Place
an X in the column which applies best to each of the statements.
1 = always; 2 = very often;
3 = often; 4 = sometimes; 5 = rarely; 6 = never.
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1
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2
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3
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4
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5
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6
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| 1.
Avoid eating with other people |
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| 2.
Cook for others but do not eat what I cook |
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| 3.
Become anxious prior to eating |
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| 4.
Am terrified about being overweight |
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| 5.
Avoid eating when I am hungry |
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| 6.
Find myself preoccupied with food |
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| 7.
Have gone on eating binges where I feel that I may not be
able to stop |
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. |
. |
. |
. |
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| 8.
Cut my food into small pieces |
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| 9.
Aware of the calorie/fat content of foods that I eat |
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| 10.
Particularly avoid foods high in carbohydrates |
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| 11.
Feel bloated after meals |
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| 12.
Feel that others would prefer if I ate more |
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| 13.
Vomit after I have eaten* |
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| 14.
Feel extremely guilty after eating |
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| 15.
Am preoccupied with a desire to be thinner |
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| 16.
Exercise strenuously to burn off calories |
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| 17.
Weigh myself several times a day |
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| 18.
Am uncomfortable if my clothes fit tightly |
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| 19.
Dislike eating a meal |
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| 20.
Wake up early in the morning |
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| 21.
Eat the same foods day after day |
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| 22.
Think about burning up calories when I exercise |
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| 23.
Menstrual periods are irregular or absent |
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| 24.
Other people think that I am too thin |
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| 25.
Am preoccupied about having fat on my body |
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| 26.
Take longer than others to eat my meals |
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| 27.
Avoid/dislike eating in restaurants |
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| 28.
Take laxatives* |
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| 29.
Avoid foods with sugar in the ingredients |
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| 30.
Eat diet foods |
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| 31.
Feel that food controls my life |
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| 32.
Attempt to be in control around food |
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| 33.
Feel that others pressure me to eat |
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| 34.
Suffer from constipation |
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| 35.
Give too much time and thought to food |
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| 36.
Feel uncomfortable after eating sweets |
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| 37.
Engage in dieting behavior |
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| 38.
Like my stomach to be empty |
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| 39.
Avoid trying new rich foods |
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| 40.
Have the impulsive to vomit after meals |
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Score 1 point for each *Often*, 2
points for *Very Often*, and 3 points for *Always*.
30 points indicates an undue preoccupation with food.
60 points indicates a potential problem with an eating disorder
and the need to seek treatment.
80 points indicates a serious problem with an eating disorder.
* We urge
you to seek professional help if you put an X in columns 1-5 for
this question, even if your overall score was below 60 points.
If you live
outside the Chicago area, here are some organizations which can
give you referrals to professionals in your area.
