YALE-BROWN OBSESSIVE COMPUL^IVE SCALE (Y-BOCS)

"f am nGw going io ask sevral qåe_tiohs about

relerence 1o the.patient's target obsessions): yolr obscssive thoughts", (Makc apecific
Time oceupied by obsessive thoughts
. How much of youi time is occupiéd.by ohsessive
brierintcrniittent intrusions. it niay be thoughts? (When-ohs¢ssion aceur as
of tota houts sich diflicultytolrssess time occupied by them in terms-
cases.estinate
Consider both the number of tines 'the time by deieriniaing how, frequently they. occur.
pre affcctéd. Ask):: How frequently dó theintrusions-poçür- and how many hours of the day
obsessiye
ruiinatigns and preoccupatiöns which: unlike-öhsessions, thiouglhts occui? (Be suire to exclude:
(but:exaggerated)}. áre ego-syntonic and rational
None .

Mild, léss than }hi/daý or

Moderate,1 to 3 hrs/dayor.occasicknal intrusión.
frequehi, intrusion."
.

Severe, greater that 3and.up to 8 Hrst day

or yry frequent intrusion, .
Ib..
Extreme; greater than 8 hrs/day orhear cornstant
:
intrüsion
Obsessiun-frec interväl (notincludd in iotâl _storej.
On:the-average, what is the longest.number of consecutive wakinghours per day. 1hat
are completdly free of obseisiye thoughta? you
of.time tn wiich obscssivé thouglhts.arc absent neeessary, aski] WJat is the loinyogt blpek .

:0 No symptoms .

Long symptom freeinterval, more thain 8 cpisecutive houts/day

Moderátely long.symptom:ffee intenval.nofe than 3 and üp.tosymptom
8
frée..
hours/day syinptóm.freë.: consecutive.
Short syuptom free interval, froml t0.3 eonsecutive höürs/day
symptom free
Extremely: sliórt symptbm' free interval. 1ess than' 1 consecutive
sydiptom=free. '. ** hours/day
.
.

Tnterference due to obsessive.thoughts

How imuclh do yoúr obsessiye tkioughts interfere witl your. rocjal or,
unctionig?. I_. thereanything,that you. do not do becaus of theni? wotk.(or:role)
(lf currently
determine hoiw.much performánce would be affectedif paitient ivere emplóyed]. niof working.
0 .None
1= Mild, slight iiñterference withv social or oeeupatiooal.activities, båt performance.
impaired,
2
Moderate definiteinterference with social pr occuptional.performance, but:stil
nanageable.
3 Sever,causës substántiai.impaimentin sodial or occupationl performance
4 EXtreme, incapacitgting
Distress a_sociated,vith obsessive thoug1ts
Hoy much distressof your 'obsssiv thoughts cause you?
Flt most cases, distress ls.cquatéd wlitf artxleiý: tifwover, patlents may report that thelr
obsessions arc disturbing" but deny "aniety,On rate arixiety that scems triggèred by
obscssions, not generailized ánxiety or-angiet ássoiated with other conditions].
None
:Mild not too disturbing
Moderaiedisturbing but stil-manageable
Severe; very disturbing. ".
Extreime, ineat coinstant.and disbling ilistuofs.
Resistinnce igainst obsession .
Q How inueh ofa!i effort do:yoü máke.to.resist the.obsessive thoughus? How oftci do
iry to disregárd-or turn your attcntiön áway frotnu Jliese tfhoughts as they.cnter you
your mind?
obsessions. How.much the patieit resist_ tlie údsessionS Imay or inay not 'cortolete
with
 measure the seveity
ability tó gontrol them: Note thät.this item doesnot directy
his/her
i.c., the clorn the
of thè intrisive thoughts; râther it rates a maifestation of healtli
'

patient makes 1ocounteract the obsessions by .means otier than avoulance- or thC
performance of compulsions. Thus. the mofe the j:tjent trics to resist: ihe 1èss. umpaurëd
accepl ol hisherfunctioning There are "activë" and "passive". fornis ol reststanice.
Patiente in. behgklora thorapy may be ençourayad 0 opnnternei.thelr ohgvasiv
symptoms.bý nof _truggling against:theni. (e.g just let ihe ihoughts conie". p»N]ve
opposition) orbs inientjonally,bringingon the disuürbing thougis: For the purposes of
this item, consicer use of these behavíoral techniöues as forms of resistance..It dhe
opsessioñs are minimal, the patientmay.notfeel the need to resist.thcm. n such cases. a
rating or "0" should be given.
-NMakeS An cffort to always resist, or symptoins so_minimal doesn't ineed,to, acively
resist
Tries to resist most of the time .

2Makes some effort to resist

3Yjelds to-ait pbsessions without attempting ta
.reluctance| sdntrol theni, but doesso with some
4
Completoly end wlllngly ylelds to all obicsskins
DEGREE OF CONTRO;OVER
Q. How müch contol ÓB`ESSIVETHQUGHTS
do you have.óveryour obsessive thought? How successful arcyou în.
stoppingor diverting your obaessive thinking?
preceding item bn resistançe, the ability of the Cañn youtodismiss, them?, flit contrástio the
closely related o the sevrity of.the intrusive pátient. control his obsessions.is more
0Complete control. thouights.].
Much .control, usually able to
concentrefion stop.or divern obsessions. with.some
cffon and
.3Litlecontrl: rarely
attention:with dfficulty. -successful in stopping or dismissing óbsessions, cai
a oontroi, exporlencod as ..
only- diver
alter öbsessive hinking. completely Invölüntary, rarely able to even momentarily
:The next soveral questlon art
patient's target dompulsfons.] about you compulsive
6. TIME behavjors,"[Make specific reference lo the
SPENT
Q. How.much tinePERKORMING
do. you, spend,COMPULSIVE BEHAVIQRS.
involving activties of daíly living areperforming compulsive. behaviors?, {When.rituals
people does ig take to complete chiefly present, ask:] How müch
routine. activities. becaúse of. longer tiain mosi
compulsions occur-as brief, intermittent
.
your cituals? qWhen.
behaviörs. it may difficult to
perforiming them in
frequently they areteims of totäl hours. In súch cases,
¢stimate
performed. Consider both the nuimber of. time by
assess iime.spent
detërmining how
Perrormod andjhow mañy-haurK, Or tha tine_ cojmpulsions
.compulsive baiavíors, .nog hymber ofdaY anosed. Count:coparate occurrencosarç¢of
are
bathroom. 20 ifferent timès a day to repetitiuns;-e.Ga- patient who goçes into the.
compulsion 20times a day, not Sor5 Xwash, his h¡nds5. imes yery quickly; perlorms
compulsions? [lh most cáses compulsions20I0 Ask:] How fréquently do' you
pertorm
but soie compulsions are
covert (e.g,
are
okservable belhaviors (e-g.; hand washing).
0 None silent checking)J:.

I Mild (spends less than I hr/day

of compul_ivelbehäyiors. perförmiry ionipulsions). or occasional
2 Moderate tspends perforimance
from "to 3. hrs/day performing
perfarmance.of compulsive behaviors"
3 Severe (spends more than compulsions), or frequent
3 and. jup to 8hrslday
frequent.perfarhmance of compulsive behaviors perförming compulsions). or very.
4.Extreme spends. more than: 8 hrsfday, .

performance of.compulsive behavjors perlorming compulsions), or uear eoistaint.

(100 numerous to count).
 COMPULSION-FREE INTERVAL(not includdd ia total scorej
Qn the average, what is ihélongest number ofconsfcutive waking hours per day that you
arecompletely free of conmpulsive behavior?[1 jecessary, ask:):What is the longest
bloek oftimein which compulsions are abestn?
0-Nosymptoms.
I.Long syinplom-feee interyak, more than 8carisekiutivehours/day sýitptonm-free
2 Moderately .long symptom-free interval, nmof¢ than.3 and. up o 8 consècutive
**.

hours/day symptom-frve
Shortsymptom-freeintervpi: froml103 tonseiutive hours/day aymptoms-free
4:Extremely shwrt symptom-ree intervaf less ihfn cónsecutjv hóur/day symptorm
Sree
INTERFERENCE DUE TOCÓMPULSIVE BEHAYIoRs
How ituch do your cimpulsive beliaylors interser lth yout socialor wok (or rolé):.*
fuhetionng? Is. thoré anything that you dori't do because, of. the compulsions? {If
Currertly not, wor3king.deternnine how:inuch pertoramance, would affected if patient
be
, were emplóyed,] *
0 None
1 . Mile, slight.intérference with social or pccupational açtivities: but .overal
performance notimpairéd: i.
2. Modrate definit interférnce withi social ofoçcupational perfomance, but stii
manageable.
.

3Seyetë,causes substantial in:pairment in socialoroccupational performanc

4 Extrme; incapäcitating 1 .'
DISTRESSASÖCIATED WETHcOMPULSIyE BEHAVIOR
o.How would you fel it prevented trom peifoml yout compulsion (4? [Pause)Hoy
anixious would you become? 1Rate degreeof distiess.patieat, would éxperiencei
performanceófthe compulsión were suddeily interrpted without reassurance ofered.
ia most, but.hot all.cases, performing eoimipulsionstreduces anxiety. I in the judgemen:
of the interviewér, anxiety isactually teduced by preventing compulsiöns-in the manne
de[cribed abóut, theM ask:} How arixious doyou'gdtwhile perfogming compulsionis.untii.
.

you'are satissiedthey are.completed?

0 None. . .

1Miló-onlý slightly anxiousif compulaioins pievenied, or only slight anxiety during

perforinance ofcompulsions
2Moderste, fipoits than ansioty would mount. but rorhatn managoable.lf sermpülslons
prevented, or that anxiety:increases but; reniains manageable during performance: of.
comipulsions
3 Seviere, prominent and'very disturbing increaselin anxietyifcompulsións interrupted,
.
or promineri and verydistutbing inorease n anixiety during perforimance of contpulsions
...
4 Extreme, Incapacitating ankiety.from any intervention aimed atmódifying activity,
.or incapacitating anxieiy develops.dyring perforinaice of
commpuilsions..
:Q.
RESISTANCE AGAINST COMPÜLSIONS
How much of au effort of you make to iesist the oompulsions?.{Only rate effort made to.
resist, not sucçess of failute. in actually controlilng the compulsions, How much the
patient resist the compulsions may ör may.iot cortelate with his ability to.control.them.
Noto that thls ltem dovu not dlrootly menaure the liiverly of the sompulslohat mther.t
rates a mainifestationi of healti,.ie., the effort the patlent makes to counteract the*
compulsions. Thus, the more the patient tries to resist, Ihe less impaired is this aspect of
his functioning f die cortipulsions are minimát, (he patient may not fell the need to resist
them, In such cáses; a rating of")":should,be given]
0 Makes an dffort to always resist, symptomss0 hiinimal doesn'ti need' to aclively resist
Tries to resis1 most of the tinie .

2 Makes sonie¢ffort to resist

3Yields-to almost al compu'sions without.attempting to control thenm, but does so
vith some relucfance
 4.Completely An willingly yielss 1o atlégnup'slsionsBEHAVIOR
DEGREE OF ÇONTROL OVERCOMPUL/ VE
Hpw rtrong ls the prlve to perforn the compuls've heljavlor? [Pause}l 1Hss iuch controf
.
the precedidg itcn on resistance, 1ie
do you have over {hecompulsions? fly coutrast to,iore closcly relatçd sa the s*verity of
ability of tho patiehtto control his compulsiorns,is ,'

the compulsions.]
0'Coinpletecontto
TMuch ¢ontrol experiènces" pçessüre to perforií 1he béhavlor.but usually able to
"
exercise voluntary control over it.
2Moderdtecotról, strong pressure to perform hehavior, can controt it only. withr
difficulty '
"

rtle controtgstonig'driveto perfortuheliaviar. miust be.oarried io completion,

can only.deláy wlil diffiçulsy., " :
No onfrol, dalvé to, perforni belhávlor exp:rienced ns commplte)y involuntary ant
.

overpowering, racely abje to even siomentarly dlaiyaçtivity ,

7*he.remaining questions are.about both.obsessións. and compulsions. Sone ask.aliout related
problems."These'are investigational items not included in total Y-BOCS.5¢ore but may hé uSetul
in assèssiag these symptoms," ."

I INSIGHT INTo OBSESSTONS ANDcOMPULSIONS

.Q Do you think yout concerns or héhaviors are
would happen yau did not perform the compulsions reasonable? [Pause]; What do you think
would.really happda? [Rate paienes insighe, iato the(s)? Are you corivinced soniething
his obsessións (s) baséd-on beliefs
'expressed sehselessness:
at thhe time.interyiew}: or,cxcessiveness of.
:0 Excellent insigh, fully rational .
1Qod .listght.| Regdily
behaviors but does not seemaoknowledgos
completely
absusdlty. or excessiveness of ihoughts or
anxicty to be cóncemed about (i.e., ha_ convinced ihat.there isn't. sometding. besides
2. Fair insight. Reluctantly- lingering doubts).:
excessive, but wavers: admits. thought or. behavíor seem,
May have spmb unfealistic
.3Poor insight. Maiöains unrcaaónable. "ór
ears; bút no fixed.convietions
that
but acknowledges validity of thougkts or behavjars are not únreasonable or .

4Lacks insightf delusional. contrary evidence (í. pvésvalued jdeas «xcessive.

Definitelyconviced, thiat present),
2. Teasonable.uniesponsiye
Avoidance'.
to. contrary.cvidence,
.' '
concerns' and belhavíor are
Q Have you beeú avojding doing
of your obsessiona anything. going any place, or bøing with
then àsk:} How much do thoughts of out of concern yoiu, asiyop beáuse
avoid things. $ontetimes yos.ayoid? wilt.perform
{Rate degre to which patient compulsíons? f yes;
that the päticat. fcsts Porcompulsions áre desigied to:"Avoid" contact delíberatelytries to
example, clothes witr sonietlhing
compulsion_; riot ás avoidant behävior. If the washing rituals would.be designatéd ás "
would constiute avoidance. patient stopped doing the laisndry
0 No
delibèrate thén this.
Mild, Minimalavoidance
voidance
2 Maderate, sone
3Severe avoidänce; çlcarly.presen
niuch' avoidaroe; avoidance
4
Extreme, very extensive avoidánce;prominent .

avoid triggering.syumptoms patiept does álmost everytlhing

Q.
DEGRET r INDEO18IYENESS helshie, can"jo
Do you have. trouble
thing twice about (elg making
Which
decisiolis. about liule ihings that
oiher:people
buy)?. [Exclude dfficulty clcthes to put on i he
ihe morning.
norning hich
which e miglit
might ino
no:
con uly . making de
miáking decisions: which' refect brand oldereat io
Ambivalenee
Ambivalence
0 None conceining ruminative -ilinking.
rationally-based difiçull çhoicés sloüld also
.

Mild, be excluded):
some lroubte making decisjons
about minor things
 2 Moderate, freely reports sigr ificant trouble naking decisións that others would not

thinktwice qbout
3 Severe, continual iveighing ofpros andons böatnonessentials.
4.Extreie: üable. to niake äny:decisions Disabfing.
OVERVALUED SENSE OFRESPONSIBILITY
Doyou f¢el very responsible: for the. conseqücrces óf:your actions? Do you blame
hot ¢ormpletely in your control? [Distinguish from
yourslf for the outçome of eveiits worthlessness.änd pathological guiliA
noriial feelings, of responsibíliy: fcelings.öf as.bad or evil)
°

guilt-ridden person expericinces.himsel!orhisactions

.

0 Nomc.
senise of over-responsibility
Mild, only meintionedoni questioning,slight
çlearly.present; patient experiencessignificant
2 Moderate ideas stated.spontaneously,
his/her reasonable contról
evemsoutside
sense ofóver-responisibility for and.peivasivei;: deeply concerned he/she is responsible
for
Scvere, ideas prominent
Self-blaming farfetched-andnearly irrationa!
3
cvents olearly outside:his control.ofresponslbillty (elg, Ifan carthquake
occurs3.000 miles
4 Extreme, delislonal sense
petform.het compulsions)
away patientblames herselfbecause shedidn't OEINERTIA : *

SLOWNÉsS/DISTURBANCE
15 PERVASIVE tàsk? Do maný roütine activities take longer
starting of finishing to depressiorn.
Q. Do you have difficuly from psychömotor retardation.seoondary
[Distinguish: obsessions
than tkey should?
performing roufine, activitiës evei wfhen specific.
Rate incréasèd tíine.spent
cannot be identifies).
0 None. starting orfinishíng activities but tasks úsually. ompletd. .
Mild, occásional.delay-in prolóngation. of routine
2 M o d e r a t e , frequcnt.
routine täsks.
Frequently late.,": difmculty lnlttatíng and complettng, .
marked
Soverc, pervaslve and,
.

:3 full ássistance.
: Usually.late. start or complete routine task without
4Extrome, unable to Do you
16, PATHOLOGICAL DOURTING
whether you performed it correctly?
an àctivity> doyou doubt
find that you
After.you completë ouf roútine activitis do you
Q at al1?When camying
doubt xhether. you didit what iýou see,heat, or fouch)?
don't trust your sënses (i.e., .
given may
pathoiogicel doubt. Exanples
'.

0None.
:=Mild,only mentioned
on queszioning,slight
some of
be.withinnormaB range. spontaneously%, clearly
present and'apparent in effn4t on
doubt. Some
2 Moderate, ideas stated, by slgnlficshi. pathologleal
behavioris.pätlenf botherid
patient' patholögical doubt
niemory prominent;,
.petformancebut stillmana eabl.
uncertainty.about perceptions o
3.Severe, doubt
frequently affects përformance.
perceptions histantly
present; pathological
mind
4Extréine, üncertainty
about
all.actiyities.-lneapacitating (eg, patientstates "my
substantialy affects almost.
eyes see"). consider globalfunction,
doesn't trust iwhat.my illness severity, Therater is required1o
to global
tems 17and,18refer obsesive-compulsivesymptoms
rioljust thie severity of fróm 0(no.
17 GLOBAL SEVERITY ofhe patient'sillness. Rated
the áverall severity raported .bythe
Interviewers judgement of (Conildon the degreé of dlstress Your
(iost gevere'putient seen) :furetional impairment reported.
iliess) to 6 and. the reliability or.
syniptoms, observ d, well a_ weighing the
patient, "tie this data during
judgenient is required
both in averaging
judgennent is(básed oii inforination obtained
This
accuracy of the datä obtained:
theinterview)..
0'Noillnes. transient:no functionafimpairment
1 llness slight,doubtful,
 2 Hlness slight, doubtful, transient; 1:o functional impairment
3 Moderat.symptoms, functions with effort
4 Moderat-Severe symptoms,limited functioning
S Severe syiploms, funètions mainly wilh assistaice
Extremely Severe symptoms, completcly numlunctional
18. GLOBAL IMPRoVEMENT whether or
Kate total oyéralf improvement present,SINCE THE INTTLAL RATING
not, in your judgement, it is due tó drug treatmen
0Vorymuehworne.
Much wdgse
2Miaimallyvacke
3 No change.
4Minimally improved
S Much improved
Veny mudli improved
19.
RELIABILATY.
Rate the.overall reliabifity of the ra:ing scores obiained. Factors
reliability inclide the patientes. cooperatives and,.his/iet natural ability "that
1o
may aieci.
The type and severity of obsessive-comful_ive communiçate.
sympkoms.present
patients concpntration, attention, pr freeonm to speak may,inierlere wih tne
ome obremlons mayONUse tho spontanieöusly(e.g, lhe contcnt of
pátlent tci ohadie.hle wórdi very datefully). .
0 Excellent
no reason to suspect data inreljable
1 Good,
factor (s)
2 Fair, factdr(s) present that rmay adversely åffeci reiiabiliy.
present that definitely reduçe reliability
3Poor, very lowreljability"
Items 17,and 18. are adapted.
ECDEU) Asessment Manúal, from-the. Clinical.Global nipression Sale (Gus .W:
Washington, D.C, U.S: Departmentfor. Psychápharinacology: Publicaüon
Additional! information regarding theof Health, Equc«tion, and Welfare{976): 76-338.
3
the Y-BOCS *an be found development,
in Goödmn WK, Price Lll, use, and psychormetric.properiies of
Brown Obsessive Compulsivo Rasmussen
Soale (YWK,,Priçe LH. Rasmussen SA: ei al: The Yale-
Brown Qbroutive Chmputulv» 8onle
(46;1012-101;1989), (Y»cS, Part 1I Valldlty SA; el al: The Yële-
Aroh Gen Peycl1latry.
Copies of aversion of. the YBQCS
Brown Obsessive Compulsive Scäle modified for use in children, the Children's Y'ale
LH, Mazure: C; Rapoport JL, (CY-BOCS) (Goodman WK, Rasmyssen SA, Price
Goodman on request. Heninger GR, Charney DS), is. available from Dr.
oiwL

3.15 HAL

-31 Sur
xLrunad