psychtests

Anxiety Disorder Screen

This screen is a measure of anxiety.
Answer all the questions. Skipping any question will not give the correct result.
Check the one that applies to how you have been feeling in the last six months.

#	Questions	No	Yes
1	Do you feel numbness and/or tingling in your hands and arms?
2	Do you feel fearful & dread that something awful is going to happen?
3	Do you feel that you are unable to relax?
4	Have you been feeling dizzy or lightheaded lately?
5	Have you had stomach problems, discomfort or indigestion?
6	Have you had difficulty breathing or had shortness of breath?
7	Are you sweating more than usual (not due to the weather)?
8	Are you having fearful thoughts about death?
9	Do you often feel nervous for no specific reason?
10	Do you feel tightness in your muscles (neck, shoulders, back)?
11	Have you been worried or anxious for no apparent reason?
12	Do you feel as if you are choking?
13	Do you fear that you are losing control or going crazy?
14	Do you feel disconnected from yourself?
15	Have you had difficulty sleeping through the night?

Personal Information:
The information below is used for research purposes only.
It will not reflect on your result.
It will not be used for any other purpose.

1 Age Range: 13 - 19yrs 20 -29yrs 30 - 39yrs 40 - 49yrs
50 - 59yrs 60 - 69yrs 70 - 79yrs 80 - 89yrs

2 Gender: Male Female

3 Marital Status: Single Married Divorced

4 Work Status: Employed Unemployed

5 Education: Did not finish High School High School
College (2 years) College (4 years) Post Graduate

6   Have you received treatment for any mental health disorder?    Yes    No

7   I have:   Depression      Anxiety Disorder      PTSD     Schizophrenia
Manic-Depressive Illness      Obsessive-Compulsive Disorder     Anorexia     Bulimia    Addictions: (Alcohol/Drugs Gambling    Sexual/Pornography )

8   What form of treatment did you receive?
Medication      Psychotherapy      Both      None

9 Who did you seek treatment from?
Physician Psychiatrist Psychotherapist/Counselor Imam

10 My religion is: Islam Other