Clinical Impairment Assessment CIA 3.0
Clinical Impairment Assessment CIA 3.0 overview
Creator and Context
The Clinical Impairment Assessment Questionnaire (CIA 3.0) is a 16 item self report measure of the secondary psychosocial impairment caused by eating disorder features.
It was developed by Kristin Bohn and Christopher Fairburn and published in 2008. Like the EDE-Q, it is distributed by CREDO at Oxford and is free for non commercial clinical and research use.
Presenting Conditions
The CIA measures the impact of eating disorder features on daily life: mood and self perception, cognitive functioning, interpersonal functioning and work performance.
Although three domains were originally described, CREDO directs users to score a single global total, and later psychometric work concluded that the subscales should not be scored.
Administration
Self administered, covering the past 28 days. Each item is rated Not at all (0), A little (1), Quite a bit (2) or A lot (3).
It is designed to be completed immediately after an eating disorder measure covering the same period, such as the EDE-Q, so that eating disorder features are at the front of the person's mind.
Desired Audience
People with eating disorders, in clinical and epidemiological settings. It is used before and after treatment to measure change in impairment.
Symptom measures tell you how ill someone is. The CIA tells you what the illness is doing to their life. In eating disorders, where people often minimise symptoms, impairment is frequently the more honest signal and the more persuasive outcome for a funder.
Considerations
It measures secondary impairment only. It is not a diagnostic or symptom measure and means very little without a co administered eating disorder measure.
Do not report subscale scores. The evidence supports a single global score.
The original validation used a treatment trial sample without healthy controls.
Free use is limited to non commercial clinical and research use. Commercial software requires a licence from CREDO.
How to score the Clinical Impairment Assessment CIA 3.0
Conducting the assessment
The person rates 16 items on the 0 to 3 scale for the past 28 days. Scores can be pro rated provided at least 12 of the 16 items are answered.
Interpretation
Items are summed to give a global score from 0 to 48. Higher scores indicate greater secondary psychosocial impairment.
A global score of 16 or above was the best cut point for predicting eating disorder case status in the original validation, with sensitivity of 76 percent and specificity of 86 percent.
There are no severity bands beyond this single threshold.
Clinical Considerations
Always administer it immediately after an eating disorder symptom measure, as designed.
Use the change in CIA score, not just the symptom score, when evaluating whether treatment is working.
Score the global total only.
Clinical Impairment Assessment CIA 3.0 use cases
Measuring the psychosocial impairment caused by an eating disorder
Assessing change across a course of treatment
Strengthening outcome reporting alongside the EDE-Q
Research in eating disorders
Category
Eating Disorder
Research Summary
Bohn, K., Doll, H. A., Cooper, Z., O'Connor, M. E., Palmer, R. L., & Fairburn, C. G. (2008). The measurement of impairment due to eating disorder psychopathology. Behaviour Research and Therapy, 46(10), 1105 to 1110.
Bohn, K., & Fairburn, C. G. (2008). Clinical Impairment Assessment Questionnaire (CIA 3.0). In C. G. Fairburn, Cognitive Behavior Therapy and Eating Disorders. New York: Guilford Press.
Raykos, B. C., Erceg-Hurn, D. M., McEvoy, P. M., & Byrne, S. M. (2019). Evidence that the Clinical Impairment Assessment (CIA) subscales should not be scored. Assessment, 26(7), 1260 to 1269.
Other Assessment Guides
Binge Eating Scale BES
Discover the Binge Eating Scale (BES): a comprehensive guide to its application, administration, scoring, and interpretation in identifying and assessing binge eating behaviors in clinical and research environments.
Eating Attitudes Test EAT-26
Learn about the Eating Attitudes Test - 26 Item (EAT-26), a key screening tool for identifying potential eating disorders. Our comprehensive guide covers its use, scoring, and interpretation, essential for professionals in clinical and educational settings
Eating Disorder Examination Questionnaire EDE-Q 6.0
A guide to the EDE-Q 6.0, the 28 item self report measure of eating disorder psychopathology. Covers the four subscales, behaviour frequency items, global scoring and the 2.3 screening threshold.
Note on Assessment licensing
Some assessments are copyright protected and require a licence or the copyright holder's permission for clinical, commercial or digital use. Where that applies, obtaining and maintaining that permission is the responsibility of the practice or organisation using the assessment. Tacklit provides the digital administration, scoring and reporting. We do not grant, transfer or supply rights to the underlying instrument.
