Gastrointestinal Symptom-Specific Anxiety Predicts Positive SCOFF Screens in Adults With Hypermobile Ehlers-Danlos...

The Sick, Control, One, Fat, Food (SCOFF) is a questionnaire that screens for risk of eating disorders. Some symptoms and psychological factors associated with disorders of gut-brain interaction (DGBI) may resemble the features of eating disorders, potentially overestimating the risk of eating disorders in populations with high DGBI prevalence such as those with Hypermobile Ehlers-Danlos syndrome/hypermobility spectrum disorder (hEDS/HSD). This study aimed to identify factors associated with screening positive on SCOFF among adult with hEDS/HSD to explore the questionnaire's suitability for this population.

A secondary analysis of data from 670 adults with hEDS/HSD recruited from Ehlers-Danlos Support UK and tertiary Neurogastroenterology. χ² tests and logistic regression were used to examine factors associated with positive SCOFF screening result and positive responses to individual SCOFF questions.

DGBI presence did not predict a positive SCOFF screen. However, high gastrointestinal symptom-specific anxiety (GSA) (AOR: 3.19, p < 0.001), fear of aversive consequences from eating (AOR: 1.97, p = 0.013), and anxiety (AOR = 2.53, p < 0.001) were significant predictors. Notably, high GSA strongly predicted a positive response to questions two (Do you worry you have lost Control over how much you eat?) and five (Would you say that Food dominates your life?) (Q2 AOR = 2.58, p = 0.006, Q5 AOR = 5.98, p < 0.001).

In hEDS/HSD, high GSA strongly predicted a positive SCOFF screening outcome, suggesting that SCOFF's questions might detect behaviors associated with worries around GI symptoms rather than an eating disorder. Positive screens in this population should be interpreted with caution and accompanied by GSA-focused assessments to enhance biopsychosocial management.