SCOFF — Brief eating-disorder screen

The SCOFF is the briefest validated eating-disorder screen in clinical practice. Five yes/no items, published by Morgan and colleagues in the BMJ in 1999, designed to surface a flag in a single question block. The acronym names the five items: Sick, Control, One stone, Fat, Food.

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What it measures

Five behavioural and cognitive markers of eating disorders:

• Sick — making yourself sick because uncomfortably full (purging)
• Control — worry that you’ve lost control over how much you eat
• One stone — recently lost more than one stone (14 lb / 6.35 kg) in three months
• Fat — believing yourself fat when others say you’re thin
• Food — food dominates your life

Each item is yes/no. Items 1 (purging) and 4 (body-image distortion) are flagged sensitive in the template so the intake panel handles them with the same trauma-informed presentation as other sensitive items.

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When to send it

• Adult intake when you want a brief eating-disorder signal
• Primary-care embedded mental-health practice
• As the first pass before sending the longer EDE-Q
• When weight or body-image concerns surface in initial conversations

Under a minute to administer. Works well in-session or async.

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Scoring and severity cutoffs

Sum of yes-scored items, range 0–5. Cutoff ≥2 is the standard threshold (Morgan 1999: sensitivity 100%, specificity 87.5% in an eating-disorder unit; specificity around 80% in primary-care populations). A positive SCOFF warrants follow-up — the EDE-Q for symptom dimensions and severity, or a clinical interview structured around the eating disorder.

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SCOFF vs EDE-Q

The SCOFF is a five-question door. It asks whether there is an eating disorder here at all, in about thirty seconds, and two “yes” answers mean look further. It does not measure severity and it does not tell you what kind of problem you’re looking at. The EDE-Q is what “look further” means. Twenty-eight items across the last month, four subscales — restraint, eating concern, shape concern, weight concern — plus counts of binge episodes, vomiting, laxative use and compensatory exercise. That is the instrument you track treatment against. Use the SCOFF at intake as a routine screen. Use the EDE-Q when the SCOFF is positive, or when eating is already part of why the client came.

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Is it free to use?

Yes. Free clinical use. Morgan, Reid and Lacey published it in the BMJ in 1999.

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Citation

Morgan, J. F., Reid, F., & Lacey, J. H. (1999). The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ, 319(7223), 1467–1468. Free clinical use.

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When not to use it

The SCOFF is a flag, not a severity instrument. It tells you to look more closely; it doesn’t tell you which symptom dimensions are involved or how severe the picture is. For symptom-dimension profiling and treatment-response tracking, use the EDE-Q. The “one stone” framing is from the original UK validation — recent weight loss may not be the primary marker in long-standing eating-disorder presentations or in atypical anorexia. Treat the question literally and weight context appropriately.

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