| 1. |
Do you think a lot about food, weight and the way your body looks? |
| 2. |
Do you believe your life would better somehow - that people would like you more, or that you would like yourself more - if you were just a little thinner? |
| 3. |
Do you constantly compare yourself to other people - their appearance, their abilities, their popularity, etc.? |
| 4. |
Do you feel pretty low about yourself, like maybe you're not a good or valuable person? |
| 5. |
Do you feel the need to be in control a lot? |
| 6. |
Do you often feel like you are out of control, or that things in your life are out of your control? |
| 7. |
Do you feel that you have to take care of other people's needs and feelings? Are their needs and feelings more important than your own? |
| 8. |
Are you a perfectionist? Do you avoid trying new things because you're afraid you won't be able to do them perfectly? Are you always pushing yourself harder than other people to do things "just right?" |
| 9. |
Do you have a hard time expressing your feelings? Is it sometimes hard to even know what you're feeling? |
| 10. |
Do you feel that you should handle your problems on your own, and not be a "burden" to others? |
| 11. |
Do you feel like you sometimes don't know who you are - like your identity is not clear, or wrapped up in just one thing (i.e., "the smart one" or "the skater")? Do you lack interests or hobbies? |
| 12. |
Do you try to avoid conflict with others whenever possible? Worry a lot about hurting other people or making them mad? |
| 13. |
Are you having a hard time adjusting to some major change in your life (i.e., going away to university, accepting your parent's divorce, your new marriage)? |
| 14. |
Do you feel like there are a lot of problems in your family, maybe ones that you don't know how to fix? |
| 15. |
Do you feel like you are supposed to fix other people's problems? |
| 16. |
Are you very influenced by what other people think? Do you feel obligated to meet other people's expectations? |
| 17. |
Do you often feel anxious or nervous? Do you have a hard time relaxing? |
| 18. |
Do you struggle with depression? |
| 19. |
Do you have urges to hurt yourself, or commit suicide?*** |
| 20. |
Has there been some trauma (i.e., an accident, death of a loved one) that you can't seem to get over? |
| 21. |
Have you been abused by someone? Does it still bother you? |
| 22. |
Do you have a family member who has struggled with an eating disorder; or a family member who seems to have problems with food and body size? |
| 23. |
Has anyone raised a concern about your eating habits or your weight recently? |
| 24. |
Do you find yourself becoming secretive or deceptive, especially about your eating habits? |
| 25. |
Do you find it easier, or more comforting, to think about food and your body instead of the issues listed in the questions above? |