Body image dissatisfaction common in inflammatory bowel disease

Last Updated: 2015-02-04

By Will Boggs MD

NEW YORK (Reuters Health) - Body image dissatisfaction (BID) is common in individuals with inflammatory bowel disease (IBD) and may be associated with lower health-related quality of life, according to the results of studies conducted in Ireland and the United States.

In one study, Dr. Sumona Saha, from the University of Wisconsin School of Medicine and Public Health, Madison, and colleagues used data from 274 participants in the Ocean State Crohn's and Colitis Area Registry (OSCCAR) to determine the trajectory of BID and its risk factors in adults with newly diagnosed IBD.

"This study shows that a disorder such as inflammatory bowel disease, which predominantly affects the gastrointestinal tract, also affects body image, and that poor body image is associated with lower health-related quality of life, even when using a disease-specific measure rather than a global quality of life measure," Dr. Saha told Reuters Health by email.

Adapted Satisfaction with Appearance (ASWAP) scores at baseline averaged 30.1 for women and 21.2 for men, where higher scores reflect greater BID, and these scores did not change significantly in the ensuing two years.

ASWAP scores did not differ significantly between patients with ulcerative colitis (UC) and patients with Crohn's disease (CD), but factors associated with greater BID (as measured by ASWAP) included female gender, greater disease activity, higher symptom burden, longer duration of steroid use, dermatologic and musculoskeletal manifestations of IBD, and, among CD patients, ileocolonic disease location.

Increasing ASWAP scores were significantly associated with decreases in health-related quality of life scores (p<0.0001).

"We are still in the early phase of understanding the full psychosocial impact of IBD and how outcomes such as body image dissatisfaction are impacted by medical and surgical therapy," Dr. Saha concluded. "Future clinical trials should consider using BID as well as other psychosocial factors as endpoints since clinical response and remission may not completely assess the efficacy of a given therapy."

In the other study, Dr. Hugh E. Mulcahy, from St. Vincent's University Hospital, University College, Dublin, and his team used different measures (a modified Hopwood Body Image Scale and the Cash Body Image Disturbance Questionnaire) to evaluate BID in 330 patients with IBD.

The median Body Image Scale score was 6 (range, 0-27), with 42 patients (13%) reporting no concern about any aspect of their body image.

Higher levels of dissatisfaction were associated with lower quality of life, self-esteem, and sexual satisfaction and with higher levels of anxiety and depression.

More than half of the patients reported some psychological and social consequences on their Cash Body Image Disturbance Questionnaires, and more than 40% contained a reference to interference with social, sporting, or personal activities.

" pecific psychological interventions are available to help treat IBD-related stress and body image dissatisfaction," the researchers conclude, "and it may be that their application, as part of new treatment algorithms, will enhance overall quality of life and compliment conventional IBD therapies in the future."

Both studies are online in the February issue of the journal Inflammatory Bowel Diseases.

Dr. Simon Knowles, clinical psychologist from Swinburne University of Technology, Hawthorn, Victoria, Australia, has studied the relationship between body image and illness perception in IBD patients. He told Reuters Health by email, "IBD can and does have a significant impact on quality of life and mental health. A biopsychosocial approach to managing IBD is needed; this includes not only screening for disease activity, but also mental health, quality of life issues." (His paper is here: http://bit.ly/1Ksh32d)

"The first important strategy is to ask if patients have mental health concerns, including BID concerns," Dr. Knowles said. "Once identified, refer to mental health experts. Doctors should also be aware of the risk factors as identified in the article."

Dr. Antonino Spinelli from Humanitas Research Hospital, Milan, Italy, and Dr. Francesco Pagnini, from Catholic University of Milan, recently reported on psychological perspectives of IBD patients undergoing surgery. They told Reuters Health in a joint email, "Considering the importance of BID, it is advisable to assess it, together with a wider set of clinical and psychological issues. In general, a psychological assessment, maybe with a semi-structured interview, could work." (Their paper is here: http://bit.ly/1ua60s9)

"When a person presents with BID, it is important to recognize and to provide the clinical and social support that he or she may need, on a case-by-case basis," they explain. "There are several clinical options (counseling, psychotherapy, support groups, CAM) that should be decided on the basis of the person's needs."

Their main message to physicians: "Pay attention to the person as a whole, not only to IBD issues."

For the Saha study, three authors report various financial relationships with government agencies and pharmaceutical companies; none of the other authors in both studies report any disclosures.

SOURCE: http://bit.ly/16AeVJk and http://bit.ly/16oB5xr

Inflamm Bowel Dis 2015.