| 1. | a. I don't feel worried about my weight or body shape when I'm with other people. |
| b. I worry about how I will look to others, but usually that doesn't make me feel disappointed in myself. | |
| c. I was worried about my appearance and weight which made me feel disappointed in myself. | |
| d. I feel very worried about my weight, and many times I feel very embarrassed and disgusted with myself. I try to avoid social contact with other people because of it. | |
| 2. | a. I have no trouble eating slowly according to the prevailing regulations. |
| b. Even though it looks like I am "gobbling up" food, I don't feel full from eating too much. | |
| c. Sometimes, I tend to eat quickly and then, I feel uncomfortable because of the fullness afterward. | |
| d. I have the habit of swallowing my food, without actually chewing it. When this happens, I usually feel uncomfortable because of being full, because I have eaten too much. | |
| 3. | a. I feel able to control or control my appetite when I want to. |
| b. I feel like I have failed to control or control my eating, more than the average person. | |
| c. I feel completely helpless when it comes to controlling or controlling my appetite for food. | |
| d. Because I felt so powerless to control or control my eating, I became very desperate to try to control it. | |
| 4. | a. I don't have the habit of eating when I'm bored. |
| b. I sometimes eat when I'm bored, but most of the time I'm able to "keep busy". and take my mind off the food. | |
| c. I have a regular habit of eating when I'm bored, but sometimes, I can use other activities to take my mind off eating. | |
| d. I have a strong habit of eating when I'm bored. It seems that nothing can help me to break this habit. | |
| 5. | a. Usually I eat when I am physically hungry. |
| b. Sometimes, I eat because of the urge / impulse to eat even though I'm not really hungry. | |
| c. I have a regular habit of eating foods, which I may not really like or enjoy, to satisfy my hunger, even though I don't physically need them. | |
| d. Even though I am not physically hungry, I have a hunger in my mouth, which seems to be satisfied only when I eat food that fills my mouth, such as a sandwich or sandwich. Sometimes, when I eat food to satisfy the hunger in my mouth, I then vomit it or take it back out so that I won't gain weight. | |
| 6. | a. I don't feel guilty or hate myself after I overeat. |
| b. After I overeat, sometimes I feel guilty or hate myself. | |
| c. Most of the time I experience strong guilt or self-loathing after I overeat. | |
| 7 | a. I don't lose total control over my eating when dieting (regulating food intake), even after periods of overeating. |
| b. Sometimes when I eat "forbidden food" I eat. on a diet (regulating food intake), I feel as if I have "failed". and even eat more. | |
| c. Often, when I overeat on a diet, I have the habit of telling myself, "I've failed now, why not just". When that happens, I eat even more. | |
| d. I have the habit of regularly starting a strict diet for myself, but I break my diet by continuing to overeat. My life seems like "in a party situation (a lot of eating)" or in a "starvation" situation. | |
| 8. | a. I rarely eat so much food that I feel uncomfortably full afterwards. |
| b. Usually around once a month, I eat large amounts of food, and eventually I feel very full | |
| c. I have regular periods or times throughout the month for eating large amounts of food, whether at mealtimes or at snack times or snacks. | |
| d. I eat so much food that I regularly feel very uncomfortable after eating, and sometimes feel a little nauseous . | |
| 9. | a. My calorie intake levels generally don't go up very high or fall very low |
| b. Sometimes after I overeat, I will try to reduce my calorie intake to almost nothing (or eat almost nothing) to compensate for the excess calories I have eaten. | |
| c. I have a regular habit of overeating at night. It seems that my routine is not feeling hungry in the morning, but overeating at night. | |
| d. In my adult years I have had week long periods where I starved myself. This period occurs after a period I overeat. It seems that I live a life like the "in a party situation (a lot of eating)" or in a "starvation" situation. | |
| 10. | a. I can usually stop eating when I want to. I know when "enough is really enough" I know. . |
| b. Occasionally, I have an urge to eat that I can't seem to control. | |
| c. Often times, I have a strong urge to eat that I can't seem to control, but other times I can control my urge to eat. | |
| d. I felt unable to control my urge to eat. I was afraid that I couldn't stop eating voluntarily | |
| 11. | a. I have no trouble or trouble stopping eating when I feel full. |
| b. I can usually stop eating when I feel full, but sometimes overeating makes me feel uncomfortable because of being full (my stomach is full). | |
| c. I have difficulty or problems stopping eating once I start eating, and usually after eating I feel uncomfortable because of being full (my stomach is full). | |
| d. Because I have the problem of not being able to stop eating when I want to, sometimes I have to make myself vomit to relieve feelings of fullness. | |
| 12. | a. It seems that I eat as much when I am with other people (family, social gatherings) and when I am alone. |
| b. Sometimes, when I'm with other people, I don't eat as much as I want because I feel worried about my eating. | |
| c. Often times, I only eat small amounts when there are other people around, because I am so embarrassed by my eating. | |
| d. I feel so embarrassed by the overeating that I have, that I choose times to overeat when I know no one will see me. I feel like a "hidden eater". | |
| 13. | a. I eat three times a day with only one snack once in a while. |
| b. I eat three times a day, but I usually also eat small meals between meals. | |
| c. When I eat small meals that make me full, I get used to skipping my regular meals. | |
| d. There are regular periods when I seem to be eating constantly, without a planned meal schedule or without eating | |
| 14. | a. I didn't think much about controlling or controlling my unwanted appetites. |
| b. There are at least certain times when I feel my thoughts are occupied (preoccupied with) trying to control or control my appetite. | |
| c. I feel that I often spend a lot of time thinking about how much food I've eaten or about trying not to eat anymore | |
| d. It seemed that most of the time I was awake I was occupied (preoccupied with) thoughts about eating or not eating. I felt like I was constantly struggling not to eat. | |
| 15. | a. I don't think much about food |
| b. I have a strong desire to eat but it only lasts for a short time. | |
| c. I have days when it seems I can think of nothing but food. | |
| d. Most of my days, I seem to be occupied (preoccupied with) thoughts about food. I feel like I live to eat. | |
| 16. | a. I usually know whether I am physically hungry or not. I take the right portion of food to satisfy my hunger |
| b. Sometimes, I am not sure whether I know that I am physically hungry or not. At such times, it is difficult for me to know how much food I should take to satisfy my hunger. | |
| c. Although I may know how many calories I should eat, I don't know the amount of "normal" food. for me. |