From the Guidelines
The initial psychiatric evaluation of a patient with a possible eating disorder should include a comprehensive assessment of eating and weight control behaviors, as well as identification of co-occurring health conditions, according to the American Psychiatric Association practice guideline 1. This evaluation should comprise several key components, including:
- Presence of, patterns in, and changes in restrictive eating, food avoidance, binge eating, and other eating-related behaviors
- Patterns and changes in food repertoire, such as breadth of food variety, narrowing or elimination of food groups
- Presence of, patterns in, and changes in compensatory and other weight control behaviors, including dietary restriction, compulsive or driven exercise, purging behaviors, and use of medication to manipulate weight
- Percentage of time preoccupied with food, weight, and body shape
- Prior treatment and response to treatment for an eating disorder
- Psychosocial impairment secondary to eating or body image concerns or behaviors
- Family history of eating disorders, other psychiatric illnesses, and other medical conditions The American Psychiatric Association recommends (1C) that the initial psychiatric evaluation of a patient with a possible eating disorder include weighing the patient and quantifying eating and weight control behaviors, as well as identifying co-occurring health conditions, including co-occurring psychiatric disorders 1. In terms of specific screening tools, while the SCOFF questionnaire, Eating Disorder Examination Questionnaire (EDE-Q), and Eating Attitudes Test (EAT-26) may be useful for detecting eating disorders, the American Psychiatric Association practice guideline 1 emphasizes the importance of a comprehensive assessment of eating and weight control behaviors, rather than relying on a single screening tool. Early identification of eating disorders is crucial, as these conditions have high mortality rates and better outcomes with prompt treatment, highlighting the need for a thorough and comprehensive evaluation, as recommended by the American Psychiatric Association 1.
From the Research
Eating Disorder Screening Tools
The following are some of the eating disorder screening tools that have been studied:
- EDE-Q (Eating Disorder Examination Questionnaire): a 22-item questionnaire that has been shown to have good validity and reliability in screening for eating disorders 2
- SCOFF: a 5-item questionnaire that has been shown to have good validity and reliability in screening for eating disorders, with a sensitivity of 84.6% and a specificity of 89.6% 3
- EDI-VS (Eating Disorder Inventory-Very Short Form): a 16-item questionnaire that has been shown to have good reliability, content validity, factor validity, convergent validity, and criterion-related validity in assessing eating disorders 4
Validation of Screening Tools
The validation of these screening tools has been studied in various populations, including:
- Primary care samples of young adult women 2
- Student populations 3, 5
- Mexican university students 5
- The results of these studies have shown that these screening tools can be effective in identifying individuals at risk of eating disorders, with the SCOFF being a useful tool for identifying Mexican university students who are at risk of eating disorders 5
Optimal Cutoff Scores
The optimal cutoff scores for these screening tools have been studied, with the following results:
- EDE-Q: a global score of >or= 2.80 yielded the optimal trade-off between sensitivity and specificity 2
- SCOFF: a score of two or more positive responses was optimal, with a sensitivity of 72% and a specificity of 73% 2, and a score of two points optimized the sensitivity (78%) and specificity (84%) in a Mexican university student population 5