1 – Not at all
2 – Same as most people
3 – More than most people
4 – Much more than most people
¹
1
2
3
4
1
Been very concerned about some aspect of your physical appearance.
2
Considered yourself misformed or misshapen in some way (e.g. nose/hair/skin/sexual organs/overall body build).
3
Considered your body to be malfunctional in some way (e.g. excessive body odour, flatulence, sweating).
4
Consulted or felt you needed to consult a plastic surgeon/dermatologist/physician about these concerns.
5
Been told by others/doctor that you are normal in spite of you strongly believing that something is wrong with your appearance or bodily functioning.
6
Spent a lot of time worrying about a defect in your appearance/bodily functioning.
7
Spent a lot of time covering up defects in your appearance/bodily functioning.
The presented answer sheet is not an original form and is not intended for printing or use as a handout.
The answer numbers are used only to label response columns. They are NOT scores and should not be used for calculating results.