Body Shape Questionnaire (BSQ)

Page created 5.i.19 from page on old psyctc.org site first started back in 2003.   Content of the pages is freely available under a Attribution-ShareAlike Creative Commons Licence. so you can quote as much or as little of it as you like but you must make whatever you do available on the same licence and give the attribution to me with a link back to here.  The full BSQ, the approved shortened forms, and any translations of any of them are different as changing them in any way loses comparability of findings so they are made available here under the Attribution-NoDerivatives Creative Commons Licence.   “NoDerivatives” here covers translation: if you want to do that, see the conditions for that.

Contents

Introduction

The BSQ is a self-report measure of the body shape preoccupations typical of bulimia nervosa and anorexia nervosa. It was first reported in: Cooper, P.J., M.J. Taylor, Z. Cooper & C.G. Fairburn (1986). The development and validation of the Body Shape Questionnaire. International Journal of Eating Disorders 6: 485-494.

The full detail is in Melanie’s PhD thesis: “The Nature and Significance of Body Image Disturbance”. Melanie J Taylor. Wolfson College Cambridge 1987. A paper copy is kept in the Library for Experimental Psychology at the university but, with Melanie sacrificing one of her paper copies and me cutting it up and putting it through a scanner, an electronic copy is now online. Go to the BSQ thesis directory to get it in total or parts.

The copyright rests legally with at least one of those four people and I have been able to contact all of them (M.J. Taylor is now M.J. Bash) and they are all happy for people to copy and the use full or shortened BSQs provided that the text is not changed in any further way.

Please note, these short forms, the two 16 item versions and the four 8 item versions are the only BSQ forms that are approved by the BSQ’s copyright holders: they do not permit creation of other short forms and regard doing so as copyright violation and bad science. This is because they believe, rightly clearly, that creation of other short forms allows more and more non-comparable results to come into the literature. We also believe that the provision of the full, the two 16 item and the four 8 item forms leaves little or no real need for other short forms to be created.

Approved shortened forms of the BSQ

The approved short forms came into existence when I did some work on the psychometric properties of the full BSQ based on data largely from women with bulimia that Bridget Dolan had collected. I suggested that four near parallel eight item short forms and two near parallel 16 item forms could be extracted from it with very little loss of internal reliability. That work was published in: Evans, C. & Dolan, B. (1993). Body Shape Questionnaire: derivation of shortened “alternate forms”. International Journal of Eating Disorders 13(3): 315-321.

Mapping of items for approved short forms

My paper with Bridget Dolan, showed that, for the data we had from white British women attending a family planning clinic, two 16 item shortened forms of the BSQ had Cronbach’s coefficient alpha values in the range .93 to .93 with non-significant differences in mean scores (paired t-tests). Four eight item scales had alpha values ranging from .87 to .92 and very nearly equivalent scores. All scales showed similar correlations with other correlated and discriminant variables (see paper for details).

The six shortened scales and the original 34 item version are enclosed. The mapping of the items from the shortened forms to the original 32 items is as follows. Items 26 and 32 from the BSQ-34, which refer to vomiting and use of laxatives, were dropped from all shortened forms.

Item #
16A
16B
8A
8B
8C
8D
1121542
234311612
3567151314
47128201618
58139211924
691410222327
7101617252930
8111834283331
91519
101723
112024
122127
132229
142530
152831
163433

Gender and using the BSQ with men

The BSQ was designed for use with women but Melanie has recently confirmed approval for changes to three items allowing the BSQ to be used with men given the increasing prevalence of, and recognition of, eating disorders and body shape concerns, in men. The changes are:

Item 9 now reads – “Has being with thin men made you feel self-conscious about your shape?”

Item 12 now reads – “Have you noticed the shape of other men and felt that your shape compared unfavourably?”

Item 25 now reads – “Have you felt that it is not fair that other men are thinner than you?”

This form of the BSQ, and the derivative shortened forms for men, will be made available here when I have time to make the changes. Results from men should be explored psychometrically and scores not just compared directly to referential scores from women as the psychology of body shape concerns may differ between men and women even in men with clear anorexia nervosa or bulimia. There is is clearly now an empirical issue about using the measure with people who don’t identify as male or female and about another change to those three items to use “people” instead of “women” or “men”. Please contact me if you want to do that so I can discuss the copyright issue with Melanie.

Scoring the BSQ and short forms

People often ask about the scoring. Each item is scored 1 to 6 with “Never” = 1 and “Always” = 6 and the overall score is the total across the 34 items, i.e. a theoretical score range from 34 to 204.

In my own use of the BSQ, years ago now, I think we had essentially no omitted items in our data. However, much of that work was with motivated people seeking treatment so such a low omission rate may not always be the case. I tend to use a “≤10% prorating” approach to all measures where someone has missed out an item. That’s to say that for the BSQ16 I would prorate (multiply by 16/15 the total across the 15 they did answer) but I wouldn’t do that if someone missed out more than one item as that would take me over the 10% criterion.

That “≤10%” prorating recommendation is not “official”. I don’t think anything was said in our paper or the original papers on the BSQ. I am clear from my own reading that this rule is used by a number of other researchers and measure developers but I’m not aware of any canonical work on prorating and maximum proportions of items to prorate. (Do contact me if you know of any such work or have done empirical or simulation work on this issue: I’d love to hear from you.) They key think is to declare it in the methods section of a paper whenever you do use prorating and to report the missing item rate.

Scoring the short forms

The scoring of the short forms is based on the same principle: add up the scores on the items. Very roughly, you can convert a score on a 16 item version to what its equivalent is on the full BSQ by multiplying the score on the 16 item version by 34/16. By the same principle you can convert scores on any 8 item version to BSQ equivalent score by multiplying by 34/8. Bear in mind that this IS approximate: because different items will have different probabilities of being scored positively at the same level of body shape preoccupation a score on one item is not equivalent to a score on another item and a so such rescaling is always only a guide. There are ways to get better rescaling rules based on empirical data using the measures, or just based on looking at the scores on the items in the shorter forms when embedded in the full form. I’m not aware of work like that having been published for the BSQ though. Do please contact me if you seen it reported for any of the short forms.

Cutting points for classifying scores

People also ask about cutting points between “normal” and “abnormal”. As far as I know, there are none. Given the complex cultural and other determinants of general body image concerns and of frank clinical eating disorders, I believe that any cutting points should be checked very carefully and not assumed to generalise across cultures.

Melanie (Bash, née Taylor) has the following in her thesis but not in the original paper about the BSQ:

Full BSQ scoreClassification
less than 80no concern with shape
80 to 110mild concern with shape
111 to 140moderate concern with shape
over 140marked concern with shape

For UK English samples, it is currently reasonable to convert those cutting points on the full BSQ to get cutting points for the 16 item and 8 item versions by multiplying the BSQ cutting points by 16/34 and by 8/34 respectively. That gives these cutting points for the 16 item short forms.

16 item scoreClassification
less than 38no concern with shape
38 to 51mild concern with shape
52 to 66moderate concern with shape
over 66marked concern with shape

and for the 8 item versions:

8 item scoreClassificationi
less than 19no concern with shape
19 to 25mild concern with shape
26 to 33moderate concern with shape
over 33marked concern with shape

As noted above, that’s not a great way of working out new cutting points for the short forms as the different items can have rather different mean scores (in clinical and in non-clinical samples) so multiplying by the numbers of items is not going to guarantee the best possible map from one version to another. Even for the UK this way of multiplying the BSQ category cutting points by the reduced numbers of items in the 16 and 8 item short forms is really only a sensible guide pending other empirical data from large clinical and non-clinical samples emerging. If you have done such work or know of such work, do please contact me and I’ll edit this to point to the work..

Given the complex cultural and other determinants of general body image concerns and of frank clinical eating disorders, I believe that for other cultures and for translated versions, any cutting points should be based on local data not transferred from those UK guidelines assuming generalisability across cultures and languages.

Psychometric properties of the BSQ

I haven’t worked in body image or eating disorders for over a decade now but I do continue to work on the psychometrics and other instruments (mostly CORE-OM and shortened forms and PSYCHLOPS and have been suprised not to see work on the psychometrics of the BSQ being published. If you have a moderately large dataset (n ≥ 500) of data from the full BSQ to recheck the shortening specification or of any of the BSQ forms to look at their psychometric properties in your sample and and you need psychometric help and would trade for authorship, do contact me!

Translations

There have been a number of translations of the BSQ into other languages and it is fine to translate the BSQ subject to the issue of
copyright (see below).  If this is, as it usually is, a student project
then speed is important and funding is nil so this is guidance for that situation. A really good translation of any questionnaire needs at least a full Master’s level research project and translation and psychometric exploration is a PhD level project. Most student work with the BSQ seems to be undergraduate work which is not ideal but these paragraphs are aimed at that situation. If you have more resources I recommend

Hall, D A., Zaragoza Domingo, S., Hamdache, L.V., Manchaiah, V., Thammaiah, S., Evans, C., Lena L. N. Wong, L.L.N. and on behalf of the International Collegium of Rehabilitative Audiology and TINnitus Research NETwork. (2017). A Good Practice Guide for Translating and Adapting Hearing-Related Questionnaires for Different Languages and Cultures. International Journal of Audiology, November, 57(3):161–175. 

https://doi.org/10.1080/14992027.2017.1393565

as a guide. (Declaration: I would recommend it as I’m a co-author but I receive no payment from it, it’s open access and almost nothing in the paper is specific to audiology.) I would also be very happy to help you with advice so if you do have resources and want to collaborate on a translation, do contact me.

Undergraduate student translation recommendations

If you can, I’d recommend that you get a couple of friends or family
members who are fluent enough in both English and your target
language(s) to do independent forward translations. Then compare the differences between the versions and discuss them and the thinking you each had in making decisions about your translations in order to come up with a final version.  I use a more elaborate version of this approach to do translations of the CORE-OM and its derivative measures (see www.coresystemtrust.org.uk for information about the CORE system, do contact me if you’d like to know more about that).

If this is a student project then your tutors will probably want to see
that you got an independent back translation and compared that with the original English version.  That “translation-backtranslation” paradigm has been very dominant in the cross-cultural psychology literature.  I believe that, used on its own, translation-backtranslation is a bad paradigm as it tends to produce rather literal and wooden translations that lose some of the spirit of the original for most psychological measures.

If you do do a translation, you are building on the copyright work of
the original authors of the BSQ so their conditions are  that the
copyright on the final version must be a Creative Commons
Attribution-NonCommercial-NoDerivs 3.0 Unported License:

http://creativecommons.org/licenses/by-nc-nd/3.0/

The copyright holders would be yourself and as many co-translators as
you consider to deserve (and want) explicit co-authorship, myself and
the authors of the original BSQ, Melanie Bash (nee Taylor), Peter
Cooper, Zafra Cooper and Chris Fairburn.

I hope all this helps with the BSQ and is acceptable to you.  Do let me
know
if you are thinking of doing a translation.

Downloading

  • English. These are the original BSQ in various formats.
  • Malay. Malay, no short forms yet.
  • Lithuanian. All forms and male and female but only in Word format.
  • Spanish.
  • … do contact me if you can do another translation.