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A Severity Rating Scale for Body Dysmorphic Disorder: Development, Reliiability, and Validity of a Modified Version of the Yale-Brown Obsessive Compulsive Scale1
Katharine A. Phillips, M.D.2 Eric Hollander, M.D.,3 Steven A. Rasmussen, M.D.,2 Bonnie R. Aronowitz, Ph.D.,3 Concetta DeCaria, Ph.D.,3 Wayne K. Goodman, M.D.4
Abstract
The authors developed the Yale Brown Obsessive Compulsive Scale Modified for Body Dysmorphic Disorder (BDDYBOCS), a 12-item semistructured clinician-rated instrument designed to rate severity of body dysmorphic disorder (BDD). The scale was administered to 125 subjects with BDD, and interviews with 15 subjects were rated by 3 other raters. Test-retest reliability was assessed in 30 subjects. Other scales were administered to assess convergent and discriminant validity, and sensitivity to change was evaluated in a study of fluvoxamine. Each item was frequently endorsed across a range of severity. Good interrater reliability, test-retest reliability, and internal consistency were obtained. BDD-YBOCS scores correlated with global severity scores but not with a measure of general psychopathology; they were modestly positively correlated with depression severity scores. Three factors accounted for 59.6 percent of the variance. The scale was sensitive to change in BDD severity. The BDD-YBOCS appears to be a reliable and valid measure of BDD severity and is a suitable outcome measure in treatment studies of BDD.
Introduction
Body dysmorphic disorder (BDD), a preoccupation with an imagined or slight defect in appearance (e.g., a "large" nose or "thinning" hair), is a relatively common disorder (Phillips et al. 1996; Simeon et al. 1995) that is receiving increasing clinical and research attention. However, investigation of BDD-in particular, assessment of treatment efficacy-has been hampered by the lack of a measure to assess BDD severity. Some researchers have used single-item global measures of illness severity and treatment response, such as the Clinical Global Impressions Scale (CGI: Hollander et al. 1994; Phillips 1996), or scales that are not specific to BDD, such as the SCL-90 (G. Perugi, personal communication). The use of such scales has significant limitations, especially in treatment studies. Single-item global measures do not capture important information about different components of the disorder, and such ratings may involve a significant degree of subjective judgment. Measures such as the SCL-90 do not reflect central aspects of BDD. The lack of a reliable and...