CIDI Panic Disorder Module
Respondent sequence number
CIDI Subsample 2 year MEC Weight
Order in which CIDI modules are asked
Entire life, ever fear or panic attack?
Ever attack for no reason, out of blue?
Panic attack past 12 months?
Past 12 mos, avoided situations bc fear?
How recently avoided situations bc fear?
Past 12 mos, month + fear another?
How recently have concern?
Past 12 mos, attacks lead to terrible?
Ever attacks life-threatening?
Ever attacks not life-threatening?
Did your heart pound or race?
Did you sweat?
Did you tremble or shake?
Did you have dry mouth?
Were you short of breath?
Feel like you were choking?
Pain or discomfort in chest?
Nausea or discomfort in stomach?
Were you dizzy or feeling faint?
Did you feel unreal?
Feel things around you unreal?
Afraid you might lose control?
Afraid you might pass out?
Afraid you might die?
Have hot flashes or chills?
Have numbness or tingling?
No. attacks w/symptoms in lifetime?
Problems began suddenly, got worse?
When did attack occur?
Remember age when attack occurred?
Exact age when attack occurred
Approx age when attack occurred
Which of three situations occurred?
Fear: Giving a speech
Fear: Party or social event
Fear: Being in a crowd
Fear: Meeting new people
Fear: Being outside, away
Fear: Traveling bus, train, car
Fear: Crowd, standing in line
Fear: Being in a public place
Fear: Animals
Fear: Heights
Fear: Storms, thunder, lightening
Fear: Flying
Fear: Closed spaces
Fear: Seeing blood
Fear: Getting an injection
Fear: Going to the dentist
Fear: Going to a hospital
Fear: Other 1
Fear: Other 2
Fear: Other 3
Years of age attack occurred
Attack in past 12 months,or more?
Earliest age attack occurred
Age last time had attack
No. attacks lifetime out of the blue
Out of the blue attack past 12 months?
No. attacks past 12 months?
No. attacks lifetime strong fear
Attack in past 12 months?
No. attacks lifetime real danger
No. attacks past 12 months
Strong Fear: Giving a speech
Strong Fear: Party or social event
Strong Fear: Being in a crowd
Strong Fear: Meeting new people
Strong Fear: Being outside, away
Strong Fear: Traveling bus, train, car
Strong Fear: Crowd, standing in line
Strong Fear: Being in a public place
Strong Fear: Animals
Strong Fear: Heights
Strong Fear: Storms, thunder, lightning
Strong Fear: Flying
Strong Fear: Closed spaces
Strong Fear: Seeing blood
Strong Fear: Getting an injection
Strong Fear: Going to the dentist
Strong Fear: Going to a hospital
Strong Fear: Other 1
Strong Fear: Other 2
Strong Fear: Other 3
Recency of fear or out of the blue
Past 12 months no. weeks attack
Single period or two+ periods?
Longest no. weeks in row attack
Largest no. attacks any one week
Largest no. attack any four weeks
Four week in row and four attacks?
Did you tell doctor about attack?
Did you tell other prof about attack?
Did you take medication for attack?
Did attacks interfere with life?
Were attacks result of phys illness?
Were attacks result of MDA?
Were attacks always result MDA?
Doctor said nerves causing attacks
Doctor said stress causing attacks
Doctor said anxiety causing attacks
Doctor said depression causing attacks
Doc said mental illness causing attacks
Doctor said medication causing attacks
Doctor said drugs causing attacks
Doctor said alcohol causing attacks
Doctor said phys illness causing attacks
Doctor said phys injury causing attacks
Doctor gave no definite diag for attacks
Anything abnormal when exam?
Were attacks always result phys ill?
General cause of problem
Attacks interfere with daily life?
No. days totally unable work
Did totally occur past 4 weeks?
No. days totally past 4 weeks
No. days cutback amount/quality
Describe quantity/quality cutback
Did cutback occur past 4 weeks?
No. days cutback past 4 weeks
No. days extreme effort to work
Did extreme occur past 4 weeks?
No. days extreme past 4 weeks
No. days interfere personal life
Did interfere occur past 4 weeks?
No. days interfere past 4 weeks
Panic Score