The Body Image Questionnaire (BIQ)

This is virtually identical to the COPS but has slightly different wording in the introduction. It is used in our clinic as part of our routine assessment for symptoms of BDD and as an outcome measure. For screening purposes the items and scoring are identical to the COPS. The score is achieved by summing Q8-19 (items 8‚ 9 and 11 are reversed) The total scores range from 0 to 72 with a higher score reflecting greater impairment and likelihood of a diagnosis of BDD. Question 20 and 21 are part of a clinical assessment of avoidance and safety seeking behaviours. The last question covers any past cosmetic procedures that people may have had. Please note‚ questions are identical in the BIQ follow up but the item numbers are different so summing Q3-Q14 and reversing items 3‚ 4 and 6 achieve scores.
Download BIQ Follow up
 
This questionnaire is part of a routine assessment. All information will be kept strictly confidential. Thank you.
1) sex ….Male ….Female
2) Age: …….
3) Weight: _________________ Height: ________________
4) Marital Status Tick one
….Single
….Married or cohabiting
…. Separated/Divorced
…. Widowed
5) Current Employment Tick one
…Unemployed
…Long-term sick leave
…Employed or Self-employed
…Retired
…Student (Full-time)
….Homemaker
6) Please study this example before completing question 6. In a moment‚ we will ask you to describe the feature(s) of your body which you dislike or would like to improve. If you want to improve more than one feature‚ please list all the features and tick the appropriate box if you are seeking a cosmetic or dermatological procedure for that feature either now or in the future. We shall refer to all such treatments as ‘procedures’. Please note‚ the 1st feature should be the feature you are most concerned about.
This is an example of a woman whose main worry was her nose and who was concerned to a lesser extent by her skin and bottom.
7) Features Causing Concern
Please describe the feature(s) of your body which you dislike or would like to improve and tick the box if you are seeking a cosmetic or dermatological procedure for that feature either now or in the future.
Please tick the appropriate box.
1st Feature (that is the feature you are most concerned about)
Nose is too crooked with a bump
Procedure sought …. Now … Future …. Not desire any procedure
2nd Feature
Blemishes and acne scars on face
Procedure sought …. Now … Future …. Not desire any procedure
3rd Feature
Bottom is too big
Procedure sought …. Now … Future …. Not desire any procedure
We will then ask you to draw a pie ch‎art and estimate the percentage of concern allocated to each feature. The person above completed her pie ch‎art like this.
Bottom
10%
Skin
30%
Nose
60%
6) Features Causing Concern
Please describe the feature(s) of your body which you dislike or would like to improve and tick the box if you are seeking a cosmetic or dermatological procedure for that feature either now or in the future.
Please tick the appropriate box
1st Feature (feature you are most concerned about)
……………………………………….
……………………………………….
Procedure sought …. Now … Future …. Not desire any procedure
 
2nd Feature
……………………………………….
……………………………………….
Procedure sought …. Now … Future …. Not desire any procedure
 
3rd Feature
……………………………………….
……………………………………….
Procedure sought …. Now … Future …. Not desire any procedure
 
4th Feature
……………………………………….
……………………………………….
Procedure sought …. Now … Future …. Not desire any procedure
 
5th Feature
……………………………………….
……………………………………….
Procedure sought …. Now … Future …. Not desire any procedure
 
Now please draw a pie ch‎art and estimate the percentage of concern allocated to each feature.
Please ensure that your percentages add up to 100%!
7) On an average day‚ how many minutes or hour(s) do you currently spend thinking about your feature(s)? Please add up all the time that your features are at the forefront of your mind and make the best estimate.
_____________ minutes or ______________ hour(s) a day
Please read the next set of questions below carefully and circle the number which best describes the way that you feel about your feature(s).
Please read the labels carefully to ensure you are circling the number that reflects how you feel because some of the answers are worded in a reverse order.
 
8) How often do you deliberately check your feature(s)? Not accidentally catch sight of it.
Please include looking at your feature in a mirror or other reflective surfaces like a shop window or looking at it directly or feeling it with your fingers.
0              1               2                3              4               5               6             7               8
|________|________|________|________|________|________|_______|________|
About 40 times or more a day
About 20 times a day
About 10 times a day
About 5 times a day
Never
Check
 
9) How much do you feel your feature(s) is currently ugly‚ unattractive or ‘not right’?
0              1               2                3              4               5               6             7               8
|________|________|________|________|________|________|_______|________|
Very ugly or ‘not right’
Markedly unattractive
Moderately unattractive
Slightly unattractive
Not at all unattractive
10) How much does your feature(s) currently cause you a lot of distress?
0              1               2                3              4               5               6             7               8
|________|________|________|________|________|________|_______|________|
Not at all distressing
Slightly distressing
Moderately distressing
Markedly distressing
Extremely distressing
 
11) How often does your feature(s) currently lead you to avoid situations or activities?
0              1               2                3              4               5               6             7               8
|________|________|________|________|________|________|_______|________|
Always Avoid
Avoid about three quarters of the time
Avoid about half of the time
avoid about
a quarter of the time
Never avoid
If so‚ what do you avoid?
……………………………………….
……………………………………….
12) How much does your feature(s) currently preoccupy you? That is‚ you think about it a lot and it is hard to stop thinking about it?
0              1               2                3              4               5               6             7               8
|________|________|________|________|________|________|_______|________|
Not at all preoccupied
Slightly preoccupied
Moderately preoccupied
very preoccupied
Extremely preoccupied
If you rated you preoccupation with your feature(s) as 4 or above‚ for how long has it preoccupied you?”
Months ________ or Years ____________
 
13) If you have a partner‚ how much does your feature(s) currently have an effect on your relationship with an existing partner? If you do not have a partner‚ how much does it have an effect on dating or developing a relationship?
0              1               2                3              4               5               6             7               8
|________|________|________|________|________|________|_______|________|
Not at all
Slightly
Moderately
Markedly
Extremely
If so‚ how does it effect your relationship/ability to date or develop a relationship?
……………………………………….
……………………………………….
14) How much does your feature(s) currently have an effect on an existing or potential sexual relationship? (e.g. enjoyment of sex‚ frequency of sexual activity)
|________|________|________|________|________|________|_______|________|
Not at all
Slightly
Moderately
Markedly
Very severely
I can’t work
If so‚ how?
……………………………………….
……………………………………….
15) How much does your feature(s) currently interfere with your ability to work or study‚ or your role as a homemaker? (Please rate this even if you are not working or studying: we are interested in your ability to work or study.)
|________|________|________|________|________|________|_______|________|
Not at all
Slightly
Moderately
Markedly
Very severely
I can’t work
If so‚ how?
……………………………………….
……………………………………….
16) How much does your feature(s) currently interfere with your social life?
|________|________|________|________|________|________|_______|________|
Not at all
Slightly
Moderately
Markedly
Very severely
I can’t work
If so‚ how?
……………………………………….
……………………………………….
17) How much do you feel your appearance is the most important aspect of who you are?
0              1               2                3              4               5               6             7               8
|________|________|________|________|________|________|_______|________|
Not at all
Slightly
Moderately
Mostly
Totally
18) How noticeable do you feel your feature is to other people (if you do not camouflage yourself e.g. with clothes‚ padding and/or makeup) and the feature has not been pointed out to them)?
18a) Please specify the 1st feature you are rating (this should be the feature you are most concerned about)……………
0              1               2                3              4               5               6             7               8
|________|________|________|________|________|________|_______|________|
Not at all noticeable
Slightly noticeable (to a stranger less than a foot away)
Moderately noticeable (to a stranger about 3 feet way)
Markedly noticeable (to a stranger about 6 feet away)
Very noticeable (to a stranger passing in the street)
18b) Please specify the 2st feature you are rating (if applicable)……………
0              1               2                3              4               5               6             7               8
|________|________|________|________|________|________|_______|________|
Not at all noticeable
Slightly noticeable (to a stranger less than a foot away)
Moderately noticeable (to a stranger about 3 feet way)
Markedly noticeable (to a stranger about 6 feet away)
Very noticeable (to a stranger passing in the street)
18c) Please specify the 3st feature you are rating (if applicable)……………
0              1               2                3              4               5               6             7               8
|________|________|________|________|________|________|_______|________|
Not at all noticeable
Slightly noticeable (to a stranger less than a foot away)
Moderately noticeable (to a stranger about 3 feet way)
Markedly noticeable (to a stranger about 6 feet away)
Very noticeable (to a stranger passing in the street)
18d) Please specify the 4st feature you are rating (if applicable)……………
0              1               2                3              4               5               6             7               8
|________|________|________|________|________|________|_______|________|
Not at all noticeable
Slightly noticeable (to a stranger less than a foot away)
Moderately noticeable (to a stranger about 3 feet way)
Markedly noticeable (to a stranger about 6 feet away)
Very noticeable (to a stranger passing in the street)
19) How does your feature compare to others of the same age‚ sex‚ and ethnic group?
19a) Please specify the 1st feature you are rating (this should be the feature you are concerned about)……………
0              1               2                3              4               5               6             7               8
|________|________|________|________|________|________|_______|________|
Everyone has the same feature ‘very normal’
Many people have the same feature
Some people have the same feature
Few people have the same feature
No one else has the same feature or degree of abnormality
19b) Please specify the 2st feature you are rating (if applicable)……………
0              1               2                3              4               5               6             7               8
|________|________|________|________|________|________|_______|________|
Everyone has the same feature ‘very normal’
Many people have the same feature
Some people have the same feature
Few people have the same feature
No one else has the same feature or degree of abnormality
19c) Please specify the 3st feature you are rating (if applicable)……………
0              1               2                3              4               5               6             7               8
|________|________|________|________|________|________|_______|________|
Everyone has the same feature ‘very normal’
Many people have the same feature
Some people have the same feature
Few people have the same feature
No one else has the same feature or degree of abnormality
19) Please specify the 4st feature you are rating (if applicable)……………
0              1               2                3              4               5               6             7               8
|________|________|________|________|________|________|_______|________|
Everyone has the same feature ‘very normal’
Many people have the same feature
Some people have the same feature
Few people have the same feature
No one else has the same feature or degree of abnormality
20) What do you avoid because of the way you feel about your feature(s)? Please read the situations below and in the second column rate the degree to which you currently avoid each of these situations on the following scale:
0=Never avoid‚ 1= Occasionally avoid‚ 2=Often avoid‚ 3= Frequently avoid‚ 4= Always avoid
Please add other situations or activities that you avoid at the end of the list.
Situation or activity
I avoid going to a party or social gathering because of my features
I avoid ha‎ving a medical examination or treatment because of my features
I avoid going to public changing room because of my features
I would avoid exercising in a gym or playing a sport because of my features
I avoid wearing a swimming costume on a beach because of my features
I avoid being physically close to someone because of my features
I avoid making love or intimacy because of my features (or only under certain conditions e.g. lights off or wearing your make up).
I avoid certain types of clothes because of my features (please specify)
I avoid certain types of lighting because of my features (please specify)
I avoid looking at pictures in magazines or on television because of my features
I avoid ha‎ving a photo or video taken by someone else because of my features
I avoid looking at old photographs because of my features. (Please specify if you have destroyed them)
I avoid ha‎ving my hair cut at all
I avoid ha‎ving my hair cut at a hairdresser
I avoid looking at my features in mirrors or reflective surfaces
OTHERS (please specify)
21) Please read the lists of activities below that you might do because of the way you feel about your feature(s). In the second column rate the degree to which you use each of the behaviours on the following scale:
0=Never‚ 1= Occasionally‚ 2=Often‚ 3= Frequently‚ 4= Always
Behaviour Frequency
I check my feature(s) in mirrors
I use a particular light to check my feature(s) in a mirror (please specify)
I check my feature(s) in other reflective surfaces (e.g. cutlery‚ windows‚ CDs) (Please specify)
I check my feature(s) directly by looking at it without a mirror
I check my feature(s) by taking photographs of myself
I check my feature(s) by feeling it with my finger(s)
I compare my feature(s) to others in magazines or on television and film
I compare my feature(s) to other people I meet
I compare my feature(s) with old pictures of my self
I pinch the fat on my skin
I wear something to distract attention from my feature (e.g. jewellery‚ a tattoo) (Please specify)
I change my posture to avoid my feature being seen at a certain angle. (Please specify)
I hide my feature(s) with something (e.g. my hand‚ a baseball cap‚ hat‚ scarf‚ baggy clothing‚ newspaper) (Please specify)
I use padding in my clothes to camouflage or increase the size of a feature. (Please specify)
I try to convince others about how unattractive my feature is
I ask others to confirm the existence of my defect in my features
I seek reassurance about whether my feature has got worse
I seek reassurance about whether my feature is camouflaged (for example by make up)
I keep changing my clothes before I go out
I get my partner or family member to “help” me in camouflaging or checking my appearance. (Please specify)
I keep measuring my feature(s)
HAIR: I wear a wig because of my features
I grow or arrange my hair to hide certain features. (Please specify)
I comb or groom (smooth/straighten) or adjust my hair more than most people
I shave‚ cut or pluck hair more than most people. (Please specify)
I use medication too promote hair growth on my head
SKIN: I clean my skin my skin more than most people
I wear more make up than most people to hide my feature(s)
I use cover up stick for spots or blemishes
I use facial peel‚ scrubs or saunas for my skin
I bleach my skin
I use a sun-bed to darken my skin
I pick my skin or squeeze spots more than most people
SHAPE OR WEIGHT: I exercise to alter my shape or weight
I body build with weights
I use steroids
I weigh myself more than necessary
I restrict my food to improve my shape or reduce my weight
I sit with my toes on the floor to avoid my thighs spreading
I eat more food to increase my weight
I use diet pills‚ laxatives or diuretics (please specify)
OTHERS (please specify)
22) Self-portrait
Can you please draw a portrait from the picture in your mind or impression that you have of your face or body (depending on the features that distress you). You can choose whatever medium you wish. Don’t worry if you are not artistic!
 
‘copyright D.Veale 2009’
The Body Image Questionnaire Child and Adolescent Version (BIQ-C)
This is virtually identical to the adult BIQ but has slightly different wording and the item on interference in sexual relationships has been replaced with an item on family relationships. The BIQ-C is in the process of being validated in children and adolescents. At present we recommend that this version is used for patients aged 17 or under as part of assessment for symptoms in BDD and as an outcome measure. For screening purposes items are identical to the COPS in adults. They score from 0 (least impaired) to 8 (most impaired). The score is achieved by summing Q3-14 although items 3‚ 4 and 6 are reversed. The total scores range from 0 to 72 with a higher score reflecting greater impairment and likelihood of a diagnosis of BDD. The cut off score for probable BDD remains to be determined but is 40 in adults.
Download BIQ Child and Adolescent Version
The Appearance Anxiety inventory (AAI)  (Veale et al‚ in submission)
The AAI is designed as process measure to monitor cognitive and behavioural responses in Body Dysmorphic Disorder. The AAI has good test-retest reliability and convergent validity. It was sensitive to change during treatment. The scale has a two-factor structure‚ with one factor ch‎aracterised by avoidance‚ and a second factor comprising of threat monitoring.
Download the Appearance Anxiety Inventory
Veale‚ D‚ Eshkevari‚ E‚ Kanakam‚ N‚ Costa‚ A‚ Werner‚ T (in submission)‚ The Appearance Anxiety Inventory.
Genital Appearance Satisfaction (GAS)(Bramwell & Morland‚ 2009)
This scale contains 11 statements about attitudes towards female genital appearance to be rated by a woman. Each item is scored between 0 and 3 and total scores range from 0 to 33. Higher scores represent greater dissatisfaction with the genitalia. The general population sample for the original study had mean 5.65 (SD 4.68) (Bramwell‚ personal communication). In our study women seeking labiaplasty had a mean and standard deviation of M=38.7 (SD=15.1) and the controls M=6.7 (SD=7.4).
Note that items 1 and 4 are reverse scored.
Download Genital Appearance Satisfaction Scale
Bramwell‚ R. and C. Morland‚ Genital appearance satisfaction in women: the development of a questionnaire and exploration of correlates. Journal of Reproductive and Infant Psychology‚ 2009. 27(1): p. 15-27.
Cosmetic Appearance Screening Scale for women seeking labiaplasty(COPS-L) (Veale et al‚ in submission)
This is a nine-item questionnaire primarily designed to identify those women who have Body Dysmorphic Disorder but it can also be used as an outcome measure. Items 1‚ 2‚ and 9 reflect the perceived abnormality or evaluation of the labia as ugly. Item 3 reflects the degree of preoccupation on the labia. Item 4 reflects the degree of distress caused by the appearance of the labia. Items 5‚ 6‚ 7 and 8 reflect the extent of interference in one’s life due to the labia. The COPS-L has good internal consistency‚ concurrent and convergent validity with measures of related constructs‚ and discriminated between women seeking labiaplasty and controls. It also discriminated between women seeking labiaplasty with and without BDD.
Download COPS-L
Veale‚ D‚ Eshkevari‚ E‚ Ellison‚ N‚ Cardozo‚ L‚ Robinson‚ D‚ & Kavouni‚ A. (in press) Validation of Genital Appearance Satisfaction and Cosmetic Procedure Screening Scales in women seeking labiaplasty. J Psychosom Obstetrics and Gynaecology.
Beliefs about Penis Size (BAPS)
(Veale et‚ al‚ in submission)
This is a 10 item self-report scale to measure beliefs about penis size for men who are anxious about the size of their penis. Respondents are asked to rate how strongly they agree or disagreewith each of the statements. The questions are answered in a Likert scale from 1 (Strongly disagree) to 5 (Strongly agree). There are no reverse items. The total consists of the sums of each column. The range is 10-50. Sensitivity to change after an effective treatment has not yet been determined.
Download BAPS.

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