Body Image Acceptance and Action Questionnaire (BI-AAQ)

1. Abstract

The Body Image Acceptance and Action Questionnaire (BI-AAQ) is a widely utilized self-report psychometric instrument designed to assess body image psychological flexibility, defined within Acceptance and Commitment Therapy (ACT) as the capacity to experience distressing or unwanted body-related thoughts, emotions, memories, and physical sensations fully and without defensive avoidance, while continuing to pursue personally meaningful, value-congruent behaviors. Developed by Kelly G. Wilson, Emily K. Sandoz, Rhonda M. Merwin, and Kate Kellum (2013), the instrument was formulated to address a critical limitation in eating disorder and body image assessment: while traditional measures evaluate the topography, frequency, or severity of negative body cognitions (e.g., body dissatisfaction, drive for thinness, weight concern), they frequently fail to evaluate how an individual functionally relates to those internal experiences. Comprising 12 items rated on a 7-point Likert scale ranging from 1 (“Never true”) to 7 (“Always true”), the BI-AAQ yields a unidimensional structure that measures the degree to which an individual exhibits body-related experiential avoidance and psychological inflexibility.

In the original psychometric validation studies, all items are framed toward body-related psychological inflexibility; when scored in the direction of psychological flexibility, items are reverse-coded such that higher composite scores represent greater psychological flexibility and acceptance surrounding body image. Psychometric evaluations across diverse non-clinical, collegiate, and clinical samples—including individuals diagnosed with anorexia nervosa, bulimia nervosa, and binge eating disorder—demonstrate exceptional internal consistency, with Cronbach’s alpha coefficients consistently ranging from α = .92 to .95, and robust two- to three-week test-retest reliability (r = .80 to .88). Confirmatory factor analyses across international adaptations have repeatedly substantiated an invariant single-factor model. The instrument exhibits strong convergent validity with general experiential avoidance, eating disorder symptom severity, depressive symptoms, and body dissatisfaction, while demonstrating significant incremental validity over general measures of psychological flexibility (such as the AAQ-II) in predicting disordered eating behaviors, quality of life impairment, and clinical treatment outcomes.

2. Keywords

Body Image Acceptance and Action Questionnaire, BI-AAQ, body image flexibility, psychological flexibility, Acceptance and Commitment Therapy, experiential avoidance, eating disorders, body dissatisfaction, cognitive defusion, psychometrics

3. Authors

The Body Image Acceptance and Action Questionnaire was developed and empirically validated by a collaborative team of clinical psychologists and contextual behavioral scientists:

• Emily K. Sandoz, Ph.D. — Endowed Professor of Social Sciences, Department of Psychology, University of Louisiana at Lafayette; Director of the Louisiana Contextual Science Research Group. Dr. Sandoz is a recognized scholar in contextual behavioral science, clinical behavior analysis, and the application of Acceptance and Commitment Therapy to eating behavior and body image distress.
• Kelly G. Wilson, Ph.D. — Professor Emeritus of Psychology, University of Mississippi; co-founder of Acceptance and Commitment Therapy. Dr. Wilson has authored seminal texts on ACT, behavioral philosophy, and experiential approaches to psychopathology.
• Rhonda M. Merwin, Ph.D. — Associate Professor in Psychiatry and Behavioral Sciences, Duke University Medical Center; Director of the ACT at Duke Program. Dr. Merwin specializes in the treatment and behavioral assessment of eating disorders, type 1 diabetes management, and contextual behavioral interventions.
• K. Kate Kellum, Ph.D. — Associate Professor of Psychology and Research Associate, Center for Behavioral Research and Service, University of Mississippi; expert in behavior analysis, relational frame theory, and research methodology.

4. Purpose

The primary purpose of the Body Image Acceptance and Action Questionnaire (BI-AAQ) is to quantify psychological flexibility specifically contextualized within the domain of body image, body shape, and body weight. For decades, clinical and social psychology conceptualized body-related pathology almost exclusively through the rubric of body dissatisfaction—the cognitive and affective discrepancy between an individual’s perceived physical appearance and their idealized aesthetic standard. While instruments such as the Body Shape Questionnaire (BSQ) and the Eating Disorder Examination Questionnaire (EDE-Q) successfully capture the intensity and frequency of negative evaluations, they do not assess an individual’s functional repertoire in response to those thoughts. Consequently, two individuals exhibiting identical levels of subjective body dissatisfaction may experience radically divergent life trajectories: one may succumb to rigid dietary restriction, social isolation, and pervasive behavioral avoidance, whereas the other may engage fully in interpersonal relationships, career goals, and physical well-being despite experiencing self-critical physical assessments.

The BI-AAQ was constructed to operationalize this distinction. Specifically, it measures body image psychological flexibility: the ability to openly experience unwanted bodily sensations, appearance-related self-evaluations, and distressing emotions without attempting to suppress, alter, or flee from them, while directing behavior toward valued ends. In clinical practice, the BI-AAQ serves several distinct functions:

• Baseline Diagnostic and Functional Assessment: It identifies the degree to which an individual’s body-related cognition restricts their behavioral repertoire, providing clinicians with direct insight into functional impairment beyond surface-level weight or shape concerns.
• Process-Based Treatment Monitoring: As a process measure tailored for third-wave cognitive behavioral therapies, the BI-AAQ tracks whether therapeutic interventions are effectively increasing acceptance and values-based action, rather than merely attempting to debate or eliminate distorted cognitions.
• Predictor of Relapse and Long-Term Recovery: Research indicates that post-treatment improvements in body image psychological flexibility predict sustained recovery from eating disorders and prevent symptom recurrence more reliably than reductions in body dissatisfaction alone.
• Targeted Research in Diverse Populations: The scale enables empirical inquiry into the mechanics of body image distress across clinical groups (e.g., anorexia, bulimia, muscle dysmorphia) and non-clinical populations (e.g., collegiate athletes, postpartum women, individuals undergoing bariatric surgery, and sexual and gender minority cohorts).

5. Psychological Construct

The psychological construct assessed by the BI-AAQ is body image psychological flexibility (or inversely, body-related psychological inflexibility and experiential avoidance). In contextual behavioral psychology, psychological flexibility is not viewed as an immutable personality trait, but rather as an overarching behavioral repertoire comprising six interrelated core processes, often illustrated via the ACT “Hexaflex” model. When applied to the physical self, body image flexibility represents the confluence of these processes under the presence of negative somatic and evaluative cues:

Acceptance vs. Experiential Avoidance of Body Image

Body-related acceptance involves the active, non-judgmental embracing of private experiences regarding one’s physical appearance, weight, shape, or biological functioning. The inverse process—experiential avoidance—entails the unwillingness to remain in contact with distressing body-related thoughts (e.g., “I look repulsive”), emotions (e.g., shame, anxiety, disgust), or interoceptive signals, accompanied by efforts to modify their form, frequency, or situational sensitivity. In the BI-AAQ, items such as “I shut down when I feel bad about my body shape or weight” (Item 5) and “I go out of my way to avoid feeling bad about my body shape or weight” (Item 12) directly index this avoidant posture, capturing how individuals construct rigid behavioral barriers to prevent somatic discomfort.

Cognitive Defusion vs. Cognitive Fusion

Cognitive fusion occurs when individuals treat internal verbal evaluations regarding their body as literal truths that dictate physical reality and behavioral necessity. A fused individual does not merely notice the thought “I am overweight and unworthy”; they experience themselves as fundamentally deficient, making avoidance or compensatory behavior seem mandatory. Defusion, conversely, represents the ability to step back and observe verbal formulations about the body as passing mental events. The BI-AAQ captures fusion through items such as “My thoughts about my body shape and weight affect how I feel about myself as a person” (Item 6) and “I feel like I must control my weight” (Item 3).

Present-Moment Awareness vs. Inflexible Attentional Engagement

Individuals with low body image flexibility exhibit narrow, biased attentional allocation toward perceived physical flaws, body checking, or constant rumination over past changes and future physical degeneration. Items such as “Worrying about my body takes up too much of my time” (Item 4) and “I focus a lot of energy on my weight and body shape” (Item 7) reflect this inflexible cognitive preoccupation, which detaches the individual from ongoing present-moment contingencies and real-world environmental reinforcers.

Self-as-Context vs. Conceptualized Self

When an individual’s identity is fused with the “conceptualized physical self,” self-worth becomes wholly contingent upon appearance metrics (e.g., waist circumference, scale readouts, athletic aesthetic). Self-as-context provides an invariant, transcendent locus from which bodily changes, illness, aging, or aesthetic imperfections can be observed without threatening the individual’s fundamental core. BI-AAQ Item 2 (“I care too much about my weight and body shape”) and Item 8 (“I cannot accept that feeling bad about my weight or shape is sometimes normal”) illustrate how rigidity in self-concept leads to catastrophic affective unraveling when aesthetic expectations are violated.

Committed Action and Values-Based Living vs. Inaction and Impulsivity

Perhaps the most critical hallmark of body image psychological flexibility is whether an individual retains the behavioral capacity to enact core values despite feeling dissatisfied with their physical form. When body image inflexibility dominates, valued domains such as social engagement, intimate relationships, professional aspirations, and physical recreation are deferred until an elusive aesthetic ideal is achieved. BI-AAQ Item 1 (“Worrying about my weight makes it difficult for me to live a life that I value”), Item 10 (“How I feel about my weight or shape causes problems in my relationships with other people”), and Item 11 (“Worrying about my shape or weight makes it hard for me to do things that I want to do”) operationalize this direct behavioral constriction.

6. Theoretical Framework

The Body Image Acceptance and Action Questionnaire is rooted in Functional Contextualism and Relational Frame Theory (RFT), which together form the empirical and philosophical bedrock of Acceptance and Commitment Therapy. Functional contextualism approaches psychological events as ongoing, situated actions embedded within historical and environmental contexts. From this perspective, psychological phenomena are neither inherently pathological nor intrinsically adaptive; rather, their utility is evaluated strictly against their workable contribution to an individual’s long-term values.

Relational Frame Theory and the Arbitrary Framing of Appearance

RFT explains how human language and higher cognition develop through learned patterns of generalized relational responding, termed relational framing. Humans do not simply respond to environmental stimuli through direct classical or operant conditioning; they arbitrarily relate symbols, concepts, and physical objects via abstract frames of coordination, comparison, opposition, and distinction. Through the transformation of stimulus functions, an abstract verbal construct (e.g., “thinness = success, purity, lovability” or “fatness = failure, undisciplined, repulsiveness”) endows raw sensory experiences (e.g., looking in a mirror, feelings of satiety, abdominal fullness) with intense emotional threat.

Because relational framing is bi-directional and generative, attempts to verbally suppress or counter conditioned body-related thoughts typically intensify their psychological salience. For instance, when an individual attempts to force the thought “I love my thighs” in direct response to the thought “My thighs are disgusting,” both thoughts remain inextricably linked within the same relational network, reinforcing appearance-related preoccupation. The BI-AAQ operationalizes a functional alternative: undermining the dominance of relational networks by altering the context in which body-related thoughts occur, rather than attempting to alter the verbal content itself.

The Dual-Path Model of Eating Pathology

Traditional cognitive-behavioral paradigms (such as Fairburn’s transdiagnostic model of eating disorders) posit that the core psychopathology of eating disorders is the “over-evaluation of shape and weight.” ACT does not dispute that over-evaluation is present, but asserts that over-evaluation leads to clinical disorder primarily when coupled with experiential avoidance. If an individual experiences thoughts of unworthiness regarding their body but exhibits high psychological flexibility, those private events do not necessitate compulsive exercise, purging, caloric deprivation, or social withdrawal. The theoretical model underpinning the BI-AAQ posits that body image inflexibility functions as the critical mediational conduit transforming body dissatisfaction into full-blown clinical distress and functional impairment.

7. Validity

The psychometric validity of the BI-AAQ has been extensively evaluated across diverse demographic, cultural, and clinical samples worldwide, confirming its robust construct, convergent, discriminant, and incremental validity.

Construct and Structural Validity

In the seminal validation study by Sandoz et al. (2013), structural validity was established through exploratory and confirmatory factor analyses across independent cohorts of undergraduate university students (total N > 900). The analyses supported a coherent, parsimonious single-factor solution accounting for approximately 52% of the total variance, with all 12 items demonstrating substantial standardized factor loadings ranging from .55 to .84. Subsequent international cross-cultural validations—including Portuguese, Spanish, Italian, Swedish, Turkish, Persian, and Chinese translations—have consistently replicated this unidimensional structure using rigorous confirmatory factor analysis (CFA), consistently satisfying stringent modern fit criteria (e.g., Comparative Fit Index [CFI] > .94, Tucker-Lewis Index [TLI] > .93, Root Mean Square Error of Approximation [RMSEA] < .07, and Standardized Root Mean Square Residual [SRMR] < .05).

Convergent Validity

The BI-AAQ exhibits robust convergent associations with established measures of eating pathology, general psychological flexibility, and general psychological distress:

• General Experiential Avoidance: Strong inverse correlations with the Acceptance and Action Questionnaire-II (AAQ-II; r = -.55 to -.68 when BI-AAQ is scored for flexibility), demonstrating that body image flexibility is aligned with, yet distinct from, generalized psychological flexibility.
• Eating Disorder Symptomatology: Significant negative correlations with the Eating Disorder Examination Questionnaire (EDE-Q global score: r = -.65 to -.76) and subscales of the Eating Disorder Inventory-3 (EDI-3), specifically Drive for Thinness (r = -.62) and Body Dissatisfaction (r = -.68).
• Body Image Distress: Marked inverse relationships with the Body Shape Questionnaire (BSQ-8C and BSQ-34: r = -.70 to -.82) and the Multidimensional Body-Self Relations Questionnaire (MBSRQ).
• Depressive and Anxiety Symptoms: Moderate-to-strong negative correlations with the Beck Depression Inventory-II (BDI-II; r = -.48 to -.58) and the Generalized Anxiety Disorder-7 (GAD-7; r = -.42 to -.52).

Discriminant and Incremental Validity

Discriminant validity was established by demonstrating that the BI-AAQ measures a construct distinct from mere physical metrics or broad affective distress. Correlations between the BI-AAQ and objective Body Mass Index (BMI) are typically low-to-modest (r = -.18 to -.29), confirming that body image psychological flexibility is not a functional artifact of an individual’s physical size, but rather reflects their psychological orientation toward their body. Crucially, multiple hierarchical regression and structural equation modeling studies have confirmed the scale’s incremental validity: the BI-AAQ accounts for significant unique variance (often 10% to 22% additional variance) in disordered eating behaviors, restrictive dieting, and psychosocial impairment after statistically controlling for general psychological flexibility (AAQ-II), general distress (BDI-II), and baseline body dissatisfaction (BSQ).

8. Reliability

Empirical investigations across non-clinical, collegiate, and clinical psychiatric populations demonstrate that the BI-AAQ possesses exemplary reliability characteristics.

Internal Consistency

In the original instrument development and psychometric analysis by Sandoz et al. (2013), the internal consistency of the BI-AAQ was exceptionally high, yielding a Cronbach’s alpha of α = .92 in the initial validation cohort and α = .93 in a cross-validation replication sample. Subsequent validation studies internationally have replicated these findings:

• Ferreira et al. (2011, 2013) — Portuguese Validation: Reported Cronbach’s alpha values of α = .94 in non-clinical female samples and α = .95 in clinical eating disorder samples.
• Pellizzer et al. (2018) — Australian Adolescent Cohort: Observed Cronbach’s α = .93 and McDonald’s omega coefficient (ω) of .94.
• Basarkod et al. (2018) — Cross-gender Invariance Study: Documented internal consistency of α = .92 for females and α = .91 for males.
• Clinical Inpatient Samples: In clinical settings involving patients with anorexia nervosa and bulimia nervosa, internal consistency coefficients consistently meet or exceed α = .91.

Corrected item-total correlations across published studies uniformly range between r = .52 and .81, well above the standard psychometric threshold of .30, indicating that each of the 12 items contributes meaningfully to the measured construct without redundancy.

Temporal Stability (Test-Retest Reliability)

The temporal stability of the BI-AAQ has been established across various retest intervals in stable baseline conditions:

• Two- to Three-Week Retest: Sandoz et al. (2013) demonstrated a test-retest reliability coefficient of r = .80 (p < .001) across a three-week interval in a non-clinical undergraduate sample.
• One-Month Retest: European adaptation studies reported intra-class correlation coefficients (ICC) ranging between .82 and .88 over a four-week span in waiting-list control conditions.
• Treatment Sensitivity: Demonstrating that the scale reflects state-like modifiability rather than fixed immutable traits, longitudinal intervention studies utilizing Acceptance and Commitment Therapy have revealed significant, large-effect-size increases in BI-AAQ scores from pre- to post-treatment (Cohen’s d ranging from 0.75 to 1.20), accompanied by high longitudinal reliability.

  9. Factor Analysis

  The latent dimensionality of the BI-AAQ was rigorously investigated during its construction through both exploratory and confirmatory psychometric frameworks.

  Exploratory Factor Analysis (EFA)

  During initial scale development, Sandoz et al. (2013) submitted candidate items reflecting experiential avoidance, cognitive fusion, and values-based behavioral disruption within the body image context to Principal Axis Factoring (PAF) with oblique (Promax) rotation. Analysis of the scree plot, parallel analysis, and eigenvalues revealed a dominant primary factor (eigenvalue > 6.2), accounting for 51.9% of the shared variance. All 12 retained items exhibited robust primary factor loadings onto this single dimension, with factor loadings ranging from .55 to .84. No secondary factor achieved an eigenvalue exceeding 1.0 or demonstrated theoretical interpretability, confirming an underlying unidimensional construct.

  Confirmatory Factor Analysis (CFA) and Goodness-of-Fit Metrics

  To verify the unidimensional structure, confirmatory factor analyses were conducted on independent cross-validation datasets. The single-factor model demonstrated an excellent fit to the empirical data across independent international investigations. Representative goodness-of-fit parameters from major structural investigations include:

  • Sandoz et al. (2013) — Initial Validation: χ²(54) = 142.31, p < .001; CFI = .96; TLI = .95; RMSEA = .061 (90% CI [.049, .074]); SRMR = .038.
  • European and Latin American Replications: CFA models across Spanish, Portuguese, and Italian cohorts have consistently yielded CFI values between .94 and .97, TLI between .93 and .96, and RMSEA estimates between .052 and .068.
  • Measurement Invariance: Multi-group confirmatory factor analyses (MGCFA) have substantiated configural, metric (weak), and scalar (strong) invariance across biological sexes (male vs. female), athletic status (athletes vs. non-athletes), and age cohorts (adolescents vs. adults), indicating that the BI-AAQ measures the construct equivalently across diverse populations and permits direct cross-group latent mean comparisons.

  Standardized Factor Loadings

  The standardized factor loadings (λ) for the 12 items onto the single body image flexibility latent factor consistently demonstrate high magnitude across published literature:

  • Item 1: λ = .78 – .84 (Impact on living a valued life)
  • Item 2: λ = .67 – .76 (Caring excessively about weight/shape)
  • Item 3: λ = .55 – .65 (Perceived compulsion to control weight)
  • Item 4: λ = .72 – .81 (Time consumed by worry)
  • Item 5: λ = .70 – .79 (Shutting down in response to body shame)
  • Item 6: λ = .74 – .82 (Fusion of self-worth with weight/shape)
  • Item 7: λ = .68 – .77 (Energy focused on weight/shape)
  • Item 8: λ = .56 – .68 (Inability to accept negative body affect as normal)
  • Item 9: λ = .71 – .78 (Prolonged recovery from body distress)
  • Item 10: λ = .69 – .77 (Interpersonal relational impairment)
  • Item 11: λ = .79 – .86 (Behavioral restriction in daily activities)
  • Item 12: λ = .66 – .75 (Going out of one’s way to avoid body distress)

  10. Instrument / Measurement Tool

  The Body Image Acceptance and Action Questionnaire is structured as follows:

  • Instrument Name: Body Image Acceptance and Action Questionnaire
  • Acronym: BI-AAQ
  • Construct Assessed: Body Image Psychological Flexibility (and body-related experiential avoidance)
  • Theoretical Framework: Acceptance and Commitment Therapy (ACT) / Contextual Behavioral Science
  • Test Type: Self-report psychometric questionnaire
  • Number of Items: 12 items
  • Administration Format: Paper-and-pencil questionnaire, computerized survey software, or mobile ecological momentary assessment (EMA) platforms
  • Completion Time: Approximately 3 to 5 minutes
  • Target Population: Adolescents (ages 12+) and adults across non-clinical, sub-clinical, and psychiatric populations
  • Response Format: 7-point Likert scale:
    • 1 = Never true
    • 2 = Very seldom true
    • 3 = Seldom true
    • 4 = Sometimes true
    • 5 = Frequently true
    • 6 = Almost always true
    • 7 = Always true
  • Scoring Protocols:
    • Flexibility Scoring (Standard Original Format): All 12 items are phrased in the direction of body image psychological inflexibility/experiential avoidance. To score the instrument in the direction of body image flexibility (as published in the original validation study by Sandoz et al., 2013), all 12 items must be reverse-scored (1 = 7, 2 = 6, 3 = 5, 4 = 4, 5 = 3, 6 = 2, 7 = 1) and then summed. Possible total scores range from 12 to 84, with higher scores reflecting greater body image acceptance, defusion, and psychological flexibility (i.e., lower experiential avoidance).
    • Inflexibility Scoring (Alternative Clinical Format): In some clinical, epidemiological, and research contexts, researchers sum the raw item responses directly (without reverse-scoring) to generate a composite index of body image psychological inflexibility / experiential avoidance. Under this scoring protocol, total scores also range from 12 to 84, with higher scores indicating greater body-related avoidance, cognitive fusion, and behavioral restriction. Clinicians and researchers must explicitly state which scoring convention is employed in their reporting.

  11. Permissions & Fee and Test Year

  The Body Image Acceptance and Action Questionnaire (BI-AAQ) was published in 2013 in the peer-reviewed Journal of Contextual Behavioral Science. Consistent with the open-science, dissemination-oriented ethos of the contextual behavioral science community and the Association for Contextual Behavioral Science (ACBS), the BI-AAQ is available as an open-access psychometric instrument.

  • Fee: Free of charge. No licensing fees, purchase costs, or per-use royalties are required for academic research, clinical assessment, or educational applications.
  • Permissions: Researchers and mental health professionals are permitted to reproduce and administer the scale in clinical and empirical contexts without seeking formal written copyright permissions from the authors, provided that appropriate academic attribution is cited (Sandoz et al., 2013).
  • Translations and Commercial Use: Researchers wishing to develop, publish, or validate novel linguistic translations or incorporate the instrument into proprietary commercial software platforms are encouraged to consult the corresponding authors and the Association for Contextual Behavioral Science.

  12. References

  • Basarkod, G., Sahdra, B., & Ciarrochi, J. (2018). Body image-acceptance and action questionnaire: Factor structure and invariance across gender. Journal of Contextual Behavioral Science, 10, 11–17. https://doi.org/10.1016/j.jcbs.2018.07.003
  • Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41(5), 509–528. https://doi.org/10.1016/S0005-7967(02)00088-8
  • Ferreira, C., Pinto-Gouveia, J., & Duarte, C. (2011). The validation of the Body Image Acceptance and Action Questionnaire: Exploring the role of body image psychological inflexibility in disordered eating. International Journal of Psychology and Psychological Therapy, 11(3), 327–345.
  • Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. https://doi.org/10.1016/j.brat.2005.06.006
  • Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and Commitment Therapy: The process and practice of mindful change (2nd ed.). Guilford Press.
  • Merwin, R. M., Zucker, N. L., Lacy, J. L., & Elliott, C. A. (2010). Interventions for eating disorders: The role of experiential avoidance. Cognitive and Behavioral Practice, 17(4), 385–398. https://doi.org/10.1016/j.cbpra.2009.09.005
  • Pellizzer, M. L., Waller, G., & Wade, T. D. (2018). Body image flexibility: A predictor of eating disorder symptoms in adolescents. European Eating Disorders Review, 26(4), 337–344. https://doi.org/10.1002/erv.2599
  • Sandoz, E. K., Wilson, K. G., Merwin, R. M., & Kellum, K. K. (2013). Assessment of body image flexibility: The Body Image-Acceptance and Action Questionnaire. Journal of Contextual Behavioral Science, 2(1–2), 39–48. https://doi.org/10.1016/j.jcbs.2013.03.002

  13. Items of the Scale

  Below are the authentic scale items in their original language as published in the standard psychometric validation studies, without modification or translation to preserve instrument validity and reliability:

  Response Scale:

  7-point Likert scale: 1 = Never true, 2 = Very seldom true, 3 = Seldom true, 4 = Sometimes true, 5 = Frequently true, 6 = Almost always true, 7 = Always true

  1. Worrying about my weight makes it difficult for me to live a life that I value.
  2. I care too much about my weight and body shape.
  3. I feel like I must control my weight.
  4. Worrying about my body takes up too much of my time.
  5. I shut down when I feel bad about my body shape or weight.
  6. My thoughts about my body shape and weight affect how I feel about myself as a person.
  7. I focus a lot of energy on my weight and body shape.
  8. I cannot accept that feeling bad about my weight or shape is sometimes normal.
  9. When I start feeling bad about my shape or weight, it takes me a long time to get over it.
  10. How I feel about my weight or shape causes problems in my relationships with other people.
  11. Worrying about my shape or weight makes it hard for me to do things that I want to do.
  12. I go out of my way to avoid feeling bad about my body shape or weight.
  ★

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