The starvation symptom inventory: Development and psychometric properties

Background: Starvation symptoms are common in patients with anorexia nervosa, and according to the transdiagnostic cognitive behavioural theory for eating disorders, they contribute to maintaining the eating disorder psychopathology. The aim of this study was therefore to describe the design and validation of the Starvation Symptoms Inventory (SSI); a self-report questionnaire that examines the symptoms of starvation in underweight patients with eating disorders. Methods: 150 female patients with anorexia nervosa were recruited, as well as 341 healthy control subjects, 30 not-underweight patients with an eating disorder, and 15 patients with bipolar depressive episodes. The 150 patients completed the Eating Disorder Examination Questionnaire and the Brief Symptom Inventory. All participants rated their starvation symptoms on a continuous Likert-type scale (0-6), and reported the number of days in which they had experienced them in the previous 28 days. Results: Principal component analysis identified a single-factor, 15-item scale, which demonstrated good internal consistency (α = 0.91) and test-retest reliability (r = 0.90). The SSI global score was significantly correlated with eating disorder and general psychopathology, demonstrating good convergent validity. SSI scores were significantly higher in the anorexia nervosa sample than in the healthy control, not-underweight eating disorder and bipolar depressive episode samples. Conclusions: These findings suggest that the SSI is a valid self-report questionnaire that may provide important clinical information regarding symptoms of starvation in patients with anorexia nervosa.