Appearance Anxiety Inventory (AAI)

The Appearance Anxiety Inventory (AAI) is a 10 question self-report scale that measures the cognitive and behavioural aspects of body image anxiety in general, and body dysmorphic disorder (BDD) in particular. Appropriate for use with adults and adolescents as young as thirteen, the brief nature of the AAI can provide a quick snapshot of symptom severity to assist in the initial assessment and to monitor treatment progress over time. 

The AAI was specifically developed by Veale et al. (2014) to capture typical BDD cognitive processes (e.g., rumination and self-focused attention) and behaviours (e.g., excessive checking or camouflaging, avoidance) that, based on the theoretical model of BDD, arise from the appearance concerns and help maintain BDD symptoms.

Example AAI items:

Appearance Anxiety Inventory questions

The AAI has three subscales that represent typical symptom clusters among people with BDD:

  1. Threat Monitoring: Assessing the degree to which an individual is vigilant about potential threats related to their appearance (e.g. checking appearance).
  2. Camouflaging: The tendency to use strategies to hide or disguise perceived flaws in appearance (e.g. with clothing or excessive use of makeup).
  3. Avoidance: Measuring the extent to which individuals avoid situations or activities due to appearance-related concerns (e.g. social withdrawal and mirror avoidance).

Developer:

Veale, D., Eshkevaria, E., Kanakama, N., Ellisona, N., Costa, A., and Werner, T. (2014). The Appearance Anxiety Inventory: Validation of a Process Measure in the Treatment of Body Dysmorphic Disorder. Behavioural and Cognitive Psychotherapy, 42, 605-616. https://doi.org/10.1017/s1352465813000556

References:

Gumpert, M., Rautio, D., Monzani, B., Jassi, A., Krebs, G., Fernández de la Cruz, L., Mataix-Cols, D., & Jansson-Fröjmark, M. (2024). Psychometric evaluation of the appearance anxiety inventory in adolescents with body dysmorphic disorder. Cognitive Behaviour Therapy, 1–13. https://doi.org/10.1080/16506073.2023.2299837

Hanley, S. M., Bhullar, N., & Wootton, B. M. (2020). Development and initial validation of the Body Dysmorphic Disorder Scale for Youth. The Clinical Psychologist, 24(3), 254–266. https://doi.org/10.1111/cp.12225

Jacobson, N. S., & Truax, P. (1991). Clinical significance : A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12–19. https://doi.org/10.1037/10109-042

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. https://doi.org/10.1016/j.jocrd.2015.12.001

Roberts, C. L. (2019). Body Dysmorphic Disorder in Adolescents: A New Multidimensional Measure and Associations with Social Risk, Mindfulness, and Self-Compassion [PhD Thesis, Griffith University]. Griffith University Research Repository. https://doi.org/10.25904/1912/551