Using the EDE for Adolescent Males
with Anorexia Nervosa
According to the results of one recent study, there is plenty of room for improvement.
Reprinted from Eating Disorders Review
May/June 2012 Volume 23, Number 3
©2012 Gürze Books
Just as one size does not fit all, some sections of the Eating Disorders Examination (EDE) may need to be redesigned for adolescent males with anorexia nervosa (AN).
Although the EDE is widely considered the "gold standard" for research and clinical practice, Alison M. Darcy PhD and colleagues at Stanford University and the University of Chicago recently wrote that the EDE may not be entirely useful for teenage males with eating disorders (Int J Eat Disord 2012; 45:110). Part of the problem is that the EDE was originally designed and developed for females.
Dr. Darcy and her colleagues compared EDE scores from 48 adolescent males with AN and matched these using a percentage of median body weight and age with scores from 48 adolescent females with AN. The participants were all teens presenting for treatment at Stanford University Hospital and Clinics and the University of Chicago. All participants were diagnosed with AN or had fulfilled inclusion criteria for clinical trials for treatment of AN. The diagnosis was made after extensive clinical assessments made during intake by experts in eating disorders in children and adolescents. The EDE was administered by trained investigators who were not involved in treatment of direct evaluation of the teens.
Results varied by gender in some categories
Adolescent males with AN scored significantly lower on "Shape Concern" and "Weight Concern" categories and on the EDE Global Score than did their female counterparts. They also scored significantly lower on the following categories: "Empty stomach," "Social eating," "Eating in secret," "Flat stomach," and "Desire to lose weight."
Some suggested changes
The authors suggest several changes in the EDE to make it more applicable to teenage males. First, they pointed out that certain questions reflect symptoms that are not part of the eating disorders symptom profile for males. "Empty stomach" is one. In addition, current scoring ranges derived from female samples bear little resemblance to those of males with similar clinical presentations.
The authors also note that interpretations of EDE scores should take into consideration the fact that adolescent males often tend to minimize their symptoms, especially in relation to questions about weight control. Differences in social eating and eating in secret may also be reflections of the greater amount of socialization that females are subjected to in terms of eating habits. The authors note that it is also possible that adolescent males are more concerned with attaining an idealized masculine shape than with specific weights.
Significantly more males than females reported self-induced vomiting, which is consistent with a recent study of DSM-IV symptoms in a large nonclinical sample of adolescents (Br J Med Psychol 1998; 71:175). Only 27 of the males (56%) met the weight cutoff suggested by the DSM-IV. More than half were below the suggested weight cutoff, and 61% had potentially life-threatening complications.
The authors suggest there is a great need for developing better measures for adolescent males with all types of eating disorders. To develop a more accurate picture of eating disorders among males, Dr. Darcy and her colleagues recommend mixed methods studies of the expression of symptoms in males using qualitative data and the incorporation of additional measures, especially concerns about shape.