Adaptation of the Barcelona Bipolar Eating Disorder Scale to Turkish and Investigation of Its Validity and Reliability

Adaptation of the Barcelona Bipolar Eating Disorder Scale to Turkish and Investigation of Its Validity and Reliability | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Adaptation of the Barcelona Bipolar Eating Disorder Scale to Turkish and Investigation of Its Validity and Reliability Hasan Ünver, Safiye Zeynep Tatlı, İbrahim Gündoğmuş, Gamze Erzin, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7854484/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study aimed to evaluate the validity and reliability of the Turkish version of the Barcelona Bipolar Eating Disorder Scale (BEDS), which can facilitate screening for comorbid eating disorders (EDs) in bipolar disorder (BD) patients. Methods A total of 100 BD patients and 129 healthy controls (HCs) were included in the study conducted at Ankara Etlik City Hospital Psychiatry Clinic. These patients were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and the Structured Clinical Interview for DSM-5 (SCID-5). Sociodemographic forms, the Turkish Vesion of BEDS, the Young Mani Rating Scale (YMRS), the Hamilton Depression Rating Scale (HAM-D), the Brief Psychiatric Rating Scale (BPRS), the Bulumic Investigatory Test Edinburgh (BITE), and the Dutch Eating Behavior Questionnaire (DEBQ) were used to assess validity and reliability. Results No statistically significant differences were found between the patient and control groups regarding the total and subscale scores of the BITE, BEDS, and DEBQ. The correlation coefficient between each item and the total score ranged from 0.313–0.644. Cronbach's alpha for the scale was 0.821. The removal of any items from the original scale did not lead to an improvement in Cronbach’s alpha. The BEDS score was found to be significantly correlated with the BITE score, DEBQ total score, emotional eating score, and external eating score (p < 0.001). There was no correlation between the BEDS score and the DEBQ Restrictive Eating Rubscale, YMRS, BPRS, or HAM-D scale scores. Conclusion The Turkish version of the BEDS is a valid and reliable scale that can be used as an assessment tool in the evaluation of eating disorders in the Turkish BD population. Validity Reliability Bipolar Disorder Barcelona Bipolar Eating Disorder Scale Eating Disorder INTRODUCTION Bipolar disorder (BD) is a chronic psychiatric illness affecting approximately 1% of the population and is characterized by recurring mood episodes, typically alternating between depression and mania and/or hypomania ( 1 , 2 ). Research indicates that nearly 70% of individuals develop symptoms before the age of 25 ( 3 ). BD is frequently accompanied by psychiatric comorbidities, which substantially impair social, occupational, and family functioning ( 4 ). Comorbidity is particularly common in BD type 1 patients ( 5 ) and has been associated with poorer outcomes, earlier onset, and a reduced treatment response ( 6 ). Moreover, mixed mood features and a higher frequency of suicidal behaviors are more prevalent in BD patients with comorbid conditions ( 7 , 8 ). The most commonly observed comorbidities include anxiety disorders, substance use disorders (SUD), obsessive–compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), various personality disorders, and eating disorders (ED) ( 9 – 11 ). BD and ED display multiple overlapping clinical characteristics that point to a clinically meaningful association between the two conditions ( 12 ). A central feature common to both is impulsivity. In BD, impulsive behaviors can manifest across different mood states, ranging from excessive spending and risky sexual behaviors during manic episodes to substance misuse or self-harming tendencies during depressive phases ( 13 ). Comparable patterns are evident in binge eating disorder (BED), where recurrent, uncontrolled eating episodes are driven by diminished inhibitory control and a sense of loss of restraint ( 14 ). This shared tendency toward impulsive action is one reason why both BD and ED frequently cooccur with other psychiatric disorders characterized by deficits in self-regulation, such as SUD, ADHD, borderline personality disorder, and impulse-control disorders ( 15 ). Another domain of convergence is mood and affective instability. BD is defined by cyclical fluctuations between manic, depressive, or mixed states ( 16 ), whereas ED patients often exhibit heightened reactivity to emotional stress, rapid mood shifts, and difficulties in regulating negative affect, particularly in the context of eating and body image ( 17 ). These parallels suggest that affective dysregulation may serve as a transdiagnostic vulnerability factor that contributes to the onset and persistence of both disorders. Notably, BD and ED tend to emerge in adolescence or early adulthood, a sensitive developmental window in which they can substantially impair academic achievement, social relationships, and occupational functioning ( 18 ). Epidemiological studies provide further support for this overlap. The reported prevalence rates of ED in individuals with BD range between 6% and 31%, which are significantly higher than those reported in the general population ( 12 ). Meta-analytic evidence suggests that individuals with bipolar disorder have a substantially increased risk of developing ED, with BED and bulimia nervosa emerging as the most prevalent comorbid conditions ( 15 ). Importantly, the coexistence of BD and ED has been associated with a more severe illness trajectory, including earlier onset of BD, increased frequency of mood episodes, greater risk of suicidality, greater likelihood of mixed affective states, and reduced psychosocial functioning ( 16 , 17 ). The Barcelona Bipolar Eating Disorder Scale (BEDS) is a concise, self-report instrument developed by Carla Torrent, Eduard Vieta, and colleagues in 2004 to screen for disordered eating behaviors in individuals with BD ( 19 ). This tool consists of ten items and was designed as a rapid and clinically practical tool to capture eating pathology that may be overlooked by standard eating disorder measures, particularly given the influence of mood instability and impulsivity on eating patterns in BD patients. Subsequent multicenter validation confirmed its reliability, validity, and sensitivity to change, with prevalence estimates highlighting its clinical utility ( 20 ). In addition to its original Spanish version, the scale has also been validated in French populations, further supporting its cross-cultural applicability ( 21 ). Despite these advances, a validated Turkish version of the BEDS is lacking. Considering that eating behaviors are culturally embedded, linguistic adaptation and validation are crucial to ensure psychometric accuracy ( 22 ). Furthermore, comorbidity with BD and an eating disorder is associated with earlier onset, increased frequency of episodes, greater suicidality, and poorer functional outcomes ( 15 ). Therefore, systematic screening in Turkish clinical populations is particularly important. Turkish versions of many eating disorder measurement tools are available. However, there is no Turkish version that can be used to diagnose and screen for ED in the BD population. A culturally adapted version would not only enhance diagnostic accuracy and early intervention but also enable international comparability in research ( 23 ). In conclusion, the overlapping features of BD and ED, such as impulsivity, emotional dysregulation, early onset, and increased comorbidity, highlight the importance of an integrated clinical approach ( 24 ). Therefore, systematic assessment of eating-related pathology in BD patients, followed by timely and personalized interventions, is essential to improve patient prognosis and reduce the cumulative burden of these comorbid disorders. Given these associations, the development of simple, self-administered tools to screen for ED symptoms in BD patients is crucial to prevent missed or delayed diagnoses. This study aims to adapt the BEDS to the Turkish population and assess its validity and reliability in both clinical and nonclinical populations. METHOD Participants and Procedure The study included consecutive patients with BD who presented to the Psychiatry Clinic of Etlik City Hospital between January 2024 and February 2025. Diagnostic evaluations were conducted in accordance with the DSM-5 criteria and verified through the Structured Clinical Interview for DSM-5 (SCID-5). The participants’ current clinical status was evaluated via the Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (HAM-D) to ascertain whether they were in a remitted or acute episode. The control group was composed of psychiatrycally healthy volunteers recruited from the Family Medicine Clinic of the same hospital. To exclude patients with psychiatric conditions, both the SCID-I and SCID-II were administered. The eligibility criteria for both groups included being between 18 and 65 years of age, having literacy in Turkish, having sufficient cognitive ability to complete questionnaires and interviews, and being willing to participate. The exclusion criteria included the presence of intellectual disability, psychotic disorders, alcohol or SUD, OCD, ADHD, personality disorders, severe medical conditions, or any other psychiatric diagnosis confirmed through the SCID-5. All required permissions to use the relevant scales were secured from their original developers to conduct the validity and reliability assessment of the Turkish version of the BEDS. Ethics Committee Approval: Before starting this study, permission was obtained from the ethics committee of the Scientific Research Committee of Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital (date: 07/01/2019, number: 58/14). All stages of the study were carried out in according to provisions of the Declaration of Helsinki as revised in Edinburgh 2000. Each participant was informed about the study beforehand and informed consent was obtained from all of them. Clinical trial number: not applicable Translation and Adaptation of the Scale The BEDS was translated into Turkish via a forward–backward translation procedure. Initially, a bilingual psychiatrist who was a native Spanish speaker translated the scale into Turkish. A second psychiatrist, blinded to the original version, performed a back-translation into Spanish. Discrepancies were resolved through consensus, and the final Turkish version was approved after pilot testing in a small patient sample to ensure linguistic clarity and cultural appropriateness. No further modifications were needed. All participants received comprehensive information regarding the study’s objectives and procedures, and written informed consent was obtained prior to the interviews and scale administration. During the baseline assessment, all participants were administered the YMRS and HAM-D. The cut-off score for both the YMRS and HAM-D was set at 7 (25, 26), and four patients were excluded from the study due to a YMRS score above 7 and two patients due to a HAM-D score above 7. Those with euthymia were first administered the SCID, and then the following assessments were administered to patients and healthcare professionals: the sociodemographic data collection form (BEDS), the Edinburgh Bulimia Research Scale (EBAT), the Dutch Eating Behavior Questionnaire (DEBQ), and the brief psychiatric rating scale (BPRS). Seven patients who completed the scales incompletely or incorrectly were excluded from further assessment. Twelve participants were excluded due to comorbid psychiatric disorders. Five of them had the comorbid OCD diagnosis and seven had the comorbid panic disorder diagnosis, Ultimately, 100 BD patients and 129 healthy controls were included in the study. Data collection tools Sociodemographic Data Collection Form : A structured sociodemographic and clinical information form was designed specifically by the research team for this study. This form included items assessing demographic variables such as age, sex, marital status, educational attainment, employment status, and income level as well as clinical variables such as age at illness onset, illness duration, family history of psychiatric and medical disorders, previous hospitalizations, history of depressive and manic episodes, and current medication use. Information regarding physical comorbidities and metabolic syndrome components was also documented. Young Mania Rating Scale (YMRS) : The YMRS, originally developed by Young and colleagues, is one of the most commonly used clinician-administered instruments for assessing manic symptom severity (27). The scale comprises 11 items evaluating domains such as elevated mood, motor activity or energy, sexual interest, sleep, irritability, speech, thought content, disruptive or aggressive behavior, appearance, and insight. Seven items are rated on a five-point Likert scale, whereas the remaining four are rated on a nine-point scale. The total scores range from 0 to 44, with higher scores reflecting greater manic symptom severity. The Turkish adaptation was validated by Karadağ et al. (28), who demonstrated its reliability and validity in clinical populations. Hamilton Depression Rating Scale (HAM-D) : The HAM-D, originally developed by Hamilton, is a clinician-rated scale designed to assess the severity of depressive symptomatology. In this study, the 17-item version was employed, covering domains such as mood, guilt, suicidal ideation, sleep disturbances, agitation, anxiety, weight loss, and somatic complaints. The items are rated on either a three- or five-point scale, with higher scores reflecting greater severity of depressive symptoms. In clinical practice, scores between 16–25 reflect mild depression, scores between 26–40 indicate moderate depression, and scores above 40 indicate severe depression. The Turkish version has been validated and shown to be reliable by Akdemir et al. (29). Edinburgh Bulimia Research Test (EBAT) : The EBAT, also known as the Bulimic Investigatory Test, Edinburgh (BITE), was developed by Henderson and Freeman in 1987 (30) as a self-report questionnaire for assessing bulimia-related symptoms and eating attitudes. It consists of 33 items (36 questions in total due to subitems), the majority of which are scored dichotomously (“Yes/No”). Five items are reverse-scored to reduce response bias. In addition, six items evaluate symptom frequency and severity via graded response options. Total scores ≥20 indicate the presence of binge eating, scores between 10–19 suggest abnormal eating attitudes, and scores <10 are considered nonpathological. The reported Cronbach’s alpha values are 0.87 for the symptom scale and 0.62 for the severity subscale. The Turkish validation study confirmed its psychometric adequacy in a sample of university students (31). Barcelona Bipolar Eating Disorder Scale (BEDS) : The BEDS was specifically developed to provide a brief, self-administered screening tool for the detection of eating disturbances in patients with BD (20). It comprises 10 items scored on a four-point scale (0–3), with higher values reflecting greater severity of eating pathology. The item scores are summed to yield a total score, which represents the overall severity of ED symptoms. The scale was originally validated in Spanish populations by Torrent et al. (20) and subsequently adapted into French (21). The Turkish adaptation in the present study followed a rigorous translation–back-translation process to ensure semantic and conceptual equivalence. Dutch Eating Behavior Questionnaire (DEBQ) : The DEBQ, developed by Van Strien et al. (32), is a 33-item self-report instrument assessing three dimensions of eating behavior: emotional eating (13 items), external eating (10 items), and restrained eating (10 items). Each item is rated on a five-point Likert scale ranging from “never” (1) to “very often” (5). Factor analyses of both the original and Turkish versions confirmed the three-factor structure. The reliability coefficients are high, with Cronbach’s alpha values reported as 0.95 for restrained eating, 0.94 for emotional eating, and 0.80 for external eating in Dutch samples. The Turkish version demonstrated comparable psychometric properties, with alphas of 0.91, 0.92, and 0.72 for restrained, emotional, and external eating, respectively (33). Brief Psychiatric Rating Scale (BPRS) : Originally developed by Overall and Gorham in 1962 (34), the BPRS is a clinician-administered scale designed to evaluate psychiatric symptom severity across a wide range of domains. The version employed in this study includes 18 items assessing symptoms such as anxiety, depression, hostility, suspiciousness, hallucinations, unusual thought content, conceptual disorganization, and emotional withdrawal. Each item is scored on a 7-point scale (0 = not present to 6 = extremely severe), yielding a total score ranging from 0--108. Scores between 15–30 generally indicate mild symptomatology, whereas scores ≥30 suggest severe psychopathology. The Turkish validation study was conducted by Soykan in 1990 (35), confirming the instrument’s clinical utility. Statistical analysis Internal consistency was evaluated via Cronbach’s alpha, and item–total correlations as well as Cronbach’s alpha values if an item was deleted were calculated. Construct validity was assessed through principal component analysis, which was supported by the Kaiser–Meyer–Olkin (KMO) measure and Bartlett’s test of sphericity. Convergent validity was examined by calculating Pearson correlation coefficients between the BEDS and other measures (DEBQ, BITE, YMRS, HAM-D, and BPRS). Group differences were analyzed via independent-samples t tests and chi-square tests, with statistical significance set at p < 0.05. RESULTS The comparisons of employment status, educational status, smoking status, marital status, weight status, income level, BITE and BEDS scores, total and subscale DEBQ scores and years of education between the BD and HC groups and the YMRS, HAM-D and BPRS scores of the BD group are shown in Table 1 . A statistically significant difference was detected between the BD and HC groups in terms of age, employment, smoking status, education, weight status and income level (p < 0.001) (Table 1 ). Table 1 Comparison of demographic and clinical characteristics between the patient and healthy control groups Variable Patient (n = 100) Healthy Control (n = 129) Test Statistic p Age, years, M (SD) 39.21 (11.79) 29.42 (10.52) t = 6.620ᵃ < .001 Gender, n (%) χ² = 4.246ᵇ .039 Female 54 (54.0) 52 (40.3) Male 46 (46.0) 77 (59.7) Education, years, M (SD) 10.83 (3.62) 14.89 (2.44) t = -10.114ᵃ < .001 Marital status, n (%) χ² = 8.731ᵇ .013 Single 44 (44.0) 82 (63.6) Married 47 (47.0) 30 (30.2) Divorced 9 (9.0) 8 (6.2) Income, n (%) χ² = 46.255ᵇ < .001 0 38 (38.0) 8 (6.2) Low 12 (12.0) 32 (24.8) Middle 19 (19.0) 59 (45.7) High 31 (31.0) 30 (23.3) Work status, n (%) χ² = 59.542ᵇ < .001 Working 29 (29.0) 73 (56.6) Nonworking 53 (53.0) 13 (10.1) Student 9 (9.0) 38 (29.5) Retired 9 (9.0) 5 (3.9) Cigarette use, n (%) χ² = 2.314ᵇ .128 No 48 (48.0) 49 (38.0) Yes 52 (52.0) 80 (62.0) Packs/year, M (SD) 7.97 (10.98) 2.23 (5.11) t = 5.247ᵃ < .001 Height (cm) 168 (9.59) 169 (18.77) t = -0.421ᵃ .674 Weight (kg) 84.75 (15.69) 70.83 (17.03) t = 6.342ᵃ < .001 YMRS, M (SD) 0.87 (1.48) — — — HAM-D, M (SD) 1.81 (1.88) — — — BPRS, M (SD) 1.98 (2.13) — — — BITE, M (SD) 17.75 (3.85) 17.49 (3.69) t = 0.501ᵃ .617 DEBQ Emotional eating 22.88 (10.57) 26.45 (11.88) t = -2.364ᵃ .019 DEBQ Restrictive eating 24.06 (8.12) 24.26 (7.80) t = 0.191ᵃ .849 DEBQ External eating 28.48 (7.86) 28.67 (6.78) t = -0.201ᵃ .841 DEBQ Total 75.34 (17.94) 79.38 (17.99) t = -1.684ᵃ .094 BEDS, M (SD) 10.01 (6.37) 9.04 (4.87) t = 1.297ᵃ .196 BPRS: Brief Psychiatric Rating Scale, BITE: Bulumic Investigatory Test Edinburgh, DEBQ: Dutch Eating Behavior Questionnaire, BEDS: Barcelona Bipolar Eating Disorder Scale. YMRS: Young Mani Rating Scale, HAM-D: Hamilton Depression Rating Scale, a; Student’s t test, b; Chi-square test; bold values indicate P values < 0.05 No statistically significant difference was found between the patient and control groups in terms of BITE, BEDS and DEBQ total and subscale scores (Table 1 ). The correlation coefficient between each item and the total score ranged from 0.313–0.644. The scale's Cronbach's alpha value was 0.821. With each item removed, the scale's Cronbach's alpha value ranged from 0.790 to 0.813. The mean standard deviation of each item ranged from 0.59 (0.84) to 1.55 (1.01). The mean scale score in our sample was 9.46 (5.58) (Table 2 ). Table 2 Item characteristics of the Barcelona bipolar dating disorder scale (BEDS) Item M (SD) Item–Total r Cronbach's α if Deleted Scale Mean if Deleted 1 0.76 (0.88) 0.431 0.813 8.70 2 1.17 (0.95) 0.535 0.802 8.29 3 0.59 (0.84) 0.476 0.808 8.87 4 0.66 (0.88) 0.571 0.798 8.80 5 0.60 (0.83) 0.432 0.812 8.86 6 0.96 (0.93) 0.602 0.795 8.50 7 0.73 (0.86) 0.618 0.794 8.73 8 1.55 (1.01) 0.314 0.827 7.91 9 1.03 (0.91) 0.644 0.790 8.44 10 1.37 (0.89) 0.452 0.811 8.10 With each item removed, the total scale score ranged from 7.91–8.86 (Table 2 ). A principal component analysis was conducted on all 10 items of the BEDS. The KMO value of 0.846 indicated sampling adequacy, supporting the use of factor analysis in the entire sample. Bartlett’s test of sphericity was statistically significant (χ² = 640.005, df = 45, p < 0.001), confirming the suitability of the data for factor analysis. Table 3 presents the factor loadings, which ranged from 0.341–0.717. The eigenvalue for the identified factor (severity and frequency of worry) was 3.326, accounting for 33.256% of the total variance. Table 3 Factor Loadings and Uniqueness Values of the BEDS Items Item Factor Loading Uniqueness 1 0.486 0.763 2 0.586 0.657 3 0.524 0.726 4 0.662 0.562 5 0.487 0.763 6 0.661 0.563 7 0.708 0.499 8 0.341 0.884 9 0.717 0.485 10 0.478 0.771 The content validity of the BEDS was assessed by examining its associations with the DEBQ (total and subscale scores), HAM-D, BPRS, YMRS, and BITE. The correlations between the BEDS total score and these measures for the entire sample are presented in Table 4 . Correlation analyses revealed a negative association with BITE (p < 0.001). In contrast, the BEDS total score was positively correlated with the DEBQ total score as well as with the scores of the emotional and external eating subscales (all p < 0.001). No significant associations were observed with the DEBQ restrictive eating subscale, YMRS, BPRS, or HAM-D. Table 4 Correlations between the total score of the BEDS and the DEBQ (total and subgroup), YMRS, BITE, HAM-D, and BPRS scores in the full study population Measure r BEDS Total p BITE -0.555 < .001 DEBQ Emotional eating 0.530 < .001 DEBQ Restrictive eating -0.021 .752 DEBQ External eating 0.532 < .001 DEBQ Total 0.542 < .001 YMRS 0.090 .373 HAM-D 0.181 .072 BPRS 0.078 .441 BPRS: Brief Psychiatric Rating Scale; BITE: Boric Investigatory Test; Edinburgh, DEBQ: Dutch Eating Behavior Questionnaire; BEDS: Barcelona Bipolar Eating Disorder Scale; YMRS: Young Mani Rating Scale; HAM-D: Hamilton Depression Rating Scale. Bold values indicate P values < 0.05. DISCUSSION This study aimed to adapt the BEDS into Turkish and examine its psychometric properties in a clinical sample of individuals with bipolar disorder and healthy controls. The results strongly support the use of the Turkish version of the BEDS as a valid and reliable instrument for identifying disordered eating behaviors in this population. The Barcelona Bipolar Eating Disorder Scale is a brief self-report instrument designed to assess disordered eating behaviors specifically within the context of bipolar disorder. It evaluates impulsive and emotion-driven eating tendencies, such as loss of control over eating, binge-like episodes, and eating in response to mood fluctuations. Rather than diagnosing a specific eating disorder, the BEDS captures the overall severity and frequency of eating-related disturbances that may emerge as part of affective instability and impulsivity in individuals with bipolar disorder. Therefore, establishing a valid and reliable version of such a scale for Turkish-speaking populations would increase its utility in both academic research and clinical practice, ultimately facilitating clinicians’ ability to monitor and follow patients more effectively. The internal consistency of the Turkish BEDS was found to be high (Cronbach's alpha = 0.821), which is comparable to the values reported in the original Spanish validation (0.79) ( 20 ) and the French version (0.82) ( 21 ). These results suggest that the scale maintains its reliability across different languages and cultural contexts. The item–total correlations ranged between 0.31 and 0.64, confirming that all the items contributed meaningfully to the underlying construct. These findings suggest that the BEDS reliably captures a coherent dimension of eating pathology, as it manifests in BD. Exploratory factor analysis supported a unidimensional structure, with factor loadings ranging from 0.34–0.72 and a single factor explaining 33.26% of the total variance. The Kaiser–Meyer–Olkin measure (0.85) and the significant Bartlett’s test (χ² = 640.01, p < 0.001) verified the adequacy of the data for factor analysis. This structure corresponds closely to the original validation, suggesting that the Turkish version preserves both the semantic and conceptual integrity of the scale. One of the problems with the scales used to assess psychiatric disorders is their length and/or the need for expert administration, which limits their clinical utility ( 20 ). In brief, self-administered screening measures are particularly valuable in clinical practice, where lengthy or interviewer-based instruments can be difficult to administer. Given the high comorbidity rates of BD and ED—especially binge eating disorder and bulimia nervosa—early detection of eating pathology in this population is essential ( 18 ). In line with this, the significant correlations observed between BEDS total scores and the emotional and external eating subscales of the DEBQ underscore the instrument's clinical sensitivity. The lack of correlation with restrained eating suggests that the BEDS focuses primarily on loss of control and emotion-focused eating rather than cognitively controlled dietary restriction. The inverse correlation with the Edinburgh Bulimic Investigation Test (BITE) may be attributed to differences in scoring direction and item framing between the two scales. Considering this context, the results are consistent with previous evidence linking BD to binge-eating symptomatology ( 24 ). Furthermore, the lack of correlation between BEDS scores and the YMRS, HAM-D, or BPRS supports the scale's discriminant validity and suggests that eating disorders are not merely reflections of existing manic, depressive, or general psychopathological states. This finding suggests that such tendencies may represent enduring personality traits rather than transient mood-related phenomena in BD patients. From a clinical perspective, the BEDS offers several practical advantages. Its brevity, clarity, and self-reported design make it suitable for use in time-constrained psychiatric settings ( 21 ). Unlike more extensive instruments such as the DEBQ or BITE, the BEDS specifically targets impulsive and emotionally reactive eating behaviors, which are common yet often overlooked in BD ( 17 ). Early identification of these symptoms is crucial, given the established links between BD–ED comorbidity and poorer clinical outcomes, including earlier onset, increased episode frequency, elevated suicidality, and reduced psychosocial functioning ( 24 ). The Turkish adaptation provides clinicians with a culturally appropriate and psychometrically sound tool for identifying such comorbidities. Routine application may enhance early intervention and contribute to a more integrative understanding of BD by accounting for both affective and behavioral dysregulation. Cultural and linguistic adaptation is vital when psychological instruments are translated, as eating behaviors are strongly influenced by cultural norms regarding food, body image, and emotional expression. The successful validation of the Turkish BEDS demonstrated that the construct of impulsivity-driven, emotionally mediated eating is recognizable and clinically relevant in the Turkish population. This achievement not only improves diagnostic precision in local practice but also promotes cross-cultural comparability in international BD and ED research. This study has several strengths. Compared with previous validation efforts, the present study included a relatively larger sample size (100 BD patients and 129 healthy controls). Moreover, the diagnostic accuracy of the clinical sample was ensured through the use of structured interviews (SCID-5), thereby increasing methodological rigor. Nevertheless, several limitations must be acknowledged. First, the patient sample consisted solely of individuals with BD type I, limiting generalizability to other BD subtypes, such as type II or cyclothymia. Second, the cross-sectional design prevents assessment of the scale’s sensitivity to longitudinal changes or treatment outcomes. Third, although the sample size was adequate for psychometric testing, future studies should include larger and more diverse samples to examine measurement invariance across gender, age, and illness stage. Third, although the sample size was adequate for psychometric testing, future studies should include larger and more diverse samples to examine measurement invariance across gender, age, and illness stage. In summary, the Turkish version of the Barcelona Bipolar Eating Disorder Scale has excellent psychometric properties, including high internal consistency, a coherent factor structure, and meaningful convergent validity. The scale effectively identifies impulsive and emotion-driven eating behaviors that are prevalent yet often underrecognized among individuals with bipolar disorder. Its brevity and ease of administration make it well suited for both clinical practice and research. Integrating the BEDS into routine assessment protocols may facilitate early detection of comorbid eating disturbances and enhance comprehensive care and prognosis in patients with bipolar disorder. Declarations Acknowledgements: Before starting this study, permission was obtained from the ethics committee of the Scientific Research Committee of Dışkapı Education and Research Hospital (fund number: 58/14, Date:07/01/2019). All stages of the study were carried out in accordance with the provisions of the Declaration of Helsinki as revised in Edinburgh 2000. Informed consent was obtained from all participants. The authors thank all the study participants and clinical staff who helped with this article. Conflict of Interest: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Financial Disclosure : This research received no specific grant and financial support from any funding agency in the public, commercial, or not-for-profit sectors. Clinical trial number : not applicable All stages of the study were carried out in according to provisions of the Declaration of Helsinki as revised in Edinburgh 2000. Informed consent was obtained from all participants. Ethics Committee Approval: Before starting this study, permission was obtained from the ethics committee of the Scientific Research Committee of Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital (07/01/2019, 58/14). All stages of the study were carried out in according to provisions of the Declaration of Helsinki as revised in Edinburgh 2000. Each participant was informed about the study beforehand and informed consent was obtained from all of them. The authors thank all the study participants and clinical staff who helped with this article. 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Impulsivity, decision-making and risk-taking behaviour in bipolar disorder: a systematic review and meta-analysis. 2020;50(13):2141-53. Pasquale EK, Boyar AM, Boutelle KNJCPR. Reward and Inhibitory Control as Mechanisms and Treatment Targets for Binge Eating Disorder. 2024;26(11):616-25. Kowalewska E, Bzowska M, Engel J, Lew-Starowicz MJBp. Comorbidity of binge eating disorder and other psychiatric disorders: A systematic review. 2024;24(1):556. Pavlidis E, Campillo F, Goldbeter A, Desroches MJCN. Multiple-timescale dynamics, mixed mode oscillations and mixed affective states in a model of bipolar disorder. 2024;18(6):3239-57. Mikhail MEJFip. Affect dysregulation in context: Implications and future directions of experience sampling research on affect regulation models of loss of control eating. 2021;12:747854. Craba A, Mazza M, Marano G, Rinaldi L, Sani G, Janiri LJETiD, Addictions,, et al. Which comes first? New insights on comorbidity between eating disorders and bipolar disorders. 2021;1:100023. Torrent C, Vieta E, Crespo J, Gonzalez-Pinto A, Del Valle J, Olivares J, et al. Barcelona Bipolar Eating Disorder Scale (BEDS): a self-administered scale for eating disturbances in bipolar patients. 2004;32(3):127-31. Torrent C, Vieta E, Garcia-Garcia MJP. Validation of the Barcelona Bipolar Eating Disorder Scale for bipolar patients with eating disturbances. 2008;41(6):379-87. Schreck-Del Bello L, Berard E, Klein R, Ritz PJERoAP. Fast screening of eating disorders among patients with bipolar disorder: validation of the French version of BEDS questionnaire. 2017;67(2):61-5. Yasir AJIjop. Cross cultural adaptation & psychometric validation of instruments: Step-wise. 2016;1(1):1-4. Heim E, Mewes R, Abi Ramia J, Glaesmer H, Hall B, Shehadeh MH, et al. Reporting cultural adaptation in psychological trials–the RECAPT criteria. 2021;3(Spec Issue):e6351. McAulay C, Mond J, Outhred T, Malhi GS, Touyz SJJoMH. Eating disorder features in bipolar disorder: clinical implications. 2023;32(1):43-53. Lukasiewicz M, Gerard S, Besnard A, Falissard B, Perrin E, Sapin H, et al. Young Mania Rating Scale: how to interpret the numbers? Determination of a severity threshold and of the minimal clinically significant difference in the EMBLEM cohort. 2013;22(1):46-58. Romera I, Pérez V, Menchón JM, Polavieja P, Gilaberte IJPR. Optimal cutoff point of the Hamilton Rating Scale for Depression according to normal levels of social and occupational functioning. 2011;186(1):133-7. Young RC, Biggs JT, Ziegler VE, Meyer DAJTBjop. A rating scale for mania: reliability, validity and sensitivity. 1978;133(5):429-35. Karadağ F, Oral ET, Aran Yalçın F, Erten EJTPD. Young mani derecelendirme ölçeğinin Türkiye’de geçerlik ve güvenilirliği. 2001;13(2):107-14. Akdemir A, ÖRSEL DS, DAĞ İ, TÜRKÇAPAR MH, İŞCAN N, ÖZBAY HJPPPD. Hamilton depresyon derecelendirme ölçeği (HDDÖ)'nin geçerliliği-güvenirliliği ve klinikte kullanımı. 1996;4(4):251-9. Henderson M, Freeman CJTBJoP. A self-rating scale for bulimia the ‘BITE’. 1987;150(1):18-24. Kızıltan G, Karabudak E, Ünver S, Sezgin E, Ünal AJAÜTFM. Tıkınırcasına yeme bozukluğu olan üniversite öğrencilerinin beslenme durumları. 2005;58(4):167-71. Van Strien T, Frijters JE, Bergers GP, Defares PBJIjoed. The Dutch Eating Behavior Questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior. 1986;5(2):295-315. Evirgen N. The prevalence of emotional eating and its relation to affect regulation in a Turkish sample of obese, overweight and normal weighted women: Sosyal Bilimler Enstitüsü; 2010. Overall JE, Gorham DRJPr. The brief psychiatric rating scale. 1962;10(3):799-812. Soykan Kahraman Ç. Institutional differences and case typicality as related to-diagnosis symptom severity prognosis and treatment: Middle East Technical University; 1990. 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Research indicates that nearly 70% of individuals develop symptoms before the age of 25 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). BD is frequently accompanied by psychiatric comorbidities, which substantially impair social, occupational, and family functioning (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Comorbidity is particularly common in BD type 1 patients (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) and has been associated with poorer outcomes, earlier onset, and a reduced treatment response (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Moreover, mixed mood features and a higher frequency of suicidal behaviors are more prevalent in BD patients with comorbid conditions (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The most commonly observed comorbidities include anxiety disorders, substance use disorders (SUD), obsessive\u0026ndash;compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), various personality disorders, and eating disorders (ED) (\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBD and ED display multiple overlapping clinical characteristics that point to a clinically meaningful association between the two conditions (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). A central feature common to both is impulsivity. In BD, impulsive behaviors can manifest across different mood states, ranging from excessive spending and risky sexual behaviors during manic episodes to substance misuse or self-harming tendencies during depressive phases (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Comparable patterns are evident in binge eating disorder (BED), where recurrent, uncontrolled eating episodes are driven by diminished inhibitory control and a sense of loss of restraint (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). This shared tendency toward impulsive action is one reason why both BD and ED frequently cooccur with other psychiatric disorders characterized by deficits in self-regulation, such as SUD, ADHD, borderline personality disorder, and impulse-control disorders (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAnother domain of convergence is mood and affective instability. BD is defined by cyclical fluctuations between manic, depressive, or mixed states (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), whereas ED patients often exhibit heightened reactivity to emotional stress, rapid mood shifts, and difficulties in regulating negative affect, particularly in the context of eating and body image (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). These parallels suggest that affective dysregulation may serve as a transdiagnostic vulnerability factor that contributes to the onset and persistence of both disorders. Notably, BD and ED tend to emerge in adolescence or early adulthood, a sensitive developmental window in which they can substantially impair academic achievement, social relationships, and occupational functioning (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEpidemiological studies provide further support for this overlap. The reported prevalence rates of ED in individuals with BD range between 6% and 31%, which are significantly higher than those reported in the general population (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Meta-analytic evidence suggests that individuals with bipolar disorder have a substantially increased risk of developing ED, with BED and bulimia nervosa emerging as the most prevalent comorbid conditions (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Importantly, the coexistence of BD and ED has been associated with a more severe illness trajectory, including earlier onset of BD, increased frequency of mood episodes, greater risk of suicidality, greater likelihood of mixed affective states, and reduced psychosocial functioning (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe Barcelona Bipolar Eating Disorder Scale (BEDS) is a concise, self-report instrument developed by Carla Torrent, Eduard Vieta, and colleagues in 2004 to screen for disordered eating behaviors in individuals with BD (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). This tool consists of ten items and was designed as a rapid and clinically practical tool to capture eating pathology that may be overlooked by standard eating disorder measures, particularly given the influence of mood instability and impulsivity on eating patterns in BD patients. Subsequent multicenter validation confirmed its reliability, validity, and sensitivity to change, with prevalence estimates highlighting its clinical utility (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). In addition to its original Spanish version, the scale has also been validated in French populations, further supporting its cross-cultural applicability (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite these advances, a validated Turkish version of the BEDS is lacking. Considering that eating behaviors are culturally embedded, linguistic adaptation and validation are crucial to ensure psychometric accuracy (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Furthermore, comorbidity with BD and an eating disorder is associated with earlier onset, increased frequency of episodes, greater suicidality, and poorer functional outcomes (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Therefore, systematic screening in Turkish clinical populations is particularly important. Turkish versions of many eating disorder measurement tools are available. However, there is no Turkish version that can be used to diagnose and screen for ED in the BD population. A culturally adapted version would not only enhance diagnostic accuracy and early intervention but also enable international comparability in research (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn conclusion, the overlapping features of BD and ED, such as impulsivity, emotional dysregulation, early onset, and increased comorbidity, highlight the importance of an integrated clinical approach (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Therefore, systematic assessment of eating-related pathology in BD patients, followed by timely and personalized interventions, is essential to improve patient prognosis and reduce the cumulative burden of these comorbid disorders. Given these associations, the development of simple, self-administered tools to screen for ED symptoms in BD patients is crucial to prevent missed or delayed diagnoses. This study aims to adapt the BEDS to the Turkish population and assess its validity and reliability in both clinical and nonclinical populations.\u003c/p\u003e"},{"header":"METHOD","content":"\u003cp\u003e\u003cstrong\u003eParticipants and Procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included consecutive patients with BD who presented to the Psychiatry Clinic of Etlik City Hospital between January 2024 and February 2025. Diagnostic evaluations were conducted in accordance with the DSM-5 criteria and verified through the Structured Clinical Interview for DSM-5 (SCID-5). The participants\u0026rsquo; current clinical status was evaluated via the Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (HAM-D) to ascertain whether they were in a remitted or acute episode.\u003c/p\u003e\n\u003cp\u003eThe control group was composed of psychiatrycally healthy volunteers recruited from the Family Medicine Clinic of the same hospital. To exclude patients with psychiatric conditions, both the SCID-I and SCID-II were administered.\u003c/p\u003e\n\u003cp\u003eThe eligibility criteria for both groups included being between 18 and 65 years of age, having literacy in Turkish, having sufficient cognitive ability to complete questionnaires and interviews, and being willing to participate. The exclusion criteria included the presence of intellectual disability, psychotic disorders, alcohol or SUD, OCD, ADHD, personality disorders, severe medical conditions, or any other psychiatric diagnosis confirmed through the SCID-5.\u003c/p\u003e\n\u003cp\u003eAll required permissions to use the relevant scales were secured from their original developers to conduct the validity and reliability assessment of the Turkish version of the BEDS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Committee Approval:\u0026nbsp;\u003c/strong\u003eBefore starting this study, permission was obtained from the ethics committee of the Scientific Research Committee of Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital (date: 07/01/2019, number: 58/14). All stages of the study were carried out in according to provisions of the Declaration of Helsinki as revised in Edinburgh 2000. Each participant was informed about the study beforehand and informed consent was obtained from all of them.\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTranslation and Adaptation of the Scale\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe BEDS was translated into Turkish via a forward\u0026ndash;backward translation procedure. Initially, a bilingual psychiatrist who was a native Spanish speaker translated the scale into Turkish. A second psychiatrist, blinded to the original version, performed a back-translation into Spanish. Discrepancies were resolved through consensus, and the final Turkish version was approved after pilot testing in a small patient sample to ensure linguistic clarity and cultural appropriateness. No further modifications were needed.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll participants received comprehensive information regarding the study\u0026rsquo;s objectives and procedures, and written informed consent was obtained prior to the interviews and scale administration. During the baseline assessment, all participants were administered the YMRS and HAM-D. The cut-off score for both the YMRS and HAM-D was set at 7 (25, 26), and four patients were excluded from the study due to a YMRS score above 7 and two patients due to a HAM-D score above 7. Those with euthymia were first administered the SCID, and then the following assessments were administered to patients and healthcare professionals: the sociodemographic data collection form (BEDS), the Edinburgh Bulimia Research Scale (EBAT), the Dutch Eating Behavior Questionnaire (DEBQ), and the brief psychiatric rating scale (BPRS). Seven patients who completed the scales incompletely or incorrectly were excluded from further assessment. Twelve participants were excluded due to comorbid psychiatric disorders. Five of them had the comorbid OCD diagnosis and seven had the comorbid panic disorder diagnosis, Ultimately, 100 BD patients and 129 healthy controls were included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ecollection tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSociodemographic Data Collection Form\u003c/strong\u003e: A structured sociodemographic and clinical information form was designed specifically by the research team for this study. This form included items assessing demographic variables such as age, sex, marital status, educational attainment, employment status, and income level as well as clinical variables such as age at illness onset, illness duration, family history of psychiatric and medical disorders, previous hospitalizations, history of depressive and manic episodes, and current medication use. Information regarding physical comorbidities and metabolic syndrome components was also documented.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYoung Mania Rating Scale (YMRS)\u003c/strong\u003e: The YMRS, originally developed by Young and colleagues, is one of the most commonly used clinician-administered instruments for assessing manic symptom severity (27). The scale comprises 11 items evaluating domains such as elevated mood, motor activity or energy, sexual interest, sleep, irritability, speech, thought content, disruptive or aggressive behavior, appearance, and insight. Seven items are rated on a five-point Likert scale, whereas the remaining four are rated on a nine-point scale. The total scores range from 0 to 44, with higher scores reflecting greater manic symptom severity. The Turkish adaptation was validated by Karadağ et al. (28), who demonstrated its reliability and validity in clinical populations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHamilton Depression Rating Scale (HAM-D)\u003c/strong\u003e:\u0026nbsp;The HAM-D, originally developed by Hamilton, is a clinician-rated scale designed to assess the severity of depressive symptomatology. In this study, the 17-item version was employed, covering domains such as mood, guilt, suicidal ideation, sleep disturbances, agitation, anxiety, weight loss, and somatic complaints. The items are rated on either a three- or five-point scale, with higher scores reflecting greater severity of depressive symptoms. In clinical practice, scores between 16\u0026ndash;25 reflect mild depression, scores between 26\u0026ndash;40 indicate moderate depression, and scores above 40 indicate severe depression. The Turkish version has been validated and shown to be reliable by Akdemir et al. (29).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEdinburgh Bulimia Research Test (EBAT)\u003c/strong\u003e: The EBAT, also known as the Bulimic Investigatory Test, Edinburgh (BITE), was developed by Henderson and Freeman in 1987 (30) as a self-report questionnaire for assessing bulimia-related symptoms and eating attitudes. It consists of 33 items (36 questions in total due to subitems), the majority of which are scored dichotomously (\u0026ldquo;Yes/No\u0026rdquo;). Five items are reverse-scored to reduce response bias. In addition, six items evaluate symptom frequency and severity via graded response options. Total scores \u0026ge;20 indicate the presence of binge eating, scores between 10\u0026ndash;19 suggest abnormal eating attitudes, and scores \u0026lt;10 are considered nonpathological. The reported Cronbach\u0026rsquo;s alpha values are 0.87 for the symptom scale and 0.62 for the severity subscale. The Turkish validation study confirmed its psychometric adequacy in a sample of university students (31).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBarcelona Bipolar Eating Disorder Scale (BEDS)\u003c/strong\u003e: The BEDS was specifically developed to provide a brief, self-administered screening tool for the detection of eating disturbances in patients with BD (20). It comprises 10 items scored on a four-point scale (0\u0026ndash;3), with higher values reflecting greater severity of eating pathology. The item scores are summed to yield a total score, which represents the overall severity of ED symptoms. The scale was originally validated in Spanish populations by Torrent et al. (20) and subsequently adapted into French (21). The Turkish adaptation in the present study followed a rigorous translation\u0026ndash;back-translation process to ensure semantic and conceptual equivalence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDutch Eating Behavior Questionnaire (DEBQ)\u003c/strong\u003e: The DEBQ, developed by Van Strien et al. (32), is a 33-item self-report instrument assessing three dimensions of eating behavior: emotional eating (13 items), external eating (10 items), and restrained eating (10 items). Each item is rated on a five-point Likert scale ranging from \u0026ldquo;never\u0026rdquo; (1) to \u0026ldquo;very often\u0026rdquo; (5). Factor analyses of both the original and Turkish versions confirmed the three-factor structure. The reliability coefficients are high, with Cronbach\u0026rsquo;s alpha values reported as 0.95 for restrained eating, 0.94 for emotional eating, and 0.80 for external eating in Dutch samples. The Turkish version demonstrated comparable psychometric properties, with alphas of 0.91, 0.92, and 0.72 for restrained, emotional, and external eating, respectively (33).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBrief Psychiatric Rating Scale (BPRS)\u003c/strong\u003e: Originally developed by Overall and Gorham in 1962 (34), the BPRS is a clinician-administered scale designed to evaluate psychiatric symptom severity across a wide range of domains. The version employed in this study includes 18 items assessing symptoms such as anxiety, depression, hostility, suspiciousness, hallucinations, unusual thought content, conceptual disorganization, and emotional withdrawal. Each item is scored on a 7-point scale (0 = not present to 6 = extremely severe), yielding a total score ranging from 0--108. Scores between 15\u0026ndash;30 generally indicate mild symptomatology, whereas scores \u0026ge;30 suggest severe psychopathology. The Turkish validation study was conducted by Soykan in 1990 (35), confirming the instrument\u0026rsquo;s clinical utility.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eanalysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInternal consistency was evaluated via Cronbach\u0026rsquo;s alpha, and item\u0026ndash;total correlations as well as Cronbach\u0026rsquo;s alpha values if an item was deleted were calculated. Construct validity was assessed through principal component analysis, which was supported by the Kaiser\u0026ndash;Meyer\u0026ndash;Olkin (KMO) measure and Bartlett\u0026rsquo;s test of sphericity. Convergent validity was examined by calculating Pearson correlation coefficients between the BEDS and other measures (DEBQ, BITE, YMRS, HAM-D, and BPRS). Group differences were analyzed via independent-samples t tests and chi-square tests, with statistical significance set at p \u0026lt; 0.05.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe comparisons of employment status, educational status, smoking status, marital status, weight status, income level, BITE and BEDS scores, total and subscale DEBQ scores and years of education between the BD and HC groups and the YMRS, HAM-D and BPRS scores of the BD group are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. A statistically significant difference was detected between the BD and HC groups in terms of age, employment, smoking status, education, weight status and income level (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eComparison of demographic and clinical characteristics between the patient and healthy control groups\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatient (n\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHealthy Control (n\u0026thinsp;=\u0026thinsp;129)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTest Statistic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, years, M (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39.21 (11.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.42 (10.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;6.620ᵃ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2; = 4.246ᵇ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.039\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e54 (54.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52 (40.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e46 (46.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77 (59.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation, years, M (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10.83 (3.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.89 (2.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et = -10.114ᵃ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2; = 8.731ᵇ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.013\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e44 (44.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82 (63.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e47 (47.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (30.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9 (9.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (6.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncome, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2; = 46.255ᵇ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38 (38.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (6.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12 (12.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32 (24.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19 (19.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59 (45.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31 (31.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (23.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWork status, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2; = 59.542ᵇ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29 (29.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73 (56.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNonworking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e53 (53.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (10.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9 (9.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38 (29.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9 (9.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCigarette use, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2; = 2.314ᵇ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.128\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e48 (48.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49 (38.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52 (52.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80 (62.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePacks/year, M (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7.97 (10.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.23 (5.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;5.247ᵃ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeight (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e168 (9.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e169 (18.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et = -0.421ᵃ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.674\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeight (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e84.75 (15.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70.83 (17.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;6.342ᵃ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYMRS, M (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.87 (1.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHAM-D, M (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.81 (1.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBPRS, M (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.98 (2.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBITE, M (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17.75 (3.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.49 (3.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.501ᵃ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.617\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDEBQ Emotional eating\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22.88 (10.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.45 (11.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et = -2.364ᵃ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.019\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDEBQ Restrictive eating\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24.06 (8.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.26 (7.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.191ᵃ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.849\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDEBQ External eating\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28.48 (7.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.67 (6.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et = -0.201ᵃ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.841\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDEBQ Total\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e75.34 (17.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79.38 (17.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et = -1.684ᵃ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.094\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBEDS, M (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10.01 (6.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.04 (4.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;1.297ᵃ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.196\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eBPRS: Brief Psychiatric Rating Scale, BITE: Bulumic Investigatory Test Edinburgh, DEBQ: Dutch Eating Behavior Questionnaire, BEDS: Barcelona Bipolar Eating Disorder Scale. YMRS: Young Mani Rating Scale, HAM-D: Hamilton Depression Rating Scale, \u003csup\u003ea;\u003c/sup\u003e Student\u0026rsquo;s t test, b; Chi-square test; bold values indicate P values\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eNo statistically significant difference was found between the patient and control groups in terms of BITE, BEDS and DEBQ total and subscale scores (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe correlation coefficient between each item and the total score ranged from 0.313\u0026ndash;0.644. The scale's Cronbach's alpha value was 0.821. With each item removed, the scale's Cronbach's alpha value ranged from 0.790 to 0.813. The mean standard deviation of each item ranged from 0.59 (0.84) to 1.55 (1.01). The mean scale score in our sample was 9.46 (5.58) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eItem characteristics of the Barcelona bipolar dating disorder scale (BEDS)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eM (SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eItem\u0026ndash;Total r\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCronbach's α if Deleted\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eScale Mean if Deleted\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.76 (0.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.431\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.813\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.17 (0.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.535\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.802\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8.29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.59 (0.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.476\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.808\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8.87\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.66 (0.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.571\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.798\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.60 (0.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.432\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.812\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8.86\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.96 (0.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.602\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.795\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.73 (0.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.618\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.794\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.55 (1.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.314\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.827\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e7.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.03 (0.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.644\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.790\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8.44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.37 (0.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.452\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.811\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8.10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWith each item removed, the total scale score ranged from 7.91\u0026ndash;8.86 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA principal component analysis was conducted on all 10 items of the BEDS. The KMO value of 0.846 indicated sampling adequacy, supporting the use of factor analysis in the entire sample. Bartlett\u0026rsquo;s test of sphericity was statistically significant (χ\u0026sup2; = 640.005, df\u0026thinsp;=\u0026thinsp;45, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), confirming the suitability of the data for factor analysis. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the factor loadings, which ranged from 0.341\u0026ndash;0.717. The eigenvalue for the identified factor (severity and frequency of worry) was 3.326, accounting for 33.256% of the total variance.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eFactor Loadings and Uniqueness Values of the BEDS Items\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFactor Loading\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUniqueness\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.486\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.763\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.586\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.657\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.524\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.726\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.662\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.562\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.487\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.763\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.661\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.563\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.708\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.499\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.341\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.884\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.717\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.485\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.478\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.771\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe content validity of the BEDS was assessed by examining its associations with the DEBQ (total and subscale scores), HAM-D, BPRS, YMRS, and BITE. The correlations between the BEDS total score and these measures for the entire sample are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Correlation analyses revealed a negative association with BITE (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In contrast, the BEDS total score was positively correlated with the DEBQ total score as well as with the scores of the emotional and external eating subscales (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No significant associations were observed with the DEBQ restrictive eating subscale, YMRS, BPRS, or HAM-D.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eCorrelations between the total score of the BEDS and the DEBQ (total and subgroup), YMRS, BITE, HAM-D, and BPRS scores in the full study population\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMeasure\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBEDS Total\u003c/p\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBITE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.555\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDEBQ Emotional eating\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.530\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDEBQ Restrictive eating\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.752\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDEBQ External eating\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.532\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDEBQ Total\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.542\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYMRS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.090\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.373\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHAM-D\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.181\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.072\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBPRS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.078\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.441\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eBPRS: Brief Psychiatric Rating Scale; BITE: Boric Investigatory Test; Edinburgh, DEBQ: Dutch Eating Behavior Questionnaire; BEDS: Barcelona Bipolar Eating Disorder Scale; YMRS: Young Mani Rating Scale; HAM-D: Hamilton Depression Rating Scale. Bold values indicate P values\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study aimed to adapt the BEDS into Turkish and examine its psychometric properties in a clinical sample of individuals with bipolar disorder and healthy controls. The results strongly support the use of the Turkish version of the BEDS as a valid and reliable instrument for identifying disordered eating behaviors in this population.\u003c/p\u003e\u003cp\u003eThe Barcelona Bipolar Eating Disorder Scale is a brief self-report instrument designed to assess disordered eating behaviors specifically within the context of bipolar disorder. It evaluates impulsive and emotion-driven eating tendencies, such as loss of control over eating, binge-like episodes, and eating in response to mood fluctuations. Rather than diagnosing a specific eating disorder, the BEDS captures the overall severity and frequency of eating-related disturbances that may emerge as part of affective instability and impulsivity in individuals with bipolar disorder. Therefore, establishing a valid and reliable version of such a scale for Turkish-speaking populations would increase its utility in both academic research and clinical practice, ultimately facilitating clinicians\u0026rsquo; ability to monitor and follow patients more effectively.\u003c/p\u003e\u003cp\u003eThe internal consistency of the Turkish BEDS was found to be high (Cronbach's alpha\u0026thinsp;=\u0026thinsp;0.821), which is comparable to the values reported in the original Spanish validation (0.79) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) and the French version (0.82) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). These results suggest that the scale maintains its reliability across different languages and cultural contexts. The item\u0026ndash;total correlations ranged between 0.31 and 0.64, confirming that all the items contributed meaningfully to the underlying construct. These findings suggest that the BEDS reliably captures a coherent dimension of eating pathology, as it manifests in BD.\u003c/p\u003e\u003cp\u003eExploratory factor analysis supported a unidimensional structure, with factor loadings ranging from 0.34\u0026ndash;0.72 and a single factor explaining 33.26% of the total variance. The Kaiser\u0026ndash;Meyer\u0026ndash;Olkin measure (0.85) and the significant Bartlett\u0026rsquo;s test (χ\u0026sup2; = 640.01, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) verified the adequacy of the data for factor analysis. This structure corresponds closely to the original validation, suggesting that the Turkish version preserves both the semantic and conceptual integrity of the scale.\u003c/p\u003e\u003cp\u003eOne of the problems with the scales used to assess psychiatric disorders is their length and/or the need for expert administration, which limits their clinical utility (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). In brief, self-administered screening measures are particularly valuable in clinical practice, where lengthy or interviewer-based instruments can be difficult to administer. Given the high comorbidity rates of BD and ED\u0026mdash;especially binge eating disorder and bulimia nervosa\u0026mdash;early detection of eating pathology in this population is essential (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). In line with this, the significant correlations observed between BEDS total scores and the emotional and external eating subscales of the DEBQ underscore the instrument's clinical sensitivity. The lack of correlation with restrained eating suggests that the BEDS focuses primarily on loss of control and emotion-focused eating rather than cognitively controlled dietary restriction.\u003c/p\u003e\u003cp\u003eThe inverse correlation with the Edinburgh Bulimic Investigation Test (BITE) may be attributed to differences in scoring direction and item framing between the two scales. Considering this context, the results are consistent with previous evidence linking BD to binge-eating symptomatology (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Furthermore, the lack of correlation between BEDS scores and the YMRS, HAM-D, or BPRS supports the scale's discriminant validity and suggests that eating disorders are not merely reflections of existing manic, depressive, or general psychopathological states. This finding suggests that such tendencies may represent enduring personality traits rather than transient mood-related phenomena in BD patients.\u003c/p\u003e\u003cp\u003eFrom a clinical perspective, the BEDS offers several practical advantages. Its brevity, clarity, and self-reported design make it suitable for use in time-constrained psychiatric settings (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Unlike more extensive instruments such as the DEBQ or BITE, the BEDS specifically targets impulsive and emotionally reactive eating behaviors, which are common yet often overlooked in BD (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Early identification of these symptoms is crucial, given the established links between BD\u0026ndash;ED comorbidity and poorer clinical outcomes, including earlier onset, increased episode frequency, elevated suicidality, and reduced psychosocial functioning (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The Turkish adaptation provides clinicians with a culturally appropriate and psychometrically sound tool for identifying such comorbidities. Routine application may enhance early intervention and contribute to a more integrative understanding of BD by accounting for both affective and behavioral dysregulation.\u003c/p\u003e\u003cp\u003eCultural and linguistic adaptation is vital when psychological instruments are translated, as eating behaviors are strongly influenced by cultural norms regarding food, body image, and emotional expression. The successful validation of the Turkish BEDS demonstrated that the construct of impulsivity-driven, emotionally mediated eating is recognizable and clinically relevant in the Turkish population. This achievement not only improves diagnostic precision in local practice but also promotes cross-cultural comparability in international BD and ED research.\u003c/p\u003e\u003cp\u003eThis study has several strengths. Compared with previous validation efforts, the present study included a relatively larger sample size (100 BD patients and 129 healthy controls). Moreover, the diagnostic accuracy of the clinical sample was ensured through the use of structured interviews (SCID-5), thereby increasing methodological rigor. Nevertheless, several limitations must be acknowledged.\u003c/p\u003e\u003cp\u003eFirst, the patient sample consisted solely of individuals with BD type I, limiting generalizability to other BD subtypes, such as type II or cyclothymia. Second, the cross-sectional design prevents assessment of the scale\u0026rsquo;s sensitivity to longitudinal changes or treatment outcomes. Third, although the sample size was adequate for psychometric testing, future studies should include larger and more diverse samples to examine measurement invariance across gender, age, and illness stage. Third, although the sample size was adequate for psychometric testing, future studies should include larger and more diverse samples to examine measurement invariance across gender, age, and illness stage.\u003c/p\u003e\u003cp\u003eIn summary, the Turkish version of the Barcelona Bipolar Eating Disorder Scale has excellent psychometric properties, including high internal consistency, a coherent factor structure, and meaningful convergent validity. The scale effectively identifies impulsive and emotion-driven eating behaviors that are prevalent yet often underrecognized among individuals with bipolar disorder. Its brevity and ease of administration make it well suited for both clinical practice and research. Integrating the BEDS into routine assessment protocols may facilitate early detection of comorbid eating disturbances and enhance comprehensive care and prognosis in patients with bipolar disorder.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eBefore starting this study, permission was obtained from the ethics committee of the Scientific Research Committee of Dışkapı Education and Research Hospital (fund number: 58/14, Date:07/01/2019). All stages of the study were carried out in accordance with the provisions of the Declaration of Helsinki as revised in Edinburgh 2000. Informed consent was obtained from all participants. The authors thank all the study participants and clinical staff who helped with this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial Disclosure\u003c/strong\u003e: This research received no specific grant and financial support from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: not applicable\u003c/p\u003e\n\u003cp\u003eAll stages of the study were carried out in according to provisions of the Declaration of Helsinki as revised in Edinburgh 2000. Informed consent was obtained from all participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Committee Approval:\u0026nbsp;\u003c/strong\u003eBefore starting this study, permission was obtained from the ethics committee of the Scientific Research Committee of Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital (07/01/2019, 58/14). All stages of the study were carried out in according to provisions of the Declaration of Helsinki as revised in Edinburgh 2000. Each participant was informed about the study beforehand and informed consent was obtained from all of them. The authors thank all the study participants and clinical staff who helped with this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eVieta E, Berk M, Schulze TG, Carvalho AF, Suppes T, Calabrese JR, et al. 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Comorbidities in youth with bipolar disorder: clinical features and pharmacological management. 2023;21(4):911-34.\u003c/li\u003e\n\u003cli\u003eSol\u0026eacute; E, Garriga M, Valent\u0026iacute; M, Vieta EJCs. Mixed features in bipolar disorder. 2017;22(2):134-40.\u003c/li\u003e\n\u003cli\u003eTondo L, Vazquez GH, Baldessarini RJJPC. Suicidal behavior associated with mixed features in major mood disorders. 2020;43(1):83-93.\u003c/li\u003e\n\u003cli\u003eCarta MG, Fineberg N, Moro MF, Preti A, Romano F, Balestrieri M, et al. The burden of comorbidity between bipolar spectrum and obsessive-compulsive disorder in an Italian community survey. 2020;11:188.\u003c/li\u003e\n\u003cli\u003eOliva V, Fico G, De Prisco M, Gonda X, Rosa AR, Vieta EJTLRHE. Bipolar disorders: an update on critical aspects. 2025;48.\u003c/li\u003e\n\u003cli\u003eSchiweck C, Arteaga-Henriquez G, Aichholzer M, Thanarajah SE, Vargas-C\u0026aacute;ceres S, Matura S, et al. Comorbidity of ADHD and adult bipolar disorder: A systematic review and meta-analysis. 2021;124:100-23.\u003c/li\u003e\n\u003cli\u003eYakovleva YV, Kasyanov ED, Mazo GEJCp. Prevalence of eating disorders in patients with bipolar disorder: a scoping review of the literature. 2023;4(2):91.\u003c/li\u003e\n\u003cli\u003eRam\u0026iacute;rez-Mart\u0026iacute;n A, Ramos-Mart\u0026iacute;n J, Mayoral-Cleries F, Moreno-K\u0026uuml;stner B, Guzman-Parra JJPm. Impulsivity, decision-making and risk-taking behaviour in bipolar disorder: a systematic review and meta-analysis. 2020;50(13):2141-53.\u003c/li\u003e\n\u003cli\u003ePasquale EK, Boyar AM, Boutelle KNJCPR. Reward and Inhibitory Control as Mechanisms and Treatment Targets for Binge Eating Disorder. 2024;26(11):616-25.\u003c/li\u003e\n\u003cli\u003eKowalewska E, Bzowska M, Engel J, Lew-Starowicz MJBp. Comorbidity of binge eating disorder and other psychiatric disorders: A systematic review. 2024;24(1):556.\u003c/li\u003e\n\u003cli\u003ePavlidis E, Campillo F, Goldbeter A, Desroches MJCN. Multiple-timescale dynamics, mixed mode oscillations and mixed affective states in a model of bipolar disorder. 2024;18(6):3239-57.\u003c/li\u003e\n\u003cli\u003eMikhail MEJFip. Affect dysregulation in context: Implications and future directions of experience sampling research on affect regulation models of loss of control eating. 2021;12:747854.\u003c/li\u003e\n\u003cli\u003eCraba A, Mazza M, Marano G, Rinaldi L, Sani G, Janiri LJETiD, Addictions,, et al. Which comes first? New insights on comorbidity between eating disorders and bipolar disorders. 2021;1:100023.\u003c/li\u003e\n\u003cli\u003eTorrent C, Vieta E, Crespo J, Gonzalez-Pinto A, Del Valle J, Olivares J, et al. Barcelona Bipolar Eating Disorder Scale (BEDS): a self-administered scale for eating disturbances in bipolar patients. 2004;32(3):127-31.\u003c/li\u003e\n\u003cli\u003eTorrent C, Vieta E, Garcia-Garcia MJP. Validation of the Barcelona Bipolar Eating Disorder Scale for bipolar patients with eating disturbances. 2008;41(6):379-87.\u003c/li\u003e\n\u003cli\u003eSchreck-Del Bello L, Berard E, Klein R, Ritz PJERoAP. Fast screening of eating disorders among patients with bipolar disorder: validation of the French version of BEDS questionnaire. 2017;67(2):61-5.\u003c/li\u003e\n\u003cli\u003eYasir AJIjop. Cross cultural adaptation \u0026amp; psychometric validation of instruments: Step-wise. 2016;1(1):1-4.\u003c/li\u003e\n\u003cli\u003eHeim E, Mewes R, Abi Ramia J, Glaesmer H, Hall B, Shehadeh MH, et al. Reporting cultural adaptation in psychological trials\u0026ndash;the RECAPT criteria. 2021;3(Spec Issue):e6351.\u003c/li\u003e\n\u003cli\u003eMcAulay C, Mond J, Outhred T, Malhi GS, Touyz SJJoMH. Eating disorder features in bipolar disorder: clinical implications. 2023;32(1):43-53.\u003c/li\u003e\n\u003cli\u003eLukasiewicz M, Gerard S, Besnard A, Falissard B, Perrin E, Sapin H, et al. Young Mania Rating Scale: how to interpret the numbers? Determination of a severity threshold and of the minimal clinically significant difference in the EMBLEM cohort. 2013;22(1):46-58.\u003c/li\u003e\n\u003cli\u003eRomera I, P\u0026eacute;rez V, Mench\u0026oacute;n JM, Polavieja P, Gilaberte IJPR. Optimal cutoff point of the Hamilton Rating Scale for Depression according to normal levels of social and occupational functioning. 2011;186(1):133-7.\u003c/li\u003e\n\u003cli\u003eYoung RC, Biggs JT, Ziegler VE, Meyer DAJTBjop. A rating scale for mania: reliability, validity and sensitivity. 1978;133(5):429-35.\u003c/li\u003e\n\u003cli\u003eKaradağ F, Oral ET, Aran Yal\u0026ccedil;ın F, Erten EJTPD. Young mani derecelendirme \u0026ouml;l\u0026ccedil;eğinin T\u0026uuml;rkiye\u0026rsquo;de ge\u0026ccedil;erlik ve g\u0026uuml;venilirliği. 2001;13(2):107-14.\u003c/li\u003e\n\u003cli\u003eAkdemir A, \u0026Ouml;RSEL DS, DAĞ İ, T\u0026Uuml;RK\u0026Ccedil;APAR MH, İŞCAN N, \u0026Ouml;ZBAY HJPPPD. Hamilton depresyon derecelendirme \u0026ouml;l\u0026ccedil;eği (HDD\u0026Ouml;)\u0026apos;nin ge\u0026ccedil;erliliği-g\u0026uuml;venirliliği ve klinikte kullanımı. 1996;4(4):251-9.\u003c/li\u003e\n\u003cli\u003eHenderson M, Freeman CJTBJoP. A self-rating scale for bulimia the \u0026lsquo;BITE\u0026rsquo;. 1987;150(1):18-24.\u003c/li\u003e\n\u003cli\u003eKızıltan G, Karabudak E, \u0026Uuml;nver S, Sezgin E, \u0026Uuml;nal AJA\u0026Uuml;TFM. Tıkınırcasına yeme bozukluğu olan \u0026uuml;niversite \u0026ouml;ğrencilerinin beslenme durumları. 2005;58(4):167-71.\u003c/li\u003e\n\u003cli\u003eVan Strien T, Frijters JE, Bergers GP, Defares PBJIjoed. The Dutch Eating Behavior Questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior. 1986;5(2):295-315.\u003c/li\u003e\n\u003cli\u003eEvirgen N. The prevalence of emotional eating and its relation to affect regulation in a Turkish sample of obese, overweight and normal weighted women: Sosyal Bilimler Enstit\u0026uuml;s\u0026uuml;; 2010.\u003c/li\u003e\n\u003cli\u003eOverall JE, Gorham DRJPr. The brief psychiatric rating scale. 1962;10(3):799-812.\u003c/li\u003e\n\u003cli\u003eSoykan Kahraman \u0026Ccedil;. Institutional differences and case typicality as related to-diagnosis symptom severity prognosis and treatment: Middle East Technical University; 1990.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Validity, Reliability, Bipolar Disorder, Barcelona Bipolar Eating Disorder Scale, Eating Disorder","lastPublishedDoi":"10.21203/rs.3.rs-7854484/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7854484/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThis study aimed to evaluate the validity and reliability of the Turkish version of the Barcelona Bipolar Eating Disorder Scale (BEDS), which can facilitate screening for comorbid eating disorders (EDs) in bipolar disorder (BD) patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA total of 100 BD patients and 129 healthy controls (HCs) were included in the study conducted at Ankara Etlik City Hospital Psychiatry Clinic. These patients were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and the Structured Clinical Interview for DSM-5 (SCID-5). Sociodemographic forms, the Turkish Vesion of BEDS, the Young Mani Rating Scale (YMRS), the Hamilton Depression Rating Scale (HAM-D), the Brief Psychiatric Rating Scale (BPRS), the Bulumic Investigatory Test Edinburgh (BITE), and the Dutch Eating Behavior Questionnaire (DEBQ) were used to assess validity and reliability.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eNo statistically significant differences were found between the patient and control groups regarding the total and subscale scores of the BITE, BEDS, and DEBQ. The correlation coefficient between each item and the total score ranged from 0.313\u0026ndash;0.644. Cronbach's alpha for the scale was 0.821. The removal of any items from the original scale did not lead to an improvement in Cronbach\u0026rsquo;s alpha. The BEDS score was found to be significantly correlated with the BITE score, DEBQ total score, emotional eating score, and external eating score (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). There was no correlation between the BEDS score and the DEBQ Restrictive Eating Rubscale, YMRS, BPRS, or HAM-D scale scores.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe Turkish version of the BEDS is a valid and reliable scale that can be used as an assessment tool in the evaluation of eating disorders in the Turkish BD population.\u003c/p\u003e","manuscriptTitle":"Adaptation of the Barcelona Bipolar Eating Disorder Scale to Turkish and Investigation of Its Validity and Reliability","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-06 16:32:29","doi":"10.21203/rs.3.rs-7854484/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d5542e0a-9a26-4e5c-99c6-667b1b143c5e","owner":[],"postedDate":"November 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-21T15:11:40+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-06 16:32:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7854484","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7854484","identity":"rs-7854484","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}