Altered Body Image Research Articles

Subjective Well-being of Primary Health Care Patients in the Western Cape, South Africa

Background: Patients living with a chronic illness face many challenges in their lives such as an altered body image, physical pain or discomfort, the need for frequent medical visits and the negative side effects of treatment. To this extent their sense of personal or subjective well-being may be compromised by the severity and chronicity of their illness. The aim of the present study was to explore the level of subjective well-being and its relationship with coping, quality of life and support from family and friends among a sample of Black South Africans attending semi-rural public clinics for treatment for hypertension and diabetes. This study was part of a larger project on treatment adherence to medication among patients living with these conditions. Methods: A convenience sample of 117 patients aged between 22 and 82 years (M=52.36, SD=13.24), receiving treatment for hypertension (n=79) or diabetes (n=24) at three primary health care clinics in the Boland area of the Western Cape were asked to participate in this study. Of the total sample, 14 (12%) were diagnosed with both conditions. Participants were asked to complete a questionnaire battery consisting of the Satisfaction with Life Scale, the Coping Strategy Indicator, the Functioning Assessment of Non-Life Threatening Conditions and the Perceived Social Support Scale. Results: The mean score of the Satisfaction with Life Scale was 28.70, which was significantly higher than those of other studies using this mea-sure. In order to address the problem of experiment-wise error, commonly associated with the use of multiple statistical comparisons, we used the Bonferronni correction in arriving at probability levels in determining statistical significance. On average the sample as a whole appeared to be largely satisfied. The mean scores on the two of the subscales of the Coping Strategy Indicator were significantly different from those obtained from other South African samples. On the Functioning Assessment of Non-Life Threatening Conditions, the mean scores on the subscales but not the total score was significantly higher than other South African samples. Conclusions: In general, participants scored significantly higher on all of the measuring instruments compared with other South African samples, indicating high levels of life satisfaction, coping, and support from others. We found no relationship between life satisfaction and gender. Age however correlated positively with satisfaction with Life, Support from family, social and emotional well being and Quality of Life, which concurs with the findings of previous studies. Contrary to other studies we found a significant negative correlation between education and SWLS but no relationship between employment and SWLS. Our sample also reported higher levels of support from friends and family that were significantly higher than those of other South African samples. The mean scores on all the subscales of the Coping Strategy Indicator were higher than that of other South African samples. South African Family Practice Vol. 50 (3) 2008: pp. 68-68d

Composantes neurosensorielles et hormonales dans l’anorexie mentale

Anorexia nervosa (AN) is often considered a multifactorial illness of unknown pathophysiology. Family and twin studies have consistently demonstrated that AN is strongly related to genetic factors. The probability of some genetic origin is 92%, genetic factors explaining around 20% of the variance. It must be remembered that 95% of the AN patients were girls or women, suggesting a role for gonadal hormonal systems and their effects on the brain and on cognitive functions. Most studies focused on the serotonin system, but other candidate genes have been suggested. At the present time, we have no evidence that women who develop AN have an adipose, metabolic, gonadal, pituitary, hypothalamic or some other dysfunctions that predispose them for the illness. It is suggested on the contrary that the symptoms of AN are physiological responses to starvation or to the response to altered body image and self-satisfaction. If this eating disorder is related to the fear of the alimentary desire of the patients, it will be easy to understand the plasma level of adiponectin, ghrelin and better understand a role for the low leptin level in the enhanced hunger. If we remember that almost 60% of these patients are engaged in a physical and mental hyperactivity, the abnormality in plasma level of cortisol, ACTH, and CRH. The decease in fat mass could explain why leptin level was low and low leptin level may explain the amenorrhea and the fall in LH, FSH, and LH–RH secretion. Moreover, anxiety, obsessive compulsive disorders and physical hyperactivity may be three interrelated factors, which could be related to serotonin and dopamine systems and in turn inhibit food intake.

What Makes a Man a Man?

Male breast cancer is a rare condition with scant research into its psychosocial impact. This phenomenologic study sought to elicit its lived experience. Following analysis of interview data, 4 key themes emerged: Living with male breast cancer, concealment as a strategy for managing the diagnosis, a contested masculinity, interacting with health services. Male breast cancer constitutes a unique lived experience for men that is unparalleled in other disease profiles. The idea of living with a feminized illness was very distressing and stigmatizing for some men. Furthermore, treatment resulted in a profound change to the concept of their embodied selves and constituted a significant change to body image and sexuality. This was reinforced in participants who experienced erectile dysfunction related to tamoxifen therapy. Sadly, some health professionals were unable to offer specific psychosocial support, and participants felt marginalized from the potential benefits of the treatment environment. However, participants adapted to the illness by reasserting and renegotiating masculinity and finding ways to accommodate life with a stigmatizing condition and an altered body image.

P2-12 The study of effect of cognitive behavioral counseling on body image alterations in women underwent mastectomy referring to sayed allshohada hospital in Isfahan in 2003

In the first 15 years of the HIV epidemic, client education alone has not resulted in sustained sexual and substance use behavior change needed for primary prevention. More recently, interventions grounded in social and behavioral science have demonstrated efficacy in the primary prevention of HIV and other sexually transmitted diseases (STDs). Many barriers exist, however, in the implementation of research-proven behavioral interventions in real-world settings. This paper describes an adaptation of the Stage of Change/Transtheoretical Model (SOC/TTM) to develop a stage-based method of counseling that is currently being used to promote sexual and substance use behavior change for reducing the risk of acquiring STDs and HIV. This behavioral counseling intervention, named Rochester STD/HIV Behavioral Counseling (RoSHBeC), was developed for front-line providers who deliver STD/HIV prevention interventions to at-risk individuals in both clinical and community-based settings. A systematic method for assessing SOC, previously described in Coury-Doniger, Levenkron, Knox, Cowell, & Urban (1999), provides the basis for the selection of practical counseling strategies adapted from the processes of change described in the TTM. The present paper traces our efforts to develop these counseling strategies specific to sexual behaviors and illustrates their use in 12 common clinical cases (STD/HIV-prevention counseling sessions). The RoSHBeC behavioral counseling intervention can also be used to influence other health-related behaviors at individual and group levels. The steps of RoSHBeC provide a structured psychological intervention that is grounded in social and behavioral science (SOC/TTM) and is practical enough to be delivered by a wide variety of providers with limited formal training in counseling and behavioral treatment methods.

Psychological and physical care of malodorous fungating wounds

To be given a diagnosis of cancer is devastating, but to develop a malodorous fungating tumour can only serve as a constant reminder of the power this disease has over a person's life. It can have a profound effect on quality of life, and the patient often experiences depression, shame, embarrassment and alteration of body image, sometimes leading to social isolation. A literature review looking at the management of these wounds demonstrated limited clinical research on which to base evidence of the best care and although much is written about the psychological effects, there is little to show that these needs are being met. The aim of this article is to explore if nurses are equipped to care for the psychological problems of these patients and briefly considers the psychological issues the nurses caring for these patients may have.

A needs assessment of lymphoedema services in Fife and resulting recommendations

Lymphoedema is a chronic condition that leads to reduced quality of life through its negative impacts on physical, psychological, and social aspects of health. Limb swelling leads to discomfort and pain, reduced movement and function, and acute inflammatory episodes. Individuals experience altered body image and self-esteem impacting on social interaction. There is evidence that specialist management of the condition leads to improved quality of life. Concern regarding the adequacy of lymphoedema services led to the commissioning of a needs assessment by the Core Cancer Review Group in Fife, Scotland. The needs assessment used a variety of methods. Current services were located through consultation of known providers and databases. Existing databases were analysed to find out the number of people requiring the service: hospital admissions and diagnoses were analysed alongside a survey of primary practices in Fife. Access to existing services was explored through a telephone survey of referrers (n = 44), and qualitative interviews with five service providers and five clients. At the time of the study, non-palliative National Health Service (NHS) provision consisted of one part-time clinician; the service provided was under pressure from rapidly increasing referrals. However, consensus from referrers, providers, and clients indicated that there were obstacles to achieving diagnosis and referral, especially for those with non-cancer-related lymphoedema. This was primarily due to poor referrer awareness of the condition, its management, and existing services, for example, only seven per cent of those surveyed would refer to existing specialist services. Delayed referral is a significant issue, as prompt intervention leads to more positive treatment outcomes. As a result of the needs assessment, recommendations were made to increase staffing levels, promote awareness of the condition and related services, and improve geographical and multidisciplinary coordination of the service.

The reflections you get: an exploration of body image and cachexia

cachexia has a detrimental effect on quality of life and is an indicator of poor prognosis. The meanings people attach to their lived experiences of cachexia are unknown. to explore the impact of cachexia on body image of people with advanced cancer, their emotions, relationships and social functioning. qualitative study using face-to-face in-depth interviews of a conversational style. Rich narrative data analysed by thematic content analysis. 12 participants recruited from two community palliative care teams in south east England. altered body image impacts on other aspects of embodiment: the emotions, spirituality, relationships and social functioning. Lives were restricted and isolated, which was compounded by emotional distancing by carers and health care professionals. Participants discussed their repeated attempts to re-adapt to disruptions of self caused by an altered body image. the key study implications focus on the need for (i) improved holistic care and support, and advice; (ii) training and awareness raising of care professionals; (iii) further research on the lived experiences of the condition and the development of effective measures of cachexia.

Development of acromegaly in a patient with anorexia nervosa: Pathogenetic and diagnostic implications

Anorexia nervosa (AN) is a psychosomatic disorder characterized by an alteration in body image, resulting in eating abnormalities that lead to malnutrition associated with secondary endocrinological disturbances. AN is associated with high levels of GH and low levels of IGF-I, suggestive of a nutritionally acquired lack of GH action or GH resistance and of an unbalanced hypothalamic GH neuroregulation with GHRH prevalence on SS tone. In this clinical report, we describe the development of acromegaly in a patient affected by AN and we discuss pathogenetic and diagnostic implications.

Dissociative Alterations in Body Image among Individuals Reporting Out-Of-Body Experiences: A Conceptual Replication

A conceptual replication of the link between self-reported dissociative alterations in body-image under experimental conditions and the reporting of prior out-of-body experiences in a recent data set was undertaken. Also examined was whether this relationship would hold for experiences reported during the experimental context and whether it is independent of self-reported New Age belief. Data from mostly undergraduates (N= 40; M age = 33.5, SD = 12.5; 27 women) in a mirror-gazing study were retrospectively analyzed. The 9 individuals who reported prior out-of-body experiences, relative to those 31 who did not, exhibited significantly greater self-reported dissociative alterations in body-image during the mirror-gazing task, even when the influence of scores on New Age belief was controlled for statistically. The same differential relationship was not found between 6 individuals who did and 34 who did not report out-of-body experiences during the task.

Keep young and beautiful… If you want to be loved: Altered body image and sexuality in the older person with cancer

Much has been written about altered body image and sexuality in cancer patients, but little consideration has been given to the specific needs of those beyond the menopause or ‘retirement’ age. Health-care professionals are often surprised when body image and sexual problems become apparent within this cohort of patients, and may share common misconceptions that sexual desire or the need for positive affirmation ceases once the first flush of youth is over. It has been argued however, that in an age which idolizes health, youth, beauty, vigour and intactness, older individuals affected by cancer are doubly disadvantaged; for at the same time that they are coming to terms with the ‘physiological assaults’ and multiple losses of old age, they may also find themselves having to cope with a diagnosis of cancer and the impact of the disease and its treatment on their psychosocial and sexual functioning.

What Should I Say? Talking With Patients About Sexuality Issues

Sexual and reproductive function is affected by all aspects of cancer, including cancer’s biologic processes of growth and metastasis, the effects of undergoing cancer treatment, and the psychological issues that occur as a result of having cancer and receiving treatment for it. These aspects can result in changes in body appearance, infertility and sterility, and the inability to have intercourse. The changes may be made worse by additional alterations in body image, fears of abandonment, loss of self-esteem, changes in sexual identify, and concerns about self (Krebs, 2005). Human sexuality includes three separate but intertwined aspects: body image, reproductive ability, and sexuality or sexual functioning. Body image, or the way individuals see themselves or think others see them, may be altered by changes in body appearance resulting from weight loss or gain, alopecia, mucositis, fatigue, or a variety of other changes that may not be visible to others. Changes in self-esteem may occur as a result of body image alterations, resulting in decreased desire and decreased sexual activity. Reproductive function, or the ability to bear or father children, may become impossible as a result of therapyrelated infertility, and sexual functioning may be altered by changes in self-perception, decreased desire, general side effects of treatment (including cancer therapies and methods to manage side effects of therapy), or numerous other reasons. Some individuals are at higher risk for sexual side effects than others based on age, gender, type of cancer, type of cancer treatment, or concomitant medical or psychological illness (Krebs, 2001, 2005). See Figure 1 for a list of factors that contribute to sexual diffi culties.

Colostomy Irrigation − an option worth considering

Having a permanent colostomy can be a devastating change in many aspects of a patient′s daily life, affecting confidence, lifestyle and relationships. Patients need to learn how to care for their stomas and adjust to a new routine of bowel function, altered physical appearance and body image. Patients′ ability and motivation to be self−caring and independent can have a positive effect on their recovery and adaptation (Black, 2004). Most of this adaptation will occur at home, supported by family, friends and healthcare professionals. Thus, nurses caring for this group of patients need to be able to inform, educate and support them during their recovery and future life. However, for some patients, achieving self−care with natural evacuation may not be enough, and to be able to have some control over when their bowel functions will further enhance their adaptation. Colostomy irrigation is a well−established procedure that can be used by patients at home to improve their confidence, achieve control over their bowel function and improve their quality of life and functioning (Karadağ et al, 2005). Although nurses inform patients about irrigation, and not all patients are suitable, it is thought that a minority (5%) of colostomists actually perform the procedure (Wade, 1989). Some nurses may therefore have little experience either teaching or supporting such patients, and may not have patients within their caseloads or local area.

Stoma Care Problems after Stoma Surgery in Northern Finland

Stoma-related complications and problems in stoma care are common after gastrointestinal surgery requiring the construction of a stoma. The frequency and types of such complications and problems were evaluated in a patient cohort operated on in Oulu University Hospital. A detailed questionnaire concerning clinical problems and stoma care was mailed to 163 stoma patients operated on during the years from 1995 to 2001 in Oulu University Hospital. One hundred and nineteen patients (70 percent) answered the questions adequately. The clinical variables concerning stoma complications and the patients' symptoms, problems with stoma care and adaptation to the situation were recorded. Special attention was paid to the patients' general wellbeing and social problems. Thirty-five patients (30%) had stoma complications, most commonly parastomal hernias (18 cases). Patients with an ileostomy had more difficulties with stoma handling more often than the patients with a colostomy. Seventy-eight patients (66%) were well adapted to their stoma, including 49 (72%) of the patients with a colostomy and 25 (56%) of the patients with an ileostomy. Of the 41 non-adapted patients, 12 did not accept their altered body image, ten had problems in social life and nine had difficulties because of faecal leakage. The quality of life analysis of 114 patients showed that their physical condition was better than before the operation in 55 cases (48%), unchanged in 16 (14%) and worse in 43 (38%). General mental health was better than before the operation in 52 cases (46%), unchanged in 23 (20%) and worse in 39 (34%) patients. Social functioning had improved after stoma surgery in 38 cases (34%), remained unchanged in 27 (24%) and deteriorated in 46 (42%) patients after stoma surgery. Patients with a colostomy reported worse subjective physical condition, mental health and social functioning than the patients with an ileostomy. Two-thirds of the patients had adapted to their stoma. The patients with an ileostomy had difficulties in stoma handling and the patients with a colostomy reported their physical, mental and social wellbeing to be affected.

Are theories of altered body image applicable to patients with chronic wounds?

Authors have attempted to define the concept of body image, discussing how it is formulated through the interplay of a complex series of dynamic psychosocial influences which grow, alter and adapt to natural changes in the body and psyche over time. This review considers concepts of altered body image (ABI) and related models, and suggests how they might be applied to patients with chronic wounds.

Psychological management and body image issues in facial transplantation

Facial transplantation, although controversial, is proposed as a major advance in facial reconstructive surgery, with the first partial transplant having taken place in France in November 2005. Although the psychological impact of facial transplantation will not be understood until several procedures have been carried out, this article examines the psychological issues likely to arise with particular reference to body image. A detailed framework for anticipation and management of psychological change is proposed. Pre-operative preparation must include thorough psychological preparation for the patient and their family. The immediate post-operative period is likely to be challenging, and a detailed management plan is proposed emphasising early return to function; subsequent psychological issues including altered body image, anxiety, shame, depression, communication and behavioural avoidance are discussed and a management strategy based on cognitive behavioural principles is proposed for the first post-operative year. Previous discussion frames psychological outcome in terms of complication and risk, tending to downplay the potential advantages of a successful procedure; the focus of this paper is on ensuring psychological adjustment as an inevitable consequence of change.

Psychological Distress in Men With Breast Cancer

This article reports the first United Kingdom study to examine the prevalence of psychological distress in men with breast cancer and the factors associated with increased distress. One hundred and sixty-one men with breast cancer completed a cross-sectional questionnaire that included measures of anxiety and depressive symptoms, cancer-specific distress, body image, coping, information and support needs, and clinical and demographic variables. Clinical levels of anxiety and depressive symptoms were reported by 6% and 1% of men, respectively, while 23% reported high levels of cancer-specific distress. Anxiety was most strongly associated with avoidance coping and fear and uncertainty about the future (42% of the variance in anxiety scores, P < .001). Depressive symptoms were associated with altered body image (35% of the variance, P < .001). Body image, avoidance coping, referral to the study by a clinician, fear and uncertainty, and wanting to receive more gender-specific information together explained 51% of the variance in cancer-related distress (P < .001). Clinical and demographic factors did not account for a significant proportion of the variance in any of the distress measures. Although the prevalence of clinical anxiety and depressive symptoms were low in this sample, almost a quarter of men experienced traumatic stress symptoms specific to breast cancer. Potential risk factors for distress include the use of avoidant coping strategies, negative body image, feelings of fear and uncertainty in relation to breast cancer, and unmet information needs. Suggestions are made for improving the information and support available to men with breast cancer.

Ethnicity, body image perception and weight-related behaviour among adolescent females attending secondary school in Trinidad

The correlates of body image perception among an ethnically diverse group of adolescent females attending secondary school in Trinidad were investigated. A cross-sectional survey was carried out among adolescent females from selected secondary schools in Trinidad. Participants completed a self-administered questionnaire consisting of sociodemographic items and standardized psychometric instruments. Two hundred and fifty-one students participated in the survey with an ethnic composition as follows: Indo-Trinidadian (35.9%), Afro-Trinidadian (28.7%), Indo-Afro mixed Trinidadian (21.9%) and other (13.5%). The results suggest that 2.4% of the participants reported having a medical diagnosis for an eating disorder Indo-Trinidadians had significantly greater body dissatisfaction than Indo-Afro-mixed Trinidadians but not more than Afro-Trinidadians (p = 0.04). Also, a significantly higher proportion of Indo-Trinidadians engaged in binge eating behaviour compared to the other ethnic groups (p < 0.001). Afro-Trinidadians were more likely to use vomiting as a mean of weight control compared to Indo- and Indo-Afro-mixed Trinidadian (p < 0. 05). Fifty-one per cent of participants had a negative body image perception. Altered body image perception was associated with a significant higher mean Body Shape Questionnaire BSQ 16 score (p < 0.001) and increased likelihood of reporting being diagnosed with an eating disorder (OR = 2.03, 95% CI: 1.78, 2.31; p = 0.01) compared to non-altered body image state. Eating Attitude Test (EAT-26) score was positively correlated with Drive-for-Thinness (p < 0.001) and BSQ16 (p < 0.001) scores and inversely correlated with the Rosenberg self-esteem score (p = 0.012). In this group of adolescents, there are ethnic differences in the level of concern over body image and associated eating, and weight-related behaviour.

The experiences of men with breast cancer in the United Kingdom

To investigate the experiences of men with breast cancer across the United Kingdom, a multi-phase study using: (a) focus groups (n = 4) with men and women with breast cancer and with healthcare professionals; (b) questionnaires to men with breast cancer (n = 161); (c) follow-up interviews with these men (n = 30) and (d) reconvening the focus groups (n = 2) for the men and women with breast cancer. The majority of men (84%, n = 135) reported their symptoms early, but were shocked to receive a breast cancer diagnosis. Disclosure of the diagnosis was commonly made to partners (80%, n = 129) and other close family and was influenced by perceptions of embarrassment, stigma and altered body image. Very little information was available to participants; that which was available was often inappropriate as it was intended for women. Over half the sample wanted much more information (56%, n = 90). This study also demonstrated low utilisation of formal support services and initiatives are needed to improve the information and support provided to men with breast cancer after diagnosis and treatment. Increasing the profile of breast cancer in men generally amongst healthcare professionals and the public is also needed.

Body image alteration after flank incision: relationship between the results of objective evaluation using computerized tomography and patient perception.

We evaluated subjective and objective alterations in body image and configuration of patients who underwent urological surgery via a flank incision. Eligible for study were 17 patients who underwent urological surgery via an 11th rib transcostal incision. Preoperative and postoperative abdominal computerized tomography were used for evaluation. The intra-abdominal contents surrounded by the vertebral bones and muscles forming the body trunk were divided into 4 subspaces. The areas of these 4 portions were measured and the calculated ratio of the contents of each portion determined preoperatively was compared with that determined postoperatively. Of the 17 patients 15 answered a questionnaire on the perception and bother of body image alteration. We compared their subjective answers with objective results using computerized tomography. The ratio of the ipsilateral-dorsal portion significantly increased postoperatively from 18.7% to 21.9% at the L2 level (p <0.001), 19.7% to 23.1% at the L3 level (p = 0.002) and 18.3% to 21.2% at the L4 level (p = 0.003). Posterolateral bulging was typically observed at the L2 level. Of the 15 patients who answered the questionnaire 9 (60%) perceived and 4 (27%) were bothered by body image alteration to at least a moderate extent. The ratio of increase in the ipsilateral-dorsal portion was significantly higher in the 9 patients who perceived at least moderate body image alteration than in the remaining 6 (2.2% versus 4.6%, p = 0.031). The intra-abdominal contents deviated in the ipsilateral-dorsal direction with the patient supine after flank incision done via the 11th rib transcostal approach. This change, typically represented by posterolateral bulging, results in an altered patient body image.

The effects of malodorous fungating malignant wounds on body image and quality of life

Malodour is a common symptom of fungating malignant wounds. This paper reviews the literature to explore the transition, caused by malodour, from normal to altered body image, and the assessment strategies that can be used by nurses.