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1-Do you consider yourself to have an eating disorder?
 
a)yes
 
b)no
 
 
 
2-If you answered yes to having an eating disorder., which group do you fit in ?
 
a) Female aged 10-20
 
b) Male aged 10-20
 
c) Female aged 20-30
 
d) Male aged 20-30
 
e) Female aged 30+
 
f) Male aged 30+
 
 
 
3-If you have an eating disorder, what type of the following you have?
 
a) Anorexia Nervosa
 
b) Bulimia Nervosa
 
c) Complusive Over-Eating
 
d) other
 
 
 
4-Do you think that the media plays a key role in the increase of eating disorders?
 
a) Yes
 
b) No
 
 
 
5-Do you think that the use of abnormally slim people in the media (i.e. fashion, TV, film etc.) contributes to low-self esteem & body image ?
 
a) Yes
 
b) No
 
 
 
6- Do you consider celebrities that are very thin bad influences?
 
a) Yes
 
b) No
 
 
 
7-if you answer is yes , state why?
   
 
 
 
8-If you do not have an eating disorder, do you ever diet?

 
a) Yes
 
b) No
 
 
 
9-If you have an eating disorder, have you ever been hospitalized for it?
 
a) Yes
 
b) No
 
 
 
10-How often do you weigh yourself?

 
a) A couple of times a year at the doctor's office
 
b) About once a month
 
c) About once a week
 
d) A couple of times a week
 
e) Daily
 
f) Two or more times a day
 
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