Eating Disorder Quality of Life Scale (EDQLS) in ethnically diverse college women: an exploratory factor analysis

Disordered Eating describes an array of symptoms characteristic of eating disorders (e.g., dietary restriction, binge eating, preoccupation with weight or shape, self-induced vomiting, excessive exercise) [1]. Disordered eating is common in women in the US [2], particularly among college women (estimates ranging 13–49%) [3], the majority of whom do not seek treatment [4].

Understanding disordered eating is particularly important for two reasons. First, disordered eating is a robust predictor of eating disorders, which have a higher mortality rate than any other mental illness [1]. Second, disordered eating is associated with a number of psychological, financial, and other costs (e.g., difficulties in social adjustment and dating) [5, 6]. Medical problems (e.g., gastrointestinal dysfunction, osteoporosis, dental problems, low fertility) are common [7] and prolonged, resulting in substantial yearly medical expenses [8] for US women.

Given these severe consequences, it is not surprising that women struggling with disordered eating experience diminished health-related quality of life (HRQOL), which is the impact of health problems on physical, psychological, and social domains of functioning and well-being [5]. The negative impact of eating disorders on HRQOL (i.e., disordered eating-related quality of life) is severe and prolonged, yet often overlooked [5, 6]. Accordingly, the inclusion of HRQOL measures in assessment and treatment of disordered eating fills an important gap in extant literature.

Reviews [6, 9] of disordered eating-specific HRQOL instruments proposed four promising candidates: (1) the Health Related Quality of Life in Eating Disorder (HeRQoLED) [10, 11]; (2) the Eating Disorder Quality of Life (EDQOL) questionnaire [12]; (3) the Quality of Life for Eating Disorders (QOL-ED) questionnaire [13]; (4) and the Eating Disorder Quality of Life Scale (EDQLS) [14]. Of these four measures, the EDQLS assesses for the broadest range of HRQOL symptoms. Specifically, the EDQLS includes items on educational/vocational functioning, future outlook, leisure activities, and individual values/beliefs. These additional domains may be developmentally salient for adolescents and emerging adults, including college women. As such, it may be a be a more robust measure for HRQOL for populations who are the highest risk for disordered eating [1]. Unfortunately, to date, the EDQLS has solely been validated in clinical samples [14, 15]. Therefore, validation of the EDQLS in non-clinical samples is a critical next step. Accordingly, the purpose of this study was to examine the psychometric properties for the EDQLS in a large, diverse sample of US college women.

This study examined the psychometric properties of the Eating Disorder Quality of Life Scale (EDQLS) in a large, diverse sample of college women. Results indicated excellent internal consistency and convergent validity with the EDEQ and support the use of total scores on the EDQLS in college women. Given that disordered eating is common among college women [4], evidence for the reliability and validity of the EDQLS in this population thus paves the way for additional research on HRQOL.

Our data suggested five factors: (1) Positive Emotionality; (2) Body/Weight Dissatisfaction; (3) Disordered Eating Behaviors; (4) Negative Emotionality; and (5) Social Engagement. As such, for college women, disordered eating-related QOL appears dependent on symptomatology, but also on valence of emotionality and on quality of social support. Additionally, negative emotionality likely contributes to both disordered eating-related QOL and to QOL in general, as individuals high on neuroticism are more prone to experience negative emotions and tend to exhibit more severe disordered eating symptoms [21].

However, these five factors do not match the previously proposed 12 domains [14, 15]; nor did the 12 domains combine to create five factors (i.e., items within domains loaded on different factors). Moreover, over one-third of the items loaded on multiple factors, demonstrating that even these factors are not distinct. Thus, our results do not support the use and interpretation of domain or subscale scores. However, domain or subscale scores will be essential to understanding the implications of disordered eating in clinical and community populations. We therefore urge additional research on the domains and factors of disordered eating-related quality of life, particularly through EDQLS scale revision and confirmatory factor analyses.

Per recommendations for exploratory factor analyses [22], the large sample size is a major strength, likely to produce a stable and replicable factor structure. In addition, participants were ethnically diverse college women, from one of most diverse universities in the US. As such, results may be somewhat more representative of the general US population than would be the case with traditional college samples, and may pave way for disordered eating-related QOL research in ethnically diverse populations. Accordingly, future studies should compare the EDQLS factor structure and the reliability and validity of domain scores in this and other populations. On the other hand, one limitation of our research was that we rephrased three items to include eating habits, rather than eating disorder: Participants may have reflected on their dietary preferences (e.g., veganism), rather than disordered eating symptoms. Future research should determine how the factor structure, reliability, and validity of the EDQLS are influenced by an explicit focus on disordered eating. Future research should also explore whether other personality correlates of disordered eating (e.g., perfectionism) [21] are important components of disordered eating-related QOL. Such research can inform future revisions of the EDQLS to create informative subscores to further improve this promising scale.

Overall results support the use of the EDQLS total scores in ethnically diverse college women. Contrary to the original 12-domain design of the EDQLS, principal components analysis suggested that the EDQLS had five factors that mapped onto the following constructs: (1) Positive Emotionality; (2) Body/Weight Dissatisfaction; (3) Disordered Eating Behaviors; (4) Negative Emotionality; and (5) Social Engagement. We therefore recommend revision of the EDQLS so that subscale scores can be used.