The following scales are routinely used in BDD. Please send us details of any further validated scales used for BDD. It was developed by Katherine Phillips and colleagues and consists of 12 items and the range is from 0 to It is widely used as an outcome measure in controlled trials.
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Maria J. Leandro S. Duarte 3. Maria F. Rosella 1. Gabriel A. Felix 1. Lydia M. Ferreira 1. Thirty patients participated in the cultural adaptation of the scale. The area under the receiver operating characteristic curve was 0. Key words: Body dysmorphic disorders; body image; psychiatry; plastic surgery; therapeutics. Body dysmorphic disorder BDD is a relatively common and often severe psychiatric disorder that is possibly underdiagnosed and underreported.
Also, BDD patients may show different degrees of insight regarding BDD beliefs of looking ugly or deformed - that is, they may recognize these beliefs as probably false or perceive them as absolutely true. Individuals with BDD frequently seek cosmetic surgery to correct perceived defects and reduce the extreme dissatisfaction with their physical appearance. An excessive concern with appearance can conceal psychopathological traits that are not always easy to recognize and may result in iatrogenic and medico-legal problems if neglected.
Internal consistency, test-retest reliability, and convergent and divergent validity were also determined for the Brazilian version of the instrument. Patient selection was conducted between May and March Written informed consent was obtained from all participants after the procedures had been fully explained and prior to their inclusion in the study; anonymity was assured.
Exclusion criteria were inability to understand the interview questions, severe physical deformities resulting from tumors or other conditions, and psychotic disorders. No patient declined participation, but two patients with very noticeable not slight physical defects and indication for orthognathic surgery were excluded from the study, for a final sample of 93 patients. Total sample and subsample sizes for the cross-cultural adaptation, reliability, and validity phases were calculated based on the methodology of Guillemin et al.
Patients with BDD symptoms were classified as having mild to moderate or severe symptoms, 1 , 10 based on their level of subjective distress and avoidance behavior BDDE scores on the specific items. Katharine A. The BDD-YBOCS is a item semi-structured clinician-rated instrument designed to measure severity of BDD symptoms in individuals showing excessive preoccupation and subjective distress with physical appearance. The first 10 items assess excessive preoccupation, obsessions, and compulsive behaviors associated with dissatisfaction with physical appearance.
The first 3 items are based on the BDD diagnostic criteria and assess preoccupation, impairment of global functioning, and subjective distress, which are related to both excessive preoccupation and compulsive behaviors. Items 11 and 12 assess insight and avoidance respectively. The total score is calculated as the sum of ratings for the 12 items, for a maximum score of Only one of the translators was informed about the objectives of the study, so as to produce a conceptual rather literal translation of the scale.
All items were checked for translation errors and evaluated for content validity. A consensus Brazilian Portuguese version of the scale was then obtained by combining elements from both translations.
The consensus version was adequately adapted to the linguistic context and care was taken to preserve all essential characteristics of the original instrument. Idiomatic, semantic, conceptual, and cultural equivalences were considered during the translation phase. Next, the consensus version was back-translated into English by two independent translators who did not have any knowledge about the original scale or purpose of the study. Both back-translated versions were evaluated and compared with the original instrument by the same multidisciplinary committee to check for possible errors made during back-translation.
A consensus back-translated version was produced and compared with the original English version. Minor differences were resolved by discussion.
This analysis resulted in the development of consensus version 1 of the BBD-YBOCS in Brazilian Portuguese, which was appropriately adapted to the linguistic and cultural context of the target population, maintaining all the essential characteristics of the original scale in English. The cultural adaptation phase served to train the second psychologist for the inter-rater reliability phase.
Version 1 of the scale was administered to 30 patients to test eventual failures of the respondents to comprehend the items. After informed consent, patients were given the opportunity to express their comprehension of the scale and suggest any changes they considered necessary.
All patients understood that the scale items were related to concerns and dissatisfaction with physical appearance. Interviews were conducted face to face. The final version was obtained when patients, translators, and health professionals reached a consensus Appendix 1 , available as online-only supplementary material. After translation and cultural adaptation, the final version of the scale was tested for reliability in 20 patients, and for face, content, and construct validity in 43 patients.
These 63 patients did not participate in the cultural adaptation phase. Test-retest reliability reproducibility is the ability of an instrument to produce stable or similar results on repeated administration when no change in patient characteristics has occurred. The instrument was assessed by test-retest procedures in three interviews conducted by two independent interviewers two experienced psychologists. Twenty patients were interviewed by psychologist 1.
The interview was repeated three hours later on the same day by psychologist 2. Two weeks later, the instrument was again administered to the same patients by psychologist 1 only.
Inter- and intra-rater reliability analyses were performed. This phase of testing is used to verify the precision of the instrument in measuring the properties for which it was designed. Face validity evaluates whether the instrument appears to measure what it was designed to measure. In this study, face validity was determined by consensus of the multidisciplinary committee responsible for the Brazilian version of the scale.
Content validity is defined as the degree to which each item is relevant to measure the target content, and examines if a scale represents the universe of concepts or domains to which it corresponds. This is usually established by specialists in the field before the items questions are worded. Establishing content validity requires a defining standard against which the content of a measure is compared.
Construct validity is the process through which the correlation of a measure with other variables is tested for theoretical consistency. In testing construct validity, hypotheses are stated regarding the direction and strength of expected relationships. Construct validity was tested by comparing the BDD-YBOCS with factors considered correlated with symptoms of severely negative body image and with the degree of dissatisfaction with appearance.
The Kolmogorov-Smirnov test was used to test the data for normal distribution. A cutoff point for symptom severity and the corresponding sensitivity and specificity were estimated by receiver operating characteristic ROC analysis. The purpose of the cultural adaptation or pretest was to evaluate if the items of the translated instrument had been clearly formulated.
Thus, the 30 patients who participated in the pretest were not included in the statistical analysis. The patients had no doubts about the questionnaire items and found the instrument easy to understand. The mean time to respond to the questionnaire was 10 min.
Thirty seven Overall, most patients were women Mean age was Seventy-three percent of patients reported that they had first experienced body dissatisfaction in adolescence; Thirty All items favorably contributed to the internal consistency of the scale Table 1. The mean difference was 1. Mean scores ranged from 6. Mean scores ranged from 8 to Different letters indicate significant differences between means.
The cutoff score was associated with a sensitivity of The area under the ROC curve was 0. In the present study, general guidelines for cross-cultural adaptation of quality of life instruments were followed to ensure the elaboration of an adequate version of the BDD-YBOCS in Brazilian Portuguese Appendix 1 , available online.
Patients and health professionals with experience in the management of BDD patients participated in the evaluation of this version. To assess the construct validity, the literature recommends evaluating the relationships of comparable constructs with similar operational concepts. In the present study, 30 and 56 patients reported high scores more severe BDD symptoms on item 8 distress and item 11 insight , respectively, which are the factors that most strongly interfere with the global functioning of BDD patients.
The level of subjective distress and psychosocial impairment associated with physical appearance may be the most important factor to be evaluated in cosmetic surgery patients. However, this belief appears to be more related to an overvaluation of the defect than to a delusional perception.
This result is consistent with the original findings of Phillips et al. Nevertheless, insight is an important part of clinical investigations, and degree of insight plays a role in predicting treatment response and prognosis in BDD patients.
This neural dynamics seems to have an impact on thinking and overall perception, which in individuals with BDD appears fragmented, affecting their level of insight. In the study population, the prevalence of BDD symptoms was The mean age This means that patients with BDD who seek cosmetic surgery will not necessarily seek psychiatric treatment later.
Support system for decision making in the identification of risk for body dysmorphic disorder: a fuzzy model. Int J Med Inform. Body dysmorphic disorder: some key issues for DSM-V.
Depress Anxiety. American Psychiatric Association. Obsessive-compulsive and related disorders. In: American Psychiatric Association.
BDD-YBOCS - Yale-Brown Obsessive Compulsive Scale Modified for Body Dysmorphic Disorder
Intraclass correlation coefficients demonstrated excellent interrater and test-retest reliability; internal consistency was strong. At some point during the disorder, repetitive behaviors or mental acts are performed in response to the appearance preoccupations e. BDD is common, with a prevalence in the general population of 1. Other BDD symptom measures have limitations. In the only previous study that examined the psychometric properties of the BDD-YBOCS, the scale had strong reliability, validity, and sensitivity to change in individuals who were seeking a clinical evaluation or treatment for BDD Phillips et al.
Scales used for BDD
Maria J. Leandro S. Duarte 3. Maria F. Rosella 1.
Assessment Tools for BDD
Katharine A. Phillips, Eric Hollander , Steven A. Rasmussen, Bonnie R. The scale was administered to subjects with BDD, and interviews with 15 subjects were rated by 3 other raters. Test-rarest reliability was assessed in 30 subjects. Other scales were administered to assess convergent and discriminant validity, and sensitivity to change was evaluated in a study of fluvoxamine. Each item was frequently endorsed across a range of severity.