MM slash DD slash YYYY
Before proceeding with the questions, please read the definitions below to familiarize yourself with "obsessions" and "compulsions".
OBSESSIONS are unwelcome and distressing ideas, thoughts, images or impulses that repeatedly enter your mind. They
may seem to occur against your will. They may be repugnant to you, you may recognize them as senseless, and they may
not fit your personality.
COMPULSIONS, on the other hand, are behaviors or acts that you feel driven to perform although you may recognize them
as senseless or excessive. At times, you may try to resist doing them but this may prove difficult. You may experience
anxiety that does not diminish until the behavior is completed.
Examples of obsessions include: the recurrent thought or impulse to apologize for some perceived wrong, or to do
serious physical harm to another person even though you never would.
Examples of compulsions include: the need to repeatedly check appliances, the lock on the door, or check the internet for
symptoms of a perceived illness. While most compulsions are observable behaviors, some are unobservable mental acts,
such as silent checking or having to recite nonsense phrases to yourself each time you have a bad thought.
Part I - Symptom Checklist
Read the following questions and check all answers that apply
Aggressive Obsessions
Example: Fear of eating with a knife or fork, handling sharp objects, walking near
glass windows
Example: Fear of poisoning other people's food, harming babies, pushing someone in front of moving object, hurting someone's feelings, being responsible by not providing assistance for some imagined catastrophe, causing harm by giving bad advice
Example: Images of murder, dismembered bodies, or other disgusting scenes
Example: Fear of shouting obscenities in public situations like church or in class, fear of writing obscenities
Example: Fear of appearing foolish in social situations
Example: Fear of driving a car into a tree, running over someone, stabbing a friend
Example: Fear of "cheating" a cashier, shoplifting inexpensive items
Example: Fear of causing an accident without being aware of it (such as a hit and
run automobile accident)
Example: Fear of causing a fire or burglary because of not being careful enough in
checking the house before leaving
Contamination Obsessions
Example: Fear of contracting AIDS, cancer, or other diseases from public restrooms,
fear of your own saliva, urine, feces, semen, or vaginal secretions
Example: Fear of picking up germs from sitting in certain chairs, shaking hands, or touching door handles
Example: Fear of being contaminated by asbestos or radon, radioactive substances, fear of things associated with towns containing toxic waste sites
Example: Fear of poisonous kitchen or bathroom cleansers, solvents, insect spray or turpentine
Example: Fear of being contaminated by touching insects, dogs, cats, or other
animals
Example: Fear of adhesive tape or other sticky substances that may trap contaminants
Example: Fear of getting ill as a direct result of being contaminated (beliefs vary about how long these disease will take to appear
Example: Fear of touching other people, touching their food after you touch
poisonous substances (like gasoline) or after you touch your own body
Sexual Obsessions
Example: Unwanted sexual thoughts about strangers, family, or friends
Example: Unwanted thoughts about sexually molesting either your own children or other children
Example: Worries like "Am I homosexual?" or "What if I suddenly become gay?" when there is no basis for these thoughts
Example: Unwanted images of violent sexual behavior toward adult strangers, friends, or family members
Hoarding/Saving Obsessions
Example: worries about throwing away seemingly unimportant things that you might
need in the future, urges you to pick up or collect useless things
Religious Obsessions
Example: Worries about having blasphemous thoughts, saying blasphemous things, or being punished for such things
Example: Worries about always doing "the right thing," having told a lie, or having cheated someone
Obsessions: Symmetry or Exactness
Example: Worries about paper and books being properly aligned; worries about
calculations or handwriting being perfect. Concerned another person will have an
accident unless things are in the right place
Miscellaneous Obsessions
Example: Belief that you need to know certain words (such as "thirteen") because of
superstitions, fear of saying something that might be disrespectful to a dead person
Example: Fear of saying certain words like "thirteen" because it is superstitious, fear
of the dead.
Example: Fear of having said the wrong thing, fear of not using the "perfect" word
Example: Worries about losing a wallet, unimportant objects such as a scrap note of
paper
Example: Random, unwanted images in your mind
Example: Words, songs, or music in your mind that you can't stop
Example: Worries about the sounds of clocks ticking loudly or voices in another
room that may interfere with sleeping
Example: Worries about common numbers (like thirteen) that may cause you to
perform activities a certain number of times or postpone an action until a certain
lucky hour of the day
Example: Fear of using objects of certain colors (e.g. black may be associated with
death, red may be associated with blood, injury, or evil)
Example: Fear of passing a cemetery, hearse, or black cat; fear of omens of death
Somatic Obsessions
Example: Worries that you may have an illness like cancer, heart disease or AIDS,
despite reassurance from your doctors that you do not and you are okay
Example: Worries that your face, ears, nose, eyes, or other part of your body is
hideous, and/or ugly despite reassurances to the contrary
Cleaning/Washing Compulsions
Example: Washing hands many times per day or for long periods of time after
touching, or thinking that you have touched, a contaminated object. This may include
washing the entire length of your arm.
Example: Taking showers or baths or performing other bathroom routines that may
last several hours. If the sequence is interrupted, the entire process may have to be
restarted.
Example: Excessive cleaning of faucets, floors, kitchen counters, or kitchen, or other
inanimate objects
Example: Asking family members to handle or remove insecticides, garbage,
gasoline cans, raw meat, paints, varnish, drugs in the medicine cabinet or kitty litter.
If you cannot avoid these things, you may wear gloves to handle objects, such as
when using a self-service gasoline pump
Checking Compulsions
Example: Checking that you haven't hurt someone without knowing it. You may ask
for reassurance or telephone to make sure that everything is alright
Example: Looking for injuries of bleeding after handling sharp breakable objects.
You may frequently go to doctors to ask for reassurance that you have not hurt yourself
Example: Searching the newspaper or listening to the radio or television for news
about some catastrophe that you believe you may have caused. You may also ask
people for reassurance that you did not cause an accident
Example: Repeated checking of door locks, stoves, electrical outlets, before leaving
home; repeated checking while reading, writing, or doing simple calculations to make
sure that you did not make a mistake (you can't be certain that you didn't)
Example: Seeking reassurance from friends or doctors that you are not having a
heart attack or getting cancer; repeatedly checking your pulse, blood pressure, or
temperature; checking yourself for body odors; checking your appearance in the
mirror; repeatedly checking the internet for information to diagnose or obtain
information about a feared disease or physical condition
Repeating Rituals
Example: Taking hours to read a few pages in a book or to write a short letter
because you get caught in a cycle of reading and rereading; worrying that you didn't
understand something you just read; searching for a 'perfect' word or phrase; having
obsessive thoughts about the shape of certain printed letters in a book.
Example: Repeating activities like turning appliances on and off, combing your hair,
going in and out of the doorway, or looking in a particular direction; not feeling
comfortable unless you do these things the 'right' way or number of times
Counting Compulsions
Example: Counting objects like ceiling or floor tiles, books in a bookcase, nails in a
wall, or even grains of sand on the beach; adding, subtracting, or recalculating in
order to obtain a certain number; counting when you repeat certain activities, like
washing.
Ordering/Arranging Compulsions
Example: Straightening paper or pens on the desktop or books in a bookcase,
wasting hours arranging things in your house in 'perfect' order and then becoming
very upset if this order is disturbed
Hoarding/Collecting Compulsions
Example: Saving old newspapers, notes, cans, paper towels, wrappers, and empty
bottles for fear that if you throw them away you may need them one day; picking up
useless objects from the street or from garbage cans.
Miscellaneous Compulsions
Example: Performing rituals in your head, like saying prayers or thinking a 'good'
thought to undo a 'bad'
Example: Asking other people to reassure you, confessing to behaviors that you may
not have done, believing that you have to tell other people certain words to feel
better
Example: Giving in to the urge to touch rough surfaces, like wood, or hot surfaces,
like a stove top; giving in to the urge to lightly touch other people; believing you need
to touch an object like a telephone to prevent an illness in your family.
Example: Staying away from sharp or breakable objects, such as knives, scissors,
and fragile glass.
Example: Arranging your food, knife, and fork in a particular order before being able
to eat, eating according to a strict ritual, not being able to eat until the hand of the
clock point exactly to a certain time.
Example: Not taking a bus or train if its number contains an "unlucky" number (like
thirteen), staying in your house on the thirteenth of the month, throwing away clothes
you wore while passing a funeral home or cemetery
Example: Pulling hair from our scalp, eyelids, eyelashes, or pubic areas, using
fingers of tweezers. You may produce bald spot that requires you to wear a wig, or
you may pluck your eyebrow or eyelids smooth.
Example: Picking at skin on face or other areas of the body that leads to irritation,
bleeding, disfigurement or infection