Psychometric properties of self-report measures of eating disorder cognitions: a systematic review

BackgroundAlthough eating disorder (ED) models display some differences in theory and treatment approach, cognitive-behavioural, schema-focused, and disorder-specific models all highlight the fundamental nature of cognitions as key factors in ED development and maintenance processes. As such, it is vital that ED cognitions continue to be assessed and monitored as therapeutic targets and treatment outcomes as well as being examined as constructs in empirical research. This review aimed to systematically identify and evaluate the psychometric properties of existing self-report measures of ED cognitions.MethodsA systematic review protocol was registered using the international prospective register of systematic reviews (PROSPERO; CRD42023440840). Included studies described the development, validation and/or the psychometric evaluation of a measure (or subscale) that was specifically developed to solely assess ED cognitions (that is thoughts, expectations, assumptions, or beliefs), in English-speaking, adult populations. The search was conducted using three electronic databases: PsycINFO, MedLine, and Embase. Two independent reviewers conducted screening, selection and evaluation of the psychometric properties of relevant measures using a standardised, well-established quality appraisal tool.ResultsOf the initial search of 7581 potential studies, 59 met inclusion criteria and described the psychometric evaluation of 31 measures (or subscales) of ED cognitions. The findings from the current review indicate that of the included measures, none currently meet all nine criteria of adequate psychometric properties. The Eating Beliefs Questionnaire (EBQ; and EBQ-18), and the Eating Disorder Inventory Body Dissatisfaction subscale (EDI [BD]) currently possess the most evidence supporting their validity, reliability, and clinical utility.ConclusionsThe findings of the current systematic review provide guidance for future researchers to focus efforts on improving evidence for the validity, reliability and utility of self-report measures of ED cognitions. Overall, the present study has provided a detailed and systematic evaluation to support researchers and clinicians in future selection of measures of ED cognitions dependent on the specific aims of their research and treatment. Theoretical and empirical research suggests that eating disorder (ED) cognitions (that is, thoughts, expectations, assumptions, and beliefs) are important factors contributing to the development and maintenance of EDs. As such, it is important to continue to assess and monitor these in research and in clinical practice. Valid, reliable and useful assessment tools are critical in this process. This systematic review aimed to identify and evaluate the psychometric properties of existing self-report measures of ED cognitions. Included studies described the development, validation and/or the psychometric evaluation of a measure specifically developed to solely assess ED cognitions. Three electronic databases were searched, and studies screened and selected by two independent reviewers. The included studies and self-report measured were evaluated using a standardised tool to evaluate their psychometric properties. Fifty-nine studies were included, that identified a total of 31 measures (or subscales) assessing ED cognitions. The findings from the current review indicate that none of the included measures currently meet all nine criteria of adequate psychometric properties. The EBQ, EBQ-18, and EDI-III (BD) currently have the most evidence in support of their psychometric properties. This study provides direction for future researchers to focus efforts on improving evidence for the validity, reliability and utility of these self-report measures. Overall, we provided information to support researchers and clinicians in future selection of measures of ED cognitions.