Extended Abstract
1. Introduction
Schilder (1935) for the first time discussed the concept of body image from a psychological point of view. Body image is defined as the mental image of our body. The multidimensional concept of body image includes understanding, perception, and attitude toward body [1-2]. The body shape concerns are common among adolescents, especially in western culture. In its more severe forms, it is among the main causes of eating disorder, Anorexia Nervosa (AN), and Bulimia Nervosa (BN). It has been emphasized in DSM [3].
The complicated concept of body image disturbance involves two relevant and yet distinct concepts: body size overestimation and body shape concern [4]. In 1987, Cooper et al. designed the first tool to measure body shape concerns and termed it as the Body Shape Questionnaire (BSQ). Its differential validity, internal consistency, and test-retest reliability were confirmed in this study designed for the North American population [3]. A great advantage of this questionnaire is raising questions to measure the major syndromes of body image [6]. This questionnaire has been widely used in the areas of clinical medicine [7], demography [8], intervention [9] and prevention [10]. The body shape questionnaire has also been widely used in populations with eating disorders [11, 12] and those without eating disorder, including female students from different racial and ethnic groups [13, 14], teenage boys and girls [15], people on diet [16], and older women [17].
The validity and reliability of this questionnaire have been confirmed by various studies [3, 5, 6, 18-21]; however, this questionnaire is very long, and it is rarely used in multi-stage studies or with other questionnaires [22]. Several short versions of the BSQ have been proposed; however, only the BSQ-C8 version has been highly sensitive to change [23]. It is important to note that body shape dissatisfaction is among the main risk factors of eating disorders [24]. Eating disorders may be associated with mental disorders such as depression, anxiety, occupational and social dysfunction, and decreased quality of life [25]. Therefore, to measure body shape dissatisfaction in each culture, specific credible and reliable tools must be used. The psychometric properties of BSQ-C8 have not been investigated in Iran; however, eating disorders are influenced by the cultural context of societies. Considering the application of this questionnaire in clinical and research areas, this study investigated the psychometric properties of the BSQ-C8 in a sample of women with eating disorders. 
2. Method
This cross-sectional and validation study was conducted in spring 2014. The BSQ-C8 was the main tool used for collecting data. The questionnaire was translated from English to Farsi and then from Farsi to English, and necessary corrections were made in the Farsi version. Using convenience sampling, 63 individuals were selected from beauty and fitness centers of Kermanshah, Iran. Informed consent was obtained from the participants. Two clinical psychologists conducted independent diagnostic interviews, and according to the diagnostic criteria of DSM-IV-TR, 46 individuals were diagnosed with eating disorder. The participants were then asked to fill out demographic characteristics forms, BSQ-C8, BSQ-34, YBOCS-BDD, and BDMCQ.
Body Shape Questionnaire-C8 (BSQ-C8)
The BSQ-C8 is a short version of the body shape questionnaire. It also contains eight questions extracted from the full version of Evans and Dolan’s questionnaire in 1993. The BSQ-C8 version has been widely used for its high sensitivity to changes with time periods. Welch et al. (2012) conducted two studies to investigate the psychometric properties of the BSQ-C8. The results showed high values of test-retest reliability, internal consistency, and convergent validity [26].
34-Item Body Shape Questionnaire (BSQ-34)
The 34-item Body Shape Questionnaire (BSQ-34) questionnaire measures body weight, shape dissatisfaction, and its subsequent obsessive mental preoccupation and distress. Higher scores indicate higher levels of dissatisfaction. This questionnaire was designed in a clinical population, including patients with anorexia nervosa and bulimia nervosa, and women without eating disorders. Body shape questionnaire is a valid and reliable scale of body image with suitable test-retest reliability [3]. The concurrent validity of this questionnaire was confirmed through correlation with other body image scales such as the Body Dysmorphic Disorder Examination (BDDE) and the Multidimensional Body-Self Relations Questionnaire (MBSRQ) [6]. 
The Body Dysmorphic Meta-Cognition Questionnaire (BDMCQ)
The 31-item Body Dysmorphic Meta-Cognition Questionnaire (BDMCQ) consists of four factors: metacognitive control strategies (on appearance), objectification of thoughts (blending thoughts), positive and negative metacognitive beliefs, and safety behaviors on body deformity. Participants report their thoughts and perceptions about their body deformity over the past two weeks in the form of a 4-point Likert scale. Rabiei et al. (2011) confirmed the concurrent validity of this questionnaire. Suitable diagnostic validity and reliability were reported for this questionnaire [27].
The Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder (YBOCS-BDD)
The 12-item Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder (YBOCS-BDD) measures the intensity of the symptoms of body dysmorphic disorder. Philips al. (1997) conducted a study on 125 outpatients, and the results of the factor analysis revealed the significance of intellectual-practical obsession and two questions related to insights, including beliefs about appearance and avoidance evaluation [28]. In Iran, Rabiei et al. supported the concurrent reliability and validity of this questionnaire. The results of the factor analysis of this questionnaire revealed the significance of obsessive compulsion about appearance and the power of thought control [29]. Data were analyzed in SPSS 16, using frequency, mean, standard deviation, Cronbach’s alpha coefficient, correlation coefficient, and Receiver Operating Characteristic (roc) curve (Figure 1).
3. Results
Two clinical psychologists conducted independent diagnostic interviews with 63 individuals. Among them, 2 individuals were diagnosed with anorexia nervosa, 20 individuals were diagnosed with bulimia nervosa, 24 individuals were diagnosed with unknown eating disorders, and 17 others showed no symptom of eating disorders.
To measure the validity and reliability of the body shape questionnaire, 46 individuals with eating disorders were examined. Using Cronbach’s alpha coefficient and split-half method, the reliability of BSQ-C8 were found as 0.79 and 0.74, respectively.
As seen in Table 1, a significant correlation found between the BSQ-C8 and the total score of the BSQ-34 (P<0.001). There were also significant correlations between this questionnaire and the BDMCQ and the subscales of meta-cognitive control strategies, thought-action fusion and positive and negative metacognitive beliefs in women with an eating disorder (P<0.001 and P=0.001). However, there was no significant correlation between the BSQ-C8 and the subscale of safety behaviors. In addition, there were significant correlations (P<0.001) between this questionnaire, the total score of the YBOCS-BDD, and the subscale of obsessive compulsion about appearance in women with eating disorders. However, no significant correlation existed between the BSQ-C8 and the subscale of power of thought control.
The cut-off point, sensitivity, specificity, efficacy, and the Overall Misclassification Rate (OMR) of the BSQ-C8 are shown in a sample of women with eating disorders in Table 2. As shown in the Table 2, the best cut-off point was found to be 26.5.
4. Discussion
Our findings suggest the reliability of the BSQ-C8 was suitable, using both Cronbach’s alpha coefficient and split-half method. Similarly, Welch et al. (2012) studied a group of students and confirmed the reliability and internal consistency of the BSQ-C8 using test-retest method and Cronbach’s alpha coefficient, respectively [26]. Pook et al. in 

 

The correlation between the BSQ-C8 and BSQ-34 was very high, which indicates that the BSQ-C8 can replace the BSQ-34 to facilitate achieving research and clinical goals.
The correlation between the BSQ-C8 and BDMCQ was very high in women with eating disorders. This correlation is justified as the metacognitive assessment involves any kind of knowledge or cognitive process associated with cognitive assessment or control [27]; therefore, the BDMCQ measures these cognitions in relation to the body shape [27]. On the other hand, serious concern about the shape of the body is a significant indicator of eating disorders [3]and people with eating disorders rely mainly on their body shape, weight, eating habits, their ability to control them, and evaluate themselves accordingly [25]. Therefore, the correlation obtained was reasonable, and it confirmed the suitable concurrent validity of the BSQ-C8. 
There was a significant correlation between the BSQ-C8 and YBOCS-BDD in women with eating disorders. The positive and significant correlation between these two questionnaires can be explained: selective attention is the first mechanism that maintains body image disturbance. Selective attention to some parts of the body increases obsessive mental preoccupation and creates a negative cognition, when encountering those parts of the body [25]. Therefore, this correlation appears reasonable and confirmed the suitable concurrent validity of the BSQ-C8 in women with an eating disorder.
Previous study has also confirmed the validity of the BSQ-C8. Welch et al. measured and confirmed the convergent validity of the BSQ-C8 [26]. However, the cut-off point of the BSQ-C8 has not been calculated in previous studies. The cut-off point was shown to be 26.5 in this study.
This study aimed to develop information on body and body shape dissatisfaction in a sample of women with eating disorders and confirmed the reliability and validity of the BSQ-C8. In the original and long version of the body shape questionnaire, some questions are not suitable for men; therefore, it is not an appropriate questionnaire for studying men [30]. On the other hand, the questions designed in BSQ-C8 are appropriate for both sexes; hence, this questionnaire can be used to measure body shape dissatisfaction in healthy men with eating disorders. Pieces of evidence such as satisfactory psychometric properties of the BSQ-C8, high correlation between this questionnaire, and the original and long version, sensitivity to treatment, suitable questions, and brevity suggests that this questionnaire is an appropriate tool for assessing body shape dissatisfaction. Therefore, BSQ-C8 is suggested to be used in non-clinical and clinical studies, such as treatment evaluation.
The present study examined a sample of women with eating disorders; therefore, the findings should be generalized to other populations with caution. Future studies should include other clinical populations as well as men. It is also recommended to conduct studies to measure other types of validity and reliability of the BSQ-C8, which were not used in this study. 
Acknowledgments
The authors hereby would like to express their appreciation to all the esteemed professors and all the participants for their sincere cooperation. This research was funded (No: 93064) by Kermanshah University of Medical Sciences.
Conflict of Interest
The authors declare no conflicts of interest.
 

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