Eating Disorder-Specific Interoceptive Perception Questionnaire (EDIP-Q)

Abstract

The Eating Disorder-Specific Interoceptive Perception Questionnaire (EDIP-Q), developed by Ortmann et al. in 2023, is a specialized self-report instrument designed to quantify difficulties in perceiving and differentiating between internal bodily states, specifically emotions, hunger, and satiety, within the context of Eating Disorders (EDs). The scale development involved multiple rigorous stages, beginning with content collection from existing measures, followed by expert review, and culminating in extensive psychometric analyses. The final instrument comprises 25 items and was validated using two distinct samples of German adults, including clinical populations diagnosed with eating disorders. The resulting evaluation confirmed strong results regarding factor structure, reliability, and validity.

Keywords

Eating Disorders, Discrimination, Emotion, Hunger, Satiety, Interoception, Psychodiagnostic Measures, Psychological Assessment, Clinical Instrument

Authors

Ortmann, Julie; Lutz, Annika P. C.; Rose, Gitta; Happ, Christian; Vögele, Claus; Schulz, André; van Dyck, Zoé

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Purpose

The primary objective of the EDIP-Q is to provide a precise evaluation of Eating Disorder-Specific Interoceptive Perception (EDIP) deficits. This assessment is crucial for generating detailed profiles of interoceptive dysfunction among individuals suffering from EDs.

By identifying specific areas of deficit—such as difficulty distinguishing between physiological hunger and emotional distress—the EDIP-Q aims to establish a robust foundation for developing highly specialized and targeted psychological and nutritional treatment strategies for patients with eating disorders.

Construct

The scale measures Eating Disorder-Specific Interoceptive Perception, defined as the subjective capacity to notice, interpret, and differentiate internal bodily sensations related specifically to affective states (emotions) and homeostatic states (hunger and satiety). The construct highlights the maladaptive processing of internal signals frequently observed in eating disorder pathologies.

Validity

The EDIP-Q demonstrates robust psychometric properties, particularly strong evidence for its construct validity. This was established through its correlation with related convergent questionnaires and, conversely, a demonstrated lack of correlation with divergent self-report measures.

Clinically, the validation study revealed that participants with self-reported Eating Disorders (EDs) reported significantly lower scores on the EDIP-Q compared to non-clinical controls, indicating greater difficulties in interoceptive perception. Furthermore, analyses elucidated nuanced differences among ED subtypes: individuals with self-reported Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Binge-Eating Disorder (BED) reported comparable difficulties in perceiving general emotions. However, those with BN and BED indicated significantly greater challenges in perceiving satiety and in differentiating between hunger and emotional states compared to individuals with AN. Conversely, individuals with AN reported higher sensitivity to satiety but lower sensitivity to hunger relative to those with BN and BED.

Reliability

The EDIP-Q exhibits high internal consistency, confirming its reliability across the total scale and its subcomponents. The overall scale demonstrated a high Cronbach’s alpha coefficient of .94.

The four distinct subscales also showed strong internal reliability, with the following alpha values reported: Emotions (.92), Hunger (.86), Satiety (.93), and Discrimination (.88).

Factor Analysis

The initial psychometric investigation involved an Exploratory Factor Analysis (EFA). Both a parallel analysis and inspection of the scree plot consistently supported a four-factor solution. A Principal Component Analysis (PCA) further confirmed this four-factor structure, which cumulatively accounted for 65.34% of the total variance observed. These findings finalized the 25-item instrument with four distinct subscales.

Subsequently, a Confirmatory Factor Analysis (CFA) was performed, affirming that the four-factor solution provided a good fit to the data, evidenced by strong fit indices: CFI = 0.95, TLI = 0.94, SRMR = 0.047, RMSEA = 0.052, 90% CI [0.049, 0.056], χ²(1, 269) = 978.122, p < .001. All 25 items exhibited high factor loadings (>.50). Given that the first-order factors were significantly interrelated (rs ranging from .45 to .64, p < .001), a second-order model was tested. This higher-order structure, where the four first-order factors loaded onto a single higher-order EDIP factor, also demonstrated a good fit to the data: CFI = 0.95, TLI = 0.94, SRMR = 0.050, RMSEA = 0.053, 90% CI [0.050, 0.057], χ²(1, 271) = 922.17, p < .001.

Instrument

Test Type: Original Inventory/Questionnaire (Self-Report Measure)

Format: Electronic administration, consisting of 25 items rated on a 7-point Likert scale.

Language Available: German and English.

Population Group: Adult populations (both male and female).

Age Group: 18 years and older.

Population Details: Validation study participants included adults located in Germany, encompassing both clinical individuals diagnosed with eating disorders and non-clinical controls.

Test Methodology: The scale uses a 7-point Likert scale ranging from 1 (Does not apply at all) to 7 (Applies completely). Lower total scores indicate greater difficulty in eating disorder-specific interoceptive perception. Methodology included assessments of Test Validity, Construct Validity, Convergent Validity, Discriminant Validity, Test Reliability, Internal Consistency (Cronbach’s alpha), Factor Analysis (EFA and CFA), and Principal Component Analysis (PCA).

Keywords

Interoceptive Perception, Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder, Self-Report, Psychometrics, Validation, Clinical Assessment

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Authors

Ortmann, Julie

• Author ORCID Identifier: http://orcid.org/0000-0002-2793-7296

• Affiliation: University of Luxembourg, Department of Behavioural and Cognitive Sciences

• Affiliation Email addresses: [email protected]

Lutz, Annika P. C.

• Author ORCID Identifier: http://orcid.org/0000-0002-3247-3262

• Affiliation: University of Luxembourg, Department of Behavioural and Cognitive Sciences

Rose, Gitta

• Author ORCID Identifier: No data is Available

• Affiliation: Independent Psychotherapist/Clinical Psychologist

Happ, Christian

• Author ORCID Identifier: No data is Available

• Affiliation: Yolande Asbl

Vögele, Claus

• Author ORCID Identifier: http://orcid.org/0000-0001-8086-0788

• Affiliation: University of Luxembourg, Department of Behavioural and Cognitive Sciences

Schulz, André

• Author ORCID Identifier: http://orcid.org/0000-0002-9381-2651

• Affiliation: University of Luxembourg, Department of Behavioural and Cognitive Sciences

van Dyck, Zoé

• Author ORCID Identifier: http://orcid.org/0000-0001-5240-4902

• Affiliation: University of Luxembourg, Department of Behavioural and Cognitive Sciences

Correspondence Address:

• Ortmann, Julie: University of Luxembourg, Department of Behavioural and Cognitive Sciences, Campus Belval, 11 Porte des Sciences, Esch-sur-Alzette, Luxembourg, L-4366, [email protected]

Permissions & Fee and Test Year

• Permissions: May be used freely for Research/Teaching purposes.

• Commercial: No

• Fee: No

• Test Year: 2023 (Development and Initial Validation)

Reference’s

Ortmann, J., Lutz, A. P. C., Rose, G., Happ, C., Vögele, C., Schulz, A., & van Dyck, Z. (2024). Development and initial validation of a self-report measure to assess eating disorder-specific interoceptive perception. Psychological Assessment, 36(2), 162–174. https://doi.org/10.1037/pas0001283

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Items of the Eating Disorder-Specific Interoceptive Perception Questionnaire (EDIP-Q)

You will find a list of statements regarding your experience of emotions, hunger, and the feeling of fullness. We are interested in your personal perception thereof, and ask you to indicate how often the following statements were applicable to you within the last month.

Please indicate your response on a 7-point scale where 1 = Does not apply at all and 7 = Applies completely.

Scoring Key:

• E = Emotion subscale item

• H = Hunger subscale item

• S = Satiety subscale item

• D = Discrimination subscale item

• ᴿ = Reversed coded item