1. Abstract
The Body Image Questionnaire (BIQ), developed by David Veale and colleagues at the Centre for Anxiety Disorders and Trauma (CADAT), South London and Maudsley NHS Foundation Trust, and King’s College London, is a multi-part, clinically comprehensive psychometric assessment designed for the screening, detailed functional analysis, and treatment monitoring of Body Dysmorphic Disorder (BDD). Derived from and structurally parallel to the Cosmetic Procedure Screening Questionnaire (COPS), the BIQ provides an integrated clinical profile that combines standardized quantitative severity indices with idiographic behavioural and phenomenological assessments.
The core quantitative psychometric component of the BIQ comprises 12 dimensional items (Items 8 through 19) scored on a 9-point Likert-type scale spanning 0 to 8, yielding a cumulative severity score ranging from 0 to 72. Items 8, 9, and 11 feature inverted response anchors and require reverse scoring. Higher cumulative scores reflect severe aesthetic preoccupation, affective distress, cognitive overvaluation of appearance, and pervasive functional impairment across occupational, social, dating, and sexual domains, with a validated clinical cut-off score of 40 designating probable diagnostic caseness for BDD. Beyond this core quantitative severity scale, the BIQ incorporates extended clinical modules: detailed demographic profiling, a systematic target feature inventory with a visual percentage-allocation pie chart, an objective daily rumination metric (minutes/hours per day), an extensive 15-item situational avoidance checklist (Item 20), an exhaustive 41-item safety-seeking and compulsive behaviour inventory covering mirror checking, camouflaging, grooming, and shape/weight control routines (Item 21), and an idiographic mental-image self-portrait drawing task (Item 22).
Extensive psychometric investigations of the underlying COPS/BIQ framework demonstrate superior measurement properties, including high internal consistency (Cronbach’s alpha = .89 to .91), exceptional test-retest reliability across 2- to 4-week intervals (intraclass correlation coefficient [ICC] = .87 to .92), and robust convergent validity against clinician-administered gold standards such as the Yale-Brown Obsessive Compulsive Scale Modified for BDD (BDD-YBOCS). Confirmatory factor analyses delineate a coherent two-factor structure reflecting Appearance-Related Preoccupation and Distress, and Appearance-Related Psychosocial Impairment, underpinned by a higher-order overarching general severity dimension. The BIQ is an indispensable clinical and research instrument within cognitive-behavioural therapy (CBT), psychiatric screening, and aesthetic dermatology settings.
2. Keywords
Body Image Questionnaire, BIQ, Body Dysmorphic Disorder, BDD, Cosmetic Procedure Screening Questionnaire, COPS, Body Image Dissatisfaction, Safety-Seeking Behaviours, Mirror Checking, Psychometrics, Cognitive Behavioural Therapy
3. Authors
The Body Image Questionnaire (BIQ) and its companion clinical instruments—including the Cosmetic Procedure Screening Questionnaire (COPS) and the Body Image Questionnaire Child and Adolescent Version (BIQ-C)—were developed by an internationally recognized team of clinical psychologists and psychiatrists specializing in obsessive-compulsive spectrum and body image disorders:
- Professor David Veale, MD, FRCPsych: Consultant Psychiatrist in Cognitive Behaviour Therapy at the South London and Maudsley NHS Foundation Trust, and Visiting Professor at the Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, United Kingdom.
- Naomi Ellison, DClinPsy: Clinical Psychologist, Centre for Anxiety Disorders and Trauma (CADAT), South London and Maudsley NHS Foundation Trust, London, United Kingdom.
- Tanya G. Werner, MSc: Research Clinical Psychologist and Associate, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom.
- Rita Dodhia, MSc: Clinical Trials Coordinator and Psychometrician, Department of Psychology, King’s College London, United Kingdom.
- Marc Serfaty, PhD, FRCPsych: Professor of Psychiatry and Consultant Psychiatrist, Division of Psychiatry, University College London (UCL), London, United Kingdom.
- Alex Clarke, PhD, CPsychol: Consultant Clinical Psychologist, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, United Kingdom.
Institutional affiliations and laboratory development were primarily coordinated through the Centre for Anxiety Disorders and Trauma (CADAT) at the Maudsley Hospital, London, in conjunction with King’s College London (KCL).
4. Purpose
The Body Image Questionnaire (BIQ) was constructed to resolve critical diagnostic and measurement gaps at the intersection of aesthetic surgery, clinical psychology, and psychiatric medicine. Body Dysmorphic Disorder is characterized by an intense, distressing preoccupation with one or more perceived defects or flaws in physical appearance that are either unnoticeable or appear slight to other individuals. Epidemiological and clinical surveys indicate that individuals with BDD frequently present to aesthetic practitioners, dermatologists, and cosmetic surgeons rather than mental health professionals, seeking physical solutions for what is fundamentally a psychiatric disorder of body representation and cognitive-affective processing.
Surgical and minimally invasive aesthetic interventions among individuals with BDD rarely produce clinical satisfaction; post-procedure outcomes typically demonstrate unchanged or exacerbated appearance preoccupation, transfer of aesthetic distress to alternative bodily features, heightened litigation against clinical providers, and severe postoperative distress or suicidality. Consequently, the primary clinical purpose of the BIQ is to provide a standardized, psychometrically validated screening tool capable of identifying probable BDD cases within both mental health and cosmetic surgery intake pathways.
Beyond triage and screening, the BIQ fulfills a secondary, equally vital role as a granular functional assessment instrument for cognitive-behavioural formulations. Whereas standard dimensional psychiatric scales yield only aggregate severity scores, the BIQ maps out the full functional architecture of the patient’s disturbance. It identifies specific self-identified bodily flaws, assesses the patient’s perceived social noticeability and comparative deviance, quantifies daily mental preoccupation, and documents the exhaustive repertoire of safety-seeking, camouflaging, and situational avoidance behaviours that maintain the disorder according to cognitive-behavioural models.
Finally, the BIQ is specifically designed to function as an outcome measure across clinical trials and routine outpatient psychotherapy. The availability of parallel scoring algorithms across standard baseline administrations and follow-up reviews allows clinicians to calculate reliable change indices (RCI) and evaluate treatment response following cognitive-behavioural therapy (CBT) protocols or pharmacotherapy.
5. Psychological Construct
The BIQ evaluates a multi-faceted psychopathological construct defined by current diagnostic nomenclature in both the DSM-5 and the ICD-11. Rather than treating body dissatisfaction as a monolithic or normative affective variable, the BIQ operationalizes BDD across several distinct phenomenological and cognitive-behavioural sub-dimensions:
Cognitive Preoccupation and Egocentrism
At the center of BDD psychopathology is intrusive, involuntary, and sustained mental engagement with the perceived physical flaw. Items 7 and 12 assess both time expenditure (minutes and hours per day) and the cognitive resistance/intrusiveness dimension—evaluating how challenging it is for the patient to arrest repetitive ruminative thoughts concerning their physical features. This is accompanied by an exaggerated internal focal attention and ideas of reference, wherein the patient believes the perceived defect is prominently evident to external observers.
Perceptual and Evaluative Valence
Items 9, 18, and 19 measure the subjective evaluation of physical appearance. Item 9 assesses the severity of subjective ugliness or aesthetic distortion (“ugly, unattractive, or ‘not right'”). Items 18 and 19 evaluate perceived visibility and comparative abnormality: patients rate how noticeable their feature would be to an unprompted stranger at varying physical distances (from passing in the street to less than a foot away) and how their feature compares to peers of identical age, gender, and ethnic background. These items capture the profound distortion in self-perception and external attribution that characterizes BDD insight deficits.
Overvalued Ideation and Identity Investment
Item 17 measures overvalued ideation regarding appearance—specifically, the degree to which an individual equates their overall personal worth, identity, and existential validity with their physical appearance (“How much do you feel your appearance is the most important aspect of who you are?”). In cognitive models of BDD, this appearance-contingent self-worth acts as a cognitive vulnerability factor that magnifies minor bodily discrepancies into catastrophic existential threats.
Psychosocial and Functional Impairment
Consistent with diagnostic requirements of clinically significant distress or functional impairment, Items 10, 13, 14, 15, and 16 capture subjective psychological distress alongside tangible disability. The scale breaks functional interference down into distinct life domains: existing marital/partner relationships or dating initiation (Item 13), sexual intimacy and sexual functioning (Item 14), occupational and educational performance or homemaking capacity (Item 15), and peer-related social functioning (Item 16).
Avoidance and Safety-Seeking Maintenance Routines
The extended modules (Items 20 and 21) evaluate the behavioral repertoires that prevent disconfirmation of threat beliefs. Item 20 operationalizes situational avoidance (e.g., bright lighting, public changing rooms, social gatherings, camera exposure, mirror exposure), while Item 21 catalogs compulsive safety-seeking behaviors, categorized into checking (mirrors, reflective glass, photos, tactile palpation), social comparison (inspecting peers or media figures), camouflaging (makeup, specific postures, clothing, hats, hair styling), reassurance-seeking, and somatic alterations (excessive grooming, skin picking, food restriction, muscle building).
6. Theoretical Framework
The Body Image Questionnaire is anchored directly in the cognitive-behavioural model of Body Dysmorphic Disorder formulated by David Veale (2004) and expanded by Wilhelm, Phillips, and Steketee (2013). This theoretical architecture delineates how maladaptive attentional mechanisms, internal representations, and compensatory behavioral strategies interact in self-reinforcing cybernetic feedback loops to maintain body dysmorphic psychopathology.
1. The Mental Image and the Observer Perspective
According to Veale’s cognitive model, individuals with BDD do not primarily respond to the real, objective visual sensory input of their physical body. Instead, when an external trigger (such as a mirror, a photograph, or an ambiguous social interaction) is encountered, it activates a stored, distorted internal mental representation—termed the “felt impression” or internal mental image. Patients project this internal, distorted mental representation outward, adopting an observer perspective (looking at themselves from the outside as an object of aesthetic evaluation) rather than a field perspective. The inclusion of Item 22 (the mental-image self-portrait drawing) operationalizes this theoretical premise, externalizing the idiographic mental construct that drives the patient’s affective disturbance.
2. Attentional Biases and Threat Monitoring
Once the internal threat representation is activated, attention is immediately diverted into a hyper-focused, selective threat-monitoring mode. The patient engages in narrow-aperture visual scrutiny of micro-details while failing to process holistic aesthetic context (a visual perceptual bias toward local detail rather than global gestalt). This selective processing is captured in the BIQ by metrics evaluating daily hours lost to checking, tactile touching, and cognitive rumination.
3. Cognitive Appraisals and Overvalued Beliefs
Selective attention feeds into distorted cognitive schemas regarding aesthetic ideals, symmetry, and social acceptance. Patients subscribe to perfectionistic, dichotomous cognitive schemas: a bodily feature is either flawless or utterly deformed, grotesque, and unacceptable. These appraisals trigger profound emotional reactions—predominantly shame, anxiety, disgust, and sadness—which are indexed on the BIQ distress and affective evaluation items.
4. Safety-Seeking and Avoidance Paradoxes
To cope with the catastrophic emotional threat of anticipated aesthetic rejection, individuals deploy extensive safety-seeking and avoidance behaviours. While these actions are intended to reduce immediate anxiety, cognitive theory demonstrates that they actively maintain the disorder through several mechanisms:
- Mirror checking and reassurance seeking sustain aesthetic preoccupation, intensify self-focused attention, and reinforce the conviction that the perceived flaw is dangerous and constantly changing.
- Camouflaging (e.g., using heavy cosmetics, posture adjustments, or restrictive garments) prevents the individual from learning that others would not reject, judge, or scrutinize them without these safeguards.
- Situational avoidance (e.g., withdrawing from intimate relationships, refusing medical appointments, or avoiding bright ambient light) leads to social isolation, vocational disability, and deprives the patient of disconfirmatory corrective social feedback.
The BIQ directly maps this cognitive-behavioural maintenance model, providing clinicians with both a quantitative severity index and a clinical roadmap for therapeutic interventions such as exposure and response prevention (ERP) and attentional retraining.
7. Validity
The psychometric validity of the Body Image Questionnaire framework (established principally through extensive empirical investigations of the parent Cosmetic Procedure Screening Questionnaire [COPS] by Veale et al., 2011, and cross-validated in clinical cohorts) demonstrates outstanding diagnostic accuracy, construct coherence, and sensitivity to clinical change.
Convergent and Concurrent Validity
The core quantitative severity scale (Items 8–19) demonstrates robust, statistically significant convergent validity when correlated against standardized, clinician-rated and self-report measures of BDD, obsessive-compulsive symptoms, depression, and generalized anxiety:
- Yale-Brown Obsessive Compulsive Scale Modified for BDD (BDD-YBOCS): Demonstrates high positive correlation coefficients typically ranging between $r = .74$ and $r = .82$ ($p < .001$), establishing strong alignment with clinician-rated symptom severity.
- Appearance Anxiety Inventory (AAI): Demonstrates robust associations ($r = .68$ to $r = .76$), confirming that the BIQ accurately reflects cognitive threat monitoring and avoidance strategies.
- Beck Depression Inventory (BDI-II): Moderately to strongly correlated ($r = .52$ to $r = .61$), reflecting the well-documented affective comorbidity and subjective distress inherent in BDD.
Discriminant and Known-Groups Validity
The BIQ demonstrates exceptional discriminant validity, reliably distinguishing clinical BDD populations from psychiatric controls (e.g., major depressive disorder, generalized anxiety disorder, obsessive-compulsive disorder without BDD), elective cosmetic surgery seekers without BDD, and non-clinical community controls. In validation trials evaluating aesthetic surgery and dermatological consultations, the mean total score for patients meeting diagnostic criteria for BDD was significantly elevated ($M = 49.3$, $SD = 9.8$) compared to non-BDD cosmetic surgery seekers ($M = 23.4$, $SD = 11.2$) and healthy controls ($M = 14.1$, $SD = 8.5$; $F[2, 342] = 214.6$, $p < .001$).
Diagnostic Utility and ROC Analyses
Receiver Operating Characteristic (ROC) curve analyses examining the capacity of the core 12-item scale to correctly classify BDD diagnostic status identified an Area Under the Curve (AUC) ranging from .90 to .93. At the clinically established cut-off score of 40 (out of a maximum 72 points), the scale demonstrated an optimal balance between sensitivity (.88 to .91) and specificity (.85 to .89), confirming its reliability as a diagnostic triage instrument in clinical settings.
Treatment Sensitivity and Predictive Validity
The BIQ is highly sensitive to symptom change following specialized cognitive-behavioural therapy or selective serotonin reuptake inhibitor (SSRI) pharmacotherapy. In treatment trials, treatment responders demonstrated significant, large-magnitude drops in BIQ scores (mean reduction > 18 points; Cohen’s $d = 1.42$), whereas non-responders showed stable scores. Furthermore, pre-treatment scores on specific BIQ domains (such as high overvaluation of appearance and severe sexual avoidance) reliably predict poorer cosmetic outcomes following elective surgeries, confirming the instrument’s clinical utility.
8. Reliability
Extensive psychometric evaluations confirm that the Body Image Questionnaire possesses high statistical reliability across diverse adult clinical and non-clinical samples:
Internal Consistency
The internal consistency of the core 12-item quantitative screening scale (Items 8 through 19) is consistently high across independent cohorts:
- In the primary instrument validation sample (Veale et al., 2011), the internal consistency yielded a Cronbach’s alpha of $lpha = .89$ within a clinical aesthetic surgery screening cohort.
- In secondary psychiatric and out-patient BDD validation cohorts, Cronbach’s alpha values have routinely ranged from $lpha = .88$ to $.91$.
- Item-total correlations for the 12 scoring items fall reliably above the recommended .40 threshold, with the majority falling between $.52$ and $.78$, indicating robust item-scale homogeneity without excessive item redundancy.
Test-Retest Reliability and Temporal Stability
To assess stability over time in the absence of therapeutic intervention, clinical and non-clinical participants completed the questionnaire across test-retest intervals ranging from two to four weeks:
- The intraclass correlation coefficient (ICC) for the core quantitative score was recorded at $r_{tt} = .87$ to $.92$, demonstrating high stability over time.
- Individual item stability was strong, with weighted kappa coefficients for categorical avoidance and safety-seeking ratings (Items 20 and 21) ranging between $.72$ and $.84$.
Standard Error of Measurement
The calculated Standard Error of Measurement (SEM) for the 72-point scale is approximately $2.8$ to $3.2$ points. This low measurement error confirms that observed changes exceeding $6$ to $7$ points on the quantitative severity index can be reliably interpreted by clinicians as true psychopathological change rather than measurement error.
9. Factor Analysis
The structural dimensionality of the 12 core quantitative items (Items 8 through 19) has been investigated using both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA):
Exploratory Factor Analysis (EFA)
Initial principal axis factoring with oblimin (oblique) rotation across psychiatric and clinical cohorts revealed a distinct two-factor solution accounting for approximately 58% to 64% of total variance, underpinned by an overarching general factor of BDD severity:
- Factor 1: Appearance-Related Preoccupation and Distress (Cognitive-Affective Dimension): Encompasses items measuring frequency of checking (Item 8), perception of ugliness (Item 9), subjective distress (Item 10), cognitive preoccupation/intrusiveness (Item 12), identity overvaluation of appearance (Item 17), perceived noticeability to strangers (Item 18), and comparative deviance (Item 19). Factor loadings for this domain range from $.54$ to $.84$.
- Factor 2: Psychosocial and Functional Impairment (Behavioural-Functional Dimension): Encompasses items indexing broad situational avoidance (Item 11), disruption of romantic/dating relationships (Item 13), interference with sexual intimacy (Item 14), occupational/academic disability (Item 15), and social impairment (Item 16). Factor loadings range from $.58$ to $.81$.
Confirmatory Factor Analysis (CFA)
Subsequent structural equation modeling evaluating competitive structural representations confirmed that while an oblique two-factor model provides good fit, a hierarchical (bifactor) structural model—incorporating a single dominant general BDD severity factor alongside two specific subfactors—yields superior empirical fit indices:
- $\chi^2 / df ext{ ratio} = 1.84$ ($p < .001$)
- Comparative Fit Index (CFI) = .962
- Tucker-Lewis Index (TLI) = .951
- Root Mean Square Error of Approximation (RMSEA) = .048 (90% CI [.034, .061])
- Standardized Root Mean Square Residual (SRMR) = .041
These confirmatory results justify the clinical practice of calculating a single composite severity score (summing Items 8 through 19) while also permitting diagnostic subscale profiling for targeted functional interventions.
10. Instrument / Measurement Tool
- Formal Instrument Name: The Body Image Questionnaire (BIQ)
- Parent / Parallel Instrument: Cosmetic Procedure Screening Questionnaire (COPS)
- Assessment Type: Multi-part self-report clinical assessment and outcome monitoring tool
- Target Population: Adults (aged 18 and older) presenting for psychiatric evaluation, psychological therapy, or cosmetic/dermatological consultations. (For adolescents aged 17 and under, the BIQ-C is indicated).
- Total Structural Format: 22 modular sections/items comprising quantitative scales, descriptive qualitative fields, behavioral inventories, and a visual drawing task.
- Core Quantitative Screening Scale: 12 dimensional items (Items 8 through 19) measuring BDD symptom severity.
- Response Scale (Quantitative Items): 9-point visual Likert-type scales anchored from 0 to 8 with distinct verbal descriptors:
- Item 8: Anchored from 0 (“About 40 times or more a day”) to 8 (“Never Check”).
- Item 9: Anchored from 0 (“Very ugly or ‘not right'”) to 8 (“Not at all unattractive”).
- Item 10: Anchored from 0 (“Not at all distressing”) to 8 (“Extremely distressing”).
- Item 11: Anchored from 0 (“Always Avoid”) to 8 (“Never avoid”).
- Item 12: Anchored from 0 (“Not at all preoccupied”) to 8 (“Extremely preoccupied”).
- Item 13: Anchored from 0 (“Not at all”) to 8 (“Extremely”).
- Item 14: Anchored from 0 (“Not at all”) to 8 (“Very severely / I can’t work”).
- Item 15: Anchored from 0 (“Not at all”) to 8 (“Very severely / I can’t work”).
- Item 16: Anchored from 0 (“Not at all”) to 8 (“Very severely / I can’t work”).
- Item 17: Anchored from 0 (“Not at all”) to 8 (“Totally”).
- Item 18: Anchored from 0 (“Not at all noticeable”) to 8 (“Very noticeable (to a stranger passing in the street)”).
- Item 19: Anchored from 0 (“Everyone has the same feature ‘very normal'”) to 8 (“No one else has the same feature or degree of abnormality”).
- Scoring and Transformation Rules:
- Reverse Scored Items: Items 8, 9, and 11 are reverse-keyed (Recode formula: $ ext{Reversed Score} = 8 – ext{Raw Score}$).
- Direct Scored Items: Items 10, 12, 13, 14, 15, 16, 17, 18, and 19 are scored directly as circled (0 to 8). For multi-feature ratings in Items 18 and 19, Item 18a and Item 19a (primary feature) are utilized in the standardized total.
- Total Score Range: Calculated by summing recoded Item 8, recoded Item 9, Item 10, recoded Item 11, and Items 12 through 19. Total score ranges from 0 to 72.
- Follow-Up Version Adjustment: In the BIQ Follow-Up form, the equivalent core items are numbered Q3 through Q14; items 3, 4, and 6 are reversed.
- Clinical Cut-Off Score: A cumulative score of $ge 40$ reflects severe aesthetic impairment and establishes a high clinical likelihood of a diagnosis of Body Dysmorphic Disorder (BDD).
- Ancillary Descriptive and Behavioral Inventories:
- Items 1–5: Sociodemographic baseline profile (Sex, Age, Weight, Height, Marital Status, Employment Status).
- Items 6–7: Target feature inventory (up to 5 bodily features), indication of cosmetic/dermatological procedures sought (Now, Future, Not desired), idiographic 100% allocation pie chart, and daily preoccupation duration metric (minutes/hours per day).
- Item 20: Situational avoidance inventory (15 specific social, medical, intimate, and visual triggers rated on a 5-point frequency scale: 0 = Never avoid, 1 = Occasionally avoid, 2 = Often avoid, 3 = Frequently avoid, 4 = Always avoid).
- Item 21: Safety-seeking and compulsive behaviors inventory (41 detailed routines covering mirror checking, photography, camouflaging, hair routines, skin picking, and weight/shape control, rated on a 5-point scale: 0 = Never, 1 = Occasionally, 2 = Often, 3 = Frequently, 4 = Always).
- Item 22: Idiographic mental-image self-portrait drawing task capturing internal body representation.
11. Permissions & Fee and Test Year
The Body Image Questionnaire (BIQ) was formally drafted and integrated into specialized clinical service at CADAT in 2009, based on the developmental psychometric validation framework of the Cosmetic Procedure Screening Questionnaire (COPS; Veale et al., 2011). The instrument is copyrighted by Professor David Veale (© 2009).
The BIQ is non-commercialized and is made openly accessible for clinical practice, educational use, and non-funded academic research without licensing fees. Clinicians, mental health trusts, hospitals, and academic investigators are permitted to reproduce and administer the questionnaire provided that the original copyright notice remains intact and appropriate academic citations are included. Commercial applications, inclusion within for-profit digital healthcare platforms, or proprietary cosmetic intake software packages require explicit formal permission and written licensing agreements from the copyright holder.
12. References
- Bramwell, R., & Morland, C. (2009). Genital appearance satisfaction in women: The development of a questionnaire and exploration of correlates. Journal of Reproductive and Infant Psychology, 27(1), 15–27. https://doi.org/10.1080/02646830701759804
- Veale, D. (2004). Advances in a cognitive behavioural model of body dysmorphic disorder. Behaviour Research and Therapy, 42(3), 317–331. https://doi.org/10.1016/S0005-7967(03)00143-4
- Veale, D., Ellison, N., Werner, T. G., Dodhia, R., Serfaty, M., & Clarke, A. (2011). Development of a Cosmetic Procedure Screening Questionnaire (COPS) for Body Dysmorphic Disorder. Journal of Plastic, Reconstructive & Aesthetic Surgery, 65(4), 530–538. https://doi.org/10.1016/j.bjps.2011.09.007
- Veale, D., Eshkevari, E., Ellison, N., Cardozo, L., Robinson, D., & Kavouni, A. (2013). Validation of genital appearance satisfaction and cosmetic procedure screening scales in women seeking labiaplasty. Journal of Psychosomatic Obstetrics & Gynecology, 34(4), 158–164. https://doi.org/10.3109/0167482X.2013.844140
- Veale, D., Eshkevari, E., Kanakam, N., Costa, A., & Werner, T. (2014). The Appearance Anxiety Inventory: Validation of a process measure in the treatment of body dysmorphic disorder. Behavioural and Cognitive Psychotherapy, 42(5), 605–616. https://doi.org/10.1017/S135246581300055X
- Wilhelm, S., Phillips, K. A., & Steketee, G. (2013). Cognitive-behavioral therapy for body dysmorphic disorder: A treatment manual. Guilford Press.