Investigations
1st investigations to order
Structured Clinical Interview for DSM-5 (SCID-5)
Test
Use to diagnose BDD.[37] The main limitation is that it must be administered by a trained clinician or rater. Reliability has been established. It includes other psychiatric disorders so can assist with differential diagnosis.
Typically, in clinical settings, the diagnosis is determined by unstructured clinical interviewing and asking questions to determine whether the DSM-5-TR criteria are met.
Result
BDD is diagnosed if all DSM-5 diagnostic criteria for BDD (A through D) are met (i.e., all the questions are answered 'yes' [score of 3])
Body Dysmorphic Disorder Diagnostic Module (BDD Module)
Test
Administer to diagnose BDD.[44] The main limitation is that it must be administered by a clinician or rater. Reliability has been established for the DSM-IV version (criteria changes for DSM-5-TR were not intended to change caseness).
Typically, in clinical settings, the diagnosis is determined by unstructured clinical interviewing and asking questions to determine whether the DSM-5-TR criteria are met.
Result
BDD is diagnosed if all DSM-5-TR diagnostic criteria for BDD (A through D) are met (i.e., all the questions are answered 'yes')
Body Dysmorphic Disorder Questionnaire (BDDQ)
Test
This is a 4-question screening test, used to screen for BDD in psychiatric, dermatology, and surgery settings.[53] The main limitation is that it is a self-report screening questionnaire, not a diagnostic test, so a positive screen should be confirmed by clinical interview. It has good psychometric properties (sensitivity, specificity, accuracy) in psychiatry settings, facial plastic and reconstructive surgery settings, and dermatology settings.
The BDD diagnosis should be confirmed by a clinician interview. Clinicians need to confirm, for example, that perceived appearance flaws are actually minimal or non-existent, that distress or impairment due to appearance preoccupations are clinically significant, and that concerns with body fat or weight are not better explained by an eating disorder.
Result
answers consistent with features of BDD
Body Dysmorphic Disorder Questionnaire, Dermatology Version (BDDQ - Dermatology Version)
Test
This is a screening test, used to screen for BDD.[54] The main limitation is that it is a self-report screening questionnaire, not a diagnostic test, so a positive screen should be confirmed by clinical interview. It has good psychometric properties (sensitivity, specificity, accuracy) in dermatology settings.The BDD diagnosis should be confirmed by a clinician interview. Clinicians need to confirm, for example, that perceived appearance flaws are actually minimal or non-existent, that distress or impairment due to appearance preoccupations are clinically significant, and that concerns with body fat or weight are not better explained by an eating disorder.
Result
answers consistent with features of BDD
Dysmorphic Concern Questionnaire (DCQ)
Test
This is a screening test, used to screen for BDD.[55] One limitation is that it is a self-report screening questionnaire, not a diagnostic test, so a positive screen should be confirmed by clinical interview. Another limitation is that not all scale items are BDD symptoms. It has good psychometric properties in psychiatric settings. The BDD diagnosis should be confirmed by a clinician interview. Clinicians need to confirm, for example, that perceived appearance flaws are actually minimal or non-existent, that distress or impairment due to appearance preoccupations are clinically significant, and that concerns with body fat or weight are not better explained by an eating disorder.
Result
BDD is likely to be present with a score of 9 or higher
Cosmetic Procedure Screening Questionnaire (COPS)
Test
This is a screening test, used to screen for BDD in a cosmetic treatment setting.[56] The main limitation is that it is a self-report screening questionnaire, not a diagnostic test, so a positive screen should be confirmed by clinical interview. It has good psychometric properties (reliability, validity, sensitivity) in a cosmetic surgery setting. The BDD diagnosis should be confirmed by a clinician interview. Clinicians need to confirm, for example, that perceived appearance flaws are actually minimal or non-existent, that distress or impairment due to appearance preoccupations are clinically significant, and that concerns with body fat or weight are not better explained by an eating disorder.
Result
individuals who score 40 or higher should be referred for further assessment
Investigations to consider
Yale-Brown Obsessive-Compulsive Scale Modified for BDD (BDD-YBOCS)
Test
Use to assess BDD severity.[57] It should be used only with individuals who have already been diagnosed with BDD; it is not a diagnostic measure. In clinical settings, when a quick assessment is needed, the first three items of the BDD-YBOCS can be used to evaluate progress with treatment. The scale is reliable, valid, and sensitive to change.
Result
a score of 20 or higher corresponds to a current BDD diagnosis; scores lower than 20 reflect subclinical, or subthreshold, BDD; the following total scores correspond to the following severity descriptors: lower than 20, subclinical BDD; 20-24, mild BDD; 25-30, moderate BDD; 31-40, severe BDD; 41-48, extremely severe BDD
Brown Assessment of Beliefs Scale (BABS)
Test
Use to assess level of insight.[58] Level of insight is a specifier for the diagnosis of BDD. So once the diagnosis is made, level of insight should be assessed. The BABS assesses insight in a range of disorders (such as BDD, obsessive-compulsive disorder, anorexia nervosa, bulimia nervosa, olfactory reference disorder, and illness anxiety disorder [hypochondriasis]). It is reliable, valid, and sensitive to change.
The BABS provides a dimensional score, with higher scores reflecting poorer insight/greater delusionality. Item 7 is excluded from the total score.
Result
excellent insight: score of 0-3; good insight: score of 4-7; fair insight: score of 8-12; poor insight: score of 13-17 plus a score of 0-3 [KP1] on item 1 (conviction); delusional beliefs (absent insight): score of greater than or equal to 18 plus a score of 4 on item 1 (100% conviction)
Use of this content is subject to our disclaimer