• eating pathology symptoms inventory;
  • eating disorders;
  • disordered eating;
  • self-report;
  • psychometrics;
  • assessment


  1. Top of page
  3. Introduction
  4. Method
  5. Results
  6. Discussion
  7. References


The Eating Pathology Symptoms Inventory [EPSI; Forbush KT, Wildes JE, Pollack LO, Dunbar D, Luo J, Patterson K, et al. Development and validation of the EPSI. Psychological Assessment, in press] is an empirically derived self-report measure of eating disorder (ED) symptoms. The EPSI is able to capture the majority of variance associated with established ED measures, yet possesses additional content that is not currently represented in any existing multidimensional ED measure. The purpose of this study was to present normative and psychometric data for the EPSI in a large sample of college men (N = 502) and women (N = 625).


Participants completed the EPSI and a battery of self-report measures to evaluate convergent and discriminant validity. To provide context as to how normative scores compare to ED psychopathology, undergraduate student scores were compared to scores from individuals with EDs (N = 150).


Confirmatory factor analyses indicated that the EPSI had a robust eight-factor structure that was replicated in both men and women. Mean scores for most scales were significantly higher in women, except for Excessive Exercise, Muscle Building, and Negative Attitudes toward Obesity, which were significantly higher in men. Most scale scores were significantly lower in college students than in patients with EDs. Results indicated excellent convergent and discriminant validity in both genders.


These data provide the first large-scale normative data for the EPSI in young adults, as well as additional evidence supporting the psychometric properties and construct validity of the EPSI. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:85–91)


  1. Top of page
  3. Introduction
  4. Method
  5. Results
  6. Discussion
  7. References

Self-report measures are commonly used to assess eating disorder (ED) symptoms in clinical and research settings.[1-4] Many ED self-report measures have undeniable strengths, including excellent internal consistency and test-retest reliability,[4] criterion-related validity for distinguishing among patient groups,[5, 6] and good-to-excellent convergent validity with other measures of disordered eating.[7-10] Nevertheless, many ED self-report measures were developed on the basis of small samples comprised exclusively of young adult women, and are associated with other psychometric issues that may limit their utility, such as poor factor structure replicability, limited discriminant validity, and reduced psychometric properties in specific populations, such as men and overweight and obese individuals [for additional review of these limitations, see Ref. [11]. In response to the limitations of certain ED self-report measures, our research group[11] developed the Eating Pathology Symptoms Inventory (EPSI), which we describe briefly, below.

The EPSI was developed according to the rigorous scale development procedures recommended by Clark and Watson.[12] Based on previous theoretical and empirical models of EDs, the initial measure included 160 items designed to assess 20 potential dimensions of eating pathology, and included items to assess all of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition [DSM-IV[13]] criteria for EDs. The initial item-pool was administered to large independent samples of community participants and college students. Exploratory, confirmatory, and multiple-group factor analyses (which test for factor invariance between groups) were used to refine the initial measure and test whether the structure was invariant between men (vs.) women and normal weight (vs.) overweight/obese participants. A revised 88-item measure was then administered to large independent samples of ED patients and general psychiatric outpatients. Based on the results of additional multivariate statistical analyses, the measure was revised a second time, and the finalized 45-item measure was administered to an independent sample of college students to confirm the structure of the measure and determine test-retest reliability.

The final 45-item version of the EPSI contained eight (factor analytically derived) scales that were highly replicable across all samples, and reflected dimensions with clear conceptual relevance to ED psychopathology. The first scale, “Body Dissatisfaction” (dissatisfaction with one's weight and/or shape), represented a large general factor that emerged in all samples and explained a substantial amount of variance in the EPSI. Body Dissatisfaction appeared to represent the “core” psychopathology of EDs, as indicated by significant factor loadings of other EPSI scales on this higher-order factor. The other scales were smaller and defined various aspects of eating pathology, including: “Binge Eating” (ingestion of large amounts of food and accompanying cognitive symptoms), “Cognitive Restraint” (cognitive efforts to limit or avoid eating, whether or not such attempts are successful), “Purging” (self-induced vomiting, laxative use, diuretic use, and diet pill use), “Excessive Exercise” (physical exercise that is intense and/or compulsive), “Restricting” (concrete efforts to avoid or reduce food consumption), “Muscle Building” (desire for increased muscularity and muscle building supplement use), and “Negative Attitudes toward Obesity” (negative attitudes toward individuals who are overweight or obese). Our results[11] indicated that the EPSI was able to capture the majority of variance associated with established ED measures, yet possessed additional content that was not represented in any existing multidimensional ED measure (e.g., Muscle Building and Negative Attitudes toward Obesity). EPSI scales were internally consistent, reliable over 2- to 4- weeks, and had excellent discriminant, convergent, and criterion-related validity. For example, the EPSI showed strong evidence of criterion validity for distinguishing among community and college samples (vs.) patients with EDs, and between general psychiatric patients (vs.) patients with EDs. Moreover, results indicated that the EPSI outperformed other multi-dimensional measures of eating pathology, such as the Eating Disorders Inventory-36 (EDI-3) and Eating Disorders Examination-Questionnaire,[10] in terms of distinguishing between patients with anorexia nervosa (vs.) bulimia nervosa. The EPSI, therefore, represents a promising new measure of ED psychopathology and is appropriate for use among a wide range of participant groups (e.g., men, women, normal weight, overweight, obese, community-recruited, general psychiatric patients, and patients with EDs) and in both clinical and research settings.

Here, we report the first large-scale normative data for the EPSI in a sample of young adult men and women. The current study also extends prior research on the construct validity of the EPSI by testing convergent and discriminant validity in a group of participants that is independent from the initial scale development samples. Given that the peak age of onset for many EDs is in young adulthood[14, 15] and the need for brief, cost-efficient, and psychometrically sound assessments of disordered eating in this population, normative and validity data will be particularly useful.

Based on our previous findings,[11] we hypothesized that the EPSI would show strong evidence of construct validity. Specifically, we hypothesized that: (a) Body Dissatisfaction would represent a higher-order factor in both college men and women and would demonstrate the highest convergent correlations with other measures of shape and weight concerns, (b) other EPSI scales would demonstrate small-to-moderate correlations with eating pathology measures, given that the EPSI scales were designed to possess distinct, non-overlapping content (i.e., EPSI scales that were not designed to assess body dissatisfaction should demonstrate lower correlations with shape and weight measures compared to EPSI Body Dissatisfaction, which directly assesses shape and weight concerns), and (c) EPSI scales would demonstrate strong discriminant validity (as indicated by smaller correlations with non-ED measures [vs. ED-related measures]). Finally, consistent with our previous research,[11] we hypothesized that men would score significantly higher than women on Muscle Building, Excessive Exercise, and Negative Attitudes toward Obesity, whereas women would score higher on other EPSI scales, given that women appear to be at greater risk for traditionally defined eating pathology.[16-18]


  1. Top of page
  3. Introduction
  4. Method
  5. Results
  6. Discussion
  7. References

Participants and Procedure

Young Adult Sample

Participants were men (N = 502) and women (N = 625) enrolled at a large Midwestern university. Students were recruited via a departmental research pool and received course credit for their participation. Following informed consent, participants completed study questionnaires online. Previous research supports the equivalency of paper-and-pencil versus online self-reports of psychopathology.[19-22] Inclusion criteria were age 18–25 years and native English speaker. Consistent with other studies providing normative data in college samples,[23-25] exclusion criteria were kept to a minimum to provide normative data that would be representative of college students, in general. To compare young adult norms to published norms for individuals with diagnosable EDs, a comparison sample of individuals receiving treatment for an ED recruited for a previous study was included (Ref. 11, see Eating Disorder Sample section).

Males reported a mean (SD) age of 19.44 (1.36) years and a mean (SD) body mass index (BMI) of 24.26 (4.37). Participants were allowed to self-report multiple racial and ethnic identities; 85.06% reported that they were Caucasian, 3.58% African-American, 3.78% Hispanic or Latino, 5.58% Asian-American, 1.79% Multiracial, and 0.20% another race or ethnicity. Females reported a mean (SD) age of 19.00 (1.09) years and a mean (SD) BMI of 23.28 (4.51). Females reported the following races and ethnicities: 85.60% Caucasian, 3.20% African-American, 2.88% Hispanic or Latina, 4.48% Asian-American, 3.52% Multiracial, and 0.32% another race or ethnicity.

Eating Disorder Sample

Participants were inpatients or intensive day hospital patients (N = 150) receiving treatment for an ED at one of two academic medical centers located in the Midwest and Eastern United States. The inclusion and exclusion criteria have been described elsewhere.[11] After informed consent or assent, participants completed paper-and-pencil questionnaires. Patients were receiving treatment for AN (n = 94; 62.7%), BN (n = 22; 14.6%), or an ED not otherwise specified (n = 34; 22.7%). Participants reported a mean (SD) age of 25.73 (10.40) years. Mean (SD) BMI was 18.78 (3.91) at the time of study participation. The sample was primarily female (94.30%), and one participant self-identified as “transgendered.” Participants self-reported the following ethnic/racial identities: Caucasian (92.35%), Hispanic (2.53%), African American (1.27%), Multiracial (3.82%), and “Other” (2.55%).

There were no differences between the college and ED samples in the proportion of Caucasian (vs.) ethnic/racial minority participants (χ2(1) = 3.09, p = .079). However, the ED sample was older (t(1,274) = 19.37, p < .001) and contained a greater proportion of female participants (χ2(2) = 88.36, p < .001) compared to the college student sample.


Previous research has tested convergent and discriminant correlations between the EPSI and common measures of ED and non-ED psychopathology.[11] In choosing measures for the current study, we selected other established measures that have not been tested in our past research. This approach is expected to provide a more rigorous test of validity by ensuring previous validity findings were not measure-dependent.

The Eating Disorder Examination Questionnaire

The Eating Disorder Examination Questionnaire (EDE-Q)[10] is a 28-item self-report questionnaire based on the EDE Interview. The EDE-Q assesses ED behaviors and attitudes and contains four rationally derived subscales: Restraint, Eating Concern, Shape Concern, and Weight Concern. Only the five-item Weight Concern scale was administered to study participants. The EDE-Q Weight Concern (EDE-Q WC) scale demonstrates good test–retest reliability and convergent validity with other measures of eating pathology.[11]

The Eating Pathology Symptoms Inventory

The EPSI[11] is a 45-item self-report questionnaire that includes eight scales: Body Dissatisfaction, Binge Eating, Cognitive Restraint, Purging, Excessive Exercise, Restricting, Muscle Building, and Negative Attitudes toward Obesity.


The SCOFF[26] is a five-item screening tool for the detection of anorexia nervosa and bulimia nervosa. The SCOFF has moderate to high sensitivity (53.3–84.6%) and specificity (89.6–93.2%) for detecting cases of anorexia nervosa and bulimia nervosa among college-aged samples of females in primary care settings.[27, 28] The SCOFF was administered to college students only.

The Trait Affect Scale

The Trait Affect Scale (TAM; adapted from Barrett[29]) is comprised of 16 adjectives from the circumplex model of positive and negative affect. Similar to other trait affect measures,[30] questions were translated from ‘states’ to ‘traits’ by asking participants to rate themselves on each item ‘in general’ (e.g., “To what extent do you generally feel nervous?”). The TAM is internally consistent (coefficient alpha = .72 for Positive Affect and .80 for Negative Affect in the present sample) and demonstrates good convergent validity with computerized experience-sampling ratings of affect.[29] The TAM was only administered to college students.

The Weight Concerns Scale

The Weight Concerns Scale (WCS)[31] is a five-item scale that assesses fear of weight gain, body and shape concerns, history of dieting, perceived overweight, and worry over weight gain. The measure has been shown to significantly predict the onset of EDs in community samples of young adult women.[17, 18] The WCS was administered only to college students. (Note: Patients with EDs originally were recruited for a different study, which is why ED patients did not complete the SCOFF, WCS, and TAM. Convergent and discriminant validity for the EPSI were excellent in patients with ED using a variety of well-established measures of ED and non-ED psychopathology. We direct interested readers to Forbush et al.[11] for additional validity information for patients with EDs).

Statistical Analysis

Data were analyzed using SPSS Version 20[32] and Mplus Version 6.[33] Confirmatory factor analysis (CFA) was conducted to test whether the structure of ED symptoms identified by Forbush et al.[11] would replicate in an independent sample. A mean- and standard errors- adjusted chi-square statistic was calculated using Robust Weighted Least Squares, which is an appropriate estimator for ordinal data. Coefficient alpha was used to test internal consistency. Means and standard deviations were used to provide normative data for the EPSI separately in each sex. Independent t-tests were used to test for sex differences on the EPSI scales. Pearson's correlations were used to test convergent validity with measures of ED psychopathology and discriminant validity with the TAM in each sex. Finally, to test criterion-related validity, independent t-tests were used to determine if EPSI scale scores were significantly different between college students and patients with EDs.


  1. Top of page
  3. Introduction
  4. Method
  5. Results
  6. Discussion
  7. References

As predicted, the EPSI's eight-factor model had a good fit to the data in both men (χ2 = 2,157.53 [917], p < .001, CFI = .947, TLI = .942, RMSEA = .052) and women (χ2 = 2,562.85 [917], p < .001, CFI = .953, TLI = .949, RMSEA = .054). Given that previous research indicates that EPSI Muscle Building has less relevance to women, we omitted this scale and re-ran the CFA in women, which resulted in an excellent fit (χ2 = 2,132.32 [719], p <.001, CFI = .958, TLI = .954, RMSEA = .056). The majority of the EPSI scales were internally consistent. Median coefficient alpha values were 0.87 in college men, 0.87 in college women, 0.86 in the combined student sample, and 0.89 in patients with EDs. However, Purging and Muscle Building were less internally consistent in college women (see Table 1).

Table 1. Descriptive statistics for the Eating Pathology Symptoms Inventory (EPSI), Eating Disorder Examination Questionnaire Weight Concern Scale (EDE-Q WC), Weight Concerns Scale (WCS), and SCOFF in college students and eating disorder patients
ScaleCollege StudentsEating Disorder PatientsdEffect Sizes
MenaWomenbCombined Student Samplec
  1. Notes: Independent t-tests were used to compare scale scores between college men (vs.) women and between the combined college sample (vs.) the eating disorder patient sample. For these comparisons, means not sharing the same subscript within a row differ from one another at p < .05.

  2. a

    n = 502.

  3. b

    n = 625 (however, the WCS had an n = 624).

  4. c

    n = 1,127.

  5. d

    n = 150.

  6. e

    Cohen's d for college males (vs.) college females.

  7. f

    Cohen's d for college student total (vs.) eating disorder total.

  8. g

    Data were available for a portion of young adults (n = 232 men and n = 316 women).

 Body dissatisfaction13.40a5.73.9020.68b6.89.9117.44c7.35.9227.79d7.04.89−1.14−1.42
 Binge eating18.17a5.34.8519.21b5.45.8718.74c5.43.8617.05d9.01.93−0.190.28
 Cognitive restraint6.70a2.80.808.39b2.86.807.64c2.96.8212.60d3.24.89−0.60−1.66
 Negative attitudes toward obesity15.18a4.69.8814.48b4.65.9014.79c4.68.8915.58c6.85.950.15−0.16
 Muscle building9.75a4.12.776.98b2.05.548.21c3.43.756.95d2.28.560.880.38
 EDE-Q WCg.75a1.12.852.11b1.62.891.53c1.58.905.61d1.39.80−0.95−2.65

Independent t-tests indicated that college women had significantly higher EPSI scores than college men on Body Dissatisfaction, Binge Eating, Cognitive Restraint, Purging, and Restricting. Consistent with our hypotheses, college men had higher scores than college women on Excessive Exercise, Muscle Building, and Negative Attitudes toward Obesity (Table 1). Additional independent t-tests in the ED patient sample indicated that men (n = 9) and women (n = 140) with EDs did not differ significantly on EPSI scores, except that men with EDs had significantly higher scores on Muscle Building than women with EDs. Cohen's d values for men (vs.) women with EDs were large for EPSI Muscle Building, medium for EPSI Body Dissatisfaction, and small for all other EPSI scale comparisons (data available upon request from first author).

Table 2 shows convergent and discriminant correlations for the EPSI scales with the EDE-Q WC scale, WCS, SCOFF, and TAM. As predicted, Body Dissatisfaction demonstrated strong, positive correlations with the SCOFF, EDE-Q WC, and WCS; Cognitive Restraint had a strong positive correlation with the WCS in college women. The SCOFF, EDE-Q WC, and WCS had small-to-moderate positive correlations with other EPSI scales. The overall pattern of convergent correlations was similar between college men and women; yet, the magnitude of convergent correlations was stronger in college women. Discriminant correlations between EPSI scales and the TAM were lower than correlations between EPSI scales and other measures of eating pathology, demonstrating evidence for discriminant validity (see Table 2).

Table 2. Convergent and discriminant validity for the Eating Pathology Symptoms Inventory (EPSI) scales in men and women
 EPSI ScaleBody DissatisfactionBinge EatingCognitive RestraintPurgingRestrictingExcessive ExerciseNegative Attitudes Toward ObesityMuscle Building
  1. Notes: Correlations ≥ |.30| are in boldface. EPSI, Eating Pathology Symptoms Inventory; EDE-Q WC, Eating Disorder Examination–Questionnaire Weight Concern Scale; WCS, Weight Concerns Scale. Positive and negative affect were assessed with the Trait Affect Measure.

  2. a

    n = 502.

  3. b

    n = 625 (for all scales except the WCS, which had an n = 624).

  4. c

    Data were available for a portion of young adults (n = 232 men and n = 316 women).

  5. d

    *p < .05, two-tailed.

  6. e

    **p < .01, two-tailed.

MenaEDE-Q WCd.76e.32e.32e.24e.15d.12.09.24e
Positive affect−.15e−.01−.02−.04−.14e.14e−.00.04
Negative affect.33e.18e.04.06.21e−.08.01.04
WomenbEDE-Q WCd.80e.37e.51e.39e.24e.24e.20e.23e
Positive affect−.26e−.17e−.13e−.13e−.12e.01−.01−.09d
Negative affect.34e.23e.09d.04.16e.05.07.09d

EPSI scale scores generally were significantly different between the ED patient and college samples (see Table 1). Consistent with the composition of the ED sample, which was comprised of a substantial portion of individuals with anorexia nervosa, college students had significantly higher scores on Binge Eating and Muscle Building compared to patients with EDs (additional comparisons indicated Binge Eating was significantly higher in individuals with bulimia nervosa compared to college students; data available from first author). No significant differences were found between college students and patients with EDs on Negative Attitudes toward Obesity. For other EPSI scales, patients with EDs had significantly higher scores than the college students. (Note: Given that the ED sample was significantly older and had a greater proportion of female participants than the college sample, we re-ran between-group comparisons for EPSI scales in an age- and gender-matched sub-sample of college students. The results of these analyses replicated the pattern of findings in the larger sample of college students).


  1. Top of page
  3. Introduction
  4. Method
  5. Results
  6. Discussion
  7. References

The goal of this study was to provide normative and validity data for the EPSI in a sample of young adults. Consistent with predictions, our results indicated that the EPSI had a robust eight-factor structure in both sexes, which replicated the findings of Forbush et al.[11] in a sample that was independent from those used to develop the measure. As hypothesized, between-group comparisons indicated that college women scored significantly higher than college men on most EPSI scales, except Excessive Exercise, Muscle Building, and Negative Attitudes toward Obesity, which were significantly higher in men. Our findings are consistent with published research indicating that men exhibit a greater desire for larger, more muscular bodies,[34, 35] and may use various behavior strategies (e.g., excessive protein supplement use and excessive exercise to increase lean muscle mass) to achieve these sex-specific aesthetic ideals.[20, 21] Notably, our results indicate that the EPSI may be more sensitive to certain “male-specific” aspects of eating pathology compared to other multidimensional ED measures. With the exception of Negative Attitudes toward Obesity, between-group comparisons showed that EPSI scale scores significantly distinguished college-recruited young adults from individuals with EDs. The results of our analyses contribute to prior research on the validity of the EPSI by demonstrating that EPSI scales possess excellent criterion validity for distinguishing college-recruited young adults from individuals with EDs.

Analyses of convergent and discriminant validity revealed three important properties of the EPSI. First, the Body Dissatisfaction scale correlates most strongly with other measures of weight and shape concerns, showing clear convergent validity and supporting conceptualizations of overvaluation of weight and shape as the core psychopathology of EDs.[36] Second, EPSI scales that were not characterized by body image concerns were significantly (albeit less strongly) correlated with other measures of weight and shape concerns. These results demonstrate that although EPSI scales are significantly related to other eating pathology measures (demonstrating evidence for convergent validity), they are also able to efficiently assess distinct dimensions of eating pathology (demonstrating evidence for discriminant validity). These results are important because many established ED measures differentiate scale content in a way that reduces discriminant validity. For example, the EDI-3 Bulimia scale contains content that assesses purging, inappropriate compensatory behavior, and binge eating. To the extent that the behaviors assessed in the Bulimia scale are distinct, the inclusion of these dimensions within a single scale would diminish discriminant validity. Conversely, certain EDE-Q scales may artificially discriminate between behaviors that potentially should be grouped together (e.g., Shape Concern and Weight Concern). In contrast, the EPSI assesses distinct ED dimensions that have only modest intercorrelations. The strong discriminant validity of the EPSI may be a particularly useful feature for future behavior genetic and clinical trials research, in which it is important to identify phenotypes that are maximally homogeneous to better characterize genetic and environmental risk factors for disordered eating or to track symptom change more precisely over time. Finally, all scales had stronger correlations with other measures of ED symptoms than with negative and positive trait affect, providing excellent evidence for discriminant validity.

The initial item pool contained questions to comprehensively assess theoretically important dimensions of eating pathology, as well as all of the DSM-IV criteria for EDs. Although the DSM-5 recently was published,[37] changes to the ED diagnostic criteria are fairly minimal and focus primarily on the frequency and duration of specific symptoms (e.g., binge eating, purging), which would not affect the content or structure of the EPSI scales. Thus, the results of the current study (as well as findings from Forbush et al.[11]) have important taxonomic implications for the organization of ED symptoms. First, results from confirmatory factor analyses support a higher-order eight-factor structure, in which Body Dissatisfaction exists at a superordinate level to the other seven EPSI factors. These results support theoretical models in which body image concerns represent the ‘core’ psychopathology shared across eating disorders.[36] Second, however, results also indicate that EPSI scales are clearly distinguishable from one another and that there is important additional variance beyond a one-factor model (e.g., a one-factor model in which all EPSI items were indicators of a latent Body Dissatisfaction factor had a very poor fit to the data [in both our previous work[11] and the present study]). Finally, results show that out of the eight EPSI scales, Body Dissatisfaction and Binge Eating demonstrate the strongest correlations with measures of depression, anxiety, and negative affect. These results are informative in providing information about which aspects of eating pathology may contribute to the high rates of comorbidity observed among mood, anxiety, and eating disorders. Together, these results indicate that EDs share a common underlying psychopathology, but that additional dimensions of EDs can be readily identified, and that certain ED symptom dimensions are correlated with other forms of internalizing psychopathology.

Although current results provide encouraging evidence in support of the validity of the EPSI, it will be important to replicate these findings in additional samples. In particular, the current sample had low representation of individuals in ethnic and racial minorities, and no studies have examined norms or validity of the EPSI in young adolescent samples. Future normative studies of the EPSI also would benefit from further characterization of threshold-level eating pathology within normative samples, which was lacking in the current study. Finally, Negative Attitudes toward Obesity was not significantly related to other ED measures in men, which indicates that this scale may have limited convergent validity in men.

In conclusion, the EPSI demonstrated good-to-excellent psychometric properties that are comparable to other well-established multidimensional ED measures. EPSI scales showed clear evidence for factor structure replicability in men and women—a feature that is not characteristic of many other self-report measures of eating pathology—and excellent convergent, discriminant, and criterion validity. These normative data can be used to guide future research and clinical work by providing a context for interpreting young adults' scores on the EPSI. Taken together, results provide the first large-scale normative data for the EPSI in young adults, as well as additional evidence supporting its psychometric properties and construct validity.


  1. Top of page
  3. Introduction
  4. Method
  5. Results
  6. Discussion
  7. References
  • 1
    Klump KL, Burt SA, McGue M, Iacono WG. Changes in genetic and environmental influences on disordered eating across adolescence: A longitudinal twin study. Arch Gen Psychiatry 2007;64:14091415.
  • 2
    McIntosh VVW, Carter FA, Bulik CM, Frampton CMA, Joyce PR. Five-year outcome of cognitive behavioral therapy and exposure with response prevention for bulimia nervosa. Psychol Med 2011;41:10611071.
  • 3
    Walsh BT, Kaplan AS, Attia E, Olmstead M, Parides M, Carter JC, et al. Fluoxetine after weight restoration in anorexia nervosa: A randomized controlled trial. JAMA: J Am Med Assoc 2006;295:26052612.
  • 4
    Peterson CB, Mitchell JE. Self-report measures. In: Mitchell JE, Peterson CB, editors. Assessment of Eating Disorders. New York: Guilford Publications, 2005, pp. 98119.
  • 5
    Cooper Z, Cooper PJ, Fairburn CG. The validity of the eating disorder examination and its subscales. Br J Psychiatry 1989;154:807812.
  • 6
    Garner DM. Eating Disorder Inventory™-3 (EDI™-3) Professional Manual. Odessa, FL: Psychological Assessment Resources, Inc., 2004.
  • 7
    Stice E, Fisher M, Martinez E. Eating Disorder Diagnostic Scale: Additional evidence of reliability and validity. Psychol Assess 2004;16:6071.
  • 8
    Thelen MH, Farmer J, Wonderlich S, Smith M. A revision of the Bulimia Test: The BULIT—R. Psychol Assess 1991;3:119124.
  • 9
    Garner DM, Olmstead MP, Polivy J. Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J Eat Disord 1983;2:1534.
  • 10
    Fairburn CG, Beglin SJ. Assessment of eating disorders: Interview or self-report questionnaire? Int J Eat Disord 1994;16:363370.
  • 11
    Forbush KT, Wildes JE, Pollack LO, Dunbar D, Luo J, Patterson K, et al. Development and validation of the Eating Pathology Symptoms Inventory (EPSI). Psychol Assess, in press.
  • 12
    Clark LA, Watson D. Constructing validity: Basic issues in objective scale development. Psychol Assess 1995;7:309319.
  • 13
    APA. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision. Washington, DC: APA, 2000.
  • 14
    Hudson JI, Hiripi E, Pope HG Jr, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 2007;61:348358.
  • 15
    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 2011;68:714723.
  • 16
    Striegel-Moore RH, Silberstein LR, Rodin J. Toward an understanding of risk factors for bulimia. Am Psychol 1986;41:246.
  • 17
    Jacobi C, Hayward C, de Zwaan M, Kraemer HC, Agras WS. Coming to terms with risk factors for eating disorders: Application of risk terminology and suggestions for a general taxonomy. Psychol Bull 2004;130:1965.
  • 18
    Jacobi C, Fittig E, Bryson SW, Wilfley D, Kraemer HC, Taylor CB. Who is really at risk? Identifying risk factors for subthreshold and full syndrome eating disorders in a high-risk sample. Psychol Med 2011;41:19391949.
  • 19
    Woodside DB, Garfinkel PE. Age of onset in eating disorders. Int J Eat Disord 1992;12:3136.
  • 20
    Olivardia R, Pope HG Jr, Hudson JI. Muscle dysmorphia in male weightlifters: A case-control study. Am J Psychiatry 2000;157:12911296.
  • 21
    Pope CG, Pope HG, Menard W, Fay C, Olivardia R, Phillips KA. Clinical features of muscle dysmorphia among males with body dysmorphic disorder. Body Image 2005;2:395400.
  • 22
    Knapp H, Kirk SA. Using pencil and paper, Internet and touch-tone phones for self-administered surveys: Does methodology matter? Comp Hum Behav 2003;19:117134.
  • 23
    Luce KH, Crowther JH, Pole M. Eating Disorder Examination Questionnaire (EDE-Q): Norms for undergraduate women. Int J Eat Disord 2008;41:273276.
  • 24
    Lavender JM, De Young KP, Anderson DA. Eating Disorder Examination Questionnaire (EDE-Q): Norms for undergraduate men. Eat Behav 2010;11:119121.
  • 25
    Watson D, O'Hara MW, Chmielewski M, McDade-Montez EA, Koffel E, Naragon K, Stuart S. Further validation of the IDAS: Evidence of convergent, discriminant, criterion, and incremental validity. Psychol Assess 2008;20:248259.
  • 26
    Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: Assessment of a new screening tool for eating disorders. BMJ 1999;319:14671468.
  • 27
    Hill LS, Reid F, Morgan JF, Lacey JH. SCOFF, the development of an eating disorder screening questionnaire. Int J Eat Disord 2010;43:344351.
  • 28
    Parker SC, Lyons J, Bonner J. Eating disorders in graduate students: Exploring the SCOFF questionnaire as a simple screening tool. Journal of American College Health 2005;54:103107.
  • 29
    Barrett LF. Feelings or words? Understanding the content in self-report ratings of emotional experience. J Pers Soc Psychol 2004;87:266281.
  • 30
    Diener E, Emmons RA. The independence of positive and negative affect. J Pers Soc Psychol 1984;47:11051117.
  • 31
    Killen JD, Taylor CB, Hayward C, Wilson DM, Haydel KF, Hammer LD, et al. Pursuit of thinness and onset of eating disorder symptoms in a community sample of adolescent girls: A three-year prospective analysis. Int J Eat Disord 1994;16:227238.
  • 32
    IBM. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp., 2011.
  • 33
    Muthén LK, Muthén BO. Mplus User's Guide, 6th ed. Los Angeles, CA: Muthén & Muthén, 19982010.
  • 34
    Olivardia R, Pope HG Jr, Borowiecki JJ III, Cohane GH. Biceps and body image: The relationship between muscularity and self-esteem, depression, and eating disorder symptoms. Psychol Men Masc 2004;5:112120.
  • 35
    Pope HG Jr, Gruber AJ, Mangweth B, Bureau B, deCol C, Jouvent R, Hudson JI. Body image perception among men in three countries. Am J Psychiatry 2000;157:12971301.
  • 36
    Fairburn CG. Eating disorders: The transdiagnostic view and the cognitive behavioral theory. In: Fairburn CG, editor. Cognitive Behavior Therapy and Eating Disorders. New York: Guilford Press, 2008, pp. 722.
  • 37
    APA. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC: APA, 2013.