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For each question select one 'cue' which relates to you.

Below is a list of phrases that describe certain feeling that people have. Rate yourself by finding the answer which best describes the extent to which you have these conditions. Select one of the five responses for each of the fourteen questions.

0= Not present, 1 = Mild, 2 = Moderate, 3 = Severe, 4 = Very severe.

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

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

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

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

Difficulty in concentration, poor memory.

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

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

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

Tachycardia, palpitations, pain in chest, throbbing of vessels, fainting feelings, missing beat.

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

Difficulty in swallowing, wind abdominal pain, burning sensations, abdominal fullness, nausea, vomiting, borborygmi, looseness of bowels, loss of weight, constipation.

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

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

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