Q: How much of your time is occupied by obsessive thoughts?

0

[When obsessions occur as brief, intermittent intrusions, it may

1

be difficult to assess time occupied by them in temns of total

2

hours. In such cases, estirnate time by detesmining how

3

frequently they occur. Consider both the number of times the

4

intrusions occur and how many hours of the day are affected.

Ask:1 How frequently do the obsessive thoughts occur? [Be sure

to exclude ruminations and preoccupations which, unlike

obsessions, are ego-syntonic and rational (but exaggerated).]

Q: On the average, what is the longest number of consecutive

waking hours per day that you are

completely free of obsessive thoughts? [If necessary, ask:1 What

is the longest block of time in which

obsessive thoughts are absent?

Q: How much do your obsessive thoughts interfere with your

0

social or work (or role) functioning? Is there anything that you

1

don’t do because of them? [If currently not working determine

2

how much

3

performance would be affected if patient were employed.]

4

2

= 1doderate, disturbing, but still manageable

3

= Severe, very disturbing

4

= Extreme, near constant and disabling distress

Q: How much distress do your obsessive thoughts cause you?

0

[In most eases, distress is equated with anxiety; however,

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patients may report that their obsessions are “disturbing” but

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deny “anxiety.” Only rate anxiety that seems triggered by

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obsessions, not generalized anxiety or associated with other

4

conditions.]

Q: How much of an effort do you make to resist the obsessive

0

thoughts? How often do you try to disregard or turn your anention

1

away from these thoughts as they eater your mind? [Only rate

2

effort made to resist, not success or failure in actually controlling

3

the obsessions. How much the patient resists the obsessions may

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or may not correlate with his/her abilig to control them. Note that

this item does not direetly measure the severig of the intrusive

thoughts; rather it rates a manifestation of health, i.e., the effort

the patient makes to counteract the obsessions by means other

than avoidance or the performance of compulsions. Thus, the

more the patient tries to resist, the less impaired is this aspect of

his/her functioning. There are “active” and “passive” forms of

resistance. Patients in behavioral therapy may be encouraged to

counteract their obsessive symptoms by not struggling against

them (e.g., “just let the thoughts come; passive opposition) or by

intentionally bringing on the disturbing thoughts. For the purposes

of this item, consider use of these behavioral techniques as forms

of resistance. If the obsessions are minimal, the patieut may not

feel the need to resist them. In such cases, a rating of “0” should

be given.]

Q: How much control do you have over your obsessive thoughts?

0

How successful are you in stopping or diverting your obsessive

1

thinking? Can you dismiss them? [In contrast to the preceding

2

item on resistance, the ability of the patient to control his

3

obsessions is more closely related to the severity of the intrusive

4

thoughts.]

Q: How much time do you spend performing compulsive

0

behaviors? [When rituals involving activities of daily living are

1

chiefly present, ask:] How much longer than most people does it

2

take to complete routine activities because of your rituals? [When

3

compulsions occur as brief, intermittent behaviors, it may difficult

4

to assess time spent performing them in terms of total hours. In

such cases, estimate time by determining how frequently they are

performed. Consider both the number of times compulsions are

performed and how many hours of the day are affected. Count

separate occurrences of compulsive behaviors, not number of

repetitions; e.g., a patient who goes into the bathroom 20

different times a day to wash his hands 5 times very quickly,

performs compulsions 20 times a day, not 5 or 5 x 20 = 100.

Ask:] How frequently do you perform compulsions? 1In most

cases compulsions are observable behaviors(e.g., land washing),

but some compulsions are covert (e.g., silent checking).]

Q: On the average, what is the longest number of consecutive

0

waking hours per day that you are completely free of compulsive

1

behavior? [If necessary, ask:] What is the longest block of time in

2

which compulsions are absent?different times a day to wash his

3

hands 5 times very quickly, performs compulsions 20 times a day,

4

not 5 or 5 x 20 = 100. Ask:] How frequently do you perform

compulsions? 1In most cases compulsions are observable

behaviors(e.g., land washing), but some compulsions are covert

(e.g., silent checking).]

Q: How much do your compulsive behaviors interfere with your

0

social or work (or role) functioning? Is there anything that you

1

don’t do because of the compulsions? [If currently not working

2

determine how much performance would be affected if patient

3

were employed.]

4

Q: How would you feel if prevented from performing your

0

compulsion(s)? [Pause] How anxious would you become? [Rate

1

degree of distress patient would experience if performance of the

2

compulsion were suddenly interrupted without reassurance

3

offered. In most, but not all cases, performing compulsions

4

reduces anxiety. If, in the judgement of the interviewer, anxiety is

actually reduced by preventing compulsions in the manner

described above, then asked: How anxious do you get while

performing compulsions until you are satisfied they are

completed?

Q: How much of an effort do you make to resist the compulsions?

0

I Only rate effort made to resist, not success or failure in actually

1

controlling the compulsions. How much the patient resists the

2

compulsions may or may not correlate with his ability to control

3

them. Note that this item does not directly measure the severity

4

of the compulsions; rather it rates a manifestation of health, i.e.,

the effort the patient makes to counteract the compulsions. Thus,

the more the patient tries to resist, the less impaired is this

aspect of his functioning. If the compulsions are minimal, the

patient may not feel the need to resist them. In such cases, a

rating of “0” should be given.]

Q: How strong is the drive to perform the compulsive behavior?

0

[Pause] How much control do you have over the compulsions? [In

1

contrast to the preceding item on resistance, the ability of the

2

patient to control his compulsions is more closely related to the

3

severity of the compulsions.]

4

Q: Do you think your concerns or behaviors are reasonable?

0

[Pause] What do you think would happen if you did not perform

1

the compulsion(s)? Are you convinced something would really

2

happen? 1Ratc patient’s insight into the senselessness or

3

excessiveness of his obsession(s) based on beliefs expressed at

4

the time of the interview.]

Q: Have you been avoiding doing anything, going any place, or

0

being with anyone because of your obsessional thoughts or out of

1

concern you will perform compulsions? [If yes, then ask:] Elow

2

much do you avoid? [Rate degree to which patient deliberately

3

tries to avoid things. Sometimes compulsions are designed to

4

“avoid” contact with something that the patient fears. For

example, clothes washing rituals would be designated as

compulsions, not as avoidant behavior. If the patient stopped

doing the laundry then this would constitute avoidance.]

3

= Severe, continual weighing of pros and cons about nonessentials.

4

= Extreme, unable to make any decisions. Disabling.

Q: Do you have trouble making decisions about little things that

0

other people might not think twice about (e.g., which clothes to

1

put on in the morning; which brand of cereal to buy)? [Exclude

2

difficulty making decisions which reflect ruminative thinking.

3

Ambivalence concerning rationally-based difficult choices should

4

also be excluded.]

Q: Do you feel very responsible for the consequences of your

0

actions? Do you blame yourself for the outcome of events not

1

completely in your control? [Distinguish from normal feelings of

2

responsibility, feelings of worthlessness, and pathological guilt. A

3

guilt-ridden person experiences himself or his actions as bad or

4

evil.]

Q: Do you have difficulty starting or finishing tasks? Do many

0

routine activities take longer than they should? [Distinguish from

1

psychomotor retardation secondary to depression. Rate increased

2

time spent performing routine activities even when specific

3

obsessions cannot be identified.]

4

Q: After you complete an activity do you doubt whether you

0

performed it correctly? Do you doubt whether you did it at all?

1

When carrying out routine activities do you find that you don’t

2

trust your senses (i.e., what you see, hear, or touch)?

3

1

= Illness slight, doubtful, transient; no functional impairment

2

= Mild symptoms, little functional impairment

3

= Moderate symptoms, functions with effort

4

= Moderate – Severe symptoms, limited functioning

5

= Severe symptoms, functions mainly with assistance

6

= Extremely Severe symptoms, completely nonfunctional

Interviewer’s judgement of the overall severity of the patient’s

0

illness. Rated from O (no illness) to 6-(most severe patient seen).

1

[Consider the degree of distress reported by the patient, the

2

symptoms observed, and the functional impairment reported.

3

weighing the reliability or accuracy of the data obtained. This

5

0

= Very much worse

1

= Much worse

2

= Minimal worse

3

= No change

4

= Minimally improved

5

= Much improved

6

= Very much improved

Rate total overall improvement present SINCE THE INITIAL

0

RATING whether or not, in your judgement, it is due to drug

1

treatment.

2

= Excellent, no reason to suspect data unreliable  . .

= Good, factor(s) present that may adversely affect reliability

= Fair, factorts) present that definitely reduce reliability

= Poor, very low reliability

obsessive-compulsive symptoms present may interfere with the

3

patient’s concentration, attention, or freedom to speak

spontaneously (e.g., the content of some obsessions may cause

the patient to choose his words very carefully).