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1. I have eating habits that are different from those of my family and friends.
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1 = Often 2 = Sometimes 3 = Rarely 4 = Never
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2. I find myself panicking if I cannot exercise as I planned, because I am afraid that I will gain weight if I don’t.
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1 = Often 2 = Sometimes 3 = Rarely 4 = Never
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3. My friends tell me that I am thin, but I don’t believe them because I feel fat.
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1 = Often 2 = Sometimes 3 = Rarely 4 = Never
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4. (females only) My menstrual period has stopped or become irregular due to no known medical reasons.
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1 = True 2 = False
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5. I have become obsessed with food to the point that I cannot go through a day without worrying about what I will or will not eat.
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1 = Often 2 = Sometimes 3 = Rarely 4 = Never
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6. I have lost more than 15% of what is considered to be a healthy weight for my height (e.g., female, 5’4" tall loses 20 pounds when a healthy weight for her is approximately 122 pounds).
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1 = True 2 = False
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7. I would panic if I got on the scale tomorrow and found that I had gained two pounds.
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1 = Often 2 = Sometimes 3 = Rarely 4 = Never
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8. I find that I prefer to eat alone or when I am sure that no one will see me, and thus make excuses so that I can eat less and less often with friends or family.
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1 = Often 2 = Sometimes 3 = Rarely 4 = Never
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9. I find myself going on uncontrollable eating binges during which I consume large amounts of food to the point that I feel sick and make myself vomit.
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1 = Never 2 = Less than one time per week 3 = One to six times per week 4 = One or more times per day
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10. (NOTE: Answer only if your answer to #9 is “1.” Otherwise leave blank.) I find myself compulsively eating more than I want to while feeling out of control and/or unaware of what I am doing.
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1 = Never 2 = Less than one time per week 3 = One to six times per week 4 = One or more times per day
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11. I use laxatives or diuretics as a means of weight control.
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1 = Never 2 = Rarely 3 = Sometimes 4 = On a regular basis
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12. I find myself playing games with food (e.g. cutting it up in tiny pieces, hiding food so people will think I ate it, chewing it and spitting it out without swallowing it, keeping hidden stashes of food).
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1 = Often 2 = Sometimes 3 = Rarely 4 = Never
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13. People around me have become very interested in what I eat and I find myself getting angry at them for pushing me to eat more.
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1 = Often 2 = Sometimes 3 = Rarely 4 = Never
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14. I have felt more depressed and irritable recently than is typical for me and/or have been spending and increasing amount of time alone.
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1 = True 2 = False
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15. I keep a lot of my fears about food and eating to myself because I am afraid no one would understand.
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1 = Often 2 = Sometimes 3 = Rarely 4 = Never
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16. I enjoy making gourmet and/or high calorie foods for others as long as I don’t have to eat any myself.
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1 = Often 2 = Sometimes 3 = Rarely 4 = Never
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17. The most powerful fear in my life is the fear of gaining weight or becoming fat.
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1 = Often 2 = Sometimes 3 = Rarely 4 = Never
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18. I exercise a lot (more than 4 times per week and/or more than 4 hours per week) as a means of weight control.
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1 = True 2 = False
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19. I find myself totally absorbed when reading foods or magazines about dieting, exercising, fitness or calorie counting to the point that I can spend hours studying them.
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1 = Often 2 = Sometimes 3 = Rarely 4 = Never
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20. I tend to be a perfectionist and am not satisfied with myself unless I do things perfectly.
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1 = Almost always 2 = Sometimes 3 = Rarely 4 = Never
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21. I go through long periods of time without eating (fasting) or eating very little as a means of weight control.
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1 = Often 2 = Sometimes 3 = Rarely 4 = Never
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22. It is important for me to try to be thinner than all of my friends.
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1 = Almost always 2 = Sometimes 3 = Rarely 4 = Never
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