Mervin Smucker: Panic Symptom Questionnaire

Below is a list of physiological symptoms that people sometimes experience when they are feeling anxious or panicky.  Please rate on the line next to each item how fearful you are of these symptoms using the numbers from 0 to 3 below.  Please rate each item.

  • N/A  –   Symptom not present
  • 0 – Not at all fearful
  • 1 – Somewhat fearful
  • 2 – Quite  fearful
  • 3 – Extremely fearful

____   1.  Lightheadedness / dizziness

_____ 2.  Shortness of breath

_____ 3.  Wobbliness in legs

____   4.  Nausea

____   5.  Blurred / distorted vision

____   6.  Tingling in fingertips

____   7.  Numbness in arms or legs

____   8.  Heart palpitations

____   9.  Pressure / heaviness in chest

____ 10.  Knot in stomach

____ 11.  Lump in throat

____ 12.  Dry throat

____ 13.  Sweating

____ 14.  Disorientation / confusion

____ 15.  Sense of disconnectedness from body

Mervin Smucker

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