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Screening for an Anxiety Disorder: Family Member
If you think a family member may be suffering from an anxiety disorder, ask him or her to answer the questions below and print out the results to share with a health care professional.
Are you troubled by the following?
| Yes No | 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 | Persistent, inappropriate thoughts, impulses, or images that you can’t get out of your mind (such as a preoccupation with germs, worry about the order of things, or aggressive or sexual impulses) |
| Yes No | Powerful and ongoing fear of social situations involving unfamiliar people |
| Yes No | Excessive worrying (for at least six months) about events or activities |
| Yes No | Fear of places or situations where getting help or escape might be difficult, such as in a crowd or on a bridge |
| Yes No | Shortness of breath or a racing heart for no apparent reason |
| Yes No | Persistent and unreasonable fear of an object or situation, such as flying, heights, animals, blood, etc. |
| Yes No | Inability to travel alone |
| Yes No | Spending more than one hour a day doing repetitive actions (hand washing, checking, counting, etc.) |
| Yes No | Experience or witnessing a traumatic life-threatening or deadly event or serious injury (such as military combat, violent crime, or serious accident) |
More days than not, do you experience the following?
| Yes No | Feeling restless |
| Yes No | Feeling easily tired distracted |
| Yes No | Feeling irritable |
| Yes No | Tense muscles or problems sleeping? |
| Yes No | Your anxiety interfering with your daily life |
Having more than one illness at the same time can make it difficult to diagnose and treat the different conditions. Depression and substance abuse are among the conditions that occasionally complicate anxiety disorders.
| Yes No | In the last year have you experienced changes in sleeping or eating habits? |
| Yes No | More days than not, do you feel sad or depressed? |
| Yes No | More days than not, do you feel disinterested in life? |
| Yes No | More days than not, do you feel worthless or guilty? |
During the last year, has the use of alcohol or drugs...
| Yes No | resulted in your failure to fulfill responsibilities with work, school, or family? |
| Yes No | placed you in a dangerous situation, such as driving a car under the influence? |
| Yes No | gotten you arrested? |
| Yes No | continued despite causing problems for you or your loved ones? |
Find out more information about helping others who have an anxiety disorder.
