Binge eating disorder questionnaire Please enable JavaScript in your browser to complete this form.NameFirstLastEmail *AgePlease respond to the following questions based on your recent experiences:Felt you ate an unusually large amount of food?Felt out of control while eating?Eaten until uncomfortably full?Eaten large amounts of food when not physically hungry?Felt embarrassed by how much you ate?Felt disgusted, depressed, or guilty after eating?Felt very upset about binge eating episodes? Do you often eat large amounts of food quickly, even when not hungry?YesNoHave you had a fear of losing control over eating?YesNoDo you feel guilty or ashamed after overeating?YesNoHow often do you feel like you have eaten what other people would regard as an unusually large amount of food (given the circumstances)?Weekly2-3 times a monthRarely your embarrassed losing Do you eat alone because of embarrassment?YesNo Has thinking about food, eating or calories, made it difficult to concentrate on things you are interested in?YesNo Has thinking about shape or weight made it difficult to concentrate on things you are interested in? YesNoQuestions or CommentsSubmit
