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The study objective was to develop a measure of body concealment related to avoidance behaviors in SSc.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Initial items for the Body Concealment Scale for Scleroderma (BCSS) were selected using item analysis in a development sample of 93 American SSc patients. The factor structure of the BCSS was evaluated in 742 Canadian patients with single\u2010factor, 2\u2010factor, and bifactor confirmatory factor analysis models. Convergent and divergent validity were assessed by comparing the BCSS total score with the Brief\u2010Satisfaction with Appearance Scale (Brief\u2010SWAP) and measures of depressive symptoms and pain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A 2\u2010factor model (Comparative Fit Index [CFI] 0.99, Tucker\u2010Lewis Index [TLI] 0.98, Root Mean Square Error of Approximation [RMSEA] 0.08) fit substantially better than a 1\u2010factor model (CFI 0.95, TLI 0.94, RMSEA 0.15) for the 9\u2010item BCSS, but the Concealment with Clothing and Concealment of Hands factors were highly correlated (\u03b1\u2009=\u20090.79). The bifactor model (CFI 0.99, TLI 0.99, RMSEA 0.08) also fit well. In the bifactor model, the omega coefficient was high for the general factor (\u03c9\u2009=\u20090.80), but low for the Concealment with Clothing (\u03c9\u2009=\u20090.01) and Concealment of Hands (\u03c9\u2009=\u20090.33) factors. The BCSS total score correlated more strongly with the Brief\u2010SWAP Social Discomfort (r\u2009=\u20090.59) and Dissatisfaction with Appearance (r\u2009=\u20090.53) subscales than with measures of depressive symptoms and pain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The BCSS sum score is a valid indicator of body concealment in SSc that extends the concepts of body concealment and avoidance beyond the realms of body shape and weight to concerns of individuals with visible differences from SSc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.22819","type":"journal-article","created":{"date-parts":[[2015,12,14]],"date-time":"2015-12-14T10:55:40Z","timestamp":1450090540000},"page":"1158-1165","source":"Crossref","is-referenced-by-count":13,"title":["Development and Validation of the Body Concealment Scale for Scleroderma"],"prefix":"10.1002","volume":"68","author":[{"given":"Lisa R.","family":"Jewett","sequence":"first","affiliation":[{"name":"McGill 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