Anxiety disorder questionnaire envelopes various problems caused by relentless anxiety and fear caused by pathological and psychological reasons.To detect disorders such as panic disorder, phobias, post traumatic distress, obsessive compulsive disorder etc. a questionnaire about an individual’s behaviour can be prepared.

In recent times, it has emerged as a very effective tool to determine the problem. A sample questionnaire is given below.

Sample Anxiety Disorder Questionnaire

Name of the Patient:_______________________________________



Date: ________________

If the answer to the questions is yes, then the individual is suffering from a particular disorder.

1)   Have you ever experienced powerful and devastating fear for no apparent reason? ____

2)   Were these time periods accompanied by symptoms like difficulty in breathing, pain in the chest, increased heart rate?________

3)   Do you worry about your performance at the place of your work which maybe school, college or office? ________

4)   Are you having any problem controlling your anger or frustration? _______

5)   Did you experience anything traumatic or disturbing in the past or recent times? ________

6)   Do you have dreams that are distressing in any way and that tend to wake you up? _______

7)   Do you recollect images from your dream even when you are awake and get anxious over them? _______

8)   Have you ever tried to stop these images or thoughts from invading your mind? _______

9)   Are you afraid to speak up in public or participating in any other social activity that requires you to mingle with people? ________

10)               Do you often commit the same act over and over again, like washing hands, checking, repeating words to yourself, mumbling and praying?________