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Four simple questions can help screen for eating disorders

Abstract

Current screening instruments for eating disorders are cumbersome to administer and have not been validated in primary care populations. We compared the performance characteristics of 2 screening tools, the SCOFF clinical prediction guide, and a new set of questions, the Eating disorder Screen for Primary care (ESP), using the Questionnaire for Eating Disorders Diagnosis as the independent standard, in 104 consecutive patients from a primary care practice and 129 university students. Twelve percent of the combined population had an eating disorder. One or no abnormal responses to the ESP ruled out an eating disorder (likelihood ratio [LR] 0.0), whereas 3 or more abnormal responses ruled one in (LR 11). The SCOFF questions were less sensitive than predicted (1 or no abnormal responses, LR 0.25), but were as effective at ruling in an eating disorder (3 or more abnormal responses, LR 11).

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References

  1. Whitehouse AM, Cooper PJ, Vize CV, Hill C, Vogel L. Prevalence of eating disorders in three Cambridge general practices: hidden and conspicuous morbidity. Br J Gen Pract. 1992;42:57–60.

    PubMed  CAS  Google Scholar 

  2. King MB. Eating disorders in a general practice population. Prevalence, characteristics and follow-up at 12 to 18 months. Psychol Med Monogr Suppl. 1989;14:1–34.

    PubMed  CAS  Google Scholar 

  3. Ghadirian AM, Englesmann F, Leichner P. Prevalence of psychosomatic and other medical illnesses in anorexic and bulimic patients. Behav Neurol. 1993;6:123–7.

    Google Scholar 

  4. Herzog DB, Keller MB, Sacks NR, Yeh CJ, Lavori PW. Psychiatric comorbidity in treatment-seeking anorexics and bulimics. J Am Acad Child Adolesc Psychiatry. 1992;31:810–8.

    PubMed  CAS  Article  Google Scholar 

  5. Fahy TA, Russell GF. Outcome and prognostic variables in bulimia nervosa. Int J Eat Disord. 1993;14:135–45.

    PubMed  Article  CAS  Google Scholar 

  6. Garner DM. The Eating Attitudes Test: an index of the symptoms of anorexia nervosa. Psycholog-Med. 1979;9:273–9.

    CAS  Article  Google Scholar 

  7. Garner DM, Olmstead MP, Polivy J. Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J Eat Disord. 1983;2:15–34.

    Article  Google Scholar 

  8. Fichter MM, Herpertz S, Quadflieg N, Herpertz-Dahlmann B. Structured interview for anorexic and bulimic disorders for DSM-IV and ICD-10: updated (third) revision. Int J Eat Disord. 1998;24:227–49.

    PubMed  Article  CAS  Google Scholar 

  9. Anstine D, Grinenko MD. Rapid screening for disordered eating in college-aged females in the primary care setting. J Adolesc Health. 2000;26:338–42.

    PubMed  Article  CAS  Google Scholar 

  10. Freund KM, Graham SM, Lesky LG, Moskowitz MA. Detection of bulimia in a primary care setting. J Gen Intern Med. 1993;8:236–42.

    PubMed  Article  CAS  Google Scholar 

  11. McNulty PAF. Prevalence and contributing factors of eating disorder behaviours in active duty navy men. Mil Med. 1997;162:753–9.

    PubMed  CAS  Google Scholar 

  12. Morgan JF, Reid F, Lacey H. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ. 1999;319:1467–8.

    PubMed  CAS  Google Scholar 

  13. Welch G, Hall A. Is the prevalence of bulimia nervosa higher among tertiary education population? N Z Med J. 1990;103:476–7.

    PubMed  CAS  Google Scholar 

  14. Mintz LB, O’Halloran MS, Mulholland AM. Questionnaire for eating disorder diagnoses: reliability and validity of operationalizing DSM-IV criteria into a self-report format. J Couns Psychol. 1997;44:63–79.

    Article  Google Scholar 

  15. Gotestam KG, Agras WS. General population-based epidemiological study of eating disorders in Norway. Int J Eat Disord. 1995;18:119–26.

    PubMed  Article  CAS  Google Scholar 

  16. Abraham S. Characteristics of eating disorders among young ballet dancers. Psychopathology. 1996;29:223–9.

    PubMed  CAS  Article  Google Scholar 

  17. Le Grange D, Tibbs J, Noakes TD. Implications of a diagnosis of anorexia nervosa in a ballet school. Int J Eat Disord. 1994;15:369–76.

    PubMed  Article  Google Scholar 

  18. Santonastaso P, Zanetti T, Sala A, Favaretto G, Vidotto G, Favaro A. Prevalence of eating disorders in Italy: a survey on a sample of 16 year old female students. Psychother Psychosom. 1996;65(3):158–62.

    PubMed  CAS  Google Scholar 

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Correspondence to Mary-Anne Cotton MBBS, MRCPsych.

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Funding for this work was received from University College, London.

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Cotton, MA., Ball, C. & Robinson, P. Four simple questions can help screen for eating disorders. J GEN INTERN MED 18, 53–56 (2003). https://doi.org/10.1046/j.1525-1497.2003.20374.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2003.20374.x

Key words

  • eating disorders
  • diagnosis
  • screening