Screen for Adult Anxiety Related Disorders (SCAARED)
Patient name
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First Name
Last Name
Patient date of birth
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Month
-
Day
Year
Date
Who should form be sent to/who is your appointment with?
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Agganis, Georgia
Aldrich, Meghan
Amin, Priyal
Athanasiou, Andreas
Balestrieri, Karen
Coleman, Russell
Daly, James
Eagan, Joan
Foley, Megan
Goharfar, Behzad
Grossman, Emily
Hall, Alexandra
Hiltunen, Karen
Hohmann, Deanna
Jackson, Patricia
Jensen, Susan
Jones, Eliza
Kelleher, Susan
Laurin Kinney, Jayne
Leonhardt, Julie Bonner
Narayan, Sara
Oliver, Dana
Scott, Kendra
Sheehy, James
Stimpson, Devin
Suriani, Christine
Triehy-Kreitler, Ashley
Voute, Susan
Wilson, Kathryn
*** Other ***
Below is a list of sentences of how people feel. Read each phrase and decide if it is "Not true or hardly ever true", "Somewhat true or sometimes true",Very true or often true" for you.
Not true or hardly ever true
Somewhat true or sometimes true
Very true or often true
1. When I feel nervous, it is hard for me to breathe.
2. I get headaches when I am at school, at work or in public places.
3. I don’t like to be with people I don’t know well.
4. I get nervous if I sleep away from home.
5. I worry about people liking me.
6. When I get anxious, I feel like passing out.
7. I am nervous.
8. It is hard for me to stop worrying.
9. People tell me that I look nervous.
10. I feel nervous with people I don’t know well.
11. I get stomachaches at school, at work, or in public places.
12. When I get anxious, I feel like I'm going crazy.
13. I worry about sleeping alone.
14. I worry about being as good as other people.
15. When I get anxious, I feel like things are not real.
16. I have nightmares about something bad happening to my family.
17. I worry about going to work or school, or to public places.
18. When I get anxious, my heart beats fast.
19. I get shaky.
20. I have nightmares about something bad happening to me.
21. I worry about things working out for me.
22. When I get anxious, I sweat a lot.
23. I am a worrier.
24. When I worry a lot, I have trouble sleeping.
25. I get really frightened for no reason at all.
26. I am afraid to be alone in the house.
27. It is hard for me to talk with people I don't know well.
28. When I get anxious, I feel like I'm choking.
29. People tell me that I worry too much.
30. I don't like to be away from my family.
31. When I worry a lot, I feel restless.
32. I am afraid of having anxiety (or panic) attacks.
33. I worry that something bad might happen to my family.
34. I feel shy with people I don't know well.
35. I worry about what is going to happen in the future.
36. When I get anxious, I feel like throwing up.
37. I worry about how well I do things.
38. I am afraid to go outside or to crowded places by myself.
39. I worry about things that have already happened.
40. When I get anxious, I feel dizzy.
41. I feel nervous when I am with other people and I have to do something while they watch me (for example: speak, play a sport.)
42. I feel nervous when I go to parties, dances, or any place where there will be people that I don't know well.
43. I am shy.
44. When I worry a lot, I feel irritable.
Anxiety (>=23)
Panic (>=5)
Generalized Anxiety (>=12)
Separation Anxiety Disorder (>=3)
Social Phobia Disorder (>=7)
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