Cross-Cultural Validity of the Eating Disorder Examination: A Study of Chinese Outpatients with Eating Disorders in Hong Kong

Article excerpt


Objective: To assess the cross-cultural validity of the Cantonese-Chinese version of the Eating Disorder Examination among Chinese outpatients.

Patients and Methods: The Cantonese-Chinese version of the Eating Disorder Examination was administered to 42 patients with anorexia nervosa, anorexia nervosa without fat phobia, bulimia nervosa or binge eating disorders and to 12 controls. An eating disorders specialist made the clinical diagnoses. The eating disorder psychopathologies of cases were compared with controls.

Results: The Cantonese-Chinese version of the Eating Disorder Examination exhibited satisfactory internal consistency, sensitivity, specificity, positive and negative predictive value for diagnosing subjects with anorexia nervosa, bulimia nervosa and binge eating disorders. All subscales discriminated between patients with anorexia nervosa or bulimia nervosa and controls. Apart from the restraint subscale, the other three subscales discriminated between those with binge eating disorders and controls. Those with anorexia nervosa and anorexia nervosa without fat phobia had similar results except for those of the weight concern subscale. No subjects with eating disorders met the definition for excessive exercise.

Conclusion: The Cantonese-Chinese version of the Eating Disorder Examination has good reliability, discrimination and criterion validity. The similarities between responses from those with anorexia nervosa and those with anorexia nervosa without fat phobia made the inclusion of fat phobia as a diagnostic criterion for anorexia nervosa in the 4th Edition of the Diagnostic and Statistical Manual of Mental Disorders questionable. The discrepancy between binge eating disorders and control regarding weight and shape concern suggests cognitive features should be considered as diagnostic criteria for binge eating disorders. The definition of excessive exercise may not be appropriate for Hong Kong Chinese population.

Key words: Anorexia nervosa; Bulimia nervosa; Eating Disorders; Psychometrics



Several community studies in Hong Kong have indicated that between 3 and 10% of young females suffer from eating disorders. At a university-affiliated psychiatric clinic in Hong Kong, the number of referrals of patients with eating disorders (primarily anorexia nervosa [AN]) has increased from 2 per year in the early 1990s to at least 1 per week by mid-2000. (1) Lee and Katzman (1) noted improvements in the quality of eating disorder research, including greater reporting of reliability and validity information over the past 2 decades. Nonetheless, compared with anxiety disorders, eating disorder studies are less likely to use structured diagnostic assessments (10% vs 21%). (2) Therefore, one of the most important challenges in the study of eating disorders is ensuring the use of high-quality assessment tools. Within Chinese societies in particular, the lack of a valid and culturally sensitive diagnostic instrument to address the complex psychopathology of eating disorders, is a significant obstacle to research. (3)

Eating disorder instruments, such as the Eating Attitude Test-26 (EAT-26; Chinese version) and Eating Disorder Inventory (EDI) have received more attention in Chinese communities. Both EAT-26 and EDI are self-reporting questionnaires and they may not provide reliable data for constructs that are more abstract and difficult to define. (4) Binge eating is one such challenging construct as opinions of what constitutes a large amount of food often vary from individual to individual and may differ markedly from that of the clinical interviewer. (5) The extent to which self-evaluation is unduly influenced by shape and weight, included in the Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-IV (6)) criteria for both AN and bulimia nervosa (BN), is also difficult to measure because it is an abstract concept that requires an awareness of self-definition. …


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