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The Brief Obsessive-Compulsive Scale (BOCS): a self-report scale for OCD and obsessive-compulsive related disorders
Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.ORCID iD: 0000-0002-3587-6075
TioHundra AB, Dept Psychiat, Norrtälje, Sweden.
Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Gothenburg, Sweden.
Stockholm Univ, Dept Psychol, Stockholm, Sweden.
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2014 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 68, no 8, 549-559 p.Article in journal (Refereed) Published
Abstract [en]

Background: The Brief Obsessive Compulsive Scale (BOCS), derived from the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the children's version (CY-BOCS), is a short self-report tool used to aid in the assessment of obsessive-compulsive symptoms and diagnosis of obsessive-compulsive disorder (OCD). It is widely used throughout child, adolescent and adult psychiatry settings in Sweden but has not been validated up to date.

Aim: The aim of the current study was to examine the psychometric properties of the BOCS amongst a psychiatric outpatient population.

Method: The BOCS consists of a 15-item Symptom Checklist including three items (hoarding, dysmorphophobia and self-harm) related to the DSM-5 category "Obsessive-compulsive related disorders", accompanied by a single six-item Severity Scale for obsessions and compulsions combined. It encompasses the revisions made in the Y-BOCS-II severity scale by including obsessive-compulsive free intervals, extent of avoidance and excluding the resistance item. 402 adult psychiatric outpatients with OCD, attention-deficit/hyperactivity disorder, autism spectrum disorder and other psychiatric disorders completed the BOCS.

Results: Principal component factor analysis produced five subscales titled "Symmetry", "Forbidden thoughts", "Contamination", "Magical thoughts" and "Dysmorphic thoughts". The OCD group scored higher than the other diagnostic groups in all subscales (P < 0.001). Sensitivities, specificities and internal consistency for both the Symptom Checklist and the Severity Scale emerged high (Symptom Checklist: sensitivity = 85%, specificities = 62-70% Cronbach's alpha = 0.81; Severity Scale: sensitivity = 72%, specificities = 75-84%, Cronbach's alpha = 0.94).

Conclusions: The BOCS has the ability to discriminate OCD from other non-OCD related psychiatric disorders. The current study provides strong support for the utility of the BOCS in the assessment of obsessive-compulsive symptoms in clinical psychiatry.

Place, publisher, year, edition, pages
2014. Vol. 68, no 8, 549-559 p.
Keyword [en]
Attention deficit hyperactivity disorder, Autism, Assessment, Compulsive behaviour, Obsessions
National Category
Research subject
URN: urn:nbn:se:oru:diva-39459DOI: 10.3109/08039488.2014.884631ISI: 000343980600005PubMedID: 24568661OAI: diva2:770276
Available from: 2014-12-10 Created: 2014-12-10 Last updated: 2016-09-19Bibliographically approved
In thesis
1. Obsessive-compulsive disorder, serotonin and oxytocin: treatment response and side effects
Open this publication in new window or tab >>Obsessive-compulsive disorder, serotonin and oxytocin: treatment response and side effects
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Obsessive-compulsive disorder (OCD), with a prevalence of 1-2 %, frequently leads a chronic course. Persons with OCD are often reluctant to seek help and, if they do, their OCD is often missed. This is unfortunate, since active treatment may substantially improve social function and quality of life. Serotonin reuptake inhibitors (SRIs) have welldocumented efficacy in OCD, but delayed response may be problematic. Methods to predict response have been lacking. Because SRIs are effective, pathophysiological research on OCD has focussed on serotonin. However, no clear aberrations of serotonin have been found, thus other mechanisms ought to be involved.

Our aims were to facilitate clinical detection and assessment of OCD, to search for biochemical correlates of response and side-effects in SRI treatment of OCD and to identify any possible involvement of oxytocin in the pathophysiology of OCD.

In study I, we tested in 402 psychiatric out-patients the psychometric properties of a concise rating scale, “Brief Obsessive Compulsive Scale” (BOCS). BOCS was shown to be easy to use and have excellent discriminant validity in relation to other common psychiatric diagnoses.

Studies II-V were based on 36 OCD patients from a randomised controlled trial of paroxetine, clomipramine or placebo. In study II, contrary to expectation, we found that the change (decrease) of serotonin in whole blood was most pronounced in non-responders to SRI. This is likely to reflect inflammatory influence on platelet turnover rather than serotonergic processes within the central nervous system.

In studies IV-V, we found relations between changes of oxytocin in plasma and the anti-obsessive response, and between oxytocin and the SRI related delay of orgasm, respectively. In both cases, the relation to central oxytocinergic mechanisms is unclear. In males, delayed orgasm predicted anti-obsessive response.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2016. 133 p.
Örebro Studies in Medicine, ISSN 1652-4063 ; 148
Adverse effects, Obsessive-compulsive disorder, Orgasm, Oxytocin, Randomised controlled trial, Rating scale, Response prediction, Serotonin, Serotonin uptake inhibitors, Sexual function
National Category
Psychiatry Family Medicine
Research subject
urn:nbn:se:oru:diva-51438 (URN)978-91-7529-153-6 (ISBN)
Public defence
2016-09-26, Campus USÖ, hörsal C3, Södra Grev Rosengatan, Örebro, 13:00 (Swedish)
Available from: 2016-07-25 Created: 2016-07-25 Last updated: 2016-09-05Bibliographically approved

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Bejerot, SusanneHumble, Mats B.
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