Yale Brown Obsessive

Compulsive Scale
(Y-BOCS)
201824015 Ayşe İdil BURGAZ
201724056 Şevval TOPRAK
201824002 Didem AKKAYA
 Content of the
Presantation
1.Purpose and the nature of the questionnaire
2.Practical evaluation
3.Technical evaluation
4.Questionnaire reviews
5.The other versions
 What is OCD?
• Obsessive–compulsive disorder is characterized by intrusive
unwanted thoughts, fears or images (obsessions) and/or ritualized
behaviors or mental acts (compulsions), generally performed to
relieve the anxiety and/or distress caused by the obsessions.

• Obsessive–compulsive disorder is considered to be the fourth most

common mental disorder and is frequently accompanied by family,
social, school and work dysfunctions.
• Obsessive–compulsive disorder (OCD) has a lifetime prevalence of 2–3%,1
affecting all age groups, across different cultures.
• The World Health Organization (WHO) estimated OCD to be among the
top 10 causes of years lived with illness related disability by 2020.
• Current classification manuals, such as the DSM-IV and the ICD-10
(WHO), regard OCD as a unitary nosological entity. While this approach
has added specificity to research studies, it may be misleading. In fact,
obsessive–compulsive (OC) symptoms are remarkably heterogeneous.
1 - PURPOSE AND THE NATURE
OF THE QUESTİONNAİRE
• Y-BOCS was developed by Wayne K.
Goodman et al.
• The scale was published in 1989.
• The Y-BOCS is designed to quantify
symptom severity and evaluate the
clinical course and the results of the
treatment response in patients with
diagnosed OCD. The Y-BOCS was
not intended to be used as a diagnostic
tool.
• Used worldwide, with translations
into more than 20 languages, it serves
as the primary outcome measure in
clinical trials of pharmacological
agents as well as in studies of
behavior therapy.
 General Information About Y-BOCS
• The Y-BOCS consists of two parts: the Symptom Checklist for evaluating the
presence of current and past symptoms, and the ten-item that assess obsessions and
compulsions separately in five dimensions (time spent, interference, distress,
resistance, and control). Separate Obsession (items 1 to 5) and Compulsion (items 6 to
10).
• Patients are graded weekly with Y-BOCS. Test application time varies between 6
weeks and 12 weeks.
• The interview typically takes 30–40 min to complete.
• The scale includes 19 items.
 Development and Design
• Item selection was based on the extensive clinical experience of the principal developers of the Y-
BOCS who collectively have examined more than 300 patients with OCD. Several versions of the
scale were piloted over a 6-month period until the first edition form was finalized.
• To maximize specificity for OCD, an attempt was made to exclude items that seemed to reflect
symptoms of depression or other anxiety disorders, item 1b enhance the sensitivity of the Y-BOCS to
change, items intended to measure putative state variables were included in the core portion of the Y-
BOCS, while items believed to reflect personality traits (eg, perfectionism) were excluded.
• Certain clinical features commonly associated with OCD, but not clearly related to the severity of the
illness, were assessed by items in the investigational component of the Y-BOCS.
 The Questionnaire Measure...
• The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was created to address the
shortcomings of previous scales by offering a standardized measure of the severity of
OCD symptoms (as specified by DSM-III-R) that is unaffected by the form or number
of obsessions or compulsions present.
• Unlike other rating scales, the Y-BOCS does not rely on the content of a patient's
symptoms when determining the seriousness of OCD.
• Due to evidence from other disorders that ratings based solely on self-report, especially
during acute stages of illness, do not correlate well with more objective evaluations, the
Y- BOCS was developed as an observer-rated instrument.
• As a result, the Y-BOCS core items (1–10) evaluate the severity of OCD's cardinal
symptoms (obsessions and compulsions) in terms of time, action, anxiety, resistance, and
control.
• Although all 19 items are scored, thetotal score is calculated using only items 1-10
(excluding items 6b and 1b). The fixation and addiction subtotals are the sums of items 1 through
5 (excluding lb) and 10 (excluding 6b).
• Items that are not included in scoring are below.
Questionnaire Designed For...
• Y-BOCS was prepared to scale the OCD symptom severity in adults and older
children.
• There is also a modified version of Y-BOCS for children (CY-BOCS). Participants
aged 6 to 17 are given the CY-BOCS, while those aged 18 and up are given the
Y-BOCS.
 Nature of the Test

• The Yale-Brown Obsessive Compulsive Scale is a standardized rating

scale with both clinician-administered (semi-structured interview)
measuring 10 items pertaining to obsessions and compulsions on a
five-point likert scale.
• Although Goodman et al. developed the Y-BOCS as a clinician-administered
measure with the purpose of making a more objective evaluation during the
acute stages of illness, several self- report versions of the Y-BOCS were
subsequently developed, including computer-administered and paper-and-
pencil forms.
• The self-report Y-BOCS is a time-saving (10 min. to complete), less costly
substitute for the interview format for assessing OCD symptoms. The present
study revealed a moderate relationship between the two assessment measures
(.45–.65) in a large sample of patients with OCD.
• The two formats generated similar results with respect to mean scores on the
Obsessions subscale, however, ratings from the Compulsion subscale were
more highly correlated. This finding suggests that compulsions may be easier
to assess than obsessions, perhaps because they are often observable behaviors
that are more straightforward to describe and report. Obsessions may also be
more easily confused by respondents with other phenomena, such as worries (
Taylor, Thordarson, & Söchting, 2002), an issue that can be corrected by
careful pre-instruction .
• Greist and colleagues have adopted the Y-BOCS for
computer administration, including the checklist, and
found excellent agreement between it and the clinician-
rated version.
• In the OCD analysis, the computer-administered version of
the Y-BOCS had a clear correlation with the clinician-
administered version and was equally capable of
separating OCD patients from subjects in the other two
groups ( patient with anxiety disorder and the nonpatient
group).
• Subjects seemed to comprehend and enjoy the process,
with no preference for the clinician interview over the
computer interview.
 The Format of the Questionnaire
• The Y-BOCS Symptom Checklist includes 75 different types of obsessions and
compulsions divided into 15 larger categories according to the behavioral
expression (eg, washing or cleaning) or thematic content (eg, aggression or
contamination) of the symptoms.
2 - PRACTICAL EVALUATION
Administration Process
• It has a long and detailed administration process, so it is a little bit difficult to administer.
• The Y-BOCS interview was administered in accordance with the manualized instructions.
• A trained clinician first explained the definitions of obsessions and compulsions to
ensure that participants understood each concept.
• The clinician then administered the symptom checklist portion of the interview, asking
respondents whether any obsessive or compulsive behaviors were currently or previously
experienced.
• From the items identified, the three most distressing symptoms from both the obsession and
compulsion categories were selected and the respondent answered questions related to
severity in five domains: time spent, interference, distress, efforts to resist, and perceived
control.
• Past symptoms should also be identified and remembered since they can reappear during subsequent ratings. The
rater faces a challenge when previously diagnosed obsessive compulsive symptoms resurface during treatment
because scoring them may wrongly mean that the seriousness of the patient's symptoms has increased or that
new symptoms have formed.
• It can be difficult to tell whether a patient has obsessions and compulsions or just compulsions in certain
situations.
• For example: if a patient reports wasting hours of his or her evenings or symmetrically arranging items in his
or her immediate environment as a compulsion, does this qualify as an obsession? One might deduce that his or
her obsession is a desire for symmetry, but is this just a construct created by the clinician to justify the
patient's bizarre behavior? There is currently no c l e a r response to this issue. If the patient claims that
rearranging the pencil on his or her desk is an attempt to expel traumatic memories of his or her parents in a car
accident, the action seems to be motivated by ideation (obsessions). If the patient does so simply because it
"feels right," it may be a compulsion.
• The final score for each object, however, should be a composite rating of all of the patient's obsessions or
compulsions.
 Scoring Procedures
• Total Y-BOCS scores range from 0 to 40, with the goal of grading severity based on the amount of
time spent dealing with symptoms.
• It has ten question items that range from 0 (no symptoms) to 4 (severe symptoms) ,with five
questions dedicated to obsessions and five questions dedicated to compulsions.
• Total scores are made up of the number of marginal scores for obsessions (0-20) and compulsions
(0-20), which can potentially range from 0 (no symptoms) to 40 (maximum severity).
• subclinical symptoms 0-7
• mild symptoms 8-15
• moderate symptoms 16-23
• serious symptoms 24–31
• extreme symptoms 32–40.
Qualifications and Training That Test
Administrator Need to Have

• It can be administered by a clinician or trained

interviewer in a semi-structured fashion. Raters must
be trained both on administration of the measure and
with respect to OCD symptomatology.
Time for a quick summary !

Staff Psychologist Dr. Cindy Haines.

 2 - TECHNICAL EVALUATION

• 14 men and 26 women that

includes 10 inpatients and 30
outpatients which means 40
patients in total.
Psychometric Proporties of the Y-BOCS
Reliability
• Based on results from the pilot study, the required sample size for an extended interrater reliability
study was calculated. It was anticipated that this sample size (40) would be large enough to allow for
inclusion of patients with a wide range of symptom severity.
• Forty patients were enrolled in placebo-controlled drug trials (either fluvoxamine maléate or
clomipramine hydrochloride) at the Clinical Neuroscience Research Unit of The Connecticut Mental
Health Center, New Haven, and represented all clinic patients with OCD appearing consecutively for
their routine therapy/evaluation appointments during the duration of the reliability study.
• In the original research, using a videotaped interview method, interrater agreement on the Y-BOCS
among 4 trained raters proved excellent.
• Study were at various stages of drug or placebo treatment.
• 19 patients were at the beginning of treatment, 12 were midway in their treatment protocol, and 9 had
completed their drug protocols.
 Interrater Reliability

• In the pilot study, spearman correlations revealed that raters generally

agreed with each other on how to rank order the patients. All rater
pairs demonstrated significant correlations (r=.72 to .98; P<.05).
Calculation of intraclass correlations revealed r =. 80 (P<. 05). This
datas clearly shows that there is excellent interrater reliability for the total
Y-BOCS score and the 10 individual items.
• Pearson's correlation coefficients between rater pairs and intraclass correlation
coefficients demonstrated excellent agreement between all raters for the Y-
BOCS totals and individual items.
Intraclass correlation coefficients
• One-way random-effects ANOVA model, were also computed
to assess interrater reliability.
 Internal Consistency
• Coefficient represents the average intercorrelation among all the
items of a test, such that ranges from 0.0 to 1.0, with 1.0
reflecting perfect homogeneity.
• The a coefficients were as follows: rater 1, = .90; rater 2, a
= .88; rater 3, = .90; rater 4, a = .91; and the mean of all raters, =
.89 (P<.001).
Analysis of Individual Items
• Pretreatment ratings from 42 outpatients with OCD entered in a trial of
fluvoxamine vs placebo.
• This set of ratings was chosen for the analysis of individual items because it
was obtained from patients representing a wide range of symptom types and
severity. For example, a variety of compulsions were present in these patients,
including mental rituals, checking, washing, repeating, and counting. All but
two patients had both obsessions and compulsions. This study included patients
with OCD both with and without substantial secondary depressive symptoms
(ie, about 50% met DSM-III criteria for major depression), reflecting a typical
sample of patients presenting for treatment.
 Validity
• In the original study, convergent and discriminant validity were
examined in baseline ratings from three cohorts of OCD patients
(total n=81).

Convergent validity
• (CGI-OCS) (r=.74; P<.0001; = 78)
• (NIMH-OC,) (r= .67; P<.001; =20)
• But not with MOCI.
 Discriminant Validity
• When the discriminant validity was
examined, it was found that there were weak
correlations between the total Y-BOCS score
and ratings of depression and anxiety in the
OCD patient samples with low levels of
secondary depressive symptoms. In contrast,
the discriminant validity of the Y-BOCS
could not be established in OCD patients
with prominent depressive symptoms .
 Sensitivity to Change

• Several drug treatment studies in OCD have shown that the Y-BOCS is a
sensitive measure of changes in severity of obsessive compulsive symptoms.
These data not only indicate that the Y-BOCS is sensitive to change, but that it
is also stable under untreated conditions.
3 - QUESTIONNAIRE REVIEWS
• Karamustafalıoğlu O. and collegues have standardized the Y-
BOCS into the Turkish in 1993.
• We couldnt reach this scale.
• Psychometric properties of Turkish version of the Yale Brown
Obsessive Compulsive Scale for heavy drinking (Y-BOCS-hd)
were examined in alcohol-dependent male patients by INCI
OZGUR ILHAN, HATICE DEMIRBAS, & YILDIRIM B.
DOGAN.
Another Study
• The prior studies reported that the 10-item Y-BOCS is a reliable and valid instrument for
assessing the severity of obsessive-compulsive symptoms in patients with OCD.
For example:
• A study by Kim and colleagues confirmed the interrater reliability, convergent validity, and
sensitivity to change of the Y-BOCS
• Y-BOCS> LOI
• Moreover, In contrast to inventories such as the Leyton Obsessional Inventory (LOI) and the
Maudsley Obsessional Compulsive Inventory (MOCI), since the total Y-BOCS score is not
directly determined by the number or specific types of obsessive- compulsive symptoms present,
the severity of OCD can be compared in patients with different types of obsession or compulsion.
Thus, the Y-BOCS rates form, not content, whereas information about content is preserved in the
Y-BOCS Symptom Checklist and Target Symptom List.
 Advantages of This Scale
• The Y-BOCS also provides a sensitive and specific measure of
changes in obsessive compulsive symptom severity and is well suited
evaluating specific effects of drug treatment on obsessive
compulsive symptoms.
• Additionally, Greits and colleagues have adapted the Y-BOCS
involving the Checklist for computer management and have
reported that there was an excellent agreement between it and the
clinician-rated version.
 Disadvantages of This Scale
• Checklist not a diagnostic instrument and does not appear useful in
discriminating the severity of OCD from the severity of depression or anxiety in
OCD patients with prominent secondary depression.
• According to Mark H. Freeston and Robert Ladouceur (1998), the symptom
checklist preceding the Y-BOCS is particularly useful in providing an overall
picture of current and previous obsessive-compulsive symptomatology. The
obsession subscale and general assessment items are also useful in evaluating the
current severity of OCD, but the application of the compulsion subscale to
neutralization strategies may not always be easy.
Other Versions
Y-BOCS-II
• Y-BOCS-II, is different from the revised first edition (1989) in several ways. The most important changes are:
1)“resistance against obsessions” (item #4) has been replaced by “obsession-free interval” ( item #2). In several studies this item
had the lowest correlation with the total Y-BOCS score. This item was not directly measure the severity of the intrusive thoughts;
rather it rated a manifestation of health. The more the patient tried to resist obsessions, the less impaired was this aspect of his/her
functioning. Conversely, patients who made less effort to resist their obsessions were viewed as less healthy or more severely ill.
2)The new item 2 (“obsession-free interval”) is intended to examine a dimension of symptom severity (duration of symptom-free
interval) that complements item 1 (duration of symptoms).
3)the scoring of all items has been expanded from 5-point (0-4) to 6-point (0-5) response scales, so that the upper limit on the
total Y- BOCS-II (sum of items 1 –10) is now equal to 50 instead of 40.
4) The new version has 66 examples of obsessive - compulsive symptoms compared to the 75 listed in the first edition.
• These changes should not have significant effects on the established psychometric performance of the scale.
• Although the Y-BOCS remains a reliable and valid measure, the Y-BOCS-II may provide an alternative method of assessing
symptom presence and severity.
Y-BOCS-II
 DY-BOCS( Dimensional Yale Brown OC Scale)

• DY-BOCS is based on the Yale–Brown Obsessive–Compulsive Scale (Y- BOCS)

created by Goodman et al.
• The DY-BOCS is a semi-structured interview-based scale for assessing the presence and
severity of OC symptom within five distinct dimensions.
• 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 checking related to contamination
worries.
• Patients are asked to endorse both lifetime and current symptoms, reviewed by a clinician
to ensure that endorsed items meet OC symptom guidelines.
• a) 88-item OC symptom checklist
• b)rating scales for each OC symptom dimension, for the
assessment of the impairment caused by the symptoms and an
overall estimate of OCD severity. The checklist provides a
detailed description of five OC symptom dimensions:
1) Aggressive Obsessions and Related Compulsions
2) Sexual/Religious Obsessions and Related Compulsions
3) Symmetry Obsessions and Related Compulsions
4) Contamination Obsessions and Related Compulsions
5) Miscellaneous Obsessions and Related Compulsions
• The Y-BOCS and the Children’s Yale–Brown Obsessive–
Compulsive Scale (CY-BOCS) were used for
measurement of convergent validity.
• Considerable data support the reliability and validity of both
the adult and child versions of this scale.
• The global DY-BOCS score was highly correlated with the
total Yale–Brown Obsessive–Compulsive Scale score
(Pearson r = 0.82, P < 0.0001).
 CY-BOCS (Childreen Yale Brown OC Scale)
• This scale is designed to rate the severity of obsessive and compulsive symptoms in children and
adolescents, ages 6 to 17 years. It can be administered by a clinican or trained interviewer in a
semi-structured fashion.
• In general, the ratings depend on the child's and parent's report; however, the final rating is based on
the clinical judgement of the interviewer. Rate the characteristics of each item over the prior
week up until, and including, the time of the interview.
• Scores should reflect the average of each item for the entire week, unless otherwise specified.
• The main difference between the Y-BOCS and the Children's Y-BOCS is the substitution of
simpler language for the various item probes.
• Based on research, this assessment has been found to be statistically valid and reliable.
• Items are same with the Y-BOCS’s items ( first edition).
• Thank you for listening.
• References
• Wootton, B., & Tolin, D. F. (2016). Obsessive-compulsive disorder. In Encyclopedia of Mental Health. Elsevier Academic Press.
• Rector, N. A., & Arnold, P. D. (2006). Assessment of patients with anxiety disorders. In Psychiatric Clinical Skills (pp. 71-89).
Mosby.
• Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., ... & Charney, D. S. (1989). The Yale-
Brown obsessive compulsive scale: I. Development, use, and reliability. Archives of general psychiatry, 46(11), 1006-1011.
• Rosenfeld, R., Dar, R., Anderson, D., Kobak, K. A., & Greist, J. H. (1992). A computer-administered version of the Yale-Brown
Obsessive-Compulsive Scale. Psychological Assessment, 4(3), 329.
• Price LH, Goodman WK, Charney DS, Rasmussen SA, Heninger GR (1987). Treatment of severe obsessive-compulsive disorder with
fluvoxamine. Am J Psychiatry. 144:1059-1061.
• Goodman WK, Price LH, Rasmussen SA, Delgado PL, Heninger GR, Charney DS.(1989) Efficacy of fluvoxamine in obsessive-
compulsive disorder: a double- blind comparison with placebo. Arch Gen Psychiatry. 46:36-44.
• Goodman WK, Price LH, Rasmussen SA, et al (1989) The Yale-Brown Obsessive Compulsive Scale (Y-BOCS): Part II. Validity. Arch
Gen Psychiatry 46: 1012-1016.
• Freeston MH, Ladouceur R, Gagnon F, Thibodeau N, Rhéaume J, Letarte H, Bujold A. (1997) Cognitive—behavioral treatment of
obsessive thoughts: a controlled study. J Consult Clin Psychol ;65(3):405.