1

SELF-RATING QUESTIONAIRE (FSSC-R)

Thomas H. Ollendick
Name:____________________________Age:_____Date:_________
DIRECTIONS: A nm!e" o# statements $hich !o%s and gi"ls se to desc"i!e the
#ea"s the% ha&e a"e gi&en !elo$. Read each ca"e#ll% and 't an X in the !o( in
#"ont o# the $o"ds that !est desc"i!e %o" #ea". The"e a"e no "ight o" $"ong
ans$e"s. Remem!e") #ind the $o"ds $hich !est desc"i!e ho$ mch #ea" %o
ha&e.
1. *i&ing an o"al "e'o"t . . . . . . . . . . None Some A lot
+. Riding in the ca" o" !s . . . . . . . . . None Some A lot
,. *etting 'nished !% mothe" . . . . . . . None Some A lot
-. .i/a"ds . . . . . . . . . . . . . . None Some A lot
0. .ooking #oolish . . . . . . . . . . . . None Some A lot
1. *hosts o" s'ook% things . . . . . . . . None Some A lot
2. Sha"' o!3ects . . . . . . . . . . . . . None Some A lot
4. Ha&ing to go to the hos'ital . . . . . . . None Some A lot
5. Death o" dead 'eo'le . . . . . . . . . None Some A lot
16. *etting lost in a st"ange 'lace . . . . . None Some A lot
11. Snakes . . . . . . . . . . . . . . . None Some A lot
1+. Talking on the tele'hone . . . . . . . . None Some A lot
1,. Rolle" coaste" o" ca"ni&al "ides . . . . . . None Some A lot
1-. *etting sick at school . . . . . . . . . None Some A lot
10. 7eing sent to the '"inci'al . . . . . . . . None Some A lot
11. Riding on the t"ain . . . . . . . . . . . None Some A lot
12. 7eing le#t at home $ith a sitte" . . . . . . None Some A lot
14. 7ea"s o" $ol&es . . . . . . . . . . . None Some A lot
15. 8eeting someone #o" the #i"st time . . . . None Some A lot
+6. 7om!ing attacks9!eing in&aded . . . . . None Some A lot
+1. *etting a shot #"om the n"se o" docto". . . None Some A lot
++. *oing to the dentist . . . . . . . . . . None Some A lot
+,. High 'laces like montains . . . . . . . None Some A lot
1:6, ;contined on !ack<
+
+-. 7eing teased . . . . . . . . . . . . None Some A lot
+0. S'ide"s . . . . . . . . . . . . . . . None Some A lot
+1. A !"gla" !"eaking into o" hose . . . . . None Some A lot
+2. =l%ing in an ai"'lane . . . . . . . . . . None Some A lot
+4. 7eing called on !% the teache" . . . . . . None Some A lot
+5. *etting 'oo" g"ades . . . . . . . . . . None Some A lot
,6. 7ats o" !i"ds . . . . . . . . . . . . . None Some A lot
,1. 8% 'a"ents c"itici/ing me . . . . . . . . None Some A lot
,+. *ns . . . . . . . . . . . . . . . . None Some A lot
,,. 7eing in a #ight . . . . . . . . . . . . None Some A lot
,-. =i"e9getting !"ned . . . . . . . . . . None Some A lot
,0. *etting a ct o" in3"% . . . . . . . . . None Some A lot
,1. 7eing in a !ig c"o$d . . . . . . . . . . None Some A lot
,2. Thnde"sto"ms . . . . . . . . . . . . None Some A lot
,4. Ha&ing to eat some #ood I don>t like . . . . None Some A lot
,5. Cats . . . . . . . . . . . . . . . . None Some A lot
-6. =ailing a test . . . . . . . . . . . . . None Some A lot
-1. 7eing hit !% a ca" o" t"ck . . . . . . . . None Some A lot
-+. Ha&ing to go to school . . . . . . . . . None Some A lot
-,. ?la%ing "ogh games d"ing "ecess . . . . None Some A lot
--. Ha&ing m% 'a"ents a"ge . . . . . . . . None Some A lot
-0. Da"k "ooms o" closets . . . . . . . . . None Some A lot
-1. Ha&ing to 't on a "ecital . . . . . . . . None Some A lot
-2. Ants o" !eetles . . . . . . . . . . . . None Some A lot
-4. 7eing c"itici/ed !% othe"s . . . . . . . . None Some A lot
-5. St"ange looking 'eo'le . . . . . . . . . None Some A lot
06. The sight o# !lood . . . . . . . . . . . None Some A lot
01. *oing to the docto" . . . . . . . . . . None Some A lot
0+. St"ange o" mean looking dogs . . . . . . None Some A lot
0,. Cemete"ies . . . . . . . . . . . . . None Some A lot
0-. *etting a "e'o"t ca"d . . . . . . . . . None Some A lot
;Contined on ne(t 'age<
,
00. *etting a hai"ct . . . . . . . . . . . None Some A lot
01. Dee' $ate" o" the ocean . . . . . . . . None Some A lot
02. Nightma"es . . . . . . . . . . . . . None Some A lot
04. =alling #"om high 'laces . . . . . . . . None Some A lot
05. *etting a shock #"om elect"icit% . . . . . None Some A lot
16. *oing to !ed in the da"k . . . . . . . . None Some A lot
11. *etting ca" sick . . . . . . . . . . . . None Some A lot
1+. 7eing alone . . . . . . . . . . . . . None Some A lot
1,. Ha&ing to $ea" clothes di##e"ent #"om othe"s. None Some A lot
1-. *etting 'nished !% m% #athe" . . . . . . None Some A lot
10. Ha&ing to sta% a#te" school . . . . . . . None Some A lot
11. 8aking mistakes . . . . . . . . . . . None Some A lot
12. 8%ste"% mo&ies . . . . . . . . . . . . None Some A lot
14. .od si"ens . . . . . . . . . . . . . None Some A lot
15. Doing something ne$ . . . . . . . . . None Some A lot
26. *e"ms o" getting a se"ios illness . . . . . None Some A lot
21. Closed s'aces . . . . . . . . . . . . None Some A lot
2+. Ea"th@akes . . . . . . . . . . . . . None Some A lot
2,. Te""o"ists . . . . . . . . . . . None Some A lot
2-. Ele&ato"s . . . . . . . . . . . . . . None Some A lot
20. Da"k 'laces . . . . . . . . . . . . . None Some A lot
21. Not !eing a!le to !"eathe . . . . . . . . None Some A lot
22. *etting a !ee sting . . . . . . . . . . None Some A lot
24. Ao"ms o" snails . . . . . . . . . . . . None Some A lot
25. Rats o" mice . . . . . . . . . . . . . None Some A lot
46. Taking a test . . . . . . . . . . . . . None Some A lot
The End