Defining clinical severity in adults with obsessive–compulsive disorder
Open accessAbstract
OBJECTIVE: The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) is the most commonly used instrument to assess the clinical severity of obsessive-compulsive symptoms. Treatment determinations are often based on Y-BOCS score thresholds. However, these benchmarks are not empirically based, which may result in non-evidence based treatment decisions. Accordingly, the present study sought to derive empirically-based benchmarks for defining obsessive-compulsive symptom severity. METHOD: Nine hundred fifty-four adult patients with obsessive-compulsive disorder (OCD), recruited through the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders, were evaluated by experienced clinicians using a structured clinical interview, the Y-BOCS, and the Clinical Global Impressions-Severity scale (CGI-Severity). RESULTS: Similar to results in treatment-seeking children with OCD, our findings demonstrated convergence between the Y-BOCS and global OCD severity assessed by the CGI-Severity (Nagelkerke R(2)=.48). Y-BOCS scores of 0-13 corresponded with 'mild symptoms' (CGI-Severity=0-2), 14-25 with 'moderate symptoms' (CGI-Severity=3), 26-34 with 'moderate-severe symptoms' (CGI-Severity=4) and 35-40 with 'severe symptoms' (CGI-Severity=5-6). Neither age nor ethnicity was associated with Y-BOCS scores, but females demonstrated more severe obsessive-compulsive symptoms than males (d=.34). Time spent on obsessions/compulsions, interference, distress, resistance, and control were significantly related to global OCD severity although the symptom resistance item pairing demonstrated a less robust relationship relative to other components of the Y-BOCS. CONCLUSIONS: These data provide empirically-based benchmarks on the Y-BOCS for defining the clinical severity of treatment seeking adults with OCD, which can be used for normative comparisons in the clinic and for future research.
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In adults with OCD, Y-BOCS scores of 14, 26, and 35 may indicate the lower limits of moderate, moderate-severe, and severe symptom intensity, respectively.
“in adults, scores of 14, 26 and 35 may indicate the lower limits of moderate, moderate-severe, and severe symptom intensity, respectively 113”
From The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management (2021) · cites this paper as [113]
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“Using empirically derived criteria for Y-BOCS 76% had “mild symptoms” (0–13; Storch et al., 2015).”
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“Regardless of parent, mean YBOCS scores at all three postpartum assessments indicated mild OCS on average (Storch et al., 2015).”
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“For the purposes of this analysis, a full response was defined as a ≥ 35% reduction in DOCS scores and a partial response as a 25%-35% reduction, aligned with recommended criteria for treatment response and remission in OCD [29,31].”
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Repetitive Thoughts and Repetitive Behaviors in Williams Syndrome
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“1 3 (Clinical Global Impression Severity subscale score [CGIS] = 0–2), 14–25 with ‘moderate symptoms’ (CGI-S = 3), 26–34 with ‘moderate to severe symptoms’ (CGI-S = 5), and 35–40 with ‘severe symptoms’ (CGI-S = 5–6) of OCD (Storch et al. 2015), indicating that the mean total Y-BOCS/ CY-BOCS score of 3.”
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“Total scores range from 0 to 40, with scores of 0–13 indicating mild symptoms, 14–24 indicating moderate symptoms and 35–40 indicating severe symptoms (Storch et al., 2015).”
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Predictors of acute outcomes for intensive residential treatment of obsessive–compulsive disorder
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Do Exposure Therapy Processes Impact the Efficacy of Deep Tms for Obsessive-Compulsive Disorder?
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Self-citationPsychometric Properties of the Yale-Brown Obsessive Compulsive Scale-II Self-Report
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“Severity quali fi ers were created based on previous research using the Y-BOCS 39 with 1 additional category that we labeled “ incapacitating ” for scores 41 to 50, and Cohen ’ s κ was run to measure agreement between the categorical quali fi ers on the Y-BOCS-II and Y-BOCS-II-SR.”
Self-citationDanner, U. N., Sternheim, L. C., van Oppen, P., Hendriks, G., van Balkom, T. J. L. M., & Cath, D. C. (2022) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2022.100759 · Cited by 9 · see citing works
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“Both studies recruited clinical populations with doubt/checking as their primary concern, with mean Y-BOCS scores indicating moderate-severe OCD (Storch et al., 2015).”
Management of obsessive-compulsive disorder in adults
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“Staging models have been proposed and applied to different mental disorders, such as schizophrenia and psychotic spectrum disorders,(11) bipolar disorders(13) and, more recently, in OCD as well.(14,15) OCD seems to be suitable for the application of staging models, particularly in the early stages of the illness, in l…”
BackgroundMethodResultInfluentialSelf-citationStriatum-Mediated Deficits in Stimulus-Response Learning and Decision-Making in OCD
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“The OCD sample had YBOCS scores ranging from 8 to 26 which are all considered clinical OCD (55, 56), mild and severe, respectively.”
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Clinical Considerations for an Evidence-Based Assessment for Obsessive-Compulsive Disorder
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Symptom Dimension Breakpoints for the Obsessive-Compulsive Inventory-Child Version (OCI-CV)
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“Based on the content of the severity questions, a DY-BOCS score equal to or above 5 indicates clinically significant symptoms, which is in line with the best breakpoint for clinical significance on the CY-BOCS [29, 30] from which the DY-BOCS originated.”
Gamma oscillations predict paroxetine response of patients with Obsessive Compulsive Disorder
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Intact capacity for implicit learning in obsessive-compulsive disorder
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OCD symptoms in succinic semialdehyde dehydrogenase (SSADH) deficiency: a case report
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“Possible total scores for the BAI ranges from 0 (low) to 63 (high); depending on the score, the anxiety level can be interpreted as “minimal” (0-7), “mild” (8-15), “moderate” (16-25), or “severe” (26-63).”
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“Inclusion criteria for the study were as follows: being over 18 years of age; having a principal diagnosis of OCD, as diagnosed by an expert clinician using the Structured Clinical Interview for Diagnosis [SCID-5-CV; (65)]; having undergone a psychodiagnostic assessment with specific OCD quantitative measures and gene…”
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“A cut-off score of 14 was employed for eligibility in the ICBT open trial as it has been found to indicate moderate symptoms of OCD (Storch et al., 2015).”
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“Total scores that range from 0–13 are considered mild, 14–25 moderate, 26– 34 moderate-severe, and 35–40 severe (Storch et al., 2015).”
Relationship between clozapine dose and severity of obsessive-compulsive symptoms
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Self-citationPatterns, predictors, and effectiveness of TMS for treatment-resistant OCD: A naturalistic study
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The prevalence of aggressive obsessions in youth with obsessive-compulsive disorder: A meta-analysis
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“Similarly, patients with OCD may underestimate the intensity of their symptoms, frequently due to limited insight into the impact of their condition (Storch et al. 2015).”
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- Authors
- Storch, E. A., De Nadai, A. S., Conceição do Rosário, M., Shavitt, R. G., Torres, A. R., Ferrão, Y. A., Miguel, E. C., Lewin, A. B., & Fontenelle, L. F.
- Affiliations
- Johns Hopkins University (US)
- Universidade de São Paulo (BR)
- Universidade Estadual Paulista (Unesp) (BR)
- Universidade Federal de Ciências da Saúde de Porto Alegre (BR)
- Universidade Federal do Rio de Janeiro (BR)
- Corresponding author
- Storch, Eric A.
- ORCID
- Venue
- Comprehensive Psychiatry
- Publisher
- Elsevier BV
- Published
- 2015-11
- Volume
- 63
- Pages
- 30-35
- ISSN
- 0010-440X (ISSN-L)
- PMC
- PMC4643407
- OpenAlex
- W2101309614
- Cited by
- 133
- References
- 37
- Citations by year
- 2026: 19 · 2025: 15 · 2024: 20 · 2023: 12 · 2022: 15 · 2021: 15 · 2020: 18 · 2019: 8 · 2018: 3 · 2017: 3 · 2016: 4
- FWCI
- 4.13
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Comprehensive Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Americanae (AECID Library) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
- Funders
- Conselho Nacional de Desenvolvimento Científico e Tecnológico (F31 MH094095, 420.122/2005-2)
- National Institutes of Health (F31 MH094095, 420.122/2005-2)
- National Institute of Mental Health (F31 MH094095, 420.122/2005-2)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- obsessive-compulsive disorder, clinical severity, Yale-Brown Obsessive Compulsive Scale, treatment decision-making
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Brazil, Female, Humans, Male, Middle Aged, Obsessive-Compulsive Disorder, Psychiatric Status Rating Scales, Severity of Illness Index, Reproducibility of Results, Treatment Outcome, Young Adult
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