Self Assessment for Anxiety, OCD & Depression

Question 1

Depressed mood

Sadness, hopelessness, helplessness, worthlessness.

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Question 2

Feelings of guilt

Self-blame, guilt about the past, feeling punished or deserving punishment.

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Question 3

Suicide

Thoughts of death or suicide, wishes to be dead, suicide attempts.

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Question 4

Insomnia (early)

Difficulty falling asleep, takes more than 30 minutes.

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Question 5

Insomnia (middle)

Restless sleep, frequent waking, or 2 or more times of waking during the night.

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Question 6

Insomnia (late)

Early morning awakening (more than 2 hours before usual time).

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Question 7

Work and interests

Decrease in interest in activities, productivity, drive, or time spent on hobbies.

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Question 8

Retardation

Slowness of thought and speech, impaired ability to concentrate, decreased motor activity.

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Question 9

Agitation

Fidgetiness, hand wringing, hair pulling, or biting of lips.

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Question 10

Anxiety (psychic)

Tension and irritability, worries about minor matters.

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Question 11

Anxiety (somatic)

Physical manifestations of anxiety such as tremor, sweating, tachycardia, shortness of breath.

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Question 12

GI symptoms

Loss of appetite, difficulty eating, constipation, abdominal pain.

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Question 13

General somatic symptoms

Heaviness in limbs, back, or head, muscular aches, fatigue, loss of energy.

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Question 14

Genital symptoms

Loss of libido, menstrual disturbances.

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Question 15

Hypochondriasis

Preoccupation with body, overestimation of seriousness of symptoms.

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Question 16

Loss of weight

Obvious weight loss (1 lb or more per week), loss of appetite, difficulty eating.

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Question 17

Insight

Acknowledgment that he/she is depressed and ill.

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Personal Information

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