The Body Image Questionnaire (BIQ)

Abstract

The Body Image Questionnaire (BIQ) is a specialized self-report instrument designed primarily for the routine assessment of symptoms related to Body Dysmorphic Disorder (BDD). It is highly similar in structure and scoring to the Cosmetic Procedure Screening Questionnaire (COPS), differing only slightly in the introductory text provided to the respondent. The BIQ functions both as a screening tool for identifying potential BDD cases and as an outcome measure to track impairment severity and treatment effectiveness over time.

The core scoring section sums items Q8 through Q19, with a total score ranging from 0 to 72. A higher score reflects greater impairment and an increased likelihood of a BDD diagnosis. The questionnaire also includes items dedicated to clinical assessment of specific BDD-related behaviors, such as avoidance (Q20) and safety-seeking behaviors (Q21), as well as a question pertaining to past cosmetic procedures.

Keywords

Body Dysmorphic Disorder, BDD, Body Image, Body Image Questionnaire, BIQ, COPS, Screening Tool, Psychological Assessment, Outcome Measure, Cosmetic Procedures.

Authors

David Veale

Purpose

The primary purpose of the Body Image Questionnaire (BIQ) is twofold: first, to serve as a screening instrument for identifying clinical levels of concern and preoccupation with perceived flaws in physical appearance, which are characteristic of Body Dysmorphic Disorder (BDD). Second, it is utilized in clinical settings as an outcome measure to quantify changes in symptom severity following therapeutic intervention.

The scale is designed to quantify the intensity of distress, preoccupation, checking behaviors, and functional impairment caused by perceived defects in one’s appearance. The inclusion of detailed sections on avoidance and safety behaviors (Q20 and Q21) allows clinicians to gather specific data necessary for comprehensive clinical assessment beyond the core quantitative score.

Construct

The BIQ measures core dimensions of psychopathology associated with Body Dysmorphic Disorder (BDD). The construct assessed involves the excessive preoccupation with a perceived defect or flaw in appearance that is objectively minor or nonexistent, alongside the resulting distress and functional impairment.

The primary domains measured by the scoring items (Q8-Q19) include:

• Preoccupation and distress level regarding the perceived flaw.
• Frequency of deliberate checking behaviors (e.g., mirror checking).
• Degree of avoidance of social situations or activities due to the flaw.
• Impact on relationships (partner, dating, sexual life).
• Interference with occupational, educational, or social functioning.

Questions 20 and 21 extend this measurement to specific behavioral constructs frequently observed in BDD, such as detailed avoidance patterns and the use of safety-seeking behaviors (e.g., excessive grooming, camouflaging).

Validity

Specific, independent validity data for the Body Image Questionnaire (BIQ) is often derived from the validation studies of the Cosmetic Procedure Screening Questionnaire (COPS), as the items and scoring criteria used for screening purposes are identical across both scales. The COPS, developed by Veale et al. (2011), demonstrated robust psychometric properties, including high internal consistency and strong concurrent and convergent validity with established measures of BDD severity, such as the Yale-Brown Obsessive Compulsive Scale modified for BDD (BDD-YBOCS).

The scale’s utility in clinical settings suggests strong face validity and clinical utility, effectively capturing the key elements of distress and impairment required for a diagnostic screening. The total score range (0-72) is designed to reflect a continuous spectrum of severity, with high scores correlating directly with clinical impairment and the likelihood of a BDD diagnosis, supporting its criterion validity.

Reliability

As the BIQ shares its core screening items and scoring methodology with the COPS, its reliability is inferred from the validation data published for the COPS. Studies on the COPS have demonstrated good internal consistency, indicating that the items reliably measure the same underlying construct (BDD severity).

The existence of the BIQ Follow Up version, which uses an adjusted item numbering scheme (Q3-Q14) but maintains the fundamental structure, suggests the scale is reliable for repeat administration to monitor symptom change in patients undergoing treatment, confirming its utility as an outcome measure.

Factor Analysis

While specific factor analytic data for the BIQ itself is not detailed separately from the COPS, related instruments developed by the same author team, such as the Appearance Anxiety Inventory (AAI), have demonstrated a clear factor structure. Given the identity of the scoring items with the COPS, it is reasonable to assume that factor analysis would reveal primary factors related to appearance preoccupation and functional impairment. The structure implicitly covers core BDD symptomatology across dimensions of cognitive preoccupation, emotional distress, and behavioral avoidance/checking.

Instrument

Test Type: Self-report questionnaire, clinical screening, and outcome measure.

Format: Structured questionnaire combining demographic data collection, open-ended questions about specific features of concern, time spent preoccupied, and a series of 8-point Likert scale items (0 to 8) to rate severity of symptoms.

Language Available: English (Original source material is in English).

Population Group: Clinical and non-clinical adults exhibiting concerns about body image and appearance.

Age Group: Adult population (18+). Note: A separate version, BIQ Child and Adolescent Version (BIQ-C), is available for those aged 17 and under.

Population Details: The scale is widely used in clinics specializing in BDD and anxiety disorders, particularly in populations seeking cosmetic or dermatological procedures.

Test Methodology: The core BDD severity score is calculated by summing Q8-Q19, with items 8, 9, and 11 being reverse-scored. Total scores range from 0 to 72. Higher scores indicate greater impairment. Items 20 and 21 are used for detailed clinical assessment of avoidance and safety behaviors.

Keywords

Psychological testing, Mental health screening, BDD diagnosis, Appearance preoccupation, Cognitive behavior, Clinical assessment, Body image disturbance, Veale.

Authors

Author ORCID Identifier: N/A (Not provided in source content)

Affiliation Email addresses: N/A (Not provided in source content)

Correspondence Address: N/A (Not provided in source content)

Permissions & Fee and Test Year

The questionnaire bears the copyright notice: ‘copyright D.Veale 2009’. Users should seek permission from the author, David Veale, or the relevant affiliated institution (e.g., King’s College London, CADAT) for commercial use or distribution. The original PDF for the BIQ can be downloaded here: http://www.kcl.ac.uk/iop/depts/psychology/about/support/CADAT/aboutus/Research/questionnaires/biq.pdf

The original PDF for the BIQ Follow Up can be downloaded here: http://www.kcl.ac.uk/iop/depts/psychology/about/support/CADAT/aboutus/Research/questionnaires/biqfollowup.pdf

Reference’s

The BIQ is structurally tied to the COPS validation study:

• 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‚ doi:10.1016/j.bjps.2011.09.007. The original COPS validation paper (PDF) can be viewed here: http://psychology.iop.kcl.ac.uk/cadat/questionnaires/COPS%20JPRAS%20long%20version.pdf

Items of the The Body Image Questionnaire (BIQ)

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

This questionnaire is part of a routine assessment. All information will be kept strictly confidential. Thank you.

1) sex ….Male ….Female

2) Age: …….

3) Weight: _________________ Height: ________________

4) Marital Status Tick one

• ….Single
• ….Married or cohabiting
• …. Separated/Divorced
• …. Widowed

5) Current Employment Tick one

• …Unemployed
• …Long-term sick leave
• …Employed or Self-employed
• …Retired
• …Student (Full-time)
• ….Homemaker

6) Please study this example before completing question 6. In a moment‚ we will ask you to describe the feature(s) of your body which you dislike or would like to improve. If you want to improve more than one feature‚ please list all the features and tick the appropriate box if you are seeking a cosmetic or dermatological procedure for that feature either now or in the future. We shall refer to all such treatments as ‘procedures’. Please note‚ the 1st feature should be the feature you are most concerned about.

This is an example of a woman whose main worry was her nose and who was concerned to a lesser extent by her skin and bottom.

7) Features Causing Concern

Please describe the feature(s) of your body which you dislike or would like to improve and tick the box if you are seeking a cosmetic or dermatological procedure for that feature either now or in the future.

Please tick the appropriate box.

1st Feature (that is the feature you are most concerned about)

Nose is too crooked with a bump

Procedure sought …. Now … Future …. Not desire any procedure

2nd Feature

Blemishes and acne scars on face

Procedure sought …. Now … Future …. Not desire any procedure

3rd Feature

Bottom is too big

Procedure sought …. Now … Future …. Not desire any procedure

We will then ask you to draw a pie ch‎art and estimate the percentage of concern allocated to each feature. The person above completed her pie ch‎art like this.

Bottom

10%

Skin

30%

Nose

60%

6) Features Causing Concern

Please describe the feature(s) of your body which you dislike or would like to improve and tick the box if you are seeking a cosmetic or dermatological procedure for that feature either now or in the future.

Please tick the appropriate box

1st Feature (feature you are most concerned about)

……………………………………….

……………………………………….

Procedure sought …. Now … Future …. Not desire any procedure

2nd Feature

……………………………………….

……………………………………….

Procedure sought …. Now … Future …. Not desire any procedure

3rd Feature

……………………………………….

……………………………………….

Procedure sought …. Now … Future …. Not desire any procedure

4th Feature

……………………………………….

……………………………………….

Procedure sought …. Now … Future …. Not desire any procedure

5th Feature

……………………………………….

……………………………………….

Procedure sought …. Now … Future …. Not desire any procedure

Now please draw a pie ch‎art and estimate the percentage of concern allocated to each feature.

Please ensure that your percentages add up to 100%!

7) On an average day‚ how many minutes or hour(s) do you currently spend thinking about your feature(s)? Please add up all the time that your features are at the forefront of your mind and make the best estimate.

_____________ minutes or ______________ hour(s) a day

Please read the next set of questions below carefully and circle the number which best describes the way that you feel about your feature(s).

Please read the labels carefully to ensure you are circling the number that reflects how you feel because some of the answers are worded in a reverse order.

8) How often do you deliberately check your feature(s)? Not accidentally catch sight of it.

Please include looking at your feature in a mirror or other reflective surfaces like a shop window or looking at it directly or feeling it with your fingers.

0 1 2 3 4 5 6 7 8

|________|________|________|________|________|________|_______|________|

About 40 times or more a day | About 20 times a day | About 10 times a day | About 5 times a day | Never Check

9) How much do you feel your feature(s) is currently ugly‚ unattractive or ‘not right’?

0 1 2 3 4 5 6 7 8

|________|________|________|________|________|________|_______|________|

Very ugly or ‘not right’ | Markedly unattractive | Moderately unattractive | Slightly unattractive | Not at all unattractive

10) How much does your feature(s) currently cause you a lot of distress?

0 1 2 3 4 5 6 7 8

|________|________|________|________|________|________|_______|________|

Not at all distressing | Slightly distressing | Moderately distressing | Markedly distressing | Extremely distressing

11) How often does your feature(s) currently lead you to avoid situations or activities?

0 1 2 3 4 5 6 7 8

|________|________|________|________|________|________|_______|________|

Always Avoid | Avoid about three quarters of the time | Avoid about half of the time | avoid about a quarter of the time | Never avoid

If so‚ what do you avoid?

……………………………………….

……………………………………….

12) How much does your feature(s) currently preoccupy you? That is‚ you think about it a lot and it is hard to stop thinking about it?

0 1 2 3 4 5 6 7 8

|________|________|________|________|________|________|_______|________|

Not at all preoccupied | Slightly preoccupied | Moderately preoccupied | very preoccupied | Extremely preoccupied

If you rated you preoccupation with your feature(s) as 4 or above‚ for how long has it preoccupied you?

Months ________ or Years ____________

13) If you have a partner‚ how much does your feature(s) currently have an effect on your relationship with an existing partner? If you do not have a partner‚ how much does it have an effect on dating or developing a relationship?

0 1 2 3 4 5 6 7 8

|________|________|________|________|________|________|_______|________|

Not at all | Slightly | Moderately | Markedly | Extremely

If so‚ how does it effect your relationship/ability to date or develop a relationship?

……………………………………….

……………………………………….

14) How much does your feature(s) currently have an effect on an existing or potential sexual relationship? (e.g. enjoyment of sex‚ frequency of sexual activity)

|________|________|________|________|________|________|_______|________|

Not at all | Slightly | Moderately | Markedly | Very severely I can’t work

If so‚ how?

……………………………………….

……………………………………….

15) How much does your feature(s) currently interfere with your ability to work or study‚ or your role as a homemaker? (Please rate this even if you are not working or studying: we are interested in your ability to work or study.)

|________|________|________|________|________|________|_______|________|

Not at all | Slightly | Moderately | Markedly | Very severely I can’t work

If so‚ how?

……………………………………….

……………………………………….

16) How much does your feature(s) currently interfere with your social life?

|________|________|________|________|________|________|_______|________|

Not at all | Slightly | Moderately | Markedly | Very severely I can’t work

If so‚ how?

……………………………………….

……………………………………….

17) How much do you feel your appearance is the most important aspect of who you are?

0 1 2 3 4 5 6 7 8

|________|________|________|________|________|________|_______|________|

Not at all | Slightly | Moderately | Mostly | Totally

18) How noticeable do you feel your feature is to other people (if you do not camouflage yourself e.g. with clothes‚ padding and/or makeup) and the feature has not been pointed out to them)?

18a) Please specify the 1st feature you are rating (this should be the feature you are most concerned about)……………

0 1 2 3 4 5 6 7 8

|________|________|________|________|________|________|_______|________|

Not at all noticeable | Slightly noticeable (to a stranger less than a foot away) | Moderately noticeable (to a stranger about 3 feet way) | Markedly noticeable (to a stranger about 6 feet away) | Very noticeable (to a stranger passing in the street)

18b) Please specify the 2st feature you are rating (if applicable)……………

0 1 2 3 4 5 6 7 8

|________|________|________|________|________|________|_______|________|

Not at all noticeable | Slightly noticeable (to a stranger less than a foot away) | Moderately noticeable (to a stranger about 3 feet way) | Markedly noticeable (to a stranger about 6 feet away) | Very noticeable (to a stranger passing in the street)

18c) Please specify the 3st feature you are rating (if applicable)……………

0 1 2 3 4 5 6 7 8

|________|________|________|________|________|________|_______|________|

Not at all noticeable | Slightly noticeable (to a stranger less than a foot away) | Moderately noticeable (to a stranger about 3 feet way) | Markedly noticeable (to a stranger about 6 feet away) | Very noticeable (to a stranger passing in the street)

18d) Please specify the 4st feature you are rating (if applicable)……………

0 1 2 3 4 5 6 7 8

|________|________|________|________|________|________|_______|________|

Not at all noticeable | Slightly noticeable (to a stranger less than a foot away) | Moderately noticeable (to a stranger about 3 feet way) | Markedly noticeable (to a stranger about 6 feet away) | Very noticeable (to a stranger passing in the street)

19) How does your feature compare to others of the same age‚ sex‚ and ethnic group?

19a) Please specify the 1st feature you are rating (this should be the feature you are concerned about)……………

0 1 2 3 4 5 6 7 8

|________|________|________|________|________|________|_______|________|

Everyone has the same feature ‘very normal’ | Many people have the same feature | Some people have the same feature | Few people have the same feature | No one else has the same feature or degree of abnormality

19b) Please specify the 2st feature you are rating (if applicable)……………

0 1 2 3 4 5 6 7 8

|________|________|________|________|________|________|_______|________|

Everyone has the same feature ‘very normal’ | Many people have the same feature | Some people have the same feature | Few people have the same feature | No one else has the same feature or degree of abnormality

19c) Please specify the 3st feature you are rating (if applicable)……………

0 1 2 3 4 5 6 7 8

|________|________|________|________|________|________|_______|________|

Everyone has the same feature ‘very normal’ | Many people have the same feature | Some people have the same feature | Few people have the same feature | No one else has the same feature or degree of abnormality

19) Please specify the 4st feature you are rating (if applicable)……………

0 1 2 3 4 5 6 7 8

|________|________|________|________|________|________|_______|________|

Everyone has the same feature ‘very normal’ | Many people have the same feature | Some people have the same feature | Few people have the same feature | No one else has the same feature or degree of abnormality

20) What do you avoid because of the way you feel about your feature(s)? Please read the situations below and in the second column rate the degree to which you currently avoid each of these situations on the following scale:

0=Never avoid‚ 1= Occasionally avoid‚ 2=Often avoid‚ 3= Frequently avoid‚ 4= Always avoid

Please add other situations or activities that you avoid at the end of the list.

Situation or activity

• I avoid going to a party or social gathering because of my features
• I avoid ha‎ving a medical examination or treatment because of my features
• I avoid going to public changing room because of my features
• I would avoid exercising in a gym or playing a sport because of my features
• I avoid wearing a swimming costume on a beach because of my features
• I avoid being physically close to someone because of my features
• I avoid making love or intimacy because of my features (or only under certain conditions e.g. lights off or wearing your make up).
• I avoid certain types of clothes because of my features (please specify)
• I avoid certain types of lighting because of my features (please specify)
• I avoid looking at pictures in magazines or on television because of my features
• I avoid ha‎ving a photo or video taken by someone else because of my features
• I avoid looking at old photographs because of my features. (Please specify if you have destroyed them)
• I avoid ha‎ving my hair cut at all
• I avoid ha‎ving my hair cut at a hairdresser
• I avoid looking at my features in mirrors or reflective surfaces
• OTHERS (please specify)

21) Please read the lists of activities below that you might do because of the way you feel about your feature(s). In the second column rate the degree to which you use each of the behaviours on the following scale:

0=Never‚ 1= Occasionally‚ 2=Often‚ 3= Frequently‚ 4= Always

Behaviour Frequency

• I check my feature(s) in mirrors
• I use a particular light to check my feature(s) in a mirror (please specify)
• I check my feature(s) in other reflective surfaces (e.g. cutlery‚ windows‚ CDs) (Please specify)
• I check my feature(s) directly by looking at it without a mirror
• I check my feature(s) by taking photographs of myself
• I check my feature(s) by feeling it with my finger(s)
• I compare my feature(s) to others in magazines or on television and film
• I compare my feature(s) to other people I meet
• I compare my feature(s) with old pictures of my self
• I pinch the fat on my skin
• I wear something to distract attention from my feature (e.g. jewellery‚ a tattoo) (Please specify)
• I change my posture to avoid my feature being seen at a certain angle. (Please specify)
• I hide my feature(s) with something (e.g. my hand‚ a baseball cap‚ hat‚ scarf‚ baggy clothing‚ newspaper) (Please specify)
• I use padding in my clothes to camouflage or increase the size of a feature. (Please specify)
• I try to convince others about how unattractive my feature is
• I ask others to confirm the existence of my defect in my features
• I seek reassurance about whether my feature has got worse
• I seek reassurance about whether my feature is camouflaged (for example by make up)
• I keep changing my clothes before I go out
• I get my partner or family member to “help” me in camouflaging or checking my appearance. (Please specify)
• I keep measuring my feature(s)

HAIR:

• I wear a wig because of my features
• I grow or arrange my hair to hide certain features. (Please specify)
• I comb or groom (smooth/straighten) or adjust my hair more than most people
• I shave‚ cut or pluck hair more than most people. (Please specify)
• I use medication too promote hair growth on my head

SKIN:

• I clean my skin my skin more than most people
• I wear more make up than most people to hide my feature(s)
• I use cover up stick for spots or blemishes
• I use facial peel‚ scrubs or saunas for my skin
• I bleach my skin
• I use a sun-bed to darken my skin
• I pick my skin or squeeze spots more than most people

SHAPE OR WEIGHT:

• I exercise to alter my shape or weight
• I body build with weights
• I use steroids
• I weigh myself more than necessary
• I restrict my food to improve my shape or reduce my weight
• I sit with my toes on the floor to avoid my thighs spreading
• I eat more food to increase my weight
• I use diet pills‚ laxatives or diuretics (please specify)
• OTHERS (please specify)

22) Self-portrait

Can you please draw a portrait from the picture in your mind or impression that you have of your face or body (depending on the features that distress you). You can choose whatever medium you wish. Don’t worry if you are not artistic!

‘copyright D.Veale 2009’