Our Ref: FOI/15/194. Date: 23 December Via Dear A.E. Freedom of Information Request

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1 Our Ref: FOI/15/194 Date: 23 December 2015 Trust Headquarters Swandean Arundel Road Worthing West Sussex BN13 3EP Tel: Via Dear A.E Freedom of Information Request Thank you for your dated 21 November 2015 requesting further information on our response to FOI/15/099. The answers to your questions are shown below. Question 1: 8) Your response: Answer 2 All assessments include clinical tools and adhere to best practice." Bearing in mind that the NBC manager (or female member of staff representing the manager at the time) stated on the telephone during July 2012, that "this is the way assessments are done" when it was specifically queried why the assessments in question were undertaken without clinical tools and not having met BMJ best practice in place at the time ( this further evidences that your FOI response Answer 2 is incorrect. Please provide a response in line with evidence supplied. Answer 1: We reiterate that all assessments include clinical tools and adhere to best practice. We have attached the tools used by the Multi-Discipinary Team although the AS-IS Self- Report would not have been in use at the time of this assessment. I hope this information is helpful. However if you are dissatisfied with the handling of your request, you have the right to ask for an internal review. Internal review requests should be submitted within two months of the date you received the response to your original request and should be addressed to: Colm Donaghy Chair: Caroline Armitage Chief Executive: Colm Donaghy Head office: Sussex Partnership NHS Foundation Trust, Swandean, Arundel Road, Worthing, West Sussex, BN13 3EP

2 Chief Executive Sussex Partnership NHS Foundation Trust Swandean Arundel Road Worthing West Sussex BN13 3EP Please remember to quote the reference number above in any future communications. If you are not content with the outcome of the internal review, you have the right to apply directly to the Information Commissioner for a decision. The Information Commissioner can be contacted at: Information Commissioner s Office Wycliffe House Water Lane Wilmslow Cheshire SK9 5AF Yours sincerely Natalie Hennings Corporate Governance Manager

3 AS-IS Self Report Questionnaire (based on DSM IV and V) (Stott & Childs 2012) To be used with adult individuals who can self report and excluding those with significant learning disability or other cognitive deficits. Please write your experiences about each of the headers below. You can write as much or as little detail as you like, but we would encourage you not to over-analyze your answers too much or worrying about the answer being perfect. For each header there are examples to help you think about the type of information that may be important. You can use the space provided or add additional sheets if necessary. The answers you write will be used as a basis for the face to face interview, which is part of your assessment process. You can either write your answers by hand, or contact me for an electronic version (Bettina.stott@sussexpartnership.nhs.uk). Please return your completed questionnaire by or post to: Autistic Spectrum Conditions Service Highdown Swandean Arundel Road Worthing BN13 3EP Tel: Your name: Date:

4 1. Please write about your experiences of friendships and relationships How often do you see your friends face to face? What do you do with them? How long have you known them? Are friendships important to you? Is it easy for you to make and keep friends? Has it always been like this? 2. Please write about your experiences of using and understanding non-verbal communication Examples of non-verbal communication include eye-contact, gestures, facial expressions, body language and tone of voice. Do you use and understand sarcasm and joke? Has it always been like this?

5 3. Please write about your experiences of understanding other people and social situations How easy is it for you to hold conversations? Do you like talking to others? What do you think of Small Talk? Is it easy for you to be and cope in groups? Do you prefer to pursue your hobbies on your own or with other people? Is it easy for you to make sense of the way other people feel or why they think or behave in a certain way? Has it always been like this? 4. Please write about how you cope with change. Is change something you are comfortable with and enjoy? How easy is it to try new things? Do you like doing things the same way and following routines? Can you give examples and write why? Has it always been like that?

6 5. Please write about your interests, collections and hobbies. Do you have any, what are they and how much time do you spend doing them? Do you like doing them on your own or with other people? Has it always been like that? 6. Please write about how you think. Do you think about things in a detailed and analytical way? Do you sometimes find yourself getting stuck and thinking about things over and over? Do you like to organise and plan things carefully? Is it easy for you to change your opinion? Has it always been like this?

7 7. Please write about your experiences of anxiety. Do you worry about things a lot? What sort of things do you worry about? What do you do when you are worried and how do you cope with it? Has it always been like this? 8. Please write about your sensory experiences. Do you have any unusual reactions to sound, vision, touch, taste and smell? Are any of these experiences particularly pleasant or unpleasant? Are you clumsy or bump into things or trip over things a lot? Has it always been like this?

8 9. Everyday functioning Have the things you wrote about impacted on your employment, education and ability to get on with other people? Has it always been like this?

9 Ritvo Autism Asperger s Diagnostic Scale Revised RAADS-R (Riva Ariella Ritvo, Ph.D. and Edward Ritvo, M.D., 2007) There are 80 questions over the next 5 pages. It will take about one hour to answer all the questions. Please tick the box that best describes how true some life experiences and personal characteristics are of you. Please answer all the statements. Tick only one answer per question. Use the following key to mark your responses: Always True - you have always been like this, now and when you were young True only now you are only like this since you are an adult or only true in recent years True only when I was younger you used to be like this only before the age of 16 Never true you have never been like this Once you have completed this questionnaire please keep it safe and bring it with you to your next appointment. The questions start on the next page.

10 Life Experiences and personal characteristics Always True 1* I am a sympathetic person. True only now True only when I was younger Never True 2 I often use words and phrases from movies and TV in conversations. 3 I am often surprised when others tell me I have been rude. 4 Sometimes I talk too loudly or too softly, and I am not aware of it. 5 I often don t know how to act in social situations. 6* I can put myself in other people s shoes. 7 I have a hard time working out what some phrases mean, like you are the apple of my eye. 8 I only like to talk to people who share my special interests. 9 I focus on details rather than the overall idea. 10 I always notice how food feels like in my mouth. This is more important to me than how it tastes. 11* I miss my best friends or family when we are apart for a long time. 12 Sometimes I offend others by saying what I am thinking, even if I don t mean to. 13 I only like to think and talk about a few things that interest me. 14 I d rather go out to eat in a restaurant by myself than with someone I know. 15 I cannot imagine what it would be like to be someone else. 16 I have been told that I am clumsy or uncoordinated. 17 Others consider me odd or different. 18* I understand when friends need to be comforted. 19 I am very sensitive to the way my clothes feel when I touch them. How they feel is more important to me than how they look.

11 Life Experiences and personal characteristics Always True 20 I like to copy the way certain people speak and act. It helps me to appear more normal. True only now True only when I was younger Never True 21 It can be very intimidating for me to talk to more than one person at the same time. 22 I have to act normal to please other people and make them like me. 23* Meeting new people is usually easy for me. 24 I get highly confused when someone interrupts me when I am talking about something I am very interested in. 25 I can be difficult for me to understand how other people are feeling when we are talking. 26* I like having a conversation with several people, i.e. around the dinner table, at school or work. 27 I take things too literally, so I often miss what people are trying to say. 28 It is very difficult for me to understand when someone is embarrassed or jealous. 29 Some ordinary textures that do not bother others feel very offensive when they touch my skin. 30 I get extremely upset when the way I like to do things is suddenly changed. 31 I have never wanted or needed to have what other people all an intimate relationship. 32 It is difficult for me to start and stop a conversation. I need to keep going until I am finished. 33* I speak with a normal rhythm. 34 The same sound, colour or texture can suddenly change from very sensitive to very dull. 35 The phrase I ve got you under my skin makes me very uncomfortable. 36 Sometimes the sound of a word or high-pitched noise can be painful to my ears.

12 Life Experiences and personal characteristics Always True 37* I am an understanding type of person. True only now True only when I was younger Never True 38 I do not connect with characters in movies and cannot feel what they feel. 39 I cannot tell when someone is flirting with me. 40 I can see in my mind in exact detail things that I am interested in. 41 I keep lists of things that interest me, even when they have no practical use (i.e. sports statistics, train schedules, calendar dates, historical facts and dates) 42 When I feel overwhelmed by my senses, I have to isolate myself to shut them down. 43* I like to talk things over with my friends. 44 I cannot tell if someone is interested or bored with what I am saying. 45 It can be very hard to read someone s face, hand and body movements when they are talking. 46 The same things (like clothes or temperatures) can feel very different to me at different times. 47* I feel very comfortable with dating or being in social situations with others. 48* I try to be as helpful as I can when other people tell me their personal problems. 49 I have been told that I have an unusual voice (i.e. flat, monotone, childish or high-pitched). 50 Sometimes a thought or a subject gets stuck in my mind and I have to talk about it even if no one is interested. 51 I do certain things with my hands over and over again (i.e. flapping, twirling things, waving things by my eyes). 52 I have never been interested in what most of the people I know consider interesting. 53* I am considered a compassionate type of person.

13 Life Experiences and personal characteristics Always True 54 I get along with other people by following a set of specific rules that help me to look normal. True only now True only when I was younger Never True 55 It is very difficult for me to work and function in groups. 56 When I am talking to someone, it is hard to change the subject. If the other person does so, I can get very upset or confused. 57 Sometimes I have to cover my ears to block out painful noises (i.e. hoover or people talking too much or too loudly). 58* I can chat and make Small Talk with people. 59 Sometimes things that should feel painful are not (i.e. when I hurt or burn myself). 60 When I am talking to someone I find it difficult to know when it is my turn to talk or listen. 61 I am considered a loner by those who know me best. 62* I usually speak in a normal tone. 63 I like things to be exactly the same day after day and even small changes in my routine upset me. 64 How to make friends and socialise is a mystery to me. 65 It calms me to spin around or to rock I a chair when I am feeling stressed. 66 The phrase He wears his heart on his sleeve does not make sense to me. 67 If I am in a place where there are many smells, textures to feel, noises or bright lights, I feel anxious or frightened. 68* I can tell when someone says one thing but means something else. 69 I like to be by myself as much as I can. 70 I keep my thoughts stacked in my memory like they are on filing cards and pick out the ones I need by looking through the stack and finding the right one (or in another unique way),.

14 Life Experiences and personal characteristics Always True 71 The same sound sometimes seems very loud or very soft, even though I know it has not changed. True only now True only when I was younger Never True 72* I enjoy spending time eating and talking with my family and friends. 73 I can t tolerate things I dislike (like smells, textures, sounds or colours). 74 I don t like to be hugged or held. 75 When I go somewhere, I have to follow a familiar route or I can get very confused or upset. 76 It is difficult to figure out what other people expect of me. 77* I like to have close friends. 78 People tell me that I give too much detail. 79 I am often told that I ask embarrassing questions. 80 I tend to point out other people s mistakes. Thank you for completing this questionnaire.

15 The Adult Autism Spectrum Quotient (AQ) NAME: Below are a list of statements. Please read each statement very carefully and rate how you or dis with it by circling your answer to the right of each statement. 1 I prefer to do things with others rather than on my own. dis dis 2 I prefer to do things the same way over and over again. dis dis 3 If I try to imagine something, I find it very easy to create a picture in my mind. dis dis 4 I frequently get so absorbed in one thing that I lose sight of other things. dis dis 5 I often notice small sounds when others do not. dis dis 6 I usually notice car number plates or similar strings of information. dis dis 7 Other people frequently tell me that what I ve said is impolite, even though I think it is polite. dis dis 8 When I m reading a story, I can easily imagine what the characters might look like. dis dis 9 I am fascinated by dates. dis dis 10 In a social group, I can easily keep track of several different people s conversations. dis dis 11 I find social situations easy. dis dis 12 I tend to notice details that others do not. dis dis 13 I would rather go to a library than a party. dis dis 14 I find making up stories easy. dis dis 15 I find myself drawn more to people than to things. dis dis 16 I tend to have very strong interests which I get upset about if I can t pursue. dis dis 17 I enjoy social chit-chat. dis dis

16 18 When I talk, it isn t always easy for others to get a word in edgeways. dis dis 19 I am fascinated by numbers. dis dis 20 When I m reading a story, I find it difficult to work out the characters intentions. dis dis 21 I don t particularly enjoy reading fiction. dis dis 22 I find it hard to make new friends. dis dis 23 I notice patterns in things all the time. dis dis 24 I would rather go to the theatre than a museum. dis dis 25 It does not upset me if my daily routine is disturbed. dis dis 26 I frequently find that I don t know how to keep a conversation going. dis dis 27 I find it easy to read between the lines when someone is talking to me. dis dis 28 I usually concentrate more on the whole picture, rather than the small details. dis dis 29 I am not very good at remembering phone numbers. dis dis 30 I don t usually notice small changes in a situation, or a person s appearance. dis dis 31 I know how to tell if someone listening to me is getting bored. dis dis 32 I find it easy to do more than one thing at once. dis dis 33 When I talk on the phone, I m not sure when it s my turn to speak. dis dis 34 I enjoy doing things spontaneously. dis dis 35 I am often the last to understand the point of a joke. dis dis 36 I find it easy to work out what someone is thinking or feeling just by looking at their face. dis dis 37 If there is an interruption, I can switch back to what I was doing very quickly. dis dis

17 38 I am good at social chit-chat. dis dis 39 People often tell me that I keep going on and on about the same thing. dis dis 40 When I was young, I used to enjoy playing games involving pretending with other children. dis dis 41 I like to collect information about categories of things (e.g. types of car, types of bird, types of train, types of plant, etc.). dis dis 42 I find it difficult to imagine what it would be like to be someone else. dis dis 43 I like to plan any activities I participate in carefully. dis dis 44 I enjoy social occasions. dis dis 45 I find it difficult to work out people s intentions. dis dis 46 New situations make me anxious. dis dis 47 I enjoy meeting new people. dis dis 48 I am a good diplomat. dis dis 49 I am not very good at remembering people s date of birth. dis dis 50 I find it very easy to play games with children that involve pretending. dis dis

18 The Cambridge Behaviour Scale (EQ) Name: How to fill out the questionnaire: Below are a list of statements. Please read each statement very carefully and rate how you or dis with it by circling your answer. There are no right or wrong answers, or trick questions. 1 I can easily tell if someone else wants to enter a conversation. dis dis 2 I prefer animals to humans. dis dis 3 I try to keep up with the current trends and fashions. dis dis 4 I find it difficult to explain to others things that I understand easily, when they don't understand it first time. dis dis 5 I dream most nights. dis dis 6 I really enjoy caring for other people. dis dis 7 I try to solve my own problems rather than discussing them with others. dis dis 8 I find it hard to know what to do in a social situation. dis dis 9 I am at my best first thing in the morning. dis dis 10 People often tell me that I went too far in driving my point home in a discussion. dis dis It doesn't bother me too much if I am late meeting a friend. dis dis 12 Friendships and relationships are just too difficult, so I tend not to bother with them. dis dis 13 I would never break a law, no matter how minor. dis dis 14 I often find it difficult to judge if something is rude or polite. dis dis 15 In a conversation, I tend to focus on my own thoughts rather than on what my listener might be thinking. dis dis 16 I prefer practical jokes to verbal humour. dis dis 17 I live life for today rather than the future. dis dis

19 18 When I was a child, I enjoyed cutting up worms to see what would happen. dis dis 19 I can pick up quickly if someone says one thing but means another. dis dis 20 I tend to have very strong opinions about morality. dis dis 21 It is hard for me to see why some things upset people so much. dis dis 22 I find it easy to put myself in somebody else's shoes. dis dis 23 I think that good manners are the most important thing a parent can teach their child. dis dis 24 I like to do things on the spur of the moment. dis dis 25 I am good at predicting how someone will feel. dis dis 26 I am quick to spot when someone in a group is feeling awkward or uncomfortable. dis dis 27 If I say something that someone else is offended by, I think that that's their problem, not mine. dis dis 28. If anyone asked me if I liked their haircut, I would reply truthfully, even if I didn't like it. dis dis 29 I can't always see why someone should have felt offended by a remark. dis dis 30 People often tell me that I am very unpredictable. dis dis 31 I enjoy being the centre of attention at any social gathering. dis dis 32 Seeing people cry doesn't really upset me. dis dis 33 I enjoy having discussions about politics. dis dis 34 I am very blunt, which some people take to be rudeness, even though this is unintentional. dis dis 35 I don t tend to find social situations confusing. dis dis 36 Other people tell me I am good at understanding how they are feeling and what they are thinking. dis dis 37 When I talk to people, I tend to talk about their experiences rather than my own. dis dis

20 38 It upsets me to see an animal in pain. dis dis 39 I am able to make decisions without being influenced by people's feelings. dis dis 40 I can't relax until I have done everything I had planned to do that day. dis dis 41 I can easily tell if someone else is interested or bored with what I am saying. dis dis 42 I get upset if I see people suffering on news programmes. dis dis 43 Friends usually talk to me about their problems as they say that I am very understanding. dis dis 44 I can sense if I am intruding, even if the other person doesn't tell me. dis dis 45 I often start new hobbies but quickly become bored with them and move on to something else. dis dis 46 People sometimes tell me that I have gone too far with teasing. dis dis 47 I would be too nervous to go on a big rollercoaster. dis dis 48 Other people often say that I am insensitive, though I don t always see why. dis dis 49 If I see a stranger in a group, I think that it is up to them to make an effort to join in. dis dis 50 I usually stay emotionally detached when watching a film. dis dis 51 I like to be very organised in day to day life and often make lists of the chores I have to do. dis dis 52 I can tune into how someone else feels rapidly and intuitively. dis dis 53 I don't like to take risks. dis dis 54 I can easily work out what another person might want to talk about. dis dis 55 I can tell if someone is masking their true emotion. dis dis 56 Before making a decision I always weigh up the pros and cons. dis dis 57 I don't consciously work out the rules of social situations. dis dis

21 58 I am good at predicting what someone will do. dis dis 59 I tend to get emotionally involved with a friend's problems. dis dis 60 I can usually appreciate the other person's viewpoint, even if I don't with it. dis dis

22 As a Child I Was (or Had): Wender Utah Rating Scale 1 Active, restless, always on the go 2 Afraid of things 3 Concentration problems, easily distracted 4 Anxious, worrying 5 Nervous, fidgety 6 Inattentive, daydreaming 7 Hot or short tempered, low boiling point 8 Shy, sensitive 9 Temper outbursts, tantrums 10 Trouble with stick-to-it-tiveness, not following through, failing to finish things started 11 Stubborn, strong willed 12 Sad or blue, depressed, unhappy 13 Uncautious, dare-devilish, involved in pranks 14 Not getting a kick out of things, dissatisfied with life 15 Disobedient with parents, rebellious, sassy 16 Low opinion of myself 17 Irritable 18 Outgoing, friendly, enjoying company of people 19 Sloppy, disorganised 20 Moody, have ups and downs 21 Feel angry

23 22 Have friends, popular 23 Well organised, tidy, neat 24 Acting without thinking, impulsive 25 Tend to be immature 26 Feel guilty, regretful 27 Lose control of myself 28 Tend to be or act irrational 29 Unpopular with other children, didn t keep friends for long, didn't get along with other children 30 Poorly coordinated, did not participate in sports 31 Afraid of losing control of self 32 Well coordinated, picked first in games 33 (For women only) Tomboyish 34 Ran away from home 35 Get in fights 36 Teased other children 37 Leader, bossy 38 Difficulty getting awake 39 Follower, lead around too much 40 Trouble seeing things from someone else's point of view 41 Trouble with authorities, trouble with school, visit to the principal's office 42 Trouble with the police, booked, convicted

24 Medical Problems as a Child: 43 Headaches 44 Stomach aches 45 Constipation 46 Diarrhea 47 Food allergies 48 Other allergies 49 Bedwetting As a Child in School: 50 Overall a good student, fast 51 Overall a poor student, slow learner 52 Slow reader 53 Slow in learning to read 54 Trouble reversing letters 55 Trouble with spelling 56 Trouble with math or numbers 57 Bad handwriting 58 Though I could read pretty well, I never really enjoyed reading 59 Did not achieve up to potential 60 Repeated grades (which grades?) 61 Suspended or expelled (which grades?)

25 CAARS-Self-Report: Long Version (CAARS-S:L) Listed below are items concerning behaviours or problems sometimes experienced by adults. Read each item carefully and decide how much or how frequently each item describes you recently. Indicate your response for each item by circling the answer that corresponds to your choice. 1 I like to do active things. Pretty 2 I lose things necessary for tasks or activities (e.g. to-do lists, pencils, books, or tools). Pretty 3 I don t plan ahead. Pretty 4 I blurt out things. Pretty 5 I am a risk-taker or daredevil. Pretty 6 I get down on myself. Pretty 7 I don t finish things I start. Pretty 8 I am easily frustrated. Pretty 9 I talk too much. Pretty 10 I am always on the go, as if driven by a motor. Pretty 11 I am disorganised. Pretty 12 I say things without thinking. Pretty 13 It's hard for me to stay in one place very long. Pretty 14 I have trouble doing leisure activity quietly. Pretty 15 I'm not sure of myself. Pretty 16 It's hard for me to keep track of several things art once. Pretty 17 I'm always moving even when I should be still. Pretty

26 18 I forget to remember things. Pretty 19 I have a short fuse/hot temper. Pretty 20 I'm bored easily. Pretty 21 I leave my seat when I am not supposed to. Pretty 22 I have the trouble waiting in line or taking turns with others. Pretty 23 I still throw tantrums. Pretty 24 I have trouble keeping my attention focused when working. Pretty 25 I seek out fast paced, exciting activities. Pretty 26 I avoid new challenges because I lack faith in my abilities. Pretty 27 I feel restless inside even if I am sitting still. Pretty 28 Things I hear or see distract me from what I'm doing. Pretty 29 I am forgetful in my daily activities. Pretty 30 Many things set me off easily. Pretty 31 I dislike quiet, introspective activities. Pretty 32 I lose things that I need. Pretty 33 I have trouble listening to what other people are saying. Pretty 34 I am an underachiever. Pretty 35 I interrupt others when talking. Pretty 36 I change plans/jobs in midstream. Pretty 37 I act OK on the outside, but inside I'm unsure of myself. Pretty

27 38 I am always on the go. Pretty 39 I make comments/remarks that I wish I could take back. Pretty 40 I can t get things done unless there is an absolute deadline. Pretty 41 I fidget (with my hands or feet) or squirm in my seat. Pretty 42 I make carless mistakes or have trouble paying close attention to detail. Pretty 43 I step on peoples toes without meaning to. Pretty 44 I have trouble getting started on a task. Pretty 45 I intrude on other's activities. Pretty 46 It takes a great deal of effort for me to sit still. Pretty 47 My moods are unpredictable. Pretty 48 I don't like homework or job activities that make me think a lot. Pretty 49 I'm absent minded in daily activities. Pretty 50 I am restless or overactive. Pretty 51 I depend on others to keep my life in order and attend to the details. Pretty 52 I annoy other people without meaning to. Pretty 53 Sometimes my attention narrows so much that I'm oblivious to everything else; other times it's so broad that everything distracts me. Pretty 54 I tend to squirm or fidget. Pretty 55 I can t keep my mind on something unless it's really interesting. Pretty 56 I wish I had greater confidence in my abilities. Pretty 57 I can t sit still for very long. Pretty

28 58 I give answers to questions before the questions have been completed. Pretty 59 I like to be up and on the go rather than being in one place. Pretty 60 I have trouble finishing tasks or schoolwork. Pretty 61 I am irritable. Pretty 62 I interrupt others when they are working ort playing. Pretty 63 My past failures make it hard for me to believe in myself. Pretty 64 I am distracted when things are going on around me. Pretty 65 I have problems organising my tasks and activities. Pretty 66 I misjudge how long it takes to do something or go somewhere. Pretty

29 Y-BOCS Symptom Checklist The following are a list of common obsessions and compulsions which people with your problem sometimes have difficulty with. Please answer each question by putting a tick in the appropriate box. We are interested in both your current and your past symptoms. Clearly mark the principal symptoms with a "P" AGGRESSIVE OBSESSIONS Current Past Fear might harm self Fear might harm others 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 friend) Fear will steal things Fear will harm others because not careful enough (e.g. Hit/run MVA) Fear will be responsible for something else terrible happening (e.g. fire/burglary) Other: CONTAMINATION OBSESSIONS Current Past Concerns or disgust with bodily waste or secretions (e.g. urine, faeces, saliva) Concern with dirt or germs Excessive concern with environmental contaminants (asbestos, radiation, toxic waste) Excessive concern with household items (e.g. solvents, cleansers) Excessive concern with animals (eg. insects) 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: SEXUAL OBSESSIONS Current Past Forbidden or perverse sexual thoughts, images or impulses Content involves children or incest Content involves homosexuality Sexual behaviour towards others (Aggressive) Other: HOARDING/SAVING OBSESSIONS Current Past Distinguish from hobbies and concern with objects of monetary or sentimental value RELIGIOUS OBSESSIONS (scrupulosity) Concerns with sacrilege and blasphemy Excess concern with right/wrong morality Other: OBSESSION WITH NEED FOR SYMMETRY OR EXACTNESS Current Past Accompanied by magical thinking (e.g. concerned that mother will have accident unless things in the right place) Not accompanied by magical thinking Other:

30 MISCELLANEOUS OBSESSIONS Current Past Need to know or remember Fear of saying certain things Fear of not saying just the right thing Fear of losing things Intrusive (non-violent) images Intrusive nonsense sounds, words or music Bothered by certain sounds/noises Lucky/unlucky numbers Colours with special significance Superstitious fears Other: SOMATIC OBSESSIONS Current Past Concerns with illness or disease Excessive concern with body part or aspect of appearance (e.g. dysmorphophobia) Other: CLEANING/WASHING COMPULSIONS Current Past Excessive or ritualised handwashing Excessive or ritualised showering, bathing toothbrushing, grooming or toilet routine Involves cleaning of household items or other inanimate objects Other measures to prevent or remove contact with contaminants Other: CHECKING COMPULSIONS Current Past Checking locks, stove, appliances, etc 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: REPEATING RITUALS Current Past Re-reading or re-writing Need to repeat routine activities (e.g. in/out door, up/down from chair) Other: COUNTING COMPULSIONS ORDERING/ARRANGING COMPULSIONS HOARDING/COLLECTING COMPULSIONS Current Past Distinguish from hobbies and concern with objects of monetary/sentimental value (e.g. carefully reads junk mail, piles up old newspapers, sorts through garbage, collects useless objects) MISCELLANEOUS COMPULSIONS Current Past Mental rituals (other than checking) Excessive list making Need to tell, ask, confess Need to touch, tap, rub Rituals involving blinking or staring Measures (not checking) to prevent harm to self, harm to others, terrible consequences Ritualised eating behaviours Superstitious behaviours Trichotillomania Other self damaging or self mutilating behaviours Others:

31 YALE-BROWN OBSESSIVE COMPULSIVE SCALE (Y-BOCS) The following questions refer to your obsessive thoughts, especially those that you marked as principal symptoms. 1 How much of your time is occupied by obsessive thoughts? How frequently do the obsessive thoughts occur? {Be sure to exclude ruminations and pre-occupations which, unlike obsessions, are ego-syntonic and rational (but exaggerated)}. None. Mild, less than 1 hour a day or occasional intrusion. Moderate, 1 to 3 hours a day or frequent intrusion. Severe, greater than 3 and up to 8 hours a day or very frequent intrusion. Extreme, greater than 8 hours a day or near constant intrusion. 2 How much do your obsessive thoughts interfere with your social or work(or role) functioning? Is there anything that you don't do because of them? {If currently not working determine how much performance would be affected if patient were employed}. None. Mild, slight interference with social or occupational activities, but overall performance not impaired. Moderate, definite interference with social or occupational performance, but still manageable. Severe, causes substantial impairment in social or occupational performance. Extreme, incapacitating. 3 How much distress do your obsessive thoughts cause you? None. Mild, not too disturbing. Moderate, disturbing, but still manageable. Severe, very disturbing. Extreme, near constant and disabling distress. 4 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? {Only rate effort made to resist, not success or failure in actually controlling the obsessions}. Makes an effort to always resist, or symptoms so minimal doesn't need to actively resist. Tries to resist most of the time. Makes some effort to resist. Yields to all obsessions without attempting to control them, but does so with some reluctance. Completely and willingly yields to all obsessions. 5 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? {in contrast to the preceding item on resistance, the ability of the patient to control his/her obsessions is more closely related to the severity of the intrusive thoughts.} Complete control. control, usually able to stop or divert obsessions with some effort and concentration. Moderate control, sometimes able to stop or divert obsessions. Little control, rarely successful in stopping or dismissing obsessions, can only divert attention with difficulty. No control, experienced as completely involuntary, rarely able to even momentarily alter obsessive thinking.

32 The next several questions are about your compulsive behaviours {Make specific reference to the patients principal compulsions}. How much time do you spend performing compulsive behaviours? How much longer than most people does it take to complete routine activities because of your rituals? How frequently do you perform 6 compulsions? {in most cases compulsions are observable behaviour(eg. hand washing) but some compulsions are covert (eg. silent checking)}. None. Mild, (spends less than 1hr/day performing compulsions), or occasional performance of compulsive behaviours. Moderate, (spends from 1-3 hrs/day performing compulsions), or frequent performance of compulsive behaviours. Severe, (spends more and up to 8 hrs/day performing compulsions), or very frequent performance of compulsive behaviours. Extreme (spends more than 8 hrs/day performing compulsions) or near constant performance of compulsive behaviours(too numerous too count). 7 How much do your compulsive behaviours interfere with your social or work (or role functioning? Is there anything that you don't do because of the compulsions? {If currently not working determine how much performance would be affected if patient were employed.} None. Mild, slight interference with social or occupational activities, but overall performance not impaired. Moderate, definite interference with social or occupational performance, but still manageable. Severe, causes substantial impairment in social or occupational performance. Extreme, incapacitating. How would you feel if prevented from performing your compulsion(s)? How anxious would you 8 become? How anxious do you get while performing compulsions until you are satisfied they are completed? None. Mild only anxious if compulsions prevented, or only slight anxiety during performance of compulsions. Moderate, reports anxiety that would mount but remain manageable if compulsions prevented, or that anxiety increases but remains manageable during performance of compulsions. Severe, prominent and very disturbing increase if compulsions interrupted, or prominent and very disturbing increase in anxiety during performance of compulsions. Extreme, incapacitating anxiety from any intervention aimed at modifying activity, or incapacitating anxiety develops during performance of compulsions. 9 How much of an effort do you make to resist the compulsions? {only rate effort made to resist, not success or failure in actually controlling the compulsions}. Makes an effort to always resist, or symptoms so minimal doesn't need to actively resist. Tries to resist most of the time. Makes some effort to resist. Yields to almost all compulsions without attempting to control them, but does so with some reluctance. Completely and willingly yields to all compulsions. How strong is the drive to perform the behaviour? How much control do you have over the 10 compulsions? {In contrast to the preceeding item on resistance, the ability of the patient to control the compulsions is more closely related to the severity of the compulsions}. Complete control. control, experiences pressure to perform behaviour but usually able to exercise voluntary control over it. Moderate control, strong pressure to perform behaviour, can control it only with difficulty. Little control, very strong drive to perform the behaviour, must be carried to completion, can only delay with difficulty. No control, drive to perform behaviour experienced as completely involuntary and overpowering, rarely able to even momentarily delay activity.

33 Example: Cambridge Depersonalization Scale (State Version) Please read these instructions carefully: This questionairee describes strange and 'funny' feelings that people may have in their daily life. Please read carefully each of the following descriptions. If you feel you are having 'Right Now' any of the following experienes, please let us know how bad it is at the moment by making a mark on the line. 0% / % (I'm not having it at all) (it's as bad as it can get) I'm feeling strange, as if I were not real or as if I were cut off from the world. Things around me are now looking 'flat' or 'lifeless', as if I were looking at a picture. I am feeling as if parts of my body didn t belong to me. I'm now having the feeling of being a 'dethatched observer' of myself. My body is feeling very light now, as if I were floating on air. I am not feeling any emotions at all. If I read this sentence aloud, my voice sounds remote and unreal. I am having a feeling of complete emptiness in my head so that I am not having any thoughts at all. I am having a feeling that my hands or my feet have become larger or smaller. My surroundings are feeling detached or unreal, as if there was a veil or fog between me and the outside world. It seems now as if things that I have recently done had taken place a long time ago. For example anything which I have done this morning feels as if it were done weeks ago. If I now try to remember important events in my life (e.g. graduation, wedding etc.), I feel so detached from the memories that it seems as if I had not been involved in them.

34 I don't seem to be feeling any affection towards my family and close friends. Objects around me are looking smaller or further away. I cannot feel properly the roller or pencil that I have in my hand, as if it were not me who were holding it. If I now try to imagine a face of a relative or friend whom I frequently see (but who is not with you at present) I do not seem able to picture it in my mind. If I pinch myself in my arm now, I feel so detached from the pain that it feels as if it were 'somebody else's pain'. I am now having the feeling of being outside my body. I am feeling as if I were not in charge of my movements, so that I feel 'automatic' and mechanical as if I were a robot. I am feeling so detached from my thoughts that they seem to have a 'life' of their own. I feel like touching myself to make sure that I have a body or a real existence. I am still having the same strange feeling as when I started to answer his questionnaire.