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The Appearance Anxiety Inventory is available online in the table of contents for this issue: http://journals.cambridge.org/jid_BCP
Introduction: the Appearance Anxiety Inventory
One of the criticisms of cognitive behaviour therapy (CBT) is the limited evidence for the factors that mediate change (Hayes, Villate, Levin and Hildebrant, 2011; Hofman, 2008; Longmore and Worrell, 2007; Worrell and Longmore, 2008). This observation also applies to CBT for Body Dysmorphic Disorder (BDD) where there is limited research into the factors that mediate the outcome of treatment. At present there have been two randomized controlled trials that demonstrated the benefits of CBT compared to a waiting list (Rosen, Reiter and Orosan, 1995; Veale et al., 1996). However, there is no evidence for the processes that may mediate improvement following treatment. Such studies are challenging since they require sample sizes much larger than that for a randomized clinical trial. This would enable linear regression models to be conducted which assess the factors that predict long term response to treatment (Kraemer, Wilson, Fairburn and Agras, 2002).
There are a number of self-report scales that measure the severity of symptoms in BDD, such as the Body Image Disturbance Questionnaire (Cash, Phillips, Santos and Hrabosky, 2004), the Dysmorphic Concern Questionnaire (Mancuso, Knoesen and Castle, 2010), the Cosmetic Procedure Screening Scale (Veale et al., 2011) and the impact of Body Image on the Quality of Life (Cash and Fleming, 2002; Hrabosky et al., 2009). There is also an observer rated scale: the Yale Brown Obsessive Compulsive Scale modified for BDD (Phillips et al., 1997). All these scales tend to measure predominantly the "output" - in particular the degree of preoccupation, distress and interference in a person's life. However, there are no scales that measure factors that may mediate response to treatment. Such measures could help to explore which mediating factors are associated with subsequent changes in outcome or prognosis. It is recognized, though, that measuring the processes and output may overlap to a certain extent, and that better outcome scales focusing on distress and quality of life may therefore be required.
The items for the new scale (i.e. the Appearance Anxiety Inventory) were drawn from the literature on trans-diagnostic processes that occur in mental disorders (Harvey, Watkins, Mansell and Shafran,...