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Masula Chiropractic Neurology

And Wellness Center

30 Philadelphia Dr. Suite A

Chico, Ca. 95973

(530) 342-6441

Braverman Quiz

D.

  1. At parties I can't control my eating. T/F
  1. Caffeinated drinks, like coffee, tea, or sodas,

          put me in a better mood. T/F

  1. I am a smoker. T/F
  1. I am a very domineering individual. T/F
  1. I am eccentric and do things differently than others. T/F
  1. I am self-centered. T/F
  1. I am very hard on myself. T/F
  1. I bloat easily after eating. T/F
  1. I crave sugar. T/F
  1. I drink more than three alcoholic beverages per week. T/F
  1. I eat alone. T/F
  1. I eat my lunch while I'm working. T/F
  1. I eat only to re-energize my body. T/F
  1. I find exercise invigorating. T/F
  1. I get easily depressed or blue. T/F
  1. I have a temper. T/F
  1. I have gained more than 20 pounds since I was 20 years old. T/F
  1. I have no energy to exercise. T/F
  1. I have trouble getting out of bed in the morning. T/F
  1. I know I need to exercise, but I always seem to put it off. T/F
  1. I need to have at least one cup of coffee to

Jump-start me in the morning. T/F

  1. I overeat when I am stressed. T/F
  1. I sometimes experience total exhaustion

without even exerting myself. T/F

  1. I tend to be a loner. T/F
  1. I'm hard on myself but I'm harder on my friends and family. T/F

Total # of T responses: __________

A.


1. Cheese is a large part of my diet. T/F

2. I am a person who can't get enough new ideas or experiences. T/F

3. I am detail oriented. T/F

4. I am flirtatious. T/F

5. I can't get enough new drugs or new places. T/F

6. I crave fatty foods. T/F

7. I don't exercise anymore. T/F

8. I eat lots of low-calorie foods, like fresh fruits and vegetables. T/F

9. I experience mood swings. T/F

10. I find it more comfortable to do things alone rather than in a large group. T/F

11. I have had an eating disorder at some point in my life. T/F

12. I have lost muscle tone. T/F

13. I have tried many alternative remedies.  T/F

14. I lack imagination. T/F

15. I like to talk about what's bothering me. T/F

16. I like to try new foods and cuisines. T/F

17. I love yoga and stretching my muscles. T/F

18. I need a lot of love and nurturing. T/F

19. I often feel agitated. T/F

20. I tend to see myself in a desirable light. T/F

21. Losing weight is a priority for me. T/F

22. Lunch or dinner is usually accompanied by at least one glass of wine. T/F

23. Some people say I have my head in the clouds. T/F

24. Sometimes, by the end of the day, I don't remember what I've eaten T/F

25. When I eat, I love to experience the aromas and the beauty of food. T/F

Total # of T responses: __________

G.

  1. Caffeine has little effect on me. T/F
  2. Cooking is one way I take care of my family/loved ones. T/F
  3. Dinner is not complete without dessert. T/F
  4. I can create strong, lasting bonds with others. T/F
  5. I can sense that others want to hurt me. T/F
  6. I choose the same things to eat all the time. T/F
  7. I crave bitter foods. T/F
  8. I don't have specific food cravings. T/F
  9. I embarrass easily. T/F
  10. I frequently drink too much. T/F
  11. I have experimented with drugs. T/F
  12. I have fits of rage. T/F
  13. I like exercise because it helps me relax. T/F
  14. I lose my temper easily. T/F
  15. I love to try new things. T/F
  16. I need a lot of food to fill me up. T/F
  17. I often feel fatigued even when I have had a good night's sleep. T/F
  18. I overeat. T/F
  19. I share too much personal information about my life with others. T/F
  20. I eat my meals quickly. T/F
  21. I tend to worry more than I used to. T/F
  22. I'm nervous and jumpy. T/F
  23. I'm afraid of confrontations and altercations. T/F
  24. My thoughts get too confused. T/F
  25. When I make a decision, it's permanent. T/F

Total # of T responses: __________

S.

  1. Eating is one of the main ways that I socialize with others. T/F
  2. I am a deep-feeling person. T/F
  3. I am easily irritated. T/F
  4. I am extremely suspicious. T/F
  5. I am very artistic. T/F
  6. I believe my ideas are superior. T/F
  7. I can easily take advantage of others. T/F
  8. I can't find meaning in life. T/F
  9. I can't relax. T/F
  10. I crave carbohydrates. T/F
  11. I crave salt. T/F
  12. I don't do the activities I used to enjoy. T/F
  13. I drain myself fiving to others but then fill myself with food. T/F
  14. I engage in daring activities such as skydiving,

          motorcycle riding, and so forth. T/F

  1. I've had thoughts of self-destruction or suicide. T/F
  2. I find myself thinking about the same things over and over again. T/F
  3. I have little energy to exercise. T/F
  4. I have many frivolous relationships. T/F
  5. I just like to "eat, drink, and be merry." T/F
  6. I need an alcoholic drink in order to get a good night's sleep. T/F
  7. I need to eat right before going to bed. T/F
  8. I rarely stick to a plan or agenda. T/F
  9. I usually grab a quick meal on the run. T/F
  10. I'm never very hungry, although sometimes

          I find myself eating more than I should. T/F

  1. I'm not as strong as I used to be. T/F

Total # of T responses: __________

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