undefined

Eating Disorder Survey

The Eating Disorder Survey is used to help individuals suffering from an eating disorder to better understand their condition and to find effective treatment options. The survey asks questions about the frequency and severity of symptoms, as well as the impact of the disorder on daily life.

2 minutes to complete

Eligibility

The survey is open to anyone who lives with an eating disorder, or who has recovered from an eating disorder.

undefined

Questions for Eating Disorder Survey

Questions

1.

Full Name

The answer should be a text input.
2.

Age

The answer should be a single choice:
  1. Under 18
  2. 18-24 years old
  3. 25-34 years old
  4. 35-44 years old
  5. 45-54 years old
  6. Over 55
3.

Gender

The answer should be a single choice:
  1. Male
  2. Female
  3. Other
  4. Prefer not to say
4.

Phone Number

The answer should be a phone number.
5.

Email Address

The answer should be an email input.
6.

Do you believe that you are overweight, even if you are not?

The answer should be a single choice:
  1. Yes
  2. No
7.

Do you feel the need to diet or control your eating in some way?

The answer should be a single choice:
  1. Yes
  2. No
8.

Do you feel guilty or ashamed after eating?

The answer should be a single choice:
  1. Yes
  2. No
9.

Do you feel like you need to exercise excessively to make up for what you have eaten?

The answer should be a single choice:
  1. Yes
  2. No
10.

Do you restrict certain foods or food groups from your diet?

The answer should be a single choice:
  1. Yes
  2. No
11.

Do you binge eat, or eat large amounts of food in a short period of time?

The answer should be a single choice:
  1. Yes
  2. No
12.

Do you purge after eating, either through vomiting, use of laxatives or diuretics, or excessive exercise?

The answer should be a single choice:
  1. Yes
  2. No
13.

Do you feel like your eating habits are impacting your quality of life?

The answer should be a single choice:
  1. Yes
  2. No

Scales Similar to Eating Disorder Survey

  • Anorexia Nervosa Diagnostic Scale
  • Bulimia Nervosa Diagnostic Scale
  • Eating Disorder Inventory
  • Eating Disorder Severity Test
  • Eating Attitudes Test
  • Body Dysmorphic Disorder Questionnaire
  • Yale Food Addiction Scale

Here are some FAQs and additional information
on
Eating Disorder Survey

What percentage of the population has disordered eating?

Eating disorders affect at least 9% of the population worldwide. 9% of the U.S. population, or 28.8 million Americans, will have an eating disorder in their lifetime.

What is the purpose of this survey?

This survey is being conducted by the National Eating Disorder Association (NEDA) to better understand the prevalence of eating disorders and related behaviors in the United States.

What is the number one most common eating disorder?

Binge eating disorder is the most common eating disorder in the U.S., according to the National Eating Disorders Association. It's characterized by episodes of eating large amounts of food, often quickly and to the point of discomfort.

Do eating disorders have a genetic link?

The role of genetics in eating disorders has been a subject of research for decades. Studies of families and twins have confirmed that eating disorders run in families because of shared genetic factors.

Want to use this template?

Loved by people at home
and at work

undefined
“BlockSurvey is a simple, effective, and scalable tool for creating surveys for leadership and learning assessment. It's one of this year's best buying choices. Each month, it keeps improving and strives to serve its customers needs.”
Nelson Emilio
Personal Branding Strategist
undefined
“I use BlockSurvey to get feedback about all my activities and events. It is really easy to get started and create my first surveys! Then I could see how easy it was to share them. Now I am thinking to use BlockSurvey also within my creative process as an author in order to listen and engage with my audience, knowing that anonymity provides the most sincere and reliable answers.”
Georgina García-Mauriño
Author & Designer
BlockSurvey social proof
G2 Crowd
4.8 Star Rating
BlockSurvey social proof
Dapp.com
Editor's choice
BlockSurvey social proof
Capterra
4.9 Star Rating

What's next? Try out templates like
Eating Disorder Survey

1000+ Templates, 50+ Categories

Want to create secure online forms and surveys?

Join BlockSurvey.

SHARE