Eating Attitudes Test

Last updated

The Eating Attitudes Test (EAT, EAT-26), created by David Garner, is a widely used 26-item, standardized self-reported questionnaire of symptoms and concerns characteristic of eating disorders. The EAT is useful in assessing "eating disorder risk" in high school, college and other special risk samples such as athletes. EAT has been extremely effective in screening for anorexia nervosa in many populations. [1]

Contents

The EAT-26 can be used in non-clinical as well as clinical settings not specifically focused on eating disorders. It can be administered in group or individual settings by mental health professionals, school counselors, coaches, camp counselors, and others with interest in gathering information to determine if an individual should be referred to a specialist for evaluation for an eating disorder. It is ideally suited for school settings, athletic programs, fitness centers, infertility clinics, pediatric practices, general practice settings, and outpatient psychiatric departments.

The EAT-26 uses a six-point scale based on how often the individual engages in specific behaviors. The questions may be answered: Always, Usually, Often, Sometimes, Rarely, and Never. Completing the EAT-26 yields a "referral index" based on three criteria: 1) the total score based on the answers to the EAT-26 questions; 2) answers to the behavioral questions related to eating symptoms and weight loss, and 3) the individual's body mass index (BMI) calculated from their height and weight. Generally, a referral is recommended if a respondent scores "positively" or meets the "cut off" scores or threshold on one or more criteria.

Permission to use the EAT-40 or EAT-26 can be obtained from David Garner through the EAT-26 website . Instructions, scoring, and interpretive information can be obtained from the EAT-26 website at no charge. Completion of the EAT-26 with anonymous feedback on the EAT-26 website is possible .

Development and history

The original version of the EAT (EAT-40) was published in 1979, with 40 items each rated on a 6-point Likert scale. [2] In 1982, Garner and colleagues modified the original version to create an abbreviated 26-item test. [3] The items were reduced after a factor analysis on the original 40-item data set revealed 26 independent items. [4] Since then, the EAT has been translated into many different languages and has gained widespread international as a tool to screen for eating disorders. [5] Both the original paper and the subsequent 1982 publication are 3rd and 4th on the list of the 10 most cited articles in the history of the journal Psychological Medicine , a prominent peer-reviewed journal in the fields of psychology and psychiatry.

The EAT was developed for a study examining possible sociocultural factors contributing to the increased prevalence of anorexia nervosa and other milder variants of the disorder. [6] This original study examined groups of highly competitive dance students and fashion models, who by career choice must focus increased attention and control over their body shapes. The EAT was used as a standardized measure of disturbed "eating attitudes" typical of anorexia nervosa. The study showed that significantly more dance students and fashion models scored above a cutoff score compared to those in a female non-clinical sample of college women. These findings were seen as support for the theory that sociocultural factors, emphasizing thinness as a marker for beauty and success for women, play a role in the increased incidence of anorexia nervosa observed in the "Twiggy era" of the 1970s and 1980s. The sociocultural hypothesis does not seem controversial today, but in the early 1980s, there was almost no mention of culture as a possible contributing factor in eating disorders. In 1998, the EAT was adopted by the National Eating Disorder Screening program based on recognition of a need for screening large populations of college and high school students for the purpose of early identification of anorexia nervosa related symptoms.

The EAT-26 is recommended as the first step in a two-stage screening process. Accordingly, individuals who score higher than a 20 should be referred to a qualified professional to determine if they meet the diagnostic criteria for an eating disorder. The EAT-26 is not designed to make a diagnosis of an eating disorder and should not be used in place of a professional diagnosis or consultation. The EAT should only be used as a screener for general eating disorders, as research has not shown it to be a valid instrument in making specific diagnoses. [3]

Limitations

The EAT suffers from the same problems as other self-report inventories, in that scores can be easily exaggerated or minimized by the person completing them. Like all questionnaires, the way the instrument is administered can have an effect on the final score. If a patient is asked to fill out the form in front of other people in a clinical environment, for instance, social expectations have been shown to elicit a different response compared to administration via a postal survey. [7]

As the EAT was originally developed to screen subjects at high risk for anorexia nervosa (AN), it remains controversial whether its present items and scoring cut-off are well-suited to diagnosing other eating disorders. Although the EAT can adequately diagnose undifferentiated eating disorders in clinical settings, it may not fare well in settings unequipped to address major eating disorders. [8]

While the EAT-26 has demonstrated good internal consistency, its test-retest reliability remains uncertain. [9] [10] [11] [12] The stability of an EAT-26 score has been demonstrated to be moderate over two years, but vulnerable to fluctuations over four years. [11] [13] This may be due to changes in an individual's eating behaviors and attitudes over time naturally or in response to receiving eating disorder treatment.

Another area of debate is the cut-off score of 20 first proposed by David Garner and colleagues to diagnose anorexia nervosa. High false-positive rates and low predictive power for screening for AN and bulimia nervosa (BN) in non-clinical settings have been reported. [11] [14] Use of the EAT-26 as a screening tool could also result in high false-negative rates in individuals with binge eating disorder (BED) or eating disorders not otherwise specified (EDNOS). [15] Such rates may be due to changes over time in the DSM and ICD criteria for eating disorders from which the items in the EAT are based. Another explanation may be the EAT's inability to distinguish subthreshold forms of abnormal eating behavior from clinical eating disorders. [15] [16] Lowering the cut-off score to 11 has been demonstrated to improve sensibility and sensitivity rates in individuals with BN, BED, and EDNOS and presents a promising solution to the aforementioned issue. [15]

See also

Other assessments

Related Research Articles

An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's physical or mental health. Types of eating disorders include binge eating disorder, where the patient eats a large amount in a short period of time; anorexia nervosa, where the person has an intense fear of gaining weight and restricts food or overexercises to manage this fear; bulimia nervosa, where individuals eat a large quantity (binging) then try to rid themselves of the food (purging); pica, where the patient eats non-food items; rumination syndrome, where the patient regurgitates undigested or minimally digested food; avoidant/restrictive food intake disorder (ARFID), where people have a reduced or selective food intake due to some psychological reasons; and a group of other specified feeding or eating disorders. Anxiety disorders, depression and substance abuse are common among people with eating disorders. These disorders do not include obesity. People often experience comorbidity between an eating disorder and OCD. It is estimated 20–60% of patients with an ED have a history of OCD.

<span class="mw-page-title-main">Bulimia nervosa</span> Type of eating disorder

Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging or fasting, and excessive concern with body shape and weight. This activity aims to expel the body of calories eaten from the binging phase of the process. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives.

Appetite is the desire to eat food items, usually due to hunger. Appealing foods can stimulate appetite even when hunger is absent, although appetite can be greatly reduced by satiety. Appetite exists in all higher life-forms, and serves to regulate adequate energy intake to maintain metabolic needs. It is regulated by a close interplay between the digestive tract, adipose tissue and the brain. Appetite has a relationship with every individual's behavior. Appetitive behaviour also known as approach behaviour, and consummatory behaviour, are the only processes that involve energy intake, whereas all other behaviours affect the release of energy. When stressed, appetite levels may increase and result in an increase of food intake. Decreased desire to eat is termed anorexia, while polyphagia is increased eating. Dysregulation of appetite contributes to anorexia nervosa, bulimia nervosa, cachexia, overeating, and binge eating disorder.

Binge eating disorder (BED) is an eating disorder characterized by frequent and recurrent binge eating episodes with associated negative psychological and social problems, but without the compensatory behaviors common to bulimia nervosa, OSFED, or the binge-purge subtype of anorexia nervosa.

Binge eating is a pattern of disordered eating which consists of episodes of uncontrollable eating. It is a common symptom of eating disorders such as binge eating disorder and bulimia nervosa. During such binges, a person rapidly consumes an excessive quantity of food. A diagnosis of binge eating is associated with feelings of loss of control. Binge eating disorder is also linked with being overweight and obesity.

Purging disorder is an eating disorder characterized by the DSM-5 as self-induced vomiting, or misuse of laxatives, diuretics, or enemas to forcefully evacuate matter from the body. Purging disorder differs from bulimia nervosa (BN) because individuals do not consume a large amount of food before they purge. In current diagnostic systems, purging disorder is a form of other specified feeding or eating disorder. Research indicates that purging disorder, while not rare, is not as commonly found as anorexia nervosa or bulimia nervosa. This syndrome is associated with clinically significant levels of distress, and that it appears to be distinct from bulimia nervosa on measures of hunger and ability to control food intake. Some of the signs of purging disorder are frequent trips to the bathroom directly after a meal, frequent use of laxatives, and obsession over one's appearance and weight. Other signs include swollen cheeks, popped blood vessels in the eyes, and clear teeth which are all signs of excessive vomiting.

The Eating Disorder Inventory (EDI) is a self-report questionnaire used to assess the presence of eating disorders, (a) anorexia nervosa both restricting and binge-eating/purging type; (b) bulimia nervosa; and (c) eating disorder not otherwise specified including binge eating disorder. The original questionnaire consisted of 64 questions, divided into eight subscales. It was created in 1984 by David M. Garner and others. There have been two subsequent revisions by Garner: the Eating Disorder Inventory-2 (EDI-2) and the Eating Disorder Inventory-3 (EDI-3).

The Body Attitudes Test (BAT) was developed by Probst et al. in 1995. It was designed for the assessment of multiple eating disorders in women. The BAT measures an individual's subjective body experience and attitudes towards one's own body. It is a questionnaire composed of twenty items which yields four different factors that evaluate the internal view of the patient's own body.

The SCOFF questionnaire utilizes an acronym in a simple five question test devised for use by non-professionals to assess the possible presence of an eating disorder. It was devised by Morgan et al. in 1999. The original SCOFF questionnaire was devised for use in the United Kingdom, thus the original acronym needs to be adjusted for users in the United States and Canada. The "S" in SCOFF stands for "Sick" which in British English means specifically to vomit. In American English and Canadian English it is synonymous with "ill". The "O" is used in the acronym to denote "one stone". A "stone" is an Imperial unit of weight which made up of 14 lbs. The letters in the full acronym are taken from key words in the questions:

The Anorectic Behavior Observation Scale (ABOS) is a thirty-item diagnostic questionnaire devised to be answered by the parents, spouse or other family member of an individual suspected of having an eating disorder. It was developed by Vandereyken et al. in 1992. The ABOS is useful for evaluations of patients with anorexia nervosa (AN) and bulimia nervosa (BN) before, during, and after clinical treatments. It can also be a significant tool for the screening of subjects in early-stage ED.

The Eating Disorder Diagnostic Scale (EDDS) is a self-report questionnaire that assesses the presence of three eating disorders; anorexia nervosa, bulimia nervosa and binge eating disorder. It was adapted by Stice et al. in 2000 from the validated structured psychiatric interview: The Eating Disorder Examination (EDE) and the eating disorder module of the Structured Clinical Interview for DSM-IV (SCID)16.

<span class="mw-page-title-main">Anorexia nervosa</span> Type of eating disorder

Anorexia nervosa (AN), often referred to simply as anorexia, is an eating disorder characterized by low weight, food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin.

The differential diagnoses of anorexia nervosa (AN) includes various types of medical and psychological conditions, which may be misdiagnosed as AN. In some cases, these conditions may be comorbid with AN because the misdiagnosis of AN is not uncommon. For example, a case of achalasia was misdiagnosed as AN and the patient spent two months confined to a psychiatric hospital. A reason for the differential diagnoses that surround AN arise mainly because, like other disorders, it is primarily, albeit defensively and adaptive for, the individual concerned. Anorexia Nervosa is a psychological disorder characterized by extremely reduced intake of food. People with anorexia nervosa have a low self-image and consider themselves overweight.

<span class="mw-page-title-main">Eating disorders and memory</span> Memory impairments linked to eating disorders

Many memory impairments exist as a result from or cause of eating disorders. Eating disorders (EDs) are characterized by abnormal and disturbed eating patterns that affect the lives of the individuals who worry about their weight to the extreme. These abnormal eating patterns involve either inadequate or excessive food intake, affecting the individual's physical and mental health.

Cognitive behavioral therapy (CBT) is derived from both the cognitive and behavioral schools of psychology and focuses on the alteration of thoughts and actions with the goal of treating various disorders. The cognitive behavioral treatment of eating disorders emphasizes on the minimization of negative thoughts about body image and the act of eating, and attempts to alter negative and harmful behaviors that are involved in and perpetuate eating disorders. It also encourages the ability to tolerate negative thoughts and feelings as well as the ability to think about food and body perception in a multi-dimensional way. The emphasis is not only placed on altering cognition, but also on tangible practices like making goals and being rewarded for meeting those goals. CBT is a "time-limited and focused approach" which means that it is important for the patients of this type of therapy to have particular issues that they want to address when they begin treatment. CBT has also proven to be one of the most effective treatments for eating disorders.

Cognitive emotional behavioral therapy (CEBT) is an extended version of cognitive behavioral therapy (CBT) aimed at helping individuals to evaluate the basis of their emotional distress and thus reduce the need for associated dysfunctional coping behaviors. This psychotherapeutic intervention draws on a range of models and techniques including dialectical behavior therapy (DBT), mindfulness meditation, acceptance and commitment therapy (ACT), and experiential exercises.

Christopher James Alfred Granville Fairburn is a British psychiatrist and researcher. He is Emeritus Professor of Psychiatry at the University of Oxford. He is known for his research on the development, evaluation and dissemination of psychological treatments, especially for eating disorders.

Grazing is a human eating pattern characterized as "the repetitive eating of small or modest amounts of food in an unplanned manner throughout a period of time, and not in response to hunger or satiety cues".

Paul E. Garfinkel is a Canadian psychiatrist, researcher and an academic leader. He is a professor at the University of Toronto and a staff psychiatrist at Centre for Addiction and Mental Health (CAMH).

Body image disturbance (BID) is a common symptom in patients with eating disorders and is characterized by an altered perception of one's own body.

References

  1. ↑ Garner & Garfinkel, (1979) http://eat-26.com/Docs/Garner-EAT-40%201979.pdf
  2. ↑ Garner, D.M., & Garfinkel, P.E. (1979).Psychological Medicine, 9, 273-279.
  3. 1 2 Garner et al. (1982). The eating attitudes test: Psychometric features and clinical correlates. Psychological Medicine, 12, 871-878.
  4. ↑ Garner, David M.; Olmsted, Marion P.; Bohr, Yvonne; Garfinkel, Paul E. (1982-11-01). "The Eating Attitudes Test: psychometric features and clinical correlates". Psychological Medicine. 12 (4): 871–878. doi:10.1017/S0033291700049163. ISSN   1469-8978. PMID   6961471. S2CID   45624525.
  5. ↑ Alvarez-Rayón, G.; Mancilla-Díaz, J. M.; Vázquez-Arévalo, R.; Unikel-Santoncini, C.; Caballero-Romo, A.; Mercado-Corona, D. (2013-07-26). "Validity of the Eating Attitudes Test: A study of Mexican eating disorders patients". Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. 9 (4): 243–248. doi:10.1007/BF03325077. ISSN   1124-4909. PMID   15844395. S2CID   31767626.
  6. ↑ Garner, D.M., & Garfinkel, P.E. (1980). Socio-cultural factors in the development of anorexia nervosa. Psychological Medicine, 10, 273-279.
  7. ↑ Bowling, Ann (2005-05-03). "Mode of questionnaire administration can have serious effects on data quality". Journal of Public Health. 27 (3): 281–291. doi:10.1093/pubmed/fdi031. ISSN   1741-3850. PMID   15870099.
  8. ↑ Williams, Paul; Hand, David; Tarnopolsky, Alex (May 1982). "The problem of screening for uncommon disorders – a comment on the Eating Attitudes Test". Psychological Medicine. 12 (2): 431–434. doi:10.1017/s003329170004678x. ISSN   0033-2917. PMID   7100366. S2CID   36300982.
  9. ↑ Doninger, Gretchen L.; Enders, Craig K.; Burnett, Kent F. (2005-03-01). "Validity Evidence for Eating Attitudes Test Scores in a Sample of Female College Athletes". Measurement in Physical Education and Exercise Science. 9 (1): 35–49. doi:10.1207/s15327841mpee0901_3. ISSN   1091-367X. S2CID   143053979.
  10. ↑ Garner, David M.; Olmsted, Marion P.; Bohr, Yvonne; Garfinkel, Paul E. (November 1982). "The Eating Attitudes Test: psychometric features and clinical correlates". Psychological Medicine. 12 (4): 871–878. doi:10.1017/S0033291700049163. ISSN   1469-8978. PMID   6961471. S2CID   45624525.
  11. 1 2 3 Nunes, M. A.; Camey, S.; Olinto, M. T. A.; Mari, J. J. (November 2005). "The validity and 4-year test-retest reliability of the Brazilian version of the Eating Attitudes Test-26". Brazilian Journal of Medical and Biological Research. 38 (11): 1655–1662. doi: 10.1590/S0100-879X2005001100013 . ISSN   0100-879X. PMID   16258635.
  12. ↑ Pereira, Ana Telma; Maia, Berta; Bos, Sandra; Soares, Maria João; Marques, Mariana; Macedo, António; Azevedo, Maria Helena (2008). "The Portuguese short form of the Eating Attitudes Test-40". European Eating Disorders Review. 16 (4): 319–325. doi:10.1002/erv.846. hdl: 10316/8437 . ISSN   1099-0968. PMID   18059073.
  13. ↑ Wood, Alison; Waller, Glen; Gowers, Simon (1994). "Predictors of eating psychopathology in adolescent girls". European Eating Disorders Review. 2 (1): 6–13. doi:10.1002/erv.2400020103. ISSN   1099-0968.
  14. ↑ Garfinkel, Paul E.; Newman, A. (2001-03-01). "The Eating Attitudes Test: Twenty-five years later". Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. 6 (1): 1–21. doi:10.1007/BF03339747. ISSN   1590-1262. PMID   11300541. S2CID   9386950.
  15. 1 2 3 Orbitello, B.; Ciano, R.; Corsaro, M.; Rocco, P. L.; Taboga, C.; Tonutti, L.; Armellini, M.; Balestrieri, M. (June 2006). "The EAT-26 as screening instrument for clinical nutrition unit attenders". International Journal of Obesity. 30 (6): 977–981. doi: 10.1038/sj.ijo.0803238 . ISSN   1476-5497. PMID   16432540.
  16. ↑ Rivas, Teresa; Bersabé, Rosa; Jiménez, Manuel; Berrocal, Carmen (November 2010). "The Eating Attitudes Test (EAT-26): Reliability and Validity in Spanish Female Samples". The Spanish Journal of Psychology. 13 (2): 1044–1056. doi:10.1017/S1138741600002687. ISSN   1988-2904. PMID   20977051. S2CID   33094581.

Further reading

General guidelines and summaries

Evidence-based treatments

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.