When looking at the EDE, I was puzzled why item 40 (“Maintained low weight”) has so much influence in generating the DSM-5 diagnosis "anorexia nervosa". As I understand it, a diagnosis would be possible with a significantly reduced BMI and an answer to item 40 with "1" or "2". Therefore, I was wondering why other criteria, such as body schema disorder, extreme fear of gaining weight and/or insight into the illness, might be considered less important.
My hypothesis is that by answering item 40 with "1" or "2", an implicit affirmation of the other criteria is assumed.
Could someone help me in this regard?
Thank you in advance.
All 40 questions together has their value. When you calculate Cronbach's alpha and have to delete some items to increse the alpha >.70, it does not matter if you delete item 40 or some other items depending on how they contribute to the alpha.
Thank you for your quick response.
For me it is more about the algorithm for assigning the diagnosis of "anorexia nervosa" provided with the interview. What I do not understand is why all diagnostic criteria, especially the C-criterion, for assigning a diagnosis of "anorexia nervosa" are fulfilled by answering item 40 with "1" or "2". The C-criterion says "disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight." - how does item 40 ("maintained low weight") account for all of this?
Check this out in case it makes it clearer:
Eating Disorder Inventory - an overview | ScienceDirect Topics. From here you see the many inventories at hand. EDE defines anorexia nervosa as:
Anorexia nervosa is typically characterized by low body weight due to intentional undernourishment.
So item 40 explains it all:)
Thank you again for your answer.
I think there is a little misunderstanding here. I am interested in the diagnosis according to DSM-5. The EDE manual says that a diagnosis according to DSM-5 is possible. The manual assigns certain items to the DSM-5 criteria. For the C-criterion, either an item on the importance of weight/shape for self-worth or item 40 must reach a certain value. I have difficulties understanding how item 40 covers the aspects of disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, and/or persistent lack of recognition of the seriousness of the current low body weight (required for the C criterion).
I think Dr. Ewalds-Kvist may be referring to the EDI (Eating Disorders Inventory, a questionnaire), not the Eating Disorders Examination, which is a structured interview. To complicate matters, there is also the EDE-Q, a questionnaire version of some of the EDE items.
A few questions:
1. Are you referring to the EDE? I assume so.
2. If yes, which version of the EDE are you using?
3. Where are the scoring instructions you are using derived from?
The latest scoring instructions are included with the EDE, version 17.0, and are described in detail in Fairburn and Beglin (1994). As you may know already, you can download the EDE and EDE-Q here: https://www.cbte.co/for-professionals/measures/
From what you describe, there seems to be an error, as there are 3 DSM-5 criteria for AN, each of which should have been assessed separately, just as you indicated.
However, the EDE items in the above download are not numbered, so might the scoring error have been introduced somehow in the version you are working from that has numbered items? If you are working from a translated version, might that have been the source of the error? Or might item 40 in your version be a summary variable that incorporates coding from the two other, non-weight-based AN criteria?
Yes, I am referring to the EDE, version 17.0. I am sorry for the confusion - in the German version the items are numbered. When I mentioned item 40, I was referring to the item "Maintained low weight". The diagnostic algorithm I am referring to is listed on pages 4 and 5 of EDE version 17.0.
My question is how "Maintained low weight" is supposed to account for the non-weight-related AN criteria, especially the C-criterion.
The diagnostic algorithm on page 5 states that the C criterion is met if "Maintained low weight" has been rated "1" or "2", even if "Importance of shape" or "Importance of weight" has not been rated "4" or higher. I don't see how "Maintained low weight" accounts for the C-criterion.
Good question. There could be a problem with the algorithm you are using. Alternatively, check the exact DSM wording for the AN diagnosis; ultimately, those criteria are what the EDE is striving for. Could the algorithm be aiming to account for the frequent denial of importance of weight/shape? You could try contacting Dr. Zafra Cooper at Yale, an EDE co-author, if need be.
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