Eating Disorder Diagnostic Scale

Abstract

The Eating Disorder Diagnostic Scale (EDDS) is a brief, psychometrically validated self-report instrument engineered to assess and diagnose eating pathology in accordance with formal psychiatric diagnostic classification systems. Developed by Eric Stice, Christopher F. Telch, and Shireen L. Rizvi in 2000, the instrument operationalizes the diagnostic criteria for anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Comprising 22 items, the EDDS uniquely serves a dual psychometric function: it utilizes algorithmic branching logic to yield full threshold, subthreshold, and provisional categorical psychiatric diagnoses, while concurrently generating a continuous dimensional overall symptom composite score that quantifies global eating pathology severity. The instrument incorporates diverse item formats, including 7-point Likert scales (evaluating cognitive disturbance, weight/shape overvaluation, and fear of weight gain), dichotomous (yes/no) behavioral filters, quantitative behavioral frequency counts (assessing objective binge eating, self-induced vomiting, laxative/diuretic misuse, fasting, and compulsive exercise), self-reported anthropometrics (body mass index; BMI), and endocrine indicators (menstrual status). Psychometric evaluations across adolescent, collegiate, community, and clinical cohorts demonstrate high internal consistency (α = .86–.91 for the continuous composite), robust 1- to 2-week test-retest reliability (r = .87–.95 for dimensional indices; κ = .79–.85 for categorical diagnoses), and excellent convergent and criterion validity against semi-structured clinical interviews, such as the Eating Disorder Examination (EDE) and the Structured Clinical Interview for DSM Disorders (SCID). The scale exhibits sound factorial validity, strong predictive validity for future psychosocial impairment and depressive onset, and high treatment sensitivity, establishing it as an indispensable, cost-effective measurement tool for psychiatric epidemiology, preventive intervention research, and clinical practice.

Keywords

Eating Disorder Diagnostic Scale, EDDS, anorexia nervosa, bulimia nervosa, binge eating disorder, psychometrics, eating pathology, body image, behavioral assessment, diagnostic screening, compensatory behaviors, binge eating

Authors

The Eating Disorder Diagnostic Scale was conceptualized, developed, and empirically validated by a team of prominent behavioral researchers and clinical psychologists specializing in eating pathology, adolescent development, and psychiatric epidemiology:

• Eric Stice, Ph.D. — Senior Research Scientist at the Oregon Research Institute and Professor (Affiliated) in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Dr. Stice is a globally recognized authority on the etiology, prevention, and neurobiology of eating disorders and obesity, widely known for developing the Dual-Pathway Model of Bulimic Pathology and the dissonance-based preventive intervention, The Body Project.
• Christopher F. Telch, Ph.D. — Clinical Psychologist and Researcher formerly affiliated with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine, recognized for his foundational work on cognitive-behavioral therapy and group treatments for binge eating disorder.
• Shireen L. Rizvi, Ph.D., ABPP — Professor of Clinical Psychology at the Graduate School of Applied and Professional Psychology (GSAPP) at Rutgers University. Dr. Rizvi is an expert in Dialectical Behavior Therapy (DBT), borderline personality disorder, and the treatment of complex, co-occurring eating pathology and suicidal behavior.

Subsequent psychometric extensions, cross-cultural adaptations, and algorithmic updates (including validation of DSM-5 diagnostic adaptations, such as the EDDS-5) have been spearheaded by Eric Stice in collaboration with clinical research investigators including Marti Fisher, Paul Rohde, C. Nathan Marti, and Heather Shaw.

Purpose

The fundamental purpose of the Eating Disorder Diagnostic Scale is to provide an empirically grounded, psychometrically sound, and cost-effective self-report instrument capable of accurately identifying diagnostic-level eating disorders while simultaneously quantifying symptom severity along a continuous dimensional spectrum. Prior to the development of the EDDS, the empirical evaluation of eating disorders was largely polarized between two methodology-dependent paradigms, each possessing marked clinical and logistical limitations.

On one end of the methodological spectrum were investigator-based semi-structured diagnostic interviews, such as the Eating Disorder Examination (EDE; Fairburn & Cooper, 1993) and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID; First et al., 1997). Although these interviews represent the gold standard in psychiatric nosology, they impose profound operational burdens: they necessitate extensive, specialized training to achieve inter-rater reliability, require between 45 and 90 minutes to administer per individual, and generate substantial financial and logistical overhead. Consequently, their routine application in large-scale prospective epidemiological investigations, public school screenings, and high-throughput clinical trials is virtually prohibitive.

On the opposite end of the spectrum were standard self-report questionnaires, such as the Eating Disorder Inventory (EDI; Garner et al., 1983) and the Eating Attitudes Test (EAT; Garner & Garfinkel, 1979). While these traditional questionnaires are brief and easily administered, they were constructed primarily to quantify continuous psychological traits (such as drive for thinness, body dissatisfaction, or interoceptive awareness) rather than to operationalize DSM diagnostic criteria. As a result, scores on traditional questionnaires cannot be directly mapped onto formal diagnostic categories without applying arbitrary, non-nosological cutoffs that frequently produce elevated rates of false positives and poor diagnostic concordance.

The EDDS was engineered precisely to bridge this methodological divide. Its primary clinical and research applications encompass:

• Diagnostic Classification: Employing an algorithmic scoring framework that maps directly onto the diagnostic criteria for anorexia nervosa, bulimia nervosa, and binge eating disorder, as well as subthreshold and atypical manifestations (traditionally captured under Eating Disorder Not Otherwise Specified [EDNOS], now Other Specified Feeding or Eating Disorder [OSFED]).
• Dimensional Severity Measurement: Providing a psychometrically robust continuous score (the EDDS Symptom Composite) that enables investigators and clinicians to track subtle shifts in eating pathology severity over time, even among individuals who do not satisfy full psychiatric criteria.
• Epidemiological Surveillance and Risk Modeling: Facilitating large-scale prospective longitudinal studies investigating the etiology, onset trajectories, and maintenance mechanisms of eating pathology across adolescent and adult populations.
• Outcome Assessment in Clinical Trials: Measuring therapeutic response and relapse in randomized controlled trials of pharmacological, cognitive-behavioral, and preventive interventions (e.g., evaluating intervention efficacy in school- or university-based prevention cohorts).

Psychological Construct

The EDDS measures eating pathology as a multidimensional construct comprising core cognitive distortions, maladaptive behavioral coping patterns, and physiological markers. Under modern psychiatric frameworks, eating disorders are conceptualized not merely as extreme dietary habits, but as complex bio-psycho-social syndromes driven by pervasive disturbances in self-evaluation, affective regulation, and impulse control. The scale systematically operationalizes several distinct yet deeply intertwined facets of this construct:

1. Overvaluation of Weight and Shape

Operationalized through Items 1 to 4, this dimension captures the cognitive core of eating disorders. In healthy cognitive development, individuals base their self-worth on multiple life domains (e.g., relationships, academic/professional achievements, personal values). In individuals with eating pathology, self-worth becomes disproportionately or exclusively contingent upon body shape, weight, and the perceived ability to control them. The construct involves:

• Subjective Feeling of Overweight: A persistent cognitive distortion wherein the individual feels intensely “fat” regardless of objective physiological status or BMI (Item 1).
• Intense Fear of Weight Gain: An overwhelming, phobic affective response to the prospect of gaining weight or becoming fat, which acts as a powerful negative reinforcer for extreme dietary restriction (Item 2).
• Weight- and Shape-Dependent Self-Evaluation: The extent to which body weight and physical contours dictate self-judgment, self-esteem, and global personal worth (Items 3 and 4).

2. Objective Binge Eating and Loss of Control

Items 5 through 8 establish the presence and temporal frequency of binge eating episodes, defined strictly by two mandatory criteria:

• Objective Overeating: Consuming an amount of food within a discrete period that is definitively larger than what most individuals would eat under similar circumstances and within a similar timeframe (Item 5).
• Subjective Loss of Control (LOC): The profound, distressing psychological experience during the eating episode that one cannot stop eating, cannot regulate what or how much is being consumed, or feels detached from one’s volitional agency (Item 6).
• Temporal Frequency and Chronicity: Evaluating the average number of days per week over the past 6 months (Item 7) and discrete episodes per week over the past 3 months (Item 8) to differentiate transient distress from clinical-threshold syndromal pathology.

3. Behavioral and Affective Features of Binge Episodes

Items 9 through 14 delineate the qualitative, behavioral, and emotional phenomenology characterizing loss-of-control eating, which is central to the formal diagnosis of binge eating disorder. These items index rapid consumption (Item 9), eating until uncomfortably or painfully full (Item 10), eating large volumes in the absence of physiological hunger cues (Item 11), secretive eating driven by embarrassment and shame (Item 12), post-binge emotional distress encompassing severe guilt, disgust, and depressive affect (Item 13), and marked generalized distress regarding uncontrollable eating (Item 14).

4. Inappropriate Compensatory Behaviors (Purging and Non-Purging)

Items 15 through 18 measure the weekly frequency of extreme compensatory maneuvers utilized to prevent weight gain, alleviate physical fullness, or mitigate the psychological terror associated with caloric intake:

• Self-Induced Vomiting: The manual or reflex-driven purge of gastric contents (Item 15).
• Misuse of Pharmacological Agents: Ingestion of laxatives or diuretics to artificially accelerate gastrointestinal transit or fluid expulsion (Item 16).
• Severe Dietary Fasting: Complete cessation of caloric intake, operationalized as skipping at least two consecutive meals to counteract eating effects (Item 17).
• Compulsive / Excessive Exercise: Rigorous, driven physical activity executed specifically and rigidly to burn calories from overeating episodes, often prioritizing exercise over essential obligations or despite physical injury (Item 18).

5. Anthropometric and Endocrine Indices

Items 19 through 22 capture somatic parameters essential for diagnostic differential algorithms. Self-reported weight (Item 19) and height (Item 20) are utilized to calculate Body Mass Index (BMI = $\text{kg}/\text{m}^2$). This metric is essential for identifying the sub-normal weight criterion characteristic of anorexia nervosa (traditionally operationalized as a BMI ≤ 17.5 $\text{kg}/\text{m}^2$ or maintaining weight below 85% of that expected for age and height). Items 21 and 22 capture menstrual irregularity and hormonal contraceptive use, indexing the physiological disruption of the hypothalamic-pituitary-gonadal axis (amenorrhea).

Theoretical Framework

The conceptual architecture of the EDDS is anchored in cognitive-behavioral and etiology-driven frameworks of eating pathology, most notably the Dual-Pathway Model of Bulimic Pathology (Stice, 2001) and the Transdiagnostic Cognitive-Behavioral Model of Eating Disorders (Fairburn, Cooper, & Shafran, 2003).

The Dual-Pathway Model of Bulimic Pathology

Formulated by Eric Stice, the Dual-Pathway Model posits that eating pathology—specifically bulimic behaviors and binge eating—emerges through two distinct, mutually reinforcing developmental pathways originating from sociocultural pressure and cognitive internalization:

1. The Sociocultural Inception: Pervasive sociocultural pressures promoting an ultra-thin, lean, or sculpted body aesthetic are communicated via mass media, familial interactions, and peer networks. When vulnerable individuals internalize this thin-ideal, an inevitable discrepancy arises between their current biological physique and their internalized standard, generating elevated body dissatisfaction (measured on the EDDS via Items 1–4).
2. The Dietary Restriction Pathway: Body dissatisfaction directly drives individuals to initiate severe caloric and dietary restriction to alter their physical shape. However, rigid dietary rules inevitably collapse under biological hunger signals and psychological fatigue, triggering counter-regulatory eating episodes—namely, objective binge eating characterized by a loss of control (Items 5–8).
3. The Negative Affect Pathway: Body dissatisfaction concurrently elevates negative affect, which is further exacerbated by the psychological distress of perceived failure to attain ideal aesthetic standards. Binge eating functions as a maladaptive affect-regulation strategy, providing temporary distraction or emotional numbing from acute distress. Subsequently, the intense guilt, self-disgust, and fear of weight gain triggered by the binge episode prompt compensatory purging, fasting, or driven exercise (Items 15–18), which in turn reinforces negative affect and initiates another cycle.

The EDDS directly operationalizes the primary observable nodes of this theoretical model, allowing investigators to track how shifts in cognitive overvaluation translate into dietary restriction, objective binging, and subsequent compensatory behavior.

The Transdiagnostic Cognitive-Behavioral Architecture

Fairburn and colleagues proposed that the diverse clinical presentations of eating disorders (anorexia, bulimia, and atypical variants) share a core cognitive psychopathology: the overvaluation of shape and weight and their control. In typical cognitive functioning, individuals assess their personal value across diverse domains (social competence, intellect, creativity). In eating disorders, the self-evaluative system becomes monopolized by physical metrics. The EDDS treats this core cognitive distortion as the central anchor of its continuous symptom scale, recognizing that while behavioral expressions may oscillate between severe restriction (anorexic phenotype) and binge-purge cycles (bulimic phenotype), the underlying cognitive mechanism remains functionally identical.

Validity

The validity of the EDDS has been subjected to extensive empirical evaluation across diverse samples, including clinical outpatients, university students, community adolescents, and clinical trial cohorts. Across psychometric investigations, the instrument has demonstrated exceptional construct, criterion, convergent, discriminant, and predictive validity.

Criterion and Diagnostic Concordance

In the seminal validation study conducted by Stice, Telch, and Rizvi (2000), the diagnostic accuracy of the EDDS was benchmarked directly against the Eating Disorder Examination (EDE) and the Structured Clinical Interview for DSM-IV (SCID). In a sample of 217 female participants across clinical and community settings, the diagnostic concordance between the EDDS self-report algorithms and structured clinical interview diagnoses yielded substantial to near-perfect agreement:

• Bulimia Nervosa Concordance: The kappa (κ) coefficient between the EDDS and the SCID/EDE for a diagnosis of bulimia nervosa was κ = .83, indicating excellent diagnostic agreement with minimal false-positive classifications.
• Binge Eating Disorder Concordance: Concordance for BED was similarly elevated, yielding a κ coefficient of .74.
• Anorexia Nervosa Concordance: Agreement for anorexia nervosa reached κ = .81. The continuous symptom composite score exhibited a diagnostic sensitivity of 93% and a specificity of 89% in discriminating clinical cases from non-clinical controls.

Convergent and Discriminant Validity

The EDDS symptom composite score exhibits robust convergent validity when correlated with established multi-item eating pathology scales. Strong positive correlations have been consistently documented with:

• The Bulimia Test-Revised (BULIT-R; r = .80 to .86), confirming that the EDDS effectively captures the specific behavioral features of bulimic symptomatology.
• The Eating Attitudes Test-26 (EAT-26; r = .72 to .78).
• The Body Shape Questionnaire (BSQ; r = .75 to .81), substantiating the fidelity of its cognitive shape/weight overvaluation items.

Demonstrating discriminant validity, correlations between the EDDS symptom composite score and constructs outside the core eating pathology domain (such as generalized anxiety, self-esteem, and social desirability) are moderate to low (r = .21 to .38), demonstrating that the scale does not merely capture generalized psychological distress or neuroticism.

Predictive and Ecological Validity

Prospective investigations utilizing the EDDS have substantiated its predictive validity. In longitudinal adolescent cohorts, elevated baseline scores on the EDDS symptom composite prospectively predicted:

• The future onset of major depressive disorder (Stice & Bearman, 2001; hazard ratio = 1.68).
• Future substance abuse and psychological distress over 1- to 4-year follow-up windows.
• Substantial functional impairment, academic decrement, and elevated healthcare utilization.

Furthermore, intervention research demonstrates that reductions in EDDS composite scores following cognitive-dissonance prevention programs correlate strongly with independent clinician ratings of symptom resolution, establishing excellent treatment sensitivity and ecological validity.

Reliability

The reliability of the EDDS has been demonstrated across multiple independent psychometric evaluations, examining both the internal consistency of its continuous dimensional composite and the temporal stability of its categorical and dimensional scores.

Internal Consistency

Internal consistency analyses indicate that the EDDS continuous symptom composite possesses high psychometric homogeneity despite covering diverse behavioral and cognitive domains:

• In the original psychometric validation (Stice, Telch, & Rizvi, 2000), the standardized Cronbach’s alpha coefficient for the symptom composite score was α = .89 in clinical samples and α = .86 in community samples.
• Subsequent large-scale adolescent cohort studies (e.g., Stice, Fisher, & Martinez, 2004) yielded Cronbach’s alpha coefficients ranging between α = .88 and .91.
• Cross-cultural adaptations (including Spanish, German, French, and Chinese translations) have confirmed robust reliability, consistently reporting internal consistency estimates exceeding α = .85 for the global composite.

Test-Retest Stability

Temporal stability assessments have demonstrated that the EDDS reliably measures eating pathology without excessive measurement attenuation over brief intervals:

• Dimensional Symptom Composite: Over a 1-week test-retest interval in non-clinical cohorts, the Pearson correlation coefficient was r = .95 (intraclass correlation coefficient [ICC] = .94). Over a 2-week interval, test-retest reliability remained robust at r = .87.
• Categorical Diagnostic Classifications: Test-retest reliability for categorical diagnoses across a 1- to 2-week period yielded substantial test-retest concordance (κ = .85 for bulimia nervosa, κ = .79 for binge eating disorder, and κ = .80 for anorexia nervosa), confirming that self-report algorithmic classification remains stable in the absence of targeted intervention.

Factor Analysis

Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) have been conducted to elucidate the structural dimensionality of the items comprising the EDDS symptom composite (specifically Items 1 through 18, which capture cognitive and behavioral symptomatology).

Structural Dimensionality and Factor Solutions

Early exploratory factor analyses conducted on clinical and non-clinical datasets revealed that the EDDS can be parsed into a coherent multi-factor structure representing the primary behavioral and cognitive manifestations of eating pathology:

• Factor 1: Body Shape and Weight Overvaluation (Cognitive Concern): Defined by robust loadings (> .75) from Items 1, 2, 3, and 4. This factor accounts for the largest proportion of common variance (frequently exceeding 35%).
• Factor 2: Binge Eating and Associated Emotional Distress: Defined by high loadings (> .60) from Items 5, 6, 7, 8, and the binge-related qualitative items 9 through 14.
• Factor 3: Compensatory / Purging Behaviors: Defined by loadings (> .65) from Items 15 (vomiting), 16 (laxatives/diuretics), 17 (fasting), and 18 (compulsive exercise).

Confirmatory Factor Analysis (CFA) and Model Fit

Subsequent confirmatory factor analytic studies evaluating both hierarchical (bifactor) and three-factor correlated models have documented satisfactory to excellent model fit indices across adolescent and adult cohorts:

Furthermore, psychometric studies investigating a higher-order overarching general factor have supported the aggregation of Items 1 through 18 into a single overall symptom composite score. Multi-group CFA has verified configural, metric, and scalar measurement invariance across biological sex and age brackets, confirming that the scale assesses the underlying latent constructs equivalently across distinct demographic groups.

Instrument / Measurement Tool

The EDDS is a multi-format, 22-item self-administered pencil-and-paper or digital assessment questionnaire. The instrument is designed to be completed in approximately 5 to 10 minutes and does not require clinical supervision during administration.

Structural Attributes and Response Formats

• Cognitive Symptom Scale (Items 1–4): Evaluated using a 7-point Likert-type response scale ranging from 0 = Not at all, through intermediate anchors (2 = Slightly, 4 = Moderately), to 6 = Extremely. These items assess feeling fat, fear of weight gain, and weight/shape overvaluation.
• Binge Eating Filter Items (Items 5–6): Dichotomous categorical format (YES / NO). Item 5 screens for objective large-volume eating; Item 6 screens for concomitant loss of control. Both must be endorsed to establish binge eating episodes.
• Binge Frequency Items (Items 7–8): Item 7 captures the average number of binge eating days per week over the past 6 months (numerical scale: 0 to 7). Item 8 captures the average number of discrete binge episodes per week over the past 3 months (numerical scale: 0 to 14).
• Binge-Related Phenomenology (Items 9–14): Dichotomous format (YES / NO) evaluating the behavioral and affective markers required for DSM binge eating disorder criteria (rapid eating, uncomfortably full, non-hungry consumption, eating alone, post-binge self-disgust/guilt, and distress).
• Compensatory Behavior Frequencies (Items 15–18): Quantitative frequency scales ranging from 0 to 14 times per week over the preceding 3 months for self-induced vomiting, laxative/diuretic misuse, fasting, and excessive exercise.
• Anthropometrics and Somatic Status (Items 19–22): Open numerical entries for current body weight in pounds (Item 19) and height in inches (Item 20), used to derive objective BMI. Categorical numerical response for missed menstrual periods (0, 1, 2, 3, n/a; Item 21) and dichotomous status for oral contraceptive use (YES / NO; Item 22).

Scoring Protocols and Diagnostic Algorithms

The EDDS can be scored using two distinct methodologies depending upon clinical or research requirements:

Method A: Dimensional Symptom Composite Score

To quantify continuous eating disorder severity, a composite score is computed by summing the responses across Items 1 through 18. For dichotomous items (Items 5, 6, and 9–14), NO is coded as 0 and YES is coded as 1 (or alternatively weighted according to standardized z-score metric depending on analytic approach). Items with frequency ranges (0–14) are retained in their raw frequency counts or capped to prevent extreme outliers. The resulting continuous sum serves as a sensitive index of total eating pathology burden, with higher scores reflecting greater clinical severity.

Method B: Diagnostic Algorithmic Classification

The EDDS scoring algorithm systematically applies DSM operational logic to classify respondents into mutually exclusive diagnostic categories:

• Anorexia Nervosa (AN):
  • Criterion A (Low Body Weight): BMI ≤ 17.5 $\text{kg}/\text{m}^2$ calculated from self-reported weight (Item 19) and height (Item 20).
  • Criterion B (Fear of Weight Gain): Score ≥ 4 on Item 2.
  • Criterion C (Body Image Disturbance / Overvaluation): Score ≥ 4 on Item 1, 3, or 4.
  • Criterion D (Amenorrhea; historical DSM-IV): Missed ≥ 3 consecutive menstrual cycles (Item 21 = 3), with verification that absence is not masked by oral contraceptives (Item 22 = NO). (Note: Dropped in DSM-5 adaptations).
• Bulimia Nervosa (BN):
  • Criterion A (Recurrent Binge Eating): Endorsement of both Item 5 = YES and Item 6 = YES, with an episode frequency of ≥ 2 times per week on Item 8 (DSM-IV) or ≥ 1 time per week (DSM-5).
  • Criterion B (Recurrent Compensatory Behavior): Frequency of ≥ 2 times per week (DSM-IV) or ≥ 1 time per week (DSM-5) on any compensatory item (Item 15, 16, 17, or 18).
  • Criterion C (Duration): Compensatory behaviors and binge episodes must have persisted for at least 3 months.
  • Criterion D (Overvaluation of Shape/Weight): Score ≥ 4 on Item 3 or Item 4.
  • Criterion E (Exclusion): Does not concurrently meet full criteria for Anorexia Nervosa.
• Binge Eating Disorder (BED):
  • Criterion A (Recurrent Binge Eating): Endorsement of Item 5 = YES and Item 6 = YES, with a frequency of ≥ 2 days per week on Item 7 over 6 months (DSM-IV) or ≥ 1 day per week over 3 months on Item 8 (DSM-5).
  • Criterion B (Binge Characteristics): Endorsement of at least 3 out of 5 behavioral features from Items 9 through 13 = YES.
  • Criterion C (Marked Distress): Endorsement of Item 14 = YES.
  • Criterion D (Absence of Compensatory Behaviors): Does not engage in regular compensatory purging, fasting, or excessive exercise (Items 15, 16, 17, and 18 all < 2 times per week under DSM-IV or < 1 under DSM-5).
  • Criterion E (Exclusion): Does not meet criteria for AN or BN.

Permissions & Fee and Test Year

The Eating Disorder Diagnostic Scale was formally introduced to the scientific literature in 2000 through the publication of its primary validation article in the APA journal Psychological Assessment (Stice, Telch, & Rizvi, 2000). A detailed scoring manual and adolescent validation were subsequently published in 2004 (Stice, Fisher, & Martinez, 2004).

Copyright and Licensing: The original instrument is copyrighted by its principal author, Dr. Eric Stice. However, in accordance with the author’s commitment to advancing scientific research and clinical assessment, the EDDS is placed in the public domain for non-commercial academic research, pedagogical purposes, and non-profit clinical screening. No licensing fees or royalty payments are required for academic or clinical research use. Researchers and clinicians may utilize, reproduce, and translate the scale provided that appropriate bibliographic credit is accorded to the original authors. For commercial applications, pharmaceutical clinical trials, or inclusion within proprietary digital healthcare platforms, formal written permission must be secured from Dr. Eric Stice or the Oregon Research Institute.

References

• Fairburn, C. G., & Cooper, Z. (1993). The Eating Disorder Examination (12th ed.). In C. G. Fairburn & G. T. Wilson (Eds.), Binge eating: Nature, assessment, and treatment (pp. 317–360). Guilford Press.
• Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41(5), 509–528. https://doi.org/10.1016/S0005-7967(02)00088-8
• First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997). Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). American Psychiatric Press.
• Garner, D. M., & Garfinkel, P. E. (1979). The Eating Attitudes Test: An index of the symptoms of anorexia nervosa. Psychological Medicine, 9(2), 273–279. https://doi.org/10.1017/S0033291700030762
• Garner, D. M., Olmstead, M. P., & Polivy, J. (1983). Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. International Journal of Eating Disorders, 2(2), 15–34. https://doi.org/10.1037/0021-843X.110.1.124
• Stice, E., & Bearman, S. K. (2001). Body-image and eating disturbances prospectively predict increases in depressive symptoms in adolescent girls: A growth curve analysis. Developmental Psychology, 37(5), 597–607. https://doi.org/10.1037/0012-1649.37.5.597
• Stice, E., Fisher, M., & Martinez, E. (2004). Development and validation of the Eating Disorder Diagnostic Scale for adolescents. Psychological Assessment, 16(1), 60–71. https://doi.org/10.1037/1040-3590.16.1.60
• Stice, E., Telch, C. F., & Rizvi, S. L. (2000). Development and validation of the Eating Disorder Diagnostic Scale: A brief self-report measure of anorexia, bulimia, and binge-eating disorder. Psychological Assessment, 12(2), 123–131. https://doi.org/10.1037/1040-3590.12.2.123
• Stice, E., & Whitenton, K. (2002). Risk factors for body dissatisfaction in adolescent girls: A longitudinal investigation. Developmental Psychology, 38(5), 669–678. https://doi.org/10.1037/0012-1649.38.5.669

13. Items of the Scale (Questionnaire)