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A New Screening Tool for Patients with Eating Disorders

 

Am Fam Physician. 2000 Apr 1;61(7):2183-2186.

Although eating disorders are among the most prevalent psychiatric conditions in young women, diagnosis is frequently delayed or missed because of problems in recognizing symptoms. Because early detection and appropriate intervention improve the prognosis of eating disorders, improved diagnostic tools would be helpful. Morgan and colleagues developed a screening questionnaire that can identify patients who require a more detailed assessment for eating disorders.

The group developed questions addressing the main features of anorexia nervosa and bulimia nervosa using focus groups of patients with eating disorders and specialists in eating disorders. These participants were not involved in the subsequent study. The initial letter of the core concept of each question provided the acronym SCOFF (see the accompanying table).

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SCOFF Questions

Do you make yourself Sick because you feel uncomfortably full?

Do you worry you have lost Control over how much you eat?

Have you recently lost more than One stone (14 pounds) in a three-month period?

Do you believe yourself to be Fat when others say you are too thin?

Would you say that Food dominates your life?


note: Score one point for every “yes”; a score of two or more is a likely indication of anorexia nervosa or bulimia.

Information from Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ 1999;319:1467.

SCOFF Questions

Do you make yourself Sick because you feel uncomfortably full?

Do you worry you have lost Control over how much you eat?

Have you recently lost more than One stone (14 pounds) in a three-month period?

Do you believe yourself to be Fat when others say you are too thin?

Would you say that Food dominates your life?


note: Score one point for every “yes”; a score of two or more is a likely indication of anorexia nervosa or bulimia.

Information from Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ 1999;319:1467.

Women who were referred to a clinic for eating disorders and were between 18 and 40 years of age were recruited for the study. Of the 116 consecutive women enrolled in the study, 68 met the diagnostic criteria for anorexia nervosa and 48 for bulimia nervosa (as specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed.). Women without eating disorders who were recruited through local colleges served as the control group. The participants and 96 control subjects completed the SCOFF questionnaire, the eating disorder inventory and the BITE self-rating scale for bulimia.

The mean duration of illness was eight years (range: one to 25 years). Women with eating disorders were significantly more likely to be in a higher socioeconomic level and unmarried than women in the control group. The mean body mass for women in the control group was 22.3, compared with 24.4 for women with bulimia nervosa and 15.1 for women with anorexia nervosa. All participants reported finding the SCOFF questionnaire acceptable and easy to use. Using two or more positive responses as a threshold, the SCOFF questionnaire provided 100 percent sensitivity and 87.5 percent specificity for anorexia nervosa and bulimia nervosa separately and combined. The questionnaire identified 12 of the 96 control subjects as false positives, but identified all of the patients with eating disorders.

The authors conclude that the SCOFF questionnaire provides an effective, acceptable and simple screening tool for use in diagnosing eating disorders. They believe the false-positive rate of 12.5 percent is acceptable in view of the high sensitivity.

Morgan JF, et al. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ. December 4, 1999;319:1467–8.

EDITOR'S NOTE: As the authors point out, this is a preliminary report, and the SCOFF tool must be assessed in other populations before it can be recommended for widespread use in the general patient population. The resemblance to the CAGE questionnaire for alcohol misuse and the high sensitivity achieved in this initial study indicate that SCOFF may become a useful addition to primary care practice. In a general patient population, the specificity of the test may be higher because the study control group consisted of female college students. In that cultural environment, the penultimate SCOFF question is almost universally answered positively, so the threshold of two positive questions may be too low. Only further studies in general patient populations will determine if the threshold can be elevated without compromising sensitivity. In patient populations in the United States, the acronym may need to be modified to accommodate the difference in language.—a.d.w.

 

 

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