Obsessions and Compulsions Survey.Please answer all items. Your answers will be e-mailed to Karin Kramer and kept confidential. Your ID Number (as assigned by Karin) Upsetting or disturbing thoughts go through my head over and over again. * Not at all true Slightly true Moderately true Very true Completely true Once I get these upsetting thoughts, I can't seem to ignore them or get rid of them. * Not at all true Slightly true Moderately true Very true Completely true Check any of the following obsessive concerns that have worried you recently: contamination from germs, sticky substances, urine, feces, or semen Yes causing a terrible event like a fire, a terrible illness, or an accident Yes things that are messy or not in a certain order Yes confessing to a crime that I haven't committed Yes blurting out something embarrassing or obscene in public Yes fears that harm may come to others if I don't perform certain rituals Yes losing control and harming others Yes forbidden or perverse sexual thoughts Yes other obsessive thoughts (describe) I feel a powerful urge to perform certain rituals when I get anxious. Not at all true Slightly true Moderately true Very true Completely true I feel like something terrible will happen if I don't perform these rituals. Not at all true Slightly true Moderately true Very true Completely true Check off any of the following compulsive rituals that you've engaged in recently. rituals when I groom myself or clean the house Yes doing things in a particular order Yes arranging things in a certain way Yes repeating certain actions over and over, such as checking to make sure that the doors are locked Yes counting things Yes praying or repeating words silently Yes washing my hands repeatedly Yes hoarding things like old newspapers or other objects Yes other rituals (describe) On average, how much time do you spend each day having obsessive thoughts? No time 5 minutes or less 5 - 10 minutes 10 - 30 minutes 30 - 60 minutes 1 - 2 hours 3 - 5 hours more than 5 hours On average, how much time do you spend each day doing compulsive rituals? No time 5 minutes or less 5 - 10 minutes 10 - 30 minutes 30 - 60 minutes 1 - 2 hours 3 - 5 hours more than 5 hours My obsessions or compulsions cause problems in my life. Not at all true Slightly true Moderately true Very true Completely true My obsessions or compulsions seem excessive. Not at all true Slightly true Moderately true Very true Completely true My obsessions or compulsions interfere with my life. Not at all true Slightly true Moderately true Very true Completely true I've been bothered by obsessive thoughts during the past month. No Maybe Yes I've engaged in compulsive rituals during the past month. No Maybe Yes Thank you!
