Panic Disorder Severity Scale (PDSS)

Helps monitor response to treatment by measuring severity of panic symptoms and their occurrence.

Refer to the text below the calculator for more information about this clinician-rated scale and its usage.

The PDSS questionnaire consists of 7 questions developed for measuring the severity of panic disorder and to provide clinicians with a reliable tool for monitoring treatment.

Please note this scale is not a diagnostic tool, but can be used to detect possible symptoms of panic disorder and trigger a formal diagnostic assessment. It is easy to administer (time duration 5-10 min) and so can also be used as a screening tool but due to its sensitivity to change, it is most widely used to monitor response to treatment.

The PDSS was associated with excellent interrater reliability, moderate internal consistency, and positive levels of validity and sensitivity to change.

Each of the 7 items are rated on a 5-point scale (from 0 to 4), so final scores range from 0 to 28, where the higher the score the greater the degree of panic disorder symptom severity. A composite score may also be documented, by dividing the score to 7.

How many panic and limited symptoms attacks did you have during the week?

No panic or limited symptom episodes (0)

Mild: no full panic attacks and no more than 1 limited symptom attack/day (+1)

Moderate: 1 or 2 full panic attacks and/or multiple limited symptom attacks/day (+2)

Severe: more than 2 full attacks but not more than 1/day on average (+3)

Extreme: full panic attacks occurred more than once a day, more days than not (+4)

If you had any panic attacks during the past week how distressing (uncomfortable, frightening) were they while they were happening?

(If you had more than one, give an average rating. If you didn’t have any panic attacks but did have limited symptom attacks, answer for the limited symptom attacks.)

Not at all distressing, or no panic or limited symptom attacks during the past week (0)

Mildly distressing (not too intense) (+1)

Moderately distressing (intense, but still manageable) (+2)

Severely distressing (very intense) (+3)

Extremely distressing (extreme distress during all attacks) (+4)

During the past week how much have you worried or felt anxious about when your next panic attack would occur or about fears related to the attacks?

(for example, that they could mean you have physical or mental health problems or could cause you social embarrassment)

Not at all (0)

Occasionally or only mildly (+1)

Frequently or moderately (+2)

Very often or to a very disturbing degree (+3)

Nearly constantly and to a disabling extent (+4)

During the past week were there any places or situations you avoided, or felt afraid of (uncomfortable in, wanted to avoid or leave), because of fear of having a panic attack?

(e.g., public transportation, movie theaters, crowds,bridges, tunnels, shopping malls, being alone) Are there any other situations that you would have avoided or been afraid of if they had come up during the week, for the same reason? If yes to either question, please rate your level of fear and avoidance this past week.

None: no fear or avoidance (0)

Mild: occasional fear and/or avoidance but I could usually confront or endure the situation. (+1)

Moderate: noticeable fear and/or avoidance but still manageable. (+2)

Severe: extensive avoidance. Substantial modification of my lifestyle was required to accommodate the avoidance making it difficult to manage (+3)

Extreme: pervasive disabling fear and/or avoidance. (+4)

During the past week, were there any activities that you avoided, or felt afraid of (uncomfortable doing, wanted to avoid or stop), because they caused physical sensations like those you feel during panic attacks or that you were afraid might trigger a panic attack?

(e.g., physical exertion, sexual relations, taking a hot shower or bath, drinking coffee, watching an exciting or scary movie) Are there any other activities that you would have avoided or been afraid of if they had come up during the week for that reason? If yes to either question, please rate your level of fear and avoidance of those activities this past week.

No fear or avoidance of situations or activities because of distressing physical sensations (0)

Mild: occasional fear and/or avoidance, but usually I could confront or endure with little distress activities that cause physical sensations. (+1)

Moderate: noticeable avoidance but still manageable. There was definite, but limited, modification of my lifestyle (+2)

Severe: extensive avoidance. There was substantial modification of my lifestyle or interference in my functioning. (+3)

Extreme: pervasive and disabling avoidance. There was extensive modification in my lifestyle (+4)

During the past week, how much did the above symptoms altogether interfere with your ability to work or carry out your responsibilities at home?

(panic and limited symptom attacks, worry about attacks, and fear of situations and activities because of attacks) If your work or home responsibilities were less than usual this past week, answer how you think you would have done if the responsibilities had been usual.

No interference with work or home responsibilities (0)

Slight interference with work or home responsibilities, but I could do nearly everything I could if I didn’t have these problems. (+1)

Significant interference with work or home responsibilities, but I still could manage to do the things I needed to do. (+2)

Substantial impairment in work or home responsibilities; there were many important things I couldn’t do because of these problems. (+3)

Extreme, incapacitating impairment such that I was essentially unable to manage any work or home responsibilities. (+4)

During the past week how much did panic and limited symptom attacks, worry about attacks and fear of situations and activities because of attacks interfere with your social life?

(If you didn't have many opportunities to socialize this past week, answer how you think you would have done if you did have opportunities.)

No interference (0)

Slight interference with social activities, but I could do nearly everything I could if I didn’t have these problems. (+1)

Significant interference with social activities but I could manage to do most things if I made the effort. (+2)

Substantial impairment in social activities; there are many social things I couldn’t do because of these problems. (+3)

Extreme, incapacitating impairment, such that there was hardly anything social I could do. (+4)

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Panic Disorder Severity Scale Explained

The PDSS questionnaire consists of 7 questions developed for measuring the severity of panic disorder and to provide clinicians with a reliable tool for monitoring treatment.

The PDSS questions address:

Panic frequency;
Distress during panic;
Panic-focused anticipatory anxiety;
Phobic avoidance of situations;
Phobic avoidance of physical sensations;
Impairment in work functioning;
Impairment in social functioning.

To complete the scale, the patient may require further clarification as to what represents panic attacks and limited symptom attacks. For the purpose of the PDSS questionnaire a panic attack is defined as a sudden rush of fear or discomfort accompanied by at least 4 of the symptoms listed below:

Rapid or pounding heartbeat;
Chest pain or discomfort;
Chills or hot flushes;
Sweating;
Nausea;
Fear of losing control or Trembling or shaking;
Dizziness or faintness going crazy;
Breathlessness;
Feelings of unreality;
Fear of dying;
Feeling of choking;
Numbness or tingling.

Episodes like panic attacks but having fewer than 4 of the listed symptoms are called limited symptom attacks.

The PDSS (developed in 1997) is best used after diagnosis, as it carries good sensitivity to change and so can help monitor response to treatment. The scale demonstrated adequate internal consistency and reliability, excellent inter-rater reliability, good discriminant validity and sensitivity to change.

References

Original reference

Shear MK, Brown TA, Barlow DH, et al. Multicenter collaborative panic disorder severity scale. Am J Psychiatry. 1997;154(11):1571-5.

Other references

Furukawa TA, Katherine shear M, Barlow DH, et al. Evidence-based guidelines for interpretation of the Panic Disorder Severity Scale. Depress Anxiety. 2009; 26(10):922-9.

Houck PR, Spiegel DA, Shear MK, Rucci P. Reliability of the self-report version of the panic disorder severity scale. Depression and anxiety. 2002; 15(4):183-5.

Specialty: Psychiatry

Year Of Study: 1997

Abbreviation: PDSS

Article By: Denise Nedea

Published On: November 3, 2020 · 12:00 AM

Last Checked: November 3, 2020

Next Review: November 3, 2025