Eating Disorder Questionnaire

Is it more than just a Diet?

The most common element surrounding all Eating Disorders is the presence of a low self esteem. Having an Eating Disorder is much more than just being on a diet. An Eating Disorder is an illness that permeates all aspects of each sufferer's life, is caused by a variety of emotional factors and influences, and has profound effects on the people suffering and their loved ones.

Consider completing the following online test if you think you have an Eating Disorder, or if you think you know someone who does. Read the question carefully and answer honestly by choosing from the dropdown menus. Please fill in your contact details below and press the send button. We will send you your results after we have received your answers. Please choose from the field below how you would like to be contacted.

Any personal information submitted is strictly confidential. We will never disclose such information to any other parties and we will not contact you without your specific consent, which you may give in the form below.

		Section A: Cognitive and Emotional Indicators
		1. I�m a perfectionist and I like to be in control.
	A1
		2. No matter what I do, it is never enough.
	A2
		3. I often seek approval from people.
	A3
		4. I have a hard time saying "no".
	A4
		I always question my own judgements and scrutinize myself over small faults.
	A5
		I am, stupid, not good enough and worthless.
	A6
		7. People are always judging me in a negative way.
	A7
		8. I hide my feelings and opinions from people for fear of being judged negatively.
	A8
		9. Within my family or circle of friends I am "the strong one" who everyone will come to with problems, and I never seem to talk much about my own.
	A9
		10. Life would be better and people would like me more if I was thin.
	A10
		11. I wish I was as "nice looking" or as "thin" as some other people.
	A11
		12. I feel fat, even though others have told me that I am not.
	A12
		13. Family members and friends often express concern about my weight-loss/gain, appearance, and/or your eating habits.
	A13
		14. I often think everyone's problems are more important then my own.
	A14
		15. I often feel numb or empty inside and feel that my life lacks fulfilment and happiness.
	A15
		16. I feel as though I have a "conscience" or "voice" that tells me negative things about myself.
	A16
		17. I do not deserve to eat or to be happy.
	A17
		18. I believe that I may suffer from Anorexia, Bulimia or Compulsive Overeating, or any combination of the three.
	A18
		19. I suffer from depression, hopelessness, lack of motivation and often find my problems overwhelming and hard to handle.
	A19
		20. I am often suicidal, stressed-out, fatigued.
	A20
		21. I often get one of the following: panic attacks; mood swings; angry outbursts; insomnia.
	A21
		22. I have been diagnosed with one of the following conditions: depression, attentive deficit disorder; bipolar mood disorder; post traumatic stress disorder (PTSD., obsessive compulsive disorder (OCD.; dissociative identity disorder, or any other psychological/neurological illness.
	A22
		Section B: Behavioural Indicators Purging is defined as any behaviour used to rid the body of food. Included in this is vomiting, taking laxatives or diuretics.
		23. I often overeat, starve myself, restrict my food in take, binge, purge, or compulsively exercise when I am feeling lonely, bad about myself or under pressure.
	A23
		24. While eating, self-starving, binging or purging I feel comforted, relieved, and in more control.
	A24
		25. I feel guilty following a binge or purge episode, after eating or during or after periods of restriction or self-starvation.
	A25
		26. When eating I often feel out of control or like I will lose control and not be able to stop.
	A26
		27. I often feel guilty after a binge, and feel like I have almost instantly gained weight.
	A27
		28. I often use self-starvation, purging, diet pills, laxatives, diuretics, or obsessive exercise as a way to attempt to lose weight.
	A28
		29. I drink a lot of water, tea or coffee, smoke, or take caffeine/diet pills as an attempt to control appetite or feel more energetic.
	A29
		30. I use alcohol, drugs, prescription medication or self-hurting behaviour such as cutting to reduce emotional pain.
	A30
		31. I weigh myself daily.
	A31
		32. I am constantly "on a diet"; counting calories and feel like I have tried every "fad diet" or "lose weight quick" scheme.
	A32
		33. I often set weight-goals for myself only to find when I reach it that I want to lose more.
	A33
		34. I hide or steal food, laxatives or diet pills; eat or exercise secretively; avoid eating in public or around others; wear clothes that hide my weight; or make excuses to avoid meals.
	A34
		35. I am often secretive about my eating practices, as I think they are abnormal.
	A35
		36. I use self-injury (cutting, burning, pulling out my own hair. as a way to cope with things.)
	A36
		37. I spend a lot of time obsessively cooking for others, reading recipes, or studying the nutritional information on food (calories, fat grams, etc..)
	A37
		Section C: Physical Indicators
		38. I am temperature sensitive (always feel cold or hot., or get tingling in my hands and feet.)
	A38
		39. I bruise easily, have a very high tolerance for pain, or extremely noise sensitive (even only slightly loud noises irritate me..)
	A39
		40. I often feel fatigued.
	A40
		41. I often suffer heart palpitations; chest pains; fainting spells, blackouts or dizziness; chronic lower back pain, headaches or light-headedness, tingling in my arms or legs, numbness in my face or other parts of my body, joint pain, excitability, mood swings, hyperactivity; low blood pressure or chronically sick with cold or flu symptoms.)
	A41
		42. I suffer some of the following symptoms: disruption in menstrual cycle and/or irregularity, infertility, decreased sex drive, irritability; lack of ability to concentrate, blurred vision; kidney and/or urinary tract infections; sore throats, dental problems; stomach cramping, blood in stools or vomit, diarrhoea, constipation and/or incontinence (loss of bowel control.; insomnia, fatigue, and/or anxiety or depression.
	A42

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