DOCS Screening Tool: Dimensional Obsessive-Compulsive Scale (Adults)

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Dimensional Obsessive-Compulsive Scale (DOCS)

Twenty questions about obsessions and compulsions, sorted into the four themes clinicians actually use: contamination, responsibility for harm, unacceptable thoughts, and the need for things to feel just right. Written for adults. About five minutes, and it asks about the last month.

I know this questionnaire from the inside. I trained at the UNC Anxiety Disorders Clinic under Dr. Jonathan Abramowitz, who developed it, and later he and I published research together on how well it tells OCD apart from other anxiety problems. It is the one I reach for first when OCD might be in the picture.

This is a screening tool, not a diagnosis. Use it to notice patterns, then bring anything that stands out to a clinician. If it is anxiety more broadly you are wondering about, the GAD-7 is a better first stop.

This questionnaire asks you about 4 different types of concerns that you might or might not experience. For each type there is a description of the kinds of thoughts (sometimes called obsessions) and behaviors (sometimes called rituals or compulsions) that are typical of that particular concern, followed by 5 questions about your experiences with these thoughts and behaviors. Please read each description carefully and answer the questions for each category based on your experiences in the last month.

Category 1: Concerns about Germs and Contamination

What this category looks like:

  • Thoughts or feelings that you are contaminated because you came into contact with (or were nearby) a certain object or person.
  • The feeling of being contaminated because you were in a certain place (such as a bathroom).
  • Thoughts about germs, sickness, or the possibility of spreading contamination.
  • Washing your hands, using hand sanitizer gels, showering, changing your clothes, or cleaning objects because of concerns about contamination.
  • Following a certain routine (e.g., in the bathroom, getting dressed) because of contamination
  • Avoiding certain people, objects, or places because of contamination.
1. About how much time have you spent each day thinking about contamination and engaging in washing or cleaning behaviors because of contamination?
2. To what extent have you avoided situations in order to prevent concerns with contamination or having to spend time washing, cleaning, or showering?
3. If you had thoughts about contamination but could not wash, clean, or shower (or otherwise remove the contamination), how distressed or anxious did you become?
4. To what extent has your daily routine (work, school, self-care, social life) been disrupted by contamination concerns and excessive washing, showering, cleaning, or avoidance behaviors?
5. How difficult is it for you to disregard thoughts about contamination and refrain from behaviors such as washing, showering, cleaning, and other decontamination routines when you try to do so?

Category 2: Concerns about being Responsible for Harm, Injury, or Bad Luck

What this category looks like:

  • A doubt that you might have made a mistake that could cause something awful or harmful to happen.
  • The thought that a terrible accident, disaster, injury, or other bad luck might have occurred and you weren’t careful enough to prevent it.
  • The thought that you could prevent harm or bad luck by doing things in a certain way, counting to certain numbers, or by avoiding certain “bad” numbers or words.
  • Thought of losing something important that you are unlikely to lose (e.g., wallet, identify theft, papers).
  • Checking things such as locks, switches, your wallet, etc. more often than is necessary.
  • Repeatedly asking or checking for reassurance that something bad did not (or will not) happen.
  • Mentally reviewing past events to make sure you didn’t do anything wrong.
  • The need to follow a special routine because it will prevent harm or disasters from occurring.
  • The need to count to certain numbers, or avoid certain bad numbers, due to the fear of harm.
1. About how much time have you spent each day thinking about the possibility of harm or disasters and engaging in checking or efforts to get reassurance that such things do not (or did not) occur?
2. To what extent have you avoided situations so that you did not have to check for danger or worry about possible harm or disasters?
3. When you think about the possibility of harm or disasters, or if you cannot check or get reassurance about these things, how distressed or anxious did you become?
4. To what extent has your daily routine (work, school, self-care, social life) been disrupted by thoughts about harm or disasters and excessive checking or asking for reassurance?
5. How difficult is it for you to disregard thoughts about possible harm or disasters and refrain from checking or reassurance-seeking behaviors when you try to do so?

Category 3: Unacceptable Thoughts

What this category looks like:

  • Unpleasant thoughts about sex, immorality, or violence that come to mind against your will.
  • Thoughts about doing awful, improper, or embarrassing things that you don’t really want to do.
  • Repeating an action or following a special routine because of a bad thought.
  • Mentally performing an action or saying prayers to get rid of an unwanted or unpleasant thought.
  • Avoidance of certain people, places, situations or other triggers of unwanted or unpleasant thoughts
1. About how much time have you spent each day with unwanted unpleasant thoughts and with behavioral or mental actions to deal with them?
2. To what extent have you been avoiding situations, places, objects and other reminders (e.g., numbers, people) that trigger unwanted or unpleasant thoughts?
3. When unwanted or unpleasant thoughts come to mind against your will how distressed or anxious did you become?
4. To what extent has your daily routine (work, school, self-care, social life) been disrupted by unwanted and unpleasant thoughts and efforts to avoid or deal with such thoughts?
5. How difficult is it for you to disregard unwanted or unpleasant thoughts and refrain from using behavioral or mental acts to deal with them when you try to do so?

Category 4: Concerns about Symmetry, Completeness, and the Need for Things to be “Just Right”

What this category looks like:

  • The need for symmetry, evenness, balance, or exactness.
  • Feelings that something isn’t “just right.”
  • Repeating a routine action until it feels “just right” or “balanced.”
  • Counting senseless things (e.g., ceiling tiles, words in a sentence).
  • Unnecessarily arranging things in “order.”
  • Having to say something over and over in the same way until it feels “just right.”
1. About how much time have you spent each day with unwanted thoughts about symmetry, order, or balance and with behaviors intended to achieve symmetry, order or balance?
2. To what extent have you been avoiding situations, places or objects associated with feelings that something is not symmetrical or “just right?”
3. When you have the feeling of something being “not just right,” how distressed or anxious did you become?
4. To what extent has your daily routine (work, school, self-care, social life) been disrupted by the feeling of things being “not just right,” and efforts to put things in order or make them feel right?
5. How difficult is it for you to disregard thoughts about the lack of symmetry and order, and refrain from urges to arrange things in order or repeat certain behaviors when you try to do so?

DOCS Total Score

0
What this means: The total adds up all four themes, 0 to 80. Two cut-offs come from the original validation study (Abramowitz et al., 2010): a total of 18 or more separated about 78% of people with OCD from people without a clinical condition, and 21 or more separated about 70% of people with OCD from people with other anxiety problems. The theme scores, 0 to 20 each, have no official cut-offs. They show where the symptoms cluster, which matters, because treating contamination fears looks quite different from treating unacceptable thoughts. A high score is information, not a label. A proper anxiety and OCD assessment is how we find out whether this is OCD, something that looks like it, or a hard month.

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The DOCS was developed by Jonathan S. Abramowitz and colleagues. © 2009 Jonathan S. Abramowitz. Items unmodified. Free for clinical and most research use via the DOCS site at UNC Chapel Hill.
References

Abramowitz, J. S., Deacon, B. J., Olatunji, B. O., Wheaton, M. G., Berman, N. C., Losardo, D., Timpano, K. R., McGrath, P. B., Riemann, B. C., Adams, T., Björgvinsson, T., Storch, E. A., & Hale, L. R. (2010). Assessment of obsessive-compulsive symptom dimensions: Development and evaluation of the Dimensional Obsessive-Compulsive Scale. Psychological Assessment, 22(1), 180-198. doi.org/10.1037/a0018260

Ong, M.-L., Reuman, L., Youngstrom, E. A., & Abramowitz, J. S. (2020). Discriminative validity of the Dimensional Obsessive-Compulsive Scale for separating obsessive-compulsive disorder from anxiety disorders. Assessment, 27(4), 810-821. doi.org/10.1177/1073191118791039