What is a normal COMPASS-31 score?

In the original validation study, healthy controls scored a mean of approximately 5–7. A score above 16 is commonly cited as suggesting a meaningful autonomic symptom burden.

What does a high COMPASS-31 score mean?

A high score reflects a greater self-reported burden of autonomic symptoms across the six domains measured. It is not a diagnosis of any condition. Scores should be discussed with your doctor or specialist.

Is the COMPASS-31 used for POTS?

Yes. The COMPASS-31 is widely used in POTS research and clinical practice to measure autonomic symptom burden. It has also been used in long COVID and ME/CFS research.

Tools

COMPASS-31

Composite Autonomic Symptom Score

The COMPASS-31 (Composite Autonomic Symptom Score) is a 31-item self-report questionnaire that measures the severity of autonomic symptoms across six domains: orthostatic intolerance, vasomotor function, secretomotor function, gastrointestinal symptoms, bladder function, and pupillomotor function. It was developed at the Mayo Clinic and published by Sletten and colleagues in 2012 as a shorter, more practical version of the original 169-item Autonomic Symptom Profile.

It is widely used in both clinical practice and research to screen for dysautonomia and to track autonomic symptom burden over time. It has been validated in multiple languages and is referenced in studies on POTS, diabetic neuropathy, and post-viral autonomic dysfunction including long COVID.

The questionnaire generates a weighted total score from 0 to 100, with higher scores indicating greater symptom severity. Each domain is scored separately and then weighted according to the original validation, so the total reflects the relative clinical importance of different symptom areas rather than simply adding up raw answers.

If you have a post-viral condition, POTS, ME/CFS, or suspected dysautonomia, the COMPASS-31 can help you quantify your symptom burden in a structured way. It is particularly useful for tracking changes over time and for bringing a concrete, standardised summary to clinical appointments.

This is a free, interactive version. Complete it below and receive your weighted score immediately, broken down by domain. No sign-up or email is required.

This is not a diagnostic tool. Your score reflects self-reported symptom severity and does not constitute a diagnosis of any condition. Scores should be discussed with your doctor or specialist. Based on: Sletten DM, Suarez GA, Low PA, Mandrekar J, Singer W. COMPASS 31: a refined and abbreviated composite autonomic symptom score. Mayo Clin Proc. 2012;87(12):1196–1201.

Domain 1 Orthostatic intolerance

Symptoms that occur when standing up or remaining upright: such as dizziness, faintness, visual changes, palpitations, or weakness of the legs.

1. When standing for prolonged periods or rising quickly, do you experience symptoms such as dizziness, faintness, lightheadedness, visual blurring, palpitations, tremulousness, or weakness of the legs?

Never Mild: occasionally, doesn't limit activity Moderate: frequently, mildly limits activity Severe: frequently, significantly limits activity Very severe: constantly present, prevents normal activity

2. When these orthostatic symptoms occur, do they improve promptly upon sitting down or lying flat?

3. Have you fainted (lost consciousness) in the past year?

No Yes

4. If you have fainted in the past year, approximately how many times?

Domain 2 Vasomotor

Symptoms related to temperature regulation and sweating.

5. Do you experience heat intolerance: unusual discomfort, worsening of symptoms, or inability to tolerate warm environments?

6. Have you noticed decreased sweating in your feet or legs compared to what it used to be?

7. Have you noticed excessive or compensatory sweating in areas that still sweat normally (such as the face, head, or trunk)?

Domain 3 Secretomotor

Symptoms related to dryness of the mouth, eyes, and throat.

8. Do you experience significant dryness of the mouth?

Never Mild: occasionally dry Moderate: frequently dry Severe: constantly dry, need to sip water frequently Very severe: interferes with eating and speaking

9. Do you experience significant dryness of the eyes?

10. Do you have difficulty swallowing because of a dry mouth or throat?

11. Do you experience significant dryness of the skin overall?

Domain 4 Gastrointestinal

Symptoms related to digestion and gut function. The autonomic nervous system plays a major role in gut motility.

12. Do you experience constipation (fewer than 3 bowel movements per week, or very hard/difficult stools)?

13. Do you experience diarrhoea?

14. Do you experience alternating constipation and diarrhoea?

15. Do you experience nausea?

16. Do you experience vomiting?

17. Do you feel full unusually quickly when eating (early satiety)?

18. Do you experience bloating or abdominal distension after meals?

19. Do you experience difficulty swallowing solid food?

20. Have you had unintentional weight loss of more than 5 kg in the past year?

No Yes, 5–10 kg Yes, more than 10 kg

21. Do you experience abdominal pain or cramping?

22. Do you experience rectal urgency (sudden need to have a bowel movement with very little warning)?

23. Do you experience faecal incontinence?

Domain 5 Bladder

Urinary symptoms related to autonomic control of the bladder.

24. Do you experience urinary urgency or increased frequency of urination?

25. Do you have difficulty starting urination or feel that your bladder doesn't empty completely?

26. Do you experience urinary incontinence (leakage of urine)?

Domain 6 Pupillomotor

Visual symptoms related to autonomic control of pupil size and light adaptation.

27. Do you have difficulty seeing clearly in low light or dim environments?

28. Do your eyes take longer than usual to adjust when moving from bright to dark environments (dark adaptation)?

29. Do you experience blurred vision?

30. Are you abnormally sensitive to bright light (photophobia)?

31. Do you experience pain, aching, or grittiness in or around the eyes?

Your COMPASS-31 score

— out of 100

Domain breakdown

Domain	Your score	Max

Understanding your score

The COMPASS-31 produces a total weighted score between 0 and 100 and individual scores for each of the six domains. Higher scores reflect a greater self-reported burden of autonomic symptoms.

In the original validation study, healthy controls scored a mean of approximately 5–7. There is no single universally agreed clinical threshold, but a total score above 16 is commonly cited in the published literature. In a large survey of over 2,300 people with post-acute COVID-19, a score of 20 or above was used to indicate moderate to severe autonomic dysfunction, and 66% of participants met that threshold.

As a rough guide: 0–10 is within the range seen in healthy individuals in the validation study. 11–20 is mildly elevated above that range. 21–40 represents a moderate symptom burden consistent with clinically significant autonomic involvement in most published studies. Above 40 represents a high symptom burden.

The domain breakdown is often as informative as the total score. A high score driven mainly by gastrointestinal symptoms tells a different story from one driven by orthostatic intolerance. When discussing your results with a clinician, the domain scores can help focus the conversation.

If you use the COMPASS-31 to track your symptoms over time, complete it under similar conditions each time and at consistent intervals (such as monthly).

This score is not a diagnosis. It reflects what you have reported about your own symptoms. Discuss your results with your doctor or specialist.