0=NO 1=SOMETIMES/SOMEWHAT 2=YES 7, 77=REFUSE TO ANSWER 8, 88=NOT APPLICABLE 9, 99=DON’T KNOW

START NEW CARD

DUP COL 1 - 10

MOD. B 1 [11 - 12]

CARD NO. 0 1 [13 - 14]

b [15]

EAT

Now I’m going to change the subject a bit and ask you some questions about eating and
weight.

NOTE 1: WAS HEIGHT MEASURED FOR STUDY? 0 2 [16]

IF YES: ENTER HEIGHT IN Q 1, THEN GO TO NOTE 2

IF NO: ASK Q 1

1. How tall is ________?

CODE HEIGHT ------------------------------------------------------------------------> |____ | ____ ____| FT/IN OR [17-19]

(CODE FT/IN OR CM)
|____ ____ ____| CM [20-22]

NOTE 2: WAS WEIGHT MEASURED FOR STUDY? 0 2 [23]

IF YES: ENTER WEIGHT IN Q 2, THEN GO TO Q 3

IF NO: ASK Q 2

2. How much does [he/she] weigh now?

CODE WEIGHT -----------------------------------------------------------------------> |____ ____ ____| LB OR [24-26]

(CODE LB OR KG)
|____ ____| KG [27-28]

3. In the last year – that is, since [[NAME EVENT]/[NAME CURRENT MONTH]
of last year] – what was [his/her] lowest weight?

CODE WEIGHT -----------------------------------------------------------------------> |____ ____ ____| LB OR [29-31]

(CODE LB OR KG)
|____ ____| KG [32-33]

NOTE 3: WAS CHILD UNDERWEIGHT (≤ CHART WEIGHT FOR 0 2* 9 [34]

HEIGHT, AT TIME OF LOWEST WEIGHT IN PAST
YEAR)?

Module B: Miscellaneous Disorders

Eating Disorders
DISC IV-P, past year Page 1 [5/20/98]
0=NO 1=SOMETIMES/SOMEWHAT 2=YES 7, 77=REFUSE TO ANSWER 8, 88=NOT APPLICABLE 9, 99=DON’T KNOW

4. In the last year (that is, since [NAME CURRENT MONTH] of last year), have you 0 1* 2* 7 9 [35]
or anyone else worried that ________ was much too thin?

IF YES, A. Now, what about the last four weeks? 0 2 7 9 [36]

Since [[NAME EVENT]//the beginning of/the middle of/the end of
[LAST MONTH]], have you or anyone else worried that [he/she] was
much too thin?

NOTE 4: WAS A * RESPONSE CODED IN NOTE 3 OR IN Q 4? 0 {2} [37]

IF YES: CONTINUE
IF NO: GO TO Q 10

a: IF A * RESPONSE WAS CODED IN NOTE 3 AND Q 4,

ONLY READ BACK ENDORSEMENT FOR NOTE 3 IN
Q 5, Q 21, AND Q 23

5. Now I’d like to ask you some questions about the time [[he/she] weighed the least
in the last year/you or other people worried that [he/she] was too thin].

Even though [[he/she] only weighed [NAME LOWEST WEIGHT]/you or other 0 2 7 9 [38]
people worried [he/she] was too thin], did [he/she] say [he/she] was worried about
being fat or becoming fat?

IF YES, A. Was there a time when [he/she] said [he/she] was worried nearly 0 2 7 9 [39]
every day about being fat or becoming fat?

IF YES, B. Did [he/she] say [he/she] sometimes worried about it so 0 2 7 9 [40]

much that it was difficult for [him/her] to think about
other things?

C. Did [he/she] say that worrying about being fat or 0 2 7 9 [41]

becoming fat made [him/her] try to keep [his/her]
weight down?

D. Now, what about the last four weeks? 0 2 7 9 [42]

(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] been
worried about being fat or becoming fat?

6. When [he/she] weighed the least in the last year, did [he/she] say [he/she] was 0 2 7 9 [43]
overweight?

IF NO, A. Did [he/she] say [he/she] was too thin? 0 2 7 9 [44]

7. Does [he/she] say [he/she] is overweight now? 0 2 7 9 [45]

IF NO, A. Does [he/she] say [he/she] is too thin? 0 2 7 9 [46]

8. When [he/she] weighed the least in the last year, did ________ say that [his/her] low 0 2 7 9 [47]
weight could cause any health problems for [him/her]?
Module B: Miscellaneous Disorders
Eating Disorders
DISC IV-P, past year Page 2 [5/20/98]
0=NO 1=SOMETIMES/SOMEWHAT 2=YES 7, 77=REFUSE TO ANSWER 8, 88=NOT APPLICABLE 9, 99=DON’T KNOW

9. Does [he/she] say that what [he/she] weighs now could cause any health problems 0 2 7 9 [48]
for [him/her]?

10. In the last year (that is, since [NAME CURRENT MONTH] of last year), has it 0 2 7 9 [49]
seemed like [he/she] often felt bad about [himself/herself] because [he/she] thought
[he/she] was fat or overweight?

IF YES, A. Did [he/she] say that losing weight would be the most important thing 0 [2] 7 9 [50]
[he/she] could do to feel better about [himself/herself]?

IF A { } RESPONSE CODED IN NOTE 4, ASK:

B. Did [he/she] say [he/she] felt that way at the same time that [he/she] 0 ‹2› 7 9 [51]
was at [his/her] thinnest in the last year?

C. Now, what about the last four weeks? 0 2 7 9 [52]

(Since [[NAME EVENT]//the beginning of/the middle of/the end of
[LAST MONTH]]), has it seemed like [he/she] often felt bad about
[himself/herself] because [he/she] thought [he/she] was fat or over­
weight?

11. In the last year (that is, since [NAME CURRENT MONTH] of last year), has 0 2 7 9 [53]
[he/she] said that there have been times when [he/she] thought about food or about
eating almost all of the time?

IF YES, A. When this happened, did [he/she] say that it was difficult for 0 2 7 9 [54]
[him/her] to think about other things?

IF YES, B. Now, what about the last four weeks? 0 2 7 9 [55]

(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] said there
have been times when [he/she] thought about food or
about eating almost all of the time?

Module B: Miscellaneous Disorders

Eating Disorders
DISC IV-P, past year Page 3 [5/20/98]
0=NO 1=SOMETIMES/SOMEWHAT 2=YES 7, 77=REFUSE TO ANSWER 8, 88=NOT APPLICABLE 9, 99=DON’T KNOW

12. Now I am going to ask you about eating binges. An eating binge is when someone
stuffs themselves with a whole lot of food in a short time – like several whole pizzas
or a whole chocolate cake or several containers of ice cream – and they don’t seem
to be able to control how much they eat.

In the last year – that is, since [NAME CURRENT MONTH] of last year – has 0 2 7 9 [56]
________ had an eating binge like that?

IF YES, A. During an eating binge, did [he/she] eat a lot more than most [boys/ 0 2 7 9 [57]
girls] [his/her] age would have for a meal?

IF NO, GO TO INSTRUCTION BOX “b”

B. Did [he/she] eat this food in a very short time – say, in less than two 0 2 7 9 [58]
hours?

IF NO, GO TO INSTRUCTION BOX “b”

C. Did [he/she] say that [he/she] wasn’t able to stop [himself/herself] 0 1 2 7 9 [59]
from eating too much when [he/she] was on an eating binge?

D. In the last year, has there been a time when [he/she] had an eating 0 2π 7 9 [60]
binge at least twice a week?

IF YES, E. Did [he/she] have eating binges at least twice a week for 0 [2] 7 9 [61]
as long as three months?

IF YES, F. Now, what about the last four weeks? 0 2 7 9 [62]

(Since [[NAME EVENT]//the beginning
of/the middle of/the end of [LAST
MONTH]]), has [he/she] had several eat­
ing binges?

b: IF { } WAS CODED IN NOTE 4 OR A π RESPONSE WAS

CODED IN Q 12D, CONTINUE

ALL OTHERS, GO TO INSTRUCTION BOX “d,” P. 9

Module B: Miscellaneous Disorders

Eating Disorders
DISC IV-P, past year Page 4 [5/20/98]
0=NO 1=SOMETIMES/SOMEWHAT 2=YES 7, 77=REFUSE TO ANSWER 8, 88=NOT APPLICABLE 9, 99=DON’T KNOW

13. Now, I’m going to ask you about things people sometimes do to lose weight or keep
their weight down.

In the last year (that is, since [NAME CURRENT MONTH] of last year), has 0 2 7 9 [63]
[he/she] often refused to eat foods that [he/she] said would make [him/her] fat?

IF YES, A. Did [he/she] refuse to eat fattening foods on most days for at least
three months? 0 2 7 9 [64]

IF A { } RESPONSE WAS CODED IN NOTE 4, ASK:

B. Did [he/she] refuse to eat fattening foods at the same time that [he/
she] was at [his/her] thinnest in the last year? 0 ‹2› 7 9 [65]

C. Now, what about the last four weeks?

(Since [[NAME EVENT]//the beginning of/the middle of/the end of 0 2 7 9 [66]
[LAST MONTH]]), has [he/she] often refused to eat foods that [he/
she] said were fattening?

14. In the last year (that is, since [NAME CURRENT MONTH] of last year), has 0 2 7 9 [67]
[he/she] made [himself/herself] throw up?

IF YES, A. Has [he/she] made [himself/herself] throw up to lose weight or to 0 2 7 9 [68]

keep from gaining weight?

IF YES, B. In the last year, was there a time when [he/she] made 0 (2) 7 9 [69]
[himself/herself] throw up at least twice a week?

IF YES, C. Did [he/she] make [himself/herself] throw 0 2∆ 7 9 [70]

up at least twice a week for as long as
three months?

IF A { } RESPONSE WAS CODED IN

NOTE 4, ASK:

D. Did [he/she] make [himself/herself] throw 0 ‹2› [71]

up at the same time that [he/she] was [his/
her] thinnest in the last year?

E. Now, what about the last four weeks? 0 2 7 9 [72]

(Since [[NAME EVENT]//the beginning
of/the middle of/the end of [LAST
MONTH]]), has [he/she] often made
[himself/herself] throw up?

START NEW CARD

DUP COL 1 - 12

CARD NO. 0 2 [13 - 14]

b [15]

Module B: Miscellaneous Disorders

Eating Disorders
DISC IV-P, past year Page 5 [5/20/98]
0=NO 1=SOMETIMES/SOMEWHAT 2=YES 7, 77=REFUSE TO ANSWER 8, 88=NOT APPLICABLE 9, 99=DON’T KNOW

15. In the last year (that is, since [NAME CURRENT MONTH] of last year), has 0 2 7 9 [16]
[he/she] taken any kind of pills or medicines to lose weight or to keep from gaining
weight?

IF YES, A. What did [he/she] take?

|____ ____| [17-18]

B. In the last year, was there a time when [he/she] took medicine to lose 0 (2) 7 9 [19]
weight or to keep from gaining weight at least twice a week?

IF YES, C. Did [he/she] take the medication at least twice a week 0 2∆ 7 9 [20]
for as long as three months?

IF A { } RESPONSE TO NOTE 4, ASK:

D. Did [he/she] take medicine to lose weight or to keep 0 ‹2› 7 9 [21]

from gaining weight at the same time that [[he/she] was
[his/her] thinnest in the last year?

E. Now, what about the last four weeks? 0 2 7 9 [22]

(Since [[NAME EVENT]//the beginning of/the middle
of/the end of [LAST MONTH]]), has [he/she] often
taken any kind of pills or medicines to lose weight or to
keep from gaining weight?

Module B: Miscellaneous Disorders

Eating Disorders
DISC IV-P, past year Page 6 [5/20/98]
0=NO 1=SOMETIMES/SOMEWHAT 2=YES 7, 77=REFUSE TO ANSWER 8, 88=NOT APPLICABLE 9, 99=DON’T KNOW

16. In the last year – that is, since [NAME CURRENT MONTH] of last year – has 0 2 7 9 [23]
________ done anything to make [himself/herself] go to the toilet a lot?

IF YES, A. What did [he/she] do?

|____ ____| [24-25]

B. Did [he/she] do things to make [himself/herself] go to the toilet a lot 0 2 7 9 [26]

because [he/she] wanted to lose weight or keep from gaining weight?

IF YES, C. Was there a time when [he/she] did something at least 0 (2) 7 9 [27]
twice a week to make [himself/herself] go to the toilet
a lot?
0 2∆ 7 9 [28]
IF YES, D. Did [he/she] often do things like this for
as long as three months?

IF A { } RESPONSE TO NOTE 4, ASK:

E. Did [he/she] do things to make [himself/ 0 ‹2› 7 9 [29]

herself] go to the toilet a lot at the same
time that [he/she] was [his/her] thinnest
in the last year?

F. Now, what about the last four weeks? 0 2 7 9 [30]

(Since [[NAME EVENT]//the beginning
of/the middle of/the end of [LAST
MONTH]]), has [he/she] done things to
make [himself/herself] go to the toilet a
lot?

IF YES, G. Has [he/she] done things to 0 2∆ 7 9 [31]

make [himself/herself] go
to the toilet at least twice a
week for the last four
weeks?

Module B: Miscellaneous Disorders

Eating Disorders
DISC IV-P, past year Page 7 [5/20/98]
0=NO 1=SOMETIMES/SOMEWHAT 2=YES 7, 77=REFUSE TO ANSWER 8, 88=NOT APPLICABLE 9, 99=DON’T KNOW

17. In the last year (that is, since [NAME CURRENT MONTH] of last year), has 0 2 7 9 [32]
[he/she] eaten no food at all for at least a full 24 hours?

IF YES, A. Did [he/she] say [he/she] did that to lose weight or to keep from 0 2 7 9 [33]
gaining weight?

IF YES, B. Was there a time when [he/she] would eat no food at all 0 (2) 7 9 [34]
at least two days a week?

IF YES, C. Did [he/she] eat no food at all about two 0 2∆ 7 9 [35]

days a week for as long as three months?

IF A { } RESPONSE TO NOTE 4 ASK:

D. Did [he/she] refuse to eat food like this at 0 ‹2› 7 9 [36]

the same time that [he/she] was at [his/
her] thinnest in the last year?

E. Now, what about the last four weeks? 0 2 7 9 [37]

(Since [[NAME EVENT]//the beginning
of/the middle of/the end of [LAST
MONTH]]), has [he/she] often eaten no
food for a full 24 hours?

18. In the last year (that is, since [NAME CURRENT MONTH] of last year), did 0 2 7 9 [38]
[he/she] spend a lot of time exercising to lose weight or keep from gaining weight?

IF YES, A. Has [he/she] spent so much time exercising that it got in the way of 0 2 7 9 [39]
doing other things?

IF YES, B. Was there a time when [he/she] spent so much time 0 (2) 7 9 [40]
exercising that it got in the way of doing other things at
least two days a week?

IF YES, C. Did [he/she] exercise like this for as long 0 2∆ 7 9 [41]

as three months?

IF A { } RESPONSE TO NOTE 4 ASK:

D. Did [he/she] spend a lot of time exercis- 0 ‹2› 7 9 [42]

ing like this at the same time that [he/she]
was [his/her] thinnest in the last year?

E. Now, what about the last four weeks? 0 2 7 9 [43]

(Since [[NAME EVENT]//the beginning
of/the middle of/the end of [LAST
MONTH]]), has [he/she] spent so much
time exercising that it often got in the way
of doing other things?

Module B: Miscellaneous Disorders

Eating Disorders
DISC IV-P, past year Page 8 [5/20/98]
0=NO 1=SOMETIMES/SOMEWHAT 2=YES 7, 77=REFUSE TO ANSWER 8, 88=NOT APPLICABLE 9, 99=DON’T KNOW

NOTE 5: WERE ANY ∆ RESPONSES CODED IN Q 14 - 18? 0 [2] [44]

IF YES: GO TO INSTRUCTION BOX “d”

IF NO: CONTINUE

c: IF ANY ( ) RESPONSES WERE CODED IN Q 14 - 18, CONTINUE

ALL OTHERS GO TO INSTRUCTION BOX “d”

19. You told me that [he/she] [NAME ( ) RESPONSES IN Q 14 - 18].

In the last year, did [he/she] do things like this for at least three months? 0 [2] 7 9 [45]

d: IF CHILD IS A BOY, CODE “8” IN Q 20 AND GO TO

INSTRUCTION BOX “e”

ALL OTHERS, CONTINUE

Module B: Miscellaneous Disorders

Eating Disorders
DISC IV-P, past year Page 9 [5/20/98]
0=NO 1=SOMETIMES/SOMEWHAT 2=YES 7, 77=REFUSE TO ANSWER 8, 88=NOT APPLICABLE 9, 99=DON’T KNOW

20. Has ________ started to menstruate – that is, has she started to have monthly 0 2 7 8 9 [46]
periods?

IF YES, A. Has she ever had regular menstrual periods? By regular, I mean every 0 2 7 9 [47]
month for at least six months.

IF YES, B. Did she start to have regular monthly periods more than 0 2 7 9 [48]
a year ago?

IF NO, GO TO INSTRUCTION BOX “e”

C. In the last year, did she miss as many as three monthly 0 2 7 9 [49]
periods in a row?

IF NO, GO TO F

IF YES, D. When she missed her periods, was she 0 2 7 9 [50]

her thinnest?

E. Has she had a menstrual period in the last 0 2 7 9 [51]

three months?

GO TO INSTRUCTION BOX “e”

F. Does she take the birth control pill? 0 2 7 9 [52]

IF YES, G. Has she taken it almost every month in 0 2 7 9 [53]

the last year?

IF NO, H. During the months when 0 2 7 9 [54]

she wasn’t taking the pill,
did she have her menstrual
period?

IF NO, I. When she 0 2 7 9 [55]

missed her
periods, was
she very
thin?

e: IF { } WAS CODED IN NOTE 4 AND ONE OR MORE ‹ ›

RESPONSES WERE CODED IN Q 10 - 18 (see tally sheet),
GO TO Q 21

ALL OTHERS GO TO INSTRUCTION BOX “f”

f: IF 2 OR MORE [ ] RESPONSES CODED IN Q 10 - 19 AND

NOTE 5, GO TO Q 22

ALL OTHERS, GO TO ELIM, P. 17

Module B: Miscellaneous Disorders

Eating Disorders
DISC IV-P, past year Page 10 [5/20/98]
0=NO 1=SOMETIMES/SOMEWHAT 2=YES 7, 77=REFUSE TO ANSWER 8, 88=NOT APPLICABLE 9, 99=DON’T KNOW

21. You said that in the last year [[he/she] was thin/you or other people worried that
[he/she] was too thin] and also that [he/she] [NAME ‹ › SYMPTOMS IN Q 10 - 18].

How old was [he/she] the first time [he/she] was like that?

CODE AGE (66 = WHOLE LIFE, ALWAYS) -----------------------------------> |____ ____| YRS. [56-57]

IF AGE NOT KNOWN, ASK: What grade was [he/she] in?

CODE GRADE (44 = PRE-K, 55 = KINDERGARTEN) -----------------------> |____ ____| GRADE [58-59]

g: IF [AGE/GRADE] GIVEN WAS CHILD’S CURRENT

[AGE/GRADE], GO TO INSTRUCTION BOX “i”

IF [AGE/GRADE] GIVEN WAS CHILD’S CURRENT

[AGE/GRADE] MINUS ONE, GO TO A

ALL OTHERS, GO TO B

A. Was that more than a year ago – that is, before [[NAME EVENT]/ 0 2 7 9 [60]
[NAME CURRENT MONTH] of last year]?

IF NO, GO TO INSTRUCTION BOX “i”

B. Since that first time, was there ever a time when [[he/she] was not 0 2 7 9 [61]
thin/you or other people did not worry that [he/she] was too thin] and
[he/she] stopped [NAME ‹ › SYMPTOMS IN Q 10 - 18]?

IF NO, GO TO INSTRUCTION BOX “i”

C. Did that time when [[he/she] wasn’t thin/you or other people didn’t 0 2 7 9 [62]
worry about [him/her] being too thin] last for two months or more?

IF NO, GO TO INSTRUCTION BOX “i”

D. You said that [[he/she] was thin/you or other people worried that
[he/she] was too thin] and [he/she] [NAME ‹ › SYMPTOMS IN
Q 10 - 18] in the last year.

How old was [he/she] when [he/she] started being this way this time?

CODE AGE (88 = NEVER STARTED AGAIN)-----------------> |____ ____| YRS. [63-64]

IF AGE NOT KNOWN, ASK: What grade was [he/she] in?

CODE GRADE (44 = PRE-K, 55 = KINDERGARTEN,
88 = NEVER STARTED AGAIN) ----------------------------------> |____ ____| GRADE [65-66]

h: IF [AGE/GRADE] GIVEN WAS CHILD’S

CURRENT [AGE/GRADE] MINUS ONE, GO TO E

ALL OTHERS, GO TO INSTRUCTION BOX “i”

E. Did [he/she] start being that way again more than a year ago – that is, 0 2 7 9 [67]
before [[NAME EVENT]/[NAME CURRENT MONTH] of last
year]?
Module B: Miscellaneous Disorders
Eating Disorders
DISC IV-P, past year Page 11 [5/20/98]
0=NO 1=SOMETIMES/SOMEWHAT 2=YES 7, 77=REFUSE TO ANSWER 8, 88=NOT APPLICABLE 9, 99=DON’T KNOW

i: IF 2 OR MORE [ ] RESPONSES CODED IN Q 10 - 19

AND NOTE 5, (see tally sheet) CONTINUE

START NEW CARD

ALL OTHERS, GO TO Q 23 DUP COL 1 - 12

CARD NO. 0 3 [13 - 14]

b [15]
22. You said that in the last year [he/she] [NAME [ ] SYMPTOMS IN Q 10 - 19 AND
NOTE 5].

How old was [he/she] the first time [he/she] ever did things like that?

CODE AGE (66 = WHOLE LIFE, ALWAYS) ----------------------------------->

|____ ____| YRS. [16-17]

IF AGE NOT KNOWN, ASK: What grade was [he/she] in?

CODE GRADE (44 = PRE-K, 55 = KINDERGARTEN) ----------------------->

|____ ____| GRADE [18-19]

j: IF [AGE/GRADE] GIVEN WAS CHILD’S CURRENT

[AGE/GRADE], GO TO Q 23

IF [AGE/GRADE] GIVEN WAS CHILD’S CURRENT

[AGE/GRADE] MINUS ONE, GO TO A

ALL OTHERS, GO TO B

A. Was that more than a year ago – that is, before [[NAME EVENT]/ 0 2 7 9 [20]
[NAME CURRENT MONTH] of last year]?

IF NO, GO TO Q 23

B. Since that first time, was there ever a time when [he/she] did not do 0 2 7 9 [21]
things like [NAME [ ] SYMPTOMS IN Q 10 - 19 AND NOTE 5]?

IF NO, GO TO Q 23

C. Did that time when [he/she] didn’t do these things last for two months 0 2 7 9 [22]
or more?

IF NO, GO TO Q 23

D. You said that [he/she] was [NAME [ ] SYMPTOMS IN Q 10 - 19

AND NOTE 5] in the last year.

How old was [he/she] when [he/she] started doing these things this
time?

CODE AGE (88 = NEVER STARTED AGAIN)-----------------> |____ ____| YRS. [23-24]

IF AGE NOT KNOWN, ASK: What grade was [he/she] in?

CODE GRADE (44 = PRE-K, 55 = KINDERGARTEN,
88 = NEVER STARTED AGAIN) ----------------------------------> |____ ____| GRADE [25-26]

k: IF [AGE/GRADE] GIVEN WAS CHILD’S

CURRENT [AGE/GRADE] MINUS ONE, GO TO E

ALL OTHERS, GO TO Q 23

Module B: Miscellaneous Disorders

Eating Disorders
DISC IV-P, past year Page 12 [5/20/98]
0=NO 1=SOMETIMES/SOMEWHAT 2=YES 7, 77=REFUSE TO ANSWER 8, 88=NOT APPLICABLE 9, 99=DON’T KNOW

E. Did [he/she] start doing these things again more than a year ago – that 0 2 7 9 [27]

is, before [[NAME EVENT]/[NAME CURRENT MONTH] of last

year]?

l: IF Q 21 WAS ASKED, READ ITALICIZED PHRASE IN Q 23

BELOW WITH APPROPRIATE READBACK

23. You said that in the last year ([[he/she] was thin/you or other people worried that
[he/she] was too thin] and also that) [he/she] [NAME ‹ › AND [ ] SYMPTOMS IN
Q 10 - 19 AND NOTE 5].

Now I’d like you to think back to the time in the last year when [his/her] doing things
to keep from gaining weight caused the most problems.

At that time, did [you (or [his/her] [CARETAKERS])/[his/her] [CARETAKERS]] 0 1 2 7 9 [28]

get annoyed or upset with ________ because of the things [he/she] did to keep from
gaining weight?

IF YES, A. How often did [you (or [his/her] [CARETAKERS])/[his/her] [CARE­

TAKERS]] get annoyed or upset with [him/her]? Would you say: a
lot of the time, some of the time, or hardly ever?

A lot of the time ..............................................................................

3 [29]
Some of the time .............................................................................
2
Hardly ever .....................................................................................
1
Refuse to answer .............................................................................
7
Don’t know .....................................................................................
9

24. At that time, did __________’s doing things so [he/she] wouldn’t gain weight keep 0 1 2 7 9 [30]
[him/her] from doing things or going places with [you or [his/her] family/[his/her]
family]?

IF YES, A. How often did this keep [him/her] from doing things or going places
with[you or [his/her] family/[his/her] family]? Would you say: a lot
of the time, some of the time, or hardly ever?

A lot of the time ..............................................................................

3 [31]
Some of the time .............................................................................
2
Hardly ever .....................................................................................
1
Refuse to answer .............................................................................
7
Don’t know .....................................................................................
9

25. At that time, did __________’s eating or doing things so [he/she] wouldn’t gain 0 1 2 7 9 [32]
weight keep [him/her] from doing things or going places with other [children/
people [his/her] age]?

IF YES, A. How often did the way [he/she] ate keep [him/her] from doing things
or going places with other [children/people [his/her] age]? Would
you say: a lot of the time, some of the time, or hardly ever?

A lot of the time ..............................................................................

3 [33]
Some of the time .............................................................................
2
Hardly ever .....................................................................................
1
Refuse to answer .............................................................................
7
Don’t know .....................................................................................
9
Module B: Miscellaneous Disorders
Eating Disorders
DISC IV-P, past year Page 13 [5/20/98]
0=NO 1=SOMETIMES/SOMEWHAT 2=YES 7, 77=REFUSE TO ANSWER 8, 88=NOT APPLICABLE 9, 99=DON’T KNOW

m: IF CHILD DID NOT ATTEND SCHOOL OR WORK IN PAST

YEAR, CODE “8” IN Q 26 - 27, THEN GO TO Q 28

26. When the problems were worst, did [his/her] doing things to keep from gaining 0 1 2 7 8 9 [34]
weight [make it difficult for [him/her] to do [his/her] schoolwork or cause problems
with [his/her] grades/make it difficult for [him/her] to do [his/her] work]?

IF YES, A. How bad were the problems [he/she] had with [his/her] [schoolwork/
work] because of the way [he/she] ate? Would you say: very bad, bad,
or not too bad?

Very bad ..........................................................................................

3 [35]
Bad ..................................................................................................
2
Not too bad ......................................................................................
1
Refuse to answer .............................................................................
7
Don’t know .....................................................................................
9

27. At that time, did [his/her] doing things to keep from gaining weight cause 0 1 2 7 8 9 [36]
__________’s [teachers/boss] to be annoyed or upset with [him/her]?

IF YES, A. How often did [his/her] [teachers/boss] seem annoyed or upset with
[him/her]? Would you say: a lot of the time, some of the time, or
hardly ever?

A lot of the time ..............................................................................

3 [37]
Some of the time .............................................................................
2
Hardly ever .....................................................................................
1
Refuse to answer .............................................................................
7
Don’t know .....................................................................................
9

28. When the problems were worst, did it seem like the things [he/she] did to keep from 0 1 2 7 9 [38]
gaining weight made [him/her] feel bad or made [him/her] feel upset?

IF YES, A. How bad did [his/her] doing these things seem to make [him/her]
feel? Would you say: very bad, bad, or not too bad?

Very bad ..........................................................................................

3 [39]
Bad ..................................................................................................
2
Not too bad ......................................................................................
1
Refuse to answer .............................................................................
7
Don’t know .....................................................................................
9

29. In the last year – that is, since [NAME CURRENT MONTH] of last year – has 0 2 7 9 [40]
________ been to see someone at a hospital or a clinic or at their office because [he/
she] [NAME ‹ › AND [ ] SYMPTOMS IN Q 10 - 19 AND NOTE 5]?

IF YES, GO TO OPTIONAL DETAILS, NEXT PAGE

IF NO, A. Does [he/she] have an appointment set up to see someone because 0 2 7 9 [41]
[he/she] does [this/these things]?

IF YES, GO TO OPTIONAL DETAILS, NEXT PAGE

Module B: Miscellaneous Disorders

Eating Disorders
DISC IV-P, past year Page 14 [5/20/98]
0=NO 1=SOMETIMES/SOMEWHAT 2=YES 7, 77=REFUSE TO ANSWER 8, 88=NOT APPLICABLE 9, 99=DON’T KNOW

OPTIONAL DETAILS:

30. Who [did _________ see/is _________ going to see]? (WRITE IN:)

Name: |____ ____| [42-43]

Profession:

Address:

A. IF SOMEONE WAS SEEN, ASK:

What did the person [he/she] saw say was the matter?

|____ ____| [44-45]

n: IF CHILD IS AGE 7 OR OLDER, CONTINUE

ALL OTHERS, GO TO ELIM, P. 17

Whole Life Screen

31. You told me that in the last year [he/she] [NAME ‹ › AND [ ] SYMPTOMS IN Q
10 - 19 AND NOTE 5].

Now I want you to think back to before the last year … since the time [he/she] turned
five years old up until the last twelve months.
(INTERVIEWER: point out age five on whole life chart.)

Since [he/she] turned five years old, was there ever a time when you or other people 0 2 7 9 [46]
were more worried about ________’s weight or about things [he/she] was doing to
keep from gaining weight than the last year?

IF YES, A. How old was [he/she] when you or other people were most worried
about this?
(INTERVIEWER: IF MORE THAN ONE YEAR IS REPORTED,
ASK: “During which single year of age was [he/she] the worst?” IF
MORE THAN ONE YEAR STILL REPORTED, ENTER YOUNGEST
AGE.)

CODE AGE --------------------------------------------------------------> |____ ____| [47-48]

IF AGE NOT KNOWN, ASK: What grade was [he/she] in?

CODE GRADE ---------------------------------------------------------> |____ ____| [49-50]
(44 = PRE-K, 55 = KINDERGARTEN,
13 = COLLEGE FRESHMAN, 14 = SOPHOMORE,
15 = JUNIOR, 16 = SENIOR, 17 = POST B.A.)

Module B: Miscellaneous Disorders

Eating Disorders
DISC IV-P, past year Page 15 [5/20/98]
0=NO 1=SOMETIMES/SOMEWHAT 2=YES 7, 77=REFUSE TO ANSWER 8, 88=NOT APPLICABLE 9, 99=DON’T KNOW

INTENTIONALLY LEFT BLANK

Module B: Miscellaneous Disorders

Eating Disorders
DISC IV-P, past year Page 16 [5/20/98]