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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.
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.
No
Yes
2. Have you ever made yourself sick (vomitted) to control your weight or shape?
No
Yes
3. Have you ever used laxatives, diet pills or diuretics (water pills) to control your
weight or shape? No
Yes
4. Have you ever been treated for an eating disorder?
No
Yes
5. Have you recently thought of or attempted suicide?
No
Yes
6. Your height and weight:
Height: feet =
and inches =
Weight: pounds =
Your Total 56
Dieting subscale 33
Food preoccupation subscale 15
Self-control subscale 8
Your Body-Mass Index (BMI) 19.1
If your BMI is... You may be...
Below 18.5 Underweight
18.5 - 24.9 Normal
25.0 - 29.9 Overweight
30.0 and Above Obese
(This is not meant as a diagnosis tool! If you are suffering from feelings
which are causing you concern and interfere with your daily functioning,
you should seek immediate treatment from a trained mental health
professional within your community. Many people who take this test also
benefit from reviewing our Eating Disorders information library or
checking out other online resources about eating disorders. Disclaimer:
We are not responsible for any use or misuse of this tool and we disclaim
all warranties, express or implied, on the information provided here. )