title: Body image dissatisfaction: clinical features, and psychosocial disability in inflammatory bowel disease.
abstract: BACKGROUND
  Body image refers to a person's sense of their physical appearance and body function. A negative body image self-evaluation may result in psychosocial dysfunction. Crohn's disease and ulcerative colitis are associated with disabling features, and body image dissatisfaction is a concern for many patients with inflammatory bowel disease (IBD). However, no study has assessed body image and its comorbidities in patients with IBD using validated instruments. Our aim was to explore body image dissatisfaction in patients with IBD and assess its relationship with biological and psychosocial variables.
  
  
  METHODS
  We studied 330 patients (median age, 36 yr; range, 18-83; 169 men) using quantitative and qualitative methods. Patients completed a self-administered questionnaire that included a modified Hopwood Body Image Scale, the Cash Body Image Disturbance Questionnaire, and other validated instruments. Clinical and disease activity data were also collected.
  
  
  RESULTS
  Body image dissatisfaction was associated with disease activity (P < 0.001) and steroid treatment (P = 0.03) but not with immunotherapy (P = 0.57) or biological (P = 0.55) therapy. Body image dissatisfaction was also associated with low levels of general (P < 0.001) and IBD-specific (P < 0.001) quality of life, self-esteem (P < 0.001), and sexual satisfaction (P < 0.001), and with high levels of anxiety (P < 0.001) and depression (P < 0.001). Qualitative analysis indicated that patients were concerned about both physical and psychosocial consequences of body image dissatisfaction, including steroid side effects and impaired work and social activities.
  
  
  CONCLUSIONS
  Body image dissatisfaction is common in patients with IBD, relates to specific clinical variables and is associated with significant psychological dysfunction. Its measurement is warranted as part of a comprehensive patient-centered IBD assessment.
authors.affiliation: *Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland; †School of Medicine and Medical Science, University College Dublin, Dublin, Ireland; ‡Department of Psychiatry, Psychotherapy and Mental Health Research, St Vincent's University Hospital, Dublin, Ireland; and §Department of Gastroenterology, St Luke's Hospital, Kilkenny, Ireland.
authors.forename: Edel
authors.initials: E
authors.lastname: McDermott
authors.forename: Georgina
authors.initials: G
authors.lastname: Mullen
authors.forename: Jenny
authors.initials: J
authors.lastname: Moloney
authors.forename: Denise
authors.initials: D
authors.lastname: Keegan
authors.forename: Kathryn
authors.initials: K
authors.lastname: Byrne
authors.forename: Glen A
authors.initials: GA
authors.lastname: Doherty
authors.forename: Garret
authors.initials: G
authors.lastname: Cullen
authors.forename: Kevin
authors.initials: K
authors.lastname: Malone
authors.forename: Hugh E
authors.initials: HE
authors.lastname: Mulcahy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001828:Body Image / Q000523:psychology*; D015331:Cohort Studies; D004644:Emotions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000503:physiopathology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011379:Prognosis; D011594:Psychometrics / Q000379:methods; D011788:Quality of Life; D012649:Self Concept; D012720:Severity of Illness Index; D012920:Social Behavior Disorders / Q000209:etiology* / Q000523:psychology; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D055815:Young Adult