General Instructions:

The questions below are designed to help health professionals evaluate anxiety symptoms.Keep in mind, a high score on this questionnaire does not necessarily mean you have an anxiety disorder - only an evaluation by a health professional can make this determination. Answer these questions as accurately as you can.

PART A Instructions:

Please click YES or NO for the following questions, based on your experience in the past MONTH:

Have you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as:

1 Concerns with contamination (dirt, germs, chemicals, radiation) or acquiring a serious illness such as AIDS? Yes No
2 Overconcern with keeping objects (clothing, tools, etc) in perfect order or arranged exactly? Yes No
3 Images of death or other horrible events? Yes No
4 Personally unacceptable religious or sexual thoughts? Yes No

Have you worried a lot about terrible things happening, such as:

5 Fire, burglary or flooding of the house? Yes No
6 Accidentally hitting a pedestrian with your car or letting it roll down a hill? Yes No
7 Spreading an illness (giving someone AIDS)? Yes No
8 Losing something valuable? Yes No
9 Harm coming to a loved one because you weren't careful enough? Yes No

Have you worried about acting on an unwanted and senseless urge or impulse, such as:

10 Physically harming a loved one, pushing a stranger in front of a bus, steering your car into oncoming traffic; inappropriate sexual contact; or poisoning dinner guests? Yes No

Have you felt driven to perform certain acts over and over again, such as:

11 Excessive or ritualized washing, cleaning or grooming? Yes No
12 Checking light switches, water faucets, the stove, door locks or the emergency brake? Yes No
13 Counting, arranging; evening-up behaviors (making sure socks are at same height)? Yes No
14 Collecting useless objects or inspecting the garbage before it is thrown out? Yes No
15 Repeating routine actions (in/out of chair, going through doorway, relighting cigarette) a certain number of times or until it feels just right? Yes No
16 Needing to touch objects or people? Yes No
17 Unnecessary rereading or rewriting; reopening envelopes before they are mailed? Yes No
18 Examining your body for signs of illness? Yes No
19 Avoiding colors ("red" means blood), numbers ("13" is unlucky) or names (those that start with "D" signify death) that are associated with dreaded events or unpleasant thoughts? Yes No
20 Needing to "confess" or repeatedly asking for reassurance that you said or did something correctly? Yes No

If you answered YES to one or more of these questions, please continue with Part B

PART B Instructions:


The following questions refer to the repeated thoughts, images, urges or behaviors identified in Part A. Consider your experience during the past 30 days when selecting an answer.

1. On average, how much time is occupied by these thoughts or behaviors each day?
0 - None 1 - Mild(less than 1 hour) 2 - Moderate (1 to 3 hours) 3 - Severe (3 to 8 hours) 4 - Extreme (more than 8 hours)
2. How much distress do they cause you?
0 - None 1 - Mild 2 - Moderate 3 - Severe 4 - Extreme
(Disabling)
3. How hard is it for you to control them?
0 - Complete control 1 - Much control 2 - Moderate control 3 - Little control No control
4. How much do they cause you to avoid doing anything, going anyplace or being with anyone?
0 - No avoidance 1 - Occasional avoidance 2 -Moderate avoidance 3 - Frequent and extensive avoidance 4 - Extreme avoidance (house- bound)
5. How much do they interfere with school work or your social or family life?
0 - None 1 -Slight interference 2 - Definitely interferes with functioning 3 - Much interference 4 - Extreme interference (disabling)


Keep in mind, a high score on this questionnaire does not necessarily mean you have an anxiety disorder - only an evaluation by a health professional can make this determination.

If you scored 8 or higher on Part B, you may want to consider consulting with a mental health professional who specializes in the treatment of OCD.

Here are several options to consider:



1. Mount Sinai Obsessive-Compulsive Disorders Treatment Center For more information, please email Wayne Goodman, MD: wayne.goodman@mssm.edu

2. International Obsessive-Compulsive Foundation: www.ocfoundation.org

3. National Institute of Mental Health: www.nimh.nih.gov


Please note: The FOCI cannot be reprinted, reproduced or modified without written permission of Dr. Goodman wayne.goodman@mssm.edu. Likewise, those individuals interested in clinical or research use of the FOCI need to obtain permission from Dr. Goodman.

© Wayne K. Goodman, MD, 1994.