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Anxiety Disorder Self-Assessment Questionnaire |
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Page 2 of 2
| BLOCK 5 |
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Are you afraid of one or more social or performance situations?
-speaking up
-taking a test
-eating, writing or working in public
-being the center of attention
-asking someone for a date |
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Do you get anxious and worried if you try to participate in those situations? |
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Do you avoid these situations when possible? |
| BLOCK 6 |
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Are you afraid on one specific object or situation, such as heights, storms, water, animals, elevators, closed-in spaces, receiving an injection, or seeing blood (excluding social situations)? |
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Do you get anxious and worried if you try to participate in those situations? |
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Do you avoid these situations when possible? |
| BLOCK 7 |
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Are you afraid of flying or a commercial airliner? |
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Do you get anxious and worried if you fly? |
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Do you avoid flying when possible? |
| BLOCK 8 |
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Are you interesting in learning more about how medications might help you manage your symptoms? |
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Or are you currently taking a medication and wish to learn more about its benefits? |
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Last Updated( Apr 13, 2009 )
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reviewed by: Harry Croft, MD
Psychiatrist, HealthyPlace.com Medical Director
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