Y-BOCS II Nerd Alert 🧠 (why I’m changing the severity thresholds)
This week I was updating a Y-BOCS II score for a client who is officially in remission from OCD (yay!), when I glanced down at the scoring thresholds in the PDF I give to consultees. I noticed something that didn’t sit right with me: I had “8–15 = mild symptoms,” but in practice I’ve been treating 12–14 and below as remission/subclinical.
So I had a moment of, “Wait… how can something be ‘mild OCD’ and ‘in remission’ at the same time?”
That sent me into a little research spiral with our best friend, Chatty G, and here’s what I found: I wasn’t totally making stuff up - the ranges I had in my handout were:
0–7 subclinical
8–15 mild
16–23 moderate
24–31 severe
32–40 extreme
40–50 “severe debilitation”
That’s basically the old/original Y-BOCS (0–40) bands — which are all over the internet — and then I stretched them up to 50 because the Y-BOCS II goes to 50 (each item is 0–5 now, not 0–4). So what I had was a reasonable clinician adaptation, not nonsense. I suspect I found this online somewhere, but in true ADHD form, I cannot be sure!
But… the Y-BOCS II doesn’t actually come with official severity cutoffs.
The manual tells us how to score it (sum items 1–10, 0–50) but it never gives us “this is mild, this is moderate.” So most of us just kept using the old Y-BOCS language and pretended it fit. (Guilty 🙋🏻♀️)
Then I found a 2025 paper that finally does what we wanted it to do: it proposes empirically derived severity benchmarks specifically for the Y-BOCS II. That paper basically says: let’s make severity fit the 0–50 scale, and let’s put remission at the bottom where it belongs. Then they tested it, and based on their research they recommend these categories:
0–14: subclinical / remission
15–21: mild
22–34: moderate
35–50: severe
This lined up exactly with what I was already doing clinically — using 14 and below as “we’re out of the OCD woods.” It also lines up with broader OCD outcome work that uses Y-BOCS remission in that same neighborhood.
So I’m updating my scoring guide to match that version.
New Language:
Y-BOCS-II (10 items, 0–5 each; total score 0–50). Severity bands based on recent Y-BOCS-II psychometric work (2025):
0–14 = subclinical / remission
15–21 = mild
22–34 = moderate
35–50 = severe
Note: earlier versions of this handout adapted the original Y-BOCS (0–40) bands to a 0–50 scale; this version reflects empirically derived Y-BOCS-II benchmarks.
I strongly encourage you to download the new version here!
Things I Think You’ll Love
It matches how we talk to clients. If someone is 12 or 13, we call that “pretty much in remission,” not “still mildly OCD.”
It’s actually tied to recent data, not just inheritance from the 1989 version. Y’all know I prefer the YBOCS II over the YBOCS primarily because it assess for avoidance compulsions - this allows us to use empirical research without missing out on the avoidance assessment.
TLDR - The Y-BOCS II goes 0–50, but the old severity bands we all used were for the 0–40 version. A 2025 paper finally offered severity ranges that actually fit the 0–50 scale, so I’m updating my handout to match.
Thanks for trusting me to keep evolving the tools I share with you — I want them to match what the current research is actually saying, and as I always say - I am learning right along side you!