Afraid of Hunger, Ashamed of Fullness: The Development and Validation of the Negative Appraisal of Gastric Sensations (NAGS) Scale and its association with Disordered Eating
Abstract
Interoceptive dysfunction is central to eating disorders, and emerging evidence indicates that the maladaptive appraisal of gastrointestinal signals predicts pathology better than body-general interoception. However, existing tools do not adequately measure this construct; they conflate sensation intensity with appraisal and assess a limited range of emotional responses, likely due to little input from eating disorder populations during tool development. To address this gap, we developed and validated the Negative Appraisal of Gastric Sensations (NAGS) scale to specifically capture the affective interpretation of hunger and fullness. Exploratory factor analysis (sample 1 n=337, 80.12% Female, 75.97% White British) and confirmatory factor analysis (sample 2 n=337, 85.16% Female, 79.23% White British) supported a two-factor scale: hunger-fear and fullness-shame. The scale demonstrated robust psychometric properties, including strong internal and test-retest reliability, as well as criterion, concurrent, convergent, and discriminant validity. The subscales successfully distinguished eating disorder from gastrointestinal disorder and non-disordered controls, and this was not attributable to differential item functioning. Exploratory analyses using latent profile analysis and hierarchical regressions supported the measure’s utility as a critical interoceptive factor in eating disorders over and above existing interoceptive measures: increases in fullness-shame predicted higher overall symptom severity, body dissatisfaction, and purge-only category membership, while increases in hunger-fear specifically predicted restriction-only category membership. As such, the scale could be considered a useful tool for researchers studying the somatic experience of eating disorders, but also primary care physicians for distinguishing primary gastrointestinal disorders from eating disorders presenting as gastrointestinal complaints.
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BibTeX
@misc{stafford2026afraid,
title = {{Afraid of Hunger, Ashamed of Fullness: The Development and Validation of the Negative Appraisal of Gastric Sensations (NAGS) Scale and its association with Disordered Eating}},
author = {Lucy Stafford and Anna Crossland and Alexandra C Pike and Catherine Preston},
howpublished = {PsyArXiv},
year = {2026},
month = sep,
doi = {10.31234/osf.io/jufgk_v2},
url = {https://osf.io/preprints/psyarxiv/jufgk_v2/},
note = {CC BY 4.0},
}
RIS
TY - UNPB
TI - Afraid of Hunger, Ashamed of Fullness: The Development and Validation of the Negative Appraisal of Gastric Sensations (NAGS) Scale and its association with Disordered Eating
AU - Lucy Stafford
AU - Anna Crossland
AU - Alexandra C Pike
AU - Catherine Preston
PY - 2026
DA - 2026/09/09
PB - PsyArXiv
DO - 10.31234/osf.io/jufgk_v2
UR - https://osf.io/preprints/psyarxiv/jufgk_v2/
AB - Interoceptive dysfunction is central to eating disorders, and emerging evidence indicates that the maladaptive appraisal of gastrointestinal signals predicts pathology better than body-general interoception. However, existing tools do not adequately measure this construct; they conflate sensation intensity with appraisal and assess a limited range of emotional responses, likely due to little input from eating disorder populations during tool development. To address this gap, we developed and validated the Negative Appraisal of Gastric Sensations (NAGS) scale to specifically capture the affective interpretation of hunger and fullness. Exploratory factor analysis (sample 1 n=337, 80.12% Female, 75.97% White British) and confirmatory factor analysis (sample 2 n=337, 85.16% Female, 79.23% White British) supported a two-factor scale: hunger-fear and fullness-shame. The scale demonstrated robust psychometric properties, including strong internal and test-retest reliability, as well as criterion, concurrent, convergent, and discriminant validity. The subscales successfully distinguished eating disorder from gastrointestinal disorder and non-disordered controls, and this was not attributable to differential item functioning. Exploratory analyses using latent profile analysis and hierarchical regressions supported the measure’s utility as a critical interoceptive factor in eating disorders over and above existing interoceptive measures: increases in fullness-shame predicted higher overall symptom severity, body dissatisfaction, and purge-only category membership, while increases in hunger-fear specifically predicted restriction-only category membership. As such, the scale could be considered a useful tool for researchers studying the somatic experience of eating disorders, but also primary care physicians for distinguishing primary gastrointestinal disorders from eating disorders presenting as gastrointestinal complaints.
ER -