Eating Disorder Examination Questionnaire (EDE-Q): Norms for Undergraduate Men

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/41620883 Eating Disorder Examination Questionnaire (EDE-Q): Norms for undergraduate men Article in Eating behaviors · April 2010 DOI: 10.1016/j.eatbeh.2009.09.005 · Source: PubMed CITATIONS READS 91 1,893 3 authors: Jason M. Lavender Kyle Patrick De Young 68 PUBLICATIONS 695 CITATIONS 24 PUBLICATIONS 277 CITATIONS University of California, San Diego SEE PROFILE University of Wyoming SEE PROFILE Drew A Anderson University at Albany, The State University of … 86 PUBLICATIONS 2,382 CITATIONS SEE PROFILE All content following this page was uploaded by Drew A Anderson on 20 January 2017. The user has requested enhancement of the downloaded file. All in-text references underlined in blue are added to the original document and are linked to publications on ResearchGate, letting you access and read them immediately. Eating Behaviors 11 (2010) 119–121 Contents lists available at ScienceDirect Eating Behaviors Eating Disorder Examination Questionnaire (EDE-Q): Norms for undergraduate men Jason M. Lavender ⁎, Kyle P. De Young, Drew A. Anderson Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, 12222, USA a r t i c l e i n f o Article history: Received 16 April 2009 Received in revised form 24 August 2009 Accepted 1 September 2009 Keywords: EDE-Q Norms Undergraduate men Assessment a b s t r a c t Normative data on the Eating Disorder Examination Questionnaire for samples of undergraduate men in the United States are presented. Participants were 404 undergraduate men aged 18–26 who completed the EDEQ as part of two larger survey studies. Mean scores, standard deviations, and percentile ranks for the Global score and four subscale scores are provided. Data regarding the frequency of objective binge eating episodes and compensatory behaviors also are reported. Although the overall prevalence of full threshold eating disorders remains lower in men than in women, body dissatisfaction and disordered eating behaviors are fairly common among young men. These results will help researchers and clinicians interpret the EDE-Q scores of undergraduate men. © 2009 Elsevier Ltd. All rights reserved. 1. Introduction The Eating Disorder Examination Questionnaire (EDE-Q; Fairburn & Beglin, 1994, 2008), derived from the Eating Disorder Examination (EDE) interview (Fairburn & Cooper, 1993; Fairburn, Cooper, & O'Connor, 2008) is one of the most widely utilized self-report measures of disordered eating. The EDE-Q is a popular alternative to the EDE, due in part to the extensive training required to administer the EDE and the substantial resources needed to assess large samples (Luce, Crowther, & Pole, 2008; Wilfley, Schwartz, Spurrell, & Fairburn, 1997). Numerous studies have revealed good convergence of the EDE and EDE-Q in community and clinical samples (Binford, Le Grange, & Jellar, 2005; Grilo, Masheb, & Wilson, 2001; Mond, Rodgers, Hay, Owen, & Beumont, 2004; Wilfley et al., 1997), although individuals tend to endorse higher rates of objective binge eating on the EDE-Q (Fairburn & Beglin, 1994; Wolk, Loeb, & Walsh, 2005). Normative data are necessary for appropriate interpretation of scores on measures such as the EDE-Q. While norms for the EDE-Q among adolescent girls and women are available, (Carter, Stewart, & Fairburn, 2001; Luce et al., 2008; Mond, Hay, Rodgers, & Owen, 2006), norms for young men have not been published. Although the prevalence of full threshold bulimia nervosa and anorexia nervosa remains lower in men than women, the gender difference in the prevalence of binge eating disorder is comparatively small (StriegelMoore & Franko, 2003). Furthermore, many young men report body dissatisfaction, which may place them at risk for disordered eating (Ricciardelli & McCabe, 2004). Men with eating disorders have been the focus of numerous studies. For example, Braun, Sunday, Huang and Halmi (1999) reported on a ⁎ Corresponding author. Tel.: +1 518 442 4851; fax: +1 518 442 4867. E-mail address: jl979833@albany.edu (J.M. Lavender). 1471-0153/$ – see front matter © 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.eatbeh.2009.09.005 sample of men and women admitted to an inpatient eating disorder service over a thirteen-year period. Overall, the authors noted that men and women were more similar than dissimilar in terms of core eating disorder attitudes and behaviors. Results from other studies support this notion and suggest that men and women exhibit comparable eating disorder symptoms, though they may differ in psychiatric comorbidity and in the frequency of certain compensatory behaviors (Carlat, Camargo, & Herzog, 1997; Olivardia, Pope, Mangweth, & Hudson, 1995; Striegel-Moore et al., 2009; Woodside et al., 2001). Studies have reported that the average age of onset of eating disorders in men is approximately 19–20 years (Braun et al., 1999; Carlat et al., 1997), suggesting that college-aged men may be at risk for developing eating disorders. Undergraduate men involved in athletic activities that stress weight control (e.g., wrestling) may be particularly vulnerable (Braun et al., 1999). The aim of the present research was therefore to provide EDE-Q norms for undergraduate men, which may be useful to researchers and clinicians seeking to assess eating pathology among members of this population. 2. Method Undergraduate men (N = 404) from a Northeastern university who were enrolled in an introductory-level psychology course participated in one of two studies that administered the EDE-Q (De Young & Anderson, 2010; Lavender & Anderson, in press). Participants had a mean age of 19.02 ± 1.41 years and BMI of 25.26 ± 4.23 kg/m2. A total of 67.8% identified themselves as Caucasian, 10.6% as African American, 7.9% as Latino American, 7.7% as Asian American, and 5.9% as other/missing. Independent samples t-tests revealed no significant differences in age and BMI between the two samples, and a chi-square analysis revealed no significant differences in ethnic composition. 120 J.M. Lavender et al. / Eating Behaviors 11 (2010) 119–121 The EDE-Q is a self-report questionnaire that assesses disordered eating attitudes and behaviors over the previous 28 days. The measure provides a Global score and four subscale scores: Restraint, Eating Concern, Shape Concern, and Weight Concern. Responses are on a 7point scale, and higher scores reflect greater eating-related pathology. Frequencies of disordered eating behaviors including binge eating and various compensatory behaviors also are assessed. In this study, Cronbach's alpha was .93 for the global score, .78 for the restraint subscale, .78 for the eating concern subscale, .89 for the shape concern subscale, and .80 for the weight concern subscale. 2.1. Data analyses To assess the similarity of male norms obtained from the present sample to norms published for undergraduate women by Luce et al. (2008) and the 18–22 age group of women reported by Mond et al. (2006), z-tests were conducted comparing the proportions of individuals who reported each eating disorder behavior. Independent samples t-tests were used to compare the global and subscale scores in this study to those of the comparison studies. Both of these were two-tailed tests with a Bonferroni-corrected p-value set at .005 for significance. 3. Results Only 0.003% of item responses necessary for calculating the EDE-Q subscale and global scores were missing. Subscale scores were calculated by averaging the available item responses when less than half of the relevant items were missing (Fairburn & Cooper, 1993; Mond et al., 2006). Failure to respond to a behavioral item was interpreted as non-endorsement of the particular behavior (Mond et al., 2006). Table 1 presents the EDE-Q global and subscale score means, standard deviations, and percentile ranks. Prior EDE-Q norms studies utilized a cut-off of ≥4 as a marker of clinical significance. Using this cut-off, 2.2% of men scored in the clinically significant range on the Restraint subscale, 1.0% on the Eating Concern subscale, 7.7% on the Shape Concern subscale, 3.7% on the Weight Concern subscale, and 1.7% on the Global scale. Table 2 presents the percentages of men who reported any occurrence or regular occurrence of disordered eating behaviors. Table 1 EDE-Q means, standard deviations, and percentile ranks for EDE-Q global and subscale scores for undergraduate men (N = 404). Mean (SD) Percentile rank 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 99 Restraint Eating concern Shape concern Weight concern Global score 1.04 (1.19) 0.43 (0.77) 1.59 (1.38) 1.29 (1.27) 1.09 (1.0) – – – – – – 0.20 0.40 0.60 0.60 0.80 1.00 1.20 1.40 1.60 2.00 2.40 2.80 3.60 5.19 – – – – – – – – – – 0.20 0.20 0.20 0.40 0.60 0.80 1.00 1.20 2.20 3.98 – 0.13 0.25 0.38 0.50 0.63 0.75 1.00 1.13 1.25 1.38 1.63 1.75 2.00 2.38 2.63 3.16 3.63 4.38 5.74 – – – 0.20 0.20 0.40 0.60 0.60 0.80 1.00 1.20 1.20 1.40 1.80 2.00 2.40 2.80 3.20 3.80 5.39 – 0.06 0.14 0.21 0.30 0.38 0.47 0.62 0.73 0.84 0.95 1.09 1.22 1.37 1.59 1.83 2.08 2.55 3.16 4.30 Table 2 Proportion of men engaging in disordered eating behaviors. Disordered eating behavior Objective binge episodes Excessive exercise Dietary restraint Self-induced vomiting Laxative misuse Any occurrence (%) Regular occurrence (%) 25.0 31.4 24.0 3.2 2.7 7.9 4.5 5.0 1.2 0.25 Note. Regular occurrence of excessive exercise was defined as exercising in a driven or compulsive way as a means of controlling weight, shape or amount of fat, or burning off calories for ≥ 20 days over the past 28 days. Regular occurrence of dietary restraint was defined as going for long periods of time (8 h) without eating anything to influence shape or weight for ≥ 13 days over the past 28 days. For all other behaviors, regular occurrence was defined as ≥ 4 occurrences over the past 28 days. Approximately one-quarter of the sample reported at least one objective eating binge and one episode of dietary restraint during the previous 4 weeks. Nearly one-third of the sample reported at least one episode of excessive exercise. The percentage of men reporting purging behaviors was fairly small. BMI was found to be positively associated with EDE-Q scores: Restraint (r = .32, p b .001), Eating Concern (r = .25, p b .001), Shape Concern (r = .39, p b .001), Weight Concern (r = .39, p b .001), and Global score (r = .40, p b .001). There were no differences between the proportion of men in this study and the proportion of undergraduate women in Luce et al's (2008) study for binge eating (25.0% versus 21.3%, respectively; z = 1.25, p N .005), excessive exercise (31.4% versus 30.8%, respectively; z = 0.17, p N .005), or dietary restraint (24.0% versus 25.9%, respectively; z = −.61, p N .005). However, men endorsed significantly lower rates of purging compared to women (self-induced vomiting: 3.2% versus 8.8%, respectively; z = −3.45, p b .005; laxative misuse: 2.7% versus 8.3%, respectively; z = − 3.59, p b .005). There were no differences between men in this study and women in the 18–22 age group from Mond et al's (2006) study for rates of binge eating (25.0% versus 20.7%, respectively; z = 1.60, p N .005), excessive exercise (31.4% versus 34.5%, respectively; z = − 0.93, p N .005), or purging (self-induced vomiting: 3.2% versus 4.8%, respectively; z = −1.32, p N .005; laxative misuse; 2.7% versus 1.3%, respectively; z = 1.90, p N .005). However, men reported significantly higher rates of dietary restraint compared to women (24.0% versus 4.7%, respectively; z = 10.80, p b .005). Additional significant differences emerged for global and subscale scores. Men scored lower on the global scale than women in Luce et al's (2008) study (t(1125) = − 8.71, p b .005; d = − 0.54) and Mond et al's (2006) study (t(1588) = −6.96, p b .005; d = −0.40). They also scored lower on the Restraint subscale (Luce et al.: t(1125) = −6.55, p b .005; d = − 0.41; Mond et al.: t(1588) = −3.20, p b .005; d = −0.18), Eating Concerns subscale (Luce et al.: t(1125) = − 10.93, p b .005; d = − 0.68; Mond et al.: t(1588) = −7.27, p b .005; d = −0.42), Shape Concerns subscale (Luce et al.: t(1125) = − 7.37, p b .005; d = − 0.46; Mond et al.: t(1588) = −7.55, p b .005; d = −0.44), and Weight Concerns subscale (Luce et al.: t(1125) = − 7.48, p b .005; d = − 0.46; Mond et al.: t(1588) = −6.84, p b .005; d = − 0.39). As indicated by Cohen's d's, these differences ranged from small to medium-sized effects. 4. Discussion This study found that one in four men reported objective binge eating and purposefully going without food for weight or shape reasons for at least 8 waking hours over the prior 4 weeks. In addition, over 30% of men endorsed engaging in “driven” or “compulsive” exercise. Rates of purging were substantially lower. Two other published studies have reported EDE-Q norms for young women, and thus represent a source for comparison to the present study. Luce et al. (2008) examined EDE-Q norms in undergraduate women while Mond et al. (2006) did so in a large J.M. Lavender et al. / Eating Behaviors 11 (2010) 119–121 community sample of women subdivided by age. Given that eating disorders are thought to be less common in men than women (APA, 2000), it may be surprising to note the similarities in data obtained in this study to those reported in the comparison studies. The rate of objective binge eating and excessive exercise was comparable to both of the normative studies in women. Conversely, the rate of dietary restraint noted in this study was similar to that found by Luce and colleagues, but differed significantly from that found by Mond and colleagues. The rates of purging found in the present sample of men were similar to those found by Mond and colleagues but were significantly lower than those found by Luce and colleagues. Men in the present study scored lower on the global score as well as the subscale scores as compared to the young women in previous studies. In general, men in the present study scored about a half standard deviation lower on the global and subscale scores than women in the two comparison studies. This is particularly interesting in light of the similar rates of objective binge eating and excessive exercise among men in the present sample and women in the comparison samples. The differences noted between this normative study of undergraduate men and the two studies of undergraduate and community young women highlight gender-based societal influences on eating behaviors and body image. Although the men in this sample reported comparable rates of objective binge eating as compared to women in the comparison studies, their score on the Eating Concerns subscale was lower. Similarly, men reported excessive exercise and dietary restraint rates that were comparable to rates reported by undergraduate women, but their scores on the Shape Concern and Weight Concern subscales were lower. It is possible that binge eating is not as distressing for men, on average, as it is for women. As a result, men may exhibit this behavior at a similar rate but score lower on scales that measure concern over the behavior and its consequences. The rates of dietary restraint and excessive exercise found in this study, which are comparable to those found in the comparison studies, may be interpreted as illustrating the dual nature of the male body ideal: low body fat and high muscularity (Cafri & Thompson, 2004; Tylka, Bergeron, & Schwartz, 2005). For men who desire to increase their size, binge eating may not be viewed as troublesome. However, this may be quite the opposite for men attempting to shed body fat. The differences in purging rates may be the result of the perception among men that eating disordered behaviors are feminine and should therefore be avoided. Additionally, purging would be counter-productive for men who desire to increase their size. For these men, excessive exercise may not be a compensatory behavior, per se, but rather a potentially pathological muscle-gain behavior. To the authors' knowledge, this is the first study to report male norms for the EDE-Q, a widely-used self-report measure of disordered eating. The present study did so with over 400 undergraduate men in the Northeastern United States. At a time when disordered eating behaviors and body image are being increasingly studied in men, it is important to establish normative data for this group. Role of funding source There were no funding sources involved in this study. Contributors Jason Lavender and Kyle De Young conducted the two studies from which the data used in the present study were drawn. Drew Anderson contributed to the conceptual- View publication stats 121 ization and design of these studies and aided in preparation of the manuscript. All authors contributed to and have approved the final manuscript. Conflict of interest All authors declare that they have no conflicts of interest. References American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: APA text revision. Binford, R. B., Le Grange, D., & Jellar, C. C. (2005). Eating Disorders Examination versus Eating Disorders Examination Questionnaire in adolescents with full and partialsyndrome bulimia nervosa and anorexia nervosa. International Journal of Eating Disorders, 37, 44–49. Braun, D. L., Sunday, S. R., Huang, A., & Halmi, K. A. (1999). 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