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

1. Default Section

Question Title

* 1. I currently suffer from:

Anorexia

Bulimia

Bulimarexia (restricting, bingeing and purging)

Emotional Eating

Obesity

Question Title

* 2. 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

Question Title

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

Yes

If yes please specify

Question Title

* 4. As a child I was:

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

Question Title

* 5. Regarding dieting:

I do not diet, although I do restrict

I do not diet or restrict

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)

Question Title

* 6. 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

Question Title

* 7. 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)

Question Title

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

Fear of calories

Food phobias

Food cravings

Fear of handling food

Fear of eating food I have not prepared

Obsessive thoughts of food

Fear of fat

Fear of carbs

Fear of sodium

Fear of sugars

Other (please specify)

Question Title

* 9. 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

Question Title

* 10. 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

Question Title

* 11. Regarding my weight:

I judge myself on the basis of how I feel about my body, i.e. if I think I look good then I feel ok about myself, but if I think I look bad, I am miserable

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.e. if the number is good, I feel good, but if the number is bad I feel horrible.

I am afraid to gain weight

Question Title

* 12. 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

Question Title

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


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

Other (please specify)

Question Title

* 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	Outpatient Family Therapy More harm than good	Outpatient Family Therapy Neutral	Outpatient Family Therapy Somewhat therapeutic	Outpatient Family Therapy Very therapeutic - made progress	Outpatient Family Therapy Exceptionally therapeutic - complete remission
Hospitalization for medical stabilization	Hospitalization for medical stabilization More harm than good	Hospitalization for medical stabilization Neutral	Hospitalization for medical stabilization Somewhat therapeutic	Hospitalization for medical stabilization Very therapeutic - made progress	Hospitalization for medical stabilization Exceptionally therapeutic - complete remission
Forced weight gain via feeding tube	Forced weight gain via feeding tube More harm than good	Forced weight gain via feeding tube Neutral	Forced weight gain via feeding tube Somewhat therapeutic	Forced weight gain via feeding tube Very therapeutic - made progress	Forced weight gain via feeding tube Exceptionally therapeutic - complete remission
In-patient residential	In-patient residential More harm than good	In-patient residential Neutral	In-patient residential Somewhat therapeutic	In-patient residential Very therapeutic - made progress	In-patient residential Exceptionally therapeutic - complete remission
In-patient therapy group	In-patient therapy group More harm than good	In-patient therapy group Neutral	In-patient therapy group Somewhat therapeutic	In-patient therapy group Very therapeutic - made progress	In-patient therapy group Exceptionally therapeutic - complete remission
Out-patient psychotherapy	Out-patient psychotherapy More harm than good	Out-patient psychotherapy Neutral	Out-patient psychotherapy Somewhat therapeutic	Out-patient psychotherapy Very therapeutic - made progress	Out-patient psychotherapy Exceptionally therapeutic - complete remission
Out-patient therapy group	Out-patient therapy group More harm than good	Out-patient therapy group Neutral	Out-patient therapy group Somewhat therapeutic	Out-patient therapy group Very therapeutic - made progress	Out-patient therapy group Exceptionally therapeutic - complete remission
Over Eaters Anonamous	Over Eaters Anonamous More harm than good	Over Eaters Anonamous Neutral	Over Eaters Anonamous Somewhat therapeutic	Over Eaters Anonamous Very therapeutic - made progress	Over Eaters Anonamous Exceptionally therapeutic - complete remission
Nutritional Counseling	Nutritional Counseling More harm than good	Nutritional Counseling Neutral	Nutritional Counseling Somewhat therapeutic	Nutritional Counseling Very therapeutic - made progress	Nutritional Counseling Exceptionally therapeutic - complete remission
Gastric Bypass Surgery	Gastric Bypass Surgery More harm than good	Gastric Bypass Surgery Neutral	Gastric Bypass Surgery Somewhat therapeutic	Gastric Bypass Surgery Very therapeutic - made progress	Gastric Bypass Surgery Exceptionally therapeutic - complete remission

Other (please specify)

Question Title

* 15. 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, peer pressure 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

Question Title

* 16. The impact that residential 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

Question Title

* 17. Regarding Bulimarexia and inpatient treatment:

I was Anorexic prior to treatment and developed symptoms of Bulimia, (so that I am now Bulimarexia) during or immediately following inpatient treatment.

I was Bulimic prior to treatment and developed symptoms of Anorexia (so that I am now Bulimarexia) during or immediately following inpatient treatment.

Question Title

* 18. Regarding outpatient treatment and Bulimarexia:

I was Anorexic prior to outpatient treatment and developed symptoms of Bulimia (Bulimarexia) during or immediately following treatment.

I was Bulimic prior to outpatient treatment and developed symptoms of Anorexia (Bulimarexia) during or immediately following treatment.

The fact that I have symptoms of both Anorexia and Bulimia (Bulimarexia) has nothing to do with the treatment I have received.

I have had no treatment, but have symptoms of both Anorexia and Bulimia (Bulimarexia).