Dimensional Obsessive-Compulsive Scale

The Dimensional Obsessive-Compulsive Scale (DOCS) is a validated 20-item self-report questionnaire developed by Abramowitz et al.

Questions: 20
Duration: 10 min
Original title: DOCS — Dimensional Obsessive-Compulsive Scale
Adaptation: Dimensional Obsessive-Compulsive Scale
Authors: Abramowitz, J. S., Deacon, B. J., Olatunji, B. O., Wheaton, M. G., Berman, N. C., Losardo, D., Timpano, K. R., McGrath, P. B., Riemann, B. C., Adams, T., Björgvinsson, T., Storch, E. A., & Hale, L. R.
Created: 2010

The Dimensional Obsessive-Compulsive Scale (DOCS) is a validated 20-item self-report questionnaire developed by Abramowitz et al. (2010) to measure the severity of obsessive-compulsive symptoms. Unlike traditional measures that group diverse symptoms into a single severity score, the DOCS specifically evaluates four distinct empirical dimensions: contamination, responsibility for harm, unacceptable thoughts, and symmetry. For each dimension, the instrument assesses five parameters of severity: time occupied by symptoms, avoidance behaviors, associated distress, functional interference, and the patient's difficulty disregarding obsessions and refraining from compulsions.

Designed for adults and older adolescents, the DOCS provides clinicians with a nuanced profile of a patient's OCD presentation. By isolating these four symptom clusters, it helps recognize OCD symptoms more accurately and guide targeted exposure and response prevention alongside a standard OCD symptoms checklist. Its sensitivity to change makes it a highly useful tool for continuous symptom monitoring and outcome evaluation in both specialized and general clinical settings.

Example result

Fictitious result, computed from a sample set of answers.

Overall score

40/ 80

A 20-item self-report questionnaire assessing past-month obsessive-compulsive symptom severity in adults across four empirically validated dimensions: (1) contamination, (2) responsibility for harm or mistakes, (3) unacceptable thoughts (taboo), (4) symmetry/completeness/exactness. Each dimension is assessed by 5 items — time occupied, avoidance, distress, functional impairment, and difficulty ignoring obsessions / resisting compulsions — with response anchors specific to each parameter. Used for initial assessment, differential diagnosis, and OCD monitoring.

généralemixed · students · United States · n = 1044 · 2010 · Abramowitz et al. (2010)

080

M = 11.93 ± 9.87

généralegeneral population · Germany · n = 223 · 2021 · Fink-Lamotte et al. (2021)

080

M = 11.85 ± 9.09

cliniquemixed · clinical: OCD · United States · n = 315 · 2010 · Abramowitz et al. (2010)

080

M = 30.06 ± 15.49

cliniquemixed · clinical: Anxiety disorders · United States · n = 198 · 2010 · Abramowitz et al. (2010)

080

M = 16.75 ± 13.14

cliniqueclinical: OCD · Germany · n = 107 · 2021 · Fink-Lamotte et al. (2021)

080

M = 28.5 ± 17.52

cliniqueclinical: Anxiety disorder · Germany · n = 30 · 2021 · Fink-Lamotte et al. (2021)

080

M = 13.37 ± 11.04

cliniqueclinical: Depression · Germany · n = 40 · 2021 · Fink-Lamotte et al. (2021)

080

M = 14.3 ± 11.56

For information

Cut-off≥ 18Probable OCD (vs. non-clinical population)

Best sensitivity/specificity balance to distinguish OCD from non-clinical adults.

Abramowitz et al. (2010)View the study ↗

Cut-off≥ 21OCD rather than another anxiety disorder

Optimal cutoff to differentiate OCD from other anxiety disorders.

Abramowitz et al. (2010)View the study ↗

Scoring

Subscale sum + total score, total score from 0 to 80, each item is scored on a 5-point scale (from 0 to 4).

Symmetry, completeness, and exactness

10/ 20

Symmetry obsessions and "not just right" sensations, with ordering and repeating compulsions.

items 16, 17, 18, 19, 20

généralemixed · students · United States · n = 1044 · 2010 · Abramowitz et al. (2010)

020

M = 2.31 ± 2.8

cliniquemixed · clinical: OCD · United States · n = 315 · 2010 · Abramowitz et al. (2010)

020

M = 6.13 ± 5.5

cliniquemixed · clinical: Anxiety disorders · United States · n = 198 · 2010 · Abramowitz et al. (2010)

020

M = 3.41 ± 4.66

Contamination

10/ 20

Contamination obsessions and washing or cleaning compulsions.

items 1, 2, 3, 4, 5

généralemixed · students · United States · n = 1044 · 2010 · Abramowitz et al. (2010)

020

M = 2.03 ± 2.89

cliniquemixed · clinical: OCD · United States · n = 315 · 2010 · Abramowitz et al. (2010)

020

M = 6.53 ± 6.4

cliniquemixed · clinical: Anxiety disorders · United States · n = 198 · 2010 · Abramowitz et al. (2010)

020

M = 3.07 ± 2.76

Responsibility for harm or mistakes

10/ 20

Obsessions regarding responsibility for harm or mistakes, with checking and reassurance seeking.

items 6, 7, 8, 9, 10

généralemixed · students · United States · n = 1044 · 2010 · Abramowitz et al. (2010)

020

M = 2.86 ± 2.9

cliniquemixed · clinical: OCD · United States · n = 315 · 2010 · Abramowitz et al. (2010)

020

M = 7.54 ± 5.84

cliniquemixed · clinical: Anxiety disorders · United States · n = 198 · 2010 · Abramowitz et al. (2010)

020

M = 4.21 ± 4.87

Unacceptable thoughts (taboo)

10/ 20

Unacceptable obsessive thoughts with violent, sexual, or religious content, with mental rituals and neutralization.

items 11, 12, 13, 14, 15

généralemixed · students · United States · n = 1044 · 2010 · Abramowitz et al. (2010)

020

M = 3.08 ± 3.25

cliniquemixed · clinical: OCD · United States · n = 315 · 2010 · Abramowitz et al. (2010)

020

M = 9.73 ± 6.2

cliniquemixed · clinical: Anxiety disorders · United States · n = 198 · 2010 · Abramowitz et al. (2010)

020

M = 7.17 ± 5.46

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What the test measures

The DOCS evaluates the severity of obsessive-compulsive symptoms across four distinct clinical dimensions. Each dimension is rated on five parameters of severity based on the patient's experience over the past month.

Contamination: Concerns about germs, sickness, or feeling dirty, leading to excessive washing or cleaning behaviors.
Responsibility for harm: Doubts about making mistakes that could cause accidents or bad luck, prompting repetitive checking or reassurance-seeking.
Unacceptable thoughts: Unwanted intrusive thoughts of violent, sexual, or immoral nature, along with mental or behavioral rituals to neutralize them.
Symmetry and completeness: The need for things to be "just right," balanced, or exact, driving ordering, arranging, or rigid perfectionism.
Symptom severity parameters: Within each dimension, the test assesses time occupied, avoidance, subjective distress, functional interference, and difficulty resisting symptoms.

This measure is intended for use with adults and adolescents to map the precise architecture of their obsessive-compulsive presentation.

When and why to use it

Clinicians use the DOCS to establish a detailed baseline of obsessive-compulsive symptoms and to monitor treatment progress across specific symptom dimensions.

Clinical Situation	Rationale for Use
Intake baseline	To map the unique symptom profile and identify the most severe dimension to target first in therapy.
Monitoring change	To evaluate response to interventions over time, using a structured progress check-in to adjust treatment.
Treatment planning	To clarify how symptoms operate, whether through overt rituals or covert maladaptive coping strategies.
Screening and differentiation	To help differentiate primary obsessive-compulsive presentations from severe worry or health anxiety.

While clinical observation provides the context, a validated DOCS score quantifies the specific dimensions of severity, offering a reliable metric to verify whether therapeutic gains are generalizing across the patient's primary concerns.

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The questions

This questionnaire asks you about 4 different types of concerns that you might or might not experience. Each category is introduced by a description of the thoughts (sometimes called obsessions) and behaviors (sometimes called rituals or compulsions) that characterize it, followed by 5 questions about your experiences over the last month. Please read each description carefully, then answer the 5 corresponding questions based on your experiences in the past month.
1. Approximately how much time each day have you spent thinking about contamination and engaging in washing/cleaning behaviors because of contamination?
This item assesses the daily duration of obsessions and washing compulsions related to contamination.
- None
- Less than one hour per day
- Between one and three hours per day
- Between 3 and 8 hours per day
- 8 hours or more per day
2. To what extent did you avoid situations to prevent triggering concerns about contamination or having to engage in washing/cleaning or showering behaviors?
This question evaluates the extent to which the patient alters their behavior to avoid contamination triggers.
- Not at all
- Mild avoidance
- Moderate avoidance
- Severe avoidance
- Extreme avoidance (of almost everything)
3. If you had thoughts about contamination but couldn't wash, clean, or shower (or decontaminate in other ways), what level of anxiety or distress did you experience?
This item measures the intensity of distress experienced when decontamination rituals are blocked or unavailable.
- No anxiety/discomfort/distress
- Mild anxiety/discomfort
- Moderate anxiety/discomfort
- Severe anxiety/discomfort
- Extreme anxiety/discomfort
4. To what extent has your daily functioning (work, school, self-care, social life) been affected by your concerns about contamination and by excessive washing/cleaning or avoidance behaviors?
This question gauges how significantly contamination concerns interfere with the patient's daily responsibilities and social life.
- Not affected at all
- Slightly affected but I functioned well
- Moderately affected but I can still manage to function
- My daily life is severely affected and I have difficulty functioning
- My life is completely disrupted and I am unable to function
5. How difficult is it for you to ignore your thoughts about contamination and to resist (when you try to resist) behaviors such as washing, showering, cleaning, and other decontamination behaviors?
This item probes the patient's perceived ability to ignore contamination thoughts and resist the urge to perform cleaning rituals.
- No difficulty
- Slightly difficult
- Moderately difficult
- Very difficult
- Extremely difficult
6. How much time each day do you spend thinking about the possibility of disasters or other negative events and engaging in checking or seeking reassurance that such things will not happen?
This item assesses the daily time consumed by thoughts of disastrous events and corresponding checking rituals.
- None
- Less than one hour per day
- Between one and three hours per day
- Between three and eight hours per day
- Eight hours or more per day
7. To what extent have you avoided situations so as not to have to check for danger or worry about possible disasters or catastrophes?
This question evaluates the degree of situational avoidance used to prevent fears of harm or the need to check.
- Not at all
- Mild avoidance
- Moderate avoidance
- Severe avoidance
- Almost total avoidance
8. When you think about the possibility of threats, dangers, or disasters, or when you cannot check or be reassured about these events, to what extent do you become anxious or uncomfortable?
This item measures the subjective anxiety triggered by thoughts of danger when checking behaviors cannot be performed.
- No anxiety or discomfort
- Mild anxiety or discomfort
- Moderate anxiety or discomfort
- Severe anxiety or discomfort
- Extreme anxiety or discomfort
9. To what extent has your daily functioning (work, school, self-care, social life) been affected by thoughts of threats, dangers, disasters, as well as by excessive checking or seeking reassurance?
This question gauges the functional impairment caused by harm-related obsessions and reassurance-seeking behaviors.
- Not affected at all
- Slightly affected but I functioned well
- Moderately affected but I can still manage to function
- My daily life is severely affected and I have difficulty functioning
- My life is completely disrupted and I am unable to function
10. How difficult is it for you to ignore or resist thoughts about risks of possible dangers, threats, or disasters and to refrain from checking or seeking reassurance, when you try to do so?
This item probes the patient's capacity to tolerate harm-related obsessions without resorting to checking or reassurance.
- No difficulty
- Slightly difficult
- Moderately difficult
- Very difficult
- Extremely difficult
11. For about how much time each day did you have unwanted thoughts and engage in behaviors and mental acts aimed at counteracting these thoughts?
This item assesses the daily duration of taboo or repugnant obsessions and the mental or physical acts used to neutralize them.
- None
- Less than one hour per day
- Between one and three hours per day
- Between three and eight hours per day
- Eight hours or more per day
12. To what extent did you avoid situations, places, objects, and other triggers (e.g., numbers, people) of unpleasant or unwanted thoughts?
This question evaluates the extent to which the patient avoids triggers that provoke unacceptable or distressing thoughts.
- Not at all
- Mild avoidance
- Moderate avoidance
- Severe avoidance
- Almost total avoidance
13. When unpleasant or unwanted thoughts come to your mind against your will, how anxious or uncomfortable do you become?
This item measures the emotional distress caused by the involuntary intrusion of taboo or unwanted thoughts.
- No anxiety or discomfort
- Mild anxiety or discomfort
- Moderate anxiety or discomfort
- Severe anxiety or discomfort
- Extreme anxiety or discomfort
14. To what extent has your daily functioning (work, school, self-care, social life) been disrupted by unpleasant or unwanted thoughts and/or by efforts to avoid or fight these thoughts?
This question gauges how much the struggle against unacceptable thoughts interferes with the patient's normal daily functioning.
- Not affected at all
- Slightly affected but I functioned well
- Moderately affected but I can still manage to function
- My daily life is severely affected and I have difficulty functioning
- My life is completely disrupted and I am unable to function
15. How difficult is it for you to ignore these unpleasant or unwanted thoughts and to refrain from using compulsive rituals/behaviors (behavioral or mental) when you try to resist?
This item probes the difficulty the patient experiences in dismissing repugnant thoughts without engaging in compulsive neutralization.
- No difficulty
- Slightly difficult
- Moderately difficult
- Very difficult
- Extremely difficult
16. For about how much time each day have you had unwanted thoughts about symmetry, order, or balance between things and engaged in behaviors aimed at achieving symmetry, order, and balance?
This item assesses the daily time spent on obsessions regarding symmetry or exactness and the corresponding ordering compulsions.
- None
- Less than one hour per day
- Between one and three hours per day
- Between three and eight hours per day
- Eight hours or more per day
17. To what extent have you avoided situations, places, or objects associated with the feeling that something is not symmetrical or 'Just Right'?
This question evaluates the avoidance of situations that trigger a distressing sense of things not being "just right".
- Not at all
- Mild avoidance
- Moderate avoidance
- Severe avoidance
- Almost total avoidance
18. When you have the feeling that something is not 'Just Right,' to what extent do you become anxious or uncomfortable?
This item measures the intensity of discomfort experienced when the need for symmetry or completeness is violated.
- No anxiety or discomfort
- Mild anxiety or discomfort
- Moderate anxiety or discomfort
- Severe anxiety or discomfort
- Extreme anxiety or discomfort
19. To what extent has your daily functioning (work, school, self-care, social life) been disrupted by the feeling that things were not 'Just Right' and by efforts to put things in order or make you feel they are 'Just Right'?
This question gauges the impact of "just right" obsessions and ordering rituals on the patient's day-to-work and social life.
- Not affected at all
- Slightly affected but I functioned well
- Moderately affected but I can still manage to function
- My daily life is severely affected and I have difficulty functioning
- My life is completely disrupted and I am unable to function
20. How difficult is it for you to ignore these thoughts about lack of symmetry and order and to refrain from putting things in order or repeating certain behaviors when you try to resist?
This item probes the patient's ability to resist the urge to arrange, order, or balance items when things feel asymmetrical.
- No difficulty
- Slightly difficult
- Moderately difficult
- Very difficult
- Extremely difficult