Is your quality of life impaired?

Afrikaanse Vraelys

Do you have an idea what is causing this?

Read through the following statements. Choose those symptoms that you experience on a regular basis and then click on the most accurate description.

This will take you to a more detailed questionnaire After completing the new questionnaire the program will automatically score your answers and give you an indication as to what is wrong.

It will also advice you on the best professionals available to treat this specific problem. It will give you a list of these professionals, where they practise and their contact numbers.

1. Have you been worrying about a lot of things most of the time over the past six months?
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme
 
2. Do you have difficulty controlling these worries, and do they interfere with your ability to focus on what you are doing?
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme
 
3. Do you have a fear of being embarrassed in front of others?
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme
 
4. Do you have attacks where you suddenly feel anxious/ frightened/ uncomfortable/ or uneasy in a situation where most people will not feel this way?
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme
 
5. Are these attacks accompanied by physical symptoms such as:
  • difficulty breathing
  • dizziness
  • accelerated heartbeat
  • fear of losing control/ dying or going crazy
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme
 
6. do you worry about having another attack ?
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme
 
7. Do you have trouble getting over a traumatic event that took place in your life?
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme
 
8. Do you have flashbacks or dreams about this traumatic event?
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme
 
9. Has this experience involved a traumatic event such as a hijack, war, natural disaster or the sudden death of someone close to you?
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme
 
10. Do you avoid things that remind you of the event?
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme
 
11. Do you feel the need to wash a lot or to count or check things many times?
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme
 
12. Do you feel anxious or uneasy in a place where it might be difficult or embarrassing to get out?
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme
 
13. Is your anxiety related to the fear of having a panic attack?
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme
 
14. Do you ever have thoughts that keep on coming back in your mind? Do these thoughts bother you but you can't get rid of them?
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme
 
15. Do you have any routines and rituals that interfere with your ability to complete tasks or organize yourself?
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme
 
16. Do you feel:
  • restless
  • tense
  • on edge
  • tired
  • easily exhausted
  • irritable
    most of the time    ?
    •
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme
 
17. Are you afraid of being embarrassed or that you will appear foolish in front of others in situations where you are the focus of attention?
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme
 
18. Are there situations that you avoid because of this fear?
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme
 
19. Does this fear affect your ability to cope at work and in social situations?
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme
 
20. Does this fear include situations such as
  • eating
  • writing
  • speaking in public?
    •
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme
 
21. Do you experience mood swings?
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme
 
22. Have you lately experienced any changes (decrease/increase) in your patterns relating to: (A - E Below)

A. Sleep

Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme

B. Eating
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme

C. Social behaviour
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme

D. Sex
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme

E. Work
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme
 
23. Are you aware of any changes in your sleeping pattern?
Not at all A little bit / doubtfully Mildly to moderate Moderate to marked Markedly to extreme

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