Body Image Dissatisfaction In Patients Research Articles

Biopsychosocial Markers of Body Image Concerns in Patients with Head and Neck Cancer: A Prospective Longitudinal Study.

(1) Background: Patients and survivors of head and neck cancer (HNC) are at a high risk of developing body image concerns. Despite the prevalence of body image concerns in patients with HNC, there is a lack of longitudinal research exploring the wide array of its associated determinants. The current longitudinal study examined the determinants and longitudinal course of body image dissatisfaction in patients with HNC. (2) Methods: Patients participated in Structured Clinical Interviews and self-administered questionnaires at four time-points: (T1) upon cancer diagnosis, (T2) at 3 months post-diagnosis, (T3) at 6 months post-diagnosis, and (T4) at 12 months post-diagnosis. They also underwent a disfigurement rating on an objective scale. (3) Results: Two hundred and twenty-four patients participated in our study. Fourteen percent to twenty-eight percent of patients reported at least moderate body image concerns across time points, with the lowest rates at baseline and the highest at 3 months (T1). It was found that patients more predisposed to developing higher levels of body image concerns presented physical markers (i.e., advanced cancer stage, lower physical functioning, higher disfigurement), psychosocial markers (i.e., higher depression, higher anxiety, and higher levels of coping with denial), and health disparities (i.e., younger age, female sex, French language, and marital status, with divorced and widowers most affected). (4) Conclusions: The findings of this study highlight the multifaceted nature of body image concerns in patients with HNC and its biopsychosocial determinants. Clinicians should pay specific attention to these biopsychosocial markers in their clinics to predict high levels of body image concerns and tailor communication/refer for support accordingly.

Interpersonal functioning and body image dissatisfaction in patients referred for NHS aesthetic surgery: A mediating role between emotion regulation and perfectionism?

Few studies have explored psychological factors associated with body image dissatisfaction in individuals seeking aesthetic surgery on the NHS. In NHS Scotland, The Adult Exceptional Aesthetic Referral Protocol (AEARP) states that individuals are only eligible for consideration for surgery where there is significant psychological distress and physical criteria associated with perceived problem of appearance. The AEARP necessitates that individuals seeking aesthetic surgery on the NHS must have a psychological assessment. It is therefore crucial to identify psychological factors associated with body image dissatisfaction that may highlight contraindications for surgery or are amenable to psychological intervention. A total of 311 consecutive patients seeking aesthetic surgery who were referred for psychological assessment under the AEARP completed a series of psychometric measures as part of routine clinical practice. Multiple mediation analyses using bootstrapped method was used to explore the relationship between interpersonal functioning, emotion regulation, perfectionism, and body image dissatisfaction. Multiple mediation analysis indicated that emotion regulation partially mediates the relationship between interpersonal functioning and body image dissatisfaction in this clinical population. This study indicates that interpersonal functioning and emotion regulation significantly relate to body image dissatisfaction in this patient group. Psychological assessment of patient suitability for aesthetic surgery should include assessment of interpersonal functioning and emotion regulation which may be amenable to psychological intervention and be of significant benefit to patients either pre- or post-operatively or instead of surgery.

Age, Disease Symptoms, and Depression are Associated With Body Image Dissatisfaction in Newly Diagnosed Pediatric Inflammatory Bowel Disease.

Body image refers to the subjective, mental representation one makes regarding their physical appearance. Children and adolescents with inflammatory bowel disease (IBD) may be prone to experiencing negative self-evaluations regarding their body image given disease-related symptoms and treatment side-effects. In this study, we aimed to examine demographic, medical, and psychosocial variables related to body image dissatisfaction (BID) in pediatric patients diagnosed with IBD and to determine which variables are most predictive of higher dissatisfaction. A total of 52 youth newly diagnosed with IBD (Crohn's disease, ulcerative colitis, indeterminate colitis) ages 8 to 17 years completed questionnaires regarding their psychosocial functioning (ie, depression, anxiety, health-related quality of life, stress), disease symptoms, and BID. BID was assessed using the modified Adapted Satisfaction with Appearance questionnaire, yielding a total score and subscale scores assessing Perceived Social Impact and Subjective Dissatisfaction. Physician global assessment of disease activity and demographic and medical characteristics were abstracted from electronic chart review. Youth endorsed low overall BID concerns but noted the highest dissatisfaction with their abdomen, chest, and arms. Older child age, greater patient-reported disease symptoms, and worse depression symptoms were most strongly associated with overall body dissatisfaction when evaluated in a hierarchical regression model. Demographic, disease-related, and psychosocial factors are associated with BID in youth newly diagnosed with IBD. Given associations between BID and adverse health outcomes in healthy youth, these findings highlight a unique opportunity to improve screening and interventions for BID in patients with IBD.

Prevalence and Correlates of Body Image Dissatisfaction in Patients with Multiple Sclerosis.

Body image dissatisfaction (BID) strongly predicts undesirable outcomes, including disordered eating, depression, and low self-esteem. People with multiple sclerosis (MS) may have higher BID due to changes in mobility and functioning and high rates of depression; however, little research has explored BID in people with MS. Identifying factors predicting BID in people with MS would help providers become more aware of BID and its possible negative outcomes. The sample included 151 adult patients with MS receiving care at the Cleveland Clinic Mellen Center for MS. The Body Shape Questionnaire was administered, and demographic information was collected from medical records. Data on MS-specific variables were collected via computerized testing. A one-sample t test, an independent-samples t test, and a hierarchical linear regression were conducted. Average scores on BID were not significantly different from the population mean. Patients with moderate/marked concern were more likely to be female and had higher body mass index values, Patient Health Questionnaire-9 scores, and Quality of Life in Neurological Disorders Stigma T-scores. There were no age differences. No MS-specific variables significantly predicted BID. People with MS show approximately the same levels of BID as the general population. Higher BID was associated with being female and with higher body mass index, depression, and stigma. No MS-specific variables predicted higher BID after controlling for significant variables. Given the evidence in the literature of the negative effects of BID on health behaviors and mood, it is important to explore whether other factors affect BID in people with MS.

Body image dissatisfaction in patients with inflammatory bowel disease: a systematic review

Background and aimsLittle is known about the relationship between inflammatory bowel disease (IBD) and body image. The aim of this systematic review was to summarise the evidence on body image...

Body image dissatisfaction in patients with inflammatory bowel disease: a systematic review protocol

BackgroundInflammatory bowel disease (IBD) is a debilitating chronic disease characterised by inflammation and ulceration of the gastrointestinal tract. It is associated with a range of debilitating symptoms and reduced quality of life. People living with IBD may also be at risk of body image dissatisfaction (BID). BID is a distorted and negative view of the physical self, which in turn can adversely affect mental health and quality of life. To date, there have been no systematic reviews of the evidence on BID in IBD patients. Therefore, the aim of this systematic review is to clarify the evidence base on BID in *IBD patients including (i) the tools used to measure BID, (ii) the prevalence and severity of BID, (iii) the risk factors associated with BID and (iv) the relationship between BID and quality of life.MethodsBibliographic databases (EMBASE, MEDLINE, PsycINFO, Cochrane CENTRAL) will be searched using a sensitive search strategy aiming to identify any quantitative study reporting on body image in the context of IBD. This will be supplemented by searches of ongoing trials registers and checking of reference lists. Studies will be assessed for eligibility using predetermined selection criteria for each question. Data will be extracted using a predefined data extraction form, and risk of bias (quality) of included studies will be assessed based on checklists appropriate to the study designs identified. Key methodological steps will be undertaken in duplicate to minimise bias and error. Synthesis will be undertaken separately for the different systematic review sub-questions. Given the anticipated heterogeneity of evidence on each question, it is likely that synthesis will be mostly narrative.DiscussionTo the best of our knowledge, this will be the first systematic review to collate the existing evidence on BID in IBD patients. Understanding the impact of BID, its relationship with quality of life, and which patients may be at greater risk, may ultimately lead to the development of interventions to prevent or treat BID and to better patient care. Any gaps in the identified evidence will help to inform the research agenda in this area.Systematic review registrationPROSPERO: (CRD42018060999).

Abstract P5-18-03: Relationships among breast symmetry, appearance investment, and body image dissatisfaction in breast cancer patients undergoing reconstruction

Abstract Purpose: Reconstruction as part of treatment for breast cancer is aimed at mitigating body image concerns post-mastectomy. Although algorithms are increasingly being developed to objectively assess breast reconstruction outcomes, previous research has not evaluated associations between objectively quantified breast aesthetic appearance and patient-reported body image outcomes. Further, the role appearance investment plays in a patient's body image is not well understood. We examined the extent to which objectively quantified breast symmetry and appearance investment were associated with body image dissatisfaction in patients undergoing cancer-related breast reconstruction. Method: Breast cancer patients in different stages of reconstruction (n=190) completed self-report measures of appearance investment and body image dissatisfaction. Vertical extent and horizontal extent symmetry values, which are indicators of breast symmetry across the vertical axis, were calculated from clinical photographs. Associations among symmetry, appearance investment, body image dissatisfaction, and patient clinical factors were examined. Multiple regression was used to evaluate the association of symmetry and appearance investment with body image dissatisfaction. Results: Vertical extent symmetry, but not horizontal extent symmetry, was associated with body image dissatisfaction. Multiple regression results indicated that decreased vertical extent symmetry (β = -0.24, p <0.01) and increased appearance investment (β = 0.37, p <0.001) were significantly associated with greater body image dissatisfaction while controlling for clinical factors.Conclusions: Our findings suggest that quantitatively measured reconstruction outcomes and appearance investment both significantly contribute to an understanding of patient-reported body image satisfaction during breast reconstruction treatment. Future studies are encouraged to utilize algorithms assessing breast aesthetic appearance and to consider patient values as predictors of body image outcomes. Symmetry Predicting Body Image Dissatisfaction Controlling for Clinical Factors Body Image Dissatisfaction (β)VE Symmetry-0.24**Appearance investment (ASI-R)0.37*** Clinial factors controlled for BMI-0.01Prior chemotherapy0.19Prior radiation therapy0.08Prior complications0.06Reconstruction timing (ref: Immediate) Delayed0.06Reconstruction type (ref: Implant) Autologous-0.01Mixed type0.09Reconstruction Stage (ref: Pre-surgery) Intermediate-0.06Final-0.15*p<.05, **p<.01, ***p<.001; ref = reference group; Note ASI-R = Appearance Schemas Inventory-Revised Citation Format: Nicklaus KM, Teo I, Reece GP, Huang S-C, Mahajan K, Andon J, Khanal P, Sun CS, Merchant FA, Markey MK, Fingeret MC. Relationships among breast symmetry, appearance investment, and body image dissatisfaction in breast cancer patients undergoing reconstruction [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-18-03.

Body image dissatisfaction in patients undergoing breast reconstruction: Examining the roles of breast symmetry and appearance investment.

Reconstruction as part of treatment for breast cancer is aimed at mitigating body image concerns after mastectomy. Although algorithms have been developed to objectively assess breast reconstruction outcomes, associations between objectively quantified breast aesthetic appearance and patient-reported body image outcomes have not been examined. Further, the role of appearance investment in explaining a patient's body image is not well understood. We investigated the extent to which objectively quantified breast symmetry and patient-reported appearance investment were associated with body image dissatisfaction in patients undergoing cancer-related breast reconstruction. Breast cancer patients in different stages of reconstruction (n=190) completed self-report measures of appearance investment and body image dissatisfaction. Vertical extent and horizontal extent symmetry values, which are indicators of breast symmetry, were calculated from clinical photographs. Associations among breast symmetry, appearance investment, body image dissatisfaction, and patient clinical factors were examined. Multi-variable regression was used to evaluate the extent to which symmetry and appearance investment were associated with body image dissatisfaction. Vertical extent symmetry, but not horizontal extent symmetry, was associated with body image dissatisfaction. Decreased vertical extent symmetry (β=-.19, P<.05) and increased appearance investment (β=.45, P<.001) were significantly associated with greater body image dissatisfaction while controlling for clinical factors. Breast symmetry and patient appearance investment both significantly contribute to an understanding of patient-reported body image satisfaction during breast reconstruction treatment.

Psychosocial predictors of body image dissatisfaction in patients referred for NHS aesthetic surgery

A limited number of studies have researched psychosocial predictors of body image dissatisfaction exclusively within the National Health Service (NHS) aesthetic surgery patient populations, despite aesthetic surgery being offered on an exceptional basis. The Adult Exceptional Aesthetic Referral Protocol (AEARP) defines criteria for aesthetic surgery under the NHS in Scotland. The protocol requires psychological assessment prior to surgery for the majority of aesthetic surgery procedures offered. It is therefore important to establish psychological predictors of body image dissatisfaction to aid with assessment and provision of psychological therapy for this patient group. 334 consecutive potential aesthetic surgery patients referred for psychological assessment under the AEARP completed psychosocial self-report assessment measures as part of routine practice. Multiple regression analysis using the forced entry method was used to investigate psychosocial predictors of body image dissatisfaction. Multiple regression analysis indicated that younger age, greater symptoms of depression, lower levels of self-esteem and greater interpersonal sensitivity significantly predicted higher levels of self-reported body image dissatisfaction. Symptoms of anxiety did not significantly predict body image dissatisfaction. This study indicates that both self perception and perception of self in relation to others, especially fear of being judged by others, significantly relates to body image dissatisfaction in this patient group. Psychological assessment of patients' suitability for aesthetic surgery should consider factors such as the patients' interpersonal functioning. Psychological intervention targeted at symptoms of depression, difficulties with self-esteem and interpersonal functioning may be of significant benefit to patients either prior to undergoing surgery or as an alternative to aesthetic surgery.

Body Image Dissatisfaction in Patients with Inflammatory Bowel Disease

Body Image Dissatisfaction in Patients with Inflammatory Bowel Disease

Body image dissatisfaction in patients with inflammatory bowel disease.

Despite the fact that the inflammatory bowel diseases (IBD) and their treatments may affect physical appearance, the effect of IBD on body image is poorly understood. The aims of this study were to determine whether body image dissatisfaction (BID) changes over time in patients with IBD and to examine the demographic and disease-related variables associated with decreased body image. Adults aged 18 and above in the Ocean State Crohn's and Colitis Area Registry with at least 2 years of follow-up were eligible for this study. All patients were enrolled within 6 months of IBD diagnosis and followed prospectively. BID was assessed using a modified version of the Adapted Satisfaction With Appearance questionnaire. Total Adapted Satisfaction With Appearance scores and 2 subscores were calculated. To assess for changes over time, general linear models for correlated data were used for continuous outcomes, and generalized estimating equations were used for discrete outcomes. Two hundred seventy-four patients were studied. BID was found to be stable over time among men and women with IBD despite overall improvements in disease activity. No differences were found in BID according to IBD subtype. Female gender, greater disease activity, higher symptom burden, longer duration of steroid use, dermatologic and musculoskeletal manifestations of IBD, and ileocolonic disease location among patients with Crohn's disease were associated with greater BID. Greater BID was associated with lower health-related quality of life. BID remains stable in an incident cohort of IBD despite improved disease activity and is associated with lower health-related quality of life.

Body image dissatisfaction: clinical features, and psychosocial disability in inflammatory bowel disease.

Body image refers to a person's sense of their physical appearance and body function. A negative body image self-evaluation may result in psychosocial dysfunction. Crohn's disease and ulcerative colitis are associated with disabling features, and body image dissatisfaction is a concern for many patients with inflammatory bowel disease (IBD). However, no study has assessed body image and its comorbidities in patients with IBD using validated instruments. Our aim was to explore body image dissatisfaction in patients with IBD and assess its relationship with biological and psychosocial variables. We studied 330 patients (median age, 36 yr; range, 18-83; 169 men) using quantitative and qualitative methods. Patients completed a self-administered questionnaire that included a modified Hopwood Body Image Scale, the Cash Body Image Disturbance Questionnaire, and other validated instruments. Clinical and disease activity data were also collected. Body image dissatisfaction was associated with disease activity (P < 0.001) and steroid treatment (P = 0.03) but not with immunotherapy (P = 0.57) or biological (P = 0.55) therapy. Body image dissatisfaction was also associated with low levels of general (P < 0.001) and IBD-specific (P < 0.001) quality of life, self-esteem (P < 0.001), and sexual satisfaction (P < 0.001), and with high levels of anxiety (P < 0.001) and depression (P < 0.001). Qualitative analysis indicated that patients were concerned about both physical and psychosocial consequences of body image dissatisfaction, including steroid side effects and impaired work and social activities. Body image dissatisfaction is common in patients with IBD, relates to specific clinical variables and is associated with significant psychological dysfunction. Its measurement is warranted as part of a comprehensive patient-centered IBD assessment.

Screening for body image dissatisfaction in patients with advanced cancer: a pilot study.

Cancer and its treatment can significantly affect appearance and body integrity. A number of studies have explored the impact of cancer and its treatment on body image, primarily in head and neck and breast cancer. The aim of this pilot study was to examine the construct of body image dissatisfaction and its measurement using a single question in patients with advanced cancer. Outpatients with advanced cancer were recruited (n=81). Assessments included Body Image Scale (BIS), Appearance Schema Inventory (ASI-R), Edmonton Symptom Assessment System (ESAS) with a total symptom distress score (TSDS) and two subscales scores (physical distress [PHS] and psychological distress [PSS]), Hospital Anxiety Depression Scale (HADS), and one question assessing the overall appearance satisfaction from the Multidimensional Body-Self Relations Questionnaire (MBSRQ). We also asked patients to rate the body image changes importance compared with five symptoms (pain, fatigue, depression, insomnia, lack of appetite). Forty-seven (58%) patients had a BIS score >10 (body image dissatisfaction) with a median of 11 (first-third quartiles, Q1-Q3; 5-16) and a median ASI-R of 3.1 (Q1-Q3; 2.8-3.5). Sensitivity and specificity of ≤3 for body image dissatisfaction in the single overall appearance question using the BIS as a standard was 0.70 and 0.71, respectively. BIS score was significantly correlated with ASI-R (r=0.248; p=0.025), age (r=-0.225; p=0.043), HADS-A (r=0.522, p<0.001), HADS-D (r=0.422, p<0.001), PSS score (r=0.371, p=0.001), PHS score (r=0.356, p=0.001), TSDS score (r=0.416, p<0.001), and the overall appearance question (MBSRQ; r=-0.449, p<0.001). Body image dissatisfaction was frequent and associated with symptom burden. A single item ≤3 has a sensitivity of 70% for body image satisfaction screening.