01732 808 626 info@thinkcbt.com

01732 808 626 info@thinkcbt.com

01732 808 626 info@thinkcbt.com

Panic Disorder (DSM-5 Assessment)
You can respond anonymously, and no data will be retained from this assessment. If you choose to include your initials and an email address, your results will be automatically sent to the email address provided. Please check that the email address has been entered correctly before submitting this form. All client information is managed on a strictly confidential basis. Please Note: Whilst every effort is made to ensure that our system is securely encrypted, email is not a completely secure means of communication. Think CBT does not accept liability for loss or theft of personal data where any individual chooses to transmit or receive information via email.
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This questionnaire is not designed to provide a definitive psychological diagnosis or to take the place of a professional consultation. Please answer all questions as accurately and honestly as possible.


The following questions ask about thoughts, feelings, and behaviors about panic attacks. A panic attack is an episode of intense fear that sometimes comes out of the blue (for no apparent reason). The symptoms of a panic attack include: a racing heart, shortness of breath, dizziness, sweating, and fear of losing control or dying. Please respond to each item by marking one box per row.

During the PAST 7 DAYS, I have…
1. felt moments of sudden terror, fear or fright, sometimes out of the blue (i.e., a panic attack)

2. felt anxious, worried, or nervous about having more panic attacks

3. had thoughts of losing control, dying, going crazy, or other bad things happening because of panic attacks

4. felt a racing heart, sweaty, trouble breathing, faint, or shaky

5. felt tense muscles, felt on edge or restless, or had trouble relaxing or trouble sleeping

6. avoided, or did not approach or enter, situations in which panic attacks might occur

7. left situations early, or participated only minimally, because of panic attacks

8. spent a lot of time preparing for, or procrastinating about (putting off), situations in which panic attacks might occur

9. distracted myself to avoid thinking about panic attacks

10. needed help to cope with panic attacks (e.g., alcohol or medication, superstitious objects, other people)