1. Default Section

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* 1. I currently suffer from:

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* 2. The symptoms of my eating disorder first occurred:

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

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* 4. As a child I was:

  Satisfied with my weight Unsatisfied with my weight Unconcerned with my weight
A normal weight
Underweight
Overweight
Up and down in my weight

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* 5. Regarding dieting:

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* 6. Presently, I diet:

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* 7. Regarding restricting:

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* 8. Regarding food, I often experience the following:

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* 9. Regarding shopping for food:

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

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* 11. Regarding my weight:

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* 12. Regarding the scale:

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* 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
Forced weight gain via feeding tube
In-patient residential
In-patient therapy group
Out-patient psychotherapy
Out-patient therapy group
Over Eaters Anonamous
Nutritional Counseling
Gastric Bypass Surgery

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* 14. Of the types of treatment 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
Outpatient Family Therapy
Hospitalization for medical stabilization
Forced weight gain via feeding tube
In-patient residential
In-patient therapy group
Out-patient psychotherapy
Out-patient therapy group
Over Eaters Anonamous
Nutritional Counseling
Gastric Bypass Surgery

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

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

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* 17. Regarding Bulimarexia and inpatient treatment:

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* 18. Regarding outpatient treatment and Bulimarexia:

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