BODY DYSMORPHIC DISORDER MODIFICATION OF THE Y-BOCS (BDD-YBOCS)©

(Adult version)
For each item circle the number identifying the response which best characterizes the patient during the past
week.
_________________________________________________________________________________________
1. TIME OCCUPIED BY THOUGHTS 0 = None
ABOUT BODY DEFECT 1 = Mild (less than 1 hr/day)
2 = Moderate (1-3 hrs/day)
How much of your time is occupied by 3 = Severe (greater than 3 and up to 8 hrs/day)
THOUGHTS about a defect or flaw in 4 = Extreme (greater than 8 hrs/day)
your appearance [list body parts of concern]?
_______________________________________________________________________________________
2. INTERFERENCE DUE TO THOUGHTS 0 = None
ABOUT BODY DEFECT 1 = Mild, slight interference with social,
occupational, or role activities, but overall
How much do your THOUGHTS about your performance not impaired.
body defect(s) interfere with your social or work 2 = Moderate, definite interference with social,
(role) functioning? (Is there anything you occupational, or role performance, but still
aren't doing or can't do because of them?) manageable.
3 = Severe, causes substantial impairment
Y/N Spending time with friends in social, occupational, or role performance
Y/N Dating 4 = Extreme, incapacitating.
Y/N Attending social functions
Y/N Doing things w/family in and outside of home
Y/N Going to school/work each day
Y/N Being on time for or missing school/work
Y/N Focusing at school/work
Y/N Productivity at school/work
Y/N Doing homework or maintaining grades
Y/N Daily activities
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3. DISTRESS ASSOCIATED WITH THOUGHTS 0 = None
ABOUT BODY DEFECT 1 = Mild, not too disturbing.
2 = Moderate, disturbing.
How much distress do your THOUGHTS 3 = Severe, very disturbing.
about your body defect(s) cause you? 4 = Extreme, disabling distress.

Rate "disturbing" feelings or anxiety that seem to be

triggered by these thoughts, not general anxiety or
anxiety associated with other symptoms.
_______________________________________________________________________________________

1 ©1997, Katharine A. Phillips, M.D., Eric Hollander, M.D.

For each item circle the number identifying the response which best characterizes the patient during the past
week.
_______________________________________________________________________________________
4. RESISTANCE AGAINST THOUGHTS 0 = Makes an effort to always resist, or
OF BODY DEFECT symptoms so minimal doesn't need to
actively resist.
How much of an effort do you make to 1 = Tries to resist most of time.
resist these THOUGHTS? 2 = Makes some effort to resist.
How often do you try to disregard them or 3 = Yields to all such thoughts without
turn your attention away from these thoughts attempting to control them but yields
as they enter your mind? with some reluctance.
4 = Completely and willingly yields to all
Only rate effort made to resist, NOT success such thoughts.
or failure in actually controlling the thoughts.
How much patient resists the thoughts may or
may not correlate with ability to control them.
__________________________________________________________________________________________________

5. DEGREE OF CONTROL OVER THOUGHTS 0 = Complete control, or no need for control

ABOUT BODY DEFECT because thoughts are so minimal.
1 = Much control, usually able to stop or divert
How much control do you have over these thoughts with some effort and
your THOUGHTS about your body defect(s)? concentration.
How successful are you in stopping 2 = Moderate control, sometimes able to stop
or diverting these thoughts? or divert these thoughts.
3 = Little control, rarely successful in stopping
thoughts, can only divert attention with
difficulty.
4 = No control, experienced as completely
involuntary, rarely able to even
momentarily divert attention.
_______________________________________________________________________________________
6. TIME SPENT IN ACTIVITIES 0 = None
RELATED TO BODY DEFECT 1 = Mild (spends less than 1 hr/day)
2 = Moderate (1-3 hrs/day)
The next several questions are about the activities/ 3 = Severe (spends more than 3 and up to
behaviors you do in relation to your body defects. 8 hours/day)
4 = Extreme (spends more than 8 hrs/day in
Read list of activities below to determine these activities)
which ones the patient engages in.

How much time do you spend in ACTIVITIES related to

your concern over your appearance [read activities patient
engages in]?

2 ©1997, Katharine A. Phillips, M.D., Eric Hollander, M.D.

 Read list of activities (check all that apply)
___Checking mirrors/other surfaces
___Grooming activities
___Applying makeup
___Excessive Exercise (time beyond 1 hr. a day)
___Camouflaging with clothing/other cover
(rate time spent selecting/changing clothes,
not time wearing them)
___Scrutinizing others' appearance (comparing)
___Questioning others about/discussing your
appearance
___Picking at skin
___Other ____________________________
For each item circle the number identifying the response which best characterizes the patient during the past
week.
_______________________________________________________________________________________

7. INTERFERENCE DUE TO ACTIVITIES 0 = None

RELATED TO BODY DEFECT 1 = Mild, slight interference with social,
occupational, or role activities, but
overall
How much do these ACTIVITIES performance not impaired.
interfere with your social or work 2 = Moderate, definite interference with
(role) functioning? (Is there any- social, occupational, or role
performance,
thing you don't do because of them?) but still manageable.
3 = Severe, causes substantial impairment in
social, occupational, or role performance.
4 = Extreme, incapacitating.
_______________________________________________________________________________________

8. DISTRESS ASSOCIATED WITH ACTIVITIES 0 = None

RELATED TO BODY DEFECT 1 = Mild, only slightly anxious if behavior
prevented.
How would you feel if you were prevented 2 = Moderate, reports that anxiety would mount
from performing these ACTIVITIES? but remain manageable if behavior is prevented.
How anxious would you become? 3 = Severe, prominent and very disturbing increase
in anxiety if behavior is interrupted.
4 = Extreme, incapacitating anxiety from any
Rate degree of distress/frustration patient would intervention aimed at modifying activity.
experience if performance of the activities were
suddenly interrupted.

_______________________________________________________________________________________

9. RESISTANCE AGAINST COMPULSIONS 0 = Makes an effort to always resist, or symptoms

so minimal doesn't need to actively resist.
How much of an effort do you make to 1 = Tries to resist most of the time.
resist these ACTIVITIES? 2 = Makes some effort to resist.
3 = Yields to almost all of these behaviors without
Only rate effort made to resist, NOT success attempting to control them, but does so with
3 ©1997, Katharine A. Phillips, M.D., Eric Hollander, M.D.
 or failure in actually controlling the activities. some reluctance.
How much the patient resists these 4 = Completely and willingly yields to all
behaviors may or may not correlate with behaviors related to body defect.
his/her ability to control them.
_______________________________________________________________________________________

10. DEGREE OF CONTROL OVER COMPULSIVE 0 = Complete control, or control is

BEHAVIOR unnecessary because symptoms are mild.
1 = Much control, experiences pressure to
How strong is the drive to perform perform the behavior, but usually able to
these behaviors? exercise voluntary control over it.
How much control do you have over them? 2 = Moderate control, strong pressure to
perform behavior, can control it only with
difficulty.
3 = Little control, very strong drive to perform
behavior, must be carried to completion,
can delay only with difficulty.
4 = No control, drive to perform behavior
experienced as completely involuntary
and overpowering, rarely able to even
momentarily delay activity.

4 ©1997, Katharine A. Phillips, M.D., Eric Hollander, M.D.

For each item circle the number identifying the response which best characterizes the patient during the past
week.
_______________________________________________________________________________________

11. INSIGHT

Is it possible that your defect might 0 = Excellent insight, fully rational.

be less noticeable or less unattractive 1 = Good insight. Readily acknowledges absurdity
than you think it is? of thoughts (but doesn’t seem completely
convinced that there isn’t something
How convinced are you that [fill in body part] besides anxiety to be concerned about).
is as unattractive as you think it is? 2 = Fair insight. Reluctantly admits that thoughts
seem unreasonable but wavers.
Can anyone convince you that it 3 = Poor insight. Maintains that thoughts are not
doesn't look so bad? unreasonable.
4 = Lacks insight, delusional. Definitely
convinced that concerns are reasonable,
unresponsive to contrary evidence.

________________________________________________________________________________________

12. AVOIDANCE 0 = No deliberate avoidance.

1 = Mild, minimal avoidance.
Have you been avoiding doing anything, 2 = Moderate, some avoidance clearly present.
going any place, or being with anyone 3 = Severe, much avoidance; avoidance prominent.
because of your thoughts or behaviors 4 = Extreme, very extensive avoidance; patient
related to your body defects? avoids almost all activities.
If YES, then ask: What do you avoid?

Rate degree to which patient deliberately

tries to avoid things such as social interactions
or work-related activities. Do not include
avoidance of mirrors or avoidance of
compulsive behaviors.

5 ©1997, Katharine A. Phillips, M.D., Eric Hollander, M.D.

Brackets [ ] indicate material that should be read. Brackets are also used to indicate a pause.
Parentheses ( ) indicate optional material that may be read.
Italicized items are instructions to the interviewer.

Phillips KA, Hollander E, Rasmussen SA, Aronowitz BR, DeCaria C, Goodman WK. A severity rating scale for body dysmorphic
disorder: development, reliability, and validity of a modified version of the Yale-Brown Obsessive Compulsive Scale.
Psychopharmacol Bull 1997;33:17-22.

6 ©1997, Katharine A. Phillips, M.D., Eric Hollander, M.D.