Profiles of resources and body image in health and illness: A comparative study among females with rheumatoid arthritis, females with breast cancer and healthy controls

Abstract

Background: The aim of this study was to examine whether or not profiles of resources (i.e., a multifaceted picture that simultaneously includes different types of resources), as described by the conservation of resources (COR) theory, and profiles
of body image (i.e., a multidimensional picture that simultaneously includes different aspects of body image) differ between females that represent two clinical samples (rheumatoid arthritis [RA]; breast cancer [BC]) and a healthy control group.
Method: The sample comprised 328 females, including 141 women with RA, 102 with a BC diagnosis, and 85 healthy women as a control group, and was collected from the general population. To measure the level of COR resources in each participant, we used the COR evaluation questionnaire (COR-E). Participants' body image was assessed with the aid of the Multidimensional Body-Self Relations Questionnaire (MBSRQ).
Results: A discriminant analysis revealed that females from the clinical groups differed with respect to their profiles of some resources and body image when compared to those of the healthy control group. In addition, we found differences in body image evaluations between women with RA and women with BC.
Conclusions: Women with RA or BC differ substantially with respect to their subjectively assessed resources and body image when compared to women with no chronic diseases. Therefore, psychological counselling designed for females with RA or BC
should be employed to help them restore the aspects altered by their respective illnesses.

Full text

Brain and Behavior. 2020;10:e01488.  
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1 of 10
https://doi.org/10.1002/brb3.1488
wileyonlinelibrary.com/journal/brb3
1 | INTRODUCTION
Chronic illness is a phenomenon that is growing in prevalence, af-
fecting an increasing portion of the population all over the world
(World Health Organization [WHO], 2018). Chronic illness can be
very stressful and is associated with major functional limitations
(e.g., arthritis; Shih, Hootman, Strine, Chapman, & Brady, 2006)
and even traumatic experiences that pose a real threat to life (e.g.,
Received:2August2019
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Revised:16O ctober2019
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Accepted:14November2019
DOI: 10.1002/brb3.1488
ORIGINAL RESEARCH
Profiles of resources and body image in health and illness:
A comparative study among females with rheumatoid arthritis,
females with breast cancer and healthy controls
Marcin Rzeszutek | Małgorzata Pięta | Marek Huzar
This is an op en access article under t he terms of the Creat ive Commons Attributio n License, which permits use, dist ribution and reproduc tion in any medium,
provide d the orig inal work is proper ly cited .
© 2019 The Auth ors. Brain and Behavior published by Wiley Periodicals , Inc.
Faculty of Psychology, University of
Warsaw, Warsaw, Poland
Correspondence
Marcin R zeszute k, Facult y of Psych ology,
University of Warsaw, Stawki 5/7, 00-183,
Warsaw, Poland.
Email: marcin.rzeszutek@psych.uw.edu.pl
Funding information
Faculty of Psychology, University
ofWarsaw,Gr ant/AwardNu mber:
5011000220/2019
Abstract
Background: The aim of this study was to examine whether or not profiles of re-
sources (i.e., a multifaceted picture that simultaneously includes different types of
resources), as described by the conservation of resources (COR) theory, and profiles
of body image (i.e., a multidimensional picture that simultaneously includes different
aspects of body image) differ between females that represent two clinical samples
(rheumatoid arthritis [R A]; breast cancer [BC]) and a healthy control group.
Method: The sample comprised 328 females, including 141 women with RA , 102
with a BC diagnosis, and 85 healthy women as a control group, and was collected
from the general population. To measure the level of COR resources in each partici-
pant, we used the COR evaluation questionnaire (COR-E). Participants' body image
was assessed with the aid of the Multidimensional Body-Self Relations Questionnaire
(MBSRQ).
Results: A discriminant analysis revealed that females from the clinical groups dif-
fered with respect to their profiles of some resources and body image when com-
pared to those of the healthy control group. In addition, we found differences in body
image evaluations between women with RA and women with BC.
Conclusions: Women with RA or BC differ substantially with respect to their subjec-
tively assessed resources and body image when compared to women with no chronic
diseases. Therefore, psychological counselling designed for females with R A or BC
should be employed to help them restore the aspects altered by their respective
illnesses.
KEYWORDS
body image, breast cancer, resources, rheumatoid arthritis

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cancer; Kangas, Henry, & Br yant, 2005). In other words, chronic dis-
ease can induce a profound change in patients' lives and well-be-
ing, and thus, appropriate stress-coping mechanisms are necessary
to help patients adapt to the sometimes overwhelming situation of
coping with an ongoing illness (e.g., Dempster, Howell, & Mccorr y,
2015). Until now, the vast majority of studies on coping with chronic
disorders have focused on the transactional model of stress and
coping (Lazarus & Folkman, 1984; for reviews, see also Kato, 2013;
Moskowitz, Hult, Bussolari, & Acree, 20 09). Taking this into account,
it is impor tant to note that there are several limitations to the afore-
mentioned model in depicting the process of coping with disease
(e.g., Skinner, Edge, Altman, & Sher wood, 20 03); in our study, we
focus on the massively understudied conservation of resources
(COR) theory (Hobfoll, 1989).
Conservation of resources theory focuses on the sociocultural
context of stress and coping, wherein the central attention is shifted
from a subjective appraisal of stress and coping (Lazarus & Folkman,
1984) to the objec tive resources defined as things that an individual
currently possesses and values (e.g., objects, states, or conditions) or
aims to achieve, maintain, and protect in the future (Hobfoll, 1989).
Therefore, in COR theory, stress and coping processes can be oper-
ationalized more specifically and are associated with an actual loss
of resources or the threat of losing them. The majority of studies
on COR theory have been conducted in nonclinical settings (e.g.,
Hobfoll, Johnson, Ennis, & Jackson, 2003; Jin, McDonald, & Park,
2016; va nWoe rk om ,B akker,&Nishi i, 2016) ,a nd th us,littleiskno wn 
about the application of this model in a clinical environment (e.g.,
Banou, Hobfoll, & Trochelman, 2009; Dirik & Karanci, 2010). Thus,
in our study, we evaluate and compare the COR resources among
two clinical samples of female participants, those with rheumatoid
arthritis (RA) and those with breast cancer (BC). We chose these
clinical entities mainly due to the biological links between them (i.e.,
there is a heightened risk of BC in RA females; see Tian, Liang, Wang,
& Zhou, 2014). Moreover, it remains unknown as to how clinical and
nonclinical samples differ in their resources' perception. Thus, we
also wanted to compare resource evaluations among the clinical
samples to those of a healthy female control group.
Rheumatoid arthritis is one of the leading debilitating chronic
diseases worldwide and is characterized by joint des truction, chronic
pain, incremental disability, and heightened mortality compared to
that of the general population (Smolen, Aletaha, & McInnes, 2016).
The aforementioned factors are linked with persistent psychological
distre ss (Rzeszutek, O niszczenko, Schier, Bier nat-Kał uża, & Gasik,
2016), poor quality of life (Matcham et al., 2014), and, in the long
run,variousR A-relatedpsychiatricdisorders (Nicassioetal.,2012).
Nevertheless, manyresearchers have noticed variousbenefit sre-
lated to coping with RA. The literature on coping with RA , although
vast, is very heterogeneous with regard to conclusions and is based
mainly on L azarus and Folkman's (1984) model (e.g., Conner et al.,
2006; N ewth & Delongis , 2004). Until n ow, only Di rik & Karanci
(2010) had observed that resource loss, as described by COR theory,
was the strongest predictor of depression of all studied psychosocial
variables, and this effec t was most visible among female R A patients.
Along with RA , BC is one of the most prevalent health prob-
lems worldwide, being the second most frequently detected type
of cancer in the world and the first most frequently detected among
women (WHO, 2018). Women with BC face multidimensional psy-
chological distress stemming from it s threat to life (Saboonchi et al.,
2014) along with a significant drop in their quality of life and a de-
cline in their psychosocial functioning (Syrowatka et al., 2017). Like
in RA patients, appropriate coping abilities can be crucial in adapting
to this disease, which are linked with less anxiety, lower levels of
depression, and an increased quality of life (Arnaboldi, Riva, Crico, &
Pravettoni, 2017). However, until now, only Banou et al. (2009) had
demonstrated the role of interpersonal resources from COR theory
in diminishing cancer-related distress in women with BC.
The second reason we compared these two clinical entities is
their relationship with one psychological variable that plays a major
role in coping with them—that is, body image. Body image is a multi-
dimensional term that encompasses the thoughts, beliefs, emotions,
and behaviors associated with an individual's physical appearance
(Cash & Pruzinsky, 2002). In RA patients, body image distortions,
which are very prevalent, are related to elevated pain and functional
limitations, all of which have been observed mainly among female
RA patients (Bode, Taal, Heij, & Laar, 2010; Gutweniger, Kopp, Mur,
& Gunther, 1999). Likewise, body image distortions in BC are the
strongest predictor of cancer-related distress and the deteriora-
tion of social functioning in females with BC (Carver et al., 1998;
Thomas & Usher, 2009). It has been determined that in females with
RA (Alleva et al., 2018; Bode et al., 2010) and those with BC (Fobair
et al., 2005; Harcour t & Rumsey, 2019), body image is shaped to a
greater ex tent by psychosocial factors than by illness-related fac-
tors, but no studies on the differences between COR resources and
body image in these patient groups have been conducted thus far.
1.1 | Current study
Taking the abovementioned research gaps into consideration, the aim
of our study is twofold. First, we want to examine whether or not the
profiles of resources and body image differ between the females that
represent different clinical samples (i.e., R A and BC patients) and a
healthy control group. Second, we aim to investigate the potential
differences between the profiles of resources and body image within
the aforementioned clinical samples. We formulated four hypotheses:
Hypothesis 1 Clinical samples of the females differ with respect to the
profiles of resources, as described by the COR theory, from the
healthy control group of females.
Hypothesis 2 Females with RA differ with respect to the profiles of
resources, as described by the COR theory, from female partic-
ipants with BC.
Hypothesis 3 Clinical samples of the females differ with respect to
body image profiles from the healthy control group of females.
Hypothesis 4 Female participants with R A differ with respect to body
image profiles from female participants with BC.

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2 | METHOD
2.1 | Participants and procedure
The study sample comprised 328 females, including 141 women
with RA, 102 with a BC diagnosis, and 85 healthy women (i.e., with
no chronic diseases), and was collec ted from the general popula-
tion. The female par ticipants with RA were recruited from the pa-
tients of the National Institute of Geriatrics, Rheumatology, and
Rehabilitation in Warsaw, Poland. The female participants with BC
were recruited from the Magodent Oncolog y Hospital in Warsaw.
The healthy control group was recruited from a nonclinical popula-
tion among the students of various Warsaw universities.
The study subjects filled out paper-and-pencil questionnaires
and participated in the study voluntarily, and thus, no remuneration
was provided for participation. In cases of clinical samples, the eligi-
bility criteria encompassed being 18 years of age or older and having
a confirmed medical diagnosis of RA or BC , which was screened by
medical doctors working in the hospitals where the research was
conducted. The exclusion criteria for clinical samples included cogni-
tive impairment, vision loss, or major joint changes that limited writ-
ing skills among RA patients and a poor emotional state among BC
patients, which was diagnosed by clinical psychologists. For the non-
clinical sample, the inclusion criteria encompassed being 18 years of
age or older and self-declaring no chronic illnesses. The research
project was approved by the ethics committee. Table 1 presents the
sociodemographic characteristics of all study par ticipants with sta-
tistical tests for differences between the groups.
The groups differed in terms of participants' age, education, em-
ployment , and place of residence. Post hoc analysis revealed that par-
ticipant s from the control group were significantly younger than RA
patients, p < .001, and BC patients, p < .001. The number of married
participants was significantly higher in the R A group than in control
group, χ2(1) = 4.87, p < .05, and the BC group, χ2(1) = 11.28, p < .01.
Education level was lower in the BC group than in the control group,
χ2(1) = 16.04, p < .001, and the RA group, χ2(1) = 10.40, p < .01.
Education level in the R A group was also significantly better than in
the control group, χ2(1) = 11.31, p < .01. The number of participants
without regular unemployment was significantly bigger in the control
group than in the RA group, χ2(3) = 54.72, p < .001, and the BC group,
χ2(1) = 100.69, p < .001. The number of participants living on the village
or in a small town was significantly bigger in the BC group, and the
number of partici pants living in cit ies with over 500 thousand re sidents
was significantly bigger in the control group, χ2(3) = 46.3 0, p < .001.
2.2 | Measures
To assess the level of subjectively possessed resources among the
participants, we used the COR evaluation questionnaire (COR-E;
Hobfoll, Lilly, & Jackson, 1992) in the Polish adaptation of Dudek et
al. (2006). The COR-E consists of two parts (A and B), each with 40
items. In part A, participants rated the ex tent to which they attach
importance to several resources, represented by objects, states, or
conditions, while in part B, they rated the extent to which they pos-
sess these resources. The items in parts A and B refer to the fol-
lowing resources: hedonistic and vital resources, spiritual resources,
family resources, economic and political resources, and power and
prestige resources. Higher scores on the COR-E indicate higher lev-
els of resources.
Participants' body image was evaluated using the
Multidimensional Body-Self Relations Questionnaire (MBSRQ), con-
structed by Thomas Cash (20 00) and adapted to Polish by Br ytek-
Matera and Rogoza (2015). We paid an appropriate nominal fee
for the use of the MBSRQ in this particular research. The MBSRQ
consists of 10 scales that evaluate several elements associated with
body image: the appearance evaluation scale, the appearance ori-
entation scale, the fitness evaluation scale, the fitness orientation
scale, the health evaluation scale, the health orientation scale, the
illness orientation scale, the body areas satisfaction scale, the over-
weight preoccupation scale, and the self-classified weight scale. The
higher the results in each subscale, the more positive the assessment
of particular aspects of body image was reported by a participant.
2.3 | Data analysis
The introductor y portion of this study's statistical analysis comprised
descriptive statistics between the analy zed variables. The principal
part of the analysis was performed with the use of a discriminant
analysis (Mclachlan, 2004). Discriminant analysis is a statistical analy-
sis used to verify associations between interval explanatory variables
and categorical outcome variables. It creates variates called discrimi-
nant functions that consist of interval explanatory variables. These
variates are then used to discriminate between the outcome variable
categories, which allows for an analysis of bet ween-group differences
regardin g the levels of analy zed variables and t he differences b etween
them. Group membership was analyzed using the grouping variable;
the levels of resources and body image dimensions were analyzed
as independent variables using two separate statistical models. The
control group and both clinical groups significantly differed in terms
of age and other differences, including education and employment,
which were consequences of this age variability. The differences be-
tween groups in terms of demographic variables were verified with
theuseofaone-wayANOVAandPearson'sχ test for independence.
The mean age of participants from the control group was lower than
the mean values of age in both clinical groups. More participants from
the control group had received secondary education, were unem-
ployed, and lived in cities with over 500 thousand residents.
The difference in participants' ages was controlled for in both
statistical models. The choice of discriminant functions was based
on Wilks's lambda test (Mclachlan, 2004), which allows for the de-
ciding of how many extracted variates discriminate between the
categories of outcome variables. The interpretation of the acquired
discriminant functions, when significant, was based on the values of
standardized canonical discriminant function coefficients. A positive

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correlation meant there was a positive association between the ex-
planator y interval variable and the extracted variate. A positive and
a negative correlation between interval variables in the same vari-
ate meant that the difference between the two inter val variables
discriminated between the categories of the outcome variable. The
values of the functions at the group centroids were depicted on
graphs to make the interpretation easier. A partial eta-squared (η2)
effect size measure was used to make the interpretation of effect
sizes possible. Following the classic guidelines of Cohen (1988), the
values of η2 should be interpreted as small if the values are less than
.06, medium if the values are in the range from .06 to .14, and large
if the values are greater than .14.
3 | RESULTS
Table 2 presents the descriptive statistics for all analyzed interval
variables in the study samples.
Theskewnessandkurtosisvaluesfellbet ween−1and1,andthus,
the use of parametric statistical methods was appropriate. To verify
Hypothe sis 1 and Hypothesis 2 , a discriminant anal ysis was performed.
The levels of all five types of resources and participants' ages were
analyzed as independent variables. Table 3 presents the values of the
standardized canonical discriminant function coefficients. Wilks's
lambda test revealed that only the first function, χ2(12) = 200.07, was
statistically significant (p < .0 01). The second func tion, χ2(5) = 7.43, was
Variable
Group
F/χ2p
Control
(N = 85)
RA
(N = 141)
BC
(N = 102)
Age in years
(M ± SD)
25.89 ± 10.19 57.26 ± 12.36 54.45 ± 15.02 152.94 .001
Marital status
Married 53 (62.4%) 66 (64 .7%) 79 (56.0%) 2.57 .277
Single 32 (37.6%) 34 (33.3%) 62 (44.0%)
Education
Elementary 0 (0%) 5 (4.9%) 23 (16.3%) 26.41 .001
Secondary 57 ( 67. 1% ) 49 (48.0%) 73 (51 .8% )
Higher
education
28 (32.9%) 48 (4 7.1 %) 45 (31.9%)
Employment
Full
employment
28 (32.9%) 20 ( 19. 6% ) 51 (36.2%) 123.45 .001
Unemployed 54 (63.5%) 0 (0%) 10 ( 7.1 %)
Illness
allowance
1 (1. 2%) 6 (5.9%) 2 5 (17.7%)
Retired 2 (2.4%) 1 2 (11. 8%) 55 (39.0%)
Place of residence
Village,small
town up to
20 thousand
residents
13 (15.3%) 13 (12.7%) 44 (31.2%) 51. 0 3 .001
City 21 to 100
thousand
residents
2 (2.4%) 2 (2.0%) 2 7 (19.1 %)
City 101
to 500
thousand
residents
1 (1. 2%) 2 (2.0%) 19 (13 .5%)
City over 500
thousand
residents
67 (78.8%) 21 (20.6%) 49 (34.8%)
Lack of
permanent
residence
1 (1. 2%) 0 (0%) 1 (0.7%)
Abbreviations: F, analysis of variance; M, mean value; SD, standard deviation; χ2, Pearson chi-
squared test of independence.
TABLE 1 Sociodemographic variables
in the studied samples

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RZES ZUTEK ET al .
statistically insignificant (p > .05), which means only the first discrimi-
nant function discriminated between the analyzed groups.
The highest values of standardized coef ficients in the first dis-
criminant function were obtained for the level of hedonistic and
vital resources and for the level of family resources. However,
the value for hedonistic and vital resources was positive, while
the value for family resources was negative, which indicates that
group differences are explained by the difference between these
two variables. Figure 1 presents the values of these functions at
the group centroids. The first (and the only statistically significant)
function differentiated between the control group and both clin-
ical samples.
The structure of the mean level of hedonistic and vital resources
and family resources shows that the level of hedonistic and vital
resources was higher in the control group, while the level of family
resources was higher in the clinical groups, η2 = .21, which supports
Hypothesis 1 (see Figure 2). The R A and BC groups did not differ with
regard to the levels of resources, which contradicts Hypothesis 2.
Hypothesis 3 and Hypothesis 4 were also verified using a discrim-
inant analysis, but this time, body image dimensions and participants'
ages were analyzed as independent variables. Table 4 presents the val-
ues of the standardized canonical discriminant function coefficients.
According to Wilks's lambda test, the first function, χ2(22) = 276.52,
p < .001, was statistically significant, and the second function was sta-
tistically significant, χ2(10) = 49.10, p < .001, which means only the first
discriminant function discriminated between the analyzed groups.
Besides participants' ages, the first function was that of the rela-
tionship between health orientation, orient ation to the disease, and
health assessment. The values of health orientation and orientation
to the disease were positive, and the value of health assessment was
negative, which indicates that the difference between health assess-
ment and health orientation and that bet ween health assessment
and orientation to the disease accounted for the between-group
differences. The second function was the function of fitness ori-
entation, satisfaction with the areas of the body, evaluation of ap-
pearance, fitness assessment, and preoccupation with weight. All
values of these body dimensions were positive. Figure 3 presents
the values of the functions at the group centroids. The first function
differentiated between the control group and the RA group, and the
second function differentiated between the BC group and both the
control group and the R A group.
TABLE 2 Descriptive statistics and pearson correlation
coefficients between analyzed variables in the whole study sample
(N = 328)
Variables MSD S K
1. Hedonistic and vital
resources
146.35 57.9 3 −0.30 −0 .26
2. Spiritual resources 104.75 33 .76 0.58 3.37
3. family resources 153.72 50.40 −0.40 −0.82
4. Economic and politi-
cal resources
111.0 3 45.08 0.82 0.86
5. Power and prestige
resources
40.00 24.16 0.32 0.92
6. Appearance
evaluation
3.30 0.77 0.80 0.87
7. Appearance
orientation
3.35 0.61 0.32 0.46
8. Fitness evaluation 3.02 0.83 −0.01 −0.13
9. Fitness orientation 3.06 0.74 0.77 0.69
10. Health evaluation 3.22 0.66 −0.14 0.36
11. Health orientation 3.40 0.58 −0.30 0.46
12. Illness orientation 3.39 0.73 0.13 0.36
13. Overweight
preoccupation
2.58 0.83 0.13 − 0.59
14. Body areas
satisfaction
3.28 0.77 0.41 0 .97
15. Self-classified
weight scale
3.27 0 .76 0.20 0.80
Abbreviations: K, kurtosis; M, mean value; S, skewness; SD, standard
deviation.
TABLE 3 Standardized canonical discriminant function
coefficients for the level of resources
Level of resources Function 1 Function 2
Hedonistic and vital resources −1. 3 2 0. 24
Spiritual resources 0.01 −0.57
Family resources 0.82 0.11
Economic and political
resources
0.27 1.06
Power and prestige resources 0.27 − 0.14
Age 0.70 0.56
Note: Positive values of standardized canonical discriminant f unction
mean that the higher the values of resources, the higher the values of
extracted discriminant function, negative values meant that the higher
the values of resources, the lower the values of ex tracted discriminant
function.
FIGURE 1 The values of the functions at group centroids in all
study samples

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Figure 4 presents the mean values of health orientation, orienta-
tion to the disease, and health assessment in the control group and
the RA group only. The acquired differences support Hypothesis 3,
η2 = .08.
Figure 5 presents the mean values of fitness evaluation, fitness
orientation, appearance evaluation, weight preoccupation, and body
area satisfaction in the control group, the RA group, and the BC
group. The means of all the aforementioned variables were lower in
the BC group than in the RA group or the control group, η2 = .06, and
these dif ferences are in line with Hypothesis 4.
4 | DISCUSSION
The results of our study were in line with Hypothesis 1, as females
from the clinical groups declared lower levels of vital and hedonistic
resource s but higher levels of family resources compared with th ose
of the healthy control group. At the same time, we did not find any
differ ences in the profil es of resources bet ween the clinica l samples,
and thus, no confirmation of Hypothesis 2 was obtained. It seems
that living with RA or BC may result in similar resource evaluations,
and this finding is interesting in itself because no previous studies
have been conducted on this topic thus far. However, in comparison
with healthy individuals, R A patients and BC patients mainly expe-
rience a lack vigor and energy and problems related to the active
pursuit of one's interests and goals or the search for pleasure or
enjoyment. This latter result is especially prevalent in RA patients,
for whom one of the central symptoms is chronic fatigue (Pollard,
Choy, Gonzalez, Khoshaba, & Scott, 2006), which is strongly re-
latedtodailypain,sleepproblems,and depression(Nicassioet al.,
2012). Impor tantly, some authors have obser ved that females with
RA report more fatigue when compared to men with RA and thus
experience much higher rates of R A pain and functional limitations
(Thyberg et al., 2009). Similarly, several studies have pointed to the
prevalence of cancer-related fatigue among females with BC, which
may be obser ved during treatment (Ancoli-Israel et al., 20 06) but
are especially observed after mastectomy (Bardwell et al., 2008).
In addition, experiencing the studied illnesses may increase the
subjective importance of family relationships. This corresponds to
several systematic reviews that show that one of the most important
predictors for quality of life and illness adaptation among both RA pa-
tients (Sharpe, 2016)andBCpatients (Mols,Vingerhoets, Coebergh,
& Poll-Franse, 2005) is satisfaction gained through close family re-
lationships. More specifically, for females with RA or BC, the major
sources of support stem from intimate relationships, as these diseases
pose multidimensional problems to self-esteem because they are es-
pecially associated with sexual problems (Essam et al., 2016; Pumo et
al., 2012).
This latter observation was somewhat observed while con-
firming Hypothesis 3, which is related to body image profiles; in
FIGURE 2 Profiles of hedonistic and vital resources and
family resources in control group and clinical samples with
95% confidence intervals computed with the use of Bonferroni
correction
TABLE 4 Standardized canonical discriminant function
coefficients for body image scales
Body image Function 1 Function 2
Appearance evaluation −0.04 0.30
Appearance orientation −0.33 −0 .17
Fitness evaluation 0.02 0.30
Fitness orientation 0.16 0.60
Health evaluation −0.59 − 0.19
Health orientation 0.72 −0.33
Illness orientation 0.42 0.23
Overweight preoccupation −0.08 0.32
Body areas satisfaction 0.06 0.37
Self-classified weight scale 0.18 0.21
Age 0.93 −0.05
Note: Positive values of standardized canonical discriminant f unction
mean that the higher the values of body image dimension, the higher
the values of extr acted discriminant func tion, negative values meant
that the higher the values of bo dy image dimension, the lower the
values of extracted discriminant function.
FIGURE 3 The values of the functions for body image at group
centroids in all study samples

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RZES ZUTEK ET al .
the clinic al sample of RA , greater health and disease orientation
were noticed, while in the control group, a more positive health
evaluation was obser ved. In other words, it seems that females
from the R A sample experienced their body image as a function of
the illness's progression, which is in line with some recent studies
(e.g.,Boyingtonetal.,2015;Vinoski-Thomas,Warren-Findlow,&
Webb, 2019). However, one of the most interesting but somewhat
counterintuitive results deals with Hypothesis 4, which relates to
the differences in body image profiles between R A females and
BCfemales. Namely,comparedwithBCfemales,R Afemalesde-
clared a greater fitness evaluation and fitness orientation, higher
weight preoccupation, increased body area satisfaction, and bet-
ter appearance evaluation. Women with BC have a very distorted
body image, as they perceive their bodies as incomplete, having
had a symbol of femininity and sexuality (i.e., the breasts) taken
away from them regardless of whether or not they have under-
gone mastectomy (Gumus et al., 2010). This state of constant in-
security, relating not only to their femininity but also to their very
lives, is a great psychological burden (Helms et al., 20 08; Shichen
et al., 2018; Puigpinós-Riera et al., 2018) and may be responsi-
ble for the very poor body satisfaction observed among the BC
participants.
4.1 | Strengths and limitations
This theory-driven study is the first comparative research on re-
source evaluation to use the COR theory and body image between
these two clinical samples with an additional healthy control group,
which is its streng th. However, we should bear in mind that the
cross-sectional design of the study makes it difficult to draw a causal
conclusion from the obtained results. Specifically, due to the study's
design, we were able to assess not resource loss nor resource gain
over time among the par ticipants, but only the current level of the
subjectively assessed resources. In addition, the study samples dif-
fered substantially regarding many demographic variables. These
FIGURE 4 Profiles of health
orientation, orientation for the disease,
and health assessment in the control
group and the RA groups with 95%
confidence intervals computed with the
use of Bonferroni correction
FIGURE 5 Profiles of fitness
evaluation, satisfaction with the A areas
of the body, appearance orientation,
fitness assessment, and preoccupation
with weight in the control group, the RA
sample and the BC sample

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RZESZUTEK ET a l.
differences are particularly visible regarding age between the
healthy group and the clinical samples. Finally, we did not have data
on the severity of the illnesses' progression among the clinical sam-
ples, and thus, medical variables were not controlled sufficiently in
our research.
5 | CONCLUSION
Despite these limitations, this study adds to the literature on the psy-
chological aspects of living with R A or BC among women. It seems
that females with R A or BC differ with respect to the subjec tively
assessed resources and body image evaluation when compared to
healthy women. Therefore, psychological counselling specifically de-
signed for R A and BC females may help these women restore these
aspects of their identities that have been altered by their respective
illnesses.
ACKNOWLEDGMENT
This study was financed by the research subsidy number
5011000220/2019 from the Faculty of Psychology, University of
Wars aw.
DISCLOSURES
Disclosure of potential conflicts of interest: Author A declares that
he has no conflict of interest. Author B declares that she has no
conflict of interest. Author C declares that he has no conflict of
interest.
CONFLICT OF INTERESTS
Nonedeclared.
ETHICAL APPROVAL
Research involving human participants and/or animals: All proce-
dures performed in studies involving human par ticipants were in
accordance with the ethical standards of the institutional and/or na-
tional research committee and with the 1964 Helsinki Declaration
and its later amendments.
INFORMED CONSENT
Informed consent was obtained from all individual participants in-
cluded in the study.
ORCID
Marcin Rzeszutek https://orcid.org/0000-0002-4230-3806
DATA AVAIL ABI LIT Y S TATEM ENT
Data are available upon the request.
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Profiles of resources and body image in health and illness: A
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