Objective: To develop a screening tool for the identification of bulimia in ambulatory practice.
Design: Administration of a 112-item questionnaire about eating and weight-control practices to women with known bulimia and to healthy control patients. Questions were compared with DSM-III-R criteria of bulimia as a “gold standard.”
Setting: Self-help group for eating disorders and hospital-based primary care practice.
Subjects: Thirty of 42 women with known bulimia met DSM-III-R criteria for current bulimia, and 124 of 130 control patients met the criterion of no history of an eating disorder.
Main results: Thirteen individual questions discriminated between bulimic subjects and control subjects with a sensitivity and specificity of >75%. When these questions were entered into a stepwise logistic model, two questions were independently significant. A “no” response to the question “Are you satisfied with your eating patterns?” or a “yes” response to “Do you ever eat in secret?” had a sensitivity of 1.00 and a specificity of 0.90 for bulimia. The positive predictive value, based on a 5% prevalence, was 0.36.
Conclusions: A set of two questions may be as effective as a more extensive questionnaire in identifying women with eating disorders, and could be easily incorporated into the routine medical history obtained from all women.
bulimia screening diagnostic tests women eating disorders
Goldberg RJ. Depression in primary care: DSM-III diagnoses and other depressive syndromes. J Gen Intern Med. 1988;3:491–7.PubMedCrossRefGoogle Scholar
Herzog T, Drinkmann A. Psychotherapy of bulimia nervosa: what is effective? A meta-analysis. J Psychosom Res. 1992;36:159–67.PubMedCrossRefGoogle Scholar
Mitchell JE. A review of the controlled trials of psychotherapy for anorexia and bulimia nervosa. J Psychosom Res. 1992;35(suppl 1):23–31.Google Scholar
Pyle RL, Mitchell JE, Eckert ED, Hatsukami D, Pomeroy C, Zimmerman R. Maintenance treatment and 6-month outcome for bulimic patients who respond to initial treatment. Am J Psychiatry. 1990;147:871–5.PubMedGoogle Scholar
Bingham RL, Plante DA, Bronson DL, Tufo HM, McKnight K. Establishing a quality improvement process for identification of psychosocial problems in a primary care practice. J Gen Intern Med. 1990;5:342–6.PubMedGoogle Scholar
Coulehan JL, Schulberg HC, Block MR. The efficiency of depression questionnaires for case finding in primary medical care. J Gen Intern Med. 1989;4:541–7.PubMedCrossRefGoogle Scholar
Cyr MG, Wartman S. The effectiveness of routine screening questions in the detection of alcoholism. JAMA. 1988;259:51–4.PubMedCrossRefGoogle Scholar