The Anxiety Test

1

1. Anxious mood: Worries, the anticipation of the worst, fearful anticipation, irritability.* This field is required.

Not Present

Mild

Moderate

Severe

Very Severe

2

2. Tension: Feelings of tension, fatigability, startle response, moved to tears easily, trembling, feelings of restlessness, inability to relax.* This field is required.

Not Present

Mild

Moderate

Severe

Very Severe

3

3. Fears: Of the dark, of strangers, of being left alone, of animals, of traffic, of crowds.* This field is required.

Not Present

Mild

Moderate

Severe

Very Severe

4

4. Insomnia: Difficulty in falling asleep, broken sleep, unsatisfying sleep and fatigue on waking, dreams, nightmares, night terrors.* This field is required.

Not Present

Mild

Moderate

Severe

Very Severe

5

5. Intellectual: Difficulty in concentration, poor memory.* This field is required.

Not Present

Mild

Moderate

Severe

Very Severe

6

6. Depressed mood: Loss of interest, lack of pleasure in hobbies, depression, early waking, diurnal swing.* This field is required.

Not Present

Mild

Moderate

Severe

Very Severe

7

7. Somatic (muscular): Pains and aches, twitching, stiffness, myoclonic jerks, grinding of teeth, unsteady voice, increased muscular tone.* This field is required.

Not Present

Mild

Moderate

Severe

Very Severe

8

8. Somatic (sensory): Tinnitus, blurring of vision, hot and cold flushes, feelings of weakness, pricking sensation.* This field is required.

Not Present

Mild

Moderate

Severe

Very Severe

9

9. Cardiovascular symptoms: Tachycardia, palpitations, pain in the chest, throbbing of vessels, fainting feelings, missing beat.* This field is required.

Not Present

Mild

Moderate

Severe

Very Severe

10

10 . Respiratory symptoms: Pressure or constriction in the chest, choking feelings, sighing, dyspnea.* This field is required.

Not Present

Mild

Moderate

Severe

Very Severe

11

11. Gastrointestinal symptoms: Difficulty in swallowing, wind abdominal pain, burning sensations, abdominal fullness, nausea, vomiting, borborygmi, looseness of bowels, loss of weight, constipation.* This field is required.

Not Present

Mild

Moderate

Severe

Very Severe

12

12. Genitourinary symptoms: Frequency of micturition, the urgency of micturition, amenorrhea, menorrhagia, development of frigidity, premature ejaculation, loss of libido, impotence.* This field is required.

Not Present

Mild

Moderate

Severe

Very Severe

13

13. Autonomic symptoms: Dry mouth, flushing, pallor, the tendency to sweat, giddiness, tension headache, raising of hair.* This field is required.

Not Present

Mild

Moderate

Severe

Very Severe

14

14. Behavior at interview: Fidgeting, restlessness or pacing, tremor of hands, a furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing, etc.* This field is required.

Not Present

Mild

Moderate

Severe

Very Severe

15

Your Anxiety Score is

16

17

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18

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19

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20

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