J. Hubert Lacey

The SCOFF questionnaire and clinical interview for eating disorders in general practice: comparative study.

Standards 2 and 3 of the national service framework for mental health outline the need to improve health care for patients with anorexia nervosa and bulimia nervosa.1 Healthcare workers in primary care are at the forefront of screening and managing these disorders. Assessment tools available to primary healthcare professionals can take a long time to administer and may need to be interpretedby specialists2; this may limit improvements in care. A screening tool was developed, but only to facitate epidemiological research.3 The SCOFF questionnaire is a brief and memorable tool designed to detect eating disorders and aid treatment (see figure). It showed excellent validity in a clinical population and reliability in a student population. 4 5 We assessed the SCOFF questionnaire in primary care. We invited sequential women attenders (aged 18-50) at two general practices in southwest London to participate. We gave participants …

SCOFF, the development of an eating disorder screening questionnaire

OBJECTIVE This article describes the three-stage development of the SCOFF, a screening tool for eating disorders. METHOD Study 1 details questionnaire development and testing on cases and controls. Study 2 examines reliability of verbal versus written administration in a student population. Study 3 validates the test as a screening tool in primary care. RESULTS The SCOFF demonstrates good validity compared with DSM-IV diagnosis on clinical interview. In the primary care setting it had a sensitivity of 84.6% and a specificity of 89.6%, detecting all true cases of anorexia nervosa and bulimia nervosa and seven of nine cases of EDNOS. Reliability between written and verbal versions of the SCOFF was high, with a kappa statistic of 0.82. DISCUSSION The SCOFF, which has been adapted for use in diverse languages, appears highly effective as a screening instrument and has been widely adopted to raise the index of suspicion of an eating disorder.

Childhood onset neuropsychiatric disorders in adult eating disorder patients: a pilot study

BackgroundAutism spectrum disorders (ASD) have been suggested to be overrepresented in anorexia nervosa. This study aimed to explore the comorbidity of ASD and other childhood onset neuropsychiatric disorders (COND) [attention-deficit/hyperactivity disorder (AD/HD) and tic disorders] in a group of severe eating disorder (ED) patients.MethodThirty female ED patients from a specialist hospital clinic were examined on measures tapping into COND and personality disorders.ResultsIn our group of longstanding ED, 53% had at least one COND diagnosis; 23% had ASD, 17% had AD/HD, and 27% had a tic disorder.ConclusionsThese preliminary data suggest that COND may be common in patients with severe ED and should be kept in mind when treating these patients.

Bulimia: factors associated with its etiology and maintenance

Fifty female patients with bulimia at normal body weight were examined in a prospective study to determine factors associated with the onset and maintenance of their disorder. Factors given by patients and interpretations drawn by the psychiatrist for the underlying, precipitating, and maintenance factors of bulimia were recorded. Bulimic patients describe a remarkably similar and consistent series of underlying factors, particularly centered on doubts concerning femininity but also including a poor relationship with parents, academic striving, parental marital conflict, and poor peer group relationships. All patients described at least one and usually two or three major groups of life events: sexual conflicts, major changes in life circumstances, and “loss” acting upon the above underlying factors which together with carbohydrate-abstinent dieting precipitated the onset of the condition. Maintenance factors included carbohydrate craving, binge eating for its sedative qualities or, alternatively, as a stimulant to replace loneliness or boredom.

Surgery for the psyche: a longitudinal study of women undergoing reduction mammoplasty

This study suggests that surgery is effective in relieving the psychological distress of women requesting reduction mammoplasty for minimal deformity. Eleven young women who applied for operation on the NHS completed measures of psychoneurosis, mood, self-esteem and body perception. Prior to operation they had a distorted body image, low self-esteem and abnormal psychoneurotic profiles. Following surgery body image returned to a normal range; their self-confidence, and view of their femininity and sexual attractiveness were also enhanced. Improvement was maintained during 6 months of follow-up. These results have implications for the NHS provision of cosmetic surgery for such patients.

Risk of postnatal depression, miscarriage, and preterm birth in bulimia nervosa: retrospective controlled study.

Objective: Bulimia nervosa is common and treatable. An association between bulimia and obstetric complications has been suggested, but sample size and absence of control have limited previous studies. Our aim was to determine if active bulimia nervosa affects obstetric outcome. Methods: This was a retrospective case-control comparison of obstetric complications in primigravidae previously treated for bulimia in a specialist eating disorder service. A cohort of 122 women with active bulimia during pregnancy was contrasted against 82 with quiescent bulimia, using structured interviews comprising the Eating Disorders Examination, Structured Clinical Interview for DSM-III-R, and systematic questions addressing obstetric complications. Results: Odds ratios (ORs) for postnatal depression, miscarriage, and preterm delivery were 2.8 (95% confidence interval [CI], 1.2–6.2), 2.6 (95% CI, 1.2–5.6) and 3.3 (95% CI, 1.3–8.8) respectively. Risk of unplanned pregnancy was markedly elevated (OR, 30.0; 95% CI, 12.8–68.7). Risk estimates were not explained by differences in adiposity, demographics, alcohol/substance/laxative misuse, smoking, or year of birth, but relative contributions of bulimic behaviors were not discerned. Conclusions: Active bulimia during pregnancy is associated with postnatal depression, miscarriage, and preterm delivery. Bulimia may be a treatable cause of adverse obstetric outcome. BN = bulimia nervosa; CI = confidence interval; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; EDNOS = eating disorder not otherwise specified; GP = general practitioner; OR = odds ratio; PCOS = polycystic ovary syndrome; SCID = Structured Clinical Interview for DSM-III-R; SD = standard deviation.

Motivational factors in women requesting augmentation and reduction mammaplasty

This study confirms that women requesting breast reduction and breast augmentation differ beyond the anatomical. There were significantly more single and co-habiting women in the breast reduction group, and significantly more separated and divorced women in the breast augmentation group, compared to women attending an obstetric clinic. The majority of women requesting surgery agreed that to feel more confident was an important reason for seeking surgery, but those requesting breast augmentation also stressed the need to feel more feminine and less shy with men. A significantly higher percentage of the breast augmentation group had been pregnant, and they had a higher average number of pregnancies than the obstetric comparison group, together with a significantly higher experience of miscarriage. The psychodynamic proposal that women requesting breast augmentation are seeking to symbolically boost their sense of femininity and womanliness is supported by this study.

The prevalence of DSM-IV personality pathology among individuals with bulimia nervosa, binge eating disorder and obesity

BACKGROUND There are numerous reports of personality disorder pathology in different eating disorders. However, few studies have directly compared personality pathology in bulimia nervosa, binge eating disorder and obesity. The present study examines group differences in DSM-IV personality pathology, considering the potential utility of understanding personality disorders in terms of diagnosis and dimensional scores. METHOD Eating disorder diagnoses were established using the Eating Disorder Examination interview. Thirty-five bulimia nervosa patients, 15 binge eating disorder patients and 37 obese patients were assessed and compared on the International Personality Disorder Examination using categorical and dimensional personality disorder scores. RESULTS For most personality disorders, there was a dichotomy of binge eaters versus non-binge eaters. In contrast, there was a continuum of severity in borderline personality disorder pathology between the groups. The dimensional system of measurement of personality pathology allowed for clearer differentiation between the groups. CONCLUSION The study strongly indicates that personality disorder difficulties are present in patients who binge eat, while obese patients who do not binge eat display significantly less personality disorder pathology. Assessment of bulimia nervosa, binge eating disorder and obesity needs to address personality disorders and pathology. Dimensional markers of personality pathology can be used to supplement categorical diagnoses, providing information about the traits that underlie diagnosis.

Polycystic ovarian morphology and bulimia nervosa: a 9-year follow-up study

OBJECTIVE To examine long-term changes in polycystic ovarian morphology in women with polycystic ovaries and bulimia nervosa after treatment of the latter condition. DESIGN Longitudinal follow-up study. SETTING Eating disorder unit of a university hospital. PATIENT(S) Eight women originally treated for bulimia nervosa (T(0)) who underwent ultrasonography up to 2 years after treatment (T(1)) and had a second ultrasonographic scan 9 years later (T(2)). INTERVENTION(S) Treatment of bulimia nervosa that combined cognitive behavioral therapy with insight-orientated psychotherapy. MAIN OUTCOME MEASURE(S) Ovarian morphology evaluated by ultrasonography, using the criteria of Adams to define polycystic ovaries; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of eating disorders. RESULT(S) At T(1), 7 women had recent bulimia and 1 was quiescent. The woman with quiescent disease had normal ovaries. Of the 7 bulimic women, 6 had polycystic ovaries and 1 had multifollicular morphology. At T(2), 5 women were bulimic, all of whom had polycystic ovaries. Three women had normal eating patterns and normal ovarian morphology. CONCLUSION(S) This study clearly shows a strong association between resolution of bulimia and changes in ovarian morphology, suggesting that changes in the former mirror changes in the latter. It also demonstrates normalization of ovarian morphology in previously polycystic ovaries.

Body image distortion in non-eating disordered women and men

This study of body image perception in 100 non-eating disordered women and men demonstrates that overperception of body widths, whilst accurately perceiving a neutral object, is not restricted to populations with eating disorders, nor is it peculiar to women. Men consistently overestimated body widths to the same extent as female subjects. Overall, 84% of women and 52% of men wished to weigh less. Considering those subjects within the 10% range of Mean Matched Population Weight (MMPW), men wished to be 0.75 kg heavier, whilst women at MMPW wished to weigh 3.25 kg less. For women, the subjects who were most satisfied with their actual weight were those who were well below MMPW. There is a tendancy that the greater the deviation of weight from normal, in either direction, the greater the degree of body width overestimation. These results suggest that the overperception of body width is more related to current weight than to concern about weight and shape, or to the presence or absence of an eating disorder. They question the use of empirical body size estimation measurement in eating disordered populations.