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Eating Disordered Habits

Dear participant, please take a few minutes of your time to complete the following questionnaire. This should not be taken as a diagnosis but merely a look into habits.

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1

What is your gender?

Select 1 answer
2

Have you ever been diagnosed with an eating disorder?

Select 1 answer
3

I consistently skip meals throughout the week on purpose.

10= strongly agree, 1= strongly disagree
4

The idea of eating meals makes me anxious.

10= strongly agree, 1= strongly disagree
5

I grew up in a household that pushed disordered eating habits onto me.

10= strongly agree, 1= strongly disagree
6

The idea of participating in a "cheat day" would ruin my day.

10= strongly agree, 1= strongly disagree
7

How would you handle anxiety around food?

You can leave a suggestion/coping mechanisms. It can be any similar advice for dealing with anxiety around other parts of your life.
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