Family Consequences of Eating Disorders
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1. Default Section
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1
. Gender:
Gender:
Female
Male
Other (please specify)
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2
. I have been diagnosed with, or meet criteria for:
I have been diagnosed with, or meet criteria for:
Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder
Another Type of Eating Disorder
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3
. My parent or parents have experienced the following emotions as a result of my eating disorder:
My parent or parents have experienced the following emotions as a result of my eating disorder:
Sadness
Anxiety
Anger
Guilt
Not sure
They didn't/don't know about it
Other (please specify)
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4
. My eating disorder has had the effect of:
My eating disorder has had the effect of:
Negatively impacting my parents' relationship
Positively impacting my parents' relationship
Causing them to separate
Not sure
Hasn't had an effect
Other (please specify)
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5
. My e.d. has had the effect of:
My e.d. has had the effect of:
Positively impacting my relationship with a partner
Negatively impacting my relationship with a partner
Not sure
Not applicable
Other (please specify)
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6
. My e.d. has had the effect of:
My e.d. has had the effect of:
Positively impacting my relationship with my child(ren)
Negatively impacting my relationship with my child(ren)
Not sure
Leading my child(ren) to have an e.d., too.
Not applicable
Other (please specify)
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7
. For those who have a younger sibling(s) only: After I developed my e.d., my younger sibling:
For those who have a younger sibling(s) only: After I developed my e.d., my younger sibling:
Developed an e.d., too.
Did not develop an e.d.
Not sure.
It's too early to tell.
Not applicable.
Other (please specify)
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8
. For those who have older siblings only: After I developed my e.d., my older sibling:
For those who have older siblings only: After I developed my e.d., my older sibling:
Not applicable
Developed an e.d., too.
Did not develop an e.d.
Not sure.
It's too early to tell.
Other (please specify)
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9
. As a result of my e.d., family member(s) have:
As a result of my e.d., family member(s) have:
Sought therapy and found it helpful for them to cope.
Sought therapy and found it unhelpful.
Have not sought therapy.
Not sure.
Other (please specify)
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10
. As a result of my e.d., family members:
As a result of my e.d., family members:
Have sought out other resources (e.g., support groups) and found them helpful
Have sought out other resources and haven't found them helpful
Have not sought out other resources
Not sure
Other (please specify)
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