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Instructions: The sentences below describe attitudes, feelings, and behaviors. Some of
the issues are related to food, the way of eating and attempts to control weight. Other
issues deal with feelingss towards oneself.
In each sentence there are five answer alternatives, from which you must choose the one
that best describes you. The response options for each sentence are:
0 = Never.
1 = Few times
2 = Sometimes.
3 = Often
4 = Almost always
5 = Always
In each sentence answer if what is said occurs to you and do not leave any blank.
Remember that there are no right or wrong answers. Just locate what is most in line with
your experience.
ANSWER ALL THE SENTENCES WITH SINCERITY
1. I eat sweets and carbohydrates (bread, noodles) without worrying.
(0) Never (1) Rarely (2) Sometimes
(3) Often (4) Almost always (5) Always
7. I plan to go on a diet.
(0) Never (1) Rarely (2) Sometimes
(3) Often (4) Almost always (5) Always
20. I think I'm generally in control of the things that happen in my life.
(0) Never (1) Rarely (2) Sometimes
(3) Often (4) Almost always (5) Always
28. I've been to potlucks (places where there is plenty of food) where I felt like I
couldn't stop eating.
(0) Never (1) Rarely (2) Sometimes
(3) Often (4) Almost always (5) Always
29. When I was little, I tried hard not to disappoint my parents and teachers.
(0) Never (1) Rarely (2) Sometimes
(3) Often (4) Almost always (5) Always
38. I tend to think about binge eating (Unusually large amount of food).
(0) Never (1) Rarely (2) Sometimes
(3) Often (4) Almost always (5) Always
46. I eat in moderation in front of others but binge (unusually large amount of food)
when they leave.
(0) Never (1) Rarely (2) Sometimes
(3) Often (4) Almost always (5) Always
49. If I put on one kilo, I worry that I may continue to gain weight.
(0) Never (1) Rarely (2) Sometimes
(3) Often (4) Almost always (5) Always
51. When I'm upset I don't know if I'm sad, scared or angry.
(0) Never (1) Rarely (2) Sometimes
(3) Often (4) Almost always (5) Always
54. I need to keep a certain distance from people; I feel uncomfortable if someone gets
too close.
(0) Never (1) Rarely (2) Sometimes
(3) Often (4) Almost always (5) Always
58. The best years of your life are when you become an adult.
(0) Never (1) Rarely (2) Sometimes
(3) Often (4) Almost always (5) Always
68. I would like to be able to have total control over my bodily needs (urination and
defecation).
(0) Never (1) Rarely (2) Sometimes
(3) Often (4) Almost always (5) Always
81. I have to watch out for my tendency to drink too much alcohol.
(0) Never (1) Rarely (2) Sometimes
(3) Often (4) Almost always (5) Always