The Cosmetic Readiness Questionnaire-Brief is a short assessment tool developed from the Cosmetic Readiness Questionnaire (CRQ; Pikoos, Buchanan, Hegarty, Rossell, 2024a) which helps cosmetic professionals assess a patient’s mindset and readiness to undergo a cosmetic procedure, including identifying body dysmorphic disorder and other psychological concerns.

The CRQ-Brief has 20-items and assesses psychological risk factors relating to readiness to undergo a cosmetic procedure. It assesses important dimensions of the cosmetic patient experience and factors which have previously been identified as predictors of patient dissatisfaction or poor treatment outcomes (e.g., Bowyer et al., 2016; Honigman et al., 2004; Pikoos, Buchanan, Hegarty, Rossell, 2024a).

The five core domains assessed in the CRQ-Brief are the same as the CRQ and include:

1. Psychological Distress: Identifies the presence of anxiety and depression symptoms.
2. Body Dysmorphia: Identifies symptoms related to body dysmorphic disorder (BDD), including body related shame, checking and avoidance.
3. Self-Criticism: Identifies self-esteem problems, propensity to be self-critical and experience shame about themselves and rumination about personal failings.
4. Unrealistic Expectations: Identifies heightened and potentially unrealistic social and psychological expectations for change following a cosmetic procedure across both internal (e.g. self-esteem) and external (e.g., professional or social) domains.
5. Past Dissatisfaction: Identifies whether patients have some concerns or reservations about past cosmetic procedures they have undertaken, which can predict a poor response in future.

Reliability Risk Index

The CRQ-Brief also includes a Reliability Risk Index (RRI), which is a validity check built into the scoring system. It helps identify when a patient’s responses may not accurately reflect their true thoughts or feelings. Patients may sometimes present themselves in an overly favourable light – for example, to avoid judgment or to increase their chances of being approved for cosmetic treatment. The RRI therefore looks for indicators that suggest a respondent has: (a) not read or considered the questions carefully, or (b) engaged in socially desirable responding.

The RRI is calculated using factors such as response time and variability in responses (unusually low or inconsistent scores). A ‘high risk’ score on the RRI suggests that the patient’s responses may not be entirely open or reliable. In such cases, a more in-depth consultation is recommended to explore their motivations, expectations, and psychological readiness for treatment.

Importantly, patients who score in the high-risk zone on the RRI also tend to score lower across the five core CRQ-Brief domains, indicating potential under-reporting of psychological factors. By including the RRI, the CRQ-Brief becomes more resilient to biased responding, enhancing its validity and clinical usefulness.

The CRQ-Brief classifies overall risk and subscales as either high, moderate or low risk. Individuals scoring in the high risk zone on the CRQ are 78% more likely to be dissatisfied with cosmetic procedures than individuals in the low risk zone (Pikoos, Buchanan, Hegarty, Rossell, 2024). Individuals who are high risk may benefit from a thorough assessment of the risks and benefits of the procedure prior to receiving a cosmetic procedure.

The CRQ and CRQ-Brief overcome many of the limitations of other BDD screening questionnaires and assessment procedures in cosmetic settings, namely:
a) Most cosmetic screening questionnaires focus solely on BDD, and disregard other psychological factors which may increase the risk of dissatisfaction.
b) On typical questionnaires where the purpose of the assessment is clear, patients may conceal important information in order to ‘pass’ the screening and access a cosmetic procedure. The CRQ-Brief’s Reliability Risk Index is the first of it’s kind to overcome this challenge.

The Cosmetic Readiness Questionnaire – Brief and full CRQ represent psychological risk factors identified which can impact on patient satisfaction or the distress experienced after a cosmetic procedure.

Scores consist of an overall risk rating as well as a risk rating for five subscales. Scores for each of the subscales are calculated by summing the items relevant to that subscale, divided by the number of items. This produces an “average score” between 0 and 4, representing the general level of agreement with the subscale, where:

0 – Strongly Disagree

1 – Slightly Disagree

2 – Neither agree nor disagree

3 – Slightly Agree

4 – Strongly Agree

A total score is computed by summing items 1 – 19 together. The new item, Item 20 regarding Past Dissatisfaction is not included in the total score, to facilitate easier comparison to the full CRQ scoring. 

Higher scores represent greater psychological risks associated with dissatisfaction with a cosmetic procedure, where:

– Low Risk = Scores below 15.5. Patients scoring in this range have minimal psychological vulnerabilities associated with dissatisfaction with appearance and cosmetic procedures.

– Moderate Risk = Scores between 15.5 and 30.5. Patients in this zone have some identified psychological risks that can make them vulnerable to dissatisfaction with cosmetic procedures. While research suggests that most people who score in this zone are satisfied with cosmetic outcomes, 45% express at least some reservations about past cosmetic procedures. It is recommended that subscales in the moderate or high-risk zone are reviewed to identify specific risks.

– High Risk = scores above 30.5. Patients in this zone have significant psychological risks that can make them vulnerable to distress or dissatisfaction with cosmetic procedures. Research suggests that patients who score in this zone have an approximate 50% probability of experiencing dissatisfaction with a cosmetic procedure. It is recommended that psychological risks are thoroughly assessed before proceeding with a procedure

The five core domains assessed in the CRQ-Brief include:

1. Psychological Distress (items 11, 14, 15, 17, 18): Identifies the presence of anxiety and depression symptoms. Scores between 3.5 and 6.5 are considered moderate risk, while scores above 10.5 are high risk.

2. Body Dysmorphia (items 6, 10, 12, 13, 16, 19): Identifies symptoms related to body dysmorphic disorder (BDD), including body related shame, checking and avoidance. Scores between 6.5 and 10.5 are considered moderate risk, while scores above 10.5 are high risk.

3. Self-Criticism (items 5, 7, 8, 9): Identifies self-esteem problems, propensity to be self-critical and experience shame about themselves and rumination about personal failings. Scores between 4.5 and 7.5 are considered moderate risk, while scores above 7.5 are high risk.

4. Unrealistic Expectations (items 1, 2, 3, 4): Identifies heightened and potentially unrealistic expectations for external (e.g., professional or social) change following a cosmetic procedure. Scores between 5.5 and 8.5 are considered moderate risk, while scores above 8.5 are high risk.

5. Past Dissatisfaction (item 20): identifies a history of dissatisfaction with past cosmetic procedures. A score of 2 is considered moderate dissatisfaction, while a score of 1 is high risk of dissatisfaction.

The Reliability Risk Index (RRI) is a built-in quality check in the online CRQ-Brief that helps identify when a questionnaire might not reflect a person’s true responses. For example, if it was completed too quickly, with little variation, or in an inconsistent way.

The RRI combines four checks of response quality:

1. Response Invariance: Looks at how much the person varies their answers. Little or no variation may suggest they weren’t paying careful attention.

2. Self-Criticism Discordance: Checks for inconsistencies between similar items that are worded in opposite directions.

3. Zero Distress Flag: Identifies cases where someone marks “0 – not at all” on nearly every distress item, which can sometimes mean the questionnaire wasn’t read carefully or that distress was under-reported. A zero score on psychological distress is uncommon, and occurs in less than 5% of the general population (Crawford & Henry, 2003)

4. Response Speed: Flags responses that were completed unusually quickly, suggesting possible inattention. Each of these areas is rated as Green (OK), Yellow (possible concern), or Red (high concern).

The four scores are then combined to give an overall RRI score (0–8):

– Low Reliability Risk (<2.5): Responses appear valid.

– Moderate Reliability Risk (2.5–3.5): Possible concerns – interpret with caution.

– High Reliability Risk (>3.5): High likelihood of invalid responding – recommend further review.

A ‘high risk’ score on the RRI suggests that the patient’s responses may not be entirely open or reliable. In such cases, a more in-depth consultation is recommended to explore their motivations, expectations, and psychological readiness for treatment.  

The Cosmetic Readiness Questionnaire – Brief (CRQ-Brief) was developed through item response theory (IRT) and confirmatory factor analysis (CFA) procedures conducted on data from 6,808 cosmetic patients (mean age 42 years, range 15–92).

The CRQ-Brief was designed to retain the psychometric robustness of the original 45-item CRQ while substantially reducing administration time, improving completion rates, and maintaining sensitivity to psychological risk factors relevant to cosmetic procedures.

The shortened version comprises 19 items across the same four psychological domains: Psychological Distress, Body Dysmorphic Disorder (BDD), Self-Criticism, and Unrealistic Expectations – plus an additional item measuring Past Dissatisfaction and embedded Reliability Risk Index (RRI), which functions as a validity check for socially desirable or inconsistent responding.

Across domains, the CRQ-Brief retained 65-83% of total test information from the full version and demonstrated excellent convergent validity with the original CRQ (CRQ Total Score correlation r = .97, p < .001). Reliability coefficients remained strong for the shortened subscales (α = .65–.83), and the overall factor structure showed good model fit in CFA (CFI = .96, TLI = .96, RMSEA = .08, SRMR = .06).

The CRQ-Brief indicated high diagnostic accuracy in identifying patients at moderate or high psychological risk, with sensitivity and specificity consistently above 90% across domains. The Body Dysmorphic Disorder subscale of the CRQ-Brief achieved particularly strong discrimination (AUC = .99 for high-risk classification).

Importantly, clinical threshold analyses confirmed that the distribution of low, moderate, and high-risk classifications on the CRQ-Brief closely mirrored that of the full CRQ (approximately 59.2% low, 30.1% moderate, and 10.7% high risk across domains). Patients with high RRI scores were more likely to show lower self-reported psychological concerns across the CRQ-Brief subscales, indicating potential under-reporting, supporting the RRI’s utility as a validity index for biased or incomplete responding.

Overall, the CRQ-Brief provides a time-efficient, psychometrically robust alternative to the original CRQ, maintaining its predictive accuracy for psychological risk and dissatisfaction while enhancing clinical usability in busy aesthetic settings.  

To integrate the Cosmetic Readiness Questionnaire smoothly in your practice, we recommend the following resources:

1. Practitioner Quick-Reference Guide – a brief guide to keep in your office which explains what each CRQ subscale measures and how to explain higher scores to patients in your consultation.
2. CRQ Results Patient Guide – an explanation of the CRQ, it’s subscales and what they mean in patient-friendly language, as well as some tips on next steps if patient’s may require onward referral. You can give this to patients when you explain the results. 
3. Patient Information Handout regarding Cosmetic Readiness Assessments. This can be useful to provide to patients if you are referring them for further psychological assessment, so they know what to expect and how to arrange it.