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Body dysmorphic disorder (BDD) is a common condition in which people are excessively preoccupied with their appearance and their perceived physical flaws. 1 It can be difficult to diagnose because the symptoms of this disorder rarely present to psychologists but instead to other practitioners, such as general practitioners, dermatologists, and cosmetic surgeons, who may be less familiar with this condition’s symptomology. 2 Researchers in the field have developed the Body Dysmorphic Disorder Questionnaire (BDDQ) to aid in recognizing and screening this condition.
The Body Dysmorphic Disorder Questionnaire is a screening measure that helps practitioners determine whether a person might have BDD. The questionnaire contains only four sections and a total of nine yes-or-no questions. It asks for additional explanations for some of the questions to determine the details and severity of specific symptoms. 3
The sections ask: 3
This questionnaire has a high sensitivity, ranging from 94%–100%, and a high specificity, ranging from 89%–100%. 3
The BDDQ measures someone’s likelihood of having BDD. The most telling question is the first question, which determines whether an individual has a preoccupation with their appearance. If a person answers “no” to this question, they need not complete the survey. The second question localizes those concerns to the body and its size. This helps determine whether an eating disorder would be a more appropriate diagnosis; if the client’s concern is linked to the perceived size of their body, it may indicate an eating disorder instead of BDD. The third question establishes whether the preoccupation causes a person significant distress or impairment. Simple insecurities alone are not signifiers of BDD, but an obsession with flaws that inhibits day-to-day activity is. The third question also gathers more information about the effect this concern has on the person’s life, including whether and how it affects their social life and job. Finally, the fourth question evaluates how much time one spends thinking about their appearance. The longer one spends obsessing over their appearance, the more likely they are to be diagnosed with BDD. 4
Certain answers inform practitioners that a person is likely to have BDD. For example, when someone answers “yes” to question one and “yes” to the follow-up question (“Do you think about your appearance problems a lot and wish you could think about them less?”), they are more likely to be diagnosed with BDD. Those who answer “yes” to the third question and any of its subset questions are also likely to have BDD. Finally, indicating via the fourth question that a person spends one to three hours, or more than three hours, per day, thinking about how they look increases the likelihood of a BDD diagnosis. 4
Some differences in interpretation and presentation of the BDDQ exist across studies. For example, some studies apply a point value to the different questions in the BDDQ, assigning a certain numerical value to BDD risk. 5 Additionally, the specific wording and order of the questions vary across studies. As contrasted with the wording of the first question presented above, one study asks, “Are you very concerned about the appearance of some part(s) of your body that you consider especially unattractive?” This same study separates question three and its subsequent clarifying questions and places the second question last. 5 Despite minor differences in presentation, the questionnaire still has the same ability to aid a clinician in diagnosing BDD.
A few studies have tested the validity and/or reliability of the BDDQ and shown that it is an accurate diagnostic tool for body dysmorphic disorder.
A 2011 analysis of studies testing the validity of screening tools for BDD specific to a cosmetic setting conducted by researchers from the University Hospitals Leuven, Belgium, found that the dermatology version of the BDDQ, the (BDDQ-DV), was one of only two tools worthy of validation. 6
Numerous studies regarding BDD have used the BDDQ as an evaluative measure and shown that after using the survey, BDD diagnosis was confirmed by an evaluatory session with a clinician. For example, in a 2001 study, researchers administered the BDDQ to 122 adults presenting for admission to a psychiatric inpatient facility, 16 of whom were diagnosed with BDD after consultation with a clinician. In this study, the administration of the questionnaire made the participants more comfortable disclosing their symptoms; all 16 reported that they would have felt too ashamed to raise the issue with a physician unless specifically asked. 7
In a 2013 study, researchers from Linköpin University in Sweden asked 2,891 female participants to fill out the BDDQ. They found that in 94% of the cases in which the questionnaire indicated that a participant might have BDD, the diagnosis was confirmed by a face-to-face assessment conducted by a clinician using the Structured Clinical Interview for DSM-IV (SCID). The Swedish translation of the BDDQ showed good validity and value as a screening tool in female populations. 5
In another study assessing screening tools for BDD in people seeking aesthetic rhinoplasty, the Body Dysmorphic Disorder Questionnaire–Aesthetic Surgery (BDDQ-AS) showed adequate reliability. 8
The BDDQ has been shown to be a useful and effective measure for BDD, but it is a screening instrument and does not connote a diagnosis of BDD. Diagnosis still requires a face-to-face interview with a trained clinician qualified to make a diagnosis. The clinician must determine the severity of the client’s distress, whether the perceived physical defect is nonexistent or slight, and whether an eating disorder may be a more accurate diagnosis. 4
Because BDD is difficult to diagnose, every valid and reliable tool is useful to practitioners. If tools like the BDDQ can be disseminated and brought into the mainstream for medical professionals across fields, including in seemingly unrelated areas like dermatology and orthodontics, people with BDD may be better able to get the diagnoses and treatments they need for their condition.
