Appearance Anxiety Inventory (AAI)

The Appearance Anxiety Inventory 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. This scale is useful as part of a diagnostic procedure for BDD as well as symptom monitoring during treatment.

Validity and Reliability

The AAI was developed by Veale et al (2014). They examined the psychometric properties in a clinical BDD sample and non-clinical community sample in the UK. The AAI was found to have good convergent validity, with correlations of .55 with the clinician rated YBOCS-BDD and .58 with the PHQ9. Internal consistency was high, with a Cronbachs Alpha of .86. Two subscales were found using factor analysis; Avoidance and Threat Monitoring.

The BDD validation sample (n = 139) had a median age of 28 and was 51.8% female. A subgroup of 12 participants had a median AAI score of 26 at diagnosis and 10.50 after CBT treatment.

The non-clinical community sample (n = 108) was used to establish the normal levels of appearance anxiety among relatively healthy individuals. The group had a median age of 28.5 and 75.9% were female. The mean score was 15.45 (SD = 8.68).

Interpretation and Scoring

Scores consistent of a total raw score derived by summing each item as well as two subscales.

– Avoidance (items 1, 3, 4, 7, 9 and 10)
– Threat Monitoring (items 2, 4, 6 and 8)

Two percentiles are presented to indicate how AAI scores compare to a body dysmorphic disorder group and a community sample. A BDD percentile of 50 indicates average symptoms for someone with a BDD diagnosis before treatment, while the community percentile represents scores in comparison to a normal population.

Veale et al. (2014) did not define a cut-off score for BDD diagnosis but Mastro et al. (2016) suggested a cutoff score of 20 as being indicative of high risk of clinical problems.

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.

References:

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.