CY-BOCS Symptom Checklist

Children’s Yale-Brown Obsessive Compulsive Scale

Administering the CY-BOCS Symptom Checklist and CY-BOCS Severity Ratings

1. Establish the diagnosis of obsessive compulsive disorder.
2. Using the CY-BOCS Symptom Checklist (below), ascertain current and past symptoms.
3. Next, administer the 10 item severity ratings (other form) to assess the severity of the OCD during the last
week.
4. Re-administer the CY-BOCS Severity Rating Scale to monitor progress.

Patient ______________________________________ Date _______________

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 CY-BOCS Symptom Checklist
Children’s Yale-Brown Obsessive Compulsive Scale

CY-BOCS Obsessions Checklist

Check all symptoms that apply (Items marked “*” may or may not be OCD Phenomena)
Current Past Contamination Obsessions Current Past Sexual Obsessions
Concern with dirt, germs, certain illnesses Forbidden or perverse sexual thoughts,
(e.g., AIDS) images, impulses
Concerns or disgust with bodily waste or Content involves homosexuality
secretions (e.g. urine, feces, saliva)
Sexual behavior towards others
Excessive concern with environmental (aggressive)
contaminants (e.g., asbestos, radiation,
Other (describe) _____________________
toxic waste)
Excessive concern with household items Hoarding / Saving Obsessions
(e.g., cleaners, solvents) Fear of losing things
Excessive concern about animals / insects Other (describe) _____________________
Excessively bothered by sticky substances Magical Thoughts / Superstitious
or residues Obsessions
Concerned will get ill because of Lucky / unlucky numbers, colors, words
contaminant
Other (describe) _____________________
Concerned will get others ill by spreading
contaminant (aggressive) Somatic Obsessions
No concern with consequences of Excessive concern with illness or disease *
contamination other than how it might feel *
Excessive concern with body part or aspect
Other (describe) _____________________ of appearance (e.g. dysmorphophobia) *
Aggressive Obsessions Other (describe) _____________________
Fear might harm self Religious Obsessions
Fear might harm others Excessive concern or fear of offending
religious objects
Fear harm will come to self
Excessive concern with right / wrong morally
Fear harm will come to others (maybe
because of something child did or did not Other (describe) _____________________
do) Miscellaneous Obsessions
Violent or horrific images
The need to know or remember
Fear of blurting out obscenities or insults
Fear of saying certain things
Fear of doing something embarrassing *
Fear of not saying just the right thing
Fear will act on unwanted impulses (e.g., to
Intrusive (non-violent) images
stab a family member)
Fear will steal things Intrusive sounds, words, music or numbers

Fear will be responsible for something else Other (describe) _____________________

terrible happening (e.g. ,fire, burglary, flood)
Other (describe) _____________________

Target Symptom List for Obsessions

OBSESSIONS (describe, listing by order of severity, with #1 being the most sever, #2 second most severe, etc):

1. _____________________________________________________________________________________

2. _____________________________________________________________________________________

3. _____________________________________________________________________________________

4. _____________________________________________________________________________________

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 CY-BOCS Symptom Checklist
Children’s Yale-Brown Obsessive Compulsive Scale

CY-BOCS Compulsions Checklist

Check all symptoms that apply (Items marked “*” may or may not be OCD Phenomena)
Current Past Washing / Cleaning Compulsions Current Past Hoarding / Saving Compulsions
Excessive or ritualized hand washing Distinguish from hobbies and concern with
objects of monetary or sentimental value.
Excessive or ritualized showering, bathing,
tooth brushing, grooming, toilet routine Difficulty throwing things away, saving bits of
paper, string, etc.
Excessive cleaning of items, such as personal
clothes or important objects Other (describe) _____________________
Other measures to prevent or remove contact Excessive Games / Superstitious
with contaminants Behaviors
Other (describe) _____________________ Distinguish from age appropriate magical
games (e.g. array of behavior, such as
Checking Compulsions
sleeping over certain spots on a floor,
Checking locks, toys, school books / items, touching an object / self certain number of
etc. times as a routine game to avoid something
Checking associated with getting washed, bad from happening
dressed, or undressed Other (describe) _____________________
Checking that did not / will not harm others Rituals Involving Other Persons
Checking that did not / will not harm self The need to involve another person (usually a
parent) in ritual (e.g. asking a parent to
Checking that nothing terrible did / will happen
repeatedly answer the same question, making
Checking that did not make mistake mother perform certain mealtime rituals
involving specific utensils) *
Checking tied to somatic obsessions
Other (describe) _____________________
Other (describe) _____________________
Miscellaneous Compulsions
Repeating Rituals
Mental rituals other than checking / counting
Rereading, erasing, or rewriting
Need to tell, ask or confess
Need to repeat activities (e.g. in / out of
doorway, up / down from chair) Measures (not checking) to prevent :
Other (describe) _____________________ harm to self
Counting Compulsions harm to others
Objects, certain numbers, words, etc. terrible consequences
Other (describe) _____________________ Ritualized eating behaviors *
Ordering / Arranging Excessive list making *
Need for symmetry / evening up (e.g. lining Need to touch, tap, rub *
items up a certain way or arranging personal
items in specific patterns) Need to do things (e.g. touch or arrange until it
Other (describe) _____________________ feels just right) *
Rituals involving blinking or staring *
Trichotillomania (hair-pulling)
Other self-damaging or self-mutilating
behaviors *
Other (describe) _____________________

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 CY-BOCS Symptom Checklist
Children’s Yale-Brown Obsessive Compulsive Scale

Target Symptom List for Compulsions

COMPULSIONS (describe, listing by order of severity, with #1 being the most sever, #2 second most severe,
etc):

1. _____________________________________________________________________________________

2. _____________________________________________________________________________________

3. _____________________________________________________________________________________

4. _____________________________________________________________________________________

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