CareOptions OnLine™

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CareOptions OnLine Patient Assessment Tools

Anxiety Disorder Assessment
Printable Version

"Anxiety disorder" is the medical term for recurring fear or anxiety that has no apparent cause. Anxiety disorders are the most widespread mental health problems in the world today.

Millions of Americans suffer from anxiety disorders that are severe enough to interfere with their everyday lives. There are several types of anxiety disorder, including:

Panic Disorder
Obsessive-Compulsive Disorder
Post-Traumatic Stress Disorder
Generalized Anxiety Disorder
Social Anxiety Disorder
Phobias (exaggerated or irrational fears)

Anxiety disorders seem to be caused by a combination of environmental and biological factors. They can be complicated by depression and by alcohol and other drug abuse.

Fortunately, most people who suffer from anxiety disorders can be treated successfully.

For each question, choose the answer that best describes your feelings or actions:

General Anxiety Disorder

1. Are you worried about such things as your work or school performance?

Often Sometimes Rarely or Never

2. Do you feel worried or anxious when there seems to be nothing to worry about?

Often Sometimes Rarely or Never

3. Do you get aches or pains that you can't trace to any physical illness or injury?

Often Sometimes Rarely or Never

4. Do you get tired easily?

Often Sometimes Rarely or Never

5. Do you have trouble sleeping?

Often Sometimes Rarely or Never

6. Does your body feel tense?

Often Sometimes Rarely or Never

7. Do you feel restless or on edge?

Often Sometimes Rarely or Never

8. Do you feel irritable or crabby?

Often Sometimes Rarely or Never

Panic Disorder

9. Do you feel fearful for no apparent reason?

Yes No

If you answered "No" to question 9, skip to question 10. If you answered "Yes," please answer the questions below:

When you feel fearful do you also:

Feel dizzy?

Often Sometimes Rarely or Never

Feel as though you can't breathe?

Often Sometimes Rarely or Never

Feel as though your heart is pounding or racing?

Often Sometimes Rarely or Never

Feel tingling or numbness in your fingers or hands?

Often Sometimes Rarely or Never

10. Do you feel as if something terrible is about to happen or feel that you are going to die, even though you don't know why you feel that way?

Often Sometimes Rarely or Never

Post-Traumatic Stress Disorder

11. Have you experienced or witnessed a horrible or terrifying event?

Yes No

If you answered "No" to question 11, skip to question 12. If you answered "Yes," please answer the questions below:

Do you have flashbacks or nightmares of that event?

Often Sometimes Rarely or Never

Are you anxious when faced with places, people, or situations that remind you of that event and do you try to avoid those things whenever possible?

Often Sometimes Rarely or Never

Do you experience any of the following: trouble sleeping, trouble concentrating, outbursts of anger or a feeling that you can't trust anyone

Often Sometimes Rarely or Never

Social Anxiety Disorder (Social Phobia)

12. Are you afraid that you will do something to embarass yourself?

Often Sometimes Rarely or Never

13. Do the following situations make you fearful?

Meeting new people?

Often Sometimes Rarely or Never

Speaking out in public?

Often Sometimes Rarely or Never

Taking a test?

Often Sometimes Rarely or Never

Eating, writing, or working in a public place?

Often Sometimes Rarely or Never

Being the center of attention?

Often Sometimes Rarely or Never

Do you try to avoid these situations if possible?

Often Sometimes Rarely or Never

Specific Phobias

14. Are you especially afraid of a particular object or situation, such as high places, small or enclosed places, dark places, elevators, closets, water, storms, animals, seeing blood, receiving an injection, riding in a car, or flying on an airplane?

Often Sometimes Rarely or Never

Do you try to avoid these objects or situations?

Often Sometimes Rarely or Never

1.	Are you worried about such things as your work or school performance?

		Often	Sometimes	Rarely or Never

2.	Do you feel worried or anxious when there seems to be nothing to worry about?

		Often	Sometimes	Rarely or Never

3.	Do you get aches or pains that you can't trace to any physical illness or injury?

		Often	Sometimes	Rarely or Never

4.	Do you get tired easily?

		Often	Sometimes	Rarely or Never

5.	Do you have trouble sleeping?

		Often	Sometimes	Rarely or Never

6.	Does your body feel tense?

		Often	Sometimes	Rarely or Never

7.	Do you feel restless or on edge?

		Often	Sometimes	Rarely or Never

8.	Do you feel irritable or crabby?

		Often	Sometimes	Rarely or Never

9.	Do you feel fearful for no apparent reason?

		Yes	No

	If you answered "No" to question 9, skip to question 10. If you answered "Yes," please answer the questions below:

	When you feel fearful do you also:

	Feel dizzy?

		Often	Sometimes	Rarely or Never

	Feel as though you can't breathe?

		Often	Sometimes	Rarely or Never

	Feel as though your heart is pounding or racing?

		Often	Sometimes	Rarely or Never

	Feel tingling or numbness in your fingers or hands?

		Often	Sometimes	Rarely or Never

10.	Do you feel as if something terrible is about to happen or feel that you are going to die, even though you don't know why you feel that way?

		Often	Sometimes	Rarely or Never

11.	Have you experienced or witnessed a horrible or terrifying event?

		Yes	No

	If you answered "No" to question 11, skip to question 12. If you answered "Yes," please answer the questions below:

	Do you have flashbacks or nightmares of that event?

		Often	Sometimes	Rarely or Never

	Are you anxious when faced with places, people, or situations that remind you of that event and do you try to avoid those things whenever possible?

		Often	Sometimes	Rarely or Never

	Do you experience any of the following: trouble sleeping, trouble concentrating, outbursts of anger or a feeling that you can't trust anyone

		Often	Sometimes	Rarely or Never

12.	Are you afraid that you will do something to embarass yourself?

		Often	Sometimes	Rarely or Never

13.	Do the following situations make you fearful?

	Meeting new people?

		Often	Sometimes	Rarely or Never

	Speaking out in public?

		Often	Sometimes	Rarely or Never

	Taking a test?

		Often	Sometimes	Rarely or Never

	Eating, writing, or working in a public place?

		Often	Sometimes	Rarely or Never

	Being the center of attention?

		Often	Sometimes	Rarely or Never

	Do you try to avoid these situations if possible?

		Often	Sometimes	Rarely or Never

14.	Are you especially afraid of a particular object or situation, such as high places, small or enclosed places, dark places, elevators, closets, water, storms, animals, seeing blood, receiving an injection, riding in a car, or flying on an airplane?

		Often	Sometimes	Rarely or Never

	Do you try to avoid these objects or situations?

		Often	Sometimes	Rarely or Never