1. How often do you worry about things being contaminated by germs?
A. Every single day
C. I don’t think I have ever worried about that
D. Sometimes I do
2. Have you ever tried to avoid situations that could trigger obsessive thoughts you have?
A. Yes, because I always think about the germs and other things I could be contaminated with. I get too nervous.
B. Yes, because I am trying to avoid bad things happening to me
C. Yes, but it never works. If I don’t count things or touch things a certain amount of times, I can’t even walk out the door. Sometimes I avoid places because I am embarrassed.
D. I am generally okay going places.
3. After you leave your house, are there times you fear you forgot to do certain things like locking the door, turning the oven off, or turn the lights off?
A. No, I am pretty responsible
B. No, I mostly worry about what will happen while I am outside the house than things I forgot to do inside the house.
C. Yes, very frequently
D. Not usually, but I will think about it sometimes randomly just wondering if I forgot to do something or turn something off if I am in a hurry to leave the house, but I won’t go back to check
4. Would you consider yourself a germaphobe?
B. Not to that extent, but I do always keep things clean and organized
C. Yes, very much so
D. Not really
5. Does it bother you if you don’t do things in a specific order, a specific number of times?
A. Not particularly, but I do like to stay organized
B. No, that doesn’t bother me
C. Yes, every single day
D. Sometimes, I like to be very neat and organized
6. Have you ever experienced thoughts of causing harm to yourself or someone else by not checking things repeatedly to be sure?
A. I just fear in general about harm form all the dangerous chemicals and germs in the world
B. Yes, very often and it really bothers me
D. I don’t understand what that means
7. Do you have certain rituals you do, such as repeating tasks or saying different phrases, to reduce anxiety?
A. Not really
B. Option Sometimes
C. Yes, and I have to do them or I can’t function
D. No, what kind of ritual?
8. Do you ever feel anxious about bad things potentially happening to you?
A. Yes, I worry that bad things will happen to me because of being contaminated by things like dirt, chemicals, germs, or radiation.
B. Yes, all of the time. I have repeated thoughts in my head about me getting hurt in some way.
C. Yes, I fear bad things will happen to me if I don’t stick to my routine of having things in a certain order and doing things a certain number of times.
D. Sometimes I do
9. Do you ever experience unwanted or unpleasant thoughts?
A. Yes, about all the germs that I touch when I am out places or potential contamination from other things
B. Yes, very frequently. They are reoccurring thoughts many times about something really bad happening to me or someone else
C. Yes, about my need for routine and symmetry
D. Sometimes I do, but nothing specific or repeated
10. How stressful is it for you if things aren’t in a certain order, in groups of a certain number, or facing a certain way?
A. That doesn’t bother me
B. I only have some things that I like a certain way, but I wouldn’t get stressed out over it
C. It could potentially cause a panic attack or anxiety attack if I don’t fix it
D. It is pretty stressful; I like to keep everything organized and seeing things out of place makes me anxious.