The newer test underlines the importance of patients’ feelings of self-loathing, feeling abandoned or isolated.

Our core beliefs are those things that we strongly believe within ourselves, and that affect the way we view every situation and experience in life. In contrast to rational core beliefs, harmful core beliefs can lead to negative thoughts, feelings and behaviors.

For patients with EDs, core beliefs play a key role in maintaining negative cognitive, affective, and behavioral symptom. As a team of Australian authors recently pointed out, Christopher Fairburn et al. hypothesized the transdiagnostic theory of eating disorders, where low self-esteem is one key factor that maintains overvaluation of eating, shape, weight, and perfectionism (Behav Res Ther. 2003. 41:509)

The 40-question Core Beliefs Questionnaire (CBQ) assesses five dimensions important in EDs: self-loathing, unassertive/inhibited behavior, demanding or needing help and support, feeling abandoned/deprived, and having high standards for oneself. Recently, three psychologists from the University of Sydney, Australia, evaluated and revised the CBQ, in an effort to improve the original version (J Eat Disord. 2022. 10:18).

Drs. Amaani H. Hatoum, Amy L. Burton, and Maree J. Abbott designed a psychometric evaluation of 763 undergraduate psychology students (71% female; mean age 19 years), who completed a battery of questions online. The authors identified a subgroup of 384 students (82% female) who appeared to have RD symptoms based on responses from the Eating Disorder Examination Questionnaire (EDE-Q); 139 students with few reported symptoms served as a control group.

How does the revised questionnaire differ?

The authors found that participants in the ED-symptomatic subgroup scored significantly higher on the original 40-item ED-CBQ total scale than did those in the non-ED subgroup. Participants in the ED symptomatic subgroup also scored significantly higher than the non-ED subgroup on the self-loathing, unassertive, abandoned, and demanding subscales. However, there was no significant difference between the ED-symptomatic and non-ED subgroups on the high standards for self-scales.

The authors report that their results have validated the importance of patients’ feelings of self-loathing, feeling abandoned or isolated, believing oneself to be demanding, needing help or being unassertive or emotionally inhibited for individuals reporting clinical or subclinical ED symptoms. The results also provided evidence supporting these ED core beliefs and the presence of eating, weight, and shape concerns and restrictive eating and binge eating.

They noted that their research indicates that although such patients have high or unrelenting standards, they may also be more self-critical than others, and ultimately believe they are failing to meet these standards.

Dr. Hatoum and colleagues note that while the ED-CBQ is “a valid, reliable, and efficient way to measure core beliefs,” the revised version, ED-CBQ-R, may also prove useful in future theoretical and empirical research.”