John F. Morgan

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.

OBJECTIVE: Empirical research addressing cognitive processing deficits in eating disorders has noted an overlap with autism spectrum disorders. We conducted a systematic review investigating the prevalence of autism spectrum disorder in its entirety in eating disordered populations. METHODS: A comprehensive search for relevant studies was performed on five electronic databases. Studies were not included if solely focused on specific traits of autism spectrum disorders, for instance, theory of mind, set shifting or central coherence. Titles, abstracts and full texts were screened by two members of the research team independently. Quantitative studies published in English were included. RESULTS: A total of eight studies were found to fit the inclusion criteria. Results showed significantly raised prevalence rates of autism spectrum disorder in eating disorder populations compared with those in healthy control participants. DISCUSSION: This discovery has clinical implications and may assist in deciphering poor responses to conventional treatment, facilitating new psychological interventions for eating disorders.

BACKGROUND: Bulimia nervosa affects women at a peak age of reproductive functioning, but few studies have examined the impact of pregnancy on bulimia. AIM: To examine the impact of pregnancy on symptoms of bulimia nervosa and associated psychopathology. METHOD: Women actively suffering from bulimia nervosa during pregnancy (n = 94) were interviewed using the eating disorder examination (12th edn) and structured clinical interview for DSM-III-R, with additional structured questions. Behaviours were recorded at conception, each trimester and postnatally. Relative risks were calculated for prognostic factors. RESULTS: Bulimic symptoms improved throughout pregnancy. After delivery, 57% had worse symptoms than pre-pregnancy, but 34% were no longer bulimic. Relapse was predicted by behavioural severity and persistence, previous anorexia nervosa ('Type II' bulimia), gestational diabetes and 'unplanned' pregnancy. Unplanned pregnancies were the norm, usually resulting from mistaken beliefs about fertility. 'Postnatal depression' was suggested in one-third of the sample, and in two-thirds of those with'Type II' bulimia, and was predicted by alcohol misuse, symptom severity and persistence. CONCLUSIONS: Postnatal treatment intervention should focus on women 'at risk' of relapse, but all women with bulimia should be assessed for postnatal depression.