Eating Disorder Questionnaire
  1. Are you at risk of disordered eating?

    Fill out the questionnaire below to identify whether you have a healthy relationship with food and your body:

  2. Contact Information

  3. Name(*)
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  4. Email(*)
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  5. Phone(*)
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  6. Preferred method of contact(*)
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  7. Questionnaire


  8. 1 - How often do you weigh yourself?






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  9. 2 - Check the statement that best describes you:





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  10. 3 - How would gaining 5 pounds make you feel?




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  11. 4 - Since you can remember, how much time have you spent dieting?





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  12. 5 - How do you feel if you missed a plan day of exercise?





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  13. Have you done any of the following to control weight?

  14. 6 - A - Cut out whole food groups (such as carbs or red meat)
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  15. 6 - B - Counted the calories of every single food you ate
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  16. 6 - C - Restricted yourself to less than 1,200 calories/day
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  17. 6 - D - Ate only a small variety of foods or the same things every day
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  18. 6 - E - Ate only no low‐cal or fat‐free foods
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  19. 6 - F - Skipped meals
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  20. 6 - G - Used diet pills or diuretics (water pills)
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  21. 6 - H - Purged when you felt full
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  22. 6 - I - Used laxatives
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  23. 7 - Do you hold yourself to food rules, such as not eating after a certain time each night or never allowing yourself to eat dessert?


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  24. 8 - Which of the following do you agree with?




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  25. 9 - Have you ever had eating binges, when you ate what most people would regard as an unusually large amount of food within a two‐hour period?






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  26. Have you done any of the following?

  27. 10 - A - Told someone I’d already eaten, even though I hadn’t, so I wouldn’t have to eat with them
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  28. 10 - B - Told someone I weighed less than I did
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  29. 10 - C - Told someone I weighed more than I did
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  30. 10 - E - Eaten a small amount with others, then gone home and eaten more alone
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  31. 11 - Have you ever binged, purged or restricted your food intake when you were having strong emotions?


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  32. 12 - Do you use your food intake as a way of getting more control in your life?


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  33. 13 - Have you ever had a period of time when you weighed much less than what other people thought you should weigh?


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  34. 14 - How often do you think about food or eating?





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  35. Send Responses
  36. When you're finished, we will evaluate your score to see whether your eating habits and attitudes put you at risk.

    Our entire staff is available to give you advice and support to help you be happier and healthier. If you have any questions, comments or concerns please call us at 617-547-2255.

Testimonials...

  • Today, I am happy, healthy and safe, and thriving because of the love and support I received at CEDC…
  • The CEDC program has left me feeling strong and optimistic, and I cannot say enough positive things about the program....I know that the road ahead will not be easy but just knowing that CEDC is there as a safety net gives me a feeling of calm…
  • Thank you for everything---especially for believing in me when I couldn’t believe in myself. Sometimes that was what convinced me to keep trying even when I felt hopeless…
  • I can’t express how grateful I am to have had people like you in my life. You have all helped me more than I could have ever dreamed possible. Every day I looked forward to coming in to partial to see your smiling faces, and your kindness has brightened the hardest of days…
  • Not only did CEDC teach me how to beat my eating disorder, but you also taught me how to be a good person, how to help other people, and listen to them….Thank you all for making me ME again.

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Contact Us

Cambridge Eating Disorder Center offers eating disorder treatment programs.

  • 3 Bow Street,
    Cambridge, MA 02138
  • 1(617)547-2255 (phone)
  • 1(617)547-0003 (fax)