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
- Downloading the measures and translations
Copyright: do not ask me for permission to use the BSQ!
As of October 2023 the management of the BSQ and approved short forms has been transferred to the non-profit MAPI trust. For non-commercial, unfunded use, you can download the using the links below. You have to sign up with MAPI but that’s free. The links should open in new tabs.
- Full 34 item BSQ
- 16 item BSQ-16A
- 16 item BSQ-16B
- 8 item BSQ-8A
- 8 item BSQ-8B
- 8 item BSQ-8C
- 8 item BSQ-8D
This means that all requests for permission to use or translate the BSQ must go to them at https://eprovide.mapi-trust.org/my-eprovide/my-requests/new.
You must sign up with them, which is free, this will ensure an optimized service. If your work has no specific funding for the use of the questionnaire you will be able to download the form you want directly from ePROVIDE, using the “online distribution” process. If that doesn’t work for you, please contact eprovidetechnicalsupport@mapi-trust.org not me!
Background
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.
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. The creation of new short forms from the BSQ is not permitted.
Mapping of items to the 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 |
Which short form should I use?
I think this should be a FAQ as it has come up pretty regularly over the years.
Mostly people are asking which of the 16 item forms or which of the 8 item forms but sometimes the question is about 16 vs. 8 items or about choosing across the full six possibilities. My starting
Mostly people are asking which of the 16 item forms or which of the 8 item forms but sometimes the question is about 16 vs. 8 items or about choosing across the full six possibilities. My starting piece of advice is that this isn’t a pure question of quantitative psychometrics and is mostly about pragmatics (16 vs. 8 items) and about the qualitative issues of the item content. However, there is a psychometric issue in the 16 vs. 8 choice: the internal consistency/reliability is higher for the 16 item forms than the eight item versions, that gains you a little statistical power and better precision of estimation: i.e. tightened confidence intervals. That’s true but the difference is tiny and I would be more influenced by how much time I am asking of respondents and, given that there are almost always other measures being offered, whether responding is going to feel repetitive (and perhaps depressing, see Blount, C., Evans, C., Birch, S., Warren, F., & Norton, K. (2002). The properties of self-report research measures: Beyond psychometrics. Psychology and Psychotherapy: Therapy, Research and Practice, 75, 151–164. https://doi.org/10.1348/147608302169616. That’s not OA, contact me if you want a copy). After that we get to which of the forms and my advice is that this should be driven by your reading of the content of the items: do any of the forms strike you as more likely to be understood by the highest proportion of your population than others? Go for the one you think will do best!
What if your respondents are repeating the measures?
I guess the first question is whether to stick with one form and repeat it, or to, say, alternate the BSQ-16A and BSQ-16B or sequence two or more of the eight item forms. For me this takes us to what you think about the “memory effect”, i.e. the idea that the respondent’s responses may be affected by what they remember of what they answered last time or across previous times. The general idea about the memory effect is that some people may try to give the answers they remember giving last time rather than perhaps answers that more accurately reflect how they are now. Of course, it’s also a memory effect if they might want to answer in a way that suggests they have more or fewer issues with body image than they had. I am no expert on this and I sense that it was a fashionable issue decades back but hasn’t been explored much recently. I know of no empirical exploration of it with the BSQ (but I may have missed something!) Clearly the argument goes that not using the same form twice in a row will remove memory effects and in principle that is true, the catch is that may be small mean shifts between answers to the different forms so we don’t know if changes we see are artefacts of forms used or real change. I honestly have no advice to give here other than that it would be really interesting, and perhaps really useful, for people to explore these issues!
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 there cannot be 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 was never “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.)
We have now agreed ongoing scoring rules with MAPI:
Missed items should be pro-rated. However, if a great number of items are omitted then it would invalidate the questionnaire.
We recommend prorating, i.e., taking the mean of the scores per completed item and multiplying by the total number of items, 34 for the full BSQ, 16 or 8 as appropriate for the short forms. Using a guide of only prorating if fewer than 10% of items are missing gives this.
Prorate up to four missing for the full BSQ, leaving smallest measure, minimum k (number of items) therefore 30.
Prorate up to two missing for the 16 item short forms, smallest k = 14.
Only one missing allowed for the 8 item short forms, minimum k = 7.
As ever, the key thing is to declare how you handled missing items, and their numbers, in the methods section of a paper whenever you do use prorating, it’s horribly easy to forget to do this and weakens our literature when we forget (yes, I have at times!)
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.
Downloading the measures and translations
As noted above, as of October 2023 MAPI trust have clarified that the copyright of the full BSQ is with Melanie Bash (nee Taylor) and she has agreed that I am co-copyright holder with her for the approved short forms. At the same time she and I have handed over management of access to the forms to MAPI. You can now get the measures through MAPI Trust’s ePROVIDE BSQ page and they have a good list of known translations with pointers to the canonical papers for each.
Comments or questions?
If you still have questions or suggestions to improve this age do contact me.
Page created 5.i.19 from page on the old psyctc.org site from 2003, last updated 26.ix.24. All the BSQ forms are copyright and managed by MAPI Trust and their ePROVIDE service. As with most pages on this PSYCTC.org site, all content that is not the BSQ forms 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.