Evidence based assessment/Anorexia nervosa (assessment portfolio)

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Medical disclaimer: This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians. Please refer to the full text of the Wikiversity medical disclaimer.

What is a "portfolio"?[edit]

  • For background information on what assessment portfolios are, click the link in the heading above.

Preparation phase[edit]

Diagnostic criteria for anorexia nervosa[edit]

ICD-10 Criteria

Anorexia nervosa is characterized by induced and sustained deliberate weight loss. It most commonly occurs in adolescent girls and young women, but may also occur in young men, children approaching puberty, and women up to menopause. The disorder is associated with psychopathological dread of fatness and flabbiness in body contour which persistently and intrusively occupies the patient's thoughts. The patients pose a low weight threshold on themselves, causing undernutrition of varying severity and disturbances in bodily function. Symptoms include dietary restriction, excessive exercise, induced vomiting and purgation, and use of appetite suppressants and diuretics.[1] Criteria include:

A. There is weight loss or, in children, a lack of weight gain, leading to a body weight at least 15% below the normal or expected weight for age and height. B. The weight loss is self-induced by avoidance of "fattening foods." C. There is self-perception of being too fat, with an intrusive dread of fatness, which leads to a self-imposed low weight threshold. D. A widespread endocrine disorder involving the hypothalamic-pituitary-gondal axis is manifest in women as amenorrhoea and in men as lost in sexual interest and potency. (An apparent exception is the persistence of vaginal bleeds in anorexic women who are on replacement hormonal therapy, most commonly taken as a contraceptive pill.) E. The disorder does not meet criteria A and B for bulimia nervosa.

Changes in DSM-5

  • The diagnostic criteria for anorexia nervosa changed slightly from DSM-IV to DSM-5. Summaries are available here and here.


Base rates of anorexia nervosa in different populations and clinical settings[edit]

This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled, and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rate of adolescent depression that they are likely to see in their clinical practice.

  • To see prevalence rates across multiple disorders, click here.
Setting (Reference) Base Rate Demography Diagnostic Method Best Recommended For
Non-clinical: Population Based (NCS-R)[2] .9% Female, .3% Male Nationally representative US sample of adults WHO-CIDI
Non-clinical: Population Based (NCS-A)[3] .3% Female, .3% Male Nationally representative US sample of adolescents WHO-CIDI
Non-clinical: Latinos in US[4] .12% Female, .03% Male Latino Households in the US WHO-CIDI
Non-clinical: African Americans and Caribbean Blacks in the US (NSAL)[5] .14% Female, .2% Male National probability sample of adult and adolescent African Americans and Caribbean Blacks WHO-CIDI
Non-clinical:   National Latino and Asian American Study (NLAAS) .12% Female, .05% Male Asian American adults in US households WHO-CIDI
Non-clinical; college students[6] .0% US African American college females EDD-Q (Eating Disorder Diagnostic Questionnaire)
Non-clinical; Adolescents[7] .8% US Female Adolescents EDDI (Eating Disorder Diagnosis Interview)
Non-clinical; student-athletes[8] .0% US Division-I Varsity Student Athletes EDI-2 (Eating Disorder Inventory-2)
Non-clinical; Military[9] 1.1% Active duty females in US Army, Navy,

Airforce, and Marines

EDI-2 (Eating Disorder Inventory-2)
Non-clinical; Commonwealth of Virginia Mid-Atlantic Twin Registry (MATR)[10] 1.62% (narrow), 3.70% (broad) US Caucasian female same-sex twins SCID (Structured Clinical Interview for DSM Disorders)
Non-clinical; Health Omnibus Survey (HOS) .46% (3 months; combined) South Australian older adolescents and adults EDE (Eating Disorder Examination)
Military[11] .04% (combined) US Military ICD codes from electronic records
Non-clinical; Military .02% (7 years) Female,

0.0% (7 years) Males

US Military Academy cadets EAT-26
Non-clinical; Military 1.1% (current & past) Female US Navy female nurses DSM-III
Non-clinical; Military .04% Female, .005% Males US veterans ICD-9-CM
Non-clinical; Military 2.5% Males Active duty males in US Navy N/A
Clinical; Collaborative Study on the Genetics of Alcoholism (COGA)[12] 1.41% (lifetime) Female,

.00% (lifetime) Male

US alcohol-dependent adults from San Diego, St. Lois, Iowa City, Farmington, New York, & Indianapolis SSAGA
Non-clinical; healthcare members .0269% (current) Healthcare provider records
Non-clinical; high school students . 00% (point), .45% (lifetime) Female

.00% (point), .00% (lifetime) Males

US high school students in west central Oregon DSM-III-R4
Clinical; substance users .4% (lifetime), .3% (current) Female

.4% (lifetime), .3% (current) Males

Canadian treatment-seeking substance users DIS9
Europe
Non-clinical; adolescents .3% Female Adolescent females residing in Navarra, Spain EAT-403
Non-clinical; adolescents .7% (lifetime) Female, .2% Male Adolescents in secondary schools in Sør-Trøndelag, County in Norway SEDs10
Non-clinical; adolescents .7% (point; age 15), 1.8% (lifetime, age 15), .00% (point, age 18), 2.6% (lifetime, age 18), .9% (3 years) Female

.00% (point & lifetime) Males

Adolescents in a comprehensive school in Ostrobothnia district in Finland RAB-T11 & RAB-R12
Australia
Non-clinical; adolescents .00% (full), 1.8% (partial) Female Adolescent females residing in Victoria, Australia BET13
Central & South America
Non-clinical; college students .00% Female Mexican first & second year college females EAT-403
East Asia
Clinical; eating disorder patients .53% Female Adolescent and adult Japanese patients at a university hospital DSM-III-R4
Non-clinical; Korean Epidemiologic Catchment Area (KECA) Study .1% (lifetime), .1% (12 months) Female

.2% (lifetime), .00% (12 months)

Males

Korean adults K-CIDI15 2.1
Centers participating in the Collaborative Study on the Genetics of Alcoholism in San Diego; St. Louis; Iowa City; Farmington, CN; New York; & Indianapolis 1.41% Females Alcohol-dependent adults Semi-Structured Assessment for the Genetics of Alcoholism; criteria based on DSM-III-R

Prediction phase[edit]

Psychometric properties of screening instruments for anorexia nervosa[edit]

The following section contains a list of screening and diagnostic instruments for anorexia nerova. The section includes administration information, psychometric data, and PDFs or links to the screenings.

  • Screenings are used as part of the prediction phase of assessment; for more information on interpretation of this data, or how screenings fit in to the assessment process, click here.
  • For a list of more broadly reaching screening instruments, click here.
Measure Format (Reporter) Age Range Administration/

Completion Time

Inter-rater reliability Test-retest reliability Construct validity Content validity Highly recommended
SCID (Structured Clinical Interview Diagnosis for DSM-IV) Module H Interview

(Patient)

G L A E X
EDE (Eating Disorder Examination) Interview

(Patient)

45min-1.25hrs E A A E X
EDE-Q (Eating Disorder Examination Questionnaire) Questionnaire

(Patient)

15-20 min NA L U E
EDDS (Eating Disorder Diagnosis Scale) Questionnaire

(Patient)

10-15 min NA A A G X

[13]Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

Likelihood ratios and AUCs of screening instruments for anorexia nervosa[edit]

  • For a list of the likelihood ratios for more broadly reaching screening instruments, click here.
[14]Screening Measure (Primary Reference) AUC DiLR+ (Score) DiLR- (Score) Clinical Generalizability Download
EDE-Q[15] [16] .96 (N=1170) -- -- Moderate: Dutch treatment-seeking females meeting DSM-IV criteria for an eating disorder versus female general population sample recruited through advertisements and personal contacts. Eating disorders were not separated.
EDE-Q [15][17] -- 6.57 (2.3+) 0.09 (<2.3) Moderate: “Clinically significant eating disorder” from a community sample versus individuals without “clinically significant eating disorder” from same sample. Eating disorders were not separated.
EAT-26 [18] .90 (N=129) 12.83 (20+) .24 (<20) Low-moderate: College women with no eating disorder versus college women with a DSM-IV eating disorder. Eating disorders were not separated.
Biological & Physical Measures
Serum leptin level[19] 0.984 (N=139) 14.72 (<2.31) 0.10 (2.31+) Adolescent and adult patients in the acute phase of AN according to the DSM-IV and no AN pretreatment versus healthy lean female volunteer university students.
Serum leptin standard deviation score (SDS)[19] 0.939 (N=139) 5.89 (<-0.45) 0.09 (-0.45+) Adolescent and adult patients in the acute phase of AN according to the DSM-IV and no AN pretreatment versus healthy lean female volunteer university students.
Body Mass Index (BMI)[19] 0.936 (N=139) 5.89 (<17.10) 0.11 (17.10+) Adolescent and adult patients in the acute phase of AN according to the DSM-IV and no AN pretreatment versus healthy lean female volunteer university students.
REDS-C1
REDS-C[20][20] 0.658 (N=333), 0.624 (N=236, > 13 years old), 0.772 (N=97, ≤ 13 years old) -- -- Children and adolescents (8-18 years old) at a clinic being treated for eating and weight concerns. Eating disorders were not separated.
EDI2
EDI-2 [21][20] 0.556 (N=77) -- -- Children and adolescents (10-18 years old) at a clinic being treated for eating and weight concerns. Eating disorders were not separated.
EDI-2 - Drive for Thinness Sub-scale[21][22] 0.97 (N=92) 29.39 (14+) 0.274 (DT≤14) Italian individuals with a DSM-IV-TR eating disorder versus individuals at risk for eating disorders. Eating disorders were not separated.
EDI-3 - Drive for Thinness Subscale (Garner, 2004)

Lehmann et al., 2013

.903 (N=1298) -- --  
EDI-3 - Eating Disorder Risk Composite [22](EDRC) (Garner, 2004) 0.942 (N=92) 52.08 (EDRC 75+, adults; 90+ adolescents) 0.379 (EDRC≤75, adults; ≤90 adolescents) Italian individuals with a DSM-IV-TR eating disorder versus individuals at risk for eating disorders. Eating disorders were not separated.
EDI-3 - Interoceptive Deficits Subscale [23](Garner, 2004) .911 (N=2561) 4.0 (9+) -- Danish females with a DSM-IV eating disorder diagnosis recruited from an eating disorder center versus non-clinical control individuals from the Danish Civil Registration system.
EDI-3 - Interoceptive Deficits Subscale (Garner, 2004)

Lehmann et al., 2013

.901 (N=1298) -- -- Dutch patients recruited from eating disorder specialized clinics versus undergraduate female psychology students from a Dutch university. Eating disorders were not separated.
EDI-3 - Asceticism Subscale[23] (Garner, 2004) .886 (N=2561) 6.5 (9+) -- Danish females with a DSM-IV eating disorder diagnosis recruited from an eating disorder center versus non-clinical control individuals from the Danish Civil Registration system.
EDI-3 - Asceticism Subscale (Garner, 2004)

Lehmann et al., 2013

.902 (N=1298) -- -- Dutch patients recruited from eating disorder specialized clinics versus undergraduate female psychology students from a Dutch university. Eating disorders were not separated.
EDI-3 - Low Self-Esteem Subscale[23] (Garner, 2004) .884 (N=2561) 5.8 (10+) -- Danish females with a DSM-IV eating disorder diagnosis recruited fm an eating disorder center versus non-clinical control individuals from the Danish Civil Registration system.
EDI-3 - Low Self-Esteem Subscale (Garner, 2004)

Lehmann et al., 2013

.906 (N=1298) -- -- Dutch patients recruited from eating disorder specialized clinics versus undergraduate female psychology students from a Dutch university. Eating disorders were not separated.
EDI-3 - Personal Alienation Subscale[23] (Garner, 2004) .88 (N=2561) -- -- Danish females with a DSM-IV eating disorder diagnosis recruited from an eating disorder center versus non-clinical control individuals from the Danish Civil Registration system.
EDI-3 - Personal Alienation Subscale (Garner, 2004)

Lehmann et al., 2013

.899 (N=1298) -- -- Dutch patients recruited from eating disorder specialized clinics versus undergraduate female psychology students from a Dutch university. Eating disorders were not separated.
EDI-3 - Emotional Dysregulation Subscale[23] (Garner, 2004) .81 (N=2561) -- -- Danish females with a DSM-IV eating disorder diagnosis recruited from an eating disorder center versus non-clinical control individuals from the Danish Civil Registration system.
EDI-3 - Emotional Dysregulation Subscale (Garner, 2004)

Lehmann et al., 2013

.779 (N=1298) -- -- Dutch patients recruited from eating disorder specialized clinics versus undergraduate female psychology students from a Dutch university. Eating disorders were not separated.
EDI-3 - Interpersonal Alienation Subscale [23](Garner, 2004) .79 (N=2561) -- -- Danish females with a DSM-IV eating disorder diagnosis recruited from an eating disorder center versus non-clinical control individuals from the Danish Civil Registration system.
EDI-3 - Interpersonal Alienation Subscale (Garner, 2004)

Lehmann et al., 2013

.743 (N=1298) -- -- Dutch patients recruited from eating disorder specialized clinics versus undergraduate female psychology students from a Dutch university. Eating disorders were not separated.
EDI-3 - Perfectionism Subscale[23] (Garner, 2004) .79 (N=2561) -- -- Danish females with a DSM-IV eating disorder diagnosis recruited from an eating disorder center versus non-clinical control individuals from the Danish Civil Registration system.
EDI-3 - Perfectionism Subscale (Garner, 2004)

Lehmann et al., 2013

.768 (N=1298) -- -- Dutch patients recruited from eating disorder specialized clinics versus undergraduate female psychology students from a Dutch university. Eating disorders were not separated.
EDI-3 - Maturity Fears Subscale[23] (Garner, 2004) .77 (N=2561) -- -- Danish females with a DSM-IV eating disorder diagnosis recruited from an eating disorder center versus non-clinical control individuals from the Danish Civil Registration system.
EDI-3 - Maturity Fears Subscale (Garner, 2004)

Lehmann et al., 2013

.678 (N=1298) -- -- Dutch patients recruited from eating disorder specialized clinics versus undergraduate female psychology students from a Dutch university. Eating disorders were not separated.
EDI-3 - Bulimia Subscale[23] (Garner, 2004) .76 (N=2561) -- -- Danish females with a DSM-IV eating disorder diagnosis recruited from an eating disorder center versus non-clinical control individuals from the Danish Civil Registration system.
EDI-3 - Bulimia Subscale (Garner, 2004)

Lehmann et al., 2013

.776 (N=1298) -- -- Dutch patients recruited from eating disorder specialized clinics versus undergraduate female psychology students from a Dutch university. Eating disorders were not separated.
EDI-3 - Interpersonal Insecurity Subscale [23](Garner, 2004) .76 (N=2561) -- -- Danish females with a DSM-IV eating disorder diagnosis recruited from an eating disorder center versus non-clinical control individuals from the Danish Civil Registration system.
EDI-3 - Interpersonal Insecurity Subscale (Garner, 2004)

Lehmann et al., 2013

.697 (N=1298) -- -- Dutch patients recruited from eating disorder specialized clinics versus undergraduate female psychology students from a Dutch university. Eating disorders were not separated.
EDI-3 - Body Dissatisfaction Subscale[23] (Garner, 2004) .722 (N=2561) 1.7 (15+) -- Danish females with a DSM-IV eating disorder diagnosis recruited from an eating disorder center versus non-clinical control individuals from the Danish Civil Registration system.
EDI-3 - Body Dissatisfaction Subscale (Garner, 2004)

Lehmann et al., 2013

.849 (N=1298) -- -- Dutch patients recruited from eating disorder specialized clinics versus undergraduate female psychology students from a Dutch university. Eating disorders were not separated.
EAT3
EAT-26 [14][24] .90 (N=129) 12.83 (20+) .24 (<20) Low-moderate: College women with no eating disorder versus college women with a DSM-IV eating disorder. Eating disorders were not separated.
EDE-Q4
EDE-Q [16][25] .96 (N=1170) -- -- Moderate: Dutch treatment-seeking females meeting DSM-IV criteria for an eating disorder versus female adult general population sample recruited through advertisements and personal contacts. Eating disorders were not separated.
EDE-Q [25][15] -- 6.57 (2.3+) 0.09 (<2.3) Moderate: “Clinically significant eating disorder” from a community sample versus female adultsindividuals without “clinically significant eating disorder” from same sample. Eating disorders were not separated.
EDE-Q [25][26] 0.89 (N=2465) -- -- Norwegian adult females with an eating disorder recruited from eating disorder specialist centers versus controls determined using the DSM-IV.
EDQ-O5
EDQ-Q [25][15] 0.72 (N=134) 1.00 (all criteria met) 0.92 (≥1 criteria not met) Dutch adults recruited from an eating disorder specialist center determined using the DSM-IV-TR.

Interpreting anorexia nervosa screening measure scores[edit]

Prescription phase[edit]

Gold standard diagnostic interviews[edit]

  • For a list of broad reaching diagnostic interviews sortable by disorder with PDFs (if applicable), click here.

Recommended diagnostic interviews for anorexia nervosa[edit]

Diagnostic instruments for anorexia nervosa
Measure Format (Reporter) Age Range Administration/

Completion Time

Interrater Reliability Test-Retest Reliability Construct Validity Content Validity Highly Recommended Free and Accessible Measures
Children's Depression Rating Scale - Revised (CDRS-R) Structured Interview[14] 6-12 15-20 minutes G A G G X

Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

Severity interviews for anorexia nervosa[edit]

Measure Format (Reporter) Age Range Administration/

Completion Time

Interrater Reliability Test-Retest Reliability Construct Validity Content Validity Highly Recommended Free and Accessible Measures
Placeholder example (CDRS-R) Structured Interview[14] 6-12 15-20 minutes G A G G X

Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

Process phase[edit]

The following section contains a brief overview of treatment options for anorexia nervosa and list of process and outcome measures for anorexia nervosa. The section includes benchmarks based on published norms for several outcome and severity measures, as well as information about commonly used process measures. Process and outcome measures are used as part of the process phase of assessment. For more information of differences between process and outcome measures, see the page on the process phase of assessment.

Process measures[edit]

Body weight is commonly monitored by clinicians throughout the AN treatment process as helping individuals regain and maintain a healthy weight is a primary treatment goal for AN. Many treatment centers have policies prohibiting patients from seeing their weight.

Motivational Stages of Change may be used to monitor individuals’ readiness to take action against eating disorder behaviors. It has demonstrated predictive validity in a sample of female adolescents attending eating disorder treatment groups.[27] See Appendix E.

Outcome and severity measures[edit]

This table includes clinically significant benchmarks for anorexia nervosa specific outcome measures

  • Information on how to interpret this table can be found here.
  • Additionally, these vignettes might be helpful resources for understanding appropriate adaptation of outcome measures in practice.
  • For clinically significant change benchmarks for the CBCL, YSR, and TRF total, externalizing, internalizing, and attention benchmarks, see here.
Clinically significant change benchmarks with common instruments for anorexia nervosa
Benchmarks Based on Published Norms
Measure Subscale Cut-off scores Critical Change
(unstandardized scores)
A B C 95% 90% SEdifference
EDE-Q [17] Global 1.4 3.2 2.3 .7 .6 .3
Restraint (-.3) 3.6 1.8 1.5 1.2 .8
Eating Concern .1 2.0 1.2 1.1 .9 .6
Weight Concern 1.5 3.9 2.6 1.0 .9 .5
Shape Concern 2.1 4.8 3.2 .9 .7 .4
EDE [17] Global 1.7 2.3 1.9 1.9 1.6 1.0
Restraint .3 3.3 1.9 1.8 1.5 .9
Eating Concern (-.5) .9 .5 .8 .7 .4
Weight Concern 2.0 2.8 2.4 1.3 1.1 .7
Shape Concern 2.0 3.2 2.6 1.2 1.0 .6
EAT-26 [28] Total 6.5 19.6 15.0 7.9 6.7 4.0

Note: “A” = Away from the clinical range, “B” = Back into the nonclinical range, “C” = Closer to the nonclinical than clinical mean.

Search terms: [Anorexia Nervosa OR eating disorder] AND [validity OR clinical significance] in Google Scholar

Treatment[edit]

Click here for more information on treatment for AN
  • Treatment of AN typically consists of restoring the individual to a healthy weight and addressing thoughts and behaviors which are related to the eating disorder. It may involve re-nutrition, psychotherapy, nutritional counseling, and medication.
  • Literature reviews of existing research indicate that evidence supporting AN treatment is lacking. A systematic review of AN treatment efficacy studies by Bulik[29] found that evidence supporting medications, medications and behavioral interventions, and behavioral interventions alone in adults is weak.
  • There is moderately strong evidence suggesting that behavioral interventions may be helpful for adolescents. In particular, adolescents may benefit from family therapy.
  • Clinical trials investigating AN treatment suffer from high rates of attrition, as key features of AN (e.g., denial, fear of weight gain) may contribute to low motivation for remaining in treatment.
  • More severe cases of AN may be treated in inpatient settings, which are equipped to manage the re-nutrition process and provide medical monitoring.
  • Partial hospitalization and intensive outpatient programs may provide intermediate levels of treatment intensity to assist individuals in the transition from intensive care to outpatient care after weight restoration.

External resources[edit]

  1. ICD-10 diagnostic criteria
  2. Find-a-Therapist
    1. This is a curated list of find-a-therapist websites where you can find a provider
  3. NIMH: Eating Disorders--About More Than Food and Eating Disorders
    1. These NIMH website posts provide more information on anorexia nervosa
  4. John's Hopkins Resource (guide about anorexia nervosa, treatment, and more)
  5. OMIM (Online Mendelian Inheritance in Man)
    1. Anorexia nervosa
  6. Effective Child Therapy page for anorexia nervosa
    1. Effective Child Therapy is website sponsored by Division 53 of the American Psychological Association (APA), or The Society of Clinical Child and Adolescent Psychology (SCCAP), in collaboration with the Association for Behavioral and Cognitive Therapies (ABCT). Use for information on symptoms and available treatments.

References[edit]

Click here for references
  1. "ICD-10 Version:2015". apps.who.int. Retrieved 2018-03-22.
  2. Hudson, James I.; Hiripi, Eva; Pope, Harrison G.; Kessler, Ronald C. (2007-02-01). "The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication".Biological Psychiatry 61 (3): 348–358. doi:10.1016/j.biopsych.2006.03.040. ISSN 0006-3223. PMC 1892232. PMID 16815322
  3. Swanson, Sonja A.; Crow, Scott J.; Le Grange, Daniel; Swendsen, Joel; Merikangas, Kathleen R. (2011-07-01). "Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement". Archives of General Psychiatry 68 (7): 714–723. doi:10.1001/archgenpsychiatry.2011.22. ISSN 1538-3636.PMID 21383252
  4. Alegria, Margarita; Woo, Meghan; Cao, Zhun; Torres, Maria; Meng, Xiao-li; Striegel-Moore, Ruth (2007-11-01). "Prevalence and correlates of eating disorders in Latinos in the United States".The International Journal of Eating Disorders. 40 Suppl: S15–21. doi:10.1002/eat.20406. ISSN 0276-3478. PMC 2680162. PMID 17584870
  5. Taylor, Jacquelyn Y.; Caldwell, Cleopatra Howard; Baser, Raymond E.; Faison, Nakesha; Jackson, James S. (2007-11-01). "Prevalence of eating disorders among Blacks in the National Survey of American Life". The International Journal of Eating Disorders. 40 Suppl: S10–14. doi:10.1002/eat.20451. ISSN 0276-3478. PMC 2882704. PMID 17879287
  6. Tyler ID. A true picture of eating disorders among African American women: a review of literature. ABNF J. 2003;14(3):73-4.
  7. Stice, E., Becker, C. B., & Yokum, S. (2013). Eating disorder prevention: Current evidence-base and future directions. Int. J. Eat. Disord. International Journal of Eating Disorders, 46(5), 478-485.
  8. Johnson C, Powers PS, Dick R. Athletes and eating disorders: the national collegiate athletic association study. Int J Eat Disord 1999;26:179e88.
  9. McNulty, PAF. (2001). Prevalence and contributing factors of eating disorder behaviors in active duty service women in the Army, Navy, Air Force and Marines. Military Medicine, 166(1), 53-58. 
  10. Kendler KS, Walters EE, Neale MC, Kessler R, Heath A, Eaves L. The structure of genetic and environmental risk factors for six major psychiatric disorders in women. Archives of general psychiatry. 1995;52:374–383.
  11. Antczak, Amanda J.; Brininger, Teresa L. (2008-12-01). "Diagnosed eating disorders in the U.S. Military: a nine year review". Eating Disorders 16 (5): 363–377. doi:10.1080/10640260802370523. ISSN 1532-530X. PMID 18821361. http://www.ncbi.nlm.nih.gov/pubmed/18821361. 
  12. Schuckit, M. A.; Tipp, J. E.; Anthenelli, R. M.; Bucholz, K. K.; Hesselbrock, V. M.; Nurnberger, J. I. (1996-01-01). "Anorexia nervosa and bulimia nervosa in alcohol-dependent men and women and their relatives". The American Journal of Psychiatry 153 (1): 74–82. doi:10.1176/ajp.153.1.74. ISSN 0002-953X. PMID 8540597. http://www.ncbi.nlm.nih.gov/pubmed/8540597. 
  13. Hunsley, J., & Mash, E. J. (2008). Guide to Assessments that Work. Cary, NC, USA: Oxford University Press, USA. Retrieved from http://www.ebrary.com
  14. 14.0 14.1 14.2 14.3 Mintz, L. B.; O'Halloran, M. S. (June 2000). "The Eating Attitudes Test: validation with DSM-IV eating disorder criteria". Journal of Personality Assessment 74 (3): 489–503. doi:10.1207/S15327752JPA7403_11. ISSN 0022-3891. PMID 10900574. https://www.ncbi.nlm.nih.gov/pubmed/10900574.  Cite error: Invalid <ref> tag; name ":4" defined multiple times with different content Cite error: Invalid <ref> tag; name ":4" defined multiple times with different content
  15. 15.0 15.1 15.2 15.3 Fairburn, C. G.; Beglin, S. J. (December 1994). "Assessment of eating disorders: interview or self-report questionnaire?". The International Journal of Eating Disorders 16 (4): 363–370. ISSN 0276-3478. PMID 7866415. https://www.ncbi.nlm.nih.gov/pubmed/7866415. 
  16. 16.0 16.1 Aardoom, Jiska J.; Dingemans, Alexandra E.; Slof Op't Landt, Margarita C. T.; Van Furth, Eric F. (December 2012). "Norms and discriminative validity of the Eating Disorder Examination Questionnaire (EDE-Q)". Eating Behaviors 13 (4): 305–309. doi:10.1016/j.eatbeh.2012.09.002. ISSN 1873-7358. PMID 23121779. https://www.ncbi.nlm.nih.gov/pubmed/23121779. 
  17. 17.0 17.1 17.2 Mond, J. M.; Hay, P. J.; Rodgers, B.; Owen, C.; Beumont, P. J. V. (May 2004). "Validity of the Eating Disorder Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples". Behaviour Research and Therapy 42 (5): 551–567. doi:10.1016/S0005-7967(03)00161-X. ISSN 0005-7967. PMID 15033501. https://www.ncbi.nlm.nih.gov/pubmed/15033501. 
  18. Garner, D. M.; Olmsted, M. P.; Bohr, Y.; Garfinkel, P. E. (November 1982). "The eating attitudes test: psychometric features and clinical correlates". Psychological Medicine 12 (4): 871–878. ISSN 0033-2917. PMID 6961471. https://www.ncbi.nlm.nih.gov/pubmed/6961471. 
  19. 19.0 19.1 19.2 Föcker, M.; Timmesfeld, N.; Scherag, S.; Bühren, K.; Langkamp, M.; Dempfle, A.; Sheridan, E. M.; Zwaan, M. de et al. (2011-04-01). "Screening for anorexia nervosa via measurement of serum leptin levels" (in en). Journal of Neural Transmission 118 (4): 571–578. doi:10.1007/s00702-010-0551-z. ISSN 0300-9564. https://link.springer.com/article/10.1007/s00702-010-0551-z. 
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