Clinical Screening Questionnaire
Complete the OCI-R–style items by rating each statement about the past month, and provide your name, date of birth, and completion date.
Please note: this form is not currently submitted through a HIPAA-compliant system, so confidentiality of your responses cannot be fully guaranteed in transit and storage. Please avoid including any information you would not want stored on a standard, non-HIPAA-compliant platform.
Create a confidential username
*
Date of Completion
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
The following statements refer to experiences that many people have in their everyday lives. Circle the number that best describes how much that experience has distressed or bothered you during the past month.
How much has each experience distressed or bothered you during the past month?
*
Rows
Not at all (0)
A little (1)
Moderately (2)
A lot (3)
Extremely (4)
I wash my hands repeatedly to feel clean.
I avoid touching objects I think might be contaminated.
I spend a lot of time cleaning to reduce feelings of contamination.
I check things multiple times to make sure they are done correctly.
I return to check doors, locks, or appliances even when I know they are secure.
I feel compelled to check that nothing bad will happen as a result of my actions.
I need things to be arranged exactly or symmetrically.
I become very upset if objects are not in a specific order.
I spend time arranging or straightening items until they feel 'just right.'
I am bothered by unwanted thoughts that keep repeating in my mind.
I experience distressing intrusive thoughts that I can’t control.
I worry about things that seem irrational or senseless but can’t stop thinking about them.
I have difficulty discarding things, even items with little value.
I collect or save things I might not need in the future.
I feel anxious about throwing things away.
I perform mental rituals (such as repeating words or numbers) to neutralize bad thoughts.
I feel a need to mentally review or undo things to prevent something bad from happening.
I find myself counting or repeating phrases in my mind to reduce anxiety.
Note:
This is a draft item set. Practitioners should verify the exact, licensed wording of each statement before clinical use.
Submit
Should be Empty: