By Rajnish Mago, MD (bio)
In my opinion, mental health clinicians should routinely ask patients with obsessive-compulsive disorder (OCD) to fill out self-rating scales for their OCD. The American Psychiatric Association’s Practice guideline for the treatment of patients with obsessive-compulsive disorder (2007, with a Guideline Watch in 2013) recommended that self-rating scales be used in persons with OCD.
Have you been using self-rating scales in your patients with OCD? If not, on this page, I will provide a simple guide to how we can use such self-rating scales, which ones to recommend, and where you can get these scales free of cost for use in your clinical practice.
Clinician-rated versus self-rating scales
If asked which rating scale should be used for OCD, most people would say the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; Second Edition; Storch et al., 2010b). It is the most well-known rating scale and is used in most of the research studies in OCD. But, the Y-BOCS is not a self-rating scale. It is clinician-rated, which means that using the Y-BOCS is time-consuming during the session with the patient.
Note: A self-rated, symptom checklist version of the Y-BOCS is also available (Storch et al., 2010a) and will be discussed below.
On the other hand, self-rating scales have a huge advantage that they are filled out by patients outside of the session with the clinician.
Multiple uses of self-rating scales in OCD
Self-rating scales can be used for more purposes than we might think. Here are some of them.
1. Identify which OCD symptoms are present—their variety and grouping
2. Evaluate the severity of the OCD symptoms that are present
Follow up visits
3. Monitor the response to treatment
4. Help patients become better self-observers
5. Help in identifying factors that make the symptoms better or worse
Which self-rating scale(s) should we use? Below, I’ll make some recommendations and explain how clinicians can obtain them at no cost.
Self-rating scales for OCD
1. Obsessive-Compulsive Inventory-Revised (OCI-R). This is the rating scale that I recommend for routine use in our clinical practices. For details on how to obtain and use this scale, please see this article:
2. Yale-Brown Obsessive-Compulsive Scale Second Edition Symptom Checklist (Y-BOCS-II-SC; Storch et al., 2010a)
3. Florida Obsessive-Compulsive Inventory (FOCI; Storch et al., 2007)[Optional to read: This inventory consists of a symptom checklist with 20 items that are grouped into 4 categories. After indicating the presence or absence of the 20 OCD symptoms asked for, the person completes a five-item severity scale. The FOCI has been shown to correlate highly with the clinician-rated version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). I got permission from the first author for FOCI, Eric Storch, Ph.D., to use the scale in my clinical work but not for posting it on this website for you to download. Anyone who wants to use it has to do the same. This is a slight barrier to using this scale but not a difficult one to overcome. You can email him at firstname.lastname@example.org and say that you want permission to use the scale in your patients. That’s it. And, of course, you only have to do this once.]
American Psychiatric Association. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Arlington, VA: American Psychiatric Association, 2007. Available online at http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/ocd.pdf. Guideline Watch (2013) available at http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/ocd-watch.pdf
Foa EB, Huppert JD, Leiberg S, Langner R, Kichic R, Hajcak G, Salkovskis PM. The Obsessive-Compulsive Inventory: development and validation of a short version. Psychol Assess. 2002 Dec;14(4):485-96. PubMed PMID: 12501574.
Huppert JD, Walther MR, Hajcak G, Yadin E, Foa EB, Simpson HB, Liebowitz MR. The OCI-R: validation of the subscales in a clinical sample. J Anxiety Disord. 2007;21(3):394-406. Epub 2006 Jun 30. PubMed PMID: 16814981.
Rapp AM, Bergman RL, Piacentini J, McGuire JF. Evidence-Based Assessment of Obsessive-Compulsive Disorder. J Cent Nerv Syst Dis. 2016 Aug 21;8:13-29. PubMed PMID: 27594793; PubMed Central PMCID: PMC4994744.
Storch EA, Kaufman DA, Bagner D, Merlo LJ, Shapira NA, Geffken GR, Murphy TK, Goodman WK. Florida Obsessive-Compulsive Inventory: development, reliability, and validity. J Clin Psychol. 2007 Sep;63(9):851-9. PubMed PMID: 17674398.
Storch EA, Larson MJ, Price LH, Rasmussen SA, Murphy TK, Goodman WK. Psychometric analysis of the Yale-Brown Obsessive-Compulsive Scale Second Edition Symptom Checklist. J Anxiety Disord. 2010a Aug;24(6):650-6. PubMed PMID: 20471199.
Storch EA, Rasmussen SA, Price LH, Larson MJ, Murphy TK, Goodman WK. Development and psychometric evaluation of the Yale-Brown Obsessive-Compulsive Scale–Second Edition. Psychol Assess. 2010b Jun;22(2):223-32.PubMed PMID: 20528050.
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