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Eating disorders: Screening, assessment and diagnosis

Screening

A five-question screening test, similar to the CAGE screen for alcohol dependence, called the SCOFF questionnaire  has been developed for eating disorders. 

The questionnaire has been evaluated and compared with other measures in specialty clinics and in primary care in England and the United States. Because in the British version the "O" represents "one stone" of weight and "sick" is understood to be "vomit," the American version is provided below in more familiar language to Canadians.

Diagnosis

Summary of DSM-5 criteria for eating disorders

If a patient screens positive or you are simply clinically concerned, take time to explore, in a non-critical way, whether the patient has a formal eating disorder. This includes taking a comprehensive weight history and asking about body image, eating behaviours, purging behaviours, medical complications and psychiatric complications. 

Weight history

Take a comprehensive lifetime weight history, including:

  • current weight and height
    • Ask: How do you feel about this weight? At what weight do you feel fat?
  • highest and lowest adult weights:
    • ideal weight. Ask: How would your life be different at that weight?
    • menstrual threshold weight. The target weight for treatment must be above this weight.
    • frequency and routine of weighing self. This part of the history will help you to understand how the eating disorder governs the patient's life.

    Body image

    Ask the patient:

    • How do you see yourself currently?
    • How much do your weight and shape determine how you feel about yourself as a person?
    • Do you fear gaining even small amounts of weight?

    Eating behaviours

    Ask the patient about:

    • dieting history
    • caloric and food group restrictions
    • episodes of binge eating with a sense of loss of control and consumption of foods that are typically avoided

    Purging behaviours

    Ask the patient about:

    • self-induced vomiting
    • use of laxatives, diuretics, diet pills
    • intensive exercise for purposes of weight loss
    • cigarette smoking to suppress appetite

    Medical complications

    See "introduction"

    Psychiatric complications

    Determine if there are any psychiatric complications, including:

    • depression
    • anxiety
    • obsessionality
    • impulsivity
    • substance use problems

Psychiatric interviewing series

David Goldbloom and Nancy McNaughton demonstrate clinical interviewing situations.

Psychiatry in primary care toolkit

A powerful mobile app packed with features that will streamline screening and assessment in primary care.

Download the Toolkit

Frequently asked questions

Clinical guidelines

Eating disorders in over 8s: management (NICE guideline CG9, 2004)