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.

1. Time occupied by obsessive thoughts

How much of your time is occupied by obsessive thoughts?

2. Interference due to obsessive thoughts

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?

3. Distress associated with obsessive thoughts

How much distress do your obsessive thoughts cause you?

4. Resistance against obsessions

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?

5. Degree of control over obsessive thoughts

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?

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

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?

7. Interference due to compulsive behaviors

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?

8. Distress associated with compulsive behavior

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

9. Resistance against compulsions

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

10. Degree of control over compulsive behavior

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

0

Points

Functionally, the patient does not report limitations due to their symptoms.

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. Check all that apply. Distinguish between current and past symptoms. These will form the basis of the Target Symptoms List. Items marked may “*” or may not be an OCD phenomena.

ADVICE

Final diagnosis of Obsessive-Compulsive Disorder (OCD) should be made with a structured clinical interview, including a thorough mental status examination and functional assessment.

MANAGEMENT

Y-BOCS Management Summary
Score OCD Severity Suggested Action
0–7 Subclinical No formal intervention required, monitor periodically
8–15 Mild Consider psychoeducation and monitoring; brief CBT if functional impact present
16–23 Moderate Recommend CBT with exposure and response prevention (ERP)
24–31 Severe CBT + pharmacotherapy (SSRIs); consider referral to specialist
32–40 Extreme Urgent referral to OCD specialist; consider intensive outpatient or inpatient program

CRITICAL ACTIONS

  • Y-BOCS is a severity rating tool and should not replace comprehensive psychiatric assessment.
  • Functional impairment and patient distress levels must guide treatment urgency and modality.
  • Screen for co-occurring conditions such as depression, anxiety disorders, or tic disorders.

FORMULA

0–40 score, with 0–4 points for each of ten questions (5 for obsessions, 5 for compulsions).

FACTS & FIGURES

Each question is rated based on:

  • 0 = No symptoms
  • 1 = Mild
  • 2 = Moderate
  • 3 = Severe
  • 4 = Extreme

Items assess time spent, interference, distress, resistance, and control over obsessive and compulsive symptoms separately.

Obsessions subtotal (0–20) + Compulsions subtotal (0–20) = Total Y-BOCS score (0–40)

EVIDENCE APPRAISAL

The Y-BOCS was developed by Goodman et al. (1989) and is considered the gold-standard measure of OCD severity. It demonstrates high inter-rater reliability (r = 0.98), test-retest reliability (r = 0.88), and internal consistency (Cronbach’s α = 0.89). The scale has been validated in clinical trials and has shown strong correlation with functional impairment in OCD.

The updated Y-BOCS-II addresses some limitations of the original, including improved response scales and expanded symptom dimensions, while maintaining robust psychometric properties (Storch et al., 2010).