In addition, we have just a few additional questions relating to some of the experiences you may have had in your life. Please answer them to the best of your ability, with the answers that most accurately reflect yourself.
Has there been any time in your life when you had five or more drinks (beer, wine, or liquor) on one occasion? YesNoMaybe
Have you ever used street drugs? YesNoMaybe
Have you ever gotten “hooked” on a prescribed medicine or taken a lot more of it than you were supposed to? YesNoMaybe
Have you ever had a panic attack, when you suddenly felt frightened or anxious, or suddenly developed a lot of physical symptoms? YesNoMaybe
Were you ever afraid of going out of the house alone, being in crowds, standing in a line, or traveling on buses or trains? YesNoMaybe
Is there anything that you have been afraid to do or felt uncomfortable doing in front of other people, like speaking, eating, or writing? YesNoMaybe
Are there any other things that you have been especially afraid of, like flying, seeing blood, getting a shot, heights, closed places, or certain kinds of animals or insects? YesNoMaybe
Have you been bothered by thoughts that didn’t seem reasonable, and kept coming back to you even when you tried not to have them? YesNoMaybe
Is there anything that you have to do over and over again and can’t resist doing, such as washing your hands again and again, counting up to a certain number, or checking something several times to make sure that you’ve done it right? YesNoMaybe
Over the last six months, have you been particularly nervous or anxious? YesNoMaybe
Have you ever had a period of time when you felt depressed or down most of the day, nearly every day? YesNoMaybe
Have you lost interest or pleasure in things that you usually enjoyed? YesNoMaybe
Has there ever been a period of time when you felt so good, “high,” or hyper that other people thought you weren’t your normal self? YesNoMaybe
Have you ever had a period when you were so irritable that you shouted at people or started fights or arguments? YesNoMaybe
Have you ever heard things that other people couldn’t hear, such as noises or the voices of people talking or whispering? YesNoMaybe
Have you ever seemed to be receiving special messages from TV, radio, or newspaper, or from how things are arranged around you? YesNoMaybe
Have you ever experienced a very frightening or life-threatening situation like a major disaster, serious accident, fire, combat, physical assault, rape, sexual abuse, or seeing another person killed or badly hurt? YesNoMaybe