Measuring body checking and avoidance in adolescents: validation of a behavioral questionnaire

BACKGROUND: Body image distortion (BID) is central to eating disorder (ED) pathology and is closely linked to body dissatisfaction. While most questionnaires assess affective, cognitive, or perceptual components of body image, the behavioral component manifesting in body checking (BC) and body avoidance (BA) has received comparatively little attention. Given that EDs typically emerge during adolescence, validated measures of behavioral BID are particularly needed for this age group. The Body Checking and Avoidance Questionnaire (BCAQ) is the only instrument assessing both BC and BA, but it has not yet been validated in adolescents. METHODS: The present study aimed to evaluate the BCAQ in a clinical sample of female German adolescents with (atypical) anorexia nervosa. Factor structure, internal consistency, and convergent and known-groups validity were examined. RESULTS: An initial confirmatory factor analysis of the original 27-item BCAQ indicated poor model fit. An exploratory factor analysis identified four items with low or inconsistent loadings. Analyses of the resulting 23-item version yielded a preliminary three-factor structure and demonstrated good reliability (Cronbach's α = 0.78-0.94) and satisfactory convergent validity, while known-groups comparisons provided limited and exploratory evidence, with a small group difference observed only for avoidance behavior. CONCLUSION: These findings provide preliminary evidence for the use of the adapted 23-item BCAQ to assess behavioral aspects of body image distortion in adolescents with (atypical) anorexia nervosa. Further longitudinal research is needed to evaluate the measure's temporal stability.