Eating Disorder Questionnaire

Eating disorder questionnaire are used in the diagnosis of anorexia, overeating or other abnormal dieting behavior. Its helps in checking the patient’s physical and emotional health, and thus find out possible solutions to alleviate the same. These questionnaires are often needed by dieticians and psychiatrists before they start counseling or treating an affected individual. These questions not only ask you about what you eat or not, but also about your feelings and general perception of beauty, attractiveness, likeability etc.

Sample Eating Disorder Questionnaire

Name:               ____________________________________________________________

Age:          ____________________               Sex:          __________________

  1. Emotional Health

a)    Do you think that you are a perfectionist? Do you long to be better than your friends and colleagues?

b)    Do you seek acceptance or approval from your friends regarding your looks or personality?

c)     Are you bothered/feel unhappy if people pass negative comments about you?

d)    Do you think that you doubt yourself and your judgments very often?

e)    Do you often find yourself comparing to actors/models/celebrities and wished you could look as nice as them?

f)      Do you ever feel depressed, stressed or de-motivated?

g)    Have you ever been diagnosed with clinical depression, OCD or other stress?

  1. Behavioral Patterns

a)    Do you often starve or restrict yourself while hungry?

b)    Do you feel like eating something when feeling depressed?

c)     Do you avoid attending parties for the fear that you’ll over eat? Do you feel guilty after a binge?

d)    Do you exercise compulsively?


  1. Physical Signs

a)    Do you think that you get tired excessively and suffer from sleeplessness?

b)     Are you sensitive to noise, temperature and light?

c)     Please mention any other physical malfunctioning like disruption in menstrual cycle, palpitation, pain in joints, headaches etc, if present.

Category: Health Questionnaire

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