Anxiety Self Assessment

The following questionnaire is a self-assessment that is intended to identify specific symptoms of anxiety. This assessment is not intended to diagnose a specific anxiety disorder; rather it is meant to provide you information about symptoms and the potential impact these symptoms are having in your life. Please answer all questions in order to receive the most comprehensive assessment. After completion, a summary of results will be sent to you via the email address you have included.

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1. I am constantly tense, worried, nervous, or "on edge" about common stressors and responsibilities in my life.
No
Yes

2. I avoid social situations and meeting new people because I fear I will be judged or embarrass myself.
No
Yes

3. I have difficulty falling or staying asleep because my mind does not seem to "switch off" when I am supposed to be relaxed.
No
Yes

4. My mind often goes "blank" when I am put on the spot or pressured to perform.
No
Yes

5. My anxiety is typically out of proportion of what might be normally expected in a given situation.
No
Yes

6. I experience intense psychological distress when I am reminded of a traumatic experience from my past.
No
Yes

7. I believe that something bad will happen if things are not done in a certain, orderly way.
No
Yes

8. I avoid certain places, like crowded grocery stores, people, animals, or other objects, (e.g., elevators, airplanes, etc.), because they lead to intense distress and anxiety.
No
Yes

9. I have experienced anxious episodes in which I could not breathe, my chest hurt, I began shaking and sweating, and my heart felt like it would pound out of my chest.
No
Yes

10. Anxiety interferes with my work, school, or family responsibilities.
No
Yes

11. When anxious, I typically have headaches or experience gastrointestinal problems.
No
Yes

12. I avoid thinking about a traumatic event that I experienced in the past and/or places associated with that traumatic event.
No
Yes

13. I become very anxious, out of the norm of what would be expected, when I have to speak or perform in front of people.
No
Yes

14. I have had panic attacks in the past and I constantly worry about having another panic attack, to the extent that I avoid going out so I can avoid having one in public.
No
Yes