Participant ID #

The following pages contain a series of statements about how people might think, feel, or behave. You are asked to indicate the extent to which each statement pertains to you personally. Your answers to the items in the questionnaire are anonymous, so please do not write your name on any of the materials. In order to complete the questionnaire, read each statement carefully and decide how much it pertains to you personally. Using a scale like the one below, indicate your answer by clicking on the appropriate response.

	1	2	3	4	5
	Definitely Disagree	Mostly Disagree	Neither Agree Nor Disagree	Mostly Agree	Definitely Agree

If you definitely disagree with the statement, you would fill in the first bubble, if you mostly disagree with the statement you would fill in the second bubble, if you neither agree nor disagree with the statement you would fill in the third bubble, if you mostly agree with the statement you would fill in the fourth bubble, if you definitely agree with the statement you would fill in the fifth bubble. There are no right or wrong answers. Just give the answer that is most accurate for you. Remember your responses are anonymous, so please be completely honest and answer all items.

	1	2	3	4	5
	Definitely Disagree	Mostly Disagree	Neither Agree Nor Disagree	Mostly Agree	Definitely Agree	Not Answered
1. Before going out in public, I always notice how I look.
2. I am careful to buy clothes that will make me look my best.
3. I would pass most physical-fitness tests.
4. It is important that I have superior physical strength.
5. My body is sexually appealing.
6. I am not involved in a regular exercise program.
7. I am in control of my health.
8. I know a lot about things that affect my physical health.
9. I have deliberately developed a healthy life-style.
10. I constantly worry about being or becoming fat.
	1	2	3	4	5
	Definitely Disagree	Mostly Disagree	Neither Agree Nor Disagree	Mostly Agree	Definitely Agree	Not Answered
11. I like my looks just the way they are.
12. I check my appearance in a mirror whenever I can.
13. Before going out, I usually spend a lot of time getting ready.
14. My physical endurance is good.
15. Participating in sports is unimportant to me.
16. I do not actively do things to keep physically fit.
17. My health is a matter of unexpected ups and downs.
18. Good health is one of the most important things in my life.
19. I don't do anything that I know might threaten my health.
20. I am very conscious of even small changes in my weight.
	1	2	3	4	5
	Definitely Disagree	Mostly Disagree	Neither Agree Nor Disagree	Mostly Agree	Definitely Agree	Not Answered
21. Most people would consider me good-looking.
22. It is important that I always look good.
23. I use very few grooming products.
24. I easily learn physical skills.
25. Begin physically fit is not a strong priority in my life.
26. I do things to increase my physical strength.
27. I am seldom physically ill.
28. I take my health for granted.
29. I often read books and magazines that pertain to health.
30. I like the way I look without my clothes on.
	1	2	3	4	5
	Definitely Disagree	Mostly Disagree	Neither Agree Nor Disagree	Mostly Agree	Definitely Agree	Not Answered
31. I am self-conscious if my grooming isn't right.
32. I usually wear whatever is handy without caring how it looks.
33. I do poorly in physical sports or games.
34. I seldom think about my athletic skills.
35. I work to improve my physical stamina.
36. From day to day, I never know how my body will feel.
37. If I am sick, I don't pay much attention to my symptoms.
38. I make no special effort to eat a balanced and nutritious diet.
39. I like the way my clothes fit me.
40. I don't care what people think about my appearance.
	1	2	3	4	5
	Definitely Disagree	Mostly Disagree	Neither Agree Nor Disagree	Mostly Agree	Definitely Agree	Not Answered
41. I take special care with my hair grooming.
42. I dislike my physique.
43. I don't care to improve my abilities in physical activities.
44. I try to be physically active.
45. I often feel vulnerable to sickness.
46. I pay close attention to my body for any signs of illness.
47. If I'm coming down with a cold or flu, I just ignore it and go on as usual.
48. I am physically unattractive.
49. I never think about my appearance.
50. I am always trying to improve my physical appearance.
	1	2	3	4	5
	Definitely Disagree	Mostly Disagree	Neither Agree Nor Disagree	Mostly Agree	Definitely Agree	Not Answered
51. I am very well coordinated.
52. I know a lot about physical fitness.
53. I play a sport regularly throughout the year.
54. I am a physically healthy person.
55. I am very aware of small changes in my physical health.
56. At the first sign of illness, I seek medical advice.
57. I am on a weight-loss diet.

For the remainder of the items use the response scale given with the item.

58. I have tried to lose weight by fasting or going on crash diets.
	Never Rarely Sometimes Often Very Often Not Answered
59. I think I am:
	Very Underweight Somewhat Underweight Normal Weight Somewhat Overweight Very Overweight Not Answered
60. From looking at me, most other people would think I am:
	Very Underweight Somewhat Underweight Normal Weight Somewhat Overweight Very Overweight Not Answered

61-69. Use this scale to indicate how satisfied you are with each of the following areas or aspects of your body.

	Very Dissatisfied	Mostly Dissatisfied	Neither Satisfied Nor Dissatisfied	Mostly Satisfied	Very Satisfied	Not Answered
61. Face (facial features, complexion)
62. Hair (color, thickness, texture)
63. Lower torso (buttocks, hips, thighs, legs)
64. Mid torso (waist, stomach)
65. Upper torso (chest or breasts, shoulders, arms)
66. Muscle tone
67. Weight
68. Height
69. Overall appearance

© Thomas F. Cash, Ph.D., Department of Psychology, Old Dominion University, Norfolk, VA 23529