Eating disorder self-assessments: How do they work?
The internet offers no shortage of quizzes and tests to help people narrow in on everything from their personality types to their travel preferences. Some of these examinations can be fun (like, Which Friends character are you?) but others need to be approached with more caution and scrutiny.
Organizations like the National Eating Disorders Association (NEDA) feature self-assessments on their websites to help whoever is interested in taking stock of their behaviors around food and exercise, and possibly spot signs of disordered eating. While this can be an informative exercise for some, it’s not the end-all be-all answer to eating and body image issues.
To make sense of how these types of assessments came to be and what effect they might have on test-takers, let’s explore the origins, intentions, and outcomes of eating disorder self-assessments.
Purpose of eating disorder self-assessments
Eating disorders can be one of the more difficult mental health conditions to identify. Because there are so many gray areas between dieting behaviors and disordered behaviors, many people can go years (or a lifetime) without recognizing their thoughts and actions as problematic.
To meet curious minds where they are, some mental health organizations have developed assessments to help people examine their relationships with food, exercise, and their bodies in a way that’s comfortable for them (i.e., behind the safety of their computers, tablets, and smartphones).
The Eating Attitudes Test (EAT-26) was one of the first eating disorders assessment tools to exist. Developed in the 1970s by the University of Toronto, the assessment is meant to detect abnormal eating attitudes and behaviors.
In 2000, the Western Journal of Medicine published a study in which they introduced the SCOFF questionnaire. At the time, researchers purported these five questions (including keywords that spell SCOFF) to address “core features of anorexia nervosa and bulimia nervosa.”
Do you make yourself Sick because you feel uncomfortably full?
Do you worry that you have lost Control over how much you eat?
Have you recently lost more than (insert weight measurement that includes an “O”) stone/pounds/kilos in a three-month period?*
Do you believe yourself to be Fat when others say you are too thin?
Would you say that Food dominates your life?
Today, we know that eating disorders are far more diverse and complex than just anorexia and bulimia, but at the time, this assessment was considered a win in the psychiatric diagnostic community.
Since the EAT-26 and SCOFF, more modern assessments have emerged that focus on identifying common symptoms and presentations in patients with eating disorders. Many of these criteria have been pulled from the Diagnostic and Statistical Manual of Mental Disorders (DSM), which lists symptoms by disorder. As these criteria evolve and broaden, the hope is that the assessments will, too.
*Actual weight omitted to protect readers’ recoveries.
Examples of eating disorders self-assessments
Modern-day eating disorder self-assessments vary by length, style of questioning, and question content. Below are two such assessments:
1. NEDA’s assessment confirms that it can “help determine if it’s time for some support” and includes an important caveat: The assessment “is not a replacement for a diagnosis.”
The screening tool has been vetted by clinicians and researchers to ensure the questions align with modern diagnoses and definitions. However, people who take the assessment should also be aware that their answers, while anonymous, may be used by NEDA’s partners for further research.
Once completed, NEDA offers resources like links to their provider databases, links to browse and sign up for research study opportunities, links to additional readings, and a post-assessment survey intended to help the NEDA team refine their processes.
2. Eating Disorder Hope offers multiple quizzes to assess a person’s relationship with body image and food. There’s one general assessment, plus three that are slightly more specific to eating disorder types (e.g., binge eating disorder, orthorexia nervosa, and body dysmorphia).
Their general 10-question assessment comprises yes/no questions using statements like:
I often feel guilty about eating.
I am very concerned about my weight.
I do not like myself or the way I look.
My weight and appearance constantly preoccupy my thoughts.
Similar to NEDA’s assessment, EDH’s quiz comes with a huge disclaimer:
“This quiz is for general informational purposes only and does not, and is not intended to, constitute medical advice. If you have or suspect you may have a health problem, talk to your healthcare provider and follow their advice regardless of any result you have obtained on this quiz.
Based on the results, participants are directed to resources to learn more about their results and, if recommended, find help.
The benefits of eating disorders self-assessments
The intention of these self-assessments is simple: to educate individuals about their risk of developing an eating disorder by examining their behaviors around food and body image. Additional benefits of online eating disorder assessments include the following.
Insight into thoughts and behaviors
Simply by reading these questions, individuals are encouraged to consider more carefully how much of their time, energy, and mental space their body and weight occupy.
Easy access to screening
Individuals no longer have to see a doctor to get a general idea of their risk for disordered eating. If needed, they can take the results of these assessments to a treatment provider to discuss them in more detail.
Encourages further action
By taking these assessments, individuals may feel emboldened to seek professional help.
The limitations of eating disorders self-assessments
Despite the easy access and self-reflection that eating disorder self-assessments provide, there are some drawbacks to these tools.
Risk of self-diagnosis
The advent of sites like WebMD has turned the layperson into a diagnostician. Although disclaimers and caveats are plastered in many places on these sites, people seeking answers might only see what they want to see and ignore the rest.
Lack of nuance
We know eating disorders are incredibly complex and diverse in symptomology and presentation. These self-assessments fail to capture that in their limited questioning. They’re also missing the inclusion of co-occurring disorders (e.g., depression, anxiety, obsessive-compulsive disorder), medical conditions, and/or cultural influences. This can skew the results, leading to false negatives or positives.
Subjectivity-leaning questions
Some of the questions on NEDA’s assessment ask individuals if they’ve felt certain symptoms, but only within the past three months. While that’s a substantial window, it doesn’t come close to covering the extent to which eating disorders can sneak in and consume a person’s life.
Emotional impacts
Depending on the results of the assessment, an individual may feel an array of emotions. From fear and concern to relief and calm, how people interpret the results may confirm their existing beliefs about their relationship with food and their bodies.
Similarly, the nature of the questions may bring up emotions. For example, NEDA asks, “How afraid are you of gaining x pounds?” (number withheld for sensitivity reasons). Which begs the question: Why has NEDA zeroed in on this number? Why assign numbers at all? This may instill in individuals a newfound fear of gaining this amount of weight.
NEDA also asks for the assessment-taker’s height and weight, as well as their lowest weight in the past year. This sets off alarms because it puts the emphasis on a measurement that isn’t always applicable to an eating disorder diagnosis.
How to approach eating disorders self-assessments
Self-assessments can be insightful, but it’s best to acknowledge them as a first step, not a final diagnosis. In order to ensure you’re getting what you need from these assessments, here are a few tips.
Let them guide you, not lead you
Consider them as arrows pointing you in a direction, not a conclusion. Before taking one of these assessments, check in with yourself and ask questions like:
What is your intention behind taking the assessment?
What do you hope to learn from the assessment?
If you get certain results, how do you plan to process them?
Follow up with a professional
The eating disorder assessments mentioned in this post include lists of resources for therapists, dietitians, and support groups that can help you gain more clarity into your relationship with food and your body. Use these resources to confer with a professional about what your next steps should be.
Final thoughts
I hope this post has shed some light on eating disorders self-assessments, including how they were developed, and how they should be used. Beyond reading the disclaimers and caveats, the questions themselves can arouse further questions about what constitutes “disordered” and therefore should be taken with a shaker full of salt.
Before, during, and after you choose to take one of these assessments, take time to reflect on the reason you’re doing so. What do you plan to do with the results? How do you think you’ll feel about the results? Asking yourself these questions can help you navigate the peculiarities and ambiguities you may encounter when answering the assessment’s questions.
Pause & Prompt
When I’m concerned about my or a loved one’s eating or exercise behaviors, I…
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