DETECTION OF BULIMIA IN A PRIMARY-CARE SETTING

Objective: To develop a screening tool for the identification of bulimia in ambulatory practice. Design: 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.'' Setting: Self-help group for eating disorders and hospital-based primary care practice. Subjects: 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. Main results: 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. Conclusions: 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.