PEDIATRICS

Body Dysmorphic Disorder Questionnaire

This questionnaire asks about concerns with physical appearance. Please read each question
carefully and circle the answer that is true for you. Also write in answers where indicated.
Name:
Todays Date:
1. Are you very worried about how you look?
Yes
No
If yes: Do you think about your appearance problems a lot and wish you could think about
them less?
Yes
No
If yes: Please list the body areas you dont like:

Examples of disliked body areas include: your skin (for example: acne, scars, wrinkles,
paleness, redness); hair; the shape or size of your nose, mouth, jaw, lips, stomach, hips, etc; or
defects of your hands, genitals, breasts or any other body part.
(Note: If you answered No to either of the above questions, you are finished with this
questionnaire. Otherwise, please continue.)

2. Is your main concern with how you look, that you arent thin enough or that you might get too fat?
Yes
No
3. How has this problem with how you look affected your life? Has it often upset you a lot?
Yes
No
Has it often gotten in the way of doing things with friends or dating?
If yes, describe how:
Has it caused you any problems with school? Yes
If yes, what are they?

No

Are there things you avoid because of how you look?

If yes, please list them:

Yes

Yes

No

No

4. How much time a day do you usually spend thinking about how you look?
a. Less than 1 hour a day
b. 1-3 hours a day
c. More than 3 hours a day
Interpretation of results:
A diagnosis of BDD is likely with the following answers:
Question 1:Yes to both parts
Question 3:Yes to any of the questions
Question 4: Answers b or c

occupation usually involves the face or head.

Nevertheless, any area of the body may
become the focus, and it is common to find
patients concerned with multiple perceived
defects. The most common sites include the
face, nose, eyes, skin, breasts, genitalia, thighs,
hips and hair. Frequently, the obsession is with
the size or shape of the body part, asymmetry
of the body part, blemishes on the skin and the
thinness or distribution of hair.1 Evidence of
BDD may include the following:6
The patient continually compares his or
her appearance with that of other people or

scrutinizes others appearances.

The patient frequently checks his or her
appearance in mirrors or any available reflecting surface; in other cases, the patient avoids
mirrors altogether.
The patient repeatedly seeks surgery and
dermatologic consults despite having been
told the treatment is unnecessary by friends,
family and practitioners.
The patient repetitively touches the perceived defect.
The patient attempts to avoid any situation in which their perceived ugliness might

46 www.advanceforPA.com a d v a n c e FOR PHYSICIAN ASSISTANTS N ove m b e r- D e c e m b e r 2 0 0 2

be exposed.
The patient often questions others for
reassurance, or the patient tries to convince
others that his or her appearance is appalling.
The Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV) lists three criteria
for the diagnosis of BDD:7
A preoccupation with an imagined defect
in appearance. If a slight physical anomaly is
present, the persons concern is markedly
excessive, according to the manual.
The preoccupation causes clinically significant distress or impairment in social, occupational or other important areas of functioning.
The preoccupation is not better accounted for by another mental disorderfor example, dissatisfaction with body shape and size
related to anorexia nervosa.
Clinical Examples

The range of preoccupation with the defective body part can vary widely. Some patients
may wear makeup to hide their appearance,
while some may end up doing physical harm
in an attempt to remove the blemish. This is
true in the case of a woman who reportedly
picked at a pimple on her neck so extensively with tweezers that she ended up exposing
her carotid artery and required emergency surgery to repair the damage.5 Some patients
exhibit paranoid-type behavior in association
with their BDD, much like that of the patient
who thought that motorists in passing cars
actually would wreck because they would be
so horrified by her appearance.5
BDD is well known for its disruption of
daily living. One case reported a 21-year-old
woman who was so preoccupied with the
shape of her thighs that she would stand for
hours in front of the mirror wondering if they
looked any thinner. She would then slap her
thighs in an effort to make the fat disappear.3
In diagnosing men with BDD, the practitioner may find that men are reluctant to confess
their symptoms. They frequently do not believe
that their perception of their appearance is inaccurate.4 Nevertheless, their cases are no less real
than those of their female counterparts, and no
less damaging to their lifestyles. A case in point
is that of a young man who refused to leave his
dormitory room without a hat to cover what he
believed was a balding head. After seeking the
help of several doctors to no avail, the young
man began spending hours on the Internet
looking for a cure to his baldness. He was
close to failing out of college when he was
finally referred to a psychiatrist.7