The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) is the gold-standard tool for
measuring obsessive compulsive symptom severity. An updated second edition was
introduced to address limitations of the original instrument, with both clinician-administered
and self-report versions.
Both the symptom checklist and the severity scale of the clinician-administered Y-BOCS-II
have been evaluated. Results suggest that the symptom checklist clusters into four factors
representing
symmetry/ordering, contamination/washing, hoarding, and sexual/religious/aggressive
symptoms (Storch et al., 2010), which are largely consistent with other studies.
Developed by: Goodman, Price, Rasmussen, Mazure, Delgado, Heninger, and Charney in
1989.
Purpose: To assess the severity and type of symptoms in individuals with Obsessive-
Compulsive Disorder (OCD), independent of the symptom type.
Format:
● Structured clinical interview.
● Also available as a self-report version (Y-BOCS-SR)
1. Symptom Checklist:
▪ Assesses the presence of various obsessions and compulsions.
▪ Includes categories like contamination, aggression, sexual, religious
obsessions, and cleaning, checking, ordering compulsions.
2. Severity Scale:
▪ 10 items divided into:
▪ 5 Obsession items
▪ 5 Compulsion items
▪ Each item rated on a scale of 0 (none) to 4 (extreme).
● Focus: Captures distress, interference, resistance, and control related to OCD
symptoms over the past 7 days.
● Population: Adolescents and adults; used globally in clinical and research settings.
2. RELIABILITY
● Internal Consistency:
● High internal consistency with Cronbach’s alpha ranging between 0.87–0.89,
indicating that the items on the scale measure a cohesive construct.
● Scoring Details
● Each item scored from 0–4:
● 0 = No symptoms
● 1 = Mild
● 2 = Moderate
● 3 = Severe
● 4 = Extreme
● Total Possible Score: 0–40
● Obsessions Subscale (Items 1–5): 0–20
● Compulsions Subscale (Items 6–10): 0–20
Interpretation Guidelines
● Scores should be interpreted in context:
o Functional impairment
o Distress level
o Degree of insight
● Best used alongside clinical interviews and DSM-5 criteria.
● Useful for monitoring treatment response over time (e.g., reductions of 25–35% in
score may indicate treatment response).
THE NATURE OF OBSESSIONAL PROBLEMS
Obsessions Unwanted and distressing intrusive thoughts often called obsessions are
senseless ideas, images, urges, doubts, and ideas that the person experiences as repug-nant,
invasive, uncontrollable, guilt-provoking, and decidedly persistent (Rachman & Hodgson,
1980).Although highly individualized, the general themes of obsessions usually pertain to
contamination, responsibility for causing (or failing to prevent) harm (to oneself or others),
uncertainty, taboo topics such as sex, violence,and blasphemy, and the need for order and
symmetry. The content of obsessions is typically incongruent with the person s belief system
and is not the type of thought one would expect of him or herself.
Obses-sions might be triggered by stimuli in the environment(e.g., a religious icon or driving
a car) or occur withoutan apparent trigger (e.g., the impulse to yell a curse wordin a place of
worship). Finally, obsessions are subjectivelyresisted , meaning that they are accompanied by
the sensethat they need to be dealt with, neutralized, or alto-gether avoided. The motivation
to resist is activated bythe fear that if action is not taken, disastrous conse-quences will likely
occur.
Subjective Resistance to Obsessions The most conspicuous type of resistance to
obsessionalthoughts is compulsive ritualizing . Compulsive rituals areperformed deliberately
in response to an obsession,usually with the aim of preventing the feared disaster and/or
reducing the associated anxiety or distress (e.g.,hand washing for 30 min after touching a
possibly con-taminated doorknob; Rachman & Hodgson, 1980).Common compulsive rituals
include washing or clean-ing, checking, or seeking reassurance from others,repeating a
routine activity until it feels right, order-ing and arranging items, and performing mental
rituals(e.g., saying a phrase or prayer to oneself). Such rituals are usually senseless and
excessive in relation to the obsessional fear, and often need to be performed repeatedly and
according to rules that the person derives on his or her own
Noncompulsive (i.e., neither rule-bound nor repeated) forms of resistance to obsessions are
alsocommon (e.g., Freeston & Ladouceur, 1997; Ladouc-eur et al., 2000). Examples of this
sort of resistance include purposely distracting oneself from obsessive thoughts and triggers,
trying to suppress (i.e., not think about) the unwanted thoughts, and brief (covert) neu-
tralization strategies such as gripping the steering wheel more tightly in response to an
obsessive thought of driving into opposing traffic. The passive avoidance of obsessional
stimuli (e.g., toilets) is also a form of resistance to obsessions. Avoidance, however,is
intended to prevent obsessional thoughts and feared consequences from occurring in the first
place, whereas neutralizing and other forms of resistance represent reactions to obsessions
that have already occurred (Rach-man & Hodgson, 1980)
Clinical observations of individuals with obsessionalproblems reveal an internal consistency
in the themesof obsessions and the strategies used to resist suchmental intrusions. Research
ndings support theseobservations, consistently showing that obsessions andresistance
strategies are thematically related (e.g., Abra-mowitz et al., 2010; McKay et al., 2004):
contamina-tion obsessions often co-occur with washing/cleaningrituals; responsibility
obsessions with checking and reas-surance-seeking rituals; obsessions about order or exact-
ness with arranging rituals; and unacceptable taboo violent, sexual, or blasphemous thoughts
with mentalrituals and more covert forms of resistance. Avoidant behavior can also generally
be predicted by the types of obsessional fears the individual has. For example,someone with
obsessional thoughts of harming her children is likely to avoid knives and other
potentialweapons. These observations underscore the relation-ship between obsessions and
the various forms of sub- jective resistance
The most signi cant change for OCD in DSM-5 ,however, is the classi cation of this disorder
within the DSM ; speci cally, OCD is no longer considered ananxiety disorder. Along with
several putatively relateddisorders, OCD is now included in a new category of disorders: the
obsessive-compulsive and related disorders(OCRDs). This change was made primarily to
grouptogether disorders characterized by the presence of obsessive thoughts and/or repetitive
behaviors (APA,2013). That is, increasing research evidence ostensiblydemonstrates
common threads running through OCDand these putatively related conditions.
Body Dysmorphic Disorder. Body dysmorphic disorder (BDD) is characterized by
preoccupation with an imagined or minor aw in one s own appearance that causes significant
distress or interference. Although it has been moved from the somatoform disorders to the
OCD chapter in DSM-5, the diagnostic criteria for BDD are essentially unchanged from
DSM-IV-TR. One exception is that it is now a criterion that repetitive behaviors or mental
acts are performed in response to the obsession-like preoccupations. A second change is the
addition of the same insight specifiers as were added for OCD. A third change is the addition
of the specifier with muscle dysmorphia, which reflects a presentation of BDD in which the
person is excessively concerned with not being muscular enough.
Global Improvement:
1. 1. Baseline Assessment:
The Y-BOCS is administered at the start of treatment to establish a baseline score.
2. 2. Follow-up Assessments:
The Y-BOCS is re-administered at regular intervals throughout treatment to monitor changes
in symptoms.
3. 3. Score Reduction:
A reduction in the Y-BOCS score from baseline indicates improvement.
4. 4. Interpreting Changes:
The magnitude of the score reduction is often used to categorize the level of improvement:
● A decrease of 25% or more is often considered mild to moderate
improvement.
● A decrease of 35-50% is often considered moderate to marked improvement.
● A decrease of 35% or more is frequently accepted as a clinically meaningful
response.
