Edi Presentation 113x56

Eating Disorders Inventory-3 by David M. Garner, PhD Was originally developed in 1984 to test the “continuum model” of anorexia

nervosa proposed by Nylander in 1971. Later revised in 1991 as the EDI-2 and again in 2004 as the EDI-3.   • Assesses risk factors and predicts responses to treatment   • It is a “TOOL” to give us a better understanding of individuals with eating disorders   • The most widely used self-report measure of psychological traits or constructs shown in individuals with eating disorders.   • Used in case conceptualization and treatment planning • It is also a research tool for assessing areas of psychopathology of interest in theory-testing, identifying meaningful patient subgroups and assessing

Purpose Aimed at the measurement of psychological traits or symptom clusters relevant to the development and maintenance of eating disorders. •

• Assesses psychological domains of understanding and treating eating disorders. • Yields 12 non-overlapping scale scores and 6 composite scores used to create clinically meaningful profiles linked to treatment plans, specific interventions and treatment monitoring.

EDI-3 •

Age/grade levels: adolescents (13yrs and older) and adult females

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Risk Factors - these disorders represent final common pathways resulting from the interplay of three broad classes of risk factors (Table 4.1) 1. Culture 2. Social 3. Individual (developmental, psychological, biological) 4. Familial

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Type of items: 1. EDI-3 is made up of 6 composites (fig. 1.1) a. Eating disorder specific (1) b. General integrative psychological constructs i. Ineffectiveness ii. Interpersonal problems iii. Affective problems iv. Over control

EDI-Symptom Checklist EDI- 3 Symptom Checklist provides data regarding frequency of symptoms 3. 4. 5. 6.

Binge Eating Self-induced Vomiting Exercise Patterns Use of Laxatives, Diet Pills, and Diuretics

Other items included: 9. Weight 10.Weight History 11.Menstrual History

EDI-Referral Form EDI- 3 Referral Form - includes 3 scales that compose the Eating Disorders Risk Composite (EDRC) 3. Drive for Thinness (DT) 4. Bulimia (B) 5. Body Dissatisfaction (BD) Referral indexes are based on information from the EDI-3  questions and the individual’s (BMI) and are used to id 

Scoring & Item Selection 0-4 pt. scoring system that provides a compromise between increasing scale variability of the original 0-3 pt. scoring system (see Data Collection Site list) 1. Items had to be able to differentiate between the eating-disorder sample and the non-clinical sample 2. Items were required to have higher item-total scale correlations with the target scale than with any other scale 3. Item-total scale correlation coefficients above .40 for the eating-disorder samples were considered desirable. “Three item-total correlations below .40 were retained because they provided  meaningful content and had a minimal impact on the total scale reliability.  The  average item-total scale correlation was .63 indicating substantial within-scale  common variance among items.  To be included on the original EDI, scales had  to meet an internal consistency criterion by having an alpha of above .80 for the 

Scoring & Item Selection Depending on whether or not the item is positively or negatively keyed, a forced – choice format was used requiring respondents to answer whether each item applies ALWAYS, USUALLY, OFTEN, SOMETIMES, RARELY OR NEVER. The most extreme responses are given a score of 4. Scoring as follows:

Standardization & Norms

Samples were drawn from several different treatment sites in the U.S. with  comparison samples obtained from centers in Canada, Europe, and Australia “The recruitment of normative samples from the United States, Canada, Europe,  and Australia is consistent with prevalence of these eating disorders in  Westernized industrial societies. Females and young adults, the predominant  clinical demographic of eating disorders, form the principal study samples.”   (MMY, 2004) A. DSM-IV-TR DIAGNOSTIC GROUPS 1. Anorexia Nervosa-Restricting Type (AN-R) 2. Anorexia Nervosa-Binge Eating/Purging Type (AN-B/P) 3. Bulimia Nervosa (BN) 4. Eating Disorders Not Otherwise Specified (EDNOS) D. Samples (Female – Caucasian) 1. Adults (18yrs. and older) a. U.S. – 983 b. International – 662 2. Adolescent (11-17 yrs.) a. U.S. - 335

Reliability • Reliability was first estimated from a single istration of the test. • Cronbach’s Alpha Coefficient was used to estimate the internal consistency.

• Composite reliabilities were calculated with the traditional composite reliability formula. 1. Eating Disorder Risk Composite ( EDRC) Reliability ranged from .90 to  .97 (Median =  .94) across the four diagnostic groups and the three  normative groups.    For the 3 EDR scales, all reliabilities were generally  in the high .80s to low .90s. 2. Reliabilities for the psychological scales and composites: a. General Psychological Maladjustment Composite (GPMC) ranged from .93 to .97 across the three normative groups. All other composite reliabilities were in the .80s to .90s across the three normative samples. a. The median reliabilities for the Psychological Scales were .84, .74, and .85

Reliability 1.Test-Retest Reliability Was conducted over a short period of time. This was done to minimize both inherent and extraneous factors that could potentially impact test scores (i.e. Treatment change, fluctuations in psychological states). The Sample consisted of 34 female participants who had undergone past treatment for Eating Disorder. Ages ranged from 15 to 55 yrs. old and the test-retest interval ranged from 1 to 7 days. The EDRC coefficients was .98 and the GPMC coefficient was .97. The median test-retest coefficients for

Validity • Evidence Based on Internal Structure 1. Intercorrelation Studies 2. Factor Analysis of the Earlier versions of the EDI 3. Exploratory Factor Analysis of the EDI-3 Eating Disorder Risk Scale  Items 4. Exploratory Factor Analysis of the EDI-3 Psychological Scale Items 5. Confirmatory Factor Analysis of the EDI-3 Psychological Scales •Evidence Based on Relationship to Other External Variables 1. Correlations with the EDI-2 2. Correlations with External Eating Disorder Measures a. Eating Attitudes Test-26 (EAT-26) b. Bulimia Test – Revised (BULIT-R) 3. Correlations with External Measures of Personality and  Psychopathology a. Rosenberg Self-Esteem Scale b. Center for Epidemiologic Studies Depression Scale (CESD)

Interpretation Qualification Level: B A degree from an accredited 4-year college or university in Psychology,  Counseling, or a closely related field PLUS satisfactory completion of  coursework in Test Interpretation, Psychometrics and Measurement Theory,  Educational Statistics, or a closely related area; OR license or certification from  an agency that requires appropriate training and experience in the ethical and  competent use of psychological tests. The EDI-3 profile must be interpreted along with other data     Clinician should be cautious in interpreting the origin and significance of the  symptoms.     Need to have a broad technical competence in the area of psychological  evaluation, as well as competence with evaluating specific medical, behavioral  and psychological symptoms that are comm0on among those with ED.

Counseling-Clinical Use / Applications in counseling ØIncorporated into the stages of counseling Ø, Learning, Action; or ØAssess problem, conceptualizing & defining problem, treatments, evaluation

Strengths • Thorough and detailed in seeking out disorders based on behavioral and psychological symptoms. • Can purchase computer version for scoring, which is less time consuming and lower risk of scoring errors The EDI-3 SP is the unlimited-use computer-based scoring program for the new Eating Disorder Inventory™-3 (EDI™-3). After istration of the EDI-3, demographic information and item responses are hand-entered into the software program by the clinician; the software generates a detailed, individualized Score Report with raw scores for all EDI-3 scales for each client. Reports can be edited on-screen to incorporate additional clinical information or to edit descriptive statements. •Samples obtained within the U.S., as well as including various cultures outside U.S. from Clinical and Nonclinical groups • Claims to only take 20 minutes to ister

Strengths • Cost is practical

•  Cited over 100 times in any given year since 1996 and the highest number of citations since publishing the manual in 2004 has been 130 in 1999.

Weaknesses 1. Difficult to understand manual….very in depth and lengthy.  There  were so many tables and graphs, it was easily confusing. 3. Only has an English-Speaking version 5. “Although test–retest coefficients across scales were excellent,  ranging from .93 to .98, test–retest data on a nonclinical sample and  larger eating disorder sample would have been useful to assess.”  Edward J. Cumella, 2006.  7. “Multiple factor analyses reveal some factor inconsistency across the  U.S. adult, International adult, and U.S. adolescent samples .”  Edward J. Cumella, 2006. 

Mental Measurements Yearbook “The instrument appears 'front-loaded' in the sense that its preliminary screening components may be more efficient and valid than the full scale. Empirically, the Drive for Thinness and Bulimia measures, as well as the Body Mass Index and canvassing of symptoms, converge with other research and clinical knowledge in presenting reasonable measures for further assessment. As the extended EDI-3 shows questionable factor structure and discriminant subscale utility, with the author's own dictate that it does not substitute for a structured clinical interview, the question comes up as to whether the added diagnostic contributions of the EDI-3 warrant the time and expense….. Despite a reasonable amount of research on this instrument, further studies correlating the instrument with other measures of similar constructs may need to be pursued. Of particular interest is the cross-cultural applicability of the EDI-3. Although studies in countries other than the United States have been undertaken, it would also be of benefit to determine the extent to which the measure may be

Multi-Cultural Issues Impossible to cover all cultures but I feel it is pretty representative of most common westernized cultures. However, race is greatly under representative as samples were predominantly Caucasian. Not very representative of male gender; but access to large enough samples is more difficult. “Despite a reasonable amount of research on this instrument, further studies correlating the instrument with other measures of similar constructs may need to be pursued. Of particular interest is the cross-cultural applicability of the EDI-3. Although studies in countries other than the United States have been undertaken, it would also be of benefit to determine the extent to which the measure may be applicable in developing countries.” (Spillane et. Al., 2004)

Additional Comments Personal critique Personally the manual gave me a headache; however, I feel if I were more educated on the assessment and statistical measures used, it might have been easier to understand. Is it a practical test? (see Table 4.37) Table 4.37 of the manual shows a decrease in the means scores from pretreatment to post treatment in the psychological scales and composites. How might it be improved? Could include: 1. Male population 2. Multi-racial/ethnic groups from developing countries less westernized than the U.S., Canada, and Australia and other races such as Hispanic, Asian, and African American, etc.

References

Cumella, E. (2006, August). Review of the Eating Disorder Inventory–3. Journal of Personality Assessment, 87(1), 116-117. Retrieved October 5, 2008, doi:10.1207/s15327752jpa8701_11 Eberenz, K., & Gleaves, D. (1994, December). An Examination of the Internal Consistency and Factor Structure of the Eating Disorder Inventory-2 in a Clinical Sample. International Journal of Eating Disorders, 16(4), 371-379. Retrieved October 5, 2008, from Psychology and Behavioral Sciences Collection database. Eberly, C., & Eberly, B. (1985, December). A Review of the Eating Disorder Inventory. Journal of Counseling & Development, 64(4), 285. Retrieved October 5, 2008, from Psychology and Behavioral Sciences Collection database. Espelage, D., Mazzeo, S., Aggen, S., Quittner, A., Sherman, R., & Thompson, R. (2003, March). Examining the construct validity of the Eating Disorder Inventory. Psychological Assessment, 15(1), 71-80. Retrieved October 5, 2008, doi:10.1037/1040-3590.15.1.71 Garner, D. (1984, 1984-2004). Eating Disorder Inventory-3. Retrieved October 5, 2008, from Mental Measurements Yearbook database. Klemchuk, H., Hutchinson, C., & Frank, R. (1990, July). Body dissatisfaction and eating-related problems on the college campus: Usefulness of the Eating Disorder Inventory with a nonclinical population. Journal of Counseling Psychology, 37(3), 297-305. Retrieved October 5, 2008, doi:10.1037/0022-0167.37.3.297 Schoemaker, C., van Strien, T., & van der Staak, C. (1994, May). Validation of the Eating Disorders Inventory in a Nonclinical Population Using Transformed and Untransformed Responses. International Journal of Eating Disorders, 15(4), 387-393. Retrieved October 5, 2008, from Psychology and Behavioral Sciences Collection database. Spillane, Nichea S., Boerner, Laura M., Anderson, Kristen G., Smith, Gregory T.