Abstract
Background: Body Dysmorphic Disorder (BDD) affects approximately 2-3% of the general population, but often goes undetected or is misdiagnosed. A number of measures have been developed to assess BDD symptoms, which have the potential to dramatically improve detection and diagnosis, and also facilitate research on this understudied disorder. This systematic review aimed to identify self-report questionnaires that provide a continuous measure of BDD symptoms, and to summarise the psychometric properties of these measures.Methods: A systematic search of four databases (PSYCHinfo, EMBASE, PubMed and MEDLINE) was conducted in June 2021. Of 1927 records identified, 30 studies were included in the review. These developed and/or validated 13 self-report measures of BDD symptoms. The Consensus-based Standards for the selection of Health Measurement Instruments (COSMIN) was used the evaluate the included studies and measures. Data regarding the following measurement properties was extracted: measure development, content validity, structural validity, cross-cultural validity, hypothesis testing for construct validity, responsiveness, test-retest reliability, internal consistency and measurement error. The methodological quality of each study was also assessed. Information on psychometric properties and methodological quality across studies was pooled to create an overall summary rating for each measure. Levels of recommendation were assigned to each measure. Measures suitable for use in young people were also noted.
Results: The Appearance Anxiety Inventory (AAI; Veale et al., 2014) achieved the highest summary rating and level of recommendation, indicating that it is the most robust measure, based on research available to date. No measures were given the lowest level of recommendation suggesting that all measures had some degree of validity and reliability. Generally, measures were downgraded due to being evaluated either partially or exclusively in non-BDD samples. Three BDD symptom severity measures have been developed specifically for young people, and a further three have been validated for use in young people.
Conclusions: Based on research to date, the AAI is the most psychometrically robust measure of BDD symptoms. However, while this measure captures cognitive and behavioral processes associated with BDD, it does not assess all DSM-5 diagnostic features of the disorder (e.g. distress and impairment). Therefore, measure selection in both research and clinical settings, should take into account the content and length of each questionnaire, as well as the psychometric properties. Despite their lower ratings, other measures have psychometric strengths and show promise. In future, researchers should utilise the COSMIN taxonomy when developing and validating measures in future to standardise this process and enable easier comparison of measures.
| Date of Award | 1 Nov 2022 |
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| Original language | English |
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| Supervisor | affiliated academic (Supervisor) & Georgina Krebs (Supervisor) |