Yale Brown Obsessive Compulsive Scale (Y-BOCS) Calculator

How does this Yale Brown Obsessive Compulsive Scale (Y-BOCS) calculator work?

This is a health tool that evaluates the severity and type of OCD characteristic symptoms in patients. It is a self report scale, therefore the patient is let to personally assess the presence and intensity of the symptoms. The interpretation of the result and any additions are then left at the clinical judgment of the assessor.

The scale was built by Wayne K Goodman and fellow researchers in 1989, in the attempt to develop a severity diagnosis and a monitoring tool.

Before beginning the interview, the evaluator is advised to define both the concept of compulsions and that of obsessions to the patient and provide some examples, for further reference. The recommended definitions are:

■ Obsessions are unwelcome and distressing ideas, thoughts, images or impulses that repeatedly enter your mind. They may seem to occur against your will. They may be repugnant to you, you may recognize them as senseless, and they may not fit your personality.

■ Compulsions, on the other hand, are behaviors or acts that you feel driven to perform although you may recognize them as senseless or excessive. At times, you may try to resist doing them but this may prove difficult. You may experience anxiety that does not diminish until the behavior is completed.

The ten questions in the scale are focused on the main effect and life quality alteration due to the presence of the mental health disturbance:

1. Time occupied by obsessive thoughts.

2. Interference due to obsessive thoughts.

3. Distress associated with obsessive behavior.

4. Resistance against obsessions.

5. Degree of control over obsessive thoughts.

6. Amount of time spent performing compulsive behaviors.

7. Interference due to compulsive behaviors.

8. Distress associated with compulsive behavior.

9. Resistance against compulsions.

10. Degree of control over compulsive behavior.

Score interpretation

There are 10 questions in the Yale Brown Obsessive Compulsive Scale (Y-BOCS) calculator that aim at interpreting the symptoms in the time period of a week.

The evaluator is advised to interview the patient by asking the questions in the order they are provided as well as listing the choices of answers. Each answer is awarded a number of points, ranging from 0 for the least intensity to 4 for the highest severity that will form the total result at the end.

There are two partial scores given as well, one summing the scores of questions 1 to 5 (for obsessions) and the second summing the scores from items 6 to 10 (for compulsions).

The total score interpretation is as follows:

Score	Level of OCD
0 - 7	Sub clinical
8 - 15	Mild
16 - 23	Moderate
24 - 31	Severe
32 - 40	Extreme

The higher the patient rates in either of the components, the more significant the negative impact of the present symptoms on the quality of life and interpersonal relations.

Y-BOCS Symptom Checklist

The following lists comprise of all the types of obsessions currently met and diagnosed in patients all over the world. Each of them is classified based on the type of fear, obsession or compulsion represented and the ones ticked by the patient usually form a target symptom list for obsessive compulsive disorder.

■ Aggressive obsessions:

- Fear might harm self;

- Fear might harm others;

- Violent or horrific images;

- Fear of blurting out obscenities or insult;

- Fear of doing something else embarrassing;

- Fear will act on unwanted impulses (e.g., to stab friend);

- Fear will steal things;

- Fear will harm others because not careful enough(e.g. hit/run motor vehicle accident);

- Fear will be responsible for something else terrible happening (e.g., fire, burglary).

■ Contamination obsessions:

- Concerns or disgust with bodily waste or secretions;

- Excessive concern with environmental contaminants (e.g. asbestos, radiation toxic waste);

- Excessive concern with household items (e.g. cleaners solvents);

- Excessive concern with animals (e.g., insects);

- Bothered by sticky substances or residues;

- Concerned will get ill because of contaminant.

■ Sexual obsessions:

- Forbidden or perverse sexual thoughts, images or impulses;

- Content involves children or incest;

- Content involves homosexuality.

■ Hoarding obsessions – distinguished from hobbies.

■ Religious obsessions – concerns with sacrilege and blasphemy.

■ Need for symmetry, exactness – things will happen unless everything is in the right place.

■ Miscellaneous obsessions:

- Need to know or remember;

- Fear of saying certain things;

- Fear of not saying just the right thing;

- Fear of losing things;

- Intrusive (nonviolent) images;

- Intrusive nonsense sounds, words, or music;

- Bothered by certain sounds/noises;

- Lucky/unlucky numbers;

- Colors with special significance.

■ Somatic obsessions – concern with illness of disease.

■ Cleaning, washing obsessions – concern with cleanness.

■ Checking obsessions.

■ Repeating compulsions, in the shape or re-reading, re-writing, repeating routine activities.

■ Counting compulsions.

■ Ordering, arranging compulsions.

■ Hoarding, collecting compulsions, as distinguished from hobby collecting.

■ Miscellaneous compulsions such as mental rituals, need to ask or confess, need to touch, measures, ritualized eating behaviors, superstitious behaviors or hair pulling.

Diagnosis of OCD

As with any mental health diagnosis, obsessive compulsive assessments are used in the primary setting to check the symptoms the patient experiences then a full psychological evaluation is performed. Many people suffering from this condition in either minor or debilitating severities don’t report their symptoms because of either shame or lack of attention to their real extent.

Therefore the primary diagnosis is often delayed until people close to the person raise signs of alarm or until the symptoms worsen and the patient realizes they need medical help.

The three levels of severity that are mainly used in classifying the diagnosis are:

■ Mild functional impairment – symptom manifestation less than an hour per day in general;

■ Moderate functional impairment – obsessive, compulsive behaviors manifested for almost three hours a day;

■ Severe functional impairment – thinking and behavioral patterns disrupting daily activities and significant with the condition for more than three hours a day.

References

1) Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, Heninger GR, Charney DS. (1989) The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry; 46(11):1006-11.

2) Rosario-Campos MC, Miguel EC, Quatrano S, Chacon P, Ferrao Y, Findley D, Katsovich L, Scahill L, King RA, Woody SR, Tolin D, Hollander E, Kano Y, Leckman JF. (2006) The Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS): an instrument for assessing obsessive-compulsive symptom dimensions. Mol Psychiatry; 11(5):495-504.

3) Garnaat SL, Norton PJ. (2010) Factor structure and measurement invariance of the Yale-Brown Obsessive Compulsive Scale across four racial/ethnic groups. J Anxiety Disord; 24(7):723-8.

4) Federici A, Summerfeldt LJ, Harrington JL, McCabe RE, Purdon CL, Rowa K, Antony MM. (2010) Consistency between self-report and clinician-administered versions of the Yale-Brown Obsessive-Compulsive Scale. J Anxiety Disord; 24(7):729-33.

29 Nov, 2015