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Family Background Questionnaire

Use the following questionnaire to reflect on your childhood. Can you identify what conditions might have contributed to your current problem with anxiety?

1.	Did either of your parents suffer from panic attacks or phobias
2.	Did you have a brother, sister, grandparent or other relative who had panic attacks or phobias
3.	Did either of your parents seem excessively prone to worry?
4.	Did either of your parents seem overly concerned about potential dangers that could befall you or other family members?
5.	Did your parents encourage exploration of the outside world or did they cultivate an attitude of caution, suspicion or distrust?
6.	Do you feel that your parents were overly critical or demanding of you? If so, how did you feel in response to this critism?
	• Put down or diminished		• Ashamed or guilty
	• Hurt or rejected		• Angry or rebellious
7.	As a child, did you feel free to express your feelings and impulses? How were feelings dealt with in your family?
	• Openly expressed	• Punished		• Denied
8.	Was it ok for you to cry? How did your parents respond when you cried?
9.	Was it ok to express anger? How did your parents respond when you got angry?
10.	What was your role in the family? How werer you perceived relative to other children in the family?
11.	Do you feel that you grew up feeling insecure? Which of the following might have contributed to your insecurity?
	• Excessive criticism by your parents • Excessive punishment • Your parents made you feel ashamed • Your parents made you feel guilty • Your parents neglected you • One or both parents abandoned you through death or divorce • Physical Abuse • Sexual abuse • Parental alcoholism
12.	If you grew up insecure, how did you respond to your feelings of insecurity?
	• By becoming very dependant on your family (did you have trouble leaving home?) • By becoming very independant on your family (Did you leave home early?) • By becoming angry or rebellious?