Dysmorphic Concern Questionnaire (DCQ)

About the DCQ: An Overview

Originally developed in Australia by Oosthuizen, Lambert, and Castle (1998), the DCQ measures a person’s degree of dysmorphic concern (i.e., the excessive preoccupation or concern with a perceived minor defect in one’s physical appearance). The DCQ was first established as a valid screening tool for dysmorphic concern (Oosthuizen et al., 1998) – a symptom found across a number of clinical disorders (e.g., eating disorders, depression, social anxiety, delusional disorder: somatic type, obsessive compulsive disorder, trichotillomania). It was later validated as a screening tool for body dysmorphic disorder (BDD; Mancuso, Knoesen, & Castle, 2010).

The DCQ is a self-report measure with seven items which ask about cognitive and behavioural aspects of dysmorphic concern. Each item is phrased with the question, “Have you ever…?” (e.g., “…been very concerned about some aspect of your physical appearance”). Each item is scored on a 4-point scale ranging from not at all (0) to much more than most people (3). The sum of the seven item scores results in the final interpretative score. A table of cut-off scores with their corresponding specificities, sensitivities, false negative and false positive percentages can be found in the article published by Mancuso and colleagues (2010). They recommend a cut-off score of equal to or greater than 9 to indicate a positive screen, but other authors have suggested ≥11 or ≥14 (Standgier, Janich, Adam-Schwebe, Berger, & Wolter, 2003). The lack of consensus stems from differing values placed on the amount of required sensitivity, specificity, or the balance between these two.

Psychometrics

The DCQ has acceptable internal consistency – despite its short length – for BDD outpatients (α = 0.73), non-BDD undergraduate (α = 0.85), and psychiatric patients (α = 0.88). The Chinese translated version of the DCQ (translated using the back translation method) also had adequate reliability (α = 0.85; Liao et al., 2010)

To establish the DCQ’s discriminant validity, Mancuso and colleagues (2010) compared the DCQ scores of 244 Australian undergraduates (aged 18 to 43 years; M = 20.80, SD = 3.10) and 57 BDD outpatients (aged 18 to 54 years; M = 29.60, SD = 9.44). The BDD group’s DCQ scores (M = 16.25, SD = 3.54) were significantly higher than the undergraduate group’s scores (M = 4.46, SD = 3.38; t(299) = 23.15, p < 0.001), even when the variance accounted for by depression and social anxiety was controlled for [F(1,272) = 268.45, p < 0.001, hp2 = 0.50]. Noteworthy, undergraduates were prior screened for BDD or an eating disorder (using the Body Dysmorphic Disorder Questionnaire and Eating Attitudes Test-26, respectively) and those who had positive results were excluded from participating. By excluding individuals with eating disorders, the discriminant validity of the DCQ could have been unduly increased.

Evidence for convergent validity has been found. The Body Dysmorphic Disorder Examination significantly predicted DCQ scores and explained 48% of the variance [F(1,63) = 58.2, p < 0.001; Jorgensen, Castle, Roberts, & Froth-Marnat, 2001].

Use

The DCQ can be acquired from the original Oosthuizen and colleagues (1998) article. The article is free to access however the DCQ is copyright protected and written permission is needed for its use (except for individual use). The DCQ is appropriate for both research and clinical settings where dysmorphic concern or body image is a variable which needs to be measured or screened for. It has also been recommended to implement the DCQ in dermatological settings (Woolley & Perry, 2015).

References

Jorgensen, L., Castle, D., Roberts, C., & Froth-Marnat, G. (2001). A clinical validation of the Dysmorphic Concern Questionnaire. Australian and New Zealand Journal of Psychiatry, 35(1), 124-128. doi: 10.1046/j.1440-1614.2001.00860.x

Liao, Y., Knoesen, N. P., Deng, Y., Tang, J., Castle, D. J., Bookun, R., Hao, W., Chen, X., & Liu, T. (2010). Body dysmorphic disorder, social anxiety and depressive symptoms in Chinese medical students. Social Psychiatry and Psychiatric Epidemiology, 45(10), 963-971. doi: 10.1007/s00127-009-0139-9

Mancuso, S. G., Knoesen, N. P., & Castle, D. J. (2010). The Dysmorphic Concern Questionnaire: A screening measure for body dysmorphic disorder. Australian and New Zealand Journal of Psychiatry, 44(6), 535-542. doi: 10.3109/00048671003596055

Oosthuizen, P., Lambert, T., & Castle, D. J. (1998). Dysmorphic concern: prevalence and associations with clinical variables. Australian and New Zealand Journal of Psychiatry, 32(1), 129-132. doi: 10.3109/00048679809062719

Standgier, U., Janich, C., Adam-Schwebe, S., Berger, P., & Wolter, M. (2003). Screening for body dysmorphic disorder in dermatological outpatients. Dermatology and Psychosomatics, 4(2), 66-71. doi: 10.1159/000072194

Woolley, A. J., & Perry, J. D. (2015). Body dysmorphic disorder: prevalence and outcomes in an oculofacial plastic surgery practice. American Journal of Ophthalmology, 159(6), 1058-1064.e1. doi: 10.1016/j.ajo.2015.02.014