Outcome Measure
Appearance Anxiety Inventory
What it measures?
- Cognitive and behavioural symptoms of body image anxiety and body dysmorphic disorder (BDD). In particular, the AAI measures the frequency of avoidance behaviour and threat-monitoring (e.g. checking, self-focussed attention) that are typical of a response to a distorted body image.
Who is it for?
The AAI has been used in cross-sectional and trial-based research with adults and adolescents aged 12 years and older (Krebs et al., 2017).
Instrument Quality
- The AAI has been reported to have good test-retest reliability and adequate convergent validity in the measurement of appearance anxiety—and is sensitive to change during treatment (Veale et al., 2014; Yurtsever, Matusiak, Szepietowska, Veale & Szepietowski, 2022). Most factor-analytic studies—including research by Roberts and colleagues (2018) using a large sample—supports a 1-factor structure.
Structure
- 10 items
- 5-point Likert scale
- Respondents are asked how often each statement about body appearance (e.g. “I compare aspects of my appearance to others”) has applied to them during the past week, including today (e.g. “I compare aspects of my appearance to others”)
Scoring instructions
Sum all items to derive the full-scale. Roberts and colleagues (2018) have found, in factor-analytic research, that the 10th item can be omitted if necessary, however we have decided to include all original ten items.
| Subscale | Item number |
|---|---|
Full-scale (AAI) |
1,2,3,4,5,6,7,8,9,10 |
Score Interpretation
What higher scores mean?
- More severe cognitive and behavioural aspects of body image anxiety during the past week. Greater likelihood of meeting criteria for Body Dysmorphic Disorder.
How to assess symptom severity & change?
| Description | Score Range | |
|---|---|---|
| Normal | 0 | |
| Moderate BDD Risk | 15 | |
| Body Dysmorphic Disorder (BDD) | >=20 | Provisional Diagnosis |
| High BDD Risk | 20 | |
| Maximum | 40 |
Instrument developers
- Veale, D., Eshkevari, E., Kanakam, N., Ellison, 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.
Refrences
* Krebs, G., de la Cruz, L. F., Monzani, B., Bowyer, L., Anson, M., Cadman, J., ... & Mataix-Cols, D. (2017). Long-term outcomes of cognitive-behavioral therapy for adolescent body dysmorphic disorder. Behavior Therapy, 48(4), 462-473 * Mastro, S., Zimmer-Gembeck, M. J., Webb, H. J., Farrell, L., & Waters, A. (2016). Young adolescents' appearance anxiety and body dysmorphic symptoms: Social problems, self-perceptions and comorbidities. Journal of Obsessive-Compulsive and Related Disorders, 8, 50-55 * Mataix-Cols, D., de la Cruz, L. F., Isomura, K., Anson, M., Turner, C., Monzani, B., ... & Krebs, G. (2015). A pilot randomized controlled trial of cognitive-behavioral therapy for adolescents with body dysmorphic disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 54(11), 895-904. *Roberts, C., Zimmer-Gembeck, M. J., Lavell, C., Miyamoto, T., Gregertsen, E., & Farrell, L. J. (2018). The appearance anxiety inventory: Factor structure and associations with appearance-based rejection sensitivity and social anxiety. Journal of Obsessive-Compulsive and Related Disorders, 19, 124-130 * Veale, D., Eshkevari, E., Kanakam, N., Ellison, 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. * Veale, D., Anson, M., Miles, S., Pieta, M., Costa, A., & Ellison, N. (2014). Efficacy of cognitive behaviour therapy versus anxiety management for body dysmorphic disorder: a randomised controlled trial. Psychotherapy and psychosomatics, 83(6), 341-35
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Severity ranges
At least two studies have employed a cutoff score of 20 to indicated “high risk” for BDD (Mastro et al., 2016; Roberts et al., 2018). This value was derived by taking the average of the median reported by Veale and colleagues (2014) of 27 for a BDD adult sample, and the median score of 13 reported for a high appearance concern adolescent sample. Mastro and colleagues (2016) also derived a middle range, denoting “moderate” risk for BDD. This group consisted of adolescents who feell below the high-risk group, but above the mean found in an appearance-concerned adult population (14.9).
Provisional diagnosis
At least two studies have employed a cutoff score of 20 to indicated “high risk” for BDD (Mastro et al., 2016; Roberts et al., 2018). This value was derived by taking the average of the median reported by Veale and colleagues (2014) of 27 for a BDD adult sample, and the median score of 13 reported for a high appearance concern adolescent sample.
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Mean
Standard Deviation
Reliability