A survey of anorexia nervosa using the Arabic version of the EAT-26 and “gold standard” interviews among Omani adolescents

  • S. Al-Adawi
  • A. S. S. Dorvlo
  • D. T. Burke
  • S. Moosa
  • S. Al-Bahlani
Original Research Paper

Abstract

Objective: The purpose of this study was to assess the validity of the Eating Attitude Test (EAT) in identifying the presence and severity of eating pathology in male and female Omani urban adolescents and to establish cut-off scores that matched those of anorexia identified by gold standard interviews without fear of fatness criteria. Methods: Both females (n=126) and males (n=136) were screened using the Arabic version of the EAT- 26 and interviewed using a semi-structured, Composite International Diagnostic Interview (CIDI) in order to investigate the relationship between false positives and false negatives at various EAT-26 cut-off points. A receiver operating characteristics (ROC) curve was calculated to discriminate the power of the EAT-26 for every possible threshold score. Results: The EAT-26 identified 29% of the subjects as probable anorexic cases as against 9.5% identified during the structured interview based on the anorexia gold standard (32% males and 68% females). The sensitivity and specificity of the EAT-26 were respectively 24% and 69.6%. When using the ROC curve, a cut-off score of 10 gave the best compromise between sensitivity (64%) and specificity (38%). Discussion: Although the EAT-26 is the most widely used screening instrument in cross-cultural studies, it does not appear to be reliable in identifying probable cases of anorexia among Omani adolescents. The use of a gold standard interview without fat phobia criteria indicated that the rate of anorexia nervosa may be more prevalent among males than previously estimated. This intriguingly high preponderance of males is discussed in terms of prevailing demographic trends in Oman.

Key words

Test reliability test validity eating attitude test Oman Arab-Islamic 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Nasser M.: Comparative study of the prevalence of abnormal eating attitudes among Arab female students of both London and Cairo Universities. Psychol. Med., 16, 621–625, 1988.CrossRefGoogle Scholar
  2. 2.
    Oyewumi L.K., Kazarian S.: Abnormal eating attitudes among a group of Nigerian youths: 11. Anorexic behaviour. East Afr. Med. J., 69, 667–669, 1992.PubMedGoogle Scholar
  3. 3.
    Soomoro G.M.M., Crisp A.H., Lynch D., Tran D., Joughin N.: Anorexia nervosa in non-white’s populations. Br. J. Psychiatry, 167, 385–389, 1995.CrossRefGoogle Scholar
  4. 4.
    Ford K.A, Dolan B.M., Evans C.: Cultural factors in the eating disorders: a study of body shape preferences of Arab students. J. Psychosom. Res., 34, 501–507, 1990.PubMedCrossRefGoogle Scholar
  5. 5.
    Lee S., Lee A.M., Leung T.: Cross-cultural validity of the eating disorder inventory: A study of Chinese patients with eating disorders in Hong Kong. Int. J. Eat. Disord., 23, 177–188, 1998.PubMedCrossRefGoogle Scholar
  6. 6.
    Al-Subaie A., Al-Shammari S., Bamgboye E., Al-Sabhan K., Al-Shehri S., Bannah A.R.: Validity of the Arabic version of the Eating Attitude Test. Int. J. Eat. Disord., 20, 321–324, 1996.PubMedCrossRefGoogle Scholar
  7. 7.
    Srinivasana T.N., Surest T.R., Jayaram V.: Emergence of eating disorders in India: Study of eating distress syndrome and development of a screening questionnaire. Int. J. Soc. Psychiatry, 44, 189–198, 1998.CrossRefGoogle Scholar
  8. 8.
    Stephens N.M., Schumakeer J.F., Sibiya T.E.: Eating disorders and dieting behaviour among Australian and Swazi university students. J. Soc. Psychol., 139, 153–158, 1999.PubMedCrossRefGoogle Scholar
  9. 9.
    Garner D.M., Garfinkel P.E.: The eating attitude test: an index of the symptoms of anorexia nervosa. Psychol. Med., 9, 273–279, 1979.PubMedCrossRefGoogle Scholar
  10. 10.
    Nasser M.: The psychometric properties of the Eating Attitude Test in a non-Western population. Soc. Psychiatry Psychiatr. Epidemiol., 29, 88–94, 1994.PubMedGoogle Scholar
  11. 11.
    Le-Grange D., Telch C.F., Tibbs J.: Eating attitudes and behaviour in 1,435 South African Caucasian and Non-Caucasian College students. Am. J. Psychiatry, 155, 250–254, 1998.PubMedGoogle Scholar
  12. 12.
    Garfinkel P.E., Newman A.: The eating attitudes test: Twenty-five years later. Eat. Weight Disord., 6, 1–24, 2001.PubMedGoogle Scholar
  13. 13.
    Nasser M.: The validity of the Eating Attitude Test in a non-Western population. Acta Psychiatr. Scand., 73, 109–110, 1986.PubMedCrossRefGoogle Scholar
  14. 14.
    Boyadjieva S., Steinhausen H.C.: The eating attitudes test and the eating disorders inventory in four Bulgarian clinical and nonclinical samples. Int. J. Eat. Disord., 19, 93–98, 1996.PubMedCrossRefGoogle Scholar
  15. 15.
    Lee Y.H, Rhee M.K., Park S.H., Sohn C.H., Chung Y.C., Hong S.K., Lee B.K., Chang P., Yoon A.R.: Epidemiology of eating disordered symptoms in the Korean general population using a Korean version of the Eating Attitudes Test. Eat. Weight Disord., 3, 153–161, 1998.PubMedGoogle Scholar
  16. 16.
    Dunn G. Pickles A., Tansella M., Vazquez-Barquero J.L.: Two-phase epidemiological surveys in psychiatric research. Br. J. Psychiatry, 174, 95–100, 1999.PubMedCrossRefGoogle Scholar
  17. 17.
    Choudry I.Y., Mumford D.B.: A pilot-study of eating disorders in Mirpur (Pakistan) using an Urdu Version of the Eating Attitudes Test. Int. J. Eat. Disord., 11, 243–251, 1992.CrossRefGoogle Scholar
  18. 18.
    Williams P., Hand D., Tarnopolsky A.: The problem of screening for uncommon disorders — a comment on the Eating Attitudes Test. Psychol. Med., 12, 431–434, 1982.PubMedCrossRefGoogle Scholar
  19. 19.
    King B.M., Bhugra D.: Eating disorders: lesson from a cross-cultural study. Psychol. Med., 19, 955–958, 1989.PubMedCrossRefGoogle Scholar
  20. 20.
    Rathner G., Messner K.: Detection of eating disorders; time for a change of emphasis. Psychol. Med., 23, 175–184, 1993.PubMedCrossRefGoogle Scholar
  21. 21.
    Steinhausen H.C., Boyadjieva S., Grigoroiu-Serbanescu M., Seidel R., Metzke C.W.: A transcultural outcome study of adolescent eating disorders. Acta Psychiatr. Scand., 101, 60–66, 2000.PubMedCrossRefGoogle Scholar
  22. 22.
    Littlewood R.: Psychopathology and personal agency: modernity, culture change and eating disorders in south Asian societies. Br. J. Med. Psychol., 68, 45–63, 1995.PubMedCrossRefGoogle Scholar
  23. 23.
    Lee S.: The Diagnostic Interview Schedule and Anorexia-Nervosa in Hong- Kong. Arch. Gen. Psychiatry, 51, 251–252, 1995.CrossRefGoogle Scholar
  24. 24.
    Weiss M.G.: Eating disorders and disordered eating in different cultures. Psychiatr. Clin. North Am., 18, 537–553, 1995.PubMedGoogle Scholar
  25. 25.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed. 4. American Psychiatric Association, Washington, DC., 1994.Google Scholar
  26. 26.
    Mintz L.B., O’Halloran M.S.: The Eating Attitudes Test: Validation with DSM-IV eating disorder criteria. J. Pers. Assess., 74, 489–503, 2000.PubMedCrossRefGoogle Scholar
  27. 27.
    Lee S., Lee A.M.: Disordered eating in three communities of China: a comparative study of female high school students in Hong Kong, Shenzhen, and rural Hunan. Int. J. Eat. Disord., 27, 317–327, 2000.PubMedCrossRefGoogle Scholar
  28. 28.
    Abou-Saleh M.T., Younis Y., Karim L.: Anorexia nervosa in an Arab culture. Int. J. Eat. Disord., 23, 207–212, 1998.PubMedCrossRefGoogle Scholar
  29. 29.
    Fairburn C.G., Beglin S.J.: Studies of the epidemiology of bulimia nervosa. Am. J. Psychiatry, 147, 401–408, 1990.PubMedGoogle Scholar
  30. 30.
    Crisp A.H.: Anorexia nervosa “feeding disorder”, “nervous malnutrition” or “weight phobia”? World Rev. Nutr. Diet., 12, 452–504, 1970.PubMedGoogle Scholar
  31. 31.
    Al-Adawi S., Al-Ismaily S., Martin R., Al-Naamani A., Al-Riyami K., Al-Maskari M., Al-Hussaini A.: Psychosocial aspects of epilepsy in Oman: attitudes of health professionals. Epilepsia, 42, 1476–1481, 2001.PubMedCrossRefGoogle Scholar
  32. 32.
    World Health Organization: Composite International Diagnostic Interview. Geneva, WHO, 1993.Google Scholar
  33. 33.
    Fichter M.M., Herpertz S., Quadflieg N., Herpertz-Dahlmann B.: Structured interview for anorexic and bulimic disorders for DSM-IV and ICD-10: updated (third) revision. Int. J. Eat. Disord., 24, 227–249, 1998.PubMedCrossRefGoogle Scholar
  34. 34.
    Khandelwal S.K., Sharan P., Saxena S.: Eating disorders: an Indian perspective. Int. J. Soc. Psychiatry, 41, 132–146, 1995.PubMedCrossRefGoogle Scholar
  35. 35.
    Lee S., Ho T.P., Hsu L.K.: Fat phobic and non-fat phobic anorexia nervosa: a comparative study of 70 Chinese patients in Hong Kong. Psychol. Med., 23, 999–1017, 1993.PubMedCrossRefGoogle Scholar
  36. 36.
    SPSS Corporation. Statistical Package for Social Sciences. Version 9.0, 1999.Google Scholar
  37. 37.
    Nasser M., Katzman M.A., Gordon R.A.: Eating Disorders and Cultures in Transition. New York, Taylor Francis, 2000.Google Scholar
  38. 38.
    Al-Adawi S., Ghassany H., Al-Naamani A., Al-Sinawi H., Martin G., Chand S.P., Al-Salmi A., Zaidan Z.A.J., Al-Hussaini A.: Sub-clinical eating disorders: preliminary study of students in Muscat. Om. Med. J., 15, 29, 1999.Google Scholar
  39. 39.
    Rieger E., Touyz S.W., Swain T., Beumont P.J.: Cross-cultural research on anorexia nervosa: assumptions regarding the role of body weight. Int. J. Eat. Disord., 29, 205–215, 2001.PubMedCrossRefGoogle Scholar
  40. 40.
    Faraone S.V., Tsuang M.T.: Measuring diagnostic accuracy in the absence of a gold standard. Am. J. Psychiatry, 151, 650–657, 1995.Google Scholar
  41. 41.
    Edreich L., Lee E.: Use of relative operating character analysis in epidemiology. Am. J. Epidemiol., 114, 649–662, 1981.Google Scholar
  42. 42.
    Vandereycken W., Van den Broucke S.: Anorexia nervosa in males. A comparative study of 107 cases reported in the literature (1970 to 1980). Acta Psychiatr. Scand., 70, 447–454, 1984.PubMedCrossRefGoogle Scholar
  43. 43.
    Margo J.L.: Anorexia nervosa in males. A comparison with female patients. Br. J. Psychiatry, 151, 80–83, 1987.PubMedCrossRefGoogle Scholar
  44. 44.
    Strober M., Freeman R., Lampert C., Diamond J., Kaye W.: Males with anorexia nervosa: a controlled study of eating disorders in first-degree relatives. Int. J. Eat. Disord., 29, 26326–26329, 2001.CrossRefGoogle Scholar
  45. 45.
    Statistical YearBook. Sultanate of Oman: Ministry of National Economy, ed. 28. Muscat, Information and Publication Center, 2000.Google Scholar
  46. 46.
    Easterlin R.A.: Birth and Fortune: the Impact of Numbers on Personal Welfare. New York, Basic Books Easter, 1980.Google Scholar
  47. 47.
    Pridham B.R.: The Arab Gulf and the Arab World. London, Croomhelm, 1988.Google Scholar
  48. 48.
    El-Islam M.F.: Cultural change and intergenerational relationships in Arabian families. Int. J. Fam. Psychiatry, 4, 321–328, 1983.Google Scholar
  49. 49.
    Kleinman A., Cohen A.: Psychiatry’s global challenge. Sci. Am., 276, 86–89, 1997.PubMedCrossRefGoogle Scholar
  50. 50.
    Katzman M.A., Lee S.: Beyond body image: the integration of feminist and transcultural theories in the understanding of self-starvation. Int. J. Eat. Disord., 22, 385–395, 1997.PubMedCrossRefGoogle Scholar
  51. 51.
    Chatty D.: Women working in Oman: individual choice and cultural constraints. Middle East Stud., 32, 241–254, 2000.CrossRefGoogle Scholar
  52. 52.
    Al-Adawi S., Salmi A, Martin RG, Ghassani H.: Zar: group distress and healing. Ment. Health. Relig. Cu., 4, 47–61, 2001.Google Scholar
  53. 53.
    DiNicola V.F.: Anorexia multiforme: Selfstarvation in historical and cultural context. Part II: Anorexia nervosa as a culture-reactive syndrome. Transcult. Psychiatry, 27, 245–286, 1990.CrossRefGoogle Scholar
  54. 54.
    Mumford D.B., Whitehouse A.M.: Socio-cultural correlates of eating disorders among Asian school girls in Bradford. Br. J. Psychiatry, 34, 677–688, 1994.Google Scholar
  55. 55.
    Fedoroff I.C., McFarlane T.: Cultural aspects of eating disorders. In: Kazarian S.S., Evans D.R. (Eds.) Cultural clinical psychology: Theory, research and practice. New York, Oxford University Press, 1998, pp. 152–176.Google Scholar
  56. 56.
    Meermann R., Vandereycken W., Napierski C.: Methodological problems of body image research in anorexia nervosa patients. Acta Psychiatr. Belg., 86, 42–51, 1986.Google Scholar
  57. 57.
    Wlodarczyk-Bisaga K., Dolan B.: A two-stage epidemiological study of abnormal eating attitudes and their prospective risk factors in Polish schoolgirls. Psychol. Med., 26, 1021–1032, 1996.PubMedCrossRefGoogle Scholar
  58. 58.
    Fairburn C.G., Cooper Z., Doll H A., Welch S.L.: Risk factors for anorexia nervosa: three integrated case-control comparisons. Arch. Gen. Psychiatry, 56, 468–476, 1999.PubMedCrossRefGoogle Scholar
  59. 59.
    Altug A., Elal G., Slade P., Tekcan A.: The Eating Attitudes Test (EAT) in Turkish university students: relationship with sociodemographic, social and individual variables. Eat. Weight Disord., 5, 152–160, 2000.PubMedGoogle Scholar
  60. 60.
    Thomas K., Ricciardelli L.A., Williams R.J.: Gender traits and self-concept as indicators of problem eating and body dissatisfaction among children. Sex Roles, 43, 441–458, 2000.CrossRefGoogle Scholar
  61. 61.
    Bhugra D., Bhui K., Gupta K.R.: Bulimic disorders and sociocentric values in north India. Soc. Psychiatry Psychiatr. Epidemiol., 35, 86–93, 2000.PubMedCrossRefGoogle Scholar
  62. 62.
    Russell G.F.: The changing nature of anorexia nervosa: an introduction to the conference. J. Psychiatr. Res., 19, 101–109, 1985.PubMedCrossRefGoogle Scholar

Copyright information

© Editrice Kurtis 2002

Authors and Affiliations

  • S. Al-Adawi
    • 1
    • 3
  • A. S. S. Dorvlo
    • 2
  • D. T. Burke
    • 3
  • S. Moosa
    • 4
  • S. Al-Bahlani
    • 5
  1. 1.Department of Behavioral Sciences and Psychiatry, College of MedicineSultan Qaboos UniversityMuscatSultanate of Oman
  2. 2.Department of Mathematics and StatisticsSultan Qaboos UniversityMuscatSultanate of Oman
  3. 3.Department of Physical Medicine and RehabilitationSpaulding Rehabilitation Hospital, Harvard Medical SchoolBostonUSA
  4. 4.College of EducationSultan Qaboos UniversitySultanate of Oman
  5. 5.Department of Health Education and InformationMinistry of HealthMuscatSultanate of Oman

Personalised recommendations