CPG for Eating Disorders

Spanish versionThere is an adapted Spanish version that has been validated in our setting by GarcíaCampayo J, et al., 2004 162 for early detection of eating disorders in primary care (women agedbetween 14 and 55 years with a cut-off point of 2 or more); sensitivity was 98% [95% CI: 93.5 to99.5] and specificity was 94% [95% CI: 86.4% to 98.5%]. For each specific eating disorder,sensitivities for 94% specificity were as follows: BN, 98%; AN, 93%; and EDNOS, 100%.Limitations relating to the adaptation of item 1 have been identified. It is recommended toreview these aspects before administering the Spanish version of SCOFF.A Catalan version has also been adapted and validated in our setting (SCOFF-c) by Muro-Sans P, et al., 2008 in a community sample comprised of Spanish adolescents (51% males and49% females; mean age=14 years; SD=1.31) 163 . In this study sensitivity was 73% (95% CI: 63.2to 82.9) and specificity was 94% (95% CI: 74.9 to 80.5). One of the possible reasons for lowsensitivity is sample characteristics (Barcelona youth who were recruited in PC).Of the numerous eating disorder screening questionnaires, results indicate the SCOFFsurvey can be a useful questionnaire given that it enables quick and easy primary care detectionof eating disorder risk groups in the community 164 . The SCOFF survey has been adopted as thestandard screening instrument in the UK 30 . Its characteristics also seem useful in monitoring thecourse of treatment (See Chapter 10, “Assessment”).EATEating Attitudes Test. DM Garner and PE Garfinkel, 1979.The EAT was designed for the assessment of disordered eating attitudes, especially those relatedwith fear of gaining weight, the impulse to lose weight and the presence of restrictive eatingpatterns. Its intention was to devise an instrument that was easy to use and easy to correct andthat was sensitive to symptomatic changes throughout time. The EAT is a self-report toolcomprised of 40 items (EAT-40). Each item is valued in a 6-point Likert scale that ranges from“never” to “always”. Scores range from 0 to 120. It is a valid and reliable questionnaire that hasbeen widely used in the assessment of eating disorders. With the 30 point or more cut-off pointin a group of AN patients and a control group, sensitivity was 100% and specificity was 84.7%,with a PPV of 78.5% and a false-positive rate of 9.8% 165 .Other studies had revealed that the EAT test can be useful for the detection of AN casesthat have not been previously diagnosed or to identify current or incipient cases of AN in highrisk populations (ballerinas, model trainees, for example) with sensitivities, specificities andPPVs that range between 75% and 91.7%, 66.1% to 75% and 16% to 18.8%, respectively, withfalse-positive rates between 23.2% and 31.7% 97 . Of all the different instruments that have beendeveloped since the 70s up until today, the EAT-40 has been the most widely endorsed for thedetection of eating disorders in the general population, and it is an instrument that seems valid toidentify current or incipient cases of AN and BN, given its easy application, high reliability,sensitivity and transcultural validity.CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS64