one of the main aspects of self-evaluation)‚ 5‚ 6 supreme importance (nothing is more important in terms of self-evaluation)

15. Has it been similar for the 2 prior months? 9 months before that? [Use “B” to indicated beginning‚ “E” to indicate the ending. Rate 00 if none] [write in the rating (#) from above item (13) into the time frame that it corresponds with]

	12	11	10	9	8	7	6	5	4	3	2	Month 1 (Current)
Yes / no

 

16. Over the past 4 weeks have you been afraid that you might gain weight (or become fat)How many days?

0 no definite fear of fatness or weight gain‚ 1‚ 2 definite fear of fatness or weight gain present on less than half the days‚ 3‚ 4 definite fear of fatness or weight gain present on more than half the days‚ 5‚ 6 definite fear of fatness or weight gain present every day

17. Has it been similar for the 2 prior months? 9 months before that?

[Write in the rating (#) from item 16 into the current month.]

	12	11	10	9	8	7	6	5	4	3	2	Month 1 (Current)
Yes / no

 

18. Over the past 4 weeks have you felt fat? [Omit item if the student is obviously overweight and rate 7.]

0 has not felt fat‚ 1‚ 2 has felt fat on less than half the days‚ 3‚ 4 has felt fat on more than half the days‚ 5‚ 6 has felt fat every day‚ 7 (Question not asked by interviewer)

19. Has it been similar for the 2 prior months? 9 months before that?

[Write in the rating (#) from above item (18) into the current month.]

	12	11	10	9	8	7	6	5	4	3	2	Month 1 (Current)
Yes / no

 

20. What was the approximate date of your first menstrual period? …../…. n/a

21. How many periods have you missed over the past 3 months? …… n/a

22. How many periods have you missed over the previous 9 months? …… n/a

23a. Were you taking the “pill” during any of these months? Yes No

23b. If yes‚ what kind? ……………………………

23c. Have you been pregnant in the past year or had any medical problems that would have caused a significant change in your weight or eating habits? Yes No

If yes‚ please describe:

24a. Have you participated in a structured weight loss treatment that cost money (e.g. Weight Watchers‚ Jenny Craig) in the past 12 months? Yes No

24b. If yes‚ how long did you participate in this paid weight loss program for? ……

24c. How much weight did you lose from participating in this program? ……

Measure Height and Weight:

25. Current Height: Record Below

26. Current Weight: Record Below

27. What has been your lowest weight in the past month? …………

28. What has been your lowest weight in the past 12 months? ………..

29. What has been your highest weight in the past month? ……….

30. What has been your highest weight in the past 12 months? …………

31. What has been your highest weight ever? …………

Thank you for your participation. Do you have any questions about the interview?

PLEASE DON’T FORGET TO MEASURE HEIGHT AND WEIGHT!

25. Current height cm (1) ___ ____ cm (2) _ ________cm

26. Current weight kg (2) _____ __ kg (2) ___ _______kg