Accommodation and Enabling Scale for Eating Disorders

Abstract

The Accommodation and Enabling Scale for Eating Disorders—Greek Version (AESED-G) is a psychological inventory developed by Lempesi et al. (2024) to systematically evaluate the accommodating and enabling behaviors demonstrated by family members of individuals diagnosed with eating disorders (ED). This 33-item instrument represents an adaptation and validation of the original AESED developed by Sepulveda, Kyriacou, and Treasure (2009).

The Greek adaptation successfully confirmed a robust five-factor model consistent with the original scale structure. These dimensions include Meal context ritual, Avoidance & modifying routine, Blind eye, Reassure seeking, and Control of family. Data for validation were collected from parents of patients with eating disorders in Greece, establishing the AESED-G as a culturally relevant and psychometrically sound measure for clinical and research applications in the Greek context.

Keywords

Accommodating Behaviors, Avoidance & Modifying Routine, Blind Eye, Control of Family, Eating Disorders, Enabling Behaviors, Family Adaptability, Greek Version, Meal Context Ritual, Reassure Seeking

Authors

Lempesi, Helen, Katerinopoulou, Athina, Tzavara, Chara, Koumoula, Anastasia, Gonidakis, Fragiskos

Purpose

The primary purpose of the AESED-G is to provide clinicians and researchers with a reliable and validated tool to quantify the extent of accommodating and enabling behaviors exhibited by parents and caregivers of patients suffering from eating disorders. Measuring these behaviors is critical, as they are often associated with the maintenance and severity of ED symptoms.

By assessing these specific patterns of interaction, the scale assists in identifying high-risk family dynamics and informs targeted family-based therapeutic interventions aimed at reducing accommodation and promoting healthier family coping strategies.

Construct

The scale measures the psychological construct of Eating Disorder Accommodation and Enabling. This construct refers to the adjustments, modifications, or specialized behaviors undertaken by family members in response to the patient’s eating disorder symptoms, rituals, or distress.

These behaviors, while often motivated by love or a desire to reduce conflict, inadvertently enable the continuation of the ED pathology. The AESED-G breaks down this complex construct into five measurable sub-dimensions, covering behavioral, emotional, and control-related aspects of family dynamics.

Validity

The validation study confirmed the scale’s structural integrity and its external relationships through rigorous testing. Specifically, convergent validity was established by examining the relationship between the AESED-G total scores and measures of general psychopathology among the respondents.

The scale demonstrated strong positive correlations with the subscales of the General Health Questionnaire (GHQ-28). This finding indicates that the degree of family accommodation measured by the AESED-G is reliably associated with the general psychological distress and coping difficulties experienced by the parents responding to their child’s eating disorder.

Reliability

The AESED-G demonstrated excellent internal consistency, confirming its reliability across the total scale and its individual subscales. Internal consistency was measured using Cronbach’s alpha coefficient.

The overall scale yielded a high Cronbach’s alpha of 0.93. Furthermore, the internal consistency for the five individual subscales was also robust, with coefficients ranging from 0.78 to 0.90, indicating that the items within each factor are highly correlated and measure the same underlying construct reliably.

Factor Analysis

The factor structure of the Greek version was confirmed through Principal Component Analysis (PCA). The PCA successfully revealed the expected five-factor structure, which is consistent with the conceptual model of the original AESED scale.

The analysis showed that the five factors collectively explained 63% of the total variance in the data. All individual items demonstrated strong factor loadings, with values exceeding 0.4. Notably, the study involved specific reclassification of certain items under the “Meal ritual” subscale to optimize the fit within the Greek population data set.

Instrument

Test Type: Inventory/Questionnaire

Format: Responses are collected using a 5-point Likert scale, where 0 represents never and 4 represents nearly always. The scale comprises 33 items, resulting in a total score range from 0 to 132. Higher scores indicate greater levels of accommodation of ED symptoms.

Language Available: Greek

Population Group: Human; Male; Female

Age Group: Adulthood (18+ years)

Population Details: Respondents were parents of patients diagnosed with eating disorders in clinical settings across Greece.

Test Methodology: Test Validity; Convergent Validity; Test Reliability; Internal Consistency; Factor Analysis; Principal Component Analysis

Keywords

Accommodation, Enabling, Family Dynamics, Psychometrics, Validation Study, General Health Questionnaire, Cronbach’s alpha, Five-Factor Model

Authors

Author ORCID Identifier: Not specified in source content

Affiliation Email addresses: [email protected] (Helen Lempesi)

Correspondence Address: National and Kapodistrian University of Athens, Eginition Hospital (Affiliation for Lead Author Helen Lempesi)

Permissions & Fee and Test Year

Permissions and Fee: Information regarding commercial permissions or fees is not detailed in the source content. Contact the corresponding author (Helen Lempesi) for usage permissions.

Files Available: No file available for download in the source content.

Test Year: 2024 (Year of validation publication)

References

Lempesi, H., Katerinopoulou, A., Tzavara, C., Koumoula, A., & Gonidakis, F. (2024). Validation of the Greek version of the Accommodation and Enabling Scale for Eating Disorders (AESED). Psychiatriki, 35(1), 34–42.

Sepulveda, A. R., Kyriacou, O., & Treasure, J. (2009). The Accommodation and Enabling Scale for Eating Disorders (AESED): development and validation of a new scale. International Journal of Eating Disorders, 42(6), 577–580.

Items of the Accommodation and Enabling Scale for Eating Disorders–Greek Version

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

The 33 individual items of the AESED-G are proprietary and were not provided in the source material. However, the scale is structured across the following five factors:

• Meal context ritual
• Avoidance & modifying routine
• Blind eye
• Reassure seeking
• Control of family