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Questionnaire Name - Eating Disorder in Hong Kong

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1	Gender
	A- Male (24)  B- Female (39)
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2	Age
	A- Below 18 (3)  B- 18-20 (23)  C- Above 20 (38)
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3	Do you have regular eating habit?
	A- Yes (44)  B- No (20)
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4	How many meals do you have each day?
	A- 1 (0)  B- 2 (9)  C- 3 (42)  D- 4 (11)  E- Above 4 (2)
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5	Do you know what eating disorder is?
	A- Yes (54)  B- No (10)
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6	If yes, what disorder(s) have you heard?
	A- Anorexia¹½­¹¯g (54)  B- Bulimia¼É­¹¯g (49)
	No Selection (10)   Select 1 item (7)   Select 2 items (48)
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7	Do you think you have experienced or are experiencing eating disorder? (If no, skip to Qs 15)
	A- Yes (5)  B- No (58)
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8	Have you experienced the following symptoms of eating disorder in long term?(You can choose more than one)
	A- Irregular diet habit (7)  B- No appetite (5)  C- Sometimes you do not want to eat much and sometimes you want to eat a lot (8)  D- Dehydration (2)  E- Eating an unusual amount of food (6)  F- None (5)  G- Others (0)
	No Selection (48)   Select 1 item (8)   Select 2 items (4) Select 3 items (3)   Select 4 items (2) Select 5 items (0)   Select 6 items (0) Select 7 items (0)
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9	Have you ever experienced the following?(You can choose more than one)
	A- Laxative ÂmÃÄ (0)  B- Diuretics §Q§¿ (0)  C- Self-induced vomiting ¦©³ï (3)  D- Excessive exercise (2)  E- None (11)  F- Others (0)
	No Selection (50)   Select 1 item (14)   Select 2 items (1) Select 3 items (0)   Select 4 items (0) Select 5 items (0)   Select 6 items (0)
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10	When was the first time you experience eating disorder?
	A- This year (5)  B- 1 year ago (1)  C- 2 years ago (2)  D- 3 years ago or longer (5)
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11	How did it affect your daily life?(You can choose more than one)
	A- Difficult to concentrate (3)  B- Sleepy all the time (4)  C- Feeling very weak (6)  D- Get sick easily (4)  E- Faint (3)  F- Depressed (4)  G- Moody (5)  H- None (4)  I- Others (0)
	No Selection (51)   Select 1 item (5)   Select 2 items (3) Select 3 items (3)   Select 4 items (2) Select 5 items (1)   Select 6 items (0) Select 7 items (0)   Select 8 items (0) Select 9 items (0)
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12	What causes do you think are responsible to your eating disorder? (You can choose more than one)
	A- School (6)  B- Family (3)  C- Friends (4)  D- Love Relationship (3)  E- Others (1)
	No Selection (54)   Select 1 item (7)   Select 2 items (2) Select 3 items (2)   Select 4 items (0) Select 5 items (0)
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13	Did(Will) you seek help?
	A- Yes (1)  B- No (11)
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14	Whom did(will) you seek help from? (Skip to Qs 20)
	A- Doctor (1)  B- Counselor (1)  C- Family (0)  D- Friends (3)  E- Others (0)
	No Selection (60)   Select 1 item (5)   Select 2 items (0) Select 3 items (0)   Select 4 items (0) Select 5 items (0)
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15	What do you think are the symptoms of eating disorder in long term? (You can choose more than one)
	A- Irregular eatng habit (50)  B- No appetite (39)  C- Sometimes you do not want to eat much and sometimes you want to eat a lot (34)  D- Dehydration (22)  E- Eating an unusual amount of food (39)  F- None (2)  G- Others (2)
	No Selection (6)   Select 1 item (8)   Select 2 items (12) Select 3 items (14)   Select 4 items (13) Select 5 items (10)   Select 6 items (2) Select 7 items (0)
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16	How do you think it will affect their lives?(You can choose more than one)
	A- Difficult to concentrate (45)  B- Sleepy all the time (27)  C- Feel very weak (52)  D- Get sick easily (46)  E- Faint (37)  F- Depressed (46)  G- Moody (41)  H- None (1)  I- Others (1)
	No Selection (6)   Select 1 item (0)   Select 2 items (3) Select 3 items (9)   Select 4 items (10) Select 5 items (12)   Select 6 items (12) Select 7 items (13)   Select 8 items (0) Select 9 items (0)
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17	What causes do you think are responsible to their eating disorders?(You can choose more than one)
	A- School (37)  B- Family (31)  C- Friends (26)  D- Love relationship (41)  E- Others (12)
	No Selection (5)   Select 1 item (15)   Select 2 items (19) Select 3 items (12)   Select 4 items (12) Select 5 items (2)
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18	Do you think people would seek help?
	A- Yes (19)  B- No (39)
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19	If yes, whom would they seek help from?
	A- Doctor (21)  B- Counselor (12)  C- Family (7)  D- Friends (17)  E- Others (2)
	No Selection (33)   Select 1 item (13)   Select 2 items (13) Select 3 items (4)   Select 4 items (2) Select 5 items (0)
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20	Are you satisfied with your body shape? (If yes, skip to Qs 24)
	A- Yes (23)  B- No (41)
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