I. Development, Use, and Reliability ‘Wayne K. Goodman, MD; Lawrence H. Price, MD; Steven A. Rasmussen, MD; Carolyn Mazur, PhD; Roberta L. Flsiachmann, BN, BSN; Candy L fil, MS; George R. Heninger, MD; Denis S. Charney, MD ‘The Yale Brown Obsessive Compulsive Scale was designed ‘to remedy the probleme of exieting cating ecalea by providing & pecttic measure of the severity of symptoms of obsessive ‘compulsive disorder thet la not influenced by the type of obees- ‘lone oF compulaions present. The scale le cliniclar-rated, 10- them scale, each ttm rated from 0 (no symptoma) to 4 lextreme rymptoma) (total range, 0 to 40}, with separate subtotals for ‘severity of obsessions and compulsions. In & study Involving ‘our evtare anv 40 patient with obeeeatve-compulatve diaarder «t various stages of treatment, interrater relablty forthe total Yale-Brown Scale acore and each of the 10 individus! Heme wos ‘excellant, with # high degree of internal consistency among ail Tem scores demonstrated with Cronbach « cowmelent Based (on pretreatment seseesment of 42 patients with obseesive-com ulalve disorder, each item waa frequently endoreed and med sured serosa 4 ange of severity, Thane findings suggeat thet the Yale-Brown Scale la a rellable ingtrument for messuring the severity of linese In patients with obsosslve-compuleive diaor- or with a range of severity and types of obeasive-compulalve 31008-1011) TP grazer recon tht obsessive compulsive dsrder (QCD) is not uncemmon,' coupled with the need to vest ‘ewtreatmgnts for OCD, inderscores the importance of rel able and valid outcome measures. To date, sseasroent of drag efficacy in OCD has been hampered by the ehortcomings of existing rating instruments, In particulay, there is need fer an inatrument that 6 sensitive to and selective for changes in severity of obeessive-compulsive aymptoms. The absence of a broadly assepted seale for OCD also roakes it dificult to ‘compare the results of different trestment trials. ‘A number of rating instruments have been used in the sasesement of OCD, but all have serious limitations, The {ngtruments most widely used in the evaluation of adults are the Leyton Obsessional Inventory.” the Maudsley Obsession- ‘coopted ee pletion August 168. From the Department of Py chity, Yale Univerity Schoo of Medicine snd ‘The Comecacye Mental Heals Centar, Ria Research Pussies, New ‘aven, Com (bre Gandman, Pic, Mazur, Remger and Cary, de ‘Fleschann pd Hiya tbe Department of Peyhatry. Brawn Unversty ‘Sihaolof Medicine, Buler Hopital, Provienoe, RI (De Raa) ‘Reprint requetst Department of Pychiniry, Yale Univerat Sedo! of atin, Thr Center Masta Hoh Cem, ask St New Haven, OT (cbr Gandman 1006 Arch Gan Psychiaty—-Vol48, November 1989 41 Compalaive Inventory," the Obsessive Compulsive ‘teale of the Comprehensive Psychopatholigical. R Seale,” and the National Institutes of Mental Obsesaive ve Scale. Some interrater data are available for these sesles, bat either thétr' not been established, oF they are not suitable for drug rent studies. For example, the original rter-asisted afthe Leyton Obsessional Inventory is cumbersome to ‘ter? and both the Leyton Obseasione! Inventory Maudsley Obsessional Compulsive Inventory rely on: ings, confound measurement of trai: with state variables, examine only certain types of obsessions and cormpuls major drawback of the Obsessive Compulsive Subscale ofthe © Comprehensive Peychopathological Rating Scale is contains items that rate symptoms (eg, depression) not ieto OCD. The Obsessive Compulsive Subscale ofthe Compre- hensive Paychopathological Rating Scale was not designed de novo to assess OCD, but was denved from a factor analysis of the parent seale, the Comprehensive Psychopathological Rate ing Seale, A weakness of the National Institite of Mental Health Obsessive Compulsive Seale is characteristic of all single-item global measures of severity, namely, information about severity and response of individual symptoms of OCD is Tost because the scale score cannot be resolved into separate components, ‘ ‘The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Waa ‘designed 1o remedy the problerrs of existing seales by provide ina specific measure of the severity of symptoms af OCD (as defined by DSM-III-R) that is not influenced by the type ot number of obsessions or compulsions present, In contrast to other rating seales, asseasment of OCD severity with the Y- BOCS does not fous on the content of patient» symptom, ‘The development, use, and reliability of the Y-BOCS are dis cussed herein, an are the paythometric propertics ofindividual Y.BOCS items. Studies of sale validly are deteribed ea: re." . DEVELOPMENT AND DESION Item selection was based on the extensive clinical ence of the principal developers of the Y-BOCS (WIC S.AR., and L.H,P.) who collectively have examined than 300 patient with OCD. Several versions ofthe scale piloted over a 6-month period until the current form (rst edition) was finalized. To maximize specificity for OCD, a ‘The Yelo-Browa Obsassive Come Scalo—Goodan atRESISTANCE CONTROL OVER ORSESSONS TM SPENTON COMPULSTONS, DTERFERENCE FROM COMPULSION LISTRESS FROM COMPULSIONS RESISTANCE etn Wo ave 3 7 A camps wm of Wem prt ha pi in ra on age FF une eal wo [SECRETS SSR OVE SORRENTO 5 Mow soma rapa reper as) How SMEAR Semeteeeaber eee So mealies te eyes Sete eset lore : >More eng rae pet a ec SC eek pnp pare hr lye in ees pate eh, a ia acca a ent se poe nn ped pny vay oy nay eo sey Sy Fig 1.—Answer key for the 10itom Yale-Brown Odeassive Compulsive Scale and the complate text for tem 10, attempt was made to exclude items that eeemed to reflect aymptoms of depression or other anxiety disorders. To en- tance the sensitivity of the ¥-BOCS to change, items intended tomeasure putative staye variables were inclided inthe core portion ofthe ¥-BOCS, While items believed to reflect person- ality traits (eg, perfectionism) were excluded, Certain clinical, features commonly associated with OCD, butnot clearly rela Biothe severity of the illness, were assessed by ters in the investigational cornpanent of the Y¥-BOCS. Tre Y-BOCS is 4 I0-item elinician-rated scale, each item rated from 0 (no syroptoms) to 4 (extreme symptoms) Fig 1) (complete eopy available on request) The Y-BOCS was de signed as an observerrated instrument because of evidence irom assessment of other disorders that ratings based on self report alone, particularly during acute stages ofiliness, corre late pooriy with more objective evaluations.** For all items. 2 higher numerical score corresponds to greater illness sever ity. The total ¥-BOCS score is the sum of items 1 to 10 (range, to 40). There are separate subtotal for severity of abses- sions (sum o tems | through 6) and compulsions (eum of tems 6 through 10) Symptoms are assessed with regard to how much they occupy the patient§ time, interfere with normal ‘Ach Gen Peychlatry—-Vol 48, November 1989 ‘functioning, cause subjective distress, are actively resisted by the patient, and can actually be controlled by the patient. Thus, the Core items (1 to 10) of the Y-BOCS measure the severity ofthe cardinal aymptoms of OCD tie, obsessions and compulsions) along the dimensions of time, interferenes, dis- tress, resistance, and control. The rationale for including items 1 to 3 and 6 to 8 was relatively straightforward; the degree to which obsessions or compulsions occupy the patient’ Lime, interfere with func- tioning, o cause distress were considered directly related to severity of illness. To safeguard the specificity of the Y-BOCS. in measuring the severity of OCD, the instructions corre sponding to these items were designed to aid the rater in excluding considerstion of other (non-OCD) eymptoms. For example, item 4 (distress from cbseasions) instructa the inter~ viewer to “only rate anxiety that seems triggered by obses- sions, not generalized anxiety or anxiety associated with other symptoms.” Items 4 and 9, which respectively measure the of resistance to obgessions and compulsions, deserve further description because several other rating scales have defined “resistance” differently."* In the Y-BOCS, resistance is a