Jill Racine, PhD

Licensed Clinical Psychologist

8140 N. MoPac Expy ∙ Westpark 3, Ste 225 ∙ Austin, TX 78759 ∙ 512.346.2332 ∙ drjillracine.com

Yale-Brown Obsessive Compulsive Scale Checklist (Y-BOCS)

Client Name: _________________________ Date of Birth: ___________ Today’s Date: ___________

Name and relationship of person completing this form (if not self): _______________________________

Please indicate if you have ever exhibited any of the obsessions or compulsions listed below. Remember,
obsessions are unwanted, intrusive thoughts. Compulsions are repetitive behaviors or thoughts that a
person uses with the intention of making their obsessions go away.

Obsessions
Contamination Current Past Only
Concern or disgust with bodily waste or secretions □ □
Concern with dirt or germs □ □
Excessive concern with household items (e.g., cleansers solvents) □ □
Excessive concern with environmental contaminants □ □
Bothered by sticky substances or residues □ □
Concerned with getting ill (e.g., AIDS) □ □
Concerned you will get others ill by spreading germs □ □
□ □
Other: ____________________________________________
Aggressive/Harming Current Past Only
Fear might harm self □ □
Fear might harm others □ □
Violent or horrific images □ □
Fear of blurting out obscenities or insults □ □
Fear will harm others because not careful enough (e.g., accidentally
□ □
running over someone with car)
Fear of being responsible for something else terrible happening
□ □
(e.g., fire, burglary)
Fear of doing something else embarrassing □ □
□ □
Other: ____________________________________________
Hoarding/Saving Current Past Only
Excessive collecting or saving □ □
Fear of losing or throwing out items by mistake □ □
□ □
Other: ______________________________________________
Need for Symmetry or Exactness Current Past Only
Bothered by things not lined up or being in order □ □
The need for things to be perfect or “just right” □ □
□ □
Other: ______________________________________________

Adapted from Goodman, W.K., Price, L.H., Rasmussen, S.A. et al.: “The Yale-Brown Obsessive Compulsive
Scale.” Arch Gen Psychiatry 46:1006-1011,1989
 Jill Racine, PhD
Licensed Clinical Psychologist
8140 N. MoPac Expy ∙ Westpark 3, Ste 225 ∙ Austin, TX 78759 ∙ 512.346.2332 ∙ drjillracine.com

Moral or Religious Obsessions (Scrupulosity) Current Past Only

Excessive concern with sacrilege or blasphemy (offending God) □ □
Excessive concern with right/wrong, morality □ □
□ □
Other: ______________________________________________
Sexual Obsessions Current Past Only
Personally unacceptable sexual thoughts/images/impulses □ □
Content involves children or incest □ □
Content involves homosexuality □ □
Content involves aggressive sexual behavior toward others □ □
□ □
Other: ______________________________________________
Somatic Current Past Only
Excessive concern with illness or disease □ □
Excessive concern with body part(s) or appearance
□ □
Other: _________________________________________
Other Current Past Only
Magical thoughts or superstitions (e.g., lucky or unlucky numbers,
□ □
words, etc.)
The need to tell or confess □ □
Intrusive sounds, words, music, or images □ □
After completing routine activities, doubts whether performed or
□ □
not
□ □
Other: _________________________________________

Compulsions:
Cleaning/Washing Compulsions Current Past Only
Excessive or ritualized hand washing □ □
Excessive or ritualized bathing, toothbrushing, grooming, or toilet
□ □
routine
Cleaning of household items or other inanimate objects □ □
□ □
Other: ______________________________________________
Checking Compulsions Current Past Only
Checking locks, stove, appliances, water faucets, school/work items □ □
Checking that did not harm self □ □
Checking that did not harm others □ □
Checking that did not make mistake (e.g., balancing checkbook over
□ □
and over)

Adapted from Goodman, W.K., Price, L.H., Rasmussen, S.A. et al.: “The Yale-Brown Obsessive Compulsive
Scale.” Arch Gen Psychiatry 46:1006-1011,1989
 Jill Racine, PhD
Licensed Clinical Psychologist
8140 N. MoPac Expy ∙ Westpark 3, Ste 225 ∙ Austin, TX 78759 ∙ 512.346.2332 ∙ drjillracine.com

Checking related to somatic obsessions (e.g., self for signs of

□ □
cancer)
□ □
Other: ______________________________________________
Repeating Compulsions Current Past Only
Rereading or rewriting □ □
Repeats same question □ □
Need to repeat routine activities (e.g., opening door, turning items
□ □
on/off)
□ □
Other: ______________________________________________
Hoarding/Collecting Compulsions Current Past Only
Difficulty throwing things away □ □
Other: ______________________________________________ □ □
Ordering/Arranging Compulsions Current Past Only
Lines up items in fixed order □ □
Need for symmetry (e.g., shoelaces must be at same tension, socks
□ □
at same height)
Can’t complete activity until just right □ □
□ □
Other: ______________________________________________
Miscellaneous Compulsions Current Past Only
Mental rituals □ □
Counting compulsions □ □
Excessive list making □ □
Pathological slowness □ □
Need to tell, ask, confess □ □
Superstitious behaviors □ □
Asking for reassurance over and over □ □
Self-damaging behaviors □ □
Rituals involving blinking or staring □ □
Need to touch, tap, or rub □ □
□ □
Other: ______________________________________________

Adapted from Goodman, W.K., Price, L.H., Rasmussen, S.A. et al.: “The Yale-Brown Obsessive Compulsive
Scale.” Arch Gen Psychiatry 46:1006-1011,1989