The Dysmorphic Concern Questionnaire (DCQ) is a brief questionnaire designed to measure a person’s degree of body image concern i.e., an excessive preoccupation with a flaw in their physical appearance.
The Dysmorphic Concern Questionnaire (DCQ: Mancuso et al., 2010) was initially designed to measure dysmorphic concern as a symptom shared by many psychiatric disorders (e.g., depression, social anxiety, eating disorders etc.) but has since been validated for use as a screening measure for body dysmorphic disorder (BDD) in both psychiatric and cosmetic settings. It is suitable for pre-procedure screening for BDD in cosmetic settings and can be used to predict later dissatisfaction with cosmetic procedures (Devoto et al., 2024).
The DCQ has seven items exploring both cognitive and behavioural elements of dysmorphic concern. Respondents rate their concern about their appearance relative to others on a 4-point Likert scale from ‘not at all’, to ‘much more than most people’.
The DCQ is designed as a screening tool, rather than a diagnostic tool, and is not considered to be an official diagnosis of BDD. The DCQ can be used by a suitably qualified professional such as a psychologist or psychiatrist to aid in the diagnostic process.
There is strong empirical and theoretical basis indicating that the presence of BDD poses a psychological risk for patients undergoing cosmetic procedures (Honigman et al., 2004; Moulton et al., 2018, Pikoos et al., 2021). For example, 82.3% of individuals with BDD who undergo cosmetic procedures will experience no improvement or worsening in their mental health condition after the procedure, and many report dissatisfaction with the outcomes (Bowyer et al., 2016).
Individuals with BDD are at three times higher risk of experiencing complications and more significant post-operative pain, when compared to a control group (Wooley & Perry, 2015). The Medical Board of Australia guidelines (2023) stipulate that cosmetic practitioners should screen for BDD using a validated assessment tool, prior to administering any cosmetic surgery or non-surgical procedures. The DCQ is a validated screening measure which is fit for this purpose (Lekakis et al., 2016).
Items are summed to produce the DCQ total score (range 0 to 21), with higher scores indicating a higher degree of dysmorphic concern. Patients scoring 9 or above are considered to have clinically significant dysmorphic concern consistent with body dysmorphic disorder (Mancuso et al., 2010).
Scores are categorised into four dysmorphic concern ratings:
Scores are presented as a percentile, comparing the respondent’s score to a sample of people seeking cosmetic surgery (Devoto et al., 2024). The percentile score contextualises responses compared to those typically found in cosmetic settings, where a percentile of 50 represents typical (and healthy) levels of body image concern. A score above the 95th percentile represents people with body image concerns in the top 5% of individuals seeking cosmetic procedures, and correspond to raw scores above 9 and are consistent with those with body dysmorphic disorder.
Patients who score 9 or above on the DCQ should be thoroughly assessed for psychological risk factors before undergoing a cosmetic procedure, including Body Dysmorphic Disorder.
Results are also presented in a graph comparing the respondents’ score to the middle two quartiles of three samples.
The chart’s shaded areas represent scores between the 25th and 75th percentile for those samples. Comparing a respondent’s score to those samples helps contextualise a respondent’s score to those typically expected in the three groups. The graph shows that there is substantial crossover between cosmetic patients who are satisfied (green) and those dissatisfied (yellow). BDD patients (red) score significantly higher, though the cutoff at 9 indicates people scoring 9 or above are best considered to be consistent with BDD.
Higher scores on the DCQ even if they don’t meet the BDD threshold (9+) are predictive of dissatisfaction with cosmetic outcomes (Devoto et al., 2024). Indeed, BDD and higher DCQ scores in general are indicative of psychological risk factors associated with poor cosmetic outcomes including distress, regret and increased body image anxiety (Devoto et al., 2024, Honigman et al., 2004; Moulton et al., 2018, Pikoos et al., 2021). For example, 82.3% of individuals with BDD who undergo cosmetic procedures will experience no improvement or worsening in their mental health condition after the procedure, and many report dissatisfaction with the outcomes (Bowyer et al., 2016).
The DCQ is a widely used measure of dysmorphic concern symptoms and has been cited in over 350 papers. It has been found to have very good internal consistency, a unidimensional factor structure, and strong convergent validity with measures such as distress, social and work impairment and depressive symptoms (Oosthuizen et al., 1998).
The DCQ has also been validated in a sample of 57 outpatients with body dysmorphic disorder (BDD; 26 male, 31 female) and 244 university students (Mancuso et al., 2010). A DCQ cutoff score of 9 was found to maximise the balance between sensitivity and specificity in the study, with correct classification of 91.6% of the combined BDD and undergraduate samples. The DCQ has also been investigated as a screening measure in a dermatological sample with 22 BDD patients, 21 patients with disfiguring skin conditions and 21 patients with mild skin conditions (Stangier et al., 2003). They opted to use a cut-off score of 11 which resulted in correct classification of 100% of BDD patients and 100% of individuals with mild skin conditions, but only 59% of individuals with disfiguring skin conditions. While there is some disagreement in the research on cut-off scores, a score of 9 is considered the most conservative cut-off to ensure individuals with BDD are correctly classified (Mancuso et al., 2010).
This sample found among those seeking mental health treatment for BDD the mean DCQ score was 16.25 (SD=3.54).
The DCQ has also been found to predict post-operative satisfaction and complications. A 2015 study (n = 728) found that patients who screened positive on the DCQ were significantly more likely to have post-operative complications following oculofacial plastic surgery than those screening negative (Wooley & Perry, 2015).
A 2024 paper explored the use of the DCQ as a predictor of post-operative satisfaction after cosmetic eyelid surgery in 454 patients (Devoto et al., 2024). The DCQ was found to be a significant predictor of post-operative satisfaction, with higher DCQ scores associated with lower satisfaction at three month follow-up after cosmetic eyelid surgery. The authors concluded that the DCQ is a brief, sensitive and specific clinical screening tool for use in a cosmetic surgery practice. The study found significant differences in DCQ scores between those satisfied and those unsatisfied with cosmetic procedure, where:
Based on the available normative data, ReadyMind determined dysmorphic concern ratings from “low” to “extremely high”.
The below table shows severity ranges and compares scores within different samples. The highlighted percentiles (green, orange and red) represent the middle two quartiles (between approximately 25th and 75th percentile) compared to satisfied cosmetic patients, dissatisfied patients (Devoto et al., 2024) and patients seeking mental health treatment for BDD (Mancuso et al., 2010).
Developer:
Mancuso, S. G., Knoesen, N. P., & Castle, D. J. (2010). The Dysmorphic Concern Questionnaire: A screening measure for body dysmorphic disorder. Australian & New Zealand Journal of Psychiatry, 44(6), 535-542. https://doi.org/10.3109/00048671003596055
References:
Devoto, M. H., Ricci, A. I. D., & Gasparini, C. (2024). The Dysmorphic Concern Questionnaire: Is It Possible to Predict a Satisfactory Result After Cosmetic Eyelid Surgery?. Ophthalmic Plastic & Reconstructive Surgery, 10-1097.
Oosthuizen, P., Lambert, T., & Castle, D. J. (1998). Dysmorphic concern: prevalence and associations with clinical variables. Australian & New Zealand Journal of Psychiatry, 32(1), 129-132.
Stangier, U., Janich, C., Adam-Schwebe, S., Berger, P., & Wolter, M. (2003). Screening for body dysmorphic disorder in dermatological outpatients. Dermatology and Psychosomatics/Dermatologie und Psychosomatik, 4(2), 66-71.