Screening for Body Dysmorphic Disorder in Dermatological Outpatients

Abstract

Background: Although body dysmorphic disorder (BDD) is frequently found in dermatological settings, it often remains unrecognised. The aims of the current study were to validate the Dysmorphic Concern Questionnaire (DCQ) as a screening instrument; and to estimate the frequency of dysmorphic concerns in a dermatological sample of female outpatients. Patients and Methods: Item characteristics and factor structure of the DCQ were analysed on the basis of data from an unselected sample of 156 dermatological outpatients. In addition, to investigate discriminative validity of the DCQ, 65 patients, including 22 patients with BDD, 21 patients with disfiguring dermatological conditions and 21 patients with non-disfiguring, mild dermatological conditions participated in the study. Diagnoses were based on the Body Dysmorphic Disorder Diagnostic Module. Additionally, the Yale-Brown Obsessive Compulsive Scale modified for BDD was applied, and the patients completed a depression questionnaire. Results: The factor structure and internal consistency of the DCQ were satisfactory. Significant correlations with depressive mood and obsessive-compulsive symptoms confirm its convergent validity. The DCQ revealed significant differences between BDD patients, patients with disfiguring disorders, and patients with non-disfiguring disorders, thus demonstrating a high discriminative validity. A cut-off value of ≧14 provided the best balance of sensitivity and specificity and resulted in correct classification of 84.6% of the patients. Of the unselected outpatients sample 9% achieved positive test results that indicate clinically significant dysmorphic concerns. Conclusion: The results confirm the validity of the DCQ as a sensitive and specific screening instrument that can be recommended as a routine assessment instrument in clinical practice.