Eating disorders are recognised by behaviour, cognition and physiology — never by the number on the scale. Name the presentation in six people the stereotype would walk straight past, and watch the panel on the right pull body size and physiological danger apart. Then run a SCOFF screen and find out what a negative screen still does not rule out.
Six people, one question each
Each person below is someone a busy clinic would be at risk of missing. Read the presentation and choose the one that fits. If you are wrong the panel tells you which criterion you skipped, and you can choose again.
What actually decided it
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Named
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First try
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Medically unstable
Name a presentation and it appears here with two facts side by side: what this person’s body size is, and what their physiology is doing.
Watch the two columns. Body size and danger are recorded separately for a reason. By the time you have named all six, the gold pill and the red pill will have stopped agreeing with each other.
SCOFF — five questions, under a minute
Tick each question this person answers yes to. Two or more affirmative answers warrants a full assessment.
How you ask decides what you learn
Open with function, not food: Tell me what a usual day of eating looks like for you, from waking up. Then name the behaviours without euphemism, because vague questions get vague answers: Some people vomit after eating, or use laxatives, diet pills or extra exercise to manage weight. Have you done any of those? Saying it matter-of-factly signals you have heard it before and will not react with disgust. Then ask the question the team often forgets while it is watching the potassium: Are you having thoughts of killing yourself?