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Read each statement and place a checkmark in the box next to each one that is true for you. It is important that you are honest and mark all that apply.

I often make excuses so that I do not have to eat with friends and family.

I often have negative thoughts about my body and feel fat.

There are "safe" foods that are okay for me to eat and there are "bad" foods that I refuse to eat.

I have eating episodes that feel out of control, in which I eat large amounts of food.

I restrict my intake of food by skipping meals or snacks.

I think that my life would be better and/or people would like me more if I were thinner.

I frequently find myself comparing my physical appearance and weight to others, including strangers and celebrities, wishing to be as thin as they are.

Family members and friends often express concern for my weight loss or gain, my appearance, and/or my eating habits.

I express frequent uncontrollable binging followed by purging episodes where I use vomiting, laxative abuse, fasting, or compulsive exercise to purge excess calories.

I eat, self-starve, and/or binge and purge to help me feel comforted, relieved, or more in control.

I feel guilty and/or as though I have instantly gained weight after a binge, snack, or meal.

I use dieting, purging, diet pills, laxatives, diuretics, and/or obsessive exercise to attempt to lose weight.

I weigh myself often or compulsively, and the number on the scale dictates my mood and self-worth for the day.

I am constantly "on a diet" and/or counting calories or the contents of my foods (fats, carbs, etc.)

I am secretive about my eating practices and/or lie about my eating behaviors.