1. Do you often fear that bad things will happen to the ones you love if you aren’t with them all the time?
2. Do your fears of bad things happening to people you care about affect your functioning in other areas of your life, such as work, school, and other responsibilities?
3. Do you ever experience so much anxiety when you aren’t home or around people you love that you have panic attacks?
4. Do you feel socially withdrawn or distracted when you are away from your loved ones?
5. Do you feel extreme anxiety or hesitation surrounding any situation where you have to leave your home or your loved ones for any period of time?
6. Do you ever experience physical signs of distress, such as headaches, nausea, diarrhea, or physical body aches?
7. Has something terrible ever happened to a loved one when you weren’t there that replays in your head?
8. Have you ever been diagnosed with an anxiety disorder, panic disorder, personality disorder, or PTSD?
9. How long have you been experiencing these symptoms?
10. Do your anxieties and/or fears ever affect your quality of life?
11. Do you always worry that something bad or negative will happen in your relationship?
12. Have you experience physical reaction such as breathing heavily, feeling faint, dizzy aur shaky when you think about seperation?
13. Have you spent time planning on being separated from your partner?
14. Do you avoid fights and situations that can cause slight possibility of seperation?
15. Have you ever relied on alcohol, medication or any other substance abuse because of the fear of seperation?
