User:WikiStudent11520/Eating Attitudes Test

Limitations
As the EAT was originally developed to screen subjects at high risk for anorexia nervosa (AN), it remains controversial whether its present items and scoring cut-off are well-suited to diagnosing other eating disorders. Although the EAT can adequately diagnose undifferentiated eating disorders in clinical settings, it may not fare well in settings unequipped to address major eating disorders.

While the EAT-26 has demonstrated good internal consistency, its test-retest reliability remains uncertain. The stability of an EAT-26 score has been demonstrated to be moderate over two years, but vulnerable to fluctuations over four years. This may be due to changes in an individual's eating behaviors and attitudes over time naturally or in response to receiving eating disorder treatment.

Another area of debate is the cut-off score of 20 first proposed by David Garner and colleagues to diagnose anorexia nervosa. High false-positive rates and low predictive power for screening for AN and bulimia nervosa (BN) in non-clinical settings have been reported. Use of the EAT-26 as a screening tool could also result in high false-negative rates in individuals with binge eating disorder (BED) or eating disorders not otherwise specified (EDNOS). Such rates may be due to changes over time in the DSM and ICD criteria for eating disorders from which the items in the EAT are based. Another explanation may be the EAT's inability to distinguish subthreshold forms of abnormal eating behavior from clinical eating disorders. Lowering the cut-off score to 11 has been demonstrated to improve sensibility and sensitivity rates in individuals with BN, BED, and EDNOS and presents a promising solution to the aforementioned issue.

The EAT suffers from the same problems as other self-report inventories, in that scores can be easily exaggerated or minimized by the person completing them. Like all questionnaires, the way the instrument is administered can have an effect on the final score. If a patient is asked to fill out the form in front of other people in a clinical environment, for instance, social expectations have been shown to elicit a different response compared to administration via a postal survey.

There are some general concerns with the EAT-26. First, varied symptoms of eating disorders and self-report instruments like the EAT measure symptoms only at that particular point in time. Therefore, considerable fluctuation is possible in some aspects of the eating disorder. Additionally, as it occurs with self-report measures generally, high scores on the EAT is typically influenced by a person's attitude. For example, a person might disclose less about their problems in order to be more socially desirable. The EAT has low positive predictive value because of denial and social desirability, as well as the possible confounding role of co-morbid factors.