Clinical Impairment Assessment Questionnaire

The Clinical Impairment Assessment Questionnaire (CIA) is a validated, 16-item self-report instrument that measures the specific psychosocial impairment…

Questions: 16
Duration: 3 min
Original title: Clinical Impairment Assessment Questionnaire
Adaptation: Clinical Impairment Assessment Questionnaire
Authors: Bohn, K. & Fairburn, C.G.
Created: 2008

The Clinical Impairment Assessment Questionnaire (CIA) is a validated, 16-item self-report instrument that measures the specific psychosocial impairment caused by eating disorder symptoms. While many assessments focus on the frequency of restrictive or binge-purge behaviours, the CIA captures the subjective toll these features take on the patient’s daily life, probing the cognitive, emotional, and interpersonal costs of eating pathology over a 28-day window.

For mental health professionals, the CIA provides a highly sensitive, repeatable metric to map functional impairment independently of symptom frequency. Because patients often normalise their eating behaviours, measuring functional interference can facilitate early recognition and support diagnostic formulation, particularly when recognising anorexia nervosa or recognising bulimia nervosa. Routinely administering the CIA alongside symptom measures ensures that the subjective burden of the disorder remains central to clinical conceptualisation and treatment planning.

Example result

Fictitious result, computed from a sample set of answers.

Overall score

24/ 48

The CIA is a 16-item self-report questionnaire measuring the severity of psychosocial impairment secondary to eating disorder features over the past 28 days. The 16 items cover domains of life typically affected by eating disorder psychopathology: mood and self-perception, cognitive functioning, interpersonal functioning, and work performance. It is designed to be completed immediately after a questionnaire assessing eating disorder psychopathology (e.g., EDE-Q) so that these difficulties are fresh in the patient's mind.

0–15

Impairment threshold not met

16–48

clinically significant impairment

Cutoff defining clinically significant psychosocial impairment secondary to eating disorder features.

généralemixed · general population · 18–50 years · Italy · n = 102 · 2018 · Calugi et al. (2018)

048

M = 2.6 ± 4.2

généralefemales · general population · 18–30 years · Sweden · n = 760 · 2011 · Welch et al. (2011)

048

M = 8.25 ± 9.35

cliniquemixed · pathology: eating disorder · 18–65 years · United Kingdom · n = 123 · Bohn et al. (2008)

048

M = 20.1 ± 13.4

cliniquemixed · pathology: eating disorder · 16–60 years · Italy · n = 259 · 2018 · Calugi et al. (2018)

048

M = 32.4 ± 11.5

cliniquefemales · pathology: eating disorder · 18–66 years · Sweden · n = 2325 · 2011 · Welch et al. (2011)

048

M = 30.22 ± 10.21

Scoring

Sum, total score from 0 to 48, each item is scored on a 4-point scale (from 0 to 3).

Have your patient take this test

Assign it in one click: your patient answers on their phone, you receive the score and its interpretation.

Assign this test to a patient

What the test measures

The CIA isolates and quantifies the psychosocial impairment secondary to an individual's eating habits, exercise routines, and concerns about body shape and weight. It covers three main dimensions of functional interference:

Cognitive impairment: the extent to which eating or shape concerns disrupt concentration, memory, and everyday decision-making, which can severely impact daily functioning.
Personal impairment: the internal emotional burden, capturing the degree to which patients feel critical of themselves, ashamed, guilty, or upset about their eating behaviours, which often overlaps with broader vulnerabilities such as low self-esteem.
Social impairment: the disruption of interpersonal relationships, including the avoidance of meals with family, isolation from social events, and interference with occupational performance or previously enjoyed activities.

This instrument is intended for adolescents and adults presenting with suspected or established eating pathology, including those being evaluated for binge eating disorder.

When and why to use it

Clinicians use the CIA to distinguish between the presence of eating disorder symptoms and the functional disability they cause. This distinction is critical for evaluating severity, tracking functional recovery, and building motivation for change.

Intake baseline: to quantify the psychosocial cost of the illness at the start of treatment, anchoring the initial case formulation and helping explore problems using the CBT model.
Monitoring change: to track functional improvements across sessions, as psychosocial functioning often lags behind or precedes symptom reduction depending on the treatment phase.
Screening and cut-off: to identify cases of clinically significant impairment that warrant further evaluation or more intensive care levels, distinguishing normal body dissatisfaction from pathological interference.
Differential support: to untangle the functional impact of eating disorders from co-occurring challenges, such as assessing whether social avoidance stems from body dysmorphic disorder or weight concerns.

A validated CIA score provides concrete data on functional severity, moving beyond clinical impression to objectively measure whether a patient is reclaiming their life from the eating disorder.

Clinical library

750+ clinical tools

A library built with and for clinicians, ready to use in session and extend between appointments.

Access all the tools

Several resource types

Psychoeducation handouts

Understand at a glance

Interactive exercises

To do and fill in

Interactive programs

A structured path

Audios

Meditation and relaxation

Psychometric tests

Automatic scoring

The questions

Please indicate the response that best describes how your eating habits, exercising, or feelings about your eating, shape, or weight have affected your life over the past four weeks (28 days). Thank you. - Over the past 28 days, to what extent have your… eating habits… exercising… or feelings about your eating, shape, or weight…
1. ...made it difficult for you to concentrate?
Evaluates cognitive interference and the loss of focus secondary to eating or weight preoccupations.
- Not at all
- A little
- Quite a bit
- A lot
2. ...caused you to be critical of yourself?
Probes the internalisation of rigid standards and self-judgment, common when [perfectionism](/blog/en/signs-perfectionism-mental-health) interacts with eating habits.
- Not at all
- A little
- Quite a bit
- A lot
3. ...prevented you from going out with other people?
Assesses social withdrawal and the avoidance of interpersonal events due to shape or eating concerns.
- Not at all
- A little
- Quite a bit
- A lot
4. ...affected your performance at work (if applicable)?
Captures the occupational or academic impact of the disorder.
- Not at all
- A little
- Quite a bit
- A lot
5. ...caused you to be forgetful?
Measures memory lapses often associated with the cognitive load of persistent food or weight-related thoughts.
- Not at all
- A little
- Quite a bit
- A lot
6. ...affected your ability to make everyday decisions?
Evaluates the broader cognitive toll on routine problem-solving and daily functioning.
- Not at all
- A little
- Quite a bit
- A lot
7. ...interfered with meals with family or friends?
Probes the disruption of commensality and the specific avoidance of shared eating contexts.
- Not at all
- A little
- Quite a bit
- A lot
8. ...made you feel upset or distressed?
Assesses the general emotional distress and emotional lability directly caused by eating or weight concerns.
- Not at all
- A little
- Quite a bit
- A lot
9. ...made you feel ashamed of yourself?
Measures the burden of shame and secrecy that frequently accompanies disordered eating patterns.
- Not at all
- A little
- Quite a bit
- A lot
10. ...made it difficult to eat out with other people?
Captures the functional restriction around social eating and the fear of public consumption.
- Not at all
- A little
- Quite a bit
- A lot
11. ...made you feel guilty?
Evaluates the presence of guilt, typically triggered by perceived dietary transgressions or lack of exercise.
- Not at all
- A little
- Quite a bit
- A lot
12. ...interfered with your ability to do things you used to enjoy?
Assesses the loss of engagement in previously valued hobbies and recreational activities.
- Not at all
- A little
- Quite a bit
- A lot
13. ...made you feel distracted?
Measures the degree of mental preoccupation and detachment from the present moment.
- Not at all
- A little
- Quite a bit
- A lot
14. ...made you feel like a failure?
Probes the devastating impact on self-worth when self-evaluation becomes exclusively tied to eating or weight control.
- Not at all
- A little
- Quite a bit
- A lot
15. ...interfered with your relationships with others?
Evaluates the broader relational strain and conflict caused by the psychological demands of the illness.
- Not at all
- A little
- Quite a bit
- A lot
16. ...made you feel worried?
Assesses anticipatory anxiety and persistent apprehension related to food, exercise, or body image.
- Not at all
- A little
- Quite a bit
- A lot