Psychological Factors Impacting the Quality of Life in Liver Transplant Recipients: Body Image Beliefs, Attachment Styles and Eating Disorders.

Abstract

Purpose: To assess the impact of psychological variables (body image beliefs, attachment styles and eating disorder) upon quality of life in liver transplant recipients. Methods: 135 adults who received liver transplantation at our center between 1/1/2007 and 9/1/ 2011 were surveyed. The questionnaire included demographic information, Body Image States Scale (BISS), Body Dysmorphic Disorder Evaluation -Self Report scale (BDDE-SR), Eating Attitude Test (EAT 26), Hospital Anxiety and Depression Scale (HADS) and Short Form Health Survey (SF 36). Results: 32 questionnaires were returned (response rate of 30.1%). Average time since transplant was 2.5 ± 2.4 years. 7 (21.9%) respondents were within 1st year post transplant; 21 (65.6%) were male, 6 (18.8%) had received dual transplant (liver-kidney). 31 (93.9%) of respondents expressed distress about at least one body part (average 3.3±1.5 body parts). Waist-Abdomen was a part of concern in 17 (53.1%) cases, followed by all-lower-body (25%). The average BISS score was 5.2±1.6. The average BDDE SR score was 41.2±32.4. The most common symptoms were general dissatisfaction with own appearance (46.9%) and frequently checking the body feature (40.6%). Multiple body image concerns on BDDE correlated with HADS score (e.g., restricting physical contact with others, avoiding physical activities, concerns about being scrutinized) (p<0.05). Avoidance and embarrassment correlated with SF 36 score on physical health, general health and emotional well being (p<0.05). 14 (43%) of respondents reported a predominant dismissive attachment style, followed by 12 (37.5%) with secure style, while 3 (9.3%) qualified for the self-model (equally high on the secure and dismissive scale). There were no statistically significant correlations between attachment styles and quality of life measures. 11(34.4%) screened positive for eating disorders on EAT: 3 (9.4%) had anorexic cognitions, while 9 (28.1%) had at least one behavior consistent with eating disorder. The most common behavior (6 subjects, 18.8%) was using laxatives or diuretics to control the body weight. Binge eating behavior was more common in liver-kidney transplant than in liver only recipients (p=0.03). The use of laxatives or diuretics to control body weight correlated with physical health scale of the SF-36(p=0.04). Conclusions: Body-image concerns and symptoms of eating behaviors, but not attachment styles, may correlate with quality of life in liver transplant recipients.