Panic Disorder Severity Scale, Self-Report

The Panic Disorder Severity Scale, Self-Report (PDSS-SR) is a globally recognized, brief assessment tool that helps clinicians evaluate the distinct symptom…

Questions: 7
Duration: 5 min
Original title: PDSS-SR — Panic Disorder Severity Scale
Adaptation: Panic Disorder Severity Scale, Self-Report
Authors: Houck, P.R., Spiegel, D.A., Shear, M.K., & Rucci, P.
Created: 2002

The Panic Disorder Severity Scale, Self-Report (PDSS-SR) is a globally recognized, brief assessment tool that helps clinicians evaluate the distinct symptom domains of panic disorder. Originally adapted from the clinician-administered PDSS, this self-report version offers a highly reliable method for capturing the multidimensional nature of panic symptomatology in adults.

Panic disorder is rarely limited to the acute physiological surges of the attacks themselves. The clinical picture is heavily shaped by the patient's catastrophic appraisals, persistent dread of future episodes, and the ensuing restriction of daily life. The PDSS-SR is specifically structured to capture this broader impact, providing actionable data on the patient's subjective distress and subsequent behavioral modifications.

Because it evaluates both interoceptive sensitivity and agoraphobic restriction, the instrument serves as an excellent standardized metric for recognizing panic disorder severity across the lifespan. It enables practitioners to establish a clear baseline and longitudinally track the specific facets of the patient's panic cycle that require targeted intervention.

Example result

Fictitious result, computed from a sample set of answers.

Overall score

11/ 28

Brief 7-item self-report questionnaire assessing the overall severity of panic disorder over the past week. It covers seven dimensions: frequency of panic attacks, distress during attacks, anticipatory anxiety, agoraphobic fear/avoidance of situations, interoceptive fear/avoidance of physical sensations, impairment in work functioning, and impairment in social functioning. Intended for adults with an established or suspected diagnosis of panic disorder; useful for screening, initial evaluation, and monitoring treatment response.

0–1

Normal

2–5

Borderline ill

6–9

Slightly ill

10–13

Moderately ill

14–28

Markedly ill

Severity bands proposed for the clinician-rated PDSS, but often cited for the PDSS-SR, to interpret overall severity.

For information

Cut-off3–7Borderline ill (with agoraphobia)

The interpretation of the PDSS total score differed according to the presence or absence of agoraphobia. When the patients were not agoraphobic, score ranges 0–1 corresponded with “Normal,” 2–5 with “Borderline”, 6–9 with “Slightly ill”, 10–13 with “Moderately ill”, and 14 and above with “Markedly ill.” When the patients were agoraphobic, score ranges 3–7 meant “Borderline ill,” 8–10 “Slightly ill,” 11–15 “Moderately ill,” and 16 and above “Markedly ill.”

Furukawa et al. (2009)View the study ↗

Cut-off8–10Slightly ill (with agoraphobia)

Furukawa et al. (2009)View the study ↗

Cut-off11–15Moderately ill (with agoraphobia)

Furukawa et al. (2009)View the study ↗

Cut-off≥ 16Markedly ill (with agoraphobia)

Furukawa et al. (2009)View the study ↗

Scoring

Sum, total score from 0 to 28, each item is rated on a 5-point scale (from 0 to 4).

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What the test measures

The PDSS-SR maps the core clinical features and secondary consequences of panic disorder over a one-week retrospective window. By disaggregating the condition into specific domains, it helps clarify which aspects of the panic cycle drive the most impairment.

The seven items target the following clinical dimensions:

Attack frequency: The occurrence of both full-threshold panic attacks and subclinical, limited-symptom episodes.
Acute distress: The subjective intensity of emotional and physiological discomfort experienced during the attacks.
Anticipatory anxiety: The persistent worry and dread regarding when the next attack will happen and what its consequences might be.
Agoraphobic avoidance: The fear and active evasion of external situations or places where escape might be difficult if panic occurs.
Interoceptive avoidance: The restriction of routine activities that induce harmless somatic sensations resembling a panic response.
Occupational interference: The extent to which the combined panic symptoms disrupt the patient's ability to work or manage home responsibilities.
Social impairment: The degree of disruption the disorder causes to the patient's interpersonal relationships and social life.

This measure is validated for adults with a suspected or established diagnosis of panic disorder with or without agoraphobia.

When and why to use it

Clinicians integrate the PDSS-SR into their workflow to obtain a rapid, comprehensive profile of panic severity and to systematically document clinical progress. Its sensitivity to therapeutic change makes it particularly useful across different phases of evidence-based care.

Common clinical indications include:

Intake baseline formulation: Structuring the initial assessment to map the severity of physiological arousal, cognitive dread, and behavioral restriction.
Treatment monitoring: Administering the scale at regular intervals to evaluate coping strategy effectiveness and ensure symptoms are remitting.
Differential support: Distinguishing whether the patient's impairment stems primarily from the attacks themselves or from extensive agoraphobic avoidance.
Relapse prevention: Identifying lingering anticipatory anxiety or subclinical avoidance during the consolidation phase of therapy.

Using this standardized scale adds a quantifiable dimension to clinical observation. It allows clinicians to reliably measure shifts in symptom burden over time, moving beyond global subjective reports to pinpoint exact areas of behavioral or cognitive change.

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The questions

The following questions pertain to your panic symptoms over the past week. A "panic attack" refers to a sudden surge of intense fear or discomfort accompanied by at least 4 physical or cognitive symptoms (for example palpitations, shortness of breath, dizziness, fear of dying or losing control) reaching a peak within 10 minutes. A "subclinical attack" (limited-symptom attack) is identical but involves fewer than 4 symptoms. For each item, choose the response that best describes your condition over the past 7 days.
1. Over the past week, how many panic attacks and limited-symptom (subclinical) attacks did you have?
Probes the sheer volume of both full-blown and limited-symptom panic episodes experienced.
- No panic or limited-symptom attacks
- Mild: No full panic attacks and no more than one limited-symptom attack per day
- Moderate: One or two full panic attacks and/or several limited-symptom attacks per day
- Severe: More than two full panic attacks, but not more than one per day on average
- Extreme: Full panic attacks occurred more than once a day, most days
2. If you had any panic attacks during the past week, how much distress (discomfort and fear) did you feel while they were happening? (If you had more than one attack, rate the average intensity. If you had no panic attacks but did have limited-symptom attacks, answer about those.)
Evaluates the acute subjective intensity of the emotional and physiological discomfort during the attacks.
- No distress, or no panic or limited-symptom attacks in the past week
- Mild distress (not too intense)
- Moderate distress (intense, but manageable)
- Severe distress (very intense)
- Extreme distress (during all attacks)
3. During the past week, how much did you worry or feel anxious about when your next panic attack might occur, or about fears related to the attacks (e.g., that they might mean you have physical or mental health problems, or that they could cause social embarrassment)?
Assesses the cognitive load of persistent dread and rumination regarding future panic events.
- Not at all
- Occasionally or only mildly
- Often or moderately
- Very often or in a very disturbing way
- Almost continuously and in a disabling way
4. During the past week, were there any places or situations (e.g., public transportation, movie theaters, crowds, bridges, tunnels, shopping malls, being alone) that you avoided or felt afraid of (felt uncomfortable in, wanted to avoid or leave) because you were afraid of having a panic attack? Were there any other situations you would have avoided or feared for the same reason if they had come up during the week? If you answer yes to either question, please rate the intensity of your fear and avoidance over the past week.
Examines the extent to which the patient avoids external places or situations out of fear of panicking.
- No fear or avoidance
- Mild: Occasional fear and/or avoidance, but I was generally able to face or endure the situation. I made no or only minor changes to my lifestyle because of it.
- Moderate: Noticeable but manageable fear and/or avoidance. I avoided some situations, but could face them with a companion. I had to make some changes to my lifestyle, but my overall functioning was not impaired.
- Severe: Significant avoidance. I had to make major changes to my lifestyle to avoid situations. As a result, I had difficulty carrying out my daily activities.
- Extreme: Pervasive, disabling avoidance and/or fear. I had to profoundly change my lifestyle, to the point I was unable to perform important tasks.
5. During the past week, were there any activities (e.g., physical exercise, sexual relations, taking a hot shower or bath, drinking coffee, watching a thrilling or scary movie) that you avoided or were afraid of (felt uncomfortable doing, wanted to avoid or stop) because they caused physical sensations similar to those you feel during panic attacks, or because you were afraid they might trigger a panic attack? Were there any other activities you would have avoided or feared for this reason if they had come up during the week? If you answer yes to either question, please rate the intensity of your fear and avoidance of these activities over the past week.
Captures the avoidance of routine physical activities that induce somatic sensations resembling panic.
- No fear or avoidance of activities due to disturbing physical sensations
- Mild: Occasional fear and/or avoidance, but I was generally able to face the situation or endure activities causing physical sensations with only mild distress. I made only minor changes to my lifestyle because of this.
- Moderate: Noticeable but manageable avoidance. I had to make some changes to my lifestyle, but it did not impair my overall functioning.
- Severe: Significant avoidance. I had to make major changes to my lifestyle, or this has impaired my overall functioning.
- Extreme: Pervasive and disabling avoidance. I had to profoundly change my lifestyle, to the point I was unable to perform important tasks or activities.
6. During the past week, to what extent did all the above symptoms (panic and limited-symptom attacks, worry about attacks, and fear of situations and activities because of attacks) interfere with your ability to work or carry out your responsibilities at home? (If your responsibilities at work or home were less than usual during the past week, estimate how you would have managed if your responsibilities had been as usual.)
Measures how profoundly the combined panic symptoms disrupt professional obligations and domestic tasks.
- None: Symptoms did not interfere with my work or home responsibilities
- Mild: Symptoms slightly interfered with my work or home responsibilities, but I was able to do almost everything I would have if I didn't have these problems.
- Moderate: Symptoms noticeably interfered with my work or home responsibilities, but I managed to complete necessary tasks.
- Severe: Symptoms significantly interfered with my work or home responsibilities; I was unable to complete several important tasks because of these problems.
- Extreme: Symptoms were extremely disabling, so I was unable to do almost any tasks related to my work or home responsibilities.
7. During the past week, to what extent did all the above symptoms (panic and limited-symptom attacks, worry about attacks, and fear of situations and activities because of attacks) interfere with your social life? (If you had no social contacts in the past week, estimate how much they would have been disrupted if the opportunity had arisen.)
Evaluates the restrictive impact of the disorder on the patient's social engagement and interpersonal life.
- None: No disruption
- Mild: Symptoms caused a slight disruption to my social activities, but I was able to do almost all the activities I would have done if I didn't have these problems.
- Moderate: Symptoms caused a noticeable disruption to my social activities, but I was able to do most of my activities with some effort.
- Severe: Symptoms caused a significant disruption to my social activities; I was unable to do many activities involving social interaction because of these problems.
- Extreme: Symptoms were extremely disabling, so I was unable to engage in almost any social activities.