title: Development and Validation of the Body Concealment Scale for Scleroderma.
abstract: Body concealment is a component of social avoidance among people with visible differences from disfiguring conditions, including systemic sclerosis (SSc). The study objective was to develop a measure of body concealment related to avoidance behaviors in SSc.
  
  
  
  Initial items for the Body Concealment Scale for Scleroderma (BCSS) were selected using item analysis in a development sample of 93 American SSc patients. The factor structure of the BCSS was evaluated in 742 Canadian patients with single-factor, 2-factor, and bifactor confirmatory factor analysis models. Convergent and divergent validity were assessed by comparing the BCSS total score with the Brief-Satisfaction with Appearance Scale (Brief-SWAP) and measures of depressive symptoms and pain.
  
  
  
  A 2-factor model (Comparative Fit Index [CFI] 0.99, Tucker-Lewis Index [TLI] 0.98, Root Mean Square Error of Approximation [RMSEA] 0.08) fit substantially better than a 1-factor model (CFI 0.95, TLI 0.94, RMSEA 0.15) for the 9-item BCSS, but the Concealment with Clothing and Concealment of Hands factors were highly correlated (α = 0.79). The bifactor model (CFI 0.99, TLI 0.99, RMSEA 0.08) also fit well. In the bifactor model, the omega coefficient was high for the general factor (ω = 0.80), but low for the Concealment with Clothing (ω = 0.01) and Concealment of Hands (ω = 0.33) factors. The BCSS total score correlated more strongly with the Brief-SWAP Social Discomfort (r = 0.59) and Dissatisfaction with Appearance (r = 0.53) subscales than with measures of depressive symptoms and pain.
  
  
  
  The BCSS sum score is a valid indicator of body concealment in SSc that extends the concepts of body concealment and avoidance beyond the realms of body shape and weight to concerns of individuals with visible differences from SSc.
authors.affiliation: McGill University and the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Jewett
authors.affiliation: San Diego State University and the University of California, San Diego.
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Malcarne
authors.affiliation: McGill University and the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Kwakkenbos
authors.affiliation: Centre for Appearance Research, University of the West of England, Bristol, UK.
authors.forename: Diana
authors.initials: D
authors.lastname: Harcourt
authors.affiliation: Centre for Appearance Research, University of the West of England, Bristol, UK.
authors.forename: Nichola
authors.initials: N
authors.lastname: Rumsey
authors.affiliation: McGill University and the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Annett
authors.initials: A
authors.lastname: Körner
authors.affiliation: McGill University and the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Russell J
authors.initials: RJ
authors.lastname: Steele
authors.affiliation: McGill University and the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Marie
authors.initials: M
authors.lastname: Hudson
authors.affiliation: McGill University and the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Murray
authors.initials: M
authors.lastname: Baron
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Haythornthwaite
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Leslie
authors.initials: L
authors.lastname: Heinberg
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Fredrick M
authors.initials: FM
authors.lastname: Wigley
authors.affiliation: McGill University and the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Brett D
authors.initials: BD
authors.lastname: Thombs
mesh_terms: D000328:Adult; D000368:Aged; D001828:Body Image / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics / Q000379:methods*; D012595:Scleroderma, Systemic / Q000523:psychology*; D012919:Social Behavior; D011795:Surveys and Questionnaires