1) you constantly worried about how you look?

2) Do you think about your appearance problems a lot and wish you could think about them less?

3)  Are there things or people you avoid because of how you look and your concerns about it?

4) Has this concern got in the way of doing things with others or other areas of your life?

5) Are there specific things you do over and over to in response to this concern (checking in the mirror, grooming for hours, camouflaging certain areas, seeking cosmetic procedures, etc)

6) On an average day, how much time do you usually spend thinking about how you look? (Add up all the time you spend in total in a day, then circle one.)