Panic Disorder Self-Report Scale*

Patient Name: ___________________________________ Date:________________________

Panic attacks are discrete episodes of intense fear, apprehension, or terror that are accompanied by several
physical symptoms. Panic attacks can either occur for no apparent reason (spontaneously) or upon
entering into or being in situations which have become associated with them (e.g., long lines, closed
spaces, driving over bridges). Do not consider fear to be a panic attack if it lasts several hours or most of
the day.
1. During the last 6 months, have you had a panic attack or a No Yes
sudden rush of intense fear or anxiety? (Circle your answer)
When was the most recent time this occurred? Date:

If NO (you have not experienced a panic attack), please leave the remainder of this form blank.
If YES, please continue.
2. Was at least 1 panic attack unexpected, as if it came out of the No Yes
blue?
3. Did it happen more than once? No Yes
4. If YES to 3, approximately how many panic attacks have you had
in your lifetime?
If NO to 1, 2, and 3, please leave the remainder of this form blank, otherwise continue.
5. Have you ever worried a lot (for at least 1 month) about having No Yes
another panic attack?
6. Have you ever worried a lot (at least 1 month) that having the No Yes
attacks meant you were losing control, going crazy, having a
heart attack, seriously ill, etcetera?
7. Did you ever change your behavior or do something different (for No Yes
at least 1 month) because of the attacks?
If YES to 5, 6 OR 7 please answer the following questions:
Think back to your most severe panic attack. Did you experience any of the following symptoms?
8. Shortness of breath or smothering sensations? No Yes
9. Feeling dizzy, unsteady, lightheaded, or faint? No Yes
10. Palpitations, pounding heart, or rapid heart rate? No Yes
11. Trembling or shaking? No Yes
12. Sweating? No Yes
13. Feelings of choking? No Yes
14. Nausea or abdominal distress? No Yes
15. Numbness or tingling sensations? No Yes
16. Flushes (hot flashes) or chills? No Yes
17. Chest pain or discomfort? No Yes
18. Fear of dying? No Yes

* Reproduced with permission from Dr. Michelle Newman. Newman MG, Holmes M, Zuellig AR, Kachin KE, Behar E. The Reliability and Validity
of the Panic Disorder Self-Report: A New Diagnostic Screening Measure of Panic Disorder. Psychol Assess. 2006; 18 (1), 49–61.

Copyright © 2016 Bianca Lauria-Horner. From The Primary Care Toolkit for Anxiety and Related Disorders: Quick, Practical Solutions for Assessment and Management,
published by Brush Education Inc. (www.brusheducation.ca). Subject to other limitations listed on this page, if any, the original purchaser is specifically authorized to
copy and distribute this worksheet for clinical purposes.
Panic Disorder Self-Report Scale

19. Fear of going crazy or doing something uncontrolled? No Yes

20. How much do these symptoms interfere with your daily functioning? (Circle one)
0 1 2 3 4
| | | | |
Not at all Mildly Moderately Severely Very severely/
disabling
21. How distressing do you find these symptoms? (Circle one)
0 1 2 3 4
| | | | |
No distress Mild distress Moderate distress Severe distress Very severe distress
22. When you have bad panic attacks, does it often take minutes No Yes
from the point at which the attack begins to the point at which it
reaches a peak or becomes most intense?
23. Just before you began having panic attacks, were you taking any No Yes
drugs or excessive amounts (more than 4 cups daily) of stimulants
(e.g., coffee, tea, or cola with caffeine)?

   a. If YES, what were you were taking? __________________________________________________

   b. How much of it were you taking (in cups, cans, etc.)? __________________________________
24. Have you ever been diagnosed with a medical problem No Yes
(hyperthyroidism, a seizure or cardiac condition, etc.) that could
have caused your panic symptoms?

Copyright © 2016 Bianca Lauria-Horner. From The Primary Care Toolkit for Anxiety and Related Disorders: Quick, Practical Solutions for Assessment and Management,
published by Brush Education Inc. (www.brusheducation.ca). Subject to other limitations listed on this page, if any, the original purchaser is specifically authorized to
copy and distribute this worksheet for clinical purposes.
FOR CLINICIAN USE

Panic Disorder Self-Report Scale

Note: Self-report tools should be reviewed by clinicians and interpreted against DSM-5 criteria in
conjunction with clinical judgment.
Note: Question 22 has been modified to reflect DSM-5 criteria; that is, in the DSM-5, wording “reaches a
peak in less than 10 minutes” has been changed to “peaks within minutes.”

Summary of Scoring Legend (detailed scoring legend appears below)

If Yes to 1, 2, 3, and 22
AND
If Yes to 5, 6, or 7
AND
If Yes to >4 symptoms from questions 8–19
AND
If 20 or 21 is scored a minimum of 2
AND
If No to 23 or 24
THEN
Results are consistent with a diagnosis of panic disorder.
Detailed Rational for Scoring Legend
The scoring system for the PDSR was devised to create a score that would best enable detection
of the presence of panic disorder. For items 1, 2, 3, 5–19, and 22, “Yes” answers were coded as 1 and “No”
answers as 0. If items 1–3 were not all answered “Yes,” participants were instructed not to complete the
remainder of the questionnaire, as the initial 3 criteria are essential to the diagnosis of panic disorder.
Items 20 and 21 were each divided by 2. Any unanswered questions were coded as 0.
Items 4, 23, and 24 were not included in the scoring system. The rationale for this scoring system was
to allot 1 point to any item required for the diagnosis of panic disorder (i.e., items 1, 2, 3, and 22), as well
as to items relevant to meeting diagnostic criteria (i.e., items 5–19), even if endorsing all of the items in
a particular section was not required for diagnosis (i.e., for diagnosis, only 1 of items 5–7 is required and
only 4 of items 8–19 are required). The latter decision was reached because we suspected that participants
who endorsed a greater number of items 5–19 were more likely to meet criteria for the disorder.
The values for items 20–21 (which measure distress and interference) were divided in half because
these are the only items for which the face value reaches a maximum of 4. This ensured that these items
would not outweigh 1-point items too heavily. Thus, for items 20–21, participants received 1 point for
moderate distress/interference (minimum required for diagnosis) and 2 points for very severe distress
or interference. Similar to the reasoning above, this decision was based on the suspicion that endorsing
greater severity and interference would suggest a greater likelihood that a participant would meet
diagnostic criteria for panic disorder.
Item 4 was not included in the scoring system because the total number of panic attacks experienced
is not crucial to meeting diagnostic criteria as long as an individual has experienced more than 1 panic
attack, and this criterion is already covered by item 3. Items 23 and 24 were not included in scoring
because the determination as to whether a medical condition caused panic disorder or whether

Copyright © 2016 Bianca Lauria-Horner. From The Primary Care Toolkit for Anxiety and Related Disorders: Quick, Practical Solutions for Assessment and Management,
published by Brush Education Inc. (www.brusheducation.ca). Subject to other limitations listed on this page, if any, the original purchaser is specifically authorized to
copy and distribute this worksheet for clinical purposes.
FOR CLINICIAN USE

Panic Disorder Self-Report Scale

intoxication or withdrawal from substances is the current cause of panic attacks requires detailed
questioning. Also, the exclusion of these items from the overall score of the measure did not decrease the
overall sensitivity and specificity of the measure when the structured interview was used as the standard
for comparison. Nonetheless, these items were retained in the questionnaire as items that could be
explored with additional interviewing.

Copyright © 2016 Bianca Lauria-Horner. From The Primary Care Toolkit for Anxiety and Related Disorders: Quick, Practical Solutions for Assessment and Management,
published by Brush Education Inc. (www.brusheducation.ca). Subject to other limitations listed on this page, if any, the original purchaser is specifically authorized to
copy and distribute this worksheet for clinical purposes.