Self Screening Test

The following screening is provided for your information purposes only! No record will be kept and you are not required to identify yourself.

  • Answer each of the following questions.
  • Base your answers on what has happened in the last six months.
  • When you have answered each question, click on one of the Submit buttons at the top or bottom of the page.
  • You will receive your confidential results.

No. Question No Yes
1. I blame myself for a lot of things
2. I've been feeling hopeless about the future
3. I've lost interest in many things
4. I feel worthless
5. I've thought about or want to commit suicide
6. Most days I feel very nervous
7. I worry about a lot of things
8. I can't stop worrying
9. I'm easily annoyed or irritated
10. Worry has changed my sleeping habits
 
No. Question No Yes
11. I have powerful and ongoing fears about social situations involving unfamiliar people
12. I get very concerned when I'm in a place where escape might be difficult such as in a crowd, on a bridge of an enclosed room
13. I have shortness of breath and a racing heart for no apparent reason
14. I have an unreasonable fear of an object of situation such as flying, heights, animals, blood or something else
15. I am unable to travel alone or without a companion
16. I am terrified about being overweight
17. I give a lot of time and thought to food
18. I've gone on eating binges where I couldn't stop
19. I vomit after eating
20. I am more than 100 pounds over-weight
 
No. Question No Yes
21. I've witnessed a life-threatening event that caused intense fear, helplessness or horror
22. I have repeated thoughts or dreams about a life-threatening event
23. I fear a life-threatening event will occur again
24. I have intense physical or emotional distress when I am exposed to things that remind me of a life threatening event
25. I have unwanted ideas, images or impulses that seem silly, nasty or horrible
26. I worry a lot about dirt, germs or chemicals
27. I worry that something bad will happen because I forget to do something
28. I worry I'll speak or act aggressively when I really don't want to
29. There are things I must do or think excessively in order to feel comfortable
30. I wash myself or things around me much more than most people do
 
No. Question No Yes
31. I have to check things over and over again or repeat them many times to be sure they are done properly
32. I have an intense fear of social situations where people might judge me
33. I'm afraid that I will be humiliated by what I do
34. I worry that people will notice that I'm blushing, sweating or show other signs of anxiety
35. I think my fears are unreasonable, but I can't stop feeling this way
36. I avoid being around people as much as I can