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Anxiety Disorders: Self-Test for Family Members

How much anxiety is too much? Ask a family member to answer "yes" or "no" to
the following questions by clicking the appropriate box next to each question,
print out the test and show the results to your health care professional.

HOW CAN I TELL IF IT'S AN ANXIETY DISORDER?

Are you troubled by:1.Repeated, unexpected panic attacks, during which you suddenly are overcome by intense fear or discomfort for no apparent reason, or the fear of having another panic attack?
Yes   No

2.
Persistent, inappropriate thoughts, impulses or images that you can't get out of your mind (such as a preoccupation with getting dirty, worry about the order of things, or aggressive or sexual impulses)?
Yes   No

3.
Powerful and ongoing fear of social situations involving unfamiliar people?
Yes   No

4.
Excessive worrying, for six months or more, about a number of events or activities?
Yes   No

5.
Fear of places or situations where getting help or escape might be difficult, such as in a crowd or on a bridge?
Yes   No

6.
Shortness of breath or a racing heart for no apparent reason?
Yes   No

7.
Persistent and unreasonable fear of an object or situation, such as flying, heights, animals, blood, etc?
Yes   No

8.
Being unable to travel alone?
Yes   No

9.
Spending too much time each day doing things over and over again (for example, hand washing, checking things, or counting)?
Yes   No

More days than not, do you:

10.
Feel restless?
Yes   No

11.
Feel easily tired or distracted?
Yes   No

12.
Feel irritable?
Yes   No

13.
Have tense muscles or problems sleeping?
Yes   No

14.
Have you experienced or witnessed a traumatic event that involved actual or threatened death or serious injury to yourself or a loved one (for example, military combat, a violent crime or a serious car accident)?
Yes   No

15.
Does your anxiety interfere with your daily life?
Yes   No

Having more than one illness at the same time can make it difficult to diagnose and treat the different conditions. Illnesses that sometimes complicate anxiety disorders include depression and substance abuse. With this in mind, please take a minute to answer the following questions:

16.
Have you experienced changes in sleeping or eating habits?
Yes   No

More days than not, do you feel:

17.
Sad or depressed?
Yes   No

18.
Disinterested in life?
Yes   No

19.
Worthless or guilty?
Yes   No

During the last year, has the use of alcohol or drugs:

20.
Resulted in your failure to fulfill responsibilities with work, school, or family?
Yes   No

21.
Placed you in a dangerous situation, such as driving a car under the influence?
Yes   No

22.
Gotten you arrested?
Yes   No

23.
Continued despite causing problems for you and/or your loved ones?
Yes   No

* © 2004