Yale–Brown Obsessive Compulsive Scale
The Yale–Brown Obsessive Compulsive Scale (Y-BOCS) is a test to rate the severity of obsessive–compulsive disorder (OCD) symptoms.
The scale, which was designed by Wayne K. Goodman and his colleagues, is used extensively in research and clinical practice to both determine severity of OCD and to monitor improvement during treatment. This scale, which measures obsessions separately from compulsions, specifically measures the severity of symptoms of obsessive–compulsive disorder without being biased towards the type of content of obsessions or compulsions present.
The scale is a clinician-rated, 10-item scale, each item rated from 0 (no symptoms) to 4 (extreme symptoms), yielding a total possible score range from 0 to 40. The scale includes questions about the amount of time the patient spends on obsessions, how much impairment or distress they experience, and how much resistance and control they have over these thoughts. The same types of questions are asked about compulsions (e.g., time spent, interference, etc.) as well. The results can be interpreted based on the total score:
- 0–7 is sub-clinical;
- 8–15 is mild;
- 16–23 is moderate;
- 24–31 is severe;
- 32–40 is extreme.
Patients scoring in the mild range or higher are likely experiencing a significant negative impact on their quality of life and should consider professional help in alleviating obsessive–compulsive symptoms.
A self-rated version of the Yale-Brown Obsessive-Compulsive Scale has been developed. The self-report and clinician-administered versions of the Y-BOCS are correlated to each other.
Accuracy and modifications
Goodman and his colleagues have developed the Yale-Brown Obsessive-Compulsive Scale—Second Edition (Y-BOCS-II) in an effort to modify the original scale which, according to Goodman, "[has become] the gold standard measure of obsessive-compulsive disorder (OCD) symptom severity". In creating the Y-BOCS-II, changes were made "to the Severity Scale item content and scoring framework, integrating avoidance into the scoring of Severity Scale items, and modifying the Symptom Checklist content and format". After reliability tests, Goodman concluded that "Taken together, the Y-BOCS-II has excellent psychometric properties in assessing the presence and severity, of obsessive-compulsive symptoms. Although the Y-BOCS remains a reliable and valid measure, the Y-BOCS-II may provide an alternative method of assessing symptom presence and severity."
Studies have been conducted by members of the Iranian Journal Of Psychiatry & Clinical Psychology to determine the accuracy of the Yale–Brown Obsessive Compulsive Scale (specifically as it appears in its Persian format). The members applied the scale to a group of individuals and, after ensuring a normal distribution of data, a series of reliability tests were performed. According to the journal, "[the] results supported satisfactory validity and reliability of translated form of Yale-Brown Obsessive-Compulsive Scale for research and clinical diagnostic applications".
The children's version of the Y-BOCS, or the Children's Yale–Brown Obsessive Compulsive Scales (CY-BOCS), is a clinician-report questionnaire designed to assess symptoms of obsessive compulsive disorder from childhood through early adolescence.
The CY-BOCS contains 70 questions and takes about 15–25 minutes. Each question is designed to ask about symptoms of obsessive compulsive behavior, though the exact breakdown of questions is unknown. For each question, children rate the degree to which the question applies on a scale of 0-4. Based on research, this assessment has been found to be statistically valid and reliable.
Question breakdown, scoring, and interpretation
The 0-4 scale is broken down as follows:
- 0: none
- 1: mild
- 2: moderate
- 3: severe
- 4: extreme
While there is not and exact breakdown of scoring for neither the child report nor the parent report, it can be assumed that the higher the overall score on the test, the more severe the OCD. The following subscores can be used as a tentative reference:
- 0-7: subclinical severity of symptoms
- 8-15: mild symptoms
- 16-23: moderate symptoms
- 24-31: severe symptoms
- 32-40: extreme symptoms
Note that these subscales only suggest these levels of severity.
The CY-BOCS has been adapted into several self- and parent-report versions, designed to be completed by parent and child working together, although most have not been psychometrically validated. However, these versions still ask the child to rate the severity of their obsessive compulsive behaviors and the degree to which each has been impairing. While this measure has been found to be useful in a clinic setting, scores and interpretations are taken with a grain of salt, given the lack of validation
Another version, which is parent-focused, is similar to the original CY-BOCS and is administered to both parent and child by the clinician. This version was distributed by Solvay Pharmaceuticals in the late 1990s, creating an association between the measure and a number of pharmaceutical groups that has caused it to be avoided by most clinicians. Severity cutoff scores for this version have not been empirically determined.
- Tables of screening tools and rating scales
- Self-report version of the CY-BOCS
- AACAP practice parameter for OCD
- Exposure and Response Prevention for OCD
- Cognitive Behavioral Therapy for OCD
- Acceptance and Commitment Therapy for OCD
- List of diagnostic classification and rating scales used in psychiatry
- Yale–Brown Obsessive Compulsive Scale - Official paper version of Y-BOCS
- Yale OCD Research Clinic - Link to clinic where the Y-BOCS was developed
- Goodman W.K, Price L.H, Rasmussen S.A, et al. The Yale–Brown Obsessive–Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry 1989;46:1006–1011. PMID 2684084
- Rosario-Campos MC, Miguel EC, et.al The Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS): an instrument for assessing obsessive-compulsive symptom dimensions. Mol Psychiatry. 2006 May;11(5):495-504 PMID 16432526
- Garnaat SL, Norton PJ. Factor structure and measurement invariance of the Yale-Brown Obsessive Compulsive Scale across four racial/ethnic groups. J Anxiety Disord. 2010 May 24. PMID 20541907
- Federici A, Summerfeldt LJ, et. al Consistency between self-report and clinician-administered versions of the Yale-Brown Obsessive-Compulsive Scale.J Anxiety Disord. 2010 May 24. PMID 20561767
- Storch, E. A., Larson, M. J., Goodman, W. K., Rasmussen, S. A., Price, L. H., & Murphy, T. K. (2010). Development and Psychometric Evaluation of the Yale-Brown Obsessive-Compulsive Scale—Second Edition. Psychological Assessment, 22(2), 223-232. doi:10.10371a0018492
- Esfahani, S., Motaghipour, Y., Kamkari, K., Zahiredin, A., & Janbozorgi, M. (2012). Reliability and Validity of the Persian Version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). (English). Iranian Journal Of Psychiatry & Clinical Psychology, 17(4), 297-303.
- Goodman, WK; Price, LH; Rasmussen, SA; Mazure, C; Fleischmann, RL; Hill, CL; Heninger, GR; Charney, DS (November 1989). "The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability.". Archives of General Psychiatry. 46 (11): 1006–11. doi:10.1001/archpsyc.1989.01810110048007. PMID 2684084.
- Gallant, J; Storch, EA; Merlo, LJ; Ricketts, ED; Geffken, GR; Goodman, WK; Murphy, TK (December 2008). "Convergent and discriminant validity of the Children's Yale-Brown Obsessive Compulsive Scale-Symptom Checklist.". Journal of anxiety disorders. 22 (8): 1369–76. doi:10.1016/j.janxdis.2008.01.017. PMID 18329843.
- Piacentini, J; Langley, A; Roblek, T (2007). Cognitive-Behavioral Treatment of Childhood OCD: It's Only a False Alarm Therapist Guide. Oxford University Press. ISBN 9780195310511.
- Piacentini, J; Bergman, RL; Chang, S; Langley, A; Peris, T; Wood, JJ; McCracken, J (November 2011). "Controlled comparison of family cognitive behavioral therapy and psychoeducation/relaxation training for child obsessive-compulsive disorder.". Journal of the American Academy of Child and Adolescent Psychiatry. 50 (11): 1149–61. doi:10.1016/j.jaac.2011.08.003. PMID 22024003.