About the AAQ
Evidence-Based Assessment for Aesthetic Medicine
The Appearance Anxiety Questionnaire helps clinicians understand whether a patient's appearance concerns may respond positively to aesthetic treatment, or whether features suggestive of body dysmorphic disorder indicate treatment is unlikely to help.
The Clinical Challenge
Many patients seeking aesthetic treatment have elevated appearance anxiety - and for most, appropriate treatment can genuinely help improve their quality of life. However, a minority present with features of Body Dysmorphic Disorder (BDD), where aesthetic treatment is unlikely to address their underlying concerns.
Research suggests that 7-15% of aesthetic patients may meet criteria for BDD. The AAQ helps differentiate between appearance anxiety that treatment can address and BDD patterns where treatment may not help.
Patient Protection
Identify vulnerable patients before potentially harmful interventions
Risk Reduction
Reduce complaints and litigation through informed consent
Appropriate Support
Ensure psychological referral when indicated
Better Outcomes
Improve overall patient satisfaction and results
Two Separate Assessments
The AAQ provides two distinct measurements that should be interpreted together but understood separately.
Appearance Anxiety Level
Measured across 7 subscales (23 items). This tells you how much appearance-related distress the patient experiences.
Key insight: High appearance anxiety alone does not contraindicate treatment. Many patients with elevated anxiety may benefit significantly from appropriate aesthetic procedures.
BDD Feature Assessment
Measured by 5 ALERT items. This identifies specific patterns associated with body dysmorphic disorder.
Key insight: BDD features indicate that treatment is unlikely to resolve the patient's concerns, regardless of technical outcome. This drives the triage recommendation.
Appearance Anxiety: Seven Domains
The appearance anxiety assessment covers seven clinical domains, helping you understand the nature and intensity of the patient's concerns.
Preoccupation
Time and mental energy devoted to appearance concerns
Social Threat
Fear of negative evaluation and judgement by others
Avoidance
Avoiding social situations due to appearance concerns
Safety Behaviours
Camouflaging, checking, and reassurance-seeking
Mood Reactivity
Emotional responses to perceived appearance changes
Self-Worth
Degree to which self-esteem is contingent on appearance
Functional Impairment
Impact on work, relationships, and daily activities
AAQ-Alert: BDD Feature Detection
Five dedicated items screen for features suggestive of BDD - patterns where aesthetic treatment is unlikely to address underlying concerns.
Symptom Migration
History of concerns shifting between body areas after treatment
Insight Discrepancy
Gap between perceived and objective appearance
Compulsive Research
Excessive time researching procedures online
Urgency
Pressure to have procedures performed immediately
Perfectionism
Unrealistic expectations of treatment outcomes
BDD Feature Triage
The triage recommendation is based on BDD features (ALERT items), not overall appearance anxiety level.
Green - Standard Pathway
Lower appearance anxiety scores. Standard consultation pathway with routine informed consent process.
Amber - Extended Discussion
Elevated appearance anxiety that may respond positively to treatment. Extended consultation to explore expectations and ensure treatment goals are realistic and achievable.
Red - BDD Features Present
Features suggestive of body dysmorphic disorder. Research indicates aesthetic treatment is unlikely to resolve BDD-related concerns. Psychological evaluation recommended to explore underlying issues.
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