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Tinnitus and hyperacusis therapy specialist unit
OCI
The following statements refer to experiences that many people have in their everyday lives. Tick the choice that best describes HOW MUCH that experience has DISTRESSED or BOTHERED you during the PAST MONTH.
Name of the patient:
Please type the email address that this form needs to be sent to. This is often the email address of your clinician who asked you to complete this form.
Questionnaire
Not at all
A little
Moderately
A lot
Extremely
1. I have saved up so many things that they get in the way.
Not at all
A little
Moderately
A lot
Extremely
2. I check things more often than necessary.
Not at all
A little
Moderately
A lot
Extremely
3. I get upset if objects are not arranged properly.
Not at all
A little
Moderately
A lot
Extremely
4. I feel compelled to count while I am doing things.
Not at all
A little
Moderately
A lot
Extremely
5. I find it difficult to touch an object when I know it has been touched by strangers or certain people.
Not at all
A little
Moderately
A lot
Extremely
6. I find it difficult to control my own thoughts.
Not at all
A little
Moderately
A lot
Extremely
7. I collect things I dont need.
Not at all
A little
Moderately
A lot
Extremely
8. I repeatedly check doors, windows, drawers, etc.
Not at all
A little
Moderately
A lot
Extremely
9. I get upset if others change the way I have arranged things.
Not at all
A little
Moderately
A lot
Extremely
10. I feel I have to repeat certain numbers.
Not at all
A little
Moderately
A lot
Extremely
11. I sometimes have to wash or clean myself simply because I feel contaminated.
Not at all
A little
Moderately
A lot
Extremely
12. I am upset by unpleasant thoughts that come into my mind against my will.
Not at all
A little
Moderately
A lot
Extremely
13. I avoid throwing things away because I am afraid I might need them later.
Not at all
A little
Moderately
A lot
Extremely
14. I repeatedly check gas and water taps and light switches after turning them off.
Not at all
A little
Moderately
A lot
Extremely
15. I need things to be arranged in a particular way.
Not at all
A little
Moderately
A lot
Extremely
16. I feel that there are good and bad numbers.
Not at all
A little
Moderately
A lot
Extremely
17. I wash my hands more often and longer than necessary.
Not at all
A little
Moderately
A lot
Extremely
18. I frequently get nasty thoughts and have difficulty in getting rid of them.
Not at all
A little
Moderately
A lot
Extremely
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