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Question 1 of 13 Fainting and Collapse

Have you fainted? Have you been passing out?


Question 2 of 13 Sensory Shutdown

Have you felt dizzy and has your vision gone black? Felt dizzy and couldn’t see anymore, as though you were blind?


Question 3 of 13 Sensory Shutdown

Have you felt as though you couldn’t hear for a while, as though you were deaf? When people were talking to you, did they sound far away?


Question 4 of 13 Sensory Shutdown

Have you had an experience of not being able to properly see things around you (blurred vision for example)?


Question 5 of 13 Physical Numbing

Have you felt as though your body or a part of your body has gone numb?


Question 6 of 13 Motor Inhibition

Have you felt as though you couldn’t move for a while, as though you were paralyzed?


Question 7 of 13 Physical Numbing

Have you felt as though your body, or a part of it was insensitive to pain (analgesia)?


Question 8 of 13 Motor Inhibition

Have you been in a state in which your body suddenly felt heavy and tired?


Question 9 of 13 Motor Inhibition

Have you experienced your body becoming stiff for a while?


Question 10 of 13 Autonomic Distress

Have you felt nauseous? Have you felt as though you were about to throw up? Have you felt yourself break out in a cold sweat?


Question 11 of 13 Depersonalization

Have you had an “out-of-body” sensation? Have you felt as though you were outside of your body?


Question 12 of 13 Speech Inhibition

Have you had moments in which you have found yourself unable to speak? Have you been able to speak only with great effort? Have you had an experience in which you could only whisper for a period of time?


Question 13 of 13 Autonomic Distress

Have you felt suddenly weak and warm?