Yale–Brown Obsessive–Compulsive Scale

The Yale–Brown Obsessive–Compulsive Scale (Y–BOCS) is a standardized rating scale with both clinician-administered and self-report versions available. The Y–BOCS measures 10 items concerning 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)

Take the test here:

Who the test is designed for

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

Recent research shows that obsessions and compulsions commonly occur among ordinary people.

Obsessions

Obsessions are unwelcome and distressing thoughts, ideas, or impulses that repeatedly enter your mind. It may seem that they are happening against your will. Some people find them disgusting, others see them as senseless, and others don’t fit their personalities. It is possible to have an obsession in the form of recurrent thoughts or impulses to harm a child, even if you would never do so, or the belief that household cleansers may result in serious illness and contamination. In contrast to worries, obsessions are based on your fear of possible negative things that might happen in your life. You may worry about failing an exam, finances, health, or personal relationships, for example. Worries differ from obsessions in that they don’t seem senseless, repugnant, or inconsistent with your personality.

Compulsions

Meanwhile, compulsions are behaviours or acts you feel compelled to perform, despite their senselessness or excess. A compulsion is usually performed in response to an obsession, according to a set of rules, or according to stereotypes. While you may try to resist doing them sometimes, this may prove difficult. When the behaviour is completed, the discomfort will likely subside. Checking the lock on the front door before leaving the house, checking appliances, water faucets, and checking the lock on the appliances may be compulsions. Compulsions can be observed or unobserved, such as silent checking or repeating nonsense phrases whenever you have a bad thought. Unlike other types of compulsive behavior, our definition of compulsions is different from those of overeating, gambling, drinking, overshopping, or other “addictive behaviours.”

Versions & translations

• The Y–BOCS is translated into over 20 languages
• CY–BOCS (ages 6–17)
• Y–BOCS-II *see updates below

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 (coming soon)
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)

OCD vs. autism

While autism and OCD overlap in some ways, autistic people find challenges in social situations. In contrast, people with OCD do not.

It’s becoming ever more indisputable that many people have both conditions. The overlap is reflected in misdiagnoses—OCD can resemble the repetitive behaviours associated with autism and vice versa. People with either condition may experience unusual responses to sensory stimuli.

75% of individuals with OCD also suffer from comorbid anxiety disorders, 63% from mood disorders, 55% from previous impulse control disorders, and 38% from substance abuse disorders.^[9]The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication (Ruscio et al., 2010) In the Ruscio study, social anxiety disorder was the most common anxiety disorder (44%), followed by specific phobia (43%), separation anxiety (37%), panic disorder (20%), and generalized anxiety disorder (8%). In most cases, these respondents indicated that anxiety disorder preceded OCD (60–90%). About 19% of respondents with OCD also had PTSD.^[10]The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication (Ruscio et al., 2010)

Autistics are twice as likely to receive an OCD diagnosis. Those with OCD are four times as likely also to be autistic.

People with OCD and autism have unique experiences distinguishable from either condition. For such people, interventions for OCD, such as cognitive behavioural therapy (CBT), may be of little benefit.

A dissimilarity between OCD and autism is found in the individual’s response to their behaviours while in public. Someone diagnosed with OCD will typically be ashamed of or embarrassed by their actions. Autistics are not as troubled by what other people think.

One vital distinction is that obsessions give rise to compulsions but not autism traits. Another is that people with OCD cannot swap their required rituals, whereas autistics have a repertoire of repetitive behaviours from which to choose.

Another contrast between OCD and autism is the purpose or motivation for the behaviour. In someone with OCD, part of their mental process involves feeling driven to fill their life with repetitive patterns. These compulsive behaviours have complex motives that are not reasonable and are diagnostic criteria.

When interrupting an autistic person’s repetitive routine, they will likely not show distress but drop the behaviour and move to another, which is not typical of someone with OCD. Since the repetitive behaviours of people with OCD are related to deep fears, if you were to stop their routine, they may become distressed to the point of a panic attack.

A noteworthy difference between OCD and autism is that a person with OCD participates in their behaviours consciously. Conversely, autistic people may demonstrate obsessive behaviours without self-awareness.

Previous studies found autism spectrum disorders (ASD) and OCD to be highly comorbid, and autism symptoms were associated with OCD severity. An 8-year study by Meier et al. (2015) found that individuals with OCD were 13 times more likely to have comorbid ASD (6.6%) than those without OCD (0.5%). Furthermore, CBT is less effective in treating OCD/ASD patients and shows a lower remission rate. In previous studies with small sample sizes, there were no differences in the severity of obsessions and compulsions between OCD patients and patients with OCD/ASD patients. As a result, autism traits may be key to predicting long-term OCD symptoms. ^[11]Associations of Autism Traits With obsessive–compulsive Symptoms and Well-Being in Patients With Obsessive–Compulsive Disorder: A Cross-Sectional Study (Doi et al., 2021)

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.

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^[12]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 high-functioning ASD Level 1 autism and are associated with significant levels of distress (if we can not engage in them fully.)

Eva:

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.

• 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.

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

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

Online autism assessments