Table 3.
Panel ratings for the potential symptom attributes of disordered eating in pregnancy
| Panel | Mean (SD) | Mode | % of panel agreement | Consensus | |
|---|---|---|---|---|---|
| Behavioural symptom items | |||||
| Dietary consumption that does not support a healthy pregnancy | P | 4.88 (.33) | 5.00 | 100% | Yes |
| C | 4.67 (1.05) | 5.00 | 93.3% | Yes | |
| Dieting behaviours (e.g., calorie counting) | P | 4.15 (.68) | 4.00 | 92.3% | Yes |
| C | 4.13 (1.41) | 5.00 | 80.0% | Yes | |
| Inflexibility and rigidity with diet (i.e., strict consumption of diet foods only) | P | 4.88 (.33) | 5.00 | 100% | Yes |
| C | 4.07 (1.03) | 4.00 | 86.7% | Yes | |
| Fasting and/or skipping meals | P | 4.88 (.33) | 5.00 | 100% | Yes |
| C | 4.53 (1.06) | 5.00 | 93.3% | Yes | |
| Use of meal replacements (when not advised by a health professional) | P | 4.54 (.81) | 5.00 | 88.5% | Yes |
| C | 4.40 (1.40) | 5.00 | 86.7% | Yes | |
| Repeated weighing | P | 3.85 (.78) | 4.00 | 76.9% | Yes |
| C | 4.67 (1.05) | 5.00 | 93.3% | Yes | |
| Refusing to eat outside of one’s home | P | 4.65 (.56) | 5.00 | 96.2% | Yes |
| C | 4.33 (1.23) | 5.00 | 86.7% | Yes | |
| Eating in secret | P | 4.73 (.45) | 5.00 | 100% | Yes |
| C | 4.60 (1.06) | 5.00 | 93.3% | Yes | |
| Eating an objectively large amount of food | P | 3.85 (.54) | 4.00 | 76.9% | Yes |
| C | 3.93 (1.03) | 4.00 | 80.0% | Yes | |
| Eating for “two” | P | 2.46 (.76) | 2.00 | 7.7% | No |
| C | 3.33 (.72) | 3.00 | 33.3% | No | |
| Eating when not physically hungry | P | 3.08 (.56) | 3.00 | 19.2% | No |
| C | 4.13 (.52) | 4.00 | 93.3% | Yes | |
| Using food to cope with/soothe strong emotions, or reward oneself | P | 3.92 (.63) | 4.00 | 84.6% | Yes |
| C | 4.07 (1.10) | 4.00 | 80.0% | Yes | |
| Eating rapidly and until uncomfortably full | P | 4.31 (.62) | 4.00 | 92.3% | Yes |
| C | 4.13 (1.13) | 5.00 | 80.0% | Yes | |
| Self-induced vomiting | P | 4.85 (.46) | 5.00 | 96.2% | Yes |
| C | 4.53 (1.13) | 5.00 | 86.7% | Yes | |
| Obsessively exercising for the purpose of controlling weight and shape | P | 4.15 (.54) | 4.00 | 92.3% | Yes |
| C | 4.60 (1.06) | 5.00 | 93.3% | Yes | |
| Exercising against medical recommendations | P | 4.92 (.27) | 5.00 | 100% | Yes |
| C | 4.60 (1.06) | 5.00 | 93.3% | Yes | |
| Exercising in secret | P | 4.88 (.33) | 5.00 | 100% | Yes |
| C | 4.80 (.56) | 5.00 | 93.3% | Yes | |
| Refusing to purchase maternity clothing | P | 2.96 (.82) | 3.00 | 15.4% | No |
| C | 2.93 (1.22) | 2.00 | 33.3% | No | |
| Wearing specific clothing to conceal pregnancy | P | 2.88 (.71) | 3.00 | 15.4% | No |
| C | 3.67 (1.05) | 4.00 | 68.8% | No | |
| Misuse of gestational diabetes medication | P | 4.96 (.20) | 5.00 | 100% | Yes |
| C | 4.80 (.78) | 5.00 | 93.3% | Yes | |
| Use of laxatives or enemas to reduce gestational weight gain/induce weight loss | P | 4.92 (.27) | 5.00 | 100% | Yes |
| C | 4.80 (.78) | 5.00 | 93.3% | Yes | |
| Use of appetite suppressants or “diet pills” | P | 4.88 (.43) | 5.00 | 96.2% | Yes |
| C | 4.80 (.78) | 5.00 | 93.3% | Yes | |
| Use of natural supplements (e.g., tea detox) | P | 4.81 (.49) | 5.00 | 96.2% | Yes |
| C | 4.67 (.82) | 5.00 | 93.3% | Yes | |
| Body checking behaviours | P | 4.00 (.49) | 4.00 | 88.5% | Yes |
| C | 4.80 (.41) | 5.00 | 100% | Yes | |
| Self-harm | P | 4.85 (.37) | 5.00 | 100% | Yes |
| C | 4.40 (.91) | 5.00 | 86.7% | Yes | |
| Not consuming enough food during pregnancy to produce milk or sustain breastfeeding, resulting in weight loss and/or binge eating behaviours a | P | 4.87 (.34) | 5.00 | 100% | Yes |
| C | 4.60 (.63) | 5.00 | 93.3% | Yes | |
| Spending an excessive amount of time (i.e., multiple hours per week) researching about the most effective ways to reduce pregnancy weight gain and/or ways to lose weight after birth | P | – | – | – | – |
| C | 4.93 (.26) | 5.00 | 100% | Yes | |
| Searching for or seeking information about disordered eating in pregnancy | P | – | – | – | – |
| C | 4.53 (.92) | 5.00 | 86.7% | Yes | |
| Using the pregnancy as a ‘valid’ excuse/reason to avoid feared foods and/or not violate dietary rules | P | – | – | – | – |
| C | 4.53 (.52) | 5.00 | 100% | Yes | |
| Obsessively recording anticipated and achieved weight gain and calculating calorie intake and exercise output to ensure only the absolute minimum weight gain (and feeling distressed if anything interferes with this) | P | – | – | – | – |
| C | 5.00 (.00) | 5.00 | 100% | Yes | |
| Preferring to ensure the nausea and ignore physical hunger signals due to fear of weight gain or changes to shape | P | – | – | – | – |
| C | 5.00 (.00) | 5.00 | 100% | Yes | |
| Going to bed hungry at the end of the day and thinking about food, but not allowing oneself to eat to subside this hunger | P | – | – | – | – |
| C | 4.93 (.26) | 5.00 | 100% | Yes | |
| Excessively reassuring doctors/midwives that low weight during pregnancy OR lack of weight gain is nothing to be concerned about by reporting vague eating habits (e.g., “I eat heaps”) | P | – | – | – | – |
| C | 4.80 (.78) | 5.00 | 93.3% | Yes | |
| Requesting early discharge from hospital because of the food that might be served and feeling anxious is this early discharge does not or cannot occur | P | – | – | – | – |
| C | 4.73 (.59) | 5.00 | 93.3% | Yes | |
| Frequent ‘fat talk’ (i.e., if a pregnant woman talks a lot about how ‘fat’ she looks or is) | P | – | – | – | – |
| C | 4.40 (.91) | 5.00 | 86.7% | Yes | |
| Chewing and spitting out large amounts of food, particularly forbidden foods | P | – | – | – | – |
| C | 4.93 (.26) | 5.00 | 100% | Yes | |
| Physical symptom items | |||||
| Low body weight | P | 3.96 (.53) | 4.00 | 96.2% | Yes |
| C | 3.80 (.56) | 4.00 | 73.3% | No | |
| Losing weight while pregnant | P | 4.73 (.60) | 5.00 | 92.3% | Yes |
| C | 3.80 (.68) | 4.00 | 80.0% | Yes | |
| Inadequate gestational weight gain | P | 4.77 (.65) | 5.00 | 96.2% | Yes |
| C | 4.46 (.64) | 5.00 | 93.3% | Yes | |
| Excessive gestational weight gain | P | 3.88 (.65) | 4.00 | 80.8% | Yes |
| C | 3.80 (.68) | 4.00 | 66.7% | No | |
| Rapid gestational weight gain | P | 3.92 (.56) | 4.00 | 80.8% | Yes |
| C | 3.60 (.83) | 4.00 | 66.7% | No | |
| Dizziness and/or fatigue | P | 3.54 (.76) | 3.00 | 46.2% | No |
| C | 2.93 (.80) | 3.00 | 13.3% | No | |
| Feeling nauseated most of the time | P | 2.08 (.85) | 2.00 | 7.7% | No |
| C | 2.67 (1.18) | 3.00 | 20.0% | No | |
| Severe morning sickness that does not stop after the first trimester (hyperemesis gravidarum) | P | 4.31 (.84) | 5.00 | 84.6% | Yes |
| C | 2.00 (1.36) | 1.00 | 20.0% | No | |
| Dehydration | P | 4.58 (.58) | 5.00 | 96.2% | Yes |
| C | 3.27 (.80) | 3.00 | 33.3% | No | |
| Abdominal bloating | P | 3.04 (.60) | 3.00 | 11.5% | No |
| C | 2.93 (.80) | 3.00 | 13.3% | No | |
| Gastrointestinal discomfort | P | 3.00 (.63) | 3.00 | 19.2% | No |
| C | 2.47 (.99) | 2.00 | 13.3% | No | |
| Unborn baby is small/underdeveloped for gestational age a | P | 3.96 (.48) | 4.00 | 87.0% | Yes |
| C | 3.47 (.74) | 3.00 | 33.3% | No | |
| Asymmetrical or slow foetal growth a | P | 3.96 (.48) | 4.00 | 87.0% | Yes |
| C | 3.53 (.74) | 3.00 | 40.0% | No | |
| The woman’s blood tests show electrolyte imbalances (e.g., low potassium) a | P | 4.31 (.84) | 5.00 | 84.6% | Yes |
| C | 4.13 (.74) | 4.00 | 80.0% | Yes | |
| Cognitive symptom items | |||||
| Overvaluation of body shape and weight | P | 4.42 (.50) | 4.00 | 100% | Yes |
| C | 4.93 (.26) | 5.00 | 100% | Yes | |
| Perceptual disturbance (e.g., perceiving self to be overweight for pregnancy stage, when objectively not) | P | 4.42 (.50) | 4.00 | 100% | Yes |
| C | 4.87 (.35) | 5.00 | 100% | Yes | |
| Poor body image | P | 4.12 (.52) | 4.00 | 92.3% | Yes |
| C | 4.47 (.99) | 5.00 | 80.0% | Yes | |
| Low self-esteem | P | 3.77 (.65) | 4.00 | 73.0% | No |
| C | 4.20 (.56) | 4.00 | 93.3% | Yes | |
| Rumination about gestational weight gain | P | 4.04 (.53) | 4.00 | 88.5% | Yes |
| C | 4.87 (.35) | 5.00 | 100% | Yes | |
| Rumination about health of baby | P | 3.08 (.63) | 3.00 | 15.4% | No |
| C | 3.07 (.80) | 3.00 | 20.0% | No | |
| Fixation on post-partum weight loss | P | 4.12 (.52) | 4.00 | 92.3% | Yes |
| C | 4.80 (.56) | 5.00 | 93.3% | Yes | |
| Self critical thoughts and fear of criticism | P | 3.31 (.79) | 3.00 | 42.3% | No |
| C | 4.20 (.56) | 4.00 | 93.3% | Yes | |
| Comparing personal eating habits to others | P | 3.77 (.59) | 4.00 | 76.9% | Yes |
| C | 3.87 (.74) | 4.00 | 80.0% | Yes | |
| Need for pregnancy to be “perfect” | P | 3.88 (.71) | 4.00 | 76.9% | Yes |
| C | 4.20 (.78) | 4.00 | 93.3% | Yes | |
| Desire for baby to be “small” or “petite” | P | 4.73 (.53) | 5.00 | 96.2% | Yes |
| C | 4.20 (1.08) | 5.00 | 80.0% | Yes | |
| Suicidal thoughts/ideation | P | 4.62 (.94) | 5.00 | 88.5% | Yes |
| C | 4.40 (.83) | 5.00 | 80.0% | Yes | |
| Frequent comparison of weight and shape, with pregnant and non-pregnant women a | P | 4.74 (.45) | 5.00 | 100% | Yes |
| C | 4.67 (.62) | 5.00 | 93.3% | Yes | |
| Belief that vomiting will not adversely impact the fetus/baby because “all pregnant women vomit” a | P | 4.78 (.52) | 5.00 | 96.0% | Yes |
| C | 4.60 (.74) | 5.00 | 86.7% | Yes | |
| Obsessive thoughts during pregnancy that relate to food (e.g., fear of food contamination, “clean eating” to avoid pesticides) a | P | 4.74 (.45) | 5.00 | 100% | Yes |
| C | 4.47 (.83) | 5.00 | 93.3% | Yes | |
| Obsessive thoughts regarding health and normality of pregnancy a | P | 3.96 (.64) | 4.00 | 87.0% | Yes |
| C | 4.07 (.85) | 4.00 | 80.0% | Yes | |
| Thoughts during pregnancy about using breastfeeding as a purgatory method and/or prolonging breastfeeding for weight loss | P | – | – | – | – |
| C | 4.73 (.80) | 5.00 | 93.3% | Yes | |
| Agonising and debating the absolute necessity of every food item consumed and/or bargaining with oneself | P | – | – | – | – |
| C | 4.93 (.26) | 5.00 | 100% | Yes | |
| Urges and thoughts of wanting to vomit to relieve physical or psychological tension | P | – | – | – | – |
| C | 2.93 (1.22) | 2.00 | 33.3% | No | |
| Thoughts that one does not deserve to eat, and having to justify food consumption ‘for the baby’ | P | – | – | – | – |
| C | 5.00 (.00) | 5.00 | 100% | Yes | |
| Thoughts of wanting to be ‘just bump’ (i.e., weight gain is only acceptable in ‘pregnancy-appropriate’ areas such as the stomach, but not the arms/thighs etc) | P | – | – | – | – |
| C | 4.33 (.82) | 4.00, 5.00 | 93.3% | Yes | |
| Thoughts of returning to a restrictive diet once the baby is no longer dependent on mother’s body (e.g., to grow in the womb, for breastfeeding, etc) | P | – | – | – | – |
| C | 4.60 (.74) | 5.00 | 86.7% | Yes | |
| Preoccupation with diets, weight management information, and the lack of weight gained by other pregnant individuals and/or admiration for how rapidly these individuals ‘snap back’ to their pre-pregnancy body weight and shape | P | – | – | – | – |
| C | 4.93 (.26) | 5.00 | 100% | Yes | |
| Affective symptom items | |||||
| Distress regarding changing shape + fear of fatness | P | 4.27 (.45) | 4.00 | 100% | Yes |
| C | 4.53 (1.06) | 5.00 | 86.7% | Yes | |
| Distress or guilt after eating “unhealthy” or “bad” foods | P | 4.19 (.49) | 4.00 | 96.2% | Yes |
| C | 4.53 (.83) | 5.00 | 93.3% | Yes | |
| Mood disturbance | P | 3.92 (.80) | 4.00 | 84.6% | Yes |
| C | 3.13 (.99) | 3.00 | 33.3% | No | |
| Anxiety about certain foods/food groups | P | 4.08 (.56) | 4.00 | 84.6% | Yes |
| C | 4.67 (.49) | 5.00 | 100% | Yes | |
| Feeling “out of control” of one’s body | P | 4.27 (.45) | 4.00 | 100% | Yes |
| C | 4.60 (.91) | 5.00 | 86.7% | Yes | |
| Feeling a “loss of control” over eating | P | 4.77 (.59) | 5.00 | 92.3% | Yes |
| C | 4.53 (1.06) | 5.00 | 93.3% | Yes | |
| Guilt after eating (any food) | P | 4.35 (.49) | 4.00 | 100% | Yes |
| C | 4.73 (.46) | 5.00 | 100% | Yes | |
| Feelings of shame + disgust about body | P | 4.92 (.27) | 5.00 | 100% | Yes |
| C | 4.80 (.41) | 5.00 | 100% | Yes | |
| Sensitivity to comments regarding weight, shape, or appearance | P | 4.04 (.60) | 4.00 | 92.3% | Yes |
| C | 4.20 (.94) | 5.00 | 80.0% | Yes | |
| Emotional detachment from pregnancy | P | 4.46 (.86) | 5.00 | 84.6% | Yes |
| C | 4.27 (.82) | 4.00 | 80.0% | Yes | |
| Social isolation | P | 4.31 (.97) | 5.00 | 84.6% | Yes |
| C | 4.47 (.74) | 5.00 | 86.7% | Yes | |
| Interpersonal mistrust | P | 3.73 (.72) | 4.00 | 76.9% | Yes |
| C | 3.73 (.88) | 4.00 | 73.3% | No | |
| Feeling relieved or thankful for pregnancy serving as a valid explanation to avoid certain foods or eating very little | P | – | – | – | – |
| C | 4.87 (.35) | 5.00 | 100% | Yes | |
| Distress in relation to increased appetite during pregnancy | P | – | – | – | – |
| C | 4.87 (.35) | 5.00 | 100% | Yes | |
| Feeling resentful toward the baby for needing constant food and nutrients to grow in the womb, followed by significant guilt and shame for feeling resentful | P | – | – | – | – |
| C | 4.60 (1.12) | 5.00 | 93.3% | Yes | |
P professional panel (N = 26), C consumer panel (N = 15) Items were rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree)
aadditional item suggested by professional panel in Round I