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Anxiety Test: Questions 1) You have panic attacks for no apparent reason. always often sometimes never 2) There is a history of panic disorder in your family. yes, all throughout one or two I don't know no 3) You are afraid of having a panic attack. always often sometimes never 4) You have planned your day’s routine around which activities and situations will least likely cause you to have a panic attack. several tiimes more than once sounds like a good idea to try never 5) You have a sudden onset of any of the following physical symptoms even though you have not exerted yourself: racing heart, sweating, shortness of breath. always often sometimes never 6) You have been overwhelmed by a sudden fear of death or entrapment even though you were not in a dangerous situation. several tiimes more than once not sure never 7) You have felt lonely or shy. I am not lonely or shy lately since adolesence your entire life 8) You have extreme, uncontrollable worry about multiple concerns, e.g. finances, health, employment, family, being late…even if should not be serious concerns. always often sometimes never 9) You believe that it is best to prepare yourself for the worst at all times. always depending on the situation when I get around to it never 10) You believe that any strange situation should be regarded as dangerous. always sometimes occasionally never 11) You often wake up in the early morning hours. always often sometimes never 12) How often do you have any of the following symptoms: tremblinig, twitching, feeling shaky, muscle tension, aches, soreness, restlessnenss. never not very often most days every day 13) How often do you have at least two of the following symptoms: shortness of breath/ smothering sensations, accelerated heart rate, sweating, or cold, clammy hands, dry mouth, dizziness/ lightheadedness, nausea/ diarrhea, hot flushes or chills, frequent urination, trouble swallowing/ “lump in throat.” everyday more than once a week once a week never or hardly ever 14) How often do you have any of the following symptoms: feeling keyed up or on edge exaggerated startle response “mind going blank” trouble falling or staying asleep irritability everyday more than once a week once a week never or hardly ever 15) You have insomnia or oversleeping. always sometimes occasionally never 16) You have lost interest in life. a long time ago am starting to get bored sometimes never 17) You feel guilty, helpless or hopeless. often sometimes situational only never 18) You lack energy and feel listless. often sometimes only when my body is physically exhausted never 19) You have recently experienced a good or bad change that you feel the effects of everyday, e.g. getting married, having a baby, changing schools or moving house. yes will soon experience such a change no 20) You have increased or decreased appetite. always sometimes situational only never 21) You have experienced recent changes in your physical activity so that you are either agitated and restless or withdrawn and lifeless. yes I know I will in the future I have in the past never 22) You have skipped a party or outing because you were afraid that the place or circumstances might cause a panic attack. many times a few times once or twice never 23) You are less efficient than you used to be, or are no longer able to work yes yes, but I'm simply getting older I had a temporary injury no 24) You need others to help you do things that most people can do on their own, and that you once were able to do unaided. always often sometimes never 25) You avoid public places like streets, stores, public transport, crowds or tunnels because you fear being far from a safe place. always often sometimes never 26) If you were forced to be in a place listed in 4, you worried, had shortness of breath, sweated, your heart raced, had abdominal pain, or any other unaccounted for physical discomforts. I avoided those situations at all costs Every time I was in a situation like that Sometimes I did and sometimes I didn't Never 27) In the last ten years or less, you have lost a baby at birth, parent, spouse, or anyone close to you. yes, very close yes, a pet I am preparing myself for a loss No 28) You feel isolated. always sometimes occasionally Never 29) You feel excessive embarrassment in social, evaluative or performance situations. always often sometimes never 30) You avoid situations where you will be the centre of attention or be forced to socialize with strangers. always often sometimes never 31) When talking to another person you. I never talk to other people Avert your eyes Make only a little eye contact make complete eye contact 32) You avoid performing any of the following activities in front of others: Eating, drinking, speaking or using a public toilet. always often sometimes never 33) Your fear of performing these public activities is interfering with your routine or personal life. everyday more than once a week less than once a week never 34) If you are forced to do any of the following, you immediately become tense and worry: public speaking or eating, using a public lavatory, being asked a question in public. always often sometimes never 35) You cross the street to avoid greeting a person you know. always often sometimes never 36) You have persistent, multiple fears that focus on a specific object, animal, or activity (other than fear of having a panic attack). yes a few fears not sure no 37) Exposure to the object worries you and almost always causes you to feel anxious or nervous. always sometimes occasionally never 38) You avoid the object or situation that you fear to the extent that it interferes with your normal routine, social activities or relationships. always sometimes occasionally never 39) You realize that your fear is excessive or unreasonable but feel unable to change how you feel. yes possibly unlikely no 40) You suffer from fatigue. always sometimes occasionally never 41) You have difficulty concentrating. always sometimes occasionally never 42) You feel tense or restless. always sometimes occasionally never 43) You are compelled to perform certain rituals to prevent or avert bad consequences, e.g. wash your hands before and/or after most activities. several times a day at least a couple of times each day once a day or less less than once a week 44) Some rituals that you often perform (hand washing/exercise/checking locks) do not bring you pleasure, but they release tension, e.g. after you have checked all of the locks thoroughly you feel that you can safely relax. always sometimes occasionally never 45) You perform any of the following activities more than three times each day: cleaning, counting, checking, touching something specific, repeating an activity, avoiding, slowing, striving for completeness. much more than three times a day three or less occasionally never 46) You are meticulous. always sometimes occasionally never 47) You need structure and rigidity. always often sometimes never 48) You are in constant doubt about how your behavior will influence your environment. always often sometimes never 49) It takes you twice or three times as long as others to perform an activity such as showering/using the toilet/reading/getting to work/any other routine activity. often due to anxiety often due to a physical condition seldom never 50) You have had, or witnessed a traumatic physical or emotional experience within the last six months, e.g. witnessed an air collision, or were present during a bank hold up, were raped, saw your home being destroyed, witnessed another person’s death, injury or rape. yes, more than one yes, one traumatic event no, but I always fear I will no 51) You have flashbacks of, or nightmares about, a recent distressing situation, or have difficulty recalling certain aspects of it. every day/night most days/nights sometimes never 52) You feel anaesthetized to (unable to feel) certain emotions or feel detached or estranged from others around you. always often sometimes never 53) You feel a sense of a foreshortened future, e.g. doubt that you will ever get married, have a career, or live a long life. always sometimes occasionally never 54) The duration for which you have ever felt a strong sense of fear. longer than 4 months 3 - 4 months 1 - 2 months less than a month 55) You have a constant sense of stimulation or excitement, which is causing you to feel irritable, have outbursts of anger, or startled response to regular things. always sometimes occasionally never 56) You try to avoid, or have lost interest in, activities or situations that you associate with a traumatic experience. yes, I always avoid everything yes, I avoid a few things I do not avoid, but have lost a slight interest nothing has changed

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