YBOCS Rating Scale

February 07, 2026

What Is the Y-BOCS?

The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is one of the most widely used and trusted tools for assessing the severity of Obsessive-Compulsive Disorder (OCD). It’s considered the gold standard in both clinical practice and research.

Importantly, the Y-BOCS does not diagnose OCD on its own. Instead, it measures how severe and impairing a person’s OCD symptoms are—regardless of what those symptoms look like.

What the Y-BOCS Measures (and What It Doesn’t)

A key strength of the Y-BOCS is that it focuses on impact, not content.

It does not score:

What the obsessions are about (e.g., contamination, harm, religion, sex)
Whether the compulsions are “visible” or purely mental
How logical or illogical the fears seem

Instead, it measures:

Time spent on obsessions and compulsions
Distress caused by them
Interference with daily life (work, relationships, functioning)
Resistance (how hard it is to stop or delay them)
Degree of control over the thoughts or behaviors

This makes the scale useful across all OCD subtypes, including:

“Pure-O” / primarily obsessional OCD
Mental compulsions (rumination, reassurance seeking, checking in the mind)
Less stereotypical or more shame-based themes

How the Y-BOCS Is Structured

The Y-BOCS has two main parts:

1. Symptom Checklist (Qualitative)

This section helps identify:

Common categories of obsessions (e.g., contamination, aggressive, sexual, religious, symmetry)
Common categories of compulsions (e.g., checking, washing, counting, mental rituals)

This checklist is not scored—it simply helps the clinician understand the person’s symptom profile and tailor treatment.

2. Severity Scale (Quantitative)

The core of the Y-BOCS is a 10-item severity scale:

5 questions about obsessions
5 questions about compulsions

Each item is rated from 0 (no symptoms) to 4 (extreme symptoms).

Total scores range from 0–40.

How Y-BOCS Scores Are Interpreted

While cutoffs can vary slightly, scores are commonly interpreted as:

0–7: Subclinical
8–15: Mild OCD
16–23: Moderate OCD
24–31: Severe OCD
32–40: Extreme OCD

Clinicians often repeat the Y-BOCS over time to track:

Response to ERP or medication
Symptom flare-ups during stress
Gradual improvement that might not feel obvious day-to-day

Why Clinicians Rely on the Y-BOCS

The Y-BOCS is especially valued because it:

Separates symptom severity from symptom content
Captures both observable and internal compulsions
Is sensitive to change over time
Helps guide treatment intensity and pacing

For many clients, seeing their score change can also be validating—it puts numbers to an experience that often feels chaotic, invisible, or misunderstood.

A Human Note

People with OCD often minimize their symptoms because:

“It’s all in my head”
“Other people have worse compulsions”
“I’m functioning, so it must not be that bad”

The Y-BOCS gently but clearly says:
If it’s taking your time, draining your energy, and hijacking your attention, it matters.

What Is the CY-BOCS?

The Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) is the most widely used clinician-rated tool for assessing the severity of Obsessive-Compulsive Disorder (OCD) in children and adolescents, typically ages 6–17.

Like the adult Y-BOCS, the CY-BOCS does not diagnose OCD by itself. Instead, it measures how much OCD is interfering with a young person’s life, regardless of what the obsessions or compulsions are about.

What the CY-BOCS Measures (and Why That Matters)

A major strength of the CY-BOCS is that it focuses on impact and impairment, not the specific content of the child’s thoughts.

It does not assess:

Whether the obsessions are “age-appropriate” or “logical”
How embarrassing or unusual the content feels
Whether compulsions are physical or mental

It does assess:

Time spent on obsessions and compulsions
Distress caused by them
Interference with school, friendships, family life, and daily routines
Resistance (how hard it is to stop or delay symptoms)
Degree of control the child feels they have

This makes the CY-BOCS effective for:

Children with primarily mental compulsions
Kids who struggle to explain symptoms clearly
OCD that overlaps with anxiety, ADHD, or neurodivergence
Cases where parents see behaviors the child minimizes—or vice versa

How the CY-BOCS Is Structured

The CY-BOCS closely mirrors the adult version but is developmentally adapted.

1. Symptom Checklist

The clinician reviews common categories of:

Obsessions (e.g., contamination, harm, symmetry, moral/religious fears)
Compulsions (e.g., checking, washing, counting, reassurance seeking, mental rituals)

This section is not scored. Its purpose is to clarify what symptoms are present and guide treatment planning.

2. Severity Scale

The core of the CY-BOCS is a 10-item severity scale:

5 items for obsessions
5 items for compulsions

Each item is rated from 0 (no symptoms) to 4 (extreme symptoms).

Total scores range from 0–40, just like the adult Y-BOCS.

How CY-BOCS Scores Are Interpreted

Common clinical ranges are:

0–7: Subclinical
8–15: Mild OCD
16–23: Moderate OCD
24–31: Severe OCD
32–40: Extreme OCD

Clinicians often use the CY-BOCS to:

Track progress during ERP therapy
Monitor symptom spikes during developmental transitions or stress
Adjust treatment pacing or family involvement
Communicate severity clearly across providers and settings (school, psychiatry, therapy)

How the CY-BOCS Is Different from the Adult Y-BOCS

While the structure is nearly identical, the CY-BOCS:

Uses child-friendly language
Incorporates parent input alongside the child’s report
Emphasizes school functioning and family impact
Allows clinicians to account for developmental insight and verbal ability

This flexibility is essential, because many children with OCD:

Don’t have the words for intrusive thoughts
Feel intense shame or fear about disclosure
Normalize symptoms because they’ve “always been this way”

A Developmentally Sensitive Reality

Children with OCD are often told:

“That’s just anxiety”
“Stop overthinking”
“You don’t have to do that”

The CY-BOCS shifts the focus from behavioral compliance to internal experience.
It recognizes that even when a child appears outwardly functional, OCD may be consuming enormous mental energy.