Academic journal article Journal of Eating Disorders

SCOFF in a General Swedish Adolescent Population

Academic journal article Journal of Eating Disorders

SCOFF in a General Swedish Adolescent Population

Article excerpt

Author(s): Erika Hansson[sup.1,2], Daiva Daukantaitn[sup.2] and Per Johnsson[sup.2]


Disordered Eating Behaviors (DEB) is not a unified concept and therefore difficult to study. DEB is used to describe various behaviors or symptoms that can "take many forms" ([3], p. 41). Fasting, the use of diet pills, purging (by vomiting or the use of laxatives), and smoking for weight control are all examples of DEB [16]. DEB is furthermore suggested to have a distinct core psychopathology, with the same mechanisms in men and women, and having to do with an over evaluation of one's own shape and weight [5].

The prevalence of DEB, despite its imprecise definition, has been calculated with frequencies varying from 15 % in boys and 33 % in girls in a study of 1895 11-17 year-old adolescents in a German sample [11] to 30 % in Israeli girls with a mean age of 14.7 years [13] to 17 % in boys and 52 % in girls with a mean age of 14.9 years in a Finnish sample [9]. The results indicate that DEB is a prevalent health problem in both girls and boys. Adolescents with DEB run a high risk of developing a clinical eating disorder [25] which renders high morbidity [12, 27] and therefore, it is of great importance to detect DEB as early as possible, providing appropriate help for adolescents at risk. For early identification of DEB, reliable and valid instruments are needed. The SCOFF-questionnaire [23] which we aim to validate in a Swedish adolescent sample in the present study, addresses core features of both anorexia nervosa and bulimia nervosa and has been used as a screening tool to enable the detection of individuals possibly at risk for an eating disorder [2, 12, 26]. During its development, great effort was made to make the SCOFF brief since it was meant to be used as part of primary care screening, often in addition to other cumbersome measures [12]. By deciding the cut-off to be the answer "yes" to two out of five questions, the researchers maximized the sensitivity of the test, which was considered a priority [12]. In the initial study by Morgan et al. [23], the test's sensitivity in the sample of adult females already diagnosed with anorexia nervosa or bulimia nervosa was 100 %, whereas in a study by Pannocchia et al. [26], the sensitivity was 97 %. The false positive rates of 12.5 % and 12.7 %, respectively, were claimed to be an acceptable trade-off for the high sensitivity.

A validation of the SCOFF in a non-clinical adolescent sample in Finland demonstrated that 81 % of the students whose eating disorder symptoms were detected by the SCOFF-questionnaire (i.e., answered "yes" to two of five questions) had undetected DEB in a health examination performed by a nurse [10]. Furthermore, the questionnaire has been found to be accurate and reliable with a reported sensitivity of 94.6 % in a sample of students administered the SCOFF and judged to be at high or low risk of an eating disorder by a health professional [8]. Other studies are more moderate in their assessment and consider the SCOFF to have acceptable psychometric properties [15] or to be restricted but feasibly useful for ruling out the presence of eating disorders, according to a study by Lahteenmaki et al. [18] in which none of the participants with current eating disorders scored zero points on the SCOFF-questionnaire.

Thus, although multiple studies have examined the SCOFF, the results suggests some inconsistencies and more research in various samples is needed.

In addition to the SCOFF, the Eating Disorder Examination Questionnaire (EDE-Q) is a widely used instrument to examine DEB. The EDE-Q is a self-reported instrument derived from the Eating Disorder Examination interview [6] and contains questions about shape, weight and eating concerns as well as the practice of food restraint. Although the EDE-Q is a highly reliable and valid instrument in screening for DEB [20, 21], it has lately been criticized for not adequately assessing eating, weight and shape control behaviors in adolescent boys [19]. …

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