Y-BOCS: Scoring and Interpretation Guide
A clinician's guide to scoring and interpreting the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the ten-item clinician-rated measure of OCD severity. Covers the structure of the interview, the obsessions and compulsions subscales, the conventional severity bands, the consensus definitions of response and remission, and how to use the scale across a course of ERP.
About this resource
The Y-BOCS was developed by Wayne Goodman, Steven Rasmussen, Lawrence Price and colleagues at Yale and Brown and published in two papers in 1989. It is a semi-structured clinician-administered interview that rates the severity of obsessions and compulsions independently of their content. The severity scale has ten items, five for obsessions and five for compulsions, each rated 0 to 4, giving a total of 0 to 40. It is preceded by a symptom checklist that catalogues the person's current and past obsessions and compulsions and identifies the principal ones that the severity ratings will refer to. The Y-BOCS is the primary outcome measure in almost every trial of exposure and response prevention and of medication for OCD, which is why its numbers are the shared currency of the field.
This resource is a scoring and interpretation guide. The Y-BOCS is copyrighted by its authors and, while it is widely available at no cost for clinical use, we do not reproduce the interview or the checklist. The guide describes the two-part structure, the five dimensions rated for each of obsessions and compulsions, the scoring, the conventional severity bands, and the international consensus definitions of treatment response, remission and relapse published by Mataix-Cols and colleagues (2016). It also notes the child version (CY-BOCS), the self-report adaptation and the revised Y-BOCS-II so that you can choose the right variant.
For clinicians delivering ERP, the Y-BOCS gives a baseline against which a 35 percent reduction (the consensus threshold for response) can be planned and tracked, and its subscale structure lets you see whether the client is reducing rituals without a corresponding fall in obsessional distress, which is a common mid-treatment pattern.
How to use it
- Obtain the official Y-BOCS, including the symptom checklist and the severity scale, and read the rater instructions and item probes before your first administration. It is a clinician-rated interview, not a questionnaire to hand over.
- Complete the symptom checklist first, then agree with the client which obsessions and compulsions are the main targets. The ten severity ratings refer to those target symptoms over the past week.
- Rate the five obsession items (time occupied, interference, distress, resistance, control) and the five compulsion items (the same five dimensions) from 0 to 4 using the anchors on the form. Sum items 1 to 5 for the obsessions subscale, 6 to 10 for the compulsions subscale, and all ten for the total.
- Place the total in the conventional severity band and share it with the client alongside the target for treatment: a reduction of at least 35 percent from baseline for response, and a total of 12 or below for remission.
- Repeat the severity scale every two to four weeks during ERP and at the end of treatment. Keep the same target symptoms across administrations unless the clinical picture has changed; if the principal symptoms change, note it, because the ratings are no longer strictly comparable.
References
- Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., Heninger, G. R., & Charney, D. S. (1989). The Yale-Brown Obsessive Compulsive Scale: I. Development, use, and reliability. Archives of General Psychiatry, 46(11), 1006-1011.
- Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Delgado, P., Heninger, G. R., & Charney, D. S. (1989). The Yale-Brown Obsessive Compulsive Scale: II. Validity. Archives of General Psychiatry, 46(11), 1012-1016.
- Mataix-Cols, D., Fernández de la Cruz, L., Nordsletten, A. E., Lenhard, F., Isomura, K., & Simpson, H. B. (2016). Towards an international expert consensus for defining treatment response, remission, recovery and relapse in obsessive-compulsive disorder. World Psychiatry, 15(1), 80-81.
- Scahill, L., Riddle, M. A., McSwiggin-Hardin, M., Ort, S. I., King, R. A., Goodman, W. K., Cicchetti, D., & Leckman, J. F. (1997). Children's Yale-Brown Obsessive Compulsive Scale: Reliability and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 36(6), 844-852.
