Eating Disorder Questionnaire
Only the last four weeks (28 days) are addressed in the following questions. Please take your time to read each question. Please take the time to answer all of the questions. Please select just one response to each question. Thank you very much.
On how many of the previous 28 days have you been?
*
Rows
No days
1-7 days
7-14 days
14-21 days
Almost
Every
day
Have you been consciously attempting to limit your food intake in order to alter your shape or weight (whether or not you have been successful)?
1
2
3
4
5
Have you gone without eating for long periods of time (8 awake hours or more) in order to change your form or weight?
6
7
8
9
10
Have you attempted (and failed) to exclude any items that you enjoy from your diet in order to impact your shape or weight?
11
12
13
14
15
Have you attempted to alter your shape or weight by adhering to certain eating guidelines (for example, a calorie limit) (whether or not you were successful)?
16
17
18
19
20
Have you ever had a strong desire to go to bed on an empty stomach in order to change your form or weight?
21
22
23
24
25
Have you ever wished to have a completely flat stomach?
26
27
28
29
30
Has worrying about food, eating, or calories made it difficult for you to focus on tasks you enjoy (such as working, listening to a conversation, or reading)?
31
32
33
34
35
Has thinking about your form or weight made it difficult for you to focus on something you enjoy (such as working, following a conversation, or reading)?
36
37
38
39
40
Have you ever been afraid about losing control of your eating?
41
42
43
44
45
Have you ever experienced a strong dread of gaining weight?
46
47
48
49
50
Have you ever felt bloated?
51
52
53
54
55
Have you ever felt compelled to lose weight?
56
57
58
59
60
How many days in the last 28 days have you eaten in secret (i.e., clandestinely)?
61
62
63
64
65
How many times have you felt guilty (as if you've done something wrong) after eating because of its impact on your shape or weight?
66
67
68
69
70
How anxious have you been about other people watching you eat in the last 28 days?
71
72
73
74
75
Has your weight had an impact on how you view (consider) yourself as a person?
76
77
78
79
80
Has your physical appearance changed how you view (evaluate) yourself as a person?
81
82
83
84
85
How upset would you have been if you were requested to weigh yourself once a week for the following four weeks (no more, no less)?
86
87
88
89
90
How unsatisfied with your appearance have you been?
91
92
93
94
95
How uneasy have you felt when looking at your body (for example, in the mirror, in a shop window reflection, while undressing or bathing or showering)?
96
97
98
99
100
How many times in the last 28 days have you consumed what others would consider an unusually large amount of food (considering the circumstances)?
*
How many of these occasions did you feel like you had lost control of your eating (during the time you were eating)?
*
How many days in the last 28 days have you had such bouts of overeating (i.e., you've eaten an unusually large amount of food and felt out of control at the time)?
*
How many times in the last 28 days have you made yourself vomit in order to regulate your shape or weight?
*
How many times in the last 28 days have you used laxatives to help you control your shape or weight?
*
How many times in the last 28 days have you exercised in a "driven" or "compulsive" manner to regulate your weight, shape, or quantity of fat, or to burn calories?
*
What is your current weight? (Please estimate as accurately as possible.)
*
What is your current height? (Please estimate as accurately as possible.)
*
For woman, have you missed any menstrual periods in the last three to four months?
Yes
No
How many?
*
Have you been taking the "pill" for a while now?
*
THANK YOU
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