|
1.
|
…you felt confused or numb?
|
Yes
|
No
|
|
2.
|
…you felt disoriented, as if you had lost your
bearings?
|
Yes
|
No
|
|
3.
|
…you felt nervous, uncomfortable, or as though
you were about to suffocate, because of hot, stale or humid air, or
because of perfume or other smells, even if they weren’t that
strong?
|
Yes
|
No
|
|
4.
|
…you felt as if something had broken in your
brain or body?
|
Yes
|
No
|
|
5.
|
…you felt that you had lost, for a few seconds,
your sight or hearing?
|
Yes
|
No
|
|
6.
|
…you worried that you might suddenly have a
panic attack? Or have heart palpitations, shortness of breath, dizziness,
or other physical symptoms? Or were you worried about what having panic
or physical symptoms might mean about your physical or mental health?
|
Yes
|
No
|
|
7.
|
…you worried a lot that there might be something
terribly wrong with you physically, as if, for instance, you were about
to have a heart attack, stroke, suffocate or die?
|
Yes
|
No
|
|
8.
|
…you felt nervous or uncomfortable or avoided
going to the dentist, because you felt trapped or suffocated in the
chair?
|
Yes
|
No
|
|
9.
|
…you felt nervous or trapped when you were in a
crowded place?
|
Yes
|
No
|
|
PA-9
|
|
|
10.
|
…you felt physically “slowed down,”
as if every movement was in slow motion?
|
Yes
|
No
|
|
11.
|
…you felt fatigued, weak, or tired or as though
the smallest task (for instance, washing your face or filling the sugar
bowl) was an effort and required a great deal of energy?
|
Yes
|
No
|
|
12.
|
…you felt very bored?
|
Yes
|
No
|
|
13.
|
…you were deeply annoyed with everything?
|
Yes
|
No
|
|
14.
|
…you felt purposeless, as if everything had lost
its significance?
|
Yes
|
No
|
|
15.
|
…you lost interest in how you looked?
|
Yes
|
No
|
|
16.
|
…you lost interest or pleasure in all or almost
all the things you usually enjoyed?
|
Yes
|
No
|
|
17.
|
…you were disappointed in yourself, you felt
useless, as if you were without any talent and you couldn’t do
anything right?
|
Yes
|
No
|
|
18.
|
…you had difficulty making even minor decisions
(such as what clothes to wear, what household task to do first)?
|
Yes
|
No
|
|
D-9
|
|
|
19.
|
…you were the kind of person to whom others were
attracted because of your confidence, enthusiasm and energy?
|
Yes
|
No
|
|
20.
|
…you (or others) thought you were very artistic
and creative?
|
Yes
|
No
|
|
21.
|
…your housework, child care, or your performance
at school, work, sports or hobbies improved a lot?
|
Yes
|
No
|
|
22.
|
…you felt really good about how you looked?
|
Yes
|
No
|
|
23.
|
…you felt that you were mentally very sharp,
brilliant and clever?
|
Yes
|
No
|
|
24.
|
…you worried that others considered you foolish,
awkward or ridiculous?
|
Yes
|
No
|
|
M-6
|
|
|
25.
|
…you worried about disapproval or hostility from
others?
|
Yes
|
No
|
|
26.
|
…you often felt particularly embarrassed or
uncomfortable meeting a new person?
|
Yes
|
No
|
|
27.
|
…you often avoided, if possible, disagreeing
with or expressing disapproval to others?
|
Yes
|
No
|
|
28.
|
…you felt embarrassed to talk on the phone in
front of other people?
|
Yes
|
No
|
|
29.
|
…you often felt afraid of making a mistake that
someone might notice when working in front of others?
|
Yes
|
No
|
|
30.
|
…you often avoided, or wished you could avoid
whenever possible, performing in public or taking an oral examination
because you were embarrassed or uncomfortable, or you worried that you
might stammer, that your voice might tremble or that you might black out?
|
Yes
|
No
|
|
31.
|
Did you ever drop out of school or interrupt your
education for the reasons in #30?
|
Yes
|
No
|
|
32.
|
…you often felt embarrassed or worried when
encountering strangers or people you didn’t know well?
|
Yes
|
No
|
|
33.
|
…you often felt afraid of being judged when
attending a party or meeting friends?
|
Yes
|
No
|
|
S-9
|
|
|
34.
|
…you often felt embarrassed or uncomfortable
when you had to ask someone you liked to come to your house or apartment?
|
Yes
|
No
|
|
35.
|
As a child or an adolescent, do you remember (or have
you ever been told) that you were always in search of the perfect friend
or that you were disappointed with the ones you had?
|
Yes
|
No
|
|
36.
|
…you often had difficulty choosing something,
without asking someone else’s advice (for example, what clothes to
wear, what to order at a restaurant, what to buy, whether to accept an
invitation, etc.)?
|
Yes
|
No
|
|
37.
|
…you were often reluctant to make changes in
your daily routine?
|
Yes
|
No
|
|
38.
|
…you were often reluctant to do something
because you thought there was a chance it wouldn’t work out well?
|
Yes
|
No
|
|
39.
|
…you often felt compelled to check to be sure
the door is locked or that the gas or the lights have been turned off?
|
Yes
|
No
|
|
40.
|
…you thought, or were told, that you often
wasted time and energy on insignificant details, treating them as much more important than they were?
|
Yes
|
No
|
|
41.
|
…you often considered yourself a person who
wasn’t good at seeing the overall picture at work or school,
because you got bogged down in the details?
|
Yes
|
No
|
|
42.
|
…you felt compelled to repeat something until
you did it just right (for example, locking and unlocking a door, turning
the light on and off, getting in and out of a parking space with the
car)?
|
Yes
|
No
|
|
43.
|
…you felt preoccupied with unwanted and
intrusive thoughts about time passing and being unable to relive the
seconds, minutes, hours?
|
Yes
|
No
|
|
PA-10
|
|
|
44.
|
…you felt distressed, weak or guilty if you were
not able to follow your diet?
|
Yes
|
No
|
|
45.
|
…any comments about physical appearance made you
uncomfortable, annoyed or distressed?
|
Yes
|
No
|
|
46.
|
…you felt overweight, even if other people
disagreed?
|
Yes
|
No
|
|
47.
|
…you felt compelled to compare your body to
others’?
|
Yes
|
No
|
|
48.
|
…you were afraid of becoming fat, even when you
were at or below your normal weight?
|
Yes
|
No
|
|
49.
|
…you would get an unbearable sense of fullness
in your stomach after eating?
|
Yes
|
No
|
|
50.
|
…you felt badly or avoided wearing close-fitting
clothes because you were not satisfied with your body?
|
Yes
|
No
|
|
51.
|
…you felt the need to check your body dimensions
by how tight your clothes fit?
|
Yes
|
No
|
|
52.
|
…you ate with a feeling of lack of control?
|
Yes
|
No
|
|
53.
|
…you ate large amounts of food when not feeling
physically hungry?
|
Yes
|
No
|
|
54.
|
…you ate and then felt disgusted with yourself,
depressed, or very guilty right after overeating?
|
Yes
|
No
|
|
E-11
|
|