Eating Disorders Screening Tools: The Psychometric Properties of the Persian version of Eating Attitude Test

Esmaeil Mousavi Asl, Behzad Mahaki, Yousef Asmari Bardezard, Youkhabeh Mohammadian

Abstract


Background: Screening for eating disorders via reliable instruments is of high importance for clinical and preventive purposes. Examining the psychometric properties of tools in societies with differing dynamics can help with their external validity. This research specifically aimed at standardization and validation of the eating attitude test (EAT‑16) in Iran. Methods: The Persian version of the EAT‑16 was produced through forward translation, reconciliation, and back translation. The current research design was descriptive cross‑sectional (factor analysis). A total of 302 nonclinical students were selected through the convenience sampling method and completed a set of questionnaires. The questionnaires included, the EAT‑16, eating beliefs questionnaire‑18 (EBQ‑18), difficulties in emotion regulation scale‑16 (DERS‑16), weight efficacy lifestyle questionnaire‑short form, self‑esteem scale, and self‑compassion scale short‑form. The construct validity of the EAT‑16 was assessed using confirmatory factor analysis and divergent and convergent validity. Internal consistency and test–retest reliability (2 weeks’ interval) were used to evaluate the reliability. Data analysis was conducted using LISREL (version 8.8) and SSPS (version 22) software. Results: EAT‑16 and subscales were found to be valid and reliable, with good internal consistency and good, test–retest reliability in a non‑clinical sample. In terms of convergent validity, EAT‑16 and subscales showed a positive correlation with the selfreport measures of EBQ‑18 and DERS‑16. EAT‑16 and subscales showed a negative correlation with self‑compassion, self‑esteem and eating self‑efficacy., Therefore, it demonstrated divergent validity with these constructs. The results of this study support the EAT‑16 four‑factor model. Conclusions: The EAT‑16 showed good validity and reliability and could be useful in assessing eating disorders in Iranian populations. The EAT‑16 is an efficient instrument that is suitable for screening purposes in the nonclinical samples

Keywords


Eating; factor analysis; psychological tests; psychometrics

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References


Swanson SA, Crow SJ, Le Grange D, Swendsen J,

Merikangas KR. Prevalence and correlates of eating disorders

in adolescents: Results from the national comorbidity survey

replication adolescent supplement. Arch Gen Psychiatry

;68:714‑23.

Keshaviah A, Edkins K, Hastings ER, Krishna M, Franko DL,

Herzog DB, et al. Re‑examining premature mortality in

anorexia nervosa: A meta‑analysis redux. Compr Psychiatry

;55:1773‑84.

Smith AR, Velkoff EA, Ribeiro JD, Franklin J. Are eating

disorders and related symptoms risk factors for suicidal thoughts

and behaviors? A meta‑analysis. Suicide Life Threat Behav

;49:221‑39.

Erskine HE, Whiteford HA, Pike KM. The global burden of

eating disorders. Curr Opin Psychiatry 2016;29:346‑53.

American Psychiatric Association. Diagnostic and Statistical

Manual of Mental Disorders. 5th ed. Washington, DC: American

Psychiatric Association; 2013.

Aspen V, Weisman H, Vannucci A, Nafiz N, Gredysa D, Kass AE,

et al. Psychiatric co‑morbidity in women presenting across the

continuum of disordered eating. Eat Behav 2014;15:686‑93.

Hilbert A, De Zwaan M, Braehler E. How frequent are eating

disturbances in the population? Norms of the eating disorder

examination‑questionnaire. PLoS One 2012;7:e29125.

Berger U, Wick K, Hölling H, Schlack R, Bormann B, Brix C,

et al. Screening of disordered eating in 12‑Year‑old girls and

boys: Psychometric analysis of the German versions of SCOFF

and EAT‑26. Psychother Psychosom Med Psychol 2011;61:311‑8.

Stice E, Marti CN, Shaw H, Jaconis M. An 8‑year longitudinal

study of the natural history of threshold, subthreshold, and

partial eating disorders from a community sample of adolescents.

J Abnorm Psychol 2009;118:587‑97.

Sanftner JL. Quality of life in relation to psychosocial risk

variables for eating disorders in women and men. Eat Behav

;12:136‑42.

Herpertz‑Dahlmann B, Dempfle A, Konrad K, Klasen F,

Ravens‑Sieberer U; BELLA Study Group. Eating disorder

symptoms do not just disappear: The implications of adolescent

eating‑disordered behaviour for body weight and mental health in

young adulthood. Eur Child Adolesc Psychiatry 2015;24:675‑84.

Loth KA, MacLehose R, Bucchianeri M, Crow S,

Neumark‑Sztainer D. Predictors of dieting and disordered eating

behaviors from adolescence to young adulthood. J Adolesc

Health 2014;55:705‑12.

Richter F, Strauss B, Braehler E, Altmann U, Berger U.

Psychometric properties of a short version of the Eating Attitudes

Test (EAT‑8) in a German representative sample. Eat Behav

;21:198‑204.

Cumella EJ. Obsessive‑compulsive disorder with eating

disorders. Am J Psychiatry 1999;156:982.

Schoemaker C. Does early intervention improve the prognosis in

anorexia nervosa? A systematic review of the treatment‑outcome

literature. Int J Eat Disord 1997;21:1‑5.

Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire:

Assessment of a new screening tool for eating disorders. BMJ

;319:1467‑8.

Killen JD, Hayward C, Wilson DM, Taylor CB, Hammer LD,

Litt I, et al. Factors associated with eating disorder symptoms in

a community sample of 6th and 7th grade girls. Int J Eat Disord

;15:357‑67.

Richter F, Strauss B, Braehler E, Altmann U, Berger U.

Psychometric properties of a short version of the Eating Attitudes

Test (EAT‑8) in a German representative sample. Eat Behav

;21:198‑204.

Garfinkel PE, Newman A. The eating attitudes test: twenty-five

years later. Eating and Weight Disorders-Studies on Anorexia,

Bulimia and Obesity 2001;6:1-21.

Berger U, Hentrich I, Wick K, Bormann B, Brix C, Sowa M,

et al. Psychometric quality of the” Eating Attitudes Test”

(German version EAT‑26D) for measuring disordered eating

in pre‑adolescents and proposal for a 13‑item short version.

Psychother Psychosom Med Psychol 2012;62:223‑6.

Striegel‑Moore RH, Dohm FA, Kraemer HC, Taylor CB,

Daniels S, Crawford PB, et al. Eating disorders in white and

black women. Am J Psychiatry 2003;160:1326‑31.

Mohammadian Y, Mahaki B, Lavasani FF, Dehghani M,

Vahid MA. The psychometric properties of the Persian version of

interpersonal sensitivity measure. J Res Med Sci 2017;22:10.

McLaughlin E. The EAT‑16: Validation of a Shortened Form

of the Eating Attitudes Test; 2014. Available from: https://

digitalrepository.unm.edu/psy_etds/94.

Belon KE, Smith JE, Bryan AD, Lash DN, Winn JL, Gianini LM.

Measurement invariance of the Eating Attitudes Test‑26 in

Caucasian and Hispanic women. Eat Behav 2011;12:317‑20.

Austin SB. Accelerating progress in eating disorders prevention:

A call for policy translation research and training. Eat Disord

;24:6‑19.

Kline RB. Principles and Practice of Structural Equation

Modeling. 4th ed. New York: Guilford Publications; 2015.

Raes F, Pommier E, Neff KD, Van Gucht D. Construction and

factorial validation of a short form of the Self‑Compassion Scale.

Clin Psychol Psychother 2011;18:250‑5.

Khanjani S, Foroughi AA, Sadghi K, Bahrainian SA.

[Psychometric properties of Iranian version of

self‑compassionscale (short form)]. Pajoohande 2016;21:282‑9.

Persian.

Rosenberg M. Society and the adolescent selfimage. New Jersey:

Princeton University Press; 2015.

Moshki M, Ashtarian H. Perceived health locus of control,

self‑esteem, and its relations to psychological well‑being status

in Iranian students. Iran J Public Health 2010;39:70‑7.

Ames GE, Heckman MG, Grothe KB, Clark MM. Eating

self‑efficacy: Development of a short‑form WEL. Eat Behav

;13:375‑8.

Ahmadipour H, Ebadi S. Psychometric properties of the persian

version of weight efficacy lifestyle questionnaire‑short form. Int

J Prev Med 2019;10:71.

Bjureberg J, Ljótsson B, Tull MT, Hedman E, Sahlin H,

Lundh LG, et al. Development and validation of a brief version

of the difficulties in emotion regulation scale: The DERS‑16.

J Psychopathol Behav Assess 2016;38:284‑96.

Shahabi M, Hasani J, Bjureberg J. Psychometric properties

of the brief Persian version of the difficulties in emotion

regulation scale (the DERS‑16). Assess Eff Interv 2018. doi:

Burton A, Mitchison D, Hay P, Donnelly B, Thornton C,

Russell J, et al. Beliefs about binge eating: Psychometric

properties of the eating beliefs questionnaire (EBQ‑18) in

eating disorder, obese, and community samples. Nutrients

;10:1306.

Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL,

Dekker J, et al. Quality criteria were proposed for measurement

properties of health status questionnaires. J Clin Epidemiol

;60:34‑42.

Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance

structure analysis: Conventional criteria versus new alternatives.

Struct Equ Model Multidiscip J 1999;6:1‑55.

Mulaik SA, James LR, Van Alstine J, Bennett N, Lind S,

Stilwell CD. Evaluation of goodnessoffit indices for structural

equation models. Psychol Bull 1989;105:430-45.

Ocker LB, Lam ET, Jensen BE, Zhang JJ. Psychometric

properties of the eating attitudes test. Meas Phys Educ Exerc Sci

;11:25‑48.

Chermelleh‑Engel K, Moosbrugger H, Müller H. Evaluating

the fit of structural equation models: Tests of significance and

descriptive goodness‑of‑fit measures. Methods Psychol Res

Online 2003;8:23‑74.

Burton AL, Abbott MJ. The revised short‑form of the Eating

Beliefs Questionnaire: Measuring positive, negative, and

permissive beliefs about binge eating. J Eat Disord 2018;6:37.

Brockmeyer T, Skunde M, Wu M, Bresslein E, Rudofsky G,

Herzog W, et al. Difficulties in emotion regulation across the

spectrum of eating disorders. Compr Psychiatry 2014;55:565‑71.

Lavender JM, Wonderlich SA, Peterson CB, Crosby RD,

Engel SG, Mitchell JE, et al. Dimensions of emotion

dysregulation in bulimia nervosa. Eur Eat Disord Rev

;22:212‑6.

Fresnics AA, Wang SB, Borders A. The unique associations

between self‑compassion and eating disorder psychopathology

and the mediating role of rumination. Psychiatry Res

;274:91‑7.

Braun TD, Park CL, Gorin A. Self‑compassion, body image,

and disordered eating: A review of the literature. Body Image

;17:117‑31.

Collin P, Karatzias T, Power K, Howard R, Grierson D,

Yellowlees A. Multi‑dimensional self‑esteem and magnitude

of change in the treatment of anorexia nervosa. Psychiatry Res

;237:175‑81.

Linardon J, de la Piedad Garcia X, Brennan L. Predictors,

moderators, and mediators of treatment outcome following

manualised cognitive‑behavioural therapy for eating disorders:

A systematic review. Eur Eat Disord Rev 2017;25:3‑12.

Vall E, Wade TD. Predictors of treatment outcome in individuals

with eating disorders: A systematic review and meta‑analysis. Int

J Eat Disord 2015;48:946‑71.

Glasofer DR, Haaga DA, Hannallah L, Field SE, Kozlosky M,

Reynolds J, et al. Self‑efficacy beliefs and eating behavior in

adolescent girls at‑risk for excess weight gain and binge eating

disorder. Int J Eat Disord 2013;46:663‑8.

Keshen A, Helson T, Town J, Warren K. Self‑efficacy as a

predictor of treatment outcome in an outpatient eating disorder

program. Eat Disord 2017;25:406‑19.

Steindl SR, Buchanan K, Goss K, Allan S. Compassion

focused therapy for eating disorders: A qualitative review

and recommendations for further applications. Clin Psychol

;21:62‑73.