703-538-2886

Eating Disorders Assessment

This is a screening measure developed by David M. Garner and Paul e. Garfinkel (The Eating Attitudes Test: Psychometric features and clinical correlates) 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.

Age

Sex

Height
ft. in.

Current Weight
lbs.

Highest Weight (excluding pregnancy)
lbs.

Lowest Adult Weight
lbs.

Ideal Weight
lbs.

Please choose one response by checking the most accurate answer for each of the following statements.

I avoid eating when I'm hungry.

Always

Usually

Often

Sometimes

Rarely

Never

I Find myself preoccupied with food.

Always

Usually

Often

Sometimes

Rarely

Never

I have gone on eating binges where I feel that I may not be able to stop.

Always

Usually

Often

Sometimes

Rarely

Never

I cut my food into small pieces.

Always

Usually

Often

Sometimes

Rarely

Never

I am aware of the calorie content of foods that I eat.

Always

Usually

Often

Sometimes

Rarely

Never

I particularly avoid food with a high carbohydrate content (i.e. bread, rice, potatoes, etc.).

Always

Usually

Often

Sometimes

Rarely

Never

I feel that others would prefer if I ate more.

Always

Usually

Often

Sometimes

Rarely

Never

I feel extremely guilty after eating.

Always

Usually

Often

Sometimes

Rarely

Never

I am preoccupied with a desire to be thinner.

Always

Usually

Often

Sometimes

Rarely

Never

I think about burning calories when I excercise.

Always

Usually

Often

Sometimes

Rarely

Never

Other people think that I am too thin.

Always

Usually

Often

Sometimes

Rarely

Never

I am preoccupied with a desire to be thinner.

Always

Usually

Often

Sometimes

Rarely

Never

I take longer than others to eat my meals.

Always

Usually

Often

Sometimes

Rarely

Never

I avoid foods with sugar in them.

Always

Usually

Often

Sometimes

Rarely

Never

I feel that food controls my life.

Always

Usually

Often

Sometimes

Rarely

Never

I display self-control around food.

Always

Usually

Often

Sometimes

Rarely

Never

I feel that others pressure me to eat.

Always

Usually

Often

Sometimes

Rarely

Never

I give too much time and thought to food.

Always

Usually

Often

Sometimes

Rarely

Never

I feel uncomfortable after eating sweets.

Always

Usually

Often

Sometimes

Rarely

Never

I like my stomach to be empty.

Always

Usually

Often

Sometimes

Rarely

Never

I have the impulse to vomit after meals.

Always

Usually

Often

Sometimes

Rarely

Never

I enjoy trying new rich foods.

Always

Usually

Often

Sometimes

Rarely

Never

Behavioral Questions

In the past six months have you:

gone on eating binges where you feel that you may not be able to stop? (Eating much more than most people would eat under the same circumstances.)

Yes

If you answered yes, how often during the worst week:

times

ever made yourself sick (vomited) to control your weight or shape?

Yes

If you answered yes, how often during the worst week:

times

ever used laxatives, diet pills, or diuretics (water pills) to control your weight or shape?

Yes

If you answered yes, how often during the worst week:

times

ever been treated for an eating disorder?

Yes

When:

Month/Day/Year

Get Results

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Reflections

2960 Sleepy Hollow Road

Falls Church,

22044

703-538-2886