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Eating Disorder Examination Questionnaire
EDE-Q 6.0
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Name:
*
Your answer
DOB:
*
MM
/
DD
/
YYYY
The following questions are concerned with the past 2 weeks (14 days) only. Please read each question carefully.
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)?
*
No days
1-2 days
3-5 days
6-7 days
8-10 days
11-13 days
every day
Have you gone long periods of time (8 waking hours or longer) without eating anything in order to influence your shape or weight?
*
No days
1-2 days
3-5 days
6-7 days
8-10 days
11-13 days
every day
Have you tried to exclude from your diet from foods that you like in order to influence your shape or weight (whether or not you have succeeded)?
*
No days
1-2 days
3-5 days
6-7 days
8-10 days
11-13 days
every day
Have you tried to follow definite rules regarding your eating ( for example calorie limit) in order to influence your shape or weight (whether or not you have succeeded)?
*
No days
1-2 days
3-5 days
6-7 days
8-10 days
11-13 days
every day
Have you had a definite desire to have an
empty stomach
with the aim of influencing your shape or weight?
*
No days
1-2 days
3-5 days
6-7 days
8-10 days
11-13 days
every day
Have you had a definite desire to have a
totally flat
stomach?
*
No days
1-2 days
3-5 days
6-7 days
8-10 days
11-13 days
every day
Has thinking about
food, eating, or calories
made it very difficult to concentrate on things you are interested in (working, conversation, reading)?
*
No days
1-2 days
3-5 days
6-7 days
8-10 days
11-13 days
every day
Has thinking about
shape or weight
made it very difficult to concentrate on things you are interested in (working, conversation, reading)?
*
No days
1-2 days
3-5 days
6-7 days
8-10 days
11-13 days
every day
Have you had a definite fear of losing control over eating?
*
No days
1-2 days
3-5 days
6-7 days
8-10 days
11-13 days
every day
Have you had a definite fear you might gain weight?
*
No days
1-2 days
3-5 days
6-7 days
8-10 days
11-13 days
every day
Have you felt fat?
*
No days
1-2 days
3-5 days
6-7 days
8-10 days
11-13 days
every day
Have you had a strong desire to lose weight?
*
No days
1-2 days
3-5 days
6-7 days
8-10 days
11-13 days
every day
How many times have you eaten what other people would consider as an
unusually large amount of food
(given the circumstances)?
*
No Days
1-2 days
3-5 days
6-7 days
8-10 days
11-13 days
every day
How many of these times did you have a sense of losing control over your eating at the time you were eating?
*
No Days
1-2 days
3-5 days
6-7 days
8-10 days
11-13 days
every day
How many days have such episodes of overeating occurred (ie. you have eaten a large amount of food and have had a sense of loss of control at the time)?
*
No Days
1-2 days
3-5 days
6-7 days
8-10 days
11-13 days
every day
How many days have you made yourself sick (vomit) as a means of controlling your shape or weight?
*
No Days
1-2 days
3-5 days
6-7 days
8-10 days
11-13 days
every day
How many days have you taken a laxative as a means of controlling your shape or weight?
*
No Days
1-2 days
3-5 days
6-7 days
8-10 days
11-13 days
every day
How many days have you exercised in a "driven" or "compulsive" way as a means of controlling your shape, weight, amount of fat, or to burn off calories?
*
No Days
1-2 days
3-5 days
6-7 days
8-10 days
11-13 days
every day
How many days have you eaten in secret? (Do not count episodes of binge eating)
*
No Days
1-2days
3-5 days
6-7 days
8-10 days
11-13 days
every day
On how many days have that you have eaten have you felt guilty because of the effect on your shape or weight? (Do not count episodes of binge eating)
*
No Days
1-2 days
3-5 days
6-7 days
8-10 days
11-13 days
every day
How concerned have you been about other people seeing you eat(Do not count episodes of binge eating)
*
Not at all
Slightly
<oderately
Markedly
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