Eating Disorder Intake

Transcription

1 Eating Disorder Intake Name: Date: A) When I think of my Eating Disorder, I consider myself to be a (Check all that apply) anorexic (eating too little, self-starvation; may also involve vomiting, laxative abuse, excessive exercise, self-injury, etc. Anorexics are noticeably underweight.) bulimic (binges on large amounts of food and purges by vomiting or laxative use; may also involve excessive exercise; most bulimics are generally height/weight proportionate or slightly over- or under-weight. A few become emaciated.) binger/starver (alternates periods of bingeing with periods of starvation or dieting; binger/starvers are usually height/weight proportionate or slightly overweight) compulsive eater/binge eater (periodically or continually over-eats, characterized by an overweight condition or obesity) I don't know. I don't think I really have an Eating Disorder. B) I practice the following behaviors (mark an "A" for "frequently" or "always" and an "S" for" sometimes", or an "R" for "rarely". Leave blank for "never".): skip meals eat only low fat, low calorie foods go all day without eating eat less than 1000 calories a day cut, burn, or otherwise injure myself count calories count fat grams exercise more than once a day exercise for more than 2 hours a day constantly think about food and eating constantly think about not eating constantly think about my weight and appearance am always "dieting" weigh myself at least once a day use laxatives vomit if I eat a little food vomit after bingeing binge on large amounts of food graze on food all day long eat too much or too often to experience real hunger ignore hunger pangs hide food from others steal food (from stores or from people) avoid eating in view of others eat "reasonably" in public, eat "extra" in private lie about eating when I haven't lie about not eating when I have

2 C) How long have you practiced ED behaviors? D) When I think about or look at my body weight and size, I believe myself to be emaciated underweight just right/average slightly overweight very overweight obese E) Other people seem to think I am emaciated underweight just right/average slightly overweight very overweight obese F) Indicate which one applies. My ED is a secret. I am the only one who knows about it. Only one person knows about my ED (counselor, doctor, teacher, best friend, parent.). Family and/or friends know about my ED. I have shared my struggle with an ED with many people for various reasons. Everyone knows I have an ED just by looking at me. G) Check all that apply. I have an ED, I don t like what I am doing, and I want help. Other people think I have an ED and think I should get help. I'm not so sure. I can take care of this myself. Counseling is unnecessary. I am being forced or pressured into counseling. I am just fine and don't need help. Other people are making a big deal out of nothing. H) Indicate which statement most strongly represents what you believe. I am responsible for my eating problems and the condition of my body. (It is the result of my own choices, either conscious or unconscious) Someone else is responsible for my eating problems and the condition of my body (i.e. genetics, parents, siblings, other relatives, spouse, friends, media, God, etc.) Circumstances are responsible for my eating problems and the condition of my body (poverty, affluence, loss, trauma, illness, abuse, neglect, hardship, culture, family lifestyle, etc.)

3 I) My eating and exercise habits negatively affect the following areas (Check all that apply): relationships physical health spiritual life mental/emotional well-being school/job performance self image J) Check all that you agree with. I am born again and have an active relationship with God through Jesus Christ. I attend church services regularly. I have a consistent prayer life. I praise and worship God when I am alone. I read my Bible or listen to the Word of God regularly. I am currently involved in God's work. My most intimate relationships tend to be with fellow Christians. God is involved in my daily life, and I am involved with Him. Churches or church leadership have hurt or disappointed me. Christians are mostly just a bunch of hypocrites. I attend church, but God doesn't seem to be a part of my life. I am afraid of God, or believe He is angry or disgusted with me. I am a Christian, but am not close to God right now. I want to improve my relationship with God. I want God's help, but He doesn't seem to help me when I ask for it. I don't think God really intervenes in people's lives. Everything is the luck of the draw and we just have to live with it. Everything that happens in this life, both good and evil, is part of God's will or plan. God gave me this ED for a reason, perhaps to teach me something. There are consequences to actions, even for Christians. God is willing to lead people out of trouble they brought on themselves. I think it is possible that my present troubles may have a spiritual root and would be remedied by a spiritual solution. I don't see a connection between Eating Disorders and spirituality. I am willing to hear more about the Bible as it may relate to Eating Disorders. TRIGGERS Some of us can identify "triggers" that seem to set off eating disorder behaviors and rituals. Mark your triggers, if applicable. A. Physical Triggers pain tiredness weakness illness hunger feeling full other

4 B. Food Triggers (foods that seem to always spell "trouble") refined sugar, sweets (candy, cake, pie, doughnuts, ice cream, soda, milkshakes, sugary cereals, ketchup, juice, flavored coffee drinks, pancakes and syrup, jam, honey, anything sweet) fat (pizza, hamburgers, French fries, cheese, fried foods, doughnuts, ice cream, milk, butter, oils, chips, mac and cheese, omelets, potato salad, gravy, anything fatty) sugar/fat combos (pastry, ice cream, pudding, custard, chocolate, desserts, sweetened peanut butters, chocolate milk, whipped cream, anything high in both sugar and fat) salty foods (potato chips, corn chips, packaged snack foods, pickled foods, smoked meats, cold cuts, French fries, condiments, store-bought prepared or packaged foods are often overly salty) white flour (white bread, rolls, biscuits, bagels, crackers, refined cereals, pastries, anything made with refined white flours) starchy foods (breads, cereals, rice, pasta, beans, peas, potatoes, squash, etc.) restaurant foods (can be feeding several addictions, such as to salt, fat, and/or sugar; meals tend to be overly large, which if eaten can lead to feelings of having "blown" it) smorgasbords, buffets, or all-you-can-eats (opportunity for over-indulgence in the case of bulimics, bingers, and overeaters or overwhelming fear which leads to eating nothing for anorexics and some bulimics, binger/starvers or chronic dieters). C. Emotional Triggers anger fear sadness, grief depression happiness things going well feelings of failure disappointment with self, others, events frustration with self or others overwhelmed, too much to do general stress other

5 D. Situation Triggers