Binge Eating Disorder Questionnaire

1. I feel very self-conscious about my weight. Frequently I feel intense shame and disgust for myself. I try to avoid social contacts because of my self-consciousness.*

Yes
No

2. At times, I tend to eat quickly. Then I feel uncomfortably full afterwards.*

Yes
No

3. Almost all the time I experience strong guilt or self-hate when I overeat.*

Yes
No

4. I have a regular habit of starting strict diets for myself, but I break the diets by going on a eating binge. My life seems to be either a “feast” or “famine.*

Yes
No

5. I eat so much food that I regularly feel uncomfortable after eating and sometimes nauseous.*

Yes
No

6. I feel incapable of controlling urges to eat. I have a fear of not being able to stop voluntarily.*

Yes
No

7. Frequently, I eat only a small amount of food when others are present because I’m very embarrassed about my eating.*

Yes
No

8. Occasionally, I feel uncertain about knowing whether or not I’m physically hungry. At these times it’s hard to know how much food it should take to satisfy me.*

Yes
No

9. What is your gender?*

Male
Female
Non-binary

10. What age range do you fall under*

11. Which of our locations is closest to you?*

Colorado Springs
Denver
Kansas City
Lincoln

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Binge Eating Disorder Questionnaire

Binge Eating Disorder Questionnaire

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