Outcome Measure
Clinical Impairment Assessment Questionnaire
What it measures?
- The severity of psychosocial impairment due to eating disorder pathology.
- Assesses self-perception, cognitive functioning, interpersonal functioning and work performance during the past 28 days.
- The items of this outcome measure assess impairment across domains in life that are often affected by eating disorder psychopathology: mood and self-perception, cognitive functioning, interpersonal function and work performance.
- The CIA was intended to be used directly after filling in a measure of current eating disorder features assessing the same time frame (e.g. the EDEQ) — to ensure that eating disorder symptoms are foremost in the patient’s mind when completing the CIA.
Who is it for?
Adolescents and adults aged 17 years +
Instrument Quality
- The CIA has demonstrated good psychometric properties in clinical (Bohn et al., 2008; Bohn and Fairburn, 2008), high risk (Vannucci et al., 2012) and community samples (Reas et al., 2010).
Structure
- 16 items
- 4-point Likert scale
- Respondents indicate to what extent (0 = “Not at all”; 3 = “A lot”) their eating habits, exercising, or feelings about eating shape or weight have impacted their functioning during the past 28 days (e.g. “interfered with you doing things you used to enjoy”)
Scoring instructions
- Sum all item responses to derive a full-scale score.
- Sum the relevant subscale-specific items to derive subscale scores.
| Subscale | Item number |
|---|---|
Cognitive Impairment |
1,4,5,6,13 |
Personal Impairment |
2,8,9,11,14,16 |
Social Impairment |
3,7,10,12,15 |
Full-scale (CIA) |
1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16 |
Score Interpretation
What higher scores mean?
- More severe psychosocial impairment due to eating disorder pathology during the past 28 days.
How to assess symptom severity & change?
| Description | Score Range | |
|---|---|---|
| Below normative mean | 0 | |
| Normative mean | 1.2 | |
| 1 SD above normative mean | 3.3 | |
| 2 SD above normative mean | 5.4 | |
| 3 SD above normative mean | 7.5 | |
| Maximum | 15 |
| Description | Score Range | |
|---|---|---|
| Below normative mean | 0 | |
| Normative mean | 4.1 | |
| 1 SD above normative mean | 8.2 | |
| 2 SD above low back pain mean | 12.3 | |
| 3 SD above normative mean | 16.4 | |
| Maximum | 18 |
Severity ranges
Mean and standard deviations are based on research by Welch, Birgegård, Parling and Ghaderi (2010), who examined a representative random sample of 760 females from the general population in Sweden (mean age = 23.9 years; SD = 3.8).
Reliable change and clinically significant improvement
Ekeroth and Birgegård (2014) calculated a reliable change index (RCI) for the CIA, and also used the method of Jacobson and Truax (1991) to evaluate clinically significant change — using a database for specialized eating disorder treatment in Sweden (N = 1042 female patients; 246 adolescents and 796 adults). Using a test-retest reliability of 0.86, the authors found that this approach was a useful method for assessing change and outcome status in eating disorder patients compared to DSM-IV diagnostic change. CS/RCI-based outcome categories were equally good or better at explaining variance in gain scores for various psychopathology measures compared to DSM eating disorder diagnoses.
Mean
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 10.2 | Mean and standard deviation values were derived from research by Bohn et al., 2008, who examined 123 English patients (age 18-65 years) with an eating disorder of clinical severity (judged by a senior specialist in the field), with a body mass index between 16.0 and 39.9. The patients were taking part in a transdiagnositic cognitive behaviour therapy trial based in two eating disorder clinics in the UK. The cutoff value of 16 demonstrated a sensitivity of 76% and a specificity of 86%. |
| Normative | 4.1 | Reas et al (2010) examined a sample of young adult women (N = 438) recruited from five different departments at two university settings in Eastern Norway (aged 18-65 years). Average body mass index was 22.5 (SD = 3.4). |
Standard Deviation
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 6.05 | Mean and standard deviation values were derived from research by Bohn et al., 2008, who examined 123 English patients (age 18-65 years) with an eating disorder of clinical severity (judged by a senior specialist in the field), with a body mass index between 16.0 and 39.9. The patients were taking part in a transdiagnositic cognitive behaviour therapy trial based in two eating disorder clinics in the UK. The cutoff value of 16 demonstrated a sensitivity of 76% and a specificity of 86%. |
| Normative | 4.1 | Reas et al (2010) examined a sample of young adult women (N = 438) recruited from five different departments at two university settings in Eastern Norway (aged 18-65 years). Average body mass index was 22.5 (SD = 3.4). |
| Description | Score Range | |
|---|---|---|
| Below normative mean | 0 | |
| Normative mean | 1.1 | |
| 1 SD above normative mean | 3.2 | |
| 2 SD above normative mean | 4.3 | |
| Maximum | 15 |
Severity ranges
Mean and standard deviations are based on research by Welch, Birgegård, Parling and Ghaderi (2010), who examined a representative random sample of 760 females from the general population in Sweden (mean age = 23.9 years; SD = 3.8).
Reliable change and clinically significant improvement
Ekeroth and Birgegård (2014) calculated a reliable change index (RCI) for the CIA, and also used the method of Jacobson and Truax (1991) to evaluate clinically significant change — using a database for specialized eating disorder treatment in Sweden (N = 1042 female patients; 246 adolescents and 796 adults). Using a test-retest reliability of 0.86, the authors found that this approach was a useful method for assessing change and outcome status in eating disorder patients compared to DSM-IV diagnostic change. CS/RCI-based outcome categories were equally good or better at explaining variance in gain scores for various psychopathology measures compared to DSM eating disorder diagnoses.
Mean
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 5.36 | Mean and standard deviation values were derived from research by Bohn et al., 2008, who examined 123 English patients (age 18-65 years) with an eating disorder of clinical severity (judged by a senior specialist in the field), with a body mass index between 16.0 and 39.9. The patients were taking part in a transdiagnositic cognitive behaviour therapy trial based in two eating disorder clinics in the UK. The cutoff value of 16 demonstrated a sensitivity of 76% and a specificity of 86%. |
| Normative | 1.1 | Mean and standard deviation values were derived from research by Reas et al (2010), who examined a sample of young adult women (N = 438) recruited from five different departments at two university settings in Eastern Norway (aged 18-65 years). Average body mass index was 22.5 (SD = 3.4). |
Standard Deviation
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 4.58 | Mean and standard deviation values were derived from research by Bohn et al., 2008, who examined 123 English patients (age 18-65 years) with an eating disorder of clinical severity (judged by a senior specialist in the field), with a body mass index between 16.0 and 39.9. The patients were taking part in a transdiagnositic cognitive behaviour therapy trial based in two eating disorder clinics in the UK. The cutoff value of 16 demonstrated a sensitivity of 76% and a specificity of 86%. |
| Normative | 2.1 | Mean and standard deviation values were derived from research by Reas et al (2010), who examined a sample of young adult women (N = 438) recruited from five different departments at two university settings in Eastern Norway (aged 18-65 years). Average body mass index was 22.5 (SD = 3.4). |
| Description | Score Range | |
|---|---|---|
| Below normative mean | 0 | |
| Normative mean | 8.25 | |
| Eating Disorder | >=16 | Provisional Diagnosis |
| 1 SD above normative mean | 17.6 | |
| 2 SD above normative mean | 26.95 | |
| 3 SD above normative mean | 36.3 | |
| Maximum | 48 |
Severity ranges
Mean and standard deviations are based on research by Welch, Birgegård, Parling and Ghaderi (2010), who examined a representative random sample of 760 females from the general population in Sweden (mean age = 23.9 years; SD = 3.8).
Provisional diagnosis
Sample consisted of 123 English patients (age 18-65 years) with an eating disorder of clinical severity (judged by a senior specialist in the field), with a body mass index between 16.0 and 39.9 (Bohn et al., 2008). The patients were taking part in a transdiagnositic cognitive behaviour therapy trial based in two eating disorder clinics in the UK. The cutoff value of 16 demonstrated a sensitivity of 76% and a specificity of 86%. Research by Richson et al (2021)—employing a male sample of members from an eating disorder registry (N = 162)—found that a CIA full-scale score of 13 best-predicted eating disorder case status in men. The authors note that the widely-used cutoff value of 16 has derived primarily from research employing female samples. Thus 13 may be more appropriate for male patient populations.
Reliable change and clinically significant improvement
Ekeroth and Birgegård (2014) calculated a reliable change index (RCI) for the CIA, and also used the method of Jacobson and Truax (1991) to evaluate clinically significant change — using a database for specialized eating disorder treatment in Sweden (N = 1042 female patients; 246 adolescents and 796 adults). Using a test-retest reliability of 0.86, the authors found that this approach was a useful method for assessing change and outcome status in eating disorder patients compared to DSM-IV diagnostic change. CS/RCI-based outcome categories were equally good or better at explaining variance in gain scores for various psychopathology measures compared to DSM eating disorder diagnoses.
Mean
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 30.22 | Welch, Birgegård, Parling and Ghaderi (2010) derived a clinical sample from a lare-scale Internet based quality control and data collection system for specialised eating disorder care, used routinely at 26 clinics/units throughout Sweden. A total of 2383 patients were included, with a diagnostic distribution of 20% anorexia nervosa (AN), 35% bulimia nervosa (BN), and 44.5% eating disorder not otherwise specified (EDNOS). |
| Normative | 8.25 | Welch, Birgegård, Parling and Ghaderi (2010) examined a representative random sample of 760 females from the general population in Sweden (mean age = 23.9 years; SD = 3.8). |
Standard Deviation
| Sample | Mean | Comments |
|---|---|---|
| Clinical | 10.207 | Welch, Birgegård, Parling and Ghaderi (2010) derived a clinical sample from a lare-scale Internet based quality control and data collection system for specialised eating disorder care, used routinely at 26 clinics/units throughout Sweden. A total of 2383 patients were included, with a diagnostic distribution of 20% anorexia nervosa (AN), 35% bulimia nervosa (BN), and 44.5% eating disorder not otherwise specified (EDNOS). |
| Normative | 9.35 | Welch, Birgegård, Parling and Ghaderi (2010) examined a representative random sample of 760 females from the general population in Sweden (mean age = 23.9 years; SD = 3.8). |
Reliability
| Value | Comments |
|---|---|
| 0.94 | Reas et al (2010) examined a sample of young adult women (N = 438) recruited from five different departments at two university settings in Eastern Norway (aged 18-65 years). Average body mass index was 22.5 (SD = 3.4). Of this sample, 62 participants completed the CIA twice over a 1-week period. Spearman’s correlation coefficient was 0.94 and the intraclass correlation coefficient was 0.98). Bohn et al (2008) reported a test-retest reliability value (intra-class correlation) of 0.86 in a clinical sample, however the exact length of the retest period was unclear. |
Instrument developers
- Bohn K, Doll HA, Cooper Z, O’Connor ME, Palmer RL, Fairburn CG (2008). The measurement of impairment due to eating disorder psychopathology. Behaviour Research and Therapy, 46(10), 1105 -1110.
- Bohn K, Fairburn CG (2008). Clinical Impairment Assessment Questionnaire (CIA 3.0) In Fairburn CB. Cognitive Behaviour Therapy and Eating Disorders. New York: Guildford Press.
Refrences
* Bohn K, Doll HA, Cooper Z, O’Connor ME, Palmer RL, Fairburn CG (2008). The measurement of impairment due to eating disorder psychopathology. Behaviour Research and Therapy, 46(10), 1105 -1110. * Bohn K, Fairburn CG (2008). Clinical Impairment Assessment Questionnaire (CIA 3.0) In Fairburn CB. Cognitive Behaviour Therapy and Eating Disorders. New York: Guildford Press.
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Severity ranges
Mean and standard deviations are based on research by Welch, Birgegård, Parling and Ghaderi (2010), who examined a representative random sample of 760 females from the general population in Sweden (mean age = 23.9 years; SD = 3.8).
Reliable change and clinically significant improvement
Ekeroth and Birgegård (2014) calculated a reliable change index (RCI) for the CIA, and also used the method of Jacobson and Truax (1991) to evaluate clinically significant change — using a database for specialized eating disorder treatment in Sweden (N = 1042 female patients; 246 adolescents and 796 adults). Using a test-retest reliability of 0.86, the authors found that this approach was a useful method for assessing change and outcome status in eating disorder patients compared to DSM-IV diagnostic change. CS/RCI-based outcome categories were equally good or better at explaining variance in gain scores for various psychopathology measures compared to DSM eating disorder diagnoses.
Mean
Standard Deviation