The clinical impairment assessment questionnaire: validation in Italian patients with eating disorders
The Clinical Impairment Assessment (CIA) is a measure of functional impairment secondary to eating disorder symptoms.
The aim of this study was to examine the psychometric proprieties of the Italian-language version of the CIA.
The tool was translated into Italian and administered to 259 Italian-speaking in- and outpatients with eating disorders and 102 healthy controls. The clinical group also completed the Eating Disorder Examination Questionnaire (EDE-Q) and the Brief Symptom Inventory (BSI).
Confirmatory factor analysis revealed a good fit for the original three-factor structure. Internal consistency was high for both the global CIA and all subscale scores, and test–retest reliability was acceptable. The high correlation between CIA and EDE-Q and BSI confirmed the convergent validity of the instrument. T test indicated higher raw scores on CIA in patients with eating disorders than healthy controls, and a cut-off score of 16 on the CIA discriminated between eating disorder and general psychopathology scores. Finally, global CIA and subscale scores were significantly higher in patients who reported objective bulimic episodes, purging behaviours, and excessive exercising than in those who did not; in underweight than in not-underweight patients, and in inpatients than outpatients, confirming the good known-groups validity of the tool.
Overall, the study showed the good psychometric properties of the Italian version of the CIA, and validated its use in Italian-speaking eating disorder patients.
Level of Evidence
Level V, Descriptive study.
KeywordsEating disorder Validity Psychometric characteristics Factor structure Functional impairment
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Human and Animal rights statement
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.WHOQOL (1995) The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med 41(10):1403–1409Google Scholar
- 6.Adair CE, Marcoux GC, Cram BS, Ewashen CJ, Chafe J, Cassin SE, Pinzon J, Gusella JL, Geller J, Scattolon Y, Fergusson P, Styles L, Brown KE (2007) Development and multi-site validation of a new condition-specific quality of life measure for eating disorders. Health Qual Life Outcomes 5:23. https://doi.org/10.1186/1477-7525-5-23 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Las Hayas C, Quintana JM, Padierna A, Bilbao A, Munoz P, Madrazo A, Urresti B, Cook EF (2006) The new questionnaire health-related quality of life for eating disorders showed good validity and reliability. J Clin Epidemiol 59(2):192–200. https://doi.org/10.1016/j.jclinepi.2005.06.005 CrossRefPubMedGoogle Scholar
- 10.Vannucci A, Kass AE, Sinton MM, Aspen V, Weisman H, Bailey JO, Wilfley DE, Taylor CB (2012) An examination of the clinical impairment assessment among women at high risk for eating disorder onset. Behav Res Ther 50(6):407–414. https://doi.org/10.1016/j.brat.2012.02.009 CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Mahmoodi M, Moloodi R, Ghaderi A, Babai Z, Saleh Z, Alasti H, Naghashian F, Mohammadpour Z (2016) The Persian Version of Eating Disorder Examination Questionnaire and Clinical Impairment Assessment: Norms and Psychometric Properties for Undergraduate Women. Iran J Psychiatry 11(2):67–74PubMedPubMedCentralGoogle Scholar
- 13.Welch E, Birgegard A, Parling T, Ghaderi A (2011) Eating disorder examination questionnaire and clinical impairment assessment questionnaire:general population and clinical norms for young adult women in Sweden. Behav Res Ther 49(2):85–91. https://doi.org/10.1016/j.brat.2010.10.010 CrossRefPubMedGoogle Scholar
- 15.Becker AE, Thomas JJ, Bainivualiku A, Richards L, Navara K, Roberts AL, Gilman SE, Striegel-Moore RH, Group HFS (2010) Validity and reliability of a Fijian translation and adaptation of the Eating Disorder Examination Questionnaire. Int J Eat Disord 43(2):171–178. https://doi.org/10.1002/eat.20675 CrossRefPubMedGoogle Scholar
- 16.Dahlgren CL, Stedal K, Ro O (2017) Eating Disorder Examination Questionnaire (EDE-Q) and Clinical Impairment Assessment(CIA): clinical norms and functional impairment in male and female adults with eating disorders. Nord J Psychiatry 71(4):256–261. https://doi.org/10.1080/08039488.2016.1271452 CrossRefPubMedGoogle Scholar
- 17.American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th Edition (DSM-5™). American Psychiatric Publishing, ArlingtonGoogle Scholar
- 20.Fairburn CG, Beglin SJ (2008) Cognitive behavior therapy and eating disorders. In: Fairburn CG (ed) Eating disorder examination questionnaire (EDE-Q 6.0). Guiford Press, New York, pp 309–313Google Scholar
- 21.Calugi S, Milanese C, Sartirana M, El Ghoch M, Sartori F, Geccherle E, Coppini A, Franchini C, Dalle Grave R (2016) The Eating Disorder Examination Questionnaire: reliability and validity of the Italian version. Eat Weight Disord. https://doi.org/10.1007/s40519-016-0276-6 CrossRefPubMedGoogle Scholar
- 29.Hooper D, Coughlan J, Mullen M (2008) Structural equation modelling: guidelines for determining model fit. Electron J Bus Res Methods 6(1):53–60Google Scholar
- 31.McDonald R (1999) Test theory: a unified treatment. Lawrence Erlbaum Associated, Inc., MahwanGoogle Scholar