Interactive Interpreter

PDSS Scoring · Panic Disorder Severity Scale (7-Item)

The PDSS (Panic Disorder Severity Scale) is a 7-item scale that rates the overall severity of panic disorder: panic frequency and distress, anticipatory anxiety, avoidance and impairment. Each item is rated 0 to 4 for a total of 0 to 28. It was built as a clinician-rated interview and has a self-report version (PDSS-SR).

For professional reference, research, and education only. Not for diagnosis or medical advice.

PDSS Score Interpreter

  • PDSS Score Calculator

    Enter each of the 7 items (0–4) to total them; the range shows below. Each item has its own anchors, so take the ratings from the form in front of you.

    0 of 7 items entered — 7 still blank. The total can only rise, so treat the range as provisional.

    Item 1
    Item 2
    Item 3
    Item 4
    Item 5
    Item 6
    Item 7

    Each item scores 0–4. Items are numbered, not reproduced — enter them from the form in front of you. Response anchors differ by item on this scale, so use the wording printed on the form.

  • Enter a total score to see its range.

  • 7 items, each rated 0 to 4 with its own anchors; sum for a total of 0 to 28. Higher scores indicate more severe panic disorder.

    Total scoreInterpretation
    25+ExtremeTotals of 25 to 28: a mean item score of about 4 (extreme).
    18–24SevereTotals of 18 to 24: a mean item score of about 3 (severe).
    11–17ModerateTotals of 11 to 17: a mean item score of about 2 (moderate).
    4–10MildTotals of 4 to 10: a mean item score of about 1 (mild). Totals of 5 or less meet the proposed definition of remission in people without agoraphobia.
    0–3None or limitedTotals of 0 to 3: a mean item score of about 0.

    These ranges read the total against the item anchors, none (0) to extreme (4): a range changes where the mean item score (total ÷ 7) passes 0.5, 1.5, 2.5 and 3.5. They are a reading aid, not a validated cutoff; the published interpretation (Furukawa et al. 2009) is under scoring below.

The PDSS (Panic Disorder Severity Scale) is a 7-item scale that rates the overall severity of panic disorder. Each item is rated 0 to 4, for a total of 0 to 28 [1] [4].

What does the PDSS measure?

The PDSS measures the overall severity of panic disorder in people who already have the diagnosis [1]. A workgroup convened by the US National Institute of Mental Health in 1993 called for one global severity rating for panic disorder, and the PDSS was developed to provide it, modelled on the Yale-Brown Obsessive Compulsive Scale [4].

Its seven items cover [4]:

  • frequency of panic attacks;
  • distress caused by panic attacks;
  • anticipatory anxiety;
  • agoraphobic fear and avoidance;
  • fear and avoidance of panic-related physical sensations;
  • impairment in work;
  • impairment in social life.

For anxiety more broadly, the GAD-7 screens for generalized anxiety and rates its severity.

How do you give the PDSS?

  • Clinician-rated interview. The original PDSS is rated by a clinician, with semi-structured interview guides and explicit anchor points for each item [4].
  • Self-report. The PDSS-SR is completed by the client and is reliable enough for clinical and research use [3].
  • Who it is for. People with an established diagnosis of panic disorder; it rates severity rather than screening for the disorder [1].
  • Repeat it. Give it at baseline and through treatment; it is sensitive to change [1] [3].

How do you score and interpret the PDSS?

  1. Rate each of the 7 items from 0 (none) to 4 (extreme), using that item's own anchors [4].
  2. Add the 7 ratings for a total from 0 to 28.
  3. Read the total against the published interpretation, which differs with and without current agoraphobia [4].
  4. To judge change, compare the total with baseline as a percentage.

Interpreting the total

Furukawa and colleagues linked PDSS totals to clinician global ratings in 568 people from two large panic disorder trials [4].

  • Without agoraphobia: 0–1 normal; 2–5 borderline; 6–9 slightly ill; 10–13 moderately ill; 14 and above markedly ill.
  • With agoraphobia: 3–7 borderline ill; 8–10 slightly ill; 11–15 moderately ill; 16 and above markedly ill.

The scorer at the top of this page uses simpler ranges that read the total against the item anchors, from none to extreme. Use the ranges above for clinical interpretation.

Remission, response and screening

  • Remission. A total of 5 or less, in people without current agoraphobia [4].
  • Response. A reduction of 40% or more from baseline. Reductions of 75–100% corresponded to very much improved, 40–74% to much improved and 10–39% to minimally improved [4].
  • Screening cutoff. In 104 psychiatric outpatients, an interview-rated total of 8 identified current panic disorder with sensitivity 83.3% and specificity 64%; its authors suggest it for screening in settings such as primary care [2].

Psychometric properties

  • Original study. Ten independent evaluators rated 186 people with panic disorder and no more than mild agoraphobia. The PDSS had excellent interrater reliability, moderate internal consistency, favourable validity and sensitivity to change [1].
  • Replication. In 104 psychiatric outpatients, 54 with current panic disorder, reliability and validity were confirmed and a one-factor solution fit the data [2].
  • Self-report form. In 108 psychiatric outpatients, Cronbach's α was 0.917 for the PDSS-SR and 0.923 for the interview. Test-retest reliability of the PDSS-SR was good (ICC 0.81), and scores fell by a mean of 7.3 points (SD 5.1) after cognitive behavioural therapy [3].

Limitations

  • Severity, not diagnosis. The PDSS rates severity in people with an established diagnosis [1]; the cutoff of 8 is a screen, with modest specificity [2].
  • Agoraphobia changes the reading. The same total means different severity with and without agoraphobia [4].
  • Interview-based norms. The interpretation ranges were derived from clinician-rated scores [4]; the self-report form's reliability is established [3], but its own interpretation ranges are not.
  • Trial samples. The interpretation came from treatment trials, whose participants may differ from routine clinical populations [4].

For individuals: This page is a clinical reference, not a diagnostic tool. If you have concerns about your own symptoms, bring this information to a qualified mental health professional.

Related

FAQ

  • What is the Panic Disorder Severity Scale?

    The Panic Disorder Severity Scale (PDSS) is a 7-item scale for rating the overall severity of panic disorder, developed by Shear and colleagues and published in 1997. It was modelled on the Yale-Brown Obsessive Compulsive Scale and is used to track severity over treatment in people with an established diagnosis of panic disorder.

  • How do you score the PDSS?

    Each of the 7 items is rated from 0 (none) to 4 (extreme), with its own anchor descriptions. Add the 7 ratings for a total from 0 to 28.

  • What is a normal PDSS score?

    In an analysis of two large trials, PDSS totals of 0 to 1 corresponded to a clinician rating of normal and 2 to 5 to borderline in people without agoraphobia. The same authors propose a total of 5 or less as remission of panic disorder, though not for people who currently have agoraphobia.

  • What PDSS change counts as a treatment response?

    A reduction of 40% or more from baseline is the proposed definition of response. Reductions of 75 to 100% corresponded to very much improved, 40 to 74% to much improved and 10 to 39% to minimally improved on the Clinical Global Impression scale.

References

    1. 1.Shear MK, Brown TA, Barlow DH, Money R, Sholomskas DE, Woods SW, Gorman JM, Papp LA. Multicenter collaborative panic disorder severity scale. Am J Psychiatry. 1997;154(11):1571-5.
    2. 2.Shear MK, Rucci P, Williams J, Frank E, Grochocinski V, Vander Bilt J, Houck P, Wang T. Reliability and validity of the Panic Disorder Severity Scale: replication and extension. J Psychiatr Res. 2001;35(5):293-6.
    3. 3.Houck PR, Spiegel DA, Shear MK, Rucci P. Reliability of the self-report version of the panic disorder severity scale. Depress Anxiety. 2002;15(4):183-5.
    4. 4.Furukawa TA, Shear MK, Barlow DH, Gorman JM, Woods SW, Money R, Etschel E, Engel RR, Leucht S. Evidence-based guidelines for interpretation of the Panic Disorder Severity Scale. Depress Anxiety. 2009;26(10):922-9.

    PDSS © M. Katherine Shear, M.D.

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