Eating Attitudes Test (EAT-40)

Abstract

The Eating Attitudes Test (EAT-40) is a seminal, 40-item self-report psychometric instrument developed in 1979 by David M. Garner and Paul E. Garfinkel. Designed primarily to assess the behavioral and cognitive symptoms characteristic of anorexia nervosa, the EAT-40 utilizes a six-point Likert scale to quantify preoccupations and attitudes related to disordered eating. Its fundamental role is to serve as an effective screening tool, helping to distinguish between individuals exhibiting clinically significant eating disturbances and those within the general population.

Although the scale has a well-known shorter iteration (EAT-26), the original EAT-40 remains a highly valued instrument in both clinical assessment and large-scale epidemiological research. It provides a robust index of severity across key domains, including dieting intensity, food preoccupation, and bulimic behaviors, establishing it as a foundational measure for identifying risk factors associated with various eating disorders.

Keywords

Eating Attitudes Test, EAT-40, Anorexia Nervosa, Eating Disorders, Screening Tool, Dietary Restraint, Bulimia, Body Image, Psychological Assessment, Psychometrics.

Authors

David M. Garner, Paul E. Garfinkel

Purpose

The primary purpose of the EAT-40 is the rapid identification of individuals who display attitudes and behaviors suggestive of clinical eating disorders. It was specifically engineered to be administered to non-clinical or high-risk populations, allowing for the early detection of subclinical or emerging symptoms before they necessitate formal diagnosis.

When Garner and Garfinkel first introduced the scale, their goal was to establish a standardized, quantifiable metric for the psychological and behavioral characteristics defining anorexia nervosa. This standardization greatly facilitated etiological research and prevalence studies. In clinical practice, a cutoff score, typically set at 30, is used to flag individuals who require immediate, in-depth diagnostic assessment by a qualified mental health professional, thereby differentiating healthy eating patterns from pathological ones.

Construct

The EAT-40 is designed to measure the complex psychological construct of disordered eating attitudes and behaviors. This construct is multidimensional, reflecting an unhealthy and often obsessive relationship with food, weight, and overall body shape. Key symptomatic dimensions captured by the scale include an intense fear of weight gain, severe preoccupation with dieting and food intake, and the implementation of compensatory behaviors such as excessive exercise or purging (self-induced vomiting or laxative use).

The instrument captures both cognitive distortions—such as feelings of guilt after eating or obsessive thinness ideals—and observable behavioral manifestations, including restrictive eating patterns (e.g., avoiding high-carbohydrate foods) and ritualistic food handling (e.g., cutting food into small pieces). Ultimately, the scale provides a comprehensive index of the symptomatic expression associated with chronic dietary restraint and severe body dissatisfaction.

Validity

The EAT-40 exhibits strong psychometric properties, evidenced by consistent validation across diverse samples and international translations. A critical finding supporting its efficacy is its high discriminant validity; the scale reliably differentiates between individuals formally diagnosed with eating disorders and healthy control groups. The original validation research confirmed that clinical populations consistently registered significantly higher scores than non-clinical groups, endorsing the EAT-40’s utility as a robust screening measure.

Furthermore, strong concurrent validity has been established through positive correlations with other established measures of eating-related psychopathology, such as the Body Shape Questionnaire (BSQ) and various depression scales. This demonstrates the scale’s capacity to accurately reflect the severity and co-occurrence of eating disturbances within high-risk and clinical populations, confirming its relevance in diagnostic contexts.

Reliability

The reliability of the EAT-40 is consistently reported as excellent across academic literature. Studies repeatedly demonstrate very high internal consistency, with Cronbach’s alpha coefficients frequently surpassing the 0.90 threshold. This indicates that the 40 items are highly homogeneous and reliably measure the single underlying construct of disordered eating, ensuring the consistency of measurement.

In addition to internal consistency, test-retest reliability has been deemed satisfactory, particularly when the instrument is administered to non-clinical populations over reasonable intervals. This stability over time confirms that the EAT-40 is a trustworthy and dependable instrument for research purposes, especially for tracking longitudinal changes in eating attitudes or evaluating intervention effectiveness.

Factor Analysis

The initial Factor Analysis conducted by Garner and Garfinkel in 1979 proposed a six-factor structure for the EAT-40. These initial factors included: 1) Dieting; 2) Bulimia and Food Preoccupation; 3) Oral Control; 4) Food Avoidance; 5) Vomiting/Laxative Use; and 6) Perceived Social Pressure to Eat. This complexity provided a highly detailed breakdown of symptoms.

However, subsequent extensive research and psychometric refinement, particularly during the development of the EAT-26, often supported a more parsimonious, three-factor model. The three most widely accepted factors identified through subsequent Factor Analysis are: 1) Dieting (focusing on restrictive behaviors and preoccupation with weight loss); 2) Bulimia and Food Preoccupation (covering binge eating, feeling controlled by food, and purging behaviors); and 3) Oral Control (measuring self-control concerning food and specific eating rituals, such as cutting food into small pieces).

Instrument

Test Type: Self-report screening questionnaire

Format: 40 items utilizing a 6-point Likert scale (1=Always, 6=Never). The scale assesses attitudes and behaviors over the preceding six months.

Language Available: Widely translated, including Spanish, French, German, Japanese, Arabic, and Persian.

Population Group: Appropriate for use with both clinical and non-clinical samples.

Age Group: Adolescents (typically starting around 13-14 years) and Adults.

Population Details: While applicable to males, the scale is historically and predominantly used in female populations. It is frequently employed in high-risk groups such as athletes, dancers, models, and university student cohorts.

Test Methodology: Respondents rate the frequency of the described behaviors or attitudes. Scoring is weighted for items indicative of disordered eating (Always=3, Very Often=2, Often=1, and 0 for the remaining options), with specific items being reverse-scored. A total score of 30 or higher is the standard clinical cutoff, indicating a strong need for further evaluation.

Keywords

Psychological Medicine, Psychometrics, Self-report, Internal Consistency, Clinical Screening, Body Dissatisfaction, Weight Concern, Purging Behaviors, Dietary Restriction, Factor Analysis.

Authors

Author ORCID Identifier: Information Not Provided in Source Content

Affiliation Email addresses: Information Not Provided in Source Content

Correspondence Address: Information Not Provided in Source Content

Permissions & Fee and Test Year

The EAT-40 was first published in 1979. Due to its status as a seminal and foundational scale in the field of eating disorders, it is often made available for non-commercial academic research and educational use without an associated fee. However, parties seeking clinical application or commercial use must formally obtain permissions from the original authors or the current copyright holders (David M. Garner and Paul E. Garfinkel).

Reference’s

• Garner DM & Garfinkel PE. The eating attitudes test: An index of the symptoms of anorexia nervosa. Psychological Medicine. 1979; 9: 273-279.
• The original PDF associated with related research can be downloaded here: http://ses.library.usyd.edu.au/bitstream/2123/4026/1/j-swinbourne-thesis.pdf
• Additional online resources for the EAT-40: http://psychcentral.com/quizzes/eat.htm
• Online EAT-40 form: http://eat-26.com/Form/index.php?test_type=eat40
• Further PDF reference (Non-English title noted in source): http://www.sid.ir/fa/VEWSSID/J_pdf/79413860106.pdf

Items of the Eating Attitudes Test (EAT-40)

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

1=Always‚ 2= Very Often‚ 3=Often‚ 4= Sometimes‚ 5= Rarely‚ 6= Never

1. Like eating with other people
2. Prepare foods for others but do not eat what I cook
3. Become anxious prior to eating
4. Am terrified about being overweight
5. Avoid eating when I am hungry
6. Find myself preoccupied with food
7. Have gone on eating binges where I feel that I may not be able to stop
8. Cut my food into small pieces
9. Aware of the calorie content of foods that I eat
10. Particularly avoid foods with a high carbohydrate content (e.g. bread‚ potatoes‚ rice etc.)
11. Feel bloated after meals
12. Feel that others would prefer if I ate more
13. Vomit after I have eaten
14. Feel extremely guilty after eating
15. Am preoccupied with a desire to be thinner
16. Exercise strenuously to burn off calories
17. Weigh myself several times a day
18. Like my clothes to fit tightly
19. Enjoy eating meat
20. Wake up early in the morning
21. Eat the same food day after day
22. Think about burning up calories when I exercise
23. Have regular menstrual periods
24. Am preoccupied with the thought of ha‎ving fat on my body (Note: Item 24 is missing in original numbering)
25. Take longer than others to eat my meals
26. Enjoy eating at restaurants
27. Take laxatives
28. Avoid foods with sugar in them
29. Eat diet foods
30. Feel that food controls my life
31. Display self control around food
32. Feel that others pressure me to eat
33. Give too much time and thought to food
34. Suffer from constipation
35. Feel uncomfortable after eating sweets
36. Engage in dieting behaviour
37. Like my stomach to be empty
38. Enjoy trying new rich foods
39. Have the impulse to vomit after meals