| Have you ever had the following symptoms develop abruptly and reach a peak within 10 minutes: |
| Question |
Response |
| 1. |
Palpitations, pounding heart, or accelerated heart rate? |
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| 2. |
Sweating? |
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| 3. |
Trembling or shaking? |
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| 4. |
A feeling of shortness of breath or smothering? |
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| 5. |
A feeling of choking? |
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| 6. |
Chest pain or discomfort? |
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| 7. |
Nausea or abdominal distress? |
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| 8. |
Feeling dizzy, unsteady, lightheaded, or faint? |
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| 9. |
Feeling unreal or detached from yourself? |
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| 10. |
Fear of losing control or going crazy? |
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| 11. |
Fear of dying? |
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| 12. |
Numbness or tingling sensations? |
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| 13. |
Chills or hot flushes? |
|
| Regarding the above symptoms: |
| Question |
Response |
| 14. |
Have these episodes happened repeatedly? |
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| 15. |
Have these episodes ever occurred "out of the blue", for no apparent reason? |
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| 16. |
Have you had persistent concern about having additional attacks for a month or more? |
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| 17. |
Have you worried about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy") for a month or more? |
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| 18. |
Have you significantly changed your behavior, because of the attacks, for a month or more? |
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