Psychological Underpinnings of Trust and Privacy Perception in the Medical Metaverse.

Body dysmorphic disorder (BDD) is a complex and potentially debilitating condition, affecting approximately 2% of the population [, ]. The disorder typically emerges during adolescence [], although often goes undetected and undiagnosed for many years. Underdiagnosis of BDD may partly result from sufferers often avoiding mental health services due high levels of shame and a preference for cosmetic treatments. Even among those who do attend mental health services, BDD may be overlooked due to diagnostic overshadowing [] and a lack of awareness of BDD among clinicians []. Consequently, ensuring the timely identification and assessment of BDD in clinical settings is an important clinical priority []. The most widely accepted tool for assessing BDD symptoms in youth is the adolescent version of the Yale-Brown Obsessive–Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS-A). Previous research has highlighted its strong psychometric properties including, a two-factor structure accounting for 56% variance, strong internal consistency (Cronbach’s alpha = 0.87), and adequate convergent and divergent validity []. However, the BDD-YBOCS-A is a clinician-administered measure, requiring both significant time commitment and specialist training. Self-report measures present a more cost-effective and efficient way to identify those with BDD symptomology, thereby informing clinical assessment []. Similarly, self-report measures are an efficient way of measuring symptom change during a course of treatment. This is crucial at an individual level, to inform ongoing care planning, but also enables evaluation of treatment efficacy and effectiveness in research and service contexts, respectively. Currently, self-report measures of BDD symptoms in youth are scarce and are either lengthy and only validated in non-clinical samples [] or focus specifically on cognitive and behavioural process relevant to therapy and do not capture distress and impairment []. The Body Image Questionnaire (BIQ) (also called the Cosmetic Procedures Screening, or COPS, when used in cosmetic settings) is a self-report measure to assess BDD symptoms in adults []. The BIQ is widely used in research and clinical settings. For example, it is the BDD symptom measure that is used in NHS Talking Therapies for Anxiety and Depression (formally known as Increasing Access to Psychological Therapies, or IAPT), the largest provider of psychological therapy in the United Kingdom []. The BIQ was originally developed as a 12-item scale but subsequently shortened to a 9-item version The 9-item version is the most widely utilised in research and clinical settings as it has been found to have high sensitivity and superior psychometric properties [, ]. The psychometric properties of the BIQ (9-item) have been evaluated in adult samples, demonstrating strong internal consistency and convergent validity, and a single-factor structure []. The BIQ has also been adapted for use in children and adolescents but there has been limited research into the properties of the youth version of the BIQ (referred to as the Body Image Questionnaire – Child and Adolescent,BIQ-C. Establishing reliable and valid measures of BDD symptoms in youth is crucial, since BDD typically develops during adolescence and may be associated with more severe and negative outcomes compared to later onset BDD [, ].