Cosmetic Procedure Screening (COPS) - The COPS is a questionnaire designed as a screening measure for Body Dysmorphic Disorder (BDD) for cosmetic settings and as a measure of severity.
The COPS comprises of 9 items. Items are scored from 0 (least impaired) to 8 (most impaired). The score is achieved by summing Q 2-10. Items 2‚ 3 and 5 are reversed. The total scores range from 0 to 72 with a higher score reflecting greater impairment and likelihood of a diagnosis of BDD. Individuals who score 40 or more should be referred for further assessment. In our service‚ we refer to the COPS as a Body Image Questionnaire.
Cosmetic Procedures Screening Questionnaire (COPS)
This questionnaire aims to understand how you feel about your appearance prior to a cosmetic procedure. All information will be kept strictly confidential.
Please study this example before completing question 1. In a moment‚ we will ask you to describe the feature(s) of your body which you dislike or would like to improve. If you want to improve more than one feature‚ please list all the features in the space provided. Please note‚ the 1st feature should be the feature you are most concerned about.
This is an example of a woman whose main worry was her nose and who was concerned to a lesser extent by her skin and bottom.
1) Features Causing Concern
Please describe the feature(s) of your body‚ which you dislike or would like to improve.
1st Feature
Nose is too crooked with a bump
2nd Feature
Blemishes and acne scars on face
3rd Feature
Bottom is too big
We will then ask you to draw a pie chart and estimate the percentage of concern allocated to each feature. The person above completed her pie chart like this.
Bottom
10%
Skin
30%
Nose
60%
1) Features Causing Concern
Please describe the feature(s) of your body which you dislike or would like to improve.
1st Feature (feature you are most concerned about)
2nd Feature
3rd Feature
4th Feature
5th Feature
Now please draw a pie chart and estimate the percentage of concern allocated to each feature.
Please ensure that your percentages add up to 100%!
From now on‚ we will refer to these concerns as your ‘feature(s).’
Please read the next set of questions below carefully and circle the number that best describes the way that you feel about your feature(s). Please read the labels carefully to ensure you are circling the number that reflects how you feel because some of the answers are worded in a reverse order.
2) How often do you deliberately check your feature(s)? Not accidentally catch sight of it.
Please include looking at your feature in a mirror or other reflective surfaces like a shop window or looking at it directly or feeling it with your fingers.
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0
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1
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2
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3
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4
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5
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6
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7
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8
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About 40 times or more a day
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About 20 times a day
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About 10 times a day
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About 5 times a day
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Never
Check
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3) How much do you feel your feature(s) is currently ugly‚ unattractive or ‘not right’?
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0
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1
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2
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3
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4
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5
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6
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7
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8
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Very ugly or ‘not right’
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Markedly unattractive
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Moderately unattractive
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Slightly unattractive
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Not at all unattractive
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4) How much does your feature(s) currently cause you a lot of distress?
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0
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1
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2
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3
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4
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5
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6
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7
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8
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Not at all distressing
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Slightly distressing
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Moderately distressing
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Markedly distressing
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Extremely distressing
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5) How often does your feature(s) currently lead you to avoid situations or activities?
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0
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1
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2
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3
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4
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5
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6
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7
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8
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Always Avoid
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Avoid about three quarters of the time
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Avoid about half of the time
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avoid about
a quarter of the time
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Never avoid
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6) How much does your feature(s) currently preoccupy you? That is‚ you think about it a lot and it is hard to stop thinking about it?
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0
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1
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2
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3
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4
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5
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6
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7
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8
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Not at all preoccupied
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Slightly preoccupied
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Moderately preoccupied
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very preoccupied
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Extremely preoccupied
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7) If you have a partner‚ how much does your feature(s) currently have an effect on your relationship with an existing partner? If you do not have a partner‚ how much does it have an effect on dating or developing a relationship?
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0
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1
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2
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3
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4
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5
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6
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7
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8
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Not at all
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Slightly
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Moderately
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Markedly
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Extremely
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8) How much does your feature(s) currently interfere with your ability to work or study‚ or your role as a homemaker? (Please rate this even if you are not working or studying: we are interested in your ability to work or study.)
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0
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1
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2
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3
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4
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5
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6
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7
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8
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Not at all
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Slightly
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Moderately
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Markedly
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Very severely
I can’t work
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9) How much does your feature(s) currently interfere with your social life?
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0
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1
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2
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3
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4
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5
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6
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7
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8
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Not at all
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Slightly
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Moderately
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Markedly
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Very severely
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10) How much do you feel your appearance is the most important aspect of who you are?
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0
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1
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2
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3
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4
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5
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6
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7
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8
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Not at all
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Slightly
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Moderately
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Mostly
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Totally
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‘copyright D.Veale 2009’
سایت روان سنجی : پرسشنامه از کینگ کالج لندن و از نشانی زیر گرفته شده است . برای آگاهی از ویژگی های روان سنجی به نشانی بالا بروید.