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Youth Symptom Checklist (Ages 4-17)

Please check which boxes apply currently or have happened in the past but are not current. If you have not had a symptom, please move to the next question.
Contamination Obsessions
Current Past
Concern with dirt, germs, certain illnesses(e.g., AIDS)
Concerns or disgust with bodily waste or secretions (e.g. urine, feces, saliva)
Excessive concern with environmental contaminants (e.g., asbestos, radiation, toxic waste)
Excessive concern with household items (e.g., cleaners, solvents)
Excessive concern about animals / insects
Excessively bothered by sticky substances or residues
Concerned will get others ill by spreading contaminant (aggressive)
No concern with consequences of contamination other than how it might feel
Other
Aggressive Obsessions
Fear might harm self
Fear might harm others
Fear harm will come to self
Fear harm will come to others (maybe because of something child did or did not do)
Violent or horrific images
Fear of blurting out obscenities or insults
Fear of doing something embarrassing
Fear will act on unwanted impulses (e.g., to stab a family member)
Fear will steal things
Fear will be responsible for something terrible happening (e.g. ,fire, burglary, flood)
Other
Sexual Obsessions
Forbidden or perverse sexual thoughts, images, impulses
Content involves homosexuality
Sexual behavior towards others (aggressive)
Other
Hoarding/Saving Obsessions
Fear of losing things
Other
Magical Thoughts / Superstitious Obsessions
Lucky / unlucky numbers, colors, words
Other
Somatic Obsessions
Excessive concern with illness or disease
Excessive concern with body part or aspect of appearance (e.g. dysmorphophobia)
Other
Religious Obsessions
Excessive concern or fear of offending religious objects
Excessive concern with right / wrong morally
Other
Miscellaneous Obsessions
The need to know or remember
Fear of saying certain things
Fear of not saying just the right thing
Intrusive (non-violent) images
Intrusive sounds, words, music or numbers
Other

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