Appearance Anxiety Inventory Research Articles

Exercise addiction, body dysmorphic disorder, and use of enhancement drugs during the COVID-19 pandemic confinement period: A transcultural study

IntroductionThe Coronavirus pandemic has originated unprecedented sanitary control measures that have conditioned people’s lifestyles and habits. Little is known about the impact of such measures, especially the most restrictive, on recent and growing phenomena such as exercise addiction, use of enhancement drugs, and Body Dysmorphic Disorder (BDD).ObjectivesThe objective was to investigate the above-mentioned phenomena during COVID-19 pandemic and how they relate.MethodsThe sample consisted of 3161 participants (65% women), from Portugal (11%), Italy (41%), Spain (16%), the UK (12%), Lithuania (12%), Japan (6%), and Hungary (4%). Mean age was 35.05 (SD = 12.10). Participants responded online to the Exercise Addiction Inventory (EAI), the Appearance Anxiety Inventory (AAI), and questions about use of enhancement drugs.Results4.3% of the participants scored above the cut-off point of the EAI, with higher values registered in the UK and Spain. Exercise addiction was higher among men. Appearance anxiety and body satisfaction problems were found in participants of all participating countries, with 15.2% scoring over the cut-off point for BDD. Higher numbers of those at risk of BDD were found in Italy, Japan, and Portugal. About 29% reported the use of fitness supplements to make them look better, with 6.4% starting a new use during the lockdown. Change in supplements use and exercise are predicted by EAI scores. Change in mental health is predicted by AAI scores.ConclusionsThis study helps to shed light on how COVID-19 lookdown induced behavioral changes and how they affect physical and mental health-related aspects in different countries.

Exercise and Use of Enhancement Drugs at the Time of the COVID-19 Pandemic: A Multicultural Study on Coping Strategies During Self-Isolation and Related Risks.

Introduction: Little is known about the impact of restrictive measures during the COVID-19 pandemic on self-image and engagement in exercise and other coping strategies alongside the use of image and performance-enhancing drugs (IPEDs) to boost performance and appearance.Objectives: To assess the role of anxiety about appearance and self-compassion on the practice of physical exercise and use of IPEDs during lockdown.Methods: An international online questionnaire was carried out using the Exercise Addiction Inventory (EAI), the Appearance Anxiety Inventory (AAI), and the Self-Compassion Scale (SCS) in addition to questions on the use of IPEDs.Results: The sample consisted of 3,161 (65% female) adults from Italy (41.1%), Spain (15.7%), the United Kingdom (UK) (12.0%), Lithuania (11.6%), Portugal (10.5%), Japan (5.5%), and Hungary (3.5%). The mean age was 35.05 years (SD = 12.10). Overall, 4.3% of the participants were found to engage in excessive or problematic exercise with peaks registered in the UK (11.0%) and Spain (5.4%). The sample reported the use of a wide range of drugs and medicines to boost image and performance (28%) and maintained use during the lockdown, mostly in Hungary (56.6%), Japan (46.8%), and the UK (33.8%), with 6.4% who started to use a new drug. Significant appearance anxiety levels were found across the sample, with 18.1% in Italy, 16.9% in Japan, and 16.7% in Portugal. Logistic regression models revealed a strong association between physical exercise and IPED use. Anxiety about appearance also significantly increased the probability of using IPEDs. However, self-compassion did not significantly predict such behavior. Anxiety about appearance and self-compassion were non-significant predictors associated with engaging in physical exercise.Discussion and Conclusion: This study identified risks of problematic exercising and appearance anxiety among the general population during the COVID-19 lockdown period across all the participating countries with significant gender differences. Such behaviors were positively associated with the unsupervised use of IPEDs, although no interaction between physical exercise and appearance anxiety was observed. Further considerations are needed to explore the impact of socially restrictive measures among vulnerable groups, and the implementation of more targeted responses.

Appearance Anxiety Inventory (AAI): creation and validation of the Polish language version.

Body dysmorphic disorder (BDD) is a disabling mental disorder characterized by preoccupation with appearance concerns. Due to lack of awareness of BDD among medical professionals and a limited number of proper diagnostic tools, the diagnosis is frequently missed. Among sparse diagnostic instruments, there is Appearance Anxiety Inventory (AAI), which was developed not only to search for BDD symptoms, but also to assess the progress of patients throughout the therapy. To translate and validate the Polish version of AAI. Both forward and backward translation of the original English version of AAI questionnaire was performed in accordance with international standards. The validation of AAI was conducted on 49 individuals. They completed the questionnaires twice with a 3-6 days' interval. Moreover, the subjects were also asked to fill the Polish versions of COPS (Cosmetic Procedure Screening Questionnaire) and RSES (Rosenberg Self Esteem Scale) for the convergent validity. The Polish version of AAI demonstrated very good internal consistency (Cronbach α coefficient value of 0.91) and good reproducibility (Intraclass Correlation Coefficient (ICC) of 0.78). Convergent validity indicated a strong correlation between AAI and COPS and a strong negative correlation between AAI and RSES (r = 0.67, p < 0.0001 and r = -0.57, p < 0.0001, respectively). The Polish version of the AAI questionnaire showed sufficient or better psychometric properties to support its use in clinical and research work with Polish speakers.

Empirically Defining Treatment Response and Remission in Body Dysmorphic Disorder Using a Short Self-Report Instrument

Determining response or remission status in body dysmorphic disorder (BDD) usually requires a lengthy interview with a trained clinician. This study sought to establish empirically derived cutoffs to define treatment response and remission in BDD using a brief self-report instrument, the Appearance Anxiety Inventory (AAI). Results from three clinical trials of BDD were pooled to create a sample of 123 individuals who had received cognitive-behavioral therapy for BDD, delivered via the Internet. The AAI was compared to gold-standard criteria for response and remission in BDD, based on the clinician-administered Yale–Brown Obsessive Compulsive Scale, modified for BDD (BDD-YBOCS), and evaluated using signal detection analysis. The results showed that a ≥ 40% reduction on the AAI best corresponded to treatment response, with a sensitivity of 0.71 and a specificity of 0.84. A score ≤ 13 at posttreatment was the optimal cutoff in determining full or partial remission from BDD, with a sensitivity of 0.75 and a specificity of 0.88. These findings provide benchmarks for using the AAI in BDD treatment evaluation when resource-intensive measures administered by clinicians are not feasible.

Cross-sectional study of perceived stress, self-esteem, body image disturbance and suicidal ideation in patients of acne vulgaris

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Acne vulgaris is characterized by chronic inflammation of the pilosebaceous units. It has been strongly associated with social impairment among adolescents. The study aims to assess the level of perceived stress, self-esteem, body image disturbance and suicidal ideation in patients of acne vulgaris; uncover any underlying association or correlation between these and the severity of acne vulgaris and further examine the association and co-relation of body image disturbance with perceived stress and self-esteem.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Cross-sectional observational study of 72 patients with acne vulgaris was undertaken by purposive sampling technique. After taking informed consent, subjects were assessed on perceived stress scale-10, Rosenberg’s self-esteem scale, appearance anxiety inventory and Columbia-suicide severity rating scale. Spearman's correlation coefficient helped to examine the correlations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; 31.94% patients had severe acne, 72.22% of patients had high body image disturbance. More than half the patients of acne had high level of perceived stress. Almost three quarters of the patients had low self-esteem. 5.55% patients had suicidal ideation. No significant association was seen between severity of acne with perceived stress, self-esteem, body image disturbance and suicidal ideation. Body image disturbance was significantly associated with perceived stress and self-esteem. A positive correlation between body image disturbance and perceived stress and a negative correlation between body image disturbance and self-esteem was obtained.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; All patients, irrespective of the objective severity of acne, can experience high perceived stress and low self-esteem along with body image disturbances. This warrants consultant liaison between dermatologists and psychiatrists in routine practice for psychosocial intervention.&lt;/p&gt;

Body Dysmorphic Disorder in the Perspective of the Alternative DSM-5 Model for Personality Disorder: A Study on Italian Community-Dwelling Women.

To evaluate the relationships between body dysmorphic disorder (BDD) and Alternative DSM-5 Model for Personality Disorder (AMPD) criterion A and dysfunctional personality trait (i.e., criterion B) measures, 420 Italian community-dwelling women were administered three measures of BDD (i.e., the Body Dysmorphic Disorder Questionnaire, the Body Dysmorphic Disorder-Dimensional Scale, and the Appearance Anxiety Inventory), as well as the Level of Personality Functioning Scale-Brief Form (LPFS-BF) and the Personality Inventory for DSM-5-Short Form (PID-5-SF). The three BDD measures showed substantial convergent validity correlations and could be reliably cumulated to obtain the BDD Cumulative Index (BDDCI). Several significant, nonnegligible correlations were observed between the BDDCI as well as the LPFS-BF scale scores and PID-5-SF personality trait scale scores. Relative importance weight analysis results showed that LPFS-BF scale scores and PID-5-SF trait scale scores were substantial predictors of the BDDCI scores (R = 0.42, f = 0.72). In particular, AMPD criterion A impairment in self-functioning and AMPD criterion B depressivity, anhedonia, perseveration, separation insecurity, and cognitive and perceptual dysregulation were core components of the dysfunctional personality profile associated with BDD.

Psychometric Properties of Persian Version of Body Image Shame Scale: A Study in Cosmetic Surgery Clinics

Background: Body image shame considerably contributes to the development and persistence of eating and body image disorders. Objectives: The current study was done to determine the psychometric properties of the body image shame scale and introduce a suitable measure for researchers and therapists in the field of psychological health. Methods: In this study, 409 (136 men and 273 females) individuals who referred to cosmetic surgery clinics in Tehran were chosen. The construct validity of the body image shame was assessed using confirmatory factor analysis and divergent and convergent validity. To assess the divergent and convergent validity of the body compassion scale, appearance anxiety inventory, dysmorphic concern questionnaire and Forms of Self-Criticizing/Attacking and Self-Reassuring Scale were used. Internal Consistency and test-retest reliability (4 weeks’ interval) were used to evaluate reliability. LISREL V8.80 and SSPS V20 were used for data analysis. Results: The results of confirmatory factor analysis showed that the two-factor model (internal and external body image shame) fitted the data (RMSEA = 0.07, NFI = 0.94, CFI = 0.92). Body image shame scale had a positive, significant correlation with dysmorphic concern, appearance anxiety, and self-criticism, and a negative, significant correlation with body compassion (P &lt; 0.05). Also, Cronbach’s alpha coefficient, for the whole of scale, internal body image shame, and external body image shame were 0.85, 0.79, and 0.82, respectively. Conclusions: Psychometric properties of the persian version of the body image shame scale were confirmed in this study. Therefore, it can be used as a valid instrument in research and clinical works in populations with concerns about body image.

Exploring the relationship between self-compassion and body dysmorphic symptoms in adolescents

Current cognitive and behavioural models of body dysmorphic disorder aetiology highlight a possible role of deficits in self-compassion as a vulnerability factor. Yet, there has been little empirical research on the role of self-compassion in adolescents' body dysmorphic symptoms (BDS). In this study, we investigated the relationship between self-compassion and adolescents’ BDS, after accounting for two potentially overlapping self-related beliefs and attitudes, namely self-esteem and self-efficacy. The participants were 449 Australian secondary school students (60% female) aged 11–17 years (Mage = 13.69, SD = 1.50) who completed the Appearance Anxiety Inventory to assess BDS, the Self-Compassion Scale-Short Form (SCS-SF), and other measures. Principal components analysis supported a two-component solution of the SCS-SF, which were labelled negative sense of self, and self-focussed perspective taking. These two components converged with measures of self-esteem and self-efficacy. As hypothesised, adolescents with a higher levels of self-compassion (total score) had lower levels of BDS. Also, when considered alongside self-esteem and self-efficacy, the negative sense of self component of self-compassion was positively associated with BDS, but self-focussed perspective taking was not. Additional research is needed to consider how to capture the positive component of self-compassion and determine whether it has a protective role in BDS and impairment.

Interrelation Between Appearance Anxiety and Sexual Functions in Women: The Role of Surgical Scars, Morphologic Features, and Accompanying Depression

IntroductionThe findings regarding the association between body mass index (BMI) and sexuality outcomes are mixed. Subjective body image has been found to be more salient in predicting sexual function than actual body size. Previous studies have demonstrated appearance anxiety to be particularly significant. AimTo evaluate the association between appearance anxiety and female sexual functions. Specific aims included the evaluation of body morphologic measurements with indicators other than BMI and determining the predictive role of surgical scars for appearance anxiety and female sexual function. MethodsSexually active women who had been in a stable heterosexual relationship for ≥6 months participated in this study. Demographic features, anthropometric measurements including BMI, skin-fold thickness (SFT) measurements from 3 regions of the body (triceps, scapula, and abdomen) and waist circumference (WC) were assessed. Finally, participants were asked to complete the Appearance Anxiety Inventory, Female Sexual Function Index, and Beck Depression Inventory. Multivariate path analyses and hierarchical multiple regression analyses were performed. Main Outcome MeasuresThe correlations of age, BMI, presence of surgical scars, and measurements of BMI, WC, and SFT as independent variables with Beck Depression Inventory, Appearance Anxiety Inventory, and Female Sexual Function Index scores were the main outcomes of the study. ResultsThe data of 329 women were analyzed. The median age of the participants was 33 (19–52) years. The mean BMI was 24.5 (SD 3.5) kg/m2. The prevalence of female sexual dysfunction was 22.8%. Multivariate analyses revealed that increased appearance anxiety (−0.45), presence of surgical scars (−0.28), accompanying depression (−0.15), SFT abdomen measurement (−0.16), and age (−0.13) were significantly associated with sexual function. Appearance anxiety was found to be associated with accompanying depression (0.56), presence of surgical scar (0.38), and measurements of the WC (0.22), BMI (0.14), SFT-abdomen (0.12), and SFT-triceps (−0.31). Clinical ImplicationsClinicians should take the strong relationship between appearance anxiety and female sexual function into consideration. Body morphologic evaluation should not be limited to BMI; surgical scars and WC and SFT measurements may play a considerable role. Strengths & LimitationsA major limitation of this study was the lack of personal distress evaluation in the participants. ConclusionSexual complaints in middle-aged women revealed the strongest correlation with appearance anxiety. Further longitudinal studies are needed to reveal its underlying factors and implications for sexuality.Cihan A, Cihan E. Interrelation Between Appearance Anxiety and Sexual Functions in Women: The Role of Surgical Scars, Morphologic Features, and Accompanying Depression. J Sex Med 2019;16:1769–1778.

The Multidimensional Youth Body Dysmorphic Inventory: Development and Preliminary Validation.

A new measure specifically designed for adolescents to assess body dysmorphic disorder (BDD)symptoms is needed to identify youth who could benefit from intervention to reduce their BDD-related symptomology. To address this gap, the Multidimensional Youth Body Dysmorphic Inventory (MY BODI) was developed and the psychometric properties were evaluated. Following development and expert assessment, Australian secondary school students (N = 582; 55% female; Mage = 13.62, SD = 1.59, aged 11 to 18years, grades 7 to 12) completed a survey with the new items and validation measures. Results from the factor analysis supported a 3-factor, 21-items measure, which aligned with the DSM-5 diagnostic criteria of Impairment/avoidance, Preoccupation/repetitive behaviours, and Insight/distress. Supporting the convergent validity of the measure, the MY BODI total score and sub-scale scores correlated with measures of BDD symptoms, including the Appearance Anxiety Inventory (AAI) and Body Dysmorphic Disorder Questionnaire-Adolescent Version (BDDQ-A). This study provides preliminary validation of the MY BODI, a self-report measure of BDD symptoms and symptom severity, using a response set aimed to facilitate more reliable reporting, which may identify risk for BDD, and symptoms of BDD.

PO-02-021 Appearance anxiety can be an independent risk factor for female sexual dysfunction

Investigation of the relationship between the levels of appearance anxiety and female sexual function index parameters in women was aimed at the current epidemiologic survey. Sexual active women who have a stable heterosexual relationship at least six months were the subjects of the study. Following informed consent demographic features, medical history, anthropometric measurements including body mass index (BMI), skinfold thickness (SFT) measurements from three different regions of the body (Triceps, Scapula, Abdomen) and waist circumference (WC) were obtained and recorded by the researchers. Finally, subjects were asked to fill Appearance Anxiety Inventory (AAI) to measure the severity of appearance anxiety, Female Sexual Function Index (FSFI) and Beck Depression Inventory (BDI). Among participants, Female sexual dysfunction (FSD) was termed who have below 26.50 points in FSFI total score as previously accepted. Nonparametric Spearman’s correlation test and Hosmer –Lemeshow test for multivariate logistic regression analyses were used with SPSS 21.0.

The emergence of Exercise Addiction, Body Dysmorphic Disorder, and other image-related psychopathological correlates in fitness settings: A cross sectional study.

IntroductionIn a society that perpetuates the strive for a perfect appearance, a fit body has become synonymous with success, but simultaneously hard to achieve. This represents a fertile ground for the development of Exercise Addiction (EA) alongside other disorders, such as Body Dysmorphic Disorder (BDD). This study aims to explore the diffusion of EA in fitness settings in the United Kingdom, Italy, Netherlands, Hungary and the previously unexplored association with appearance anxiety, BDD, self-esteem and the use of fitness supplements.MethodsA large cross-sectional sample (N = 1711) was surveyed in fitness settings using the Exercise Addiction Inventory (EAI), Appearance Anxiety Inventory (AAI) and Rosenberg’s Self Esteem Scale (RSE) in addition to questions surrounding the use of fitness supplements.ResultsCompulsive exercise, appearance anxiety and low self-esteem were present in this sample according to the psychometric measures used (EAI, AAI, RSE). 11.7% scored over the cut off for EA, with alarming peaks in the Netherlands (20.9%) and the United Kingdom (16.1%). 38.5% were found at risk of BDD, mainly female (47.2%). 39.8% used fitness enhancing supplements without medical consultation (95.5%). This cohort of supplement users scored higher in both EAI and AAI. The logistic regression model revealed a strong association between the consumption of sport products and the level of EA across the sample with an odds ratio (OR) of 3.03. Other co-variable factors among female were appearance anxiety (AAI; OR 1.59) and to a lesser extent self-esteem (RSE) (OR 1.08).ConclusionsThis study identified a high risk of EA, appearance anxiety and BDD amongst a cohort of gym users internationally. The previously-unexplored association between these disorders and the unsupervised use of a variety of fitness products, including illicit drugs, highlights the need for informed and integrated responses targeting such vulnerable individuals.

Application of a transdiagnostic treatment for emotional disorders to body dysmorphic disorder: A randomized controlled trial

BackgroundBody dysmorphic disorder (BDD) is a common disorder which is associated with a high rate of comorbidity and functional impairment. Although research shows that cognitive-behavioral therapy can be an efficacious treatment for BDD, there is growing evidence that dysregulated emotion is a core deficit. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) is a transdiagnostic, emotion focused cognitive-behavioral therapy protocol that has been developed to target emotion regulation processes that play an important role in the development and maintenance of many emotional disorders Methods: In the present study, 128 patients meeting criteria for BDD were randomized to either the UP (n = 64) or waitlist/treatment-as-usual (WL/TAU) condition. Diagnoses were determined using semi-structural interviews and patients also completed the Brown Assessment of Beliefs Scale (BABS), the Appearance Anxiety Inventory (AAI), the Difficulties in Emotion Regulation Scale (DERS), the Beck Depression Inventory (BDI) and the Clinical Global Impression (CGI). ResultsRepeated measure ANOVA indicated that the UP significantly decreased depression, BDD symptoms and body-related anxiety, as well as significantly improving emotional regulation all with large effect sizes compared to the TAU/WL condition. Treatment gains as well as remission of comorbid conditions were maintained at the three-month follow-up. Limitations: Our study limitations include restricted follow-up periods and excluding participants who were actively suicidal. Conclusions: To our knowledge, this is the first examination of the UP for BDD, and results suggest that this disorder shares common mechanisms with other disorders of emotion, and that the UP may be an additional efficacious treatment for this condition.

The appearance anxiety inventory: Factor structure and associations with appearance-based rejection sensitivity and social anxiety

The 10-item Appearance Anxiety Inventory (AAI; Veale et al., 2013) was developed to assess cognitive processes and behaviours characteristic of Body Dysmorphic Disorder (BDD). Although the AAI has a number of advantages for research and is widely used, the structure of it has only been evaluated in one previous study. The aim of this study was to conduct an independent evaluation of the AAI's factor structure and convergent validity. Two studies were conducted. Participants in Study 1 were 730 Australian university students (Mage = 21 years). Using exploratory and confirmatory factor analyses, results indicated that 9 AAI items loaded highly on a single factor. However, both the 9-item and the 10-item AAI had good reliability. In Study 2, the AAI 9-item measure was confirmed in a sample of 862 Australian adolescents (Mage = 13 years), and the results were compared to using the 10-item AAI. In each study, the 9-item AAI had excellent convergent validity with measures of body dysmorphic symptoms and appearance-based rejection sensitivity. The decision to use the 10 items of the AAI or to exclude the one item focused on “checking appearance (e.g., in mirrors)” to use a 9-item measure should depend on the research purpose.

The use of supplements and performance and image enhancing drugs in fitness settings: A exploratory cross-sectional investigation in the United Kingdom.

The strive for perfection is prevalent in the fitness industry. This study aimed to explore the use of products to enhance performance alongside exposure to exercise addiction, appearance anxiety and self-esteem in fitness settings. An online survey was prepared and piloted before wider dissemination in fitness clubs via snowballing and selected mailing lists. A list of commonly used products, including Performance and Image Enhancing Drugs (PIEDs) was provided. Exercise addiction (Exercise Addiction Inventory; EAI), anxiety levels (Appearance Anxiety Inventory; AAI) and their self-esteem (Rosenberg's Self-Esteem Scale; RSE) were also measured. 377 questionnaires were completed. A significant number of participants declared the use products either to lose weight (16%) or to reach their fitness goals (41%). The Internet played a major role in both the supply of information and the provision of the enhancement products (33.7%) and side effects were reported (10.5%). Only a limited number of participants sought a medical opinion about taking products (5.1%). EAI scores were high (m=20.02 ± 4.1), AAI (m=15.98 ± 4.8) showed an intermediate level of anxiety, while self-esteem was low (RSE m=12.59 ± 2.2). This pilot study identified the emergence of a new drug trend in fitness settings and showed a potential relationship to exercise addiction, anxiety disorders and low self-esteem. The Internet played a crucial role in disseminating often untested products, including PIEDs without medical supervision and unwanted side-effects were reported. More studies in the field are required in order to safeguard public health and inform policy making.

‘If you have good skin, you are god. If you have bad skin, you are a piece of rubbish’. Mastery of shame and anger in treatment-resistant body dysmorphic disorder: a single case study

AbstractBody dysmorphic disorder (BDD) is characterized by a preoccupation with a perceived flaw in one's appearance, and is often emotionally linked with early adverse experiences. Cognitive behavioural therapy (CBT) is effective but may not resolve shame and anger that can be at the emotional root of BDD. This paper presents a single-case study of a 25-year-old man with a history of treatment-resistant BDD characterized by a preoccupation with facial skin linked to a developmental history of sexual abuse and bullying. He was treated at a national residential specialist unit for 16 weeks during which time he received three individual 1-hour weekly CBT sessions (42 sessions overall), and participated in the residential group programme and therapeutic community. CBT was enhanced using imagery rescripting, compassion-focused therapy and family work to specifically target shame and anger-based past experiences. Severity of BDD was assessed with the BDD-Yale–Brown Obsessive Compulsive Scale (BDD-YBOCS) at pre-, mid-, post-, 3-month and 18-month follow-ups; a weekly self-report measure (Appearance Anxiety Inventory), and a client-drawn self-portrait of his perceived skin flaws at pre- and post-treatment. Treatment outcome was positive. The BDD-YBOCS dropped 94% from the extremely severe range pre-treatment to the sub-clinical range post-treatment. BDD symptoms improved progressively throughout treatment, and when the emotions of anger and shame were resolved (as reported by the client) fell to the non-clinical range. Gains were maintained at 18-month follow-up. We conclude that enhancing CBT for BDD using emotion-focused techniques is to be recommended, particularly when emotional memories continue to affect body shame.

Young adolescents' appearance anxiety and body dysmorphic symptoms: Social problems, self-perceptions and comorbidities

Body Dysmorphic Disorder (BDD) is a chronic and severe condition in adults. Yet, its prevalence and correlates are poorly understood in younger age groups. In this study, the Appearance Anxiety Inventory (Veale et al., 2014) was used as an indicator of BDD symptoms, and young adolescents reporting high appearance anxiety were compared to their same-age peers on social, self-perceptual and comorbid dysfunction. Adolescents (N=387, 10–13 years) reported their appearance anxiety, body mass index, family and peer appearance teasing and acceptance, appearance conversations, self-competence, and general and appearance-based rejection sensitivity. Peer-reports identified who was victimized and accepted at school. Comorbid conditions were measured, including depression, social anxiety, and extreme weight management behaviors. Thirty-five adolescents (89% girls) had high appearance anxiety symptoms, and had significant deficits in self-reported, but not peer-reported, measures of social functioning, self-competence, and measures of rejection sensitivity. They also experienced more symptoms of depression and social anxiety, and reported more extreme weight management behaviors. A third group was identified as moderate risk, and on many measures, formed a unique middle group between their low- and high-risk peers. Item analysis isolated three questions about appearance concerns that could assist practitioners to identify adolescents in need of intervention.

Efficacy of Cognitive Behaviour Therapy versus Anxiety Management for Body Dysmorphic Disorder: A Randomised Controlled Trial

Background: The evidence base for the efficacy of cognitive behaviour therapy (CBT) for treating body dysmorphic disorder (BDD) is weak. Aims: To determine whether CBT is more effective than anxiety management (AM) in an outpatient setting. Method: This was a single-blind stratified parallel-group randomised controlled trial. The primary endpoint was at 12 weeks, and the Yale-Brown Obsessive Compulsive Scale for BDD (BDD-YBOCS) was the primary outcome measure. Secondary measures for BDD included the Brown Assessment of Beliefs Scale (BABS), the Appearance Anxiety Inventory (AAI) and the Body Image Quality of Life Inventory (BIQLI). The outcome measures were collected at baseline and week 12. The CBT group, unlike the AM group, had 4 further weekly sessions that were analysed for their added value. Both groups then completed measures at their 1-month follow-up. Forty-six participants with a DSM-IV diagnosis of BDD, including those with delusional BDD, were randomly allocated to either CBT or AM. Results: At 12 weeks, CBT was found to be significantly superior to AM on the BDD-YBOCS [β = -7.19; SE (β) = 2.61; p < 0.01; 95% CI = -12.31 to -2.07; d = 0.99] as well as the secondary outcome measures of the BABS, AAI and BIQLI. Further benefits occurred by week 16 within the CBT group. There were no differences in outcome for those with delusional BDD or depression. Conclusions: CBT is an effective intervention for people with BDD even with delusional beliefs or depression and is more effective than AM over 12 weeks.

The Appearance Anxiety Inventory: Validation of a Process Measure in the Treatment of Body Dysmorphic Disorder

At present there are no measures to identify the cognitive processes and behaviours that might mediate the outcome of treatment in people with Body Dysmorphic Disorder (BDD). To develop and validate a process measure that can be used to assess the progress of patients throughout therapy and in research for BDD. The psychometric properties of the Appearance Anxiety Inventory (AAI) were explored in a clinical group of participants diagnosed with BDD (Study 1) and in a non-clinical community group with high appearance concerns (Study 2). Item characteristics, reliability, and factor structure were analysed. Convergent validity with measures of related symptoms was assessed. The AAI was found to have good test-retest reliability and convergent validity in the measurement of appearance anxiety. It was also sensitive to change during treatment. The scale was found to have a two-factor structure in the clinical group, with one factor characterized by avoidance, and a second factor comprised of threat monitoring. However, in the community sample it appeared to have a one-factor structure. The results suggest that the AAI has the psychometric properties to determine whether changes in cognitive processes and behaviours can mediate the outcome following treatment in patients with BDD. This supports its potential usefulness in clinical and research settings.