Eating Disorder Test (EAT-26) — 26 Questions, 3 Subscales

The EAT-26 (Eating Attitudes Test, 26-item version) is the most widely used self-report screening tool for eating disorders worldwide, developed by David Garner and colleagues in 1982. It is a brief, validated instrument scored on a 0-78 scale, with a clinical cut-off of 20 — scores at or above 20 indicate that further professional evaluation is warranted. The EAT-26 is used in research, primary care, school screening programs, and as a standard intake instrument in eating-disorder treatment centres globally. It has three subscales: Dieting (13 items), Bulimia & Food Preoccupation (6 items), and Oral Control (7 items).

Eating disorders are serious mental health conditions characterised by persistent disturbances in eating behaviour and related thoughts and emotions. The DSM-5 recognises several distinct conditions: Anorexia Nervosa (restriction of food intake leading to significantly low body weight, intense fear of gaining weight, body image disturbance), Bulimia Nervosa (recurrent binge eating followed by compensatory behaviours like vomiting, laxatives, or excessive exercise), Binge Eating Disorder (recurrent binge eating without regular compensatory behaviours — the most common eating disorder), and ARFID (Avoidant/Restrictive Food Intake Disorder — restricted eating not driven by body image concerns, more common in children and autistic adults). About 9% of the US population will have an eating disorder at some point in their lifetime; rates are rising, particularly in adolescents and young adults.

Anorexia Nervosa (AN) — restriction of food intake, intense fear of weight gain, body image disturbance, significantly low body weight; lifetime prevalence ~1%. Bulimia Nervosa (BN) — recurrent binge eating + compensatory behaviours (vomiting, laxatives, excessive exercise) at least once a week for 3 months; lifetime prevalence ~1.5%. Binge Eating Disorder (BED) — recurrent binge eating without regular compensatory behaviours; most common adult eating disorder; lifetime prevalence ~2.8%. ARFID — restrictive eating not driven by body image concerns; often co-occurs with autism. OSFED (Other Specified Feeding or Eating Disorder) — eating disorders that don't fit other categories but cause significant distress or impairment; very common, often under-diagnosed. All carry significant medical risk and require professional treatment.

Evidence-based eating disorder treatment includes: Family-Based Treatment (FBT, also called the Maudsley method) — the gold standard for adolescents with anorexia, involves the family taking active role in re-feeding. CBT-E (Enhanced Cognitive Behavioural Therapy for Eating Disorders, Christopher Fairburn) — strongest evidence for adult bulimia and binge eating disorder; typically 20 sessions. MANTRA (Maudsley Anorexia Nervosa Treatment for Adults) — designed specifically for adult anorexia. DBT (Dialectical Behavior Therapy) — useful for eating disorders with emotion regulation difficulties or co-occurring BPD. Nutritional rehabilitation with a registered dietitian (RD) is essential alongside any psychological treatment. For medical instability (significant weight loss, electrolyte imbalances, cardiac issues), medical stabilisation in inpatient or partial hospitalisation may be needed before outpatient psychological work can be effective.

Eating disorders are among the most serious mental health conditions. Anorexia nervosa has one of the highest mortality rates of any mental health condition — roughly 5-10% of people with anorexia die from medical complications or suicide. Bulimia nervosa carries significant medical risk from electrolyte imbalances, cardiac arrhythmias, esophageal damage, and dental erosion. Binge eating disorder substantially increases risk for type 2 diabetes, cardiovascular disease, and severe obesity-related medical conditions. The good news is that early intervention is highly effective: 60-80% of people with eating disorders who receive evidence-based treatment achieve full recovery. The key factor is access to specialised treatment — generic therapy is often the wrong tool.

Eating disorders can affect anyone but population research shows specific patterns: women are diagnosed at higher rates (though the gap is narrowing — male eating disorders are significantly under-recognised); peak age of onset is adolescence and young adulthood (12-25); LGBTQ+ adults, particularly transgender and non-binary people, have substantially elevated rates; athletes in weight-class or appearance-focused sports (running, gymnastics, wrestling, ballet) are over-represented; eating disorders co-occur frequently with anxiety, depression, OCD, autism, and trauma. The traditional stereotype of 'thin white teenage girl' is misleading — eating disorders occur across all body sizes, genders, ages, and ethnicities. If your EAT-26 score is elevated, please don't dismiss it based on demographics.

No — the EAT-26 is a screening tool, not a diagnostic instrument. A score above the clinical cut-off of 20 indicates the need for further evaluation by a qualified clinician, but diagnosis requires a clinical interview, often including the EDE (Eating Disorder Examination, the gold-standard diagnostic interview) and medical evaluation. False positives and false negatives both occur with the EAT-26. The right interpretation: a score above 20 means 'this warrants professional follow-up', not 'I definitely have an eating disorder'. Conversely, a score below 20 with significant subjective distress also warrants follow-up — clinical eating disorders can sometimes occur below the EAT-26 threshold.

The EAT-26 takes most people 5-7 minutes to complete. It is 26 items rated on a 6-point frequency scale. Results appear instantly with your total score, subscale breakdown, and explicit indication of whether you meet the validated screening cut-off (≥20).