| RPT |
.| .| YBOCSII Symptom Checklist| | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| Location: <.Location.>| | Veteran: <.Patient_Name_Last_First.>| SSN: <.Patient_SSN.>| DOB:
attention, customer gets injured because you gave him wrong materials or information. | <*Answer_7084*>| 10. Fear might harm self or others on impulse. Examples: physically harming loved ones,
stabbing or poisoning dinner guests, driving car into oncoming traffic, pushing stranger in front of a train. Distinguish from homicidal/suicidal intent. | <*Answer_7085*>| 11. Fear of being
responsible for terrible events. Examples: fire, burglary, flooding house, company going bankrupt, pipes freezing.| <*Answer_7086*>| 12. Fear of blurting out obscenities or insults. Examples:
shouting blasphemies in church, yelling fire in the movie theatre, writing obscenities in a business letter.| <*Answer_7087*>| 13. Fear of doing something else embarrassing or inappropriate.
Examples: sexual contact, spitting, taking off clothes in public, walking out with unpaid merchandise. Distinguish from social phobia.| <*Answer_7088*>| 14. Violent, horrific or repulsive
images. Examples: intrusive and disturbing| images of car crashes or disfigured people. Distinguish from PTSD.| <*Answer_7089*>| 15. Excessive concern with right/wrong or scrupulosity.
Examples: worries about always doing "the right thing", unfounded worries about lying or cheating, didn't say prayers perfectly.| <*Answer_7090*>| 16. Concern with sacrilege or blasphemy.
Examples: intrusive unacceptable| thoughts or images about God or religion. Concerns about adherence to religious| principles exceed those of religious peer group.| <*Answer_7091*>| 17.
Excessive fears of Satan or demonic possession. Examples: fears triggered by "Red Devil" paint, sports teams with word devil in them, "666", pentangles.| <*Answer_7092*>| 18. Forbidden or
improper sexual thoughts or images. Examples: unwanted sexual thoughts about family members; images of unacceptable acts. Distinguish from paraphilias by asking about fantasy life.|
<.Patient_Date_Of_Birth.> (<.Patient_Age.>)| Gender: <.Patient_Gender.>| | | | Questions and Answers| | 1. Excessive concern with germs. Examples: AIDS or hepatitis.| <*Answer_7076*>| 2.
<*Answer_7093*>| 19. Experiences unwanted sexual impulses. Examples: concerned that might "snap" and commit sexual violation. Feels as if hand is moving toward someone's private parts in the absence
of arousal. Distinguish from paraphilias. | <*Answer_7094*>| 20. Excessive concerns about sexual orientation or gender identity. Examples: person repeatedly wonders if s/he is gay
even though there is every reason to believes s/he is heterosexual. Distinguish from realistic issues around sexual or gender identity. | <*Answer_7095*>| 21. Need for symmetry or exactness.
Examples: certain things can't be touched or moved, clothes organized in closet alphabetically, bothered if pictures are not straight or canned goods not lined up.| <*Answer_7096*>| 22.
Perfection in appearance or grooming. Examples: excessive concern about appearance of clothing, such as wrinkles, lint, loose threads; bothered if hair not parted exactly straight. Distinguish from
OCPD. | <*Answer_7097*>| 23. Fear of saying the wrong thing. Ex: patient may appear to have thought blocking because she is reviewing every possible interpretation of what she is about to say.|
<*Answer_7098*>| 24. Excessively bothered by things not sounding 'just right.' Examples: readjusting stereo system until it sounds 'just right'; asks family members to say things in just the
right way, excessively bothered by visual, auditory or somatic sensations of not being 'just right'. | <*Answer_7099*>| 25. Need to know or remember. Examples: needing to remember insignificant
things like license plate numbers, bumper stickers, advertising slogans, names of actors.| <*Answer_7100*>| 26. Need to hoard or save things. Examples: afraid that something valuable might be
discarded with recycled newspapers even though all valuables are locked up in the safe. Distinguish from hobbies and concern with objects of monetary or sentimental value. | <*Answer_7101*>|
Excessive concern with contaminants or chemicals. Examples: household cleansers, asbestos, radiation, pesticides and toxic waste.| <*Answer_7077*>| 3. Concern will harm others by spreading
27. Fear of losing objects, information, or a person. Examples: otherwise rational man feared "losing" his 5-year old daughter when mailing envelopes; patient concerned that her "essence" would be
left behind when getting up from a chair. | <*Answer_7102*>| 28. Magical or superstitious fears. Examples: colors with special significance(black connected with death, red associated with blood
and injury), black cats, stepping on side walk cracks, (un)lucky numbers, getting pregnant from using a swimming pool. | <*Answer_7103*>| 29. Intrusive meaningless sounds, words, or music.
Examples: songs or music with no special significance play over and over in one's mind like a broken record.| <*Answer_7104*>| 30. Excessive or ritualized hygiene. Examples: washes hands like
surgeon scrubbing for the operating room, uses harsh detergents or very hot water; takes long ritualized showers; excessive tooth brushing or toilet routine. | <*Answer_7105*>| 31. Cleaning of
household items, inanimate objects or pets. Examples: floors kept so clean you can eat off them; prolonged vacuuming; daily thorough washing of car tires.| <*Answer_7106*>| 32. Checking locks,
stove, appliances, emergency brake, faucets, etc. Examples: Checking that the doors are locked, stove is turned off, appliances unplugged.| <*Answer_7107*>| 33. Checking that nothing terrible
did/will happen. Examples: makes sure that did not run over a pedestrian or did not leave cabinet open to poisonous substances, etc.| <*Answer_7108*>| 34. Checking that did not make mistake.
Examples: homework, counting money, writing.| <*Answer_7109*>| 35. Checking tied to somatic obsessions. Examples: repeatedly probing groin to see if hernia is present; scrutinizing skin for
signs of cancer; excessive exploration of lymph nodes. Distinguish from hypochondriasis. | <*Answer_7110*>| 36. Need to repeat routine activities or boundary crossings. Examples: going through
germs or contaminants. Examples: transfer germs from one object to another.| <*Answer_7078*>| 4. Bothered by bodily waste or fluids. Examples: urine, feces, saliva or blood.|
doorway, crossing state lines; may get stuck trying to enter a building, doing/undoing rituals, taking clothes on/off, may have to repeat a certain number of times. | <*Answer_7111*>| 37.
Evening up behaviors. Examples: movement on right side up body has to be balanced with same movement on left side; adjusts height of stockings, tension of shoelaces, plucks or cuts hair to achieve
symmetry. Distinguish latter from richotillomania, in which hair is not pulled for a specific purpose. | <*Answer_7112*>| 38. Re-reading or re-writing. Examples: doubt information that just
read, written letters must look perfect. Distinguish from dyslexia.| <*Answer_7113*>| 39. Counting compulsions. Examples: counting things like ceiling or floor tiles,| books in a bookcase,
words in a sentence.| <*Answer_7114*>| 40. Ritualized activity of daily living routines. Example: may have to put clothes on in a certain order, can only go to bed after following an elaborate
series of steps, brush teeth in a ritualistic manner. | <*Answer_7115*>| 41. Excessive religious rituals. Example: Repeating prayers or passages from the Bible an inordinate number of times.|
<*Answer_7116*>| 42. Ordering or arranging compulsions. Example: straightening piles of stationary on a desktop or adjusting books in a bookcase.| <*Answer_7117*>| 43. Repeating what
someone else has said. Example: word, phrase, or sound. Distinguish from echolalia of Tourette's Syndrome.| <*Answer_7118*>| 44. Asking for reassurance. Example: repeatedly asking spouse that
they performed a routine correctly.| <*Answer_7119*>| 45. Ritualized eating behaviors. Ex: arrange or eat food in particular way or a specific order to avert a feared consequence other than
gaining weight, as in anorexia nervosa.| <*Answer_7120*>| 46. Saves or collects useless items. Examples: piles up old newspapers, collects useless objects; house an become obstacle course with
<*Answer_7079*>| 5. Bothered by sticky substances or residues. Examples: adhesives, chalk dust, or grease.| <*Answer_7080*>| 6. Excessive concern with becoming pregnant or of making someone
piles of trash. Distinguish from hobbies and concern with objects of monetary or sentimental value. | <*Answer_7121*>| 47. Picks up objects that most people would pass by. Examples: shards of
broken glass, nails, pieces of paper with writing on them, staples.| <*Answer_7122*>| 48. Examines things that leave one's possession. Examples: sifts through garbage, ritual for washing off
dinner plates to separate waste from accidentally lost items; won't throw out used disposable vacuum bags or the cat litter. | <*Answer_7123*>| 49. Buys many unneeded items. Examples: buys 20
umbrellas, 100 boxes of moth balls, etc. May not be symptom of OCD unless behavior is excessive (e.g., wastes a lot of money, or accumulates closets full of unnecessary items.). |
<*Answer_7124*>| 50. Need to tell, ask or confess things. Examples: confessing to sins or wrongs that didn't commit; feels must describe every detail so that nothing is left out; repeats the same
question in different ways to make sure it was understood. | <*Answer_7125*>| 51. Need to do something until it feels "just right." Examples: adjusts car seat, straightens pictures, arranges
papers on desk, doesn't let go of handshake, until feels an internal signal that its OK. Has no specific feared consequences in mind. | <*Answer_7126*>| 52. Need to touch, tap, or rub.
Examples: urge to touch or run finger along surfaces or edges, lightly touches other people; taps a certain number of times; rubs against soft materials. May be difficult to distinguish from complex
motor tics of Tourette's. | <*Answer_7127*>| 53. Staring or blinking rituals. May be difficult to distinguish from motor tics of Tourettes Syndrome. If patient says has to blink a certain
number or times or stare to neutralize an obsession, endorse as compulsions here. | <*Answer_7128*>| 54. Superstitious behaviors. Examples: steps over sidewalk cracks, spits after having an
pregnant. Example: Woman afraid of conception if she swims in public pool.| <*Answer_7081*>| 7. Concerned with having an illness/disease. It is not always clear where to draw the line between
unwanted thought; makes sure sentences never contain 13 words; makes sign of the cross before dialing area code for New Jersey. | <*Answer_7129*>| 55. Mental rituals (other than checking or
counting). Examples: silently reciting prayers or nonsense words to neutralize unwanted thoughts.| <*Answer_7130*>| 56. Pervasive slowness. Extensive difficulty in starting, executing, and
finishing a wide range of routines tasks. In extreme cases, may be unable to complete tasks without assistance and may become"paralyzed". Distinguish from psychomotor retardation secondary to
depression or a primary movement disorder. | <*Answer_7131*>| 57. Ritualized avoidance. Examples: plans course on roadmap to stay at least 1 mile from chemical factories.| <*Answer_7132*>|
58. Active measures to avoid contact with contaminants or other feared objects. Ex: wears rubber gloves, doesn't shake hands, has one clean and one dirty hand, won't go near anyone who seems to have
a cut, won't sit down in a chair that has a red spot. | <*Answer_7133*>| 59. Avoids doing things, going places or being with someone because of obsessions.| <*Answer_7134*>| 60. Avoid
contact with contaminated objects or people.| <*Answer_7135*>| 61. Avoid handling sharp or dangerous objects, or operating vehicles or machinery, out of concern might harm others.|
<*Answer_7136*>| 62. Avoid contact with people, children or animals because of unwanted impulses.| <*Answer_7137*>| 63. Avoids talking to or writing to others for fear will say or write the
wrong thing.| <*Answer_7138*>| 64. Avoids watching TV, listening to radio or reading newspaper to shield from disturbing information.| <*Answer_7139*>| 65. Avoids going shopping out of
concern will buy extra items that aren't needed.| <*Answer_7140*>| 66. Avoids doing things, going places, or being with someone that would trigger time consuming or onerous rituals (e.g.,
somatic obsessions and somatic preoccupations of hypochondriasis. Factors that point to OCD are the presence of compulsions not limited to seeking reassurance. | <*Answer_7082*>| 8. Fear of
washing, dressing, etc.).| <*Answer_7141*>| 67. Avoids reading or writing because it may bring on rituals (e.g., re-reading, re-writing).| <*Answer_7142*>| Obsession 1:|
<*Answer_7143*>| Obsession 2:| <*Answer_7144*>| Obsession 3:| <*Answer_7145*>| Compulsion 1:| <*Answer_7146*>| Compulsion 2:| <*Answer_7147*>| Compulsion 3:|
<*Answer_7148*>| Avoidance 1:| <*Answer_7149*>| Avoidance 2:| <*Answer_7150*>| Avoidance 3:| <*Answer_7151*>| | | Information contained in this note is based on a self-report
assessment and is not sufficient to use alone for diagnostic purposes. Assessment results should be verified for accuracy and used in conjunction with other diagnostic activities and procedures.|
$~
eating certain foods. Examples: excessive concern about risks of certain foods or food preparations, afraid will choke, food will change body chemistry. Distinguish from anorexia nervosa, in which
concern is gaining weight. | <*Answer_7083*>| 9. Fear might harm self or others because not careful enough. Examples: parked car rolling down hill, hit a pedestrian because not paying
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