Further Validation for a Measure of Disordered Eating in An Independent Sample of Male and Female Elite Athletes: The Athletic Disordered Eating (ADE) Scale

Overview

Journal Int J Eat Disord

Publisher Wiley

Specialty Social Sciences

Date 2024 Dec 4

PMID 39630973

Authors

Scott J Fatt

Katarina Prnjak

Georgina L Buckley

Emma George

Phillipa Hay

Nikki Jeacocke

Deborah Mitchison

Affiliations

Soon will be listed here.

Abstract

Background: Elite athletes experience unique pressures and cognitions associated with disordered eating, which may not be appropriately captured by existing tools. The Athletic Disordered Eating (ADE) scale is a recently developed and first measure of disordered eating specifically developed and validated in current and former athletes. This study aimed to provide further validation for the ADE in an independent sample of elite athletes.

Method: Participants were 237 elite athletes (M = 26.1, SD = 8.6; 75.9% female; 73.0% current athletes) participating in various sports across Australia and the United States. Participants completed an online survey including the ADE, demographic questions, and other measures of eating disorder symptoms (Eating Disorder Examination-Questionnaire Short-form, Clinical Impairment Assessment), and related constructs. Twenty-five athletes also completed a clinical interview to determine eating disorder caseness.

Results: The four-factor structure of the ADE from the original validation was confirmed. Further, the ADE demonstrated adequate measurement invariance across male and female current and former athletes; internal consistency for the total score and each subscale; convergent and discriminant validity; and criterion-related validity-with a score of 40 balancing sensitivity and specificity against other scales with established cut-offs for a likely eating disorder. The high-risk cut-off (ADE ≥ 33) had high sensitivity but low specificity in identifying eating disorder cases, as confirmed by the clinical interview.

Discussion: The ADE is a low-time-burden screening tool for disordered eating, validated in independent samples of diverse athletes. It should be considered for future use in screening, early identification, and monitoring treatment progress in elite athletes.

References

Gideon N, Hawkes N, Mond J, Saunders R, Tchanturia K, Serpell L . Development and Psychometric Validation of the EDE-QS, a 12 Item Short Form of the Eating Disorder Examination Questionnaire (EDE-Q). PLoS One. 2016; 11(5):e0152744. PMC: 4854480. DOI: 10.1371/journal.pone.0152744. View

Hazzard V, Schaefer L, Mankowski A, Carson T, Lipson S, Fendrick C . Development and Validation of the Eating Disorders Screen for Athletes (EDSA): A Brief Screening Tool for Male and Female Athletes. Psychol Sport Exerc. 2020; 50. PMC: 7392177. DOI: 10.1016/j.psychsport.2020.101745. View

Morgado F, Meireles J, Neves C, Amaral A, Ferreira M . Scale development: ten main limitations and recommendations to improve future research practices. Psicol Reflex Crit. 2020; 30(1):3. PMC: 6966966. DOI: 10.1186/s41155-016-0057-1. View

Lichtenstein M, Johansen K, Runge E, Hansen M, Holmberg T, Tarp K . Behind the athletic body: a clinical interview study of identification of eating disorder symptoms and diagnoses in elite athletes. BMJ Open Sport Exerc Med. 2022; 8(2):e001265. PMC: 9214368. DOI: 10.1136/bmjsem-2021-001265. View

Garner D, Olmsted M, Bohr Y, Garfinkel P . The eating attitudes test: psychometric features and clinical correlates. Psychol Med. 1982; 12(4):871-8. DOI: 10.1017/s0033291700049163. View

Rodin J, Silberstein L, Striegel-Moore R . Women and weight: a normative discontent. Nebr Symp Motiv. 1984; 32:267-307. View

Pensgaard A, Sundgot-Borgen J, Edwards C, Jacobsen A, Mountjoy M . Intersection of mental health issues and Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the IOC consensus on REDs. Br J Sports Med. 2023; 57(17):1127-1135. DOI: 10.1136/bjsports-2023-106867. View

Furukawa T, Kessler R, Slade T, Andrews G . The performance of the K6 and K10 screening scales for psychological distress in the Australian National Survey of Mental Health and Well-Being. Psychol Med. 2003; 33(2):357-62. DOI: 10.1017/s0033291702006700. View

Karrer Y, Halioua R, Motteli S, Iff S, Seifritz E, Jager M . Disordered eating and eating disorders in male elite athletes: a scoping review. BMJ Open Sport Exerc Med. 2020; 6(1):e000801. PMC: 7642204. DOI: 10.1136/bmjsem-2020-000801. View

10.

Torstveit M, Ackerman K, Constantini N, Holtzman B, Koehler K, Mountjoy M . Primary, secondary and tertiary prevention of Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the IOC consensus on REDs. Br J Sports Med. 2023; 57(17):1119-1126. DOI: 10.1136/bjsports-2023-106932. View

11.

Fatt S, George E, Hay P, Jeacocke N, Gotkiewicz E, Mitchison D . An Umbrella Review of Body Image Concerns, Disordered Eating, and Eating Disorders in Elite Athletes. J Clin Med. 2024; 13(14). PMC: 11278087. DOI: 10.3390/jcm13144171. View

12.

Bohn K, Doll H, Cooper Z, OConnor M, Palmer R, Fairburn C . The measurement of impairment due to eating disorder psychopathology. Behav Res Ther. 2008; 46(10):1105-10. PMC: 2764385. DOI: 10.1016/j.brat.2008.06.012. View

13.

Wells K, Jeacocke N, Appaneal R, Smith H, Vlahovich N, Burke L . The Australian Institute of Sport (AIS) and National Eating Disorders Collaboration (NEDC) position statement on disordered eating in high performance sport. Br J Sports Med. 2020; 54(21):1247-1258. PMC: 7588409. DOI: 10.1136/bjsports-2019-101813. View

14.

Chapa D, Johnson S, Richson B, Bjorlie K, Won Y, Nelson S . Eating-disorder psychopathology in female athletes and non-athletes: A meta-analysis. Int J Eat Disord. 2022; 55(7):861-885. PMC: 9303059. DOI: 10.1002/eat.23748. View

15.

Crane P, van Belle G, Larson E . Test bias in a cognitive test: differential item functioning in the CASI. Stat Med. 2004; 23(2):241-56. DOI: 10.1002/sim.1713. View

16.

Jefferies P, Gallagher P, Dunne S . The Paralympic athlete: a systematic review of the psychosocial literature. Prosthet Orthot Int. 2012; 36(3):278-89. DOI: 10.1177/0309364612450184. View

17.

Martinsen M, Sundgot-Borgen J . Higher prevalence of eating disorders among adolescent elite athletes than controls. Med Sci Sports Exerc. 2013; 45(6):1188-97. DOI: 10.1249/MSS.0b013e318281a939. View

18.

Mountjoy M, Ackerman K, Bailey D, Burke L, Constantini N, Hackney A . 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023; 57(17):1073-1097. DOI: 10.1136/bjsports-2023-106994. View

19.

Fatt S, George E, Hay P, Jeacocke N, Day S, Mitchison D . A systematic review and meta-synthesis of qualitative research investigating disordered eating and help-seeking in elite athletes. Int J Eat Disord. 2024; 57(8):1621-1641. DOI: 10.1002/eat.24205. View

20.

Nagel D, Black D, Leverenz L, Coster D . Evaluation of a screening test for female college athletes with eating disorders and disordered eating. J Athl Train. 2006; 35(4):431-40. PMC: 1323370. View