Eating Disorder Screening Form

The Eating Disorder Screening Form provides a structured, clinically informed questionnaire for identifying patients who may be struggling with anorexia nervosa, bulimia nervosa, binge eating disorder, or other disordered eating patterns. Modeled after the Eating Attitudes Test (EAT-26), one of the most widely validated screening tools for eating disorders, this form uses carefully worded questions that assess attitudes toward food, eating behaviors, body image perception, and compensatory behaviors. Early identification of eating disorders is critical because these conditions carry the highest mortality rate of any psychiatric illness, yet they frequently go undetected in primary care and mental health settings.

The screening begins with demographic information and weight history, including current weight, height, highest and lowest adult weights, desired weight, and any recent significant weight changes. The EAT-26 style screening questions evaluate dieting behavior, food preoccupation, purging or compensatory behaviors, perceived pressure to eat, control over eating, and body dissatisfaction using a Likert frequency scale. Additional sections assess specific behaviors such as binge eating episodes, self-induced vomiting, laxative or diuretic use, excessive exercise patterns, and restriction or fasting. A body image assessment captures the patient's self-perception and the degree of distress associated with weight and shape concerns.

This eating disorder screening questionnaire is ideal for primary care practices conducting routine behavioral health screening, pediatric and adolescent medicine offices where eating disorders are most likely to first present, college health centers, sports medicine clinics evaluating athletes for the female or male athlete triad, outpatient psychiatric and therapy practices, and eating disorder treatment programs conducting intake assessments. The form includes an emergency contact section for patients identified as high-risk, ensuring that clinical staff have immediate access to a support person if urgent intervention is needed. Screening results can guide referral to specialized eating disorder treatment and help providers initiate sensitive, evidence-based conversations about disordered eating.