Body Uneasiness Test Research Articles

Exploring body uneasiness in severe and enduring eating disorders: insights from clinical practice

IntroductionBody uneasiness is a central facet of body image disturbances observed in individuals with eating disorders (EDs). This study aimed to address gaps in understanding body uneasiness in severe and enduring eating disorders (SE-EDs) and explore variations in psychopathology between individuals with different durations of the disorder. We hypothesized that patients with SE-ED might develop habitual behaviors that contribute to ambivalence toward treatment and the persistence of symptoms.MethodsA sample of 360 ED patients was evaluated at the beginning and end of a specialized intensive rehabilitation program. All patients completed the Eating Disorder Examination Questionnaire (EDE-Q) and the Body Uneasiness Test (BUT). They were divided into two groups: SE-ED (> 7 years) and acute (aED, < 3 years) duration.ResultsCompulsive self-monitoring showed a significant change between the start and end of treatment, differing between groups, with a larger change observed in SE-ED (p < 0.048). In SE-ED, it was associated with lower chances of dropout (p = 0.044), opposite to aED (p = 0.009). Treatment responses were primarily related to eating psychopathology, further highlighting differences between the two groups.ConclusionsThis study underscores the possible presence of a habit in SE-ED and the importance of tailoring interventions to address unique needs based on the duration of the disorder. Furthermore, it highlights the need for further research to improve treatment outcomes in SE-EDs.

The influence of body image on psychological symptomatology in breast cancer women undergoing intervention: a pre-post study.

Body image concerns related to breast cancer surgery may challenge patients' quality of life and their treatment outcomes, thus representing a key aspect to be assessed in the psycho-oncological settings. The present longitudinal study is aimed to (1) investigate the association between preoperative body image and postoperative psychological symptoms in breast cancer patients; (2) explore the impact of pre-/post-surgery variation in body image on psychological symptomatology. N = 72 women undergoing breast cancer surgery were preoperatively screened (T1) using the Body Uneasiness Test (BUT) and were assessed postoperatively (T2) using the Symptom Checklist-90 Revised (SCL-90-R) and re-administered the BUT. Spearman's correlation was used to investigate the relationship between age, preoperative body image and postoperative psychological symptoms, and variation in body image. To predict post-surgical psychological symptomatology, two separated multiple regression models were used to evaluate preoperative body image and its variation after surgery controlling for covariates (i.e., education; intervention type). P significance was set as 0.05 for all analyses and adjusted for multiple comparisons. At T1, anxiety in relation to body image scores emerged as the most frequently experienced psychological symptomatology after surgery (all adjusted p < 0.05). Significant correlations were observed between all SCL-90-R scores at T2 and avoidance behaviors and depersonalization scores at T1. The associations were most significantly strong for somatization, depression, anxiety, and hostility (all adjusted p < 0.05). However, change in body image between pre- and post-intervention was not associated with psychological symptomatology at T2 (all adjusted p > 0.05). Pre-surgery body avoidance was significantly associated with post-intervention psychological symptoms (SOMβ = 0.453, p = 0.0001; DEPβ = 0.507, p = 0.0001; AXβ = 0.459, p = 0.0001; HOSβ = 0.410, p=. 0001). However, increased weight phobia between pre- and post-surgery was statistically associated with increased somatization, anxiety, depression and hostility at T2 (βSOM = 0.439, p = 0.0001; βDEP = 0.454, p = 0.0001; βANX = 0.471, p = 0.0001). Overall, pre-/post-intervention body concerns were significantly associated with primary psychological symptoms in breast cancer patients undergoing surgery. Higher levels of body avoidance and weight phobia were significantly associated with the primary psychological dimensions assessed. As body concerns might act as quality-of-life predictors, their evaluation is crucial in fostering patients' well-being and treatment adherence.

(001) INHIBITION AND EXCITATION IN THE SEXUAL BRAIN: AN USEFUL TOOL FOR THE PREDICTION OF THE DIAGNOSIS AND TREATMENT OF HYPOACTIVE SEXUAL DESIRE IN WOMEN WITH SEXUAL DYSFUNCTION

Abstract Introduction HSDD (Hypoactive Sexual Desire Disorder) is one of the most common sex-related disorders among women. Despite its considerable prevalence, factors affecting sexual desire as well as therapeutic outcomes of treatment of HSDD in women have been scarcely studied. According to the Dual Control Model (DCM), for years female sexual desire has been identified as the result of two mainly centrally acting brain processes: excitation or inhibition towards sexual cues. In this context, the SIS (Sexual Inhibition Scale)/SES (Sexual Excitation Scale) validated questionnaire could represent an useful tool for the clinician to better characterize patients’ lack of desire. Objective This study was aimed at exploring both the inhibitory and excitatory components of sexual desire in women referring to our Clinic for sexual dysfunction, in order to find a cut-off value in the SIS/SES score predicting a diagnosis of HSDD. A secondary aim was also to identify clinical, relational and biochemical parameters significantly associated with these two dimensions of sexual desire. Methods We retrospectively recruited a consecutive series of 133 women consulting for Female Sexual Dysfunction (FSD). Patients underwent clinical and biochemical evaluation, a structured interview and completed several self-administered questionnaires, including SIS/SES, Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Body Uneasiness Test (BUT), Emotional Eating Scale (EES) and Middlesex Hospital Questionnaire (MHQ). Results The ROC curve for SES score showed an accuracy of 0.687 ± 0.05 (p&amp;lt;0.0001) in identifying HSDD; considering a cut-off value of 47.5, the sensitivity and specificity for HSDD detection were 70.5% and 55.6%, respectively. In addition, the best cut-off value for SIS1 to diagnose HSDD was 32.5, with 0.664 ± 0.048 AUC (p=0.002), 68.2% sensitivity and 53.3% specificity. We next stratified FSD women according to these SES/SIS1 cut-off values, thus identifying patients with pathological (pSES, pSIS1) or non-pathological (npSES, npSIS1) scores and the following 4 different subgroups: group 1 npSES/npSIS1; group 2 npSES/pSIS1; group 3 pSES/npSIS1; group 4 pSES/pSIS1. Among the 4 groups we did not find any statistically significant difference concerning the main characteristics explored, including lifestyle, hormonal and metabolic factors, with the exception of age, which was associated with a progressive worsening of either SES and SIS1 scores (F=4.299, p=0.006). Concerning relational factors, we demonstrated that the longer the duration of the relationship, the more pathological the excitatory/inhibitory scores, even when adjusted for age (F=5.588, p=0.001). Noteworthy, with exception for FSFI orgasm (FSFI-O) and satisfaction (FSFI-S) domains, all others FSFI domains scores showed similar significant differences with the worst values observed in pSES subgroups, independently from the presence of pSIS1. In contrast, FSDS-R score showed a highly significant variation among subgroups, but with the pSIS1 subgroup displaying the worst distress score independently from the presence of pSES. Among endocrinological factors, only total testosterone levels showed significant variation among groups (F=5.952, p&amp;lt;0.001), with the lower level observed in FSD women with pSES or pSIS1, in whatever combination as compared to npSES/npSIS1, even after age-adjustment (F=3.176, p=0.027). Regarding psychopathological factors, in an age-adjusted model, we found a significantly different MHQ total score among the 4 groups, with the worst value associated with the pSIS1 group combined or not with pSES. We also explored eating disorder symptoms. The 4 groups reported significantly different values in the EES, with pSES/pSIS1 group showing the highest score, even after adjusting for age (F=3.316, p=0.023). We then investigated the relevance of stratifying HSDD patients according to SIS1 and SES np/p scores in predicting the beneficial effects of treatments for HSDD (improvement yes/no). Interestingly, we found that SES, but not SIS scores, could predict HSDD treatment outcome after 6 months; in particular, the lower the level of SES at baseline, the higher the improvement in FSFI-D domain during treatment is predictable. Finally, we explored which were the main determinants for SES/SIS1 scores in the study population. Noteworthy, a significantly stepwise increase of SES score was observed as a function of total testosterone levels (r=0.192, p=0.049). Conclusions In conclusion, the cutoffs of SIS1/SES found in this study could help characterizing HSDD women and identifying subgroups of patients with the highest probability to benefit from testosterone treatment. From a broader viewpoint, our study suggests that women diagnosed with HSDD should be evaluated by using more appropriate tools, including those not routinely employed in clinical practice, so that different “nuances” of this sexual disorder could be recognized and consequently adequately treated in a tailored therapy perspective. Disclosure No.

Does botulinum toxin affect psycho-social aspects in dystonia?

Dystonia is a movement disorder in which sustained muscle contractions give rise to abnormal postures or involuntary movements. It is a disabling and disfiguring disorder that affects activities of daily living and gives people a bizarre appearance often associated with psychological morbidity, embarrassment and social avoidance. Intramuscular injection of botulinum toxin (BoNT) is the most effective treatment for motor symptoms in focal dystonia, but little is known about its impact on the psycho-social dimension. The main aim of this study was to evaluate psycho-social changes in patients with focal dystonia after starting BoNT treatment using self-reported scales. The Beck Depression Inventory (BDI-II), the 36-Item Short Form Health Survey (SF-36), the Body Uneasiness Test (BUT), the State-Trait Anxiety Inventory (STAI) and the Visual Analogue Scale (VAS) assessing body self-image, satisfaction with physical aspects, social avoidance, self-reported depression, and self-distress were completed by 11 patients with dystonia and 9 patients with hyperhidrosis as a control group before BoNT (T0). VAS was then performed after four weeks (T1) to assess whether BoNT induced changes in the psychosocial dimension. Our results showed that only depressive symptoms and rumination about body defects improved in patients with dystonia after BoNT treatment, while improvement in self-distress and satisfaction with physical aspects was also found in hyperhidrosis. Individuals with hyperhidrosis experience poorer psychological well-being and suffer from higher levels of distress compared to dystonic patients. This suggests that individuals with this disabling condition are more vulnerable to social impact than dystonic patients.

The effects of gender-affirming hormone therapy and mastectomy on psychopathology, body image, and quality of life in adults with gender dysphoria who were assigned female at birth

PurposeIndividuals with gender dysphoria (GD) may request hormone therapy and various surgical operations to change their physical characteristics. The present study aimed to investigate the effects of two treatments, mastectomy and gender-affirming hormone therapy (GAHT), on adults with GD who were assigned female at birth (GD AFAB).MethodsIn this cross-sectional study, we gathered data from a total of 269 individuals in three groups: (a) untreated group (n = 121), (b) GAHT group (n = 84) who had been receiving treatment for at least 6 months, and (c) GAHT-MAST group (n = 64) who had been using GAHT for at least 6 months and had undergone mastectomy at least 3 months prior. All participants were asked to complete the Symptom Checklist-90-Revised (SCL-90-R), the Body Uneasiness Test (BUT), and the World Health Organization’s Quality of Life Questionnaire- Brief Form, Turkish Version (WHOQOL-BREF-Tr).ResultsWe found that individuals in the untreated group had higher psychopathological symptoms and body uneasiness scores, and lower quality of life scores compared to both GAHT and GAHT-MAST groups. There was no difference in psychopathology between the GAHT-MAST group and the GAHT group, but body uneasiness scores were lower, and quality of life scores were higher in the GAHT-MAST group.ConclusionOur study suggests that individuals receiving GAHT improved mental health, body satisfaction, and overall quality of life. Combining mastectomy with GAHT may further enhance these benefits.

Psychotic-like anomalous self-experiences in feeding and eating disorders: Their role in eating psychopathology through the mediation of body uneasiness and embodiment and identity disorders.

Psychotic-like anomalous self-experiences (ASEs) are core and early features of schizophrenia spectrum disorders, which have been recently also postulated to underlie embodiment disturbance in feeding and eating disorders (FEDs). The present study was aimed at investigating the interplay between ASEs and specific psychopathology in FED. Ninety persons with Anorexia Nervosa and 41 with Bulimia Nervosa were evaluated with the inventory of psychotic-like anomalous self-experiences (IPASE), identity and eating disorders (IDEA), body uneasiness test (BUT), and eating disorder examination questionnaire (EDE-Q). The same assessment was performed for 92 subjects recruited from the general population. Structural equation modelling was employed to test the role of embodiment/identity disorders in mediating the relationship between ASEs and ED psychopathology. Patients with FED displayed high scores on IPASE, comparable with people with schizophrenia spectrum disorders. A significant correlation was also demonstrated between IPASE, BUT and EDE-Q. All IPASE domains were strongly related to feeling extraneous from one's own body by IDEA. All IPASE domains demonstrated a high relationship with BUT Depersonalization scale. A strong correlation was also reported between total scores of IPASE and IDEA. The mediation model confirmed that ASEs impact on FED symptomatology through the mediation of both embodiment/identity disorders and body image. Anomalous interoceptive processes may represent the first step of a maladaptive process-impairing embodiment, selfhood, and identity in FED. Assessment of ASEs might be a valid tool to identify an early-shared vulnerability of severe disorders characterized by embodiment alterations.

Beyond the surface: Understanding obsessive symptoms and body perceptions, from shape concerns to fear of blushing

IntroductionRecent reclassifications have expanded the understanding of Obsessive-Compulsive Disorders (OCDs), now incorporated into a broader category known as Obsessive-Compulsive Disorder and Related Disorders (OCRDs). This study sought to assess obsessive-compulsive symptoms and body uneasiness among outpatients seeking treatment for Eating Disorders (ED). Additionally, we aimed to explore associations and potential mediation effects between obsessive-compulsive symptoms and body uneasiness. This investigation extended beyond concerns related solely to body shape and weight, encompassing fears associated with specific body components (such as facial features, abdominal region, and limbs) or functions (including sweating, blushing, emitting noises, and releasing odors). MethodsPsychometric assessments included the Obsessive-Compulsive Inventory-Revised (OCI-R) and the Body Uneasiness Test (BUT). Statistical analyses involved bivariate correlations, linear regression, and mediation analysis to explore the associations and potential mediation effects between obsessive-compulsive symptoms and different manifestations of body uneasiness. ResultsThe sample (N = 210) demonstrated substantial obsessive-compulsive symptoms and notable body discomfort. OCI-R scores positively correlated with various dimensions of body dissatisfaction, including shape, weight, and specific body components or functions. Linear regression revealed significant associations between OCI-R scores and overall body uneasiness (BUT-A) as well as concerns about body components or functions (BUTB). Mediation analysis indicated that BUT-A mediated the relationship between obsessive-compulsive symptoms and BUTB. ConclusionThis study offers new insights into the comprehensive landscape of OCRDs. It specifically emphasizes the association between obsessive-compulsive symptoms and body uneasiness, embracing not only concerns about body shape and weight but also extending to body components and functions.

Emotional dysregulation and eating symptoms in gender dysphoria and eating disorders: the mediating role of body uneasiness

Emotional dysregulation is a key transdiagnostic dimension of several clinical conditions, including eating disorders (EDs) and gender dysphoria (GD). Not only is there frequent comorbidity between EDs and GD, but GD individuals also commonly experience ED symptoms and body-image disturbances. However, more research is needed to understand how specific body-related experiences may differently interact with difficulties in emotion regulation and dysfunctional eating behaviors in EDs and GD. Thus, the present study aimed at exploring potential associations between emotional dysregulation and ED symptomatology in individuals diagnosed with anorexia nervosa (AN), bulimia nervosa (BN), or gender dysphoria (GD), also considering the mediating role of specific dimensions of body uneasiness. A national sample of N = 96 help-seekers assigned female at birth (n = 32 with AN, n = 32 with BN, n = 32 with GD) was recruited from two specialized care centers. Participants completed the Eating Disorder Inventory-3 (EDI-3) and the Body Uneasiness Test (BUT), while the Shedler-Westen Assessment Procedure–200 (SWAP-200) was used to evaluate emotional dysregulation. Findings showed that several body uneasiness dimensions mediated the relationship between emotional dysregulation and ED symptoms, in both AN-BN and GD participants. In GD individuals, body avoidance emerged as a significant mediator of the relationship between emotional dysregulation and ED symptoms, whereas in both AN-BN patients and GD individuals, depersonalization toward the body emerged as a significant mediator. The results suggest that the interplay between emotional dysregulation, body uneasiness, and ED symptoms may be crucial for the development of comprehensive and tailored prevention strategies.

Dental anxiety, Quality of Life and body image: gender differences in Italian and Spanish population.

Dental anxiety is an excessive and irrational negative emotional state experienced by population; the dental anxiety is common throughout the lifespan and is an obstacle to improving oral health behaviors and outcomes. The aim of this study was to assess gender differences in dental anxiety and to investigate if oral health impacts patients' Quality of Life and the perception of their body image. The sample consisted of 366 subjects selected in Italy and Spain (January 2021-September 2021). For this study, data were gathered using Google Forms (Google LLC, Mountain View, CA, USA). Data were collected including the Dental Anxiety Scale (DAS), Oral Health Impact Profile (OHIP-14) questionnaires and Body Uneasiness Test. Women showed higher scores than men for the dental anxiety. The regression analysis showed that gender, age, and Oral Health Impact are predictors of "dental anxiety." A borderline significance emerges for the independent variable body uneasiness. The dental anxiety is widespread in the population, with a higher prevalence among women and increases with increasing age. It can negatively affect patients' Quality of Life, well-being, and self-esteem. These results underline the importance of addressing both individual and group strategies for preventing or treating dental anxiety.

COVID-19 pandemic impact among adolescents with eating disorders referred to Italian psychiatric unit.

The COVID-19 pandemic has triggered or exacerbated eating disorders (EDs), especially in adolescents. This study examined the prevalence of admissions of patients with EDs at the Child and Adolescent Psychiatry Unit from the pre-COVID-19 pandemic to March 2023 and explored the differences in dimensions of ED's symptomatology according to the year of access. We included 174 children and adolescents, 94.3% females and 5.7% males, with a diagnosis of ED (Mage = 14.87; SD = 1.72). The Eating Disorder Inventory-3 (EDI-3), the Body Uneasiness Test (BUT) and Youth Self Report ASEBA (YSR) were assessed. A one-way analysis of variance test was performed. EDs' hospitalization prevalence was higher in the years 2020 and 2021 compared to pre-COVID-19 and the year 2022. Considering the ED psychopathology (EDI-3), findings showed a higher score in the dimension of the push to thinness, body dissatisfaction, asceticism, and fear of maturity in the year 2021 compared to pre-pandemic. Regarding the discomfort related to the image of one's own body (BUT), results showed an increase in the global severity index in the year 2022 compared to pre-pandemic and in weight phobia in the year 2021 compared to the year 2020. Concerning the internalizing symptoms (YSR), a tendency was found for withdrawal/depression, with higher levels in the year 2022 compared to the year 2020. Our study highlighted the increase of different types of EDs symptomatology related to concerns about weight, especially 2 and 3 years after the outbreak of the pandemic, on which the literature is still scarce, especially in the Italian context.

(007) Physical activity and female sexual dysfunction: too much of a good thing?

Abstract Introduction Research on the relationship between physical activity (PA) and female sexual dysfunction (FSD) is lacking. Objectives To investigate the clinical, psychological, and sexual correlates of PA in women with FSD. Methods A non-selected series of n=322 pre- and post-menopausal patients consulting for FSD was retrospectively studied. Regular involvement in PA and its frequency (&amp;lt;1 hour/week: sedentary, 1-3 hours/week: active, 4-6 hours/week: very active, &amp;gt;6 hours/week: extremely active) were investigated with a specific question. FSDs, including HSDD (Hypoactive sexual desire disorder) and FGAD (Female genital arousal disorder), were diagnosed according to a structured and clinical interview. Participants underwent a physical examination and a clitoral Doppler ultrasound, and were asked to complete the Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Body Uneasiness Test (BUT), and Middlesex Hospital Questionnaire (MHQ). Results At multivariate analysis, women engaging in PA (67.4%, n=217) scored significantly higher in several FSFI domains - including desire, arousal and lubrication - and showed lower sexual distress and lower resistance of clitoral arteries, as compared to sedentary women. A significant, inverse association between PA and HSDD was observed. Mediation analysis demonstrated that the negative association between PA and HSDD was partly mediated by body image concerns (BUT Global severity index), psychopathological symptoms (MHQ total score) and sexual distress (FSDS-R score). These latter two factors also partly mediated the association between PA and a reduced risk of FGAD, whilst a lower BMI was a full mediator in the relationship between PA and FGAD. Finally, extreme PA was associated with significantly worse scores in several psychosexual parameters (i.e. sexual satisfaction and histrionic/hysterical symptoms), even compared to a sedentary lifestyle. Conclusions In women with FSD, PA was associated with better sexual function and clitoral vascularization, lower sexual distress and reduced odds of HSDD and FGAD; the benefits of PA on sexuality were mediated by both psychological and organic determinants; excessive PA was related with a poor overall sexual function and with a low sexual satisfaction. Disclosure No.

(025) Inhibition and Excitation in the Sexual Brain: An Useful Tool for the Prediction of Therapeutic Outcomes in Women with Sexual Dysfunction

Abstract Introduction The “Dual control model” of sexual response postulates that sexual desire and associated behaviors depend on the balance between excitation and inhibition. These aspects have not been evaluated in women with sexual dysfunction (FSD). Objectives The aim of our study was to explore the psychosexual correlates of excitation and inhibition in women with FSD, according to their menopausal state. We also aimed at performing a pre-post analysis in a sub-sample of patients followed for 3-6 months, investigating the possible relationships between excitation and inhibition and the changes in questionnaires related to sexual function. Methods In an observational, retrospective study, we recruited a consecutive series of 66 women consulting for FSD. Patients underwent a clinical evaluation, a structured interview and completed several self-administered questionnaires, including Sexual Inhibition/Sexual Excitation Scale (SIS/SES), Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Body Uneasiness Test (BUT) and Middlesex Hospital Questionnaire (MHQ). A subgroup of patients (n=28) was evaluated at 3-6 months follow-up, using the FSFI and FSDS-R questionnaires. Results Considering the whole sample, the SES scale was positively correlated with several psychosexual and relational parameters, including masturbation (p=0.005), number of lifetime partners (p=0.004) and histrionic personality traits (p=0.013), and negatively with the presence of a stable relationship (p=0.038) and its length (p=0.026). Sexual inhibition due to the fear of performance failure (SIS1 scale) positively correlated with conflicts within the couple (p=0.012), lack of privacy (p&amp;lt;0.0001), symptoms of general psychopathology (p=0.001; in particular, anxiety) and body image concerns (p=0.015). Regarding sexual parameters, the SES scale was associated with the total FSFI score (p=0.016), and the desire (p=0.011), arousal (p=0.030), lubrication (p=0.046) and orgasm domains (p=0.025), whereas the SIS1 scale was associated with the FSDS-R score (p=0.028). In premenopausal women, the SIS1 scale was associated with the diagnosis of Hypoactive Sexual Desire Disorder (HSDD), even after adjusting for confounders (p=0.047), whereas in postmenopausal women, we found an association between HSDD and the SES scale (p=0.039). Given these correlations, we developed two cut-off values for the SES and SIS1 scales, according to which a score &amp;lt; 49 on the SES (in postmenopausal women) and a score &amp;gt; 34 on the SIS1 (in premenopausal women) accurately identified patients diagnosed with HSDD. In postmenopausal women, the ROC curve for the SES scale showed an accuracy (AUC) of 0.734 +− 0.107, p=0.037, in identifying HSDD; considering a cut-off value of 49, the sensitivity and specificity for HSDD detection were 85.7% and 66.7%, respectively. In premenopausal women, the ROC curve for the SIS1 scale showed an AUC of 0.853 +− 0.081, p=0.007, in identifying HSDD; considering a cut-off value of 34, the sensitivity and specificity for HSDD detection were 78.6% and 75.0%, respectively. The mean change in FSFI total score was not correlated with the SES or SIS2 scales (p=0.214 and p=0.402, respectively), but only with the SIS1 scale (p=0.026). When comparing patients with low excitation (SES scale &amp;lt;49) and high inhibition (SIS1 scale &amp;gt;34) with the rest of the sample, they showed a significantly lower change in FSFI total score (p=0.018). Conclusions In women consulting for FSD, sexual excitation and inhibition, which may be easily assessed by the SIS/SES questionnaire, emerge as key aspects in both the diagnostic evaluation and planning of therapeutic outcomes, in the perspective of a personalized sexual medicine approach. Disclosure No.

Gut-Brain Interaction Disorders and Anorexia Nervosa: Psychopathological Asset, Disgust, and Gastrointestinal Symptoms.

Gastrointestinal (GI) symptoms are very common in subjects with eating disorders (EDs). This study aimed to (a) investigate the prevalence of gut-brain interaction disorders (DGBIs) in anorexia nervosa (AN) patients, according to ROME IV criteria; and (b) explore AN psychopathological assets and disgust that might impact GI symptoms. Thirty-eight female patients consecutively diagnosed with untreated AN (age 19.32 ± 5.59) in an outpatient clinic devoted to EDs underwent Eating Disorder Inventory-3 (EDI-3), Hospital Anxiety and Depression Scale (HADS), Social Phobia Anxiety Scale (SPAS), Body Uneasiness Test (BUT), and Disgust Scale (DS) questionnaires. The presence of DGBIs was evaluated and GI symptoms were assessed using a standardized intensity-frequency questionnaire. A total of 94.7% of our sample met the diagnostic criteria for functional dyspepsia (FD), of which 88.8% presented the postprandial distress syndrome (PDS) subtype and 41.6% presented the epigastric pain syndrome (EPS) subtype. In addition, 52.6% of the sample met the diagnostic criteria for irritable bowel syndrome (IBS), while for functional constipation (FC), prevalence reached 7.9%. All participants presented a pathological score on the disgust scale. Significant correlations were found between several GI symptoms and psychopathological asset and disgust. AN is a multifactorial disorder. It is necessary to implement studies with an integrated approach, taking into account DGBIs, as well as to monitor the emotional-cognitive structure that acts as a factor in maintaining the disorder.

(055) Application of a Very Low Calorie Ketogenic Diet (VLCKD) Protocol in Women's Endocrinology: Psychosexual Correlates of Weight Loss

Abstract Introduction The role of obesity in female sexuality is controversial and there are no intervention studies aimed at evaluating the effect of the Very Low Calories Ketogenic Diet (VLCKD) on female sexual function, in particular on arousal. Objective To evaluate the psychosexual correlates of obesity and Metabolic Syndrome (MetS) in a sample of women consulting for sexual symptoms; to investigate the change in measures of arousal after weight loss obtained with VLCKD. Methods In a retrospective study, n=322 women consulting for sexual symptoms were enrolled. The patients underwent a clinical, laboratory, sexual and psychological examination and were studied by color-Doppler ultrasound for the evaluation of genital vascularization, with measurement of the Pulsatility Index (PI) of the clitoral artery. They completed the Female Sexual Function Index (FSFI), Female Sexual Distress Scale - Revised (FSDS-R), Body Uneasiness Test, Eating Disorder Examination Questionnaire (EDE Q), and Middlesex Hospital Questionnaire, for psychiatric symptoms. Twelve patients underwent a nutritional intervention aimed at weight loss, based on a VLCKD protocol. These cases were compared with patients treated with different strategies for sexual symptoms, in a 1:1 case-control study (matched for BMI, age and menopausal status). Results In the total sample, clitoral PI was significantly higher in obese women (p = 0.018) and in those diagnosed with MetS (p=0.043). A statistically significant inverse correlation emerged between WC ≥ 88 cm and FSFI Arousal score (p=0.028). In patients undergoing a nutritional intervention with VCLKD protocol (n=12), after a mean follow-up of 20+-2 weeks, BMI showed a reduction of 6.7+-2.8 kg/m2 (p&amp;lt;0.001) and WC of 14.3+-5.2 cm (p&amp;lt;0.001), with fat mass loss of 14.6+-5.4 kg (-37.1%; p&amp;lt;0.001). At follow-up, the total FSFI and FSDS-R scores significantly improved (17.0+-13.6 vs. 11.2+-7.9, p=0.016, and 7.4+-8.3 vs. 13.3+-10.6, p=0.039, respectively). Among the FSFI subdomains, Arousal showed a significant increase (p=0.035). We also observed an improvement in EDE total score (p=0.032), Shape (p=0.008) and Weight subscales (p=0.011), BUT-B Positive Symptoms Distress Index (p=0.009) and BUT-A Body Image Concerns (p=0.043), and MHQ total score (p&amp;lt;0.001). The clitoral artery PI at follow-up showed a non-significant reduction. At multivariate analysis, the change in the Total FSFI was correlated with the BUT-B PSDI score change (p=0.031) and the EDE Shape change (p=0.043), when including DeltaMHQ and DeltaWC as further covariates. Finally, in a 1:1 case-control study, a significant difference emerged in the improvement of FSFI total score, which was more relevant in cases than in controls (p=0.046); on the other hand, there was no difference in the change in FSDS-R score between cases and controls. Conclusions Our data suggest that weight loss obtained by VLCKD is associated with an improvement in sexual function, and in particular in Arousal, whose change could be mediated by improved body image parameters. The effect of weight loss on cardiometabolic risk factors related to sexual dysfunction requires dedicated longitudinal studies, with the use of objective methods. Disclosure No

(008) Psychosexual, Relational and Clinical Correlates of Orgasmic Function and Female Orgasm Disorder in Women Consulting for Sexual Symptoms

Abstract Introduction Female Orgasm Disorder and its risk factors are still under-investigated. Objective To describe the psychological, relational and clinical correlates of orgasmic function during partnered sexual activity in women consulting for sexual symptoms. Methods In an observational retrospective study, we collected data from a consecutive sample of 430 heterosexual, sexually active women (mean age 46±12.9 years) consulting for sexual symptoms. All patients underwent a structured interview and a physical, gynecologic and laboratory examination; they completed a series of validated questionnaires, including the Female Sexual Function Index (FSFI), the Female Sexual Distress Scale-Revised (FSDS-R), the Middlesex Hospital Questionnaire (MHQ), the Body Uneasiness Test (BUT-A and BUT-B), the Sexual Inhibition/Excitation Scale (SIS/SES), and the Dyadic Adjustment Scale (DAS). Results 268 subjects (62%) reported a persistent distressing decrease of the frequency of orgasm for at least six months. Among them, 93 (22% of the whole sample) reported a mild decrease, 91 (21%) a severe decrease, and 19% reported anorgasmia. Nine women described Anorgasmia as lifelong. The severe decrease of orgasm frequency during partnered sexual activity was associated with the inability to reach orgasm with masturbation (p=0.009). After adjusting for age and menopausal status, the FSFI Orgasm (FSFI-O) domain was negatively associated with MHQ total score (p=0.001), an index of general psychopathology, and with body image concerns, explored through both BUT-A and BUT-B global measures. The stronger correlation emerged with the BUT-A Avoidance subscale (p=0.005). Among other psychological parameters, significant, negative correlations were observed between FSFI-O and a reported diagnosis of psychiatric disease, including mood disorders (p=0.001), use of antidepressants (p=0.001), chronic stress (p=0.002), and familiar conflicts (p=0.008). Noteworthy, no correlation was observed between FSFI-O and Inhibition/Excitation measures. When exploring sexual and relational parameters, we found that women displaying higher FSFI-O scores were more likely to be engaged in a stable sexual relationship (p=0.003), to report at least three sexual encounters per month (p&amp;lt;0.001) and lack of marital conflict (p=0.004). Among sexual dysfunctions in the male partner, as perceived by the woman, only low desire showed a clear negative correlation with FSFI-O (p=0.002). FSFI-O was also positively correlated with the Dyadic Satisfaction (p&amp;lt;0.001) and the Dyadic Cohesion subscales (p=0.032). Finally, when considering clinical parameters, women with a history of endometriosis (p=0.008), genitourinary disorders (i.e., recurrent vulvovaginitis or urinary tract infections; p=0.027), urinary incontinence (0.017) and pelvic surgery (i.e. hysterectomy; p=0.017) reported significantly lower FSFI-O scores. FSFI-O was not correlated with metabolic or hormonal laboratory parameters, including estradiol, prolactin or testosterone levels. When considering the diagnosis of severe FOD, the main clinical risk factors were psychiatric diseases (OR 1.566, CI 1.034;2.370), past Unwanted sexual experiences (OR 1.679, CI 1.109;2.541), urinary incontinence (OR 1.644, CI 1.132;1.387) and past pelvic surgery (OR 1.710, CI 1.129;2.591). Conclusions Orgasmic function was correlated with anxiety and depressive symptoms, use of antidepressants, body image concerns, marital conflicts and low partner’s desire, independently of age and menopausal status. Risk factors for severe FOD were psychiatric diseases, abuse history, urinary incontinence and past pelvic surgery. Disclosure No

The association between sport type and eating/body image concerns in high school students: a cross-sectional observational study

PurposeDisordered eating and body image concerns are increasingly common among adolescents, possibly representing the underpinning of eating disorders (EDs). This cross-sectional observational study aimed at investigating the relationship between various patterns of sports involvement or inactivity, and the abovementioned psychopathological dimensions.MethodsAll adolescents attending their 3rd–5th Italian grade in a single high school reported their sociodemographic and anthropometric data, their weekly sports involvement, and filled the Eating Disorders Examination Questionnaire 6.0 (EDE-Q), the Body Uneasiness Test, and the Muscle Dysmorphia Disorder Inventory (for boys). Comparisons were performed considering sex, weekly hours of activity, and different sports type (none, individual, or team sports).ResultsOf 744 enrolled students, 522 (70.2%) completed the survey. Girls showed higher underweight rates, preference for inactivity or individual sports, and higher psychometric scores compared to boys. Among girls, no differences were found based on time spent exercising or sports type. Inactive boys displayed worse weight- and shape-based psychopathology, higher body uneasiness, and higher appearance intolerance compared to those who devoted more time to exercise. Among boys, individual and team sports were associated with lower EDE-Q scores compared to inactivity, whereas body uneasiness and appearance intolerance were lower only in team sports.ConclusionsThe study confirms the presence of remarkable sex differences in eating and body concerns of adolescents. Among boys, sports involvement is tied to lower ED psychopathology, and preference for team sports may be associated with reduced concerns. Wider longitudinal studies on will clarify the direction and specificity of these findings.Level of evidenceLevel V—Cross-sectional observational study.

Body Uneasiness, Body Figure Perception, and Body Weight: Factor Structure and Longitudinal Measurement Invariance of a Set of Attitudinal and Perceptual Body Image Assessment Tools in Adolescents.

Body image is a multifaceted construct that includes attitudinal and perceptual components, but its attention has mainly been focused on the facet of body dissatisfaction. The present longitudinal study extended the validation of a multifacet attitudinal questionnaire, the Body Uneasiness Test (BUT), against perceptions of body shape and weight. A convenient sample of adolescents took part in a 2-year unbalanced panel study (5 waves). The participants completed the BUT questionnaire and selected their perceived actual, ideal, and reflected body figures along the Contour Drawing Rating Scale; ideal/actual and ideal/normative body mass index discrepancies were also included. After replicating the expected five-factor structure of the BUT items, results from confirmatory factor analysis revealed that the five BUT scales loaded on an attitudinal dimension, whereas the perceived body figures and the discrepancy indices were on a perceptive domain. Such a two-domain structure of body image measures showed gender and seasonal (1-year) measurement invariance, whereas longitudinal 6-month and 18-month invariance partially failed. Overall, the present findings support the validity of the Body Uneasiness Test in adolescence, further demonstrating a preliminary multidimensional structure of body image onto which attitudinal and perceptual body image-related measures were projected.

Internalized transphobia predicts worse longitudinal trend of body uneasiness in transgender persons treated with gender affirming hormone therapy: a 1-year follow-up study.

Given the relationship between interiorized stigma and body image, it could be hypothesized that high levels of internalized transphobia (IT) might predict higher levels of body uneasiness in subjects with gender dysphoria (GD) and worse improvement of body image after gender affirming hormone therapy (GAHT). We sought to evaluate the relationship between IT and body uneasiness in subjects with GD and the role of IT in moderating the improvement of body image after GAHT. In total, 200 individuals with GD performed the baseline assessment; 99 were re-evaluated 12months after starting GAHT. At baseline participants were evaluated through a face-to-face interview and filled self-administered questionnaires to evaluate GD (Utrecht Gender Dysphoria Scale [UGDS]), IT attitudes (Attitudes Toward Transgendered Individuals [ATTI] Scale), body uneasiness (Body Uneasiness Test, part A [BUT-A]), and general psychopathology (Symptom Checklist 90-Revised [SCL 90-R]). The same questionnaires, except ATTI, were readministered at follow-ups. Outcomes were based on measures of the associations between IT and baseline characteristics of the sample, the longitudinal trends of GD, body uneasiness, and general psychopathology; and IT as a moderator of the longitudinal trend of body uneasiness. At baseline, IT correlated with lower level of education, higher GD, and more severe body uneasiness. Longitudinal analyses showed significant improvements in GD, body uneasiness, and general psychopathology during GAHT. Moderation analysis confirmed that participants with more transphobic attitudes showed less improvement after GAHT with regard to body uneasiness (bTime*ATTI = -.002, P = .040). The Johnson-Neyman technique revealed that no significant improvement in body uneasiness was found for participants with ATTI scores lower than 71.14. The presence of IT should be investigated in subjects with GD who require gender affirming treatments to provide specific interventions aimed at targeting this dimension. Strengths of this study include the mixed cross-sectional and longitudinal design and the dimensional evaluation of the investigated constructs. Limitations include the small sample size and the limited follow-up. Furthermore, the effects of gender affirming surgery were not evaluated. The association of IT with both baseline body uneasinessand the longitudinal course of this dimension highlighted the clinical significance of body uneasiness and the importance of making continuous efforts to improve education and information to fight societal stigmas.

General psychopathological symptoms in children, adolescents, and young adults with anorexia nervosa-a naturalistic study on follow-up and treatment.

Recent research has assessed the role of general psychopathological symptoms in the natural history of mental health conditions, including anorexia nervosa (AN) in adults and obesity in children.Nevertheless, literature assessing general psychopathological symptoms in young patients with AN and their potential prognostic role in long-term outcomes is lacking. Observational, naturalistic study, involving young patients hospitalized for AN. General psychopathological symptoms were assessed by administering Symptom Check List-90-R (SCL-90-R) at admission (T0) and discharge (T1). AN-specific psychopathology was assessed with Eating Disorders Inventory-3 Eating Disorder Risk (EDRC) and Body Uneasiness Test Global Severity Index (BUT-GSI). Potential T0-T1 modifications of general psychopathological symptoms and their possible associations with baseline psychopathological, weight, and psychopharmacological variables were assessed with a generalized linear model (GLM), corrected for baseline SCL-90-R scores. Then, possible associations between T0 general psychopathological symptoms and the risk of re-hospitalization at 1year were assessed with the Kaplan-Meier method and Cox regression. This study enrolled 133 patients (mean age 16.9 ± 2.9years, F = 91.8%). A significant T0-T1 reduction (p < 0.001) in almost all the general psychopathological symptoms (except paranoia) emerged. The GLM revealed that higher EDI-3 EDRC scores were associated with higher T1 SCL-90-R scores in multiple domains. Cox regressions revealed a predictive role of SCL-90-R interpersonal sensitivity (B = 0.113, hazard ratio = 1.119, p = 0.023) on the risk of re-hospitalization at 1year. Conclusion: General psychopathological symptoms in young patients with AN may be influenced by hospital treatment interventions and have a potential prognostic role on post-discharge outcomes. Further longitudinal studies are required. What is Known: • General psychopathological symptoms represent a relevant feature that clinicians should consider in the diagnosis, treatment, and prognosis of multiple psychiatric conditions. Co-occurring psychiatric comorbidities, moreover, have been documented to impact individuals diagnosed with Anorexia Nervosa (AN) in the developmental age.Despite this evidence, the literature lacks studies assessing the occurrence and impact of general psychopathological symptoms in young patients with AN. What is New: • The clinical picture of children, adolescents, and young adults with AN mays be impacted by multiple general psychopathological symptoms, including Somatization, Obsession-compulsion, Interpersonal sensitivity, Depression, Anxiety, Hostility, Phobia, Paranoia, and Psychoticism, which may improve with a multidisciplinary hospital intervention.The occurrence of these symptoms, particularly "interpersonal sensitivity", may negatively impact the prognosis of the affected patients.

Global psychological assessment with the evaluation of life and sleep quality and sexual and cognitive function in a large number of patients with acromegaly: a cross-sectional study.

Acromegaly is associated with somatic disfigurements which impair self-perception of well-being and quality of life. Nowadays, limited data are available on the interplay between hormonal excess and psychological discomfort. The study aimed at investigating the psychological profile, sleep quality, sexual function, cognitive functions, and quality of life in patients with acromegaly. In 223 acromegaly patients from 5 referral centres, global psychological profile, sleep quality, sexual function, cognitive function, and quality of life were investigated. Depression was found in ~30% of patients, and anxiety in two-thirds, together with severe discomfort in body image mainly in women. Obstructive sleep apnoea syndrome risk and sleep disorders were found in >50% of patients and daily sleepiness in ~20%. Sexual dysfunction was reported in most of the patients, with the most severe impairment in women. Cognitive functions were compromised in ~10% of cases. Disease duration and patient's age and gender were the main determinants of these psychopathological conditions. Depression (P = 0.047), somatic-affective mood lowering (P = 0.021), state (P < 0.001) and trait (P = 0.013) anxiety, and body image distortion in body uneasiness test A (P < 0.001) and B (P = 0.006) were significantly worsened in patients <45 years and slightly worsened in those with disease duration less than 2 years. Male (P < 0.001) and female (P < 0.001) sexual function scores were significantly worsened in patients aged >64 years and slightly worsened in those with disease duration for more than 10 years, particularly in presence of cardiometabolic and respiratory complications. Cognitive symptoms were slightly worsened in older patients and in those with long disease duration. Acromegaly is associated with a relevant impairment of psychological profile persisting despite remission and long-term medical treatment.