A New Scale Measures Compulsive Food Restriction

The Self-Starvation Scale may be very helpful for patients with extreme food restriction.

Reprinted from Eating Disorders Review
May/June Volume 26, Number 3
©2015 iaedp

Self-starvation by patients with anorexia nervosa (AN) is one of the most striking features of the disorder. It has been viewed as rewarding or habit-based, and at times is likened to compulsive drug-seeking behavior. Drs. Lauren R. Godier and Rebecca J. Park, of Oxford University, developed a novel measure of self-starvation, the Self-Starvation Scale (SS), to better understand the extent to which self-starvation may show addiction-like qualities (Eating Behavior. 2015. 17:10). The scale was partially adapted from the Yale Food Addiction Scale (YFAS) (Appetite. 2009; 52:430).

The SS asks a series of 17 questions about behavior during the previous 4 weeks, and each question has a different factor loading. The SS uses a 7-point Likert-like rating scale, from 0 (never) to 6 (every day) to record how many of the previous 28 days a behavior has occurred. For example, Question 8 states, ‘I have restricted my food intake so much that I have concentrated on this instead of doing other activities.’

The Oxford researchers tested the scale among four groups of volunteers. The first group included 126 healthy volunteers with no prior eating disorders. Then, 78 individuals between 18 and 65 were recruited in three study groups: (1) persons with acute AN (n=41); (2) weight-restored individuals with a history of AN (n=18); and (3) individuals fully recovered from AN (n=19) The questionnaire was created using Bristol Online Surveys (University of Bristol, England). In addition to the SS, the Eating Disorder Examination Questionnaire (EDE-Q) and the Clinical Impairment Assessment, the Patient Health Questionnaire, and the Generalized Anxiety Disorder Assessment were included. Other questionnaires measured food addiction, excessive exercise, and impulsivity, and participants also provided demographic information, including height and weight (to calculate body mass index, or BMI, kg/m2); in addition, patients in the AN sample reported their lowest BMI, age of onset of the disorder, duration of illness, and treatment received.

The scale showed good reliability

The SS, which was developed to provide a tool to further assess the concept of compulsive dependence on starvation, showed good reliability and was significantly related to measures of eating disorder symptoms, compulsive exercise, depression, and anxiety. SS scores also correlated significantly with scores of food addiction, as measured by the Yale Food Addiction Scale. Because that scale centers on the rigid control of eating behavior seen in eating disorders, they add that “the result is likely to reflect the compulsive and rule-driven nature of self-starvation.” The predictive ability was greatest for the group with current AN, suggesting that the SS may be particularly helpful as an index of extreme food restriction in AN. The availability of this scale should increase attention on the potentially addictive qualities of self-starvation.

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