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Nearly 80% of eating disorders go undetected. What screening tools can help identify them?
“In the United States, there are roughly 28.8 million people with an eating disorder, which is about 9% of our population. Globally, that jumps up to 70 million,” said Rebecca Owens, DNP, MBA, MSN, RN-BC, to the audience of the American Psychiatric Nurses Association (APNA) 35th Annual Conference.
Owens explained that up to 80% of eating disorders go undetected or never receive treatment. She felt it was important to start with a review of the 4 big ED classifications: anorexia nervosa, bulimia nervosa, avoidant/restrictive food intake disorder, and binge eating disorder.
With 92% of frontline clinicians admitting in hindsight to potentially missing an eating disorder (ED) diagnosis, Owens suggested 2 screening tools for consideration that might help clinicians catch more patients that need care: the SCOFF Questionnaire and the EDA-5.
The SCOFF Questionnaire is a UK-developed, straightforward, 5 question screener for EDs that can be used in almost any setting. Studies show it is highly effective for potential or actual ED identification, particularly high mortality disorders (anorexia or bulimia), with good psychometric properties.
SCOFF stands for:
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 (a couple pounds) in a 3-month period?
F- Do you believe yourself to be FAT when others say you are too thin?
F- Would you say that FOOD dominates your life?
EDA-5 is an electronic, semi structured, interview-based, diagnostic tool that is available online at: https://eda5.org/. It facilitates ED diagnoses in general medicine and psychiatric settings and reduces patient-clinician burden in ED determination. Owens shared a few sample screens and told the APNA audience she finds it to be a “very practical, very easy tool to use.”
“The more of us that are understanding the complexities of eating disorders, the better it will be for our patients and communities,” said Owens.
Owens also emphasized the urgent need for improved ED treatment outcomes, and more availability of specialized ED services. “We want to be prepared to capture and help these patients get into timely treatment. It quite literally could be a life and death measure, as we’ve heard through the statistics.”
In a psychiatric setting, step 1 may be an identification of the ED itself, as patients may be coming in for other psychiatric comorbidities, such as an anxiety disorder, a mood disorder, or substance use disorder.
“There’s a lot to learn,” Owens said. “Early screening, diagnosis, and treatment are crucial to prevent long term, life threatening EDs.”