Dysmorphic Concern Questionnaire (DCQ)

Abstract

The Dysmorphic Concern Questionnaire (DCQ) is a concise, 7-item self-report measure developed by Oosthuizen, Lambert, and Castle (1998) in Australia. Its primary function is to quantify an individual’s degree of Dysmorphic Concern—defined as the excessive preoccupation or distress related to a perceived minor defect in physical appearance. The DCQ was initially validated as a screening tool for dysmorphic concern symptoms present in various clinical disorders and was later specifically validated for screening Body Dysmorphic Disorder (BDD). Items cover cognitive and behavioral aspects, utilizing a 4-point Likert scale to generate a total interpretative score.

Keywords

Dysmorphic Concern Questionnaire, DCQ, Body Dysmorphic Disorder, BDD, body image, self-report, psychological screening, dysmorphic concern, psychometrics.

Authors

Oosthuizen, P., Lambert, T., Castle, D. J.

Purpose

The fundamental purpose of the DCQ is to serve as a rapid and effective screening tool for identifying individuals experiencing high levels of dysmorphic concern. This construct is recognized as a core symptom across a spectrum of psychological conditions, including eating disorders, depression, social anxiety, delusional disorder (somatic type), obsessive compulsive disorder, and trichotillomania.

Following its initial development, the DCQ was specifically validated by Mancuso and colleagues (2010) as an effective measure for screening for Body Dysmorphic Disorder (BDD). The measure is suitable for application in both research settings, where body image or dysmorphic concern is a variable of interest, and clinical environments. Furthermore, its use has been strongly recommended for implementation in dermatological and cosmetic surgery settings to screen patients prior to treatment (Woolley & Perry, 2015).

Construct

The DCQ measures Dysmorphic Concern, which is defined as the excessive preoccupation or overwhelming worry related to a perceived flaw or minor defect in one’s physical appearance. This preoccupation is often disproportionate to any actual physical anomaly.

The seven items comprising the DCQ are designed to capture both the cognitive (e.g., persistent worry, self-consciousness) and behavioral (e.g., checking, reassurance seeking) manifestations associated with this psychological construct. By focusing on the intensity and frequency of these concerns, the DCQ provides an aggregate score reflecting the severity of dysmorphic preoccupation experienced by the individual.

Validity

Substantial evidence supports both the convergent and discriminant validity of the DCQ.

Discriminant Validity: Mancuso and colleagues (2010) demonstrated strong discriminant validity by comparing the scores of 57 BDD outpatients against 244 non-BDD Australian undergraduates. The BDD group showed significantly higher DCQ scores (M = 16.25, SD = 3.54) compared to the undergraduate group (M = 4.46, SD = 3.38; t(299) = 23.15, p < 0.001). This significant difference persisted even when controlling for the influence of confounding variables such as depression and social anxiety [F(1,272) = 268.45, p < 0.001]. It is important to note that the undergraduate sample was screened to exclude individuals with positive results for BDD or eating disorders (using the Body Dysmorphic Disorder Questionnaire and Eating Attitudes Test-26, respectively). While this strengthens the measure’s specificity, researchers suggest that this exclusion may have potentially inflated the observed level of discriminant validity.

Convergent Validity: Evidence for convergent validity was established by Jorgensen and colleagues (2001), who found that scores on the Body Dysmorphic Disorder Examination significantly predicted DCQ scores. This relationship was robust, with the Body Dysmorphic Disorder Examination accounting for 48% of the variance in DCQ scores [F(1,63) = 58.2, p < 0.001], confirming that the DCQ measures a construct highly related to established measures of BDD severity.

Reliability

Despite its brevity, the DCQ exhibits acceptable to good internal consistency across diverse populations, demonstrating its reliability as a consistent measure of dysmorphic concern.

Reported reliability coefficients (Cronbach’s alpha, α) include:

• BDD Outpatients: α = 0.73
• Non-BDD Undergraduates: α = 0.85
• Psychiatric Patients: α = 0.88

The cross-cultural adequacy of the DCQ has also been supported. A Chinese translated version, which utilized the rigorous back-translation method, demonstrated adequate reliability (α = 0.85; Liao et al., 2010).

Factor Analysis

Information regarding the specific factor structure or underlying factor analysis of the Dysmorphic Concern Questionnaire (DCQ) was not explicitly detailed in the original source material.

Instrument

Test Type: Screening Tool, Self-Report Questionnaire

Format: 7 items, scored on a 4-point Likert scale (0 = not at all to 3 = much more than most people).

Language Available: English, Chinese (validated translation)

Population Group: Clinical (Psychiatric and BDD outpatients), Non-clinical (Undergraduate students), Dermatological patients.

Age Group: Adults (Samples utilized ranged from 18 to 54 years).

Population Details: Used effectively across various clinical and non-clinical settings, including Australian undergraduates and BDD outpatients.

Test Methodology: The sum of the seven item scores yields the final interpretative score. Mancuso and colleagues (2010) recommend a cut-off score of 9 or greater to indicate a positive screen for BDD. However, a lack of consensus exists, with other researchers suggesting cut-offs of ≥11 or ≥14 (Standgier et al., 2003). This variation is attributed to differing requirements regarding the balance between sensitivity and specificity in various clinical contexts.

Keywords

Psychometrics, clinical screening, internal consistency, convergent validity, discriminant validity, dermatological psychiatry, body image disturbance, preoccupation.

Authors

Author ORCID Identifier: Not Publicly Available in Source

Affiliation Email addresses: Not Publicly Available in Source

Correspondence Address: Not Publicly Available in Source

Permissions & Fee and Test Year

The DCQ was first published in 1998 by Oosthuizen, Lambert, and Castle. The scale itself is copyright protected. While the original article describing the measure is often free to access, written permission is generally required for research or clinical use, with the exception of individual, non-commercial use.

Reference’s

Jorgensen, L., Castle, D., Roberts, C., & Froth-Marnat, G. (2001). A clinical validation of the Dysmorphic Concern Questionnaire. Australian and New Zealand Journal of Psychiatry, 35(1), 124-128. doi: 10.1046/j.1440-1614.2001.00860.x

Liao, Y., Knoesen, N. P., Deng, Y., Tang, J., Castle, D. J., Bookun, R., Hao, W., Chen, X., & Liu, T. (2010). Body dysmorphic disorder, social anxiety and depressive symptoms in Chinese medical students. Social Psychiatry and Psychiatric Epidemiology, 45(10), 963-971. doi: 10.1007/s00127-009-0139-9

Mancuso, S. G., Knoesen, N. P., & Castle, D. J. (2010). The Dysmorphic Concern Questionnaire: A screening measure for body dysmorphic disorder. Australian and New Zealand Journal of Psychiatry, 44(6), 535-542. doi: 10.3109/00048671003596055

Oosthuizen, P., Lambert, T., & Castle, D. J. (1998). Dysmorphic concern: prevalence and associations with clinical variables. Australian and New Zealand Journal of Psychiatry, 32(1), 129-132. doi: 10.3109/00048679809062719

Standgier, U., Janich, C., Adam-Schwebe, S., Berger, P., & Wolter, M. (2003). Screening for body dysmorphic disorder in dermatological outpatients. Dermatology and Psychosomatics, 4(2), 66-71. doi: 10.1159/000072194

Woolley, A. J., & Perry, J. D. (2015). Body dysmorphic disorder: prevalence and outcomes in an oculofacial plastic surgery practice. American Journal of Ophthalmology, 159(6), 1058-1064.e1. doi: 10.1016/j.ajo.2015.02.014

Items of the Dysmorphic Concern Questionnaire (DCQ)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The DCQ is a 7-item self-report questionnaire. Each item is phrased using the introductory question, “Have you ever…?” followed by a specific scenario related to dysmorphic concern.

Example item phrasing used in the questionnaire:

• “…been very concerned about some aspect of your physical appearance”

Items are scored on a 4-point scale:

1. not at all (0)
2. a little (1)
3. more than most people (2)
4. much more than most people (3)