Age: Ethnicity:

Gender: Level of Study:

Instructions: This is a screening measure to help you determine whether you might have an eating disorder that needs professional attention. This screening measure is not designed to make a diagnosis of an eating disorder or take the place of a professional diagnosis or consultation. Please take the time to fill out the below form as accurately, honestly and completely as possible. All of your  responses are confidential.

Please choose a response for each of the following statements:

Always Usually Often Sometimes Rarely NeverI am terrified about being overweight.I avoid eating when I am hungry.I find myself preoccupied with food.I have gone on eating binges where I feel that I may not be able to stop.I cut my food into small pieces.

I am aware of the calorie content of foods that I eat. Always Usually Often Sometimes Rarely NeverI particularly avoid food with a high carbohydrate content (i.e. bread, rice, potatoes, etc.)I feel that others would prefer if I ate more.I vomit after I have eaten.

I feel extremely guilty after eating.I am preoccupied with a desire to be thinner.I think about burning up calories when I exercise. Always Usually Often Sometimes Rarely NeverOther people think that I am too thin.I am preoccupied with the thought of having fat on my body.I take longer than others to eat my meals.I avoid foods with sugar in them.I eat diet foods.

I feel that food controls my life.

Always Usually Often Sometimes Rarely NeverI display self-control around food.I feel that others pressure me to eat.I give too much time and thought to food.I feel uncomfortable after eating sweets.I engage in dieting behavior.

I like my stomach to be empty.

I have the impulse to vomit after meals.I enjoy trying rich new foods.

Eating Attitude Test: Part 2

The second part of the test requires answering just 6 more questions, then your score and results will be calculated and displayed for you.

1. Have you gone on eating binges where you feel that you may not be able to stop? Eating much more food than most people would eating under the same circumstances.

o Noo Yes

2. Have you ever made yourself sick (vomitted) to control your weight or shape?o Noo Yes

3. Have you ever used laxatives, diet pills or diuretics (water pills) to control your weight or shape?o Noo Yes

4. Have you ever been treated for an eating disorder?o Noo Yes

5. Have you recently thought of or attempted suicide?o Noo Yes

Your height and weight:

Height:  feet

and  inches

Weight:  pounds