1) I have eating habits that are different from those
of my family and friends | 1=Often
2=Sometimes
3=Rarely
4=Never |
2) I find myself panicking if I cannot exercise as I planned,
because I am afraid that I will gain weight if I don't. | 1=Often
2=Sometimes
3=Rarely
4=Never |
3) My friends tell me that I am thin, but I don't believe
them because I feel fat. | 1=Often
2-Sometimes
3=Rarely
4=Never |
4) (Females only) My mentrual period has stopped or become
irregular due to no known medical reason. | 1=Often
2-Sometimes
3=Rarely
4=Never |
5) I have become obsessed with food to the point that I
cannot go through a day without worrying about what I will
or will not eat. | 1=Often
2=Sometimes
3=Rarely
4=Never |
6) I have lost more that 15% of what is considered to be
a healthy weight for my height (e.g. female, 5'4 tall loses 20
pounds when a healthy weight for her is approximately 122 lbs.) | 1=Often
2=Sometime
3=Rarely
4=Never |
7) I would panic if I got on the scale tomorrow and found
that I gained two pounds. | 1=Often
2=Sometimes
3=Rarely
4=Never |
8) I find that I prefer to eat alone or when I am sure that no
one will see me, and thus make excuses so that I can eat less
and less often with friends and family. | 1=Often
2=Sometimes
3=Rarely
4=Never |
| 9) I find myself going on uncontrollable eating binges during which I consume large amounts of food to the point that I feel sick and make myself vomit. | 1=Often
2=Less than 1 time per week
3=1-6 times per week
4=1 or more times per day |
| 10) (NOTE: Answer only if your answer to #9 is "1" otherwise leave blank.) I find myself compulsively eating more than I want to while feeling out of control and/or unaware of what I am doing. | 1=Never
2=Less than 1 time per week
3=1-6 times per week
4=1 or more times per day |
| 11) I use laxatives or diuretics as a means of weight control. | 1=Never
2=Rarely
3=Sometimes
4=On a regular basis |
12) I find myself playing games with food (e.g. cutting it up in tiny pieces, hiding food so people will think I ate it, chewing it and spitting
it out without swallowing it, keeping hidden stashes of food). | 1=Often
2=Sometimes
3=Rarely
4=Never |
13) People around me have become very interested in what I eat
and I find myself getting angry at them for pushing me to eat more. | 1=Often
2=Sometimes
3=Rarely
4=Never |
| 14) I have felt more depressed and irritable recently than is typical for me and/or have been spending and increasing amount of time alone. |
1=True
2=False
|
15) I keep a lot of my fears about food and eating to myself
because I am afraid no one would understand. |
1=Often
2=Sometimes
3=Rarely
4=Never
|
16) I enjoy making gourmet and/or high calorie foods for others
long as I don't have to eat any myself. | 1=Often
2=Sometimes
3=Rarely
4=Never |
17) The most powerful fear in my life is the fear of gaining weight
or becoming fat. | 1=Often
2=Sometimes
3=Rarely
4=Never |
18) I exercise a lot (more than 4 times per week and//or more than
4 hours per week) as a means of weight control. | 1=True
2=False |
19) I find myself totally absorbed when reading foods or magazines about dieting, exercising, fitness or calorie counting to the point
that I can spend hours studying them. | 1=Often
2=Sometimes
3=Rarely
4=Never |
20) I tend to be a perfectionist and am not satisfied with myself
unless I do things perfectly. | 1=Almost always
2=Sometimes
3=Rarely
4=Never |
21) I go through long periods of time without eating (fasting) or
eating very little as a means of weight control. | 1=Often
2=Sometimes
3=Rarely
4=Never |
| 22) It is important for me to try to be thinner than all of my friends. | 1=Almost always
2=Sometimes
3=Rarely
4=Never |