Reliability of self-reported eating disorders: Optimizing population screening

Area of Science:

• Psychiatry
• Epidemiology
• Psychometrics

Background:

• Accurate screening for eating disorders in the general population is crucial for early intervention.
• Existing screening tools, such as the Eating Disorder Inventory (EDI), have limitations in large-scale application.

Purpose of the Study:

• To evaluate the utility of brief self-report screening questions for identifying eating disorders in a population-based sample.
• To compare the performance of these short questions against established diagnostic criteria and existing instruments.

Main Methods:

• A population-based sample of female twins (N=2881) completed self-report eating disorder screening questions and EDI subscales.
• Diagnostic interviews based on the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria for anorexia and bulimia were conducted with a subset of participants (N=549).
• Sensitivities, specificities, and receiver operating characteristic (ROC) curves were calculated to assess screening accuracy.

Main Results:

• For bulimia (current and lifetime), screening questions focusing on purging behaviors demonstrated optimal sensitivity and specificity.
• For anorexia (current and lifetime), the questions "Have you ever had anorexia" and "Has anybody ever suspected that you might have an eating disorder?" yielded the best performance.
• These simple screening questions generally outperformed the EDI subscales in identifying cases.

Conclusions:

• Brief self-report screening questions represent a viable, accessible method for population-level eating disorder screening.
• These simple questions offer a practical alternative to more complex instruments, demonstrating comparable or superior accuracy.
• The findings support the use of these questions in community-based screening initiatives for eating disorders.