Professional Documents
Culture Documents
To cite this article: Stevie Chariese Stanford & Raymond Lemberg (2012) A Clinical Comparison
of Men and Women on the Eating Disorder Inventory-3 (EDI-3) and the Eating Disorder Assessment
for Men (EDAM), Eating Disorders: The Journal of Treatment & Prevention, 20:5, 379-394, DOI:
10.1080/10640266.2012.715516
Taylor & Francis makes every effort to ensure the accuracy of all the information (the
“Content”) contained in the publications on our platform. However, Taylor & Francis,
our agents, and our licensors make no representations or warranties whatsoever as to
the accuracy, completeness, or suitability for any purpose of the Content. Any opinions
and views expressed in this publication are the opinions and views of the authors,
and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content
should not be relied upon and should be independently verified with primary sources
of information. Taylor and Francis shall not be liable for any losses, actions, claims,
proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or
howsoever caused arising directly or indirectly in connection with, in relation to or arising
out of the use of the Content.
This article may be used for research, teaching, and private study purposes. Any
substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,
systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Conditions of access and use can be found at http://www.tandfonline.com/page/terms-
and-conditions
Downloaded by [Michigan State University] at 20:17 03 January 2015
Eating Disorders, 20:379–394, 2012
Copyright © Taylor & Francis Group, LLC
ISSN: 1064-0266 print/1532-530X online
DOI: 10.1080/10640266.2012.715516
RAYMOND LEMBERG
Eating Disorder Program, Prescott House, Prescott, Arizona, USA
INTRODUCTION
Eating disorders have long been assumed to occur primarily in women. Until
recently, one of the most frequently cited statistics was that men comprised
approximately 5% to 10% of the anorexic population and an estimated 10%
379
380 S. C. Stanford and R. Lemberg
for female issues. Most concluded that men have lower mean scores than
women on the three primary eating disorder risk scales: Bulimia, Drive for
Thinness, and Body Dissatisfaction (Gupta, Schork, & Dhaliwal, 1993; Oates-
Johnson & DeCourville, 1999). These three subscales are a focus of this
study, as existing research shows females scoring much higher than males
on these three problematic scales.
Differences between men and women are seen in the constructs of
body dissatisfaction. Andersen, Cohn, and Holbrook (2000) criticize the use
of the EDI, suggesting that men may not relate when they are asked typical
questions such as “I think my thighs are too large” or “I like the shape of my
buttocks.” Additional items that may not apply to men are “I am preoccupied
with a desire to be thinner” and “Other people think that I am too thin,” since
Downloaded by [Michigan State University] at 20:17 03 January 2015
many males with eating disorders often do not strive to be “thin” as much
as “muscular.” Evidence shows that males generally wish to change their
bodies from the waist up, while females usually dislike their bodies from
the waist down (Andersen, 1999). Weltzin et al. (2005) found that men were
less likely than women to engage in typical compensatory behaviors such as
vomiting and more likely to engage in activities such as excessive exercise
to control their body weight. They also found that men were less likely
to restrict food intake and more likely to binge eat than women (Weltzin
et al., 2005). Considering these critical differences between genders, it is
necessary to ensure that items claiming to measure drive for thinness, body
dissatisfaction, and bulimia are in fact capturing these constructs.
To date, no research has been done on the comparability of the EDI-
3 between men and women. In a report written in 2006 on the EDI-3,
Edward Cumella stated that “the EDI-3’s primary deficit involves a lack of
information about its utility and application with men in both a clinical and
nonclinical population” (2006, p. 117). To date, various male measures detect
body checking, muscle appearance satisfaction, and drive for muscularity.
However, not one measure is designed specifically to detect eating disorders
in males.
content validity evaluation with eating disorder experts, five main areas of
assessment for men were established: weight concerns, food issues, exer-
cise issues, body image/appearance concerns, and disordered eating. It is
proposed that the EDAM is a more inclusive instrument for assessing eating
disorders in males.
In comparing the EDI-3 and the EDAM, this study attempted to exam-
ine gender differences and predictability for the instruments. Results were
mixed. While the EDI-3 (EDRC) score was able to correctly predict eat-
ing disorders in men and significantly differentiate between males and
females, results from an examination of the subscales of the EDI-3 differed.
Results from the Body Dissatisfaction scale were particularly interesting;
it was unable to correctly predict eating disorders in men, indicating that
Downloaded by [Michigan State University] at 20:17 03 January 2015
the items were not capturing the construct of body dissatisfaction in men.
Furthermore, it was shown that women with eating disorders scored signif-
icantly higher than men. Results from analysis of the EDAM demonstrated
an ability to correctly predict eating disorders in men and was also able
to show significant differences on items measuring presentation, symptoms,
and drives behind eating disorders. Findings support the hypothesis that
the presentation of eating disorders are significantly different in men and
women, providing evidence that there is a need to develop a valid and
reliable eating disorder assessment tool specifically for men.
METHOD
Participants
One hundred and eight clinical subjects (78 men and 30 female) served
participated in this study. Participants were current clients at residential
treatment facilities that ranged from 90-day treatment centers to long-term
residential treatment centers where clients stay up to 1 year. Clients were
receiving treatment for eating disorders and addictions such as chemical
dependency, sexual addiction, and gambling addiction. The total number of
participants (male and female) diagnosed with an eating disorder was 66
(with an additional 45 males without eating disorders for comparison).
Measures
DEMOGRAPHIC QUESTIONNAIRE
Participants were asked to complete a demographic questionnaire, provid-
ing basic demographic information about themselves. The questionnaire
addressed participants’ gender, age, race, level of education, relationship
status, sexual orientation, history of childhood abuse, weight history, and
previous treatment history (for eating disorders and other co-occurring
addictions).
Comparison of Men and Women on the EDI-3 and EDAM 383
Procedure
Participants were introduced to the study as an investigation of gender,
health and eating habits. Each participant was a volunteer randomly selected
from client populations in residential treatment facilities. The demographic
questionnaire and eating disorder instruments were distributed to each par-
ticipant in an all-inclusive packet. The preliminary version of the EDAM was
entitled “The Health, Fitness and Eating Habit Survey” with the purpose of
eliminating bias from a “male specific” instrument. The completion of the
contents of the packet was administered by a staff member at each facility.
384 S. C. Stanford and R. Lemberg
This was done in person, in the form of paper and pencil administration.
Informed consent was also obtained from each client. Participants were
debriefed with their primary therapists following completion of the study.
Data Analysis
LOGISTICAL REGRESSION
Logistical regression allows one to predict a discrete outcome, such as
group membership, from a set of variables that may be continuous, discrete,
dichotomous, or a mix (Tabachnick & Fidell, 2000). In this study, the discrete
outcome variable was diagnosis of an eating disorder or no diagnosis of an
eating disorder. The predictor variables used were the EDI-3 Eating Disorder
Downloaded by [Michigan State University] at 20:17 03 January 2015
Risk Composite score, the three subscales of the EDI-3, and the EDAM total
score. This study examined to what extent each of these instruments and
subscales predict diagnosis of an eating disorder in men.
RESULTS
Predictability of EDI-3
EDI-3 EATING DISORDER RISK COMPOSITE (EDRC) SCORE
A binary logistical regression was conducted to investigate whether the
Eating Disorder Risk Composite (EDRC) score of the EDI-3 could discrimi-
nate between men with eating disorders and men without eating disorders.
The omnibus test of model coefficients demonstrated that the EDRC could
significantly predict an eating disorder in men, X 2 = 48.01, df = 1, N = 48,
p < .001. The model predicts that 88.5% of the men were correctly cat-
egorized, suggesting the EDRC has the ability to predict eating disorders
in men when compared to men without eating disorders. The Drive for
Thinness scale and the Bulimia scale were both significant, while the Body
Dissatisfaction scale was not found to be significant in discriminating the dif-
ference between men and women with eating disorders. Results are shown
in Table 1.
Comparison of Men and Women on the EDI-3 and EDAM 385
TABLE 1 Logistical Regression Predicting Extent to Which Men Are Diagnosed With Eating
Disorders Based on Their EDRC Total, EDI-3 Subscales, and EDAM Total Scores
Predictability of EDAM
Downloaded by [Michigan State University] at 20:17 03 January 2015
Gender Differences
EDI-3 EATING DISORDER RISK COMPOSITE (EDRC) SCORE
A between subjects one way analysis of variance was run to determine
if there was a significant difference between men and women with eat-
ing disorders on the EDRC score. The Levene’s test of homogeneity of
variance indicated that the error variance across groups was equal at the
p < .05 alpha level. The ANOVA revealed a significant difference on the
EDRC score between men (M = 36.70, SD = 10.14) and women (M = 45.53,
SD = 9.78) at a F(1,62) = 12.35, p = .001, Partial eta-squared = .17. This
difference is significant, therefore, significantly differentiating between men
and women with eating disorders.
of the person with the eating disorder. For men (M = 35.03, S = 9.88),
and for women (M = 43.17, SD = 11.00). Results show that women scored
significantly higher than men on the Drive for Thinness scale.
and men did not score significantly different on the Bulimia scale.
Source DV SS df MS F p
groups was equal at the p < .05 alpha level. The ANOVA revealed a sig-
nificant difference on the EDAM total score between men (M = 70.64,
S = 19.84) and women (M = 83.87, SD = 21.05) at an F(1, 62) = 6.59,
p = .013, Partial eta-squared = .10. Results show that men and women
scored significantly different on the EDAM total score.
DISCUSSION
has shown that males are less likely than females to have a drive for thinness
and are more likely to strive for lean muscularity (McCreary & Sasse, 2000).
Examining the Drive for Thinness scale alone determined that females scored
significantly higher (M = 43.17) than males (M = 35.03). This suggests that
females with eating disorders have a more pronounced desire to be thin.
As mentioned previously, research shows that males desire a lean muscular
physique, often reporting a desire to increase muscularity rather than to lose
weight (Grieve, Wann, Henson, & Ford, 2006). They often desire a larger,
bulkier appearance. For instance, Pope et al. (2000) stated that college-aged
men desire to gain an average of 28 pounds of muscle mass to have an “ideal
physique.” This would account for a significantly lower score in the area of
drive for thinness. Scores on this subscale suggest that men have more of
a desire to be muscular, rather than a drive for thinness that is consistent
among females with eating disorders.
Some men, however, do have a desire to be thin. In such cases, males
may score lower because males would not endorse some of the items on
this scale. For example, a male with a desire to be thinner may respond to
“I would like to lose fat around my midsection” rather than the current items
that state “I am terrified about gaining weight.” Men who actually have a
drive to be thin may not score significantly because they do not endorse
items that were made to measure this construct in females. The Drive for
Thinness subscale correctly predicted eating disorder diagnoses in males,
compared to males without eating disorders. However, when comparing
males and females with eating disorders, females scored higher on Drive for
Thinness, suggesting that this subscale focuses on symptoms that are more
suitable for women.
BULIMIA
The study investigated how males and females compared in symptoms of
bulimia. As noted previously, males and females differ in their symptoms of
bulimia. Males tend to exercise more as a compensatory method; females
Comparison of Men and Women on the EDI-3 and EDAM 389
tend to use laxatives and purge more than males do (Button, Aldridge, &
Palmer, 2008; Weltzin et al., 2005). Statistical analysis showed that in per-
sons with eating disorders, male scores (M = 48.00) were not significantly
different from females (M = 50.77). This finding was particularly interesting
because most research cited that males and females differed significantly in
their symptoms of bulimia. Upon further examination, it appears that males
and females responded similarly to items on the bulimia scale because of
wording such as “I stuff myself with food,” and “I have gone on eating
binges where I felt that I could not stop” (Garner, 2004). Most items on
the Bulimia scale related to the issues of binge eating. Only one item on the
bulimia scale referred to the compensatory method of vomiting. The Bulimia
scale measures binge eating issues, which do not differ among males and
Downloaded by [Michigan State University] at 20:17 03 January 2015
females. Therefore, their scores were similar for eating disorders in general,
which, for many of the men in this study, actually reflected a diagnosis
of binge eating disorder. Interesting, this result indicated that the Bulimia
scale on the EDI-3 may in fact, adequately measures binge eating symptoms
in men.
BODY DISSATISFACTION
According to the EDI-3 manual, the Body Dissatisfaction subscale is designed
to assess discontentment with the overall body shape and size or regions that
are of extraordinary concern to those who have eating disorders (Garner,
2004). However, the items on the Body Dissatisfaction subscale of the EDI-
3 were developed to measure body dissatisfaction for women; therefore,
it was necessary to determine if this subscale could predict body dissatis-
faction in males. Results from logistical regression analysis showed that the
Body Dissatisfaction subscale alone could not significantly predict diagnosis
of an eating disorder diagnosis for males. The regression equation indicated
the probability of correctly categorizing a diagnosis of an eating disorder
decreases by a multiplicative factor of .973 as the Body Dissatisfaction score
increases. Essentially, this subscale indicated that the more body dissatis-
faction a male has, the less likely he is to have an eating disorder. This
is counterintuitive, clearly indicating that the Body Dissatisfaction subscale,
developed for women, does not discriminate between men with and men
without eating disorders.
In a statistical analysis of males and females with eating disorders, a
between subjects MANOVA found that, in the area of body dissatisfaction,
males scored significantly lower (M = 37.73) than females (M = 47.33). This
result indicates that men with eating disorders have lower body dissatisfac-
tion. This contradicts studies that have shown that body dissatisfaction in
men is increasing: in some areas, it equals body dissatisfaction in females
(Ricciardelli & McCabe, 2001). These findings once again suggest that the
symptoms of body dissatisfaction in women are different, and this subscale
390 S. C. Stanford and R. Lemberg
results in significantly lower scores for men. To assume that men have less
body dissatisfaction than women is a mistake. Olivardia et al. (2004) showed
that American men exhibited substantial levels of body dissatisfaction: most
prefer to gain muscle mass and lose fat. Therefore, if the Body Dissatisfaction
scale were actually measuring symptoms of body dissatisfaction in males,
the scores would mostly likely reflect this. It is likely that the items on the
Body Dissatisfaction scale are not capturing the construct of body dissatis-
faction in males as they are for females. Items in this subscale, such as “I
think my buttocks are too large,” and “I think my hips are too big,” are not
typical concerns that men would endorse when describing discontent with
their bodies. When studying males, Park and Read (1997) found the two
main concerns were: to “have larger arms” and “to have a ‘V’ shaped body.”
Downloaded by [Michigan State University] at 20:17 03 January 2015
eating disorder category, an eating disorder was not the primary diagnosis,
indicating that their eating disorder symptoms might not have been as severe
as those for the women, thus producing a lower total score on the EDAM.
Another issue that may have contributed to females attaining higher
scores is the language that was used when describing emotions in the EDAM.
Many of the items used words such as “terrified to gain fat” or “obsessed
with losing weight.” It has been suggested that men respond differently to
verbal expressions related to body size. One study analyzing the personal
ads in the Washington magazine compared the self-descriptions of body
size and shape of those seeking social partners. When women described
themselves as “thin,” statistics showed them to be only 87% of the average
female population weight—13% below average. In contrast, the men who
described themselves as “thin” were 5% above the population for men of
similar body weight by comparison. Men were shown to be more likely to
be at least above average in weight when they call themselves “fat” or “over-
weight,” while women are taught to see themselves as fat from about third
grade (Andersen et al., 2000). Interestingly, Dr. Katherine Halmi, Professor
of Psychiatry at the New York Hospital, Westchester Center, has said, “Even
normal-weight women consider themselves fat, and only very thin women
consider themselves to be normal” (Anderson & DiDomenico, 1992). It sig-
nificant to note that there are numerous favorable expressions to describe
larger men such as buff, monster, or hulk. Yet, there are few similar words
to describe women of larger than average stature (Anderson & DiDomenico,
1992).
This suggests a significant difference in the way in which genders
view themselves when related to body shape and size. They may feel as
if words such as this are too strong and may have endorsed items using
terms such as “worried” or “concerned.” It is also possible that women
may always score higher on an eating disorder instrument due to the soci-
etal concerns and pressure for women to lose weight and attain an ideal
body image. It could be argued that this pressure is higher for women sim-
ply due to sociocultural gender expectations. The results of this analysis
392 S. C. Stanford and R. Lemberg
provide further evidence that males and females differ significantly in their
symptoms, severity, presentation, and manifestation of eating disorders.
ders. However, it is not the dominant feature for males, who tend to have
a desire for lean muscularity. Such items on the Drive for Thinness scale as
“I am preoccupied by the desire to be thinner,” and “I am terrified of gain-
ing weight” should be replaced by “I am preoccupied by the desire to be
lean and muscular.” A more fitting item would also be “I am concerned with
the thought of gaining fat” because most males seek to gain weight in the
form of muscle, while losing fat. An assessment tool using these alternatives
would be more likely to capture the drive for thinness construct among men
with eating disorders.
The inability of the EDI-3 to capture body dissatisfaction in males with
eating disorders is a critical point. The items on the EDI-3 measuring body
dissatisfaction do not represent body concerns pertinent to males. As noted
earlier, items stating, “I think that my thighs are too large,” or “I think
my hips are too big” measure body concerns specific to women. Again,
males with eating disorders would be more likely to endorse such items
as “I would like bigger arms” or “I think my abdominal muscles need to
be more defined.” Because men have distinctly different body concerns, the
assessment tool should concentrate on the areas of the body and appearance
concerns relevant to men.
CONCLUSIONS
The most critical point to be derived from this study is to prompt development
and utilization of a valid and reliable male-specific eating disorder assessment
tool. Results of this study provide evidence that the most widely used eating
disorder assessment tool, the EDI-3, does not adequately detect symptoms
in males with eating disorders. A main focus of this study was to determine
if EDI-3 was appropriate for measuring eating disorders in men and if
there was a need to develop a male-specific eating disorder instrument;
the results conclusively indicate the necessity to continue development and
attain validity on an a gender specific instrument such at the EDAM.
Comparison of Men and Women on the EDI-3 and EDAM 393
REFERENCES
Button, E., Aldridge, S., & Palmer, R. (2008). Males assessed by a specialized
eating disorders service: Patterns over time and comparisons with females.
International Journal Eating Disorders; 41, 758–761.
Cumella, E. J. (2006). Review of the Eating Disorder Inventory-3. Journal of
Personality Assessment, 87, 116–117.
Garner, D. M. (2004). Eating Disorder Inventory-3: Professional manual. Lutz, FL:
Psychological Assessment Resources, Inc.
Grieve, F. G., Wann, D., Henson, C. T., & Ford, P. (2006). Healthy and unhealthy
weight management practices in collegiate men and women. Journal of Sport
Behavior, 29, 229–241.
Gupta, M. A., Schork, N. J., & Dhaliwal, J. S. (1993). Stature, drive for thinness and
body dissatisfaction: A study of males and females from a non-clinical sample.
Canadian Journal of Psychiatry, 38(1), 59–61.
Hudson, J. I., Hiripi, E., Pope, H. G., Jr., & Kessler, R. C. (2007). The prevalence and
correlates of eating disorders in the National Comorbidity Survey Replication.
Biological Psychiatry, 61, 348–358.
Keel, P., Baxter, M. G., Heatherton, T. F., & Joiner, T. E. (2007). A 20-year longitu-
dinal study of body weight, dieting, and eating disorder symptoms. Journal of
Abnormal Psychology, 116, 422–432.
McCreary, D. R., & Sasse, D. K. (2000). An exploration of the drive for muscularity
in adolescent boys and girls. Journal of American College Health, 48, 297–304.
Nevonen, L., & Broberg, A. G. (2005). A comparison of sequenced individual and
group psychotherapy for eating disorder not otherwise specified. European
Eating Disorders Review, 13, 29–37.
Oates-Johnson, T., & Decourville, N. (1999). Weight preoccupation, personality,
and depression in university students: An interactionist perspective. Journal
of Clinical Psychology, 55, 1157–1166.
Olivardia, R., Pope, H., Borowiecki, J. J., & Cohane, G. (2004). Biceps and body
image: The relationship between muscularity and self-esteem, depression and
eating disorder symptoms. Psychology of Men and Masculinity, 5, 112–120.
Olivardia, R., Pope, H. G., & Hudson, J. I. (2000). Muscle dysmorphia in male
weightlifters: A case control study. American Journal of Psychiatry, 157,
1291–1296.
Olivardia, R., Pope, H. G., Mangweth, B., & Hudson, J. I. (1995). Eating disorders in
college men. American Journal of Psychiatry, 152, 1279–1285.
394 S. C. Stanford and R. Lemberg
Parks, P. S. M., & Read, M. H. (1997). Adolescent male athletes: Body image, diet,
and exercise. Adolescence, 32, 593–602.
Pope, H. G., Gruber, A., Magweth, B., Bureau, B., deCol, C., Jovent, R., & Hudson,
J. I. (2000). Body image perception among men in three countries. American
Journal of Psychiatry, 157, 1297–1301.
Rathner, G., & Rumpold, G. (1994). Convergent validity of the eating disorder inven-
tory and the anorexia nervosa inventory for self-rating in an Austrian nonclinical
population. Journal of Eating Disorders, 16, 381–393.
Ricciardelli, L. A., & McCabe, M. P. (2001). Dietary restraints and negative affect as
mediators of body dissatisfaction and bulimic behavior in adolescent girls and
boys. Behavior Research and Therapy, 39, 1317–1328.
Spillane, N. S., Boerner, L. M., Andersen, K. G., & Smith, G. T. (2004). Comparability
of the eating disorder inventory-2 between men and women. Assessment, 11,
Downloaded by [Michigan State University] at 20:17 03 January 2015
85–93.
Streigel-Moore, R. H., Rosselli, R., Perrin, N., DeBar, L., Wilson, G. T., & May, A.
(2009). Gender differences in the prevalence of eating disorder symptoms.
International Journal of Eating Disorders, 42, 471–474.
Tabachnick, B. G., & Fidell, L. S. (2000). Using multivariate statistics (4th ed).
Boston, MA: Allyn and Bacon.
Weltzin, T. E., Weisensel, N., Franczyk, D., Burnett, K., Klitz, C., & Bean, P. (2005).
Eating disorders in men: Update. Journal of Men’s Health & Gender, 2, 186–193.
Wonderlich, S. A., Gordon, K. H., Mitchell, J. E., Crosby, R. D., & Engel, S. G.
(2009). Validity and utility of binge eating disorder. International Journal of
Eating Disorders, 42, 687–705.