1. Have you lost interest in favorite activities?


2. Are you experiencing sleep problems?


3. Have you recently gained or lost weight?


4. Do you feel irritable or angry?


5. Do you feel guilty, anxious or have difficulty concentrating?


6. Are your grades starting to slip or are you having problems at work?


7. Have you ever experienced a sudden onset of intense fear accompanied by a sense of imminent danger?


8. Do you regularly experience rapid heart palpitations, shortness of breath, nausea, and a fear of losing control or dying?


9. Have you limited your activity in order to control your anxiety? For example, do you stay inside and avoid people, places, or things that you fear will trigger an attack?


10. Do you drink because you have problems? To relax?


11. Do you drink when you get mad at other people, your friends or parents?


12. Do you prefer to drink alone, rather than with others?


13. Are you using illegal substances on a daily basis?


14. Are you preoccupied with food?


15. Do you feel guilty about eating?


16. Do you feel the need to be superior and perfect in academics, athletics and weight control?


17. Do you feel your weight is one of the few aspects of your life that you can control?


18. Do you diet excessively and/or abuse laxatives, diet pills or diuretics?


19. Do you feel you have become isolated from your family and friends?


20. Do you have thoughts of harming yourself or others? If the answer to this question is yes, please seek help immediately by calling 911.

If your responses are a cause of concern for you, contact Yellowbrick at 866.364.2300.