Measures

The Dietary Rules Inventory (DRI)

Nature and use

The Dietary Rules Inventory (DRI) is a 28-item self-report measure designed to assess the dietary rules of patients with eating disorders. It is focused on the last 28 days. The 28 items covers the principal dietary rules associated with eating disorder psychopathology.

The DRI It is quick and easy to complete, and could, therefore, be readily integrated into routine clinical practice, providing a better understanding of the dietary rules drivng eating behaviours in patients with eating disorders, and therefore, targets for intervention. It can be also used in the studies which assess the effect of the treatment of eating disorder.

Status of the DRI

The design and validation of the SSI has been published on Eating and Weight Disorders. A transdiagnostic sample of 320 patients with eating disorders, as well as 95 patients with obesity and 122 healthy controls were recruited. Patients with eating disorders also completed the Dutch Eating Behaviour Questionnaire (DEBQ), the Eating Disorder Examination Questionnaire, the Brief Symptoms Inventory and the Clinical Impairment Assessment. Dietary rules were rated on a continuous Likert-type scale (0–4), rating how often (from never to always) they had been applied over the previous 28 days. DRI scores were significantly higher in patients with eating disorders than in patients with obesity and healthy controls. Principal factor analysis identified that 55.8% of the variance was accounted for by four factors, namely ‘what to eat’, ‘social eating’, ‘when and how much to eat’ and ‘caloric level’. Both global score and subscales demonstrated high internal and test–retest reliability. The DRI global score was significantly correlated with the DEBQ ‘restrained eating’ subscale, as well as eating-disorder and general psychopathology and clinical impairment scores, demonstrating good convergent validity. These findings suggest that the DRI is a valid self-report questionnaire that may provide important clinical information regarding the dietary rules underlying dietary restraint in patients with eating disorders.

Scoring of the DRI

  • Global score: sum of all items divided by 28
  • What to eat’: sum of items 5, 9, 10, 11, 12, 13, 14, 17 divided by 7
  • Social eating: sum of items 2, 7, 8, 15, 16, 18, 19 divided by 7
  • When and how much to eat: sum of items 21, 3, 4, 6, 20, 21, 22, 23, 24, 27, 28 divided by 11
  • Caloric level: sum of items 25, 26, divided by 2

Copyright

The DRI (and its items) is under copyright. It is freely available for non-commercial research use only and no permission need to be sought.

For commercial use of the DRI contact: rdalleg@gmail.com

Reference

Calugi, S., Morandini, N., Milanese, C., Dametti, L., Sartirana, M., Fasoli, D., & Dalle Grave, R. (2021). Validity and reliability of the Dietary Rules Inventory (DRI). Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity. doi:10.1007/s40519-021-01177-6 Full Text 

Dietary Rules Inventory (DRI)_English version 

The Eating Problem Check List

Nature and Use

The Eating Problem Checklist (EPCL) is a 16-item self-report measure designed to assess eating-disorder behaviours and psychopathology in patients with eating disorders session-by-session. It is focused on the past 7 days. The 15 items cover the principal behaviours and attitudes of eating disorder psychopathology.

The EPCL It is quick and easy to complete, and could therefore be readily integrated into routine clinical practice, enabling assessment of weekly changes. The tool allows the clinician and the patient to assess, through the review of each single item score, the change occurred in specific eating-disorder psychopathology expressions, at weekly intervals. Moreover, through the assessment of the two subscale scores (i.e., body image and eating concerns), the tool permits to assess the weekly changes of the core psychopathology of eating disorders. As an aid for clinicians and patients in identifying improvement and/or deterioration the EPCL would enable prompt focusing of the treatment on specific expressions of an individual’s eating-disorder psychopathology. Moreover, sudden gains (i.e., large, rapid and stable changes in symptomatology between two consecutive treatment sessions) seem associated with greater overall post-treatment symptom reduction and better outcomes than those who did not. Associations between sudden gains and short- and long-term improvements, also appear to have a positive impact on alliance.

In our clinical practice, we find very useful to review and discuss carefully with the patient the single item EPCL scores on a weekly basis (after the CBT-E collaborative weighing procedure). This review, if associated with the monitor records review of the last seven days, helps to highlight, when there is a weekly change of at least one point in one or more items of EPCL, the changes that patients have made and identify the behavioural expressions of their eating-disorder psychopathology to be addressed by the treatment. What is more, by recording weekly EPCL data on a spreadsheet, it is possible to observe whether—as assumed by the CBT-E theory – modification of certain behaviours (e.g. by adopting regular eating, reducing dietary restraint, weekly weighing,  and/or interrupting dysfunctional body checking) is associated with a reduction in concerns about eating, shape and weight over time—one of the primary goals of CBT-E

Status of the EPCL  

The design and validation of the EPCL has been published on Eating Disorders. The EPCL demonstrated good internal consistency, test–retest reliability and concurrent and criterion validity, and principal component analysis of the session-by-session data identified two factors (‘eating concerns’ and ‘body image concerns’) that accounted for 51.3% of the variance. Furthermore, session-by-session analysis indicated that the EPCL is able to identify weeklyspecific changes and/or deterioration in eating-disorder psychopathology.

Scoring of the EPCL

The total score is obtained by adding the items of section two, while the scores of the two subscales are obtained through the sum of the following items, always of the second section: Concern for the body image sum of the items 4, 5, 6, 7, 8 ; Concern for feeding sum of items 1, 2, 3, 9

Copyright

The EPCL (and its items) is under copyright. It is freely available for non-commercial research use only and no permission need to be sought.

For commercial use of the EPCL contact: rdalleg@gmail.com

Reference

Dalle Grave, R., Sartirana, M., Milanese, C., El Ghoch. M.  Brocco, C.  Pellicone, C., Calugi, S. (in press). Validity and reliability of the Eating Problem Checklist (EPCL). Eating Disorders. doi:10.1080/10640266.2018.1528084.

The Starvation Symptom Inventory (SSI)

Nature and Use

The Starvation Symptoms Inventory (SSI) is a 15 items self-report measure that examines the symptoms of starvation in underweight patients with eating disorders. It is focused on the past 28 days. The SSI

can be easily integrated in routine clinical practice to assess the starvation symptoms in underweight patients with eating disorders and to assess their changes during the process of weight restoration in those who attend specialized eating disorder treatments. It can be also used in the studies which assess the effect of the treatment of eating disorder.

Status of the SSI

The design and validation of the SSI has been published on Nutrients.  Principal component analysis identified a single-factor, 15-item scale, which demonstrated good internal consistency (alfa= 0.91) and test–retest reliability (r = 0.90). The SSI global score was significantly correlated with eating disorder and general psychopathology, demonstrating good convergent validity. SSI scores were significantly higher in the anorexia nervosa sample than in the healthy control, not-underweight eating disorder and bipolar depressive episode samples. These findings suggest that the SSI is a valid self-report questionnaire that may provide important clinical information regarding symptoms of starvation in patients with anorexia nervosa.

The structure of the SSI mirrors that of EDE-Q, and participants are asked to provide an estimate of the number of days out of the preceding 28 (four weeks) in which they have experienced these symptoms on a 7-point Likert scale ranging from ‘never’ (0) to ‘always’ (6).

Scoring of the SSI

The score of the questionnaire is obtained by adding the scores of the 15 items. The resulting scores range from 0 to 90, where the highest score indicates increased frequency of starvation symptoms over the last 28 days. In patients with anorexia nervosa the average score obtained is 55.1 while in healthy controls 10.4.

Copyright

The SSI (and its items) is under copyright. It is freely available for non-commercial research use only and no permission need to be sought.

For commercial use of the SSI contact: rdalleg@gmail.com

Reference

Calugi, S., Miniati, M., Milanese, C., Sartirana, M., El Ghoch, M., & Dalle Grave, R. (2017). The Starvation Symptom Inventory: Development and Psychometric Properties. Nutrients, 9(9), 967. doi:10.3390/nu9090967