Evidence-Based Brief Obsessive-Compulsive Scale

Abstract

We were impressed to read the thorough review of Evidence-Based Assessment of Obsessive-Compulsive Disorder published by Amy Rapp and coworkers in your journal in August 2016.1 Unfortunately they had missed to mention the Brief Obsessive-Compulsive Scale (BOCS), a self-rating measure for obsessive-compulsive disorder (OCD), which has been around for a couple of decades and is widely used in Sweden. We published an article describing the BOCS and its psychometric properties recently in the Nordic Journal of Psychiatry.2 Brief Obsessive-Compulsive Scale consists of a 15-item Symptom Checklist including 3 items (hoarding disorder, body dysmorphic disorder, and nonsuicidal self-injury disorder) related to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) category “Obsessive-compulsive related disorders”, accompanied by a single 6-item severity scale for obsessions and compulsions combined. It encompasses the revisions made in the Yale-Brown Obsessive-Compulsive Scale, Second Edition (Y-BOCS-II) severity scale by including obsessive-compulsive free intervals and extent of avoidance and excluding the resistance item. The study2 included a total of 402 Swedish psychiatric outpatients with OCD, attention-deficit/hyperactivity disorder, autism spectrum disorder, or other psychiatric disorders who completed the BOCS. Principal component factor analysis produced 5 subscales titled “symmetry,” “forbidden thoughts,” “contamination,” “magical thoughts,” and “dysmorphic thoughts.” The OCD group scored higher than all other diagnostic groups on all subscales (P < .001). Sensitivities and specificities in relation to other diagnoses and internal consistency for both the Symptom Checklist and the Severity Scale emerged high (Symptom Checklist: sensitivity = 85%, specificity = 62%–70%, Cronbach α = 0.81; Severity Scale: sensitivity = 72%, specificity = 75%–84%, Cronbach α = 0.94). Few other OCD scales have been tested on large groups of diverse psychiatric patients, and to our knowledge, none has showed such a strong support for utility in the assessment of obsessive-compulsive symptoms in clinical psychiatry as the BOCS. To our great surprise, the BOCS was in fact cited by Rapp and coworkers in your journal (see Ref. 52), but the authors incorrectly state that the results derive from a study on the Y-BOCS-II. We hope your readers will pay attention to this mistake. The BOCS is freely available to download as supplementary material from the Web page where it was originally published (http://www-tandfonline-com.proxy.kib.ki.se/doi/full/10.3109/08039488.2014.884631) and on www.memogen.se.