Cross-Cultural Validation and Application of the EDE-Q 6.0 for Screening and Assessment of Eating Disorders in Chinese Females

Objective: This study aims to evaluate the cross-cultural validity and utility of the Chinese version of the Eating Disorder Examination Questionnaire 6.0 (EDE-Q 6.0) as a screening and assessment tool for eating disorders (EDs) among Chinese females. Method: Participants included 652 female patients diagnosed with EDs and 311 healthy female controls, with data collected from five separate research projects conducted between 2018 and 2024. Receiver operating characteristic (ROC) curve analysis determined diagnostic accuracy and optimal cut-off scores. Correlation analyses, Wilcoxon signed-rank tests, and regression analyses were used to evaluate the relationship between changes in EDE-Q 6.0 scores and other clinical measures following treatment in 55 patients with anorexia nervosa (AN) and 74 patients with bulimia nervosa (BN). Results: The Chinese version of the EDE-Q 6.0 demonstrated strong diagnostic accuracy in distinguishing EDs from the healthy population, with an optimal cut-off global score of 2.54 (area under ROC curve = 88.5%, sensitivity = 77.5%, specificity = 91.8%), significantly higher than in previous reports. Changes in EDE-Q 6.0 scores significantly correlated with clinical measures such as BMI, binge-eating frequency, Beck Depression Inventory, Beck Anxiety Inventory, and Eating Disorder Inventory subscales in both patients with AN and patients with BN (p < 0.05). Wilcoxon tests and stepwise regression confirmed its validity in reflecting clinical changes, capturing symptom variability related to BMI and depression in AN (p < 0.01) and binge-eating frequency and body dissatisfaction in BN (p < 0.01). Conclusion: The Chinese version of the EDE-Q 6.0 is a valid and effective screening and assessment tool for EDs in Chinese females. The updated cut-off score, now closer to international standards, reflects progress in the cultural adaptation of the tool and a potential shift in acceptance to report psychological problems among Chinese patients.