Screening for Panic Disorder
If you are concerned that you might suffer from panic disorder, answer the questions below honestly with Yes or No responses. Then record the results and share them with your health care professional. You can also download this survey as a Word Document here.
Are you troubled by:
- Pounding heart
- Sweating
- Trembling or shaking
- Shortness of breath
- Choking
- Chest Pain
- Nausea or abdominal discomfort
- “Jelly” legs
- Dizziness
- Numbness or tingling sensations
- Chills or hot flushes
- Fear of losing control or “going crazy”
- Fear of dying
As a result of these attacks, have you…
- Experienced a fear of places or situations where getting help or escape might be difficult, such as a crowd on a bridge?
- Felt unable to travel without a companion?
For at least one month following an attack, have you…
- Felt persistent concern about having another one?
- Worried about having a heart attack or “going crazy”?
- 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. Conditions that sometimes complicate anxiety disorders include depression and substance abuse, among others.
In the last year, have you experienced:
- Changes in sleeping or eating habits?
- Feeling sad or depressed more days than not?
- A disinterest in life more days than not?
- A feeling of worthlessness or guilt more days than not?
- An inability to fulfill responsibilities at work/school or family due to alcohol or drug abuse?
- A dangerous situation, such as driving under the influence, caused by alcohol or drug use?
- Being arrested due to alcohol or drugs?
- The need to continue using alcohol or drugs despite it causing problems for you and/or your loved ones?
