Lev-Ari et al.

Journal of Eating Disorders (2021) 9:57

https://doi.org/10.1186/s40337-021-00403-x

RESEARCH ARTICLE Open Access

Eating Disorder Examination Questionnaire

(EDE-Q-13): expanding on the short form
Lilac Lev-Ari1,2* , Rachel Bachner-Melman1,3 and Ada H. Zohar1,2

Abstract
Objective: The Eating Disorders Examination–Questionnaire (EDE-Q) is widely used but time-consuming to complete.
In recent years, the advantages and disadvantages of several brief versions have therefore been investigated. A seven-
item scale (EDE-Q-7) has excellent psychometric properties but excludes items on bingeing and purging. This study
aimed to evaluate a thirteen-item scale (EDE-Q-13) including items on bingeing and purging.
Method: Participants were 1160 (188 [11.4%] males) community volunteers of mean age 28.79 ± 9.92. They
completed the full EDE-Q in Hebrew, as well as measures of positive body experience, social and emotional
connection, life satisfaction, positive and negative affect and positive eating. The six EDE-Q items about
bingeing and purging, recoded to correspond to the response categories of the other EDE-Q questions, were
added to the EDE-Q-7, resulting in the EDE-Q-13.
Results: Confirmatory factor analysis confirmed the hypothesized EDE-Q-13 structure, including the bingeing
and purging subscales. Strong positive correlations were found between the EDE-Q-13 and the original EDE-Q
scores. The EDE-Q-13 showed convergent validity with related measures.
Conclusions: The EDE-Q-13 in Hebrew is a brief version of the EDE-Q that includes bingeing and purging
subscales and has satisfactory psychometric properties. Its use in clinical and research contexts is encouraged.
Keywords: EDE-Q, Eating disorders, Assessment, EDE-Q-7, EDE-Q-13

Plain English summary The expected structure of the EDE-Q-13 was confirmed.
The Eating Disorders Examination–Questionnaire (EDE- EDE-Q-13 and the original EDE-Q scores were highly cor-
Q) is a widely used questionnaire that assesses eating related, and the EDE-Q-13 was associated with question-
disorder symptoms, however its 28 items take time to naires that are associated with the EDE-Q. The EDE-Q-13
complete. In this study we examined a 13-item version of is a brief version of the EDE-Q that includes bingeing and
the EDE-Q, consisting of a seven-item version shown to purging subscales. It can be used to estimate the presence
have good properties and six EDE-Q items assessing binge of eating disorder symptoms in community samples.
eating and purging. The full EDE-Q and measures of
positive body experience, social and emotional connection,
life satisfaction, positive and negative affect and positive Introduction
eating were completed online by 1160 community The EDE-Q has been in use for over quarter of a century
volunteers (11.4% males) between 18 and 76 years of age. [1] and has been translated into many languages, including
Hebrew [2]. This widely used self-report questionnaire
* Correspondence: [email protected] discriminates between disordered eating and eating dis-
1
Clinical Psychology Graduate Program, Ruppin Academic Center, Emek orders in screening community samples [3], in primary
Hefer, Israel
2
Lior Zfaty Suicide and Mental Pain Research Center, Emek Hefer, Israel
care [4] and supports the clinical diagnosis of eating
Full list of author information is available at the end of the article disorders [5].
© The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,
which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give
appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if
changes were made. The images or other third party material in this article are included in the article's Creative Commons
licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons
licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain
permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the
data made available in this article, unless otherwise stated in a credit line to the data.
Lev-Ari et al. Journal of Eating Disorders (2021) 9:57 Page 2 of 9

The four subscales of the EDE-Q were originally Machado et al. [13] recruited individuals receiving
determined in a clinical interview [6] (as Restraint, and treatment at two eating disorder clinics and a large
Eating-, Weight- and Shape- Concern. Subsequently, control group of community volunteers to compare
some confirmatory factor analyses have found that several short versions of the EDE-Q to the original
weight and shape concern were better considered as a Fairburn and Beglin [1] 28-item questionnaire. While
single factor [2, 7, 8], so that a three-factor structure was specificity and sensitivity of the Carey et al. [7] 18-
recommended. Other studies have suggested alternate item and the Kliem et al. [14] eight-item versions were
four-factor structures [9]. adequate, only the Grilo et al. [8] seven-item version
Because of the usefulness of the EDE-Q clinically, retained the three-factor structure found in the ori-
epidemiologically, and in basic research, there have been ginal 28-item EDE-Q. Based on these results, Machado
several attempts to derive a short form of the question- et al. [13] recommended the use of the seven-item ver-
naire. Grilo et al. [8] administered the EDE-Q to a sion of the EDE-Q together with the final six bingeing
sample of undergraduate students in the United States, and purging items of the original 28-item scale. How-
and found, using confirmatory factor analysis, a 3-factor ever, the six bingeing and purging items (e.g. “in the
solution: Dietary Restraint, Shape/Weight overvaluation, past 28 days how many times have you eaten what
and Body Dissatisfaction. In their analyses, they found other people would regard as an unusually large
that a short seven-item form not only reproduced this amount of food [given the circumstances]?”) require
hypothesized three-factor solution, but that it showed open numerical responses questions allowing answers
higher convergent validity than did the longer versions between 0 and infinity, whereas the response categor-
of the EDE-Q they considered. However, the seven items ies for the other items are grouped, for example “no
selected did not include any that measured bingeing or days”, “1–5 days”, 6–12 days”. People with EDs tend to
purging. inflate the number of their bingeing and purging
A 12-item version of the EDE-Q was suggested by episodes, resulting in inadequate reliability for these
Gideon et al. [10], who derived the items in a careful subscales that are therefore generally excluded from
two-stage process using participants with and without analyses [15]. An advantage of including the bingeing
clinical eating disorders. They changed the response and purging items (with adapted response scale) is
scale of the items to a four-point scale to improve the that they focus on behaviors, and therefore comple-
response distribution and excluded less informative ment the items that relate to weight and shape
items. The 12 items selected included two pertaining to (over)concern.
bingeing; the other items related to restriction and body The main thrust of this study was to produce a short,
and weight concerns. This 12-item scale was shown to user-friendly version of the EDEQ that would not only
have excellent internal reliability, test-retest reliability, retain the excellent psychometric qualities of some of the
and to distinguish between participants with and without other short versions (e.g. the 12-item version), but also
eating disorders. The time frame for reference was the the three-factor structure of the original 28-item EDEQ,
previous week. Gideon et al. [10] found the 12-items enabling specific concepts to be measured. We examine
were best described as a single factor and suggested the use of a 13-item version of the EDE-Q that included
using their 12-item EDE-Q as a user-friendly, weekly Grilo et al.’s [8] seven-item version and the six items
assessment of treatment efficacy in eating disorder about bingeing and purging recoded so that their
facilities. The good psychometric properties of the 12- response categories correspond to those of the other
item version were replicated in a Mandarin transla- items. The 13 items were hypothesized to conform
tion administered to Chinese university students [11]. to a five-factor solution: The original three factors of
Further analysis of the Gideon et al. [10] data by the Grilo et al. [8] seven-item version i.e. Dietary
another research group [12] calculated a cut-off score Restraint, Shape and Weight Over-evaluation, Body
for optimal sensitivity and specificity for the 12-item Dissatisfaction, as well as a Bingeing and a Purging
version, increasing its usefulness as a screening tool. factor, missing from the other short versions of the
Careful systematic work on large samples of British EDE-Q. We chose to use a community sample,
adult females and males in the community resulted in because this enabled participants (both women and
an 18-item version of the EDE-Q for females, and a men) of different ages to participate, and because a
16-item version for males. The 18-item version was short, parsimonious questionnaire seems particularly
subsequently validated for females, with a three-factor suitable for use in the community. We examined
solution: Shape and Weight Concern, Preoccupation convergent validity by observing the pattern of corre-
and Eating Concern, and Restriction [7]. The 16-item lations between EDE-Q-13 scores with measures of
version for males produced a similar item structure, concepts that are related to ED symptomatology.
which required further confirmation. These concepts include positive body experiences or
Lev-Ari et al. Journal of Eating Disorders (2021) 9:57 Page 3 of 9

body image, and enjoyment from (positive) eating, contains 28 items assessing core eating disorder
which can be expected to be negatively associated symptoms related cognitions, and includes four
with ED symptoms. We also chose to include subscales, each containing five to eight items. The
emotional, affective and social variables that have instructions for answering the questionnaire are “In
been shown to be associated with recovery from ED, the past 28 days,”: 1) Dietary Restraint (DR) e.g.
namely positive and negative affect, life satisfaction “How often have you been deliberately trying to limit
and social and emotional connection [16]. the amount of food you eat to influence your shape
We hypothesized that: or weight [whether or not you have succeeded]?”; 2)
Eating Concern (EC) e.g. “How concerned have you
1. The EDE-Q-13 would demonstrate good been about other people seeing you eat?”; 3) Weight
construct structure for a five-factor model: Eating Concern (WC) e.g. “How often have you had a defin-
restraint, Shape and Weight Over-evaluation, ite fear that you might gain weight?”; and 4) Shape
Body Dissatisfaction, Bingeing and Purging (using Concern (SC) e.g. “How often have you had a definite
confirmatory factor analysis [CFA]). desire to have a totally flat stomach?”. A global score
2. Total and subscale scores of the EDE-Q-13 would averaging the subscales is also used. The responses to
correlate strongly with the original EDE-Q total and 22 items are rated using a seven-point forced-choice
subscale scores. format from 0 to 6. For some questions the answers
3. EDE-Q-13 total scores (and the original EDE-Q are 0 ‘0 days’, 1 ‘1–5 days’, 2 ‘6–12 days’, 3 ‘13–15
scores) would correlate negatively with measures days’, 4 ‘16–22 days’, 5 ‘23–27 days’ and 6’every day’.
of positive body experiences, positive affect, For some of the questions, the answers range from 0
positive eating, life satisfaction and social and ‘never’ to 6 ‘always’; and for some questions from 0
emotional connection and positively with negative ‘not at all’ to 6 ‘very much’. Higher scores reflect
affect. greater symptom severity. The remaining six items
4. EDE-Q-13 total scores would yield a pattern of about the frequency of binge eating and compensa-
correlations similar to that yielded by the 28-item tory behaviors require open, numerical responses, are
EDE-Q total scores. used for diagnostic purposes and are generally ex-
cluded from factor analyses. A cut-off of four (for
Method subscales and the global score) indicates risk for a
Participants clinical eating disorder, for both men and women
A total of 1160 (188; 11.4% males) Israeli community [17]. Zohar et al. [2] assessed 292 community volun-
volunteers between 18 and 76 years of age (M = 28.79, teers and found sound psychometric properties for
SD = 9.92) registered online to participate in the the Hebrew translation but recommended combining
study. Half of the participants were recruited via the WC and SC into one subscale. In the current study,
social media and the other half via an introductory the internal reliability for the total score and all sub-
psychology course (in a college in the middle of scales was acceptable (Cronbach’s alpha > .78).
Israel), for which they received class credit. Two
thirds (65.9%) of the participants were single, 368 EDE-Q-13 Our proposed version of the EDE-Q contains
(31.7%) were married and 54 (4.7%) were divorced or seven items from the original questionnaire as suggested
reported “other” status. 89.8% were Jewish, 8.7% were by Machado et al. [13] that were pulled from the
Muslim, .7% were Christian and the rest (.8%) were complete EDE-Q. These items are the original items 1, 3
‘other’ or did not wish to reply. They had 0–11 chil- and 4 that assess DR, items 22 and 23 that assess WC
dren (M = 1.16, SD = 1.65) and a mean of 13.98 years and SC (Shape and Weight Over-evaluation [SWO], as
of schooling (SD = 2.23). Their body mass index in Machado et al. [13], and items 25 and 26 that meas-
(BMI) ranged between 16.31 and 53.15 (M = 23.46, ure BD. For psychometric as well as content purposes,
SD = 5.11). we unified response formats for all items. The question-
naire opens with a phrase relevant to all questions, ‘On
Measures how many of the past 28 days ......’, and the 12 questions
Eating disorder symptoms that follow ask about specific thoughts or behaviors.
Response options are six frequency categories: 1–5
Ede-q Eating disorder symptoms were assessed using (score of 1); 6–12 (score of 2); 13–15 (score of 3); 16–22
the original version of the Eating Disorders Examination (score of 4); 23–27 (score of 5); and every day (score of
– Questionnaire [1]. The EDE-Q was translated into 6). The six open-ended Bingeing (e.g. “You felt a loss of
Hebrew with permission [2], using a process of trans- control over your food as you were eating”) and Purging
lation, independent back translation and revision. It (e.g. “You made yourself vomit in order to control your
Lev-Ari et al. Journal of Eating Disorders (2021) 9:57 Page 4 of 9

weight”) items that appear at the end of the 28-item Life satisfaction
EDE-Q were recoded and reformatted with the same fre- Life Satisfaction was assessed using the Satisfaction with
quency response categories and included in the scoring Life Scale (SWLS) [22]. The SWLS contains five items
of the EDE-Q-13, following the general recommendation that cognitively appraise the respondents’ life in general.
of Machado et al. [13]. It should be noted, however, that The SWLS is a common measure of well-being and has
although the adaptation of these items into a Likert-type good psychometric properties [22]. Items are scored
response format was not suggested by Machado et al. between 1 (“strongly disagree”) and 7 (“strongly agree”),
[13], we initiated this step so that scoring would be with high scores indicating greater life satisfaction. A
uniform. The EDE-Q-13 appears in Appendix. Hebrew version previously used in research was admin-
istered in this study [23]. The alpha Cronbach in this
study was 0.89.
Positive body experiences
Positive body experiences were measured by the
Positive and negative affect
Dresden Body Image Questionnaire-35 (DKB-35) [18,
Positive and negative affect were assessed via the Positive
19];. The DKB-35 is a 35-item scale presenting a positive
and Negative Affect Schedule – Short Form (PANAS-
and comprehensive conceptualization of body image,
SF) [24]. The PANAS-SF is a ten-item questionnaire
originally validated in German. In a community sample
with five items about positive affect (PANAS-SF-Pos)
of 349 men and women, the German questionnaire was
and five about negative affect (PANAS-SF-Neg). Respon-
shown to be reliable and valid with internal consistency
dents were asked to report the strength with which they
of the subscales ranging between 0.76 and 0.91. The
usually feel emotions such as excitement or anger on a
scale showed good construct validity and stability over 7
five-point Likert scale between 1 (“hardly at all”) to 5
days [18]. It was translated into Hebrew and English
(“very strongly”). The PANAS-SF has been shown to
following the star paradigm with permission from the
have good validity and reliability in various cultures [24].
authors [2, 20]. The Hebrew version used in this study
A Hebrew translation previously used in research [25]
has shown good reliability and validity [2]. Its five
was administered in this study. The alpha Cronbach in
subscales, rated between 1 (“not at all true for me”) and
this study was 0.79 for positive affect and 0.83 for
5 (“very true for me”), are: 1) Vitality e.g. “I am physic-
negative affect.
ally fit”; 2) Body Narcissism (BN) e.g. “I find it pleasant
and stimulating when somebody looks at me attentively”;
Positive eating
3) Sexual Fulfillment (SF) e.g. “I feel my body pleasantly
Positive eating was reported by completing the Posi-
and intensely in sexuality”; 4) Body Acceptance (BA) e.g.
tive Eating Scale (PES) [26], an eight-item question-
“I am satisfied with how I look”; and 5) Physical Contact
naire that asks about enjoyment of eating. It has two
(PC) e.g. “Physical contact is important for me to
subscales that assess Satisfaction with Eating (e.g. “I
express closeness.” The subscales displayed excellent re-
am relaxed about eating”) and Pleasure when Eating
liability, with Cronbach’s alphas ranging between 0.80
(e.g. “Eating is fun for me”). The PES was validated
and 0.90.
and has been shown to have good psychometric
properties and the same structure in a large longitu-
Social and emotional connection dinal community sample (n = 772) from Germany,
Social and emotional connection was assessed using the India and the US, with alpha Cronbach 0.87 [26].
seven-item Social and Emotional Connection (SEC) Six-month test-retest reliability was 0.67 [26]. Items
subscale of the Eating Disorders Recovery Question- are scored on a five-point Likert scale between 1 (“I
naire (EDRQ) [21]. The EDRQ is a 28-item, psychomet- strongly disagree”) and 4 (“I strongly agree”). A
rically sound questionnaire assessing recovery from an Hebrew translation (used in [26]) was used in this
eating disorder. Its other subscales are Physical Health, study, and the alpha Cronbach was 0.93.
Lack of Symptoms and Body Acceptance. Sample items
for this SEC subscale are “I am in touch with my own Procedure
feelings” and “I am able to express my emotions in The study received approval from the Institutional
words”. The original scale was written in Hebrew, and Internal Review Board. Participants were sent a link to
alpha’s Cronbach was 0.92 [21]. Responses are noted on the questionnaires, which they completed online. A full
a seven-point Likert scale between 0 (I do not agree at explanation about the study was provided on the first
all) and 6 (I completely agree), with higher scores screen, and informed consent was provided. Partici-
reflecting fewer problems with emotional and social pants reported on demographic information, height
connection. The alpha Cronbach of the SEC subscale of and weight, before completing the questionnaires. All
the EDRQ was 0.92. participants completed the EDE-Q (original version)
Lev-Ari et al. Journal of Eating Disorders (2021) 9:57 Page 5 of 9

and the DKB-35 and a subset of 960 participants also constructs as they are conceptualized theoretically or em-
completed the PANAS-SF, PES, SWLS, and SEC. The pirically. The following values were chosen for acceptance
EDE-Q was then completed twice, once using the ori- of the hypothesized structure: Comparative Fit Index
ginal format and once using the EDE-Q-13 format. (CFI) > .90 [27], root mean square error of approximation
The Bingeing and Purging questions that required (RMSEA) < .08 [28] and SRMR<.08 (see Fig. 1). The model
open numerical responses in the original format were showed good fit (χ2(55) = 282.63; p < .001; CFI = .98, RMSE
recoded and rescored in accordance with the other A = .05; SRMR = .04). Cronbach’s alphas for the EDE-Q-
items for the EDE-Q-13. On the last screen, contact 13 subscales were .99 for SWO, .89 for BD, .92 for ER, .89
details of the researchers were provided and partici- for Bingeing and .63 for Purging.
pants were encouraged to send them questions, com-
ments or difficulties. Hypothesis 2: Total and subscale scores of the EDE-Q-
13 would correlate strongly with the original EDE-Q
Data analysis total and subscale scores (n = 1160)
AMOS 23.0 was used for the CFA. To test for convergent
validity, Pearson correlations were calculated between Pearson correlations between the EDE-Q-13 subscales
EDE-Q-13 total scores and positive body experiences and the original EDE-Q subscales are presented in Table 1.
(DKB-35), positive eating (PES), positive and negative All correlations were significant at p < .001 and ranged be-
affect (PANAS-SF), satisfaction with life (SWLS) and so- tween .29 and .95. The correlation between EDE-Q-13
cial and emotional connection (SEC). Analyses were con- total scores and the original EDE-Q total score was .92.
ducted using the Statistical Package for the Social Sciences Pearson inter-correlations between the EDE-Q-13
(SPSS, version 23). subscales are presented in Table 2. All correlations were
significant at p < .001 and ranged between .15 and .83.
Results The mean for Purging was lowest (1.43) and all other
means ranged between 3.41–3.93.
Hypothesis 1: The EDE-Q-13 would demonstrate good
construct structure (using CFA). Hypotheses 3 and 4: EDE-Q-13 total scores (and the
original EDE-Q scores) would correlate negatively with
CFA of EDE-Q-13 (N = 1160) measures of positive body experiences (DKB-35), positive
CFA was used to test the hypothesized structure of the affect (PANAS-SF-Pos), positive eating (PES), life
EDE-Q-13. This analysis examines the consistency of satisfaction (SWLS) and social and emotional connection

Fig. 1 CFA of the five-factor EDE-Q-13 model. Note: Ellipses indicate latent variables. Rectangles indicate observed variables. Arrows
between latent variables indicate significant correlations between latent variables. Correlations between latent and observed variables
were significant at p < .001
Lev-Ari et al. Journal of Eating Disorders (2021) 9:57 Page 6 of 9

Table 1 Correlations between the EDE-Q-13 and the original EDE-Q total and subscales
Original EDE-Q Eating Restraint Eating Concerns Shape and Weight Concerns EDE-Q total
EDE-Q-13
Eating Restraint .95 .58 .66 .82
Shape and Weight Overevaluation .61 .65 .86 .78
Body Dissatisfaction .59 .60 .89 .77
Bingeing .30 .50 .35 .41
Purging .30 .28 .22 .29
EDE-Q-13 total .86 .75 .88 .92
Note: All correlations were significant at the p < .001 (2-tailed). Pearson correlations between .0–.30 (positive or negative) are considered to be of low strength,
between .30–.60 of medium strength and above .60 as strong

(SEC) and positively with negative affect (PANAS-SF- remaining seven items of the EDE-Q-13 (mean = 3.27,
Neg). EDE-Q-13 total scores would yield a pattern of SD = 1.77) than those who reported bingeing (mean =
correlations similar to that yielded by the 28-item EDE-Q 3.96, SD = 1.80; t = − 7.49, p < .001), and that participants
total scores. who reported no purging had lower total scores on the
seven remaining items of the EDE-Q-13 (mean = 3.56,
Pearson correlations between the EDE-Q-13 and the SD = 1.79) than those who reported purging (mean =
original EDE-Q total scores and the DKB-35, PANAS- 3.84, SD = 1.84; t = − 3.14, p = .002).
SF, PES, SWLS and SEC are presented in Table 3. All
correlations were significant at p < .001 and ranged Discussion
between −.09 and .69. The correlations of the EDE- The purpose of this study was to compare the Hebrew
Q-13 total score and the original EDE-Q total score version of the 13-item EDE-Q-13 with that the Hebrew
with other variables assessing body acceptance and translation of the complete 28-item EDE-Q. The re-
psychological well-being were similar. These findings sponses to the bingeing and purging items of the original
further our understanding of the validity of the EDE- questionnaire were restructured and included in the
Q-13, which showed high convergent validity with scoring of the short version. The structure of the scales
body acceptance, negative affect and positive eating was compared using CFA and the pattern of correlations
and divergent validity with vitality, body narcissism, between the total and subscale scores of both ques-
physical contact, positive eating and psychological tionnaires was observed, as well as the pattern of
wellbeing. correlations between EDE-Q-13 and EDE-Q total
To verify that bingeing and purging behaviors are valid scores respectively with several scales measuring re-
indications of the severity of eating pathology, we com- lated variables.
pared EDE-Q-13 scores, excluding the Bingeing and Our results supported a five-factor model for the EDE-
Purging items respectively, for participants who reported Q-13, with subscale scores for Eating Restraint, Body
some versus no bingeing and participants who reported Dissatisfaction, Shape and Weight Over-evaluation,
some versus no purging. Over half (53%) of the partici- Bingeing and Purging. This factor structure found for
pants reported no purging and 37% reported no binge- the EDE-Q-13 replicated the factor structure of the
ing. Two one-sided t-tests showed that participants who EDE-Q7 presented in Machado et al. [13] and added
reported no bingeing had lower total scores on the Bingeing and Purging subscales. It also replicated two of

Table 2 Intercorrelations between the EDE-Q-13 subscales (n = 1160)

Eating Shape and Weight Body Dissatisfaction Bingeing Purging EDE-Q-13 total
Restraint Overevaluation
Eating Restraint .57 .54 .24 .26 .83
Shape and Weight .72 .28 .16 .81
Overevaluation
Body Dissatisfaction .30 .15 .80
Bingeing .42 .53
Purging .42
Mean (SD) 3.50 (2.19) 3.72 (2.11) 3.93 (2.00) 3.41 (6.47) 1.43 (3.15) 3.11 (2.35)
Note: All correlations were significant at the p < .001 (2-tailed). Pearson correlations between .0–.30 (positive or negative) are considered to be of low strength,
between .30–.60 of medium strength and above .60 as strong
Lev-Ari et al. Journal of Eating Disorders (2021) 9:57 Page 7 of 9

Table 3 Correlations between a. total EDE-Q-13 and 28-item EDE-Q scores and b. DKB-35, PANAS-SF, PES, SWLS and SEC scores (n = 960)
DKB-35 PANAS-SF
Vitality BA BN SF PC Pos Neg PES SWLS SEC
EDE-Q-13 total −.31 −.51 −.09 −.28 −.15 −.13 .45 −.53 −.29 −.35
Original EDE-Q total −.37 −.69 −.14 −.37 −.20 −.13 .50 −.63 −.34 −.37
Note: All correlations were significant at p < .001 (2-tailed). DKB-35 Dresden Body Image Questionnaire-35, PANAS-SF Positive And Negative Affect Scale – Short
Form, Vitality DKB-35 Vitality subscale, BA DKB-35 Body Acceptance subscale, BN DKB-35 Body Narcissism subscale, SF DKB-35 Sexual Fulfillment subscale, PC DKB-
35 Physical Contact subscale, Pos PANAS-SF Positive subscale, Neg PANAS-SF Negative subscale, PES Positive Eating Scale, SWLS Satisfaction with Life, SEC Social
and Emotional Connection subscale of the Eating Disorder Recovery Questionnaire
Pearson correlations between .0–.30 (positive or negative) are considered to be of low strength, between .30–.60 of medium strength and above .60 as strong

the four original factors in the 28-item EDE-Q: Restraint predominantly Jewish Israelis; an Arabic version would
subscale with the Weight and Shape Concern items be helpful for assessing Israeli Arabs. Second, this study
combined into a single factor (Shape and Weight Over- was conducted with a community sample of predomin-
evaluation) as in many previous studies [2, 29]. A major antly female, single, educated community sample and
disadvantage of the full EDE-Q to date is that the open- may therefore not be generalizable to other populations.
ended structure of the response categories of the Binge- This may also be a reason for the somewhat low reliabil-
ing and Purging items has prevented them from being ity of the Purging subscale. Third, although the use of
included in scoring and data analyses. The recoding of the Likert format for the binge/purge items allows re-
these items and the inclusion of Bingeing and Purging searchers and clinicians to incorporate behavioral fre-
subscales in the EDE-Q-13 score is therefore a major quency information within a continuous subscale or
advantage of this short version of the questionnaire. global scale score, it also obscures the actual frequency
Participants who scored above 1 on the Bingeing or of binge eating/purging, such that it no longer becomes
Purging subscales scored higher on the EDE-Q-13 total possible to determine whether participants reported
scores excluding these two subscales, supporting the “clinical” levels of these behaviors (i.e., 4x/month). It is
importance of these additional items. also unclear whether adding scores for bingeing and
Another major advantage of the EDE-Q-13 is that it is purging behaviors may result in some respondents with
short, user-friendly and parsimonious. Its total and these behaviors receiving higher scores on the total scale
subscale scores correlated strongly with those of the 28- that may or may not be warranted. Further studies
item EDE-Q, so that significant information does not should investigate the validity of the EDE-Q-13 in clin-
seem to be missed when it is used in lieu of the longer ical settings, its ability to accurately distinguish between
version, and it preserves the central features of the EDE- cases and controls and its sensitivity to change.
Q. The correlations of the Purging subscale, and to a The EDE-Q is widely used, but reporting on the full
lesser extent the Bingeing subscale, with the other version is time-consuming, and presents significant
subscales and with the original EDE-Q total tended to participant burden, which may deter some respondents
be low. This could be explained by the low levels of pur- from completing the entire questionnaire. Researchers
ging (and bingeing) observed in our community sample wishing to use a short version of the questionnaire have
and the resulting restricted range of scores. Correlations tried to decide which version is most useful [13] Al-
and intercorrelations should therefore be examined in though the shortest version suggested had only seven
clinical samples. The EDE-Q-13 also showed convergent items and excellent psychometric properties, it omitted
validity. Participants who reported higher levels of eating to ask about bingeing and purging. Thus, the EDE-Q-13
disorder symptoms tended to have significantly lower builds on the seven-item version but adds bingeing and
levels of positive body experiences, positive affect, purging items, important in assessing ED symptomatol-
positive eating, life satisfaction and social and emotional ogy. The EDE-Q-13 makes self-report less burdensome
connection to others, and significantly higher levels of in two distinct ways: it is more than 50% shorter than
negative affect. Although the strength of the correlations the original version, and it has a unified response scale.
between EDE-Q-13 scores and body satisfaction, affect, Future research should try and validate this version of
positive eating, psychological well-being and personal the EDE-Q in other languages and in clinical settings.
contact could be interpreted as small to medium, they
were in line with those between the long version of the Conclusions
EDE-Q and the other measures. We found that the EDE-Q-13 was reliable and showed
Our study has limitations. First, the version of the convergent validity. It is possible to use this short and
EDE-Q-13 used in this study was in Hebrew, so its user-friendly self-report to estimate the presence of
psychometric properties should be verified in other lan- eating disorder symptoms in community samples for
guages. Since it was administered in Hebrew, it included research and clinical purposes.
Lev-Ari et al. Journal of Eating Disorders (2021) 9:57 Page 8 of 9

Appendix EDE-Q-13 (Continued)

EDE-Q-13 what other
Instructions: The following questions adress the past 4 people would
regard as an
weeks (28 days) only. Please read each question carefully. unusually large
Please answer all the questions and choose one answer amount of
food (given the
for each question. Thank you. circumstances)?
Remember that the questions only refer to the past 4
14. 9. did you have a
weeks (28 days) only. sense of
having lost
control over
0 1 2 3 4 5 6 your eating (at
EDE-Q EDE-Q-13 On how many 0 1–5 6–12 13–15 16–22 23–27 Every the time that
of the past 28 day you were
days ...... eating)?

1. 1. have you been 15. 10. have such

deliberately episodes of
trying to limit overeating
the amount of occurred (i.e.
food you eat you have eaten
to influence an unusually
your shape or large amount
weight of food and
(whether or have had a
not you have sense of loss of
succeeded)? control at the
time)?
3. 2. have you tried
to exclude 16. 11. have you
from your diet made yourself
any foods that sick (vomit) as
you like in a means of
order to controlling
influence your your shape or
shape or weight?
weight 17. 12. have you taken
(whether or laxatives as a
not you have means of
succeeded)? controlling
4. 3. have you tried your shape or
to follow weight?
definite rules 18. 13. have you
regarding your exercised in a
eating (for “driven” or
example, a “compulsive”
calorie limit) in way as a
order to means of
influence your controlling
shape or your weight,
weight shape or
(whether or amount of fat
not you have or to burn off
succeeded)? calories?
22. 4. has your
weight
influenced Questions 1–3: Restricted Eating; 4–5 Shape and
how you think
about (judge) Weight Over-evaluation; 6–7 Body Dissatisfaction; 13–
yourself as a 15 Bingeing; 16–18 Purging.
person?
23. 5. has your shape
influenced Abbreviations
how you think EDE-Q: Eating Disorders Examination–Questionnaire; EDE-Q-7: Eating
about (judge) Disorders Examination–Questionnaire – seven items; EDE-Q-13: Eating
yourself as a Disorders Examination–Questionnaire – thirteen items; DR: Dietary Restraint;
person? EC: Eating Concern; WC: Weight Concern; SC: Shape Concern; DKB-35: The
25. 6. have you been Dresden Body Image Questionnaire-35; BN: Body Narcissism; SF: Sexual
dissatisfied Fulfillment; BA: Body Acceptance; PC: Physical Contact; SEC: Social and
your weight? Emotional Connection; EDRQ: The Eating Disorders Recovery Questionnaire;
26. 7. have you been SWLS: The Satisfaction with Life Scale; PANAS-SF: The Positive and Negative
dissatisfied Affect Schedule – Short Form; PANAS-SF-Pos: Positive affect; PANAS-SF-
your shape? Neg: Negative affect; PES: The Positive Eating Scale; CFA: Confirmatory factor
analysis; CFI: Comparative Fit Index; RMSEA: Root mean square error of
13. 8. have you eaten
approximation
Lev-Ari et al. Journal of Eating Disorders (2021) 9:57 Page 9 of 9

Acknowledgements predictive role of a nested general (g) and primary factors. Int J Methods
We have no acknowledgments. Psychiatr Res. 2013;22(3):195–203. https://doi.org/10.1002/mpr.1389.
10. Gideon N, Hawkes N, Mond J, Saunders R, Tchanturia K, Serpell L.
Authors’ contributions Development and psychometric validation of the EDE-QS, a 12 item short
The corresponding author (Lilac Lev-Ari, PhD, [email protected]) conceived form of the eating disorder examination questionnaire (EDE-Q). PLoS One.
and conducted the study and wrote parts of the manuscript. She also has 2016;11(5):e0152744. https://doi.org/10.1371/journal.pone.0152744.
full access to the data and has the right to publish it. All the authors 11. He J, Sun S, Fan X. Validation of the 12-item short form of the eating
participated in a meaningful way in the preparation of the manuscript. disorder examination questionnaire in the Chinese context: confirmatory
Professor Zohar and Professor Bachner-Melman advised on the recoding of factor analysis and Rasch analysis. Eat Weight Disord. 2020;1(1):201–9.
the questionnaire, wrote significant parts of the manuscript and edited it. Dr. https://doi.org/10.1007/s40519-019-00840-3.
Lev-Ari performed all statistical analyses. The author(s) read and approved 12. Prnjak K, Mitchison D, Griffiths S, Mond J, Gideon N, Serpell L, et al. Further
the final manuscript. development of the 12-item EDE-QS: identifying a cut-off for screening purposes.
BMC Psychiatry. 2020;20(1):1–7. https://doi.org/10.1186/s12888-020-02565-5.
13. Machado PP, Grilo CM, Rodrigues TF, Vaz AR, Crosby RD. Eating disorder
Funding
examination–questionnaire short forms: a comparison. Int J Eat Disord.
There is no funding to claim and authors have nothing to disclose.
2020;53(6):937–44 https://doi.org/10.1002/eat.23275.
14. Kliem S, Mößle T, Zenger M, Strauß B, Brähler E, Hilbert A. The Eating
Availability of data and materials Disorder Examination-Questionnaire 8: A brief measure of eating disorder
All data and materials are available upon request. psychopathology (EDE-Q8). Int J Eat Disord. 2016;49(6):613–6 https://doi.
org/10.1002/eat.22487.
Declarations 15. Goldfein JA, Devlin MJ, Kamenetz C. Eating disorder examination-
questionnaire with and without instruction to assess binge eating in
Ethics approval and consent to participate patients with binge eating disorder. Int J Eat Disord. 2005;37(2):107–11.
All ethical guidelines were adhered to and IRB approval was received. https://doi.org/10.1002/eat.20075.
16. Bachner-Melman R, Lev-Ari L, Zohar AH, Lev SL. Can recovery from an
Consent for publication eating disorder be measured? Toward a standardized questionnaire. Front
All authors have given their consent for publication. Psychol. 2018;9:2456. https://doi.org/10.3389/fpsyg.2018.02456.
17. Luce KH, Crowther JH, Pole M. Eating disorder examination questionnaire
(EDE-Q): norms for undergraduate women. Int J Eat Disord. 2008;41(3):273–
Competing interests
6. https://doi.org/10.1002/eat.20504.
We have no competing interests and have nothing to disclose.
18. Matthes J, Franke GH, Jäger S. Psychometrische Prüfung des Dresdner
Körperbildfragebogens (DKB-35) in einer nicht-klinischen Stichprobe. Z Med
Author details
1 Psychol. 2012;21(1):21–30. https://doi.org/10.3233/ZMP-2011-2028.
Clinical Psychology Graduate Program, Ruppin Academic Center, Emek
19. Pöhlmann K, Roth M, Braehler E, Joraschky P. The Dresden body image inventory
Hefer, Israel. 2Lior Zfaty Suicide and Mental Pain Research Center, Emek
(DKB-35): validity in a clinical sample. Psychother Psychosom Medizinische
Hefer, Israel. 3School of Social Work, Hebrew University of Jerusalem,
Psychol. 2013;64(3–4):93–100. https://doi.org/10.1055/s-0033-1351276.
Jerusalem, Israel.
20. Lev-Ari L, Zohar AH, Bachner-Melman R. Enjoying your body: The
psychometric properties of an English version of the Dresden Body Image
Received: 3 November 2020 Accepted: 4 April 2021
Questionnaire. Aust J Psychol. 2020;72(4). https://doi.org/10.1111/ajpy.12284.
21. Bachner-Melman R, Lev-Ari L, Zohar AH, Linketsky M. The eating disorders
recovery questionnaire: psychometric properties and validity. Eat Weight
References Disord. 2021:1–11 https://doi.org/10.1007/s40519-021-01139-y.
1. Fairburn CG, Beglin SJ. Assessment of eating disorders: interview or self- 22. Diener ED, Emmons RA, Larsen RJ, Griffin S. The satisfaction with life scale. J
report questionnaire? Int J Eat Disord. 1994;16(4):363–70 https://doi.org/10.1 Pers Assess. 1985;49(1):71–5. https://doi.org/10.1207/s15327752jpa4901_13.
002/1098-108X(199412)16:4<363::AID-EAT2260160405>3.0.CO;2-%23. 23. Shmotkin D, Lomranz J. Subjective well-being among holocaust survivors:
2. Zohar AH, Lev-Ari L, Bachner-Melman R. The EDE-Q in Hebrew: structural an examination of overlooked differentiations. J Pers Soc Psychol. 1998;
and convergent/divergent validity in a population sample. Isr J Psychiatry 75(1):141. https://doi.org/10.1037/0022-3514.75.1.141–55.
Relat Sci. 2017;54(3):15–21. 24. Thompson ER. Development and validation of an internationally reliable
3. Mond JM, Hay PJ, Rodgers B, Owen C. Eating disorder examination short-form of the positive and negative affect schedule (PANAS). J Cross-
questionnaire (EDE-Q): norms for young adult women. Behav Res Ther. Cult Psychol. 2007;38(2):227–42 https://doi.org/10.1177/0022022106297301.
2006;44(1):53–62. https://doi.org/10.1016/j.brat.2004.12.003. 25. Zohar AH, Denollet J, Lev Ari L, Cloninger CR. The psychometric properties
4. Mond JM, Myers TC, Crosby RD, Hay PJ, Rodgers B, Morgan JF, et al. of the DS14 in Hebrew and the prevalence of type D personality in Israeli
Screening for eating disorders in primary care: EDE-Q versus SCOFF. Behav adults. Eur J Psychol Assess. 2011;27(4):274. https://doi.org/10.1027/1015-
Res Ther. 2008;46(5):612–22. https://doi.org/10.1016/j.brat.2008.02.003. 5759/a000074–81.
5. Schaefer LM, Smith KE, Leonard R, Wetterneck C, Smith B, Farrell N, et al. 26. Sprösser G, Klusmann V, Ruby MB, Arbit N, Rozin P, Schupp HT, et al. The
Identifying a male clinical cutoff on the eating disorder examination- positive eating scale: relationship with objective health parameters and
questionnaire (EDE-Q). Int J Eat Disord. 2018;51(12):1357–60. https://doi. validity in Germany, the USA and India. Psychol Health. 2018;33(3):313–39.
org/10.1002/eat.22972. https://doi.org/10.1080/08870446.2017.1336239.
6. Cooper Z, Fairburn C. The eating disorder examination: a semi-structured 27. Bentler PM, Bonett DG. Significance tests and goodness of fit in the analysis
interview for the assessment of the specific psychopathology of eating of covariance structures. Psychol Bull. 1980;88(3):588–606 https://doi.org/1
disorders. Int J Eat Disord. 1987;6(1):1–8 https://doi.org/10.1002/1098-108X(1 0.1037/0033-2909.88.3.588.
98701)6:1<1::AID-EAT2260060102>3.0.CO;2-9. 28. Browne MW, Cudeck R. Alternative ways of assessing model fit. In: Bollen
7. Carey M, Kupeli N, Knight R, Troop NA, Jenkinson PM, Preston C. Eating KA, Long JS, editors. Testing structural equation models. Newbury Park:
disorder examination questionnaire (EDE-Q): norms and psychometric Sage; 1993. p. 136–62.
properties in UK females and males. Psychol Assess. 2019;31(7):1–39. https:// 29. Hilbert A, De Zwaan M, Braehler E. How frequent are eating disturbances in
doi.org/10.1037/pas0000703. the population? Norms of the eating disorder examination-questionnaire.
8. Grilo CM, Reas DL, Hopwood CJ, Crosby RD. Factor structure and construct PLoS One. 2012;7(1):e29125. https://doi.org/10.1371/journal.pone.0029125.
validity of the eating disorder examination-questionnaire in college
students: further support for a modified brief version. Int J Eat Disord. 2015;
48(3):284–9. https://doi.org/10.1002/eat.22358. Publisher’s Note
9. Friborg O, Reas DL, Rosenvinge JH, Rø Ø. Core pathology of eating disorders Springer Nature remains neutral with regard to jurisdictional claims in
as measured by the eating disorder examination questionnaire (EDE-Q): the published maps and institutional affiliations.