OBSESSIVE CONCERNS CHECKLIST PAGE 1
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1 1 OBSESSIVE CONCERNS CHECKLIST PAGE 1 Name: Date : Age: Sex: For some people certain thoughts may seem to occur against their will and they cannot get rid of them. Only endorse items which apply to you due to: (1) their having been performed excessively, (2) their undesirability, (3) your attempts to resist, and (4) their having interfered with your functioning in some way. Rate the thoughts listed below from 1 to 5, according to the degree of disturbance during the past week: 1 This thought does not trouble me at all 2 This thought rarely troubles me (once a week or less) 3 This thought often troubles me (several times weekly) 4 This thought troubles me very often (daily) 5 This thought troubles me continually (all waking hours) I. AGGRESSIVE OBSESSIONS 1. Actively harming others intentionally 2. Harming yourself intentionally 3. Going crazy and harming others 4. Violent or repulsive images, thoughts or words 5. Blurting out obscenities or insults 6. Making embarrassing or obscene gestures 7. Writing obscenities 8. Acting out in antisocial ways in public 9. Having insulted or offended others 10. Acting on impulses to rob, steal from, take advantage of, or cheat others 11. Rejecting, divorcing, or being unfaithful to a loved one 12. Deliberately hoping that others will have accidents, become ill or die II. SEXUAL OBSESSIONS 1. Forbidden or perverse thoughts, images or impulses 2. Sex with children 3. Sex with animals 4. Incest 1 From Freedom From Obsessive Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty by Jonathan Grayson. Berkely/Penguin Press. NY Adapted and Modified from Obsessive- Compulsive Disorders: A Complete Guide to Getting Well And Staying Well by Fred Penzel.
2 OBSESSIVE CONCERNS CHECKLIST PAGE 2 5. Being homosexual or acting homosexually 6. Doubt about your sexual identity 7. Sex with religious figures or celebrities 8. Acting sexually toward others 9. Doubt about possibly having acted sexually toward others 10. Doubt about possibly having been acted upon sexually by others 11. Other: III. CONTAMINATION OBSESSIONS 1. Bodily waste or secretions, e.g. feces, urine, saliva, perspiration, blood, semen 2. Dirt or grime 3. Germs, or viruses 4. Environmental contaminants (asbestos, lead, radiation, toxic wastes, etc.) 5. Household chemicals (cleansers, solvents, drain openers, insecticides) 6. Auto exhaust or other poisonous gases 7. Garbage, refuse, or their containers 8. Grease or greasy items 9. Sticky substances 10. Medication, or the effects of having ingested medication in the past 11. Your food or drink having been adulterated or tampered with by others 12. Broken glass 13. Poisonous plants 14. Contact with live animals 15. Contact with dead animals Contact with insects 16. Contact with other people 17. Contact with unclean or shabby looking people 18. Contracting an unspecified illness 19. Contracting a specific illness: 20. Spreading illness to, or contaminating others 21. Hospitals, doctor's offices and health care workers 22. Leaving or spreading an essence or trace of yourself behind on objects or others 23. Being contaminated by thoughts of harm happening to yourself or others 24. A specific person, or place felt to be contaminated in some nonspecific way 25. Being contaminated by certain words: 26. Being contaminated by the names of certain illnesses 27. Being contaminated by seeing an ill or disabled person 28. Being contaminated by the memory of a person who has died
3 OBSESSIVE CONCERNS CHECKLIST PAGE Being contaminated by certain numbers or their multiples 30. Being contaminated by certain colors 31. Your belongings being contaminated by having been present or used when something unpleasant was occurring 32. Being contaminated by evil or the devil 33. Other: IV. RELIGIOUS OBSESSIONS 1. Being deliberately sinful or blasphemous 2. Doubtful thoughts as to whether you acted sinfully or blasphemously in the past 3. Fears of having acted sinfully or unethically 4. Doubting your faith or beliefs 5. Unacceptable thoughts about religious figures, religion, or deities 6. Thoughts of being possessed 7. Thoughts of having to be perfectly religious 8. Other: V. OBSESSIONS OF HARM, DANGER, LOSS, OR EMBARRASSMENT 1. Having an accident, illness or being injured 2. An accident, illness or injury happening to someone else 3. Accidentally losing control and harming others 4. Accidentally losing control and harming self 5. Causing harm to others through your own negligence or carelessness 6. Causing harm to others through my thoughts 7. Causing harm to self through your own negligence or carelessness 8. Causing harm to self through my thoughts 9. Never being able to be happy, or never being able to get what you want in life 10. Doubt about whether you somehow harmed or injured others in the past 11. Being deliberately harmed by others 12. Being rejected by a loved one 13. Being cheated or taken advantage of by others 14. Having somehow cheated or taken advantage of others 15. Having insulted or offended others 16. Objects in the environment having been moved or changed in unexplainable ways 17. Damage or theft of property 18. Losing or misplacing property
4 OBSESSIVE CONCERNS CHECKLIST PAGE Forgetting information (memories, facts, appointments, etc.) 20. Being trapped in an unsatisfactory life or relationship 21. Being looked at or noticed by others in a critical way 22. Acting inappropriately in public 23. Your own mortality 24. The mortality of your family and friends 25. Your children not being your own 26. Other: VI. SUPERSTITIOUS OR MAGICAL OBSESSIONS 1. Having bad luck 2. Bad luck happening to someone else 3. Lucky or unlucky numbers or their multiples 4. Lucky or unlucky colors 5. Lucky or unlucky objects or possessions 6. The possibility that thinking or hearing of bad events can make them occur to yourself others 7. Certain words names, or images being able to cause bad luck 8. Certain actions or behaviors being able to cause bad luck 9. Being possessed 10. Places, objects or people associated with unlucky occasions causing bad luck by contact 11. The need to perform certain activities a special number of times 12. Lucky or unlucky mental arrangements of things VII. HEALTH AND BODY-FOCUSED OBSESSIONS 1. Parts of your body are ugly or disfigured in some way 2. Your body gives off a bad odor (e.g., breath, armpits, genital, etc) 3. Your body has scars or marks 4. Question how certain parts of your body work or function 5. A part of your body does not work properly or functions differently than it used to 6. Parts of your body are asymmetrical 7. Part(s) of your body is (are) too large or small 8. You are overweight or underweight 9. You will choke or vomit accidentally 10. You are going bald or have thinning hair
5 OBSESSIVE CONCERNS CHECKLIST PAGE Part(s) of your body is (are) aging prematurely 12. Clothing does not fit certain parts of your body correctly (too loose or too tight) 13. You have brain damage or your mental faculties are impaired 14. You have undiagnosed serious illnesses. Which ones: 15. Other: VIII. PERFECTIONISTIC OBSESSIONS 1. Questioning whether you have said, done, or thought certain things perfectly 2. Questioning whether others perfectly understand what you have said 3. Wanting to do, think, or say everything (or certain things) perfectly 4. Wanting to have a perfect appearance 5. Wanting your clothes to fit perfectly 6. Questioning whether you have told the truth perfectly 7. Making or keeping your home or possessions perfectly clean or pristine 8. Keeping your possessions in perfect order 9. Ordering things or making them symmetrical 10. Wanting to know everything about a specific subject or topic 11. Perfectly understanding what you have read 12. Perfectly communicating your thoughts through writing IX. NEUTRAL OBSESSIONS 1. Sounds, words, or music 2. Nonsense or trivial images 3. Counting for no special reason 4. Repetitive questions for which there are no answers or which are unimportant 5. The excessive awareness of your own thought processes 6. The awareness of specific things in your environment (sounds, colors, objects, etc.) 7. Excessive awareness of normal body functioning (breathing, eyes blinking, heart, etc.) 8. Excessive awareness of abnormal body functioning (ringing in ears, aches, stiffness, pains, etc) 9. Other:
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