Detection of bulimia in a primary care setting

To develop a screening tool for the identification of bulimia in ambulatory practice.

Administration of a 112-item questionnaire about eating and weight-control practices to women with known bulimia and to healthy control patients. Questions were compared with DSM-III-R criteria of bulimia as a "gold standard."

Self-help group for eating disorders and hospital-based primary care practice.

Thirty of 42 women with known bulimia met DSM-III-R criteria for current bulimia, and 124 of 130 control patients met the criterion of no history of an eating disorder.

Thirteen individual questions discriminated between bulimic subjects and control subjects with a sensitivity and specificity of > 75%. When these questions were entered into a stepwise logistic model, two questions were independently significant. A "no" response to the question "Are you satisfied with your eating patterns?" or a "yes" response to "Do you ever eat in secret?" had a sensitivity of 1.00 and a specificity of 0.90 for bulimia. The positive predictive value, based on a 5% prevalence, was 0.36.

A set of two questions may be as effective as a more extensive questionnaire in identifying women with eating disorders, and could be easily incorporated into the routine medical history obtained from all women.