Which EDE-Q items are structurally relevant in borderline personality disorder? An exploratory graph analysis

BACKGROUND: Borderline personality disorder (BPD) frequently co-occurs with eating disorders (EDs). Despite this clinical relevance, the dimensional structure of commonly used assessment instruments, such as the Eating Disorder Examination Questionnaire (EDE-Q), has not been sufficiently examined in BPD populations. Previous research suggests that the original four-factor structure of the EDE-Q may not be stable across different populations. METHODS: This study examined the structure of the EDE-Q in a clinical sample of individuals with BPD (N = 73) using Exploratory Graph Analysis (EGA), a network-based approach to dimensionality assessment. Dimensionality and item stability were evaluated using nonparametric bootstrapping. Robustness was assessed via sensitivity analyses, including median imputation, variation of the regularization parameter, comparison of community detection algorithms, and leave-one-item-out procedures. RESULTS: After iterative item reduction, a three-dimensional solution emerged, comprising 13 items. The identified dimensions reflected (1) Restraint, (2) Cognitive-Interpersonal Eating Concerns, and (3) Body Dissatisfaction. The final solution demonstrated high robustness across all sensitivity analyses, with identical dimensional structures and item assignments under multiple conditions. CONCLUSIONS: The findings suggest that the original four-factor structure of the EDE-Q may not fully generalize to individuals with BPD. Several aspects of the identified structure are consistent with previous research reporting deviations from the original EDE-Q model. These findings underscore the importance of validating assessment instruments within specific clinical populations and support a cautious interpretation of standard EDE-Q subscale scores in individuals with BPD.