BRIEF REPORT

Eating Disorder Examination Questionnaire: Psychometric

Properties and Norms for the Portuguese Population
Paulo P. P. Machado1*, Carla Martins2, Ana R. Vaz1, Eva Conceição1, Ana Pinto Bastos1 & Sónia Gonçalves1
1
Psychotherapy and Psychopathology Research Unit, CIPsi, School of Psychology, University of Minho, Portugal
2
Human Cognition Lab, CIPsi, School of Psychology, University of Minho, Portugal

Abstract
Objective: The first aim of the current study was to establish general population norms for the Portuguese version of the Eating Disorder
Examination Questionnaire (EDE-Q) in a large community sample of female adolescents and young women, as well, for a diverse Eating
Disorder (ED) clinical sample, and for women with obesity without an ED. A second aim of the study was to assess the discriminant
validity of the EDE-Q and providing cut-off scores for the total scale and subscales.
Method: A sample of female adolescents and young women (N = 4091) from the general population, 416 women who met diagnostic
criteria for an ED and 138 women seeking obesity treatment completed the EDE-Q.
Results: Norms for the EDE-Q global subscale were provided. Within the community sample, norms were provided for both high school
and college samples. Receiver operating characteristic analysis showed that the EDE-Q total score accurately discriminate between
participants with and without an ED. Current norm contributes to the clinical utility of the EDE-Q, providing both a cut-off score
and reliable change index. Results showed that the EDE-Q is a reliable instrument, but the theorized four subscales structure was not
supported by an explorative factor analysis.
Conclusion: Results will help both researchers and clinicians interpreting the EDE-Q scores and to establish comparison with data
produced in different countries. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.
Received 13 March 2014; Revised 21 May 2014; Accepted 19 June 2014
Keywords
psychological testing; psychometrics

*Correspondence
Paulo P. P. Machado, PhD, FAED, Escola de Psicologia, Universidade do Minho, Campus de Gualtar Braga, 4710 Portugal. Tel: 351 25 3604240; Fax: 351 25
3606224.
Email: pmachado@psi.uminho.pt

Published online 29 August 2014 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/erv.2318

Introduction Hoek, 2007). In addition, normative data can be used to assess

The Eating Disorder Examination Questionnaire (EDE-Q,
Fairburn & Beglin, 1994) is a widely used self-report measure
of eating disordered behaviour and attitudes and was derived
from the EDE interview (Fairburn & Cooper, 1993). The EDE
is generally considered the instrument of choice for the assess-
ment and diagnosis of eating disorders (ED). Like the EDE,
the EDE-Q has a 28-day time frame, and it asks directly about
the frequency of key eating disorder behaviours, as well as
attitudes towards key features of ED psychopathology such as
restraint, eating concern, shape concern and weight concern.
Its items are based closely on the corresponding questions
from the EDE interview, and it uses the same seven-point
rating scale.
Normative data are essential for the accurate interpretation of
self-report instruments and to its correct use as a screening instru-
ment and/or an outcome monitoring tool. For example, in two-
stage epidemiological studies where a screening tool is used in a
large initial sample, accurate normative data provide a useful
guide to select participants for the second stage (e.g. Machado,
Gonçalves, & Hoek, 2013; Machado, Machado, Gonçalves, &
clinically significant change. To measure individual change, the
criterion of clinical significance proposed by Jacobson and Truax
(1991) is often used. Their criterion posits that (i) the magnitude
of change has to be statistically reliable and (ii) by the end of treat-
ment, patients have a score that falls within the functional range
of symptomatology.
The original version of the EDE-Q has showed good psycho-
metric properties (see, Berg, Peterson, Frazier, & Crow, 2012,
for a review) and is currently available in several languages. How-
ever, EDE-Q scores and norms may vary considerably among
countries and populations. Currently, normative and/or psycho-
metric data for the EDE-Q are available in Australia (Mond,
Hay, Rodgers, & Owen, 2006), USA (Luce, Crowther, & Pole,
2008; Quick & Byrd-Bredbenner, 2013; Rose, Vaewsorn,
Rosseli-Navarra, Wislson, & Weissman, 2013), UK (Carter,
Stewart, & Fairburn, 2001; White, Haycraft, Goodwin, & Meyer,
2013), Sweden (Welch, Birgegård, Parling, & Ghaderi, 2011),
The Netherlands (Aardoom, Dingemans, Landt, & van Furth,
2012), Spain (Villarroel, Penelo, Portell, & Raich, 2009), Greece
(Giovazolis, Tsaounis, & Vallianatou, 2012), Mexico (Penelo,
Negrete, Portell, & Raich, 2013), Germany (Hilbert, de Zwaan,

448 Eur. Eat. Disorders Rev. 22 (2014) 448–453 © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.

P. P. P. Machado et al.
& Braehler, 2012), Norway (Reas, Rǿ, Kapstad, & Lask, 2010) and
Turkey (Yucel et al., 2011).1
The first aim of the current study was to establish general popu-
lation norms for the Portuguese version of the EDE-Q (P-EDE-Q)
in a large community sample of female adolescents and young
women. Normative data will be provided, as well, for a diverse ED
clinical samples [including participants with a diagnosis of anorexia
nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED)
and Eating Disorder Not Otherwise Specified (EDNOS)], and for
women with obesity without an ED. A second aim of the study
was to assess the discriminant validity of the EDE-Q determining
how well the EDE-Q could discriminate participants with and with-
out an ED diagnosis, as well as providing cut-off scores for the total
scale and subscales.
Method
Participants
Two studies were conducted. The first study, from now on re-
ferred to as Study 1, included participants recruited from two
community samples of female adolescents and young women
from the general population. This study aimed at establishing
norms for the Portuguese population. The second study, referred
as Study 2, included female adolescents and young women from
clinical samples. This second study aimed at establishing cut-off
scores and at testing the discriminant validity of the P-EDE-Q.
Study 1: Community sample
Participants were 4091 Portuguese-speaking women from the
North (N = 1214, 29.7%), Centre (N = 1615, 39.5%) and South
(N = 1262, 30.8%) of continental Portugal. These samples were
used in previously reported epidemiological studies. In the first
study, described elsewhere (Machado et al., 2007), a nationally
representative sample of 2028 high school female students from
11 public schools responded to the EDE-Q. The age of the 2028
participants ranged from 12 to 23 years; the mean age was
16.19 years (SD = 1.33), and mean body mass index (BMI) was
20.92 (SD = 3.80). In the second study, (Machado et al., 2013) a
sample of 1020 female university students was screened at stage
1. Most of the students (78%) in this sample were from the North
of the country and the remaining from the South. Both campuses
are part of the public university system and accept students from
all over the country. The age of the 1020 participants, at stage 1,
ranged from 18 to 58 years, mean age was 21.81 years (SD = 4.13)
and mean BMI was 21.99 (SD = 3.39).
Study 2: Clinical sample
Participants in the clinical sample were 416 women who met
Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition (DSM-IV-TR; APA, 2000) criteria for eating disorder.
Forty per cent (N = 167) AN, 26% BN (N = 122), 10% (N = 45)
BED and 18% (N = 82) EDNOS excluding BED. All participants
were recruited in treatment centres with the exception of 118 that
were identified in the community samples used on study 1. In
1
Table S1 provides a comparison of scores and occurrence of eating behaviours
studies of the Eating Disorder Examination Questionnaire in several countries
and language versions.
Eur. Eat. Disorders Rev. 22 (2014) 448–453 © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.
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Portuguese EDE-Q
addition, 138 women seeking obesity treatment were assessed.
These participants had a BMI > 30 and did not meet criteria for
an ED as assessed by the EDE. A staff psychiatrist or a doctoral
level clinical psychology researcher ascertained participants’ eat-
ing disorder diagnosis in a semi-structured interview based on
DSM-IV criteria (APA, 2000).
Table S2 presents the demographics of the community and
clinical samples, including age, weight, height and BMI.
Measures
Eating Disorders Examination Questionnaire (Fairburn & Beglin,
1994) is self-report measure derived from the EDE interview
(Fairburn & Cooper, 1993). The original 36-item version of the
EDE-Q (Fairburn & Beglin, 1994) was used in Study 1, and the
most recent 28-item version (Fairburn & Beglin, 2008) was used
in Study 2. The main difference between the two versions is that
the 36-item version includes questions regarding subjective binge
eating and diuretic misuse, whereas the 28-item version does not.
Both versions include the same 22 items assessing the core fea-
tures of eating disorder psychopathology. Items addressing ED
particularly on behaviours, attitudes or feelings are scored using
a 7-point (i.e. 0–6), forced-choice, rating scheme focusing on
the past 28 days. This instrument generates a global score, which
is the average of his four subscale scores, namely, restraint, eating
concern, shape concern and weight concern. The present studies
used a Portuguese translation of the EDE-Q, which was autho-
rized by the original scale authors.
Procedure
Translation of the Eating Disorder Examination
Questionnaire and Eating Disorder Examination
The P-EDE-Q and the P-EDE were translated and adapted
from the original English version EDE-Q (Fairburn & Beglin,
1994, 2008) and EDE (Fairburn & Cooper, 1993), respectively.
The original versions of the instruments were translated by the
first author (P. P. M). An experienced and fluent bilingual (En-
glish and Portuguese) psychologist then translated the Portuguese
version back into English. We compared the original English
questionnaire with the back-translated one. Identified discrepan-
cies were analysed and adjustments to the Portuguese version
were made when necessary. A preliminary version was checked
and administered to a small group of graduate students, whose
feedback was incorporated in the final Portuguese version.
Students filled in the P-EDE-Q questionnaire in the classroom
setting after their informed consent, and when needed, their par-
ents’ or guardians’ consent was obtained and the confidentiality of
their answers assured. In addition, weight and height were
assessed for all participants and BMI (kg/m2) computed.
Missing data
In order to deal with missing data, we followed Fairburn and
Cooper’s (1993) recommendation on calculations for both the
EDE-Q subscales and the global score. Thus, subscale scores were
calculated when data for more than half of its items were avail-
able, whereas the global score was calculated when scores on more
than half of the four subscales were available.
449
 10990968, 2014, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/erv.2318 by Cochrane Portugal, Wiley Online Library on [20/11/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Portuguese EDE-Q P. P. P. Machado et al.

Statistical analyses Results

The internal consistency reliability of the EDE-Q was measured
with Cronbach’s α coefficients. Norms were provided using de-
scriptive statistics. An exploratory factor analysis (principal com-
ponent analysis) using direct oblimin rotation was conducted to
examine the underlying factor structure of the 22 attitudinal items
of the EDE-Q. To assess the discriminant validity of the P-EDE-Q,
receiver operating characteristic (ROC) analysis was conducted.
For each analysis, we computed area under the curve (AUC).
Finally, using the method suggested by Jacobson and Truax
(1991), normative and clinical data for the EDE-Q were analysed
to provide the reliable change index and cut-off scores for clini-
cally significant change. When change exceeds measurement error
on the basis of the reliability of the P-EDE-Q, this is one of the
two criteria posited by Jacobson and Truax (1991) as indicative
of clinically meaningful change. As reliability index, the internal
consistency of the healthy sample was used, according the sugges-
tions of Tingey, Lambert, Burlingame and Hansen (1996) for
whom the use of internal consistency is more appropriate if we
are measuring change over time. The second criterion requires
movement from a score reflecting a level of functioning that is
closer to the mean of the clinical population to a score that is
closer to the mean of the functional population. The cut-off score
on the P-EDE-Q determining the point at which a score is more
likely to belong the dysfunctional population than a functional
population has been estimated by cut-off C proposed by Jacobson
and Truax (1991). Patients who show reliable change and pass the
cut-off are considered recovered, and those who show reliable
change only in the positive direction are considered as improved.
Missing data
For the attitudinal items, the percentage of missing data ranged
from 0% to 2.4%, and for the behavioural items, the percentage
of missing data ranged from 0.4% to 1.4%. If we include the items
questioning about the number of days that a specific behaviour
occurred, the highest percentage of missing data was 9.4%.
Study 1: Community sample
Internal consistency reliability
Internal consistencies were computed for each of the commu-
nity samples. Cronbach’s alpha for the high school sample was
global score, α = 0.94; restraint, α = 0.79; eating concern,
α = 0.72; shape concern, α = 0.90; and weight concern, α = 0.80.
For the college students’ sample, the internal consistency coeffi-
cients were global score, α = 0.97; restraint, α = 0.92; eating
concern, α = 0.90; shape concern, α = 0.93; and weight concern,
α = 0.84.
Portuguese Eating Disorder Examination Questionnaire
norms
Because of its interest for both research and clinical practice, we
present normative data for the two community samples separately
(high school versus college students), dividing the total sample by
age (i.e. up to 18 years of age versus 18 years or older).
Table 1 presents descriptive data (means and standard
deviations), percentile ranks for the P-EDE-Q Global Score and

Table 1 Mean (SD) scores and corresponding percentile ranks of the Eating Disorder Examination Questionnaire (global score and subscales) in the general
population by sample group (N = 4048)

Global score Restraint Eating concern Shape concern Weight concern

High school College High school College High school College High school College High school College

Mean (SD) 1.32 (1.25) 1.49 (1.50) 0.91 (1.25) 1.36 (1.66) 0.64 (0.95) 1.13 (1.55) 1.84 (1.62) 1.69 (1.68) 1.89 (1.67) 1.89 (1.67)
Percentile rank
5 0.00 0.00 — — — — — — — —
10 0.06 0.03 — — — — 0.00 — — —
15 0.16 0.13 — — — — 0.13 0.00 0.00 —
20 0.25 0.22 — — — — 0.25 0.13 0.25 0.00
25 0.33 0.31 — 0.00 — — 0.50 0.25 0.50 0.25
30 0.43 0.38 — 0.20 — — 0.63 0.38 0.50 0.50
35 0.54 0.49 0.00 0.20 0.00 0.00 0.75 0.50 0.75 0.75
40 0.66 0.60 0.20 0.40 0.20 0.20 1.00 0.63 1.00 0.75
45 0.79 0.73 0.20 0.40 0.20 0.20 1.25 0.88 1.25 1.00
50 0.93 0.87 0.40 0.60 0.20 0.40 1.38 1.00 1.50 1.25
55 1.10 1.08 0.40 0.75 0.20 0.40 1.63 1.25 1.75 1.50
60 1.30 1.31 0.60 1.00 0.40 0.60 2.00 1.63 2.00 2.00
65 1.51 1.63 0.80 1.20 0.60 0.80 2.25 2.00 2.25 2.50
70 1.78 1.95 1.20 1.60 0.60 1.20 2.63 2.38 2.75 3.00
75 2.08 2.35 1.40 2.15 0.80 1.80 2.97 3.00 3.00 3.50
80 2.36 2.93 1.80 2.80 1.20 2.40 3.38 3.88 3.50 3.50
85 2.69 4.01 2.40 3.80 1.40 3.80 4.00 4.00 4.00 3.75
90 3.18 4.08 2.80 4.60 2.00 4.20 4.38 4.25 4.50 4.25
95 3.79 4.50 3.60 5.00 2.80 4.20 5.00 5.00 5.19 5.00
99 4.83 4.93 5.00 5.60 4.20 4.72 5.88 5.38 6.00 5.50

450 Eur. Eat. Disorders Rev. 22 (2014) 448–453 © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.
 10990968, 2014, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/erv.2318 by Cochrane Portugal, Wiley Online Library on [20/11/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
P. P. P. Machado et al. Portuguese EDE-Q

the four subscales for the two general population samples
(high school and college), and Table S3 is provided with norms
for the total sample divided by age group.
Key symptoms and behaviours
Table 2 presents the percentage of women, in the general pop-
ulation by sample group, endorsing any or regular occurrence of
key eating disordered behaviours over the previous 28 days, as
measured by the EDE-Q. Regular occurrence was defined as four
or more occurrences over the previous 28 days (i.e. ≥1 a week)
with the exception of eating restraint and excessive exercise. Reg-
ular occurrence was defined as ≥13 days for dietary restraint and
≥20 days for excessive exercise. Objective binge eating is an epi-
sode characterized by eating large amount of food and sense of
loss of control. In addition to objective binge eating, the EDE also
asks individuals to report the number of episodes over the past
28 days in which loss of control during eating was experienced
without the individual having eaten an objectively large amount
of food, such episodes are considered subjective binge eating
episodes.
Attitudes to shape and weight
Within the high school group, 303 (15.1%) scored in the
clinically relevant range (i.e. EDE-Q score ≥ 4.0) for the Shape
Concern subscale and 323 (16.1%) did it so for the Weight Con-
cern subscale. In addition, 656 (32.8%) stated to have experienced
a strong desire to lose weight on more than a half of the past
28 days. Four hundred and two (19.7%) and 282 (13.8%) college
students had a clinically relevant score in the Shape Concern and
Weight Concern subscales, respectively. Five hundred (24.6%) in-
dicated that they experienced a strong desire to lose weight on
more than a half of the past 28 days.
Study 2: Clinical sample
Factor structure
The factor structure of the EDE-Q was examined using the
clinical sample. The exploratory factorial analysis produced three
factors explaining 63.27% of the variance. The three factors did
not reproduce the theoretical four subscales (Table S4). The first
factor included five items of the Shape Concern and four items
of the Weight Concern subscale. The second factor included four
items of the Restraint subscale, two items of the Shape Concern
subscale and one additional item of Food Concern subscale. The
third factor included four items of the Food Concern scale, one
item of the Shape Concern subscale and one item of the Restraint
subscale.
Discriminant validity of the Portuguese Eating Disorder
Examination Questionnaire
A ROC analysis was used to assess the discriminant validity of
the EDE-Q. We computed the AUC to assess the power of the
P-EDE-Q to discriminate between participants with and without
a diagnosis of eating disorders. The ROC analysis showed an
AUC of 0.83 (95% CI = 0.81–0.85). This result suggests that the
EDE-Q has a good discriminant power and that there is 83% like-
lihood that a randomly selected individual from the ED group
would score higher on the EDE-Q than a randomly selected one
from the community sample.
Clinical significance and reliable change
To measure significant clinical change, the cut-off score and
the reliable change index were computed using formula C pro-
posed by Jacobson and Truax (1991). The estimation of the cut-
off scores was calculated as 2.12 for the global score and 1.49,
1.37, 2.63 and 2.12, respectively, for the Restraint, Eating
Concern, Weight Concern and Shape Concern subscales. When
a patient’s score falls at or below a total score of 2.12, it is con-
cluded that his or her functioning is more similar to that of
nonpatients than of patients at that time.
The reliable change indices were calculated as 0.83 points for
the global score and 1.59, 1.39, 2.07 and 1.42, respectively, for
the Restraint, Eating Concern, Weight Concern and Shape Con-
cern subscales. Individuals who change in a positive or negative
direction by at least 0.83 points at the global scale are regarded
as having made reliable change.
Discussion
To our knowledge, this is the first study to provide norms for the
Portuguese version of the EDE-Q using a large community sam-
ple as well as a diverse clinical sample, including patients with
AN, BN, BED, EDNOS and obesity without ED.

Table 2 Proportion of women, in the general population by sample group, endorsing any or regular occurrence of key eating disordered behaviours over the
previous 28 days, as measured by the Eating Disorder Examination Questionnaire

Any occurrence (%) Regular occurrence (%)

High school (N = 2024) College (N = 2067) High school (N = 2024) College (N = 2067)

Objective binge eating episodes 15.8 27.2 5.8 1.9

Subjective binge eating episodes 24.8 27.7 9.3 4.8
Self-induced vomiting 2.9 7.8 0.9 2.7
Laxative misuse 1.6 3.1 0.9 0.8
Diuretic misuse 1.8 4.1 1.0 1.5
Dietary restraint 14.8 24.0 4.9 17.6
Excessive exercise 12.9 15.0 2.0 0.3

Note: Regular occurrence is defined as ≥4 over the previous 28 days (i.e. at least once a week), with the exception of dietary restraint (≥13 days) and excessive exercise
(≥20 days).

Eur. Eat. Disorders Rev. 22 (2014) 448–453 © 2014 John Wiley & Sons, Ltd and Eating Disorders Association. 451
 10990968, 2014, 6, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/erv.2318 by Cochrane Portugal, Wiley Online Library on [20/11/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Portuguese EDE-Q P. P. P. Machado et al.

The results of the present study revealed that the four subscales
of the EDE-Q have excellent internal consistency. Thus, consider-
ing these results and those of previous studies (Fairburn & Beglin,
1994; Luce & Crowther, 1999), the P-EDE-Q appears to have ad-
equate psychometrical properties and therefore to be an appropri-
ate self-report measure for the screening of ED in Portuguese
research and clinical settings. Further, the results of the current
study support the reliability and clinical usefulness of the
Portuguese version of EDE-Q. The younger community sample
appears to have shown less internal consistency compared with
older participants, although, still in a very good level, this fact
might suggest that the EDE-Q is better suited to older subjects
than to younger ones.
Norms were established for both P-EDE-Q global score and
subscales, and the frequency of disturbed eating behaviours. Data
were provided for both community and clinical samples. These
norms can now be used in both clinical settings and research
studies, not only interpreting the meaning of P-EDE-Q scores
but also in determining its clinical significance using the statisti-
cally derived cut-off scores. Effects of treatment can be compared
with the index of reliable change facilitating clinical decisions
about the impact of treatment. In addition, this study provided
evidence for the power of the P-EDE-Q in discriminating individ-
uals with and without an ED.
Although there is same variation across countries and samples,
these tend to be less marked when analysing results from similar
samples (e.g. college students). The P-EDE-Q global scores and
frequencies of key eating behaviours for community samples in
the current study appear similar to those reported for other coun-
tries and language versions. The P-EDE-Q global scores for our
clinical samples appear somewhat lower than those reported in
other studies (e.g. Aardoom et al., 2012). This last result might
be an artefact of heterogeneous clinical samples across studies
(e.g. severity and treatment setting). Another interesting finding
is the fact that patients with an AN diagnosis tend to score lowest
than those with BN and BED. This finding should be considered
when assessing cases of AN in the community. Our study found
a lower cut-off score than previous studies (e.g. Mond et al.,
2008); this might be due to heterogeneity in the clinical sample.
The current study did not provide support for the theoretical
four-factor structure of the EDE-Q (Fairburn & Beglin, 1994),
and this finding is consistent with the other ones (e.g. Aardoom
et al., 2012; White et al., 2013).
The main strength of the study is its big sample size and the
representativeness of the samples of adolescent women from the
whole Portuguese continental territory. Another strength is the
extent to which the sample comprises a wide age range permitting
that the obtained norms may be applied to full age range of
adolescence.
However, results of this study should consider some limita-
tions. Norms should be interpreted carefully, given that levels of
ED psychopathology vary from sample to sample. Furthermore,
although the high school sample is representative of the country’s
population, the college sample is not. In addition the clinical sam-
ple was a convenience one recruited from a limited number of
clinical sites, most of the recruited patients were undergoing
outpatient treatment, and this might have excluded the most se-
vere cases. A further limitation of this study was the fact that it
was restricted to women, and these results cannot be generalized
to men.
Acknowledgements
This research was partially supported by a Fundação para a
Ciência e a Tecnologia (FCT)/Foundation for Science and
Technology, Portugal research grant to the first author (PTDC/
PSI-PCL/099981/2008).

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