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Debra, holding a banner that says ‘Y–BOCS’.
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Yale–Brown Obsessive–Compulsive Scale

Published: January 29, 2023
Last updated on July 10, 2023

The Yale–Brown Obsessive–Compulsive Scale (Y–BOCS) is a standardized rating scale with both clinician-administered and self-report versions available that measures obsessions and compulsions, and is considered the “gold standard” in the measurement of obsessive–compulsive disorder (OCD) symptom severity and treatment response.[1]Measurement of risk-taking in obsessive-compulsive disorder (Steketee & Frost, 1994)[2] Dimensional structure of the Yale–Brown Obsessive-Compulsive Scale (Y–BOCS) (Moritz et al., 2002)

Basic information
Questions: 58-item checklist + 10 questions
Duration: 5–10 minutes
Type: screening tool
Author: Wayne Goodman
Publishing year: 1989
Seminal papers: The Yale–Brown Obsessive–Compulsive Scale Part I – Development, Use, and Reliability (Goodman et al., 1989)

The Yale–Brown Obsessive–Compulsive Scale Part II – Validity (Goodman et al., 1989)

Take the test here:

Dr. Natalie’s rating: 4 stars for appropriate and respectful wording, 2 stars for clarity & lack of ambiguity, and 5 stars for testing accuracy.Dr. Natalie’s rating: 4 stars for appropriate and respectful wording, 2 stars for clarity & lack of ambiguity, and 5 stars for testing accuracy.

Who the test is designed for

  • The Y–BOCS assessment is administered to adult participants ages 18–85.

Versions & translations

Taking the test

The Y–BOCS consists of 10 statements, giving you 5 choices for each statement:

  1. No symptoms
  2. Few symptoms
  3. Some symptoms
  4. Many symptoms
  5. Severe symptoms

Scoring

  • Scores range from 0 points (no symptoms) to 4 points (extreme symptoms)
  • Total score is calculated by summing items 1 to 10
  • Scoring range: 0–40

Score interpretation

There are 10 questions in the Yale–Brown Obsessive–Compulsive Scale (Y–BOCS) calculator intended to interpret symptoms over the past seven days.

Each answer is awarded a point from 0 for the least intensity to 4 for the highest severity, forming the total result at the end.

Two partial scores are given—one summing the scores of questions 1 to 5 (for obsessions) and the second summing the scores from items 6 to 10 (for compulsions).

  • 0–7: none
  • 8–15: mild
  • 16–23: moderate
  • 24–31: severe
  • 32–40: extreme

Scoring methods

You can take the test using two methods of scoring:

  1. Automated-scoring.
  2. Self-scoring, if you want documentation of your answers.

Validity

How reliable, accurate, and valid is the Y-BOCS?

The Yale–Brown Obsessive–Compulsive Scale[3]The Yale–Brown Obsessive–Compulsive Scale Part I – Development, Use, and Reliability (Goodman et al., 1989)[4]The Yale–Brown Obsessive–Compulsive Scale Part II – Validity (Goodman et al., 1989) is considered the “gold standard” in the measurement of obsessive–compulsive disorder (OCD) symptom severity and treatment response.[5]Measurement of risk-taking in obsessive-compulsive disorder (Steketee & Frost, 1994)[6]Dimensional structure of the Yale–Brown Obsessive–Compulsive Scale (Y–BOCS) (Moritz et al., 2002)

A study comprising four raters and 40 patients with obsessive-compulsive disorder demonstrated excellent inter–rater veracity. A high degree of internal consistency is shown with Cronbach’s α coefficient. Based on the pretreatment assessment of 42 patients with obsessive–compulsive disorder, each item was frequently endorsed and measured across various severity ranges. These findings denote the Yale–Brown Scale as a reliable instrument for measuring the degree of severity and types of symptoms associated with obsessive-compulsive disorder.[7]The Yale–Brown Obsessive–Compulsive Scale Part I – Development, Use, and Reliability (Goodman et al., 1989)

Studies indicate that the Yale-Brown Scale is a valid instrument for assessing symptom severity and outcome measures in drug trials.[8]The Yale–Brown Obsessive–Compulsive Scale Part II – Validity (Goodman et al., 1989)

Updates

The Y–BOCS was updated to the Y–BOCS II in 2004. The most noteworthy changes are:

  • The phrase “resistance against obsessions” (item #4) is replaced by “obsession-free interval”.
  • Scoring of all items 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.
  • Assessment of avoidance behaviors is given added emphasis as reflected in the instructions and anchor points for most items.
  • Extensive modifications are made to the content and format of the Symptom Checklist.
  • Fine-tuning of wording or format.

*Although the Y–BOCS-II offers many improvements, the original version remains widely available online. As far as automated scoring availability, the Y–BOCS is, by all appearances, exclusively used.

Dr. Natalie Engelbrecht pointing to the title ‘Discussion’.

Discussion

Natalie:
  • My score: Obsessions subtotal = 5;  Compulsions subtotal = 1; Yale–Brown obsessive–compulsive Scale (Y–BOCS) Total Score = 6.
  • Interpretation: This score is indicative of a sub-clinical level of obsessive-compulsive disorder.

Back in 2020, Eva scored 40 (which is the highest possible score). It is interesting because Eva and Kendall laughed at the statements, ‘I completely and willingly yield to all obsessions’ and ‘I completely and willingly yield to all compulsions.’ They both said before taking the test, ‘Who completely yields?’ They both fully admitted they give into all their obsessions and compulsions.

I tend to choose friends with an OCD work ethic because I have high standards for good quality. It helps when they check and recheck my work and ask questions to ensure the details are complete. This website would not look this way if Eva and Kendall did not completely and freely yield fully to their special interest obsessions. So again, here we see where variant neurology is not necessarily negative.

The research shows that autistics do not resist their obsessions and compulsions[9]Children’s Yale–Brown obsessive–compulsive scale in autism spectrum disorder: component structure and correlates of symptom checklist (Scahill et al., 2014)—in fact, it makes many of us feel bad when we do. My obsessive qualities come up in helping people and the people who are my special interests.

The two groups [individuals with primary OCD and autistics without intellectual disability] had similar frequencies of obsessive-compulsive symptoms, with only somatic obsessions symptoms, with only somatic obsessions and repeating rituals being more common in the OCD group. The OCD group had higher obsessive-compulsive symptom severity ratings. Still, up to 50% of the ASD group reported at least moderate levels of interference from their symptoms.

I arrange my life to fully engage in my obsessions—my son, best friend, and Eva. I spend time with them every day. When I can’t, that is when I have significant distress and interference in my day. So why do I score subclinically? When I took the test, thinking about not having access to the three of them, my score was very different: Obsessions subtotal = 17;  Compulsions subtotal = 18; Yale-Brown obsessive–compulsive Scale (Y–BOCS) Total Score = 35.  Interpretation: This score is indicative of an extreme level of obsessive-compulsive disorder being present in the evaluated patient.

So it comes back to the fact that females engage in socially acceptable special interests while males do not. So while most of my special interests (psychology, autism) don’t distress me, my obsessions can cause significant distress if I can not engage in them.

Conclusion: Obsessions and compulsions are common in adults with ASD Level 1 autism and are associated with significant levels of distress (if we can not engage in them fully.)

Eva:
  • My score: Obsessions subtotal = 7; Compulsions subtotal = 14; Yale–Brown Obsessive–Compulsive Scale (Y–BOCS) Total Score = 21.
  • Interpretation: This score is indicative of a moderate level of obsessive-compulsive disorder being present in the evaluated patient.

I don’t expect this to be very accurate when self-administered, because you will first have to make a subjective consideration of what constitutes obsessive thoughts in the first place. Based on that, the very first question (How much of your time is occupied by obsessive thoughts?) already gives me pause. How do I answer this? I genuinely don’t know. I spend a lot of my time on very particular things, and cognitive processes are certainly involved in that. But do they constitute obsessive thoughts? I have no clue! But this first question is crucial when it comes to answering any of the questions that follow. On item #2 I’m confronted with the question of whether my obsessive thoughts cause interference with functioning in my social, work, or other roles. But whether or not that applies—and to what extent—depends entirely on what I consider to be obsessive thoughts in the first place! I would also say that I work in a field where my obsessive nature actually contributes to my output, so I can’t necessarily say it interferes—even if I do have a lot of obsessive thoughts.

Item #6 also puzzles me; what does it mean to ‘perform’ my obsessive thoughts? I suppose it’s getting at whether my obsessive thoughts lead to compulsive behaviors, but I’m not entirely sure if that’s how I ought to interpret it.

In Natalie’s discussion you might have read that I scored a maximum of 40 points in 2020. I believe I’m less obsessive–compulsive than I was back then, but I still struggle with certain compulsions. But both because I’ve changed over the years as well as my subjective interpretation of the test, I now score significantly lower. What troubles me about that is that I don’t know to what extent the lower score is due to my interpretation.

Kendall:

Am I conscientious and thorough in my work? Or do I possess a severe level of obsessive-compulsive disorder? I can’t say that I recall hearing the phrase, severely conscientious. Moving along. The response options are sometimes amusing; for example—completely and willingly yield to all obsessions. However, in considering the description of common obsessions:

  • Excessive fears of contamination.
  • Recurring doubts about danger.
  • Extreme concern with order, symmetry, or exactness.
  • Fear of losing important things.

I had no choice but to make that selection, plus other similar responses. The test is quick and easy. The questions are straightforward, with the response options uncomplicated.

 

To read more on alexithymia and aspects of this construct that are commonly mistaken for autism, have a look at:

Alexithymia & autism guide

Dr. Natalie Engelbrecht pointing at a psychometric test.

The Y–BOCS

Part 1: Symptom checklist
Aggressive obsessions

Check all which apply to you.

1. I fear I might harm myself
EXAMPLES: Fear of eating with a knife or fork, fear of handling sharp objects, fear of walking near glass windows
2. I fear I might harm other people
EXAMPLES: Fear of poisoning other people’s food, fear of harming babies, fear of pushing someone in front of a train, fear of hurting someone’s feelings, fear of being responsible by not providing assistance for some imagined catastrophe, fear of causing harm by giving bad advice
3. I have violent or horrific images in my mind
EXAMPLES: Images of murder, dismembered bodies, or other disgusting scenes
4. I fear I will blurt out obscenities
EXAMPLES: Fear of shouting obscenities in public situations like church or class, fear of writing obscenities
5. I fear doing something embarrassing
EXAMPLES: Fear of appearing foolish in social situations
6. I fear I will act on an unwanted impulse
EXAMPLES: Fear of driving a car into a tree, fear of running someone over, fear of stabbing a friend
7. I fear I will steal things
EXAMPLES: Fear of “cheating” a cashier, fear of shoplifting inexpensive items
8. I fear that I’ll harm others because I’m not careful enough
EXAMPLES: Fear of causing an accident without being aware of it (such as a hit-and-run accident)
9. I fear I’ll be responsible for something else terrible happening
EXAMPLES: Fear of causing a fire or burglary because of not being careful enough in checking the house before leaving
Contamination obsessions

Check all which apply to you.

10. I am concerned or disgusted with bodily waste or secretions
EXAMPLES: Fear of contracting AIDS, cancer, or other diseases from public rest rooms; fear of your own saliva, urine, feces, semen, or vaginal secretions
11. I am concerned with dirt or germs
EXAMPLES: Fear of picking up germs from sitting in certain chairs, shaking hands, or touching door handles
12. I am excessively concerned with environmental contaminants
EXAMPLES: Fear of being contaminated by asbestos or radon, fear of radioactive substances, fear of things associated with towns containing toxic waste sites
13. I am excessively concerned with certain household cleansers
EXAMPLES: Fear of poisonous kitchen or bathroom cleansers, solvents, insect spray or turpentine
14. I am excessively concerned with animals
EXAMPLES: Fear of being contaminated by touching an insect, dog, cat, or other animal
15. I am bothered by sticky substances or residues
EXAMPLES: Fear of adhesive tape or other sticky substances that may trap contaminants
16. I am concerned that I will get ill because of contamination
EXAMPLES: Fear of getting ill as a direct result of being contaminated (beliefs vary about how long the disease will take to appear)
17. I am concerned that I will contaminate others
EXAMPLES: Fear of touching other people or preparing their food after you touch poisonous substances (like gasoline) or after you touch your own body
Sexual obsessions

Check all which apply to you.

18. I have forbidden or perverse sexual thoughts, images, or impulses
EXAMPLES: Unwanted sexual thoughts about strangers, family, or friends
19. I have sexual obsessions that involve children or incest
EXAMPLES: Unwanted thoughts about sexually molesting either your own children or other children
20. I have obsessions about homosexuality
EXAMPLES: Worries like “Am I a homosexual?” or “What if I suddenly become gay?” when there is no basis for these thoughts
21. I have obsessions about aggressive sexual behavior toward other people
EXAMPLES: Unwanted images of violent sexual behavior toward adult strangers, friends, or family members
Hoarding/Saving obsessions

Check all which apply to you.

22. I have obsessions about hoarding or saving things
EXAMPLES: Worries about throwing away seemingly unimportant things that you might need in the future, urges to pick up and collect useless things
Religious obsessions

Check all which apply to you.

23. I am concerned with sacrilege and blasphemy
EXAMPLES: Worries about having blasphemous thoughts, saying blasphemous things, or being punished for such things
24. I am excessively concerned with morality
EXAMPLES: Worries about always doing “the right thing,” having told a lie, or having cheated someone
Obsession with need for symmetry or exactness

Check all which apply to you.

25. I have obsessions about symmetry or exactness
EXAMPLES: Worries about papers and books being properly aligned, worries about calculations or handwriting being perfect
Miscellaneous obsessions

Check all which apply to you.

26. I feel that I need to know or remember certain things
EXAMPLES: Belief that you need to remember insignificant things like license plate numbers, the names of actors on television shows, old telephone numbers, bumper stickers or t-shirt slogans
27. I fear saying certain things
EXAMPLES: Fear of saying certain words (such as “thirteen”) because of superstitions, fear of saying something that might be disrespectful to a dead person, fear of using words with an apostrophe (because this denotes possession)
28. I fear not saying just the right thing
EXAMPLES: Fear of having said the wrong thing, fear of not using the “perfect” word
29. I fear losing things
EXAMPLES: Worries about losing a wallet or other unimportant objects, like a scrap of note paper
30. I am bothered by intrusive (neutral) mental images
EXAMPLES: Random, unwanted images in your mind
31. I am bothered by intrusive mental nonsense sounds, words or music
EXAMPLES: Words, songs, or music in your mind that you can’t stop
32. I am bothered by certain sounds or noises
EXAMPLES: Worries about the sounds of clocks ticking loudly or voices in another room that may interfere with sleeping
33. I have lucky and unlucky numbers
EXAMPLES: Worries about common numbers (like thirteen) that may cause you to perform activities a certain number of times or to postpone an action until a certain lucky hour of the day
34. Certain colors have special significance to me
EXAMPLES: Fear of using objects of certain colors (e.g. black may be associated with death, red with blood or injury)
35. I have superstitious fears
EXAMPLES: Fear of passing a cemetery, hearse, or black cat; fear of omens associated with death
Somatic obsessions

Check all which apply to you.

36. I am concerned with illness or disease
EXAMPLES: Worries that you have an illness like cancer, heart disease or AIDS, despite reassurance from doctors that you do not
37. I am excessively concerned with a part of my body or an aspect of my appearance (dysmorphophobia)
EXAMPLES: Worries that your face, ears, nose, eyes, or another part of your body is hideous, ugly, despite reassurances to the contrary
Cleaning/Washing compulsions

Check all which apply to you.

38. I wash my hands excessively or in a ritualized way
EXAMPLES: Washing your hands many times a day or for long periods of time after touching, or thinking that you have touched, a contaminated object.This may include washing the entire length of your arms
39. I have excessive or ritualized showering, bathing, tooth brushing, grooming, or toilet routines
EXAMPLES: Taking showers or baths or performing other bathroom routines that may last for several hours. If the sequence is interrupted, the entire process may have to be restarted
40. I have compulsions that involve cleaning household items or other inanimate objects
EXAMPLES: Excessive cleaning of faucets, toilets, floors, kitchen counters, or kitchen utensils
41. I do other things to prevent or remove contact with contaminants
EXAMPLES: Asking family members to handle or remove insecticides, garbage, gasoline cans, raw meat, paints, varnish, drugs in the medicine cabinet, or kitty litter. If you can’t avoid these things, you may wear gloves to handle them, such as when using a self-service gas pump
Checking compulsions

Check all which apply to you.

42. I check that I did not harm others
EXAMPLES: Checking that you haven’t hurt someone without knowing it. You may ask others for reassurance or call or text someone to make sure everything is all right
43. I fear saying certain things
EXAMPLES: Fear of saying certain words (such as “thirteen”) because of superstitions, fear of saying something that might be disrespectful to a dead person, fear of using words with an apostrophe (because this denotes possession)
44. I check that nothing terrible happened
EXAMPLES: Searching the newspaper or listening to the radio or television for news about some catastrophe that you believe you caused. You may also ask people for reassurance that you didn’t cause an accident
45. I check that I did not make a mistake
EXAMPLES: Repeated checking of door locks, stoves, electrical outlets, before leaving home; repeated checking while reading, writing, or doing simple calculations to make sure that you didn’t make a mistake (you can’t be certain that you didn’t)
46. I check some aspect of my physical condition tied to my obsessions about my body
EXAMPLES: Seeking reassurance from friends or doctors that you aren’t having a heart attack or getting cancer; repeatedly taking pulse, blood pressure, or temperature; checking your appearance in a mirror, looking for ugly features
Repeating rituals

Check all which apply to you.

47. I reread or rewrite things
EXAMPLES: Taking hours to read a few pages in a book or to write a short letter because you get caught in a cycle of reading and rereading; worrying that you didn’t understand something you just read; searching for a “perfect” word or phrase; having obsessive thoughts about the shape of certain printed letters in a book
48. I need to repeat routine activities
EXAMPLES: Repeating activities like turning appliances on and off, combing your hair, going in and out of a doorway, or looking in a particular direction; not feeling comfortable unless you do these things the “right” way or the “right” number of times
Counting compulsions

Check all which apply to you.

49. I have counting compulsions
EXAMPLES: Counting objects like ceiling or floor tiles, books in a bookcase, nails in a wall, or even grains of sand on a beach; counting when you repeat certain activities, like washing
Ordering/Arranging compulsions

Check all which apply to you.

50. I have ordering or arranging compulsions
EXAMPLES: Straightening paper and pens on a desktop or books in a bookcase, wasting hours arranging things in your house in “order” and then becoming very upset if this order is disturbed
Hoarding/Collecting compulsions

Check all which apply to you.

51. I have compulsions to hoard or collect things
EXAMPLES: Saving old newspapers, notes, cans, paper towels, wrappers and empty bottles for fear that if you throw them away you may need them; picking up useless objects from the street or from garbage cans
Miscellaneous compulsions

Check all which apply to you.

52. I have mental rituals (other than checking/counting)
EXAMPLES: Performing rituals in your head, like saying prayers or thinking a “good” thought to undo a “bad” thought. These are different from obsessions, because you perform these rituals intentionally to reduce anxiety or feel better
53. I need to tell, ask, or confess
EXAMPLES: Asking other people to reassure you, confessing to wrong behaviors you never even did, believing that you have to tell other people certain words to feel better
54. I need to touch, tap, or rub things
EXAMPLES: Giving in to the urge to touch rough surfaces, like wood, or hot surfaces, like a stove top; giving in to the urge to lightly touch other people; believing you need to touch an object like a telephone to prevent an illness in your family
55. I take measures (other than checking) to prevent harm or terrible consequences to myself or family
EXAMPLES: Staying away from sharp or breakable objects, such as knives, scissors, and fragile glass
56. I have ritualized eating behaviors
EXAMPLES: Arranging your food, knife, and fork in a particular order before being able to eat, eating according to a strict ritual, not being able to eat until the hands of a clock point exactly at a certain time
57. I have superstitious behaviors
EXAMPLES: Not taking a bus or train if its number contains an “unlucky” number (like thirteen), staying in your house on the thirteenth of the month, throwing away clothes you wore while passing a funeral home or cemetery
58. I pull my hair out (trichotillomania)
EXAMPLES: Pulling hair from your scalp, eyelids, eyelashes, or pubic areas, using your fingers or tweezers. You may produce bald spots that require you to wear a wig, or you may pluck your eyebrows or eyelids smooth
Part 2: Scaling
Obsessive thoughts

Review the obsessions you checked on the Y-BOCS Symptom Checklist to help you answer the first five questions. Please think about the times when these symptoms were at their worst in the last 3-6 months (including today), and check one answer for each question.

1. Time occupied by obsessive thoughts
How much of your time is occupied by obsessive thoughts?
2. Interference due to obsessive thoughts
How much do your obsessive thoughts interfere with your work, school, social, or other important role functioning? Is there anything that you don’t do because of them?
3. Distress associated with obsessive thoughts
How much distress do your obsessive thoughts cause you?
4. Resistance against obsessions
How much of an effort do you make to resist the obsessive thoughts? How often do you try to disregard or turn your attention away from these thoughts as they enter your mind?
5. Degree of control over obsessive thoughts
How much control do you have over your obsessive thoughts? How successful are you in stopping or diverting your obsessive thinking? Can you dismiss them?
Compulsive behaviors

Review the compulsions you checked on theY-BOCS Symptom Checklist to help you answer these five questions. Please think about the times when these symptoms were at their worst in the last 3-6 months (including today), and check one answer for each question.

6. Time spent performing compulsive behaviors
How much time do you spend performing compulsive behaviors? How much longer than most people does it take to complete routine activities because of your rituals? How frequently do you do rituals?
7. Interference due to compulsive behaviors
How much do your compulsive behaviors interfere with your work, school, social, or other important role functioning? Is there anything that you don’t do because of the compulsions?
8. Distress associated with compulsive behavior
How would you feel if prevented from performing your compulsion(s)? How anxious would you become?
9. Resistance against compulsions
How much of an effort do you make to resist the compulsions?
10. Degree of control over compulsive behavior
How strong is the drive to perform the compulsive behavior? How much control do you have over the compulsions?

Recommended next steps

After the Y–BOCS, consider taking one of the tests below.

RAADS–R

Identifies adults who often “escape diagnosis”
due to a subclinical level presentation

CAT-Q

Measures camouflaging, and can account
for lower scores on other autism tests

Aspie Quiz

Identifies neurodivergence and
potential co-occurring conditions

Online autism tests can play an essential role in the process of self-discovery, and may inform your decision to pursue a formal diagnosis. For a formal assessment, please see a knowledgeable medical professional trained in assessing autism.

Embrace Autism | Yale–Brown Obsessive–Compulsive Scale | icon Diagnosis

If you are looking for an autism assessment,
have a look at the following post:

Online autism assessments

References

 

This article
was written by:
dr-natalie-engelbrecht
Dr. Natalie Engelbrecht ND RP

Dr. Natalie Engelbrecht ND RP is a dually licensed naturopathic doctor and registered psychotherapist, and a Canadian leader in trauma, PTSD, and integrative medicine strictly informed by scientific research.

She was diagnosed at 46, and her autism plays a significant role in who she is as a doctor, and how she interacts with and cares for her patients and clients.

Want to know more about her? Read her About me page.

Disclaimer

Although our content is generally well-researched
and substantiated, or based on personal experience,
note that it does not constitute medical advice.

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