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Abstract Background In eating disorders (EDs), treatment outcome measurement has traditionally focused on symptom reduction rather than functioning or quality of life (QoL). The Eating Disorders Quality of Life Scale (EDQLS) was recently developed to allow for measurement of broader outcomes. We examined responsiveness of the EDQLS in a longitudinal multi-site study. Methods The EDQLS and comparator generic QoL scales were collected in person at baseline, and 3 and 6 months from 130 participants (mean age 25.6 years; range 14-60) in 12 treatment programs in four Canadian provinces. Total score differences across the time points and responsiveness were examined using both anchor- and distribution-based methods. Results 98 (75%) and 85 (65%) responses were received at 3 and 6 months respectively. No statistically significant differences were found between the baseline sample and those lost to follow-up on any measured characteristic. Mean EDQLS total scores increased from 110 (SD = 24) to 124.5 (SD = 29) at 3 months and 129 (SD = 28) at 6 months, and the difference by time was tested using a general linear model (GLM) to account for repeated measurement (p < .001). Responsiveness was good overall (Cohen's d = .61 and .80), and confirmed using anchor methods across 5 levels of self-reported improvement in health status (p < .001). Effect sizes across time were moderate or large for for all age groups. Internal consistency (Chronbach's alpha=.96) held across measurement points and patterns of responsiveness held across subscales. EDQLS responsiveness exceeded that of the Quality of Life Inventory, the Short Form-12 (mental and physical subscales) and was similar to the 16-dimension quality of life scale. Conclusions The EDQLS is responsive to change in geographically diverse and clinically heterogeneous programs over a relatively short time period in adolescents and adults. It shows promise as an outcome measure for both research and clinical practice.

Abstract Background In eating disorders (EDs) treatment, outcome measurement has traditionally focused on symptom reduction rather than functioning or quality of life (QoL). Generic QoL measures lack sensitivity for some diagnoses and many not be responsive in eating disorder patients. This article describes the development and validation of a condition-specific QoL measure for adolescents and adults with eating disorders – the Eating Disorders Quality of Life Scale (EDQLS). Methods Multi-source and multi-stage methods were used to develop the EDQLS, with participation of patients with EDs, their family members and ED treatment providers. Sources for domain and item development included 39 articles, 12 patient and 10 treatment provider interviews, and 31 first person narratives from the internet. Four stages of validation and pre-testing involving 17 patients, 10 family members and 18 providers reduced 233 items to 40 items in 12 domains. These items were pilot tested in 41 ED patients. Results The final instrument was then validated in a 12 site sample of 171 individuals aged 14–60 with EDs. All items showed good dispersion. The total raw mean score was 110 out of 200 (SD 27.6) with higher scores indicating better QoL. Internal consistency was excellent (Cronbach's alpha = .96) and subscale internal consistency ranged from alpha .36 to .79 providing evidence for a strong overall construct and some multi-dimensionality. Validity was supported by significant differences in mean EDQLS according to severity levels on the EDI-2 (F = 95.3, p Conclusion The EDQLS has promising psychometric characteristics and may be useful for evaluating ED treatment effectiveness.

The Readiness and Motivation Interview (RMI) is a semistructured interview measure of readiness and motivation to change that can be used for all eating disorder diagnoses. The RMI has demonstrated excellent psychometric properties and has both clinical and predictive utility in adult samples. This study examined the psychometric properties of the RMI in a younger population, namely, 12- to 18-year-old girls with eating disorders. Study participants (N = 65) completed the RMI and measures of convergent, discriminant, and criterion validity. Adolescents with eating disorders were able to conceptualize and articulate their readiness for change and to report the extent to which change efforts were for themselves versus for others. RMI readiness profiles across eating disorder symptom domains in adolescents were comparable to those in adults, with higher reported readiness to change binge eating than to change dietary restriction or compensatory strategies. Differences in internal consistency between adult and adolescent samples are discussed. Interviewing adolescents early in treatment about readiness may assist clinicians in forming an alliance with this difficult-to-engage population, while also providing valuable information for treatment planning.

Given that individuals with eating disorders are typically ambivalent about changing their eating patterns, what approach is most helpful in working with this challenging group? This research compared the responses of clients with eating disorders and those of care providers to written clinical vignettes. All participants rated collaborative interventions as more acceptable and more likely to produce positive clinical outcomes than directive interventions. In addition, clients who were least ready for change rated directive interventions as less acceptable and less likely to produce adherence than did clients who were more ready. Despite participants' clear preference for collaborative interventions, directive interventions were rated as equally likely to occur. The implications of participant preferences and reasons that these preferences may not be reflected in actual clinical practice are addressed.

ABSTRACT The support provided by family and friends is integral to patient motivation and clinical outcomes across health care populations. However, little is known about factors that promote or interfere with the type of support offered. Objective This research examined factors associated with collaborative versus directive support among carers of adults with eating disorders. Method Participants were mothers, fathers, partners, friends, and siblings (N = 141) of eating disorder patients in hospital or residential treatment. Two methodologies were used to assess directive and collaborative support stance: a questionnaire of support behaviors and coded responses to clinical vignettes. Measures of interpersonal functioning, psychiatric distress, caregiving experience, and closeness with their loved one were also completed. Results Although carers rated a collaborative stance as more helpful than a directive stance, 60% of responses to the clinical vignettes were directive. Across both methodologies, collaborative support behaviors were associated with beliefs about helpful support and with a less vindictive and cold interpersonal style. Whereas use of a directive support stance was exclusively associated with negative caregiving experiences, collaborative responses were associated with both positive and negative experiences. Discussion Although the benefits of collaborative support have been well established, this is the first study to examine factors associated with the use of support stance. Findings suggest a number of ways to help carers create and maintain collaborative relationships, including addressing beliefs and interpersonal style and capitalizing on both positive and negative experiences with their loved one. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:498-505) [ABSTRACT FROM AUTHOR]