| The following anxiety self test has been developed to assist adults in determining if they may be experiencing symptoms related to social anxiety. This is only a preliminary questionaire and should not be used to diagnose or treat any condition, disorder or disease. |
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| 1. Do you go out of your way to avoid social situations in which you might meet new people because of extreme discomfort around strangers or an overwhelming fear that you’ll do or say something embarrassing? |
| Yes |
| No |
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| 2. Do you experience problems with severe anxiety when asked to perform or speak in front of a group of people? |
| Yes |
| No |
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| 3. Does the thought of performing or speaking in public bring on emotional stress responses that include heart palpitations, racing heart rate or pounding of the heart? |
| Yes |
| No |
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| 4. Does the thought of performing or speaking in public bring on emotional stress responses like excessive sweating? |
| Yes |
| No |
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| 5. Does the thought of performing or speaking in public bring on emotional stress responses like shortness of breath or feeling as if you cannot breathe? |
| Yes |
| No |
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| 6. Does the thought of performing or speaking in public bring on emotional stress responses like fear that you're going crazy or are detached from reality? |
| Yes |
| No |
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| 7. Does the thought of performing or speaking in public bring on emotional stress responses like shaking or trembling? |
| Yes |
| No |
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| 8. Are you noticeably bothered by having to perform such tasks as eating, drinking, or writing in front of other people? |
| Yes |
| No |
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| 9. Has the fear of social interaction seriously interfered with your ability to maintain your normal routine in occupational, academic, or personal settings? |
| Yes |
| No |
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| 10. Do you regularly abuse alcohol or illicit substances such as marijuana, cocaine, or methamphetamine? |
| Yes |
| No |
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| 11. Do you feel like your constantly being judged or “sized up” when in public? |
| Yes |
| No |
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| 12. Do you go out of your way or take extreme measures to avoid social situations or situations in which you might be expected to perform? |
| Yes |
| No |
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| 13. Do you experience extreme nervousness, panic, or discomfort when dealing with authority figures such as a teacher or your boss? |
| Yes |
| No |
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| 14. Do you understand that your fears are unreasonable or excessive but feel powerless to control them? |
| Yes |
| No |
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