Click on the appropriate answer:
Do you use alcohol, nicotine, chocolate, carbohydrate foods, or other substances to calm down?	Yes No
Do you feel at times as if your legs or arms shake for no obvious reason?	Yes No
Do you experience cold sweats or feel clammy for no obvious reason?	Yes No
Do you experience feelings that something bad is going to happen?	Yes No
Do you feel waves of nausea or butter flies in your stomach?	Yes No
Do you sometimes notice having difficulty breathing calmly?	Yes No
Do you wake up in the middle of the night and feel restless?	Yes No
Do you feel your heart pounding or experience rapid heartbeat?	Yes No
Do you get unexplained chills, head rushes, or hot flashes?	Yes No
Do you experience spells when the world feels unreal?	Yes No
Do you often feel as if you have to do things right now?	Yes No
Do you experience light-headedness or unsteadiness?	Yes No
Do you frequently have trouble falling asleep?	Yes No
Do you experience shakiness or shortness of breath?	Yes No
Do you get feelings of choking or throat tightness?	Yes No
Do you find yourself worrying over small matters?	Yes No
Do you often feel restless and unable to sit still?	Yes No
Do you experience numbness or tingling?	Yes No
Do you frequently feel tense or up-tight?	Yes No
Do you excessively fear dying?	Yes No

 

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