ED Examination Questionnaire Adolescents Validity Questioned

Adolescent Girl with school books

To properly treat eating disorders (EDs), clinicians must use the best tools for every population. Researchers are continually working to ensure that every questionnaire, test, and treatment involved in ED identification, rehabilitation, and recovery is effective and evidence-based.

Through this research, a recent study has found that what is “possibly the most widely used self-report measure of EDs,” the Eating Disorder Examination Questionnaire (EDE-Q), may be less valid for many populations, particularly adolescents.


One of the most significant concerns that clinicians and researchers have with both the adult and youth EDE-Q are the subscales it measures.

The questionnaire “comprises four subscales of postulated underlying psychopathology: Restraint, Eating Concern, Shape Concern, and Weight Concern [Mantilla].”

Numerous factor analytic studies have shown that the results that occur using the EDE-Q’s subscales cannot be replicated. Put more simply, looking at the four factors mentioned above does not reflect “a consistent and uniform underlying structure of psychopathology [1].”

Researchers note that this inconsistency may be because the subscales were based on theoretical assumptions as opposed to experimental observations and results [1].

These studies found support for differing numbers of subscales, with one suggesting a two-factor model where Eating, Shape, and Weight Concern were all combined into one factor and Restraint continued to stand alone [2].

In addition to the debate over how many and what subscales will provide consistent and accurate measurement, researchers are concerned that the EDE-Q is not the best testing tool for adolescents.

While there is a version particularly for younger subjects, there is little research done on to prove or disprove its efficacy.


The main finding of the study was that the use of four subscales in the EDE-Q was not supported for use with adolescents. These results are consistent with those previously mentioned in regards to the adult version of the questionnaire.

The study also indicated that, with adolescent girls, actual ED behaviors are more one-dimensional.

This would explain why examining four subfactors is less consistent in this population, as “during earlier years, these concerns may tend to be global in nature. As these girls grow older, the same concerns might tend to differentiate and develop into the underlying structures” examined in the EDE-Q [1].

Results of the study also found gender differences and concluded that “young teenage girls have undifferentiated beliefs about the central importance of shape and weight for self-esteem, while in boys these concerns may be more domain-specific and less impactful [1].”


This study is the first to examine the EDE-Q in this manner, therefore, much further study needs to happen.

What this study makes clear is that how teenagers conceptualize size, weight, body-image, and self-esteem is very different from adults and this needs to be taken into consideration during every step of the treatment and recovery process.

Image of Margot Rittenhouse.About the Author: Margot Rittenhouse is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.


[1] Mantilla, E. F., Birgegard, A., Clinton, D. (2017). Factor analysis of the adolescent version of the eating disorders examination questionnaire (EDE-Q): results from swedish general population and clinical samples. Journal of Eating Disorders, 5:19.
[2] Becker, A. E. et al. (2010). Validity and reliability of a Fijian translation and adaptation of the rating disorder examination questionnaire. International Journal of Eating Disorders.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on November 6, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on November 6, 2017.
Published on EatingDisorderHope.com