Eating Disorder Examination-Questionnaire-Bulimia subscale (EDE-Q-B)

Abstract

The Eating Disorder Examination-Questionnaire-Bulimia subscale (EDE-Q-B) is derived from the comprehensive Eating Disorder Examination-Questionnaire (EDE-Q), a widely used self-report questionnaire designed to assess the presence and severity of core eating disorder features over the preceding 28 days (or, as often modified, the past seven days). The EDE-Q-B specifically targets behaviors and attitudes characteristic of Bulimia Nervosa, including objective and subjective binge eating episodes, and various compensatory behaviors such as self-induced vomiting, misuse of laxatives or diuretics, and excessive exercise. This subscale is essential for screening, outcome monitoring, and research into the psychopathology of eating disorders.

Keywords

EDE-Q, Bulimia Nervosa, Binge Eating, Purging, Compensatory behaviors, Eating Disorder Assessment, Self-report questionnaire, Body Image.

Authors

Christopher G. Fairburn and Sarah J. Beglin (Original EDE and EDE-Q); Sylvia Herbozo (Modified subscale application).

Purpose

The primary purpose of the EDE-Q-B is to quantify the frequency and severity of specific behaviors associated with bulimic spectrum disorders. It provides a standardized method for assessing key diagnostic criteria defined in classification systems like the DSM-5, particularly focusing on episodes of loss of control when eating and subsequent attempts to counteract the caloric intake.

While the full EDE-Q measures four general subscales (Restraint, Eating Concern, Shape Concern, and Weight Concern), the specific bulimia subscale focuses on the behavioral frequency counts—such as objective binge episodes, subjective binge episodes, vomiting, laxative use, and excessive exercise—which are critical indicators for clinical diagnosis and severity tracking of Bulimia Nervosa.

Construct

The scale measures the core behavioral and attitudinal features of eating disorder psychopathology, with a direct focus on bulimic behaviors. The construct is multi-faceted, encompassing:

• Binge Eating Episodes: Both objective (unusually large amount of food with loss of control) and subjective (loss of control over a standard or small amount of food).
• Compensatory Behaviors: Maladaptive actions taken to prevent weight gain following eating, including purging (vomiting, laxatives/diuretics) and non-purging methods (excessive exercise).
• Weight and Shape Concern: Cognitive aspects, such as the degree to which weight and shape influence self-evaluation.

Validity

The EDE-Q, from which the EDE-Q-B is derived, possesses strong established validity. The original EDE interview is considered the gold standard for clinical assessment, and the EDE-Q demonstrates excellent concurrent validity with the interview version, particularly concerning frequency counts of key behaviors.

The scale’s content validity is high, as the items directly map onto the diagnostic criteria for eating disorders. Criterion validity is supported by the scale’s ability to differentiate between clinical and non-clinical populations, and between specific diagnostic groups (e.g., Anorexia Nervosa versus Bulimia Nervosa). Studies using the EDE-Q-B components frequently confirm its utility in identifying clinically significant symptoms.

Reliability

The EDE-Q generally exhibits good to excellent internal consistency (reliability), particularly for the core attitudinal subscales (Shape, Weight, Eating Concern). While the specific behavioral frequency items (bingeing and purging) are typically assessed using raw counts rather than averaged scores, the test-retest reliability for these frequency measures over short periods (e.g., one to two weeks) is generally acceptable, demonstrating stability in reporting core behaviors.

Factor Analysis

Factor analytic studies of the full EDE-Q typically yield a four-factor structure corresponding to the standard subscales: Restraint, Eating Concern, Shape Concern, and Weight Concern. However, when researchers utilize only the behavioral frequency items that constitute the EDE-Q-B (bingeing and compensatory behaviors), these items load distinctly, confirming their status as separate diagnostic indicators rather than continuous psychological traits. In clinical application, these items are often treated as a set of distinct behaviors (frequency counts) rather than a single summed factor score.

Instrument

Test Type: Self-report questionnaire

Format: Mixed format, using Likert scales (0-6 or 1-5) for attitudinal items and frequency counts (0-7 days or specific number of times) for behavioral items. The modified version included planning/intention items utilizing a 5-point Likert scale.

Language Available: English (Original); numerous translations exist due to the widespread use of the EDE-Q.

Population Group: Clinical and non-clinical populations.

Age Group: Typically utilized with adolescents and adults (age 16 and older).

Population Details: Originally developed for assessing individuals presenting with eating disorders, but frequently used in research on college students and community samples to identify subclinical symptoms, such as the study by Herbozo (2007) focusing on college women.

Test Methodology: Retrospective report, typically covering the past seven or 28 days.

Keywords

Eating Disorder Examination, EDE-Q-B, Purging behavior, Binge eating, Weight preoccupation, Body shape concern, Psychological assessment, Clinical screening.

Authors

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

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

Correspondence Address: N/A (Contact information for Fairburn is typically managed through the Centre for Research on Eating Disorders at Oxford, UK.)

Permissions & Fee and Test Year

The original Eating Disorder Examination-Questionnaire (EDE-Q) was formally published in 1994 by Fairburn & Beglin. Use of the instrument for academic or clinical purposes generally requires no fee, though proper citation is mandatory. The specific modified bulimia subscale items focusing on behavioral intentions were utilized and documented in research published in 2007 by Herbozo.

Reference’s

• Fairburn‚ C.G. & Beglin‚ S.J (1994). Assessment of eating disorders: Interview of self-report questionnaire? International Journal of Eating Disorders‚ 16‚ 363 – 370.
• Herbozo‚ Sylvia.‚ (2007). The Effects of Ambiguous Appearance-related Feedback on Body Image‚ Mood States‚ and Intentions to Use Body Changes Strategies in College Women. University of South Florida‚ College of Arts and Sciences‚ Department of Psychology.

The instrument utilized in the Herbozo (2007) dissertation can be found on pages 125-126. The original PDF can be downloaded here: http://usf.sobek.ufl.edu/content/SF/S0/02/68/04/00001/E14-SFE0002487.pdf

Items of the Eating Disorder Examination-Questionnaire-Bulimia subscale (EDE-Q-B)

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

On how many days during the past week

1. Have you felt fat? 0days‚ 1days‚ 2days‚ 3days‚ 4days‚ 5days‚ 6days‚ 7days

2. Have you had a definite fear that youmight gain weight or become fat? 0days‚ 1days‚ 2days‚ 3days‚ 4days‚ 5days‚ 6days‚ 7days

Over the past week

3. Has your weight influenced how you thinkabout (judge) yourself as a person? Not at all‚ Slightly‚ Moderately‚ Extremely

4. Has your shape influenced how you thinkabout (judge) yourself as a person? Not at all‚ Slightly‚ Moderately‚ Extremely

5. During the past week have there been times when you felt you have eaten whatother people would regard as an unusually large amount of food given thecircumstances? YES NO

6. During the times when you ate an unusually large amount of food‚ did youexperience a loss of control‚ i.e. feel you couldn’t stop eating or control whator how much you were eating? YES NO

7. How many times during the past week have you eaten an unusually large amount of food and experienced a loss of control? ____________(please write in number or indicate zero)

8. During the past week‚ have you had other times where you felt youuncontrollably ate a large amount of food‚ but the amount eaten wouldnot have been considered large by most people? YES NO

9. How many times during the past week have you uncontrollably eaten a largeamount of food that others might not consider large?________________(please write in number or indicate zero)

10. How many times during the past week have you made yourself sick in order toprevent weight gain or counteract the effects of eating?________________(write in number or indicate zero)

11. How many times during the past week have you used laxatives or diuretics inorder to prevent weight gain or counteract the effects of eating?__________ (write in number or indicate zero)

12. How many times during the past week have you engaged in excessive exercise specifically for the purpose of counteracting overeating episodes?_______________ (write in number or indicate zero)

Modified Eating Disorder Examination-Questionnaire-Bulimia subscale

1. I plan to make myself sick in order to prevent weight gain or counteract the effects of eating.

2. I plan to use laxatives or diuretics in order to prevent weight gain or counteract the effects of eating.

3. I plan to vigorously exercise for an hour or more in order to prevent weight gain or counteract the effects of eating.

4. I plan to use diet pills in order to prevent weight gain or help me lose weight.

5. I plan to smoke cigarettes in order to prevent weight gain or help me lose weight.

6. I plan to skip meals in order to prevent weight gain or help me lose weight.

7. Do you plan todeliberately eatless in order to notbecome heavier?

1=Strongly Disagree‚ 2=Somewhat Disagree‚ 3= Neither Agree Nor Disagree‚ 4=Somewhat Agree‚ 4=Strongly Agree