Anorexia Nervosa Inventory for Self-rating (ANIS)

• Screening for eating disorder, e. g. in
• unselected samples of epidemiologic community studies (students etc.)
• in- and outpatients
• Assessing severity of a verified eating disorder
• Evaluating the course of a verified eating disorder

Due to the concise and clearly structured design of the ANIS application and scoring is quick and simple.

Among others aims of application of the ANIS may be documentation of the course of treatment, baseline evaluation of a patient, quality and process control during therapy, and evaluation of therapy outcome.

The ANIS is partially based on the theoretical concepts of Hilde Bruch (1973) of body image disturbance, disturbed proprio- and interoceptive awareness, and an all-pervasive feeling of insufficiency in anorexia nervosa. During work on the ANIS the concept of disturbed proprio- and interoceptive awareness emerged as not suitable for assessment by self-rating questionnaire. Both other concepts of Hilde Bruch could be confirmed by factor analysis: a) figure consciousness, and b) insufficiency. Other areas covered by the ANIS concern typical symptoms which are frequently found to be associated with anorexia nervosa. Obsessive-compulsive behaviour is a common feature in anorexics and is assessed by the ANIS very concisely and related to eating behaviour. Feelings of negative effects of meals are a feature of all types of anorexia nervosa, while disinhibited eating binges mark the bulimic type of anorexia nervosa. Both features describe a substantial part of the disturbed attitudes and behaviours in anorexia nervosa. General questionnaires do not cover these areas at all. Additional items of the ANIS refer to sexual anxieties and rejection of intimate contacts frequently found in anorexia nervosa.

One hundred and fifty-two potential items were collected from clinical experience and the literature. Expert-rating resulted in 48 items rated as relevant and suitable for self-rating. The sample consisted of 101 female patients with anorexia nervosa and 118 age-matched female controls. Exploratory factor analysis (maximum likelihood, varimax rotation) resulted in a six-factor solution including 31 items. The number of factors extracted was determined by clinical interpretability, simple structure and reproducibility in different analyses. The work of Rathner and Rainer (1998) confirmed the six-factor solution in a sample of 1402 German speaking female student aged 11 to 20 years in the Southern Tyrol.

Items are assessed for the present state on a six grade scale coded from 0 to 5.

A six-factor-solution was derived from factor analysis by Fichter and Keeser (1980):

1. Figure Consciousness (Items 3, 6, 9, 12, 15, 19, 21, 23, 27 and 29)
2. Insufficiency (Items 2, 4, 14, 16, 20, 25 and 31)
3. Anancasm (Items 1, 8, 11, 13 and 30)
4. Negative Effects of Meals (Items 7, 17, 22 and 28)
5. Sexual Anxieties (Items 5, 18 and 26)
6. Binge-eating (Items 10 and 24)

A total scale is derived from items 1 to 31. Item 32 is a reliability item.

The questionnaire is in a closed format with graduations from

0 = applies not at all

1 = applies a little

2 = applies moderately

3 = applies considerably

4 = applies pretty much

5 = applies very much

Endorsed values are added to sum scores without weighting. No inversed items are included. Scoring of any subscale should not be made when subjects missed answering more than two (one for binge-eating scale) items. No total score should be computed if one or more sub scores could not be computed.

No inverted items are included in the ANIS. The values endorsed are added to sub scores (see list above for items included in each subscale) and the total score. All items bear the weight of 1.

For each subscale means and standard deviations in anorexia nervosa and healthy controls are available (Fichter & Keeser, 1980). For female students age 11-20 means, standard deviations and percentiles separately for age groups, body weight and eating behaviour are available (Rathner & Rainer, 1997; Rathner & Waldherrr, 2005).

Objectivity in applying, scoring and interpreting the ANIS is given. In the order listed above factors/subscales explained 10.1%, 8.5%, 7.1%, 9.1%, 5.2% and 4.9% of the total variance summing up to a total of44.9% of the variance explained. The factor solution was stable in three anorexic patient groups differentiated by symptom severity and in healthy controls. All items had loads above 0.40 in all samples except item 8 which was retained for clinical reasons.

Cronbach’s alpha of the total score was 0.89 to 0.94 in different samples and above 0.80 in the subscales except for anancasm.

1. Fichter, M.M. (1989). Instrumente zur Erfassung relevanter Symptombereiche bei Essstörungen (Anorexia-nervosa-Inventar zur Selbstbeurteilung) in Fichter, M.M. (Hrsg.) Bulimia nervosa. Enke Verlag Stuttgart 296-299
2. Fichter, M.M. (1990). Self-Report Instruments for the assessment of relevant symptoms in eating disorders (Anorexia nervosa Inventory for self rating (Anis)) in Fichter, M.M. (Ed) Bulimia nervosa: Basic research, diagnosis and therapy. John Wiley & Sons. Chichester, UK
3. Fichter, M., Keeser, W. (1980). Das Anorexia-nervosa-Inventar zur Selbstbeurteilung (ANIS). Archiv für Psychiatrie und Nervenkrankheiten, 228, 67-89. Springer Verlag
4. Fichter, M.M., Elton, M., Sourdi, L., Weyerer, S., Koptagel-Ilal, G. (1988). Anorexia Nervosa in Greek and Turkish Adolescents. European Archives of Psychiatry and Neurological Science. 336, 200
5. Fichter, M.M., Quadflieg, N., Georgopoulou, E., Xepapadakos, F., Fthenakis, W.E. (2005): Time Trends in Eating Disturbances in Young Greek Migrants. International Journal of Eating Disorders, 38, 310-322
6. Rathner, G. (1992). Aspects of the natural history of normal and disordered eating and some methodological considerations. In: W. Herzog, H.C. Deter, W. Vandereycke (Hrsg.), The Course of Eating Disorders. Long-term follow-up studies of anorexia and bulimia nervosa. Springer, Berlin Heidelberg New York, pp 273-303.
7. Rathner, G. & Meßner, K. (1993). Detection of eating disorders in a small rural town: an epidemiological study. Psychological Medicine, 23, 175-184.
8. Rathner, G., Rainer, B. (1998). The Factor Structure of the Anorexia Nervosa Inventory for Self-Rating in a population-based sample and derivation of a shortened form. European Archives of Psychiatry and Clinical Neuroscience, 248, 171-179
9. Rathner, G., Rainer, B. (1997). Normen für das Anorexia-nervosa-Inventar zur Selbstbeurteilung bei weiblichen Adoleszenten der Risikogruppe für Essstörungen. Klinische Psychologie, Psychiatrie & Psychotherapie. 45, 3, 302-318.
10. Rathner, G., Rumpold, G. (1994). Convergent Validity of the Eating Disorder Inventory and the Anorexia Nervosa Inventory for Self-Rating in an Austrian Nonclinical Population. International Journal of Eating Disorders. 16, 4, 381-393
11. Rathner, G. & Waldherr, K. (2005). Prozentrangnormen des ANIS. In B. Tuschen-Caffier, M. Pook & A. Hilbert (Hrsg.), Diagnostik von Essstörungen und Adipositas (S. 45-46). Göttingen: Hogrefe.