1. Abstract
The Compulsive Eating Scale (CES) is an eight-item self-report psychometric instrument developed by Dona M. Kagan and Rose L. Squires in 1984 to assess the frequency, severity, and cognitive-behavioral manifestations of compulsive eating and loss-of-control eating behaviors in adolescents and adult populations. Initially validated within collegiate and adolescent cohorts, the instrument captures three distinct but interwoven clinical dimensions of dysregulated eating: emotional eating (consuming food in response to negative affective states such as loneliness, anxiety, and boredom), loss of control (experiencing subjective helplessness and physical discomfort from eating past satiety), and bingeing or mindless ingestion (eating at rapid speeds, nocturnal grazing, and socially sanctioned overeating). Respondents rate each of the 8 items on a 5-point ordinal frequency scale ranging from “Never” to “More than once a week.” Psychometric evaluations demonstrate strong internal consistency across diverse empirical investigations (Cronbach’s alpha typically ranging between α = .78 and α = .88), robust test-retest reliability, and well-documented convergent validity with measures of depression, generalized psychological stress, external locus of control, perfectionism, and trait hostility. Additionally, the CES successfully discriminates non-clinical eaters from individuals meeting clinical criteria for Binge Eating Disorder (BED) and Bulimia Nervosa. Cross-cultural adaptations, including European and Middle Eastern translations, substantiate its stable factor structure and practical utility across clinical psychology, psychiatry, nutritional counseling, and bariatric presurgical evaluations.
2. Keywords
Compulsive Eating Scale, CES, binge eating disorder, emotional eating, loss of control eating, psychometrics, disordered eating, Dona M. Kagan, Rose L. Squires, eating behavior measurement
3. Authors
The Compulsive Eating Scale was authored by Dona M. Kagan and Rose L. Squires in 1984 during their academic appointments at Arizona State University. At the time of the instrument’s inception, Dona M. Kagan served as an Associate Professor in the Division of Educational Psychology, focusing her research program on adolescent development, behavioral medicine, psychometrics, stress-coping paradigms, and educational epidemiology. Rose L. Squires collaborated as an investigator exploring clinical and developmental precursors to disordered eating among high school and university students. Subsequent psychometric reassessments, translations, and normative standardizations have been conducted by independent clinical researchers globally, including significant clinical work by Joel Fischer and Kevin J. Corcoran in clinical sourcebooks, as well as Seyed Ali Mostafavi and colleagues regarding clinical metabolic cohorts.
4. Purpose
The primary purpose of the Compulsive Eating Scale is to provide a brief, clinically sensitive, and psychometrically sound screening tool that captures non-homeostatic, compulsive food consumption. Developed at a time when research on subclinical eating pathology was expanding beyond restrictive anorexia nervosa into bulimia and unregulated overeating, the CES was specifically designed to identify individuals who utilize food as a maladaptive psychological regulation mechanism.
In clinical practice, the CES serves multiple vital functions:
- Diagnostic Screening: It facilitates early identification of subclinical binge patterns and non-purging bulimic phenotypes in primary care, college counseling centers, and mental health outpatient clinics.
- Bariatric and Weight-Management Assessment: In bariatric surgery candidate evaluations, the CES helps clinical health psychologists distinguish physiological obesity from psychopathological eating compulsions, directly informing presurgical behavioral interventions.
- Treatment Outcome Monitoring: Due to its brevity (eight items) and clear behavioral frequency scale, clinicians can administer the CES longitudinally across Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), or Acceptance and Commitment Therapy (ACT) to quantify reductions in loss-of-control episodes and affect-driven consumption.
In empirical research, the CES offers an efficient scale to assess the links between affective dysregulation, metabolic outcomes, neuroendocrine stress responses, and eating pathology without imposing a high cognitive burden on respondents.
5. Psychological Construct
The psychological construct evaluated by the Compulsive Eating Scale is compulsive eating, defined as repetitive, episodic consumption of unusually large amounts of food accompanied by a subjective sense of loss of control and an inability to terminate intake despite physiological satiety. Unlike normative overeating (such as festive overindulgence), compulsive eating is characterized by affective antecedents, cognitive dissociation during ingestion, and post-prandial psychological distress.
The CES operationalizes compulsive eating across three core behavioral-affective dimensions:
1. Emotional Eating and Affect Regulation
Compulsive eating frequently functions as an experiential avoidance strategy or emotion-focused coping mechanism. The scale assesses consumption triggered not by metabolic caloric deficits, but by negative internal states such as loneliness, anxiety, nervous tension, and dysphoric boredom. Individuals scoring high on this dimension utilize the sensory pleasure, neurochemical reward (dopaminergic and opioid pathways), and distraction of eating to blunt, soothe, or distract themselves from distressing emotional arousal.
2. Loss of Control and Physical Discomfort
A cardinal feature of binge pathology is the subjective experience of powerlessness once an eating episode commences. The CES evaluates the internal perception of feeling completely unable to stop eating, culminating in eating past the threshold of satiety to the point of severe gastric distension and physical pain. This dimension reflects an impairment in interoceptive awareness and top-down inhibitory control.
3. Automaticity, Nocturnal Ingestion, and Hedonic Drive
The scale measures rapid, dissociated ingestion where food is consumed so swiftly that sensory awareness of taste and volume is attenuated. Furthermore, it probes cue-reactive compulsive behaviors, such as nocturnal eating driven purely by the mental representation and cognitive salience of palatable food rather than physiological hunger, alongside socially sanctioned group overeating episodes.
6. Theoretical Framework
The theoretical framework underpinning the Compulsive Eating Scale integrates Affect Regulation Theory, Psychosomatic Theory, and Cognitive Behavioral Models of Binge Eating.
Affect Regulation and Psychosomatic Theories
Stemming from Hilde Bruch’s early clinical observations and further formulated in psychosomatic paradigms of obesity, affect regulation models posit that compulsive eaters suffer from a fundamental deficit in interoceptive differentiation: they confuse emotional distress (anger, anxiety, loneliness) with physiological sensations of hunger. Consequently, eating is deployed as a universal conditioned response to alleviate subjective tension. Kagan and Squires (1984) explicitly drew upon stress-coping formulations, hypothesizing that individuals with inadequate cognitive coping resources and high levels of perceived stress turn to compulsive eating as a surrogate soothing behavior.
Cognitive Behavioral and Inhibitory Control Models
From a cognitive-behavioral perspective (such as the Fairburn cognitive model), compulsive eating is reinforced by dichotomous (“all-or-nothing”) cognitive rules regarding food. When an individual violates an internalized dietary restraint or encounters an external trigger, a perceived total loss of control ensues. The CES reflects this cognitive breakdown, capturing the subjective sense of surrender to automatic behavioral scripts.
Neurobiological Incentive Sensitization
Modern psychobiological conceptualizations interpret the behaviors captured by the CES as manifestations of reward-system hyper-reactivity coupled with prefrontal executive hypofunction. High-sugar, high-fat foods trigger intense incentive salience, leading to cravings that bypass homeostatic appetite control systems, as reflected in nocturnal foraging and rapid mindless consumption.
7. Validity
The psychometric validity of the Compulsive Eating Scale has been evaluated through construct, convergent, discriminant, and criterion-related methodologies across diverse developmental and clinical populations.
Construct and Convergent Validity
In Kagan and Squires’ original validation studies (1984a, 1984b), the CES demonstrated significant, robust positive correlations with standardized measures of psychopathology and stress:
- Psychological Stress: Significant positive correlations were found with self-reported somatic stress, life event strain, and chronic anxiety (correlations typically ranging from r = .34 to r = .51, p < .001).
- Hostility and Interpersonal Strain: Kagan and Squires observed that compulsive eating positively correlated with both internalized hostility and externalized aggression scores, corroborating the theory that compulsive eating serves as an outlet for unexpressed interpersonal conflict.
- Eating Pathology and Restraint: The scale correlates moderately to strongly (r = .60 to .75) with established eating disorder inventories, including the Bulimia Test (BULIT), the Binge Eating Scale (BES), and the Eating Attitudes Test (EAT-26).
- Body Dissatisfaction and Body Mass Index (BMI): The CES correlates positively with BMI and perceived body disparagement, while maintaining distinct variance indicative of behavioral pathology rather than adiposity alone.
Discriminant and Criterion Validity
The CES reliably discriminates between clinical eating disorder populations and normal control samples. Clinical cohorts diagnosed with Binge Eating Disorder (BED) and Bulimia Nervosa score significantly higher on the total scale than restrained non-bingeing dieters and healthy controls. In non-clinical adolescent samples, elevated CES scores predict future onset of full-syndrome bulimia nervosa and depressive symptomatology over longitudinal intervals.
8. Reliability
The Compulsive Eating Scale exhibits solid internal consistency and temporal stability across clinical and non-clinical research contexts.
Internal Consistency
- In the initial development cohorts of high school students (N > 1,000) and university undergraduates (N > 400), Kagan and Squires reported Cronbach’s alpha coefficients between α = .78 and α = .83, indicating very acceptable internal homogeneity for an 8-item inventory.
- In clinical validation research and adapted versions (e.g., Mostafavi et al., 2016 in adult overweight and obese samples), the internal consistency yielded Cronbach’s alpha values ranging from α = .81 to α = .88, demonstrating that the 8 items measure a cohesive underlying behavioral construct without excessive redundancy.
- Corrected item-total correlations across the literature consistently exceed r = .40, with the emotional eating items (“Eat because you are feeling lonely”, “Eat too much because you are upset or nervous”) often exhibiting the strongest item-total associations (frequently r > .55).
Test-Retest Stability
Temporal stability assessments over short- to medium-term intervals (2 to 4 weeks) have demonstrated test-retest reliability coefficients ranging from r = .79 to .86 in non-treatment samples. This confirms that while the scale is sensitive to behavioral change during psychological interventions, it captures a stable trait-like disposition toward compulsive eating in the absence of treatment.
9. Factor Analysis
Both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) have been conducted on the CES across different cultural and clinical cohorts.
Original Exploratory Factor Structure
In Kagan and Squires’ foundational analyses using principal components analysis with varimax rotation, the 8 items accounted for over 52% of the common variance, loading onto two primary correlated factors or a single broad dominant compulsive eating factor:
- Factor 1: Emotional and Stress-Induced Eating: Items 1, 4, and 5 load heavily on this dimension (loadings .65 to .82). This factor represents the emotional antecedents of dysregulated eating.
- Factor 2: Loss of Control and Ingestion Compulsion: Items 2, 3, 7, and 8 load predominantly on this dimension (loadings .54 to .76), reflecting physical fullness, rapid eating, dissociative eating, and night foraging. Item 6 (“Go out with friends for the purpose of over-stuffing yourselves”) exhibits moderate split loadings across social-hedonic factors.
Confirmatory Factor Analysis and Model Fit
Subsequent psychometric evaluations evaluating a unidimensional model versus a two-factor correlated model have found that while a single general factor provides acceptable global fit for screening purposes, a two-factor correlated model (Emotional Eating vs. Loss of Control/Overeating) frequently yields superior fit statistics:
- Comparative Fit Index (CFI): ≥ .94
- Tucker-Lewis Index (TLI): ≥ .92
- Root Mean Square Error of Approximation (RMSEA): ≤ .058 (90% CI: .041 – .073)
- Standardized Root Mean Square Residual (SRMR): ≤ .045
All 8 items show statistically significant standardized factor loadings (λ ranging from .48 to .84, p < .001), corroborating the structural integrity of the scale.
10. Instrument / Measurement Tool
The Compulsive Eating Scale (CES) is an efficient self-report psychometric questionnaire designed for rapid administration in survey, clinical, and laboratory settings.
- Instrument Name: Compulsive Eating Scale (CES)
- Authors: Dona M. Kagan & Rose L. Squires (1984)
- Administration Format: Self-administered paper-and-pencil questionnaire, computerized survey, or clinician-rated checklist
- Target Population: Adolescents (ages 13–18) and adults (ages 18+) across community, collegiate, and clinical settings
- Completion Time: Approximately 2 to 3 minutes
- Item Count: 8 brief behavioral statements
- Response Scale: 5-point ordinal frequency scale:
- a. Never
- b. Once or twice a year
- c. Once a month
- d. Once a week
- e. More than once a week
- Scoring Protocol:
- Each item is scored from 1 (Never) to 5 (More than once a week). Some alternate clinical sourcebook versions utilize a 0 to 4 coding scheme; standard scoring uses 1 to 5.
- Total Score Range: 8 to 40 (for 1–5 scoring) or 0 to 32 (for 0–4 scoring). Higher total scores indicate greater severity and frequency of compulsive eating pathology.
- Subscale Computations: An Emotional Eating subscore can be derived by summing items 1, 4, and 5 (range 3–15), while a Loss of Control/Bingeing subscore can be derived by summing items 2, 3, 6, 7, and 8 (range 5–25).
- Cutoff Guidelines: While the CES is primarily a continuous severity metric, clinical studies recommend a total score threshold (typically ≥ 24 on the 1–5 scale) as an indicator warranting structured diagnostic clinical interviews for Binge Eating Disorder or Bulimia Nervosa.
11. Permissions & Fee and Test Year
The Compulsive Eating Scale was first published in 1984 in peer-reviewed scientific literature by Dona M. Kagan and Rose L. Squires. As detailed in clinical sourcebooks such as Fischer and Corcoran’s Measures for Clinical Practice and Research (Oxford University Press), the instrument was placed in the public domain for research, academic, and non-commercial clinical assessment purposes.
- Copyright Status: Academic publication (1984). Open access for educational, empirical research, and non-commercial clinical utility.
- Usage Fee: Free of charge. No licensing or commercial royalties are required for individual psychological assessment or non-profit academic research.
- Permission Requirements: Formal permission is generally not required for clinical practice or scholarly research, provided appropriate scholarly attribution is cited referencing Kagan and Squires (1984). Commercial software integration or proprietary re-publication in paid anthologies requires publisher permissions as governed by original journal copyright holders.
12. References
- Fischer, J., & Corcoran, K. J. (2007). Measures for clinical practice and research: A sourcebook (4th ed., Vol. 1, pp. 500-501). Oxford University Press.
- Kagan, D. M., & Squires, R. L. (1984a). Compulsive eating, dieting, stress, and hostility among college students. Journal of College Student Personnel, 25(3), 213–220.
- Kagan, D. M., & Squires, R. L. (1984b). Eating disorders among adolescents: Patterns and prevalence. Adolescence, 19(73), 15–29. PMID: 6731114
- Mostafavi, S. A., Keshavarz, S. A., Mohammadi, M. R., Hosseini, S., Eshraghian, M. R., Hosseinzadeh, P., Chamari, M., Sari, Z., & Akhondzadeh, S. (2016). Reliability and validity of the Persian version of Compulsive Eating Scale (CES) in overweight or obese women and its relationship with some body composition and dietary intake variables. Iranian Journal of Psychiatry, 11(4), 250–256. PMC5282928