SCOFF Questionnaire

Foundational Context

The SCOFF questionnaire was developed by John Morgan, Fiona Reid, and J. Hubert Lacey in 1999 at St. George's Hospital Medical School in London. It was designed in response to the absence of a brief, clinically practical screening tool for eating disorders suitable for use in primary care and general medical settings. At the time of its development, longer instruments existed but were too burdensome for routine screening in busy clinical environments.

The SCOFF acronym was constructed from the five core behavioural and attitudinal features most consistently associated with anorexia nervosa and bulimia nervosa. Each item was selected for its ability to capture a clinically meaningful eating disorder marker using simple, accessible language. Subsequent validation studies have confirmed its utility across primary care, general internal medicine, and student health populations, and it has been translated into multiple languages for international use.

What the Assessment Measures

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.

Interpretation Guidelines

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. At this threshold, the SCOFF demonstrates sensitivity of approximately 84.6–100% and specificity of approximately 87.5–89.6% depending on the population studied (Morgan et al., 1999; Hill et al., 2010).

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 patients 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 instrument only.

Psychometric Properties

Reliability

• Adequate internal consistency for a 5-item binary scale
• Good inter-rater reliability when administered verbally

Validity

• Sensitivity 84.6–100% for anorexia nervosa and bulimia nervosa at cutoff ≥2
• Specificity 87.5–89.6% across primary care and general medical samples
• Positive predictive value varies with the prevalence of eating disorders in the setting
• Validated in primary care, general medicine, and student health populations
• Cross-cultural validity supported across multiple European studies

Administration Considerations

• Very brief; completed in under 2 minutes
• Appropriate for adults and adolescents; may require age-appropriate phrasing for younger patients
• 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 behaviors, 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

Limitations

• Limited coverage of binge eating disorder and ARFID, conditions not well-represented by the original five items
• 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

SCOFF Questionnaire Overview

Frequently Asked Questions

What is the SCOFF questionnaire?

The SCOFF questionnaire is a validated 5-item screening tool for eating disorders (anorexia nervosa and bulimia nervosa). Developed by Morgan, Reid, and Lacey (1999), SCOFF is an acronym: Sick (self-induced vomiting), Control (loss of eating control), One stone (significant weight loss), Fat (body image distortion), and Food (food dominates life). A score of 2 or more Yes responses indicates a positive screen.

What does a positive SCOFF score mean?

A SCOFF score of 2 or more (2–5 Yes responses) is a positive screen, indicating elevated likelihood of an eating disorder. This warrants thorough clinical evaluation by a trained clinician. A positive screen is not a diagnosis, anorexia nervosa and bulimia nervosa require clinical assessment using DSM-5-TR criteria.

What eating disorders does SCOFF screen for?

The SCOFF was originally validated for anorexia nervosa and bulimia nervosa. It screens for purging behavior, loss of eating control, significant weight loss, body image distortion, and food preoccupation, symptoms characteristic of these two conditions. It does not screen specifically for binge-eating disorder (BED) or ARFID (Avoidant/Restrictive Food Intake Disorder).

What are common comorbidities with eating disorders?

Eating disorders frequently co-occur with depression (50–75%), anxiety disorders (50–65%), OCD, substance use disorders, and borderline personality disorder. Emotion dysregulation is a transdiagnostic factor particularly relevant in bulimia nervosa. Complete assessment should include screening for these comorbid conditions alongside the SCOFF.

How accurate is the SCOFF questionnaire?

In the original validation study (Morgan et al., 1999), the SCOFF had sensitivity of 84.6% and specificity of 89.6% for detecting clinical eating disorders in a primary care setting. Subsequent validations have replicated adequate performance across multiple populations. Like all screening tools, it is not a definitive diagnostic tool.

When should the SCOFF be used?

The SCOFF is appropriate for initial screening of eating disorder symptoms in primary care, mental health, and general practice settings. It is particularly useful as a brief screen during routine mental health intake, especially for patients presenting with depression, anxiety, body image concerns, or significant weight change.

Copyright: The SCOFF questionnaire is available for free use in clinical practice and research. Cite Morgan et al. (1999) in research publications.