A five-question questionnaire may help clinicians identify eating disorder risks more efficiently in young people already being assessed for substance misuse, revealing a cluster of emotional and psychiatric vulnerabilities that often go unnoticed.
A brief five-question questionnaire may offer clinicians and researchers a faster way to spot eating disorder risk in young people who are already being assessed for substance use concerns. A new study in the Journal of Eating Disorders found that the Eating Disorder Screen for Primary Care, or ESP, could identify hidden risk in adolescents and young adults enrolled through substance use research programmes, while also pointing to a clear pattern of emotional and psychiatric distress among those who screened positive.
The findings matter because eating disorders and substance use disorders often appear together, yet eating symptoms are not routinely measured in studies or clinics focused on drugs and alcohol. According to the study led by Emily Giddens at Monash University, with colleagues at the Medical University of South Carolina and the University of Melbourne, that blind spot may leave clinicians missing an important part of the picture, particularly in young people whose difficulties with emotion regulation and impulsive behaviour may drive both types of problems.
The research team looked at 682 participants aged 15 to 25, drawn from 722 assessment visits. Each completed the ESP alongside a wider battery of measures covering emotion regulation, impulsivity, depression, anxiety and substance use. Clinical diagnoses were established with a structured interview, allowing the researchers to test how well the screen worked against a formal diagnostic standard. They found that the traditional ESP cut-off of two or more cast the net too widely in this population, catching many people who did not meet diagnostic criteria. A threshold of three or more gave a more useful balance between sensitivity and specificity.
That adjusted cut-off also revealed a distinctive psychological profile. Young people who screened positive reported more difficulty managing emotions, higher levels of negative urgency, more depressive symptoms and greater anxiety than their peers who did not screen positive. Negative urgency is the tendency to act rashly under emotional strain, and it has previously been linked to both binge eating and substance use. The study also found that the at-risk group used cannabis more often and reported more problems related to cannabis and nicotine, even though they were not heavier alcohol users. That pattern suggests eating disorder risk may cluster with particular substances rather than with substance use in general.
The broader clinical context also points to the need for caution and precision. The US Preventive Services Task Force says current evidence is still insufficient to judge the overall benefits and harms of routine screening for eating disorders in adolescents and adults who do not show obvious signs of illness. Against that backdrop, the new research argues not for blanket screening in every setting, but for targeted use of a very short tool where eating concerns might otherwise go unnoticed, especially in services already seeing young people for substance use.
For clinicians, the practical appeal is obvious: the ESP is quick, low burden and, in this sample, informative enough to guide further assessment. For researchers, it offers a simple way to add eating disorder risk into studies of youth substance use without turning an intake into a lengthy interview. The study’s authors say the results strengthen the case for integrated screening, because the young people most likely to endorse eating disorder risk also appear more burdened by mood symptoms, emotional instability and cannabis and nicotine involvement. In that sense, a one-minute questionnaire may do more than flag disordered eating; it may help identify a broader cluster of vulnerabilities that often travel together.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
