Assessment

This chapter focuses on the assessment of body dysmorphic disorder (BDD). We begin with a focus on assessment at the initiation of treatment in psychological/psychiatric settings. People with BDD are often reticent to talk about their issues or see their problem as being ameliorable only by a cosmetic "fix". Thus, the mental health professional needs to inquire about BDD symptoms in a sensitive and supportive manner. Comorbid psychiatric disorders are common and should be assessed. A longitudinal perspective should be gained, including when symptoms began, how they evolved over time, and the impact on development (notably social interaction). It can be useful to ask the patient to walk you through an "average day", to understand rituals, avoidance, and impact on functioning. BDD is often accompanied by shame and risk for suicide—to this end, a risk assessment and plan are required. Engagement in treatment that addresses underlying psychological/psychiatric issues, and diverting the individual from seeking cosmetic procedures, takes time and care. We subsequently describe screening and diagnostic assessment tools, symptom checklists, and dimensional measures of symptoms for BDD (both patient- and clinician-completed). These can be useful adjuncts to the clinical interview and can help establish treatment efficacy.