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.

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Silver Spring, MD 20910

240.485.1001

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ADAA is a national nonprofit organization dedicated to the prevention, treatment, and cure of anxiety, OCD, PTSD, depression, and related disorders and to improving the lives of all people who suffer from them.

 

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