Yale-Brown Obsessive Compulsive Scale (Y-BOCS) First Name: Last Name: Email Address: Phone Number: Check all symptoms that you are experiencing or have experienced at least once in the recent past. Aggressive Thoughts, Fears or Images: Fear I might harm myself YesAggressive Thoughts, Fears or Images: Fear I might harm others YesAggressive Thoughts, Fears or Images: Violent or horrific images YesAggressive Thoughts, Fears or Images: Fear of blurting out obscenities or insults YesAggressive Thoughts, Fears or Images: Fear of doing something else embarrassing YesAggressive Thoughts, Fears or Images: Fear I will act on unwanted impulses (e.g., stab a friend) YesAggressive Thoughts, Fears or Images: Fear I will steal things YesAggressive Thoughts, Fears or Images: Fear I will harm others because not careful enough (e.g., hit/run accident) YesAggressive Thoughts, Fears or Images: Fear of being responsible for something else terrible happening (e.g., fire, burglary) YesAggressive Thoughts, Fears or Images: Other aggressive thought(s) YesContamination Concerns: Concerns or disgust with bodily waste or secretions (e.g., urine, feces, saliva) YesContamination Concerns: Concern with dirt or germs YesContamination Concerns: Excessive concern with of environmental contaminants (e.g., asbestos, radiation, toxic waste) YesContamination Concerns: Excessive concern with household items (e.g., cleansers, solvents) YesContamination Concerns: Excessive concern with animals (e.g., insects) YesContamination Concerns: Bothered by sticky substances or residues YesContamination Concerns: Concerned I will get ill because of contaminant(s) YesContamination Concerns: Concerned I will get others ill by spreading contamination YesContamination Concerns: No concern with consequences of contamination other than how it might feel YesContamination Concerns: Other contamination concerns YesSexual Thoughts: Forbidden or unacceptable sexual thoughts/images/impulses YesSexual Thoughts: Thought content involves children or incest YesSexual Thoughts: Thought content involves homosexuality YesSexual Thoughts: Thoughts of aggressive sexual behavior toward others YesSexual Thoughts: Other sexual thoughts (specify) YesHoarding/Saving Concerns: Hoarding or saving behaviors (excluding hobbies or concern with objects with monetary or sentimental value) YesHoarding/Saving Concerns: Fears of mistakenly discarding important things along with unimportant items YesReligious Concerns/Scrupulosity: Excessive concern with sacrilege or blasphemy YesReligious Concerns/Scrupulosity: Excessive concern with sin, right/wrong, morality YesReligious Concerns/Scrupulosity: Other religious or moral concerns (specify) YesConcern with Symmetry or Exactness: Accompanied by magical thinking (e.g., concerned that spouse/child/mother will have an accident unless things are in the right place) YesConcern with Symmetry or Exactness: Not accompanied by magical thinking (it just feels uncomfortable) YesSomatic Fears and Thoughts: Concern with having an illness or disease YesSomatic Fears and Thoughts: Excessive concern with body part(s) or my appearance YesSomatic Fears and Thoughts: Other body-related concerns (specify) YesMiscellaneous Thoughts and Concerns: Need to know or remember YesMiscellaneous Thoughts and Concerns: Fear of saying certain things YesMiscellaneous Thoughts and Concerns: Fear of not saying just the right thing YesMiscellaneous Thoughts and Concerns: Fear of losing things YesMiscellaneous Thoughts and Concerns: Intrusive non-violent images YesMiscellaneous Thoughts and Concerns: Intrusive nonsense sounds, words, or music YesMiscellaneous Thoughts and Concerns: I'm very bothered by certain sounds/noises YesMiscellaneous Thoughts and Concerns: Concern with lucky/unlucky numbers YesMiscellaneous Thoughts and Concerns: Colors with special significance YesMiscellaneous Thoughts and Concerns: Superstitious fears YesMiscellaneous Thoughts and Concerns: Other concerns (specify) YesCleaning/Washing Concerns: Excessive or repetitive hand washing YesCleaning/Washing Concerns: Excessive or repetitive showering, bathing, tooth brushing, grooming, or toilet routines YesCleaning/Washing Concerns: Excessive cleaning of household items or other objects (e.g., glasses, cell phone) YesCleaning/Washing Concerns: Excessive measures to prevent or remove contact with contaminants YesCleaning/Washing Concerns: Other cleaning behaviors (specify) YesChecking Behaviors: Checking locks, stoves, appliances, etc. YesChecking Behaviors: Checking that I did not/will not harm others YesChecking Behaviors: Checking that I did not/will not harm myself YesChecking Behaviors: Checking that nothing terrible did/will happen YesChecking Behaviors: Checking that I did not make mistakes YesChecking Behaviors: Checking tied to concerns about my body or appearance YesChecking Behaviors: Other checking behaviors (specify) YesRepeating Behaviors: Re-reading or re-writing multiple times YesRepeating Behaviors: Need to repeat routine activities (in/out the door, up/down the chair) YesRepeating Behaviors: Other repeating behaviors (specify) YesCounting Concerns: Repetitive counting YesOrdering/Arranging Behaviors: Unavoidable ordering or arranging YesHoarding & Collecting Behaviors: Unavoidable hoarding or collecting (e.g., I carefully read junk mail, pile up old newspapers, sort through garbage, collect useless objects.) YesRepetitive Mental Patterns: I use special words, images, numbers, repeated mentally to push away other thoughts or images. YesRepetitive Mental Patterns: I say special prayers (short and long) repeated in a set manner (e.g. \"God is good\") to push away other thoughts or images YesRepetitive Mental Patterns: Mental counting YesRepetitive Mental Patterns: Mental (silent and unwritten) list making YesRepetitive Mental Patterns: Mental reviewing (e.g., reviewing conversations) YesRepetitive Mental Patterns: Other mental patterns (specify) YesMiscellaneous Repetitive Behaviors: Excessive list making (in writing or talking aloud) YesMiscellaneous Repetitive Behaviors: I have urges to ask, tell, or confess YesMiscellaneous Repetitive Behaviors: I have urges to touch, tap, or rub YesMiscellaneous Repetitive Behaviors: I have urges involving blinking or staring YesMiscellaneous Repetitive Behaviors: I try hard to prevent harm to self or others, or to prevent terrible consequences YesMiscellaneous Repetitive Behaviors: I have certain repetitive eating behaviors YesMiscellaneous Repetitive Behaviors: Superstitious behaviors YesMiscellaneous Repetitive Behaviors: Hair pulling YesMiscellaneous Repetitive Behaviors: Skin picking YesMiscellaneous Repetitive Behaviors: Other repetitive behaviors: (specify) Yes