Questionnaires for Self-Exploration > Anxiety Questionnaire

1. Have you ever experienced a sudden onset of intense fear or discomfort accompanied by a sense of imminent danger or impending doom?

Yes
No

2. If yes, which of the following best describe your symptoms? Please check all that apply:

rapid heart rate, palpitations, pounding heart

sweating

trembling or shaking

shortness of breath, or the feeling of smothering

feeling of choking

discomfort or pain in the chest area

nausea or abdominal discomfort

feeling dizzy, lightheaded, unsteady, or faint

feelings of unreality, like being disconnected from yourself

fear of loosing control or going crazy

fear of dying

numbness or tingling sensations

chills or hot flushes

3. After experiencing the above symptoms, did you have concerns about having additional attacks?

Yes
No

4. Do you worry about the cause of these attacks? For example, do you feel as if you are going crazy, losing control, having a heart attack, or experiencing a life threatening illness?

Yes
No

5. 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?

Yes
No