Anorexia Nervosa Stages of Change Questionnaire

Abstract

The Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ or ANSOC-Q) is a specialized, 20-item, self-report psychometric instrument developed in 2000 by Rieger and colleagues. Its primary function is to quantify an individual’s readiness to recover from Anorexia Nervosa (AN). The scale is theoretically grounded in the Transtheoretical Model (TTM) of behavioral change, developed by Prochaska and DiClemente. By assessing the respondent’s current stage—ranging from precontemplation to maintenance—across key symptomatic domains of AN, the ANSOCQ provides clinicians and researchers with a valuable measure of motivational status, which is highly predictive of treatment engagement and outcome.

Keywords

Anorexia Nervosa, Stages of Change Model, ANSOCQ, Readiness to Recover, Eating Disorders, Transtheoretical Model, Psychometric Scale, Weight Restoration

Authors

Rieger, E., Touyz, S., Schotte, D., Beumont, P., Russel, J., Clarke, S., Kohn, M., & Griffiths, R.

Purpose

The core purpose of the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) is to assess the specific stage of motivational readiness for change in individuals diagnosed with Anorexia Nervosa. Unlike traditional symptom-focused assessments, the ANSOCQ provides a measure of how prepared a patient is to engage in therapeutic behaviors necessary for recovery, such as weight gain, ceasing compensatory behaviors, and normalizing eating patterns.

This measurement is crucial for effective clinical intervention, as treatment success for eating disorders often depends heavily on the patient’s intrinsic motivation. By identifying whether a patient is in Precontemplation (not ready to change) or Action (actively changing), clinicians can tailor interventions to match the patient’s current motivational stage, thereby maximizing the potential for positive treatment outcomes.

Construct

The ANSOCQ measures the psychological construct of Stages of Change (SOC) as applied specifically to AN pathology. The TTM posits that individuals move through five distinct stages when changing a problematic behavior, and the ANSOCQ operationalizes these stages across 20 items related to core AN symptoms.

Each of the 20 items in the questionnaire presents five statements (a through e), corresponding to the five stages of change:

• Precontemplation (a): Denial or lack of intention to change the behavior (e.g., “I do not need to gain weight”).
• Contemplation (b): Recognizing the problem and beginning to consider change, but not yet committed (e.g., “In some ways I think that I might be better off if I gained weight”).
• Preparation (c): Intending to take action in the immediate future, usually within the next month (e.g., “I have decided that I will attempt to gain weight”).
• Action (d): Actively modifying behavior, experiences, or environment (e.g., “At the moment I am putting in a lot of effort into gaining weight”).
• Maintenance (e): Working to prevent relapse and consolidate gains made during the action stage (e.g., “I am working to maintain the weight gains I have made”).

The items cover a broad range of eating disorder symptoms, including weight gain, body shape concern, fear of fatness, restrictive eating behaviors, and the use of compensatory weight control methods.

Validity

The ANSOCQ has demonstrated sound psychometric properties in clinical populations. Initial validation research by Rieger et al. (2000) established the instrument’s content and concurrent validity. Content validity is supported by the comprehensive coverage of core AN symptoms mapped onto the TTM framework.

Concurrent validity is typically established by demonstrating that scores on the ANSOCQ correlate significantly with established measures of eating disorder psychopathology (such as the Eating Disorder Examination or EDE) and clinical indicators of severity (like BMI). Patients scoring higher on the Action and Maintenance stages are generally expected to show better clinical functioning and lower symptom severity compared to those in Precontemplation.

Reliability

Studies assessing the reliability of the ANSOCQ generally focus on internal consistency and test-retest reliability. Internal consistency, often measured using Cronbach’s alpha, is typically reported as acceptable for a multidimensional scale designed to capture motivational readiness across various domains.

The test-retest reliability is essential for stages of change measures, confirming that motivational status remains stable over short periods in the absence of targeted intervention. The consistent application of the five-statement response format across all 20 items contributes to the scale’s structural reliability and consistent scoring methodology.

Factor Analysis

Factor analytic studies of the ANSOCQ generally aim to confirm the underlying structure derived from the Transtheoretical Model. While the scale is structured around 20 thematic items, the primary factor structure is expected to reflect the five hypothesized stages (Precontemplation, Contemplation, Preparation, Action, and Maintenance) as distinct factors.

Research often supports a factor structure where the items load appropriately onto their corresponding stage factor, indicating that the scale successfully differentiates between levels of motivation toward recovery. This structure confirms the instrument’s utility in capturing the dynamic, stage-based nature of change experienced by individuals with Anorexia Nervosa.

Instrument

Test Type: Self-report questionnaire

Format: 20 items, each consisting of 5 statements (a-e) corresponding to the five stages of change (Precontemplation, Contemplation, Preparation, Action, Maintenance). Respondents select the statement(s) that best describe their current attitude or behavior.

Language Available: Primarily English (original development). Translations may exist for research use.

Population Group: Clinical population diagnosed with Anorexia Nervosa (AN).

Age Group: Typically adolescents and adults, consistent with standard AN diagnostic populations.

Population Details: Individuals undergoing assessment or treatment for AN, used to gauge motivational status prior to or during therapy.

Test Methodology: The questionnaire is scored based on which stage statement (a-e) is selected for each item, providing a profile of the individual’s readiness across various recovery domains.

Keywords

Psychological Assessment, Motivational Interviewing, TTM, Eating Disorder Treatment, Clinical Psychology, Rieger, ANSOCQ

Authors

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

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

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

Permissions & Fee and Test Year

The ANSOCQ was developed and published in 2000. Permissions for clinical and research use should be sought from the primary author, Dr. Elizabeth Rieger, or the copyright holder of the journal, the International Journal of Eating Disorders.

The original PDF discussing the scale development and validation is available here: The original PDF can be downloaded here: http://ses.library.usyd.edu.au/bitstream/2123/4026/1/j-swinbourne-thesis.pdf

Reference’s

Rieger, E., Touyz, S., Schotte, D., Beumont, P., Russel, J., Clarke, S., Kohn, M., & Griffiths, R. (2000). Development of an instrument to assess readiness to recover in anorexia nervosa. International Journal of Eating Disorders, 4, 387-396.

Supplemental Information Link: http://www.wales.nhs.uk/sitesplus/866/opendoc/224781

Items of the Anorexia Nervosa Stages of Change Questionnaire

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

ANSOC – Q

Instructions: Each of the items below is made up of 5 statements. For each item‚ please read the five statements carefully. Then se‎lect the statement (or statements) which best describe/s your current attitude or behavior (not how you have been in the past or how you would like to be).

1.The following statements refer to gaining weight:

• a) as far as I am concerned‚ I do not need to gain weight
• b) In some ways I think that I might be better off if I gained weight
• c) I have decided that I will attempt to gain weight
• d) At the moment I am putting in a lot of effort into gaining weight
• e) I am working to maintain the weight gains I have made

2.The following statements refer to body weight:

• a) as far as I am concerned‚ I do not need to weigh at least _____kg (in‎sert your minimal normal weight)
• b) In some ways I think that I might be better off if I weighed at least _____kg
• c) I have decided that I will attempt to reach at least _____kg
• d) At the moment I am putting in a lot of effort to reach at least _____kg
• e) I am working to maintain a weight of at least _____kg

3. The following statements refer to parts of the body which may particularly concern you in terms of weight gain (such as hips‚ thighs‚ stomach‚ or buttocks):

• a) There is not way I would be prepared to gain weight on these body parts
• b) Sometimes I think I would be prepared to gain weight on these body parts
• c) I have decided that I am prepared to gain weight on these body parts
• d) I am presently trying to gain weight on these body parts
• e) I am working to maintain the weight I gained on these body parts

4. The following statements refer to your appearance:

• a) I do not want to be a normal weight because I would be less satisfied with my appearance at a weight of at least _____kg (in‎sert your minimal normal weight)
• b) I have occasionally thought about being a normal weight because in some ways I would be more satisfied with my appearance at a weight of at least _____kg
• c) I have decided to reach a normal weight because I would be more satisfied with my appearance at a weight of at least _____kg
• d) I am presently trying to reach a normal weight because I will be more satisfied with my appearance at a weight of at least _____kg
• e) I am working to maintain a normal weight because I am more satisfied with my appearance at a weight of at least _____kg

5. The following statements refer to your health:

• a) I do not need to be a normal weight because there are no risks to my health when I weigh below _____kg (in‎sert your minimal normal weight)
• b) I have occasionally thought about being a normal weight because of the risks to my health when I weigh below _____kg
• c) I have decided to reach a normal weight because of the risks to my health when I weigh below _____kg
• d) I am presently trying to reach a normal weight because of the risks to my health when I weigh below _____kg
• e) I am working to maintain a normal weight because of the risks to my health when I weigh below _____kg

6. The following statements refer to the importance of body shape and weight:

• a) I do not exaggerate the importance of my body shape or weight in determining my happiness and success
• b) Sometimes I think that I exaggerate the importance of my body shape or weight in determining my happiness and success
• c) I have decided that I need to reduce the importance that I place on my body shape or weight in determining my happiness and success
• d) I often try to challenge the importance that I place on my body shape or weight in determining my happiness and success
• e) I have succeeded in reducing my tendency to place too much importance on my body shape or weight in determining my happiness and success and want it to stay this way

7. The following statements refer to a fear of fatness:

• a) My fear of becoming fat is not excessive
• b) I occasionally think that my fear of becoming fat is excessive
• c) I have decided that I need to do something about the fear I have of becoming fat because it is controlling me
• d) I know that my fear of becoming fat has caused problems and now I am trying to correct this
• e) I have succeeded in reducing my fear of becoming fat and I want it to stay this way

8. The following statements refer to weight loss:

• a) I would prefer to lose more weight
• b) Sometimes I think that it might be time to stop losing weight
• c) I have decided that it is time to stop losing weight
• d) I am trying to stop losing weight
• e) I have managed to stop losing weight and hope to stay this way

9. The following statements refer to body fat versus muscle:

• a) I might think about gaining muscle on purpose‚ but I would never think of gaining fat on purpose
• b) Sometimes I think that I may need to gain some fat even though I would prefer to have only muscle
• c) I have decided that to be healthy I need to have some fat on my body
• d) I realize that I need to have some fat on my body and I am working to achieve this
• e) I have managed to increase the level of fat on my body which I am trying to maintain

10. The following statements refer to the rate of weight gain:

• a) There is no way I would be prepared to gain at least 1kg a week
• b) Sometimes I think I would be prepared to gain at least 1kg a week
• c) I have decided that in general it would be best for me to gain at least 1kg a week
• d) I am putting in a lot of effort to gain at least 1kg a week
• e) I am working to maintain my weight by would be prepared to gain at least 1kg a week if necessary

11. The following statements refer to certain shape and weight standards which you may have for evaluating your body (such as only being satisfied with your body when your stomach is flat or when you are below a certain weight):

• a) The standards I use to evaluate my body are not too strict
• b) Sometimes I think that the standards I use to evaluate my body may be too strict
• c) I have decided that the standards I use to evaluate my body are too strict and need to be changed
• d) I am putting in a lot of effort to change the strict standards which I use to evaluate my body
• e) I have managed to let go of the strict standards which I used in the past to evaluate my body and am hoping to keep it this way

12. The following statements refer to certain foods which you may avoid eating (such as food high in calories or fat‚ red meat or dairy products):

• a) There are certain foods which I strictly avoid and would not even consider eating
• b) There are certain foods which I try to avoid‚ although sometimes I think that it might be okay to eat them occasionally
• c) I think that I am too strict in the foods which I allow myself to eat and have decided that I will attempt to eat foods which I usually avoid
• d) I am putting in a lot of effort to regularly eat foods which I usually avoid
• e) I used to avoid eating certain foods which I now eat regularly

13. The following statements refer to daily food consumption:

• a) There is not need for me to eat 3 standard-size meals and a snack each day
• b) Sometimes I think that I should eat 3 standard-size meals and a snack each day
• c) I have decided that I need to eat 3 standard-size meals and a snack each day
• d) I am putting in a lot of effort to eat 3 standard-size meals and a snack each day
• e) I am working to maintain a current eating pattern which includes 3 standard-size meals and a snack each day

14. The following statements refer to time spent thinking about food and your weight (such as thoughts about becoming fat‚ counting the calories or fat content of food‚ or calculating the amount of energy used when exercising):

• a) There is nothing wrong with the amount of time I spend thinking about food and my weight
• b) The amount of time I spend thinking about food and my weight is a problem sometimes
• c) I have decided that I need to use strategies to help me reduce the amount of time I spend thinking about food and my weight
• d) I am using strategies to help me reduce the amount of time I spend thinking about food and my weight
• e) I used to spend too much time thinking about food and my weight which I have managed to reduce and am working to keep it this way

15. The following statements refer to certain eating behaviors (such as needing to eat food at a specific rate or time‚ moving around on the plate‚ being unable to eat all food on a plate‚ taking longer than others to eat meals‚ ha‎ving difficulty eating with others‚ needing to chew food a certain number of times or needing to stick to the same food plan each day):

• a) There is nothing that I need to change about the way I eat my meals
• b) I sometimes think that I need to change aspects of the way I eat my meals
• c) I have decided that I will try to change aspects of the way I eat my meals
• d) I am putting a lot of effort to change aspects of the way I eat my meals
• e) I have succeeded in changing aspects of the way I eat my meals and want it to stay this way

16. The following statements refer to feelings associated with eating (such as feeling guilty) and not eating (such as feeling in control):

• a) There is no need for me to change the feelings I associate with eating and not eating
• b) I sometimes think that I need to change the feelings I associate with eating and not eating
• c) I have decide that I will try to change the feelings I associate with eating and not eating
• d) I am putting in a lot of effort to change the feelings I associate with eating and not eating
• e) I have succeeded in changing the feelings I associate with eating and not eating and want it to stay this way

18.The following statements refer to methods which you may use to control your weight (such as restricting your eating‚ exercising‚ vomiting‚ taking laxatives or other pills). You may se‎lect more than one statement for the different methods you use to control your weight. Please indicate which weight control method/s you are referring to in the blank space/s provided.

• a) There is nothing seriously wrong with the methods (_______________) I use to control my weight
• b) I have been thinking that there may be problems associated with the methods (_______________) I use to control my weight
• c) I have decide that I will attempt to stop using certain methods (_______________) to control my weight
• d) I am putting in a lot of effort to stop using certain methods (_______________) to control my weight
• e) I have managed to stop using certain methods (_______________) to control my weight and I would like it to stay this way

19.The following statements refer to certain ch‎aracteristics (such as perfectionism‚ low self esteem or feeling a need for control):

• a) I do not have any problems in the way I approach life which I need to work on
• b) I sometimes think that I may have certain problems in the way I approach life which I need to work on
• c) I have certain problems in the way I approach life which I have decided to work on
• d) I am actively working on problems in the way I approach life
• e) The problems in the way I approach life I have improved and I am trying to keep it this way

20. The following statements refer to relationship problems (such as relationships with family or friends):

• a) I do not have any problems in my relationships with others which I need to work on
• b) I sometimes think that I may have certain problems in my relationships with others which I need to work on
• c) I have certain problems in my relationships with others which I have decided to work on
• d) I am actively working on problems in my relationships with others
• e) The problems in my relationships with others have improved and I am trying to keep it this way