No online quiz can diagnose an eating disorder, but validated screening tools used by doctors can tell you whether your relationship with food, weight, and eating warrants professional evaluation. Two of the most widely used screens take less than five minutes, and answering “yes” to just two out of five questions on either one is enough to flag a problem. Here’s what those tools ask, what the warning signs look like, and what a professional assessment actually involves.
The SCOFF: Five Questions Doctors Use
The SCOFF questionnaire is the most studied eating disorder screening tool in the world. It gets its name from the first letter of each key word in its five questions:
- S: Do you make yourself Sick because you feel uncomfortably full?
- C : Do you worry you have lost Control over how much you eat?
- O : Have you recently lost more than One stone (14 pounds) in a 3-month period?
- F : Do you believe yourself to be Fat when others say you are too thin?
- F : Would you say that Food dominates your life?
Each “yes” counts as one point. A score of 2 or more suggests a likely eating disorder and means you should seek a full evaluation. In the original validation study, this two-point threshold caught 100% of cases of anorexia and bulimia. A large meta-analysis later found the SCOFF has an overall sensitivity of 86% and specificity of 83%, meaning it correctly identifies most people who have an eating disorder and correctly clears most people who don’t.
The ESP: Four Questions That Rule It Out
The Eating Disorder Screen for Primary Care (ESP) takes a slightly different angle. Its four scored questions are:
- Are you satisfied with your eating patterns? (A “no” is the abnormal response here.)
- Do you ever eat in secret?
- Does your weight affect the way you feel about yourself?
- Do you currently suffer with, or have you ever suffered in the past with, an eating disorder?
Three or more abnormal responses strongly suggest an eating disorder. One or zero abnormal responses effectively rules one out. In a head-to-head comparison, the ESP was better than the SCOFF at ruling out an eating disorder (100% sensitivity at a cutoff of two abnormal answers, compared to 78% for the SCOFF). If you answer these four questions honestly and only one or none applies to you, the likelihood that you have a clinical eating disorder is extremely low.
The EAT-26: A Deeper Self-Assessment
If you want something more detailed, the Eating Attitudes Test (EAT-26) is a 26-item questionnaire you can find online. It measures three dimensions of your eating behavior: dieting habits, preoccupation with food and urges to binge or purge, and the degree to which you control your food intake. Each item is scored on a six-point scale. A total score of 20 or above indicates disordered eating tendencies that need clinical follow-up. The EAT-26 picks up a wider range of problems than the shorter screens, including patterns that don’t fit neatly into one diagnosis.
Behavioral Warning Signs to Watch For
Screening tools ask direct questions, but eating disorders also show up in daily habits you might not connect to a diagnosis. Common behavioral red flags include:
- Eating only a narrow list of “safe” foods, typically low-fat or low-calorie options
- Cooking elaborate meals for others but not eating them yourself
- Avoiding eating in public or around other people
- Rigid rituals around meals, like cutting food into tiny pieces or spitting food out after chewing
- Exercising compulsively, including through injury, or at an intensity that’s notably different from those around you
- Withdrawing socially, especially from situations that involve food
- Eating in secret or hiding food wrappers
None of these behaviors alone confirms a diagnosis, but if several feel familiar, that pattern matters more than any single habit.
Physical Signs Your Body May Show
Eating disorders leave physical traces even when the behavioral signs are hidden. A resting heart rate that’s unusually slow, dizziness when standing up, and feeling cold all the time are among the most common cardiovascular effects of severe restriction. Some people develop fine, downy hair on their face and along their spine, which is the body’s attempt to conserve heat, not a hormonal change. Frequent vomiting erodes tooth enamel over time and can cause swollen glands along the jawline. Menstrual periods often become irregular or stop entirely.
Electrolyte imbalances from purging, laxative use, or extreme restriction can cause muscle cramps, heart palpitations, and fatigue. Low potassium levels in particular can become dangerous, affecting heart rhythm. These physical changes can develop gradually enough that you normalize them, so recognizing them as warning signs is important.
The Main Types of Eating Disorders
Eating disorders aren’t limited to the stereotypes most people picture. The three most recognized types each have distinct patterns.
Anorexia Nervosa
Characterized by restricting food intake to the point of significantly low body weight, an intense fear of gaining weight, and a distorted perception of your own body. People with anorexia often genuinely cannot see how thin they are, or they acknowledge it intellectually but don’t feel alarmed by it.
Bulimia Nervosa
Involves repeated episodes of eating a large amount of food in a short period (typically within two hours) while feeling unable to stop, followed by behaviors to compensate: self-induced vomiting, laxative misuse, fasting, or excessive exercise. A person with bulimia may be at a normal weight or even above it, which can make the disorder invisible to others. Self-worth is heavily tied to body shape and weight.
Binge Eating Disorder
The most common eating disorder. It shares the binge episodes of bulimia, eating rapidly, past the point of fullness, when not hungry, often alone out of embarrassment, but without the compensatory purging. What distinguishes it clinically is the significant distress that follows: disgust, depression, or guilt after a binge. This is not the same as occasionally overeating at a holiday meal.
ARFID
Avoidant/Restrictive Food Intake Disorder looks nothing like the others. There’s no fear of weight gain or body image distortion. Instead, a person with ARFID eats an extremely limited variety or volume of food, sometimes due to sensory sensitivities to texture or taste, sometimes triggered by a fear of choking or vomiting. It leads to weight loss, nutritional deficiencies, or significant interference with daily life. ARFID is common in children but affects adults too.
What a Professional Evaluation Looks Like
If a screening tool flags you, the next step is seeing a provider who can do a full assessment. This typically involves a conversation about your eating behaviors, thoughts about food and your body, and your emotional state, combined with a physical exam and blood work.
Standard lab tests include a complete blood count and a comprehensive metabolic panel checking your electrolytes, kidney function, and blood sugar. Low potassium, low sodium, and low blood sugar are all common findings. If your periods have stopped or you’re showing signs of hormonal disruption, thyroid and reproductive hormone levels may be checked. In people who have been underweight for a prolonged period, a bone density scan can assess whether bone loss has occurred.
An EKG is typically ordered if there’s a very slow heart rate, fainting episodes, or abnormal electrolytes, because eating disorders can cause heart rhythm changes that carry real risk. These tests aren’t designed to prove or disprove an eating disorder on their own. They assess how much medical impact the disorder has already had and guide the urgency of treatment.
Why Screening Tools Have Limits
The SCOFF, ESP, and EAT-26 are designed to cast a wide net. They’re good at catching problems, but they also flag some people who don’t have a clinical eating disorder, particularly those going through temporary stress or dietary changes. A positive screen is a signal, not a sentence. It means the next step is a thorough evaluation with a professional who specializes in eating disorders, where context, history, and clinical judgment fill in what a five-question tool cannot.
Eating disorders also look different across ages, genders, and body sizes. They affect roughly 2% to 7% of women at some point in their lives, with lower but real rates in men. They occur at every weight. Waiting until you “look sick enough” to seek help is one of the most common and most dangerous reasons people delay getting evaluated.