OVEREATING TRIGGER PROFILE

Instructions: Read each of the items below and then rate them on a scale of 1 to 10, according to how likely they are to cause you to eat inappropriately or to accompany inappropriate eating.

 PLEASE CIRCLE ONLY ONE NUMBER FOR EACH ITEM.

=======================================Very Unlikely..Possibly..Very Likely
                                                                                                                               1 2 3            4 5 6 7        8 9 10
Social
1. Arguing or having conflict with someone........................................................................1 2 3 4 5 6 7 8 9 10
2. Being with others when they are eating...........................................................................1 2 3 4 5 6 7 8 9 10
3. Being urged to eat by someone else..................................................................................1 2 3 4 5 6 7 8 9 10
4. Feeling inadequate around others.....................................................................................1 2 3 4 5 6 7 8 9 10

Emotional
5. Feeling badly, such as anxious; depressed.......................................................................1 2 3 4 5 6 7 8 9 10
6. Feeling good, happy or relaxed...........................................................................................1 2 3 4 5 6 7 8 9 10
7. Feeling bored, having too much time to on hand.............................................................1 2 3 4 5 6 7 8 9 10
8. Feeling stressed or excited.................................................................................................1 2 3 4 5 6 7 8 9 10

Situational
9. Seeing an ad for food.....................................................;......................................................1 2 3 4 5 6 7 8 9 10
10. Passing by a bakery, cookie shop or other enticement to eat....................................1 2 3 4 5 6 7 8 9 10
11. Being involved in a party, celebration or special occasion.........................................1 2 3 4 5 6 7 8 9 10
12. Eating out.............................................................................................................................1 2 3 4 5 6 7 8 9 10

Thinking
13. Making excuses to myself about why it's okay to eat even when not hungry..........1 2 3 4 5 6 7 8 9 10
14. Beating myself up for being so fat or unable to control my eating ...........................1 2 3 4 5 6 7 8 9 10
15. Worrying about others or about difficulties I am having............................................1 2 3 4 5 6 7 8 9 10
16. Thinking about how things should or shouldn't be......................................................1 2 3 4 5 6 7 8 9 10


Physiological 
18. Experiencing trembling, headache or light headedness associated with not eating too much caffeine.......................................................................................................................................1 2 3 4 5 6 7 8 9 10 
19. Experiencing fatigue or feeling overtired.....................................................................1 2 3 4 5 6 7 8 9 10 
20. Experiencing hunger pangs or urges to eat even though I have eaten recently.....1 2 3 4 5 6 7 8 9 10

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    Last modified on 04/14/2008