{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:12:17Z","timestamp":1760238737508,"version":"build-2065373602"},"reference-count":64,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T00:00:00Z","timestamp":1599004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["MAKE"],"abstract":"<jats:p>Eating disorders are very complicated and many factors play a role in their manifestation. Furthermore, due to the variability in diagnosis and symptoms, treatment for an eating disorder is unique to the individual. As a result, there are numerous assessment tools available, which range from brief survey questionnaires to in-depth interviews conducted by a professional. One of the many benefits to using machine learning is that it offers new insight into datasets that researchers may not previously have, particularly when compared to traditional statistical methods. The aim of this paper was to employ k-means clustering to explore the Eating Disorder Examination Questionnaire, Clinical Impairment Assessment, and Autism Quotient scores. The goal is to identify prevalent cluster topologies in the data, using the truth data as a means to validate identified groupings. Our results show that a model with k = 2 performs the best and clustered the dataset in the most appropriate way. This matches our truth data group labels, and we calculated our model\u2019s accuracy at 78.125%, so we know that our model is working well. We see that the Eating Disorder Examination Questionnaire (EDE-Q) and Clinical Impairment Assessment (CIA) scores are, in fact, important discriminators of eating disorder behavior.<\/jats:p>","DOI":"10.3390\/make2030019","type":"journal-article","created":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T09:29:28Z","timestamp":1599038968000},"page":"347-360","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Exploring the Eating Disorder Examination Questionnaire, Clinical Impairment Assessment, and Autism Quotient to Identify Eating Disorder Vulnerability: A Cluster Analysis"],"prefix":"10.3390","volume":"2","author":[{"given":"Natalia","family":"Stewart Rosenfield","sequence":"first","affiliation":[{"name":"Schmid College of Science and Technology, Chapman University, Orange, CA 92866, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0174-7002","authenticated-orcid":false,"given":"Erik","family":"Linstead","sequence":"additional","affiliation":[{"name":"Fowler School of Engineering, Chapman University, Orange, CA 92866, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,9,2]]},"reference":[{"key":"ref_1","unstructured":"American Psychiatric Association Publishing (2015). Feeding and Eating Disorders: DSM-5\u00ae Selections, American Psychiatric Association Publishing."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Sweitzer, M.M., Watson, K.K., Erwin, S.R., Winecoff, A.A., Datta, N., Huettel, S., Platt, M.L., and Zucker, N.L. (2018). Neurobiology of social reward valuation in adults with a history of anorexia nervosa. PLoS ONE, 13.","DOI":"10.7924\/r45t3km1m"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1016\/j.jaac.2010.05.017","article-title":"Lifetime prevalence of mental disorders in US adolescents: Results from the National Comorbidity Survey Replication\u2013Adolescent Supplement (NCS-A)","volume":"49","author":"Merikangas","year":"2010","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/j.biopsych.2006.03.040","article-title":"The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication","volume":"61","author":"Hudson","year":"2007","journal-title":"Biol. Psychiatry"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1146\/annurev.psych.53.100901.135103","article-title":"Causes of Eating Disorders","volume":"53","author":"Polivy","year":"2002","journal-title":"Ann. Rev. Psychol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Anderson, L., Shaw, J.M., and McCargar, L. (1997). Physiological effects of bulimia nervosa on the gastrointestinal tract. Can. J. Gastroenterol. Hepatol., 11.","DOI":"10.1155\/1997\/727645"},{"key":"ref_7","unstructured":"Nolen-Hoeksema, S. (2011). Abnormal Psychology, McGraw-Hill."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1002\/eat.20537","article-title":"The point prevalence of bulimic disorders from 1990 to 2004","volume":"41","author":"Crowther","year":"2008","journal-title":"Int. J. Eat. Disord."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1017\/S0033291705006148","article-title":"Point prevalence of bulimia nervosa in 1982, 1992, and 2002","volume":"36","author":"Keel","year":"2006","journal-title":"Psychol. Med."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Stevens, E., Atchison, A., Stevens, L., Hong, E., Granpeesheh, D., Dixon, D., and Linstead, E. (2017, January 18\u201321). A cluster analysis of challenging behaviors in autism spectrum disorder. Proceedings of the 2017 16th IEEE International Conference on Machine Learning and Applications (ICMLA), Cancun, Mexico.","DOI":"10.1109\/ICMLA.2017.00-85"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.ijmedinf.2019.05.006","article-title":"Identification and analysis of behavioral phenotypes in autism spectrum disorder via unsupervised machine learning","volume":"129","author":"Stevens","year":"2019","journal-title":"Int. J. Med Inform."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12920-016-0165-x","article-title":"Machine learning derived risk prediction of anorexia nervosa","volume":"9","author":"Guo","year":"2015","journal-title":"BMC Med. Genom."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1037\/0003-066X.62.3.181","article-title":"Risk factors for eating disorders","volume":"62","author":"Bulik","year":"2007","journal-title":"Am. Psychol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1016\/j.conb.2004.10.016","article-title":"Reward representations and reward-related learning in the human brain: Insights from neuroimaging","volume":"14","year":"2004","journal-title":"Curr. Opin. Neurobiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1805","DOI":"10.1176\/appi.ajp.2007.07071151","article-title":"Anorexia Nervosa","volume":"164","author":"Attia","year":"2007","journal-title":"Am. J. Psychiatry"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/S0306-4530(00)00062-7","article-title":"Central dopaminergic function in anorexia and bulimia nervosa: A psychoneuroendocrine approach","volume":"26","author":"Brambilla","year":"2001","journal-title":"Psychoneuroendocrinology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1002\/eat.1054","article-title":"Altered response to meta-chlorophenylpiperazine in anorexia nervosa: Support for a persistent alteration of serotonin activity after short-term weight restoration","volume":"30","author":"Frank","year":"2001","journal-title":"Int. J. Eat. Disord."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1016\/j.biopsych.2005.05.003","article-title":"Increased dopamine D2\/D3 receptor binding after recovery from anorexia nervosa measured by positron emission tomography and [11c] raclopride","volume":"58","author":"Frank","year":"2005","journal-title":"Biol. Psychiatry"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.pscychresns.2015.06.013","article-title":"Striatal dopamine type 2 receptor availability in anorexia nervosa","volume":"233","author":"Broft","year":"2015","journal-title":"Psychiatry Res. Neuroimaging"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1017\/S0033291700054945","article-title":"Socio-cultural factors in the development of anorexia nervosa","volume":"10","author":"Garner","year":"1980","journal-title":"Psychol. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/0005-7967(90)90003-2","article-title":"The thin ideal, depression and eating disorders in women","volume":"28","author":"McCarthy","year":"1990","journal-title":"Behav. Res. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1037\/0033-2909.105.2.260","article-title":"Socioeconomic status and obesity: A review of the literature","volume":"105","author":"Sobal","year":"1989","journal-title":"Psychol. Bull."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1002\/1098-108X(199201)11:1<85::AID-EAT2260110112>3.0.CO;2-T","article-title":"Cultural expectations of thinness in women: An update","volume":"11","author":"Wiseman","year":"1992","journal-title":"Int. J. Eat. Disord."},{"key":"ref_24","first-page":"414","article-title":"Risk and trigger factors for the development of eating disorders in female elite athletes","volume":"26","year":"1994","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1001\/archpsyc.1995.03950160054010","article-title":"A prospective study of outcome in bulimia nervosa and the long-term effects of three psychological treatments","volume":"52","author":"Fairburn","year":"1995","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1037\/0033-2909.128.5.825","article-title":"Risk and maintenance factors for eating pathology: A meta-analytic review","volume":"128","author":"Stice","year":"2002","journal-title":"Psychol. Bull."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Clark, D.M., Fairburn, C.G., and Jones, J.V. (1997). The Science and Practice of Cognitive Behaviour Therapy, Springer.","DOI":"10.1093\/med:psych\/9780192627254.001.0001"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1037\/0021-843X.102.2.297","article-title":"The social self in bulimia nervosa: Public self-consciousness, social anxiety, and perceived fraudulence","volume":"102","author":"Silberstein","year":"1993","journal-title":"J. Abnorm. Psychol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1097\/PSY.0b013e31815c40f1","article-title":"Shared temperament risk factors for anorexia nervosa: A twin study","volume":"70","author":"Wade","year":"2008","journal-title":"Psychosom. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1521\/jscp.1994.13.3.288","article-title":"Adverse effects of the media portrayed thin-ideal on women and linkages to bulimic symptomatology","volume":"13","author":"Stice","year":"1994","journal-title":"J. Soc. Clin. Psychol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/j.eatbeh.2006.11.016","article-title":"Effects of a reality TV cosmetic surgery makeover program on eating disordered attitudes and behaviors","volume":"8","author":"Mazzeo","year":"2007","journal-title":"Eat. Behav."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1002\/eat.10171","article-title":"Adverse effects of social pressure to be thin on young women: An experimental investigation of the effects of \u201cfat talk\u201d","volume":"34","author":"Stice","year":"2003","journal-title":"Int. J. Eat. Disord."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Astorino, A., Berti, R., Astorino, A., Bitonti, V., De Marco, M., Feraco, V., Palumbo, A., Porti, F., and Zannino, I. (2020, January 24\u201328). Early Detection of Eating Disorders Through Machine Learning Techniques. Proceedings of the International Conference on Learning and Intelligent Optimization, Athens, Greece.","DOI":"10.1007\/978-3-030-53552-0_5"},{"key":"ref_34","unstructured":"Paul, S., Jandhyala, S.K., and Basu, T. (2018). Early Detection of Signs of Anorexia and Depression Over Social Media using Effective Machine Learning Frameworks. CLEF (Working Notes), Ramakrishna Mission Vivekananda Educational and Research Institute."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Ram\u00edrez-Cifuentes, D., Mayans, M., and Freire, A. (2018, January 24\u201326). Early risk detection of anorexia on social media. Proceedings of the International Conference on Internet Science, St. Petersburg, Russia.","DOI":"10.1007\/978-3-030-01437-7_1"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.jpsychores.2009.05.012","article-title":"Assessment methods for eating disorders and body image disorders","volume":"69","author":"Kohls","year":"2010","journal-title":"J. Psychosom. Res."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Wilson, G.T. (1993). Assessment of Binge Eating, Guilford Press.","DOI":"10.1002\/1098-108X(199301)13:1<25::AID-EAT2260130104>3.0.CO;2-T"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1002\/(SICI)1098-108X(199904)25:3<349::AID-EAT15>3.0.CO;2-M","article-title":"The reliability of the eating disorder examination\u2014Self-report questionnaire version (EDE-Q)","volume":"25","author":"Luce","year":"1999","journal-title":"Int. J. Eat. Disord."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1002\/erv.721","article-title":"Denial of illness in anorexia nervosa\u2014A conceptual review: Part 1 diagnostic significance and assessment","volume":"14","author":"Vandereycken","year":"2006","journal-title":"Eur. Eat. Disord. Rev. Prof. J. Eat. Disord. Assoc."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1017\/S0033291700030762","article-title":"The Eating Attitudes Test: An index of the symptoms of anorexia nervosa","volume":"9","author":"Garner","year":"1979","journal-title":"Psychol. Med."},{"key":"ref_41","first-page":"119","article-title":"A revision of the Bulimia Test: The BULIT\u2014R","volume":"3","author":"Thelen","year":"1991","journal-title":"Psychol. Assess. A J. Consult. Clin. Psychol."},{"key":"ref_42","unstructured":"Bohn, K., and Fairburn, C.G. (2008). The clinical impairment assessment questionnaire (CIA). Cogn. Behav. Ther. Eat. Disord., 315\u2013317."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1002\/eat.20373","article-title":"Psychometric properties of the eating disorder examination-questionnaire: Factor structure and internal consistency","volume":"40","author":"Peterson","year":"2007","journal-title":"Int. J. Eat. Disord."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1002\/eat.20200","article-title":"Development and psychometric validation of an eating disorder-specific health-related quality of life instrument","volume":"39","author":"Engel","year":"2006","journal-title":"Int. J. Eat. Disord."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/1477-7525-5-23","article-title":"Development and multi-site validation of a new condition-specific quality of life measure for eating disorders","volume":"5","author":"Adair","year":"2007","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1001\/archpsyc.57.7.659","article-title":"The natural course of bulimia nervosa and binge eating disorder in young women","volume":"57","author":"Fairburn","year":"2000","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1001\/archpsyc.56.1.63","article-title":"Long-term outcome of bulimia nervosa","volume":"56","author":"Keel","year":"1999","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1017\/S0033291708003292","article-title":"Lifetime course of eating disorders: Design and validity testing of a new strategy to define the eating disorders phenotype","volume":"39","author":"Anderluh","year":"2009","journal-title":"Psychol. Med."},{"key":"ref_49","first-page":"9","article-title":"Unsupervised and semi-supervised clustering: A brief survey","volume":"1","author":"Grira","year":"2004","journal-title":"Rev. Mach. Learn. Tech. Process. Multimed. Content"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"65579","DOI":"10.1109\/ACCESS.2019.2916648","article-title":"Unsupervised machine learning for networking: Techniques, applications and research challenges","volume":"7","author":"Usama","year":"2019","journal-title":"IEEE Access"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"McGregor, A., Hall, M., Lorier, P., and Brunskill, J. (2004). Flow Clustering Using Machine Learning Techniques, Springer.","DOI":"10.1007\/978-3-540-24668-8_21"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1109\/TNN.2005.845141","article-title":"Survey of clustering algorithms","volume":"16","author":"Xu","year":"2005","journal-title":"IEEE Trans. Neural Netw."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1002\/1098-108X(199109)10:5<571::AID-EAT2260100510>3.0.CO;2-J","article-title":"Structured Interview for Anorexia and Bulimia Nervosa (SIAB): Development of a new instrument for the assessment of eating disorders","volume":"10","author":"Fichter","year":"1991","journal-title":"Int. J. Eat. Disord."},{"key":"ref_54","unstructured":"Fairburn, C.G. (2008). Cognitive Behavior Therapy and Eating Disorders, Guilford Press."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1080\/08039488.2016.1271452","article-title":"Eating Disorder Examination Questionnaire (EDE-Q) and Clinical Impairment Assessment (CIA): Clinical norms and functional impairment in male and female adults with eating disorders","volume":"71","author":"Dahlgren","year":"2017","journal-title":"Nord. J. Psychiatry"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.brat.2010.10.010","article-title":"Eating disorder examination questionnaire and clinical impairment assessment questionnaire: General population and clinical norms for young adult women in Sweden","volume":"49","author":"Welch","year":"2011","journal-title":"Behav. Res. Ther."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1002\/1098-108X(199412)16:4<363::AID-EAT2260160405>3.0.CO;2-#","article-title":"Assessment of eating disorders: Interview or self-report questionnaire?","volume":"16","author":"Fairburn","year":"1994","journal-title":"Int. J. Eat. Disord."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/S0005-7967(03)00161-X","article-title":"Validity of the Eating Disorder Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples","volume":"42","author":"Mond","year":"2004","journal-title":"Behav. Res. Ther."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1016\/j.brat.2008.06.012","article-title":"The measurement of impairment due to eating disorder psychopathology","volume":"46","author":"Bohn","year":"2008","journal-title":"Behav. Res. Ther."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1023\/A:1005653411471","article-title":"The autism-spectrum quotient (AQ): Evidence from asperger syndrome\/high-functioning autism, malesand females, scientists and mathematicians","volume":"31","author":"Wheelwright","year":"2001","journal-title":"J. Autism Dev. Disord."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1007\/s10803-006-0073-6","article-title":"The autism-spectrum quotient (AQ)\u2014Adolescent version","volume":"36","author":"Hoekstra","year":"2006","journal-title":"J. Autism Dev. Disord."},{"key":"ref_62","unstructured":"MacQueen, J. (1967, January 1). Some methods for classification and analysis of multivariate observations. Proceedings of the Fifth Berkeley Symposium on Mathematical Statistics and Probability, Oakland, CA, USA."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Rousseeuw, P. (1987). Silhouettes: A Graphical Aid to the Interpretation and Validation of Cluster Analysis. J. Comput. Appl. Math., 20.","DOI":"10.1016\/0377-0427(87)90125-7"},{"key":"ref_64","unstructured":"Baarsch, J., and Celebi, M.E. (2012, January 14\u201316). Investigation of internal validity measures for K-means clustering. Proceedings of the International Multiconference of Engineers and Computer Scientists, Hong Kong, China."}],"container-title":["Machine Learning and Knowledge Extraction"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2504-4990\/2\/3\/19\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:05:46Z","timestamp":1760177146000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2504-4990\/2\/3\/19"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,2]]},"references-count":64,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020,9]]}},"alternative-id":["make2030019"],"URL":"https:\/\/doi.org\/10.3390\/make2030019","relation":{},"ISSN":["2504-4990"],"issn-type":[{"type":"electronic","value":"2504-4990"}],"subject":[],"published":{"date-parts":[[2020,9,2]]}}}