SCOFF questionnaire: Free template

Key takeaways

The SCOFF questionnaire is a five-question screen for probable anorexia nervosa or bulimia nervosa.

A score of 2 or more is a positive screen and calls for a specialist eating disorder assessment.

Administration takes under two minutes, which is why the screen survives a full appointment list.

NICE guideline NG69 names SCOFF, but tells clinicians not to use a screening tool as the sole method of deciding.

Sensitivity drops for binge eating disorder and ARFID, so a low score does not close the question.

Pabau turns the five items into a digital form, so the score lands in the patient record on submission.

The SCOFF questionnaire is a five-question screen for probable anorexia nervosa or bulimia nervosa. Score one point per yes. A total of 2 or more is a positive screen, and the patient needs a specialist assessment. The whole screen takes under two minutes to administer.

Eating disorders carry one of the highest mortality rates in psychiatry, and early identification changes the outcome. Plenty of cases still go undetected, because a booked-out appointment leaves no room for a long assessment. Below are the five items, how to score them, and what a low score does not rule out.

What is the SCOFF questionnaire?

The SCOFF questionnaire is a five-item screening instrument for probable anorexia nervosa or bulimia nervosa. Morgan and colleagues published it in 1999, working at St George’s Hospital Medical School in London. They wanted a screen any clinician could remember and run without specialist training.

The acronym stands for the five yes/no questions at the core of the screen. Each letter maps to one question, which is what makes the set easy to recall mid-appointment. Between them, the items cover induced vomiting, loss of control, weight loss, body image distortion, and preoccupation with food.

SCOFF screens rather than diagnoses. A positive result points to the need for a specialist eating disorder assessment, which confirms the diagnosis and shapes the treatment plan.

The five SCOFF questions

Each question scores as either yes (1 point) or no (0 points). Ask all five during the screening conversation and note the patient’s answers as you go. Here are the five validated items:

• S for Sick: Do you make yourself sick because you feel uncomfortably full?
• C for Control: Do you worry you have lost control over how much you eat?
• O for One stone: Have you recently lost more than one stone (14 pounds, or 6.35 kg) in a three-month period?
• F for Fat: Do you believe yourself to be fat when others say you are too thin?
• F for Food: Would you say that food dominates your life?

The phrasing is deliberately plain and conversational. You can adapt the wording slightly to suit the patient in front of you, as long as the substance of each question stays intact. Plain language reduces stigma and encourages honest answers, which matters here because shame and denial often block disclosure.

Scoring and interpreting the result

Scoring is straightforward. Award one point for each yes and zero for each no. The total runs from 0 to 5.

The threshold is a score of 2 or more, which counts as a positive screen and warrants referral for a detailed assessment. In the original 1999 validation study by Morgan et al., that cut-off caught every confirmed case of anorexia nervosa and bulimia nervosa in the sample.

When to screen, and which patients to prioritize

SCOFF is built for primary care, private practice, and community health settings where clinicians already screen for mental health conditions. The main use cases:

• Routine health screening: Run it as part of an annual health check or a new patient assessment
• Unexplained symptoms: Use it when a patient presents with weight loss, gastrointestinal complaints, or fatigue and no clear medical cause
• Mental health follow-up: Screen patients already diagnosed with anxiety, depression, or obsessive-compulsive disorder, which commonly co-occur with eating disorders
• Adolescent and young adult visits: Prioritize 12 to 25 year olds, the peak age of onset
• Pre-treatment assessment: Establish a baseline before prescribing a medication known to affect appetite or weight

UK clinicians should read the guidance carefully before leaning on the score. NICE guideline NG69 names SCOFF as an example of a screening tool. It then recommends against using such a tool as the sole method of deciding whether a patient has an eating disorder. Weight, growth, rapid weight change, and what family members report all belong in the same judgment.

That is a caveat, not a reason to skip the screen. Two minutes of structured questions still surfaces cases that a general conversation misses.

Sensitivity, specificity, and validation evidence

Morgan and colleagues reported 100% sensitivity and 87.5% specificity at a cut-off of 2. Those headline figures come from the original 1999 BMJ paper. The comparison ran 116 women aged 18 to 40 with confirmed anorexia or bulimia nervosa, recruited from a specialist eating disorders clinic. The control group was 96 students aged 18 to 39.

That design matters when you read those numbers. It was a case-control study of known cases against healthy students, not a consecutive sample of primary care patients. Performance in an unselected primary care list is lower, so treat 100% sensitivity as a ceiling rather than an expectation.

Later work confirmed the tool travels. Botella and colleagues pooled 15 studies in the Spanish Journal of Psychology in 2013, covering 882 cases and 4,350 controls. SCOFF also performs in both interview and self-report formats, and validated translations exist in Spanish, Dutch, Italian, and Swedish.

The caveat that matters most: SCOFF was built to detect anorexia nervosa and bulimia nervosa. Sensitivity drops for atypical eating disorders, binge eating disorder, and avoidant/restrictive food intake disorder (ARFID). The table below sets out which presentations a negative screen actually clears.

Limitations and when to refer

No screening tool is perfect. These are the limitations worth holding in mind when you read a SCOFF score:

• Language and literacy: The screen relies on clear verbal or written communication. It can miss cases where a language barrier or a cognitive difficulty gets in the way
• Denial and minimization: Patients underreport out of shame or limited insight. A low score does not rule out an eating disorder when clinical suspicion stays high
• Atypical presentations: Sensitivity is lower for binge eating disorder, ARFID, and eating disorders not otherwise specified (EDNOS)
• Cultural factors: Attitudes toward body image and food vary, so read the answers in the context of the individual patient
• Presence, not severity: SCOFF flags probable eating disorder pathology. It says nothing about severity, chronicity, or medical complications

Where body image distortion dominates and eating behavior looks unremarkable, a body dysmorphia questionnaire is the better fit. That is a different differential, and SCOFF was never built to separate the two.

If the screen comes back at 2 or more, refer to an eating disorder specialist or a mental health service for a full assessment. Do not diagnose or start treatment on a SCOFF score alone. Record the score, the date, and the referral plan in the patient’s notes.

How it compares with EAT-26 and the EDE-Q

Clinicians have alternatives. The EAT-26, or Eating Attitudes Test, runs to 26 items and covers a broader range of eating behaviors and attitudes. It gives more detail and takes longer. The EDE-Q, or Eating Disorder Examination Questionnaire, is a 28-item gold-standard assessment used mainly after diagnosis rather than for screening.

SCOFF wins on brevity, and brevity is what gets a tool used. In a booked-out practice, a five-question screen that takes two minutes gets run far more consistently than a 26-item questionnaire. That is why it stays the sensible first-line screen for probable eating disorders in general practice and community health.

How Pabau captures and acts on a SCOFF score

Most practices still run SCOFF on paper. Someone prints the five questions, the patient ticks yes or no, and a clinician adds up the total by hand. The sheet then sits in a folder, away from the record it belongs to.

Practice management software like Pabau closes that loop. The five items become a digital patient intake form the patient completes before the appointment, and every answer lands in their record on submission. So you can open the notes and see the score without hunting for a printout.

From there, our software for therapy practices handles the follow-up. A positive screen can trigger an automated reminder and a booked follow-up appointment, so the referral does not depend on someone remembering it. Practically, that means:

• The score reaches the next clinician: It sits in the patient record, not in a filing cabinet
• Follow-up is automated: A positive screen can fire a reminder and a booked appointment
• Documentation is dated: The screen, the score, and what happened next are all timestamped
• No rekeying: The patient’s own responses are the record

Every Pabau subscription includes digital forms, automations, and reporting, so none of this sits behind a higher tier. New practices get structured onboarding to set the forms up properly before they go live.

Turn SCOFF into a form that files itself

Pabau captures the five SCOFF responses in a digital intake form, files the score against the patient record, and can trigger the referral follow-up automatically. Your team stops chasing paper and rekeying totals.

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Conclusion

SCOFF earns its place because it is short enough to get used. That is its advantage over the EAT-26 and the EDE-Q. It is also why the score works better as a prompt than as an answer.

So treat a 2 as a referral trigger and a 0 as an open question. Take the eating history anyway when the clinical picture points that way, and write down what you asked and what you did about it.

The screen takes two minutes. The follow-up is where it usually breaks down. Book a demo to see how Pabau scores the form, flags a positive result, and files it against the patient record.

Continue your research

Worried SCOFF is missing something? SCOFF has lower sensitivity for binge eating disorder. The binge eating disorder questionnaire gives clinicians a dedicated screen for the presentation SCOFF is weakest on.

Screening a mental health caseload? Anxiety and depression commonly sit alongside eating disorders. The PHQ-9 and GAD-7 template covers both in one pass.

Supporting a patient after diagnosis? The eating disorder worksheets give therapists structured exercises to use in ongoing recovery work.

Frequently asked questions