No other psychiatric disorder has as many physical signs and laboratory findings as the eating disorders. Obesity is not one of those signs because most people who are overweight do not have a formal eating disorder. It is more likely to be normal-weight or underweight women who present for help with an undiagnosed eating disorder. The chief complaint is rarely “I think I have an eating disorder”; rather, the patient may ask for help with:
- constipation, bloating or fluid retention
- weight loss, despite being at a normal weight
- mood instability, anxiety, sleep or concentration problems.
The following physical signs and laboratory findings are also common:
- marked weight loss
- bradycardia and hypotension
- amenorrhea or light, irregular periods
- impaired temperature regulation
- delayed gastric emptying
- hair loss, dry skin and growth of lanugo hair
- hypokalemic, hypochloremic metabolic alkalosis
- elevated salivary amylase
- parotid hypertrophy
- EKG findings of low voltage, T-wave inversion, prolonged QTc interval
- osteoporosis at a young age.
Screening and Assessment
The SCOFF is a brief five-question screening test for eating disorders, similar to the CAGE screen for alcohol dependence. The name of the questionnaire is somewhat controversial because the word “scoff” means to eat greedily. The SCOFF has been evaluated and compared with other measures in specialty clinics and in primary care in England and the United States. In the British version, the “O” represents “one stone” of weight and “sick” is understood to be “vomit.” The American version is provided below, using language more familiar to Canadians.
- Do you make yourself vomit (Sick) because you feel uncomfortably full?
- Do you worry that you have lost Control over how much you eat?
- Have you recently lost more than 15 pounds (One stone) in a 3-month period?
- Do you believe you are Fat when others say you are too thin?
- Would you say that Food dominates your life?
Give 1 point for every “yes.” Scoring 2 or higher indicates a likely case of anorexia nervosa or bulimia.
Reproduced with permission from “The SCOFF questionnaire: Assessment of a new screening tool for eating disorders,” by J.F. Morgan et al., 1999, BMJ, 319, p. 1467. © 1999 BMJ Publishing Group.
In Eating Disorders: