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Part A - Have you been bothered by unpleasant thoughts or
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images that repeatedly enter your mind, such as
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1. Concerns with contamination (dirt, germs, chemicals, radiation) or acquiring a serious illness such as AIDS?
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2. Overconcern with keeping objects (clothing, tools, etc) in perfect order or arranged exactly?
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3. Images of death or other horrible events?
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4. Personally unacceptable religious or sexual thoughts?
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Have you worried a lot about terrible things happening, such as
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5. Fire, burglary or flooding of the house?
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6. Accidentally hitting a pedestrian with your car or letting it roll down a hill?
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6. Accidentally hitting a pedestrian with your car or letting it roll down a hill?
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7. Spreading an illness (giving someone AIDS)?
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8. Losing something valuable?
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9. Harm coming to a loved one because you weren't careful enough?
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Have you worried about acting on an unwanted and
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senseless urge or impulse, such as
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10. Physically harming a loved one, pushing a stranger in front of a bus, steering your car into oncoming traffic; inappropriate
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Have you felt driven to perform certain acts over and over again, such as:
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11. Excessive or ritualized washing, cleaning or grooming?
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12. Checking light switches, water faucets, the stove, door locks or the emergency brake?
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13. Counting, arranging; evening-up behaviors (making sure socks are at same height)?
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14. Collecting useless objects or inspecting the garbage before it is thrown out?
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15. Repeating routine actions (in/out of chair, going through doorway, r elighting cigar ette) a cer tain number of times or unt
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16. Needing to touch objects or people?
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17. Unnecessary rereading or rewriting; reopening envelopes before they are mailed?
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18. Examining your body for signs of illness?
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19. Avoiding colors (“red” means blood), numbers (“13” is unlucky) or names (those that start with “D” signify death) that are a
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20. Needing to “confess” or repeatedly asking for reassurance that you said or did something correctly
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If you answered YES to one or more of these questions, please continue with Part B
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Part B - In the past month...
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1. On average, how much time is occupied by these thoughts or behaviors each day?
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2. How much distress do they cause you?
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3. How hard is it for you to control them?
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4. How much do they cause you to avoid doing anything, going any place or being with anyone?
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5. How much do they interfere with school, work or your social or family life?
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For Clinical Use
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Sum on Part B (Add Items 1 to 5)
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