Eating Disorder Examination Questionnaire (EDE-Q)

This form can be used as a tool to assess your eating, weight, and shape concerns and/or as part of your eligibility for an Eating Disorder Management Plan.

Please note, this form will not be treated as an initial inquiry or referral to Centre for Integrative Health. If you are seeking support for eating or weight concerns for yourself or someone else, please contact our client care team on (07) 3161 0845 or info@cfih.com.au.

About you

I am *

an individual with concerns about eating/weightthe loved one of someone with concerns about eating/weighta medical/health practitioner supporting someone with eating/weight concerns

I would like to be contacted about support options available at Centre for Integrative Health *

yesno

Today's date *

Email address: *Where should we email a copy of the completed and scored questionaire?

Respondent's Information

First Name *

Last Name *

Date of birth *

Contact phone number: *

Eating Disorder Questionnaire

The following questions are concerned with the past four weeks (28 days) only.

On how many of the past 28 days....

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)?

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

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

For the following questions, please select 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.

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

On how many of the past 28 days...

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

EDEQ Global Score