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Body image, pain and level of resources among arthritis patients: the moderating role of gender
Abstract
Arthritis is a highly debilitating group of chronic diseases that affects both physical and psychosocial functioning. The aim of this study was to examine the associations between body image, subjective pain intensity and level of resources described by Conservation of Resources (COR) theory among arthritis patients. In particular, the moderating role of the participants’ gender was explored via multiple linear regression analysis. 200 arthritis patients were recruited, including 141 females and 59 males. Body image was evaluated using the Multidimensional Body-Self Relations Questionnaire, subjective pain intensity was measured via the Numerical Rating Scale and level of resources was assessed using the COR evaluation questionnaire. A negative relationship was confirmed between the level of satisfaction with body image and pain intensity among participants. A positive relationship was found between body-image subscales and level of COR resources. These relationships were moderated by the participants’ gender, i.e. only among males a positive association between body image and pain and, respectively, body image and resources was found. Enhancing body awareness is an essential part of psychological counselling for patients with arthritis and our study added to the literature by showing how body image may be related to pain and resources in this patient group.
... COR theory illustrates the sociocultural aspects of stress and coping and resources as described by COR confer a symbolic value as they are essential to one's selfimage and identity [19]. However, till now the relationship between COR resources and body image in the clinical settings was noticed only among rheumatoid arthritis patients [37], so examining this relationship in case of psoriasis is an interesting research gap to fill. ...
Purpose:
The aim of the study was first to examine the heterogeneity of body image and resources, as described by the conservation of resources theory (COR), in a sample of psoriatic patients and explore whether heterogeneity within these variables explains the possible differences in levels of life satisfaction among the participants. Second, we aimed to investigate if life satisfaction level among the observed profiles of psoriatic patients, extracted on the basis of their body image and resources, differed from that of the healthy comparison group.
Methods:
The sample consisted of 735 participants, including 355 adults with a medical diagnosis of psoriasis and 380 healthy adults recruited from a non-clinical general population. Participants filled the Satisfaction with Life Scale, the Multidimensional Body-Self Relations Questionnaire and the COR evaluation questionnaire.
Results:
Latent profile analysis revealed four classes of psoriatic patients with different levels of resources and body image. The group with the highest level of resources and the most positive body image did not differ from the healthy comparison group regarding satisfaction with life. The group with the lowest level of resources and the most negative body image was characterized by the lowest satisfaction with life.
Conclusions:
The results of our study may change the simplifying trend that highlights the traditionally very poor well-being of psoriatic patients. Moreover, the discovery of specific profiles of these patients, which differ with regard to psychological variables, can lead to rethinking contemporary forms of psychological counselling in psoriatic patients.
The purpose of the empirical study (April–May 2020) was to determine the type and level of affect, specifics of coping styles during the coronavirus disease 2019 (COVID-19) pandemic lockdown, as well as mutual understanding between parents and children. We hypothesized that the combination of positive and negative affect magnitude is a factor in well-being and mutual understanding with children, as well as the coping style during the lockdown. The study involved 705 respondents aged 16–77, including 435 parents living with children under 16. Personal traits, positive and negative affect, coping styles, and well-being were studied by Ten-Item Personality Inventory (TIPI)-RU, Positive and Negative Affect Scale (PANAS)-RU, Brief COPE, Satisfaction with Life Scale (SWLS), respectively. Mutual understanding was studied using a self-report questionnaire. Cluster analysis (k-means method) was used to divide the sample into clusters in accordance with the combination of positive and negative affect. According to the data obtained, parents from the “positive-affective” cluster have much better mutual understanding with both younger and older children than participants from other clusters.
This study evaluated severe psychological symptoms in the United Kingdom and Austria after four weeks of lockdown due to COVID-19. Two cross-sectional online surveys were performed with representative population samples according to age, gender, region, and education. Depressive symptoms were measured with the Patient Health Questionnaire (PHQ-9), anxiety symptoms with the Generalized Anxiety Disorder scale (GAD-7), and insomnia symptoms with the Insomnia Severity Index (ISI). The sample size was N = 1005 for Austria (52% women) and N = 1006 (54% women) for the UK. In total, 3.2% of the Austrian sample and 12.1% of the UK sample had severe depressive symptoms (PHQ-9 ≥ 20 points; χ2(1) = 57.24; p < 0.001), 6.0% in Austria vs. 18.9% in the UK had severe anxiety symptoms (GAD-7 ≥ 15 points; χ2(1) = 76.17; p < 0.001), and 2.2% in Austria and 7.3% in the UK had severe insomnia (ISI; ≥22 points; χ2(1) = 28.89; p < 0.001). The prevalence of severe depressive, anxiety or insomnia symptoms was around three times higher in the UK than in Austria.
Introduction
Research indicates that body image disturbance is associated with poorer psychosocial outcomes for individuals with physical health conditions, with poorest body image reported for individuals with visible bodily changes. Using White’s (2000) theoretical model of body image the present paper aimed to examine the nature of these relationships in two distinct groups: individuals with an amputation and individuals with diabetes. It was hypothesized that body image disturbance would be associated with psychosocial outcomes and would mediate the relationships between self-ideal discrepancy and personal investment in psychosocial outcomes.
Methods
Individuals with diabetes (N = 212) and individuals with an amputation (N = 227) provided details regarding their medical condition, and completed measures assessing body image, investment, self-ideal discrepancy, depression, anxiety, and quality of life. Structural equation and invariance modeling were used to test the model paths and the invariance of the model.
Results
As hypothesized, body image disturbance was found to mediate the relationships between personal investment and psychosocial outcome, and between self-ideal discrepancy and psychosocial outcome. The predicted paths were invariant across groups, although the model accounted for more variance in people with an amputation than people with diabetes.
Conclusion
Body image disturbance, personal investment, and self-ideal discrepancy are important factors contributing to psychosocial outcome for individuals with diabetes and individuals with an amputation. These findings not only confirm the validity of the model in these two groups, but they emphasize the importance of targeting body image in future psychological interventions for individuals with a health condition.
The main goal of the current study was to investigate sex differences in the relationship between the level of trauma symptoms appearing in posttraumatic stress disorder (PTSD) and intensity of pain in a sample of 300 Polish patients suffering from chronic pain, specifically rheumatoid arthritis and lower back pain. We also focused on participants' body image with body esteem as a mediator. To assess the intensity of pain among participants, we used the Numerical Rating Scale. The level of trauma symptoms was assessed with the PTSD Factorial Version Inventory. To measure body image among participants, we used the Body Esteem Scale. The results of our study suggest that trauma symptoms and body image dimensions were significant predictors of pain intensity among men suffering from chronic pain. Moreover, trauma symptoms and age were significant predictors of pain intensity among women suffering from chronic pain. Finally, we demonstrated that sex differentiates the reaction to chronic pain.
To explore the disease-related, body image (BI) perceptions of women diagnosed with, rheumatoid arthritis (RA) and fibromyalgia (FM).
A purposive sample of twenty-seven females participated in individual semi-structured phone interviews to elicit BI perceptions relative to pain, activity limitations and coping measures. Sessions were digitally recorded, transcribed verbatim, and content analyzed.
Body image perceptions relative to 5 major themes emerged in the analysis. They focused on Pain, Disease Impact on Physical and Mental Function, Weight, Diseased-Induced Fears and, Coping measures. Pain was a common experience of all participants. Other troubling factors verbalized by participants included dislike and shame of visibly affected body parts, and disease-induced social, psychological and physical limitations. RA participants thought that manifested joint changes, such as swelling and redness, undergirded their prompt diagnosis and receipt of health care. Contrarily, women with fibromyalgia perceived that the lack of visible, disease-related, physical signs led to a discounting of their disease, which led to delayed health care and subsequent frustrations and anger. All but one participant used prayer and meditation as a coping measure.
The body image perceptions evidenced by the majority of participants were generally negative and included specific focus on their disease-affected body parts (e.g. joints), mental function, self-identity, health care experiences, activity limitations and overall quality of life. Given the global effect of RA and FM, assessment and integration of findings about the BI perceptions of individuals with FM and RA may help define suitable interdisciplinary strategies for managing these conditions and improving participants' quality of life.
The study aimed to explore associations between coping self-efficacy and psychological distress in early and established rheumatoid arthritis (RA) patients. Two samples differing in disease duration were collected at outpatient rheumatology clinics in Eastern Slovakia. The first sample consisted of 146 established patients with disease duration of 12 years or more (age = 58.02 SD = 10.38 years; disease duration = 16.08 SD = 3.60 years; 86 % women) and the second sample consisted of 102 early RA patients with disease duration of 4 years or less (age = 53.25 SD = 12.32; disease duration = 2.8 SD = 1.23 years; 75 % women). The patients underwent a routine rheumatology check and completed questionnaires regarding functional disability, neuroticism and extraversion, coping self-efficacy and psychological distress. The data were analyzed using hierarchical linear regression models. Coping self-efficacy was significantly negatively associated with psychological distress in both samples with the strongest association with anxiety in the early RA group. These associations remained significant after controlling for sociodemographic, disease related and personality variables. Psychological distress was further associated with disease activity, functional disability, neuroticism and extraversion. However, different patterns in respect to anxiety and depression with the duration of RA was observed. Coping self-efficacy accounted for a unique variance in psychological distress even after controlling for the influence of disease activity, functional status and personality traits. The strongest association was observed with anxiety in early RA patients. As a result, management and intervention programs increasing self-efficacy for coping strategies might be beneficial for reducing anxiety and depression especially during the early phase of the disease.
Psychology has increasingly turned to the study of psychosocial resources in the examination of well-being. How resources are being studied and resource models that have been proffered are considered, and an attempt is made to examine elements that bridge across models. As resource models span health, community, cognitive, and clinical psychology, the question is raised of whether there is overuse of the resource metaphor or whether there exists some underlying principles that can be gleaned and incorporated to advance research. The contribution of resources for understanding multicultural and pan-historical adaptation in the face of challenge is considered. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The aims were to investigate how the body image is affected in fibromyalgia syndrome (FMS) in comparison to healthy people, as well as to explore the relationship of the body image with the level of pain, functional status, severity of depression, and quality of life (QoL). Demographic variables, symptoms of fibromyalgia, and number of fibromyalgia tender points for 51 patients with FMS and 41 control subjects were recorded. All patients were asked to mark the level of pain on visual analogue scale (VAS). Six-minute walking test was recorded for functional assessment. The impact of the disease was evaluated by fibromyalgia impact questionnaire (FIQ). All patients were asked to complete body image scale (BIS), Beck depression inventory (BDI), and short form-36 (SF-36). There were no differences between groups with regard to demographic variables (p > 0.05). Mean VAS was 7.5 ± 1.4 for the patients with FMS and 0.3 ± 0.4 for control subjects (p p p p r = 0.843) and FIQ (r = 0.290) in patients with FMS (p r = −0.288), energy/vitality (r = −0.519), mental health (r = −0.442), and general health (r = −0,492) subscores (p
Rheumatoid arthritis (RA) is a chronic disease, which can lead to considerable psychological distress. The present study evaluated anxiety and depression symptoms for this chronic and painful illness within the framework of the conservation of resources (COR) theory. Coping strategies, coping self-efficacy, religiousness and social support are very important personal resources, which have been found to protect individuals from psychological distress. The aim of the present study was to examine the predictive values of socio-demographic and illness-related variables, perceived social support, ways of coping, religiousness, arthritis self-efficacy and resource loss for psychological distress in a sample of 117 RA patients from Turkey, a secular, Islamic, non-western developing country. The results revealed that RA patients experience considerable anxiety and depressive symptoms. The results of the regression analysis showed that gender, helplessness coping and resource loss are significant predictors of anxiety, whereas arthritis self-efficacy and resource loss are significant predictors of depression. Resource loss appeared as an important predictor for both anxiety and depression. This finding was consistent with the COR theory. The clinical implications of these findings are discussed.
Two hundred and thirty-five adolescents completed a questionnaire on the subject of eating attitudes, self-esteem, reasons for exercise, and their ideal versus current body size and shape. As predicted, boys were as likely to want to be heavier as lighter, whereas very few girls desired to be heavier. Only girls associated body dissatisfaction with the concept of self-esteem. Male self-esteem was not affected by body dissatisfaction. Specific reasons for exercise were found to correlate with low self-esteem and disordered eating, regardless of sex. The results are discussed in relation to burgeoning published research in this area.
Body Image provides a comprehensive summary of research on body image in men, women, and children drawing together research findings from the fields of psychology, sociology, clothing, and gender studies. This third edition has been thoroughly revised and updated to reflect the significant increase in research on body image since the previous edition, as well as the significant cultural changes in how men's and women's bodies are viewed. Data are also included from interviews and focus groups with men, women, and children who have spoken about their experiences of body image and body dissatisfaction, producing a comprehensive understanding of how men and women construct and understand their bodies in the twenty-first century. The only sole-authored text to provide a comprehensive view of body image research, focusing on men, women, and children, Body Image will be invaluable to students and researchers, as well as practitioners with an interest in body image and how to reduce body dissatisfaction.
Background Efforts to better understand the phenomenon of the ‘bottom’, the beginning of the process of turning away from alcohol, are important for both theoretical and practical goals. The conservation of resources theory by Hobfoll may represent a suitable framework to base these attempts around. Aim The aim of the study was to examine the role of resource loss in completing alcoholism treatment on the basis of Hobfoll’s conservation of resources theory. Methods The study included 86 patients undergoing inpatient alcoholism treatment. An assessment of resource loss and gain during the previous year, as well as of the decisional balance regarding the pros and cons of drinking alcohol, took place at the beginning of therapy. Results The results of hierarchical binary logistic regression confirmed that resource loss was the only significant predictor of therapy completion, after adjustment for decisional balance, demographics and basic clinical data. Additionally, gender moderated the relationship between resource gain and therapy completion: while an increase in gain was related to a decreased chance of completing therapy in men, the opposite effect was noted in women. Conclusions Resource loss has more influence than decisional balance in predicting therapy completion, which can be translated into clinically valid recommendations based on gender differences.
Western health professions are trying to become more effective in helping patients to manage chronic pain and, as a result, are looking to complementary and alternative methods, often originating from the east (Asia). The physiotherapy profession, however, appears to be at a critical juncture in its development, whereby incorporation of too much holistic treatment may destabilise 'the body as a machine' concept, a concept that has long been the profession's major basis for its rationale for treatment. Yet, a large amount of recent literature has warranted the need for physiotherapists dealing with chronic pain, to understand the psyche as unseparate from the soma in order for treatment to provide a lasting effect. Such understanding puts large emphasis on physiotherapeutic intervention being placebo- or nocebo-based, thus implying that intervention will often become a necessity in order to tolerate pain, or, become a conduit that exacerbates the pain. This is supported by evidence indicating that both modality intervention and psychological intervention are one of the key inhibitors to those with long-term chronic pain effectively managing their condition independently. Body-mindfulness practice, stemming from an ancient Indian form of meditation, is a process adopted recently by behavioural therapists in the West to ease psychological disorders. It claims to bridge the intervention conundrum in those suffering with long-term chronic pain. Body-mindfulness practice might, therefore, prove useful as a self-empowerment process in addition to being an antidote to dependence or exacerbation from physiotherapy treatment intervention. The physiotherapy profession has been looking for ways to merge the conceptual understanding of the 'body as a machine' with holism and is keen to do this without sacrificing its highly regarded professional status. Body-mindfulness practice appears to be a middle road that blends unreactive awareness to the grounded reality of arising physical sensations, healing the Cartesian split of the psyche from the soma. In addition, physiotherapists appear to be well suited professionals for guiding body-mindfulness practice due to their ability in assessing the fundamental aspects required for the process to unfold.
Recent neuroscientific evidence has confirmed the important role of cognitive and behavioral factors in the development and treatment of chronic pain. Neuropathic and musculoskeletal pain are associated with substantial reorganization of the primary somatosensory and motor cortices as well as regions such as the anterior cingulate cortex and insula. What is more, in patients with chronic low back pain and fibromyalgia, the amount of reorganizational change increases with chronicity; in phantom limb pain and other neuropathic pain syndromes, cortical reorganization correlates with the magnitude of pain. These findings have implications for both our understanding of chronic pain and its prevention and treatment. For example, central alterations may be viewed as pain memories that modulate the processing of both noxious and nonnoxious input to the somatosensory system and outputs of the motor and other response systems. The cortical plasticity that is clearly important in chronic pain states also offers potential targets for rehabilitation. The authors review the cortical changes that are associated with chronic pain and the therapeutic approaches that have been shown to normalize representational changes and decrease pain and discuss future directions to train the brain to reduce chronic pain.
Unlabelled:
This study evaluates the construct validity (including sensitivity to change) of the numerical rating scale (NRS) for pain intensity (I) and unpleasantness (U) and participant pain scale preferences in children/adolescents with acute postoperative pain. Eighty-three children aged 8 to 18 years (mean = 13.8, SD = 2.4) completed 3 pain scales including NRS, Verbal Rating Scale (VRS), and faces scales (Faces Pain Scale-Revised [FPS-R] and Facial Affective Scale [FAS], respectively) for pain intensity (I) and unpleasantness (U) 48 to 72 hours after major surgery, and the NRS, VRS and Functional Disability Index (FDI) 2 weeks after surgery. As predicted, the NRSI correlated highly with the VRSI and FPS-R and the NRSU correlated highly with the VRSU and FAS 48 to 72 hours after surgery. The FDI correlated moderately with the NRS at both time points. Scores on the NRSI and NRSU at 48 to 72 hours were significantly higher than at 2 weeks after surgery. Children found the faces scales the easiest to use while the VRS was liked the least and was the hardest to use. The NRS has adequate evidence of construct validity including sensitivity for both pain intensity and unpleasantness. This study further supports the validity of the NRS as a tool to measure both intensity and unpleasantness of acute pain in children.
Perspective:
This article evaluates the construct validity including sensitivity of the Numerical Rating Scale for pain intensity and pain unpleasantness over time in children after major surgery. The NRS could be used by clinicians to assess these 2 different dimensions of children's pain experience in acute pain settings.
The objective of this article is to assess the contribution of disease activity, pain, and psychological factors to self-reported sleep disturbance in patients with rheumatoid arthritis (RA), and to evaluate whether depression mediates the effects of pain on sleep disturbance. The sample included 106 patients with confirmed RA who participated in an assessment of their disease activity, pain, psychological functioning, and sleep disturbance during a baseline evaluation prior to participating in a prospective study to help them manage their RA. Self-measures included the Rapid Assessment of Disease Activity in Rheumatology, the SF-36 Pain Scale, the Helplessness and Internality Subscales of the Arthritis Helplessness Index, the Active and Passive Pain Coping Scales of the Pain Management Inventory, the Center for Epidemiological Studies Depression Scale, and the Pittsburgh Sleep Quality Index. Hierarchical multiple regression analysis confirmed that higher income, pain, internality, and depression contributed independently to higher sleep disturbance. A mediational analysis demonstrated that depression acted as a significant mechanism through which pain contributed to sleep disturbance. Cross-sectional findings indicate that pain and depression play significant roles in self-reported sleep disturbance among patients with RA. The data suggest the importance of interventions that target pain and depression to improve sleep in this medical condition.
Perceptions and evaluations of the own body are important sources of self-esteem. Having a rheumatic disease challenges maintenance of positive self-esteem due to consequences of the disease such as unfavorable sensations as pain and limited (physical) functioning. We expect that a positive experience of the own body in spite of a rheumatic disease (body-self harmony) will be associated with higher levels of self-esteem and that experiencing the body as unworthy part of the own person or as disabler for own strivings (body-self alienation) will result in lower levels of self-esteem. For this explorative study, the body experience questionnaire (BEQ) measuring body-self unity was developed and piloted. One hundred sixty-eight patients visiting the outpatient rheumatology clinic of the Medisch Spectrum Twente, Enschede, The Netherlands, completed a questionnaire on touchscreen computers to measure body-self unity (BEQ), illness cognitions (illness cognition questionnaire), pain intensity, functional limitations (health assessment questionnaire disability index), self-esteem (Rosenberg Self-Esteem Scale) and demographics. To analyze predictors of self-esteem, hierarchical regression analyses were employed. The BEQ revealed a two-factor structure with good reliability (subscale harmony, four items, Cronbach's α = 0.76; subscale alienation, six items, Cronbach's α = 0.84). The final model of the hierarchical regression analyses showed that self-esteem can be predicted by the illness cognitions helplessness and acceptance, by harmony and most strongly by alienation from the body. R(2) of the final model was 0.50. The relationship between functional limitations and self-esteem was totally mediated by the psychological constructs body-self unity and illness cognitions. This explorative study showed the importance of the unity of body and self for self-esteem in patients with a rheumatic disease.
Arthritis and mental health disorders are leading causes of disability commonly seen by health care providers. Several studies demonstrate a higher prevalence of anxiety and depression in persons with arthritis versus those without arthritis.
Determine the national prevalence of serious psychological distress (SPD) and frequent anxiety or depression (FAD) in adults with arthritis, and in adults with arthritis, identify risk factors associated with SPD.
Cross-sectional data from the 2002 National Health Interview Survey, an in-person household interview survey, were used to estimate the prevalence of SPD and FAD in adults with (n=6,829) and without (n=20,676) arthritis. In adults with arthritis, the association between SPD and sociodemographic, clinical, and functional factors was evaluated using multivariable logistic regression.
The prevalence of SPD and FAD in adults with arthritis is significantly higher than in adults without arthritis (5.6% vs 1.8% and 26.2% vs 10.7%, P<.001, respectively). In adults with arthritis, SPD was significantly associated with younger age, lower socioeconomic status, divorce/separation, recurrent pain, physical inactivity, having functional or social limitations, and having comorbid medical conditions. Adults aged 18 to 44 years were 6.5 times more likely to report SPD than those 65 years or older, and adults with recurrent pain were 3 times more likely to report SPD than those without recurrent pain.
Serious psychological distress and FAD affect persons with arthritis and should be addressed in their treatment. Younger adults with arthritis, and those with recurrent pain or either functional or social limitations, may be at higher risk for SPD.
Body image in patients with rheumatoid arthritis
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