Eating Disorder Examination Questionnaire (EDE-Q)

Abstract

The Eating Disorder Examination Questionnaire (EDE-Q) is a widely utilized, self-report instrument derived from the structured clinical interview, the Eating Disorder Examination (EDE). It is designed to assess the specific cognitive and behavioral psychopathology characteristic of eating disorders over the preceding 28 days. The EDE-Q provides dimensional scores across four key subscales, making it an essential tool for both clinical assessment and research into the severity and maintenance of eating disturbances.

Keywords

Eating Disorder Examination Questionnaire, EDE-Q, Eating disorders, psychometrics, Restraint, Shape Concern, Weight Concern, Anorexia Nervosa, Bulimia Nervosa, Binge eating.

Authors

Christopher G. Fairburn, Sarah J. Beglin, K.H. Luce, J.H. Crowther.

Purpose

The primary purpose of the EDE-Q is to quantify the severity and frequency of core eating disorders symptoms, including behavioral features (e.g., restricting, purging, compensatory behaviors) and attitudinal features (e.g., concerns about shape and weight). It serves as an efficient alternative to the extensive EDE interview, allowing for large-scale data collection in research settings and routine monitoring in clinical practice.

By focusing on the previous four weeks (28 days), the questionnaire allows clinicians and researchers to track changes in specific aspects of psychopathology accurately, aiding in the evaluation of treatment efficacy and diagnostic classification based on DSM criteria.

Construct

The EDE-Q measures the central features of eating disorder psychopathology, which are organized into four distinct subscales derived from the original EDE interview structure. These four subscales capture the cognitive distortions and behavioral excesses that drive eating disorders like Anorexia Nervosa and Bulimia Nervosa.

The four core constructs measured are:

• Restraint: Measures attempts to restrict eating and control calorie intake to influence shape or weight.
• Eating Concern: Reflects preoccupation with food, eating, and fear of loss of control over eating, including objective and subjective binge eating episodes.
• Shape Concern: Assesses dissatisfaction with body shape, fear of becoming fat, and the influence of shape on self-evaluation.
• Weight Concern: Measures dissatisfaction with weight, desire to lose weight, and the influence of weight on self-evaluation.

Validity

The EDE-Q demonstrates strong concurrent and discriminant validity, particularly in clinical populations. Its structure is highly correlated with the original EDE interview, which is considered the gold standard for assessing eating disorder symptoms. Studies confirm that the EDE-Q successfully distinguishes between clinical groups (e.g., BN vs. AN) and non-clinical controls, supporting its utility as a diagnostic screening tool.

Furthermore, the EDE-Q shows good predictive validity, with high global scores correlating significantly with greater overall eating disorder severity and poorer treatment outcomes. The behavioral frequency items (e.g., purging, laxative use, objective binge eating) correspond well with self-monitoring records and clinical reports, affirming the questionnaire’s ability to capture key diagnostic behaviors.

Reliability

The EDE-Q exhibits high internal consistency across its subscales, typically showing Cronbach’s alpha values well above 0.70 in clinical samples. Research by Luce & Crowther (1999) and others confirms the reliability of the self-report version. Test-retest reliability is also generally strong, indicating that the measure produces consistent scores over short retest intervals, provided the patient’s clinical status has not significantly changed.

While the overall scale is robust, some individual behavioral items show lower base rates (e.g., laxative use), which can sometimes affect the reliability of specific frequency counts in non-clinical or mixed samples, though the core attitudinal subscales remain highly reliable.

Factor Analysis

Initial factor analysis generally supported the four-factor structure inherited from the EDE interview: Restraint, Eating Concern, Shape Concern, and Weight Concern. However, subsequent research, particularly in non-clinical and adolescent samples, sometimes suggests that a two-factor model (Attitudinal/Cognitive features and Behavioral features) or a three-factor model (combining Shape and Weight Concerns) may offer a better fit. Despite these variations, the four-subscale scoring method remains the standard for clinical interpretation, as it aligns best with the theoretical model proposed by Fairburn.

Instrument

Test Type: Self-report questionnaire; Screening tool for eating disorders psychopathology.

Format: 28 core items scored on a 7-point Likert scale (0-6), supplemented by 12 frequency questions detailing specific behaviors (e.g., vomiting, binge eating episodes).

Language Available: English (Original), widely translated into numerous languages including Spanish, German, French, and Japanese.

Population Group: Clinical and non-clinical populations.

Age Group: Typically utilized with adolescents (14+) and adults.

Population Details: Used across diverse settings including university clinics, general practice, and specialized eating disorder treatment centers.

Test Methodology: Respondents answer questions based on experiences over the past four weeks (28 days). Scores are calculated by averaging item scores within each subscale to produce a mean subscale score (0-6), and a Global Score (mean of the four subscale scores).

Keywords

Self-report measure, cognitive symptoms, behavioral symptoms, body image, psychometric assessment, clinical psychology, Fairburn, EDE, diagnostic screening.

Authors

Author ORCID Identifier: N/A

Affiliation Email addresses: N/A

Correspondence Address: N/A

Permissions & Fee and Test Year

The original EDE interview was developed in the 1980s, and the self-report questionnaire (EDE-Q) was formally introduced and validated in the mid-1990s (Fairburn & Beglin, 1994). The EDE-Q is generally available for use in clinical research settings, though formal permission may be required depending on the version and setting. Users should consult the Oxford Centre for Research into Eating Disorders (OCRED) for definitive copyright and usage guidelines. The original PDF referenced in the source content can be downloaded here: http://ses.library.usyd.edu.au/bitstream/2123/4026/1/j-swinbourne-thesis.pdf.

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.
• Luce, K.H. & Crowther, J.H. (1999). The reliability of the eating disorder examination self-report questionnaire version (EDE-Q). International Journal of Eating Disorders, 25, 349- 351.

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

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

Instructions

The following questions are concerned with the PAST FOUR WEEKS ONLY (28 days).

Please read each question carefully and circle the appropriate number on the right. Please answer all the questions.

No Days=0, 1 – 5days=1, 6 – 12days=2, 13 – 15days=3, 16 – 22days=4, 23-27days=5, Everyday=6

On how many days out of the past 28 days ……

OVER THE PAST FOUR WEEKS (28 DAYS)

16. Over the past four weeks (28 days), have there been any time when you have felt that you have eaten what other people would regard as an unusually large amount of food given the circumstances? (Please put appropriate number in box.)

0 – No [ ]

1 – Yes [ ]

17. How many such episodes have you had over the past four weeks?

[ ] [ ] [ ]

18 During how many of these episodes of overeating did you have a sense of having lost control over your eating?

[ ] [ ] [ ]

_______________________________________________________________________

19. Have you had other episodes of eating in which you have had a sense of having lost control and eaten too much, but have not eaten an unusually large amount of food given the circumstances?

0 – No [ ]

1 – Yes [ ]

20. How many such episodes have you had over the past four weeks?

[ ] [ ] [ ]

21. Over the past four weeks have you made yourself sick (vomit) as a means of controlling your shape or weight?

0 – No [ ]

1 – Yes [ ]

22. How many times have you done this over the past four weeks?

[ ] [ ] [ ]

23. Have you taken laxatives as a means of controlling your shape or weight?

0 – No [ ]

1 – Yes [ ]

24. How many times have you done this over the past four weeks?

[ ] [ ] [ ]

25. Have you taken diuretics (water tablets) as a means of controlling your shape or weight?

0 – No [ ]

1 – Yes [ ]

26. How many times have you done this over the past four weeks?

[ ] [ ] [ ]

27. Have you exercised hard as a means of controlling your shape or weight?

0 – No [ ]

1 – Yes [ ]

28. How many times have you done this over the past four weeks?

[ ] [ ] [ ]

OVER THE PAST FOUR WEEKS (28 DAYS) (please circle the number which best describes your behaviour

NOT AT ALL=0, 1 , SLIGHTLY=2, 3 , MODERATELY=4 , 5 , MARKEDLY=6