Measuring Recovery

A new questionnaire seeks to define recovery from an eating disorder among patients, family, and clinicians.

Defining recovery from an eating disorder is critical for clinical and research purposes. Dr. Rachel Bachner-Melman and colleagues at Ruppin Academic Center, Hebrew University of Jerusalem, and the University of Haifa argue for the importance of accepted outcome definitions; however, to arrive at consensus definitions, useful measures of potential recovery defining factors are needed.

Dr. Bachner-Melman and colleaguesdescribed the results of their study of 213 volunteers using a 28-item multidimensional questionnaire, the Eating Disorders Recovery Endorsement Questionnaire, or EDREQ, which covers the main features of recovery from an eating disorder (Front Psychol. 2018;9: article 2456). The EDREQ is a refinement of a recovery checklist proposed by Noordenbos and Sebring in 2006 (Eat Disord. 2006; 14:41), which was further refined in 2012 by Emanuelli et al. (Eur Eat Disord Rev. 2012; 20:363).

Most studies of recovery have used a medical model including behavioral and physical symptoms; some, focusing on patients with anorexia nervosa, have used body mass index alone.  However, the authors’ questionnaire sought to rate how important the participants thought each of 56 criteria was for recovery. The participants included 118 patients with a lifetime eating disorder diagnosis, 58 healthy family members of patients with eating disorders, and 37 eating disorder clinicians. All participants also completed the ED-15((

Four areas emerged

Exploratory factors analysis was used to examine the structure of the questionnaire, and 4 main factors were identified.  The most popular was Absence of Symptomatic Behavior. Following this were Acceptance of Self and Body, Social and Emotional Connections, and Physical Health. According to the authors, the respondents thus reconfirmed the medical model that recovery is foremost an improvement in symptoms, while physical health is given less importance.

The authors noted that the original version of the EDREQ questionnaire contained 56 items, but using the 7 strongest items in each factor gives a measure only 28 items long. Despite this, the 28-item version still had strong psychometric characteristics. Periodically assessing recovery during therapy and follow-up with the EDREQ could provide a measure of recovery from an eating disorder for use in research studies, program outcome monitoring, and tracking the progress of therapy in individual patients. The authors noted that the study results were limited by the small sample size and that the eating disorder patient and clinic groups were overwhelmingly female and thus larger studies including more diverse groups are warranted.

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