Psychometric evaluation and refinement of the Eating Disorder Examination Questionnaire in a clinical eating disorder...

The Eating Disorder Examination Questionnaire (EDE-Q) is one of the most widely utilized eating disorder (ED) assessments. However, its measurement structure remains obscured by mixed findings, which may be due to studies primarily featuring community samples with limited clinical ED symptom relevance and potential measurement noninvariance across ED types. The present study aimed to employ both factor analytic and item response theory analyses in a clinical sample of individuals (n = 2,032) seeking ED treatment at a higher level of care facility to discern the EDE-Q's structure and invariance across sociodemographic and clinical characteristics including age, race, gender, ED type, and treatment setting. Study aims also included generation of a reduced-item EDE-Q that reflected its truer measurement structure and scores with greater interpretability. Factor analytic and item response theory models uniformly indicated the EDE-Q is unidimensional with items reflecting overall ED symptom severity. Removing eight items based on item residual covariance patterns and ED theory based on expert consensus yielded a 13-item EDE-Q that had improved unidimensional fit and retained majority of the information conveyed by the original scale. The 13-item EDE-Q was also invariant across age, race, gender, level of care, and ED type. The 13-item EDE-Q is recommended as an alternative to the original and previously proposed models, as it has a more reliable total score, has better goodness of fit, and is invariant across sociodemographic and clinical characteristics. Nonetheless, more work is required to develop scales that capture specific cognitive, behavioral, and affective components of disordered eating. (PsycInfo Database Record (c) 2025 APA, all rights reserved).