Child & Youth Mental Health Algorithm - GPSC

CY-BOCS Symptom ChecklistChildren’s Yale-Brown Obsessive Compulsive ScaleCY-BOCS Obsessions ChecklistCheck all symptoms that apply (Items marked “*” may or may not be OCD Phenomena)Current Past Contamination ObsessionsConcern with dirt, germs, certain illnesses(e.g., AIDS)Concerns or disgust with bodily waste orsecretions (e.g. urine, feces, saliva)Excessive concern with environmentalcontaminants (e.g., asbestos, radiation,toxic waste)Excessive concern with household items(e.g., cleaners, solvents)Excessive concern about animals / insectsExcessively bothered by sticky substancesor residuesConcerned will get ill because ofcontaminantConcerned will get others ill by spreadingcontaminant (aggressive)No concern with consequences ofcontamination other than how it might feel *Other (describe) _____________________Aggressive ObsessionsFear might harm selfFear might harm othersFear harm will come to selfFear harm will come to others (maybebecause of something child did or did notdo)Violent or horrific imagesFear of blurting out obscenities or insultsFear of doing something embarrassing *Fear will act on unwanted impulses (e.g., tostab a family member)Fear will steal thingsFear will be responsible for something elseterrible happening (e.g. ,fire, burglary, flood)Other (describe) _____________________Current Past Sexual ObsessionsForbidden or perverse sexual thoughts,images, impulsesContent involves homosexualitySexual behavior towards others(aggressive)Other (describe) _____________________Hoarding / Saving ObsessionsFear of losing thingsOther (describe) _____________________Magical Thoughts / SuperstitiousObsessionsLucky / unlucky numbers, colors, wordsOther (describe) _____________________Somatic ObsessionsExcessive concern with illness or disease *Excessive concern with body part or aspectof appearance (e.g. dysmorphophobia) *Other (describe) _____________________Religious ObsessionsExcessive concern or fear of offendingreligious objectsExcessive concern with right / wrong morallyOther (describe) _____________________Miscellaneous ObsessionsThe need to know or rememberFear of saying certain thingsFear of not saying just the right thingIntrusive (non-violent) imagesIntrusive sounds, words, music or numbersOther (describe) _____________________Target Symptom List for ObsessionsOBSESSIONS (describe, listing by order of severity, with #1 being the most sever, #2 second most severe, etc):1. _____________________________________________________________________________________2. _____________________________________________________________________________________3. _____________________________________________________________________________________4. _____________________________________________________________________________________Page 2 of 4