Florida Obsessive-Compulsive Inventory (FOCI)

The Florida Obsessive-Compulsive Inventory (FOCI) is a free to use measure of the number of symptoms of obsessive-compulsive disorder (OCD) present, as well as the severity of the symptoms1. It was initially developed in 2007 by researchers at the University of Florida1, 2. It was based on the Yale-Brown Obsessive-Compulsive Scale-Self Report (Y-BOCS-SR), which was considered the gold standard at the time and the only other self-report measure for OCD. However, the FOCI is a much quicker measure to use and to score, taking less than 5 minutes2.

One of the primary reasons the FOCI was developed is that there were some concerns surrounding the Y-BOCS-SR’s validity due to its use of separate obsession and compulsion scales when factor analysis is conducted1. Secondly, many of the other OCD measures that had been used by clinicians in the past were not able to measure the number and severity of symptoms in a brief manner. Thus, the FOCI was developed with the Y-BOCS in mind, was reviewed by OCD experts for reliability and relevance, and was revised in consultation with a few OCD in-patients1, 2.

Psychometric Properties

Once the final FOCI was developed, its psychometric properties were measured using 113 previously diagnosed (using DSM-III-R or DSM-IV) OCD patients, who were diagnosed at least one year prior. It has been since found to have good internal consistency (α = 0.89), adequate reliability (K-R 20 = 0.83) for the SC, and is highly correlated with the Y-BOCS-SR total score (previously considered the gold standard)1, 2.

In addition, internal consistency has been shown with the moderate correlations between the two parts of the measure (SC and SS, rs < 0.45). It has also shown to correlate with other measures such as the DASS and Hamilton Depression Rating Scale (depression/anxiety) and Clinical Global Impression Scale (psychopathology severity)1, 2.

Scoring

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 symptoms1, 2.

Cultural issues

There does not appear to be any issues between gender, culture or age at this stage of research, and the measure has been adapted into a child version (C-FOCI), which has been translated into Spanish. The adult version has been translated into Thai and Chinese, and all versions developed to date have similar psychometric properties to the adult English version3 – 6.

Critical analysis

While it cannot measure the severity of individual symptoms, it does measure the severity of the impact of the symptoms on the client. It cannot, for example, determine the severity of contamination concerns versus the severity of avoiding certain numbers; but it can determine the severity of time consumed on the behaviours.

One other issue with the FOCI is that there is no option to add extra symptoms to the list, and the list is not exhaustive. However, the list does include the most common obsessions and compulsions that occur in OCD clients. Because the FOCI is a self-report, it is possible that the client may indicate this in another way (such as writing their own) or, because it should be followed by a clinical interview, this can be brought to the clinicians attention on deeper analysis.

The FOCI has established, good sensitivity to change, and is therefore a great tool to use when determining the success or failure of treatment interventions over time, and there are no known issues with using the measure multiple times with the same client. Because it is quick to complete and easy to score, it is preferable to use the FOCI instead of longer assessments, such as the Y-BOCS. However, it should be noted that the English version has not been tested across clinical and non-clinical populations or clinical-OCD versus other clinical populations.

Finally, it is worth noting that there is a high correlation with the FOCI and measures of depression and anxiety.  However, this is thought to be due to the high co-morbidity of these disorders.

References

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

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

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

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

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

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