Assessment-6: Yale-Brown Obsessive Compulsive Scale (Y-BOCS)

Introduction
Developed in the late 1960s by a collaborative effort led by Dr Wayne K. Goodman of
Yale University and Dr Donald S. Klein of Brown University [1], the Y-BOCS emerged from
a need for a standardized and reliable measure to quantify OCD symptom severity. The Y-
BOCS serves a multitude of purposes in the realm of OCD. Primarily, it functions as a clinician-
administered rating scale to assess the severity of both obsessions and compulsions, the
hallmarks of OCD. The scale provides a semi-structured interview format, guiding the
clinician in exploring the patient's experience with intrusive thoughts, urges, and repetitive
behaviours.
The Y-BOCS boasts robust psychometric properties, solidifying its position as a gold
standard tool. Internal consistency, a measure of how well items within the scale cohere, is
demonstrably high, with Cronbach's alpha coefficients exceeding 0.8. This indicates a high
degree of internal coherence within the scale. Test-retest reliability, reflecting the scale's ability
to yield consistent scores across administrations, is also commendable, with studies reporting
strong correlations between scores obtained on separate assessments.
The Y-BOCS comprises 10 items, five dedicated to assessing obsessions and the
remaining five to compulsions. Each item is rated on a 0 to 4-point scale, with higher scores
reflecting greater symptom severity. For instance, a score of "0" for time occupied by obsessive
thoughts translates to "none," while a score of "4" indicates "greater than 8 hours a day or near
constant intrusion". The sum of the obsession item scores yields an obsessions subscale score,
and likewise for the compulsions. The total Y-BOCS score is the sum of both subscale scores,
offering a comprehensive severity index.
Standardized interpretations accompany the Y-BOCS, allowing clinicians to translate
raw scores into clinically meaningful categories. Scores typically range from 0 to 40, with
higher scores indicating greater symptom severity. A score of 0-7 falls within the subclinical
range, suggesting minimal OCD symptoms. Scores from 8-15 signify mild OCD, 16-23
moderate OCD, 24-31 severe OCD, and 32-40 extreme OCD

Psycho Diagnostic Report

Proforma of the client
Name: M.S
Age: 22 years
Gender: Female
SES: Upper middle
Occupation: Student
Place of Residence: Bangalore
Languages spoken: Hindi and English
Presenting complaints:
• Presents with concerns about intrusive thoughts and repetitive behaviours that
significantly impact her daily life.
• Reports feeling overwhelmed and distressed by these thoughts and behaviours.

Tests administered: Yale-Brown Obsessive Compulsive Scale (Y-BOCS)

Test results
Table 6.1 Results for Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
Scale Score
Obsessive Thoughts 10
Compulsive Behaviour 11
Total Score 21

Interpretation
M.S., age 22 years, shows concern about intrusive thoughts and repetitive behaviours
that significantly impact her daily life. She also reports feeling overwhelmed and distressed by
these thoughts and behaviours He was administered the Yale-Brown Obsessive Compulsive
Scale (Y-BOCS) to measure the severity of obsessive-compulsive disorder.
The overall score for was Yale-Brown Obsessive Compulsive Scale was 21. This score
lies in the moderate range (16-23).
Through the symptom checklist, it was understood that the client has various obsessions
and thoughts that seem to trouble them. This includes obsessions such as concerns or disgust
with bodily waste or secretions, excessive concern with household items, and concern that she
will get ill because of contaminants. The fear of contamination prevents her from participating
in social activities or using public transportation. M.S. feels isolated and ashamed of her
symptoms, which further increases her anxiety. She also exhibits a need for symmetry or
exactness where she feels ill at ease until things are in a certain order. She, however, does not
have any magical thinking regarding her obsession with symmetry. In addition to these
thoughts and concerns, she displays an excessive and ritualized handwashing compulsion. M.S.
washes her hands repeatedly throughout the day, often for several minutes each time until her
hands become cracked and sore. She also displays excessive or ritualized showering, which
causes her extreme difficulty in daily functioning. She started to exhibit this behaviour recently
with concerns about contamination in the past as well as currently. M.S. also exhibits ordering
and arranging compulsions, both currently and in past. She also engages in mental counting or
repeating phrases in her head to neutralize the anxiety caused by her intrusive thoughts.
With respect to the time occupied by obsessive thoughts, she reports that she spends at
least one to three hours a day occupied by obsessive thoughts. On asking how much her
obsessive thoughts interfere with her work, school, social, or other important role functioning,
she reports definite interference with social or occupational performance but feels it is still
manageable, however annoying it is currently for her. In short, she reports the distress by
obsessive thoughts to be disturbing but still manageable. About how often she tries to disregard
or turn her attention away from such thoughts as they enter her mind, she reports that she does
make some effort to resist, as they significantly impact her academic and social life. The time
spent on handwashing and arranging objects leads to missed deadlines and academic struggles
as well. Upon asking how much control she thinks she has over her obsessive thoughts, she
reports that it is only sometimes that she can stop or divert her obsessions.
With respect to the time spent performing compulsive behaviours, she reports a frequent
performance of the compulsive behaviour. On asking how much her compulsive behaviours
interfere with her work, school, social, or other important role functioning, she reports definite
interference with social or occupational performance but feels it is still manageable as she is
sometimes able to divert her obsessions and prevent from indulging in compulsions. When
asked how she would feel when she was prevented from performing her compulsions, she
reports that there is a prominent and very disturbing increase in anxiety if compulsions are
interrupted. This is when she constantly tries to make some effort to resist against her
compulsions. When asked about how strong the drive to perform the compulsive behaviour is,
she responds with a strong pressure to perform a behaviour and can control it only with
difficulty.

Impression
The client has a score of 21 on Y-BOCS, which indicates that the client could have a
moderate case of OCD.

Recommendations
• Cognitive-behavioural therapy (CBT) is the first-line treatment for OCD and has been
shown to be highly effective. A specific form of CBT called Exposure and Response
Prevention (ERP) is particularly helpful. ERP involves gradual exposure to triggers that
provoke anxiety and resisting the urge to engage in compulsions. Through this process,
M.S. can learn that the feared consequences (getting sick, feeling out of control) do not
actually happen, reducing her anxiety and the need for compulsions.
• Selective Serotonin Reuptake Inhibitors (SSRIs) are medications often used to manage
anxiety and compulsive behaviours associated with OCD. A doctor can determine if
medication would be a beneficial addition to therapy.
Summary
M.S., a 22-year-old college student from Bangalore, is experiencing symptoms that
suggest Obsessive-Compulsive Disorder (OCD). These symptoms include intrusive thoughts
about contamination, illness, and needing things to be symmetrical. She also engages in
repetitive behaviours like excessive handwashing, showering, and arranging objects, along
with mental compulsions. These thoughts and behaviours cause her significant distress and
interfere with her daily life. An assessment with the Yale-Brown Obsessive Compulsive
Scale (Y-BOCS) resulted in a score of 21, which indicates moderate OCD severity.
Considering this score and her symptoms, M.S. likely has a moderate case of OCD. The
recommended course of treatment is Cognitive-Behavioral Therapy (CBT) with Exposure
and Response Prevention (ERP). Medication may also be an option, but that would require
consultation with a doctor.