Case 57: Assessment Measures in Research on Eating Disorders: Most Prominent Evaluation Methods Spanning the Scholarly Literature

Assessment Measures in Research on Eating Disorders: Most Prominent Evaluation Methods Spanning the Scholarly Literature

Chris Piotrowski

        Eating Disorders (ED) have attracted extensive clinical and research attention, manifested by the exponential growth of articles and book chapters on ED conditions indexed in the scholarly literature. Yet most mental health practitioners only occasionally treat ED patients and tend to be less informed about specific tests and measures used in the assessment process involving this unique clinical group. Thus, the aim of the current article is to provide a referral guide for the general practitioner on the most relied upon measures, scales, inventories, and tests in the study of ED populations. To that end, a triangulated, bibliometric procedure compiled a listing of more than 100 instruments reported in ED research. Based on this pool of measures, a keyword search (All Fields) on each instrument was conducted in the database PsycINFO in order to determine the number of ‘Hits’ generated by the online search. Since primary research studies were of interest, only the search results for journal articles were tabulated. This first analysis produced a ranking of the most frequently used assessment instruments (n=84) in ED-related research. As this search option depicts comprehensive (overly inclusive) parameters for test inclusion, it was decided to subject the pool of 84 instruments to an online search in the database ProQuest, with the restriction to ‘Abstract only’ inclusion. Based on both analyses, the most prominent and visible measures specific to ED, evident in the research literature were: the Eating Disorder Inventory, Eating Attitudes Test, Three- Factor Eating Questionnaire, Eating Disorder Examination (EDE-Q), Body Shape Questionnaire, Multidimensional Body-Self Relations Questionnaire, Binge Eating Scale, and the Restraint Scale. Several measures of general health status or mental health (e.g., Beck Depression Inventory, SF-36, General Health Questionnaire, Hospital Anxiety & Depression Scale, Barratt Impulsiveness Scale, Brief Symptom Inventory, MMPI) were also frequently included in research studies of ED populations. This listing provides a handy referral guide to the major assessment instruments encountered in ED research. On a cautionary note, these findings illustrate that while there are copious evaluation tools available when treating ED patients, research findings in the field are subject to a lack cohesion and generalizability due to the vast breadth of assessment instruments that serve as the basis for data collection and analysis in ED studies.

        The topic of eating disorders, over the past 30 years, has witnessed substantial (and ever increasing)clinical, empirical, and theoretical interest in the mental health field (Anderson et al., 2018; Fairburn, 2008; Hudson et al., 2007; Imperatori et al., 2017; Keel &Klump, 2003; Szmukler et al., 1998;Stice et al., 2004; Thompson, 2001), particularly advances in the efficacy of the clinical treatment and management of these challenging, refractory clinical conditions (Gilbert & Commerford, 2000; Johnson et al., 1996; Linardon et al., 2017; Mizes, 1998; Wonderlich et al., 2008).In fact, a recent search of the mental literature (PsycINFO database) indicated the following voluminous scholarship on the issue of assessment/testing regarding eating disorders:  5,684  per-reviewed  articles;  68

books; 316 dissertations.

Within this burgeoning body of research, the issue of the evaluation and assessment of eating disorders has attracted and generated extensive clinical attention (Allison & Baskin, 2009; Barnes et al., 2012; Berg et al., 2012; Clausen et al., 2011; Grilo et al., 2001; Martin et al., 2000; Mond et al., 2008; Stewart et al., 2017; Walsh et al., 2016). Thus, mental health clinicians increasingly rely on psychometrically-sound methods/approaches for both screening and comprehensive evaluation of patients experiencing a myriad of dysfunctions across the eating disorders spectrum (Sandberg & Erford, 2013; Tury et al., 2010). Yet, a cursory review of the literature points to a vast array of evaluation approaches that frame this clinical area. Moreover, these research streams and investigatory  domains,  which  are  rather

Chris Piotrowski, PhD, research consultant, University of West Florida, USA; Email: cpiotrowski@uwf.edu

Keywords: Eating Disorder, evaluation, measures, tests, Bibliometric study, research trends expနnsive, reflect a wide net of coverage involving the study of child and adolescent samples (Micali & House, 2011; Munkholm et al., 2017; Overas et al., 2008) as well as gender differences (e.g., Murray et al., 2017; Woodside et al., 2001), and quality of life issues (Jenkins et al., 2011).

        Due to the ‘medical’ orientation in viewing ED conditions, much of the clinical and research focus regarding assessment of ED resides outside the purview/scope of psychosocial assessment per se, including the study of personality factors (see Farstad et al., 2016). In fact, there is sparse research on the application of projective techniques in the study of eating disorders (e.g., Daini, 2009). Thus, mental health practitioners are largely unaware on the scope of the myriad of assessment approaches available in the clinical literature when presented with patients suffering from the vast domain of eating- related dysfunctions. Hence, the aim of the current study is to a) conduct a bibliometric search of the extant literature on the instruments that have attracted the most attention in research studies related to eating disorders, b) identify key survey-based studies that report the most prevalent, i.e. popular, assessment methods used by clinicians in practice, and c) present a listing of the most prominent instruments discussed in the research literature that should serve as a handy referral guide in the selection of assessment measures, inventories, questionnaires, and scales in the treatment of eating disorders and related conditions.

Method:

        The first task was to compile a listing of potential measures and assessment instruments used by or discussed by ED scholars and clinicians. Both lists and rankings of popular ED measures, scales, questionnaires, and inventories were noted in several published reports on assessment practices of ED professionals (Anderson & Paulosky, 2004; Towne et al., 2017) and reviews of the literature (e.g., Marek et al., 2016; Micali& House, 2011). Second, extensive coverage of tests and measures discussed in books or book chapters on the topic of ED provided additional prospective instruments for inclusion. 3rd, comprehensive online searches of the mental health literature on the subject category of ED also identified prominent instruments noted in side-bar menus regarding ‘measurement/ testing’. Hence, these procedures generated a potential pool of over 100 instruments reported in ED research.

        The next task was to conduct online searches in the database PsycINFO on each assessment measure. If the measure contained the word ‘Eating’ then the official title of the instrument was used as the input term; otherwise, using Boolean logic parameters, the name of the instrument was combined with the keyword ‘Eating’. In order to identify only primary research, this analysis focused solely on the scholarly journals literature. In PsycINFO, the best parameter for comprehensive coverage of topical searches is to use the ‘All Fields’ search option. This process produces the total number of ‘hits’ for the specific test noted or discussed in the periodical journals indexed by PsycINFO. This procedure was followed for each of the 100+ instruments noted above.

        This procedure then produced a ranking (based on search ‘Hits’) across all assessment instruments. In order to determine a more targeted focus on individual instruments, a search of the cited in the ‘Abstracts only’ option was needed. Since the database ProQuest provides such a search option, I decided to re-run the listing of the 84tests in ProQuest that had at least 10 ‘Hits’ in the PsycINFO search output. Table 1 shows the ranking of these instruments in PsycINFO, as well as the ‘Abstract’ search output for each measure in ProQuest. Perhaps the ProQuest listing reflects a more reliable estimate on whether a test was a main focus of the research study, whereas the PsycINFO  listing  depicts  an  ‘overinclusive’ coverage or mention of the assessment measure.

Findings:

        This rather comprehensive list of prominent assessment instruments under the designation Eating Disorders require a caveat –both professional and research attention to the myriad of conditions under the umbrella of ‘Eating Disorders’ casts a wide shadow – i.e., scholarship in this area spans a diversity of investigatory topics or conditions such as medical (e.g., gastrointestinal, malabsorption, nutrition), psychobiosocial (e.g., anorexia, bulimia, dieting, appetite, body image, appetite), social (cultural factors, nutritional fads, advertising/marketing) and intervention (fasting, appetite, weight management, psychological/behavioral therapy). Accordingly, general evaluation procedures and assessment methods across these areas are quite prolific and emerging research on ‘new’ instruments or measures appears unabated in the scholarly literature. Further, a major reason for the use of a broad spectrum of measures in ED research has been the study of co-morbidity factors, quite prevalent in this clinical population (Anderson et al., 2018).

        Despite this vast expanse of research, the current analysis illustrates that some measures receive extensive coverage, investigatory attention, and discussion in the extant literature, whereas other measures attract but scant research interest. Based on the rankings in both the PsycINFO and ProQuest database presented in Table 1, it seems that several instruments, specific to ED assessment, have received the most exposure and recognition in the extant literature, i.e., the Eating Disorder Inventory, the Eating Attitudes Test, the Three-Factor Eating Questionnaire, the Eating Disorder Examination (EDE-Q), the Body-Shape Questionnaire, Multidimensional Body-Self Relations Questionnaire, the Binge Eating Scale, and the Restraint Scale. Interestingly,

the Child Feeding Questionnaire was quite popular in studies indexed in ProQuest.

Likewise, many broadband ‘health status’ measures (e.g., SF-36, General Health Questionnaire) and mental health tests (i.e., MMPI, Brief Symptom Inventory) are frequently applied in comprehensive evaluations of ED populations. Such adjutant applications have been reported in the assessment practices of health psychologists (Piotrowski & Lubin, 1990). At the same time, symptom- specific measures of psychopathology, such as the Beck Inventories, are used in the assessment of mental health factors in medical or health- related conditions (Piotrowski, 2017). Thus, traditional psychological tests (see Frauenhoffer et al., 1998; Piotrowski & Keller, 1992), particularly self-report inventories, are a common tool used in the assessment process reported in the methods section of ED research studies.

Undoubtedly, instruments recently introduced in the periodicals literature have had limited time to make a mark on the field, and thus, comparison with well-established tests and assessment procedures/formats are difficult to ascertain. However, the current listing, illustrated here, provides a tentative view on the ranking of the most popular assessment instruments garnering visibility in the scholarly (periodicals) literature. Hence, this review a) provides a guiding framework to inform both researchers and clinicians on selection and potential use of assessment approaches regarding the vast expanse of eating disorders, and b) serves as a basis for inspiring continued bibliometric study (see Borner, 2015, pp. 56-59) in order to shed light on ‘mapping’ the extant scholarly literature on the scope and breadth of assessment methods in the clinical area of eating disorders.

Conclusion:

In addition to the listing in Table 1, several observations during this review and analysis seem noteworthy:

1. Assessment instruments (measures, scales, tests) on the topic of ED reflect a vast scope and cross-disciplinary umbrella, including psychiatry, psychology, behavior analysis, social work, nursing, nutritional sciences, physiology & exercise, complimentary medicine, professional counseling, gastroenterology, public health, and allied health fields; thus, there has been and continues to be a profusion of ED instruments in the field. This creates a double-edged sword, where emerging ED research proliferates at a rapid and exponential pace while, at the same time, advances in knowledge are stymied due to lack of investigatory cohesion and focus of emerging scholarship. Hence, research findings tend to lack generalization and are based on a potpourri of investigatory methods and frameworks. There seems to be few scientific guidelines to standardize research efforts across ED investigations and thus, integrated, coordinated findings, based on a multidisciplinary  perspective,  are  rather infrequently presented or discussed in scholarly reports.

1. Due to the lack of systematically integrated assessment protocols across ED studies, both theoretical and clinical applications of research findings have been stymied with regard to advances in identifying and explicating optimal therapeutic interventions in the treatment of eating disorders.
2. The perennial debate regarding the efficacy of semi-structured interview formats versus self- report measures or scales (e.g., Black & Wilson, 1996) in ED research continues unabated.
3. There appears to be escalating research attention devoted to the issue of body image over the past decade (e.g., Gilbert & Commerford, 2000; Jiang & Vartanian, 2017).
4. Research scholars continue to expand the breadth of available ED instruments by adapting established clinical measures to ED populations. A recent example involves the applicability of the Multidimensional Assessment of Interoceptive Awareness (MAIA) for clinical use (Brown et al., 2017).
   

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