Instructions: The following questions are concerned with the past four weeks (28 days) only. Please read each question carefully. Please answer all the questions. Thank you.
Questions 1 to 12: Please circle the appropriate number on the right. Remember that the questions only refer to the past four weeks (28 days) only.
Have you been deliberately trying to limit the amount of food you eat to influence your shape or weight (whether or not you have succeeded)?
Have you gone for long periods of time (8 waking hours or more) without eating anything at all in order to influence your shape or weight?
Have you tried to exclude from your diet any foods you like in order to influence your shape or weight (whether or not you have succeeded)?
Have you tried to follow definite rules regarding your eating (for example, a calorie limit) in order to influence your shape or weight (whether or not you have succeeded)?
Have you had a definite desire to have an empty stomach with the aim of influencing your shape or weight?
Have you had a definite desire to have a totally flat stomach?
Has thinking about food, eating or calories made it very difficult to concentrate on things you are interested in (for example, working, following a conversation or reading)?
Has thinking about shape or weight made it very difficult to concentrate on things you are interested (for example, working, following a conversation or reading?
Have you had a definite fear of losing control over eating?
Have you had a definite fear that you might gain weight?
Have you felt fat?
Have you had a strong desire to lose weight?