SCOFF Questionnaire

Abstract

The SCOFF Questionnaire is a concise, five-item screening tool developed by Morgan, Reid, and Lacey in 1999. It was designed to quickly identify individuals who may be at risk for or currently suffering from eating disorders (EDs), such as Anorexia Nervosa and Bulimia Nervosa, in both clinical and non-specialist settings. Its simplicity, ease of recall, and high efficiency make it a highly recommended initial assessment measure, particularly for use in primary health care environments.

Keywords

SCOFF, Screening Tool, Eating Disorders, Anorexia Nervosa, Bulimia Nervosa, Primary Care, Self-report, Psychometrics.

Authors

J. Morgan, F. Reid, J. Lacey

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Purpose

The primary purpose of the SCOFF Questionnaire is to serve as a rapid, easily administered screening instrument for identifying potential cases of eating disorders. Developed for use by a wide range of professionals and non-professionals, the tool is intended to clarify clinical suspicion regarding the presence of an ED rather than providing a formal clinical diagnosis.

The instrument was designed to be time-efficient and simple, facilitating quick integration into routine patient encounters in primary care settings. Successful administration (either orally or in written form) leads to a score that determines the necessity for a more comprehensive clinical assessment.

Construct

The SCOFF Questionnaire measures five core behavioral and cognitive features highly characteristic of established eating disorders, particularly Anorexia Nervosa and Bulimia Nervosa. The construct assesses critical symptomatic areas summarized by the acronym SCOFF, which stands for:

• S: Sickness (self-induced vomiting).
• C: Control (loss of control over eating).
• O: One stone (rapid, significant weight loss).
• F: Fat (distorted body image/perception).
• F: Food (food dominating life).

The tool focuses on recent pathological behaviors and beliefs related to food, body image, and weight management, which are central components of clinical ED diagnostic criteria.

Validity

The validity of the SCOFF as a screening tool has been extensively supported through large-scale meta-analyses and numerous replication studies across diverse linguistic and cultural contexts. The foundational development of the five items was achieved through focus groups involving both eating disordered patients and specialized clinicians, ensuring strong content validity rooted in clinical experience.

Psychometric studies confirm that the SCOFF exhibits high sensitivity for detecting both Anorexia Nervosa and Bulimia Nervosa, especially when the appropriate cut-off score is applied. This high level of diagnostic accuracy reinforces its utility as a reliable first-line measure in clinical practice.

Reliability

The reliability of the SCOFF is demonstrated by its consistent and highly efficient performance across numerous international validation studies, confirming its robustness as a detection tool, even when used by non-specialists. A specific study by Perry et al. (2002) confirmed that the reliability of the instrument is consistent regardless of the method of administration, whether the questions are presented orally or in a written format.

The instrument’s success stems from its concise, unambiguous wording, which minimizes ambiguity and contributes to high inter-rater consistency and ease of interpretation, supporting its utility as a standardized screening measure.

Factor Analysis

The SCOFF is explicitly designed as a brief, pragmatic, and unidimensional measure focused on rapid screening. It aims to capture the presence of five critical symptoms rather than delineating complex dimensional psychopathology. Therefore, it is generally conceptualized and utilized as a single-factor instrument measuring overall eating disorder risk.

The scoring methodology, which sums the number of ‘yes’ responses, reflects this single-factor approach. This method prioritizes cumulative risk assessment, reinforcing the tool’s primary function as an efficient detection mechanism rather than a detailed multivariate diagnostic scale.

Instrument

Test Type: Self-report Screening Tool (Dichotomous Yes/No format)

Format: Five core questions, administered orally or in written form.

Language Available: English (UK and US versions), German, Finnish, Spanish, Japanese, French, and Italian, among others.

Population Group: General population, utilized across clinical settings, primary care, and community samples.

Age Group: Primarily validated among adolescents and young adults, though widely used across adult populations.

Population Details: The tool was initially developed in the United Kingdom. It is a self-report measure, which may present limitations, including reduced effectiveness for male and older populations who may exhibit different symptomology or atypical presentations of eating disorders. The tool does not screen for excessive exercise or past weight loss history.

Test Methodology: Each “yes” response to the five questions is scored as 1, with a total score ranging from 0 to 5. A score of 2 or higher is the standard cut-off point recommended for warranting further comprehensive clinical assessment. A cut-off score of 3 has been suggested in subsequent research as the optimal compromise between sensitivity and specificity.

Keywords

Psychological assessment, Eating behavior, Screening, Body image, Weight loss, Primary care, Psychopathology.

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Authors

Author ORCID Identifier: Information not provided in source content.

Affiliation Email addresses: Information not provided in source content.

Correspondence Address: Information not provided in source content.

Permissions & Fee and Test Year

The SCOFF Questionnaire is free and easily accessible for use in clinical and research settings. It was originally published in 1999 by Morgan, Reid, and Lacey in the BMJ.

Reference’s

• Botella, J., Sepúlveda, A., Huang, H. and Gambara, H. (2013). A Meta-Analysis of the Diagnostic Accuracy of the SCOFF. The Spanish Journal of Psychology, 16. Doi:10.1017/sjp.2013.92.
• Garcia, F., Grigioni, S., Chelali, S., Meyrignac, G., Thibaut, F. and Dechelotte, P. (2010). Validation of the French version of SCOFF questionnaire for screening of eating disorders among adults. The World Journal of Biological Psychiatry, 11(7), pp.888-893. Doi:10.3109/15622975.2010.483251.
• Garcia-Campayo, J., Sanz-Carrillo, C., Ibañez, J., Lou, S., Solano, V. and Alda, M. (2005). Validation of the Spanish version of the SCOFF questionnaire for the screening of eating disorders in primary care. Journal of Psychosomatic Research, 59(2), pp.51-55. Doi:10.1016/j.jpsychores.2004.06.005.
• Lähteenmäki, S., Aalto-Setälä, T., Suokas, J., Saarni, S., Perälä, J., Saarni, S., Aro, H., Lönnqvist, J. and Suvisaari, J. (2009). Validation of the Finnish version of the SCOFF questionnaire among young adults aged 20 to 35 years. BMC Psychiatry, 9(1). Doi:10.1186/1471-244X-9-5.
• Morgan, J., Reid, F. and Lacey, J. (1999). The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ, 319(7223), pp.1467-1468. Doi:10.1136/bmj.319.7223.1467.
• Pannocchia, L., Fiorino, M., Giannini, M. and Vanderlinden, J. (2011). A Psychometric Exploration of an Italian Translation of the SCOFF Questionnaire. European Eating Disorders Review, 19(4), pp.371-373. Doi:10.1002/erv.1105.
• Perry, L., Morgan, J., Reid, F., Brunton, J., O’Brien, A., Luck, A. and Lacey, H. (2002). Screening for symptoms of eating disorders: Reliability of the SCOFF screening tool with written compared to oral delivery. International Journal of Eating Disorders, 32(4), pp.466-472. Doi:10.1002/eat.10093.
• Solmi, F., Hatch, S., Hotopf, M., Treasure, J. and Micali, N. (2014). Validation of the SCOFF questionnaire for eating disorders in a multiethnic general population sample. International Journal of Eating Disorders, 48(3), pp.312-316. Doi:10.1002/eat.22373.

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Items of the SCOFF Questionnaire

The following five items constitute the core SCOFF Questionnaire. An answer of ‘yes’ to two or more questions warrants further questioning and more comprehensive assessment.

• S – Do you make yourself Sick because you feel uncomfortably full?
• C – Do you worry you have lost Control over how much you eat?
• O – Have you recently lost more than One stone (6.35 kg) in a three-month period?
• F – Do you believe yourself to be Fat when others say you are too thin?
• F – Would you say Food dominates your life?

A further two questions have been shown to indicate a high sensitivity and specificity for Bulimia Nervosa and indicate a need for further questioning and discussion:

1. Are you satisfied with your eating patterns?
2. Do you ever eat in secret?