Eating Disorder Test TestQuestions DemographicInformation YourResults Please note, all fields are required to receive a final result. How much more or less do you feel you worry about your weight and body shape than other people your age?*I worry a lot less than other peopleI worry a little less than other peopleI worry about the same as other peopleI worry a little more than other peopleI worry a lot more than other peopleHow afraid are you of gaining 3 pounds?*Not afraid of gainingSlightly afraid of gainingModerately afraid of gainingVery afraid of gainingTerrified of gainingWhen was the last time you went on a diet?*I have never been on a dietI was on a diet about one year agoI was on a diet about 6 months agoI was on a diet about 3 months agoI was on a diet about 1 month agoI was on a diet less than 1 month agoI’m on a diet nowCompared to other things in your life, how important is your weight to you?*My weight is not important compared to other things in my lifeMy weight is a little more important than some other things in my lifeMy weight is more important than most, but not all, things in my lifeMy weight is the most important thing in my lifeDo you ever feel fat?*NeverRarelySometimesOftenAlwaysIn the past 3 months, how many times have you had a sense of loss of control AND you also ate what most people would regard as an unusually large amount of food at one time, defined as definitely more than most people would eat under similar circumstances?*Eat much more rapidly than normal?*YesNoEat until feeling uncomfortably full?*YesNoEat large amounts of food when not feeling physically hungry?*YesNoEat alone because of feeling embarrassed by how much you are eating?*YesNoHow distressed or upset have you felt about these episodes?*Not at allA littleModeratelyGreatlyExtremelyFeel disgusted, depressed, or very guilty afterward?*YesNoIn the past 3 months, how many times have you done any of the following as a means to control your weight and shape:Made yourself throw-up?*Used diuretics or laxatives?*Exercised excessively?*Fasted?*Do you consume a small amount of food (i.e., less than 1200 calories/day) on a regular basis to influence your shape or weight?*YesNoDo you struggle with a lack of interest in eating or food?*YesNoDo you avoid certain or many foods because of such features as texture, consistency, temperature, or smell, or have other people suggested this may be the case for you?*YesNoDo you avoid certain or many foods because of fear of experiencing negative consequences like choking or vomiting, or have other people suggested this may be the case for you?*YesNoHave you experienced significant weight loss* but are not overly concerned with the size or shape of your body?*YesNoAre you currently in treatment for an eating disorder?*YesNoWhat was your lowest weight in the past year, including today, in pounds?*Please enter a number greater than or equal to 20.What is your current weight in pounds?*Please enter a number greater than or equal to 20.What is your current height in inches?*Please enter a number greater than or equal to 20. Please take a moment to answer the following optional questions. Your answers are totally anonymous—we won't be able to identify you based on this information. Your answers help us provide better information and support for people like you. You can answer as many or as few questions as you would like. When you are done, scroll to the bottom of the survey and click "submit" to receive your screening results.About YouAge Range11-1718-2425-3435-4445-5455-6465+GenderMaleFemaleAnother GenderEnter GenderPlease check this box if you identify as transgender. Please check this box if you identify as transgender. Race/EthnicityAsian or Pacific IslanderBlack or African-American (non-Hispanic)Hispanic or LatinoNative American or American IndianWhite (non-Hispanic)More than one of the aboveOtherHousehold IncomeLess than $20,000$20,000 - $39,999$40,000 - $59,999$60,000 - $79,999$80,000 - $99,999$100,000 - $149,999$150,000+Which of the following populations describes you? Veteran or active duty military Caregiver of someone living with emotional or physical illness LGBTQ+ Student Trauma survivor New or expecting mother Healthcare worker Who are you caring for? My spouse or partner My parent My child Another relative Other Caring For - OtherAs a caregiver, what supports do you need? The person I'm helping is getting treatment but is getting worse (meds or therapy stopped working) The person I'm helping is getting treatment but also needs something else (side effects cause other problems, not sure what else to do) The person I'm helping is getting treatment but also needs something else (side effects cause other problems, not sure what else to do) The person I'm helping doesn't want treatment and I want to figure out how to help them I need help because the stress of caretaking is hard Other Caregiver Support - OtherWhich of the following best describes your sexual orientation? Lesbian Gay Bisexual Queer Pansexual Asexual Other Sexual Orientation - OtherAbout Your Mental HealthHave you ever been diagnosed with a mental health condition by a professional (doctor, therapist, etc.)?YesNoHave you ever received treatment/support for a mental health problem?YesNoAre you receiving treatment/support now?YesNoThink about your mental health test. What are the main things contributing to your mental health problems right now?Choose up to 3. Coronavirus Racism Relationship problems Past trauma Current events (news, politics, etc.) Loneliness or isolation Grief or loss of someone or something Financial problems Other… Mental Health Problems - OtherAbout Your HealthDo you currently have health insurance?YesNoDo you have any of the following general health conditions? Heart disease Diabetes Cancer Arthritis or other chronic pain COPD or other lung conditions Movement Disorders (involuntary tics, tardive dyskinesia) HIV/AIDS Other If 'Other' please specify (for general health conditions)Additional InformationStateI live outside the United StatesAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingI live in a U.S. TerritoryZip/Postal CodeWhat country do you live in?AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsPhoneThis field is for validation purposes and should be left unchanged.
