Florida Obsessive-Compulsive Inventory (FOCI)

Abstract

The Florida Obsessive-Compulsive Inventory (FOCI) is an empirically validated, brief self-report psychometric instrument designed to assess both the presence and the severity of obsessive-compulsive symptoms in clinical and research settings. Developed in 2007 by Eric A. Storch and colleagues at the University of Florida, the instrument addresses a critical gap in psychiatric assessment by offering an efficient alternative to lengthy clinician-administered interviews and cumbersome self-report questionnaires. The FOCI comprises two distinct, sequentially administered components totaling 25 items: a 20-item Symptom Checklist (FOCI-SC) evaluating the lifetime or current presence of common obsessions and compulsions via a dichotomous response format (No = 0, Yes = 1), and a 5-item Symptom Severity Scale (FOCI-SS) rating the overall clinical impact across time spent, subjective distress, functional interference, resistance efforts, and degree of control on a 5-point Likert-type scale ranging from 0 to 4.

Psychometric investigations demonstrate that the FOCI possesses robust measurement properties. In clinical samples diagnosed with obsessive-compulsive disorder (OCD) according to DSM-IV and DSM-5 criteria, the Symptom Checklist demonstrates strong internal consistency (Kuder-Richardson Formula 20, $KR–20 = 0.83$), while the Severity Scale demonstrates high internal consistency (Cronbach’s $\alpha = 0.89$ to $0.92$) and a unidimensional factor structure accounting for substantial variance. The instrument exhibits strong convergent validity through pronounced correlations with gold-standard measures such as the Yale-Brown Obsessive Compulsive Scale Self-Report (Y-BOCS-SR) and clinician-rated Y-BOCS ($r = 0.76–0.84$), moderate correlations with indices of general affective distress such as the Depression Anxiety Stress Scales (DASS) and Hamilton Depression Rating Scale (HAM-D), and excellent sensitivity to therapeutic changes resulting from cognitive-behavioral therapy (CBT) and pharmacotherapy. With an administration time under five minutes, the FOCI serves as an indispensable tool for rapid triage, broad population screening, longitudinal treatment monitoring, and specialized psychopathology research.

Keywords

Florida Obsessive-Compulsive Inventory, FOCI, obsessive-compulsive disorder, psychometrics, symptom checklist, symptom severity, Yale-Brown Obsessive Compulsive Scale, cognitive behavioral therapy, treatment monitoring, clinical assessment

Authors

The Florida Obsessive-Compulsive Inventory was conceptualized, developed, and psychometrically validated by a collaborative team of clinical psychologists, psychiatrists, and behavioral scientists based at the University of Florida College of Medicine and affiliated academic medical centers:

• Eric A. Storch, Ph.D. – Primary investigator; Professor and Vice Chair of Research in the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine (formerly at the Department of Pediatrics and Department of Psychiatry, University of Florida). Dr. Storch is an internationally recognized authority on pediatric and adult obsessive-compulsive and related disorders.
• David A. S. Kaufman, Ph.D. – Department of Clinical and Health Psychology, University of Florida, Gainesville, FL.
• Daniel M. Bagner, Ph.D., ABPP – Department of Psychology, Florida International University, Miami, FL (formerly at University of Florida).
• Lisa J. Merlo, Ph.D., MPE – Department of Psychiatry, Division of Addiction Medicine, University of Florida College of Medicine, Gainesville, FL.
• Nathan A. Shapira, M.D., Ph.D. – Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL.
• Gary R. Geffken, Ph.D. – Departments of Psychiatry and Pediatrics, University of Florida College of Medicine, Gainesville, FL.
• Tanya K. Murphy, M.D., M.S. – Department of Pediatrics and Department of Psychiatry, Rothman Center for Neuropsychiatry, University of South Florida, St. Petersburg, FL (formerly at University of Florida).
• Wayne K. Goodman, M.D. – D. C. and Irene Ellwood Professor and Chair of the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine (formerly Chair of Psychiatry at University of Florida and co-creator of the original Yale-Brown Obsessive Compulsive Scale).

Purpose

The Florida Obsessive-Compulsive Inventory (FOCI) was engineered to address several persistent diagnostic and administrative challenges in the operational assessment of obsessive-compulsive disorder (OCD). Historically, the clinician-administered Yale-Brown Obsessive Compulsive Scale (Y-BOCS) established the empirical standard for quantifying obsessive-compulsive symptom severity. However, the semi-structured format of the Y-BOCS requires substantial clinical training, sophisticated interviewing skills, and typically between 30 and 45 minutes to administer. While a self-report adaptation (Y-BOCS-SR) was later introduced to alleviate practitioner burden, clinicians and psychometricians observed that respondents often experienced confusion regarding the structural division between obsessions and compulsions, leading to inconsistent scoring, administrative fatigue, and compromised psychometric validity.

The primary rationale behind the development of the FOCI was the creation of an exceptionally brief, psychometrically sound, self-administered questionnaire capable of being completed and scored in less than five minutes. The creators intended to provide a dual-utility instrument that bifurcates the clinical picture into two critical, distinct operational domains: (a) a comprehensive inventory of symptom phenomenology (the number and topical breadth of obsessions and compulsions endorsed) and (b) an aggregated measurement of pervasive functional impairment and clinical distress (overall symptom severity).

In routine clinical practice, the FOCI operates as a rapid screening measure in psychiatric outpatient facilities, primary care clinics, university counseling centers, and specialized behavioral health programs. By establishing an empirical cutoff on the Severity Scale (scores $ge 8$), clinicians can swiftly detect clinically meaningful obsessive-compulsive pathology that warrants comprehensive clinical diagnostic evaluation. Furthermore, because of its brief format, the FOCI provides exceptional utility as a longitudinal tracking measure. In clinical trials and intensive outpatient or residential programs, patients can complete the FOCI weekly or session-by-session to monitor therapeutic trajectory, evaluate response to exposure and response prevention (ERP) protocols, and assess outcomes of selective serotonin reuptake inhibitor (SSRI) pharmacotherapy.

In psychiatric research, the FOCI fulfills the demand for low-burden, scalable phenotyping across large epidemiological cohorts, digital mental health interventions, and neuroimaging studies where testing time is strictly limited. By decoupling the count of diverse symptom manifestations from the global level of functional impairment, researchers can independently analyze the determinants of phenomenological diversity versus clinical disability.

Psychological Construct

The psychological construct evaluated by the FOCI corresponds directly to the diagnostic criteria for Obsessive-Compulsive Disorder as delineated in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR and DSM-5). This construct encompasses two interdependent yet functionally distinct psychological phenomena: intrusive cognitive-affective events (obsessions) and purposeful, repetitive behavioral or mental rituals (compulsions), alongside their cumulative debilitating impact on psychological functioning.

1. Obsessions (Intrusive Cognitive-Affective Manifestations)

Obsessions are defined as recurrent, persistent, intrusive, and unwanted thoughts, urges, or mental images that evoke marked anxiety, apprehension, disgust, or distress. Within the FOCI Symptom Checklist, these cognitive intrusions are evaluated across their most prevalent thematic presentations:

• Harm and Aggressive Intrusions: Intrusive thoughts regarding causing catastrophic injury, physical harm, or death to oneself or others, either through deliberate horrific impulse or through negligent failure to prevent accidents (e.g., Items 1, 2, and 7).
• Contamination Concerns: Pervasive distress regarding contact with dirt, biological toxins, bacteria, viruses, household chemicals, or sticky substances, driven by fear of disease, physical corruption, or causing illness in loved ones (e.g., Item 3).
• Symmetry, Order, and “Just Right” Incongruity: Subjective tension, internal unease, or psychological distress triggered by spatial asymmetry, disorganization, or an affective sense that items are misaligned or incomplete (e.g., Item 4).
• Taboo, Sexual, and Religious Invasions (Scrupulosity): Distressing, ego-dystonic mental images or impulses centered on forbidden sexual themes, blasphemous ideas, moral transgressions, or religious sacrilege that sharply violate the individual’s core moral framework (e.g., Items 5 and 9).
• Magical Thinking and Catastrophic Responsibility: The cognitive conviction that negative events, disasters, or fatal illnesses will befall family members or innocent persons unless arbitrary mental or physical countermeasures are deployed (e.g., Item 6).
• Acquisitive and Hoarding Concerns: Excessive emotional attachment to inert possessions or marked distress surrounding the discard of non-functional items (e.g., Item 8).

2. Compulsions (Repetitive Behavioral and Mental Neutralizations)

Compulsions represent repetitive, stereotyped motor actions or covert mental operations that an individual feels driven to enact in rigid compliance with idiosyncratic rules or in response to an obsession. These behaviors are aimed at reducing acute anxiety, preventing dreaded future catastrophes, or achieving a state of subjective internal closure. Within the FOCI Symptom Checklist, compulsions are assessed across the classic empirical dimensions:

• Checking Behaviors: Stereotyped, repetitive verification of locks, electrical appliances, water taps, or physical safety parameters to forestall catastrophic disasters or quell internal uncertainty (e.g., Item 11).
• Washing and Cleaning Rituals: Protracted, ritualized hand washing, excessive showering routines, sterilization of household objects, and strict avoidance of perceived environmental contaminants (e.g., Item 12).
• Repeating, Counting, and Movement Rituals: Motor sequences repeated a specific number of times, verbal reiterations, counting objects, or specific stepping/touching patterns executed until an internal feeling of completion or “just-rightness” is achieved (e.g., Items 10, 14, and 16).
• Ordering and Arranging: Rigorous, exhausting alignment, re-positioning, and geometric balancing of physical items within the living environment (e.g., Item 13).
• Reassurance Seeking and Checking with Others: Repetitive questioning of trusted figures to confirm that no harm was committed, no contamination occurred, or that catastrophic events will not happen (e.g., Item 15).
• Mental Neutralizations: Covert rituals conducted entirely within the mind, including mental reviewing of past conversations, repeating silent prayers, reciting specific numeric sequences, or mentally counteracting “bad” thoughts with “good” thoughts (e.g., Item 19).
• Correctional Behaviors: Compulsive re-reading and re-writing driven by fear of misunderstanding, error, or perceived moral culpability (e.g., Item 17).

3. Dimensional Symptom Severity and Functional Impairment

Beyond the mere presence or absence of specific symptoms, the clinical essence of OCD resides in its disruptive impact on the individual’s psychological autonomy and daily life. The FOCI Severity Scale captures this overarching dimensional construct through five classical parameters adapted from the clinical core of the Y-BOCS:

1. Temporal Burden (Time Consumed): The chronological duration expended daily in obsessive cognitive loops and compulsive behavioral rituals.
2. Subjective Distress: The emotional toll, internal anguish, and psychological suffering directly elicited by the symptoms.
3. Functional Interference: The degree of operational disruption across vital social, familial, vocational, academic, and interpersonal domains.
4. Active Resistance: The extent to which the individual exerts conscious volitional effort to suppress, challenge, or resist yielding to obsessional urges and compulsive demands.
5. Volitional Control: The individual’s perceived degree of self-efficacy and mastery when attempting to arrest obsessive ruminations or cease compulsive rituals.

Theoretical Framework

The construction and clinical utility of the Florida Obsessive-Compulsive Inventory are grounded in contemporary cognitive-behavioral models of obsessive-compulsive disorder, anchored primarily by the theoretical frameworks established by Paul Salkovskis (1985, 1989), Jack Rachman (1997, 1998), David M. Clark (2004), and the Obsessive Compulsive Cognitions Working Group (OCCWG, 1997, 2005).

1. The Cognitive Appraisal Model

Cognitive formulations posit that intrusive thoughts, violent flashes, doubts, and blasphemous impulses are universal cognitive phenomena occurring regularly in non-clinical populations. In healthy individuals, these intrusive cognitions are rapidly dismissed as meaningless mental noise. In contrast, an individual vulnerable to OCD misinterprets these intrusions as personally meaningful, catastrophic, and reflective of profound moral or physical danger. According to Salkovskis, the fundamental cognitive error in OCD is the inflated sense of personal responsibility—the irrational conviction that one has the absolute power and duty to prevent harm from occurring to oneself or others.

These catastrophic misinterpretations prompt heightened physiological arousal and profound emotional distress. To alleviate this distress and neutralize the perceived personal responsibility, the individual mobilizes compulsive rituals or cognitive neutralization strategies. However, because these neutralizing actions prevent natural habituation and block the disconfirmation of catastrophic expectations, a self-perpetuating, negative-reinforcement feedback loop is established. The FOCI captures both the diversity of these cognitive intrusions and the resulting functional bondage measured by the Severity Scale.

2. The Functional Impairment and Metacognitive Perspective

The theoretical architecture of the FOCI Severity Scale reflects metacognitive and dimensional psychopathology principles. Metacognitive models (Wells, 1997) emphasize beliefs about thoughts (e.g., “Thought-Action Fusion,” the belief that having an unacceptable thought is morally equivalent to performing the action, or increases the objective probability of the event occurring). When thoughts are appraised through these lenses, the individual perceives an urgent demand to control cognition.

The five severity dimensions operationalized in the FOCI (time, distress, interference, resistance, and control) reflect the failure of volitional cognitive control systems. As obsessional intrusions consume greater psychological bandwidth, active resistance progressively erodes, functional interference spreads across occupational and interpersonal spheres, and the individual experiences a devastating loss of self-efficacy. By quantifying these five parameters into a global severity score, the FOCI aligns with the transdiagnostic dimensional paradigm championed by the National Institute of Mental Health’s Research Domain Criteria (RDoC), specifically within the domains of Negative Valence Systems (threat responsiveness) and Cognitive Systems (inhibitory control).

Validity

The psychometric validity of the Florida Obsessive-Compulsive Inventory has been extensively evaluated across clinical psychiatric samples, outpatient psychotherapeutic cohorts, and university populations, establishing solid construct, convergent, discriminant, and predictive validity.

1. Convergent Validity

Convergent validity has been repeatedly demonstrated through strong statistical associations with established, gold-standard measures of obsessive-compulsive symptomatology:

• In the foundational validation study by Storch et al. (2007), conducted with 113 DSM-IV-diagnosed adult OCD outpatients, the FOCI Severity Scale (FOCI-SS) correlated exceptionally well with the Yale-Brown Obsessive Compulsive Scale Self-Report (Y-BOCS-SR) total score ($r = 0.76, p < 0.001$) and with the clinician-administered Y-BOCS total score ($r = 0.63, p < 0.001$).
• The FOCI Symptom Checklist (FOCI-SC) demonstrated significant correlations with the total number of symptoms checked on the Y-BOCS Symptom Checklist ($r = 0.68, p < 0.001$).
• In an independent cross-validation by Aleda et al. (2009), the FOCI-SS exhibited robust convergent correlations with the Obsessive-Compulsive Inventory-Revised (OCI-R) total score ($r = 0.73$) and its respective subscales, confirming that the brief 5-item scale accurately gauges broad OCD symptom severity.
• Cross-cultural investigations, including the validation of the Chinese version (FOCI-C) by Zhang et al. (2017) and the Thai version (FOCI-T) by Saipanish et al. (2015), corroborated these convergent dynamics, reporting correlations with the clinician-administered Y-BOCS ranging between $r = 0.69$ and $r = 0.78$.

2. Discriminant Validity

To establish discriminant validity, researchers have investigated the extent to which the FOCI differentiates OCD symptoms from overlapping constructs of general affective distress, depression, and generalized anxiety:

• Correlations between the FOCI-SS and measures of depressive symptomatology, such as the Hamilton Depression Rating Scale (HAM-D) and the Beck Depression Inventory-II (BDI-II), have consistently remained within the moderate range ($r = 0.38–0.49$). While these correlations are statistically significant—which is theoretically expected given the exceptionally high diagnostic comorbidity between OCD and major depressive disorder (often exceeding 50%)—they are substantially lower than the correlations observed with dedicated OCD instruments ($r > 0.70$).
• Correlations with general negative affect on the Depression Anxiety Stress Scales (DASS-21) and the State-Trait Anxiety Inventory (STAI) demonstrate moderate shared variance ($r = 0.41–0.52$), indicating that while the FOCI taps into anxiogenic affective states, its primary latent variance is driven by obsessive-compulsive phenomena rather than diffuse dysphoria.
• Importantly, the FOCI-SC (symptom count) displays even greater divergence from depressive indices ($r < 0.30$), demonstrating that specific obsessive-compulsive phenomenological diversity is clearly differentiated from general mood dysregulation.

3. Criterion and Predictive Validity

Receiver Operating Characteristic (ROC) curve analyses have confirmed the strong predictive utility of the FOCI for detecting clinical OCD status:

• In clinical screening paradigms, a score of 8 or greater on the FOCI Severity Scale provides the optimal balance of sensitivity and specificity for differentiating individuals meeting formal DSM-IV/DSM-5 diagnostic criteria for OCD from healthy controls and non-OCD psychiatric outpatients. Sensitivity values at this cutoff consistently exceed 0.85, with specificity hovering between 0.81 and 0.88.
• The FOCI demonstrates excellent treatment sensitivity to change. In longitudinal trials examining manualized Cognitive-Behavioral Therapy (specifically Exposure and Response Prevention), pre-to-post treatment effect sizes for the FOCI-SS were large ($d = 1.24–1.52$), paralleling changes observed on the clinician-rated Y-BOCS. Changes in FOCI scores significantly correspond with clinician-rated Clinical Global Impression–Improvement (CGI-I) ratings.

Reliability

The Florida Obsessive-Compulsive Inventory displays consistently high indices of internal consistency, item-total cohesion, and temporal stability across diverse clinical and non-clinical cohorts.

1. Internal Consistency

Because the FOCI consists of two structurally distinct parts with different measurement metrics, internal consistency must be evaluated separately for the dichotomous Symptom Checklist and the polytomous Severity Scale:

• FOCI Symptom Checklist (FOCI-SC, Items 1–20): Evaluated using the Kuder-Richardson Formula 20 ($KR–20$), the checklist achieved a coefficient of 0.83 in the original validation study of 113 OCD patients (Storch et al., 2007). In subsequent psychiatric samples, $KR–20$ values have spanned from 0.81 to 0.86, demonstrating robust internal coherence across this broad inventory of obsessions and compulsions.
• FOCI Symptom Severity Scale (FOCI-SS, Items 21–25): Demonstrates high internal consistency. In the seminal psychometric report, Cronbach’s alpha was $\alpha = 0.89$. Subsequent cross-validation investigations have yielded comparable or superior values: Aleda et al. (2009) reported $\alpha = 0.88$; Zhang et al. (2017) observed $\alpha = 0.90$ in a Chinese psychotherapeutic sample; and Saipanish et al. (2015) documented $\alpha = 0.89$ in a Thai psychiatric cohort. Corrected item-total correlations for the five severity items consistently range from $r = 0.68$ to $r = 0.81$, confirming that each individual item contributes heavily to the overarching construct.

2. Test-Retest Reliability and Temporal Stability

The temporal stability of the FOCI has been investigated in both untreated control groups and stable clinical cohorts over intervals ranging from 1 to 4 weeks:

• In a 2-week test-retest assessment among stable outpatients with OCD who underwent no pharmacological or psychotherapeutic modifications, the intra-class correlation coefficient (ICC) for the FOCI Severity Scale was $r = 0.86$ ($p < 0.001$), indicating excellent temporal reliability.
• The Symptom Checklist exhibited an ICC of $r = 0.82$ over the same 2-week window, reflecting strong stability in symptom endorsement over time while allowing sufficient responsiveness when clinical remission or symptom substitution occurs.

Factor Analysis

Extensive exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) have confirmed the underlying structural architecture of the FOCI.

1. Factor Structure of the Severity Scale (FOCI-SS)

Both exploratory and confirmatory factor analytic studies support a unidimensional, single-factor model for the five-item Severity Scale (Items 21–25):

• In the original EFA conducted by Storch et al. (2007) utilizing principal axis factoring, eigenvalues strongly supported a single-factor extraction (eigenvalue = 3.52), accounting for approximately 70.4% of the total variance. All five items exhibited uniformly high factor loadings ranging between 0.75 and 0.88:
• Item 21 (Time consumed): Factor loading $lambda = 0.81$
• Item 22 (Distress elicited): Factor loading $lambda = 0.86$
• Item 23 (Interference caused): Factor loading $lambda = 0.88$
• Item 24 (Resistance effort): Factor loading $lambda = 0.75$
• Item 25 (Perceived control): Factor loading $lambda = 0.83$
• Confirmatory factor analyses in independent psychiatric cohorts (e.g., Zhang et al., 2017) have verified this unifactorial structure with exceptional goodness-of-fit parameters: Comparative Fit Index ($CFI = 0.991$), Tucker-Lewis Index ($TLI = 0.982$), Root Mean Square Error of Approximation ($RMSEA = 0.043$, 90% CI [0.000, 0.082]), and Standardized Root Mean Square Residual ($SRMR = 0.021$). A single latent factor of “Obsessive-Compulsive Severity” is thus robustly confirmed.

2. Dimensional Structure of the Symptom Checklist (FOCI-SC)

Because the Symptom Checklist covers diverse symptom subtypes, factor analysis of the dichotomous items (using tetrachoric correlation matrices appropriate for binary indicators) reveals a multi-dimensional structure that closely maps onto the classic four-factor or five-factor symptom dimensions widely recognized in the OCD literature:

• Dimension 1: Harm, Aggression, and Checking (Items 1, 2, 7, 11, 15) – Reflecting fears of catastrophic events and secondary verification rituals.
• Dimension 2: Contamination and Decontamination (Items 3, 12) – Reflecting concerns regarding pathogens/dirt and excessive washing/cleaning.
• Dimension 3: Symmetry, Ordering, Repeating, and Counting (Items 4, 10, 13, 14, 16, 17) – Capturing “just-right” phenomena, spatial arrangement, and repetitive motor actions.
• Dimension 4: Unacceptable/Taboo Thoughts and Neutralizations (Items 5, 9, 19) – Encompassing religious (scrupulosity), moral, and sexual intrusions alongside mental rituals.
• Dimension 5: Hoarding Concerns and Behaviors (Items 8, 18) – Capturing difficulties discarding and impulses to collect unneeded possessions.

Instrument / Measurement Tool

The operational administration, formatting, structural breakdown, and scoring mechanics of the Florida Obsessive-Compulsive Inventory are structured as follows:

• Instrument Name: Florida Obsessive-Compulsive Inventory (FOCI)
• Primary Purpose: Rapid self-report assessment of obsessive-compulsive symptom count (breadth) and global clinical severity (functional impact).
• Administration Format: Paper-and-pencil questionnaire, web-based digital assessment, or clinician-assisted self-report.
• Target Population: Adults (aged 18 and older) evaluated for or diagnosed with obsessive-compulsive disorder or related conditions. (A specialized child version, the Children’s Florida Obsessive-Compulsive Inventory [C-FOCI], exists for youth aged 7–17).
• Estimated Administration Time: Under 5 minutes (approximately 2 to 4 minutes).
• Total Item Count: 25 items divided across two distinct sections:
• Part A: Symptom Checklist (Items 1–20) – Evaluates the presence of common obsessions and compulsions.
• Part B: Symptom Severity Scale (Items 21–25) – Evaluates global clinical severity across time, distress, interference, resistance, and control.
• Response Scales and Coding:
• Part A (Symptom Checklist, Items 1–20): Dichotomous format, where respondents select either “No” (scored as 0) or “Yes” (scored as 1).
• Part B (Symptom Severity Scale, Items 21–25): 5-point Likert-type rating scale ranging from 0 to 4 with distinct anchors for each dimension:
• Item 21 (Time): $0 = \text{None}$, $1 = \text{Less than 1 hr/day}$, $2 = \text{1 to 3 hrs/day}$, $3 = \text{3 to 8 hrs/day}$, $4 = \text{Greater than 8 hrs/day}$.
• Item 22 (Distress): $0 = \text{Not at all}$, $1 = \text{Mild}$, $2 = \text{Moderate}$, $3 = \text{Severe}$, $4 = \text{Extreme/near constant}$.
• Item 23 (Interference): $0 = \text{None}$, $1 = \text{Mild}$, $2 = \text{Moderate}$, $3 = \text{Severe}$, $4 = \text{Extreme}$.
• Item 24 (Resistance): $0 = \text{Always resist}$, $1 = \text{Try to resist most of the time}$, $2 = \text{Make some effort to resist}$, $3 = \text{Yield to all obsessions/compulsions reluctantly}$, $4 = \text{Completely yield to all obsessions/compulsions without attempt to control}$.
• Item 25 (Control): $0 = \text{Complete control}$, $1 = \text{Much control}$, $2 = \text{Moderate control}$, $3 = \text{Little control}$, $4 = \text{No control}$.
• Scoring Procedures:
• Symptom Checklist Score (FOCI-SC): Calculated by summing all “Yes” responses across Items 1 through 20. Total possible score ranges from 0 to 20, reflecting overall symptom breadth/count.
• Symptom Severity Score (FOCI-SS): Calculated by summing the scores across Items 21 through 25. Total possible score ranges from 0 to 20, reflecting overall clinical severity. (Alternatively, a mean severity score can be derived by dividing the sum by 5, yielding a range of 0.0 to 4.0).
• Conditional Administration Rule: Respondents who endorse zero symptoms on Part A (all “No” responses) bypass Part B and receive a severity score of 0. If at least one “Yes” is endorsed on Part A, the respondent completes Part B rating their symptoms as an aggregate whole.
• Reverse Scoring: None. All items are keyed in the pathological direction such that higher values consistently indicate greater symptom presence, greater distress, lower control, and more pronounced impairment.
• Clinical Interpretation Guidelines:
• FOCI-SS Score 0–7: Subclinical or minimal obsessive-compulsive symptomatology.
• FOCI-SS Score $ge 8$: Clinically significant threshold indicating probable obsessive-compulsive disorder that warrants comprehensive clinical diagnostic interview.
• FOCI-SS Score 8–11: Mild-to-moderate clinical severity.
• FOCI-SS Score 12–15: Moderate-to-severe clinical impairment.
• FOCI-SS Score 16–20: Extreme, profoundly incapacitating clinical severity.

Permissions & Fee and Test Year

The Florida Obsessive-Compulsive Inventory (FOCI) was originally published in 2007 by researchers at the University of Florida College of Medicine (Storch et al., 2007). The instrument was intentionally developed as an open-access, public-domain measurement tool to facilitate broad clinical screening and academic research into obsessive-compulsive disorder without financial barrier.

The FOCI is completely free of charge for non-commercial clinical practice, health-system utilization, academic research, and educational applications. Clinicians and researchers are permitted to reproduce and administer the scale in paper or digital formats, provided appropriate academic attribution is maintained by citing the seminal validation articles (Storch et al., 2007; Aleda et al., 2009). Commercial distribution, incorporation into for-profit proprietary software packages, or fee-based clinical diagnostic systems requires formal authorization from the primary instrument copyright holders and developers (contact: Dr. Eric A. Storch, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX).

References

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Piqueras, J. A., Rodríguez-Jiménez, T., Ortiz, A. G., Moreno, E., Lázaro, L., & Storch, E. A. (2017). Factor structure, reliability and validity of the Spanish version of the Children’s Florida Obsessive-Compulsive Inventory (C-FOCI). Child Psychiatry & Human Development, 48(1), 166–179. https://doi.org/10.1007/s10578-016-0661-4

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Saipanish, R., Hiranyatheb, T., Jullagate, S., & Lotrakul, M. (2015). A study of diagnostic accuracy of the Florida Obsessive-Compulsive Inventory – Thai version (FOCI-T). BMC Psychiatry, 15, Article 251. https://doi.org/10.1186/s12888-015-0643-2

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Storch, E. A., Khanna, M., Merlo, L. J., Loew, A., Franklin, M. E., Reid, J. M., Goodman, W. K., & Murphy, T. K. (2009). Children’s Florida Obsessive Compulsive Inventory: Psychometric properties and feasibility of a self-report measure of obsessive-compulsive symptoms in youth. Child Psychiatry & Human Development, 40(3), 467–483. https://doi.org/10.1007/s10578-009-0138-9

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Zhang, C. C., McGuire, J. F., Qiu, X., Jin, H., Li, Z., Cepeda, S., Goodman, W. K., & Storch, E. A. (2017). Florida Obsessive-Compulsive Inventory: Psychometric properties in a Chinese psychotherapy-seeking sample. Journal of Obsessive-Compulsive and Related Disorders, 12, 41–45. https://doi.org/10.1016/j.jocrd.2016.11.006

13. Items of the Scale (Questionnaire)