Obsessive-Compulsive Disorder

Transcription

Obsessive-Compulsive Disorder - American Association for

Obsessive-Compulsive Disorder
Diagnostic Criteria
300.3 (F42)
A. Presence of obsessions, compulsions, or both:
Obsessions are defined by (1) and (2):
1. Recurrent and persistent thoughts, urges, or images that are experienced, at some
time during the disturbance, as intrusive and unwanted, and that in most individuals
cause marked anxiety or distress.
2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to
neutralize them with some other thought or action (i.e., by performing a compulsion).
Compulsions are defined by (1) and (2):
1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g.,
praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or
mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
Note: Young children may not be able to articulate the aims of these behaviors or
mental acts.
B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per
day) or cause clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
C. The obsessive-compulsive symptoms are not attributable to the physiological effects
of a substance (e.g., a drug of abuse, a medication) or another medical condition.
D. The disturbance is not better explained by the symptoms of another mental disorder
(e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder];
skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic
movement disorder; ritualized eating behavior, as in eating disorders; preoccupation
with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies,
as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or
repetitive patterns of behavior, as in autism spectrum disorder).
Specify if:
With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.
With poor insight: The individual thinks obsessive-compulsive disorder beliefs are
probably true.
With absent insight/delusionai beliefs: The individual is completely convinced that
obsessive-compulsive disorder beliefs are true.
Specify if:
Tic-related: The individual has a current or past history of a tic disorder.
For parents, teachers, and child care providers:
Screening children for OCD
1. Does the child repeatedly wash her hands, use hand sanitizers, or take long
showers?
2. Does he avoid being touched, refuse to play sports, or refuse to sit in certain places
or allow others to?
3. Does she resist or avoid public places or public bathrooms?
4. Does he seek reassurance from you, for example, that he is not sick or dirty, that he
did something correctly, or that "everything is OK"?
5. Does she fear harm or danger to herself or others, or fear she will cause harm to
others?
6. Does he need to check or have you check to make sure doors or windows are locked?
7. Does she save useless items, such as scraps of paper, candy wrappers, bottle caps?
8. Does he refuse to allow others to touch his things?
9. Is she preoccupied with religious observances, praying, or saying prayers a certain
number of times?
10. Does he have to apologize repeatedly or say goodbye or goodnight in a certain
sequence and is very distressed when the sequence is interrupted?
11. Does she erase her printing or writing excessively and insist that it must be perfect
or "just right"?
12. Does he reread things multiple times or take a very long time to read things?
13. Does she rearrange things in her room or in the house or insist that they be lined
up in a certain way or "just right"?
13. Is he extremely slow with dressing, activities, chores, or school work?
14. Do family and friends have to obey her rules regarding what they can touch, or
where they can sit or walk?
15. Does he worry that his thoughts can cause an event to happen or not happen?
16. Does she worry that food may have gone bad or even be poisoned?
17. Does he avoid "unlucky" or "unsafe" numbers in favor of "lucky" or "safe" ones?
18. Does she repeatedly turn light switches or electronic toys off and on?
This test is not meant to replace a thorough evaluation by a mental health professional trained in
assessing obsessive-compulsive disorder (OCD). If you answered "yes" to any of the above questions,
the child may have O C D . If the severity of the symptom(s) is low, perhaps no treatment is needed. But
if the child is easily upset, throwing tantrums, crying, or seemingly overreactive to situations involving
these questions, an evaluation by a mental health professional familiar with O C D in children is
recommended.
Adapted by Vicki Easterling, LCSyV from information provided by
ocdchicago.org and ocdeducationstation.org
2008 The Austin Center for the Treatment of Obsessive-Compulsive Disorder
Original: 10/1/86
First Revision: 3/1/90
Second Revision: 5/1/91
Third Revision: 5/1/93
Fourth Revision: 6/17/99
Fifth Revision: 10/04/07
CHILDREN'S
YALE-BROWN
OBSESSIVE COMPULSIVE SCALE
(CY-BOCS)
DEVELOPED BY
WAYNE K. GOODMAN, M.D.1
LAWRENCE SCAHILL, MSN, PhD2
LAWRENCE H. PRICE, M.D.3
STEVEN A. RASMUSSEN, M.D.3
MARK A. RIDDLE, M.D. 4
JUDITH L. RAPOPORT, M.D.5
NATIONAL INSTITUTE OF MENTAL HEALTH1
THE CHILD STUDY CENTER2
YALE UNIVERSITY SCHOOL OF MEDICINE
DEPARTMENT OF PSYCHIATRY3
BROWN UNIVERSITY SCHOOL OF MEDICINE
CHILD PSYCHIATRY DIVISION4
JOHNS HOPKINS SCHOOL OF MEDICINE
and
CHILD PSYCHIATRY BRANCH5
NATIONAL INSTITUTE OF MENTAL HEALTH
Investigators interested in using this rating scale should contact Lawrence Scahill, M.S.N., Ph.D., at the
Yale Child Study Center, P.O. Box 207900, New Haven, CT 06520 or Wayne Goodman, M.D., at the
National Institute of Mental Health, Bethesda, MD.
Scahill, L., Riddle, M.A., McSwiggin-Hardin, M., Ort, S.I., King, R.A., Goodman, W.K., Cicchetti, D. &
Leckman, J.F. (1997). Children's Yale-Brown Obsessive Compulsive Scale: reliability and validity. J Am Acad
Child Adolesc Psychiatry, 36(6):844-852.
1
GENERAL INSTRUCTIONS
Overview:
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.
Informants:
Information should be obtained by interviewing the parent(s) (or guardian) and the child together.
Sometimes, however, it may also be useful to interview the child or parent alone. Interviewing strategy may
vary depending on the age and developmental level of the child or adolescent. All information should be
combined to estimate the score for each item. Whenever the CY-BOCS is administered more than once to the
same child, as in a medication trial, consistent reporting can be ensured by having the same informant(s) present
at each rating session.
Definitions:
Before proceeding with the questions, define "obsessions" and "compulsions" for the child and primary
caretaker as follows (sometimes, particularly with younger children, the interviewer may prefer using the terms
"worries" and "habits"):
"OBSESSIONS: are thoughts, ideas, or pictures that keep coming into your mind even though you do not want
them to. They may be unpleasant, silly or embarrassing."
"AN EXAMPLE OF AN OBSESSION IS: the repeated thought that germs or dirt are harming you or other
people, or that something unpleasant might happen to you or someone in your family or someone special to
you. These are thoughts that keep coming back, over and over again."
"COMPULSIONS: are things that you feel you have to do although you may know that they do not make sense.
Sometimes you may try to stop from doing them but this might not be possible. You might feel worried or
angry or frustrated until you have finished what you have to do."
"AN EXAMPLE OF A COMPULSION IS: the need to wash your hands over and over again even though they
are not really dirty, or the need to count up to a certain number while you do certain things."
"Do you have any questions about what these words called obsessions and compulsions mean?"
Symptom Specificity and Continuity:
In some cases, it may be difficult to delineate obsessions and compulsions from other closely related
symptoms such as phobias, anxious worries, depressive ruminations or complex tics. Separate assessment of
these symptoms may be necessary. Although potentially difficult, the delineation of obsessions and
compulsions from these closely related symptoms is an essential task of the interviewer. (A full discussion of
how to make this determination is beyond the scope and purpose of this introduction.) Items marked with an
asterix are items where this delineation may be especially troublesome.
2
Once the interviewer has decided whether or not a particular symptom will be included as an obsession
or compulsion on the checklist, every effort should be made to maintain consistency in subsequent rating(s). In
a treatment study with multiple ratings over time, it may be useful to review the initial Target Symptom
Checklist (see below) at the beginning of subsequent ratings (prior severity scores should not be reviewed).
Procedure:
Symptom Checklist: After reviewing with the child and parent(s) the definitions of obsessions and
compulsions, the interview should proceed with a detailed inquiry about the child's symptoms using the
Compulsions Checklist and Obsessions Checklist as guides. It may not be necessary to ask about each and
every item on the checklist, but each symptom area should be covered to ensure that symptoms are not missed.
For most children and adolescents, it is usually easier to begin with compulsions (pages 9 and 10).
Target Symptom List: After the Compulsions Checklist is complete, list the four most severe
compulsions on the Target Symptom List on page 10. Repeat this process, listing the most severe obsessions,
on the Target Symptom List on page 5.
Severity Rating: After completing the Checklist and Target Symptom List for compulsions,
inquire about the severity items: Time Spent, Distress, Resistance, Interference, and Degree of Control
(questions 6 through 10 on pages 11 through 13). There are examples of probe questions for each item. Ratings
for these items should reflect interviewer's best estimate from all available information from the past week, with
special emphasis on the Target Symptoms. Repeat the above procedure for obsessions (Pages 4 through 8).
Finally, inquire about and rate questions 11 through 19 on pages 14 and 18. Scores can be recorded on the
scoring sheet on page 19. All ratings should be in whole integers.
Scoring:
All 19 items are rated, but only items 1-10 are used to determine the total score. The total CY-BOCS
score is the sum of items 1-10; the obsession and compulsion subtotals are the sums of items 1-5 and 6-10,
respectively. At this time, items 1A and 6A are not being used in the scoring.
Items 17 (global severity) and 18 (global improvement) are adapted from the Clinical Global Impression
Scale (Guy, W., 1976) to provide measures of overall functional impairment associated with the presence of
obsessive-compulsive symptoms.
3
Name
Date
CY-BOCS OBSESSIONS CHECKLIST
Check all items that apply (Item marked "*" may or not be OCD phenomena.)
Current Past
Contamination Obsessions
Concern with dirt, germs, certain illnesses (e.g., AIDS)
Concerns or disgust with bodily waste or secretions (e.g., urine, feces, saliva)
Excessive concern with enviromental contaminants (e.g., asbestos, radiation, toxic waste)
Excessive concern with household items (e.g., cleaners, solvents)
Excessive concern about animals/insects
Excessively bothered by sticky substances or residues
Concerned will get ill because of contaminant
Concerned will get others ill by spreading contaminant (aggressive)
No concern with consequences of contamination other than how it might feel *
Other (Describe)
Aggressive Obsessions
Fear might harm self
Fear might harm others
Fear harm will come to self
Fear harm will come to others (may be because something child did or did not do)
Violent or horrific images
Fear of blurting out obscenities or insults
Fear of doing something else embarrassing *
Fear will act on unwanted impulses (e.g. to stab a family member)
Fear will steal things
Fear will be responsible for something else terrible happening (e.g. fire, burglary,
flood)
Other (Describe)
Sexual Obsessions
[Are you having any sexual thoughts? If yes, are they routine or are they repetitive
thoughts that you would rather not have or find disturbing? If yes, are they:]
Forbidden or perverse sexual thoughts, images, impulses
Content involves homosexuality *
Sexual behavior towards others (Aggressive)
Other (Describe)
Hoarding/Saving Obsessions
Fear of losing things
Other (Describe)
Magical Thoughts/Superstitous Obsessions
Lucky/unlucky numbers, colors, words
Other (Describe)
4
Current Past
Somatic Obsessions
Excessive concern with illness or disease *
Excessive concern with body part or aspect of appearance (e.g., dysmorphophobia) *
Other (Describe)
Religious Obsessions (Scrupulosity)
Excessive concern or fear of offending religious objects (God)
Excessive concern with right/wrong, morality
Other (Describe)
Miscellaneous Obsessions
The need to know or remember
Fear of saying certin things
Fear of not saying just the right thing
Intrusive (non-violent) images
Intrusive sounds, words, music, or numbers
Other (Describe)
TARGET SYMPTOM LIST FOR OBSESSIONS
Obsessions (Describe, listing by order of severity, with #1 being the most severe, #2 the second most
severe, etc.):
1.
2.
3.
4.
5
QUESTIONS ON OBSESSIONS (ITEMS 1-5) "I AM NOW GOING TO ASK YOU QUESTIONS ABOUT
THE THOUGHTS YOU CANNOT STOP THINKING ABOUT." (Review for the informant(s) the Target
Symptoms and refer to them while asking questions 1-5).
Time Occupied by Obsessive Thoughts
1.
• How much time do you spend thinking about these things?
(When obsessions occur as brief, intermittent intrusions, it may be impossible to assess time occupied
by them in terms of total hours. In such cases, estimate time by determining how frequently they occur.
Consider both the number of times the intrusions occur and how many hours of the day are affected).
• How frequently do these thoughts occur?
[Exclude ruminations and preoccupations which, unlike obsessions, are ego-syntonic and rational (but
exaggerated).]
0 - NONE
1 - MILD
less than 1 hr/day or occasional intrusion
2 - MODERATE
1 to 3 hrs/day or frequent intrusion
3 - SEVERE
greater than 3 and up to 8 hrs/day or very frequent intrusion
4 - EXTREME
greater than 8 hrs/day or near constant intrusion
1B. Obsession-free Interval (not included in total score)
• On average, what is the longest amount of time per day that you are not bothered by obsessivethoughts?
0 - NONE
1 - MILD
long symptom free intervals, more than 8 consecutive hrs/day symptom-free
2 - MODERATE
moderately long symptom-free intervals, more than 3 and up to 8 hrs/day
3 - SEVERE
brief symptom-free intervals, from 1 to 3 consecutive hrs/day symptom-free
4 - EXTREME
less than 1 consecutive hr/day symptom free
2. Interference due to Obsessive Thoughts
• How much do these thoughts get in the way of school or doing things with friends?
• Is there anything that you don't do because of them?
(If currently not in school determine how much performance would be affected if patient were in school.)
0 - NONE
1 - MILD
slight interference with social or school activities, overall performance not impaired
2 - MODERATE
definite interference with social or school performance, but still manageable
3 - SEVERE
causes substantial impairment in social or school performance
4 - EXTREME
incapacitating
6
3. Distress Associated with Obsesssive Thoughts
• How much do these thoughts bother or upset you?
(Only rate anxiety/frustration that seems triggered by obsessions, not generalized anxiety or anxiety
associated with other symptoms.)
0 - NONE
1 - MILD
infrequent, and not too disturbing
2 - MODERATE
frequent, and disturbing, but still manageable
3 - SEVERE
very frequent, and very disturbing
4 - EXTREME
near constant, and disabling distress/frustration
4. Resistance Against Obsessions
• How hard do you try to stop the thoughts or ignore them?
(Only rate effort made to resist, not success or failure in actually controlling the obsessions. How much
patient resists the obsessions may or may not correlate with their ability to control them. Note that this item
does not directly measure the severity of the intrusive thoughts; rather it rates a manifestation of health, i.e.,
the effort the patient makes to counteract the obsessions. Thus, the more the patient tries to resist, the less
impaired is this aspect of his functioning. If the obsessions are minimal, the patient may not feel the need to
resist them. In such cases, a rating of "0" should be given.)
0 – NONE
makes an effort to always resist, or symptoms so minimal doesn't need to actively resist.
1 - MILD
tries to resist most of the time
2 - MODERATE
makes some effort to resist
3 - SEVERE
yields to all obsessions without attempting to control them, but does so with some
reluctance
4 – EXTREME
completely and willingly yields to all obsessions
5. Degree of Control Over Obsessive Thoughts
• When you try to fight the thoughts, can you beat them?
• How much control do you have over the thoughts?
(In contrast to the preceding item on resistance, the ability of the patient to control his obsessions is more
closely related to the severity of the intrusive thoughts.
0 - COMPLETE CONTROL
1 - MUCH CONTROL
usually able to stop or divert obsessions with some effort and concentration.
2 - MODERATE CONTROL sometimes able to stop or divert obsessions
3 - LITTLE CONTROL
4 - NO CONTROL
rarely successful in stopping obsessions, can only divert attention with difficulty
experienced as completely involuntary, rarely able to even momentarily divert
thinking
7
Name
Date
CY-BOCS COMPULSIONS CHECKLIST
Check all items that apply (Item marked "*" may or not be OCD phenomena.)
Current Past Washing/Cleaning Compulsions
Excessive or ritualized handwashing
Excessive or ritualized showering, bathing, toothbrushing, grooming, or toilet routine
Excessive cleaning of items; such as personal clothes or important objects
Other measures to prevent or remove contact with contaminants
Other (Describe)
Checking Compulsions
Checking locks, toys, school books/items, etc.
Checking associated with getting washed, dressed, or undressed.
Checking that did not/will not harm others
Checking that did not/will not harm self
Checking that nothing terrible did/will happen
Checking that did not make mistake
Checking tied to somatic obsessions
Other (Describe)
Repeating Rituals
Rereading, erasing, or rewriting
Need to repeat routine activities (e.g. in/out doors, up/down from chair)
Other (Describe)
Counting Compulsions
Objects, certain numbers, words, etc.
Describe:
Ordering/Arranging
Need for symmetry/evening up (e.g., lining items up a certain way or arranging personal items in
specific patterns)
Other (Describe)
Hoarding/Saving Compulsion
[distinguish from hobbies and concern with objects of monetary or sentimental value]
Difficulty throwing things away, saving bits of paper, string, etc.
Other (Describe)
Excessive Games/Superstitious Behaviors
[distinguish from age appropriate magical games]
(e.g., array of behavior, such as stepping over certain spots on a floor, touching an object/self
certain number of times as a routine game to avoid something bad from happening.)
Other (Describe)
8
Current Past Rituals Involving Other Persons
The need to involve another person (usually a parent) in ritual (e.g., asking a parent to repeatedly
answer the same question, making mother perform certain meal time-rituals involving specific
utensils).*
Other (Describe)
Miscellaneous Compulsions
Mental rituals (other than checking/counting)
Need to tell, ask, or confess
Measures (not checking) to prevent harm to self ; harm to others
Ritualized eating behaviors *
Excessive list making *
Need to touch, tap, rub *
Need to do things (e.g., touch or arrange) until it feels just right) *
Rituals involving blinking or staring *
Trichotillomanis (hair-pulling) *
Other self-damaging or self-mutilating behaviors *
Other (Describe)
; terrible consequences
TARGET SYMPTOM LIST FOR COMPULSIONS
Compulsions (Describe, listing by order of severity, with #1 being the most severe, #2 second most severe,
etc.):
1.
2.
3.
4.
9
QUESTIONS ON COMPULSIONS (ITEMS 6-10) "I AM NOW GOING TO ASK YOU QUESTIONS
ABOUT THE HABITS YOU CAN'T STOP." (Review for the informant(s) the Target Symptoms and refer to
them while asking questions 6-10).
6A. Time Spent Performing Compulsive Behaviors
• How much time do you spend doing these things?
• How much longer than most people does it take to complete your usual daily activities because of the
habits?
(When compulsions occur as brief, intermittent behaviors, it may be impossible to assess time spent
performing them in terms of total hours. In such cases, estimate time by determining how frequently they
are performed. Consider both the number of times compulsions are performed and how many hours of the
day are affected.)
• How often do you do these habits?
[In most cases compulsions are observable behaviors (e.g., handwashing), but there are instances in which
compulsions are not observable (e.g., silent checking).]
0 - NONE
1 - MILD
(spends less than 1 hr/day performing compulsions), or occasional performance of
compulsive behaviors
2 - MODERATE
(spends from 1 to 3 hrs/day performing compulsions), or frequent performance of
compulsive behaviors
3 - SEVERE
(spends more than 3 and up to 8 hrs/day performing compulsions), or very
frequent performance of compulsive behaviors
4 - EXTREME
(spends more than 8 hrs/day performing compulsions), or near constant
performance of compulsive behaviors (too numerous to count).
6B. Compulsion-free Interval
• How long can you go without performing compulsive behavior?
[If necessary ask: What is the longest block of time in which (your habits) compulsions are absent?]
0 - NO SYMPTOMS
1 - MILD
long symptom-free interval, more than 8 consecutive hrs/day symptom-free
2 - MODERATE
moderately long symptom-free interval, more than 3 and up to 8 consecutive
hrs/day symptom-free.
3 - SEVERE
short symptom-free interval, from 1 to 3 consecutive hrs/day symptom free
4 - EXTREME
less than 1 consecutive hr/day symptom-free
10
7. Interference due to Compulsive Behaviors
• How much do these habits get in the way of school or doing things with friends?
• Is there anything you don't do because of them?
(If currently not in school, determine how much performance would be affected if patient were in school.)
0 - NONE
1 - MILD
slight, interference with social or school activities, but overall performance not impaired
2 – MODERATE
definite interference with social or school performance, but still manageable
3 - SEVERE
causes substantial impairment in social or school performance
4 - EXTREME
incapacitating
8. Distress Associated with Compulsive Behavior
• How would you feel if prevented from carrying out your habits?
• How upset would you become?
(Rate degree of distress/frustration patient would experience if performance of the compulsion were
suddenly interrupted without reassurance offered. In most, but not all cases, performing compulsions
reduces anxiety /frustration.)
• How upset do you get while carrying out your habits until you are satisfied?
0 - NONE
1 - MILD
only slightly anxious/frustrated if compulsions prevented, or only slight
anxiety/frustration during performance of compulsions.
2 - MODERATE
reports that anxiety/frustration would mount but remain manageable if
compulsions prevented. Anxiety/frustration increases but remains manageable
during performance of compulsions.
3 - SEVERE
prominent and very disturbing increase in anxiety/frustration if compulsions
interrupted. Prominent and very disturbing increase in anxiety /frustration during
performance of compulsions.
4 - EXTREME
incapacitating anxiety/frustration from any intervention aimed at modifying
activity. Incapacitating anxiety/frustration develops during performance of
compulsions.
11
9. Resistance Against Compulsions
• How much do you try to fight the habits?
(Only rate effort made to resist, not success or failure in actually controlling the compulsions. How much
the patient resists the compulsions may or may not correlate with his ability to control them. Note that this
item does not directly measure the severity of the compulsions; rather it rates a manifestation of health, i.e.,
the effort the patient makes to counteract the compulsions. Thus, the more the patient tries to resist, the less
impaired is this aspect of their functioning. If the compulsions are minimal, the patient may not feel the
need to resist them. In such cases, a rating of "0" should be given.)
0 - NONE
Makes an effort to always resist, or symptoms so minimal doesn't need to actively
resist.
1 - MILD
Tries to resist most of the time.
2 - MODERATE
Makes some effort to resist
3 - SEVERE
Yields to almost all compulsions without attempting to control them, but does so
with some reluctance.
4 - EXTREME
completely and willingly yields to all compulsions
10. Degree of Control over Compulsive Behavior
• How strong is the feeling that you have to carry out the habit(s)?
• When you try to fight them what happens?
(For the advanced child ask:)
• How much control do you have over the habits?
(In contrast to the preceding item on resistance, the ability of the patient to control his compulsions is
closely related to the severity of the compulsions.)
0 - COMPLETE CONTROL
1 - MUCH CONTROL
experiences pressure to perform the behavior, but usually able to exercise
voluntary control over it
2 - MODERATE CONTROL
moderate control, strong pressure to perform behavior, can control it only
with difficulty
3 - LITTLE CONTROL
little control, very strong drive to perform behavior, must be carried to
completion, can only delay with difficulty
4 - NO CONTROL
no control, drive to perform behavior experienced as completely
involuntary and overpowering, rarely able to delay activity (even
momentarily)
12
CHILDREN'S YALE-BROWN OBSESSIVE COMPUSLIVE SCALE
Patient Name
Rater
CYBOCS TOTAL (add items 1-10)
Patient ID
_____ Date
1. TIME SPENT ON OBSESIONS
0
1
2
3
4
1b. OBSESSION-FREE INTERVAL
(do not add to subtotal or total score)
No
Symptoms
0
Long
1
Moderately
Long
2
Short
3
Extremely
Short
4
2. INTERFERENCE FROM OBSESSIONS
0
1
2
3
4
3. DISTRESS OF OBSESSIONS
0
1
2
3
4
0
1
2
3
4
Complete
control
Much
control
Moderate
control
Little
control
No
control
0
1
2
Always resists
4. RESISTANCE
5. CONTROL OVER OBSESSIONS
6. TIME SPENT ON COMPULSIONS
6b. COMPULSION-FREE INTERVAL
Completely yields
3
4
OBSESSION SUBTOTAL (add items 1-5)
1
2
3
0
[
]
4
No
Symptoms
Long
Moderately
Long
Short
Extremely
Short
(do not add to subtotal or total score)
0
1
2
3
4
7. INTERFERENCE FROM COMPULSION
0
1
2
3
4
8. DISTRESS FROM COMPULSIONS
0
1
2
3
4
Always resists
0
9. RESISTANCE
Complete
control
10. CONTROL OVER COMPULSIONS
0
Completely yields
1
Much
control
1
2
Moderate
control
2
3
Little
control
3
COMPULSION SUBTOTAL (add items 6-10)
19. RELIABILITY
EXCELLENT = 0
GOOD = 1
FAIR = 2
4
No
control
4
[
POOR = 3
EXCELLENT = no reason to suspect data unreliable; GOOD= factor(s) that may adversely affect reliability;
FAIR= factor(s) that definitely reduce reliability; POOR= very low reliability.
13
]
14
piacentiniTG14app.111_124
12/22/06
12:41 PM
Page 112
Current Symptoms Self-Report Form
Week of:
Instructions: Please check the response next to each item that best describes your behavior during the past week.
Children’s Yale-Brown OC Scale (CY-BOCS) Self-Report Symptom Checklist
Name of Child:
1
Never or
Date: Rarely
Informant: Often
Sometimes
Very Often
This questionnaire can be completed by the child/adolescent, parents, or both working together.
We
are attention
interestedtoindetails
getting
most
accurate information possible. There are no right or wrong
Fail to give
close
or the
make
careless
answers.
Please just answer the best you can. Thank you.
mistakes in
my work
Please check all COMPULSIVE SYMPTOMS that you have noticed during the past week.
2
Fidget with hands or feet or squirm in seat
3
Have diffidoes
cultynot
sustaining
my attention
in tasksare
or typically done to reduce fear of distress associated with
make sense.
Compulsions
fun activities
obsessive thoughts.
4
Leave my seat in situations in which seating is
Washing/Cleaning Compulsions
expected
5
Don’t listen when terrupted,
spoken to directly
needs to wash hands in particular order of steps)
6
Feel restless
7
Don’t follow through on instructions and fail to
Excessive cleaning of items (e.g., clothes, faucets, floors or important objects)
finish work
8
Have difficulty engaging
leisure
activities
or door;
doing refusing to shake hands; asking family members to refoot toin
flush
toilet
or open
fun things quietly move insecticides, garbage)
9
Other washing/cleaning
Have difficulty organizing
tasks and activitiescompulsions (Describe)
COMPULSIONS are things you feel compelled to do even though you may know the behavior
Excessive or ritualized hand washing (e.g., takes long time to wash, needs to restart if inExcessive or ritualized showering, bathing, tooth brushing, grooming, toilet routine
(see hand washing)
Other measures to prevent or remove contact with contaminants (e.g., using towel or
10
Feel “on the go” or “driven by a motor”
11
Avoid, dislike,
or amCompulsions
reluctant to engage in work that
Checking
requires sustained mental effort
Checking locks, toys, schoolbooks/items, and so on
12
Talk excessively Checking associated with getting washed, dressed, or undressed
13
Checking
that
did not/will not harm others (e.g., checking that nobody’s been hurt,
Lose things necessary
for tasks
or activities
14
Blurt out answers before questions have been
Checking that did not/will not harm self (e.g., looking for injuries or bleeding after
completed
15
Am easily distracted
Checking that nothing terrible did/will happen (e.g., searching the newspaper or televi-
16
Have difficulty awaiting turn
17
Am forgetful in daily
activities
lations,
homework)
18
Checking
Interrupt or intrude
on otherstied to health worries (e.g., seeking reassurance about having an illness, re-
asking for reassurance, or telephoning to make sure that everything is alright)
handling sharp or breakable objects, asking for reassurance that everything is alright)
sion for news about catastrophes)
Checking that did not make a mistake (e.g., while reading, writing, doing simple calcu-
peatedly measuring pulse, checking for body odors or ugly features)
From R. A. Barkley & K. R. Murphy
Attention-Defi
cit Hyperactivity
Disorder: A clinical workbook (2nd ed.). New York: Guilford Press.
Other(1998),
checking
compulsions
(Describe)
Reprinted with permission.
Programs That Work It's Only A False Alarm
TM
Copyright
© 2007
University
Press
Copyright
© 2005
OxfordOxford
University
Press
12/22/06
12:41 PM
Page 113
Week of:
Repeating Compulsions
1
Never or
Rarely
Sometimes
Often
Very Often
Rereading, erasing, or rewriting (e.g., taking hours to read a few pages or write a few
because
over not understanding or needing letters to be perfect)
Fail to give close sentences
attention to
details of
or concern
make careless
mistakes in my work
Needing to repeat routine activities (e.g., getting up and down from a chair or going in and
out of a doorway, turning the light switch or TV on and off a specific number of times)
2
3
Have difficulty sustaining my attention in tasks or
fun activities
4
Leave myCounting
seat in situations
in which seating is
Compulsions
expected
5
or spoken)
Don’t listen whenread
spoken
to directly
6
Feel restless
Arranging/Symmetry
7
Arranging/ordering
(e.g.,failspends
hours straightening paper and pens on a desktop or
Don’t follow through
on instructions and
to
books in a bookcase, becomes very upset if order is disturbed)
finish work
8
Symmetry/evening
up (e.g.,
in leisure activities
or arranges
doing things or own self so that two or more sides are
“even”
or
symmetrical)
fun things quietly
9
Have difficulty organizing tasks and activities
Other repeating compulsions (Describe)
Counts objects (e.g., floor tiles, CDs or books on a shelf, his/her own steps, or words
Other arranging compulsions (Describe)
10
11
Hoarding/Saving
Compulsion
not count
Avoid, dislike,
or am reluctant
to engage(do
in work
that saving sentimental or needed objects)
requires sustainedDifficulty
mental effthrowing
ort
things away; saving bits of paper, string, old newspapers, notes,
12
Talk excessively or garbage
13
forhoarding/saving
tasks or activitiescompulsions (Describe)
Other
14
15
completed
Excessive Games/Superstitious Behaviors (must be associated with anxiety, not just a game)
16
Have difficulty awaiting
ject/selfturn
a certain number to times to avoid something bad happening, not leaving
17
Am forgetful in daily activities
18
Rituals Involving Other Persons
Interrupt or intrude on others
cans, paper towels, wrappers and empty bottles; may pick up useless objects from street
Behaviors such as not stepping on cracks or lines on floor/sidewalk, touching an obhome on the th of the month)
Needing to involve another person (usually a parent) in rituals (e.g., excessive asking for
reassurance,
parent Disorder:
to answer
the same
question,
making
parent
wash
(1998), repeatedly
Attention-Defiasking
cit Hyperactivity
A clinical
workbook
(2nd ed.).
New York:
Guilford
Press.
excessively)
TM
Copyright
© 2007
University
Press
Copyright
© 2005
OxfordOxford
University
Press
12/22/06
12:41 PM
Page 114
Week of:
Children’s Yale-Brown OC Scale (CY-BOCS) Self-Report Symptom Checklist continued
1
Never or
Rarely
Sometimes
Often
Very Often
Excessive telling, asking, or confessing (e.g., confessing repeatedly for minor or imagined transgressions,
askingcareless
for reassurance)
Fail to give close attention
to details or make
mistakes in my work
Measures (not checking) to prevent harm to self or others or some other terrible conse-
quences (e.g., avoids sharp or breakable objects, knives, or scissors)
2
3
Have difficulty sustaining
attention
in tasks
eating; my
eating
according
to aorstrict ritual)
fun activities
4
jects, or other
people,
perhaps
to prevent a bad occurrence)
Leave my seat in situations
in which
seating
is
expected
Excessive list making
5
Needing
do things (e.g., touch or arrange) until it feels “just right”
Don’t listen when spoken
toto
directly
6
Feel restless
7
finish work
8
Pleaseengaging
check all
SYMPTOMS
that you have noticed during the past week.
Have difficulty
in OBSESSIVE
leisure activities
or doing
fun thingsOBSESSIONS
quietly
are intrusive, recurrent, and distressing thoughts, sensations, urges, or images
9
Ritualized eating behaviors (e.g., arranging food, knife, fork in a particular order before
Excessive touching, tapping, rubbing (e.g., repeatedly touching particular surfaces, ob-
Avoiding saying certain words (e.g., goodnight or goodbye, person’s name, bad event)
Other (Describe)
10
11
that you may experience. They are typically frightening and may be either realistic or unrealistic
in nature.
Contamination Obsessions
Avoid, dislike, or am
reluctant
to engage
in dirt,
workgerms,
that certain illnesses (e.g., from door handles, other
Excessive
concern
with
requires sustained mental
eff
ort
people)
12
Talk excessively
13
Lose things necessary for tasks or activities
14
stances)
Blurt out answers before
questions have been
completed
Excessive concern with contamination from household items (e.g., cleaners, solvents)
15
Excessive concern about contamination from touching animals/insects
16
Excessively
turn bothered by sticky substances or residues (e.g., adhesive tape, syrup)
17
Am forgetful in daily activities
18
Concerned
on others will get others ill by spreading contaminant
Excessive concern/disgust with bodily waste or secretions (e.g., urine, feces, semen,
sweat)
Excessive concern with environmental contaminants (e.g., asbestos or radioactive sub-
Concerned will get ill as a result of being contaminated by something (e.g., germs, animals, cleaners)
Other washing/cleaning obsessions (Describe)
From R. A. Barkley & K. R. Murphy (1998), Attention-Deficit Hyperactivity Disorder: A clinical workbook (2nd ed.). New York: Guilford Press.
TM
Copyright
© Oxford
2007 Oxford
University
Press
Copyright
© 2005
University
Press
12/22/06
12:41 PM
Page 115
Week of:
Aggressive Obsessions
Never or
Rarely
Sometimes
Often
Very Often
Fear might harm self (e.g., using knives or other sharp objects)
1
Fail to give close attention to details or make careless
Fear might harm others (e.g., fear of pushing someone in front of a train, hurting somemistakes in my work
one’s feelings, causing harm by giving wrong advice)
2
Fidget with handsFear
or feet
or squirm
in will
seat happen to self
something
bad
3
my attention
in tasks
or to others
Fear something
bad will
happen
fun activities
4
ing images)
Leave my seat in situations
in which seating is
expected
Fear of blurting out obscenities or insults (e.g., in public situations like church, school)
5
Don’t listen whenFear
spoken
willtoactdirectly
on unwanted impulses (e.g., punch or stab a friend, drive a car into a tree)
6
Feel restless
7
Fear will be responsible for terrible event (e.g., fire or burglary because didn’t check
finish work
8
in leisure activities
or (Describe)
doing
Other aggressive
obsessions
fun things quietly
9
Violent or horrific images (e.g., images of murders, dismembered bodies, other disgust-
Fear will steal things against his or her will (e.g., accidentally “cheating” cashier or
shoplifting something)
locks)
10
Feel “on Hoarding/Saving
the go” or “driven Obsessions
by a motor”
11
abouttothrowing
things because he or she might need them in
Avoid, dislike, or Worries
am reluctant
engage in away
work unimportant
that
the
future,
urges
to
pick
up
and
collect
useless
things
12
Health-Related Obsessions
Talk excessively
13
Excessive
concern
with illness or disease (e.g., worries that he or she might have an illLose things necessary
for tasks
or activities
14
Blurt out answersabout
beforevomiting)
questions have been
completed
ness like cancer, heart disease, or AIDS despite reassurance from doctors; concerns
15
Excessive concern with body part or aspect of appearance (e.g., worries that his or her
face, ears, nose, arms, legs, or other body part is disgusting or ugly)
16
Have difficulty awaiting turn
17
Religious/Moral
Obsessions
Am forgetful
in daily activities
18
on thoughts,
others
mous
saying blasphemous things, or being punished for these things)
Other health-related obsessions (Describe)
Overly concerned with offending God or other religious objects (e.g., having blaspheExcessive
concern
with right/wrong,
moralityA clinical
(e.g., worries
always
doing
“the Press.
(1998),
Attention-Defi
cit Hyperactivity Disorder:
workbook about
(2nd ed.).
New York:
Guilford
right thing,” worries about having told a lie or having cheated someone)
TM
Copyright
2007 Oxford
University
Press
Copyright
© 2005©Oxford
University
Press
12/22/06
12:41 PM
Page 116
Week of:
Children’s Yale-Brown OC Scale (CY-BOCS) Self-Report Symptom Checklist continued
Other religious obsessions (Describe) Never or
Rarely
Sometimes
Often
Very Often
1
Fail to give close attention to details or make careless
mistakes inMagical
my work
Obsessions
2
Has
lucky/unlucky
numbers, colors, words, or gives special meaning to certain numbers,
Fidget with hands or
feet
or squirm in seat
colors, or words (e.g., red is a bad color because once had a bad thought while wearing
3
4
my attention in tasks or
red shirt)
fun activities
Sexual Obsessions
Leave my seat in situations in which seating is
Forbidden or upsetting sexual thoughts, images, or impulses (e.g., unwanted images of
expected
violent sexual behavior toward others, or unwanted sexual urges toward family members
5
Don’t listen when spoken
to directly
or friends)
6
Feel restless
7
Other sexual obsessions (Describe)
finish work
8
9
Obsessions about sexual orientation (e.g., that he or she may be gay or may become gay
when there is no basis for these thoughts
Have difficulty engaging in leisure activities or doing
fun things quietly
Fear of doing something embarrassing (e.g., appearing foolish, burping, having “bath-
10
accident”)
Feel “on the go” orroom
“driven
by a motor”
11
The
need totoknow
orin
remember
Avoid, dislike, or am
reluctant
engage
work thatthings (e.g., insignificant things like license plate numbers,
bumper
stickers,
T-shirt
slogans)
12
Talk excessively
13
activities
Fearforoftasks
not or
saying
the right thing (e.g., fear of having said something wrong or not
14
Intrusive (nonviolent) images (e.g., random, unwanted images that come into his or her
completed
15
16
or herturn
mind that can’t stop; bothered by low sounds like clock ticking or people talking)
17
Uncomfortable
sense of incompleteness or emptiness unless things done “just right”
Am forgetful in daily
activities
18
Interrupt or intrude on others
Fear of saying certain things (e.g., because of superstitious fears, fear of saying “thirteen”)
using “perfect” word)
mind)
Intrusive sounds, words, music, or numbers (e.g., hearing words, songs, or music in his
Other obsessions (Describe)
From R. A. Barkley & K. R. Murphy (1998), Attention-Deficit Hyperactivity Disorder: A clinical workbook (2nd ed.). New York: Guilford Press.
Adapted from Goodman, W. K., Price, L. H., Rasmussen, S. A. et al. (). The Yale-Brown Obsessive–Compulsive
Scale. Arch Gen Psychiatry, , –.
TM
Copyright
© Oxford
2007 Oxford
University
Press
Copyright
© 2005
University
Press
Code #_____
Date:
______
Self checklist for Obsessive-Compulsive Disorder (OCD)
Please circle the appropriate number for each question.
Does not
get in the
way of life
Gets in
the way
some time
Gets in
the way
much of the
time
Gets in
the way
a lot of
the time
1. Doing certain things even though I don't have to.
1
2
3
4
5
6
7
2. Getting “stuck” on certain words or thoughts.
1
2
3
4
5
6
7
3. Checking things over and over.
1
2
3
4
5
6
7
4. Hating dirt and dirty things.
1
2
3
4
5
6
7
5. Not touching something that someone else
has used.
1
2
3
4
5
6
7
6. Needing to have things clean and neat.
1
2
3
4
5
6
7
7. Washing my hands a lot.
1
2
3
4
5
6
7
8. Putting books or things away in a certain
order or until they are “just right.”
1
2
3
4
5
6
7
9. Getting angry if other kids mess up my
desk or things.
1
2
3
4
5
6
7
10. Checking my homework to make sure
it is just right.
1
2
3
4
5
6
7
11. Repeating things over and over again.
1
2
3
4
5
6
7
12. Counting things over and over again.
1
2
3
4
5
6
7
13. Having trouble finishing my schoolwork.
1
2
3
4
5
6
7
14. Using a favorite number to do things
that number of times.
1
2
3
4
5
6
7
15. Worrying about doing “bad” things.
1
2
3
4
5
6
7
16. Worrying a lot about doing things “just right.”
1
2
3
4
5
6
7
Does not
get in the
way of life
Gets in
the way
some time
Gets in
the way
much of the
time
Gets in
the way
a lot of
the time
17. Having trouble making up my mind.
1
2
3
4
5
6
7
18. Repeating certain actions.
Describe:________________
1
2
3
4
5
6
7
19. Moving or talking in a special way to avoid
bad things from happening.
1
2
3
4
5
6
7
20. Saying special numbers or words
over and over.
1
2
3
4
5
6
7
21. Other:
1
2
3
4
5
6
7
22. Other:
1
2
3
4
5
6
7
23. Other:
1
2
3
4
5
6
7
24. Other:
1
2
3
4
5
6
7
* modified from the Leyton Obsessional Inventory
(revised 1/17/01)
Code # _____
Name:
Date:
______
Parent checklist for Obsessive-Compulsive Disorder (OCD)
Does not
get in the
way of life
Gets in
the way
some time
Gets in
the way
much of the
time
Gets in
the way
a lot of
the time
1. My child engages in senseless behaviors.
1
2
3
4
5
6
7
2. My child seems to get “stuck” on certain words.
1
2
3
4
5
6
7
3. My child checks things over and over.
1
2
3
4
5
6
7
4. My child hates dirt and dirty things.
1
2
3
4
5
6
7
5. My child will not touch something that someone
else has handled.
1
2
3
4
5
6
7
6. My child needs to have things clean and neat.
1
2
3
4
5
6
7
7. My child frequently washes hands and/or makes
trips to bathroom.
1
2
3
4
5
6
7
8. My child puts books and personal items away in
a certain order or until they are “just right.”
1
2
3
4
5
6
7
9. My child gets angry if other people mess up his
or her desk or things.
1
2
3
4
5
6
7
10. My child spends a lot of time checking
homework to make sure it is just right.
1
2
3
4
5
6
7
11. My child repeats certain things over and over.
1
2
3
4
5
6
7
12. My child counts things over and over.
1
2
3
4
5
6
7
13. My child has trouble finishing schoolwork.
1
2
3
4
5
6
7
14. My child has a favorite number that he or she
uses to do things that number of times.
1
2
3
4
5
6
7
Does not
get in the
way of life
Gets in
the way
some time
Gets in
the way
much of the
time
Gets in
the way
a lot of
the time
15. My child worries about doing “bad” things.
1
2
3
4
5
6
7
16. My child worries a lot about doing things
“just right.”
1
2
3
4
5
6
7
17. My child has trouble making up his or her mind.
1
2
3
4
5
6
7
18. My child repeats certain behaviors.
Describe:________________________
1
2
3
4
5
6
7
19. My child seems to move or talk in a special way.
1
2
3
4
5
6
7
20. My child says special numbers or words over
and over.
1
2
3
4
5
6
7
21. Other:
1
2
3
4
5
6
7
22. Other:
1
2
3
4
5
6
7
23. Other:
1
2
3
4
5
6
7
24. Other:
1
2
3
4
5
6
7
Please list medications taken this week:
Name of medication
Dosage
How many times per day?
(revised 1/17/01)
Code # ______
Date:
Name:
Class taught:
______
Student's name: ________________
Teacher checklist for Obsessive-Compulsive Disorder (OCD)
Does not
get in the
way of life
Gets in
the way
some time
Gets in
the way
much of the
time
Gets in
the way
a lot of
the time
1. This student seems to engage in senseless
behaviors.
1
2
3
4
5
6
7
2. This student seems to get “stuck” on certain
words or thoughts.
1
2
3
4
5
6
7
3. This student checks things over and over.
1
2
3
4
5
6
7
4. This student hates dirt and dirty things.
1
2
3
4
5
6
7
5. This student will not touch something that
someone else has handled.
1
2
3
4
5
6
7
6. This student needs to have things clean and neat.
1
2
3
4
5
6
7
7. This student frequently washes hands and/or
makes trips to bathroom.
1
2
3
4
5
6
7
8. This student puts books and personal items away
in a certain order or until they are “just right.”
1
2
3
4
5
6
7
9. This student gets angry if other students mess up.
his or her desk or things.
1
2
3
4
5
6
7
10. This student spends a lot of time checking
homework to make sure it is just right.
1
2
3
4
5
6
7
Does not
get in the
way of life
Gets in
the way
some time
Gets in
the way
much of the
time
Gets in
the way
a lot of
the time
11. This student repeats certain things over and over.
1
2
3
4
5
6
7
12. This student counts things over and over.
1
2
3
4
5
6
7
13. This student has trouble finishing schoolwork.
1
2
3
4
5
6
7
14. This student has a favorite number that he or she
uses to do things that number of times.
1
2
3
4
5
6
7
15. This student worries about doing “bad” things.
1
2
3
4
5
6
7
16. This student worries a lot about doing things
“just right.”
1
2
3
4
5
6
7
17. This student has trouble making up his or her
mind.
1
2
3
4
5
6
7
18. This student repeats certain behaviors.
Describe: ___________________
1
2
3
4
5
6
7
19. This student seems to move or talk in a
special way.
1
2
3
4
5
6
7
20. This student says special numbers or words
over and over.
1
2
3
4
5
6
7
21. Other:
1
2
3
4
5
6
7
22. Other:
1
2
3
4
5
6
7
23. Other:
1
2
3
4
5
6
7
24. Other:
1
2
3
4
5
6
7
(revised 1/17/01)
Children’s Florida Obsessive-Compulsive Inventory
C-FOCI
Name:
Date:
General Instructions: The questions below are designed to help your doctors evaluate anxiety
symptoms. Please answer these questions as honestly as you can.
Instructions: Please circle YES or NO for the following questions, based on your experience in the
past MONTH:
Have you been bothered by unpleasant thoughts or images that repeatedly enter your mind,
such as:
1 Concerns with dirt, germs, chemicals or getting really sick?
YES
NO
2 Overconcern with keeping objects (clothes, toys, books) in perfect order or
arranged exactly?
YES
NO
3 Frequent images of death or other horrible things?
YES
NO
4 Fire, someone robbing you or flooding of the house?
YES
NO
5 Accidentally hitting a pedestrian with your car or hurting someone?
YES
NO
6 Spreading an illness (giving someone AIDS)?
YES
NO
7 Losing something valuable?
YES
NO
8 Harm coming to a loved one because you weren't careful enough?
YES
NO
YES
NO
YES
NO
11 Counting, arranging; evening-up behaviors (making sure socks are at same height)? YES
NO
12 Repeating routine actions (in/out of chair, going through doorway, opening/closing
YES
things) a certain number of times or until it feels just right?
NO
13 Needing to touch objects or people?
YES
NO
14 Unnecessary rereading or rewriting?
YES
NO
15 Examining your body for signs of illness?
YES
NO
16 Avoiding colors (“red” means blood), numbers (“13” is unlucky) or names (those
that start with “D” signify death) that are associated with scary events or
thoughts?
YES
NO
Have you worried a lot about terrible things happening, such as:
Have you felt driven to perform certain acts over and over again, such as:
9 Excessive or ritualized washing, cleaning or grooming?
10 Checking light switches, water faucets, the stove, or door locks?
17 Needing to “confess” or repeatedly asking for reassurance that you said or did
something correctly?
YES
NO
PART B Instructions: The following questions refer to the repeated thoughts, images, urges or
behaviors identified in Part A. Consider your experience during the past month when selecting an
answer.
Circle the most appropriate number from 0 to 4.
In the past month...
1. On average,
how much time is
occupied by these
thoughts or behaviors
each day?
2. How much do these
things bother you?
3. How hard is it for you
to control them?
4. How much do they
cause you to avoid doing
things, going places or
being with people?
5. How much do they
interfere with school,
your social or family life,
or your job?
For clinician use:
Sum on Part B
(Add Items 1 to 5):
0
1
2
3
4
None
Mild
(less than
1 hour)
Moderate
(1 to
3 hours)
Severe
(3 to
8 hours)
Extreme
(more than
8 hours)
0
1
2
3
4
None
Mild
Moderate
Severe
Extreme
(disabling)
0
1
2
3
4
Complete
control
Much
control
Moderate
control
Little
control
No
control
0
1
2
3
4
No
avoidance
Occasional
avoidance
Moderate
avoidance
Frequent
and
extensive
avoidance
Extreme
avoidance
(housebound)
0
1
2
3
4
None
Slight
interference
Definitely
interferes
with
functioning
Much
interference
Extreme
interference
(disabling)
Child OC Impact Scale - Revised (COIS - RC)
Child Self-Report
Name: _____________________________________
Age: _______
Date: _________________
Please rate how much your obsessive compulsive symptoms (unwanted thoughts and/or rituals) have caused
problems for you in the following areas over the past month. If a specific question does not apply, mark “Not at
all”.
In the past month, how much trouble have you had
doing the following things because of your OCD?
Not
at all
Just a
Little
Pretty
Much
Very
Much
1.
Taking tests or exams
0
1
2
3
2.
Being with a group of strangers
0
1
2
3
3.
Being absent from school
0
1
2
3
4.
Going shopping or trying on clothes
0
1
2
3
5.
Making new friends
0
1
2
3
6.
Going to a friend’s house during the day
0
1
2
3
7.
Writing in class
0
1
2
3
8.
Eating in public other than a restaurant, like on a picnic,
in the park, or at a friend’s house
0
1
2
3
Eating meals at home
0
1
2
3
10. Getting to school on time in the morning
0
1
2
3
11. Going on a date
0
1
2
3
12. Visiting relatives
0
1
2
3
13. Going to the bathroom
0
1
2
3
14. Watching television or listening to music
0
1
2
3
15. Reading books or magazines for fun
0
1
2
3
16. Being with a group of people you know
0
1
2
3
17. Going on a family vacation
0
1
2
3
18. Having relatives visit
0
1
2
3
19. Having a friend come to your house during the day
0
1
2
3
9.
Copyright © 2007, John Piacentini. Cite: Piacentini, Peris, Bergman, Chang, & Jaffer. (2007). Functional Impairment in Childhood OCD: Development
and Psychometrics Properties of the Child Obsessive-Compulsive Impact Scale-Revised (COIS-R), J Clinical Child Adol Psychology, 36, 645-653.
Name: ______________________________________
In the past month, how much trouble have you had
COIS-RC (child self-report)
Page 2
Not
Just a
Pretty
Very
at all
Little
Much
Much
20. Concentrating on your work
0
1
2
3
21. Going to a restaurant or fast food place
0
1
2
3
22. Having a boyfriend/girlfriend
0
1
2
3
23. Going to the movies
0
1
2
3
24. Getting to classes on time during the day
0
1
2
3
25. Keeping friends you already have
0
1
2
3
26. Eating lunch with other kids
0
1
2
3
27. Having someone spend the night at your house
0
1
2
3
28. Being prepared for class, e.g., having your books,
paper or pencils ready when needed
0
1
2
3
29. Talking on the phone
0
1
2
3
30. Bathroom or grooming (brushing your teeth or combing
his/her hair) in the morning
0
1
2
3
31. Completing assignments in class
0
1
2
3
32. Doing homework
0
1
2
3
33. Getting good grades
0
1
2
3
doing the following things because of your OCD?
Child OC Impact Scale - Revised (COIS - RP)
Parent Report about Child
Name: _____________________________________
Age: _______
Date: _________________
Please rate how much your child’s obsessive compulsive symptoms (unwanted thoughts and/or rituals) have
caused problems for him or her in the following areas over the past month. If a specific question does not
apply, mark “Not at all”.
In the past month, how much trouble has your child had
doing the following things because of his or her OCD?
Not
at all
Just a
Little
Pretty
Much
Very
Much
1.
Taking tests or exams
0
1
2
3
2.
Being with a group of strangers
0
1
2
3
3.
Leaving the house
0
1
2
3
4.
Going shopping or trying on clothes
0
1
2
3
5.
Making new friends
0
1
2
3
6.
Going to a friend’s house during the day
0
1
2
3
7.
Writing in class
0
1
2
3
8.
Eating in public other than a restaurant, like on a picnic,
in the park, or at a friend’s house
0
1
2
3
Doing fun things during recess or free time
0
1
2
3
10. Getting to school on time in the morning
0
1
2
3
11. Going on a date
0
1
2
3
12. Visiting relatives
0
1
2
3
13. Getting ready for bed at night
0
1
2
3
14. Getting along with his/her parents
0
1
2
3
15. Getting along with his/her brothers or sisters
0
1
2
3
16. Being with a group of people that he/she knows
0
1
2
3
17. Going on a family vacation
0
1
2
3
18. Having relatives visit
0
1
2
3
19. Doing chores that he/she is asked to do, like washing
the dishes, taking the garbage out or cleaning his/her room
0
1
2
3
9.
Name: ______________________________________
In the past month, how much trouble has your child had
COIS-RP (parent-report about child)
Page 2
Not
Just a
Pretty
Very
at all
Little
Much
Much
20. Concentrating on his/her work
0
1
2
3
21. Going to a restaurant or fast food place
0
1
2
3
22. Having a boyfriend/girlfriend
0
1
2
3
23. Going to temple or church
0
1
2
3
24. Going to school outings or field trips
0
1
2
3
25. Keeping friends he/she already has
0
1
2
3
26. Eating lunch with other kids
0
1
2
3
27. Having someone spend the night at his/her house
0
1
2
3
28. Being prepared for class, e.g., having his/her books,
paper or pencils ready when needed
0
1
2
3
29. Spending the night at a friend’s house
0
1
2
3
30. Bathroom or grooming (brushing his/her teeth or combing
his/her hair) in the morning
0
1
2
3
31. Completing assignments in class
0
1
2
3
32. Doing homework
0
1
2
3
33. Getting dressed in the morning
0
1
2
3
doing the following things because of his or her OCD?
FAMILY ACCOMMODATION SCALE FOR
OBSESSIVE-COMPULSIVE DISORDER
Self-Rated Version (FAS-SR)
Developed by:
Anthony Pinto, Ph.D., Barbara Van Noppen, Ph.D.,
& Lisa Calvocoressi, Ph.D.
Copyright and Permissions
The Family Accommodation Scale for Obsessive Compulsive Disorder - Self-Rated Version (FAS-SR)
Copyright © 2012 by Anthony Pinto, Ph.D., Barbara Van Noppen, Ph.D., & Lisa Calvocoressi, Ph.D.
The Family Accommodation Scale for Obsessive Compulsive Disorder - Self-Rated Version (FAS-SR)
includes a modified version of the Yale Brown Obsessive Compulsive Scale (YBOCS) Checklist,
copyright © 1986, 1989, with permission.
Reference
Pinto, A., Van Noppen, B., & Calvocoressi, L. (in press). Development and preliminary psychometric evaluation
of a self-rated version of the Family Accommodation Scale for Obsessive-Compulsive Disorder. Journal of
Obsessive-Compulsive and Related Disorders.
Correspondence
For permission to use or adapt this instrument for clinical or research purposes, please contact
Lisa Calvocoressi, Ph.D., Yale University School of Public Health, Yale University School of Medicine:
[email protected].
FAMILY ACCOMMODATION SCALE FOR OCD
Self-Rated Version (FAS-SR)
Today’s Date: ____/____/____
Your Gender: (circle one)
1 = female
2 = male
I am the patient’s __________. [What is your relation to the patient?] (circle one)
1 = parent
2 = spouse
3 = partner
4 = adult child
5 = sibling
6 = other
INTRODUCTION FOR THE FAMILY MEMBER
You have been asked to complete this questionnaire because you have a relative or significant other who has been
diagnosed with obsessive-compulsive disorder (OCD) and who has identified you as the family member who is
most involved with him/her and the OCD. Throughout this questionnaire, your relative/significant other with OCD
is referred to as “your relative” and you are referred to as the “family member.”
Part I of this questionnaire describes obsessions and compulsions and asks you to identify your relative’s current
OCD symptoms to the best of your knowledge. Part II of this questionnaire asks you to identify possible ways in
which you may be modifying your behavior or routines in response to your relative’s OCD.
PART I: REPORT OF RELATIVE’S OCD SYMPTOMS
OBSESSIONS
Obsessions are distressing ideas, thoughts, images or impulses that repeatedly enter a person's mind and may seem
to occur against his or her will. The thoughts may be repugnant or frightening, or may seem senseless to the person
who is experiencing them.
Below is a list of different types of obsessions common in OCD. Please place a check mark by each type of
obsession that your relative experienced (to the best of your knowledge) during the past week.
____
HARMING OBSESSIONS
Examples: fears of harming oneself or others, stealing things, blurting out obscenities or insults, acting on
unwanted or embarrassing impulses; being responsible for something terrible happening (e.g., a fire or
burglary); experiencing violent or horrific images.
____ CONTAMINATION OBSESSIONS
Examples: excessive concerns about or disgust with bodily waste, secretions, blood, germs; excessive
concerns about being contaminated by environmental toxins (e.g., asbestos, radiation, or toxic waste),
household cleansers/solvents, or animals (e.g., insects); discomfort with sticky substances or residues; fears
of contaminating others.
____ SEXUAL OBSESSIONS
Examples: unwanted, repeated thoughts with forbidden or perverse sexual themes (e.g., sexual involvement
with children).
____
HOARDING/SAVING OBSESSIONS
Examples: worries about throwing out seemingly unimportant things, resulting in accumulation of
possessions that fill up or clutter active living areas or the workplace.
____ RELIGIOUS OBSESSIONS
Examples: intrusive blasphemous thoughts; excessive concerns about right and wrong/morality.
2
____ OBSESSION WITH NEED FOR SYMMETRY OR EXACTNESS
Examples: worries about whether items have been moved; worries that possessions are not properly
aligned; worries about calculations or handwriting being perfect.
____ SOMATIC OBSESSIONS
Examples: excessive concerns about having an illness like AIDS or cancer, despite reassurance to the
contrary; excessive concerns about a part of the body or aspect of appearance.
____ MISCELLANEOUS OBSESSIONS
Examples: an excessive need to know or remember unimportant details; a fear of losing things; a fear of
saying certain words; a fear of not saying just the right thing; a discomfort with certain sounds or noises; or
repeated thoughts of lucky or unlucky numbers.
COMPULSIONS
Compulsions (also called rituals) are defined as behaviors or mental acts that a person feels driven to perform,
although s/he may recognize them as senseless or excessive. It may be difficult or anxiety provoking for a person
to resist performing these behaviors.
Below is a list of different types of compulsions common in OCD. Please place a check mark by each type of
compulsion that your relative experienced (to the best of your knowledge) during the past week.
____
CLEANING/WASHING COMPULSIONS
Examples: excessive or ritualized handwashing, showering, bathing, toothbrushing, grooming, or toilet
routine; excessive cleaning of household items; efforts to prevent contact with contaminants.
____
CHECKING COMPULSIONS
Examples: excessively checking locks, stove, appliances; checking to ensure that nothing terrible did or
will happen, or that s/he did not make a mistake; checking tied to fears of illness.
____
REPEATING RITUALS
Examples: rereading and/or rewriting things; repeating routine activities (e.g., going in/out of door, getting
up/down from chair).
____
COUNTING COMPULSIONS
Examples: counting floor tiles, books on a shelf, or words in a sentence.
____ ORDERING/ARRANGING COMPULSIONS
Examples: excessive straightening of papers on a desk, adjusting furniture or picture frames.
____ HOARDING/SAVING/COLLECTING COMPULSIONS
Examples: saving old newspapers, junk mail, wrappers, broken tools since they may be needed one day;
picking up useless objects from the street or garbage cans.
____ MISCELLANEOUS COMPULSIONS
Examples: seeking reassurance (e.g., by repeatedly asking the same question); excessive listmaking; taking
measures to prevent harm to self or others, or to prevent terrible consequences; mental rituals other than
checking or counting (e.g., reviewing, ritualized praying); need to touch or tap things; ritualized eating
behaviors.
3
PART II: REPORT OF FAMILY MEMBER’S RESPONSES TO OCD
INSTRUCTIONS: Keeping in mind your relative's OCD symptoms that you identified in Part I, the next set of
items describe possible ways that you may have responded to those symptoms during the past week. For each
item, please indicate the number of days during the past week that you responded to your relative in the way
specified. For each item, fill in a circle in the NUMBER OF DAYS column. If an item refers to something you
did not do at all in the last week, fill in the circle for “none/never happened.”
NUMBER OF DAYS THIS PAST WEEK
None/
Never
1
day
2-3
days
4-6
days
Every
day
1. I reassured my relative that there were no grounds for his/her
OCD-related worries.
Examples: reassuring my relative that s/he is not contaminated
or that s/he is not terminally ill.
2. I reassured my relative that the rituals he/she already
performed took care of the OCD-related concern.
Examples: reassuring my relative that s/he did enough ritualized
cleaning or checking.
3. I waited for my relative while s/he completed compulsive
behaviors.
4. I directly participated in my relative’s compulsions.
Examples: doing repeated washing or checking at my relative’s
request.
5. I did things that made it possible for my relative to complete
compulsions.
Examples: driving back home so my relative can check if the
doors are locked; creating extra space in the house for my
relative’s saved items.
6. I provided my relative with OCD with items s/he needs to
perform rituals or compulsions.
Examples: shopping for excessive quantities of soap or cleaning
products for my relative.
7. I did things that allowed my relative to avoid situations that
might trigger obsessions or compulsions.
Examples: touching public door knobs for my relative so s/he
wouldn’t have to.
4
NUMBER OF DAYS THIS PAST WEEK
None/
Never
1
day
2-3
Days
4-6
Days
Every
day
8. I helped my relative make simple decisions when s/he couldn’t
do so because of OCD.
Examples: deciding which clothes my relative should put on in the
morning or what brand of cereal s/he should buy.
9. I helped my relative with personal tasks, such as washing,
grooming, toileting, or dressing, when his/her ability to function
was impaired by OCD.
13. I stopped myself from doing things that could have led my
relative to have obsessions or compulsions.
Examples: not moving items that my relative has carefully lined up.
14. I made excuses or lied for my relative when s/he missed work
or a social activity because of his/her OCD.
15. I didn’t do anything to stop unusual OCD-related behaviors by
my relative.
Examples: tolerating my relative’s repetitive actions such as going
in and out of a doorway or touching/tapping objects a certain
number of times.
16. I put up with unusual conditions in my home because of my
relative’s OCD.
Examples: leaving the home cluttered with papers that my relative
won’t throw away.
17. I cut back on leisure activities because of my relative’s OCD.
Examples:spending less time socializing, doing hobbies, exercising.
18. I changed my work or school schedule because of my relative’s
OCD.
19. I put off some of my family responsibilities because of my
relative’s OCD.
Examples: I spent less time than I would have liked with other
relatives; I neglected my household chores.
10. I helped my relative prepare food when s/he couldn’t do so
because of OCD.
11. I took on family or household responsibilities that my relative
couldn’t adequately perform due to OCD.
Examples: doing bills, shopping, and/or taking care of children for
my relative (when, except for OCD, I wouldn’t have done so).
12. I avoided talking about things that might trigger my relative’s
obsessions or compulsions.
TOTAL SCORE (sum of responses to items 1-19)
5
KATHERINE YOST, PhD, LMFT
Washington State Licensed Marriage and Family Therapist #LF 60034433
345 – 118th Ave SE Suite 110
Bellevue, WA 98005
425.405.0494\
OBSESSIVE COMPULSIVE DISORDER
Self Help Reading List
For Children
Huebner, D. (2007). What to do when your brain gets stuck: A kid’s guide to overcoming OCD
Washington, DC: Magination Press, APA
March, J.S. & Benton, C. M. (2007). Talking back to OCD: The program that helps kids and
teens say “no way” –and parents say “way to go.” NY: Guilford
Niner, H.L. (2004). Mr. Worry: A story about OCD. Morton Grove, IL: Albert Whitman & Co.
Wagner, A.P. (2002). What to do when your child has obsessive-compulsive disorder:
Strategies and solutions. AL: Lighthouse Press.
For Parents of Children with OCD
Chansky, T.E. (2006). Freeing your child from Obsessive-Compulsive Disorder. NY: Three
Rivers Press.
Wagner, A.P. & Jutton, P. (2004) Up and down the worry hill: A children’s book about obsessive
compulsive disorder and its treatment. AL: Lighthouse Press.
For Families
Landsman, K.J., Rupertus, K.M., & Pedrick, C. (2005). Loving someone with OCD: Help for
you and your family. Oakland, CA: New Harbinger.
VanNoppen, B., Pato, M., & Rasmussen, S. (2003). Learning to live with OCD: Help for
families. New Haven, CT: OCFoundation.
Personal Accounts
Bell, J. (2007). Rewind, replay, repeat: A memoir of obsessive-compulsive disorder. MN:
Hazelton.
Bell, J. (2009). When in doubt, make belief: An OCD inspired approach to living. NY: New
World Library.
Colas, E. (1998). Just checking: Scenes from the life of an obsessive-compulsive. NY: Simon &
Schuster.
Personal Self Help (* Recommended)
Abramowitz, J.S. (2009). Getting over OCD: A 10-step workbook for taking back your life. NY:
Guilford.
Antony, M.M. & Swinson, R.P. (2009). When perfect isn’t good enough: Strategies for coping
with perfectionism. Oakland, CA: New Harbinger.
Baer, L. (2000). The Imp of the mind. NY: Little, Brown, & Co.
Frost, R. & Steketee, G. (2010). Stuff: Compulsive hoarding and meaning of things. Boston:
Houghton Mifflin Harcourt.
*Grayson, J. (2003). Freedom from obsessive compulsive disorder: A personalized recovery
program for living with uncertainty. NY: Penguin.
Hyman, B.M. & Dufrene, T. (2008). Coping with OCD: Practical strategies for living well with
OCD. Oakland, CA: New Harbinger.
Penzel, F. (2000). Obsessive-Compulsive Disorders: A complete guide to getting well and
staying well. NY: Oxford University Press.
*Schwartz, J.M. and Beyette, B. (1996). Brainlock: Free yourself from obsessive-compulsive
behavior. NY: Harper Collins.
KATHERINE YOST, PhD, LMFT
Washington State Licensed Marriage and Family Therapist #LF 60034433
345 – 118th Ave SE Suite 110
Bellevue, WA 98005
425.405.0494\
OBSESSIVE COMPULSIVE DISORDER
Suggested Reading List for Professionals
Abramowitz, J. S. (2006). Obsessive-compulsive disorder: Evidence based practice. Cambridge,
MA: Hogrefe & Huber Publishers.
Freeman, J. B. (2009). Family-based treatment for young children with OCD. NY: Oxford
University Press.
March, J. and Mulle, K. (1998). OCD in children and adolescents: A cognitive behavioral
treatment manual. NY: Guilford Press.
Piacentini, J., Langley, A., &Roblek, T. (2007). Cognitive behavioral treatment of childhood
OCD: It’s only a false alarm –therapist guide. NY: Oxford University Press.
Storch, E.A., Murphy, T.K.m & Geffken, G.R. (eds) (2007). Handbook of child and adolescent
Obsessive-Compulsive Disorder. NY: Lawrence Erlbaum.
Wagner, A.P. (2007). Treatment of OCD in children and adolescents: A professional’s kit (2nd
ed.) Rochester, NY: Lighthouse Press
Wilhelm, S. & Steketee, G.S. (2006). Cognitive therapy for obsessive-compulsive disorder: A
guide for professionals. Oakland, CA: New Harbinger.
iPhone/iPad Apps available from iTunes App Store (examples)
Breathe2Relax
Relax and Rest Guided Meditation
YBOCS OCD Test
iCounselor OCD
FOR FUTHER INFORMATION CONTACT
International OCD Foundation
PO Box 961029
Boston, MA 02196
www.ocfoundation.org
References for 2013 AAMFT workshop: Empowering Families with Pediatric OCD
**Especially of interest
Adelman, C.B. & Lebowitz, E.R. (2012). Poor insight in pediatric obsessive compulsive disorder:
developmental considerations, treatment implications, and potential strategies for
improving insight. Journal of Obsessive-Compulsive and Related Disorders, 119-124.
**Bamber, D., Tamplin, S., Park, R.J., Kyte, Z.A.,& Goodyer, J.M. (2002). Development of a short
Leyton Obsessional Inventory for children and adolescents. Journal of the American
Academy of Child and Adolescent Psychiatry, 41 (10), 1236-1252.
Berman, N.C., Wheaton, M.G., & Abramowitz, J.S. (2013). Childhood trauma and thought
action fusion: A multi-method examination. Journal of Obsessive-Compulsive and
Related Disorders, 2 (1), 43-47.
Bipeta, R., Yerramilli, S.S., Pingali, S. Karredla, A.R., Ali, M.O. (2013). A cross-sectional study of insight
and family accommodation in pediatric obsessive-compulsive disorder. Child and Adolescent
Psychiatry and Mental Health, 7:20
Canal Sans, J., Hernandez-Martinez, C., Munoz, S.C., Garcia, L.L., & Trallero, J.T. (2011). The Leyton
Obsessional Inventory-Child Version: Validity and reliability in Spanish non-clinical population.
International Journal of Clinical and Health Psychology, 12 (1), 81-96.
Geffken, G., Sajid, M., &Macnaughton, K. (2005). The course of childhood OCD, its antecedents, onset,
comorbidities, remission, and reemergence: A 12 year case report. Clinical Case Studies, 4 (380).
Gillihan, S.J., Williams, M.T., Malcoun, E., Yadin, E., & Foa, E.B. (2012). Common pitfalls in exposure and
response prevention (EX/RP) for OCD. Journal of Obsessive-Compulsive and Related Disorders,
1, 251-257.
Keeley, M.L., Storch, E.A., Dhungana, P., &Geffken, G.R. (2007). Pediatric obsessive-compulsive
disorder: A guide to assessment and treatment. Issues in Mental Health Nursing, 28, 555-574.
Koburi, O., Salkovskis, P.M., Read, J., Lounes, N. & Wong, V. (2012). A qualitative study of the
investigation of reassurance seeking in obsessive-compulsive disorder. Journal of ObsessiveCompulsive and Related Disorders, 1, 25-32.
Merlo, L.J., Lehmkuhl, H.D., Geffken, G.R., & Storch, E.A. (2009). Decreased Family Accommodation
associated with improved therapy outcome in Pediatric obsessive compulsive disorder. Journal
of Consulting and Clinical Psychology, 77 (2), 355-360.
Piacentini,J. & Bergman, R.L. et al. (2011). Controlled comparison of family cognitive behavioral therapy
and psychoeducation/relaxation training for child OCD. Journal of the American Academy for
Child and Adolescent Psychiatry, 50 (11), 1149-1161.
**Pinto, A., Van Noppen, B., & Calvocoressi, L. (in press). Development and preliminary psychometric
evaluation of a self-rated version of the Family Accommodation Scale for Obsessive-Compulsive
Disorder. Journal of Obsessive-Compulsive and Related Disorders.
Renshaw, K.D., Steketee, G., & Chambless, D.L. (2005). Involving family members in the treatment of
OCD. Cognitive Behaviour Therapy, 34 (3), 164-175.
Steketee, G. &Van Noppen, B. (2003). Family approaches to treatment for obsessive compulsive
disorder. Brazilian Journal of Psychiatry, 25 (1), 43-50.
**Storch,E.A. & Geffken, G.R. et al. (2007) Family Accommodation in pediatric obsessive-compulsive
disorder. Journal of Clinical Child and Adolescent Psychology, 36 (2), 207-216.
**Storch, E.A., Khanna, M., Merlo, L.J., Loew, B.A., Franklin, M., Reid, J.M., Goodman, W.K., & Murphy,
T.K. (2009). Children’s Florida Obsessive Compulsive Inventory: Psychometric Properties and
Feasibility of a Self-Report Measure of Obsessive-Compulsive Symptoms in Youth. Child
Psychiatry Human Development, 40, 467-483.
Storch, E.A., Lehmkuhl, H, Pence, S.L., Geffken, G.R., Ricketts, E., Storch, J.F., Murphy, T.K. (2009).
Parental experiences of having a child with obsessive-compulsive disorder: Associations with
clinical characteristics and caregiver adjustment. Journal of Child and Family Studies, 18, 249258.
**Szymanski, J. & Bourne, C. (Winter 2013). OCD and related disorders in the new DSM 5 and what it
means for you. OCD Newsletter, International OCD Foundation, Inc. 27 (1), 1&6-9.
Taylor, S. (2012). Endophenotypes of obsessive-compulsive disorder: Current status and future
directions. Journal of Obsessive-Compulsive and Related Disorders, 1, 258-262.

Obsessive-Compulsive Disorder - American Association for

Transcription

Similar documents

CY-BOCS Symptom Checklist

Compulsive Disorder

Obsessions and Compulsions - Self Help Guides

Obsessions and Compulsions - Northumberland, Tyne and Wear

OCD CHALLENGES AND STRATEGIES

Osteochondrosis Diseccans (OCD)