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Am Fam Physician. 2000;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).

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?

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.

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