Symptom Checklist A (SCA)
The following questionnaire provides a list of symptoms you may currently experience.
Please answer as honestly as you can!
Which of the following symptoms are
troublesome for you?
1. Category P:
 Pounding or racing heart
 Chest pain or discomfort
 Shortness of breath or smothering sensations
 Trembling or shaking
 Feeling of choking
 Sweating
 Dizziness, unsteady feeling,
lightheadedness, or faintness
 Nausea or abdominal distress
 Feeling you or your surroundings are strange
or unreal
 Numbness or tingling in face, hands, or legs
 Hot flashes or chills
 Fear of dying (e.g., fear of having a heart
attack)
 Fear of going crazy
 Fear of doing something uncontrolled
Panicky feelings are:
 Unexpected
 Occurring when you are confronted by
something frightening
2. Category PAa:
 Sitting near exits when at the movies or in a
restaurant
 Checking where the closest exit is when
visiting a shopping mall
 Carrying medication, money, cell phone,
pager, water, or other safety items
 Avoiding activities (like exercise, sex, or
thriller movies) that might trigger physical
arousal
 Drinking alcohol to combat feelings of panic
 Avoiding caffeine, alcohol, or other
substances
 Frequently checking blood pressure
 Distracting yourself from panicky feelings
(e.g., by watching TV or reading)
 Insisting on being accompanied when
leaving the house
 Always needing to know the whereabouts of
your spouse, partner, or other “safe” person
Joachim Sehrbrock, Ph.D., RCC
Which of the following situations do you try
to avoid? (Check and circle the ones that apply):
3. Category PAb:
 Crowded public places: supermarkets,
theatres, malls, sport events, etc.
 Enclosed and confined places: tunnels,
bridges, small rooms, elevators, airplanes,
subways, buses, getting a haircut, long lines,
other: __________________
 Driving: especially on highways and
bridges, bad traffic, and over long distances
 Being away from home
 Being alone
4. Category SP:
 Situations (heights, closed spaces, dentists,
elevators, airplanes/flying)
 Animals (snakes, rats, spiders, dogs, other:
_______________)
 Natural environment (heights, storms,
lightning, water)
 Illness or bodily harm (disease, injuries)
 Sight of blood or needles makes you queasy
 Other (choking, eating certain foods,
vomiting)
 Being exposed to any of these makes you
feel anxious or panicky
 You know that your fear of these situations
is excessive or unreasonable
Which of the following applies to you?
5. Category G:
 Cannot stop worrying even if it doesn’t
seem to solve anything or is unproductive
 Feeling restless
 Feeling on edge or keyed up
 Excessive muscle tensions
 Being easily fatigued
 Difficulty concentrating
 Mind going blank
 Feeling irritable
 Difficulties sleeping
 Waking up and instantly starting to worry
 Difficulty controlling worries or symptoms
 Symptoms have lasted for more days than
not for more than 6 months
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6. Category SA:
 Fear of speaking in front of people or in
public situations
 Fear of blushing in front of others
 Fear of being humiliated or embarrassed
 Fear of choking on or spilling food while
eating with others or in public
 Fear of writing or signing documents when
others are present
 Fear of being watched (e.g., at work)
 Fear of crowds
 Fear of meeting people you don’t know
 Fear of using public toilets
 You know that your fear of these situations
is excessive or unreasonable
7. Category O:
 Fear of saying certain things because they
might come true
 Concern that someone will have an accident
unless things are in the right place
 Intrusive (non-violent) images, nonsense
sounds, words, or music
 Fear of acting on unwanted impulses (e.g.,
throwing yourself out of the window or
hurting a friend)
 Violent or horrific images
 Fear that something terrible might happen if
you didn’t accomplish or do something
 Fear of blurting out obscenities or insults
 Fear of stealing things
 Fear of being responsible for something
terrible happening (e.g., a fire or a burglary)
 Sexual thoughts, images or urges
 Fear of acting on “forbidden” impulses
(incest, homosexuality, aggressive sexual
acts)
 Concerns about dirt, germs, or bodily waste
or secretions (urine, feces, saliva)
 Concern about getting ill from possible
contaminants
 Concern about environmental contaminants
(asbestos, radiation, toxic waste)
 Excessive concern about animals (e.g.,
insects)
 Trying to control, ignore or suppress
thoughts or impulses
8. Category O1:
 Repetitive or ritualized hand washing,
bathing, tooth brushing, grooming
Joachim Sehrbrock, Ph.D., RCC
 Excessive counting, praying, or repeating
words silently
 Excessive cleaning of household items or
other inanimate objects
 Checking locks, stove, appliances
 Checking that nothing terrible did/will
happen
 Checking that you didn’t make a mistake
 Needing to repeat routine activities (e.g.,
exercise, going in/out door or up-down from
chair, rereading, rewriting)
 Collecting or not being able to get rid of
useless objects (e.g., junk mail, old
newspapers, garbage, other objects, ear
swabs, wrappers)
 Excessive list making
 Ritualized blinking or starting
 Ritualized eating behaviors
 Engaging in superstitious behaviors
 Hair Pulling
9. Category PT:
 Repetitive, intrusive, or upsetting thoughts
about a distressing event
 Recurrent dreams or nightmares related to
the event
 Intense or vivid flashbacks
 Feeling or acting as if the event was
happening again
 Attempts to avoid thoughts or feelings
associated with the trauma
 Attempts to avoid activities or external
situations associated with the event (e.g., not
driving after a car accident)
 Feeling emotionally numb or being out of
touch with feelings
 Feeling detached or estranged from friends
or others
 Losing interest in activities that used to give
pleasure
 Feeling on edge
 Difficulty falling or staying asleep
 Difficulty concentrating
 Starting easily
 Scanning the environment for signs of
danger or threat
 Irritability
 Outbursts of anger or frustration
 Elevated bodily arousal that can spiral into
feelings of panic
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