Patient's name________________________________ Today's Date: ___/___ /___
mm dd yy
Clinician ____________________________________
Dimensional Yale-Brown Obsessive-Compulsive Severity
Scale
 Clinician's Ratings of Current Severity by Symptom Dimension
 Aggressive Obsessions and Related Compulsions
 Sexual and Religious Obsessions and Related Compulsions
 Symmetry, Ordering, Counting, and Arranging Obsessions and
Compulsions
 Contamination Obsessions and Cleaning Compulsions
 Hoarding and Collecting Obsessions and Compulsions
 Somatic Obsessions and Compulsions
 Miscellaneous Obsessions and Compulsions
 Clinician's Ratings of Current Global Symptom Severity
June 2000
This scale is based in part on items from the Yale-Brown Obsessive Compulsive Sale (Goodman et al.,
1989; Rosenfeld et al., 1993), the results of earlier factor analyses (Leckman et al., 1997; Mataix-Cols
et al., 1999; Summerfeldt et al., 1999), and the DSM-IV field trial for OCD (Foa et al., 1995).
Clinician Version 9.0
DIMENSIONAL YALE-BROWN OBSESSIVE-COMPULSIVE SCALE
Rationale
This rating scale is designed to evaluate the nature and current severity of obsessive-compulsive
symptoms. It is an extension of the original Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). The
impetus for this new scale came from the results of factor analytic studies of the Y-BOCS symptom checklist
in which four to five symptom dimensions have been consistently identified (Baer, J. Clin. Psychiatry 1994;
55:18–23; Leckman et al., Am. J. Psychiatry 1997; 154:911-917; Mataix-Cols et al., Am. J. Psychiatry 1999;
156:1409-16). These factors were: (1) aggressive obsessions and related compulsions, (2) sexual and
religious obsessions and related compulsions; (3) symmetry, ordering, counting, and arranging obsessions and
compulsions; (4) contamination obsessions and cleaning compulsions; and (5) hoarding and collecting
obsessions and compulsions.
Additional support for a dimensional approach has come from several sources. First, this factor
structure has been confirmed by investigators in Canada (Summerfeldt et al., Behav Res Ther 1999; 37:297311). Second, based on family study data from Yale (Alsobrook et al., Neuropsychiatric Gene, 1999; 88:66975), two factors, were found to be associated with increased rates of OCD among first degree family
members. The specific finding was that individuals with high scores on Factor 3 nearly were twice as likely
to have first-degree family members with OCD compared to individuals with low scores. This suggests that
some of the genetic determinants of OCD might be associated with particular symptom dimensions.
Third, Scott Rauch and his colleagues at Massachusetts General Hospital have recently published a
preliminary PET study (using an implicit learning activation technique) where they analyzed their results in
light of this factor structure (Rauch et al., CNS Spectrums 1998; 3:37-43). They found that severity scores on
factor (1) were positively associated with the blood flow (at each voxel) in the striatum but not with other
brain regions.
These results suggest the following:
1. It may be better to view OCD as a multidimensional disorder rather than a unitary condition;
2. A dimensional approach to OC symptoms may be useful in genetic and neurobiological studies;
3. Rating OC symptom severity within dimensions may be more sensible than making other distinctions,
e.g., rating the severity of obsessions vs. compulsions as is presently done in the Y-BOCS; and
4. It is possible that using a multidimensional severity scale in treatment studies may reveal clinically
relevant patterns of response (some treatments may do better in treating specific sets of symptoms, e.g., the
Black et al. (J Clin Psychiatry 1998; 59:420-425) or the Mataix-Cols et al. studies that indicate that
individuals with hoarding obsessions and related compulsions are less responsive to treatment).
Consequently, this new instrument was developed - the Dimensional Yale-Brown Obsessivecompulsive Scale (DY-BOCS). Practically, by dividing symptoms by dimension, it is possible to inquire
about symptom types that are inherently ambiguous. For example, checking compulsions are now asked
about in several of the domains - checking related to sexual and religious obsessions vs. obsessions based on
contamination worries. Other differences from the Y-BOCS include: inclusion of avoidance as an integral
part of the severity ratings; expansion of ordinal severity scales (frequency, distress and interference) from 5
to 6 anchor points; and the absence of severity ratings based on the patient's effort to resist and control their
symptoms.
Acknowledgements
The DY-BOCS is based on the Y-BOCS created by Wayne K. Goodman, Lawrence H. Price, Steven
A. Rasmussen, and colleagues (Goodman et al., 1989; 1989). Many of the desirable elements of the Y-BOCS
are retained in the DY-BOCS. The DY-BOCS is a product of a collaborative team of investigators from Yale
University (James F. Leckman, Sheila Woody, Lawrence Scahill, and Sara Patrick), the Universidade de São
Paulo (Maria C. Rosario-Campos and Euripedes C. Miguel), and Yukiko Kano (University of Tokyo). Many
2
other colleagues have contributed critiques and comments including Gail Steketee, Steven A. Rasmussen,
Susanne Bejerot, David A. Clark, Dean McKay, David Rosenberg, Scott Rauch, John E. Calamari, Steven
Taylor, Fugen Neziroglu, Neal Swerdlow, David L. Pauls, Bradley S. Peterson, Robert A. King, Diane
Findley, C. Neill Epperson, John P. Alsobrook, and Donald J. Cohen. Their suggestions and encouragement
are gratefully acknowledged.
General Instructions
Like the Y-BOCS, the DY-BOCS is intended for use as a semi-structured interview by qualified raters.
Qualifications are based on training, experience and demonstrated reliability.
Self-report questionnaire. In the interest of time, patients and families (if the patient is a child or
adolescent) are asked to complete a self-report questionnaire that includes an extensive inventory of
obsessive-compulsive symptoms prior to the DY-BOCS interview. The rater should review the completed
questionnaire prior to beginning the DY-BOCS interview.
DY-BOCS interview. We typically begin the interview by thanking the patient (and other informants) for
the time they devoted to complete the questionnaire. In cases where the patient is a child or adolescent, it is
important to establish who completed the questionnaire and how much participation the patient had in its
completion. If the patient had a marginal role, it will be essential to establish the accuracy of the self-report. If
the self-report data are judged inaccurate, indicate this on the clinician rating form (below).
Next the interviewer should inquire if the patient had any difficulty in completing the questionnaire. It
may be helpful to review the definitions of obsessions and compulsions provided at the beginning of the selfreport questionnaire and ask if the patient had any questions concerning what the definitions mean.
Following this discussion, it is best to outline the rest of the interview - state that the interview will focus
on five discrete groups of obsessive-compulsive symptoms. Then briefly describe the seven symptom
categories:
The first category concerns obsessions about harm (aggressive content) coming to oneself, to close family
members or to other people because of some action (or lack of action) by the patient.
The second category includes sexual, moral and religious obsessions. The compulsions in this category
are mostly checking compulsions that relate directly to the obsessions.
The third category includes obsessions about things needing to be perfect or exact. Other obsessions deal
with a need for things to look or sound "just right" or to be symmetrical or properly aligned. Related
compulsions include the need to count, order, arrange, or do certain things over and over again in hopes of
getting it just right.
The fourth category is simply contamination obsessions and cleaning and washing compulsions.
The fifth category includes obsessions and compulsions that relate to hoarding or collecting.
The sixth category includes obsessions and compulsions that relate to somatic concerns about health
distinction from body dysmorphic and hypochondriacal symptoms.
The seventh category includes miscellaneous obsessions and compulsions that relate to superstitions
among other symptoms.
Next, based on the information contained in the self-report the interviewer should identify symptoms in
the first category present during the previous seven-day period. The interview should also indicate symptoms
that have been present in the past but are not currently being experienced. Use the checklists for this purpose.
As with the Y-BOCS, the rater must ascertain whether the reported symptoms are bona fide symptoms of
OCD and not symptoms of another disorder, such as simple phobia, hypochondriasis, body dysmorphic
disorder or paraphilia. Record this information on the clinician’s checklist provided below. Be sure to inquire
about possible avoidance behaviors that may waste time, restrict or interfere with the patient's life, and that
may cause distress. Rate only those symptoms present during the previous one-week period.
3
Once the group of symptoms has been identified (combining obsessions, related compulsions and
avoidance behaviors), the three severity ratings for the first symptom category should be completed on the
form provided. These ratings of duration, distress, and impairment should reflect the best judgment of the
interviewer and be independent of the patient's self-ratings. The rater should assess the items in the listed
order and use the questions provided. As with the Y-BOCS, the interviewer is free to ask additional questions
for clarification. Having completed the first category checklist and ratings, the interviewer should repeat this
process for each of the four remaining categories. If the patient is symptom-free in any category, check the
appropriate box and move on to the next category.
This version of the DY-BOCS also includes a “Other OC Spectrum Symptoms” category of obsessivecompulsive symptoms. us Obsessions and Compulsions,” and “Other OC Spectrum Symptoms” category of
obsessive-compulsive symptoms. This is an assortment of symptoms - some are from the original Y-BOCS
and others that have been included for research purposes. As before, the interviewer should document the
presence of any of these symptoms during the previous week using the checklist provided.
Finally, the interviewer should make a global, composite rating of symptom severity reflecting all
obsessions and compulsions. In making these ratings the interviewer needs to review all of the major
obsessions and compulsions mentioned in each category. If the patient has symptoms in only one dimension,
then the global ratings can be taken directly from the ratings on that dimension - without the need for any
additional interviewing in most cases.
Practical Points
In practice if difficulties are encountered in using this scale, it is often because the patient has difficulty in
deciding in which dimension a particular symptom (or set of symptoms) belongs. In an effort to clarify how
best to approach this issue a few practical points (with supporting examples) are discussed below. In general,
however, we follow the patient’s lead, so if the patient rates a symptom on the DY-BOCS self report on a
particular dimension and if the clinician determines that the symptom in question is bona fide, then the
clinician should make a severity rating for that category.
Selection of the most appropriate symptom dimension. Conceptually, some symptoms or constellations
of symptoms may be included in more than one symptom dimension. It is commonplace for patients in
completing the Self Report to check items in more than one dimension even though there is only a unitary set
of symptoms. For example, obsessions about disease, related checking compulsions and an excessive need for
reassurance conceivably might be under dimension (6) or (4). Our recommendation is for the clinician to rate
them under dimension (6) unless there is a clear spontaneous report of contamination obsessions and cleaning
rituals. If contamination obsessions and cleaning rituals are present (or have been present in the past) and that
is the patient’s concern, the interviewer should make a rating for that dimension. In our experience, while it is
best not to parse a unitary group of symptoms (as perceived by the patient) between two dimensions,
sometimes it is necessary.
Hybrid symptom combinations. Hybrid symptoms do occur (the combination of an obsession from one
category with a compulsion from another). For example, cleaning compulsions performed because of
"religious" or moral obsessions. Here a patient is obsessed with doing the "morally right thing" and is unable
to leave a public bathroom unless he has compulsively cleaned the facilities used. In this instance, because of
the patient's clarity that the cleaning compulsions were done in order to do the right thing, two ratings would
need to be made – one for factor 2 and one for factor 4.
Complex ensembles. It is not unusual for patients to describe discrete periods of time when symptoms
from one dimension are interleaved with symptoms from another. For example, making sure things look
symmetrical and "just right" as well as having worries about harm (aggressive content) befalling a close
4
family member and needing to check the burners on the stove. In these instances, it is often possible for the
patient and interviewer to separate these symptoms into their respective dimensions and to rate them
accordingly.
5
Checklist of Aggressive Obsessions and Related Compulsions
(past week)
Checklist check once () for any symptoms present during the past week.
Here the emphasis is on aggressive thoughts and images. Care may be needed to distinguish
between contamination and somatic obsessions. The term “harm” was used in the self-report. It is
inherently ambiguous and some subjects may have checked some of the harm items when the
symptoms are best understood in another context, i.e., contamination or somatic worries. Check
only if clear that obsessions or compulsions are present and have aggressive content.
Aggressive Obsessions
Related compulsions
_____ Might harm self (aggressive content)
_____ Might be harmed (aggressive content)
_____ Might harm loved ones unintentionally
(close family members)
_____ Might harm others unintentionally
_____ Might harm loved ones intentionally
(close family members)
_____ Might harm others intentionally
_____ Checking that no harm to self has
occurred
_____ Might be responsible for something else terrible
happening
_____ Violent or horrific images
_____ Might blurt out obscenities or insults
_____ Might do something embarrassing
_____ Might be responsible for something terrible
_____ Might act on other unwanted aggressive impulses
_____ Might say harmful things (aggressive content)
_____ Checking that no harm to others
has occurred
_____ Checking compulsions to prevent harm
_____ Repeating to prevent harm
_____ Mental rituals to prevent harm
_____ Checking that nothing terrible has
happened
Avoidance – aggressive obsessions
_____ Intentional avoidance of people, places or things because of any of the above
obsessions or compulsions concerning aggressive obsessions
Other obsessions or compulsions in this category (describe):___________________________
_______________________________________________________________________________
_______________________________________________________________________________
Symptoms in this category were present during the past week? Yes No
If yes, complete the next page. If no, skip to next section.
6
Severity Ratings (past week) for Aggressive Obsessions and Related
Compulsions
1. How much of your time is occupied by these obsessions and compulsions? Or how
frequently do these obsessive thoughts and compulsions occur? Be sure to include the amount of time
wasted by avoidance behaviors.
0 = No time at all
1 = Rarely, present during the past week, often not on a daily basis, typically less than 3 hours/week
2 = Occasionally, more than 3 hours/week, but less than 1 hour/day - occasional intrusion, need to
perform compulsions, or avoidance (occurs no more than 5 times a day)
3 = Frequently, 1 to 3 hours/day - frequent intrusion, need to perform compulsions, or avoidance
(occurs more than 8 times a day, but most hours of the day are free of these obsessions,
compulsions, and related avoidance)
4 = Almost always, more than 3 and up to 8 hours/day - very frequent intrusion, need to perform
compulsions, or avoidance (occurs more than 8 times a day and occurs during most hours of the
day)
5 = Always, more than 8 hours/day - near constant intrusion of obsessions, need to perform
compulsions, or avoidance (too numerous to count and an hour rarely passes without several
obsessions, compulsions and/or avoidance)
2. How much distress do these obsessions and related compulsions cause? In most cases,
distress is equated with anxiety, guilt, a sense of dread, or a feeling of exhaustion. It may be helpful to think
about how distressed you would feel if you were prevented from performing your compulsions? Or how much
distress you feel from needing to repeat your compulsions over and over again. Or how you would feel if you
encountered something (person, place, or thing) you were planned to avoid? [Only rate distress or
discomfort that seems triggered by these obsessions, the need to do the compulsions, or distress associated
with avoidance].
0 = No distress
1 = Minimal - when symptoms are present they are minimally distressing
2 = Mild - some clear distress present, but not too disturbing
3 = Moderate - disturbing - but still tolerable
4 = Severe - very disturbing
5 = Extreme - near constant and disabling distress
3. How much do these obsessions and related compulsions interfere with your
family life, friendships, or ability to perform well at work or at school? Is there anything you
can't do because of them? If you avoid things because of these thoughts, please include the interference that
is the result of that avoidance. If you are not currently studying or working, how much would your
performance be affected if you were a full time student or employee?
0 = No interference
1 = Minimal, slight interference with social or occupational activities, overall performance not impaired
2 = Mild, some interference with social or occupational activities, overall performance affected to a small
degree
3 = Moderate, definite interference with social or occupational performance but still manageable
4 = Severe interference, causes substantial impairment in social or occupational performance
5 = Extreme, incapacitating interference
7
Sexual and Religious Obsessions and Related
Compulsions Severity Ratings (past week)
Checklist check once () for any symptoms present during the past week.
Here the emphasis is on obsessions and compulsions based on sexual and religious concerns.
Moral concerns that are not explicitly religious in character belong in this category as well. There
may be some inherent overlap with the aggressive domain. However, check items in this category if
the primary issue concerns sexual, moral or religious matters.
Obsessions with sexual content
Related compulsions
_____ Forbidden or improper sexual thoughts
_____ Content involves children or incest
_____ Content involves homosexuality
_____ Content involves violent sexual acts
_____ Checking compulsions
related to sexual obsessions
_____ Repeating compulsions related to sexual
obsessions
_____ Mental rituals related to sexual
obsessions
Avoidance because of sexual obsessions
_____ Intentional avoidance of people, places or things because of any of the above
obsessions or compulsions concerning sex
Obsessions with religious content*
Related compulsions
_____ Content involves sacrilege or blasphemy
_____ Excessive concern with what is morally
right or wrong
_____ Checking or other compulsions
related to religious obsessions
_____Fear saying certain things
_____ Need to tell, ask or confess things
_____ Repeating compulsions related to religious
obsessions
_____ Mental rituals related to religious
obsessions
Avoidance - religious
_____ Intentional avoidance of people, places or things because of any of the above
obsessions or compulsions concerning religious topics
Other obsessions or compulsions in this category (describe):___________________________
_______________________________________________________________________________
_______________________________________________________________________________
Symptoms in this category were present during the past week? Yes No
If yes, complete the next page. If no, skip to next section.
8
Severity Ratings (past week) for Sexual and Religious
Obsessions and Related Compulsions
1. How much of your time is occupied by these obsessions and compulsions? Or how
frequently do these obsessive thoughts and compulsions occur? Be sure to include the amount of time
wasted by avoidance behaviors.
0 = No time at all
1 = Rarely, present during the past week, often not on a daily basis, typically less than 3 hours/week
2 = Occasionally, more than 3 hours/week, but less than 1 hour/day - occasional intrusion, need to
perform compulsions, or avoidance (occurs no more than 5 times a day)
3 = Frequently, 1 to 3 hours/day - frequent intrusion, need to perform compulsions, or avoidance
(occurs more than 8 times a day, but most hours of the day are free of these obsessions,
compulsions, and related avoidance)
4 = Almost always, more than 3 and up to 8 hours/day - very frequent intrusion, need to perform
compulsions, or avoidance (occurs more than 8 times a day and occurs during most hours of the
day)
5 = Always, more than 8 hours/day - near constant intrusion of obsessions, need to perform
compulsions, or avoidance (too numerous to count and an hour rarely passes without several
obsessions, compulsions and/or avoidance)
2. How much distress do these obsessions and related compulsions cause? In most cases,
distress is equated with anxiety, guilt, a sense of dread, or a feeling of exhaustion. It may be helpful to think
about how distressed you would feel if you were prevented from performing your compulsions? Or how much
distress you feel from needing to repeat your compulsions over and over again. Or how you would feel if you
encountered something (person, place, or thing) you were planned to avoid? [Only rate distress or
discomfort that seems triggered by these obsessions, the need to do the compulsions, or distress associated
with avoidance.]
0 = No distress
1 = Minimal - when symptoms are present they are minimally distressing
2 = Mild - some clear distress present, but not too disturbing
3 = Moderate - disturbing - but still tolerable
4 = Severe - very disturbing
5 = Extreme - near constant and disabling distress
3. How much do these obsessions and related compulsions interfere with your
family life, friendships, or ability to perform well at work or at school? Is there anything you
can't do because of them? How much do these symptoms bother other people and so affect your
relationships with them? If you avoid things because of these thoughts, please include the interference that
is the result of that avoidance. If you are not currently studying or working, how much would your
performance be affected if you were a full time student or employed?
0 = No interference
1 = Minimal, slight interference with social or occupational activities, overall performance not impaired
2 = Mild, some interference with social or occupational activities, overall performance affected to a small
degree
3 = Moderate, definite interference with social or occupational performance but still manageable
4 = Severe interference, causes substantial impairment in social or occupational performance
5 = Extreme, incapacitating interference
9
Checklist of Symmetry, Ordering, Counting, and Arranging Obsessions and
Compulsions (past week)
Checklist check once () for any symptoms present during the past week.
This dimension is usually fairly distinctive when present. However, overlaps can occur with other
dimensions, particularly when there are concerns about harm or illness. Check these items only if in
your best judgement the symptoms are best accounted for under this category. Similarly, if you are
uncertain about which category best covers the symptoms in question, please indicate your doubts
with annotations and rate the symptoms accordingly in more than one dimension.
Obsessions
Compulsions
_____ Content involves needing things to be
perfect or exact or “just right”
_____ Content involves needing things to be
_____ Checking for own mistakes
_____ Ordering and arranging compulsions
_____ Compulsions involving touching, tapping or
rubbing
symmetrical or correctly aligned
_____ Fear not saying “just the right thing”
_____ Compulsions involving evening-up, or aligning
_____
_____
_____
_____
Re-reading or re-writing compulsions
Repeating routine activities
Counting compulsions
Other mental rituals
Avoidance
_____ Intentional avoidance of places or things because of these obsessions or
compulsions
Other symptoms in this category (describe):____________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Symptoms in this category were present during the past week? Yes No
If yes, complete the next page. If no, skip to next section.
10
Severity (past week) of Symmetry, Ordering, Counting, and Arranging
Obsessions and Compulsions
1. How much of your time is occupied by these obsessions and compulsions? Or how
frequently do these obsessive thoughts and compulsions occur? Be sure to include the amount of time
wasted by avoidance behaviors.
0 = No time at all
1 = Rarely, present during the past week, often not on a daily basis, typically less than 3 hours/week
2 = Occassionally, more than 3 hours/week, but less than 1 hour/day - occasional intrusion, need to
perform compulsions, or avoidance (occurs no more than 5 times a day)
3 = Frequently, 1 to 3 hours/day - frequent intrusion, need to perform compulsions, or avoidance
(occurs more than 8 times a day, but most hours of the day are free of these obsessions,
compulsions, and related avoidance)
4 = Almost always, more than 3 and up to 8 hours/day - very frequent intrusion, need to perform
compulsions, or avoidance (occurs more than 8 times a day and occurs during most hours of the
day)
5 = Always, more than 8 hours/day - near constant intrusion of obsessions, need to perform
compulsions, or avoidance (too numerous to count and an hour rarely passes without several
obsessions, compulsions and/or avoidance)
2. How much distress do these obsessions and related compulsions cause you? In most
cases, distress is equated with anxiety, guilt, a sense of dread, or a feeling of exhaustion. It may be helpful
to think about how distressed you would feel if you were prevented from performing your compulsions? Or
how much distress you feel from needing to repeat your compulsions over and over again. Or how you would
feel if you encountered something (person, place, or thing) you were planned to avoid? [Only rate distress or
discomfort that seems triggered by these obsessions, the need to do the compulsions, or distress associated
with avoidance.]
0 = No distress
1 = Minimal - when symptoms are present they are minimally distressing
2 = Mild - some clear distress present, but not too disturbing
3 = Moderate - disturbing - but still tolerable
4 = Severe - very disturbing
5 = Extreme - near constant and disabling distress
3. How much do these obsessions and related compulsions interfere with your
family life, friendships, or ability to perform well at work or at school? Is there anything you
can't do because of them? How much do these symptoms bother other people and so affect your
relationships with them? If you avoid things because of these thoughts, please include the interference that
is the result of that avoidance. If you are not currently studying or working, how much would your
performance be affected if you were a full time student or employed?
0 = No interference
1 = Minimal, slight interference with social or occupational activities, overall performance not impaired
2 = Mild, some interference with social or occupational activities, overall performance affected to a small
degree
3 = Moderate, definite interference with social or occupational performance but still manageable
4 = Severe interference, causes substantial impairment in social or occupational performance
5 = Extreme, incapacitating interference
11
Checklist of Contamination Obsessions and Cleaning Compulsions
Checklist check once () for any symptoms present during the past week.
Again, this category is usually quite distinctive when present and in some individuals it is the only
dimension present. Care may be needed to distinguish between aggressive and somatic
obsessions. Check only if clear obsessions or compulsions that include contamination content are
present.
Obsessions
Compulsions
_____ Content involves dirt and germs
_____ Compulsive or ritualized hand
washing
_____ Repeated cleaning of household
items or other inanimate objects
_____ Ritualized showering, bathing, or
toilet routines
_____ Measures taken to prevent contact with
household contaminants
_____ Mental rituals associated with contamination
_____ Concerns or disgust with bodily waste or
secretions
_____ Content involves environmental
household contaminants
_____ Content involves insects or animals
_____ Bothered by sticky substances
_____ Content involves worry about becoming
ill because of contamination
Avoidance
_____ Intentional avoidance of places or things because of these obsessions or compulsions
Other symptoms in this category (describe):____________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Symptoms in this category were present during the past week? Yes No
If yes, complete the next page. If no, skip to next section.
12
Severity (past week) of Contamination Obsessions and Cleaning Compulsions
1. How much of your time is occupied by these obsessions and compulsions? Or how
frequently do these obsessive thoughts and compulsions occur? Be sure to include the amount of time
wasted by avoidance behaviors.
0 = No time at all
1 = Rarely, present during the past week, often not on a daily basis, typically less than 3 hours/week
2 = Occasionally, more than 3 hours/week, but less than 1 hour/day - occasional intrusion, need to
perform compulsions, or avoidance (occurs no more than 5 times a day)
3 = Frequently, 1 to 3 hours/day - frequent intrusion, need to perform compulsions, or avoidance
(occurs more than 8 times a day, but most hours of the day are free of these obsessions,
compulsions, and related avoidance)
4 = Almost always, more than 3 and up to 8 hours/day - very frequent intrusion, need to perform
compulsions, or avoidance (occurs more than 8 times a day and occurs during most hours of the
day)
5 = Always, more than 8 hours/day - near constant intrusion of obsessions, need to perform
compulsions, or avoidance (too numerous to count and an hour rarely passes without several
obsessions, compulsions and/or avoidance)
2. How much distress do these obsessions and related compulsions cause? In most cases,
distress is equated with anxiety, guilt, a sense of dread, or a feeling of exhaustion. It may be helpful to think
about how distressed you would feel if you were prevented from performing your compulsions? Or how much
distress you feel from needing to repeat your compulsions over and over again. Or how you would feel if you
encountered something (person, place, or thing) you were planned to avoid? [Only rate distress or
discomfort that seems triggered by these obsessions, the need to do the compulsions, or distress associated
with avoidance.]
0 = No distress
1 = Minimal - when symptoms are present they are minimally distressing
2 = Mild - some clear distress present, but not too disturbing
3 = Moderate - disturbing - but still tolerable
4 = Severe - very disturbing
5 = Extreme - near constant and disabling distress
3. How much do these obsessions and related compulsions interfere with your
family life, friendships, or ability to perform well at work or at school? Is there anything you
can't do because of them? How much do these symptoms bother other people and so affect your
relationships with them? If you avoid things because of these thoughts, please include the interference that
is the result of that avoidance. If you are not currently studying or working, how much would your
performance be affected if you were a full time student or employed?
0 = No interference
1 = Minimal, slight interference with social or occupational activities, overall performance not impaired
2 = Mild, some interference with social or occupational activities, overall performance affected to a small
degree
3 = Moderate, definite interference with social or occupational performance but still manageable
4 = Severe interference, causes substantial impairment in social or occupational performance
5 = Extreme, incapacitating interference
13
Checklist of Collecting and Hoarding Obsessions and Compulsions
Checklist check once () for any symptoms present during the past week.
This is a distinctive category that at times overlaps with concerns about doing harm. Check only if
clear obsessions or compulsions that include collecting and hoarding are present.
Obsessions
Compulsions
_____
_____
_____
_____
_____ Hoarding
_____ Mental rituals that relate to hoarding
Content involves needing to save things
Content involves distress over discarding things
Unable to decide to throw things away
Obsessions about losing things
Avoidance
_____ Intentional avoidance of places or things because of these obsessions or compulsions
Other symptoms in this category (describe):____________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Symptoms in this category were present during the past week? Yes No
If yes, complete the next page. If no, skip to next section.
14
Severity (past week) of Collecting and Hoarding
1. How much of your time is occupied by these obsessions and compulsions? Or how
frequently do these obsessive thoughts and compulsions occur? Be sure to include the amount of time
wasted by avoidance behaviors.
0 = No time at all
1 = Rarely, present during the past week, often not on a daily basis, typically less than 3 hours/week
2 = Occasionally, more than 3 hours/week, but less than 1 hour/day - occasional intrusion, need to
perform compulsions, or avoidance (occurs no more than 5 times a day)
3 = Frequently, 1 to 3 hours/day - frequent intrusion, need to perform compulsions, or avoidance
(occurs more than 8 times a day, but most hours of the day are free of these obsessions,
compulsions, and related avoidance)
4 = Almost always, more than 3 and up to 8 hours/day - very frequent intrusion, need to perform
compulsions, or avoidance (occurs more than 8 times a day and occurs during most hours of the
day)
5 = Always, more than 8 hours/day - near constant intrusion of obsessions, need to perform
compulsions, or avoidance (too numerous to count and an hour rarely passes without several
obsessions, compulsions and/or avoidance)
2. How much distress do these obsessions and related compulsions cause? In most cases,
distress is equated with anxiety, guilt, a sense of dread, or a feeling of exhaustion. It may be helpful to think
about how distressed you would feel if you were prevented from performing your compulsions? Or how much
distress you feel from needing to repeat your compulsions over and over again. Or how you would feel if you
encountered something (person, place, or thing) you were planned to avoid? [Only rate distress or
discomfort that seems triggered by these obsessions, the need to do the compulsions, or distress associated
with avoidance.]
0 = No distress
1 = Minimal - when symptoms are present they are minimally distressing
2 = Mild - some clear distress present, but not too disturbing
3 = Moderate - disturbing - but still tolerable
4 = Severe - very disturbing
5 = Extreme - near constant and disabling distress
3. How much do these obsessions and related compulsions interfere with your
family life, friendships, or ability to perform well at work or at school? Is there anything you
can't do because of them? How much do these symptoms bother other people and so affect your
relationships with them? If you avoid things because of these thoughts, please include the interference that
is the result of that avoidance. If you are not currently studying or working, how much would your
performance be affected if you were a full time student or employed?
0 = No interference
1 = Minimal, slight interference with social or occupational activities, overall performance not impaired
2 = Mild, some interference with social or occupational activities, overall performance affected to a small
degree
3 = Moderate, definite interference with social or occupational performance but still manageable
4 = Severe interference, causes substantial impairment in social or occupational performance
5 = Extreme, incapacitating interference
15
Somatic Obsessions and Compulsions Symptoms
Checklist check once () for any other symptoms present during the past week.
Do not include symptoms related to body dysmorphic disorder or hypochondriasis. In hypochondriasis
subjects believe that they have a serious illness or they are preoccupied with the idea that they do have a
serious illness.
Somatic obsessions
_____ Content involves illness or disease
Related compulsions
_____ Checking or other compulsions
related to somatic obsessions
_____ Mental rituals other than checking related to
somatic obsessions
Avoidance – somatic obsessions
_____ Intentional avoidance of people, places or things because of any of the above
obsessions or compulsions concerning illness or disease
Other symptoms in this category (describe):____________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Symptoms in this category were present during the past week? Yes No
If yes, complete the next page. If no, skip to next section.
16
Severity (past week) of Somatic Obsessions and Compulsions*
1. How much of your time is occupied by these obsessions and compulsions? Or how
frequently do these obsessive thoughts and compulsions occur? Be sure to include the amount of time
wasted by avoidance behaviors.
0 = No time at all
1 = Rarely, present during the past week, often not on a daily basis, typically less than 3 hours/week
2 = Occasionally, more than 3 hours/week, but less than 1 hour/day - occasional intrusion, need to
perform compulsions, or avoidance (occurs no more than 5 times a day)
3 = Frequently, 1 to 3 hours/day - frequent intrusion, need to perform compulsions, or avoidance
(occurs more than 8 times a day, but most hours of the day are free of these obsessions,
compulsions, and related avoidance)
4 = Almost always, more than 3 and up to 8 hours/day - very frequent intrusion, need to perform
compulsions, or avoidance (occurs more than 8 times a day and occurs during most hours of the
day)
5 = Always, more than 8 hours/day - near constant intrusion of obsessions, need to perform
compulsions, or avoidance (too numerous to count and an hour rarely passes without several
obsessions, compulsions and/or avoidance)
2. How much distress do these obsessions and related compulsions cause? In most cases,
distress is equated with anxiety, guilt, a sense of dread, or a feeling of exhaustion. It may be helpful to think
about how distressed you would feel if you were prevented from performing your compulsions? Or how much
distress you feel from needing to repeat your compulsions over and over again. Or how you would feel if you
encountered something (person, place, or thing) you were planned to avoid? [Only rate distress or
discomfort that seems triggered by these obsessions, the need to do the compulsions, or distress associated
with avoidance.]
0 = No distress
1 = Minimal - when symptoms are present they are minimally distressing
2 = Mild - some clear distress present, but not too disturbing
3 = Moderate - disturbing - but still tolerable
4 = Severe - very disturbing
5 = Extreme - near constant and disabling distress
3. How much do these obsessions and related compulsions interfere with your
family life, friendships, or ability to perform well at work or at school? Is there anything you
can't do because of them? How much do these symptoms bother other people and so affect your
relationships with them? If you avoid things because of these thoughts, please include the interference that
is the result of that avoidance. If you are not currently studying or working, how much would your
performance be affected if you were a full time student or employed?
0 = No interference
1 = Minimal, slight interference with social or occupational activities, overall performance not impaired
2 = Mild, some interference with social or occupational activities, overall performance affected to a small
degree
3 = Moderate, definite interference with social or occupational performance but still manageable
4 = Severe interference, causes substantial impairment in social or occupational performance
5 = Extreme, incapacitating interference
17
Miscellaneous Symptoms
Checklist check once () for any other symptoms present during the past week.
Miscellaneous Obsessions
Compulsions
_____ Superstitious fears
_____ Luck or unlucky numbers
_____ Colors with special significance
_____ Intrusive nonsense sounds, words or
music
_____ Intrusive (nonviolent) images
_____
_____
_____
_____
_____ Need to know or remember certain things
_____ Compulsions re: knowing, remembering
Superstitious behavior
Related compulsions
Related compulsions
Related compulsions
_____ Related compulsions
_____ Excessive list making
______ Obsessive slowness
Avoidance associated with Miscellaneous Obsessions and Compulsions
_____ Intentional avoidance of places or things because of these obsessions or compulsions
Other symptoms in this category (describe):____________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Symptoms in this category were present during the past week? Yes No
If yes, complete the next page. If no, skip to next section.
18
Severity (past week) of Miscellaneous Obsessions and Compulsions*
1. How much of your time is occupied by these obsessions and compulsions? Or how
frequently do these obsessive thoughts and compulsions occur? Be sure to include the amount of time
wasted by avoidance behaviors.
0 = No time at all
1 = Rarely, present during the past week, often not on a daily basis, typically less than 3 hours/week
2 = Occasionally, more than 3 hours/week, but less than 1 hour/day - occasional intrusion, need to
perform compulsions, or avoidance (occurs no more than 5 times a day)
3 = Frequently, 1 to 3 hours/day - frequent intrusion, need to perform compulsions, or avoidance
(occurs more than 8 times a day, but most hours of the day are free of these obsessions,
compulsions, and related avoidance)
4 = Almost always, more than 3 and up to 8 hours/day - very frequent intrusion, need to perform
compulsions, or avoidance (occurs more than 8 times a day and occurs during most hours of the
day)
5 = Always, more than 8 hours/day - near constant intrusion of obsessions, need to perform
compulsions, or avoidance (too numerous to count and an hour rarely passes without several
obsessions, compulsions and/or avoidance)
2. How much distress do these obsessions and related compulsions cause? In most cases,
distress is equated with anxiety, guilt, a sense of dread, or a feeling of exhaustion. It may be helpful to think
about how distressed you would feel if you were prevented from performing your compulsions? Or how much
distress you feel from needing to repeat your compulsions over and over again. Or how you would feel if you
encountered something (person, place, or thing) you were planned to avoid? [Only rate distress or
discomfort that seems triggered by these obsessions, the need to do the compulsions, or distress associated
with avoidance.]
0 = No distress
1 = Minimal - when symptoms are present they are minimally distressing
2 = Mild - some clear distress present, but not too disturbing
3 = Moderate - disturbing - but still tolerable
4 = Severe - very disturbing
5 = Extreme - near constant and disabling distress
3. How much do these obsessions and related compulsions interfere with your
family life, friendships, or ability to perform well at work or at school? Is there anything you
can't do because of them? How much do these symptoms bother other people and so affect your
relationships with them? If you avoid things because of these thoughts, please include the interference that
is the result of that avoidance. If you are not currently studying or working, how much would your
performance be affected if you were a full time student or employed?
0 = No interference
1 = Minimal, slight interference with social or occupational activities, overall performance not impaired
2 = Mild, some interference with social or occupational activities, overall performance affected to a small
degree
3 = Moderate, definite interference with social or occupational performance but still manageable
4 = Severe interference, causes substantial impairment in social or occupational performance
5 = Extreme, incapacitating interference
*Just include the miscellaneous obsessions and compulsions listed on p.17 in making these severity ratings
19
Global Obsessive-compulsive Symptom Severity
Indicate your best judgment concerning which symptom categories are present. Review with
the patient how well their obsessions and compulsions fit within a given symptom category: 2 = Clearly
present and symptoms are readily understood in terms of a given symptom dimension; 1 = might be present,
but significant uncertainty exists such that their symptoms are not readily understood in terms of a given
symptom dimension; 0 = symptoms within a given dimension were absent or “probably absent” during the
past week.
_____ Aggressive obsessions and related compulsions
_____ Sexual and religious obsessions and related compulsions
_____ Symmetry, ordering, counting, and arranging obsessions and compulsions
_____ Contamination obsessions and cleaning compulsions
_____ Collecting and hoarding
_____ Somatic obsessions and compulsions
_____ Miscellaneous obsessions and compulsions
Rank order the symptom categories by severity for the past week. 1 = most severe, 2 = next most
severe, and so on. Please mark each category. If symptoms were absent during the past week, place a "0"
in the space provided.
_____ Aggressive obsessions and related compulsions
_____ Sexual and religious obsessions and related compulsions
_____ Symmetry, ordering, counting, and arranging obsessions and compulsions
_____ Contamination obsessions and cleaning compulsions
_____ Collecting and hoarding obsessions and compulsions
_____ Somatic obsessions and compulsions
_____ Miscellaneous obsessions and compulsions
List the patient's most prominent obsessive-compulsive symptoms:
1.___________________________________________________________________________
2.___________________________________________________________________________
3.___________________________________________________________________________
20
What is the worst thing that the patient worries will happen if she/he did not respond to
obsessive thoughts or urges to perform compulsions or rituals? Please describe:
__________________________________________________________________________
__________________________________________________________________________
How certain is the patient that this feared consequence is reasonable and will actually
occur?
0 = Certain that the feared consequence will not happen
1 = Mostly certain that the feared consequence will not happen
2 = Unsure whether or not the feared consequence will or won't happen
3 = Mostly certain that that the feared consequence will happen
4 = Certain that the feared consequence will happen
Finally review all obsessive-compulsive symptoms endorsed as occurring during the past
week (excluding "other" symptoms judged not be bona fide obsessive-compulsive symptoms) and
make a global severity rating for the past week using the ordinal scales on the next page and
complete the score sheet.
Reliability of informant(s) Excellent = 0 Good = 1
Fair = 2 Poor = 3
21
Global Severity Obsessions and Compulsions (past week)
1. How much of your time is occupied by these obsessions and compulsions? Or how
frequently do these obsessive thoughts and compulsions occur? Be sure to include the amount of time
wasted by avoidance behaviors.
0 = No time at all
1 = Rarely, present during the past week, often not on a daily basis, typically less than 3 hours/week
2 = Occasionally, more than 3 hours/week, but less than 1 hour/day - occasional intrusion, need to
perform compulsions, or avoidance (occurs no more than 5 times a day)
3 = Frequently, 1 to 3 hours/day - frequent intrusion, need to perform compulsions, or avoidance
(occurs more than 8 times a day, but most hours of the day are free of these obsessions,
compulsions, and related avoidance)
4 = Almost always, more than 3 and up to 8 hours/day - very frequent intrusion, need to perform
compulsions, or avoidance (occurs more than 8 times a day and occurs during most hours of the
day)
5 = Always, more than 8 hours/day - near constant intrusion of obsessions, need to perform
compulsions, or avoidance (too numerous to count and an hour rarely passes without several
obsessions, compulsions and/or avoidance)
2. How much distress do these obsessions and related compulsions cause? In most cases,
distress is equated with anxiety, guilt, a sense of dread, or a feeling of exhaustion. It may be helpful to think
about how distressed you would feel if you were prevented from performing your compulsions? Or how much
distress you feel from needing to repeat your compulsions over and over again. Or how you would feel if you
encountered something (person, place, or thing) you were planned to avoid? [Only rate distress or
discomfort that seems triggered by these obsessions, the need to do the compulsions, or distress associated
with avoidance.]
0 = No distress
1 = Minimal - when symptoms are present they are minimally distressing
2 = Mild - some clear distress present, but not too disturbing
3 = Moderate - disturbing - but still tolerable
4 = Severe - very disturbing
5 = Extreme - near constant and disabling distress
3. How much do these obsessions and related compulsions interfere with your
family life, friendships, or ability to perform well at work or at school? Is there anything you
can't do because of them? How much do these symptoms bother other people and so affect your
relationships with them? If you avoid things because of these thoughts, please include the interference that
is the result of that avoidance. If you are not currently studying or working, how much would your
performance be affected if you were a full time student or employed?
0 = No interference
1 = Minimal, slight interference with social or occupational activities, overall performance not impaired
2 = Mild, some interference with social or occupational activities, overall performance affected to a small
degree
3 = Moderate, definite interference with social or occupational performance but still manageable
4 = Severe interference, causes substantial impairment in social or occupational performance
5 = Extreme, incapacitating interference
22
Clinician Rating of Impairment
Finally, we would like you to think about how much impairment these symptoms have caused
cumulatively (up until the present time) to the patient's self-esteem, social, family and job (or
academic) functioning as well as her or his ability to cope with life’s difficulties. Please refer to the
anchor points listed below. Choose the best value between 0-15, including the ones that are
between the anchor points.
0 NONE
3 MINIMAL. Obsessions and compulsions associated with subtle difficulties in self-esteem, family
life, social acceptance, or school or job functioning (infrequent upset or concern about obsessions
and compulsions vis à vis the future, periodic, slight increase in family tensions because of
obsessions and compulsions, friends or acquaintances may occasionally notice or comment about
obsessions and/or compulsions in an upsetting way).
6 MILD Obsessions and compulsions associated with minor difficulties in self-esteem, family life,
social acceptance, or school or job functioning.
9 MODERATE Obsessions and compulsions associated with some clear problems in self-esteem
family life, social acceptance, or school or job functioning (episodes of dysphoria, periodic distress
and upheaval in the family, frequent teasing by peers or episodic social avoidance, periodic
interference in school or job performance because of obsessions and/or compulsions).
12 MARKED Obsessions and compulsions associated with major difficulties in self-esteem, family
life, social acceptance, or school or job functioning,
15 SEVERE Obsessions and compulsions associated with extreme difficulties in self-esteem, family
life, social acceptance, or school or job functioning (severe depression with suicidal ideation,
disruption of the family (separation/divorce, residential placement), disruption of ties - severely
restricted life because of social stigma and social avoidance, removal from school or loss of job).
Reliability of informant(s) Excellent = 0 Good = 1
Fair = 2 Poor = 3
23
DY-BOCS Score Sheet
Patient's name______________________________ Clinician ____________________ Today's Date: __ / _ _ / _ _
mm dd
yy
1. DOCSSS Clinician Severity Ratings by Symptom Dimension for the Past Week
Symptom Dimension
Time
(0-5)
Distress
(0-5)
Interference
(0-5)
Total
(0-15)
Contamination & Cleaning
Hoarding & Collecting
Symmetry, Ordering, Counting & Arranging
Harm due to Injury, Violence, Aggression,
Natural Disasters and related compulsions
Sexual & Religious
Miscellaneous
2. DOCSSS Global Severity Ratings for the Past Week
Time
(0-5)
Distress
(0-5)
Interference
(0-5)
Impairment
(0-15)
Total Score
(0-30)
All Obsessions & Compulsions
Time required to complete the ratings: ________ minutes
2
OC Spectrum Symptoms
Other Somatic obsessions*
Related compulsions
_____ Content involves bodily appearance
_____
_____
_____
____
_____ Content concerns the urge to pluck hair
_____ Content concerns the urge to pick skin
Related grooming compulsions
Related dressing compulsions
Related eating habits
Related compulsions related to
physical exercise
_____ Trichotillomania
_____ Skin picking
Obsessions related to separation or union*
Compulsions
_____ Concerns about being separated from
a close family member
_____ Concerns about becoming or being too
much like another person
_____ Compulsions to prevent the loss of a
close family member
_____ Related compulsions
_____ Content involves food or eating
Tic-related Obsessions*
_____ Staring rituals
_____ Urge to repeat something you heard
* As in the original Y-BOCS, do not include these obsessions and compulsions in the severity ratings.
Specialized rated instruments should be employed to rate separation anxiety disorder, tic disorders,
eating disorders, body dysmorphic disorder, and trichotillomania. They are included here to document
OC spectrum symptoms for research purposes.