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NUMBER |
QUESTION
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YES
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NO
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| 1 |
I believe I have
had anxiety (or panic) attacks on at least two occasions. |
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| 2 |
There have been
times when my heart raced, or I felt like I was going to die, or I broke
out in a cold sweat for no apparent reason. |
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| 3 |
I used to have
a bad temper when I was younger but I learned to control it. |
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| 4 |
When I am faced
with a frustrating situation, I just try to put it out of my mind. |
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| 5 |
One of my parents
seemed to have panic or anxiety attacks even if they did not know what
to call them. |
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| 6 |
If somebody does
something to me that is rude, insulting
or really stupid, I will generally try not to let it bother me. |
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| 7 |
If I am in crowds,
or go a theater or restaurant or a
sports event, I need to sit on an aisle or near a door, and know
how to get out fast at any time. |
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| 8 |
I will not fly
in airplanes of any kind. |
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| 9 |
I like to be driving
any car in which I am riding. |
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| 10 |
To tell the honest
truth, I tend to be critical of others, even if I don't express it openly
or to their faces. |
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| 11 |
I do not let myself
get angry about minor things. |
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| 12 |
From the time I
was very young, I never caused my parents any problems and tried to not 'make
waves'. |
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| 13 |
I have a strong
dislike of embarrassing myself in any way. |
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| 14 |
One of my parents
had a really bad temper and I decided early in life that I was not going
to be like him or her. |
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| 15 |
I have pretty good
reason to believe that I either was not a planned child or that I was
not born at a good time for my parents. |
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| 16 |
I can't stand any
kind of fighting and arguing. |
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| 17 |
When I have been
alone, I have at least twice punched a wall, or thrown something in anger
or yelled out loud, or cursed someone who was not there at the time. |
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| 18 |
I tend to worry
a lot about hurting other people's feelings. |
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| 19 |
There have been
times in my life when I have been unable to do certain things like get
in an elevator, go through a tunnel, cross a bridge or look out of a window
in a high building. |
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| 20 |
Sometimes I drink
to calm my nerves. |
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| 21 |
I tend to be a
perfectionist in many aspects of my life. |
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| 22 |
I have had some
periods of depression in my life even when things were not really so bad. |
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