Eating Disorder Diagnostic Scale

Abstract

The Eating Disorder Diagnostic Scale (EDDS) is a robust and widely adopted self-report instrument used for screening and assessing the core behavioral and attitudinal symptoms associated with various types of eating disorders. Specifically, it is utilized to identify potential cases of Bulimia Nervosa (BN) and Binge Eating Disorder (BED). Developed primarily by Eric Stice and colleagues, the EDDS offers a quantified measure of critical diagnostic criteria, such as the frequency of objective binge eating episodes, the subjective experience of loss of control during eating, and the utilization of compensatory behaviors (e.g., purging, fasting, excessive exercise).

The 22-item scale is designed to capture both the qualitative aspects of psychological distress related to weight and shape, and the quantitative frequency of specific disordered eating behaviors over defined retrospective periods (typically three or six months). Its efficient self-report format makes it highly valuable for large-scale epidemiological studies and initial clinical triage.

Keywords

Eating Disorder Diagnostic Scale, EDDS, Bulimia Nervosa, Binge Eating Disorder, Self-report measure, Compensatory behaviors, Body dissatisfaction, Psychopathology, Screening tool.

Authors

Eric Stice, M. Fisher, E. Martinez

Purpose

The fundamental purpose of the EDDS is to provide an efficient and highly standardized method for assessing eating disorder symptomatology across both clinical and academic research environments. It functions as a rapid, yet comprehensive, screening tool that can quantify the severity of core symptoms based on established frequency and intensity criteria, offering a practical alternative to time-intensive structured diagnostic interviews.

Crucially, the scale is structured to measure specific behaviors whose frequencies are required for differential diagnoses according to psychiatric standards, such as the minimum occurrence of objective binge eating and related compensatory behaviors over specified timeframes (e.g., three or six months). This quantification allows the EDDS to be highly valuable in longitudinal studies, where it is used to track minute changes in behavior and evaluate the efficacy of prevention or intervention programs, particularly those testing the dual-pathway model of bulimic pathology.

Construct

The EDDS is designed to measure several distinct, yet highly interrelated, psychological constructs that are central to the development and persistence of eating disorders. These constructs are broadly divided into core attitudinal components related to self-perception and specific behavioral components related to disordered eating and weight control.

Key constructs assessed include: Body image disturbance (e.g., perceived fatness and the disproportionate influence of shape and weight on overall self-evaluation); Binge Eating (defined as episodes involving the consumption of an unusually large amount of food accompanied by a profound sense of loss of control); and Compensatory Behaviors, which encompass maladaptive attempts to counteract caloric intake, such as self-induced vomiting, misuse of laxatives or diuretics, restrictive fasting, and excessive exercise.

Validity

The EDDS has consistently demonstrated strong psychometric properties, with robust evidence supporting its criterion and construct validity. Specific research conducted by Stice and colleagues (2004) confirmed that scores derived from the EDDS exhibit a high correlation with scores from established gold-standard measures of eating pathology, such as the structured clinical interview known as the Eating Disorder Examination (EDE). This high correlation provides strong evidence for the scale’s convergent validity.

Furthermore, the instrument possesses good discriminant validity, meaning it is effective at statistically differentiating individuals who meet the full diagnostic criteria for specific conditions (e.g., Bulimia Nervosa) from healthy control groups or individuals presenting only with subclinical symptoms. Its item structure and overall content are closely aligned with the official clinical criteria outlined in the DSM, thereby enhancing its overall face and content validity for clinical research and diagnostic screening.

Reliability

Studies evaluating the EDDS consistently report high internal consistency across its various subscales, indicating that the items within a specific domain (such as those measuring binge-related cognitions or purging frequency) reliably measure the same underlying psychological trait. This consistency ensures the scale provides a unified measure of each symptom cluster.

While explicit coefficient values were not detailed in the source material, the broader academic literature confirms that the EDDS subcomponents—specifically Binge Eating frequency and Purging frequency—demonstrate acceptable to excellent test-retest reliability when administered over short intervals. This stability confirms that the measures are consistent and reliable indicators of symptom prevalence over time.

Factor Analysis

Although the EDDS is frequently employed dimensionally, allowing researchers to score symptoms based on frequency thresholds, factor analytic research generally supports a robust multi-factor structure. This structure typically aligns closely with the major diagnostic domains of eating disorders.

These empirically derived factors tend to separate into distinct components: 1) subjective distress related to weight and shape (the attitudinal factors), and 2) objective, measurable disordered behaviors (the bingeing and purging factors). This validated factor structure is critical, as it supports the scale’s utility not only as a simple diagnostic screen but also as a tool for quantifying the severity and specific nature of underlying traits relevant to eating disorder risk, often utilized when testing theoretical models like the dual-pathway model of bulimic pathology.

Instrument

Test Type: Self-report questionnaire / Screening and Diagnostic Tool

Format: The instrument consists of 22 items, utilizing mixed response formats. These formats include Likert-type scales (ranging from 0 to 6) for attitudinal and psychological distress measures, frequency counts (ranging up to 14 times per week/day) for behavioral measures, and dichotomous (YES/NO) responses for specific symptom presence.

Language Available: Primarily English; translated versions, including Spanish, are available and utilized in international academic research.

Population Group: Clinical populations exhibiting symptoms of eating disorders, as well as general populations for use in screening, risk assessment, and epidemiological studies.

Age Group: Adolescents and adults, typically aged 14 and above.

Population Details: The EDDS has been extensively validated across diverse samples, including high school and college students, and patients actively receiving treatment for eating disorders. It is a standard measure in longitudinal research tracking risk factors for psychopathology.

Test Methodology: The scale is administered via paper-and-pencil or digital self-administration. Scoring involves calculating frequency scores for key behaviors (e.g., those defining Binge Eating Disorder) and summing attitudinal items to assess the severity of body dissatisfaction. This scoring process allows researchers to efficiently determine if the frequency thresholds defined by DSM criteria for conditions like Bulimia Nervosa or BED are met. The original PDF containing additional documentation can be downloaded here: http://www.banrepcultural.org/sites/default/files/natalia-rojas-segura-Thesis_final.pdf

Keywords

Psychometrics, Screening tool, Body weight, Purging behaviors, Body image dissatisfaction, Longitudinal assessment, Diagnostic criteria, Dual-pathway model, Eating Disorder Diagnostic Scale.

Authors

Author ORCID Identifier: N/A (Information not provided in source material)

Affiliation Email addresses: N/A (Information not provided in source material)

Correspondence Address: N/A (Information not provided in source material)

Permissions & Fee and Test Year

The Eating Disorder Diagnostic Scale is recognized as an academic research instrument. It was primarily developed by Eric Stice and colleagues in the early 2000s, with the key scoring procedures documented and published in 2004. The instrument is typically made freely available for non-commercial academic and clinical research applications. It is often distributed through resources provided by the Oregon Research Institute (ORI) measures website, confirming that researchers generally do not incur usage fees for its implementation.

Reference’s

• Stice, E., Fisher, M., & Martinez, E. (2004). Scoring procedures for the Eating Disorder Diagnostic Scale. (Referenced for scoring methodology).
• Stice, E. (2001). A prospective test of the dual-pathway model of bulimic pathology: Mediting effects of dieting and negative affect. Journal of Abnormal Psychology, 110, 124-135.
• Stice, E. & Bearman, K. (2001). Body-image and eating disturbances prospectively predict increases in depressive symptoms in adolescent girls: A growth curve analysis. Developmental Psychology, 37, 597-607.
• Stice, E. & Whitenton, K. (2002). Risk factors for body dissatisfaction in adolescent girls: A longitudinal investigation. Developmental Psychology, 38, 669-678.

Items of the Eating Disorder Diagnostic Scale

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

EATING SCREEN

Over the past 3 months…

1. Have you felt fat? 0Not at all, 1, 2=Slightly, 3, 4=Moderately, 5, 6=Extremely

2. Have you had a definite fear that you might gain weight or become fat? 0Not at all, 1, 2=Slightly, 3, 4=Moderately, 5, 6=Extremely

3. Has your weight influenced how you think about (judge) yourself as a person? 0Not at all, 1, 2=Slightly, 3, 4=Moderately, 5, 6=Extremely

4. Has your shape influenced how you think about (judge) yourself as a person? 0Not at all, 1, 2=Slightly, 3, 4=Moderately, 5, 6=Extremely

5. During the past 6 months have there been times when you felt you have eaten what other people would regard as an unusually large amount of food (e.g., a quart of ice cream) given the circumstances? YES NO

6. During the times when you ate an unusually large amount of food, did you experience a loss of control (feel you couldn’t stop eating or control what or how much you were eating)? YES NO

7. How many DAYS per week on average over the past 6 MONTHS have you eaten an unusually large amount of food and experienced a loss of control? 0 1 2 3 4 5 6 7

8. How many TIMES per week on average over the past 3 MONTHS have you eaten an unusually large amount of food and experienced a loss of control? 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

During these episodes of overeating and loss of control did you…

9. Eat much more rapidly than normal? YES NO

10. Eat until you felt uncomfortably full? YES NO

11. Eat large amounts of food when you didn’t feel physically hungry? YES NO

12. Eat alone because you were embarrassed by how much you were eating? YES NO

13. Feel disgusted with yourself, depressed, or very guilty after overeating? YES NO

14. Feel very upset about your uncontrollable overeating or resulting weight gain? YES NO

15. How many times per week on average over the past 3 months have you made yourself vomit to prevent weight gain or counteract the effects of eating? 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

16. How many times per week on average over the past 3 months have you used laxatives or diuretics to prevent weight gain or counteract the effects of eating? 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

17. How many times per week on average over the past 3 months have you fasted (skipped at least 2 meals in a row) to prevent weight gain or counteract the effects of eating? 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

18. How many times per week on average over the past 3 months have you engaged in excessive exercise specifically to counteract the effects of overeating episodes? 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

19. How much do you weigh? If uncertain, please give your best estimate. _____ lbs.

20. How tall are you? _Please specify in inches (5 ft.= 60 in.)___ in.

21. Over the past 3 months, how many menstrual periods have you missed? 0 1 2 3 n/a

22. Have you been taking birth control pills during the past 3 months? YES NO