DETECTION OF BULIMIA IN A PRIMARY-CARE SETTING

Objective: To develop a screening tool for the identification of bulim ia in ambulatory practice. Design: Administration of a 112-item questi onnaire 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-he lp group for eating disorders and hospital-based primary care practice . Subjects: Thirty of 42 women with known bulimia met DSM-III-R criter ia for current bulimia, and 124 of 130 control patients met the criter ion of no history of an eating disorder. Main results: Thirteen indivi dual questions discriminated between bulimic subjects and control subj ects with a sensitivity and specificity of >75%. When these questions were entered into a stepwise logistic model, two questions were indepe ndently significant. A ''no'' response to the question ''Are you satis fied with your eating patterns?'' or a ''yes'' response to ''Do you ev er eat in secret?'' had a sensitivity of 1.00 and a specificity of 0.9 0 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 disor ders, and could be easily incorporated into the routine medical histor y obtained from all women.