Updated
Original VAYEMA symptom and impact self-check – not a validated scale
Agoraphobia symptoms
Answer the symptom statements below to see which experiences and areas of daily life you report as most affected. These are original VAYEMA questions, not a validated diagnostic scale. No clinical severity or probability score is calculated.
Answers are processed only in this page by this assessment. They are not submitted, monitored or automatically saved. No name, email or account is required. Use a private device and clear your answers when finished.
For adults aged 18 and over. This self-check cannot diagnose or rule out a condition. Concerns about a child require an age-appropriate professional assessment.
Thinking about the past four weeks, how well does each statement describe your experience?
Additional context – not included in any questionnaire score
These are original VAYEMA questions, not a diagnostic instrument or a validated severity scale. They summarise the experiences you select and do not predict a diagnosis or future harm. Background condition information; this source does not endorse this self-check.
What an agoraphobia assessment looks beyond
The clinician does not diagnose solely from whether you leave home. They ask about fear of situations where escape or help may seem difficult, the degree of avoidance and the effect on life. Some people enter places with considerable distress or only under specific conditions. Others have practical or medical barriers that require a different explanation or additional support.
The NIMH overview describes several kinds of agoraphobic situations, including transport, crowds and being outside alone. A professional needs the meaning of those situations for you. The assessment should not reduce every difficulty with public spaces to one condition or assume the same treatment fits every person.
Describe the feared outcome, not only the location
Saying that a supermarket is difficult is a useful start, but the clinician may ask what you fear there. Is the concern about panic symptoms, getting help, reaching an exit, becoming embarrassed or something else? The same location can be difficult for different reasons, which affects how the pattern is understood and what treatment might address.
Choose one or two examples rather than list every place you have avoided. Include situations that are easier and what makes them different. You do not need to make the account perfectly consistent. A clinician can explore the variation and distinguish a particular fear from a broader pattern, sensory difficulty or a response to real danger.
Map avoidance and the effort needed to participate
An assessment should consider what you no longer do and what you still do only with substantial preparation. A person may appear to function well because family members shop, work is remote or journeys are carefully limited. Those arrangements may be useful, but the question is whether they are chosen freely or mainly dictated by fear.
Describe the time, effort and distress involved rather than judge yourself by a simple success or failure. A completed outing may still have required hours of preparation or affected the rest of the day. The NHS assessment guidance includes avoidance strategies and everyday behaviour as part of understanding the problem.
Explain companions, routes and other precautions
The clinician may ask what changes when you are accompanied, near home or able to leave quickly. You might rely on a particular person, a familiar route or reassurance that help is available. These observations can clarify the feared outcome. They are not evidence that you should abruptly remove support before an assessment.
Some assistance is medically or practically necessary. Explain the purpose of each arrangement and any disability or health concern involved. A professional should distinguish appropriate support from anxiety-related precautions rather than treat them all alike. Relatives should not force an outing, withhold essential help or create a test to prove whether the fear is genuine.
Discuss panic symptoms and other relevant experiences
Panic attacks may be part of the history, but are not required in every agoraphobic presentation. A clinician asks what happened during any episodes, whether medical causes were considered and how fear changed afterwards. They may also explore depression, other anxiety patterns, trauma-related concerns or substance use where relevant.
The panic disorder guide explains that related condition. A low number of recent attacks does not settle the assessment if many activities have been avoided. Equally, one frightening episode does not establish agoraphobia. The wider pattern and its consequences need to be considered together rather than inferred from a single event.
Physical health and genuine access barriers must stay visible
Tell the clinician about mobility, breathing, balance, pain, sensory needs and any other factor affecting participation. Medication effects or medical conditions may also contribute to symptoms. The NHS notes that physical assessment may be relevant when evaluating agoraphobic or panic-like experiences. Psychological care should not become a reason to disregard a new physical problem.
A useful assessment asks both what you fear and what the environment actually requires. An inaccessible building is not made accessible by changing a belief. Necessary medical precautions should not be removed as though they were anxiety rituals. New, severe or potentially urgent symptoms need the appropriate medical response rather than interpretation through this worksheet.
Why the preparation tool has no score
Formal measures can contribute to clinical assessment or monitoring, but they do not independently determine diagnosis or the suitability of an outing. A professional still needs the context, duration, impact and possible alternative explanations. A numerical result should not become permission to ignore health needs or a rule that you must reach a threshold before asking for help.
These prompts are an original unscored aid, not a validated agoraphobia scale. They produce no severity label, probability estimate or care-setting recommendation. Their purpose is to organise a limited amount of information for discussion. You can skip prompts, clear them or attend without a worksheet. Repeated testing is not required to establish that a difficult pattern deserves attention.
Arrange an accessible first conversation
If travel or the consulting environment is difficult, explain that at first contact. The NHS overview notes the possibility of a telephone consultation when attendance is not manageable. Other formats depend on the service, clinical needs and available professional. Access should be discussed rather than treated as a hidden condition you must overcome alone.
At VAYEMA, ask about the appropriate assessment arrangement, treatment language and whether someone can support you. You may also ask for private time with the clinician. A home visit or online appointment is not automatically suitable for every clinical task, and availability should be confirmed before you plan around it.
Ask how the findings connect to treatment
The recommendation should explain the working understanding, any uncertainty and the relevant approach. For CBT or exposure work, ask what is being targeted, how tasks are planned and how genuine medical or accessibility needs are protected. You should know who provides care, what the initial commitment is and when the plan will be reviewed.
The treatment guide describes the main discussions. A high symptom burden should not automatically select an intensive programme, and a preference for remote care should not be mistaken for a complete clinical plan. The purpose is a proportionate arrangement that addresses your goals and can be adapted according to response.
Keep notes private and know when not to wait
Nothing typed here is sent to VAYEMA, interpreted or added to an inquiry record. Reviewing the notes repeats your own words. An optional download remains on your device and should be kept private. Share information through an agreed clinical channel, not on the assumption that a professional can see what you entered on this page.
You can read the understanding guide or contact the team directly. Family support may help relatives with their own concerns. If restriction prevents essential care or basic needs, seek appropriate advice promptly. Immediate danger or a medical emergency needs urgent local services rather than a routine inquiry or a completed worksheet.
Frequently asked questions about agoraphobia assessment
Is this an agoraphobia diagnostic test?
No. It is an original, optional preparation worksheet with no score. A clinician needs to assess the feared situations, context, impact and alternative explanations. The prompts cannot determine a diagnosis, environmental safety or treatment plan, and they should not be used to judge whether you are independent enough to deserve help.
What if I can go out with someone but not alone?
That difference is useful to describe. The clinician can explore what the companion changes and what you fear without them. It does not establish the diagnosis by itself or mean support should be withdrawn suddenly. Medical, practical and psychological factors need to be considered together.
Should I try a feared journey before the appointment?
You do not need to do so to complete these notes or prove the concern. Describe your existing experience. Any therapeutic practice should be appropriately planned, with genuine risks and health needs considered. Do not force yourself or another person into a challenge based on a website assessment.
Can I be assessed without having panic attacks?
Yes. Agoraphobic concerns do not always involve a history of panic attacks. Explain the situations and feared consequences rather than assume a missing symptom makes assessment pointless. A professional can determine which formulation or diagnosis is relevant and what support would address it.
Will my accessibility needs be treated as avoidance?
They should be assessed in their own right. Explain mobility, sensory, medical and environmental barriers clearly. A useful plan preserves necessary accommodations while exploring anxiety-related restriction where relevant. The two can coexist, and psychological treatment should not be used to dismiss a genuine access problem.
Will the tool alert someone if I cannot obtain essential care?
No. Entries are not transmitted or monitored. Contact an appropriate healthcare service directly and explain the access barrier and urgency. The worksheet is only a private communication aid. Immediate danger or a medical emergency requires urgent services rather than waiting for a routine website response.
Resources and references
[1] NIMH: agoraphobia and related phobia patterns