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Panic Disorder Assessment

Questionnaire to identify the onset of symptoms of Panic Disorder



1)

Do you ever experience shortness of breath?

 
 
 

2)

Do you ever experience chest pain or discomfort?

 
 
 

3)

Do you ever have a feeling of dying or losing control?

 
 
 

4)

Do you experience unexpected shaking or trembling?

 
 
 

5)

Do you have feelings that you are detached from your surroundings?

 
 
 

6)

Do you have a fear of crowded places?

 
 
 

7)

Do you have a fear of being alone in social situations?

 
 
 

8)

Do you ever feel helpless in public places?

 
 
 

9)

Do you experience feelings of over-dependence on others?

 
 
 

10)

Do you experience fear in places it may be hard to leave? (such as a train or elevator)

 
 
 

11)

Do you ever experience tingling or numbness in hands or feet?

 
 
 

12)

Do you experience the inability to stop worrying about things?

 
 
 

13)

Do you have difficulty handling uncertainty or indecisiveness?

 
 
 

14)

Do you find it difficult to relax or concentrate?

 
 
 

15)

Do you experience fatigue, headaches, or nausea?

 
 
 


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