The Eating Disorder Assessment for DSM-5 (EDA-5): Development and Validation of a Structured Interview for Feeding and Eating Disorders

A number of interview-based assessment tools are available to assign DSM-IV1 eating disorder diagnoses. Commonly used measures in research studies include the Eating Disorder Examination (EDE2) and the Structured Clinical Interview for DSM-IV (SCID-IV3). However, these measures have limitations. For example, although the DSM-IV criteria for anorexia nervosa (AN) include disturbances in the experience of body weight or shape and a lack of recognition of the seriousness of low weight (Criterion C), these features are not evaluated by the EDE4. Further, diagnostic agreement using DSM-IV assessment interviews is variable. For example, using the standards described by Landis and Koch (19775), kappa statistics for the diagnosis of AN are moderate for the interviewer-based EDE in comparison to self-report (κ=0.566). Moderate to substantial agreement has been observed for AN (κ=0.68) and for eating disorder not otherwise specified (κ=0.60), with higher agreement for bulimia nervosa (BN; κ=0.83) between clinician interview and SCID-IV7. Taken together, these findings suggest that the current diagnostic instruments provide an incomplete assessment of DSM-IV eating disorder criteria and have inconsistent reliability estimates across diagnoses. In addition, with the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-58), the category of feeding and eating disorders has been revised. Both modest (e.g., reducing the frequency of binge eating and/or purging behaviors for the diagnosis of BN), and major (e.g., merging feeding and eating disorders into one category; designating binge eating disorder (BED) and avoidant/restrictive food intake disorder (ARFID) as formal diagnostic categories) changes were made from earlier versions of the DSM. Given the limitations of the existing measures for DSM-IV eating disorder diagnoses, and the differences between DSM-IV and DSM-5 diagnostic criteria for feeding and eating disorders, new diagnostic assessment tools are needed. In constructing a new diagnostic instrument, we elected to develop an interview-based instrument for feeding and eating disorders that aimed to reduce participant and staff burden in research settings with a focused diagnostic evaluation that did not also assess related psychopathology. Such a measure might also be helpful in non-research settings to assist in determining if an individual’s symptoms meet DSM-5 criteria. Thus, we created a semi-structured interview for feeding and eating disorder diagnosis, the Eating Disorders Assessment for DSM-5 (EDA-5). Two studies, described below, evaluated the initial psychometric properties of the EDA-5. Study 1 evaluated the diagnostic validity of the EDA-5 relative to the EDE, the test-retest reliability of diagnoses generated by the EDA-5, and the acceptability of the measure. Study 2 used an electronic application (“app”) of the EDA-5 and examined the diagnostic validity of the EDA-5 to an unstructured clinician interview and a self-report diagnostic measure. Study 2 also examined group differences between diagnostic groups identified by the EDA-5 on two self-report measures of eating disorder psychopathology.