We should like to know how you have been feeling about your appearance over the PAST FOUR WEEKS. Please read each question and circle the appropriate number to the right. Please answer all the questions.

		Never
		|	Rarely
		|	|	Sometimes
		|	|	|	Often
		|	|	|	|	Very often
		|	|	|	|	|	Always
		|	|	|	|	|	|
1.	Has feeling bored made you brood about your shape?...........................	1	2	3	4	5	6
2.	Have you thought that your thighs, hips or bottom are too large for the rest of you?..............................................................................................	1	2	3	4	5	6
3.	Have you worried about your flesh being not firm enough?...................	1	2	3	4	5	6
4.	Have you felt so bad about your shape that you have cried?..................	1	2	3	4	5	6
5.	Have you avoided running because your flesh might wobble?...............	1	2	3	4	5	6
6.	Has being with thin women made you feel self-conscious about your shape?......................................................................................................	1	2	3	4	5	6
7.	Have you worried about your thighs spreading out when sitting down?	1	2	3	4	5	6
8.	Has eating even a small amount of food made you feel fat?...................	1	2	3	4	5	6
9.	Have you avoided wearing clothes which make you particularly aware of the shape of your body?......................................................................	1	2	3	4	5	6
10.	Has eating sweets, cakes, or other high calorie food made you feel fat?	1	2	3	4	5	6
11.	Have you felt ashamed of your body?.....................................................	1	2	3	4	5	6
12.	Has worry about your shape made you diet?..........................................	1	2	3	4	5	6
13.	Have you felt happiest about your shape when your stomach has been empty (e.g. in the morning)?...................................................................	1	2	3	4	5	6
14.	Have you felt that it is not fair that other women are thinner than you?.	1	2	3	4	5	6
15.	Have you worried about your flesh being dimply?.................................	1	2	3	4	5	6
16.	Has worry about your shape made you feel you ought to exercise?.......	1	2	3	4	5	6