Domain 1: Genetics

1, 4, 7, 9, 14, 16, 18, 23, 25

Domain 2: Environment

2, 5, 8, 10, 12, 17, 19, 21, 24, 26

Domain 3: Personal History

3, 6, 11, 13, 15, 20, 22, 27

Domain 4: 5Ds of Abnormal Behavior(Distress, Deviance, Dangerousness, Dysfunction and Duration

28-45

1. My close relative/s is diagnosed with anxiety.

2. My parents pressure me on my academics.
3. I am shaking every time I remember how someone hurt me.
4. My close relative/s is diagnosed with anxiety.
5. I overreact when I am with my friends.
6. I was happy as a child.
7. My close relative/s is diagnosed with depression.
8. I have problem/s with my family.
9. I have a close family member with Panic Disorder
10. I have issue/s in financial aspect.
11. I do not experience panic attacks.
12. There are individuals that I consider as my friends.
13. I have feelings that things are not real.
14. My close relative/s is diagnosed of Psychiatric Disorders
15. I’m afraid of going crazy.
16. I have a close family member who experiences Panic attack.
17. I am comfortable in a crowded area.
18. Someone in my family has a mental illness.
19. I have a stressful environment.
20. I do not have issues concerning my respiratory health.
21. I had a near death experience.
22. I had/have an asthma.
23. My parent/s could not handle big traumatic moments.
24. I feel safe in my environment.
25. I have a close relative who is ‘high strung’ or ‘stressed out’ all the time.
26. Loud noises do not bother me.
27. I have Lung cancer.
28. For the past 30 days, I have no trouble relaxing and sleeping.
29. For the past 30 days, I tried to hurt myself when I feel embarrassed.
30.For the past 30 days, I feel calm when I’m doing something that I cannot control.
31.For the past 30 days, when I begin to sweat in a social situation, I fear people will think negatively on
me.
32.For the past 30 days, I experience delusions that interfere with my cognitive processes.
33.For the past 30 days, I feel a racing heart, sweaty, trouble breathing, faint, or shaky while reciting.
34.For the past 30 days, it scares me when I am unable to keep a task on my mind.
35.For the past 30 days, I worry too much about different things.
36.For the past 30 days, I feel fine when I am drawing attention to myself.
37.For the past 30 days, I felt anxious, worried, or nervous when I am alone.
38.For the past 30 days, it scares me when I blush in front of people.
39.For the past 30 days, I worry that other people will notice my anxiety.
40.For the past 30 days, I have fear of drawing attention to oneself.
41.For the past 30 days, I have fear of doing something uncontrolled.
42.For the past 30 days, I thought to end my life.
43.For the past 30 days, I have been drinking alcohol too much.
44.For the past 30 days, I have been gambling.
45.For the past 30 days, I harmed myself.