SCOFF eating disorder questionnaire

What this assessment is

SCOFF is a five-question eating-disorder screen with a total from 0 to 5. Two or more endorsements raise suspicion of an eating disorder and support further assessment, but the cutoff is not a diagnosis or a severity scale, and a result below 2 cannot rule out an eating disorder.

John Morgan, Fiona Reid, and J. Hubert Lacey introduced the questionnaire in a 1999 BMJ study, and its name is an acronym drawn from the original questions.

Who it was designed for

The original specialist study involved women aged 18 to 40. A later general-practice study tested women aged 18 to 50.

A subsequent evidence review for the U.S. Preventive Services Task Force pooled 10 adult studies. Evidence for adolescents was much thinner, so performance from adult studies should not be assumed to transfer unchanged to every age, gender, language, or setting.

How it is administered

SCOFF uses five yes-or-no responses. The questions do not share one recent recall period. Use the complete standard form without adding a new timeframe or changing the wording and response choices. The published 0-to-5 total assumes five answered questions, and no replacement or prorating rule was found. A blank is not a no.

What it measures

The questionnaire screens for a small set of warning signs that can accompany eating disorders. It does not provide a full account of current intake, compensatory behavior, weight history, physical symptoms, or daily impairment.

The EAT-26 is a longer eating-attitudes screen with a different response format and separate referral criteria.

How scoring works

Each endorsed response scores 1, and each non-endorsed response scores 0. Add the five values for a total from 0 to 5.

No weighting is used. The standard positive-screen rule is 2 or higher, but there are no severity bands. A total of 4 does not establish a more severe diagnosis than a total of 2.

How to interpret a SCOFF score

A total of 2 or higher supports further assessment. In the original specialist study, that rule identified all cases and correctly screened out 87.5% of controls (1999). The general-practice study identified 84.6% of participants with an eating disorder and correctly screened out 89.6% without one (2002).

Larger evidence gives a more cautious picture. According to the AHRQ evidence review, pooled results from 10 adult studies identified 84% of cases and correctly screened out 80% of participants without an eating disorder. These figures describe study groups, not the probability that one person's result is correct.

A result below 2 can miss illness. Continue assessment when persistent symptoms, behavior changes, physical changes, or the person's own concern suggest a problem.

Medical safety is separate from the score

SCOFF cannot identify the type or severity of an eating disorder or show whether someone is medically stable. Medical risk is not scored. A low total does not rule out a dangerous physical complication.

The NICE eating-disorder guideline bases acute medical care on physical state, including severe dehydration, severe malnutrition, severe electrolyte imbalance, or signs of organ failure. Urgent symptoms need direct medical assessment regardless of the SCOFF total.

Evidence and limitations

The developers designed SCOFF as a simple, memorable way to raise suspicion before clinical assessment. False positives and false negatives still occur, and accuracy varies across populations and settings.

Use the result to decide whether more assessment is needed. Do not use it to confirm or dismiss a diagnosis, determine medical stability, or select treatment.