Please read each statement carefully and circle the number that you think best describes your condition over the past week, including today.
| Items | 0 | 1 | 2 | 3 |
|---|---|---|---|---|
| 1. Occasionally, I feel numbness and tingling in my body as well as weakened senses. | ||||
| 2. I feel excited. | ||||
| 3. Sometimes I feel wobbly in my legs. | ||||
| 4. I am unable to relax. | ||||
| 5. I feel afraid that something really bad is going to happen. | ||||
| 6. I feel dizzy. | ||||
| 7. Sometimes my heart pounds and races. | ||||
| 8. Sometimes I feel unsteady. | ||||
| 9. I often feel terrified and scared. | ||||
| 10. I feel nervous. | ||||
| 11. Sometimes I feel like being choked. | ||||
| 12. My hands tremble often. | ||||
| 13. I am unsteady, shaky and unable to relax. | ||||
| 14. I feel so afraid to the point of losing control. | ||||
| 15. Sometimes I find it difficult to breathe. | ||||
| 16. I am afraid that I am going to die. | ||||
| 17. I feel extreme and unrealistic fear. | ||||
| 18. I often suffer from indigestion and my stomach feels uncomfortable. | ||||
| 19. Sometimes I feel like I am going to faint. | ||||
| 20. My face often gets flushed. | ||||
| 21. I sweat a lot. (not from being hot) |