Screening for Eating Disorders
Overview
Other Names
- Anorexia nervosa (AN)
- Avoidant restrictive food intake disorder (ARFID)
- Binge-eating disorder (BED)
- Bulimia Nervosa (BN)
ICD-10 Coding
- Z13.21, Encounter for screening for nutritional disorder
- F50.9, Eating disorder, unspecified
- 96160, Instrument-based health risk assessment (e.g., mini-nutritional assessment, HEADDSSS questionnaires)
- 96127, Instrument-based assessment of potential emotional or behavioral conditions (e.g., depression screen)
Prevalence
Pearls & Alerts
Any concern expressed by a parent or caregiver about a child’s eating behaviors, weight, or shape should heighten concern for a possible eating disorder (current or future). Always assess for suicidality in youth with eating disorders. [Medical: 2016]
While routine screening for depression and suicidality is recommended at all preventive care visits for youth ages 12-18, [Siu: 2016] suicide rates are increased in patients with eating disorders. [Hornberger: 2021] Consider more frequent screening and vigilance when an eating disorder is suspected or diagnosed.
Importance of Recognition
Warning Signs of Eating Disorders
- Excessive or rapid weight gain or loss
- Failure to achieve or maintain appropriate increases in weight or height
- Notable fluctuations in weight
- Bradycardia or arrhythmia
- Chest pain
- Palpitations
- Orthostatic tachycardia or hypotension
- Shortness of breath
- Edema in the extremities
- Cardiac murmur
- Abdominal and/or epigastric pain
- Bloating
- Early satiety
- Gastroesophageal Reflux Disease
- Vomiting or hematemesis
- Constipation
- Hemorrhoids or rectal prolapse
- Brittle or thinning hair or nails, or hair loss,
- Dry, sallow skin
- Lanugo
- Carotenemia or carotenoderma (appearing orange),
- Calloused knuckles
- Poor wound healing
- Bruising on the spine from excessive exercise
- Dental erosions or caries
- Palatal abrasions
- Aphthous ulcers
- Angular stomatitis
- Sialoadenitis or parotid gland enlargement
- Orthostatic changes/dizziness or Syncope
- Weakness
- Memory loss
- Seizures/Epilepsy
- Hypothermia/cold extremities or cold intolerance
- Hot flashes or sweating episodes
- Stress fractures or low bone mineral density
- Primary or secondary amenorrhea or oligomenorrhea
- Excessive concern about weight or body image
- Inappropriate dieting, including rigidity about types or quality of foods
- Compulsive exercising
- Fatigue
- Insomnia
- Self-injurious Behavior or Suicidality
- Depression
- Anxiety Disorders
- Obsessive-compulsive features
- Attention problems
Screens for Eating Disorders
Eating Disorders Screening Tool (NEDA)
- Ages: 13 and older [Mairs: 2016]
- Languages: English
- Sensitivity/specificity: Likely high. 86% of NEDA’s self-selected online participants screened positive, among mostly adult respondents. NEDA’s tool is adapted from the Stanford-Washington University Eating Disorder Screen supported by grant funding from the National Institute of Mental Health (R01 MH081125 and R01 MH100455). Question 19 is from the Primary Health Questionnaire (PHQ-9). The Stanford-Washington tool had >0.90 sensitivity and specificity for most eating disorders. [Wilfley: 2013]
- Scoring: Automated
Eating Attitudes Test (EAT-26)
- Ages: 13 and older [Mairs: 2016]
- Languages: many versions
- Sensitivity/specificity: unclear in pediatric population. An Irish study suggests using a shorter version, the EAT-18, for improved validity in adolescents. [McEnery: 2016]
- Scoring: Referral is advised for a total score ≥20, any positive responses in Part C, or “extremely low” body weight compared to age-matched norms. The cutoff score of 20 for the 26-question ChEAT20 is also commonly used.
Eating Disorder Screen for Primary Care (ESP)
- Are you satisfied with your eating patterns? (A “no” to this question was classified as an abnormal response).
- Do you ever eat in secret? (A “yes” to this and all other questions was classified as an abnormal response).
- Does your weight affect the way you feel about yourself?
- Have any members of your family suffered from an eating disorder?
- Do you currently suffer with or have you ever suffered in the past with an eating disorder?
- Ages: Normed in a broad range of ages, including a small number of adolescents
- Languages: English
- Sensitivity/specificity: 100%/71% from a validation study combining a primary care population with a somewhat higher-risk population of university students [Cotton: 2003]
- Scoring: 3 or more abnormal responses are considered a positive screen for an eating disorder
Patient Health Questionnaires (PHQ)
- Ages: Adults (extrapolated for use in children and adolescents)
- Languages: More than 20
- Sensitivity/specificity: 89%/96% [Striegel-Moore: 2010]
- Scoring: Bulimia nervosa is suspected with a positive response to questions 6A, 6B, 6C, and 8; binge eating disorder if positive response to questions 6A, 6B, 6C, but negative or blank question 8.
The Sick, Control, One, Fat & Food (SCOFF) Questionnaire
- Do you make yourself Sick because you feel uncomfortably full?
- Do you worry you have lost control over how much you eat?
- Have you recently lost more than 14 lb (6.3 kg or One stone) in a 3-month period?
- Do you believe yourself to be Fat when others say you are too thin?
- Would you say that Food dominates your life?
- Ages: Adults (extrapolated for use in adolescents)
- Languages: Translated into many languages for different studies
- Sensitivity/specificity: A 2017 multi-ethnic study in London found 54%/94%, suboptimal for a general population screen. [Solmi: 2015] Prior to that, the SCOFF was found to have 85%/90% relatively in a relatively homogeneous primary care setting in London (not pediatric-specific). [Hill: 2010]
- Scoring: One point should be given for every “yes” answer; a score of 2 or higher indicates a likelihood of an eating disorder. A cutoff point of 2 is advised.

Children’s Eating Disorder Examination-Questionnaire (ChEDE-Q8)
- Ages: Best for 8-14 yrs, but studied in ages 7-18
- Language: German, English (the versions vary slightly)
- Sensitivity/specificity: N/A. strong initial validation study.
- Scoring: Scoring is 0-6 for each question. The article provides a table by age and sex to determine cutoff percentiles. >=90%ile considered a critical result.

Adolescent Binge Eating Questionnaire (ADO-BED)
- Ages: 12-18 years
- Languages: English
- Sensitivity/specificity: 83%/96%
- Scoring: A positive response to questions 1 or 2 plus more than 6 positive responses to questions 3-10 identifies those at high risk for BED; a score of 3 or fewer indicates a low likelihood of BED.

What to Do with a Positive Screen
- Check CBC, CMP, and electrocardiogram (ECG) in all. See
Eating Disorders: A Guide to Medical Care (
364 KB).
- Selective use of the following tests: leptin level, TSH and T4, amylase and lipase, gonadotropins (LH, FSH) and sex steroids (estradiol, testosterone), Dual Energy X-ray Absorptiometry (DEXA).
- Consider performing a longer diagnostic evaluation using the Eating Disorders Examination (EDE) (see Eating Disorders: Diagnostic Measures (E-CBT)) which is validated in adults and children down to age 9 (considered the gold standard for diagnosis), or a modified version, the children’s EDE (also see Eating Disorders: Diagnostic Measures (E-CBT)), which can be used for younger children down to age 8.
- Consider hospitalization and/or referral to a multidisciplinary eating disorders program; these usually include some or all of the following: psychiatrist, family therapist, psychologist, pediatrician, nurse, dietician, and other therapists.
- Evaluate for comorbid conditions such as depression, anxiety, or obsessive-compulsive disorder. • Consider symptom-based referrals to a pediatric cardiologist, endocrinologist, psychiatrist, behavioral health specialist, and/or pediatric gynecologist.
- For adolescents with anorexia nervosa, consider referral for family-based treatment; these patients may be less responsive to antidepressants. [Harrington: 2015]
- For adolescents with bulimia nervosa, refer for short-term psychotherapy (e.g., cognitive behavior therapy) and consider antidepressant medications. [Harrington: 2015]
Referral Information

Refer for difficult-to-manage behavioral problems or consultation on pharmacological management.
Refer to a registered dietician (nutritionist) for implementing a nutritional treatment plan, guidance on healthy diet and exercise, discussing behaviors related to food and eating.
Refer for ongoing monitoring and treatment of mental health issues, cognitive behavioral therapy, family therapy, and support.
Refer for digestive system consequences of disordered eating behaviors
Refer for menstrual dysfunction (delayed menarche, oligomenorrhea, and amenorrhea)
Refer for evaluation and management of the athletes with low energy availability, bone mineral loss, and (when relevant) menstrual dysfunction
Refer for bone health issues (e.g., stress fractures)
Refer for growth and menstrual disturbance and concurrent conditions (e.g., thyroid disease or osteopenia/osteoporosis. See Osteoporosis and Pathologic Fractures).
Refer for medical care and emotional issues of teens.
Refer for medical and emotional issues of children, adolescents, and their families, and for assistance in diagnosing suspected neurodevelopmental disorders like autism spectrum disorder.
Resources
Information & Support
For Professionals
National Eating Disorders Association (NEDA)
A nonprofit organization dedicated to supporting individuals and families affected by eating disorders. Serves as a catalyst
for prevention, cures, and access to quality care.
Eating Disorders: A Guide to Medical Care ( 364 KB)
A 24-page resource developed to promote recognition and prevention of medical morbidity and mortality associated with eating
disorders, using current research and best practices. 2016/3rd Edition; Academy for Eating Disorders’ Medical Care Standards
Committee.
NICE Guideline: Recognition and Treatment of Eating Disorders
Assessment, treatment, monitoring, and inpatient care for those with eating disorders. Details the most effective treatments
for anorexia nervosa, binge eating disorder, and bulimia nervosa; National Institute for Health and Care Excellence (United
Kingdom).
Disordered Eating Didactic Presentation Slides (MAPP-Net) ( 280 KB)
A 26-minute, Project Echo presentation including medical evaluation, binge eating/purging signs, physical findings, laboratory
abnormalities, admission criteria (SAHM), refeeding syndrome, goal weight, outpatient medical care; Montana Access to Pediatric
Psychiatry Network.
Disordered Eating Didactic Presentation Recording (MAPP-Net)
A Project Echo presentation about the medical evaluation, signs, binge eating/purging signs, physical findings, laboratory
abnormalities, admission criteria (SAHM), refeeding syndrome, goal weight, outpatient medical care. Recorded December 11,
2019. Presenter Adrienne Coopey, DO; Montana Access to Pediatric Psychiatry Network.
Research Roundup with Dr. Lewis First, Clinical Report on Eating Disorders (AAP)
This 33-minute podcast from the Pediatrics On Call series discusses highlights of the American Academy of Pediatrics (AAP)'s
Committee on Adolescence 2021 clinical report on Eating Disorders. Aired on Feb. 2, 2021.
For Parents and Patients
National Eating Disorders Association (NEDA)
A nonprofit organization dedicated to supporting individuals and families affected by eating disorders. Serves as a catalyst
for prevention, cures, and access to quality care.
Energy In: Recommended Food & Drink Amounts for Children (HealthyChildren.org)
This pediatrician-approved resource provides information about calorie needs and recommended food group servings and links
to more information about portion sizes.
Practice Guidelines
Hornberger LL, Lane MA.
Identification and Management of Eating Disorders in Children and Adolescents.
Pediatrics.
2021;147(1).
PubMed abstract
This clinical report includes a review of common eating disorders diagnosed in children and adolescents, outlines the medical
evaluation of patients suspected of having an eating disorder, presents an overview of treatment strategies, and highlights
opportunities for advocacy; Committee on Adolescence, American Academy of Pediatrics.
Lock J, La Via MC.
Practice parameter for the assessment and treatment of children and adolescents with eating disorders.
J Am Acad Child Adolesc Psychiatry.
2015;54(5):412-25.
PubMed abstract
This practice parameter from the American Academy of Child and Adolescent Psychiatry reviews evidence-based practices for
the evaluation and treatment of eating disorders in children and adolescents.
Patient Education
Eating Disorders: About More Than Food (NIMH)
Patient education about eating disorders that can be printed as a PDF; National Institute of Mental Health.
Eating Disorders: Conversation Tips for Friends & Family ( 129 KB)
2-page printable handout explaining how and how not to talk about suspected eating disorders; Intermountain Healthcare.
What Is an Eating Disorder? (NEDA brochure)
2-page colorful, printable brochure (8.5 x 14') explaining eating disorders and how to seek help; National Eating Disorders
Association.
Tools
Adolescent Binge Eating Scale (ADO-BED) Questionnaire ( 268 KB)
10-question screen developed to identify obese adolescents at risk for binge eating disorder (BED)
Children’s Eating Disorder Examination-Questionnaire (ChEDE-Q8) ( 17 KB)
An 8-item self-report to screen for anorexia nervosa, bulimia nervosa, and binge‐eating disorder in children ages 12-18.
Dietary Reference Intake Calculator for Healthcare Professionals (USDA)
Calculates daily nutrient recommendations based established by the Health and Medicine Division of the National Academies
of Sciences, Engineering and Medicine. Represents the current scientific knowledge; however, individual requirements may be
higher or lower than recommendations. Entering height, weight, age, and activity level generates BMI, estimated daily calorie
needs, and recommended intakes of macronutrients, vitamins, and minerals based on DRI data. For use with ages 3 and older;
US Dept. of Agriculture.
Eating Attitudes Test (EAT-26, EAT-40)
26 or 40 question screeners to assess, risk of disordered eating based on behaviors and thoughts. The website uses the EAT
score in combination with BMI and patterns of recent weight loss to recommend need for further evaluation. Free but requires
permission to reproduce link or download.
Eating Disorders Screening Tool (NEDA)
Online, self-reported questionnaire for those 13 years and older with approximately 20 questions, taking <5 minutes to complete.
Upon completion, the site indicates level of risk and offers next steps; National Eating Disorders Association.
Management of Eating Disorders Care Process Model (Intermountain) ()
This care process model (CPM) and accompanying patient education were developed by a multidisciplinary team including primary
care physicians (PCPs), mental health specialists, registered dietitians, and eating disorder specialists, under the leadership
of Intermountain Healthcare’s Behavioral Health Clinical Program. Based on national guidelines and emerging evidence and shaped
by local expert opinion, this CPM provides practical strategies for early recognition, diagnosis, and effective treatment
of anorexia nervosa, bulimia nervosa, binge-eating disorder, and other eating disorders.
Patient Health Questionnaire (PHQ) Screeners
Free screening tools in many languages with scoring instructions to be used by clinicians to help detect mental health disorders.
Select from right menu: PHQ, PHQ-9, GAD-7, PHQ-15, PHQ-SADS, Brief PHQ, PHQ-4, PHQ-8.
The SCOFF: A Quick Assessment for Eating Concerns ( 234 KB)
A 5-question screen developed for primary care clinicians to screen for eating problems.
Services for Patients & Families in Rhode Island (RI)
Service Categories | # of providers* in: | RI | NW | Other states (5) (show) | | ID | MT | NM | NV | UT |
---|---|---|---|---|---|---|---|---|---|---|
Adolescent Medicine | 6 | 1 | 2 | 8 | 1 | 2 | 2 | |||
Developmental - Behavioral Pediatrics | 11 | 1 | 2 | 8 | 2 | 3 | 8 | |||
Food & Nutrition | 27 | 6 | 333 | 191 | 225 | 308 | 240 | |||
Mental Health/Counseling | 234 | 47 | 493 | 301 | 844 | 783 | 1056 | |||
Obstetrics & Gynecology | 4 | 14 | 74 | 63 | ||||||
Pediatric Endocrinology | 13 | 1 | 2 | 15 | 29 | 6 | 4 | |||
Pediatric Gastroenterology | 19 | 1 | 3 | 16 | 8 | 6 | 4 | |||
Pediatric Orthopedics | 12 | 2 | 4 | 14 | 13 | 6 | 19 | |||
Pediatric Sports Medicine | 5 | 2 | 2 | 4 | 5 | 2 | 4 | |||
Psychiatry | 85 | 44 | 21 | 22 | 107 | 89 |
For services not listed above, browse our Services categories or search our database.
* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.
Helpful Articles
Harrington BC, Jimerson M, Haxton C, Jimerson DC.
Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa.
Am Fam Physician.
2015;91(1):46-52.
PubMed abstract
Recommendations for primary care clinicians on anorexia and bulimia, based on DSM-5 diagnostic criteria. Includes information
relevant for adolescents and adults.
Herpertz-Dahlmann B.
Adolescent eating disorders: update on definitions, symptomatology, epidemiology, and comorbidity.
Child Adolesc Psychiatr Clin N Am.
2015;24(1):177-96.
PubMed abstract
This article aims to convey basic knowledge on these frequent and disabling disorders, and to review new developments in classification
issues resulting from the transition to DSM-5.
Brigham KS, Manzo LD, Eddy KT, Thomas JJ.
Evaluation and Treatment of Avoidant/Restrictive Food Intake Disorder (ARFID) in Adolescents.
Curr Pediatr Rep.
2018;6(2):107-113.
PubMed abstract / Full Text
Information for pediatricians should be aware of the diagnostic criteria and management of adolescent patients with ARFID.
Heckathorn DE, Speyer R, Taylor J, Cordier R.
Systematic Review: Non-Instrumental Swallowing and Feeding Assessments in Pediatrics.
Dysphagia.
2016;31(1):1-23.
PubMed abstract
A study to identify and report on non-instrumental assessments available to clinicians for pediatric swallowing and/or feeding
function in order to support clinical decision making.
Page Bibliography
Colton PA, Olmsted MP, Rodin GM.
Eating disturbances in a school population of preteen girls: assessment and screening.
Int J Eat Disord.
2007;40(5):435-40.
PubMed abstract
Study assessed the utility of the Children's Eating Attitudes Test (cEAT) questionnaire in screening for interview-ascertained
eating disturbances but found that t cEAT was not an efficient screening tool for interview-ascertained mild eating disturbances
in preteen girls.
Cotton MA, Ball C, Robinson P.
Four simple questions can help screen for eating disorders.
J Gen Intern Med.
2003;18(1):53-6.
PubMed abstract / Full Text
A study comparing the performance characteristics of 2 eating disorder screening tools, the SCOFF clinical prediction guide,
and a new set of questions, the Eating disorder Screen for Primary care (ESP).
Goldschmidt AB, Doyle AC, Wilfley DE.
Assessment of binge eating in overweight youth using a questionnaire version of the Child Eating Disorder Examination with
Instructions.
Int J Eat Disord.
2007;40(5):460-7.
PubMed abstract / Full Text
A study validating the Youth Eating Disorder Examination-Questionnaire (YEDE-Q), a self-report version of the Child Eating
Disorder Examination (ChEDE), to assess the spectrum of ED psychopathology in youth.
Harrington BC, Jimerson M, Haxton C, Jimerson DC.
Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa.
Am Fam Physician.
2015;91(1):46-52.
PubMed abstract
Recommendations for primary care clinicians on anorexia and bulimia, based on DSM-5 diagnostic criteria. Includes information
relevant for adolescents and adults.
Herpertz-Dahlmann B.
Adolescent eating disorders: update on definitions, symptomatology, epidemiology, and comorbidity.
Child Adolesc Psychiatr Clin N Am.
2015;24(1):177-96.
PubMed abstract
This article aims to convey basic knowledge on these frequent and disabling disorders, and to review new developments in classification
issues resulting from the transition to DSM-5.
Hill LS, Reid F, Morgan JF, Lacey JH.
SCOFF, the development of an eating disorder screening questionnaire.
Int J Eat Disord.
2010;43(4):344-51.
PubMed abstract
This article describes the three-stage development of the SCOFF, a screening tool for eating disorders.
Hornberger LL, Lane MA.
Identification and Management of Eating Disorders in Children and Adolescents.
Pediatrics.
2021;147(1).
PubMed abstract
This clinical report includes a review of common eating disorders diagnosed in children and adolescents, outlines the medical
evaluation of patients suspected of having an eating disorder, presents an overview of treatment strategies, and highlights
opportunities for advocacy; Committee on Adolescence, American Academy of Pediatrics.
Kliem S, Schmidt R, Vogel M, Hiemisch A, Kiess W, Hilbert A.
An 8-item short form of the Eating Disorder Examination-Questionnaire adapted for children (ChEDE-Q8).
Int J Eat Disord.
2017;50(6):679-686.
PubMed abstract
A psychometric evaluation of a short form of the child version of the Eating Disorder Examination (ChEDE‐Q) to provide a valid
self‐report assessment of eating disorder psychopathology in children.
Lock J, La Via MC.
Practice parameter for the assessment and treatment of children and adolescents with eating disorders.
J Am Acad Child Adolesc Psychiatry.
2015;54(5):412-25.
PubMed abstract
This practice parameter from the American Academy of Child and Adolescent Psychiatry reviews evidence-based practices for
the evaluation and treatment of eating disorders in children and adolescents.
Mairs R, Nicholls D.
Assessment and treatment of eating disorders in children and adolescents.
Arch Dis Child.
2016;101(12):1168-1175.
PubMed abstract
This review article focuses on the psychiatric assessment and treatment of four feeding or eating disorders: anorexia nervosa,
avoidant-restrictive food intake disorder, bulimia nervosa and binge eating disorder. The article emphasizes the importance
of a family-focused, developmentally appropriate and multidisciplinary approach to care but does not address medical assessment
and treatment.
McEnery F, Fitzgerald A, McNicholas F, Dooley B.
Fit for Purpose, Psychometric Assessment of the Eating Attitudes Test-26 in an Irish Adolescent Sample.
Eat Behav.
2016;23:52-57.
PubMed abstract
This study examined the psychometric properties of the original Eating Attitudes Test-26 (EAT-26) and explained why a revised,
six-factor EAT-18 model may be more suitable for the general adolescent population.
Medical Care Standards Committee.
Eating Disorders: A Guide to Medical Care.
Academy for Eating Disorders.
3rd ed; 2016.
/ https://www.aedweb.org/resources/online-library/publications/medical-c...
Critical Points for Early Recognition & Medical Risk Management in the Care of Individuals with Eating Disorders
Rosen DS.
Identification and management of eating disorders in children and adolescents.
Pediatrics.
2010;126(6):1240-53.
PubMed abstract
This AAP clinical report includes a discussion of diagnostic criteria and outlines the initial evaluation, treatment including
pharmacotherapy, and monitoring of the patient with disordered eating. Reaffirmed Feb 2018
Siu AL.
Screening for Depression in Children and Adolescents: US Preventive Services Task Force Recommendation Statement.
Pediatrics.
2016;137(3):e20154467.
PubMed abstract
Solmi F, Hatch SL, Hotopf M, Treasure J, Micali N.
Validation of the SCOFF questionnaire for eating disorders in a multiethnic general population sample.
Int J Eat Disord.
2015;48(3):312-6.
PubMed abstract / Full Text
A study aimed to validate the SCOFF, an eating disorders (ED) screening questionnaire, in a multi-ethnic general population
sample of adults.
Striegel-Moore RH, Perrin N, DeBar L, Wilson GT, Rosselli F, Kraemer HC.
Screening for binge eating disorders using the Patient Health Questionnaire in a community sample.
Int J Eat Disord.
2010;43(4):337-43.
PubMed abstract / Full Text
Wilfley DE, Agras WS, Taylor CB.
Reducing the burden of eating disorders: a model for population-based prevention and treatment for university and college
campuses.
Int J Eat Disord.
2013;46(5):529-32.
PubMed abstract / Full Text