Florida Obsessive-Compulsive Inventory (FOCI)

Abstract

The Florida Obsessive-Compulsive Inventory (FOCI) is a concise, free-to-use self-report measure developed in 2007 by researchers at the University of Florida. Designed to assess both the presence and the severity of symptoms of obsessive-compulsive disorder (OCD), the FOCI offers a rapid alternative to longer assessments like the Yale-Brown Obsessive-Compulsive Scale-Self Report (Y-BOCS-SR), which was previously considered the gold standard. The development of the FOCI addressed concerns regarding the factor structure and length of existing instruments, aiming to provide clinicians with a quick, reliable, and valid tool for symptom tracking and treatment monitoring in clinical populations.

Keywords

Florida Obsessive-Compulsive Inventory, FOCI, OCD, Obsessions, Compulsions, Self-report, Severity scale, Symptom checklist, Psychometric properties, Y-BOCS.

Authors

Eric A. Storch, David A. S. Kaufman, Daniel Bagner, Lisa J. Merlo, Nancy A. Shapira, Gary R. Geffken, Tara K. Murphy, Wayne K. Goodman.

Purpose

The primary purpose of the FOCI is twofold: first, to quickly quantify the number of obsessive-compulsive symptoms present in an individual; and second, to measure the overall severity and impact of these symptoms. Developed specifically to be quicker and easier to score than its predecessor, the Y-BOCS-SR, the FOCI serves as an efficient screening tool and a reliable instrument for monitoring treatment efficacy over time.

The scale was developed to overcome limitations noted in other measures, particularly the structural validity issues associated with the Y-BOCS-SR’s use of separate obsession and compulsion scales during factor analysis. By focusing on a rapid, 20-item checklist followed by a severity rating, the FOCI allows clinicians to quickly establish a baseline of OCD traits (scores 8+) and track changes efficiently during intervention.

Construct

The FOCI measures the core behavioral and cognitive manifestations of Obsessive-Compulsive Disorder (OCD). This condition is characterized by the presence of obsessions (recurrent, persistent thoughts, urges, or images) and/or compulsions (repetitive behaviors or mental acts performed in response to an obsession or according to rigid rules). The instrument divides the construct into two measurable components: the presence of specific symptoms (measured by the Symptom Checklist, SC) and the overall functional impairment and distress caused by these symptoms (measured by the Severity Scale, SS).

Although the FOCI measures the severity of the symptoms collectively, it does not provide individual severity ratings for each specific obsession or compulsion (e.g., contamination concerns versus checking rituals). Instead, it focuses on the global impact, such as the amount of time consumed by the behaviors, offering a practical measure of psychopathology severity relevant for clinical settings.

Validity

The FOCI has demonstrated strong evidence of validity, particularly through its high correlation with established measures of OCD severity. Initial validation studies, conducted on 113 previously diagnosed OCD patients, confirmed that the FOCI total score is highly correlated with the total score of the Y-BOCS-SR, which was the clinical gold standard at the time of FOCI’s development. This finding supports the FOCI’s concurrent validity.

Furthermore, the FOCI has shown expected correlations with measures assessing related constructs, thereby supporting its convergent validity. Specifically, it correlates with the Hamilton Depression Rating Scale (HDRS) and the Depression Anxiety Stress Scales (DASS), a correlation thought to reflect the high rate of comorbidity between OCD, depression, and anxiety disorders. It also correlates positively with the Clinical Global Impression Scale (CGI), indicating its ability to reflect overall psychopathology severity.

Reliability

The reliability of the FOCI has been well-established across multiple studies. The instrument exhibits good internal consistency, with a Cronbach’s alpha ($alpha$) reported at 0.89 for the overall measure. The Symptom Checklist (SC) component specifically demonstrated adequate reliability, measured using the Kuder-Richardson Formula 20 (K-R 20) at 0.83.

Crucially for clinical practice, the FOCI has demonstrated good sensitivity to change. This makes it an invaluable tool for repeated measurement, allowing clinicians to accurately determine the success or failure of various pharmacological or psychological treatment interventions over extended periods. Because the measure is quick and easy to administer, repeated use presents no known issues, enhancing its utility for longitudinal tracking.

Factor Analysis

The FOCI was partially developed in response to structural issues identified in the Y-BOCS-SR, where the use of separate obsession and compulsion scales complicated factor analysis. The FOCI structure, comprising the Symptom Checklist (SC) and the Severity Scale (SS), exhibits internal consistency demonstrated by moderate correlations between the two parts ($r_s < 0.45$).

This moderate correlation suggests that while the presence of symptoms (SC) is linked to the overall severity (SS), they remain distinct components of the OCD construct. The cross-cultural adaptations of the FOCI (e.g., Thai and Chinese versions) have generally reported similar psychometric properties, suggesting the stability of the underlying factor structure across different linguistic and cultural groups.

Instrument

Test Type: Self-report screening and severity measure.

Format: The instrument consists of two parts: 1) the Symptom Checklist (SC), a 20-item binary (Yes/No) list of common symptoms (10 obsessions, 10 compulsions); and 2) the Severity Scale (SS), which rates the overall severity of symptoms identified in the SC.

Language Available: English, Thai, Chinese. The child version (C-FOCI) is available in English and Spanish.

Population Group: Clinical population (diagnosed with OCD).

Age Group: Adult (FOCI); Child/Youth (C-FOCI).

Population Details: Initial validation sample consisted of 113 patients previously diagnosed with OCD using DSM-III-R or DSM-IV criteria, diagnosed at least one year prior to testing. The English version has not been extensively tested across clinical versus non-clinical populations.

Test Methodology: If the individual marks “yes” for more than one symptom on the SC (range 0–20), they proceed to complete the SS, where they rate the severity of their symptoms as a whole. A total score of 8 or higher on the combined scale indicates possible OCD traits. Administration typically takes less than 5 minutes.

Keywords

Self-report, Obsessive-Compulsive Disorder, Psychometrics, Treatment monitoring, Internal consistency, Symptom severity, Clinical screening, DSM-IV, Comorbidity.

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: Not provided in source content.

Correspondence Address: Correspondence is typically directed to the lead author, Eric A. Storch, formerly affiliated with the University of Florida.

Permissions & Fee and Test Year

The Florida Obsessive-Compulsive Inventory (FOCI) is described as a free to use measure, enhancing its accessibility for widespread clinical and research application. The scale was initially developed and published in 2007 by researchers associated with the University of Florida.

Reference’s

1. Storch, E. A., Kaufman, D. A. S., Bagner, D., Merlo, L. J., Shapira, N. A., Geffken, G. R., Murphy, T. K., & Goodman, W. K. (2007). Florida Obsessive-Compulsive Inventory: Development, reliability and validity. Journal of Clinical Psychology, 63(9), 851 – 859. DOI: 10.1002/jclp.20382
2. Aleda, M. A., Geffken, G. R., Jacob, M. L., Goodman, W. K., & Storch, E. A. (2009). Further psychometric analysis of the Florida Obsessive-Compulsive Inventory. Journal of Anxiety Disorders, 23, 124 – 129. DOI:10.1016/j.janxdis.2008.05.001
3. 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, 251 – 257. DOI: 10.1186/s12888-015-0643-2
4. Storch, E. A., Khanna, M., Merlo, L. J., Loew, A., Franklin, M., 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, 467 – 483. DOI: 10.1007/s10578-009-0138-9
5. Piqueras, J. A., Rodriquez-Jimenez, T., Ortiz, A. G., Moreno, E., Lazaro, 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, 166 – 179. DOI: 10.1007/s10578-016-0661-4
6. 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. DOI: 10.1016/j.jocrd.2016.11.006

Items of the Florida Obsessive-Compulsive Inventory (FOCI)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The FOCI contains two parts: 1) the symptom checklist (SC) and 2) the severity scale (SS). The SC measures the number of symptoms present from a 20-item list of common symptoms that the individual will circle either “yes” for present or “no” for not present (range 0 – 20; 10 each of obsessions and compulsions). If there is more than one “yes”, the client completes the SS on the second page. They will rate the severity of their symptoms identified on the SC. The clinician adds the total and a score of 8+ indicates possible OCD traits. The clinician can also average the scores over the SS to find an overall severity The SS measures the severity of the symptoms that have been identified, as a whole, and not individual symptoms.