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Unofficial Eating Disorder Diagnosis

Are you satisfied with your weight
Yes
No
Other
Please Specify:
Are you trying to change your weight?
Yes
No
Which of the following behaviors do you engage in?
Restricting
Binging
Purging
Over-exercising
Self harm
Dieting
If restricting, about how many calories do you consume a day? (skip if not applicable)
Fast
<100
100-300
300-500
500-800
800-1000
1000+
If purging which methods do you use?
Vomiting
Laxatives
Diueretics
Diet pills
Exercise
Other
Please Specify:
If binging, how frequent are your binges?
3x+ a day
1-3 a day
3-6 a week
1-3 a week
Other
Please Specify:
What is your bmi?
<16
16-19
19-23
23-26
26-29
30-35
>35
Unsure
Have you lost or gained at least 10% of your body weight in the past 5 months
Yes, lost
Yes, gained
No
Unsure
Have you ever been treated for an eating disorder?
Yes
No
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