The GI-specific Avoidance Scale (GIAS): Development, psychometric validation, and incremental power of a new questionnaire

Background and AimsAvoidance of symptom-related situations is common in chronic gastrointestinal (GI) conditions, contributing to greater symptom severity, psychological distress, and reduced quality of life. However, no validated measure exists to comprehensively assess GI-specific avoidance. We developed and validated the GI-specific Avoidance Scale (GIAS), a self-report instrument measuring behavioral and cognitive avoidance specific to GI symptoms. MethodsFollowing literature review and multidisciplinary input, an initial pool of 58 items was generated and refined through expert and patient ratings, yielding 37 items. A sample of 102 adults (mean age 40.8 years) with medically diagnosed GI conditions completed the GIAS and validated measures of avoidance, psychological flexibility, illness shame, GI symptoms, distress, and quality of life. Exploratory factor analysis was used to determine factor structure. Internal consistency, convergent validity, incremental validity, and mediation analyses were conducted. ResultsFactor analysis supported a 20-item, three-factor solution: General Avoidance, Food Avoidance, and Intimacy/Body Exposure Avoidance. Internal consistency was excellent for the total scale ( = .94) and good-to-excellent for subscales ( = .82-.94). GIAS scores correlated positively with illness shame, GI symptoms, and distress, and negatively with psychological flexibility, self-compassion, and quality of life. GIAS showed incremental validity over a general illness avoidance measure (IBAS) in predicting GI symptoms and anxiety. Moreover, mediation models suggested that GI-specific avoidance partially mediates bidirectional associations between GI symptoms and psychological distress. ConclusionsThe GIAS is a novel, psychometrically robust, and multidimensional self-report questionnaire of GI-specific avoidance. It holds potential for clinical assessment, treatment planning, and evaluation of intervention mechanisms in GI populations.