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Panic Disorder Self-Report

Panic attacks are discrete episodes of intense fear, apprehension, or terror that are accompanied by several physical symptoms. Panic attacks can either occur for no apparent reason (spontaneously) or upon entering into or being in situations which have become associated with them (e.g., long lines, closed spaces, driving over bridges). Do not consider fear to be a panic attack if it lasts several hours or most of the day.

Pleaase answer 

 OPTIONS
1. During the last 6 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 remainder of this form blank.
If YES, please continue.

 OPTIONS
2. Was at least 1 panic attack unexpected, as if it came out of the blue?
3. Did it happen more than once?
4. 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 remainder of this form blank, otherwise continue.

 OPTIONS
5. Have you ever worried a lot (for at least 1 month) about having another panic attack?
6. Have you ever worried a lot (at least 1 month) that having the attacks meant you were losing control, going crazy, having a heart attack, seriously ill, etcetera?
7. Did you ever change your behavior or do something different (for at least 1 month) because of the attacks?

If YES to 5, 6 OR 7 please answer the following questions:
Think back to your most severe panic attack. Did you experience any of the following symptoms?

 OPTIONS
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?
21. How distressing do you find these symptoms?
22. When you have bad panic attacks, does it often take 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)?
24. Have you ever been diagnosed with a medical problem (hyperthyroidism, a seizure or cardiac condition, etc.) that could have caused your panic symptoms?