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There are high rates of obesity and low self-esteem in patients with psychosis. The occurrence of negative voice content directly about appearance is therefore plausible. Derogatory comments about appearance are likely to be distressing, increase depression and contribute to social withdrawal.
To systematically assess the occurrence of voice content regarding appearance and identify correlates.
Sixty patients experiencing verbal auditory hallucinations at least once a week in the context of non-affective psychosis completed a measure assessing positive and negative voice content about appearance. They also completed assessments about body image, self-esteem, psychiatric symptoms and well-being.
Fifty-five (91.7%) participants reported hearing voices comment on their appearance. A total of 54 (90%) patients reported negative voice content about their appearance with 30 (50%) patients experienced negative appearance comments on a daily basis. The most common negative comment was ‘the voices tell me that I am ugly’ (n = 48, 80%). There were 39 (65%) patients who reported positive voice content on appearance. The most frequent positive comment was ‘I look as nice as other people’ (n = 26, 43.3%). Negative voice content about appearance was associated with body image concerns, paranoia, voice hearing severity, depression, worry, negative self-beliefs and safety-seeking behaviours. Positive appearance voice content was associated with greater body esteem and well-being and lower levels of depression and insomnia.
Voice content about appearance is very common for patients seen in clinical services. Negative voice content may reflect – and subsequently reinforce – negative beliefs about one's appearance, low self-esteem, worry and paranoia.
The aim of this research was to analyse variation in body image perception and satisfaction by age, sex and nutritional status in an adult sample from the Basque Country, Spain. A case-control study was performed for 227 women and 178 men aged 18–70 years. Stunkard’s silhouettes were used to evaluate Current Body Image (CBI) and Ideal Body Image (IBI), as well as dissatisfaction and inconsistency scores. Nutritional status was assessed following the WHO criteria for BMI in an adult population. The sample was divided into four groups based on sex and age (early adulthood <45 years, and middle/older adulthood ≥45 years). The Mann–Whitney U test was employed to evaluate sex and age differences, and the Gamma coefficient to assess the association between body image variables and nutritional status. Significant age differences in CBI (p<0.05) and sex differences in IBI (p<0.001) were detected. Both variables showed a positive association with BMI (p<0.01), which indicates that BMI is a biological characteristic related to body image satisfaction and influences participants’ perception of themselves. Dissatisfaction scores showed that both sex and age differences (p<0.05) were negatively associated with BMI (p<0.001). Only participants ≥45 years presented sex differences in inconsistency scores (p<0.05); this variable was associated with BMI in women (p<0.01). Preferences in body image showed sexual dimorphism, with women preferring thinner bodies than men – a pattern observed in many Western populations – linked in part to sociocultural pressures. Women were more dissatisfied with their bodies than men; a higher dissatisfaction was observed in older relative to younger participants. The results confirm the association between nutritional status and body size perception and satisfaction, but also the relationship between nutritional status and the reliability with which women can classify themselves; in men, this relationship was not as clear.
To assess the reliability and validity of body weight (BW) and body image (BI) perception reported by parents (in children) and by adolescents in a South American population.
Cross-sectional study. BW perception was evaluated by the question, ‘Do you think you/your child are/is: severely wasted, wasted, normal weight, overweight, obese?’ BI perception was evaluated using the Gardner scale. To evaluate reliability, BW and BI perceptions were reported twice, two weeks apart. To evaluate validity, the BW and BI perceptions were compared with WHO BMI Z-scores. Kappa and Kendall’s tau-c coefficients were obtained.
Public and private schools and high schools from six countries of South America (Argentina, Peru, Colombia, Uruguay, Chile, Brazil).
Children aged 3–10 years (n 635) and adolescents aged 11–17 years (n 400).
Reliability of BW perception was fair in children’s parents (κ=0·337) and substantial in adolescents (κ=0·709). Validity of BW perception was slight in children’s parents (κ=0·176) and fair in adolescents (κ=0·268). When evaluating BI, most children were perceived by parents as having lower weight. Reliability of BI perception was slight in children’s parents (κ=0·124) and moderate in adolescents (κ=0·599). Validity of BI perception was poor in children’s parents (κ=−0·018) and slight in adolescents (κ=0·023).
Reliability of BW and BI perceptions was higher in adolescents than in children’s parents. Validity of BW perception was good among the parents of the children and adolescents with underweight and normal weight.
Body image is a vital and complex issue in cancer patients, but not well recognized. In the ambulatory psychiatric-oncology clinic, we assessed what portion of cancer patients endorsed appearance problems and if they differed in terms of depression, anxiety, or distress scores when compared with those who did not endorse appearance problems.
All adult patients with active cancer diagnosis seen in the outpatient psychiatry oncology clinic (June 2014–January 2016) who provided informed consent were included (N = 1,939) in the cross-sectional study design. “Appearance problems” were assessed as a categorical, binomial variable (yes/no) using the National Comprehensive Cancer Network Distress Thermometer checklist. Other assessments included the Patient Health Questionnaire-9, Patient Health Questionnaire-2, Generalized Anxiety Disorder-7, Distress Thermometer, and Edmonton Symptom Assessment Scale.
The overall prevalence rate of individuals who endorsed appearance problems was approximately 36%; they were more likely to be younger, female, Black or Hispanic, and not in a committed relationship (all results for demographic variables were statistically significant; all p < .001). Importantly, those patients who endorsed appearance problems exhibited higher scores for depression (p < .0001), anxiety (p < .0001), and distress (p < .0001), and these differences were of medium effect size (Cohen's d = 0.5−0.6).
Significance of results
The current results underscore the need to identify patients with body image problems early given that they are likely to exhibit higher magnitude of anxiety, depression and distress symptoms while undergoing cancer care. The results highlight the importance of body image issues and the need to evaluate them in cancer patients.
Objectives: A rich body of literature has established the role of body image distortion and dissatisfaction in the development and maintenance of eating disorders. However, many of the currently used techniques require explicit comparison of the person’s body to an external stimulus. As the body schema is a largely unconscious construct, explicit comparison tasks may reflect a proxy, rather than the body schema itself. Methods: Here we use an implicit mental motor imagery (MMI) task to interrogate the body schema in healthy control participants (N=40) and participants at a residential eating disorder treatment center (N=42). By comparing the time it takes to imagine making a movement along a part of the body to the time it takes to actually make the same movement, we were able to assess participants’ mental image of their body (i.e., body schema). Results: We found that participants with eating disorders, but not healthy controls, exhibited distortions of the body schema such that they believed their abdomen, buttocks, and thighs to be larger than they really are. Additionally, the MMI task used here provided information above and beyond traditional self-report measures (i.e., Body Shape Questionnaire). Together the MMI task and traditional measures provide the most information. Conclusions: Findings using the novel MMI task are in line with the literature; participants with eating disorders consider themselves to be larger than they truly are. Taken together, results of this study suggest that MMI tasks provide complementary information to traditional self-report measures. (JINS, 2018, 22, 000–000)
The present study developed a Brazilian adaptation of the BAS for young adolescents, testing its factor structure by the Confirmatory Factor Analysis (CFA), concurrent and criterion validity, and its internal consistency. Participants were 347 adolescents (171 male and 176 female, aged between 10 and 13 years old). Three psychologists experts in psychological evaluation and three teachers of Portuguese of elementary school also participated for the adaptation stage of the items in order to be properly understood by the sample age group. There were few changes from the version culturally adapted for the Brazilian adult population. Cronbach’s alpha coefficients were satisfactory for the general population and both sexes (.804; female =.851; male =.752). The one-factor model of the BAS was confirmed by the confirmatory factor analysis with good indicators for the measurements of adjustment to the model, χ2 = 77.9; GFI = 0.967; NFI = 0.940, CFI = 0.979; TLI = 0.968; RMSEA;.038). The convergent validity analyzes revealed significant correlations between BAS scores and BMI (r = –.230; p < .001) and between the first and body image satisfaction (r = .309; p < .001). The BAS version for Brazilian young adolescents had adequate levels of validity and reliability, keeping the one-dimensional structure which indicates its use in Brazilian adolescent’s samples.
How do non-Western societies envisage the relationship between the body and ageing? The present work aimed to shed light on this question by exploring how adult men and women of different ages living in Dakar, Senegal, view their bodies. A quantitative methodology was selected, and this study was carried out on a sample of 1,000 dwellers of the Senegalese capital, aged 20 and older. This sample was constructed using the quota method in order to strive for representativeness. Results indicate that appearance was highly important for Senegalese women and men, and for younger and older adults alike. As in Western cultures, beauty and youth were strongly connected. The large majority of Senegalese women and men were satisfied with their looks across the lifespan. However, older women were slightly less satisfied, consistent with the double standard hypothesis. Little discrepancy was found between felt age and chronological age throughout the entire lifecourse, arguing against an ageless self hypothesis in this African population. The mask of ageing hypothesis was also rejected, as men's and women's identification with their body did not diminish significantly across age. These observations from an African perspective call for greater attention to the ageing process in non-Western societies in order to challenge hypotheses developed in Western societies and understand more broadly the role of culture.
This study is the first to evaluate scar satisfaction and body image in thyroidectomy patients using validated assessment tools.
A total of 123 thyroidectomy patients were recruited over 8 months. Both patients and clinicians completed assessment tools that included: the Manchester Scar Scale (to measure scar perception), Dysmorphic Concern Questionnaire (to assess body image), Body Dysmorphic Concern Questionnaire (to screen for body dysmorphic disorder) and EQ-5D (to measure life quality). A separate image panel comprising experts and non-experts assessed 15 scar photographs. The results were analysed using non-parametric descriptive statistics.
Poor body image was associated with poor scar perception (ρ = 0.178, p = 0.05). Poor life quality correlated with poor scar perception (ρ = −0.292, p = 0.001). Scar length did not affect scar perception. Prevalence of body dysmorphic disorder among patients was found to be 8.94 per cent, which is higher than general population rates.
Negative body image and life quality impact negatively upon scar perception.
This research aimed to reveal the relationship between self-harm behaviour, body image, and self-esteem, and examined whether there was a difference between the body image and self-esteem of the adolescents who exhibited self-harm behaviour and those who did not. The study was conducted with the participation of 263 high school students — 143 females (54.3%) and 120 males (45.6%) — who studied in various high schools in the Trabzon province, Turkey. The students’ ages ranged from 15 to 18; the mean age was 17.02 (SD = 1.59). The research was conducted using the Inventory of Statements about Self-Injury, the Body Perception Scale, the Rosenberg Self-Esteem Scale, and a personal information form. The research concluded that there was a significant relationship between body image and self-esteem of the adolescents, and that body image and self-esteem were the significant regressors of self-harm behaviour.
Our objective was to evaluate long-term altered appearance, distress, and body image in posttreatment breast cancer patients and compare them with those of patients undergoing active treatment and with general population controls.
We conducted a cross-sectional survey between May and December of 2010. We studied 138 breast cancer patients undergoing active treatment and 128 posttreatment patients from 23 Korean hospitals and 315 age- and area-matched subjects drawn from the general population. Breast, hair, and skin changes, distress, and body image were assessed using visual analogue scales and the EORTC BR–23. Average levels of distress were compared across groups, and linear regression was utilized to identify the factors associated with body image.
Compared to active-treatment patients, posttreatment patients reported similar breast changes (6.6 vs. 6.2), hair loss (7.7 vs. 6.7), and skin changes (5.8 vs. 5.4), and both groups had significantly more severe changes than those of the general population controls (p < 0.01). For a similar level of altered appearance, however, breast cancer patients experienced significantly higher levels of distress than the general population. In multivariate analysis, patients with high altered appearance distress reported significantly poorer body image (–20.7, CI95% = –28.3 to –13.1) than patients with low distress.
Significance of results:
Posttreatment breast cancer patients experienced similar levels of altered appearance, distress, and body-image disturbance relative to patients undergoing active treatment but significantly higher distress and poorer body image than members of the general population. Healthcare professionals should acknowledge the possible long-term effects of altered appearance among breast cancer survivors and help them to manage the associated distress and psychological consequences.
The aim of the study was to investigate the relationship between body image and prevalence of underweight, normal weight, and overweight in adolescents. The study included 1702 girls and 1547 boys, aged 14–16 years, who completed questionnaire assessing body satisfaction. The participants’ BMI status: underweight, normal weight or overweight was determined on the basis of BMI cut-off values. Results revealed that more girls (p < .001) showed low body satisfaction (44.8%) and fewer girls (p < .001) had high body satisfaction (17.6%) compared to boys (28.5% and 29.0%, respectively). A two-way ANOVA revealed a significant interaction between BMI status and gender on body satisfaction F(2, 3243) = 4.10, p = .017, η2 = .003. In boys, body satisfaction was higher in normal weight and underweight in comparison to overweight individuals (p < .001). Underweight girls presented higher body satisfaction than those who were normal weight and overweight (p < .001). Our findings indicated that, in relation to gender, BMI status can be associated with different body satisfaction in adolescents. This should be taken into consideration when designing programs aimed at obesity and disordered eating prevention and body image improvement. Due to the fact that underweight girls and boys have high body satisfaction, this can lead to behaviors that maintain low body weight in adolescents and in turn this may have negative health consequences.
A higher tolerance for a larger body size has been associated with obesity in black South African (SA) women. The aim of the present study was to explore perceptions regarding body size and weight loss in a sample of black women from a low-income community in Cape Town, SA.
Qualitative pilot study including five focus groups. Data were analysed using thematic analysis.
Khayelitsha, Cape Town, SA.
Twenty-one black SA women.
The majority of participants had positive perceptions of overweight/obesity, which were influenced by community and cultural perceptions, but some inconsistencies were observed as overweight/obesity was also associated with ill health. Participants identified many benefits to weight loss, but due to the association with sickness, they were concerned about being stigmatised in their community. Although participants had knowledge about healthy eating, the main barrier to eating healthily included the perceived higher cost of healthier food and food insecurity. All participants saw exercise as a strategy to lose weight and improve health, and were interested in participating in a community-based exercise intervention, but negative community perceptions and conflicting views regarding who should lead the intervention were identified as barriers.
These findings highlight the complexities surrounding participants’ perceptions regarding body size, weight loss and weight-loss interventions, and emphasise low socio-economic status as a barrier to change. The study also highlights the strong influence of cultural ideals and community perceptions on personal perceptions. These findings underscore the necessity for culturally appropriate weight-loss interventions in low-income, transitioning communities.
Overvaluation of body shape/weight is thought to be the core psychopathology underlying eating disorders, which propels engagement in non-compensatory weight-control behaviors. In turn, these behaviors lead to binge eating and/or maintenance of low weight thereby reinforcing overvaluation. The present study investigated the reciprocal relationship between overvaluation and engagement in non-compensatory weight-control behaviors (defined in two ways: restrictive eating and compulsive exercise) among women diagnosed with anorexia nervosa or bulimia nervosa (N = 237).
Participants completed clinical interviews in which weekly eating disorder symptoms and behaviors were assessed over 2 years.
Overvaluation on a given week was associated with greater engagement in non-compensatory weight-control behaviors during the following week. Further, engagement in non-compensatory weight-control behaviors on a given week was associated with greater overvaluation during the following week. These findings held true regardless of participants’ shape/weight concerns (feelings of fatness and fat phobia), and eating disorder diagnosis.
Our data provide empirical support for key aspects of the transdiagnostic cognitive-behavioral model of eating disorders and suggest that targeting non-compensatory weight-control behaviors in treatment may help alleviate overvaluation and shape/weight concerns.
To determine the potential predictors of body size dissatisfaction in Chinese children.
The Child’s Body Image Scale was used to assess body size perception and dissatisfaction. BMI was calculated from objectively measured height and weight. Predictors of body size dissatisfaction were examined by logistic regression analysis.
Hong Kong, China.
Six hundred and twenty children (53 % boys, aged 6·1–12·9 years) from a state-run primary school.
Female sex (adjusted OR (AOR)=1·91; 95 % CI 1·32, 2·76), age (AOR=2·62; 95 % CI 1·65, 4·16 for 8–10 years; AOR=2·16; 95 % CI 1·38, 3·38 for >10 years), overweight (AOR=6·23; 95 % CI 3·66, 10·60) and obesity (AOR=19·04; 95 % CI 5·64, 64·32) were positively associated with desire to be thinner. Size misperception was a strong predictor of body size dissatisfaction, irrespective of actual weight status (AOR=1·90; 95 % CI 1·02, 3·54 for overestimation; AOR=0·43; 95 % CI 0·27, 0·67 for underestimation).
Body size dissatisfaction is prevalent among Chinese children as young as 6 years. Female sex, age, overweight, obesity and overestimation of size were associated with increased desire to be thinner. These findings emphasise the importance of preventing body image issues from an early age.
The objective was evaluating the psychometric properties of the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ–3) among Brazilian young adults of both genders. The sample was composed by 506 undergraduate students (295 females and 211 males), aged between 17 and 29 years old. Exploratory and confirmatory factor analyses were used for construct validity (N = 506). Correlations between the SATAQ–3 scores and those of the Tripartite Influence Scale (TIS) and Body Shape Questionnaire (BSQ) were used for convergent validity. Reliability was assessed through internal consistency (α) and reproducibility (test-retest) through comparison of the means obtained at two different time points and through intra-class correlation. The scale presented a factor structure composed of five factors, replicated in the confirmatory factor analysis with satisfactory values for the measurements of adjustment to the model. Correlations with the BSQ and TIS scores were rho = .52 and rho = –.35, respectively. Cronbach’s alpha coefficients were satisfactory, and their stability was demonstrated. Brazilian SATAQ–3 had good validity and reproducibility, being indicated for use in samples of Brazilian youths.
The purpose of this study was to validate the Spanish version of Motl and Conroy’s model of the Social Physique Anxiety Scale (SPAS–7). To achieve this goal, a sample of 398 secondary school students was used, and the psychometric properties of the SPAS–7 were examined through different analyses. The results supported the seven-item model, although the item 5 did not show any significant correlation with two items from this model and had a lower factor loading than the rest of items. The structure of the model was invariant across gender and Body Mass Index (BMI). Alpha value over .70 and suitable levels of temporal stability were obtained. Girls and students classified according to the BMI as overweight and obese had higher scores in social physique anxiety than boys and the group classified as underweight and normal range. The findings of this study provided reliability and validity for the SPAS–7 in a Spanish adolescent sample.
Lymphoedema secondary to cancer is a relatively neglected and under-researched condition. Few studies report people's experiences of care and treatment provision when living with the condition. Current practice focuses on the physical treatment yet psychosocial needs often remain unmet. A previous study examining the patient perspective identified the theme of being ‘abandoned by medicine’. Perceived lack of support may result in a delayed adaptation and acceptance of this long-term condition and can significantly impact on psychological well-being. We explore this emerging theme alongside others in order to provide a guide to action for improvements for patient benefit.
The central aim was to explore women's views of their care and treatment following a diagnosis with lymphoedema secondary to cancer. This forms part of a larger study aimed at assessing appropriate screening tools to measure psychosocial distress.
A mixed-methods approach was used for the main study. Here we report the qualitative component, derived from in-depth semi-structured interviews conducted in the homes of the participants (n = 14) and focus group discussions (n = 15). In addition, qualitative comments from questionnaire data from a large-scale postal survey are included (n = 104).
Participants identified considerable deficiencies in health care workers’ knowledge and awareness of lymphoedema, which subsequently impacted on the patients’ needs for information, support and understanding. Access to appropriate treatment was patchy and problems were identified with the process of obtaining compression garments, massage and other sources of help. Although lymphoedema is a long-term disfiguring condition, and much is known about how this impacts on patients’ emotional well-being, little attention was paid by health professionals to potential psychosocial consequences. In essence women had to become experts of their own condition and cope as best as they could. We provide recommendations to improve service delivery and address these unmet needs.
Research suggests that the strength of the relationship between body image and emotional distress decreases with age. Past research has focused on expected aging-related body changes, and has not yet examined unexpected body changes (e.g., breast cancer surgery). The present post-hoc study assessed relationships between age, body image, and emotional distress in women facing breast cancer surgery.
Older (≥65 years, n = 40) and younger (<65 years, n = 40) women were matched on race/ethnicity, marital status, and surgery type. Within one week prior to surgery, participants completed measures of demographics, aspects of body image, and emotional distress (general and surgery-specific).
Results indicated that: (1) body image did not differ by age (p > 0.999); (2) older women reported less pre-surgical emotional distress than younger women (p's < 0.01); and, (3) age moderated the relationship between body image and emotional distress (p's < 0.06).
Significance of results:
The results suggest that younger women, particularly those with poor body image, are at an increased risk for pre-surgical emotional distress. These women may benefit from pre-surgical interventions designed to improve body image or to reduce pre-surgical emotional distress.
Background: The aim of this study was to assess the relationships between gender, migration status, perceived health, body image, and sexual activity and satisfaction among older adults. It was hypothesized that men and those who are long-standing residents in Israel will report better perceived health, a positive body image, and these will be associated with greater sexuality, compared with women, new immigrants with poorer perceived health and a negative body image.
Methods: The sample included 200 respondents who were 60 years and older, functionally independent and living with a spouse or a partner for at least one year, heterosexual, and living in the community in Israel. Respondents were recruited through community-based services for older persons and snowballing. Multivariate analyses were performed to examine differences by groups of respondents and to identify the best predictors of the outcome variables.
Results: The majority had some kind of sexual activity. No significant differences were found between men and women with regard to perceived health, body image, sexual activity and satisfaction, but significant differences were found between new immigrants from former Soviet Union countries and long-standing residents in Israel. Mental health, age, and migration status were significant in explaining sexual activity, while age, education, and sexual activity were significant in explaining sexual satisfaction.
Conclusions: A variety of factors play a role with regard to sexuality in old age, in particular immigration status. Appropriate interventions can help older adults cope with the determinants that negatively affect their mental health and sexual life.
Background: Different body-related behaviours and cognitions (checking, avoidance, comparison, display) have been shown to be related to unhealthy eating attitudes in a non-clinical sample. Aims: This study tested whether the use of body-related behaviours is higher in eating-disordered women than in non-clinical women. It also examined whether the use of body-related behaviours is associated with psychological characteristics (particularly anxiety, depression and narcissistic characteristics), controlling for age and eating pathology. Method: Ninety-nine adult women with diagnosed eating disorders (mean age = 30.4 years, SD = 9.44; mean body mass index = 21.9, SD = 6.39) completed standardized measures of eating pathology, anxiety and depression, narcissistic characteristics, and body-related behaviours and cognitions. Results: The Body-Related Behaviours Scale (BRBS) had acceptable levels of internal consistency in this group, and its scales were only weakly to moderately correlated with each other. There were no differences between diagnostic groups, but the clinical group had higher scores that a previous non-clinical sample on three of the scales. The four body-related behaviours had different patterns of association with eating pathology, depression and narcissistic features. However, anxiety was not associated with BRBS scores. Conclusions: The findings support the importance of a wide range of body-related behaviours and cognitions in understanding the eating disorders. However, the lack of an association with anxiety is counter to the suggestion that the various behaviours measured by the BRBS reflect safety behaviours on the part of sufferers. Depression and narcissistic features might be more important in maintaining such behaviours.