Screening for Panic Disorder
If you suspect that you might suffer from panic disorder, answer the questions below, print out the results and share them with your health care professional.
Are you troubled by the following?
|Yes No||Repeated or unexpected “attacks” during which you suddenly are overcome by intense fear or discomfort for no apparent reason|
If yes, during an attack did you experience any of these symptoms?
|Yes No||Pounding heart|
|Yes No||Trembling or shaking|
|Yes No||Shortness of breath|
|Yes No||Chest pain|
|Yes No||Nausea or abdominal discomfort|
|Yes No||"Jelly" legs|
|Yes No||Fear of losing control or "going crazy"
|Yes No||Fear of dying|
|Yes No||Numbness or tingling sensations|
|Yes No||Chills or hot flushes|
As a result of these attacks, have you…
|Yes No||experienced a fear of places or situations where getting help or escape might be difficult, such as in a crowd or on a bridge?|
|Yes No||felt unable to travel without a companion?|
For at least one month following an attack, have you…
|Yes No||felt persistent concern about having another one?|
|Yes No||worried about having a heart attack or “going crazy”?|
|Yes No||changed your behavior to accommodate the attack?|
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 panic disorder.
|Yes No||Have you experienced changes in sleeping or eating habits?|
More days than not, do you feel…
|Yes No||sad or depressed?|
|Yes No||disinterested in life?|
|Yes No||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?|
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association, 1994.