The 13-item Body-Focused Shame and Guilt Scale (BF-SGS; Weingarden et al., 2016) assesses proneness to experiencing self-conscious emotions, including body shame and body guilt, in the context of body dysmorphic disorder. The BF-SGS can be administered online or in-person, has been validated for use with adults, and is free to use with appropriate citations in any setting. This chapter first discusses the development of the BF-SGS and then provides evidence of its psychometrics. Specifically, internal consistency reliability and test-retest reliability support the use of the body shame and body guilt subscales; convergent validity and discriminant validity further support the use of the body shame subscale. Additionally, this chapter directs the reader to the appropriate location of the BF-SGS items in their entirety, provides instructions for administering the BF-SGS to participants, and describes the item response scale and scoring procedure. Logistics of use, including copyright and contact information, are provided for readers.

The 10-item Beliefs About Penis Size Scale (BAPS; Veale et al., 2014) measures boys’ and men’s beliefs about masculinity and shame related to their penis size. Penis size is a primary appearance concern of men, and these concerns may result in penile dysmorphic disorder, which is a form of body dysmorphic disorder specifically focused on being preoccupied with and distressed by one’s penis size. The BAPS can be administered online or in-person to adolescents and adults and is free to use. This chapter discusses the development of the BAPS and provides evidence of its psychometrics. Findings suggest that the BAPS is a unidimensional measure. Internal consistency reliability as well as convergent, concurrent, and discriminant validity support the use of the BAPS with boys and men. This chapter provides the BAPS items in their entirety, instructions for administering the BAPS to participants, item response scale, and scoring procedure. Logistics of use, such as permissions, copyright, and contact information, are provided for readers.

The 19-item Muscle Appearance Satisfaction Scale (MASS; Mayville et al., 2002) assesses the behavioral, cognitive, and affective domains of muscle dysmorphia, which is a variant of body dysmorphic disorder that involves the perceived lack of muscle mass and/or muscle definition. The MASS’s content was designed to capture the characteristics specific to muscle dysmorphia as a form of body dissatisfaction that primarily affects individuals involved in weightlifting. It can be used within research and as a measure of clinical change when treating muscle dysmorphia in applied settings. The MASS can be administered online or in-person to adults and is free to use. This chapter first discusses the development of the MASS and then provides evidence of its psychometrics. Exploratory and confirmatory factor analysis revealed a 5-factor solution among weightlifters. Internal consistency, test-retest reliability, convergent validity, criterion validity, and discriminant validity support the use of the MASS. This chapter provides the MASS items, instructions for administering the measure to participants, the item response scale, and the scoring procedure. Links to available translations are included. Logistics of use, such as permissions, copyright, and citation information, are also provided for readers.

The 12-item Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS; Phillips et al., 1997) is a widely used, semi-structured, clinician or rater-administered measure of a person’s current severity of body dysmorphic disorder (BDD). To emphasize, the BDD-YBOCS is a severity measure and not a screening or diagnostic measure of BDD, and it should be used only in individuals who have already been diagnosed with BDD. The BDD-YBOCS has been the primary outcome measure in most treatment studies of BDD and is also used in clinical settings. It can be administered online or in-person to children, adolescents, and adults and is free to use, although a fee may be charged for more than a certain number of free uses. This chapter first discusses the development of the BDD-YBOCS and then provides evidence of its psychometrics. It has three factors: a core symptoms factor (BDD diagnostic criteria), a resistance-control factor (for thoughts/preoccupation), and a repetitive behaviors factor. Internal consistency, interrater reliability, test-retest reliability, convergent validity, and discriminant validity support the use of the BDD-YBOCS. It is sensitive to change as a result of clinical intervention. This chapter directs readers for how to obtain the full list of items. Logistics of use, such as permissions, copyright, and contact information, are provided for readers.

The 10-item Cosmetic Procedure Screening Scale (COPS; Veale et al., 2012) is used to screen for body dysmorphic disorder (BDD) within cosmetic settings and is often used as an outcome measure in the treatment of BDD. It can be used to predict dissatisfaction with a cosmetic procedure. The 9-item Body Image Questionnaire (BIQ-9) omits the first COPS item and is considered a weekly version of the COPS. A labia specific version, the COPS-L and a penis specific version, the COPS-P are also available. This chapter first discusses the development of the COPS and then provides evidence of its psychometrics. More specifically, the COPS is unidimensional, although the BIQ-9 has been found to contain two factors (interference/avoidance, other BDD symptoms) among adolescents. Internal consistency reliability, sensitivity to change, test-retest reliability, and convergent validity support the use of the COPS and BIQ-9. Next, this chapter provides the COPS items in their entirety, instructions for administration and scoring, and the item response scale. Links to known translations are included. Logistics of use, such as permissions, copyright, and contact information, are available for readers.

The 54-item Body Dysmorphic Disorder Symptom Scale (BDD-SS; Wilhelm et al., 2013) is a comprehensive, self-report measure that assesses the presence and severity of cognitive and behavioral symptoms associated with body dysmorphic disorder (BDD). The BDD-SS can be administered online or in person to adolescents and adults and is free for use in clinical and research settings. This chapter outlines the development of the BDD-SS, highlighting its creation to address the need for a self-report tool that captures the heterogeneous symptoms of BDD. The BDD-SS has demonstrated moderate reliability (α = .75-.83) and convergent validity with other BDD-related measures, such as the BDD-YBOCS. Although factor structure and invariance have not yet been established, the BDD-SS has proven useful for identifying specific symptom profiles and treatment targets. This chapter provides the complete set of BDD-SS items, instructions for administration, the item response scale, and scoring procedures. Logistics of use, including permissions, copyright, and contact information, are also included for users.

The 7-item Dysmorphic Concern Questionnaire (DCQ; Oosthuizen et al., 1998) is designed to screen for, and quantify the degree of, dysmorphic concern in an individual. Dysmorphic concern describes an individual’s preoccupation with certain features of their physical appearance (e.g., hair, skin, nose, genitalia). Excessive levels may cause clinically significant distress and functional impairment, leaning to a diagnosis of body dysmorphic disorder (BDD). However, the DCQ is not a diagnostic tool for BDD; rather, it is a dimensional measure of dysmorphic concern and a screening tool with validated cut-offs for both clinically relevant appearance concern and BDD. The DCQ can be administered online or in-person to adolescents and adults and is free to use. This chapter first discusses the development of the DCQ and then provides evidence of its psychometrics. More specifically, the DCQ has a unidimensional factor structure within exploratory and confirmatory factor analyses. Internal consistency reliability, convergent validity, discriminant validity, and structural validity support the use of the DCQ. Next, this chapter provides the DCQ items in their entirety, instructions for administration and scoring, and the item response scale. Links to available translations are included. Logistics of use, such as permissions, copyright, and contact information, are available for readers.

The 10-item Appearance Anxiety Inventory (AAI; Veale et al., 2013) assesses cognitive processes and behaviours characteristic of body dysmorphic disorder (BDD). The AAI is derived from a theoretical model of BDD that defines appearance anxiety as a person’s responses to their perceived flaws and shame about their appearance (e.g., appearance-focused attention, comparison, rumination, checking, and avoidance). The AAI can be administered online or in-person to adolescents and adults and is free to use. This chapter first discusses the development of the AAI and then provides evidence of its psychometrics. Findings from exploratory and confirmatory factor analysis support a 2-factor structure (appearance avoidance, threat monitoring), yet a single factor accounted for most of the scale’s variance and therefore the AAI is calculated as a single appearance anxiety score. Internal consistency reliability, test-retest reliability, convergent validity, and sensitivity to change as a result of therapy support the use of the AAI. Next, this chapter provides the AAI items in their entirety, instructions for administering the AAI to participants, item response scale, and scoring procedure. Links to known translations are provided. Logistics of use, such as permissions, copyright, and contact information, are provided for readers.

Chapter 12 covers the topic of body dysmorphic disorder. Through a case vignette with topical MCQs for consolidation of learning, readers are brought through the diagnosis and treatment of a patient with body dysmorphic disorder. topics covered inlcude diagnosis, differential diagnoses, co-morbidities, risk assesment and management.

Based on a review using the new criteria for empirically supported treatments, this chapter emphasizes exposure with response prevention for obsessive-compulsive disorder, a treatment that has strong research support. Cognitive therapy is also discussed. Credible components of treatment include exposure, behavioral experiments, and cognitive reappraisal. A sidebar also reviews treatments for body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation.

• Healthy eating habits include choosing mostly nutritious food options from what is available to you (for example, fruits and vegetables), but also include enjoying food and making eating a fun part of your life.

• Always denying yourself foods that you enjoy or eating too much or too little to feel good, isn’t healthy and may lead to disordered eating, or even a serious eating disorder. If you think that you or someone you know may have an eating disorder, talk with an adult and look for treatment ASAP.

• Treatment for eating disorders is possible, but most effective if it begins early in the development of the disorder and includes specialists with expertise in treating eating disorders.

Sociocultural theories of body image propose that different societies have different conceptions of the ideal body shape. Within contemporary Westernized cultures, advertisements, the Internet, and social media networks promote particular assumptions about what constitutes the ‘ideal’ body, and thus exert a strong social pressure to achieve such a body shape. Individuals go to great lengths to achieve and maintain a body image that corresponds to these archetypes of ‘beauty’, which are reinforced as having a superior social value. Such social ideals of beauty are often entirely unrealistic, and can result in body dissatisfaction, appearance anxiety, body image disorder, low self-esteem, and depressive symptoms. Attempts to attain the ideal body can lead to excessive behaviours, such as compulsive exercising, the use of image- and performance-enhancing drugs (IPEDs), and eating disorders. This chapter focuses on excessive exercising and the use of IPEDs, and how these behaviours relate to distress about body image.

We are living in an era in which appearance and body image can become the main focus of thoughts and behaviours, resulting in physical, psychological, and social suffering, about which patients, health professionals, and organizations may or may not have insight. This chapter presents the case of a 32-year-old man with body dysmorphic disorder (BDD) who presented for a psychiatric consultation because he believed that his current psychotropic medication was preventing him from achieving his desired body shape. Exercise had become such an overwhelming preoccupation that it was having negative effects on the other areas of his life, and thus required intervention. Possible etiological and maintenance factors, in particular excessive and dysfunctional exercise behaviours (exercise addiction), were explored. Remission of symptoms only occurred after psychotherapy was included as part of the intervention, demonstrating the positive effects of a treatment plan that combines pharmacology with other therapeutic approaches.

Exercise addiction (AE), which can be defined as engaging in excessive and problematic physical exercise, is still not officially included in the psychiatric nosography, although this disorder can be identified as linked to addictive behaviours. Many different etiopathogenetic hypotheses have been proposed to account for the epidemiological distribution of EA in the general population. However, a clear phenomenological concept of the disorder and shared diagnostic tools are still lacking. It is frequently comorbid with eating disorders and body dysmorphic disorder, which can both trigger EA and develop secondary to it. In recent times it has been proposed that the lockdowns and other restrictions which were imposed during the COVID-19 pandemic could have been possible risk factors for the development or worsening of EA, as physical exercise was widely recommended as a strategy for coping with these restrictions. The initial evidence about the emergence of EA during the COVID-19 pandemic is presented.

This chapter tackles a psychiatric kind that does not pertain to cognitive science narrowly conceived, though it is strongly rooted in cognition. It concerns Body Dysmorphic Disorder (BDD), a condition that involves persistent and intrusive thoughts about a perceived bodily flaw that is not observable or appears slight to others, leading to repetitive behaviors and tending to result in significant distress or functional impairment. The chapter argues that the disorder has an important cognitive component involving certain deficits in visual processing, in interpreting the mental states of others, and in assessing evidence for and against one’s beliefs. A causal model of BDD is proposed that aims to show how its main features fit together. Based on this causal model, there are strong grounds for considering it a distinct psychiatric kind. This model implies a revision of the standard psychiatric taxonomy based on an analysis of the underlying causes of the disorder as opposed to its superficial symptoms. It also suggests the feasibility of constructing cognitive causal models of other psychiatric disorders.

Distinguishes between adaptive and maladaptive anxiety. Describes the essential features of, and models and treatments for, panic attacks and panic disorder. Describes the essential features of, and models and treatments for, phobias. Describes the essential features of, and models and treatments for, generalized anxiety disorder. Describes the essential features of, and models and treatments for, obsessive-compulsive and related disorders.