Body Dysmorphic Disorder (BDD) is characterized by a distressing and impairing preoccupation with a nonexistent or slight defect in appearance. Patients with the disorder present to both psychiatric and non-psychiatric physicians. A few studies have assessed BDD prevalence in the general population and have shown that the disorder is relatively common. To date, no BDD assessment instruments have been validated in the general population. Our aim was to validate a brief self-screening instrument, the Body Dysmorphic Disorder Questionnaire (BDDQ), in a female community sample. The BDDQ was translated into Swedish and filled out by 2891 women from a randomly selected community sample. The questionnaire was validated in a subsample of 88 women, using the Structured Clinical Interview for DSM-IV (SCID) together with clinical assessment as the gold standard. In the validation subsample, the BDDQ showed good concurrent validity, with a sensitivity of 94%, a specificity of 90% and a likelihood ratio of 9.4. The questionnaire can therefore be of value when screening for BDD in female populations.
Body Dysmorphic Disorder (BDD) is a psychiatric disorder, defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV as a distressing and impairing preoccupation with an imagined defect in appearance; if a slight physical anomaly is present, the person's concern is markedly excessive (American Psychiatric Association, 2000). BDD is characterized by a pattern of obsessive thoughts, feelings and compulsive behaviors. The preoccupations are very time consuming (occurring on average 3–8 h a day) and usually difficult to resist or control (Phillips and Hollander, 2008). BDD is associated with significant distress, disability (including social isolation and occupational dysfunction), cosmetic surgery and suicidality (Phillips, 1991, Phillips, 2007 and Crerand et al., 2005Phillips and Menard, 2006). BDD appears to be relatively common. The three largest studies (n>2000) in general populations found BDD prevalence rates of 1.7–2.4% ( Rief et al., 2006, Koran et al., 2008 and Buhlmann et al., 2010). Using structured clinical interviews examining community samples, prevalence rates of 0.7–3% have been reported ( Faravelli et al., 1997, Bienvenu et al., 2000 and Otto et al., 2001). Studies of psychiatric samples have reported BDD in 2.6–16.0% patients ( Zimmerman and Mattia, 1998, Grant et al., 2001, Conroy et al., 2008 and Kollei et al., 2011). In dermatology settings, most studies have found BDD rates of 8.8–14% ( Phillips et al., 2000, Uzun et al., 2003 and Bowe et al., 2007). The ratio of females to males is in the range of 1:1–3:2 ( Phillips et al., 2008).
The Body Dysmorphic Disorder Questionnaire (BDDQ) is a brief, self-report measure, which is derived from the DSM-IV diagnostic criteria for BDD. Using close-ended questions it asks the respondents whether their appearance concerns are sources of preoccupation and, if so, it assesses the degree to which they cause distress or interfere with the person's social or occupational functioning (Phillips, 2009). The questionnaire was developed as a screening instrument for BDD in psychiatric settings and was validated in a psychiatric outpatient sample (n=66), displaying high sensitivity (100%) and specificity (89%) ( Phillips et al., 1995). In a psychiatric inpatient sample (n=122) the sensitivity was 100% and the specificity was 93% ( Grant et al., 2001). A slightly modified version of the questionnaire was validated in a dermatology patient sample (n=46) and presented high sensitivity and specificity (100% and 92% respectively) ( Dufresne et al., 2001). Subsequently the BDDQ has been widely used for BDD screening, e.g. with 1000 dermatology and plastic surgery outpatients ( Vulink et al., 2006), 100 psychiatric inpatients ( Conroy et al., 2008), 160 patients with maxillofacial problems ( Vulink et al., 2008) and 300 dermatological patients ( Conrado et al., 2010).
The above-mentioned psychometric data are dependent on the study setting, including prevalence of the disease in the examined sample. The results of previous prevalence studies suggest that BDD rates vary significantly depending on the population studied, sample size, and assessment methods, which may be a result of methodological differences and limitations (e.g. non-representative populations, small sample sizes and insufficient assessment methods) (Buhlmann and Winter, 2011). To our knowledge, neither the BDDQ nor any other BDD assessment instruments, have been validated in the general population. In Scandinavia, there are no instruments available for screening of BDD that we know of. Presuming that the occurrence of, and undetected suffering from, BDD are at levels similar to other Western countries, translating a screening instrument into Swedish was justified.