# Validation of the Brief Assessment of Stress and Eating (BASE) in cisgender gay men and lesbian women

## TL;DR

The BASE tool effectively detects eating disorders in gay men and lesbian women, offering a reliable alternative to existing tools that were mainly tested in heterosexual women.

## Contribution

The BASE screening tool was validated for use in cisgender gay men and lesbian women, a population often overlooked in eating disorder research.

## Key findings

- The BASE outperformed the SCOFF questionnaire in detecting eating disorders among gay men.
- BASE showed good performance in identifying probable eating disorders in both gay men and lesbian women.
- Optimal BASE thresholds varied by group, with higher sensitivity at lower cutoffs.

## Abstract

Sexual minority adults are at elevated risk for eating disorders (EDs), yet existing screening tools have rarely been validated in this population. Most ED screening instruments have been validated in predominately cisgender, heterosexual female samples limiting their generalizability to populations with different symptom patterns. Validation studies in cisgender sexual minority (SM) adults are critical to improving detection and addressing disparities in ED identification. The present study evaluated the psychometric performance of the Brief Assessment of Stress and Eating (BASE), a validated 10-item screening tool that assesses DSM-5-aligned eating disorder symptoms and subclinical dysregulated eating behaviors, in a national sample of cisgender gay men and lesbian women.

Participants were 1,499 cisgender SM adults (61.7% gay men, 38.3% lesbian women) recruited from The PRIDE Study, a U.S.-based longitudinal cohort of sexual and gender minority adults. Respondents completed the BASE, SCOFF questionnaire, and the Eating Disorder Diagnostic Scale-5 (EDDS-5) which we used to derive probable DSM-5 eating disorder (probable ED) status. Receiver operating characteristic (ROC) and precision–recall (PR) curve analyses were conducted to evaluate classification accuracy and identify optimal thresholds.

Both the BASE and SCOFF performed significantly above chance in detecting EDDS-5-derived probable EDs. Among gay men, the BASE (AUC: ROC = 0.785, PRC = 0.702) outperformed the SCOFF (ROC = 0.744, PRC = 0.630). In lesbian women, the two screeners performed similarly (BASE AUC = 0.807; SCOFF AUC = 0.806). Optimal BASE thresholds varied by group with higher sensitivity at lower cutoffs (e.g., ≥ 7).

The BASE provides a reliable, efficient alternative to traditional instruments for screening eating disorders in sexual minority adults, with good performance for identifying EDDS-5–derived probable EDs. Findings support the BASE as a reliable and valid screening tool for use with cisgender SM adults in community, healthcare, and research contexts.

In the United States, gay men and lesbian women are more likely to experience eating problems than people who identify as heterosexual. Many existing tools for spotting eating disorders were created and tested mainly in heterosexual women, which may limit their usefulness for other groups. One brief tool, the 10-item Brief Assessment of Stress and Eating (BASE), had not previously been tested in gay men and lesbian women. In this study, we examined how well the BASE works in a large national sample of adults who identified as gay men or lesbian women. We found that the BASE was able to reliably detect people who were likely to have eating disorders, and it performed especially well for gay men compared to another widely used tool, the SCOFF questionnaire. These results suggest that the BASE can be a useful and efficient option for identifying eating disorders among sexual minority adults in research, healthcare, and community settings.