Signs & Symptoms of Anxiety

Instructions

Circle one number for each item that best describes how much you have experienced each symptom over the last week.

  1. Feeling nervous:
    Not at all
    Sometimes
    Often
    Most of the time

  2. Frequent Worrying:
    Not at all
    Sometimes
    Often
    Most of the time

  3. Trembling, twitching, feeling shaky:
    Not at all
    Sometimes
    Often
    Most of the time

  4. Muscle tension, muscle aches, muscle soreness:
    Not at all
    Sometimes
    Often
    Most of the time

  5. Restlessness
    Not at all
    Sometimes
    Often
    Most of the time

  6. Easily tired:
    Not at all
    Sometimes
    Often
    Most of the time

  7. Shortness of breath:
    Not at all
    Sometimes
    Often
    Most of the time

  8. Rapid heartbeat
    Not at all
    Sometimes
    Often
    Most of the time

  9. Sweating - not due to the heat:
    Not at all
    Sometimes
    Often
    Most of the time

  10. Dry mouth:
    Not at all
    Sometimes
    Often
    Most of the time

  11. Dizziness or light-headedness:
    Not at all
    Sometimes
    Often
    Most of the time

  12. Nausea, diarrhea, or stomach problems:
    Not at all
    Sometimes
    Often
    Most of the time

  13. Frequent urination
    Not at all
    Sometimes
    Often
    Most of the time

  14. Flushes (hot flashes) or chills:
    Not at all
    Sometimes
    Often
    Most of the time

  15. Trouble swallowing or "lump in throat":
    Not at all
    Sometimes
    Often
    Most of the time

  16. Feeling keyed up or on edge:
    Not at all
    Sometimes
    Often
    Most of the time

  17. Quick to startle:
    Not at all
    Sometimes
    Often
    Most of the time

  18. Difficulty concentrating
    Not at all
    Sometimes
    Often
    Most of the time

  19. Trouble falling asleep or stying asleep:
    Not at all
    Sometimes
    Often
    Most of the time

  20. Irritablility:
    Not at all
    Sometimes
    Often
    Most of the time

  21. Avoiding places where I might be anxious:
    Not at all
    Sometimes
    Often
    Most of the time

  22. Frequent thoughts of danger:
    Not at all
    Sometimes
    Often
    Most of the time

  23. Seeing myself as unable to cope:
    Not at all
    Sometimes
    Often
    Most of the time

  24. Frequent thoughs that something terrbile will happen
    Not at all
    Sometimes
    Often
    Most of the time