Norton Eating Disorders Survey All rights reserved, copyright Dr. J. Renae Norton 2007

2. The symptoms of my eating disorder first occurred:

The symptoms of my eating disorder first occurred: Before the age of 10

Between the ages of 11 and 13

Between the ages of 14 to 19

Between the ages of 20 to 29

Between the ages of 30 to 49

After the age of 50

3. There was a specific event that triggered the onset of my eating disorder :

There was a specific event that triggered the onset of my eating disorder : Yes

If yes please specify

4. As a child I was:

	Satisfied with my weight	Unsatisfied with my weight	Unconcerned with my weight
A normal weight	As a child I was: A normal weight Satisfied with my weight	Unsatisfied with my weight	Unconcerned with my weight
Underweight	Underweight Satisfied with my weight	Unsatisfied with my weight	Unconcerned with my weight
Overweight	Overweight Satisfied with my weight	Unsatisfied with my weight	Unconcerned with my weight
Up and down in my weight	Up and down in my weight Satisfied with my weight	Unsatisfied with my weight	Unconcerned with my weight

5. Regarding dieting:

Regarding dieting: I do not diet

I started when I was a child

I started as a teenager

I started as an adult

I was influenced by a parent to begin dieting

I was influenced by my peers

I was influenced by a significant other

I was influenced by the media

Other (please specify)

6. Regarding restricting:

Regarding restricting: I do not restrict

I started as a child

I started as a teenager

I started as an adult

I restrict every once in a while

I restrict during the day, and eat normally at night

I restrict 24/7

I restrict except when I am going to purge, then I eat "normally"

I restrict except when I am going to purge, then I binge

Other (please specify)

7. Presently, I diet:

Presently, I diet: Not at all

Occasionally - several times a year

Often - once or twice a month

Most of the time - 50% of the time or more

All the time - 95% of the time or more

8. Regarding food, I often experience the following:

Regarding food, I often experience the following: Fear of calories

Fear of carbs

Fear of eating food I have not prepared

Fear of fat

Fear of handling food

Fear of sodium

Fear of sugars

Food cravings

Food phobias

Obsessive thoughts of food

Other (please specify)

9. Regarding shopping for food:

Regarding shopping for food: I buy very healthy food all the time

I buy very healthy food except when I buy binge food

I buy mostly fast food or processed foods

I spend more than I can afford on food

I have been reduced to stealing food for a binge

I buy food all the time that I know I will never eat

I rarely shop for food

10. While shopping for food, I may obsess for long periods of time in the grocery store by:

While shopping for food, I may obsess for long periods of time in the grocery store by: Reading every label

Eliminating any food that does not meet my criteria

Adding up the calories (or fat, or carbs etc.) before putting something in my cart

Debating whether or not to purchase a particular item

Fantasizing about binging on certain foods

Tempting myself by browsing aisles I normally try to avoid

Examining and re-examining produce/meats/fish

11. Regarding my weight:

Regarding my weight: I judge myself on the basis of how I feel about my body

I want to be smaller

I want to be as small as possible

I want to be a normal weight

I judge my self worth on the basis of what I weigh

I am afraid to gain weight

12. Regarding the scale:

Regarding the scale: I weigh myself once per week

I weigh myself once per day

I weigh myself multiple times per day

I have such a strong need to know my weight that I cannot function normally

I do not weigh myself at all

13. My perception of the following types of treatment is as follows:

	More harm than good	Neutral	Somewhat therapeutic	Very therapeutic
Hospitalization for medical stabilization	My perception of the following types of treatment is as follows: Hospitalization for medical stabilization More harm than good	Neutral	Somewhat therapeutic	Very therapeutic
Forced weight gain via feeding tube	Forced weight gain via feeding tube More harm than good	Neutral	Somewhat therapeutic	Very therapeutic
In-patient residential	In-patient residential More harm than good	Neutral	Somewhat therapeutic	Very therapeutic
In-patient therapy group	In-patient therapy group More harm than good	Neutral	Somewhat therapeutic	Very therapeutic
Out-patient psychotherapy	Out-patient psychotherapy More harm than good	Neutral	Somewhat therapeutic	Very therapeutic
Out-patient therapy group	Out-patient therapy group More harm than good	Neutral	Somewhat therapeutic	Very therapeutic
Over Eaters Anonamous	Over Eaters Anonamous More harm than good	Neutral	Somewhat therapeutic	Very therapeutic
Nutritional Counseling	Nutritional Counseling More harm than good	Neutral	Somewhat therapeutic	Very therapeutic
Gastric Bypass Surgery	Gastric Bypass Surgery More harm than good	Neutral	Somewhat therapeutic	Very therapeutic

Other (please specify)

14. Of the types of treatent that I have received, I would rate each as follows:

	More harm than good	Neutral	Somewhat therapeutic	Very therapeutic - made progress	Exceptionally therapeutic - complete remission
Hospitalization for medical stabilization	Of the types of treatent that I have received, I would rate each as follows: Hospitalization for medical stabilization More harm than good	Neutral	Somewhat therapeutic	Very therapeutic - made progress	Exceptionally therapeutic - complete remission
Forced weight gain via feeding tube	Forced weight gain via feeding tube More harm than good	Neutral	Somewhat therapeutic	Very therapeutic - made progress	Exceptionally therapeutic - complete remission
In-patient residential	In-patient residential More harm than good	Neutral	Somewhat therapeutic	Very therapeutic - made progress	Exceptionally therapeutic - complete remission
In-patient therapy group	In-patient therapy group More harm than good	Neutral	Somewhat therapeutic	Very therapeutic - made progress	Exceptionally therapeutic - complete remission
Out-patient psychotherapy	Out-patient psychotherapy More harm than good	Neutral	Somewhat therapeutic	Very therapeutic - made progress	Exceptionally therapeutic - complete remission
Out-patient therapy group	Out-patient therapy group More harm than good	Neutral	Somewhat therapeutic	Very therapeutic - made progress	Exceptionally therapeutic - complete remission
Over Eaters Anonamous	Over Eaters Anonamous More harm than good	Neutral	Somewhat therapeutic	Very therapeutic - made progress	Exceptionally therapeutic - complete remission
Nutritional Counseling	Nutritional Counseling More harm than good	Neutral	Somewhat therapeutic	Very therapeutic - made progress	Exceptionally therapeutic - complete remission
Gastric Bypass Surgery	Gastric Bypass Surgery More harm than good	Neutral	Somewhat therapeutic	Very therapeutic - made progress	Exceptionally therapeutic - complete remission

Other (please specify)

15. The most common mistake professionals made while treating me was:

The most common mistake professionals made while treating me was: They did not understand me as an individual, i.e. they had a "One size fits all" approach

I felt that I was being judged

I was not properly medicated

The treatment did not take into account the triggers/stressors in my environment (family, job, marriage, school, social factors etc)

They were naive about the disorder, it was easy to deceive them

They encouraged me to eat high carbohydrate and/or highly processed foods to help me "overcome" my fears

I was not given a choice about whether to eat and limited choices about what to eat

My weight gain was so rapid that I did not have suficient time to adjust to my new body size before being discharged

I was not prepared for, nor did I understand the impact of transitioning back to a normal routine

16. The impact that treatment has had on me has been:

The impact that treatment has had on me has been: Extremely positive, I am in remission and have a normal relationship with food

Very positive, although I am still struggling with some issues, I have maintained a healthy weight and/or no longer binge and purge

Minimal change as my relationship with food did not improve during or after treatment and I still have the same symptoms

Negative, as I began losing weight and/or binging and purging within the first 3 months following treatment

Very negative, as my symptoms worsened and/or new ones developed following treatment OR

I was Anorexic prior to treatment, and developed symptoms of Bulimia during or immediately following treatment OR

I was Bulimic prior to treatment, and developed symptoms of Anorexia during or immediately following treatment

1. Default Section

1. I currently suffer from:

2. The symptoms of my eating disorder first occurred:

3. There was a specific event that triggered the onset of my eating disorder :

4. As a child I was:

5. Regarding dieting:

6. Regarding restricting:

7. Presently, I diet:

8. Regarding food, I often experience the following:

9. Regarding shopping for food:

10. While shopping for food, I may obsess for long periods of time in the grocery store by:

11. Regarding my weight:

12. Regarding the scale:

13. My perception of the following types of treatment is as follows:

14. Of the types of treatent that I have received, I would rate each as follows:

15. The most common mistake professionals made while treating me was:

16. The impact that treatment has had on me has been: