YBOCS Yale-Brown Obsessive Compulsive Scale For OCD

PATIENT 22.
NAME_________________________________DATE_________________________
YALE-BROWN OBSESSIVE COMPULSIVE SCALE (Y-BOCS)*
Questions 1 to 5 are about your obsessive thoughts

Obsessions are unwanted ideas, images or impulses that intrude on thinking against your wishes and efforts to resist
them. They usually involve themes of harm, risk and danger. Common obsessions are excessive fears of
contamination; recurring doubts about danger, extreme concern with order, symmetry, or exactness; fear of losing
important things.
Please answer each question by circling the appropriate number.
1. TIME OCCUPIED BY OBSESSIVE THOUGHTS SCORE __________

How much of your time is occupied by obsessive thoughts?
0 = None
1 = Less than 1 hr/day or occasional occurrence
2 = 1 to 3 hrs/day or frequent
3 = Greater than 3 and up to 8 hrs/day or very frequent occurrence
4 = Greater than 8 hrs/day or nearly constant occurrence
2. INTERFERENCE DUE TO OBSESSIVE THOUGHTS SCORE __________

How much do your obsessive thoughts interfere with your work, school, social, or other important role
functioning? Is there anything that you don’t do because of them?
0 = None
1 = Slight interference with social or other activities, but overall performance not
impaired
2 = Definite interference with social or occupational performance,
but still manageable
3 = Causes substantial impairment in social or occupational performance
4 = Incapacitating
3. DISTRESS ASSOCIATED WITH OBSESSIVE THOUGHTS SCORE __________

How much distress do your obsessive thoughts cause you?
0 = None
1 = Not too disturbing
2 = Disturbing, but still manageable
3 = Very disturbing
4 = Near constant and disabling distress
4. RESISTANCE AGAINST OBSESSIONS SCORE __________

How much of an effort do you make to resist the obsessive thoughts? How often do you try to disregard or
turn your attention away from these thoughts as they enter your mind?
0 = Try to resist all the time
1 = Try to resist most of the time
2 = Make some effort to resist
3 = Yield to all obsessions without attempting to control them, but with some
reluctance
4 = Completely and willingly yield to all obsessions
23.
5. DEGREE OF CONTROL OVER OBSESSIVE THOUGHTS SCORE __________
How much control do you have over your obsessive thoughts? How successful are you in stopping or diverting
your obsessive thinking? Can you dismiss them?
0 = Complete control
1 = Usually able to stop or divert obsessions with some effort and concentration
2 = Sometimes able to stop or divert obsessions
3 = Rarely successful in stopping or dismissing obsessions, can only divert attention
with difficulty
4 = Obsessions are completely involuntary, rarely able to even momentarily alter
obsessive thinking.
The next several questions are about your compulsive behaviors.

Compulsions are urges that people have to do something to lessen feelings of anxiety or other discomfort. Often
they do repetitive, purposeful, intentional behaviors called rituals. The behavior itself may seem appropriate but it
becomes a ritual when done to excess. Washing, checking, repeating, straightening, hoarding and many other
behaviors can be rituals. Some rituals are mental. For example, thinking or saying things over and over under your
breath.
6. TIME SPENT PERFORMING COMPULSIVE BEHAVIORS SCORE __________

How much time do you spend performing compulsive behaviors? How much longer than most people does it
take to complete routine activities because of your rituals? How frequently do you do rituals?
0 = None
1 = Less than 1 hr/day or occasional performance of compulsive behaviors
2 = From 1 to 3 hrs/day, or frequent performance of compulsive behaviors
3 = More than 3 and up to 8 hrs/day, or very frequent performance of compulsive
behaviors
4 = More than 8 hrs/day, or near constant performance of compulsive behaviors
(too numerous to count)
7. INTERFERENCE DUE TO COMPULSIVE BEHAVIORS SCORE __________

How much do your compulsive behaviors interfere with your work, school, social, or other important role
functioning? Is there anything that you don’t do because of the compulsions?
0 = None
1 = Slight interference with social or other activities, but overall performance
not impaired
2 = Definite interference with social or occupational performance, but still
manageable
3 = Causes substantial impairment in social or occupational performance
4 = Incapacitating
24.
8. DISTRESS ASSOCIATED WITH COMPULSIVE BEHAVIOR SCORE __________
How would you feel if prevented from performing your compulsion(s)? How anxious would you become?
0 = None
1 = Only slightly anxious if compulsions prevented
2 = Anxiety would mount but remain manageable if compulsions prevented
3 = Prominent and very disturbing increase in anxiety if compulsions interrupted
4 = Incapacitating anxiety from any intervention aimed at modifying activity
9. RESISTANCE AGAINST COMPULSIONS SCORE __________

How much of an effort do you make to resist the compulsions?
0 = Always try to resist
1 = Try to resist most of the time
2 = Make some effort to resist
3 = Yield to almost all compulsions without attempting to control them, but with
some reluctance
4 = Completely and willingly yield to all compulsions
10. DEGREE OF CONTROL OVER COMPULSIVE BEHAVIOR SCORE __________

How strong is the drive to perform the compulsive behavior? How much control do you have over the
compulsions?
0 = Complete control
1 = Pressure to perform the behavior but usually able to exercise voluntary control
over it
2 = Strong pressure to perform behavior, can control it only with difficulty
3 = Very strong drive to perform behavior, must be carried to completion, can only
delay with difficulty
4 = Drive to perform behavior experienced as completely involuntary and over-
powering, rarely able to even momentarily delay activity.
TOTAL SCORE ______________

Use Exit button to go back Print this
Y-BOCS Symptom Checklist
Instructions: Generate a Target Symptoms List from the attached Y-BOCS Symptom Checklist by
asking the patient about specific obsessions and compulsions. Chock all that apply. Distinguish between
current and past symptoms. Mark principal symptoms with a "p". These will form the basis
of the Target Symptoms List. Items marked may “*” or may not be an OCD phenomena.
Current Past Current Past
AGGRESSIVE OBSESSIONS
Fear might harm self SOMATIC OBSESSIONS
Fear might harm others Concern with illness or disease*
Violent or horrific images Excessive concern with body part or aspect of
Fear of blurting out obscenities or insults Appearance (eg., dysmorphophobia)*
Fear of doing something else embarrassing* Other
Fear will act on unwanted impulses (e.g., to stab
friend) CLEANING/WASHING COMPULSIONS
Fear will steal things
Fear will harm others because not careful enough Excessive or ritualized handwashing
(e.g. hit/run motor vehicle accident) Excessive or ritualized showering, bathing,
Fear will be responsible for something else terrible toothbrushing grooming, or toilet routine Involves
happening (e.g., fire, burglary cleaning of household items or other inanimate objects
Other measures to prevent or remove contact with
Other:_______________________________ contaminants
CONTAMINATION OBSESSIONS Other
Concerns or disgust w\ with bodily waste or CHECKING COMPULSIONS
secretions (e.g., urine, feces, saliva Concern with dirt
or germs Checking locks, stove, appliances etc.
Excessive concern with environmental contaminants Checking that did rot/will not harm others
(e.g. asbestos, radiation toxic waste) Checking that did not/will not harm self
Excessive concern with household items (e.g., Checking that nothing terrible did/will happen
cleansers solvents)
Checking that did not make mistake
Excessive concern with animals (e.g., insects)
Checking tied to somatic obsessions
Bothered by sticky substances or residues
Other:
Concerned will get ill because of contaminant
Concerned will get others ill by spreading contaminant REPEATING RITUALS
(Aggressive) Rereading or rewriting
No concern with consequences of contamination Need to repeat routine activities jog, in/out door,
other than how it might feel up/down from chair)
Other: Other _____________________________
SEXUAL OBSESSIONS
Forbidden or perverse sexual thoughts. images. or
COUNTING COMPULSIONS
impulses
___________________________________
Content involves children or incest
Content involves homosexuality* ORDERING/ARRANGING COMPULSIONS
Sexual behavior towards others (Aggressive)* ___________________________________
Other:
HOARDING/COLLECTING COMPULSIONS
(distinguish from hobbies and concern with objects of monetary or
HOARDING/SAVING OBSESSIONS sentimental value (e.g., carefully reads junk mail, piles up old newspapers,
(distinguish from hobbies and concern with objects of monetary or sorts through garbage, collects useless objects.)
sentimental value)
___________________________________
RELIGIOUS OBSESSIONS (Scrupulosity)

Concerned with sacrilege and blasphemy
Excess concern with right/wrong, morality MISCELLANEOUS COMPULSIONS
Other: Mental rituals (other than checking/counting)
OBSESSION WITH NEED FOR SYMMETRY OR EXACTNESS Excessive listmaking
Accompanied by magical thinking (e.g., concerned Need to tell, ask, or confess
that another will have accident dent unless less Need to touch, tap, or rub*
things are in the right place) Rituals involving blinking or staring*
Not accompanied by magical thinking
Measures (not checking) to prevent: harm to self -
harm to others terrible consequences
MISCELLANEOUS OBSESSIONS
Need to know or remember Ritualized eating behaviors*
Fear of saying certain things Superstitious behaviors
Fear of not saying just the right thing Trichotillomania *
Fear of losing things Other self-damaging or self-mutilating behaviors*
Intrusive (nonviolent) images Other
Intrusive nonsense sounds, words, or music
Bothered by certain sounds/noises*
Adapted from Goodman, W.K., Price, L.H., Rasmussen, S.A. et al.:
Lucky/unlucky numbers “The Yale-Brown Obsessive Compulsive Scale.”
Colors with special significance Arch Gen Psychiatry 46:1006-1011,1989
3 superstitious fears
Other:
Original: 10/1/86
First Revision: 3/1/90
Second Revision: 5/1/91
Third Revision: 5/1/93
Fourth Revision: 6/17/99
Fifth Revision: 10/04/07
CHILDREN'S
YALE-BROWN
OBSESSIVE COMPULSIVE SCALE
(CY-BOCS)
DEVELOPED BY
WAYNE K. GOODMAN, M.D.1

LAWRENCE SCAHILL, MSN, PhD2
LAWRENCE H. PRICE, M.D.3
STEVEN A. RASMUSSEN, M.D.3
MARK A. RIDDLE, M.D. 4
JUDITH L. RAPOPORT, M.D.5
NATIONAL INSTITUTE OF MENTAL HEALTH1
THE CHILD STUDY CENTER2

YALE UNIVERSITY SCHOOL OF MEDICINE
DEPARTMENT OF PSYCHIATRY3
BROWN UNIVERSITY SCHOOL OF MEDICINE
CHILD PSYCHIATRY DIVISION4

JOHNS HOPKINS SCHOOL OF MEDICINE
and
CHILD PSYCHIATRY BRANCH5

NATIONAL INSTITUTE OF MENTAL HEALTH
Investigators interested in using this rating scale should contact Lawrence Scahill, M.S.N., Ph.D., at the
Yale Child Study Center, P.O. Box 207900, New Haven, CT 06520 or Wayne Goodman, M.D., at the
National Institute of Mental Health, Bethesda, MD.
Scahill, L., Riddle, M.A., McSwiggin-Hardin, M., Ort, S.I., King, R.A., Goodman, W.K., Cicchetti, D. &
Leckman, J.F. (1997). Children's Yale-Brown Obsessive Compulsive Scale: reliability and validity. J Am Acad
Child Adolesc Psychiatry, 36(6):844-852.
1
GENERAL INSTRUCTIONS
Overview:
This scale is designed to rate the severity of obsessive and compulsive symptoms in children and
adolescents, ages 6 to 17 years. It can be administered by a clinican or trained interviewer in a semi-structured
fashion. In general, the ratings depend on the child's and parent's report; however, the final rating is based on
the clinical judgement of the interviewer. Rate the characteristics of each item over the prior week up until, and
including, the time of the interview. Scores should reflect the average of each item for the entire week, unless
otherwise specified.
Informants:
Information should be obtained by interviewing the parent(s) (or guardian) and the child together.
Sometimes, however, it may also be useful to interview the child or parent alone. Interviewing strategy may
vary depending on the age and developmental level of the child or adolescent. All information should be
combined to estimate the score for each item. Whenever the CY-BOCS is administered more than once to the
same child, as in a medication trial, consistent reporting can be ensured by having the same informant(s) present
at each rating session.
Definitions:
Before proceeding with the questions, define "obsessions" and "compulsions" for the child and primary
caretaker as follows (sometimes, particularly with younger children, the interviewer may prefer using the terms
"worries" and "habits"):
"OBSESSIONS: are thoughts, ideas, or pictures that keep coming into your mind even though you do not want
them to. They may be unpleasant, silly or embarrassing."
"AN EXAMPLE OF AN OBSESSION IS: the repeated thought that germs or dirt are harming you or other
people, or that something unpleasant might happen to you or someone in your family or someone special to
you. These are thoughts that keep coming back, over and over again."
"COMPULSIONS: are things that you feel you have to do although you may know that they do not make sense.
Sometimes you may try to stop from doing them but this might not be possible. You might feel worried or
angry or frustrated until you have finished what you have to do."
"AN EXAMPLE OF A COMPULSION IS: the need to wash your hands over and over again even though they
are not really dirty, or the need to count up to a certain number while you do certain things."
"Do you have any questions about what these words called obsessions and compulsions mean?"
Symptom Specificity and Continuity:

In some cases, it may be difficult to delineate obsessions and compulsions from other closely related
symptoms such as phobias, anxious worries, depressive ruminations or complex tics. Separate assessment of
these symptoms may be necessary. Although potentially difficult, the delineation of obsessions and
compulsions from these closely related symptoms is an essential task of the interviewer. (A full discussion of
how to make this determination is beyond the scope and purpose of this introduction.) Items marked with an
asterix are items where this delineation may be especially troublesome.
2
Once the interviewer has decided whether or not a particular symptom will be included as an obsession
or compulsion on the checklist, every effort should be made to maintain consistency in subsequent rating(s). In
a treatment study with multiple ratings over time, it may be useful to review the initial Target Symptom
Checklist (see below) at the beginning of subsequent ratings (prior severity scores should not be reviewed).
Procedure:
Symptom Checklist: After reviewing with the child and parent(s) the definitions of obsessions and
compulsions, the interview should proceed with a detailed inquiry about the child's symptoms using the
Compulsions Checklist and Obsessions Checklist as guides. It may not be necessary to ask about each and
every item on the checklist, but each symptom area should be covered to ensure that symptoms are not missed.
For most children and adolescents, it is usually easier to begin with compulsions (pages 9 and 10).
Target Symptom List: After the Compulsions Checklist is complete, list the four most severe
compulsions on the Target Symptom List on page 10. Repeat this process, listing the most severe obsessions,
on the Target Symptom List on page 5.
Severity Rating: After completing the Checklist and Target Symptom List for compulsions,
inquire about the severity items: Time Spent, Distress, Resistance, Interference, and Degree of Control
(questions 6 through 10 on pages 11 through 13). There are examples of probe questions for each item. Ratings
for these items should reflect interviewer's best estimate from all available information from the past week, with
special emphasis on the Target Symptoms. Repeat the above procedure for obsessions (Pages 4 through 8).
Finally, inquire about and rate questions 11 through 19 on pages 14 and 18. Scores can be recorded on the
scoring sheet on page 19. All ratings should be in whole integers.
Scoring:
All 19 items are rated, but only items 1-10 are used to determine the total score. The total CY-BOCS
score is the sum of items 1-10; the obsession and compulsion subtotals are the sums of items 1-5 and 6-10,
respectively. At this time, items 1A and 6A are not being used in the scoring.
Items 17 (global severity) and 18 (global improvement) are adapted from the Clinical Global Impression
Scale (Guy, W., 1976) to provide measures of overall functional impairment associated with the presence of
obsessive-compulsive symptoms.
3
Name Date
CY-BOCS OBSESSIONS CHECKLIST
Check all items that apply (Item marked "*" may or not be OCD phenomena.)
Current Past Contamination Obsessions

Concern with dirt, germs, certain illnesses (e.g., AIDS)
Concerns or disgust with bodily waste or secretions (e.g., urine, feces, saliva)
Excessive concern with enviromental contaminants (e.g., asbestos, radiation, toxic waste)
Excessive concern with household items (e.g., cleaners, solvents)
Excessive concern about animals/insects
Excessively bothered by sticky substances or residues
Concerned will get ill because of contaminant
Concerned will get others ill by spreading contaminant (aggressive)
No concern with consequences of contamination other than how it might feel *
Other (Describe)
Aggressive Obsessions
Fear might harm self
Fear might harm others
Fear harm will come to self
Fear harm will come to others (may be because something child did or did not do)
Violent or horrific images
Fear of blurting out obscenities or insults
Fear of doing something else embarrassing *
Fear will act on unwanted impulses (e.g. to stab a family member)
Fear will steal things
Fear will be responsible for something else terrible happening (e.g. fire, burglary,
flood)
Other (Describe)
Sexual Obsessions
[Are you having any sexual thoughts? If yes, are they routine or are they repetitive
thoughts that you would rather not have or find disturbing? If yes, are they:]
Forbidden or perverse sexual thoughts, images, impulses
Content involves homosexuality *
Sexual behavior towards others (Aggressive)
Other (Describe)
Hoarding/Saving Obsessions
Fear of losing things
Other (Describe)
Magical Thoughts/Superstitous Obsessions

Lucky/unlucky numbers, colors, words
Other (Describe)
4
Current Past Somatic Obsessions
Excessive concern with illness or disease *
Excessive concern with body part or aspect of appearance (e.g., dysmorphophobia) *
Other (Describe)
Religious Obsessions (Scrupulosity)

Excessive concern or fear of offending religious objects (God)
Excessive concern with right/wrong, morality
Other (Describe)
Miscellaneous Obsessions
The need to know or remember
Fear of saying certin things
Fear of not saying just the right thing
Intrusive (non-violent) images
Intrusive sounds, words, music, or numbers
Other (Describe)
TARGET SYMPTOM LIST FOR OBSESSIONS
Obsessions (Describe, listing by order of severity, with #1 being the most severe, #2 the second most
severe, etc.):
1.
2.
3.
4.
5
QUESTIONS ON OBSESSIONS (ITEMS 1-5) "I AM NOW GOING TO ASK YOU QUESTIONS ABOUT
THE THOUGHTS YOU CANNOT STOP THINKING ABOUT." (Review for the informant(s) the Target
Symptoms and refer to them while asking questions 1-5).
1. Time Occupied by Obsessive Thoughts

• How much time do you spend thinking about these things?
(When obsessions occur as brief, intermittent intrusions, it may be impossible to assess time occupied
by them in terms of total hours. In such cases, estimate time by determining how frequently they occur.
Consider both the number of times the intrusions occur and how many hours of the day are affected).
• How frequently do these thoughts occur?
[Exclude ruminations and preoccupations which, unlike obsessions, are ego-syntonic and rational (but
exaggerated).]
0 - NONE
1 - MILD less than 1 hr/day or occasional intrusion
2 - MODERATE 1 to 3 hrs/day or frequent intrusion
3 - SEVERE greater than 3 and up to 8 hrs/day or very frequent intrusion
4 - EXTREME greater than 8 hrs/day or near constant intrusion
1B. Obsession-free Interval (not included in total score)

• On average, what is the longest amount of time per day that you are not bothered by obsessivethoughts?
0 - NONE
1 - MILD long symptom free intervals, more than 8 consecutive hrs/day symptom-free
2 - MODERATE moderately long symptom-free intervals, more than 3 and up to 8 hrs/day
3 - SEVERE brief symptom-free intervals, from 1 to 3 consecutive hrs/day symptom-free
4 - EXTREME less than 1 consecutive hr/day symptom free
2. Interference due to Obsessive Thoughts

• How much do these thoughts get in the way of school or doing things with friends?
• Is there anything that you don't do because of them?
(If currently not in school determine how much performance would be affected if patient were in school.)
0 - NONE
1 - MILD slight interference with social or school activities, overall performance not impaired
2 - MODERATE definite interference with social or school performance, but still manageable
3 - SEVERE causes substantial impairment in social or school performance
4 - EXTREME incapacitating
6
3. Distress Associated with Obsesssive Thoughts
• How much do these thoughts bother or upset you?
(Only rate anxiety/frustration that seems triggered by obsessions, not generalized anxiety or anxiety
associated with other symptoms.)
0 - NONE
1 - MILD infrequent, and not too disturbing
2 - MODERATE frequent, and disturbing, but still manageable
3 - SEVERE very frequent, and very disturbing
4 - EXTREME near constant, and disabling distress/frustration
4. Resistance Against Obsessions

• How hard do you try to stop the thoughts or ignore them?
(Only rate effort made to resist, not success or failure in actually controlling the obsessions. How much
patient resists the obsessions may or may not correlate with their ability to control them. Note that this item
does not directly measure the severity of the intrusive thoughts; rather it rates a manifestation of health, i.e.,
the effort the patient makes to counteract the obsessions. Thus, the more the patient tries to resist, the less
impaired is this aspect of his functioning. If the obsessions are minimal, the patient may not feel the need to
resist them. In such cases, a rating of "0" should be given.)
0 – NONE makes an effort to always resist, or symptoms so minimal doesn't need to actively resist.
1 - MILD tries to resist most of the time
2 - MODERATE makes some effort to resist
3 - SEVERE yields to all obsessions without attempting to control them, but does so with some
reluctance
4 – EXTREME completely and willingly yields to all obsessions
5. Degree of Control Over Obsessive Thoughts

• When you try to fight the thoughts, can you beat them?
• How much control do you have over the thoughts?
(In contrast to the preceding item on resistance, the ability of the patient to control his obsessions is more
closely related to the severity of the intrusive thoughts.
0 - COMPLETE CONTROL
1 - MUCH CONTROL usually able to stop or divert obsessions with some effort and concentration.
2 - MODERATE CONTROL sometimes able to stop or divert obsessions
3 - LITTLE CONTROL rarely successful in stopping obsessions, can only divert attention with difficulty
4 - NO CONTROL experienced as completely involuntary, rarely able to even momentarily divert

thinking
7
Name Date
CY-BOCS COMPULSIONS CHECKLIST
Check all items that apply (Item marked "*" may or not be OCD phenomena.)
Current Past Washing/Cleaning Compulsions

Excessive or ritualized handwashing
Excessive or ritualized showering, bathing, toothbrushing, grooming, or toilet routine
Excessive cleaning of items; such as personal clothes or important objects
Other measures to prevent or remove contact with contaminants
Other (Describe)
Checking Compulsions
Checking locks, toys, school books/items, etc.
Checking associated with getting washed, dressed, or undressed.
Checking that did not/will not harm others
Checking that did not/will not harm self
Checking that nothing terrible did/will happen
Checking that did not make mistake
Checking tied to somatic obsessions
Other (Describe)
Repeating Rituals
Rereading, erasing, or rewriting
Need to repeat routine activities (e.g. in/out doors, up/down from chair)
Other (Describe)
Counting Compulsions
Objects, certain numbers, words, etc.
Describe:
Ordering/Arranging
Need for symmetry/evening up (e.g., lining items up a certain way or arranging personal items in
specific patterns)
Other (Describe)
Hoarding/Saving Compulsion
[distinguish from hobbies and concern with objects of monetary or sentimental value]
Difficulty throwing things away, saving bits of paper, string, etc.
Other (Describe)
Excessive Games/Superstitious Behaviors

[distinguish from age appropriate magical games]
(e.g., array of behavior, such as stepping over certain spots on a floor, touching an object/self
certain number of times as a routine game to avoid something bad from happening.)
Other (Describe)
8
Current Past Rituals Involving Other Persons
The need to involve another person (usually a parent) in ritual (e.g., asking a parent to repeatedly
answer the same question, making mother perform certain meal time-rituals involving specific
utensils).*
Other (Describe)
Miscellaneous Compulsions
Mental rituals (other than checking/counting)
Need to tell, ask, or confess
Measures (not checking) to prevent harm to self ; harm to others ; terrible consequences
Ritualized eating behaviors *
Excessive list making *
Need to touch, tap, rub *
Need to do things (e.g., touch or arrange) until it feels just right) *
Rituals involving blinking or staring *
Trichotillomanis (hair-pulling) *
Other self-damaging or self-mutilating behaviors *
Other (Describe)
TARGET SYMPTOM LIST FOR COMPULSIONS
Compulsions (Describe, listing by order of severity, with #1 being the most severe, #2 second most severe,
etc.):
1.
2.
3.
4.
9
QUESTIONS ON COMPULSIONS (ITEMS 6-10) "I AM NOW GOING TO ASK YOU QUESTIONS
ABOUT THE HABITS YOU CAN'T STOP." (Review for the informant(s) the Target Symptoms and refer to
them while asking questions 6-10).
6A. Time Spent Performing Compulsive Behaviors

• How much time do you spend doing these things?
• How much longer than most people does it take to complete your usual daily activities because of the
habits?
(When compulsions occur as brief, intermittent behaviors, it may be impossible to assess time spent
performing them in terms of total hours. In such cases, estimate time by determining how frequently they
are performed. Consider both the number of times compulsions are performed and how many hours of the
day are affected.)
• How often do you do these habits?
[In most cases compulsions are observable behaviors (e.g., handwashing), but there are instances in which
compulsions are not observable (e.g., silent checking).]
0 - NONE
1 - MILD (spends less than 1 hr/day performing compulsions), or occasional performance of

compulsive behaviors
2 - MODERATE (spends from 1 to 3 hrs/day performing compulsions), or frequent performance of

compulsive behaviors
3 - SEVERE (spends more than 3 and up to 8 hrs/day performing compulsions), or very

frequent performance of compulsive behaviors
4 - EXTREME (spends more than 8 hrs/day performing compulsions), or near constant

performance of compulsive behaviors (too numerous to count).
6B. Compulsion-free Interval

• How long can you go without performing compulsive behavior?
[If necessary ask: What is the longest block of time in which (your habits) compulsions are absent?]
0 - NO SYMPTOMS
1 - MILD long symptom-free interval, more than 8 consecutive hrs/day symptom-free
2 - MODERATE moderately long symptom-free interval, more than 3 and up to 8 consecutive

hrs/day symptom-free.
3 - SEVERE short symptom-free interval, from 1 to 3 consecutive hrs/day symptom free
4 - EXTREME less than 1 consecutive hr/day symptom-free
10
7. Interference due to Compulsive Behaviors
• How much do these habits get in the way of school or doing things with friends?
• Is there anything you don't do because of them?
(If currently not in school, determine how much performance would be affected if patient were in school.)
0 - NONE
1 - MILD slight, interference with social or school activities, but overall performance not impaired
2 – MODERATE definite interference with social or school performance, but still manageable
3 - SEVERE causes substantial impairment in social or school performance
4 - EXTREME incapacitating
8. Distress Associated with Compulsive Behavior

• How would you feel if prevented from carrying out your habits?
• How upset would you become?
(Rate degree of distress/frustration patient would experience if performance of the compulsion were
suddenly interrupted without reassurance offered. In most, but not all cases, performing compulsions
reduces anxiety /frustration.)
• How upset do you get while carrying out your habits until you are satisfied?
0 - NONE
1 - MILD only slightly anxious/frustrated if compulsions prevented, or only slight

anxiety/frustration during performance of compulsions.
2 - MODERATE reports that anxiety/frustration would mount but remain manageable if

compulsions prevented. Anxiety/frustration increases but remains manageable
during performance of compulsions.
3 - SEVERE prominent and very disturbing increase in anxiety/frustration if compulsions

interrupted. Prominent and very disturbing increase in anxiety /frustration during
performance of compulsions.
4 - EXTREME incapacitating anxiety/frustration from any intervention aimed at modifying

activity. Incapacitating anxiety/frustration develops during performance of
compulsions.
11
9. Resistance Against Compulsions
• How much do you try to fight the habits?
(Only rate effort made to resist, not success or failure in actually controlling the compulsions. How much
the patient resists the compulsions may or may not correlate with his ability to control them. Note that this
item does not directly measure the severity of the compulsions; rather it rates a manifestation of health, i.e.,
the effort the patient makes to counteract the compulsions. Thus, the more the patient tries to resist, the less
impaired is this aspect of their functioning. If the compulsions are minimal, the patient may not feel the
need to resist them. In such cases, a rating of "0" should be given.)
0 - NONE Makes an effort to always resist, or symptoms so minimal doesn't need to actively
resist.
1 - MILD Tries to resist most of the time.
2 - MODERATE Makes some effort to resist
3 - SEVERE Yields to almost all compulsions without attempting to control them, but does so
with some reluctance.
4 - EXTREME completely and willingly yields to all compulsions
10. Degree of Control over Compulsive Behavior

• How strong is the feeling that you have to carry out the habit(s)?
• When you try to fight them what happens?
(For the advanced child ask:)
• How much control do you have over the habits?
(In contrast to the preceding item on resistance, the ability of the patient to control his compulsions is
closely related to the severity of the compulsions.)
0 - COMPLETE CONTROL
1 - MUCH CONTROL experiences pressure to perform the behavior, but usually able to exercise
voluntary control over it
2 - MODERATE CONTROL moderate control, strong pressure to perform behavior, can control it only
with difficulty
3 - LITTLE CONTROL little control, very strong drive to perform behavior, must be carried to
completion, can only delay with difficulty
4 - NO CONTROL no control, drive to perform behavior experienced as completely

involuntary and overpowering, rarely able to delay activity (even
momentarily)
12
CHILDREN'S YALE-BROWN OBSESSIVE COMPUSLIVE SCALE
CYBOCS TOTAL (add items 1-10)

Patient Name _____ Date Patient ID
Rater
1. TIME SPENT ON OBSESIONS 0 1 2 3 4
1b. OBSESSION-FREE INTERVAL No Moderately Extremely

Symptoms Long Long Short Short
(do not add to subtotal or total score) 0 1 2 3 4
2. INTERFERENCE FROM OBSESSIONS 0 1 2 3 4
3. DISTRESS OF OBSESSIONS 0 1 2 3 4
Always resists Completely yields

4. RESISTANCE 0 1 2 3 4
Complete Much Moderate Little No

control control control control control
5. CONTROL OVER OBSESSIONS 0 1 2 3 4
OBSESSION SUBTOTAL (add items 1-5) [ ]

6. TIME SPENT ON COMPULSIONS 0 1 2 3 4
6b. COMPULSION-FREE INTERVAL No Moderately Extremely

Symptoms Long Long Short Short
(do not add to subtotal or total score) 0 1 2 3 4
7. INTERFERENCE FROM COMPULSION 0 1 2 3 4
8. DISTRESS FROM COMPULSIONS 0 1 2 3 4
Always resists Completely yields

9. RESISTANCE 0 1 2 3 4
Complete Much Moderate Little No

control control control control control
10. CONTROL OVER COMPULSIONS 0 1 2 3 4
COMPULSION SUBTOTAL (add items 6-10) [ ]

19. RELIABILITY EXCELLENT = 0 GOOD = 1 FAIR = 2 POOR = 3
EXCELLENT = no reason to suspect data unreliable; GOOD= factor(s) that may adversely affect reliability;
FAIR= factor(s) that definitely reduce reliability; POOR= very low reliability.
13
14
Instructions to Clinicians using the obsession and Compulsion Log
The obsession and Compulsion Log (OCL) provides two kinds of

clinical information. First, it illustrates the nature of a
patient's current obsessions and compulsions. Second,it is an
. -- index of clinical severity by providing information on the
frequency of obsessions and the. amount of time spent engaged in
compulsive rituals.'
Typically, patients are instructed to record all obsessions and
compulsions that occur over,the course of a single day. However,,~
the time period within which obsessions and compulsions are
recorded wi~l vary according to the patient's condition. For
example, when obsessions are relatively infrequent, the patient
may need to complete the log for several days or longer to
,prcivide sUfficient clinical data. __ .On the other hand, patients
with constant or very frequent' obsessio-ns'-may have difficulty
completing the log for an entire 24-hour period. These patients
can be ,instructed ·to record obsessions and compUlsions for some
designated time period less than 24 hours.' When considering what
time period to assign, remember the purpose of the oeL is to
obtain a sample of obsessions and compulsions adequate enough to
.make clinical decisions. '
,.
OBSESSION AND COMPULSION LOG NAHE, _ DATE _
In the appropriate column below, please wrIte each obsession (e.g., an

unpleasant thought or image, a "contaminated" object, etc.) you encounter,
the time of the obsession, the compulsion (e.g., washing, checking, .
repeating a·mental ritual) you performed in response to the ·obsessIon, and
how long you spent performing the compulsion.· .
Time Obsession compulsion Duration

.~
.'
DASS Name: Date:
Please read each statement and circle a number 0, 1, 2 or 3 that indicates how much the statement
applied to you over the past week. There are no right or wrong answers. Do not spend too much time
on any statement.
The rating scale is as follows:

0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of time
3 Applied to me very much, or most of the time
1 I found myself getting upset by quite trivial things 0 1 2 3

2 I was aware of dryness of my mouth 0 1 2 3
3 I couldn't seem to experience any positive feeling at all 0 1 2 3
4 I experienced breathing difficulty (eg, excessively rapid breathing, 0 1 2 3
breathlessness in the absence of physical exertion)
5 I just couldn't seem to get going 0 1 2 3
6 I tended to over-react to situations 0 1 2 3
7 I had a feeling of shakiness (eg, legs going to give way) 0 1 2 3
8 I found it difficult to relax 0 1 2 3
9 I found myself in situations that made me so anxious I was most 0 1 2 3
relieved when they ended
10 I felt that I had nothing to look forward to 0 1 2 3
11 I found myself getting upset rather easily 0 1 2 3
12 I felt that I was using a lot of nervous energy 0 1 2 3
13 I felt sad and depressed 0 1 2 3
14 I found myself getting impatient when I was delayed in any way 0 1 2 3
(eg, elevators, traffic lights, being kept waiting)
15 I had a feeling of faintness 0 1 2 3
16 I felt that I had lost interest in just about everything 0 1 2 3
17 I felt I wasn't worth much as a person 0 1 2 3
18 I felt that I was rather touchy 0 1 2 3
19 I perspired noticeably (eg, hands sweaty) in the absence of high 0 1 2 3
temperatures or physical exertion
20 I felt scared without any good reason 0 1 2 3
21 I felt that life wasn't worthwhile 0 1 2 3
Please turn the page 

Reminder of rating scale:
0 Did not apply to me at all
1 Applied to me to some degree, or some of the time
2 Applied to me to a considerable degree, or a good part of time
3 Applied to me very much, or most of the time
22 I found it hard to wind down 0 1 2 3

23 I had difficulty in swallowing 0 1 2 3
24 I couldn't seem to get any enjoyment out of the things I did 0 1 2 3
25 I was aware of the action of my heart in the absence of physical 0 1 2 3
exertion (eg, sense of heart rate increase, heart missing a beat)
26 I felt down-hearted and blue 0 1 2 3
27 I found that I was very irritable 0 1 2 3
28 I felt I was close to panic 0 1 2 3
29 I found it hard to calm down after something upset me 0 1 2 3
30 I feared that I would be "thrown" by some trivial but 0 1 2 3
unfamiliar task
31 I was unable to become enthusiastic about anything 0 1 2 3
32 I found it difficult to tolerate interruptions to what I was doing 0 1 2 3
33 I was in a state of nervous tension 0 1 2 3
34 I felt I was pretty worthless 0 1 2 3
35 I was intolerant of anything that kept me from getting on with 0 1 2 3
what I was doing
36 I felt terrified 0 1 2 3
37 I could see nothing in the future to be hopeful about 0 1 2 3
38 I felt that life was meaningless 0 1 2 3
39 I found myself getting agitated 0 1 2 3
40 I was worried about situations in which I might panic and make 0 1 2 3
a fool of myself
41 I experienced trembling (eg, in the hands) 0 1 2 3
42 I found it difficult to work up the initiative to do things 0 1 2 3
DASS Scoring Template
S
A
D
A
D
S
A
S
A
D
S
S
D
S
A
D
D
S
A
A
D
Apply template to both sides of sheet and sum scores for each scale.
For short (21-item) version, multiply sum by 2.
111
British Journal of Clinical Psychology (2003), 42, 111–131

2003 The British Psychological Society
www.bps.org.uk
The Depression Anxiety Stress Scales (DASS):

Normative data and latent structure in a large
non-clinical sample
John R. Crawford* and Julie D. Henry

Department of Psychology, King’s College, University of Aberdeen, UK
Objectives. To provide UK normative data for the Depression Anxiety and Stress
Scale (DASS) and test its convergent, discriminant and construct validity.
Design. Cross-sectional, correlational and confirmatory factor analysis (CFA).
Methods. The DASS was administered to a non-clinical sample, broadly representa-
tive of the general adult UK population (N = 1,771) in terms of demographic variables.
Competing models of the latent structure of the DASS were derived from theoretical
and empirical sources and evaluated using confirmatory factor analysis. Correlational
analysis was used to determine the influence of demographic variables on DASS scores.
The convergent and discriminant validity of the measure was examined through
correlating the measure with two other measures of depression and anxiety (the
HADS and the sAD), and a measure of positive and negative affectivity (the PANAS).
Results. The best fitting model (CFI = .93) of the latent structure of the DASS
consisted of three correlated factors corresponding to the depression, anxiety and
stress scales with correlated error permitted between items comprising the DASS
subscales. Demographic variables had only very modest influences on DASS scores.
The reliability of the DASS was excellent, and the measure possessed adequate
convergent and discriminant validity
Conclusions. The DASS is a reliable and valid measure of the constructs it was
intended to assess. The utility of this measure for UK clinicians is enhanced by the
provision of large sample normative data.
The Depression Anxiety Stress Scale (DASS) is a 42-item self-report measure of anxiety,
depression and stress developed by Lovibond and Lovibond (1995) which is
increasingly used in diverse settings. Its popularity is partly attributable to the fact
*Requests for reprints should be addressed to John R. Crawford, Department of Psychology, King’s College, University of
Aberdeen AB24 3HN, UK (e-mail: [email protected]).
112 John Crawford and Julie D. Henry
that, unlike many other self-report scales, the DASS is in the public domain (i.e. the
measure can be used without incurring any charge). The DASS was originally intended
to consist of only two subscales—one measuring anxiety, the other depression—each
composed of items that were purportedly unique to either construct. Ambiguous items
(i.e. items non-specifically related to depression and anxiety) were not included in the
measure but were regarded as controls. This strategy was adopted because the authors’
original intention was to develop measures that would maximally discriminate between
depression and anxiety. However, during scale development it was revealed that the
control items tended to form a third group, of items characterized by chronic non-
specific arousal. More items were added to this group and the third scale, the stress
scale, emerged. Lovibond and Lovibond maintain that, although this scale is related to
the constructs of depression and anxiety, it nevertheless represents a coherent measure
in its own right.
Whilst Lovibond and Lovibond’s (1995) attempt to develop a measure that maximally
discriminates between the constructs of depression and anxiety is not unique (Beck,
Epstein, Brown, & Steer, 1988; Costello & Comrey, 1967), the strategy adopted for scale
construction is. Conventionally, items are derived from pre-existing anxiety and
depression scales, with factor analyses of clinical data used to identify those which
measure different constructs. By contrast, Lovibond and Lovibond employed
predominantly non-clinical samples for scale development on the basis that depression
and anxiety represent dimensional, not categorical, constructs. Moreover, core
symptoms of anxiety and depression which were unique to one but not both of the
disorders were identified from the outset, and not on an a posteriori basis. Thus,
unconventionally, the initial items selected were retained, with new items compatible
with the emerging factor definitions successively added.
Preliminary evidence has been presented, which suggests that the DASS does possess
adequate convergent and discriminant validity (Lovibond & Lovibond, 1995). A large
student sample (N = 717) was administered the Beck Depression Inventory (BDI; Beck,
Ward, Mendelsohn, Mock, & Erbaugh, 1961), the Beck Anxiety Inventory (BAI; Beck et
al., 1988) and the DASS. The BAI and DASS anxiety scale were highly correlated
(r = .81), as were the BDI and DASS depression scale (r = .74). However, between-
construct correlations were substantially lower (r = .54 for DASS depression and BAI;
r = .58 for DASS anxiety and BDI). Moreover, Antony, Bieling, Cox, Enns, and Swinson
(1998) found a similar pattern of correlations in a clinical sample.
To assess the DASS’s psychometric properties, Lovibond and Lovibond (1995)
administered the measure to a large non-clinical sample (N = 2,914). It was found that
reliability, assessed using Cronbach’s alpha, was acceptable for the depression, anxiety
and stress scales (.91, .84 and .90, respectively). These values are similar to those
obtained from clinical populations (Antony et al., 1998; Brown, Chorpita, Korotitsch, &
Barlow, 1997).
At present, interpretation of the DASS is based primarily on the use of cut-off scores.
Lovibond and Lovibond (1995) presented severity ratings from ‘normal’ to ‘extremely
severe’ on the basis of percentile scores, with 0–78 classified as ‘normal’, 78–87 as
‘mild’, 87–95 as ‘moderate’, 95–98 as ‘severe’, and 98–100 as ‘extremely severe’.
However, these original norms were based predominantly on students. This means that
the generalizability of their results to the normal population is uncertain. Moreover,
although 1,307 of the participants in this study were non-students, no information was
presented regarding whether they were broadly representative of the general
DASS in a non-clinical sample 113
population; all that was stated was that they were ‘white and blue collar workers’
(Lovibond & Lovibond, 1995, p. 9).
Relatedly, the influence of demographic characteristics on DASS scores has gone
largely uninvestigated. In development of the DASS, this analysis was restricted to
gender and age. Although the test authors did not state explicitly whether age and/or
gender yielded a significant effect, ‘. . . there was a trend towards higher scores in the
youngest and oldest age brackets’ (Lovibond & Lovibond, 1995, p. 28). However,
Andrew, Baker, Kneebone, and Knight (2000) found that in a sample of elderly
community volunteers (N = 53), scores on all three DASS subscales were almost half
those reported by Lovibond and Lovibond. It is possible that this discrepancy is
attributable to idiosyncrasies in one or both of these samples or the influence of
potential mediating factors such as years of education or occupation. Yet no study to
date has assessed the influence of either of these latter variables. The relationships
between demographic variables and DASS scores in the general population are of
interest in their own right, but investigation of these relationships would also serve the
very practical purpose of identifying whether normative data should be stratified.
If the use of the DASS in research and clinical practice is to be optimal, then it is also
necessary to delineate the underlying structure of the instrument. This is particularly
important given that Lovibond and Lovibond (1995) found through empirical analyses
that, in both clinical and non-clinical samples, symptoms conventionally regarded as
core to the syndrome of depression (American Psychiatric Association, 1994) were
actually extremely weak markers of this construct. Specifically, items pertaining to
changes in appetite, sleep disturbance, guilt, tiredness, concentration loss, indecision,
agitation, loss of libido, diurnal variation in mood, restlessness, irritability and crying
were excluded from the measure.
Moreover, the legitimacy of the stress scale as an independent measure must be
assessed. In an influential series of papers, Clark and Watson (Clark & Watson, 1991a,
1991b; Watson, Clark, & Tellegen, 1988) have argued that anxiety and depression have
an important shared component which they call ‘negative affectivity’ (NA). NA is a
dispositional dimension, with high NA reflecting the experience of subjective distress
and unpleasurable engagement, manifested in a variety of emotional states such as guilt,
anger and nervousness, and low NA represented by an absence of these feelings
(Watson & Clark, 1984). Studies have supported the existence of a dominant NA
dimension (Watson & Clark, 1984; Watson & Tellegen, 1985) and provide evidence that
it is highly related to the symptoms of both anxiety and depression (Brown et al., 1997;
Watson, Clark, Weber et al., 1995; Watson, Weber et al., 1995). Thus, there are strong
theoretical grounds for suggesting that the stress scale is simply a measure of NA,
particularly given that this scale actually originated from items believed to relate to both
dimensions.
To date, four studies have directly tested the construct validity of the DASS (Antony
et al., 1998; Brown et al., 1997; Clara, Cox, & Enns, 2001; Lovibond & Lovibond, 1995).
Lovibond and Lovibond (1995) conducted a principal-components analysis in a student
sample (N = 717) which revealed that the first three factors accounted for a high
proportion of the variance. Furthermore, all items loaded on their designated factor
except for anxiety item 30 (‘I feared that I would be ‘‘thrown’’ by some trivial but
unfamiliar task’) which loaded on the stress factor. In the same sample, a confirmatory
factor analysis (CFA) was then used to quantitatively compare the fit of a single-factor
model, a two-factor model (in which depression was one factor, and anxiety and stress
were collapsed into another) and a three-factor model corresponding to the three DASS
scales. The three-factor model was found to represent the optimal fit, and a significantly
better fit than the two-factor model.
Analogous findings have been reported in two independent clinical samples. Brown
et al. (1997) conducted an exploratory factor analysis (EFA) with varimax rotation using
data derived from a sample (N = 437) of patients suffering from a range of affective
disorders. A three-factor solution emerged, reproducing Lovibond and Lovibond’s
(1995) hypothesized structure. The only discrepancies were that anxiety item 9 (‘I
found myself in situations which made me so anxious that I was most relieved when
they ended’) and stress item 33 (‘I was in a state of nervous tension’)1 double loaded,
and anxiety item 30 failed to load strongly on any factor. Brown et al. then administered
the instrument to an independent clinical sample (N = 241) and employed CFA to test
the fit of four models. The first three models corresponded exactly to those tested by
Lovibond and Lovibond. In addition, a model revised according to the results of the EFA
conducted with Brown et al.’s first sample was also tested. The results revealed that the
revised model represented the optimal fit, and a significantly better fit than the model
corresponding to Lovibond and Lovibond’s original specifications.
Finally, both Clara et al. (2001) and Antony et al. (1998) identified three factor
solutions in clinical samples (N = 258 and N = 439, using CFA and EFA respectively).
Antony et al. (1998), however, again noted discrepancies; stress items 22 (‘I found it
hard to wind down’) and 33 double loaded on anxiety, and anxiety items 9 and 30
double loaded on stress. Thus, whilst these studies suggest that there is a slight degree
of misspecification, they have consistently supported the validity of a three-factor
structure corresponding to the dimensions of anxiety, depression and stress. To date,
though, no study has tested the construct validity of the DASS in a sample drawn from
the general adult population.
The aims of the present study were:
(1) to investigate the influence of demographic variables on DASS scores in the

general adult UK population;
(2) to provide UK normative data for the DASS in the form of tables for converting
raw scores to percentiles;
(3) to evaluate competing models of the latent structure of the DASS using CFA
(details of the parameterization of the models, and the theoretical, methodolo-
gical and empirical considerations that guided their selection, are presented in
the methods section);
(4) to obtain estimates of the reliability of the DASS; and
(5) to test the convergent and discriminant validity of the DASS.
Method
Participants
Complete DASS data were collected from 1,771 members of the general adult
population (females = 965, males = 806). Participants were recruited from a wide
variety of sources including commercial and public service organizations, community
centres and recreational clubs. The mean age of the sample was 40.9 (SD = 15.9) with a
range of 15–91 years. The mean years of education was 13.8 (SD = 3.1).
1
Brown et al. (1997) refer to item 33 as item 34.
Materials and procedure

Each potential participant received an introductory letter, a DASS form, and a form for
recording demographic variables. A subset of participants also received and completed
two additional self-report measures of depression and anxiety, as well as a measure of
positive and negative affect. These were the Hospital Anxiety and Depression Scale
(HADS, N = 1512; Zigmond & Snaith, 1983), the Personal Disturbance scale (sAD,
N = 733; Bedford & Foulds, 1978), and the Positive and Negative Affect Schedule
(PANAS, N = 740; Watson et al., 1988). Participants sealed the completed forms in an
envelope, and these were either collected by the researcher or returned by mail. The
refusal rate was approximately 18% (participants who failed to return forms or returned
entirely blank forms were also treated as refusals). In addition, of the 1,786 completed
forms, 15 contained either some missing data or contained equivocal responses; these
forms were discarded.
Each participant’s occupation was coded using the Office of Population Censuses
and Surveys (1990) Classification of occupations. Retired participants, and those
describing themselves as househusbands/housewives, were coded by their previous
occupations, as were those currently unemployed. Those who had never worked were
coded as 5 (i.e. unskilled).
The percentage of participants in the occupational codes of professional (1),
intermediate (2), skilled (3), semi-skilled (4) and unskilled (5) was 11, 38, 34, 9 and 8,
respectively. The corresponding percentage for each code in the general adult
population census is 7, 32, 42, 14 and 5, respectively. Thus, whilst there was a broad
spread, there was a slight overrepresentation of professional occupations, and a slight
underrepresentation of skilled and semi-skilled occupations. The percentage of
participants in each of four age bands (18–29, 30–44, 45–59, 60+) was 30, 31, 26
and 14. The corresponding percentage for each age band in the general adult
population census is 27, 25, 22 and 26, respectively. Again it can be seen that there was
a broad spread, although there was a relative underrepresentation of individuals in the
oldest age group.
The Hospital Anxiety and Depression Scale (HADS)

The HADS was developed by Zigmond and Snaith (1983) to provide a brief means of
identifying and measuring severity of depression and anxiety in non-psychiatric clinical
environments. It consists of 14 items, seven of which measure depression, the other
seven anxiety. The respondent is asked to underline the reply which most closely
matches how they have felt during the past week.
The Personal Disturbance Scale (sAD)

The sAD is a brief (14-item) self-report measure derived from the Delusions-Symptoms
States Inventory (DSSI; Bedford & Foulds, 1978), and consists of seven anxiety and
seven depression items.
The Positive and Negative Affect Schedule (PANAS)

The PANAS is a brief (20-item) self-report measure of positive affect and negative affect
developed by Watson et al. (1988). It is claimed that the PANAS provides independent
(i.e. orthogonal) measures of these constructs. The ‘past week’ time format was
adopted.
Statistical analysis
Basic statistical analysis was conducted using SPSS Version 8. Confidence limits on
Cronbach’s alpha were derived from Feldt’s (1965) formulae.
CFA (robust maximum likelihood) was performed on the variance-covariance matrix
of the DASS items using EQS for Windows Version 5 (Bentler, 1995). The fit of CFA
models was assessed using the Satorra–Bentler scaled chi square statistic (S-B À2), the
average off-diagonal standardized residual (AODSR), the Comparative Fit Index (CFI),
the Robust Comparative Fit Index (RCFI) and the Root Mean Squared Error of
Approximation (RMSEA). Off-diagonal standardized residuals reflect the extent to which
covariances between observed variables have not been accounted for by the models
under consideration. Values for the CFI and RCFI can range from zero to unity; these
indices express the fit of a model relative to what is termed the ‘null model’ (the null
model posits no relationship between any of the manifest variables). There is general
agreement that a model with a CFI of less than 0.95 should not be viewed as providing a
satisfactory fit to the data (Hu & Bentler, 1999). The RMSEA has been included as this fit
index explicitly penalizes models which are not parsimonious.
A model is considered to be nested within another model if it differs only in imposing
additional constraints on the relationships between variables specified in the initial
model. The difference between chi square for nested models is itself distributed as chi
square with k degrees of freedom where k equals the degrees of freedom for the more
constrained model minus the degrees of freedom for the less constrained model. This
means that it is possible to test directly whether more constrained models have a
significantly poorer fit than less constrained models; this feature of CFA is one of its
major advantages over EFA. In the present case there is a slight complication because
the S-B À2 is used as an index of fit rather than the standard chi-square statistic (the
Satorra–Bentler statistic is recommended when the raw data are skewed). The
difference between S-B À2 for nested models is typically not distributed as chi square.
However, Satorra and Bentler (2001) have recently developed a scaled difference chi-
square test statistic that can be used to compare S-B À2 from nested models. This
statistic is used in the present study.2
Parameterization of competing models of the DASS

The first model (Model 1a) to be evaluated was a single-factor model; this model
expressed the hypothesis that the variance in the DASS can be partitioned into one
general factor plus error variance associated with each individual item. It is standard
practice to test the fit of a one-factor model because it is the most parsimonious of all
possible models. A further model was tested (Model 1b) in which again all items were
presumed to load upon only one general factor. However, as can be seen in Table 6,
items in each of the DASS scales are grouped into categories hypothesized to measure
the same subcomponents of the relevant construct. In Model 1b, items from the same
content categories were permitted to covary. No study to date has tested a model
parameterized to allow for such correlated error.
Models 2a–2c expressed variants on the hypothesis that the DASS measures two
factors, anxiety and depression. For all three models the items in the stress and anxiety
scale were collapsed into one factor to test the hypothesis that the stress scale does not
represent an independent construct but, rather, simply measures anxiety. In Model 2a
2
In the course of analysing the present data we wrote a computer program (for PCs) that carries out this test. The program
can be downloaded from www.psyc.abdn.ac.uk/homedir/jcrawford/sbdiff.htm
these two factors were constrained to be orthogonal and in Model 2b, permitted to
correlate. Model 2b was then retested, but additionally permitted correlated error
between items from the same content categories (Model 2c).
Models 3a–3d tested Lovibond and Lovibond’s (1995) three-factor structure,
specifying the dimensions of anxiety, depression and stress. In Model 3a, the three
factors were constrained to be orthogonal, with Model 3b permitting the factors to
correlate in accordance with Lovibond and Lovibond’s original specifications. Model 3c
represented a test of the model which Brown et al. (1997) derived through an EFA in a
clinical sample, and which represented the optimal fit of four CFA models tested in an
independent clinical sample. The model was parameterized according to Lovibond and
Lovibond’s original specifications, except that some items were permitted to load on
more than one factor. Specifically, stress item 33 also loaded on anxiety, anxiety item 9
on stress, and anxiety item 30 on all three factors. Finally, Model 3c was retested, but
additionally permitted correlated error (Model 3d).
Results
Influence of demographic variables on DASS scores
As the DASS scales had a high positive skew, analysis of their relationships with
demographic variables (i.e. t-tests and correlations) was performed on the logarithm of
their scores. Independent samples t-tests revealed that females obtained significantly
higher scores than males on the anxiety scale (M = 4.0, SD = 6.17 [females]; M = 3.0,
SD = 4.23 [males]; t = –2.29, p < .05), depression scale (M = 6.1, SD = 8.14 [females];
M = 4.9, SD = 6.55 [males]; t = –2.68, p < .01), and total of the three scales (M = 19.9,
SD = 20.82 [females]; M = 16.6, SD = 15.95 [males]; t = –2.20, p <.05). The difference
between males and females on the stress scale did not achieve statistical significance
(M = 9.8, SD = 8.56 [males]; M = 8.7, SD = 7.35 [females]; t = –1.802, p > .05).
Table 1. Correlations between demographic variables and DASS scores
DASS
Demographic variable Anxiety Depression Stress Total
Age –.036 –.109** –.183** –.147**

Occupational code .066** .018 –.039 .005
Years of education –.033 –.008 .086** –.054*
Gender .054* .064** .043 .052*
* Correlation significant at .05 level (two-tailed); ** correlation significant at .01 level (two-tailed).
The influence of the remaining demographic variables (age, years of education and
occupational code) on the DASS anxiety, depression, stress and total scales was tested
through correlational analyses, the results of which are presented in Table 1. The point-
biserial correlations between gender and the DASS scale scores are also presented in
this table as an index of effect size (males were coded as 0, females as 1, so a positive
correlation represents a higher score in females). It can be seen from Table 1 that the
influence of all demographic variables on DASS scores is very modest.
Summary statistics and normative data for the DASS

The means, medians, SDs and ranges for each of the three DASS scales are presented in
Table 2 for the total sample. Additionally, for each subscale the percentage of
participants falling into each of the five categories (normal, mild, moderate, severe and
extremely severe) created by the use of Lovibond and Lovibond’s (1995) cut-off scores
is presented. However, these cut-offs have been presented purely for comparative
purposes, and it is important to reiterate that DASS scores should be regarded as
providing an individual’s score on an underlying dimension.
Table 2. Summary statistics for DASS
Percentage in each DASS category
Median M SD Range Normal Mild Moderate Severe Extremely severe

(0–78a) (78–87) (87–95) (95–98) (98–100)
Total sample
(N = 1771)
Anxiety 2 3.56 5.39 0–40 94.4 2.0 3.8 2.0 3.2
Depression 3 5.55 7.48 0–42 81.7 6.2 6.3 2.9 2.9
Stress 8 9.27 8.04 0–42 80.2 8.4 5.9 3.5 2.0
Total 13 18.38 18.82 0–121
a
Lovibond and Lovibond’s (1995) percentile cut-offs corresponding to each DASS category.
Visual inspection of the distribution of raw scores on the four scales revealed that, as
is to be expected in a sample drawn from the general adult population, they were
positively skewed, particularly the anxiety scale. Kolmogorov–Smirnov tests confirmed
that the distributions deviated highly significantly from a normal distribution (Z ranged
from 5.24 to 10.70, all ps < .001).
Given the positive skew, use of the means and SDs from a normative sample is not
useful when interpreting an individual’s score. Therefore, Table 3 was constructed for
conversion of raw scores on each of the DASS scales to percentiles.
Testing competing confirmatory factor analytic models of the DASS

The fit statistics for the CFA models are presented in Table 4. It can be seen that the
general factor model (Model 1a) had a very poor fit; the À2 is large, and the fit indices
are low. However, all items loaded highly on this factor, evidence that there is
substantial common variance among the items. Permitting correlated error (Model 1b)
led to an improved, but still badly fitting, model. The two-factor models also had a poor
fit, although the correlated factors models (Models 2b and 2c) were better than their
more constrained counterpart (Model 2a). Again, correlated error led to an
improvement in fit (Model 2c having higher fit indices and a lower À2 than Model 2b).
Model 3a tested Lovibond and Lovibond’s (1995) three-factor structure but specified
orthogonal constructs. This was associated with low fit indices and a very high À2.
Although permitting correlated factors in Model 3b improved the model’s fit, it was still
Table 3. Raw scores on the DASS converted to percentiles
Raw scores
Percentile Depression Anxiety Stress Total Percentile
5 0 0 0 1 5
10 0 0 1 2 10
15 0 0 2 3 15
20 0 0 3 5 20
25 1 0 3 6 25
30 1 0 4 7 30
35 1 1 5 8 35
40 2 1 6 10 40
45 2 1 7 12 45
50 3 2 8 13 50
55 3 2 8 15 55
60 4 3 9 17 60
65 5 3 10 19 65
70 6 4 12 22 70
75 7 4 13 24 75
76 8 5 13 24 76
77 8 5 13 25 77
78 8 5 14 26 78
79 9 5 14 27 79
80 9 6 14 28 80
81 9 6 15 28 81
82 10 6 15 29 82
83 10 6 16 30 83
84 11 7 16 31 84
85 11 7 17 32 85
86 12 7 17 34 86
87 13 8 18 35 87
88 14 8 18 36 88
89 14 8 19 39 89
90 15 9 20 40 90
91 16 10 21 42 91
92 17 11 22 46 92
93 18 12 23 48 93
94 20 13 25 54 94
95 22 15 26 60 95
96 24 17 28 64 96
97 27 20 30 72 97
98 31 22 34 79 98
99 36 26 37 91 99
poor. However, for both models, all items loaded highly on the appropriate construct.
Model 3c represented a revised version of Lovibond and Lovibond’s model based on the
empirical findings of Brown et al. (1997) and represented a superior fit. As with Brown
et al.’s study, items 9 and 33 loaded equivalently on the anxiety and stress factors (.36
vs. .36; .41 vs. .40, respectively), and item 30 loaded weakly on all three factors (ranging
from .12 to .35). Again, none of the fit indices was acceptable. Model 3d was identical to
120
Table 4. Fit indices for CFA models of DASS
Model S-Bw2 w2 a df AODSR CFI RCFI RMSEA
Single factor
1a. Single factor 7,259.3 14,144.5 819 .0560 .726 .542 .096
John Crawford and Julie D. Henry
1b. Single factor with correlated error 3,986.4 7,616.1 779 .0475 .860 .772 .070
Anxiety and depression as . . .
2a. independent factors 6,172.2 11,902.2 819 .2063 .773 .619 .087
2b. correlated factors 5,421.9 10,341.7 818 .0459 .805 .673 .081
2c. correlated factors with correlated error 2,965.0 5,607.6 778 .0385 .901 .844 .059
Lovibond & Lovibond’s model with . . .
3a. independent factors 5,661.8 10,945.0 819 .2662 .792 .656 .084
3b. correlated factors 4,298.2 8,148.0 816 .0422 .850 .752 .071
3c. correlated factors, revised 4,059.5 7,656.9 812 .0377 .860 .769 .069
3d. correlated factors, revised, and correlated error 2,347.8 4,403.2 772 .0322 .925 .888 .052
a
The Satorra–Bentler scaled chi square statistic (S-B À2) was used to evaluate model fit. However, the normal chi square is also required when testing for a
difference between the S-B À2 statistic obtained from nested models; hence we present both statistics in this table.
Table 5. Results of testing for differences between nested CFA models of DASS
Comparison statistics
More constrained Less constrained S-B À2 df p
Model 1a Model 1b 3,272.9 40 <.001

Model 2a Model 2b 750.3 1 <.001
Model 1a Model 2b 1,837.4 1 <.001
Model 2b Model 2c 2,457.0 40 <.001
Model 1b Model 2c 1,021.4 1 <.001
Model 3a Model 3b 1,363.6 3 <.001
Model 1a Model 3b 2,961.1 3 <.001
Model 2b Model 3b 1,123.7 2 <.001
Model 3b Model 3c 238.7 4 <.001
Model 3c Model 3d 1,711.7 40 <.001
Model 1b Model 3d 1,638.6 7 <.001
Model 2c Model 3d 617.2 6 <.001
Model 3c but additionally permitted correlated error. This model was associated with
the optimal fit according to all criteria, with high fit indices and a À2 value that,
although statistically significant,3 was substantially lower than that for the other models
tested.
The fit of the correlated factors models is markedly superior to their independent
factors counterparts. As noted, inferential statistics can be applied to compare nested
models. Models 2a and 3a are nested within Models 2b and 3b respectively in that they
differ only by the imposition of the constraint that the factors are independent. The
results from chi square difference tests used to compare these nested models are
presented in Table 5. It can be seen that the correlated factors models had a
significantly better fit (p < .001) than their independent factors counterparts,
demonstrating that the conception of independence between the scales is untenable.
This is underlined by the correlations between the three factors in Models 3b–3d. For
the optimal Model, 3d, the correlations were depression–anxiety (r = .75), stress–
depression (r = .77) and stress–anxiety (r = .74). These correlations are higher than the
respective correlations between the scales: depression–anxiety (r = .70), stress–
depression (r = .72) and stress–anxiety (r = .70)—although these latter correlations
are themselves substantial. This is because the factors in the CFA models are measured
without error, whereas the correlation between the scales is attenuated by
measurement error and the unique variance associated with each item.
Although it may appear initially that the general factor model is very different from
the correlated factors models, it is also nested within these models. Models 2b and 3b
can be rendered equivalent to a single factor simply by constraining the correlation
between factors to unity (i.e. r = 1.0). The chi square difference tests comparing Model
1 with Models 2b and 3b were both highly significant, demonstrating that it is also
untenable to view the DASS as measuring only a single factor of negative affectivity or
general psychological distress.
Allowing for correlated error between the items also resulted in a significant
3
When dealing with large sample sizes and a large number of items it is unusual to obtain non-significant À2 values for CFA
models of self-report data (Byrne, 1994).
improvement in the fit of Models 1b, 2c and 3d compared with their more constrained
counterparts, Models 1a, 2b and 3c, respectively. Moreover, the addition of the double
loadings identified by Brown et al. (1997) led to improvement, with Model 3c a
significantly better fit than Model 3b (p < .001).
Evaluation of the optimal model

As shown in Table 6, all items in Model 3d loaded .47 on the specific factor they were
intended to represent, with the exception of the three ‘weak’ items identified in earlier
factor analyses (items 9, 30 and 33). Cross-validating Brown et al.’s (1997) clinical
study, anxiety item 9 and stress item 33 loaded identically on the anxiety and stress
factors (item 9 loaded .36 on both factors; and item 33 loaded .40 on each construct).
Item 30 loaded only weakly on all three factors (.13, .36 and .23 on depression, anxiety
and stress, respectively). Although allowing correlated error between items of related
subscales led to a significant improvement in fit, the item-specific correlations revealed
that not all of the subsets appeared to be related in the manner hypothesized. That is,
although the majority were positively related, some correlations were negative, albeit
modestly so.
A schematic representation of the structure for the optimal Model (3d) is presented
as Figure 1 (the associated factor loadings are presented in Table 6). By convention,
latent factors are represented by large ovals or circles, the error variances as smaller
ovals or circles (as they are also latent variables) and manifest (i.e. observed) variables as
rectangles or squares. Single-headed arrows connecting variables represent a causal
path. Double-headed arrows represent covariance or correlation between variables but
do not imply causality.
Reliabilities of the DASS

The reliabilities (internal consistencies) of the DASS anxiety, depression, stress and total
score were estimated using Cronbach’s alpha. Alpha was .897 (95% CI = .890–.904) for
the anxiety scale, .947 (95% CI = .943–.951) for the depression scale, .933 (95%
CI = .928–.937) for the stress scale, and .966 (95% CI = .964–.968) for the total score.
Convergent and discriminant validity of the DASS

To examine the convergent and discriminant validity of the DASS, Pearson product–
moment correlations were calculated between each of the DASS scales and the sAD,
HADS and PANAS scales. These correlations are presented in Table 7. With respect to
convergent validity, the DASS depression scale correlated highly with sAD depression
(.78). William’s (1959) test revealed that this correlation was higher than that between
sAD depression and HADS depression (.58; t = 9.10, p < .001). Similarly, the
correlation between DASS depression and HADS depression (.66) was significantly
higher than the HADS–sAD correlation (t = 4.19, p < .001). DASS anxiety scores also
exhibited a high convergent validity. The correlation between DASS anxiety and sAD
anxiety (.72) was significantly higher than that between the sAD and HADS anxiety
scales (.67; t = 2.40, p < .05). However, although the correlation between DASS
anxiety and HADS anxiety was substantial and highly significant (.62, p < .001), it was
lower than the aforementioned correlation between HADS anxiety and sAD anxiety
(t = 2.41, p < .05).
Table 6. DASS items with factor loadings from confirmatory factor analysis (Model 3d)
Factor
Scale/item summary Subscale Depression Anxiety Stress
Depression
26 Downhearted & blue DYS .77
13 Sad & depressed DYS .78
37 Nothing future hopeful HLNS .82
10 Nothing to look forward to HLNS .81
38 Life meaningless DoL .78
21 Life not worthwhile DoL .79
34 Felt worthless S-Dep .80
17 Not worth much as person S-Dep .77
16 Lost interest in everything LoI/I .81
31 Unable to become enthusiastic LoI/I .78
3 Couldn’t experience positive ANH .71
24 Couldn’t get enjoyment ANH .75
5 Couldn’t get going INRT .53
42 Difficult to work up initiative INRT .64
Anxiety
25 Aware of action of heart AutAr .62
19 Perspired noticeably AutAr .60
2 Dryness of mouth AutAr .47
4 Breathing difficulty AutAr .50
23 Difficulty swallowing AutAr .57
7 Shakiness SkME .63
41 Trembling SkME .62
40 Worried about situations/panic SitAnx .62
9 Situations made anxious SitAnx .36 .36
30 Feared would be ‘thrown’ SitAnx .13 .36 .23
28 Felt close to panic SubAA .80
36 Terrified SubAA .70
20 Scared for no good reason SubAA .74
15 Feeling faint SubAA .58
Stress
22 Hard to wind down DRel .69
29 Hard to calm down DRel .79
8 Difficult to relax DRel .68
12 Using nervous energy NerAr .67
33 State of nervous tension NerAr .40 .40
11 Upset easily EU/A .79
1 Upset by trivial things EU/A .69
39 Agitated EU/A .78
6 Overreact to situations I/OR .72
27 Irritable I/OR .77
18 Touchy I/OR .76
35 Intolerant kept from getting on IMPT .62
14 Impatient when delayed IMPT .53
32 Difficulty tolerating interruptns IMPT .63
Note. DYS = dysphoria; HLNS = hopelessness; DoL = devaluation of life; S-Dep = self-deprecation;
LoI/I = lack of interest/involvement; ANH = anhedonia; INRT – inertia; AutAr = autonomic arousal;
SkME = skeletal musculature effects; SitAnx = situational anxiety; SubAA = subjective anxious affect;
DRel = difficulty relaxing; NerAr = nervous arousal; EU/A = easily upset/agitated; I/OR = irritable/
over-reactive; IMPT = impatient.
Figure 1. Graphical representation of a correlated three-factor model of the DASS (Model 3d);
cross-loadings have been omitted in the interests of clarity.
Table 7. Correlations between the DASS, sAD, HADS and PANAS
DASS DASS DASS sAD sAD HADS HADS PANAS PANAS

depression anxiety stress depression anxiety depression anxiety PA NA
DASS depression – – – – – – –
DASS anxiety .70 – – – – – –

(1771)
DASS stress .72 .71 – – – – –
(1771) (1771)
sAD depression .78 .56 .56 – – – –
(733) (733) (733)
sAD anxiety .62 .72 .67 .70 – – –
(733) (733) (733) (758)
HADS depression .66 .49 .54 .58 .52 – –
(1512) (1512) (1512) (746) (746)
HADS anxiety .59 .62 .71 .54 .67 .53 –
(1512) (1512) (1512) (746) (746) (1792)
PANAS PA –.48 –.29 –.31 – – –.52 –.31 –
(740) (740) (740) (0) (0) (989) (989)
PANAS NA .60 .60 .67 – – .44 .65 –.24 –
(740) (740) (740) (0) (0) (989) (989) (1003)
Note. N for each correlation in parentheses.

DASS in a non-clinical sample
125
In common with all other self-report scales of anxiety and depression, the
discriminant validity of the DASS was less impressive: the between-construct
correlations (i.e. DASS anxiety with HADS depression, etc.) were all highly significant
(see Table 7). However, Williams’ tests revealed that when the DASS scales were paired
with their opposites from the other scales, all these latter (between-construct)
correlations were significantly lower (p < .05 or beyond) than the corresponding
within-construct correlations referred to above.
The correlations between PA and NA with the DASS scales are of particular interest,
especially the correlations between PA and the depression scale, and NA and the stress
scale. The depression scale’s correlation with PA was highly significant and negative in
sign (–.48); thus scoring high on depression was associated with low levels of PA. Using
Meng, Rosenthal, and Rubin’s (1992) method of comparing sets of non-independent
correlations, this correlation was significantly higher than the correlations between PA
and the other two DASS scales (–.29 for anxiety and –.31 for stress; z = 8.36, p < .001).
The correlation between the stress scale and NA (.67) was significantly higher than the
correlation of NA with the other two DASS scales (.60 for both anxiety and depression;
z = 3.64, p < .001).
Discussion
Influence of demographic variables
One basic aim of the present study was to examine the influence of demographic
variables on DASS scores. Although nine out of the 16 relationships examined proved
significant, the size of the effects was very modest. The percentage of variance
explained ranged from a low of 0.003% (occupational code and total score) to 3.35%
(age and stress). Thus, for practical purposes, the influence of gender, occupation,
education and age on DASS scores can be ignored; the significant effects result from the
high statistical power conferred by a large sample size. This simplifies interpretation of
DASS scores, as these variables do not need to be taken into consideration.
The effects of gender on DASS scores were very modest; the largest effect was on the
depression scale, but even here gender only accounted for 0.41% of the variance in
scores. This result is surprising given that epidemiological studies generally report a
higher incidence of anxiety and depression in females (Horwath & Weissman, 1995;
Meltzer, Gill, Petticrew, & Hinds, 1995). It is not clear why substantial gender effects
did not emerge in the present study, but this finding is consistent with Lovibond and
Lovibond’s (1995) study in which gender effects were also very modest. The
explanation may lie in the combination of two factors. First, epidemiological studies
are concerned with caseness, in other words only with the number of individuals that
meet clinical criteria, rather than measuring milder manifestations of psychological
distress. Second, the DASS intentionally omits many of the symptoms that form part of
traditional psychiatric criteria (Lovibond & Lovibond, 1995).
Normative data
Despite the widespread use of the DASS in the English-speaking world, adequate
normative data for the English language version do not appear to have been presented
previously. Instead, interpretation of the DASS has been based primarily on norms
derived from a sample predominantly composed of students (Lovibond & Lovibond,

1995). The current study usefully complements this by providing normative data
derived from a sample known to be broadly representative of the general adult
population.
The tabulation method in Table 3 was adopted to permit conversion of raw scores to
percentiles for all three scales and the total scale using the same table. Because of this,
and because of the granularity of raw scores, it can be seen that, in a few cases, a given
raw score can correspond to more than one percentile (e.g. for the stress scale a raw
score of 8 spans the 50th to 55th percentiles). When this occurs the user should take
the highest percentile. Should clinicians or researchers prefer to express an individual’s
standing on the DASS as a normalized z score or T score, it would be a relatively simple
task to derive these from the percentile tables. For example, a raw score of 22 on the
DASS depression scale would convert to a T score of 66 or a z score of 1.64, given that
this raw score corresponds to the 95th percentile.
The only previous normative data for the DASS comes from Lovibond and Lovibond’s
(1995) Australian sample. The mean score in the present sample for depression was
5.55 (SD = 7.48), for anxiety 3.56 (SD = 5.39) and for stress 9.27 (SD = 8.04). These
means are slightly lower than the norms presented by Lovibond and Lovibond:
depression = 6.34 (SD = 6.97); anxiety = 4.70 (SD = 4.91) and stress = 10.11
(SD = 7.91). The minor differences may be because Lovibond and Lovibond’s data
were derived from a sample predominantly composed of students; there is evidence of
elevated rates of psychological disturbance in student populations (Boyle, 1985; Gotlib,
1984).
Competing models of the structure of the DASS

CFA was used to test competing models of the latent structure of the DASS. From the fit
statistics in Table 4, it is clear that the hypothesis that the DASS measures a single factor
(Models 1a and 1b) is untenable. Analogously, all the two-factor models (Models 2a–2c)
were associated with poor fits, although permitting correlated factors (Models 2b and
2c) and correlated error (Model 2c) each led to an improvement.
Model 3a represented a test of Lovibond and Lovibond’s (1995) three-factor
structure, but specified orthogonal factors. This model, as well as a model in which
correlated factors were permitted (Model 3b), represented poor fits, with large À2 and
low fit indices. However, both had a significantly better fit than their more constrained
one-factor counterparts (Models 1a and 1b, respectively) and Model 3b’s two-factor
counterpart (Model 2b). This indicates that it is untenable to view the DASS as
measuring only one or two dimensions; the stress scale represents a legitimate
construct in its own right. Model 3c, identical to Model 3b except for Brown et al.’s
(1997) empirically derived revisions, represented a significantly better fit than Model
3b. However, additionally permitting correlated error between related subscales
resulted in the optimal fitting model, as reflected by all criteria, even though some of
the subscales appear to consist of items that are heterogeneous in content.
The conclusion from the CFA modelling, therefore, is that, consistent with previous
empirical findings, the depression, anxiety and stress scales do represent legitimate
constructs in their own right. Moreover, the current study supports Brown et al.’s
(1997) findings that minor adjustments are required to optimize fit.
Reliabilities
The reliabilities of the DASS scales, as measured by Cronbach’s alpha, were .90 for
anxiety, .95 for depression, .93 for stress and .97 for the total scale. The narrowness of
the confidence limits associated with these coefficients indicates that they can be
regarded as providing very accurate estimates of the internal consistency of the DASS in
the general adult population. There is no absolute criterion for the reliability of an
instrument. However, as a rule of thumb, Anastasi (1990) has suggested that a should
be at least .85 if the intention is to use an instrument to draw inferences concerning an
individual. By this criterion all three DASS subscales and the total scale can be viewed as
possessing adequate reliability.
Convergent and discriminant validity of the DASS

The correlations between the anxiety and depression scales presented in Table 7, and
the inferential statistical methods used to analyse them, suggest that the convergent
validity of the DASS is superior to the other scales examined (e.g. the DASS scales’
correlations with the other scales were significantly higher than the correlation
between the other scales in three out of the four comparisons). The discriminant
validity of scales is generally assessed by examining the magnitude of their correlations
with measures of other constructs; a high correlation is taken as evidence of poor
discriminant validity. However, in the present case there are strong theoretical grounds
and empirical evidence that anxiety and depression are far from independent
constructs; it is an invariant finding that such scales are highly correlated. Therefore
it would have been very surprising if the DASS had bucked this trend. Moreover, the
DASS scales were developed to maximize the breadth of each construct, in addition to
differentiating between them. However, there was nevertheless some evidence for
discriminant validity in that the within-construct correlations involving the DASS and
the other self-report scales were all significantly higher than the corresponding
between-construct correlations.
There is some overlap between Lovibond and Lovibond’s (1995) conception of stress
as measured by their stress scale, and the construct of negative affectivity. The question
therefore arises whether stress is in fact equivalent to NA. The correlation between the
NA and stress scales was significantly higher than NA’s correlation with the other DASS
scales. This is consistent with the overlap referred to above. However, the magnitude of
the difference between these correlations was relatively modest (the significant effect is
more a reflection of the higher statistical power conferred by the large sample size).
Furthermore, it is clear from the absolute magnitude of the correlation between NA and
stress (.67) that, although the constructs are associated, they cannot be viewed as
interchangeable. This correlation is attenuated by measurement error in the NA and
stress scales but, as both instruments are very reliable, the degree of attenuation is
modest. When a correction for attenuation4 was applied to the correlation (Nunnally &
Bernstein, 1994), it rose to .75. Therefore, the present results indicate that, even if the
constructs could be measured without error, only 56% of the variance would be shared
variance.
Independent evidence that stress, as measured by the DASS, should not be regarded
as synonymous with NA comes from Lovibond’s (1998) study of the long-term temporal
4
The reliability coefficients (Cronbach’s alpha) used in this formula were calculated in the present sample: a for the stress
scale is reported in the text; a for the NA scale was .85.
stability of the DASS. If the stress scale is simply an index of non-specific vulnerability to
distress (i.e. NA), then stress scores at Time 1 should have been a more powerful
predictor of anxiety at Time 2 than was depression, and a more powerful predictor of
depression scores at Time 2 than was anxiety. Neither of these two patterns was
observed, yet stress scores at Time 1 were relatively good predictors of stress scores at
Time 2.
Conclusions and future research

To conclude, the DASS has been shown to possess impressive psychometric properties
in a large sample drawn from the general adult population. The results from CFA
modelling strongly support the construct validity of the DASS scales, and the reliabilities
of all three scales and the total scale were excellent. The normative data presented here
should serve as useful supplements to existing normative data as they are based on a
sample that was broadly representative of the general adult population in terms of age,
gender and social class. The present norms are also, to our knowledge, the only UK
norms currently available.
Although beyond the scope of the present investigation, it would be valuable
formally to examine whether the DASS is factorially invariant. In the present study, for
example, it was shown that the demographic variables (e.g. age and gender) exerted
only a negligible effect on DASS scores. However, simultaneous multi-group CFA could
also be employed to test whether the latent structure is invariant across age groups and
gender (see Byrne, 1989, 1994). More importantly, this method could be used to
examine whether the DASS is factorially invariant across cultures and across healthy and
clinical populations. Examination of this latter issue would not only provide important
information for those using the DASS in research or practice, but would also constitute
a stringent test on the broader theoretical question of whether the constructs of
anxiety, depression and stress should be viewed as continua rather than syndromes.
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YBOCS Yale-Brown Obsessive Compulsive Scale For OCD

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PATIENT 22.

Questions 1 to 5 are about your obsessive thoughts

Please answer each question by circling the appropriate number.

1. TIME OCCUPIED BY OBSESSIVE THOUGHTS SCORE __________

2. INTERFERENCE DUE TO OBSESSIVE THOUGHTS SCORE __________

3. DISTRESS ASSOCIATED WITH OBSESSIVE THOUGHTS SCORE __________

4. RESISTANCE AGAINST OBSESSIONS SCORE __________

The next several questions are about your compulsive behaviors.

6. TIME SPENT PERFORMING COMPULSIVE BEHAVIORS SCORE __________

7. INTERFERENCE DUE TO COMPULSIVE BEHAVIORS SCORE __________

9. RESISTANCE AGAINST COMPULSIONS SCORE __________

10. DEGREE OF CONTROL OVER COMPULSIVE BEHAVIOR SCORE __________

TOTAL SCORE ______________

RELIGIOUS OBSESSIONS (Scrupulosity)

WAYNE K. GOODMAN, M.D.1

NATIONAL INSTITUTE OF MENTAL HEALTH1

THE CHILD STUDY CENTER2

CHILD PSYCHIATRY DIVISION4

CHILD PSYCHIATRY BRANCH5

Symptom Specificity and Continuity:

Current Past Contamination Obsessions

Magical Thoughts/Superstitous Obsessions

Religious Obsessions (Scrupulosity)

TARGET SYMPTOM LIST FOR OBSESSIONS

1. Time Occupied by Obsessive Thoughts

1 - MILD less than 1 hr/day or occasional intrusion

2 - MODERATE 1 to 3 hrs/day or frequent intrusion

3 - SEVERE greater than 3 and up to 8 hrs/day or very frequent intrusion

4 - EXTREME greater than 8 hrs/day or near constant intrusion

1B. Obsession-free Interval (not included in total score)

2 - MODERATE moderately long symptom-free intervals, more than 3 and up to 8 hrs/day

3 - SEVERE brief symptom-free intervals, from 1 to 3 consecutive hrs/day symptom-free

4 - EXTREME less than 1 consecutive hr/day symptom free

2. Interference due to Obsessive Thoughts

3 - SEVERE causes substantial impairment in social or school performance

1 - MILD infrequent, and not too disturbing

2 - MODERATE frequent, and disturbing, but still manageable

3 - SEVERE very frequent, and very disturbing

4 - EXTREME near constant, and disabling distress/frustration

4. Resistance Against Obsessions

1 - MILD tries to resist most of the time

2 - MODERATE makes some effort to resist

4 – EXTREME completely and willingly yields to all obsessions

5. Degree of Control Over Obsessive Thoughts

2 - MODERATE CONTROL sometimes able to stop or divert obsessions

4 - NO CONTROL experienced as completely involuntary, rarely able to even momentarily divert

Current Past Washing/Cleaning Compulsions

Excessive Games/Superstitious Behaviors

TARGET SYMPTOM LIST FOR COMPULSIONS

6A. Time Spent Performing Compulsive Behaviors

1 - MILD (spends less than 1 hr/day performing compulsions), or occasional performance of

2 - MODERATE (spends from 1 to 3 hrs/day performing compulsions), or frequent performance of

3 - SEVERE (spends more than 3 and up to 8 hrs/day performing compulsions), or very

4 - EXTREME (spends more than 8 hrs/day performing compulsions), or near constant

6B. Compulsion-free Interval

1 - MILD long symptom-free interval, more than 8 consecutive hrs/day symptom-free

2 - MODERATE moderately long symptom-free interval, more than 3 and up to 8 consecutive

3 - SEVERE short symptom-free interval, from 1 to 3 consecutive hrs/day symptom free

Age –.036 –.109 –.183 –.147**