European Eating Disorders ReviewEur. Eat. Disorders Rev. 16, 451–462 (2008) The Development of the Childhood Retrospective Perfectionism Questionnaire (CHIRP) in an Eating Disorder Sample Laura Southgate 1*, Kate Tchanturia 1, David Collier 1 and Janet Treasure 2 1 Division of Psychological Medicine, Institute of Psychiatry, Kings College London, UK 2 Department of Academic Psychiatry, Guy’s, King’s and St. Thomas’ Medical School, London, UK This investigation explored the prevalence and predictive value of childhood obsessive-compulsive personality traits (OCPTs) in the development of eating disorders (EDs) using a novel retrospective questionnaire. To reduce bias associated with retrospective selfreport data, an identical informant version of the questionnaire was also utilised. Substantial test–retest and inter-rater reliabilities were found for the questionnaire, as well as concordant validity with the semi-structured interview from which it was derived. Participants with an ED (n ¼ 246) endorsed more childhood behaviours reflecting OCPTs than the control group (n ¼ 89). This was mirrored in the informant report data (n ¼ 93). The prevalence rate for each OCPT in childhood was significantly higher in the total ED sample compared to the control group. Both proband and informant reports of childhood traits predict the later development of an ED according to a strong dose–response relationship. The potential utility of this measure in future retrospective and prospective research studies is highlighted. Copyright # 2008 John Wiley & Sons, Ltd and Eating Disorders Association. Keywords: eating disorders; risk factors; questionnaire development; perfectionism; inflexibility INTRODUCTION Distinct from obsessive-compulsive disorder (OCD), obsessive-compulsive personality disorder * Correspondence to: Dr Laura Southgate, PhD, Eating Disorders Research Unit (PO59), Institute of Psychiatry, Kings College London, De Crespigny Park, SE5 8AF, UK. Tel: 0207 8480134. Fax: 0207 8480181. E-mail: l.southg[email protected]
(OCPD) is defined in DSM-IV as ‘a pervasive pattern of preoccupation with orderliness, perfectionism, mental and interpersonal control’ (APA, 1994). The reported presence of such traits in individuals with eating disorders (EDs) both premorbidly and following recovery suggests these are stable traits (Anderluh, Tchanturia, RabeHesketh, & Treasure, 2003; Kaye et al., 1998; Lilenfeld et al., 2000; Srinivasagam, Kaye, Plotnicov, Greeno, Weltzin, & Rao, 1995). The increased Copyright # 2008 John Wiley & Sons, Ltd and Eating Disorders Association. Published online 28 April 2008 in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/erv.870 Rastam. & Treasure. including individuals with a personal experience of an ED. we developed a short retrospective self-report measure of childhood OCPT. 16. 451–462 (2008) DOI: 10. The control group consisted of 89 females who did not have a history of an ED. & Gillberg. we also developed an informant report version of the questionnaire. 1998). In order to join the database. Information sheets describing the study were provided along with freepost envelopes with which to return the questionnaires. It is generally accepted that premorbid personality can be involved in the development and expression of psychiatric disorders (Duggan. Copyright # 2008 John Wiley & Sons. Lifetime diagnoses were determined for each participant based upon knowledge of current and past diagnoses and were assigned according to a formal diagnostic hierarchy. Concurrent validity was evaluated by comparing the data obtained from the questionnaire with that elicited in the EATATE semi-structured interview. Palmer. 1995. The return of questionnaires was taken to imply participant consent in the study. Eat. For example if participants had pure histories of AN (incorporating all sub-types) or BN (binge–purge behaviour with no history of low weight) they were given that lifetime diagnosis as appropriate. who were invited by the proband to complete (independently) an informant version of the CHIRP questionnaire. The aims of the current study were to investigate the psychometric properties of this novel retrospective questionnaire.. Ltd and Eating Disorders Association. utilising items from the EATATE semi-structured interview assessment of these traits (Anderluh et al. our hypotheses were that participants with a history of an ED would report a greater endorsement of behaviours associated with OCPTs in childhood than a sample of non-clinical control participants and that these traits would be apparent to informants.. in its development (see Anderluh et al. 2004) OCPTs that developed in childhood were identified as medium potency risk factors. 2003). METHOD Participants Two hundred and forty-six female participants with a lifetime history (thus including individuals at acute and recovered illness states) of AN (n ¼ 170) or BN (n ¼ 76) were recruited from clinical settings (inpatient and outpatient services) and the community. The informant report questionnaire consisted of identical items to the proband version that related to clearly observable behaviours.. by way of a volunteer database maintained by the eating disorder research unit at the Institute of Psychiatry. To minimise the biases associated with retrospective self-report data and also to test methodology suitable for informant reports in childhood. & Agras. they were given the lifetime diagnosis of BN. to explore the prevalence and predictive validity of premorbid traits suggestive of obsessive-compulsive personality. Ninety-three ‘informants’ also took part in this study.. Kraemer. ensuring that their full range of pathology was taken into account (Kaye et al. taking into account duration and severity. With this goal in mind. & Lee. In line with prior studies of childhood OCPTs in women with EDs (Anderluh et al. 2002). They consisted of family members or close friends of the probands recruited into the study. The construct validity of this measure relied on the involvement of ED ‘experts’. de Zwaan. Hayward. Egan. recruited from the local community. Rabe-Hesketh. Karwautz. Collier. Disorders Rev. limited to one informant per proband. McCarthy. from which the questionnaire was derived. London. If a participant had a symptom history containing discrete episodes of AN and BN. The importance of these premorbid features emphasises the need for a reliable measurement tool that could be used to screen for phenotypic traits in childhood and for use in prospective longitudinal research.1002/erv . 1998. 2003).. The reliability of the questionnaire was explored through the measurement of test–retest and inter-rater reliability. 2000). Southgate et al. Milton. 2003). 2000. Eur. This study was approved by the South London and Maudsley NHS Trust and the Central and North West London NHS Trust Research Ethics Committees. Lilenfeld et al. 452 prevalence of obsessive-compulsive personality traits (OCPTs) amongst first-degree relatives of individuals with EDs and their pattern of transmission highlights their potential aetiological significance (Lilenfeld et al.. Gillberg. In a systematic review of risk factor research in ED (Jacobi. 2003.L. and to retrospectively examine the relationship between childhood OCPTs and the development of an ED. individuals are required to provide baseline information with regards to their current and lifetime symptom history. in a large sample of females with a lifetime history of either anorexia nervosa (AN) or bulimia nervosa (BN) based upon both self and informant report data. probands and their informants were asked to ensure that they complete their questionnaires individually and separately to minimise any influence in their responses. 453 the use of pronouns to denote the proband as the reference for the responses. part 1 (Anderluh et al. investigators did not have any direct contact with the informants. The informant questionnaire consists of identical items as found in the proband version. & Rizvi. 2004). Disorders Rev. & Friedman. part 2 to explore concordant validity (Anderluh et al. Ltd and Eating Disorders Association. This diagnostic screen was sent to members of the volunteer database along with the retrospective childhood OCPTs questionnaire. in order to screen for the childhood traits of ‘global perfectionism’. ‘perfectionism’. The presence of each trait and its effect on the child’s life in terms of relationships with the world and others. Participants taking part in ongoing studies in the department were also asked to fill out a questionnaire and were invited to take home an informant version to give to an appropriate informant. was developed by academics. rule bound behaviour and rigidity. To maintain participant confidentiality. good friend).. Stice. The childhood retrospective perfectionism questionnaire (CHIRP)—informant report version. 2003).Childhood Personality Traits in EDs Materials Diagnostic measures As participants were recruited by different means. 451–462 (2008) DOI: 10. 2003). This section of the EATATE interview (from which the CHIRP questionnaire was derived). to assess five childhood traits that reflect obsessive-compulsive personality. sibling. Lavori. was assessed and rated according to a manualised scoring system.g. Eat. This 20-item questionnaire requires a yes/no answer to assess the presence of variety of behaviours in childhood believed to be typical of OCPTs. Questionnaire items refer to perfectionist tendencies (with regards to school work. The EDDS is a one page self-report questionnaire that can distinguish between full and sub-threshold diagnoses of AN and BN. childhood caution.. Within the study instructions. (Stice et al. Eur. A common factor for each measure was that they assessed and allocated ED diagnoses according to DSM-IV criteria. ‘inflexibility’. 0 for absent. Separate freepost return envelopes were provided to emphasise this point. 1 for present but not influencing the child’s life or 2 for the presence of a trait that impinges on the child’s life. 2000). Scoring the CHIRP Questionnaire Each questionnaire was scored according to the following dimensional and categorical scoring procedures.and informant report CHIRP questionnaire. 1987). Copyright # 2008 John Wiley & Sons. 2003). differing only in Members of the volunteer database were sent a copy of the self. along with instructions on how to complete them. The EATATE interview. ‘inflexibility’ and ‘need for order and symmetry’. Informants are also asked to rate as a percentage. 16. Telch. ‘excessive doubt and cautiousness’ and ‘drive for order and symmetry’. This was determined by eliciting the relationship between the informant and the proband and the number of childhood years (up to 12) that they had known the proband. two diagnostic instruments were used to assign diagnoses. Participants who had completed the questionnaire as part of another ongoing study in the research unit had their current and lifetime diagnoses determined using the EATATE interview. order/tidiness and hobbies).1002/erv . 1993) but adapted to assess lifetime symptoms of ED following the Longitudinal Interval Follow-up Evaluation (Keller. Stice. hence the recruitment of informants was reliant on the proband. The informant had to be someone who had good knowledge of the proband in childhood (e. parent. how reliable they would consider their answers to be. Fisher. ‘Childhood’ is explicitly defined as being up to 12 years of age to ensure that the behaviours assessed were present during a time preceding the onset of an ED for the vast majority of the clinical population (Fairburn & Harrison. The eating disorder diagnostic scale (EDDS.. The EATATE interview. This is a semi-structured clinical interview based upon the Eating Disorders Examination (Fairburn & Cooper. self-care/appearance. & Martinez. ‘rule driven’. Procedure Childhood obsessive-compulsive personality traits The childhood retrospective perfectionism questionnaire (CHIRP)—self-report version. 2000. clinicians and personal experts (service users) in the area of EDs. The majority of Table 1. Kruskal Wallis to test for main effects and Mann–Whitney U-tests for pairwise analyses. 16. using two-tailed tests with a 5% level of significance. finding periods of transition difficult. Table 1 details the childhood traits assessed. with ED status as the dependent variable and (1) total CHIRP questionnaire score as the independent (predictor) variable. the behaviours measured to determine the presence or absence of these traits and the scoring protocol. Disorders Rev. (2003). Where the assumptions of parametric testing were violated.L. Informant questionnaire The same scoring systems as used for the proband questionnaire. Between group analyses for normally distributed continuous variables were conducted using oneway ANOVA with Bonferroni post-hoc analyses where appropriate. every ‘yes’ response received a score of 1 and the total summed (question 6c reversed scored). Cohen’s k analyses investigated the inter-rater and test–retest reliabilities based on the presence/absence of each individual trait assessed (perfectionism.1002/erv . Southgate et al. The association between childhood personality features and the development of an ED was determined using logistic regression analyses. The dimensional score represented the number of behaviours that each participant endorsed as being relevant to them in childhood. The scoring procedure was kept as close as possible to that of the interview used by Anderluh et al. non-parametric tests were used. with weighted ks to determine the reliability for the total number of childhood traits endorsed. The nature and the quantity of traits present (0–3) was determined in this way for each participant. Ltd and Eating Disorders Association. (2) total number of childhood traits present (0–3) as the independent variable. Analyses were conducted using SPSS version 12 and STATA 8. At least one behaviour had to be endorsed in both the rigidity and rule bound domains The trait was regarded to have been present if relevant behaviours were endorsed in both the areas of life investigated Copyright # 2008 John Wiley & Sons. Simply. 454 Proband questionnaire A scoring system was designed to provide an overall dimensional questionnaire score and to obtain categorical childhood trait scores. Statistical Analysis The psychometric properties of the CHIRP questionnaire were determined using intra-class correlation coefficients to explore test–retest reliability and inter-rater reliability. applying Bonferroni correction procedure to correct for multiple testing.e. Eur. Childhood traits reflecting obsessive-compulsive personality as measured by the CHIRP questionnaire OCP trait Behaviour assessed relevant to trait Questionnaire scoring protocol Perfectionism Perfectionism is assessed separately in four areas of the child’s life: School work Self care (appearance) Looking after room Hobbies (including caring for pets) Inflexibility is assessed by exploring the presence of: Rigid behaviours (i. 451–462 (2008) DOI: 10.0. making detailed plans) Rule-bound behaviours (excessively careful to obey rules) Drive for order and symmetry is assessed in two areas of the child’s life: Appearance (clothes or hair) Looking after room The trait was regarded to have been present if at least one behaviour was endorsed in any two of the four perfection domains Inflexibility Drive for order and symmetry The trait was regarded to have been present if any behaviour relating to childhood rigidity and any childhood rule-bound behaviour was endorsed. inflexibility and symmetry). x2 analyses explored the prevalence of the childhood traits across the ED and control participants. behaviours endorsed). Analyses were performed on both the self-report and witness data. were employed with the informant questionnaire to (a) derive a dimensional score to represent the number of behaviours relating to obsessive-compulsive personality that was relevant each proband and (b) produce an overall OCPT score (0–3). based upon the total questionnaire score (representing the number of RESULTS Psychometric Properties of the Questionnaire Complete reports were collected from 77 proband– informant participant pairs. The endorsement of particular behaviours was taken to reflect the presence of specific traits. Eat. 001 0.01 0. 16.3%).98). Having been audio taped.60 0.001 0.44–0.7%).54 p < 0.001 Proband–informant pairs.30 p < 0.34 p < 0.92–0. AN n ¼ 45. ‘Fair’ to ‘substantial’ agreement between scores derived from differing time points (test–retest reliability).35).5%).8%) with the remaining being siblings (18. Prevalence of Childhood OCPT Total questionnaire score (dimensional analyses) based on self. Fifty-nine probands completed the questionnaire at two separate time points in order to investigate test–retest reliability. mode ¼ 12 years) and estimated their reports to be highly reliable (median reliability as a percentage ¼ 92%.60 0. IQR ¼ 15%).001 p < 0. Age differences were found. BN n ¼ 20). Ltd and Eating Disorders Association. highlighting the reliability and consistency of the interview data used in this current study. Table 4 displays participant descriptive statistics according to lifetime ED group. Informants knew the proband well throughout the whole of childhood (median ¼ 12 years. thus containing individuals in acute and recovered illness states. Unweighted k analysis.and informant report data Complete reports were collected from 93 informants (related proband diagnostic category: control n ¼ 28.96. Reliability and validity analyses for the total data set based upon the categorical (trait) scoring procedure Trait Child Perfectionismy Inflexibilityy Drive for order and symmetryy Total number of traits (0–3)z y z Test–retest reliability (n ¼ 59) 0.28 p < 0. The ‘substantial’ to ‘large’ (Landis & Koch. Anderluh et al.43 p < 0. Table 3 displays the results of the reliability and validity analyses based upon the categorical scoring procedure.49 0. 30 interviews were randomly picked to be re-rated by an assessor blind to participant diagnosis and the previous scores provided by the interviewer. The mean duration between questionnaire completions was 5.83 0.67 0..73 0. Disorders Rev. Eur.8%) and friends (4.8%). the participants with lifetime BN being significantly older than the control and AN groups. 1977) correlation coefficients reported support the utility of this questionnaire. Reliability and validity analyses based upon the dimensional scoring procedure Psychometric property Test–retest reliability Inter-rater reliability Concurrent validity Sample size Intra-class correlation coefficient n r 95% CI 59 77y 81 0.99 months (2.001 p < 0. mode ¼ 12 years) and estimated their reports to be highly reliable (median reliability as a percentage ¼ 95%. 95% CI: 0.001 0.1002/erv .73 Agreement rating Substantial Substantial Substantial y Landis and Koch (1977). Copyright # 2008 John Wiley & Sons. inter-quartile range ¼ 20%). other relatives (3. A very high correlation between the two rater’s scoring was found (r ¼ 0.001 p < 0. Eat. conducted using intra-class correlation coefficients. 451–462 (2008) DOI: 10. Informants knew the proband well throughout the whole of childhood (median ¼ 12 years. In order to assess concurrent validity 81 probands had taken part in the semi-structured EATATE interview (part 2.46 0.35 p < 0.73 0. The majority of informants were parents (72. Table 2 displays the results of the reliability and validity analyses based upon the dimensional scoring procedure.45–0. Proband–informant pairs.Childhood Personality Traits in EDs 455 Table 2.001 0.3%) and friends (4. conducted using Cohen’s k analyses (weighted and unweighted).38 p < 0.58–0. other relatives (4. 2003) prior to completing the CHIRP questionnaire.001 Inter-rater reliability (n ¼ 77) Concurrent validity (n ¼ 81) 0.001 0. Weighted k analysis. informants were parents (77%) with the remaining being siblings (12.61 p < 0. Correlational analyses Table 3. informants (inter-rater reliability) and data collection formats (concurrent validity) were found. 64) 3. Disorders Rev.01 Bonferroni post-hoc tests.64.25 (4. 95% CI 1.and informant report questionnaires and (3) to determine the strength of the relationship between OCPTs in childhood and the development of an ED. OR 1.47) 30. According to the self-report data. control participants had significantly lower total scores on the CHIRP questionnaire compared to those with a lifetime history of AN or BN. Results confirmed with non-parametric Mann–Whitney analyses with Bonferroni adjustment of the a level ( p < 0. 95% CI 1.27–1.53. Ltd and Eating Disorders Association. A significantly higher proportion of informants for the ED participants endorsed the presence ‘perfectionism’ and ‘inflexibility’ in their subjects during childhood compared to the control informants. Copyright # 2008 John Wiley & Sons. both proband questionnaire scores (l2 (1) ¼ 63.71 (11. The proportion of participants endorsing the presence of each of the three childhood traits was significantly higher in the ED group compared to the control group.76.017).1002/erv . Eat. Participant characteristics and total CHIRP questionnaire score (based on self. lifetime AN participants had significantly lower current BMIs than the other participant groups. both the proband reports (l2 (1) ¼ 63.91 (df ¼ 2. Eur.64 (3.48) 9. With participant diagnostic category (lifetime ED or control participant) as the dependent variable and total questionnaire score (dimensional analyses) as the predictor variable. (2) to investigate the prevalence of childhood OCPTs in adults with a lifetime history of an ED.01 C < BN p < 0. 90) p Pair-wise comparisons 4.31 (4. 95% CI 1. 456 Table 4.04 (3.97) were found to be significant predictors of ED status.06 (3.05.05 AN < BN p < 0. p ¼ 0. The pattern of results using the informant reports mirrored that of the self-report scores.001 BN < C p < 0. measured by self. p < 0.28.48) 9. No significant relationship was found. The relationship between OCPTs in childhood and the development of an eating disorder Based upon proband self-report (n ¼ 335) and informant report (n ¼ 93) data.49) and witness questionnaire scores (l2 (1) ¼ 13.001 C < AN p < 0.47) could accurately predict participant diagnostic category. OR 2.75 <0.001.93.81–5.48) 9. 16. 332) p Pair-wise comparisons 29.69) 9. Southgate et al.87 <0. 451–462 (2008) DOI: 10.05 AN < C p < 0. p < 0.01 C < BN p < 0.87 (11.L. sharing similar scores. (1) to investigate the psychometric properties of a novel retrospective questionnaire measure of childhood personality traits.001.and informant reports and the odds ratios comparing the total ED group and the control participants are displayed in Table 5.001.001 3.05 <0. hence this variable was not required to be entered into the subsequent analyses as a covariate.57) 9.49) and witness reports (l2 (1) ¼ 12. logistic regression analyses were conducted to determine the discriminant validity of the CHIRP questionnaire.42 88. OR 3. Thus the strongest dose–response relationships for the development of an ED were found when using the questionnaire data categorically.001 C<BN p < 0. OR 1.001. As expected. DISCUSSION The aims of the current study were threefold.99) 21. Similarly with the number of OCPTs endorsed (0–3) as the predictor variable.57 (5.47) 17.40) 22.79.33 (2.80) 33.13 (9. (Spearmans and Pearsons) were performed to determine the relationship between age and CHIRP questionnaire total score.56–4.12) 57. 90) <0. 95% CI 2.and informant report data The prevalence of OCPTs in childhood determined by self.23 (2.001 C < AN p < 0.01 Control n ¼ 28 AN n ¼ 45 BN n ¼ 20 F (df ¼ 2. The presence of childhood traits (categorical analyses) based upon self. p < 0.and informant report data) Self-report Age BMI CHIRP total Informant report CHIRP total Control n ¼ 89 AN n ¼ 170 BN n ¼ 76 F (df ¼ 2.12–1.54 (4.38. 60% (25) 11. this novel measure of childhood personality appears to have some utility. 1997. Childhood personality traits relating to perfectionism.78 15. The foremost limitation in retrospective research is the potential for memory bias. 16.. the similarity of premorbid features being in line with the similarity in enduring traits found in individuals upon recovery (Matsunaga. This close relationship enhances the likelihood that the informant provided a reliable account of the proband during childhood (Ready. Doll.60% (1) 9. 2000). Clarke.50% (48) 34. potentially representing individuals with less severe EDs and associated personality pathology. Cooper.001 >0. calling into question the reliability of self-report measures in particular. The majority of informants who completed the witness questionnaire were parents. Firstly. Therefore when judged against these quality standards.34 <0. The informant report data generally mirrored the findings of the selfreport data. The results of the between group analyses were in accordance with the hypotheses that (a) participants with a history of an ED would report a greater endorsement of OCPT related behaviours in childhood than a sample of healthy control participants and (b) these traits would be apparent to informants. inflexibility and need for order and symmetry) and the development of an ED. 2003) the prevalence of OCPTs in childhood did not differ between the AN and BN participants and the magnitude of increased risk associated with the presence of each childhood trait found was smaller. C) Participant group (lifetime diagnoses) Self-report Perfectionism Inflexibility Symmetry Informant report Perfectionism Inflexibility Symmetry p-value Odds ratio (95% CI) AN (n) BN (n) ED (n) Control (n) df ¼ 1 78.82) Assumption of x2 violated therefore significance value determined using fishers exact test.00% (14) 55. allowing superior diagnostic sensitivity and specificity.20% (45) 55.32) 7. thus providing confidence in the results of this study (Zimmerman. Watson.29 (2. Two explanations may account for these discrepancies..40% (17) 76. Secondly.30% (4) 3.1002/erv .10% (5) 70.80% (171) 19.49 1. Participants with an ED had a significantly greater experience of OCPT in childhood than the control participants and a dose–response relationship was found with the three traits (perfectionism. 95% CI ¼ 95% confidence interval. compared to the exclusively clinical sample recruited in the former study. Fairburn.00% (11) 10.20% (2) 48. inflexibility/rigidity and the drive for order and symmetry were associated with the development of both AN and BN (Anderluh et al. The results from this study concord with the overall literature.07) 11.001 <0. our exploration highlighted adequate test–retest and inter-rater reliability and concurrent validity.27 76.44) 12.59 (6. & Rao.32–21. Doll. Welch. 2003.50–10. By comparing retrospective self-report data obtained by questionnaire to that obtained by interview and witness reports. Informants reported close contact with the proband for all of their childhood years.40% (36) 10.10% (181) 71.20% (129) 71.90) 3. Eur.00 (3.60–10.Childhood Personality Traits in EDs 457 Table 5. 1994).00% (16) 2.10 13.00% (54) 22.20% (52) 73.80% (7) 35. Fairburn. Behaviour related to this trait may be less observable to others than perfectionism and inflexibility.70% (10) 14.90% (31) 55. 1999.00% (2) 69.80% (31) 18.001 6.25% (31) 71. Thus OCPTs are reflective of vulnerability factors for both disorders.02 (1. the second most frequent proband–informant relationship being siblings.51–44. McConaha. Rastam. In comparison to our previous findings using a semi-structured interview (Anderluh et al. Ltd and Eating Disorders Association. Plotnicov. 1992). 451–462 (2008) DOI: 10. the use of an interview has the advantage of eliciting greater detail. Pollice. & O’Connor. & Westerhouse.30% (117) 18.003 <0.00 (2.29 0. Eat.37) 68.05 4. the participants in the current study were recruited from both clinical settings and from our volunteer database.001 <0. Davies.00 (0. & Welch.32–23. Kaye.38–27. informant reports and semi-structured interviews are considered to be the most valid methods of such data collection. allowing responses to be based on a longitudinal perspective of the individual’s behaviour in a variety of different contexts. As a consequence. the only difference being the reduced prevalence of the trait ‘drive for order and symmetry’ as reported by the informants of the ED probands. Prevalence of childhood traits reflecting obsessive-compulsive personality among participants with a history of an ED and controls x2 statistic (ED vs. Srinivasagam Copyright # 2008 John Wiley & Sons. 1998. Disorders Rev. its limitations lie in the time and costs associated with interviewer training and administration. Thus. & Lizardi. whilst the diagnosis of ‘eating disorder not otherwise specified’ (EDNOS) is commonly found in the clinical setting (Fairburn & Bohn. Furthermore. (Carter. a large proportion of cases may have had a long duration of illness. 2002. 1997. Literature suggests that OCPTs increase individual vulnerability towards the development of an ED.. research which is difficult and costly to conduct. Klein. EDNOS as a lifetime diagnostic category was not relevant as each participant had previously met DSM-IV diagnostic criteria (APA. longitudinal prospective risk factor studies are required (Jacobi et al. 2004). The inter-rater reliability based upon the presence/absence of each individual trait was smaller than the agreement found when utilising the dimensional score. Further research is required to explore the prevalence of OCPTs in individuals with ‘subthreshold’ EDs or EDNOS. Gillberg. Whilst the current study identified childhood OCPTs to be retrospective correlates of EDs in general (as no significant differences were found between AN and BN participants) a psychiatric control group was not included thus it is still to be determined as to whether the traits explored here reflect specific vulnerability towards ED psychopathology or generic factors involved in a variety of psychiatric disorders. Anderson. the problem of ‘state’ versus ‘trait’ and the heterogeneous nature of the phenotypes. Overall. 1994) for either AN or BN at some point in their lifetime. Participants recruited from adult treatment settings have undergone a different selection process. 458 et al. Ouimette. This methodology makes a substantial attempt to overcome some of the short comings associated with the conceptualisation of current diagnoses. Riso. 451–462 (2008) DOI: 10. being found in previous literature investigating self-informant concordance regarding the presence of personality traits and disorders (Bernstein et al. Participants from the volunteer database were tested approximately 15 years following the onset of the illness. 1995). The current results need be confirmed in prospective longitudinal studies. A limitation of this instrument was that the reliability of the categorical subscales was low compared to that of the dimensional score. 2004. The instability of the ED diagnostic categories poses a problem for research. & Woodside. We opted to minimise the burden as we wanted an instrument that could be used broadly in longitudinal studies. the ‘gold standard’ for risk factor research (Kazdin. The concordance of the data obtained from the retrospective questionnaire with that determined from the EATATE semi-structured interview.1002/erv . a diagnosis of AN or BN ‘trumps’ that of EDNOS. Copyright # 2008 John Wiley & Sons. Noda. including their temporal instability. the inter-rater concordance reflects an absence of self-presentation biases in the ED participants. 16. The fact that the findings reported here were comparable with the consensus in the literature. 2004. The potential for such research is made increasingly possible with this quick and simple questionnaire that reliably measures the construct under study. 2004). Members of the volunteer database cannot be considered a true community sample due to the self-selected nature of such individuals. Two limitations arise from this. especially in EDs due to the relatively low incidence of disorder. Wentz-Nilsson. & O’Hara. Following the lifetime diagnostic approach (taking an individual’s full symptom profile into account). it is not clear as to the extent to which the data obtained may be generalised to the ED population as a whole. It will be interesting to use this measure in adolescent cases and to examine whether it does predict prognosis.. confirmed the utility of this questionnaire as a quick and easy measure of childhood personality traits. Eur. following a symptom hierarchy to derive lifetime diagnoses for each ED participant. & Rastam.. 2005) and may have been a relevant current diagnosis for some participants included in this study. Gillberg. endorses the criterion validity of this novel measure. Eat. Southgate et al.. however this enabled the recruitment of a large clinical and control participant sample. Ltd and Eating Disorders Association. allowing a large participant sample to be tested. Blackmore. These findings are typical (Kraemer. To confirm this. This study utilised a trait approach to diagnostic classification. Whilst the use of the EATATE interview has the advantage of eliciting greater detail and thus allowing superior diagnostic sensitivity and specificity. Steinhausen. 1994). First.L. 1999) and so these traits may be over represented. Skodol et al. Second. Disorders Rev. defending the reliability of self-report data with this clinical group. Sutandar-Pinnock. There is always a tension between increasing the reliability of factors by expanding the number of items and the burden this imposes on subjects. OCPTs have been recognised to be a factor maintaining the illness. It is acknowledged that the use of two different diagnostic screening methods is not ideal. the longer time elapsed between these distant events may make it less easy to distinguish premorbid traits from those that arise secondary to the ED. M. B. L. & Lee. Comprehensive Psychiatry. Doll. W. 44. R. Mitropoulou. Lilenfeld. 38. Coming to terms with risk factors for eating disorders: Application of risk terminology and suggestions for a general taxonomy. 468–476. European Eating Disorders Review. (2004).. 1–9. G. (2002). & Treasure. Personality-disorders. the association between these premorbid traits and the later development of an ED highlight features of psychopathology that would benefit from therapeutic intervention. & Koch. K. P. et al. Carter. nature. & Offord. 10. & Woodside. Risk factors for bulimia nervosa: A community based case-control study. Kaye. D.). Clinical Psychology Review.. R. Moss. 361. H. & Welch. 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Please think back to the time when you were a child.. . . . Copyright # 2008 John Wiley & Sons.. Eur. .1002/erv .. Name .. . friends. . 451–462 (2008) DOI: 10.. . up to the age of 12 years.. 461 However only judge if a behaviour was present if you: EITHER took longer than others doing things because of attention to detail or high standards and if in your judgement this interfered with other activities (e. . .. ..Childhood Personality Traits in EDs APPENDIX A: THE CHILDHOOD RETROSPECTIVE PERFECTIONISM QUESTIONNAIRE (CHIRP) PROBAND VERSION Permission is given for the questionnaire to be used but it should not be modified without written permission from the authors.g.. . . leisure time. . Then judge if the following behaviours described you at that time.... Ltd and Eating Disorders Association. . .. .1002/erv .% reliable (where 0% is not at all reliable and 100% is perfect). .Date. .....g... .. . . . Eur. ... Southgate et al. ...... .Completed by.. teachers) commented on it I estimate that my account is . Subject/Child’s Name.. . . ... ... 462 APPENDIX B: THE CHILDHOOD RETROSPECTIVE PERFECTIONISM QUESTIONNAIRE (CHIRP) INFORMANT VERSION Permission is given for the questionnaire to be used but it should not be modified without written permission from the authors.. ... leisure time....... school or hobbies) OR this behaviour was so extreme that other people (e.. 16.... We ask you to only judge a behaviour as being present in your child if they: EITHER took longer than others doing things because of attention to detail or high standards and if in your judgement this interfered with other activities (e. relatives.. .. 451–462 (2008) DOI: 10.....g....... friends. .. In the following questions we are interested in certain behaviours that may have been relevant to your child up to the age of 12... . Eat.. Disorders Rev. Copyright # 2008 John Wiley & Sons.... . siblings.. . . .... .L..... Ltd and Eating Disorders Association.