APA DSM5TR Level2RepetitiveThoughtsAndBehaviorsAdult

The APA is offering a number of “emerging measures” for further research and
clinical evaluation. These patient assessment measures were developed to be

administered at the initial patient interview and to monitor treatment progress.
They should be used in research and evaluation as potentially useful tools to
enhance clinical decision-making and not as the sole basis for making a clinical
diagnosis. Instructions, scoring information, and interpretation guidelines are
provided; further background information can be found in DSM-5-TR. The APA
requests that clinicians and researchers provide further data on the
instruments’ usefulness in characterizing patient status and improving patient
care at http://www.dsm5.org/Pages/Feedback-Form.aspx.
Measure: LEVEL 2—Repetitive Thoughts and Behaviors—Adult (adapted from the

Florida Obsessive-Compulsive Inventory [FOCI] Severity Scale [Part B])
Rights granted: This material can be reproduced without permission by
clinicians for use with their own patients. Any other use, including electronic
use, requires written permission from Dr. Goodman.
Rights holder: © 1994 Wayne K. Goodman, MD, and Eric Storch, PhD.
To request permission for any other use beyond what is stipulated above,
contact: Wayne K. Goodman, MD ([email protected])
LEVEL 2—Repetitive Thoughts and Behaviors—Adult*
*Adapted from the Florida Obsessive-Compulsive Inventory (FOCI) Severity Scale (Part B)
Name: ___________________________ Age: ____ Date:_____________
If the measure is being completed by an informant, what is your relationship with the individual receiving care? __________________
In a typical week, approximately how much time do you spend with the individual receiving care? __________________ hours/week
Instructions: On the DSM-5-TR Level 1 cross-cutting questionnaire that you just completed, you indicated that during the past 2
weeks you have been bothered by “unwanted repeated thoughts, images, or urges” and/or “being driven to perform certain
behaviors or mental acts over and over” at a mild or greater level of severity. The questions below ask about these feelings in
more detail and especially how often you have been bothered by a list of symptoms during the past 7 days. Please respond to
each item by marking ( or x) one box per row.
Clinician
Use
Item
During the past SEVEN (7) DAYS….
Score
1. On average, how much     
time is occupied by these 0—None 1—Mild 2—Moderate 3—Severe 4—Extreme
thoughts or behaviors (Less than an (1 to 3 hours a day) (3 to 8 hours a day) (more than 8
each day? hour a day) hours a day)
2. How much distress do     
these thoughts or 0—None 1—Mild 2—Moderate 3—Severe (very 4—Extreme
behaviors cause you? (slightly (disturbing but still disturbing) (overwhelming
disturbing) manageable) distress)
3. How hard is it for you to     
control these thoughts or 0—Complete 1—Much control 2—Moderate control 3—Little control 4—No control
behaviors? control (usually able to (sometimes able to (infrequently able (unable to
control thoughts control thoughts or to control thoughts control thoughts
or behaviors) behaviors) or behaviors) or behaviors)
4. How much do these     
thoughts or behaviors 0—No 1—Mild 2—Moderate 3—Severe 4 - Extreme
cause you to avoid doing avoidance (occasional (regularly avoid (frequent and (nearly complete
anything, going anyplace, avoidance) doing these things) extensive avoidance;
or being with anyone? avoidance) house- bound)
5. How much do these     
thoughts or behaviors 0—None 1—Mild 2— Moderate; 3—Severe 4—Extreme
interfere with school, (slight (definite (substantial (near-total
work, or your social or interference) interference interference) interference;
family life? with functioning, but incapacitated)
still manageable)
Total/Partial Raw Score:
Prorated Total Raw Score (if 1 item is left unanswered):
Average Total Score:
© 1994 Wayne K. Goodman, MD and Eric Storch, PhD. This material can be reproduced without permission by clinicians for use with their own patients.
Any other use, including electronic use, requires written permission from Dr. Goodman ([email protected])
Instructions to Clinicians
The DSM-5-TR Level 2—Repetitive Thoughts and Behavior—Adult measure is an adapted version of the 5-item
Florida Obsessive-Compulsive Inventory (FOCI) Severity Scale (Part B) that is used to assess the domain of
repetitive thoughts and behaviors in individuals age 18 and older. The measure is completed by an individual
prior to a visit with the clinician. If the individual receiving care is of impaired capacity and unable to complete
the form (e.g., an individual with dementia), a knowledgeable informant may complete the measure. Each
item asks the individual (or informant) to rate the severity of the individual’s repetitive thoughts and behaviors
during the past 7 days.
Scoring and Interpretation

Each item on the measure is rated on a 5-point scale (i.e., 0 to 4) with the response categories having different
anchors depending on the item. The total score for the measure can range of score from 0 to 20, with higher
scores indicating greater severity of repetitive thoughts and behaviors. The clinician is asked to review the
score of each item on the measure during the clinical interview and indicate the raw score for each item in the
section provided for “Clinician Use.” The raw scores on the 5 items should be summed to obtain a total raw
score. If the individual has a score of 8 or higher, you may want to consider a more detailed assessment for an
obsessive compulsive disorder. In addition, the clinician is asked to calculate and use the average total score.
The average total score reduces the overall score to a 5-point scale, which allows the clinician to think of the
individual’s repetitive thoughts and behavior in terms of none (0), mild (1), moderate (2), severe (3), or
extreme (4). The use of the average total score was found to be reliable, easy to use, and clinically useful to the
clinicians in the DSM-5 Field Trials. The average total score is calculated by dividing the raw total score by
number of items in the measure (i.e., 5).
Note: If 2 or more items are left unanswered on the measure (i.e., more than 25% of the total items are
missing), the total scores should not be calculated. Therefore, the individual (or informant) should be
encouraged to complete all of the items on the measure. If only 4 of the 5 items on the measure are answered,
you are asked to prorate the raw score by first summing the scores of items that were answered to get a
partial raw score. Next, multiply the partial raw score by the total number of items on the measure (i.e., 5).
Finally, divide the value by the number of items that were actually answered (i.e., 4) to obtain the prorated
total raw score.
Prorated Score = (Partial Raw Score x number of items on the measure)

Number of items that were actually answered
If the result is a fraction, round to the nearest whole number.
Frequency of Use
To track change in the severity of the individual’s repetitive thoughts and behavior over time, the measure
may be completed at regular intervals as clinically indicated, depending on the stability of the individual’s
symptoms and treatment status. For individuals of impaired capacity, it is preferred that completion of the
measure at follow-up appointments is by the same knowledgeable informant. Consistently high scores on the
measure may indicate significant and problematic areas for the individual that might warrant further
assessment, treatment, and follow-up. Your clinical judgment should guide your decision.
Instructions, scoring, and frequency of use on this page only: Copyright © 2013 American Psychiatric Association. All rights reserved.
This material can be reproduced without permission by researchers and by clinicians for use with their patients.

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The APA is offering a number of “emerging measures” for further research and

clinical evaluation. These patient assessment measures were developed to be

Measure: LEVEL 2—Repetitive Thoughts and Behaviors—Adult (adapted from the

Name: _______________ Age: Date:_

Scoring and Interpretation

Prorated Score = (Partial Raw Score x number of items on the measure)

If the result is a fraction, round to the nearest whole number.

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