Self Assessment for Anxiety, OCD & Depression

Question 1

Anxious mood

Worries, anticipation of the worst, fearful anticipation, irritability.

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Question 2

Tension

Feelings of tension, inability to relax, startle response, moved to tears easily, trembling, feelings of restlessness.

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Question 3

Fears

Of dark, of strangers, of being left alone, of animals, of traffic, of crowds.

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Question 4

Insomnia

Difficulty in falling asleep, broken sleep, unsatisfying sleep and fatigue on waking, dreams, nightmares, night terrors.

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Question 5

Intellectual

Difficulty in concentration, poor memory.

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Question 6

Depressed mood

Loss of interest, lack of pleasure in hobbies, depression, early waking, diurnal swing.

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Question 7

Somatic (muscular)

Pains and aches, twitching, stiffness, myoclonic jerks, grinding of teeth, unsteady voice, increased muscular tone.

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Question 8

Somatic (sensory)

Tinnitus, blurring of vision, hot and cold flushes, feelings of weakness, pricking sensation.

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Question 9

Cardiovascular symptoms

Tachycardia, palpitations, pain in chest, throbbing of vessels, fainting feeling, feeling pulse.

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Question 10

Respiratory symptoms

Pressure or constriction in chest, choking feelings, sighing, dyspnea.

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Question 11

Gastrointestinal symptoms

Difficulty in swallowing, flatulence, abdominal pain, burning sensations, abdominal fullness, nausea, vomiting, constipation, looseness of bowels.

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Question 12

Genitourinary symptoms

Frequency of micturition, urgency of micturition, amenorrhea, menorrhagia, development of frigidity, premature ejaculation, loss of libido, impotence.

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Question 13

Autonomic symptoms

Dry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, raising of hair.

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Question 14

Behavior at interview

Fidgeting, restlessness or pacing, tremor of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing, etc.

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