Page created 5.i.19 from page on the old psyctc.org site from 2003, updated 28.xi.22. As with most pages on this site, the content 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. However, 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
- Copyright and creating other forms
- Approved short forms
- Gender and using the BSQ with men
- Scoring
- Psychometric properties
- Cautionary note: DON’T ask me for the reliability let alone the validity of the BSQ!
- Original PhD thesis about the development of the BSQ
- Translations and translation procedure
- Downloads and completed translations
- Malay
- Lithuanian
- Spanish
- Chinese
- Bahasa Indonesia
- Greek
- Italian
- Contact me about the BSQ (please make sure you aren’t asking me about something that is answerable by reading information here sensibly!)
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.
Copyright and creating other forms
The copyright of the full BSQ 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 # | ||||||
|---|---|---|---|---|---|---|
| 1 | 1 | 2 | 1 | 5 | 4 | 2 |
| 2 | 3 | 4 | 3 | 11 | 6 | 12 |
| 3 | 5 | 6 | 7 | 15 | 13 | 14 |
| 4 | 7 | 12 | 8 | 20 | 16 | 18 |
| 5 | 8 | 13 | 9 | 21 | 19 | 24 |
| 6 | 9 | 14 | 10 | 22 | 23 | 27 |
| 7 | 10 | 16 | 17 | 25 | 29 | 30 |
| 8 | 11 | 18 | 34 | 28 | 33 | 31 |
| 9 | 15 | 19 | ||||
| 10 | 17 | 23 | ||||
| 11 | 20 | 24 | ||||
| 12 | 21 | 27 | ||||
| 13 | 22 | 29 | ||||
| 14 | 25 | 30 | ||||
| 15 | 28 | 31 | ||||
| 16 | 34 | 33 |
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.
Why I don’t think we can have a meaningful ungendered BSQ
The authors created a gendered instrument. Later they allowed that an adaptation for men, but still gendered, could be created and that’s explained immediately above.
However, the question of “using the BSQ with women and men” or of having an ungendered version is coming up. I am not convinced, and I believe Melanie agrees with me, that you can.
The issue is whether
“How do you compare your body with that of other [men|women]?”
is the same as
“How do you compare your body with that of other people?”
They are not for me, I identify as male and I really am not sure how I would answer the question:
“How do you compare your body with that of other women?”
For me it’s grammatically flawed and if I were to turn it into:
“How do you compare your body with that of women?”
I am into completely different territory from trying to answer:
“How do you compare your body with that of other men?”
Perhaps that shows I have a rather binary, gender stereotyped position (I am in my 60s!) However, I think there are issues here that are important to the kinds of self-appraisal the BSQ is designed to measure and which will get very muddled if people try to create an ungendered form. As we move more and more to online rather than paper forms this can be handled by having a branching form that asks for the gender of the respondent early on and then asks the items that are gendered with the same gender form … however, that begs the question of what should happen if you also want a non-binary gender identification. These issues matter and can’t just be solved by using an ungendered form with both/all genders. I suspect ultimately they will need new methods for us to handle them well.
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 score | Classification |
|---|---|
| less than 80 | no concern with shape |
| 80 to 110 | mild concern with shape |
| 111 to 140 | moderate concern with shape |
| over 140 | marked 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 score | Classification |
|---|---|
| less than 38 | no concern with shape |
| 38 to 51 | mild concern with shape |
| 52 to 66 | moderate concern with shape |
| over 66 | marked concern with shape |
and for the 8 item versions:
| 8 item score | Classificationi |
|---|---|
| less than 19 | no concern with shape |
| 19 to 25 | mild concern with shape |
| 26 to 33 | moderate concern with shape |
| over 33 | marked 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 surprised to be seeing rather little work on the psychometrics of the BSQ though I certainly haven’t been following this exhaustively. 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.
Cautionary note about psychometric properties of the BSQ and short forms
I get a number of contacts asking me for “the reliability and validity of the [BSQ and/or short form(s)]” Please don’t ask this!
Why not?!
a) Because the answer for Cronbach’s reliability in the development sample data are in Melanie’s paper and thesis and for the short forms are in the paper I and Dr. Dolan did to develop them (and I’m happy to send you a copy of that paper if you ask me).
b) However, those are simply internal reliabilities and there are other indices of reliability, principally test-retest reliability and these are no indication of validity. There is good work addressing validity in Melanie’s thesis but validity is a many faceted idea.
c) Even these internal reliability values are from the measure in English, from specific samples that were collected over twenty years ago now. There is no guarantee that they are still good guesstimates of the population reliability of the measures in UK non-help-seeking and help-seeking samples any more: attitudes to body image change. Even more importantly, attitudes to body image are substantially determined by cultural issues so might be very different in other countries and cultures. It’s not for the BSQ but for a dramatic example, see the work I did around the time of doing the BSQ short form work: Evans, C., Dolan, B., & Toriola, A. (1997). Detection of intra- and cross-cultural non-equivalence by simple methods in cross-cultural research: Evidence from a study of eating attitudes in Nigeria and Britain. Eating and Weight Disorders, 2, 67–78. https://doi.org/10.1007/BF03397154. Contact me if you want a copy of that but make sure you say that’s what you want: the messages I get from the contact form don’t say what page they came from.
d) Translation of any measure is never perfect, even when the cultural location is the same full “measurement invariance” is rare if samples are large enough to catch the likely changes which may sometimes be substantial. For examples exploring this, not for the BSQ, from my own work (again, contact me if you want copies):
- Paz, C., Evans, C., Valdiviezo-Oña, J., & Osejo-Taco, G. (2020). Acceptability and Psychometric Properties of the Spanish Translation of the Schwartz Outcome Scale-10 (SOS-10-E) Outside the United States: A Replication and Extension in a Latin American Context. Journal of Personality Assessment, 1–10. https://doi.org/10.1080/00223891.2020.1825963
- Paz, C., Hermosa-Bosano, C., & Evans, C. (2021). What Happens When Individuals Answer Questionnaires in Two Different Languages. Frontiers in Psychology, 12, 688397.
https://doi.org/10.3389/fpsyg.2021.688397 - Paz, C., Mascialino, G., & Evans, C. (2020). Exploration of the psychometric properties of the Clinical Outcomes in Routine Evaluation-Outcome Measure in Ecuador. BMC Psychology, 8(1), 94–105.
https://doi.org/10.1186/s40359-020-00443-z
So please: no more requests for “the reliability and validity of the [BSQ and/or short form(s)]” If I do bother to waste time answering it will be just to point you here.
Translations
In the light of some recent events (in 2020/21) I am tightening up on translations to save me time (my work on the BSQ is completely unpaid and in my own time) and to try to impose some quality control. If this is a student project your supervisor must contact me as well as you yourself and s/he must agree to take responsibility for ensuring you comply with these terms:
- 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 translation remains with them in return for which they, and I, will ensure that the translation is shared for others to use with full credit to you for the translation work.
- I recommend that you let me help you with the translation as recent experience has shown that the English in some of the items are a little unusual in English: vernacular or uncommon use of words that would be familiar to any first language UK English speaker from the late 20th Century but easy to mistranslate even for very expert translators if their first language isn’t UK English. I have found that the easiest way to fix these is for you to get a backtranslation of your forward translation (by someone with some competence in English but who has never seen the original English BSQ) and for us to discuss that quickly in an Emeeting. Alternatively we could use an Emeeting to discuss any issues you found in the translation and I can ask about how you translated these tricky items.
- However, to be a legal translation you must supply me with the following. If this is not done your translation is illegal and work with it cannot be submitted for publication:
- A summary in English (and your target language by all means) of the translation process used (see more information below).
- An electronic copy of the translation (of the full 34 item BSQ) that I can mount for others to use and which I can use copy and paste if I wish to transfer the translation to another format.
- A copy of the thesis, dissertation, report and any publication about the translation or done by you using the translation.
- If you find you are unable to complete the translation you will tell me: I have nothing but sympathy for people who try generously to do things, unrewarded, for everyone and can’t always do all we want to do: I know about being there! Just tell me and have my heartfelt sympathy, if you have done enough that might be useful to someone else in the future, I would love it if you would share that with me but clearly you don’t have to do that.
- You agree that if I am contacted by anyone else wishing to translate to your target language before I you complete your translation, that I will put them in touch with you (and your supervisor, and their supervisor if that person is a student). This is so we can collectively decide if they can help you or, if they can’t help you, when they can expect the finished translation will be available for them to use it.
- Assuming you complete the translation I will make the translation available in these BSQ web pages for others to use with acknowledgements to you and whoever else helped you and I will mount your summary of the translation process you used and either mount any documents, e.g. a thesis, giving more detail, if the copyright and regulations applying to that allow that.
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.
Translation processes appropriate to logistics
A really good translation of any questionnaire is 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. Usually with student projects then speed is important and funding is nil so this is guidance for that situation.
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 explore the thinking you each had in making decisions about your translations. In the light of this discussion, come up with a final version. If you possibly can doing some “qualitative field testing” asking people who have never seen the original BSQ asking them to talk through what they understand of each component of the measure.
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 CORE and/or the CORE translation process.
If this is a student project then your tutors may ask that you get an independent back translation and compare that with the original English version. That “translation-backtranslation” paradigm has been very dominant in the cross-cultural psychology literature. It’s always wise to get such a back-translation, or several, however the evidence is increasingly clear 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. Sometimes it produces translations that are frankly terrible. Almost all modern translation guidelines require more than translation and back-translation.
Translations if you have more resources than a UG student project
If you have more resources I recommend the CORE process (see https://www.coresystemtrust.org.uk/translations/) and, though it’s for a more “expert driven” paradigm than the CORE one, I also contributed to this very thorough open access guideline paper:
Hall, D A. et al. (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
(Almost nothing in the paper is specific to audiology.)
Declaration: of course I would recommend the CORE process and that paper I’m a co-author on both but I receive no income from CORE or my papers! Three other recent papers I have co-authored that could help you are:
Yassin, S., & Evans, C. (2021). A journey to improve Arabic‐speaking young peoples’ access to psychological assessment tools: It’s not just Google translate! Counselling and Psychotherapy Research, capr.12431. https://doi.org/10.1002/capr.12431 (This is sadly not open access but if you contact me I can legitimately send you a copy.
Paz, C., Hermosa-Bosano, C., & Evans, C. (2021). What Happens When Individuals Answer Questionnaires in Two Different Languages. Frontiers in Psychology, 12, 688397. https://doi.org/10.3389/fpsyg.2021.688397 (open access)
Evans, C., Paz, C., & Mascialino, G. (2021). “Infeliz” or “Triste”: A Paradigm for Mixed Methods Exploration of Outcome Measures Adaptation Across Language Variants. Frontiers in Psychology, 12, 695893. https://doi.org/10.3389/fpsyg.2021.695893 (open access)
If you have more than UG student resources for a translation do please contact me as I have recently found that my advising on some of the English in the BSQ, and helping review back-translations, really does avoid some nasty traps.
Downloading and translated versions
- English. These are the original BSQ in various formats.
- Chinese.
- Greek.
- Italian.
- Lithuanian. All forms and male and female but only in Word format.
- Malay. Malay, no short forms yet.
- Nepali. A translation is underway in Nepal (as of September 2023) so please don’t start another! I can put you in touch with the team working on it there.
- Spanish.
Comments or questions?
If you have got to here having read all the above: well done! If you have questions or comments, do contact me, you’ve earned the right!
Page created 5.i.19 from page on the old psyctc.org site from 2003, last updated 21.ix.23. As with most pages on this site, the content 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. However, 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.