Scales have been developed to aid the clinician in assessing the severity of BDD symptoms, course of illness, and prior treatments. These scales can also assist the clinician in ruling out other phenomenologically similar disorders such as anorexia nervosa or bulimia nervosa:
The Body Dysmorphic Disorder Questionnaire (BDDQ) is a brief, client-administered scale assessing if patients are concerned that a particular area of their body is unattractive and why they believe this area is unattractive. The client is asked to describe the area(s) of dislike and how much time is spent thinking about these perceived defects on a daily basis. The BDDQ rules out bulimia nervosa and anorexia nervosa by asking whether the main body appearance concern centers on being too fat. It further assesses how this bodily preoccupation affects their daily life in terms of functional impairment and the avoidance of certain activities or people.
The Yale-Brown Obsessive Compulsive Scale (BDD-YBOCS: Appendix C) has been modified for BDD to track severity and change over the course of treatment. The YBOCS is a 12-item scale assessing both urges and thoughts to engage in behavior and actual behavior engagement over the preceding week. The BDD-YBOCS has good inter-rater reliability and validity.
Questions to Ask Patients:
- 1) Are you concerned with your bodily appearance or feel that an area of your body is particularly unattractive?
- 2) If yes, ask Eating Disorder questions:
a. What is the lowest weight you have been in the past year?
b. Do you restrict your food intake?
c. If no, then ask “Do you often eat large amounts of food and then purge immediately afterwards?”
If “no” to question #2, further assess for the presence of BDD.
If “yes” to #2, explore Eating Disorder criteria.