Eating Disorder Examination Questionnaire (EDE-Q 6.0)

First Name *

Last Name *

Birth Date *

Date of Assessment

Instructions:

The following questions are concerned with the past four weeks (28 days) only.
Please read each question carefully and answer all the questions. Thank you.

Questions 1 to 12

Please circle the appropriate number on the right. Remember that the questions only refer to the past four weeks (28 days) only.

ON HOW MANY OF THE PAST 28 DAYS ...

1. Have you been deliberately trying to limit the amount of food you eat to influence your shape or weight (whether or not you have succeeded)? *

2. Have you gone for long periods of time (8 waking hours or more) without eating anything at all in order to influence your shape or weight? *

3. Have you tried to exclude from your diet any foods that you like in order to influence your shape or weight (whether or not you have succeeded)? *

4. Have you tried to follow definite rules regarding your eating (for example, a calorie limit) in order to influence your shape or weight (whether or not you have succeeded)? *

7. Has thinking about food, eating or calories made it very difficult to concentrate on things you are interested in (for example, working, following a conversation, or reading)? *

8. Has thinking about shape or weight made it very difficult to concentrate on things you are interested in (for example, working, following a conversation, or reading)? *

Questions 13-18

Please fill in the appropriate number in the boxes on the right. Remember that the questions only refer to the past four weeks (28 days).

13. Over the past 28 days, how many times have you eaten what other people would regard as an unusually large amount of food (given the circumstances)? *

14. On how many of these times did you have a sense of having lost control over your eating (at the time you were eating)? *

15. Over the past 28 days, on how many DAYS have such episodes of overeating occurred (i.e. you have eaten an unusually large amount of food and have had a sense of loss of control at the time)? *

16. Over the past 28 days, how many times have you made yourself sick (vomit) as a means of controlling your shape or weight? *

17. Over the past 28 days, how many times have you taken laxatives as a means of controlling your shape or weight? *

18. Over the past 28 days, how many times have you exercised in a “driven” or “compulsive” way as a means of controlling your weight, shape or amount of fat, or to burn off calories *

Questions 19 to 20

Please circle the appropriate number. Please note that for these questions the term “binge eating” means eating what others would regard as an unusually large amount of food for the circumstances, accompanied by a sense of having lost control over eating.

ON HOW MANY OF THE PAST 28 DAYS ...

20. On what proportion of the times that you have eaten have you felt guilty (felt that you’ve done wrong) because of its effect on your shape or weight? ... Do not count episodes of binge eating. *

In the past 28 days...

24. How much would it have upset you if you had been asked to weigh yourself once a week (no more, or less, often) for the next four weeks? *

27. How uncomfortable have you felt seeing your body (for example, seeing your shape in the mirror, in a shop window reflection, while undressing or taking a bath or shower)? *

28. How uncomfortable have you felt about others seeing your shape or figure (for example, in communal changing rooms, when swimming, or wearing tight clothes)? *

Restraint Score

Eating Concern Score

Shape Concern Score

Weight Concern Score

Global Score

Additional Questions

What is your weight at present? *(Please give your best estimate)

What is your height? *(Please give your best estimate)

Gender *

Over the past three to four months have you missed any menstrual periods? *

YesNoN/A

How many?

Have you been taking the “pill”? *

YesNoN/A