Le diagnostic des troubles alimentaires est rendu difficile par les limites que présentent les critères acceptés du DSM IV, par l'incapacité des questionnaires existants à diagnostiquer plus d'un ou deux troubles à la fois, et par l'absence d'évaluation des troubles dits « subcliniques ». Le Questionnaire for Eating Disorder Diagnosis (Q-EDD) propose un moyen pour diagnostiquer de manière plus nuancée les troubles cliniques du DSM IV et fournit aussi une évaluation des troubles subcliniques. Le Q-EDD a été traduit en français et appliqué sur une population d'adolescents (n = 1 001) afin de déterminer la fréquence des troubles du comportement alimentaire dans cette population. Les résultats montrent que les fréquences des troubles du DSM IV (anorexie, boulimie, etc.) sont proches des autres études, indiquant une bonne validité de façade. Nous relevons aussi un taux important de jeunes dans la catégorie du BMI « maigreur importante ». Ce résultat s'explique par des différences culturelles et morphologiques, et aussi par la nécessité de prendre en compte un BMI au percentile 10 pour les jeunes en voie de croissance. De passation simple et peu coûteuse, le Q-EDD est un bon outil de diagnostic pour les troubles alimentaires.

Precise diagnosis of eating disorders has long been problematic. First off, although the DSM IV provides clear criteria, these are applicable to a very narrow range of disorders. Subclinical disorders, although well defined in the literature, are difficult to diagnose as no tool has been previously available. These subclinical disorders are particularly important if one considers that they are often precursors to more serious and life-threatening eating disorders. In addition, choice of diagnostic tool for eating disorders has also long been the cause of difficulty for both researchers and clinicians. Although interviews are favored for their in-depth approach, they are sometimes difficult to implement and often too long and costly to use on a regular basis. Most available questionnaires are limited by their approach to one or two diagnostic categories, and again, until now, no tool has fully addressed the issue of subclinical disorders. The goal of this work was to translate and use a new questionnaire, The Questionnaire for Eating Disorders (Q-EDD), which was developed in the United States and based on both DSM IV criteria as well as carefully developed subclinical disorder criteria. The Q-EDD can identify the major eating disorder categories while at the same time distinguishing between different qualities in each (for example restricting versus compensatory anorexia). Moreover, the Q-EDD can identify several subclinical disorder categories, providing useful insight into potentially dangerous evolution of these disorders. In collaboration with one of the original authors, the questionnaire was translated into French with careful attention to DSM IV criteria in order to preserve its original validity. The questionnaire was read by several professionals in psychology as well as lay people to assure its face validity and ease of use. Once the questionnaire was adequately translated and corrected, it was used for an epidemiological study with a large sample of adolescents and young adults (n = 1 001) from several Junior High and High Schools in the greater metropolitan area of Toulouse, France. The schools were located in a variety of neighborhoods and represented a wide range of population, some of them being more academic oriented, others being more oriented towards practical training. The population was composed of 703 females and 298 males, with an average age of 17.06 years. In addition, the population included several different ethnic categories, all of which are similarly represented in the general French population. The results from the Q-EDD showed levels of va[shy]rious clinical disorders to replicate data from previous epidemiological studies with 1.5 % of the population suffering from a serious clinical DSM IV disorder ; 7.9 % suffering from DSM IV disorders NOS ; and 20.9 % suffering subclinical disorders. In addition to this finding of 30 % of the population with an eating disorder, it was noted that a large number of these young people fell into the « severe underweight » and « low weight » categories. Indeed, nearly 10 % of this group were within the weight criteria for anorexia, despite the fact that they did not meet the other criteria. This finding seemed to warrant additional investigation, and as a result, a different cut-off for severe underweight was established using literature references ; this cut-off was set at the 10 ^th percentile for BMI based on age. Yet, even with this new cut-off, 6 % of this population still met a « severe underweight » criteria suggestive of anorexic pathology. These results led to the formulation of 2 hypotheses to explain this finding, the first of which exami[shy]nes morphological differences, the second of which suggests cultural differences in terms of eating habits and diet. The French version of the Q-EDD appears to follow the psychometric properties of the orginal version, moreover it provides useful and rich data regarding eating disorders in a format that is simple and efficient.