Obsessive Compulsive Inventory Questionnaire Template

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OCI
Name………………………………………… Date………………..
The following statements refer to experiences which many people have in their everyday lives. In the
column labelled DISTRESS, please CIRCLE the number that best describes HOW MUCH that
experience has DISTRESSED or BOTHERED YOU DURING THE PAST MONTH. The numbers in
this column refer to the following labels: 0 = Not at all
1 = A little
2 = Moderately
3 = A lot
4 = Extremely
___________________________________________________________________________
DISTRESS
1. Unpleasant thoughts come into my mind against my will and
0
1
2
3
4
I cannot get rid of them
2.
I think contact with bodily secretions (perspiration, saliva,
0
1
2
3
4
blood, urine, etc) may contaminate my clothes or somehow
harm me.
I ask people to repeat things to me several times, even though
0
1
2
3
4
3.
I understood them the first time.
I wash and clean obsessively.
0
1
2
3
4
4.
5.
I have to review mentally past events, conversations and actions 0
1
2
3
4
to make sure that I didn't do something wrong.
6.
I have saved up so many things that they get in the way.
0
1
2
3
4
I check things more often than necessary
0
1
2
3
4
7.
8.
I avoid using public toilets because I am afraid of disease or
0
1
2
3
4
contamination.
9.
I repeatedly check doors, windows, drawers etc.
0
1
2
3
4
10. I repeatedly check gas and water taps and light switches after
0
1
2
3
4
turning them off.
11. I collect things I don't need.
0
1
2
3
4
12. I have thoughts of having hurt someone without knowing it.
0
1
2
3
4
13. I have thoughts that I might want to harm myself or others.
0
1
2
3
4
14. I get upset if objects are not arranged properly.
0
1
2
3
4
15. I feel obliged to follow a particular order in dressing,
0
1
2
3
4
undressing and washing myself.
16. I feel compelled to count while I am doing things
0
1
2
3
4
17. I am afraid of impulsively doing embarrassing or harmful
0
1
2
3
4
things.
18. I need to pray to cancel bad thoughts or feelings.
0
1
2
3
4
19. I keep on checking forms or other things I have written.
0
1
2
3
4
20. I get upset at the sight of knives, scissors and other sharp
0
1
2
3
4
objects in case I lose control with them.
21. I am excessively concerned about cleanliness.
0
1
2
3
4
22. I find it difficult to touch an object when I know it has been
0
1
2
3
4
touched by strangers or certain people.
23. I need things to be arranged in a particular order
0
1
2
3
4

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