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				Does your child or someone you know tend to ... | 
			
			
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				1. | 
				be overly concerned with body appearance or weight? | 
			
			
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				2. | 
				be moody and irritable? | 
			
			
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				3. | 
				have anxiety, depression, or suicidal thoughts? | 
			
			
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				4. | 
				have anxiety around meal times? | 
			
			
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				5. | 
				feel guilt or dislike themselves? | 
			
			
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				6. | 
				diet frequently or often make excuses not to eat? | 
			
			
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				7. | 
				have problems with overeating? | 
			
			
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				8. | 
				have obsessive behaviors with food, such as only drinking from a certain cup or eating certain foods only on certain days of the week? | 
			
			
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				9. | 
				wear baggy clothes, layer their clothes, or their clothing style has changed? | 
			
			
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				10. | 
				hoard food? | 
			
			
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				11. | 
				spend time in the bathroom after meals? | 
			
			
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				12. | 
				be socially withdrawn or isolated? | 
			
			
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				13. | 
				avoid social situations where food is available? | 
			
			
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				14. | 
				have given up or lost interest in some former hobbies? | 
			
			
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				15. | 
				have had dramatic weight loss or rapid fluctuations in weight? | 
			
			
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				16. | 
				be dehydrated (evident in thinning hair, sallow skin, and dry, brittle nails)? | 
			
			
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				17. | 
				have edema where the body retains water or fluid, making it look puffy? | 
			
			
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				18. | 
				have irregular or stopped menstrual periods? | 
			
			
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				19. | 
				experience slowed metabolism (which causes slower heart rate, low blood pressure, lower body temperature, feels cold often, bluish-colored fingers, toes, hands, or feet)? | 
			
			
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				20. | 
				develop hypoglycemia or low blood sugar (which causes confusion, illogical thinking, coma, shakiness, and irritability)? | 
			
			
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				21. | 
				sometimes feel faint, dizzy, or fatigued? | 
			
			
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				22. | 
				have trouble with concentration, memory, and thinking ability? | 
			
			
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				23. | 
				have frequent constipation, diarrhea, cramps, or other bowel problems? | 
			
			
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				24. | 
				often have a sore throat, indigestion, and heartburn? | 
			
			
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				25. | 
				bruise easily? | 
			
			
				
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				| Total 'Yes' | 
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				(out of 25 possible) | 
			
			
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				| Interpretation | 
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