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Outpatient Program (EIOP)
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Binge Eating Disorder Questionnaire
Binge Eating Disorder Questionnaire
Binge Eating Disorder Questionnaire
edcare
2023-11-14T09:09:33-07:00
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
*
Under 18
Ages 18-24
Ages 25-34
Ages 35-44
Age 45-54
Ages 55+
11. Which of our locations is closest to you?
*
Denver, CO
Kansas City, KS
Omaha, NE
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