SCOFF Questionnaire

The SCOFF (Sick, Control, One stone, Fat, Food) is a 5-item yes/no screening questionnaire for anorexia nervosa and bulimia nervosa, where 2 or more Yes answers is a positive screen ^[1].

Foundational context

The SCOFF questionnaire was developed by John Morgan, Fiona Reid, and J. Hubert Lacey at St George's Hospital Medical School in London ^[1]. It was designed as a brief, practical eating disorder screen for primary care and general medical settings, where longer questionnaires were too burdensome for routine use.

Its development ran in three stages: testing on cases and controls, a comparison of written and verbal administration in students, and validation as a screening tool in primary care ^[2].

The SCOFF acronym comes from the five core behavioural and attitudinal features it asks about, in simple, accessible language. It has been adapted for use in many languages ^[2].

What does the SCOFF measure?

The SCOFF comprises 5 yes/no questions covering key features of disordered eating:

• S, Sick: Do you make yourself Sick (vomit) because you feel uncomfortably full?
• C, Control: Do you worry that you have lost Control over how much you eat?
• O, One stone: Have you recently lost more than One stone (approximately 6 kg / 14 lb) in a three-month period?
• F, Fat: Do you believe yourself to be Fat when others say you are too thin?
• F, Food: Would you say that Food dominates your life?

Each "Yes" response scores 1 point. Total score: 0–5.

How do you give the SCOFF?

• Very brief; completed in under 2 minutes
• Appropriate for adults and adolescents; may require age-appropriate phrasing for younger clients
• Can be self-administered or clinician-administered
• Sensitive clinical framing is important, eating disorder screening questions can be distressing; follow a trauma-informed approach
• A positive screen should prompt discussion of eating behaviours, weight history, and physical symptoms in a non-judgmental way
• Refer to an eating disorders specialist or team when screen is positive
• When documenting in clinical notes, the SCOFF score and screen status (positive/negative) belong in the Objective section of a SOAP note

How do you score and interpret the SCOFF?

Score range:

• 0–1: Negative screen; eating disorder unlikely
• ≥2: Positive screen; possible anorexia nervosa or bulimia nervosa; further evaluation warranted

Clinical threshold:

• ≥2 is the validated cutoff ^[1]. Its accuracy at this threshold is under Psychometric properties below.

Interpretation notes:

• The SCOFF is designed to screen for the two most prevalent restrictive/purging eating disorders (anorexia nervosa, bulimia nervosa) and may not capture binge eating disorder or avoidant/restrictive food intake disorder (ARFID).
• A positive screen requires follow-up with a structured clinical interview and, where appropriate, medical evaluation including weight history and laboratory assessment.
• Item O (weight loss of >1 stone) may produce false positives in people with unrelated medical causes of weight loss; clinical judgment is needed.
• The questionnaire is not intended as a severity measure, it is a binary screening tool only.

Psychometric properties

Reliability

• Written vs verbal. Agreement between the written and verbal versions was high (kappa 0.82) in a student population ^[2].

Validity

• Primary care. Against DSM-IV diagnosis on clinical interview, the SCOFF 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 ^[2].
• Meta-analysis. Across 25 validation studies, pooled sensitivity was 0.86 and specificity 0.83 ^[3].
• Where it works less well. Sensitivity was highest in case-control studies of young women with anorexia or bulimia nervosa, and lower in studies with more men, people with binge eating disorder, or large community samples ^[3].
• Positive predictive value varies with the prevalence of eating disorders in the setting.

Limitations

• Limited coverage of binge eating disorder and ARFID, conditions not well represented by the original five items; the evidence does not support it as a screen for the full range of DSM-5 eating disorders ^[3]
• Does not quantify symptom severity or frequency
• The weight-loss item (O) may not apply across all cultural or body-size contexts
• Self-report may be influenced by denial, shame, or minimization, particularly in anorexia nervosa
• Not intended for serial symptom monitoring, use condition-specific measures (e.g., EDE-Q) for ongoing assessment
• Emotion dysregulation is a transdiagnostic risk factor in eating disorders, particularly binge-purge type bulimia; the DERS (Difficulties in Emotion Regulation Scale) can quantify this dimension alongside the SCOFF