Cognitive and Behavioral Processes in Body Dysmorphic Disorder: Psychometric Properties Persian Version of the Appearance Anxiety Inventory in Cosmetic Surgery Clinics

Abstract

Background: The Appearance Anxiety Inventory (AAI) is a practical tool for understanding cognitive and behavioral processes in body dysmorphic disorder (BDD). Objectives: The purpose of this study was to investigate the psychometric properties of the Persian version of the AAI in individuals visiting cosmetic surgery clinics. Methods: The study design was cross-sectional, and 334 individuals who were referred to cosmetic surgery clinics in Tehran in 2020 - 2021 were selected through convenience sampling. Participants completed the AAI, Body Compassion Scale (BCS), Body Image Shame Scale (BISS), Dysmorphic Concern Questionnaire, and the Form of Self-criticizing/Attacking & Self-reassuring Scale. Confirmatory factor analysis, divergent and convergent validity, internal consistency, and test-retest reliability of the AAI were analyzed using SPSS version 24 and LISREL 8.80. Results: The results of the confirmatory factor analysis showed that both the one-factor and two-factor models (avoidance and threat monitoring) of the AAI have a good fit. The AAI has a positive and significant correlation with the Questionnaire of Concern about Body Dysmorphic, Shame of Body Image, and Self-Criticism, and a negative and significant correlation with the BCS, indicating appropriate convergent and divergent validity. Cronbach's alpha coefficient for the whole scale, avoidance, and threat monitoring dimensions were 0.81, 0.77, and 0.63, respectively. Test-retest reliability for the AAI and avoidance and threat monitoring subscales were 0.89, 0.91, and 0.78, respectively. Conclusions: The AAI is a suitable tool for research and clinical work, demonstrating good validity and reliability in individuals visiting cosmetic surgery clinics. This study complements the cross-cultural literature on the AAI.