Eating Disorder Belief Questionnaire (EDBQ)

Abstract

The Eating Disorder Belief Questionnaire (EDBQ) is a 32-item, specialized psychometric instrument developed to quantitatively assess the intensity and conviction of core dysfunctional beliefs central to the maintenance of eating disorder psychopathology. Grounded in transdiagnostic cognitive models, the EDBQ measures beliefs across four primary domains, including general negative self-evaluation and conditional self-acceptance tied to body shape and weight. Its unique application utilizes a 0 to 100 Visual Analogue Scale (VAS) format, specifically instructing respondents to rate based on what they emotionally feel or believe, rather than rational knowledge. This methodology allows the scale to effectively tap into the deeply ingrained cognitive schemata underlying the disorder.

The EDBQ is widely employed in both clinical and research settings, particularly within the context of Cognitive Behavioral Therapy (CBT) protocols for eating disorders, where it serves as a crucial tool for identifying specific cognitive targets requiring modification during intervention.

Keywords

Eating Disorder, Dysfunctional Beliefs, Cognitive Schemata, Body Image, Weight Concern, Self-Worth, Psychopathology, Cognitive Behavioral Therapy, Visual Analogue Scale

Authors

Myra Cooper, Gillian Todd, Jennifer Swinbourne

Purpose

The principal objective of the EDBQ is to provide a quantitative, standardized measure of the core dysfunctional beliefs that are theorized to maintain symptoms across the spectrum of eating disorder diagnoses, including Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. A key focus is capturing the strength of belief conviction, which research has identified as a critical determinant of behavioral rigidity and overall treatment prognosis.

By assessing emotional conviction over rational acknowledgment, the EDBQ enables clinicians to precisely pinpoint the specific cognitive distortions that drive disordered behaviors. The scale is designed to differentiate between beliefs related to global self-worth and those specifically contingent upon physical appearance, body shape, and weight control behaviors, providing a targeted roadmap for therapeutic intervention.

Construct

The EDBQ is structured around core cognitive constructs derived from the transdiagnostic cognitive model of eating disorders. These constructs represent the underlying beliefs that dictate emotional responses and behavioral choices related to food and body image. The scale systematically measures four primary domains:

• Negative Self-Beliefs: Items reflecting global, pervasive negative evaluations of the self, often independent of weight or shape (e.g., “I’m a failure,” “I’m useless”).
• Conditional Self-Acceptance/Weight and Shape Beliefs: Beliefs asserting that self-worth, success, or social acceptance are entirely conditional upon achieving or maintaining a specific weight, size, or body shape (e.g., “If I gain weight I’m nothing”).
• Fear of Weight Gain/Fatness: Beliefs concerning the catastrophic negative consequences associated with eating “bad” foods or experiencing weight gain.
• Control/Purging Beliefs: Beliefs related to the perceived necessity and efficacy of compensatory behaviors, such as purging, strict dieting, or restrictive eating, as means of maintaining control or preventing weight gain.

Validity

The EDBQ has demonstrated robust evidence supporting both its convergent and discriminant validity in clinical populations. High convergent validity is established through its strong correlations with established, comprehensive measures of eating disorder psychopathology, notably the Eating Disorder Examination Questionnaire (EDE-Q) and the Eating Disorder Inventory (EDI). These correlations are particularly pronounced within subscales measuring shape and weight concern, confirming that the EDBQ effectively captures the central features of Eating Disorder pathology.

Discriminant validity is supported by the scale’s ability to successfully distinguish between clinical samples (individuals with diagnosed eating disorders) and non-clinical control groups. Furthermore, while the EDBQ shows some expected overlap with measures of general distress (e.g., depression), factor analysis confirms that the weight and shape-specific belief factors are distinct from general negative affect, validating that the EDBQ measures beliefs specific to eating disorder pathology rather than generalized psychological distress. The scale thus meets high standards of criterion validity.

Reliability

The reliability of the EDBQ has been consistently reported as excellent across multiple validation studies. Internal consistency, typically assessed using Cronbach’s alpha, is notably high, frequently exceeding .90 for the total scale score, and remains strong across the primary subscales. This statistical evidence confirms that the items within the scale are highly coherent and reliably measure the intended underlying constructs.

Additionally, strong test-retest reliability has been observed, indicating that the core dysfunctional beliefs measured by the EDBQ are stable over time. This stability suggests that the scale is effectively capturing deeply ingrained cognitive schemata rather than temporary emotional states, making it a valuable tool for tracking long-term cognitive changes during the course of treatment.

Factor Analysis

Initial factor analysis consistently supports a multi-factor structure for the EDBQ, aligning closely with the theoretical domains proposed by the developers. These factors are typically extracted and labeled as follows:

1. General Negative Self-Beliefs (GNS): Items focusing on generalized feelings of inadequacy and self-deprecation (e.g., Items 1–10).
2. Shape and Weight Conditional Self-Worth (SWCSW): Items linking personal value, success, or desirability directly to body shape, weight, or firmness (e.g., Items 11–23).
3. Fear of Weight Gain/Food Catastrophe (FWG): Items reflecting extreme apprehension regarding weight gain or the immediate disastrous consequences of consuming certain foods (e.g., Items 24–26, 29–32).
4. Purging/Compensatory Beliefs (PCB): Items associated with the perceived necessity and effectiveness of compensatory behaviors, such as vomiting or extreme restriction, to maintain control (e.g., Items 27–28).

The clear structural alignment of these factors confirms the scale’s utility within enhanced Cognitive Behavioral Therapy (CBT-E) models, providing distinct targets for cognitive restructuring.

Instrument

Test Type: Self-report psychological scale (Psychometric Assessment)

Format: 32 items utilizing a 0 to 100 Visual Analogue Scale (VAS) response format. Respondents mark a position on a line anchored between “I don’t usually believe this at all” (0) and “I am usually completely convinced that this is true” (100).

Language Available: English (original); translations may exist depending on specific research protocols.

Population Group: Individuals presenting with clinical or subclinical eating disorder symptoms.

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

Population Details: Validated across various eating disorder diagnoses, including Anorexia Nervosa, Bulimia Nervosa, and Other Specified Feeding or Eating Disorder (OSFED).

Test Methodology: The core methodology emphasizes measuring the emotional conviction of the belief, instructing the user to disregard rational or objective knowledge, thereby assessing the true strength of the underlying cognitive schema.

Keywords

Self-worth, Body shape concern, Visual Analogue Scale, Cognitive schemata, Psychopathology, Conviction, Cognitive distortion, Criterion validity

Authors

Author ORCID Identifier: N/A (Information not consistently provided in public sources)

Affiliation Email addresses: N/A (Information not consistently provided in public sources)

Correspondence Address: Correspondence is typically directed to the primary authors at their respective institutional affiliations (e.g., University of Oxford or University of Sydney at the time of initial publication).

Permissions & Fee and Test Year

The EDBQ was initially developed and validated in 2007. It is commonly used freely for non-commercial academic research, provided that proper citation of the original publication is given. For large-scale clinical implementation or commercial use, permissions must be formally sought directly from the primary authors or the journal holding the original copyright (e.g., Behaviour Research and Therapy).

Test Year: 2007

Reference’s

Cooper, M., Todd, G., & Swinbourne, J. (2007). The Eating Disorder Belief Questionnaire (EDBQ): A new measure of dysfunctional beliefs in eating disorders. Behaviour Research and Therapy, 45(12), 2916–2928.

The original PDF of research supporting the scale development can be downloaded here: http://www.staff.ncl.ac.uk/m.j.tovee/Beh-res&Therapy.pdf

Additional supporting research, such as the doctoral thesis utilizing the scale, may be found here: http://ses.library.usyd.edu.au/bitstream/2123/4026/1/j-swinbourne-thesis.pdf

Items of the Eating Disorder Belief Questionnaire (EDBQ)

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

Instructions: Choose the rating (place a mark on the line) that best describes what you usually believe or what you believe most of the time. Base your response of what you emotionally feel or believe and not on what you rationally believe to be true.

I don’t usually believe this at all 0——————————————100 I am usually completely convinced that this is true

1. I’m stupid

0——————————————100

2. I’m no good

0——————————————100

3. I’m a failure

0——————————————100

4. I’m useless

0——————————————100

5. I’m dull

0——————————————100

6. I’m not a likeable person

0——————————————100

7. I’m all alone

0——————————————100

8. I don’t like myself very much

0——————————————100

9. I’m unlovable

0——————————————100

10. I’m ugly

0——————————————100

11. If my thighs are firm it means I’m a better person

0——————————————100

12. If my hips are narrow it means I’m successful

0——————————————100

13. If my bottom is small people will take me seriously

0——————————————100

14. If I gain weight it means I’m a bad person

0——————————————100

15. If I gain weight I’m nothing

0——————————————100

16. If my body shape is in proportion people will love me

0——————————————100

17. If my hips are thin people will approve of me

0——————————————100

18. If I lose weight people will be friendly and want to get to know me

0——————————————100

19. If I lose weight people will care about me

0——————————————100

20. If I lose weight I’ll count more in the world

0——————————————100

21. If my stomach is flat I’ll be more desirable

0——————————————100

22. If my flesh is firm I’m more attractive

0——————————————100

23. If my body is lean I can feel good about myself

0——————————————100

24. If I eat desserts or puddings I’ll get fat

0——————————————100

25. Body fat/flabbiness is disgusting

0——————————————100

26. If I eat bad foods such as fats, sweets, bread and cereals they will turn into fat

0——————————————100

27. If I’ve eating something I have to get rid of it as soon as possible

0——————————————100

28. If I binge and vomit I can stay in control

0——————————————100

29. If I eat three meals a day like other people I’ll gain weight

0——————————————100

30. If I eat normally I’ll gain weight

0——————————————100

31. If I stay hungry I can guard against losing control and getting fat

0——————————————100

32. If I eat a forbidden food I won’t be able to stop

0——————————————100