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Social Anxiety Checklist

Social Anxiety disorder affects more than 13 percent of Americans.
Despite the millions of diagnosed social anxiety disorder sufferers who have been treated and received help, there are millions more that remain undiagnosed and untreated.

It is a real and serious health problem that can respond to treatment. The first step is seeking help. If you suspect that you might suffer from social anxiety disorder (social phobia), fill out the following checklist by clicking the "yes" or "no" boxes next to each question, print out the test and show the results to your health care professional.

Are you troubled by:

Yes No	An intense and persistent fear of a social situation in which people might judge you?
Yes No	Fear that you will be humiliated by your actions?
Yes No	Fear that people will Notice that you are blushing, sweating, trembling, or showing other signs of anxiety?
Yes No	Knowing that your fear is excessive or unreasonable?

Does the feared situation cause you to:

Yes No

Always feel anxious?

Yes No

Experience a "panic attack", during which you suddenly are overcome by intense fear or discomfort, including any of these symptoms?

Yes No	Pounding heart
Yes No	Sweating
Yes No	Trembling or shaking
Yes No	Shortness of breath
Yes No	Choking
Yes No	Chest pain
Yes No	Nausea or abdominal discomfort
Yes No	"Jelly" legs
Yes No	Dizziness
Yes No	Feelings of unreality or being detached from yourself
Yes No	Fear of losing control, "going crazy"
Yes No	Fear of dying
Yes No	Numbness or tingling sensations
Yes No	Chills or hot flashes

Yes No

Go to great lengths to avoid participating in the feared situation?

Yes No

Does all of this interfere with your daily life?

Having more than one illness at the same time can make it difficult to diag No se and treat the different conditions. Illnesses that sometimes complicate anxiety disorders include depression and substance abuse. With this in mind, please take a minute to answer the following questions:

Yes No

Have you experienced changes in sleeping or eating habits?

More days than not, do you feel:

Yes No	Sad or depressed?
Yes No	Disinterested in life?
Yes No	Worthless or guilty?

During the last year, has the use of alcohol or drugs:

Yes No	Resulted in your failure to fulfill responsibilities with work, school, or family?
Yes No	Placed you in a dangerous situation, such as driving a car under the influence?
Yes No	Gotten you arrested?
Yes No	Continued despite causing problems for you and/or your loved ones?

Reference:
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington,
DC, American Psychiatric Association, 1994.

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