APA - DSM5 - Severity Measure For Separation Anxiety Disorder Adult PDF
APA - DSM5 - Severity Measure For Separation Anxiety Disorder Adult PDF
APA - DSM5 - Severity Measure For Separation Anxiety Disorder Adult PDF
Instructions: The following questions ask about thoughts, feelings, and behaviors that you may have had about being
separated from home or from people who are important to you. Please rate how often the following statements are true for
you. Please respond to each item by marking ( or x) one box per row.
Clinician
Use
Half of Most of All of the Item
During the PAST 7 DAYS, I have… Never Occasionally
the time the time time score
felt moments of sudden terror, fear, or
1. 0 1 2 3 4
fright when separated
felt anxious, worried, or nervous about
2. 0 1 2 3 4
being separated
have had thoughts of bad things happening
to people important to me or bad things
3. 0 1 2 3 4
happening to me when separated from
them (e.g., getting lost, accidents)
felt a racing heart, sweaty, trouble
4. 0 1 2 3 4
breathing, faint, or shaky when separated
felt tense muscles, felt on edge or restless,
5. or had trouble relaxing or trouble sleeping 0 1 2 3 4
when separated
avoided going places where I would be
6. 0 1 2 3 4
separated
when separated, left places early to go
7. 0 1 2 3 4
home
spent a lot of time preparing for how to
8. 0 1 2 3 4
deal with separation
distracted myself to avoid thinking about
9. 0 1 2 3 4
being separated
needed help to cope with separation (e.g.,
10. alcohol or medications, superstitious 0 1 2 3 4
objects)
Total/Partial Raw Score:
Prorated Total Raw Score: (if 1-2 items left unanswered)
Average Total Score:
Craske M, Wittchen U, Bogels S, Stein M, Andrews G, Lebeu R. Copyright © 2013 American Psychiatric Association. All rights reserved.
This material can be reproduced without permission by researchers and by clinicians for use with their patients.
Instructions to Clinicians
The Severity Measure for Separation Anxiety Disorder—Adult is a 10-item measure that assesses the severity of
symptoms of separation anxiety disorder in individuals age 18 and older. The measure was designed to be
completed by an individual upon receiving a diagnosis of separation anxiety disorder (or clinically significant
separation anxiety symptoms) and thereafter, prior to follow-up visits with the clinician. Each item asks the
individual to rate the severity of his or her separation anxiety disorder during the past 7 days.
Note: If 3 or more items are left unanswered, the total score on the measure should not be calculated. Therefore,
the individual receiving care should be encouraged to complete all of the items on the measure. If 1 or 2 items
are left unanswered, you are asked to calculate a prorated score. The prorated score is calculated by summing
scores of items that were answered to get a partial raw score. Multiply the partial raw score by the total number
of items on the Severity Measure for Separation Anxiety Disorder (i.e., 10) and divide the value by the number of
items that were actually answered (i.e., 8 or 9). The formula to prorate the partial raw score to Total Raw Score is:
Frequency of Use
To track changes in the severity of the individual’s separation anxiety disorder over time, the measure may be
completed at regular intervals as clinically indicated, depending on the stability of the individual’s symptoms and
treatment status. Consistently high scores on a particular domain may indicate significant and problematic areas
for the individual that might warrant further assessment, treatment, and follow-up. Your clinical judgment should
guide your decision.