`Early warning' test devised for eating disorders
Friday 03 December 1999
Scoff, an acronym of the first letters of key words in the screening test, has been tried out by researchers at the medical school of St George's Hospital in Tooting, south London, who say the questions are easy to remember and apply.
Dr John Morgan, a clinical research fellow in psychiatry at St George's, who devised the questionnaire, said it was intended to help GPs and hospital doctors to detect sufferers. In a trial of 212 women, the test identified all those suffering from anorexia and bulimia.
It also suggested problems in 12.5 per cent of the unaffected women, but Dr Morgan, 32, said the error rate was an "acceptable trade-off" for the accuracy of the test in picking up all the genuine sufferers. The test had picked him as a possible sufferer, when he returned from Egypt underweight after a bout of amoebic dysentery.
More than 100,000 people in the UK are estimated by the Eating Disorders Association to have a disorder such as anorexia or bulimia, but many go undiagnosed. "This is a way of helping doctors by raising their index of suspicion. It is not a diagnosis," Dr Morgan said.
Studies published in the past decade put the death rate from anorexia studied over a 20-year period at between 5 and 20 per cent, more than deaths from schizophrenia, but doctors are still not taking the condition seriously, Dr Morgan said. "I did a study of gynaecologists and they were hopeless at detecting anorexia and regarded it as trivial. Male doctors can be very hostile to it."
Women account for 85 per cent of cases, according to the Eating Disorders Association, but is also seen in men. Lena Zavaroni, the Seventies pop star who died in October after brain surgery, was a lifelong anorexia sufferer, and Adam Rickett of Coronation Street has also admitted to having the disorder. Treatment usually involves cognitive therapy, and success is greater the earlier treatment is started.
Despite its name, the Scoff test, which was published in The Lancet, proved acceptable to the women questioned, who were aged 18 to 40, Dr Morgan said. It is modelled on a widely used four-question test called Cage, used to detect people with drink problems.
Critics said Scoff was unlikely to work outside the confines of the hospital. Dr Dee Dawson, who runs the Rhodes Farm clinic for children with eating disorders in north London, said: "It sounds incredibly simplistic. These are standard questions. The problem we all face with these patients is that they don't tell the truth. That is why our assessment takes a couple of hours." She added: "Being secretive is the hallmark of bulimia, and anorexia runs it close second. I have known patients who lived for 10 years vomiting three times a day and their partners never found out."
A spokesman for the Eating Disorders Association agreed. "We welcome any test but people are unlikely to say, `Yes, that's me, I have got a problem', because of the denial that is associated with the condition."
1 Do you make yourself Sick because you feel uncomfortably full?
2 Do you worry you have lost Control over how much you eat?
3 Have you recently lost more than One stone in a three-month period?
4 Do you believe yourself to be Fat when others say you are thin?
5 Would you say that Food dominates your life?
If you answer yes to two or more questions you have anorexia or bulimia
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