RESEARCH ARTICLE

French Adaptation of the Eating Disorder Recovery
Self-Efficacy Questionnaire (EDRSQ): Psychometric
Properties and Conceptual Overview
Stéphanie Couture1*, Serge Lecours1, Genevieve Beaulieu-Pelletier1,
Frederick L. Philippe2 & Irene Strychar3,4
1Département de Psychologie, Université de Montréal, Canada

2

Department of Psychology, McGill University, Montreal, Canada

3Département de Nutrition, Université de Montréal, Canada

4

Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Canada

Abstract
High prevalence of Eating Disorders (EDs) and poor treatment outcome rates have urged research in the assessmentof EDs. Self-efficacy is a key motivational factor in the recovery from EDs. A self-report measure, the Eating Disorder
Recovery Self-Efficacy Questionnaire (EDRSQ), was recently developed to assess confidence in adopting healthyeating behaviours and in maintaining a realistic body image. The objectives of this study were to (a) translate the
EDRSQ to French (EDRSQ-F), (b) assess the psychometric properties of this French version, and (c) establish
normative data for a non-clinical sample. Participants were 203 undergraduate women. They completed the
EDRSQ-F and measures of ED symptoms, depression and self-esteem. A confirmatory factor analysis (CFA) revealed
a bi-factorial structure. Both scales demonstrated evidence of reliability and theoretically consistent evidence ofconstruct validity. Findings support the validity of the EDRSQ-F and suggest it is a useful instrument for theassessment of EDs. Copyright # 2010 John Wiley & Sons, Ltd and Eating Disorders Association.

Keywords
eating disorders; self-efficacy; anorexia nervosa; bulimia nervosa; screening*CorrespondenceStéphanie Couture, Department of Psychology, University of Montreal, C.P. 6128, Succ. Centre-Ville, Montreal, Quebec H3C 3J7, Canada.
Tel: (514) 703-6191. Fax: (514) 343-2285.
Email: stephanie.couture@gmail.com

Published online 1 March 2010 in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/erv.996

Introduction
Eating disorders (EDs), both clinical and subclinical,
have become an important public health issue (Chavez& Insel, 2007; Park, 2007). Prevalence rates as high as
13% have been reported for clinical EDs (Johnson,
Cohen, Kasen, & Brook, 2006). Moreover, subclinicaleating disorders might affect as much as 61% of thecollege female population (Gutzwiller, Oliver, & Katz,
2003). It is also known that subclinical EDs tend to234

progress towards clinical EDs (Patton, Johnson-Sabine,
Wood, Mann, & Wakeling, 1990). In fact, some authors
conceptualize EDs as a continuum ranging from theabsence of symptoms to full-blown clinical disorders,
including various intensities of purgative and restrictive
symptoms (e.g. Mazzeo & Espelage, 2002). Therefore, it
has been recommended to screen and initiate treatments for those who are affected by subclinical ED
because the mere presence of these symptoms is preoccupying (Ackard, Fulkerson, & Neumark-Sztainer,

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S. Couture et al.

2007). Moreover, an early treatment initiation has
been recognized as a powerful positive prognostic
factor (Rosen, 2003). These findings support theimportance of a thorough screening process for atrisk populations.
Also, EDs are chronic psychiatric disorders that are
further complicated by relapse rates as high as one thirdand persistent subthreshold symptoms (Eckert, Halmi,
Marchi, Grove, & Crosby, 1995; Herzog et al., 1999). As
many as 20% of those treated will even continue to meetclinical levels of pathology (Keel & Mitchell, 1997).
Given the chronicity of EDs and their resistance totreatment, the National Institute of Mental Health has
urged researchers to identify new treatment targets thatare derived from studies that focus on premorbid traits
and traits that persist through the illness and after
recovery (Chavez & Insel, 2007). Some authors havesuggested that motivational factors might be important
premorbid personality traits that contribute to theonset and maintenance of EDs (Pinto, Guarda,
Heinberg, & DiClemente, 2006; Rieger et al., 2000;
Vitousek, Watson, & Wilson, 1998). Thus, the screening scope needs to be larger than the sole assessment ofsymptoms to include motivational factors. One ofthem, the concept of self-efficacy, is considered to be a
key factor in EDs and is described as one’s confidence inbeing able to carry out a behaviour in order to produce
a desired result (Bandura, 1997). In clinical ED
populations, self-efficacy appeared to be an important
predictor of recovery (Goodrick, Pendleton, Kimball,
Carlos Poston, Reeves, & Foreyt, 1999; Linde et al.,
2004; Stotland, Zuroff, & Roy, 1991; Wilson, Fairburn,Agras, Walsh, & Kraemer, 2002). Very few self-efficacy
studies focused on bulimia and even less pertained toanorexia or sub-clinical EDs. Studies pertaining toeating self-efficacy in sub-clinical populations suggested
that self-efficacy is an important motivational factor
implicated in EDs (Bardone-Cone, Abramson, Vohs,
Heatherton, & Joiner, 2006; Berman, 2006). However,
the measurement of eating self-efficacy remains
problematic. The studies cited previously either usedgeneral self-efficacy instruments or questionnaires
assessing binge eating and overeating that neglected
the restrictive manifestations of the ED spectrum. It
appears crucial to determine if self-efficacy is as
important in the restrictive manifestations as it is at
the binging and purging end of the spectrum. Since selfefficacy is thought to be specific, its measure must
pertain to the problematic behaviours.

French Adaptation of the EDRSQ

A recent article reported the creation and validationof an instrument measuring the confidence in one’s
ability to adopt healthy eating habits in the context ofrecovery from EDs. The Eating Disorder Recovery SelfEfficacy Questionnaire (EDRSQ; Pinto et al., 2006) isdesigned to include all manifestations of the spectrumof clinical and sub-clinical EDs. It is composed of two
scales, Normative Eating Self-Efficacy (NESE) and Body
Image Self-Efficacy (BISE). The NESE scale measuresthe confidence in the ability to adopt healthy eating
habits without becoming anxious and without restricting, bingeing, purging and exercising excessively. The
BISE scale measures the confidence in the ability tomaintain a realistic body image that is not overshadowed by an unhealthy drive for thinness.
The EDRSQ was validated with 116 individuals
suffering from ED, 10% of them being in partial
remission. The instrument presented interesting psychometric properties. Moderate to high negative
correlations were found between the EDRSQ scoresand ED indicators, demonstrating convergent evidenceof validity. In a second study, Pinto, Heinberg,
Coughlin, Fava, and Guarda (2008) tested thepredictive validity of the EDRSQ among 104 underweight female inpatients. They found that patients’EDRSQ score at admission was positively related toweight regain and negatively related to higher scores on
the Eating Disorder Inventory 2 (EDI-2; Garner, 1991)
subscales and to the length of hospital stay. Statedotherwise, the less self-efficacy the patient displayed, theless weight she gained, the more she was symptomaticon the EDI-2 and the longer she remained hospitalized.
The EDRSQ thus appears to be a good predictor ofoutcome of EDs. It appears to be a useful contribution
to a more thorough documentation of the clinicalpicture of those affected during the assessment stage.
Moreover, it is the only validated measure of eating
disorder recovery self-efficacy that can be used for thefull spectrum of EDs. However, the EDRSQ has only
been validated in a clinical setting and its authors
recommend establishing its psychometric properties in
non-clinical populations.
The French-speaking population is currently affectedby a high prevalence of EDs (e.g. Basdevant, Pouillon,
Lahlou, Le Barzic, Brillant, & Guy-Grand, 1995) and theleaders of these communities have recently acknowledged the importance of taking action towards thisproblem. A thorough assessment of EDs, including an
index of motivation for behaviour change such as theEur. Eat. Disorders Rev. 18 (2010) 234–243 ß 2010 John Wiley & Sons, Ltd and Eating Disorders Association.

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French Adaptation of the EDRSQS. Couture et al.

EDRSQ, is required to tailor existing treatments to theneeds of those affected. Therefore, the present study’s
objectives were threefold: (a) to translate the EDRSQ to
French (EDRSQ-F), (b) to assess the psychometricproperties of the French version and (c) to establish
normative data for a non-clinical sample.

MethodParticipants and procedure
The translation of the EDRSQ was done according to
the method described by Vallerand (1989). First, twobilingual contributors translated the EDRSQ to French,
producing two parallel French versions of the EDRSQ.
Then, both versions were back-translated into English
by two other contributors. The similarity between theoriginal English questionnaire and the back-translated
English versions is a marker of the quality of theintermediary French version. Subsequently, a committee evaluated both French versions according to theirreadability and concordance with the original version.
For four of the 23 items, the committee members had adivergence of opinion and discussion was held until aconsensus was reached. Finally, the committee decided
upon a final version of the EDRSQ-F. The committee
was composed of three graduate students, a professor of
Nutrition and a professor of Psychology.
Participants were recruited on a voluntary basis
during an undergraduate psychology course and wereasked to complete the EDRSQ-F and other questionnaires. They were assured that all their responses would
remain confidential and anonymous. No incentives
were provided to the participants. The only inclusion
criteria were to be a female and to be over 18 years ofage. The participants were informed of the study andthen signed a consent form.
Participants were 203 undergraduate female students
at a French-Canadian university with a mean age of 21.8
years (SD ¼ 3.9). The mean Body Mass Index (BMI)
was 21.7 kg/m2 (SD ¼ 3.4). A slightly larger than
expected proportion of the sample was underweight,
since 12% had a BMI lower than 18.5 kg/m2, comparedto the population estimate of 3.9% for Canadian
women (Statistics Canada, 2005). Table 1 provides
further details on demographic characteristics of thesample. The majority of the participants completed
the questionnaires in the classroom. When this option
was not possible, they were asked to complete thequestionnaires at home (n ¼ 53). There were no236

Table 1 Participant demographics
Characteristics

Distribution (%)

Ethnicity
CaucasianAfro-American
LatinoArab
AsianMarital status
SingleMarriedLiving with someone
Widowed or divorced
Annual earning
0–10 k
10–20 k20–30 k30 and more
BMI (kg/m2)
Less than 18.5
18.5–24.9
25–29.9
Over 30

84.2
3.0
1.5
5.4
5.0
78.0
3.5
17.5
1.0
63.5
26.0
7.5
3.0
11.8
75.9
8.9
3.4

k ¼ 1000; BMI ¼ Body Mass Index; kg/m2 ¼ kilogram by square
meter.

differences pertaining to demographics, weight, BMI,
self-efficacy, self-esteem and ED symptomatology
between those who completed the questionnaires in
the classroom and those who completed them at home.
However, the participants who completed the questionnaires at home were slightly older than those whocompleted them in the classroom (t(199) ¼ 2.418,
p < .05). Two weeks later, the participants were asked
to complete the EDRSQ-F a second time to establish
the test–retest reliability.

Measures
Demographic information
Basic demographic information included age, ethnicity, education, marital status, revenue, weight andheight.
Eating Disorder Recovery Self-Efficacy
Questionnaire-French (EDRSQ-F)
The French version of the EDRSQ (Pinto et al., 2006)
was used to assess participants’ confidence in theiraptitude to adopt or maintain healthy eating habits andEur. Eat. Disorders Rev. 18 (2010) 234–243 ß 2010 John Wiley & Sons, Ltd and Eating Disorders Association.

S. Couture et al.

attitudes. The EDRSQ is composed of 23 items grouped
in two scales, NESE and BISE. NESE measures theconfidence in the ability to normalize one’s eating
behaviours in different contexts and to refrain fromrisky eating behaviours such as restricting, binging,
purging and exercising excessively. The NESE scale iscomposed of 14 items and an item example is ‘I can eat
a cheeseburger without compensating by restricting,exercising excessively or purging’. BISE measures theconfidence in the ability to base one’s self-esteem onother aspects than weight and to maintain a realistic
body image that is not overshadowed by an unhealthy
drive for thinness. The BISE scale is composed of nine
items and an item example is ‘I can look at my stomachor thighs without wondering if I’ve gained or lost
weight’. Items are rated on a five-point scale ranging
from 1 (Not at all confident) to 5 (Extremely confident).
The original article used both scales separately and did
not provide data pertaining to a total score for the
EDRSQ.
Beck Depression Inventory (BDI)
Depressive symptoms were established to assess theexternal construct validity of the EDRSQ-F. The BDI isa valid and reliable self-report measure of depressive
symptoms (Beck & Steer, 1987; Beck, Steer, & Garbin,
1988; Beck, Ward, Mendelson, Mock, & Erbaugh,1961). In this study, the French version of the BDI wasused (Bourque & Beaudette, 1982) and the internalconsistency was .85. Based on clinical assumptions, thecorrelation with both scales of the EDRSQ was expected
to be moderate and negative, of a predicted magnitudeof .40. However, in the original English validation of
the NESE and BISE scales, these correlations wereslightly higher (.57 and .62, respectively).
Eating Attitude Test-26 (EAT-26)
Behavioural symptoms of eating disorders wereassessed with the EAT-26 (Garner, Olmsted, Bohr, &Garfinkel, 1982). This scale was included in this study inorder to provide convergent validity for the EDRSQ-F.
The EAT-26 is a widely used scale that has demonstrated strong evidence of validity in the measure of ED
behavioural symptoms (e.g. Garner et al., 1982). The
French version was used (Carrot, Lang, Estour, Pellet,
Gauthey, & Wagon, 1987; Leichner, Steiger, PuentesNeuman, Perreault, & Gottheil, 1994). In this study,
the internal consistency of the EAT-26 was .89. The

French Adaptation of the EDRSQ

correlation with both scales of the EDRSQ-F was
expected to be strong and negative, with a predicted
magnitude of .70, based on correlations with other
ED measures found in the original validation of the
EDRSQ.

Eating Disorder Inventory-2 (EDI-2)
Psychological symptoms of eating disorders wereassessed using the EDI-2 (Garner, 1991) to provide
evidence of convergent, divergent and external construct validity for the EDRSQ-F. The EDI-2 is a widelyused self-report instrument composed of 11 scales
designed to assess different aspects of EDs. Participantsin this study completed four EDI-2 scales in order toassess the construct validity of the EDRSQ-F. First,
participants completed the Drive for Thinness andBody Dissatisfaction subscales in order to assess theconvergent validity of the EDRSQ-F. These two
subscales measure respectively attitudes and behaviours
towards the pursuit of thinness and body image. Basedon the English validation of the EDRSQ, for the NESE
scale, the respective expected correlations with thesetwo EDI-2 scales were .70 and .60. For the BISE, therespective expected correlations with the EDI-2 scales
were .70 and .80. Therefore, there was a predicteddifference between the two scales of the EDRSQ (NESE
and BISE) for the Body Dissatisfaction scale of the EDI2. A negative correlation of a greater magnitude is to be
expected with the BISE scale since it measures theconfidence in the ability to have low levels of body
dissatisfaction. Second, participants completed the
Maturity Fears subscale to assess the divergent validityof the EDRSQ-F since this subscale measures a moregeneral characteristic of ED patients that is not
associated with ED symptoms. Based on the English
validation of the EDRSQ, the expected correlation withboth scales of the EDRSQ was expected to be small andnegative (.20). Third, participants completed the
Ineffectiveness subscale of the EDI-2 in order to further
assess the external construct validity of the EDRSQ. The
Ineffectiveness subscale was created to measure Bruch’s(1962; 1973; 1978) ineffectiveness construct, described
as a general and pervading feeling of helplessness,
emptiness and a sense of not being in control of one’s
needs, behaviours and impulses, as though the person’s
body did not belong to herself (Garner, Garfinkel,
Stancer, & Moldofsky, 1976). In the original validation,
the Ineffectiveness subscale of the EDI-2 was not

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French Adaptation of the EDRSQS. Couture et al.

assessed. Based on clinical assumptions, we hypothesized that the ineffectiveness and self-efficacy concepts
would be related yet distinct. We hypothesized that thecorrelation between both EDRSQ scales and thissubscale would be of .40. The French version of the
EDI-2 was used in this study (Archinard, Rouget,
Painot, & Liengme, 2002). The internal consistency of
the Drive for Thinness and Body Dissatisfaction
subscales was .89 and .92, respectively. The internalconsistency of the Maturity Fears and Ineffectivenesssubscales was .83 and .84, respectively.

by Westen and Rosenthal (2003) was calculated toprovide a summary index of the overall constructvalidity of the EDRSQ-F. The index is called r alertingCV.
It is calculated using a correlation between (a) the
pattern of predicted correlations between the EDRSQ-F
and the other questionnaires and (b) the pattern ofcorrelations actually obtained. All tests of significancewere based on a set at .05.

Rosenberg Self-Esteem Scale (RSE)The original version of the EDRSQ was created toaccount for two important aspects of eating disorder
recovery self-efficacy: NESE and BISE. The twoconstructs were thought to be different, yet associated.
In order to test this model, a CFA was conducted. The
model was composed of two latent variables (NESE and
BISE) each with 14 and nine observed variables,
respectively. The covariance matrix served as the
database for the CFA and the method of estimation
was Maximum Likelihood. The analysis confirmed thebi-factorial structure of the EDRSQ-F. The x2/df ratio
was in an acceptable range (x2 (df ¼ 223,
N ¼ 203) ¼ 429.94, p < .001; x2/df ¼ 1.93) and otherfit indices were adequate: Normed Fit Index(NFI) ¼ .97; Non-Normed Fit Index (NNFI) ¼ .99,
Comparative Fit Index (CFI) ¼ .99, Root Mean Square
Error of Approximation (RMSEA) ¼ .068 [.058; .077]
and Standardized Root Mean Residual (SRMR) ¼ .048.
All loadings ranged from .50 to .89. Since both latentvariables were correlated (r ¼ .78), a one-factor
structure was tested and was deemed inadequate(RMSEA ¼ .110 [.103; .120]; x2 (df ¼ 224, N ¼ 203) ¼
783.56, p < .001; NC (x2/df) ¼ 3.50; Dx2 ¼ 353.62).
These results suggest that the bi-factorial model should
be preferred.

The RSE (Rosenberg, 1965) is a well-establishedmeasure of self-esteem (Rosenberg, 1965). The French
version (Vallières & Vallerand, 1990) was used in thisstudy to assess the external construct validity of the
EDRSQ-F since self-esteem is a construct related to, yetdifferent, from self-efficacy. The correlation with bothscales of the EDRSQ was expected to be positive andmoderate (.40). The internal consistency in this study
was .87.

Statistical analyses
First, to document the factor structure of the EDRSQ-F,
a confirmatory factor analysis (CFA) was conductedusing LISREL 8 (Jöreskog and Sörbom, 2003). The
other analyses were performed with SPSS 13.0 for Mac
OS.X (SPSS, Chicago, IL). Student’s t-tests forindependent samples were used to determine if there
were differences on the scores obtained by those whocompleted the questionnaires within classroom sessions
and those who completed them at home. The internalconsistency of the EDRSQ-F scales and other questionnaires was evaluated using Cronbach a coefficients.
The relationship between the two administrations of
the EDRSQ-F (test–retest reliability) was calculated forthe two scales using Pearson product moment
correlations. Student’s t-tests for independent samples
were used to determine if the mean scores on NESE andBISE were different in our group of non-clinicalparticipants compared to the clinical and remission
groups presented in the original validation study (Pinto
et al., 2006). Relationships among EDRSQ-F scales andthe other questionnaires used to assess convergent,
divergent and external construct validity were evaluatedusing Pearson product moment correlations. Moreover, an index of construct validity recently proposed
238

Results
Confirmatory factor analysis

Internal consistency and reliability
The two scales of the EDRSQ-F, NESE and BISE
demonstrated good internal consistency reliability. The
Cronbach’s a coefficients for NESE and BISE were .96
and .91, respectively. In the original English version of
the EDRSQ, the Cronbach a coefficient for both scales
was very similar (.97 for NESE and .95 for BISE).
Test–retest reliability was also calculated for bothscales of the EDRSQ-F and was found to be excellent.
For NESE and BISE respectively, the correlations

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S. Couture et al.

between both administrations were .91 ( p < .01) and.89 ( p < .01) for the 2-week interval.

French Adaptation of the EDRSQTable 2 Intercorrelations among original and French EDRSQ scales
and convergent, divergent and external construct validity measures
EDRSQ
NESE

Group means on EDRSQ-F scales
Since there are no existing normative values for a nonclinical population for the EDRSQ, we calculated amean score and a standard deviation for both NESE andBISE scales. Given the EDRSQ scoring range is from 1 to5, so is the mean score for each scale, with a higher scorereflecting a higher level of self-efficacy. In our sample,
the mean scores for NESE and BISE were 4.3 (SD ¼ 0.8)
and 3.4 (SD ¼ 0.8), respectively. In the original English
validation, participants either met full criteria of ED or
were in partial remission. For the clinical group, themean score for the NESE scale was 2.2 (SD ¼ 1.0),
which is statistically different from our sample(t(272) ¼ 17.79, p < .0001). For the partial remission
group, the mean NESE score was 2.8 (SD ¼ 1.1), whichis also statistically different from our group(t(213) ¼ 6.1710, p < .0001). For the BISE scale, themean score for the clinical group was 2.0 (SD ¼ 0.9),(t(272) ¼ 11.2820, p < .0001) and it was 2.3 (SD ¼ 1.0)(t(213) ¼ 4.0894, p < .0001) for the partial remission
group. Therefore, the non-clinical group demonstrated
a significatively higher level of eating self-efficacy thanthe clinical and partial remission group.

BISE

EDRSQ-F
NESE

BISE

Convergent validity
EDI-2 Drive for Thinness
.71 .69 .77 .68
EDI-2 Body dissatisfaction
.61 .76 .61 .75
EAT-26y——.77 .59
Divergent validity
EDI-2 Maturity Fears
.30 .26 .29 .28
External construct validity——.35 .45
Rosenberg Self-Esteem Scaley
Beck Depression Inventory
.57 .62 .37 .42
EDI-2 Ineffectivenessy——.44 .49
EDRSQ ¼ Eating Disorder Recovery Self-Efficacy Questionnaire;
EDRSQ-F ¼ Eating Disorder Recovery Self-Efficacy Questionnaire—
French; NESE ¼ Normative Eating Self-Efficacy; BISE ¼ Body Image
Self-Efficacy; EDI-2 ¼ Eating Disorder Inventory-2; EAT-26 ¼ Eating
Attitude Test-26.
y
In the original English validation of the EDRSQ, data pertaining to
the EDI-2 Ineffectiveness subscale, Eat-26 and Rosenberg SelfEsteem Scale are unavailable.
p < .01.

Divergent validity
Correlations between the EDRSQ scales and EDI-2
Maturity Fears subscale are presented in Table 2. The
relation was small to moderate for both versions of the
EDRSQ, thus providing good support for the divergent
validity of the EDRSQ.

Validity
Convergent validity

External construct validity

The NESE and BISE scales were positively correlated,r (203) ¼ .74, p < .001 in our sample. This correlation isslightly weaker than the correlation between the scales
found in the original validation, where r (114) ¼ .81,
p < .001. Table 2 presents the correlations between thetwo scales of the EDRSQ-F and measures of eating
pathology, namely the Drive for Thinness and Body
Dissatisfaction subscales of the EDI-2 and the EAT-26.
Correlations between the EDRSQ-F scales and thepathological measures were large and negative. Data
from the validation of the original English version are
also presented in Table 2. Results tend to be similar forboth versions of the EDRSQ. Furthermore, themagnitude of the association between BISE and the
Body Dissatisfaction subscale is greater than for NESE
in both versions of the EDRSQ. These results provide
additional support for the convergent validity of the
EDRSQ scales.

Correlations between the EDRSQ scales and BDI,
Ineffectiveness and RSE are presented in Table 2. The
correlation between both EDRSQ scales and BDI is
negative and small to moderate, suggesting that amore depressed mood is associated with a lower level ofself-efficacy. In addition, both scales of the EDRSQ-F
and the EDI-2 Ineffectiveness subscale were negatively
and moderately correlated, suggesting that a greater
eating self-efficacy is associated with a lower senseof ineffectiveness. Moreover, both EDRSQ-F subscales
are positively associated with RSE, with a relation ofsmall to moderate magnitude, suggesting that a greater
self-esteem is associated with a greater eating selfefficacy.
Overall construct validity of the EDRSQ-F
An index of overall construct validity was proposedby Westen and Rosenthal (2003). This statistical tool

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French Adaptation of the EDRSQS. Couture et al.

provides an overall index of construct validity thatis readily interpretable as a Pearson correlation. For
both NESE and BISE scales, r alertingCV was .99 and.98, respectively. This result indicates a very highconvergence between the calculated and expected
correlations between the EDRSQ-F and the otherquestionnaires, thus indicating an excellent overall
construct validity.

Discussion
The purposes of the present study were to adapt the
EDRSQ for the French-speaking population and toevaluate its psychometric properties in a non-clinicalsample. A number of findings emerged. First, theFrench version of the EDRSQ fits a bi-factorial structure
identical to the one of the original English version.
Second, results suggest that the French version of the
EDRSQ is a reliable self-report instrument since bothsubscales demonstrate excellent test–retest reliability
and excellent internal consistency. Third, both EDRSQF scales show evidence of good construct validity
because their relationships with related constructs are
consistent with what was theoretically expected. These
correlations are also consistent with those presented
in the original English validation of the EDRSQ,
supporting the quality of the translation. An overall
index of construct validity, r alertingCV (Westen &Rosenthal, 2003) was also calculated and the magnitudeof the correlations for both subscales suggested that our
predicted pattern of correlations provided a very
accurate expectation of the pattern of correlations
actually observed, thus supporting excellent constructvalidity.
A more in depth discussion of construct validity
is important despite the excellent results provided by
the r alertingCV. Convergent validity was demonstrated
through negative and strong correlations with measuresof ED. These correlations indicated that a higher
perceived self-efficacy was associated with less drive forthinness, less body dissatisfaction and fewer behaviours
aimed at losing weight. In addition, although bothEDRSQ-F scales are correlated, it can be assumed thatthey are not redundant and measure different aspects ofself-efficacy in recovery from an ED because of theirpattern of association with different measures of
convergent validity. As expected, BISE shows an
association of a larger magnitude with EDI-2 Body
Dissatisfaction than does NESE. In opposition, NESE
240

shows an association of a greater magnitude with EAT26, a scale measuring cognitive and behavioural efforts
in losing weight. Thus, there seems to be a conceptual
difference between the two dimensions of the EDRSQF, the NESE scale pertaining to the adoption of healthyeating habits and the BISE scale pertaining to themaintenance of a realistic body image that is notovershadowed by body dissatisfaction. Thus, the BISE
and NESE scales provide a unique picture of the
motivation for behaviour change by quantifying two
important and complementary aspects of eating
disorder recovery self-efficacy.
The Maturity Fears of the EDI-2 was used to support
divergent validity of the EDRSQ-F. Indeed, a negativeand small correlation was obtained with both EDRSQ-F
scales, despite a large variance. The construct validity of
the EDRSQ-F was further supported by its relationships
with other related yet distinct constructs. As expected,
both NESE and BISE scales were positively but
moderately correlated with self-esteem. In addition,
both scales showed a negative and small to moderateassociation with depression. This relationship suggeststhat more depressed participants showed lower levels of
self-efficacy. The association between self-efficacy anddepression was to be expected because it has
consistently been found in the ED literature (e.g. Lindeet al., 2004; Pinto et al., 2006) and in the general selfefficacy literature (Bandura, 1992, 2000). However, thisassociation is smaller than the one found in the originalarticle. The population studied could explain thisdiscrepancy. Since the population in the original study
was composed of participants with clinical ED, it islikely that they displayed more pathological scores on
general measures of mental health such as the BDI.
Unfortunately, the original article does not provide
data pertaining to the mean and standard deviation of
the BDI scale. The smaller association found with the
EDRSQ-F might also be caused by a smaller variancesince our sample is likely to be more homogenous.
Finally, a moderate and negative relationship was
found between the EDI-2 Ineffectiveness subscale andboth scales of the EDRSQ-F, suggesting that the feelingof ineffectiveness would be only moderately associatedwith a low level of self-efficacy. This finding supports
prior research indicating that confidence in the ability
to control eating when an abundance of food isavailable was moderately and inversely related toineffectiveness (Berman, 2006). The Ineffectivenesssubscale was first designed to capture Bruch’s concept

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S. Couture et al.

of a general sense of being ineffective (Bruch, 1962,
1973, 1978). In light of the present findings, it would
appear that self-efficacy and effectiveness are notredundant concepts, thus confirming the theoreticalassumption that the two concepts are related yet
distinct.
This study has some limitations. First, the EDRSQ-F
has not been validated in a clinical sample ofparticipants and thus future research should validate
the EDRSQ-F in a clinical ED population. Second,
future research should try to replicate the factorial
structure of the EDRSQ-F with a larger sample size inorder to further support its stability within a different
sample. Third, more research is needed to document
the use of EDRSQ for men. Further research is alsoneeded to deepen our understanding of the role ofeating self-efficacy in the prevention of EDs, magnitude
of symptoms, treatment compliance, as well as successand relapse rates. Nevertheless, this study supports the
EDRSQ as a promising instrument for the field. It is
psychometrically sound and conceptually interesting.
Indeed, it is the only validated instrument measuring
eating disorder recovery self-efficacy that has been
designed for the whole spectrum of presentation of EDs.
The information provided by the NESE and BISE scales
is specific to the behaviours to be changed and draws acomplementary picture of the patient’s eating disorder
recovery self-efficacy. The EDRSQ seems to be a useful
instrument to widen the scope of assessment of EDs toinclude motivational indices influencing behaviouralchange. It seems promising for documenting prognosis,
for monitoring patients’ progress and motivation
during treatment as well as for individualizing existingtreatments. Moreover, in line with the National
Institute of Mental Health’s recommendation, it could
be used to design self-efficacy-based approaches tointervention.

Acknowledgements
This research was sponsored with a grant provided to
the first author by the Fonds Québécois de la Recherche
sur la Société et la Culture. The authors thank Catherine
Senecal and Julie Doyon for their important contribution with the translation of the EDRSQ and Gabrielle
Maliha and Elodie Beroard for their help with the
management of the data set. Finally, they thank KevinJohnson and Dick Johnson for their support and input.

French Adaptation of the EDRSQ

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