Unikel SC, Bojorquez CI, Carreño GS, Caballero RA

Language: Spanish
References: 19
Page: 44-51
PDF size: 126.36 Kb.

ABSTRACT

The Eating Disorder Inventory (EDI) is a psychometric instrument developed by Garner et al. for the evaluation of psychological traits in patients with eating disorders. The questionnaire offers an integral evaluative approach that includes other psychological characteristics besides those of fear of fatness. It consists of 64 items in 8 subscales: 1) Drive for Thinness, 2) Bulimia, 3) Body Dissatisfaction, 4) Ineffectiveness, 5) Perfectionism, 6) Interpersonal Distrust, 7) Interoceptive Awareness, 8) Maturity Fears. The EDI is an instrument widely used for the exploration of eating disorders (ED). Nevertheless, the use of psychometric scales in a population other than the one in which they were originally developed, requires careful adaptation. Items should be phrased in a culturally significant way, and even after that, constructs still could have different meanings in different contexts. The factorial grouping of the EDI in open populations has been reported as different from the results in clinical samples. Also, Lee and cols. reported a low correlation of the EDI subscales that measure weight preoccupation and the General Health Questionnaire – 12, concluding that fear of fatness is not related with emotional distress in their sample. In Mexico City, Alvarez and Franco conducted a validation study, finding good reliability and discriminative power, and a factorial grouping close to the original. On the other hand, in a sample of teenage girls from a semi-rural area, the factorial grouping was very different. Although we already have data about the EDI’s specificity and sensitivity in Mexican ED patients, there are no studies of the validity and reliability of the test in this population. Therefore, our main objective in this work was to validate the EDI in a sample of Mexican ED patients. Also, the score information provided could be used for comparison purposes with other clinical samples.
A non-probabilistic sample was obtained of all subsequent patients attending the ED Clinic at the National Institute of Psychiatry Ramón de la Fuente (INPRF) in the period 19972002 (n=523). Patients were diagnosed according to DSM-IV criteria in a clinical interview. They also completed other questionnaires, such as the Symptom Check List (SCL90) and the Coopersmith’s Self-esteem Inventory. According to diagnosis, the sample was composed of compulsive/purging type anorexia nervosa, 5.7%; restrictive anorexia nervosa, 8%; purging type bulimia nervosa 45.1% and eating disorders not otherwise specified 41.3%. Mean age was 19.9 years (s.d.=3.9), within a rank of 13 to 39 years. Mean age at the beginning of ED was 16 years (s.d.=3.1). Mean educational level was 12 years (s.d.=3), i.e. high-school level. The sample included single women 93.9%, married 4.8% and divorcees, 1.4%. Mean Body Mass Index was 21 (s.d.=5.5). Participants completed the EDI, SCL90, and Coopersmith’s self-esteem inventory during their first visit to the Clinic. They were assured of the voluntary nature and confidentiality of their participation. Completing the tests took them about 60 minutes. An internal reliability analysis was conducted, followed by a factorial analysis of main components with Varimax rotation. Pearson correlations were made to assess the concurrent validity of EDI and other instruments. Analysis of variance was employed to compare between diagnostic groups. Data were captured and analysed in the SPSS software, version 10.0.
The first step of the analysis was the item-total correlation, considering as valid correlations equal or over 0.28. This step eliminated 12 items that were not included in further analyses. Cronbach’s alpha was 0.93. Most of the items in the Perfectionism subscale disappeared in this step. Second step was factorial analysis. We found 6 factors with a minimum of 3 items included with factorial charges equal or over .40. Then a second analysis was conducted with only the 40 items that had been grouped in the 6 factors. Factor 1 included items from Bulimia and Interoceptive Awareness; factor 2, from Drive for Thinness and Body Dissatisfaction; factor 3, from Interoceptive Awareness; factor 4, from Ineffectiveness; factor 5, from Maturity Fears; and factor 6, from Body Dissatisfaction. The resulting factorial structure explained 56% of total variance. Cronbach’s alpha of the final version was 0.92. Correlation analysis showed a positive and significant correlation of EDI with SCL-90, and a negative and significant correlation of EDI with Coopersmith’s self-esteem inventory. Comparisons between diagnostic groups showed that bulimia nervosa patients had the highest scores in the EDI. Patients with restrictive AN had the lowest scores in all sub-scales except for Maturity Fears. Bulimia nervosa and compulsive/purging type AN patients were different from restrictive AN and EDNOS patients in the total score of Interoceptive Awareness and Ineffectiveness subscales. Bulimia nervosa was different from the other groups in Bulimia and Drive for Thinness subscales.
The results show that, in this sample, many of the EDI items have a poor correlation with the scale, and factorial grouping is different from the original. However, once non-correlated items are eliminated, a version of the EDI remains that is valid and reliable. Items from the Perfectionism subscale were eliminated because of low correlation with the rest of the EDI. This supports the findings in Bulgaria, rural Mexico, and Mexico City. Maturity Fears, which also had dubious results in other studies, grouped correctly in this sample, although it did not distinguish among diagnostic groups. Analysis of variance showed that subscales were able to differentiate the Bulimia nervosa patients. Also, most of the variance explained corresponded to the Bulimia subscale, suggesting that EDI can detect bulimic attitudes, and so is a useful complement to instruments that are more capable of detecting anorexia nervosa, such as the Eating Attitudes Test. However, this could also be an effect of the sample’s composition, with more than half of it being bulimic patients. Another important segment of variance was explained by Interoceptive Awareness, Ineffectiveness and Maturity Fears subscales, psychological traits that are not necessarily related to ED. In this sample, psychological subscales correlated with eating and weight attitude subscales, showed that Mexican patients do present ED according to the way they are conceptualized in the DSM-IV. Our results show that the EDI is adequate for the evaluation of psychological traits of ED patients in Mexico. Perfectionism and Interpersonal Distrust subscales are an exception, that requires further investigation.

REFERENCES

1. ALVAREZ D, FRANCO K: Validación del Eating Disorder Inventory (EDI) en población mexicana:(Tesis). Universidad Nacional Autónoma de México campus-Iztacala, México, 2001.

2. ALVAREZ D, FRANCO K, MANCILLA JM, ALVAREZ G, LOPEZ X: Factores predictores de la sintomatología de los trastornos alimentarios. Psicologia Contemporanea, 7:26-35, 2000.

3. AMERICAN PSYCHIATRIC ASSOCIATION: DSM-IV: Diagnostic and Statistical Manual of Mental Disorders. Cuarta edición. APA, Washington, 1994.

4. BEHAR R, DE LA BARRERA M, MICHELOTTI J: Clinical characteristics and gender identity among eating disordered patients subtypes. Rev Med Chil, 131:748-58, 2003.

5. BONICATO S, DEW MA, SORIA JJ, SEGHEZZO ME: Validity and reliability of Symptom Check List ’90 (SCL90) in an Argentine population sample. Soc Psychiatry Epidem, 32:332-338, 1997.

6. BOYADJIEVA S, STEINHAUSEN HC: The eating attitudes test and the Eating Disorder Inventory in four Bulgarian clinical and nonclinical samples. Int J Eating Disord, 19:93-98, 1996.

7. COOPERSMITH S: The antecedents of self-esteem: A psychiatric view. Consulting Psychologists Press, San Francisco, 1967.

8. CRUZ C, LOPEZ L, BLAS C, GONZALEZ L, CHAVEZ RA: Datos sobre la validez y confiabilidad de la Symptom Check List 90 (SCL90) en una muestra de sujetos mexicanos. Salud Mental, 28:72-81, 2005.

9. DEROGATIS LR, LIPMAN RS, COVI L: SCL-90: An outpatient psychiatric rating scale-preliminary report. Psychopharmacol Bull, 9:13-27, 1973.

10. FABREGA H: Cultural and historical foundations of psychiatric diagnosis. En: Mezzich JE, Kleinman A, Fabrega H, Parron D (eds.) Culture and Psychiatric Diagnosis. A DSMIV perspective. American Psychiatric Press, Washington, 3-14, 1996.

11. GARCIA E, VAZQUEZ V, LOPEZ JC, ARCILA D: Validez interna y utilidad diagnóstica del Eating Disorder Inventory en mujeres mexicanas. Salud Publica Mex, 45:206-210, 2003.

12. GARNER DM: EDI2. Inventario de Trastornos de la Conducta Alimentaria. Manual. TEA ediciones, Madrid, 1998.

13. GARNER DM, GARFINKEL P: The eating attitudes test: an index of the symptoms of anorexia nervosa. Psychol Med, 9:273-279, 1979.

14. GARNER DM, OLMSTED M, POLIVY J: Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J Eating Disord, 2:15-35, 1983.

15. JOINER TE, HEATHERTON TF: First and second order factor structure of five subscales of the Eating Disorder Inventory. Int J Eating Disord, 23:189-198, 1998.

16. LARA MA, VERDUZCO MA, ACEVEDO M, CORTES J: Validez y confiabilidad el inventario de autoestima de Coopersmith para adultos, en población mexicana. Rev Latinoamericana Psicologia, 25:247-255, 1993.

17. LEE S, LEE AM, LEUNG T: Cross-cultural validity of the Eating Disorder Inventory: a study of Chinese patients with eating disorders in Hong Kong. Int J Eating Disord, 23:177188, 1998.

18. LEE S,LEE AM,LEUNG T,YU H:Psychometric properties of the Eating Disorder Inventory (EDI-1) in a nonclinical Chinese population in Hong Kong. Int J Eating Disord, 21:187194, 1997.

19. NEVONEN L, BROBERG AG: Validating the Eating Disorder Inventory-2 (EDI-2) in Sweden. Eating Weight Disord, 6: 59-67, 2001.