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I AM: 
[ ] anorexic
[ ] ednos 
[] bulimic 
[ ] living off diet pills 
[x] hungry 
[x] thirsty 
[ ] drinking something 
[ ] fasting/starving myself
 
PEOPLE: 
[ ] ask if I’m anorexic/bulimic 
[x] have called me fat
[x] have said I’m skinny
[x] have said I’m ugly 
[x] have said I’m pretty
[x] spread rumors about me 
[x] force me to eat 
[] say I eat too much
[ ] wish I’d eat more 
[] don’t know I’m anorexic/bulimic/ednos
 
I WISH: 
[x] I was THIN 
[x] I had a better body 
[x] I didn’t have to eat 
[x] I could control myself 
[x] I was under 110lbs 
[x] I could avoid food 
[x] I wasn’t fat 
[x] I was pretty 
[] I could stop being anorexic/bulimic/ednos
 
I LOVE:
[] feeling hungry 
[] seeing a difference when fasting 
[] shaking 
[] feeling airy 
[x] losing weight 
[ ] being anorexic/bulimic 
[] green tea 
[ ] diet pills 
[x] being able to turn down food 
[x] feeling good about myself 
 
APPEARANCE: 
[ ] I am shorter than 5’4
[x] I think I’m ugly sometimes
[x] I have many scars 
[x] I wish my hair was a different color
[] I have friends who have never seen my natural hair color
[ ] I have a tattoo
[x] I am self-conscious about my appearance
[ ] I have/had braces 
[x] I wear glasses 
[x] I would get plastic surgery if it were 100% safe, free of cost, and scar-free 
[x] I’ve been told I’m attractive by a complete stranger 
[] I have more than 2 piercings
[] I have piercings in places besides my ears 
[ ] I have freckles 
 
FAMILY:
[] I’ve sworn at my parents
[x] I’ve run away from home 
[ ] I’ve been kicked out of the house 
[x] My biological parents are together 
[ ] I have a sibling less than one year old 
[] I want to have kids someday
[] I’ve had children 
[ ] I’ve lost a child 
[ ] I can’t have children
 
RELATIONSHIPS: 
[x] I’m single 
[ ] I’m married
[ ] I’ve gone on a blind date 
[ ] I’ve been the dumpee more than the dumper
[x] I miss someone right now 
[x] I have a fear of abandonment 
[ ] I’ve cheated in a relationship 
[ ] I’ve gotten divorced 
[x] I’ve had feelings for someone who didn’t have them back
[ ] I’ve told someone I loved them when I didn’t
[] I’ve told someone I didn’t love them when I did 
[] I’ve kept something from a past relationship
[] I’ve been ‘the other woman’
 
SEXUALITY: 
[] I’ve had a crush on someone of the same sex
[ ] I’ve had a crush on a teacher 
[] I am a cuddler
[] I’ve kissed in the rain
[x] I’ve hugged a stranger 
[] I have kissed a stranger
 
BAD TIMES: 
[] I’ve consumed alcohol
[] I regularly drink
[x] I can’t swallow pills
[] I can swallow numerous pills at a time without water
[] I have been diagnosed with clinical depression
[x] I shut others out when I’m upset
[x] I take anti-depressants
[] I’m anorexic or bulimic or have EDNOS
[x] I’ve slept an entire day when I didn’t need it 
[x] I’ve hurt myself on purpose
[] I’m addicted to self harm
[x] I’ve woken up crying 
[x] I’ve lost weight 
[x] I’ve gained weight 
[x] My weight holds me back 
[x] Weight consumes me 
[] I’m at my thinnest 
[x] I’m at my biggest 
[] I’ve lost weight and kept it off 
[ ] I’ve lost weight but gained it back 
[] My weight affects my mood 
[] I weigh myself daily 
[x] I am jealous of everyone smaller than me 
[] I thrive on compliments 
[x] I feel bigger than people who are my size 
[] I feel happy when I’m hungry 
[] I get depressed after I eat 
[x] I’ve skipped a meal 
[x] I’ve thrown food away 
[x] I’ve spit food out 
[] I’ve fasted 
[] I’ve taken diet pills 
[] I’ve used laxatives 
[] I’ve purged 
[x] I exercise 
[ ] I exercise so I can eat 
[] I work out secretly 
[] I work out daily 
[ ] I’ve fainted from exhaustion 
 
I’ve done: 
[] Weed 
[] Cigarettes 
[] Alcohol 
[] Diet pills 
[] Pain killers 
[] Sleeping pills
[] Anti-depressants 
[ ] Ecstasy 
[ ] LSD 
[ ] Mushrooms 
[] Speed 
[ ] Cocaine 
[ ] Other

HABITS:
[x] I keep my eating habits a secret 
[] I look at thinspo 
[] I collect thinspo 
[x] I count calories 
[x] I’ve had negative intake days 
[x] I avoid food 
[ ] I hate food 
[] I love food 
[ ] I want to be this way 
[x] I don’t want to be like this 
[x] I wish I could have more control 
[ ] Being thin is my top priority 
[] I am in treatment 
[x] I’m doing this for me 
[ ] I’m doing this for someone 
[ ] I’m doing this to prove myself

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