Thinking about my body and how it seems flawed: psychometric properties of the Italian version of the Cognitive Fusion Questionnaire adapted to Body Dysmorphic Disorder

Introduction: Body Dysmorphic Disorder (BDD) is a mental disorder characterized by undesired worries about defects or body imperfections (APA, 2013). Cognitive fusion, a process of the Acceptance Commitment Therapy (ACT) defined as the tendency to identify thoughts with reality and let behavior be guided excessively by cognition, seems relevant in the BDD’s symptomatology (Dastgir & Karimi, 2019). However, Cognitive Fusion Questionnaire (CFQ; Gillanders et al., 2014), a scale that measures general cognitive fusion, may not accurately capture the body defects-related cognitive fusion. The present study aimed to investigate the psychometric properties of the 7-item Italian version of the CFQ (Donati et al., 2021) contextually adapted to BDD (BDD-CFQ). Methods: Participants were 120 men (mean-age=35.37; SD=11.78) and 166 women (mean-age=32.31; SD=9.14), who completed Italian measures of general cognitive fusion, body compassion, BDD’s symptomatology, and psychological well-being, in addition to the BDD-adapted version of the CFQ-7. Factorial structure, construct, and predictive validity were tested for men and women separately. Results: The EFAs showed that the BDD-CFQ has a unifactorial structure, with optimal factor loadings in both sexes. Internal consistency was excellent for men (α=.94) and women (α=.92). Regarding construct validity, the scale showed strong positive and negative correlations with the BDD’s symptoms and body compassion levels, respectively. Predictive validity was tested with a hierarchical regression model, showing that higher scores on the BDD-CFQ predicted lower levels of psychological well-being among men and women. Significant explained variance increased after the inclusion of body compassion in the regression models for both sexes. Mediation analyses showed that body compassion mediated the relationship between the BDD-CFQ and psychological well-being in both men and women. Discussion: BDD-CFQ is a brief scale that seems useful to measure an important ACT’s process that is negatively associated with maladaptive health outcomes, and it has the potential to predict psychological well-being. These findings may be relevant for providing increasingly tailored measure targeting ACT-processes affecting patients who manifest specific concerns about body defects and for evaluating the efficacy of the ACT treatment for BDD.