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Munns LB, Preston C. The role of bodily experiences during pregnancy on mother and infant outcomes. J Neuropsychol 2024. [PMID: 38764291 DOI: 10.1111/jnp.12370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/11/2024] [Accepted: 04/15/2024] [Indexed: 05/21/2024]
Abstract
Pregnancy is a transformative time for women and their bodies, and therefore thoughts and feelings and about one's own body and internal bodily sensations may understandably change during this period. Body satisfaction and interoception have been found to influence factors such as antenatal attachment (AA) and maternal mental health. However, mixed results in the literature suggest complex relationships between the bodily experience during pregnancy and outcomes, necessitating a broader investigative approach. We aim to examine the relationship between the pregnancy bodily experience and multiple mother-infant outcomes. It is hypothesised that poor bodily experiences during pregnancy will have negative impacts on these outcomes. Cross-sectional online survey data was collected from individuals at various gestations throughout pregnancy as part of a larger longitudinal study (N = 253, mean age = 32). We analysed validated measures of pregnancy body satisfaction, interoceptive sensibility, AA and mood, as well as intentions to breastfeed. Linear regressions were used to confirm findings from previous literature and a network analysis allowed for a more exploratory approach to understanding the importance of the bodily experience during pregnancy. Multiple regressions found low body satisfaction predicts higher levels of anxiety, depression and AA. A network analysis revealed relationships between body satisfaction and interoception during pregnancy and mother-infant outcomes, including depression and AA. Our results highlight the far-reaching effects of poor bodily experiences during pregnancy on a variety of outcomes. Understanding the impact of the pregnant bodily experience can help identify at-risk individuals and inform interventions.
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Murray K, Dawel A, Batterham PJ, Gulliver A, Farrer LM, Rodney Harris RM, Shou Y, Calear AL. Cognitive reappraisal moderates the protective effect of body satisfaction on mental health and wellbeing in adults: A prospective study during COVID-19 lockdown. J Affect Disord 2024; 351:268-277. [PMID: 38290577 DOI: 10.1016/j.jad.2024.01.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Body satisfaction is associated with mental health and well-being in adults. However, prospective studies are needed to better understand its protective effects, and in whom these are most beneficial. This study investigated body satisfaction as a predictor of depressive symptoms, generalised anxiety, and well-being in a representative Australian sample collected during the initial COVID-19 lockdown. Two emotion regulation strategies - cognitive reappraisal and expressive suppression - were also tested as moderating variables. METHODS The sample comprised 684 adults aged 19 to 87 years who completed three primary waves of data spanning two months [Wave 3 (W3), W4 and W7] from the Australian National COVID-19 Mental Health, Behaviour and Risk Communication Survey. RESULTS Hierarchical multiple regression models controlling for demographic and COVID-19 risk factors, as well as W3 for each outcome variable, indicated that W3 body satisfaction predicted greater W7 well-being, and fewer W7 depressive symptoms and greater W7 well-being in participants reporting low levels of W4 cognitive reappraisal. No moderation for W4 expressive suppression was observed, nor predictive relationships between W3 body satisfaction and W7 anxiety. LIMITATIONS The two-month follow-up period precludes conclusions relating to the longer-term protective effects of body satisfaction within and beyond the pandemic context. Examination of focal relationships in clinical samples, and inclusion of broader indices of body image, emotion regulation and mental health, is needed in future studies. CONCLUSIONS Findings suggest body satisfaction warrants attention in community well-being promotion in adults, and may be particularly beneficial for those lack adaptive emotion regulation strategies.
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Affiliation(s)
- Kristen Murray
- School of Medicine and Psychology, College of Health and Medicine, Building 39, The Australian National University, Canberra ACT 2601, Australia.
| | - Amy Dawel
- School of Medicine and Psychology, College of Health and Medicine, Building 39, The Australian National University, Canberra ACT 2601, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, College of Health and Medicine, 63 Eggleston Road, The Australian National University, Canberra ACT 2601, Australia
| | - Amelia Gulliver
- Centre for Mental Health Research, College of Health and Medicine, 63 Eggleston Road, The Australian National University, Canberra ACT 2601, Australia
| | - Louise M Farrer
- Centre for Mental Health Research, College of Health and Medicine, 63 Eggleston Road, The Australian National University, Canberra ACT 2601, Australia
| | - Rachael M Rodney Harris
- Fenner School of Environment and Society, College of Science, The Australian National University, Canberra ACT 2601, Australia
| | - Yiyun Shou
- School of Medicine and Psychology, College of Health and Medicine, Building 39, The Australian National University, Canberra ACT 2601, Australia; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549; Lloyd's Register Foundation Institute for The Public Understanding of Risk, National University of Singapore, Singapore 117602
| | - Alison L Calear
- Centre for Mental Health Research, College of Health and Medicine, 63 Eggleston Road, The Australian National University, Canberra ACT 2601, Australia
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Eggart M, Valdés-Stauber J, Müller-Oerlinghausen B, Heinze M. Dysfunctional self-reported interoception predicts residual symptom burden of fatigue in major depressive disorder: an observational study. BMC Psychiatry 2023; 23:667. [PMID: 37700276 PMCID: PMC10498532 DOI: 10.1186/s12888-023-05168-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Fatigue is a core symptom of major depressive disorder (MDD) and is frequently refractory to antidepressant treatment, leading to unfavorable clinical/psychosocial outcomes. Dysfunctional self-reported interoception (i.e., maladaptive focus on the body's physiological condition) is prevalent in MDD and could contribute to residual symptom burden of fatigue. Therefore, we explored (a.) cross-sectional correlations between both dimensions and investigated (b.) prospective associations between interoceptive impairments at admission and symptom severity of fatigue at the end of hospitalization. METHODS This observational, exploratory study included 87 patients suffering from MDD who completed self-rating scales, the Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2), and the Multidimensional Fatigue Inventory (MFI-20), at the beginning and end of hospitalization. Bivariate correlations (r) and hierarchical regression analyses were performed. RESULTS The cross-sectional analysis showed moderate to large negative correlations between the MAIA-2 and MFI-20 dimensions except for the Not-Distracting scale. Symptoms of general, physical, and mental fatigue at the end of hospitalization were predicted by reduced body Trusting (β = -.31, p = .01; β = -.28, p = .02; β = -.31, p = .00, respectively). Increased Body Listening (β = .37, p = .00), Not-Worrying (β = .26, p = .02), and diminished Attention Regulation (β = -.32, p = .01) predicted higher mental fatigue. CONCLUSIONS Diminished body confidence at baseline identified patients at risk for post-treatment fatigue and could therefore serve as a target for improving antidepressant therapy. Body-centered, integrative approaches could address treatment-resistant fatigue in MDD. However, clinicians may also consider the potential adverse effect of increased Body Listening and Not-Worrying on mental fatigue in psychotherapeutic and counselling approaches. Due to the exploratory nature of this study, the results are preliminary and need to be replicated in pre-registered trials with larger sample sizes.
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Affiliation(s)
- Michael Eggart
- Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, Neuruppin, 16816, Germany.
- Department of Psychiatry and Psychotherapy I, Ulm University and Center for Psychiatry Südwürttemberg, Ravensburg, 88214, Germany.
- Faculty Social Work, Health and Nursing, Ravensburg-Weingarten University of Applied Sciences, Weingarten, 88250, Germany.
| | - Juan Valdés-Stauber
- Department of Psychiatry and Psychotherapy I, Ulm University and Center for Psychiatry Südwürttemberg, Ravensburg, 88214, Germany
| | - Bruno Müller-Oerlinghausen
- Faculty of Medicine and Psychology, Brandenburg Medical School Theodor Fontane, Neuruppin, 16816, Germany
- Charité - Universitätsmedizin Berlin, Berlin, 10117, Germany
| | - Martin Heinze
- Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, Neuruppin, 16816, Germany
- Faculty of Medicine and Psychology, Brandenburg Medical School Theodor Fontane, Neuruppin, 16816, Germany
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, 15562, Germany
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Pehlivan MJ, Sherman KA, Wuthrich V, Horn M, Basson M, Duckworth T. Body image and depression in endometriosis: Examining self-esteem and rumination as mediators. Body Image 2022; 43:463-473. [PMID: 36345084 DOI: 10.1016/j.bodyim.2022.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
Endometriosis is a chronic systemic disease affecting 1 in 10 people assigned female at birth, that can result in appearance-based and functional bodily changes which can negatively impact body image. Empirical evidence supports the body dissatisfaction-driven hypothesis that negative body image leads to greater depressive symptoms; but potential underlying mechanisms are under-researched. This prospective study investigated the mediating role of two theoretically-derived intervening factors, self-esteem and rumination, in individuals living with endometriosis who typically report high rates of body image concerns and depressive symptoms. Initially, 996 participants completed the first online survey (T0) assessing demographic, medical and psychological factors. Of these, 451 completed surveys at 1-month (T1) and 2-months (T2) follow-up assessing self-esteem, rumination and depression. Bootstrapped analyses with full-information maximum likelihood estimation indicated that poor body image (T0) predicted greater depressive symptoms over time (T2). Self-esteem (T1), but not rumination (T1), mediated the body image-depression relationship. These results provide support for the body dissatisfaction-driven hypothesis and further identify that self-esteem is a key meditating factor. This highlights the importance of addressing self-esteem in body image focused interventions.
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Affiliation(s)
- Melissa J Pehlivan
- Centre for Emotional Health, Department of Psychological Sciences, Macquarie University, NSW, Australia
| | - Kerry A Sherman
- Centre for Emotional Health, Department of Psychological Sciences, Macquarie University, NSW, Australia.
| | - Viviana Wuthrich
- Centre for Emotional Health, Department of Psychological Sciences, Macquarie University, NSW, Australia
| | - Mary Horn
- Centre for Emotional Health, Department of Psychological Sciences, Macquarie University, NSW, Australia
| | - Michelle Basson
- Centre for Emotional Health, Department of Psychological Sciences, Macquarie University, NSW, Australia
| | - Tanya Duckworth
- School of Psychology, University of Adelaide, South Australia, Australia
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Rekkers ME, Aardenburg L, Scheffers M, van Elburg AA, van Busschbach JT. Shifting the Focus: A Pilot Study on the Effects of Positive Body Exposure on Body Satisfaction, Body Attitude, Eating Pathology and Depressive Symptoms in Female Patients with Eating Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11794. [PMID: 36142068 PMCID: PMC9517204 DOI: 10.3390/ijerph191811794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
One of the most commonly used techniques for the treatment of body image problems in eating disorders (ED) is body exposure (BE). However, evidence of its effectiveness in clinical populations is scarce. In the Positive Body Experience (PBE) protocol, the focus of positive BE is on aesthetic, functional and tactile aspects of the body. The current study evaluates the outcomes of positive BE with regard to changes in attitudinal body image and eating pathology, as well as the factors that influence these changes, in a sample of 84 adult female patients with different EDs who did not receive any other treatment for their EDs during the period in which BE treatment occurred. The results show significant positive changes in attitudinal body image, ED behaviors and depressive symptoms, with depressive symptoms at baseline mediating the changes in attitudinal body image. This study indicates that the PBE protocol is a suitable intervention for reducing negative attitudinal body image in anorexia and bulimia nervosa patients, as well as those with binge eating disorder. Furthermore, the results suggest that positive non-weight-related and functional body satisfaction are strong catalysts for change and that depressive symptoms play an important role in the ability to change. Additional RCTs are needed to gain more insight into the effects of PBE.
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Affiliation(s)
- Marlies E. Rekkers
- Faculty of Social Sciences, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
- Department of Human Movement and Education, Windesheim University of Applied Sciences, Campus 2-6, 8017 CA Zwolle, The Netherlands
| | - Lisanne Aardenburg
- GGZ inGeest, Mental Health Institute, Laan van de Helende Meesters 433, 1186 DL Amstelveen, The Netherlands
| | - Mia Scheffers
- Department of Human Movement and Education, Windesheim University of Applied Sciences, Campus 2-6, 8017 CA Zwolle, The Netherlands
| | - Annemarie A. van Elburg
- Faculty of Social Sciences, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
- Rintveld, Centre for Eating Disorders, Altrecht Mental Health Institute, 3705 WE Zeist, The Netherlands
| | - Jooske T. van Busschbach
- Department of Human Movement and Education, Windesheim University of Applied Sciences, Campus 2-6, 8017 CA Zwolle, The Netherlands
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Rob Giel Onderzoekcentrum, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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Kalisvaart H, van Broeckhuysen-Kloth S, van Busschbach JT, Geenen R. Picturing disturbed body experience: A comparison of body drawings in persons with somatoform disorder and a general population sample. Psychiatry Res 2022; 314:114661. [PMID: 35691104 DOI: 10.1016/j.psychres.2022.114661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 05/05/2022] [Accepted: 05/31/2022] [Indexed: 11/19/2022]
Abstract
People with somatic symptom disorder or somatoform disorder are considered to have a troubled relationship to their body that is hard to assess with self-report questionnaires alone. To examine the potential value of own-body drawings as an assessment tool, objective features of drawings from 179 patients referred to treatment for somatoform disorder, were compared to those of 173 age-and-sex matched persons from the general population. While two factors had been found in the somatoform disorder sample, in the general population only the factor that reflected 'details' in own-body drawings was replicated. The two samples did not score differently on this factor. The general population sample showed a less strong association between objective body drawings scores on this 'details' factor and self-reported scores of body experience than the somatoform disorder sample. Moreover, the phenomenological contents of the drawings were more oriented towards health or appearance than the mostly mixed or unclear orientation of persons with somatoform disorder. Because the objective scoring of body drawings did not differ between groups while the contents of body drawings appeared to differ, the results suggest that this objective scoring of body drawings is not appropriate to distinguish people with and without somatoform disorder.
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Affiliation(s)
- Hanneke Kalisvaart
- Altrecht Psychosomatic Medicine Eikenboom, Altrecht, Zeist, the Netherlands; School of Human Movement and Education, Windesheim University of Applied Sciences, Zwolle, the Netherlands.
| | | | - Jooske T van Busschbach
- School of Human Movement and Education, Windesheim University of Applied Sciences, Zwolle, the Netherlands; University Center of Psychiatry, University Medical Center, University of Groningen, Groningen, the Netherlands
| | - Rinie Geenen
- Altrecht Psychosomatic Medicine Eikenboom, Altrecht, Zeist, the Netherlands; Department of Psychology, Utrecht University, Utrecht, the Netherlands
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Petruzzelli MG, Margari L, Furente F, Marzulli L, Piarulli FM, Margari A, Ivagnes S, Lavorato E, Matera E. Body Emotional Investment and Emotion Dysregulation in a Sample of Adolescents with Gender Dysphoria Seeking Sex Reassignment. J Clin Med 2022; 11:jcm11123314. [PMID: 35743384 PMCID: PMC9224617 DOI: 10.3390/jcm11123314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023] Open
Abstract
Adolescents with gender dysphoria (GD) often have internalizing symptoms, but the relationship with affective bodily investment and emotion dysregulation is actually under-investigated. The aims of this study are: (1) the comparison of Self-Administrated Psychiatric Scales for Children and Adolescents’ (SAFA), Body Investment Scale’s (BIS), and Difficulties in Emotion Regulation Scale’s (DERS) scores between GD adolescents (n = 30) and cisgenders (n = 30), (2) finding correlations between body investment and emotion regulation in the GD sample, (3) evaluating the link between these dimensions and internalizing symptomatology of GD adolescents. In addition to the significant impairment in emotion regulation and a negative body investment in the GD sample, Spearman’s correlation analyses showed a relationship between worse body protection and impaired emotion regulation, and binary logistic regressions of these dimensions on each SAFA domain evidenced that they may have a role in the increased probability of pathological scores for depression. Our results focused on the role played by emotion regulation and emotional investment in the body in the exacerbating and maintenance of internalizing symptoms, in particular depression, and self-harming behaviors in GD adolescents.
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Affiliation(s)
- Maria Giuseppina Petruzzelli
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (M.G.P.); (L.M.); (F.M.P.); (A.M.)
| | - Lucia Margari
- Department of Biomedical Sciences and Human Oncology, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (L.M.); (S.I.); (E.M.)
| | - Flora Furente
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (M.G.P.); (L.M.); (F.M.P.); (A.M.)
- Correspondence:
| | - Lucia Marzulli
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (M.G.P.); (L.M.); (F.M.P.); (A.M.)
| | - Francesco Maria Piarulli
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (M.G.P.); (L.M.); (F.M.P.); (A.M.)
| | - Anna Margari
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (M.G.P.); (L.M.); (F.M.P.); (A.M.)
| | - Sara Ivagnes
- Department of Biomedical Sciences and Human Oncology, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (L.M.); (S.I.); (E.M.)
| | - Elisabetta Lavorato
- Psychiatry Unit, Azienda Ospedaliero-Universitaria Policlinico di Bari, 70100 Bari, Italy;
| | - Emilia Matera
- Department of Biomedical Sciences and Human Oncology, University Hospital “A. Moro”, Piazza Giulio Cesare 11, 70100 Bari, Italy; (L.M.); (S.I.); (E.M.)
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Black women's experiences of gendered racial sexual objectification, body image, and depressive symptoms. Body Image 2022; 41:443-452. [PMID: 35567996 DOI: 10.1016/j.bodyim.2022.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/16/2022] [Accepted: 04/28/2022] [Indexed: 11/20/2022]
Abstract
Black women navigate unique sexual objectification experiences and concerns about their bodies as a consequence of the race- and gender-based marginalization that they face. However, less is known about the influence of gendered racial sexual objectification experiences on Black women's mental health (i.e., depressive symptoms) or the contributions of key body image indicators (i.e., body surveillance and current-ideal body image discrepancy) that reflect Black women's engagement in monitoring and managing their bodies. We surveyed 1595 Black women to test our hypotheses that experiences of gendered racial sexual objectification (i.e., frequency and stress appraisal) would be positively associated with depressive symptoms and that body surveillance and current-ideal body image discrepancy would moderate this association. Analyses showed that more frequent experiences of gendered racial sexual objectification and higher stress appraisal of these experiences were significantly associated with more depressive symptoms. Furthermore, body surveillance and current-ideal body image discrepancy moderated the relation between gendered racial sexual objectification and depressive symptoms. Findings highlight how Black women's objectification and increased engagement in body monitoring and management practices are associated with their experiences of depressive symptoms, and thus, may negatively influence their mental health.
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Rekkers ME, Scheffers M, van Busschbach JT, van Elburg AA. Measuring body satisfaction in women with eating disorders and healthy women: appearance-related and functional components in the Body Cathexis Scale (Dutch version). Eat Weight Disord 2021; 26:2665-2672. [PMID: 33591559 PMCID: PMC8602219 DOI: 10.1007/s40519-021-01120-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 01/19/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Differentiating the concept of body satisfaction, especially the functional component, is important in clinical and research context. The aim of the present study is to contribute to further refinement of the concept by evaluating the psychometric properties of the Dutch version of the Body Cathexis Scale (BCS). Differences in body satisfaction between clinical and non-clinical respondents are also explored. METHOD Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to investigate whether functional body satisfaction can be distinguished as a separate factor, using data from 238 adult female patients from a clinical sample and 1060 women from two non-clinical samples in the Netherlands. Univariate tests were used to identify differences between non-clinical and clinical samples. RESULTS EFA identified functionality as one of three factors, which was confirmed by CFA. CFA showed the best fit for a three-factor model, where functionality, non-weight, and weight were identified as separate factors in both populations. Internal consistency was good and correlations between factors were low. Women in the non-clinical sample scored significantly higher on the BCS than women with eating disorders on all three subscales, with high effect sizes. CONCLUSIONS The three factors of the BCS may be used as subscales, enabling researchers and practitioners to use one scale to measure different aspects of body satisfaction, including body functionality. Use of the BCS may help to achieve a more complete understanding of how people evaluate body satisfaction and contribute to further research on the effectiveness of interventions focussing on body functionality. LEVEL OF EVIDENCE Cross-sectional descriptive study, Level V.
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Affiliation(s)
- Marlies E Rekkers
- Faculty of Social Sciences, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands. .,School of Human Movement and Education, Windesheim University of Applied Sciences, Campus 2-6, 8017 CA, Zwolle, The Netherlands.
| | - Mia Scheffers
- School of Human Movement and Education, Windesheim University of Applied Sciences, Campus 2-6, 8017 CA, Zwolle, The Netherlands
| | - Jooske T van Busschbach
- School of Human Movement and Education, Windesheim University of Applied Sciences, Campus 2-6, 8017 CA, Zwolle, The Netherlands.,Rob Giel Research Center, University Medical Center Groningen, University Center of Psychiatry, University of Groningen, P. O Box 30.001, CC72, 9700 RB, Groningen, The Netherlands
| | - Annemarie A van Elburg
- Faculty of Social Sciences, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands.,Centre for Eating Disorders, Altrecht Mental Health Institute, Rintveld, 3705WE, Zeist, The Netherlands
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Dinesh AA, Helena Pagani Soares Pinto S, Brunckhorst O, Dasgupta P, Ahmed K. Anxiety, depression and urological cancer outcomes: A systematic review. Urol Oncol 2021; 39:816-828. [PMID: 34503900 DOI: 10.1016/j.urolonc.2021.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/25/2021] [Accepted: 08/05/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The interplay between physical and mental aspects of a cancer diagnosis are well recognised. However, little consensus exists on the impact of depression and anxiety on urological cancer outcomes. Therefore, this systematic review aimed to investigate the relationship between these conditions and functional or oncological outcomes in urological malignancy. MATERIALS AND METHODS A systematic search was conducted using PubMed, Embase, PsycINFO and Global Health databases up to June 2020. Studies evaluating the relationship of anxiety and depression disorders or symptoms on functional and mortality outcomes were included. Outcome measures included validated urinary, sexual, body image questionnaire scores and all-cause or disease-specific mortality. RESULTS Of 3,966 studies screened, 25 studies with a total of 175,047 urological cancer patients were included. Significant anxiety and depressive symptoms and disorders were found to impact functional outcomes in several cancer types. A consistent negative association existed for sexual function in prostate, testicular and penile cancer patients. Additionally, poorer urinary function scores were seen in prostate cancer, with increased body image issues in testicular and prostate cancer. Importantly, both overall and disease-specific mortality outcomes were poorer in bladder and prostate cancer patients. CONCLUSIONS Co-existing depression and anxiety appears to be negatively associated with functional and mortality outcomes in urological cancers. This appears especially evident in male cancers, including prostate and testicular cancer. Although not proving causation, these findings highlight the importance of considering mental wellbeing during follow-up for early recognition and treatment. However, current evidence remains heterogenous, with further studies required exploring patients at risk.
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Affiliation(s)
- Ayushi Anna Dinesh
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | | | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom; Department of Urology, King's College Hospital, London, United Kingdom.
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11
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Eggart M, Todd J, Valdés-Stauber J. Validation of the Multidimensional Assessment of Interoceptive Awareness (MAIA-2) questionnaire in hospitalized patients with major depressive disorder. PLoS One 2021; 16:e0253913. [PMID: 34170963 PMCID: PMC8232409 DOI: 10.1371/journal.pone.0253913] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/16/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Interoception refers to the sensation, interpretation, and integration of internal somatic signals. Abnormalities in self-reported interoception are prevalent features of major depressive disorder (MDD) and may affect treatment outcomes. In the present study, we investigated the psychometric properties of the revised eight-dimensional and 37-item Multidimensional Assessment of Interoceptive Awareness questionnaire (the MAIA-2) in a severely depressed sample, after translating two updated scales (Not-Distracting, Not-Worrying) into German. Specifically, we examined the measure's internal consistency reliability, sensitivity to change, and minimal important differences (MID) with a focus on patient's antidepressive responses to treatment. METHODS The study enrolled 110 participants (age: M = 46.85, SD = 11.23; female: 55.45%) undergoing hospital treatment, of whom 87 were included in the pre-post analysis. Participants completed a German translation of MAIA-2 and the Beck Depression Inventory-II (pre-/post-treatment). Internal consistency reliability was determined by Cronbach's α/McDonalds's ω, sensitivity to change was determined by effect sizes, and MIDs were determined by distribution- (0.5*SD) and anchor-based approaches (mean change method; ROC curve cut-points). RESULTS Depression severity reduced over the course of treatment (Median = -65.22%), and 34.48% of patients achieved remission. Reliability was appropriate for post-treatment (range of ω: .70-.90), but questionable for two pre-treatment scales (Noticing: ω = .64; Not-Distracting: ω = .66). The eight dimensions of MAIA-2 were sensitive to change (standardized response mean: .32-.81; Cohen's effect size: .30-.92). Distribution-based MIDs (.38-.61) and anchor-based mean change MIDs (remission vs. partial response: .00-.85; partial response vs. nonresponse: .08-.88) were established on the group level. For six scales, ROC cut-points (remission: .00-1.33; response: -.20-1.00) demonstrated accurate classification to treatment response groups on the individual level. CONCLUSIONS This study demonstrated the applicability of the MAIA-2 questionnaire in MDD. The updated version may have led to reliability improvements regarding the revised scales, but subthreshold reliability was evident prior to treatment. The measure's dimensions were sensitive to change. MIDs were established that corresponded with antidepressive treatment outcomes. Our findings are consistent with a growing area of research which considers somatic feelings as key contributors to mental health.
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Affiliation(s)
- Michael Eggart
- Department of Psychiatry and Psychotherapy I, Ulm University and Center for Psychiatry Südwürttemberg, Ravensburg, Germany
- Faculty Social Work, Health and Nursing, Ravensburg-Weingarten University of Applied Sciences, Weingarten, Germany
| | - Jennifer Todd
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, United Kingdom
- Centre for Psychological Medicine, Perdana University, Kuala Lumpur, Malaysia
| | - Juan Valdés-Stauber
- Department of Psychiatry and Psychotherapy I, Ulm University and Center for Psychiatry Südwürttemberg, Ravensburg, Germany
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Dunne J, Flores M, Gawande R, Schuman-Olivier Z. Losing trust in body sensations: Interoceptive awareness and depression symptom severity among primary care patients. J Affect Disord 2021; 282:1210-1219. [PMID: 33601698 PMCID: PMC10398840 DOI: 10.1016/j.jad.2020.12.092] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Interoceptive dysfunction is emerging as an important biomarker for mental illnesses, such as depression which is a leading cause of disability and death worldwide. Little empirical research explains the relationship between interoception and depression. METHODS Using multivariable linear regression models and cross-sectional baseline data from a randomized control trial of primary care patients (N = 281), we analyzed the relationship between depression severity (none/slight, mild, and moderate/severe via the PROMIS depression scale) and the Multidimensional Assessment of Interoceptive Awareness (MAIA) subscales (noticing, not distracting, not worrying, attention regulation, emotional awareness, selfregulation, body listening and trusting). RESULTS Adjusted results suggest moderate/severe depression was inversely associated with body trusting (p < .001), body listening (p < .01), noticing (p < .01), emotional awareness (p < .01), and self-regulation (p < .05). Mild depression was inversely associated with body trusting (p <.01). After correction for multiple comparisons, the relationship between MAIA body trusting and mild and moderate/severe depression remained significant. LIMITATIONS Our findings may not be generalizable to other populations or healthcare settings. Additionally, findings cannot be interpreted as causal due to our inability to establish temporality. CONCLUSIONS Lack of body trust appears important for understanding how individuals with depression interpret or respond to interoceptive stimuli and may represent the leading edge of interoceptive dysregulation seen in depressive disorders. Our findings support a hypothesis about mechanisms of action underlying hypoactivation in depression. Further, these results support clinical identification of subtypes of depression, such as those with high levels of co-occurring anxiety.
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Affiliation(s)
- Julie Dunne
- Cambridge Health Alliance, Center for Mindfulness and Compassion, 1035 Cambridge Street, Suite 21, Cambridge, MA, 02141, USA; Boston College, W. F. Connell School of Nursing, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA.
| | - Michael Flores
- Cambridge Health Alliance, Health Equity Research Lab, 1035 Cambridge Street, Suite 26, Cambridge, MA, 02141, USA; Harvard Medical School, Department of Psychiatry, 1493 Cambridge Street, Cambridge, MA, 02139, USA
| | - Richa Gawande
- Cambridge Health Alliance, Center for Mindfulness and Compassion, 1035 Cambridge Street, Suite 21, Cambridge, MA, 02141, USA; Harvard Medical School, Department of Psychiatry, 1493 Cambridge Street, Cambridge, MA, 02139, USA
| | - Zev Schuman-Olivier
- Cambridge Health Alliance, Center for Mindfulness and Compassion, 1035 Cambridge Street, Suite 21, Cambridge, MA, 02141, USA; Harvard Medical School, Department of Psychiatry, 1493 Cambridge Street, Cambridge, MA, 02139, USA
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13
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Can changes in multidimensional self-reported interoception be considered as outcome predictors in severely depressed patients? A moderation and mediation analysis. J Psychosom Res 2021; 141:110331. [PMID: 33338695 DOI: 10.1016/j.jpsychores.2020.110331] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/05/2020] [Accepted: 12/06/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Somatic complaints (e.g. pain) and abnormal self-reported interoception (e.g. maladaptive bodily self-focus) are common features of major depressive disorder (MDD) with sex-specific manifestations. Whereas somatic symptoms are associated with adverse clinical outcomes (e.g. residual symptoms), studies are scarce investigating the role of interoception as an outcome predictor for specific hospital treatment of MDD. Therefore, multivariate associations between changes in multidimensional self-reported interoception, somatic symptoms, and clinical improvements are explored by hypothesizing interactions with sex and an interoceptive mechanism. METHODS In this naturalistic study, 87 hospitalized participants suffering from MDD completed questionnaires at pre- and post-treatment assessing multidimensional self-reported interoception (MAIA-2), somatic symptom burden (SCL-90-S® SOMA), and depression severity (BDI-II). We performed a multiple hierarchical regression analysis to test for interaction effects. The mediation hypothesis was path-analytically tested in a parallel mediation model by bootstrapping confidence intervals for (in)direct effects. RESULTS Improvements in self-reported interoception independently predicted positive treatment response, ΔRadj2=8.61%, ΔF(8, 74) = 3.23, p < .01. Prediction effects were moderated by sex, ΔRadj2=5.54%, ΔF(8, 66) = 2.22, p < .05. Post-hoc analyses revealed significant effects of body confidence in women, B = -4.26, t(28) = -2.78, p < .01, and of self-regulation in men, B = -3.21, t(17) = -2.27, p < .05. Effects of somatic symptom relief on treatment outcome were partially mediated by self-reported interoception, total indirect = 2.94 [95% BCa CI 0.99, 5.69]. CONCLUSION Interoception patterns changed significantly and predicted outcome of hospital treatment in severely depressed patients. Our study could imply the need to consider body sensations additionally as a target for antidepressive treatments. The development of tailored interoceptive interventions in depressive patients represents a promising vision for the future.
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van Mierlo LA, Scheffers M, Koning I. The relative relation between body satisfaction, body investment, and depression among dutch emerging adults. J Affect Disord 2021; 278:252-258. [PMID: 32971318 DOI: 10.1016/j.jad.2020.09.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/29/2020] [Accepted: 09/08/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Depression is one of the biggest global health problems, especially among emerging adults (18 to 25). A negative body image is a well-known risk factor for the development of depressive symptoms. However, little is known about how different aspects of body image relate to depressive symptoms. Therefore, the current study explores the relation between body satisfaction, body investment, and depressive symptoms, moderated by sex and physical activity, among a non-clinical sample of emerging adults. METHODS Cross-sectional data from 410 Dutch emerging adults (Mage = 21.95 years, SD = 1.98, 80.60% women) within a convenience sample was used within a hierarchical multiple regression analysis. RESULTS Results showed that a higher body satisfaction and more body investment were related to fewer depressive symptoms. This relation was somewhat stronger for body investment than for body satisfaction. Furthermore, the relation between lower body satisfaction and more depressive symptoms was stronger for participants with a lower level of physical activity. No other moderation effects were found. LIMITATIONS This results should be seen within the light of their limitations. This study used cross-sectional data and therefore no causal relations can be determined. Also, the sample was biased in which mostly highly educated females participated. CONCLUSIONS However, this research is unique for adding different concepts of body image in one model. The findings propose that interventions regarding depressive symptoms among emerging adults should focus, next to body satisfaction, on the emotional investment in the body and the enhancement of physical activity.
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Affiliation(s)
- Lieselot A van Mierlo
- Windesheim University of Applied Sciences, Campus 2, 8017 CA Zwolle, the Netherlands.
| | - Mia Scheffers
- Windesheim University of Applied Sciences, Campus 2, 8017 CA Zwolle, the Netherlands
| | - Ina Koning
- Utrecht University, Padualaan 14, 3584 CH Utrecht, the Netherlands
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15
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Kogure GS, Ribeiro VB, Lopes IP, Furtado CLM, Kodato S, Silva de Sá MF, Ferriani RA, Lara LADS, Maria Dos Reis R. Body image and its relationships with sexual functioning, anxiety, and depression in women with polycystic ovary syndrome. J Affect Disord 2019; 253:385-393. [PMID: 31082731 DOI: 10.1016/j.jad.2019.05.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/06/2019] [Accepted: 05/04/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is associated with lower levels of satisfaction with body image, which can affect sexuality and social well-being. Thus, we evaluated body image in women with PCOS and its association with body dis(satisfaction), anthropometric indices, sexual function, anxiety, and depression. METHODS In this cross-sectional study, 94 women of reproductive age were grouped by body mass index (BMI) and sexual function. The Female Sexual Function Index (FSFI), Body Shape Questionnaire (BSQ), Figure Rating Scale (FRS), hospital anxiety (HADS-A) and depression (HADS-D) measurement scales, and anthropometric indices were used for data collection. RESULTS Women with PCOS presented with perceptual distortions of self-image independent of sexual function and BMI. There were negative correlations between HADS-A and HADS-D scores and the FSFI total score, and HADS-D scores had positive correlations with weight, anthropometric indices, and BSQ total score. The degree of dis(satisfaction) was a predictor of FSFI total score, depression, and anxiety, and the FSFI total score was predicted by HADS-D. Desired and ideal-gender BMIs were risk factors for sexual dysfunction, and overweight and obesity were risk factors for the degree of dis(satisfaction). LIMITATIONS This study had the limitations of using a cross-sectional design and it investigated a restricted number of clinical/biochemical parameters, as well as lacked objective measures of acne and hirsutism, and a control group. CONCLUSIONS Perception and cognitive-affective dimensions appear to play important roles in body image dysfunction in women with PCOS, and impact sexual dysfunction and depression associated the syndrome. Furthermore, these results provide additional treatment considerations for women with PCOS.
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Affiliation(s)
- Gislaine Satyko Kogure
- Ribeirão Preto Medical School, Human Reproduction Sector, Departament of Gynecology and Obstetrics, University of São Paulo, Ribeirão Preto 14049-900 SP, Brazil.
| | - Victor Barbosa Ribeiro
- Ribeirão Preto Medical School, Human Reproduction Sector, Departament of Gynecology and Obstetrics, University of São Paulo, Ribeirão Preto 14049-900 SP, Brazil; Federal Institute of São Paulo, Jacareí Campus, Brazil
| | - Iris Palma Lopes
- Ribeirão Preto Medical School, Human Reproduction Sector, Departament of Gynecology and Obstetrics, University of São Paulo, Ribeirão Preto 14049-900 SP, Brazil
| | - Cristiana Libardi Miranda Furtado
- Ribeirão Preto Medical School, Human Reproduction Sector, Departament of Gynecology and Obstetrics, University of São Paulo, Ribeirão Preto 14049-900 SP, Brazil; Drug Research and Development Center, Federal University of Ceará, Fortaleza, Brazil
| | - Sérgio Kodato
- Department of Psychology, Faculty of Philosophy, Science and Letters, University of São Paulo, Ribeirão Preto, Brazil
| | - Marcos Felipe Silva de Sá
- Ribeirão Preto Medical School, Human Reproduction Sector, Departament of Gynecology and Obstetrics, University of São Paulo, Ribeirão Preto 14049-900 SP, Brazil
| | - Rui Alberto Ferriani
- Ribeirão Preto Medical School, Human Reproduction Sector, Departament of Gynecology and Obstetrics, University of São Paulo, Ribeirão Preto 14049-900 SP, Brazil
| | - Lúcia Alves da Silva Lara
- Ribeirão Preto Medical School, Human Reproduction Sector, Departament of Gynecology and Obstetrics, University of São Paulo, Ribeirão Preto 14049-900 SP, Brazil
| | - Rosana Maria Dos Reis
- Ribeirão Preto Medical School, Human Reproduction Sector, Departament of Gynecology and Obstetrics, University of São Paulo, Ribeirão Preto 14049-900 SP, Brazil
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16
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Scheffers M, Kalisvaart H, van Busschbach JT, Bosscher RJ, van Duijn MAJ, van Broeckhuysen-Kloth SAM, Schoevers RA, Geenen R. Body image in patients with somatoform disorder. BMC Psychiatry 2018; 18:346. [PMID: 30348134 PMCID: PMC6198536 DOI: 10.1186/s12888-018-1928-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 10/10/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although body-related problems are common in patients with somatoform disorder, research focusing on how patients with somatoform disorder perceive and evaluate their body is scarce. The present study compared differences in body image between patients with somatoform disorder and respondents from a general population sample. It also examined differences within the somatoform disorder group between men and women and between the diagnostic subgroups conversion disorder, pain disorder and undifferentiated somatoform disorder. METHODS Data were obtained from 657 patients (67.5% female) with somatoform disorder (DSM-IV-TR 300.7, 300.11, 300.81, 300.82) and 761 participants (58.6% female) from the general population. The Dresden Body Image Questionnaire (DBIQ) was used to assess body image in five domains: body acceptance, vitality, physical contact, sexual fulfilment, and self-aggrandizement. Confirmatory factor analysis and analyses of variance were performed. Since differences in age and sex were found between the somatoform disorder sample and the comparison sample, analyses were done with two samples of 560 patients with somatoform disorder and 351 individuals from the comparison sample matched on proportion of men and women and age. RESULTS Patients scored significantly lower than the comparison sample on all DBIQ domains. Men scored higher than women. Patients with conversion disorder scored significantly higher on vitality and body acceptance than patients with undifferentiated somatoform disorder and pain disorder. CONCLUSIONS The mostly large differences in body image between patients with somatoform disorder and the comparison sample as well as differences between diagnostic subgroups underline that body image is an important feature in patients with somatoform disorder. The results indicate the usefulness of assessing body image and treating negative body image in patients with somatoform or somatic symptom disorder.
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Affiliation(s)
- M. Scheffers
- grid.449957.2Windesheim University of Applied Sciences, School of Human Movement and Education, Campus 2-6, 8017 CA Zwolle, the Netherlands
| | - H. Kalisvaart
- grid.449957.2Windesheim University of Applied Sciences, School of Human Movement and Education, Campus 2-6, 8017 CA Zwolle, the Netherlands ,Altrecht Psychosomatic Medicine, Vrijbaan 2, 3705 WC Zeist, the Netherlands
| | - J. T. van Busschbach
- grid.449957.2Windesheim University of Applied Sciences, School of Human Movement and Education, Campus 2-6, 8017 CA Zwolle, the Netherlands ,0000 0000 9558 4598grid.4494.dDepartment of Psychiatry, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, CC72, 9700, RB Groningen, the Netherlands
| | - R. J. Bosscher
- grid.449957.2Windesheim University of Applied Sciences, School of Human Movement and Education, Campus 2-6, 8017 CA Zwolle, the Netherlands
| | - M. A. J. van Duijn
- 0000 0004 0407 1981grid.4830.fDepartment of Sociology, University of Groningen, Grote Rozenstraat, 31 9712 TG Groningen, the Netherlands
| | | | - R. A. Schoevers
- 0000 0000 9558 4598grid.4494.dDepartment of Psychiatry, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, CC72, 9700, RB Groningen, the Netherlands ,Research School of Behavioural and Cognitive Neurosciences (BCN), Interdisciplinary, Center for Psychopathology and Emotion regulation (ICPE), P.O. Box 30.001, CC72, 9700, RB Groningen, the Netherlands
| | - R. Geenen
- Altrecht Psychosomatic Medicine, Vrijbaan 2, 3705 WC Zeist, the Netherlands ,0000000120346234grid.5477.1Department of Psychology, Utrecht University, Heidelberglaan 1, 3584CS, Utrecht, the Netherlands
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