Panic Attack

Welcome to your Panic Attack TestControl your Panic Attack, the Perfect Guide

Please read each statement and select which indicates how much the statement applied to you. There are no right or wrong answers. Do not spend too much time on any one statement. This assessment is not intended to be a diagnosis. If you are concerned about your results in any way, please speak with a qualified health professional. All your information is Confidential.

1- During the last six months, have you had a panic attack or a sudden rush of intense fear or anxiety?

If NO (you have not experienced a panic attack), please leave the rest of this form blank

If YES, please continue
2- When was the most recent time this occurred? (please record date)
3- Was at least one panic attack unexpected, as if it came out of the blue?
4- Did it happen more than once?
If YES to 3, approximately how many panic attacks have you had in your lifetime?

If NO to 1, 2, and 3, please leave the rest of this form blank, otherwise continue
5- Have you ever worried a lot (for at least one month) about having another panic attack?
6- Have you ever worried a lot (for at least one month) that having the attacks meant you were losing control, going crazy, having a heart attack, seriously ill, etc?
7- Did you ever change your behavior or do something different (for at least one month) because of the attacks?

If YES to 5, 6 or 7 please answer the following questions:
8- Shortness of breath or smothering sensations?
9- Feeling dizzy, unsteady, lightheaded, or faint?
10- Palpitations, pounding heart, or rapid heart rate?
11- Trembling or shaking?
12- Sweating?
13- Feelings of choking?
14- Nausea or abdominal distress?
15- Numbness or tingling sensations?
16- Flushes (hot flashes) or chills
17- Chest pain or discomfort?
18- Fear of dying?
19- Fear of going crazy or doing something uncontrolled?
20- How much do these symptoms interfere with your daily functioning? (Please select one)
21- How distressing do you find these symptoms? (Please select one)
22- When you have bad panic attacks, does it often take less than ten minutes from the point at which the attack begins, to the point at which it reaches a peak or becomes most intense?
23- Just before you began having panic attacks, were you taking any drugs or excessive amounts (more than 4 cups daily) of stimulants (e.g. coffee, tea, or cola with caffeine)?
If YES, what was it that you were taking?
How much of it were you taking (in cups, etc.)?
24- Have you ever been diagnosed with a medical problem (e.g. hyperthyroidism, a seizure or cardiac condition, etc.) that could have caused your panic symptoms?

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