PATIENT

22.

NAME_________________________________DATE_________________________

YALE-BROWN OBSESSIVE COMPULSIVE SCALE (Y-BOCS)*

Questions 1 to 5 are about your obsessive thoughts

Obsessions are unwanted ideas, images or impulses that intrude on thinking against your wishes and efforts to resist them. They usually involve themes of harm, risk and danger. Common obsessions are excessive fears of contamination; recurring doubts about danger, extreme concern with order, symmetry, or exactness; fear of losing important things.

Please answer each question by circling the appropriate number.

1. TIME OCCUPIED BY OBSESSIVE THOUGHTS

SCORE __________ How much of your time is occupied by obsessive thoughts?

= None 1 = Less than 1 hr/day or occasional occurrence 2 =

1 to 3 hrs/day or frequent 3 = Greater than 3 and up to 8 hrs/day or very frequent occurrence 4 = Greater than 8 hrs/day or nearly constant occurrence

2. INTERFERENCE DUE TO OBSESSIVE THOUGHTS

SCORE __________ How much do your obsessive thoughts interfere with your work, school, social, or other important role functioning? Is there anything that you don’t do because of them?

= None 1 = Slight interference with social or other activities, but overall performance not impaired 2 = Definite interference with social or occupational performance, but still manageable 3 = Causes substantial impairment in social or occupational performance 4 = Incapacitating

3. DISTRESS ASSOCIATED WITH OBSESSIVE THOUGHTS

SCORE __________ How much distress do your obsessive thoughts cause you?

= None 1 = Not too disturbing 2 = Disturbing, but still manageable 3 = Very disturbing 4 = Near constant and disabling distress

4. RESISTANCE AGAINST OBSESSIONS

SCORE __________ How much of an effort do you make to resist the obsessive thoughts? How often do you try to disregard or turn your attention away from these thoughts as they enter your mind?

= Try to resist all the time 1 = Try to resist most of the time 2 = Make some effort to resist 3 = Yield to all obsessions without attempting to control them, but with some reluctance 4 = Completely and willingly yield to all obsessions

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5. DEGREE OF CONTROL OVER OBSESSIVE THOUGHTS

SCORE __________ How much control do you have over your obsessive thoughts? How successful are you in stopping or diverting your obsessive thinking? Can you dismiss them?

= Complete control 1 = Usually able to stop or divert obsessions with some effort and concentration 2 = Sometimes able to stop or divert obsessions 3 = Rarely successful in stopping or dismissing obsessions, can only divert attention with difficulty 4 = Obsessions are completely involuntary, rarely able to even momentarily alter

obsessive thinking.

The next several questions are about your compulsive behaviors.

Compulsions are urges that people have to do something to lessen feelings of anxiety or other discomfort. Often they do repetitive, purposeful, intentional behaviors called rituals. The behavior itself may seem appropriate but it becomes a ritual when done to excess. Washing, checking, repeating, straightening, hoarding and many other behaviors can be rituals. Some rituals are mental. For example, thinking or saying things over and over under your breath.

6. TIME SPENT PERFORMING COMPULSIVE BEHAVIORS

SCORE __________ How much time do you spend performing compulsive behaviors? How much longer than most people does it take to complete routine activities because of your rituals? How frequently do you do rituals?

= None 1 = Less than 1 hr/day or occasional performance of compulsive behaviors 2 = From 1 to 3 hrs/day, or frequent performance of compulsive behaviors 3 = More than 3 and up to 8 hrs/day, or very frequent performance of compulsive

behaviors 4 = More than 8 hrs/day, or near constant performance of compulsive behaviors

(too numerous to count)

7. INTERFERENCE DUE TO COMPULSIVE BEHAVIORS

SCORE __________ How much do your compulsive behaviors interfere with your work, school, social, or other important role functioning? Is there anything that you don’t do because of the compulsions?

= None 1 = Slight interference with social or other activities, but overall performance

not impaired 2 = Definite interference with social or occupational performance, but still

manageable 3 = Causes substantial impairment in social or occupational performance 4 = Incapacitating

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8. DISTRESS ASSOCIATED WITH COMPULSIVE BEHAVIOR

SCORE __________ How would you feel if prevented from performing your compulsion(s)? How anxious would you become?

= None 1 = Only slightly anxious if compulsions prevented 2 = Anxiety would mount but remain manageable if compulsions prevented 3 = Prominent and very disturbing increase in anxiety if compulsions interrupted 4 = Incapacitating anxiety from any intervention aimed at modifying activity

9. RESISTANCE AGAINST COMPULSIONS

SCORE __________ How much of an effort do you make to resist the compulsions?

= Always try to resist 1 = Try to resist most of the time 2 = Make some effort to resist 3 = Yield to almost all compulsions without attempting to control them, but with some reluctance 4 = Completely and willingly yield to all compulsions

10. DEGREE OF CONTROL OVER COMPULSIVE BEHAVIOR

SCORE __________ How strong is the drive to perform the compulsive behavior? How much control do you have over the compulsions?

= Complete control 1 = Pressure to perform the behavior but usually able to exercise voluntary control over it 2 = Strong pressure to perform behavior, can control it only with difficulty 3 = Very strong drive to perform behavior, must be carried to completion, can only

delay with difficulty 4 = Drive to perform behavior experienced as completely involuntary and over-

powering, rarely able to even momentarily delay activity.

TOTAL SCORE ______________

Y-BOCS Symptom Checklist Instructions: Generate a Target Symptoms List from the attached Y-BOCS Symptom Checklist by asking the patient about specific obsessions and compulsions. Chock all that apply. Distinguish between current and past symptoms. Mark principal symptoms with a "p". These will form the basis of the Target Symptoms List. Items marked may “*” or may not be an OCD phenomena.

CLEANING/WASHING COMPULSIONS

Excessive or ritualized handwashing

Excessive or ritualized showering, bathing, toothbrushing grooming, or toilet routine Involves cleaning of household items or other inanimate objects Other measures to prevent or remove contact with contaminants Other

CHECKING COMPULSIONS

Checking locks, stove, appliances etc.

Checking that did rot/will not harm others Checking that did not/will not harm self Checking that nothing terrible did/will happen Checking that did not make mistake Checking tied to somatic obsessions Other:

REPEATING RITUALS Rereading or rewriting Need to repeat routine activities jog, in/out door, up/down from chair) Other _____________________________

COUNTING COMPULSIONS

___________________________________

ORDERING/ARRANGING COMPULSIONS

___________________________________

HOARDING/COLLECTING COMPULSIONS (distinguish from hobbies and concern with objects of monetary or sentimental value (e.g., carefully reads junk mail, piles up old newspapers, sorts through garbage, collects useless objects.)

___________________________________

MISCELLANEOUS COMPULSIONS Mental rituals (other than checking/counting) Excessive listmaking Need to tell, ask, or confess Need to touch, tap, or rub* Rituals involving blinking or staring*

Measures (not checking) to prevent: harm to self -harm to others terrible consequences Ritualized eating behaviors* Superstitious behaviors Trichotillomania * Other self-damaging or self-mutilating behaviors*

Other

Current Past

SOMATIC OBSESSIONS

Concern with illness or disease* Excessive concern with body part or aspect of Appearance (eg., dysmorphophobia)* Other

AGGRESSIVE OBSESSIONS Fear might harm self Fear might harm others Violent or horrific images Fear of blurting out obscenities or insults Fear of doing something else embarrassing* Fear will act on unwanted impulses (e.g., to stab friend) Fear will steal things Fear will harm others because not careful enough (e.g. hit/run motor vehicle accident) Fear will be responsible for something else terrible happening (e.g., fire, burglary

Other:_______________________________

Current Past

SEXUAL OBSESSIONS

Forbidden or perverse sexual thoughts. images. or impulses Content involves children or incest Content involves homosexuality* Sexual behavior towards others (Aggressive)* Other:

HOARDING/SAVING OBSESSIONS (distinguish from hobbies and concern with objects of monetary or sentimental value)

RELIGIOUS OBSESSIONS (Scrupulosity) Concerned with sacrilege and blasphemy Excess concern with right/wrong, morality Other:

OBSESSION WITH NEED FOR SYMMETRY OR EXACTNESS

Accompanied by magical thinking (e.g., concerned that another will have accident dent unless less things are in the right place) Not accompanied by magical thinking

MISCELLANEOUS OBSESSIONS Need to know or remember Fear of saying certain things Fear of not saying just the right thing Fear of losing things Intrusive (nonviolent) images Intrusive nonsense sounds, words, or music Bothered by certain sounds/noises* Lucky/unlucky numbers Colors with special significance

3 superstitious fears Other:

CONTAMINATION OBSESSIONS Concerns or disgust w\ with bodily waste or secretions (e.g., urine, feces, saliva Concern with dirt or germs Excessive concern with environmental contaminants (e.g. asbestos, radiation toxic waste) Excessive concern with household items (e.g., cleansers solvents) Excessive concern with animals (e.g., insects) Bothered by sticky substances or residues Concerned will get ill because of contaminant Concerned will get others ill by spreading contaminant (Aggressive) No concern with consequences of contamination other than how it might feel Other:

Adapted from Goodman, W.K., Price, L.H., Rasmussen, S.A. et al.: “The Yale-Brown Obsessive Compulsive Scale.” Arch Gen Psychiatry 46:1006-1011,1989