Laura Hill

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: The objective of this study is to determine whether eating disorders can present for the first time in older people. METHOD: This is a descriptive study of patients above the age of 50 years who have presented to a national eating disorder center within the last 10 years. RESULTS: Thirty-two patients were identified; data were available for 26 of these patients and 11 agreed for further interview and questionnaire completion. There were no cases where the eating disorder had its onset late in life. Of the 11 interviewed, six participants retained a diagnosis of anorexia nervosa, four had Eating Disorder Not Otherwise Specified and only one was recovered. Comorbid depression was universal in those still suffering with an eating disorder diagnosis, and their level of social functioning was impaired. DISCUSSION: Anorexia nervosa is a chronic and enduring mental illness that, although rare, can be found in older people. In our sample, we found no evidence of late-onset disorders; all described cases were lifelong.

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