Correlates of body image in individuals with endometriosis: The role of body compassion and endometriosis-related symptoms
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This study found that nonmenstrual abdominal pain, difficulty detaching from negative body thoughts, and lower body acceptance were associated with poorer body image in individuals with endometriosis.
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This cross-sectional study surveyed 261 individuals with endometriosis to examine how body compassion and specific disease symptoms correlate with body image outcomes. The results indicated that higher levels of body compassion, particularly acceptance and defusion, were significantly associated with more positive body attitudes and lower dissatisfaction. Conversely, greater symptom distress and certain pain types, such as abdominal and urinary pain, predicted negative appreciation of body size and general body dissatisfaction. Relevance to endometriosis: Centrally about the condition, this paper investigates the psychological correlates of body image specifically within a diagnosed endometriosis population.
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Abstract
Knowledge pertaining to the interplay between body image, body compassion, and endometriosis-related symptoms is limited. The current study aimed to elucidate the relationships between body compassion, body image, and endometriosis-related symptoms, and explore whether endometriosis-related factors or body compassion are significant correlates of body image. Individuals with self-reported symptomatic endometriosis (n = 261), aged 18 years and over, provided endometriosis-related information and completed the Body Attitude Test and Body Compassion Scale. Regression analyses determined that the presence nonmenstrual abdominal pain, lower ability to defuse from negative body-related thoughts, lower body-related acceptance, and higher levels of common humanity were significant correlates of body image, as measured by the Body Attitude Test, in the current endometriosis sample. Preliminary support is noted for the potential inclusion of compassion-focused interventions for addressing body image concerns in endometriosis, with nonmenstrual abdominal pain, dyspareunia, nausea, and bloating viewed as important symptoms for consideration.
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Abstract
Introduction
Method
Participants
Measures
Sociodemographic and endometriosis-related information
Body-related measures
Design and data analysis
Results
| Demographic characteristic | Frequency | Percent (%) |
|---|---|---|
| Country of residence | ||
| Australia/Oceania (e.g., New Zealand, Papua New Guinea) | 231 | 88.5 |
| United Kingdom | 10 | 3.8 |
| North America | 20 | 7.7 |
| Highest level of academic attainment | ||
| High school or below | 42 | 16.1 |
| Vocational certificate/qualification | 55 | 21.1 |
| Bachelor/Postgraduate degree | 164 | 62.8 |
| Employment status | ||
| Student | 51 | 19.5 |
| Employed | 166 | 63.6 |
| Unable to work due to health | 46 | 16.9 |
| Relationship status | ||
| Single | 69 | 26.4 |
| Committed | 111 | 42.5 |
| Married | 81 | 31.1 |
| Sexuality | ||
| Gay, lesbian, or same gender attracted | 22 | 9.2 |
| Straight/heterosexual | 192 | 73.6 |
| Bisexual | 34 | 13.0 |
| Asexual | 13 | 4.9 |
| Reproductive history | ||
| I have never tried to conceive | 155 | 59.4 |
| I have tried to conceive but have never been pregnant | 23 | 8.8 |
| I am currently trying to conceive | 15 | 5.7 |
| I am currently pregnant | 2 | 0.8 |
| I have been pregnant/no miscarriages | 23 | 8.8 |
| I have been pregnant/1or more births/1or more miscarriages | 24 | 9.2 |
| I have been pregnant/Nil live births | 19 | 7.3 |
Body-related outcomes
Body Compassion Scale (n = 228)
| Variable | 1. | 2. | 3. | 4. | 5. | 6. | 7. | 8. | 9. | 10. | 11. | 12. | 13. | 14. | 15. | 16. | 17. | 18. | 19. | 20. | 21. | 22. | 23 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1. Dysmenorrhea | - | 0.001 | 0.001 | 0.637 | 0.175 | 0.140 | 0.157 | 0.001 | 0.078 | 0.466 | 0.305 | 0.095 | 0.013 | 0.177 | 0.008 | 0.011 | 0.674 | 0.009 | 0.118 | 0.217 | 0.015 | 0.017 | 0.168 |
| 2. Back pain | 0.36 | - | 0.001 | 0.002 | 0.032 | 0.001 | 0.165 | 0.001 | 0.102 | 0.001 | 0.001 | 0.005 | 0.001 | 0.036 | 0.286 | 0.003 | 0.058 | 0.341 | 0.006 | 0.001 | 0.055 | 0.001 | 0.103 |
| 3. Abdominal pain | 0.36 | 0.47 | - | 0.011 | 0.009 | 0.001 | 0.003 | 0.182 | 0.835 | 0.001 | 0.001 | 0.001 | 0.007 | 0.483 | 0.004 | 0.001 | 0.459 | 0.009 | 0.003 | 0.001 | 0.012 | 0.001 | 0.175 |
| 4. Dyspareunia | 0.06 | 0.32 | 0.25 | - | 0.001 | 0.008 | 0.046 | 0.110 | 0.857 | 0.364 | 0.806 | 0.005 | 0.002 | 0.003 | 0.931 | 0.014 | 0.002 | 0.230 | 0.040 | 0.037 | 0.015 | 0.004 | 0.252 |
| 5. Post coital | 0.20 | 0.25 | 0.29 | 0.60 | - | 0.157 | 0.045 | 0.011 | 0.010 | 0.001 | 0.315 | 0.006 | 0.001 | 0.001 | 0.243 | 0.002 | 0.447 | 0.816 | 0.015 | 0.555 | 0.011 | 0.004 | 0.177 |
| 6. Bowel pain | 0.15 | 0.26 | 0.30 | 0.27 | 0.16 | - | 0.001 | 0.004 | 0.084 | 0.003 | 0.102 | 0.001 | 0.057 | 0.424 | 0.589 | 0.004 | 0.065 | 0.969 | 0.058 | 0.002 | 0.097 | 0.006 | 0.033 |
| 7. Urination pain | 0.16 | 0.16 | 0.33 | 0.29 | 0.31 | 0.46 | - | 0.001 | 0.488 | 0.216 | 0.100 | 0.006 | 0.014 | 0.549 | 0.837 | 0.963 | 0.190 | 0.313 | 0.845 | 0.174 | 0.192 | 0.487 | 0.306 |
| 8. HMB | 0.47 | 0.44 | 0.16 | 0.26 | 0.49 | 0.38 | 0.50 | - | 0.766 | 0.008 | 0.077 | 0.118 | 0.296 | 0.082 | 0.949 | 0.837 | 0.033 | 0.144 | 0.480 | 0.676 | 0.117 | 0.353 | 0.833 |
| 9. Fertility | 0.38 | 0.33 | 0.04 | 0.01 | −0.71 | −0.39 | −0.25 | −0.08 | - | 0.847 | 0.060 | 0.018 | 0.897 | 0.856 | 0.689 | 0.929 | 0.712 | 0.389 | 0.520 | 0.068 | 0.381 | 0.838 | 0.973 |
| 10. Fatigue | 0.07 | 0.33 | 0.29 | 0.10 | 0.43 | 0.24 | 0.14 | 0.32 | 0.04 | - | 0.001 | 0.001 | 0.018 | 0.278 | 0.370 | 0.109 | 0.854 | 0.439 | 0.739 | 0.007 | 0.126 | 0.101 | 0.108 |
| 11. Bloating | 0.10 | 0.33 | 0.29 | 0.03 | 0.11 | 0.13 | 0.18 | 0.21 | 0.38 | 0.32 | - | 0.006 | 0.001 | 0.637 | 0.152 | 0.128 | 0.276 | 0.020 | 0.014 | 0.017 | 0.036 | 0.001 | 0.325 |
| 12. Nausea | 0.19 | 0.24 | 0.33 | 0.31 | 0.33 | 0.29 | 0.33 | 0.21 | −0.60 | 0.27 | 0.23 | - | 0.010 | 0.433 | 0.063 | 0.017 | 0.435 | 0.002 | 0.048 | 0.001 | 0.001 | 0.001 | 0.615 |
| 13. Vulva pain | 0.42 | 0.40 | 0.35 | 0.47 | 0.52 | 0.26 | 0.45 | 0.23 | 0.01 | 0.21 | 0.48 | 0.35 | - | 0.001 | 0.413 | 0.002 | 0.058 | 0.020 | 0.001 | 0.081 | 0.001 | 0.001 | 0.071 |
| 14. Clitoral pain | 0.44 | 0.46 | 0.16 | 0.76 | 0.93 | 0.20 | 0.19 | 0.65 | 0.01 | 0.26 | 0.12 | −0.19 | 0.73 | - | 0.040 | 0.096 | 0.481 | 0.143 | 0.051 | 0.098 | 0.014 | 0.005 | 0.009 |
| 15. Body Compassion Scale Total | −0.25 | −0.08 | −0.21 | −0.09 | −0.12 | −0.04 | 0.02 | 0.08 | −0.08 | −0.07 | −0.10 | −0.15 | −0.10 | −0.43 | - | 0.001 | 0.001 | 0.001 | 0.001 | 0.001 | 0.001 | 0.001 | 0.003 |
| 16. BCS defusion | −0.23 | −0.22 | −0.26 | −0.23 | −0.33 | −0.22 | −0.01 | −0.03 | 0.02 | −0.12 | −0.11 | −0.19 | −0.37 | −0.36 | 0.76 | - | 0.037 | 0.001 | 0.001 | 0.001 | 0.001 | 0.001 | 0.050 |
| 17. BCS common humanity | −0.04 | 0.14 | 0.05 | 0.29 | 0.08 | 0.14 | 0.14 | 0.25 | −0.07 | 0.01 | 0.08 | 0.06 | 0.24 | −0.16 | 0.65 | 0.14 | - | 0.001 | 0.341 | 0.664 | 0.863 | 0.117 | 0.556 |
| 18. BCS acceptance | −0.24 | −0.07 | −0.19 | −0.11 | −0.03 | 0.01 | −0.11 | −0.17 | −0.17 | −0.06 | −0.17 | −0.25 | −0.29 | −0.32 | 0.74 | 0.55 | 0.24 | - | 0.001 | 0.001 | 0.001 | 0.001 | 0.001 |
| 19. BAT NABS | 0.15 | 0.21 | 0.21 | 0.19 | 0.26 | 0.15 | −0.02 | 0.08 | −0.12 | 0.02 | 0.18 | 0.16 | 0.41 | 0.41 | −0.51 | −0.58 | −0.03 | −0.66 | - | 0.001 | 0.001 | 0.001 | 0.001 |
| 20. BAT LBF | 0.12 | 0.32 | 0.32 | 0.19 | 0.06 | 0.23 | −0.14 | 0.05 | 0.34 | 0.19 | 0.17 | 0.27 | 0.22 | 0.35 | −0.35 | −0.51 | −0.01 | −0.28 | 0.41 | - | 0.001 | 0.001 | 0.395 |
| 21. BAT Dissatisfaction | 0.22 | 0.14 | 0.18 | 0.22 | 0.27 | 0.13 | 0.14 | 0.18 | −0.17 | 0.11 | 0.15 | 0.28 | 0.41 | 0.51 | −0.65 | −0.65 | −0.14 | −0.81 | 0.80 | 0.38 | - | 0.001 | 0.001 |
| 22. Body Attitude Test Total | 0.22 | 0.25 | 0.27 | 0.26 | 0.30 | 0.21 | 0.07 | 0.11 | −0.04 | 0.12 | 0.24 | 0.27 | 0.45 | 0.57 | −0.61 | −0.69 | −0.06 | −0.72 | 0.92 | 0.61 | 0.90 | - | 0.001 |
| 23. Body Mass Index | 0.12 | 0.12 | −0.09 | −0.10 | −0.13 | −0.15 | −0.10 | −0.02 | 0.01 | −0.11 | −0.07 | −0.04 | 0.21 | 0.50 | −0.18 | −0.12 | −0.04 | −0.30 | 0.46 | 0.05 | 0.39 | 0.37 | - |
Body attitude test (n = 228)
Body compassion, body image, and endometriosis-related symptoms
Contribution of endometriosis-specific factors, endometriosis-related symptoms, and body compassion to body image
Negative appreciation of body size
| Correlate | Negative appreciation | Lack of familiarity | General dissatisfaction | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| b | β | t | p | b | β | t | p | b | β | t | p | |
| Step 1 | ||||||||||||
| Age | 0.03 | 0.03 | 0.45 | 0.653 | −0.03 | −0.05 | −0.69 | 0.488 | −0.01 | −0.01 | −0.08 | 0.937 |
| Body Mass Index | 0.37 | 0.35 | 5.64 | 0.001 | −0.02 | −0.03 | −0.48 | 0.629 | 0.21 | 0.28 | 4.46 | 0.001 |
| Symptom duration | −0.09 | −0.10 | −1.16 | 0.247 | 0.02 | 0.03 | 0.03 | 0.973 | −0.03 | −0.05 | −0.63 | 0.526 |
| Symptom distress | 2.19 | 0.16 | 2.30 | 0.022 | 2.34 | 0.26 | 3.77 | 0.001 | 2.33 | 0.23 | 3.37 | 0.001 |
| Pain VAS | 0.03 | 0.12 | 1.79 | 0.073 | 0.05 | 0.26 | 3.83 | 0.001 | 0.01 | 0.05 | 0.75 | 0.449 |
| Step 2 | ||||||||||||
| Age | 0.08 | 0.09 | 1.04 | 0.297 | 0.01 | 0.001 | 0.013 | 0.989 | 0.01 | 0.02 | 0.27 | 0.785 |
| Body Mass Index | 0.38 | 0.36 | 5.87 | 0.001 | −0.03 | −0.04 | −0.74 | 0.458 | 0.20 | 0.27 | 4.35 | 0.001 |
| Symptom duration | −0.17 | −0.18 | −2.25 | 0.025 | −0.02 | −0.03 | −0.40 | 0.686 | −0.07 | −0.11 | −1.34 | 0.179 |
| Symptom distress | 2.80 | 0.20 | 2.87 | 0.004 | 1.88 | 0.20 | 2.88 | 0.004 | 2.70 | 0.27 | 3.77 | 0.001 |
| Pain VAS | 0.01 | 0.05 | 0.77 | 0.438 | 0.04 | 0.21 | 2.77 | 0.006 | 0.01 | 0.02 | 0.26 | 0.791 |
| Dysmenorrhea | −1.99 | −0.14 | −1.71 | 0.088 | −0.46 | −0.04 | −0.59 | 0.555 | −1.48 | −0.14 | −1.73 | 0.085 |
| Abdominal | 2.87 | 0.15 | 2.27 | 0.024 | −0.15 | −0.01 | −0.18 | 0.852 | 1.07 | 0.07 | 1.15 | 0.250 |
| Bowel pain | 1.77 | 0.11 | 1.47 | 0.141 | −0.02 | −0.02 | −0.03 | 0.973 | 2.05 | 0.17 | 2.33 | 0.020 |
| Urination pain | −1.67 | −0.11 | −1.78 | 0.077 | 0.27 | 0.02 | 0.44 | 0.659 | −2.34 | −0.22 | −3.39 | 0.001 |
| HMB | −0.24 | −0.02 | −0.19 | 0.847 | 1.45 | 0.14 | 1.67 | 0.095 | 0.468 | 0.04 | 0.49 | 0.622 |
| Constipation | 0.82 | 0.05 | 0.77 | 0.439 | −0.04 | −0.04 | −0.05 | 0.953 | −0.04 | −0.01 | −0.05 | 0.954 |
| Bloating | 0.96 | 0.05 | 0.74 | 0.461 | 1.33 | 0.10 | 1.54 | 0.125 | 0.64 | 0.04 | 0.67 | 0.502 |
| Vulva | −0.99 | −0.06 | −0.89 | 0.374 | 1.25 | 0.12 | 1.68 | 0.094 | −0.69 | −0.06 | −0.85 | 0.394 |
| Clitoral | 3.89 | 0.16 | 2.36 | 0.019 | 0.39 | 0.02 | 0.36 | 0.719 | 1.46 | 0.08 | 1.21 | 0.227 |
| Step 3 | ||||||||||||
| Age | 0.11 | 0.12 | 1.96 | 0.051 | 0.03 | 0.05 | 0.62 | 0.534 | 0.04 | 0.06 | 1.20 | 0.233 |
| Body Mass Index | 0.27 | 0.25 | 5.57 | 0.001 | −0.06 | −0.09 | −1.50 | 0.135 | 0.10 | 0.13 | 3.60 | 0.001 |
| Symptom duration | −0.13 | −0.13 | −2.22 | 0.028 | −0.01 | −0.01 | −0.13 | 0.894 | −0.04 | −0.05 | −1.09 | 0.278 |
| Symptom distress | 0.59 | 0.04 | 0.83 | 0.409 | 1.22 | 0.14 | 2.02 | 0.045 | 0.74 | 0.08 | 1.83 | 0.068 |
| Pain VAS | −0.01 | −0.04 | −0.64 | 0.523 | 0.02 | 0.13 | 1.77 | 0.075 | −0.01 | −0.07 | −1.60 | 0.110 |
| Dysmenorrhea | −0.84 | −0.06 | -1.00 | 0.319 | 0.07 | 0.01 | 0.10 | 0.921 | −0.58 | −0.06 | −1.23 | 0.220 |
| Abdominal | 3.48 | 0.18 | 3.84 | 0.001 | 0.29 | 0.02 | 0.38 | 0.702 | 1.51 | 0.11 | 2.95 | 0.004 |
| Bowel pain | −0.37 | −0.02 | −0.43 | 0.672 | −0.74 | −0.07 | −1.01 | 0.316 | 0.12 | 0.01 | 0.24 | 0.812 |
| Urination pain | 0.46 | 0.03 | 0.65 | 0.517 | 0.75 | 0.08 | 1.30 | 0.210 | −0.45 | −0.04 | −1.13 | 0.262 |
| HMB | −0.73 | −0.05 | −0.80 | 0.427 | 1.02 | 0.10 | 1.31 | 0.193 | 0.15 | 0.01 | 0.29 | 0.775 |
| Constipation | 0.20 | 0.01 | 0.27 | 0.791 | −0.19 | −0.02 | −0.29 | 0.772 | −0.68 | −0.06 | −1.59 | 0.114 |
| Bloating | −0.22 | −0.01 | −0.24 | 0.813 | 0.70 | 0.05 | 0.88 | 0.380 | −0.23 | −0.02 | −0.45 | 0.656 |
| Vulva | −0.36 | −0.02 | −0.45 | 0.655 | 1.01 | 0.10 | 1.47 | 0.142 | 0.08 | 0.01 | 0.18 | 0.859 |
| Clitoral | 2.30 | 0.10 | 1.91 | 0.058 | −0.07 | −0.01 | −0.06 | 0.949 | 0.19 | 0.01 | 0.27 | 0.785 |
| Defusion | −0.32 | −0.32 | −5.97 | 0.001 | −0.25 | −0.40 | −5.68 | 0.001 | −0.20 | −0.29 | −6.80 | 0.001 |
| Humanity | 0.11 | 0.11 | 2.32 | 0.021 | 0.02 | 0.04 | 0.63 | 0.528 | 0.06 | 0.09 | 2.38 | 0.018 |
| Acceptance | −0.75 | −0.47 | −8.59 | 0.001 | −0.08 | −0.07 | −1.05 | 0.296 | −0.74 | −0.66 | −15.11 | 0.001 |
Lack of body familiarity
General body dissatisfaction
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