Mean length of illness for cases was 8 years (SD 4.81 range 1-25). As expected, more cases than controls were in the highest socioeconomic groups ((P<0.001, χ 2=47.4, df=3), and cases were more likely to be single, separated, or divorced (P<0.001, χ 2=13.0, df=1). No significant differences existed between cases and controls for age or ethnicity. Cases and controls were asked the SCOFF questions orally they also completed the eating disorder inventory 3 and the BITE self rating scale for bulimia. We recruited 96 women aged 18-39 as controls these women, recruited through advertising by local colleges, were confirmed as not having an eating disorder.
We recruited cases sequentially from referrals to a specialist clinic: 116 women aged 18-40 years who were confirmed as having either anorexia nervosa (n=68) or bulimia (n=48), according to the criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. *One point for every “yes” a score of ≥2 indicates a likely case of anorexia nervosa or bulimia Would you say that Food dominates your life? Have you recently lost more than One stone in a 3 month period?ĭo you believe yourself to be Fat when others say you are too thin? We developed and tested a similar tool for eating disorders- with questions designed to raise suspicion that an eating disorder might exist-before rigorous clinical assessment.ĭo you make yourself Sick because you feel uncomfortably full?ĭo you worry you have lost Control over how much you eat? In alcohol misuse the CAGE questionnaire 4 has proved popular with clinicians because of its simplicity. No simple, memorable screening instruments are available for non-specialists. Ability to diagnose the condition varies and can be inadequate, 1 and existing questionnaires for detection 2 3 are lengthy and may require specialist interpretation. Early detection and treatment improves prognosis, but presentation is often cryptic-for example, via physical symptoms in primary care.
The resulting scale, the Diabetes Eating Problem Survey–Revised (DEPS-R), has 16 items, is rated on the same 6-point Likert scale as the original measure, and is scored by summing all 16 items ( Table 1). Four of these questions were eliminated, due primarily to the lack of face validity and low item-to-total correlation. For example, the original DEPS included seven questions about insulin use and feelings about insulin. When duplicate questions were found, we included the item with higher item-to-total correlation. We then examined the remaining questions for redundancy ( Table 1). In revising the DEPS for use with a pediatric population in the current era of diabetes management, we first eliminated any items with low face validity (items that did not appear to measure disordered eating). The original 28-item DEPS previously demonstrated excellent internal consistency (Cronbach's α = 0.95) and was significantly correlated with diabetes-specific distress ( r = 0.83, P < 0.001) in an adult population ( 15). A short, self-report measure designed explicitly for this purpose would likely be useful for clinicians and researchers, as it would be a way to screen quickly and efficiently to identify need for further evaluation or intervention.
Therefore, it is important to use a screening measure designed specifically for people with diabetes when assessing disordered eating in this population.
Second, general measures of disordered eating do not identify disordered eating behaviors that are unique to individuals with type 1 diabetes, such as insulin restriction or omission. General measures of disordered eating may misidentify what is an appropriate level of attention to food intake for a person with type 1 diabetes as a disordered eating behavior. First, diabetes management necessitates an emphasis on food intake and carbohydrate counting. General measures of disordered eating may not be appropriate for use in individuals with type 1 diabetes for several reasons. Although there are many measures of disordered eating, there is currently no validated screening tool for disordered eating in people with diabetes for use in a clinical population ( 14).