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Over the past four weeks:

Question Never Rarely Sometimes Often Very Often Always
1. Has feeling bored made you brood about your shape?
2. Have you been so worried about your shape that you have been feeling you ought to diet?
3. Have you thought that your thighs, hips, or bottom are too large for the rest of you?
4. Have you been afraid that you might become fat (or fatter)?
5. Have you worried about your flesh being not firm enough?
6. Has feeling full (e.g.. after eating a large meal) made you feel fat?
7. Have you felt so bad about your shape that you have cried?
8. Have you avoided running because your flesh might wobble?
9. Has being with thin women made you feel self-conscious about your shape?
10. Have you worried about your thighs spreading out when sitting down?
11. Has eating even a small amount of food made you feel fat?
12. Have you noticed the shape of other women and felt that your own shape compared unfavorably?
13. Has thinking about your shape interfered with your ability to concentrate (e.g., while watching television, reading, listening to conversations)?
14. Has being naked, such as when taking a bath, made you feel fat?
15. Have you avoided wearing clothes which make you particularly aware of the shape of your body?
16. Have you imagined cutting off fleshy areas of your body?
17. Has eating sweets, cakes, or other high-calode food made you feel fat?
18. Have you not gone out to social occassions (e.g., parties) because you have felt bad about your shape?
19. Have you felt excessively large and rounded?
20. Have you felt ashamed of your body?
21. Has worry about your shape and made you diet?
22. Have you felt happiest about your shape when your stomach has been empty (e.g., in the morning)?
23. Have you thought that you are in the shape you are because you lack self-conrol?
24. Have you worried about other people seeing rolls of fat around your waist or stomach?
25. Have you felt that it is not fair that other women are thinner than you?
26. Have you vomited in order to feel thinner?
27. When in company have you worried about taking up too much room (e.g., sitting on sofa, or a bus seat)?
28. Have you worried about your flesh being dimply?
29. Has seeing your reflection (e.g., in a mirror or shop window) made you feel bad about your shape?
30. Have you pinched areas of your body to see how much fat there is?
31. Have you avoided situations where people could see your body (e.g., communal changing rooms or swimming pools)?
32. Have you taken laxatives in order to feel thinner?
33. Have you been particularly self-conscious about your shape when in the company of other people?
34. Has worry about your shape made you feel you ought to exercise?