how can you treat what you cannot measure?

I do not think we can make much progress on changing diagnosis, treatment, or public opinion on brain disease unless we can measure it. Although the pursuit of biomarkers for brain illness is progressing, it is still "early days."

I am so glad to see some real analysis of this issue going on out of BYU. The authors of "Towards a physiologically based diagnosis of anorexia nervosa and bulimia nervosa" have identified several empirical methods of diagnosis that do not depend on self-reports.

Among them: leptin, cortisol, insulin, neuropeptide Y, glucose, bone mineral density, free thyroxine, sex hormone binding, hypochloremia, and several others.

As opposed to the SCOFF, EAT, BITE, EDE, BSS, DIET (love these acronyms!) questionnaires - pretty much primers on "how to throw off alarm by your loved ones AND learn about purging methods you hadn't even thought of yet."

Or the most common: "weight."

Without reliable and quantitative measurements, people really don't believe in an illness. Without measurement of sickness there is also no clarity in diagnosis or way to measure recovery or compare treatments.

If you are interested in the full text of the BYU article, email me.


  1. Hello

    I can post from here but not e-mail - well not very easily anyway.
    Yes, I'm interested in receiving the whole article and passing it on.

  2. Slight nitpick-y point: I know that SCOFF and possibly the EAT were designed as screening tools and not as diagnostic tests. Because the SCOFF is quick and easy to administer and fairly sensitive and specific, it's a pretty good tool- especially in older teens and adults.

  3. C,

    You're right, of course. And I'm not scoffing at SCOFF in order to get rid of it. I just think it isn't enough. I've observed that many patients get screened and that's the last measurement they get. None of the clinicians we consulted ever ordered or asked about any other measurement than weight.


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