Page 83 - JCBP-2-4

Journal of Clinical and
Basic Psychosomatics Adverse life events and body image

the hospital, where they signed an informed consent form body that they “feel.” First, the participants selected the
and completed a questionnaire, providing information on silhouette they believed represented their body when they
age, sex, diagnosis of ED or RMDD, duration of illness, looked at themselves in the mirror (visual BID); second,
years of treatment, and number of hospitalizations. they were instructed to close their eyes and try to feel their
The interviewer recorded the height and weight of the body before choosing the body shape (non-visual BID).
participants to obtain BMI. The following tests were used The difference between the figure they chose and the actual
to assess the clinical features, ALEs, and body image: shape according to BMI defined the BID. We defined
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1. Traumatic life events questionnaire. This is a 23-item three categories: (1) overestimation of the body shape,
self-report questionnaire designed to assess ALEs with (2) underestimation of the body shape, and (3) absence of
dichotomous responses (YES/NO). Participants select BID when the figure they chose was superior, inferior, or
their most distressing traumatic experiences and equal to the actual BMI, respectively.
report the age at which they occurred and the level
of distress associated with them. This allows for the 2.3. Statistical analysis
examination of common ALEs, both interpersonal and All statistical analyses were performed using Statistical
non-interpersonal, over the course of an individual’s Package for the Social Sciences 24.0 (IBM Software,
lifetime. The questionnaire has been tested on diverse Illinois). To examine differences within the ED group,
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populations and has satisfactory psychometric Student’s t-test was used to compare the presence of
properties (internal consistency of 0.74 – 0.91). interpersonal ALEs and pre-13 interpersonal ALEs
2. Contour Drawing Rating Scale (CDRS). This scale (a dichotomized categorical variable) with the quantitative
was developed and validated by Thompson and Gray variables when the sample size was >30. When the sample
in 1995. It consists of nine male and nine female size was <30, the Mann–Whitney U test was used. To
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drawings that are rated from 1 to 9 based on their size. examine intergroup differences (ED, RMDD, and control
Participants select the drawing that represents their groups) in the quantitative measures of BID, impulsivity,
ideal body and the one that they believed was closest and perfectionism in relation to interpersonal ALEs, pre-
to their actual weight. This scale is useful in assessing 13 ALEs, and pre-13 interpersonal ALEs, the one-factor
body dissatisfaction and BID and has good internal parametric analysis of variance test and Kruskal–Wallis
consistency (Cronbach’s alpha coefficient: 0.92). test were used. Similarly, a linear regression model was
3. Eating disorder inventory (EDI-2): This is also a self- established to assess the impact of pre-13 interpersonal
report measure of ED. This questionnaire comprises ALEs on BID, perfectionism, and impulsivity. All statistical
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91 items and uses a 6-point Likert scale (1 = never; tests were performed using a two-tailed approach, with the
6 = always). It explores a range of clinical features and is significance level set at an alpha value of 0.05.
classified into 11 subscales: Drive for Thinness, Bulimia,
Body Dissatisfaction, Inefficacy, Perfectionism, 3. Results
Interpersonal Distrust, Interoceptive Awareness, 3.1. General sample description
Maturity Anxiety, Ascetism, Impulse Regulation, and
Social Insecurity. It can discriminate patients with As shown in Table 1, 72 patients with ED (91.1%) reported
illness from those who are not clinically ill. Its internal having experienced ALEs in their lifetime, with 69.6%
consistency score ranges from 0.83 to 0.93. reporting non-visual BID and 65% reporting visual BID.
The mean duration of illness was 17.1 (range: 1 – 47;
The primary outcome of the study was the presence of SD: 2.9) years, and 44.3% of patients reported at least
ALEs. In accordance with a previous study, we classified one hospitalization (mean: 0.81, range: 0 – 5, SD: 1.1).
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the recorded ALEs into two categories: (1) interpersonal Furthermore, 100% and 80.5% of participants in the
ALEs and (2) non-interpersonal ALEs. In addition, an RMDD and control groups reported the presence of ALEs,
analysis that considered the presence of pre-13 ALEs (both respectively, and no differences were noted between non-
interpersonal and non-interpersonal) and the presence of visual and visual BID in 60% of patients in the RMDD
pre-13 interpersonal ALEs was conducted. group and 61% of patients in the control group. Family and

The secondary outcomes assessed included levels social relationships were considered better in the control
of perfectionism, impulsivity, and the presence of BID. group.
To examine the presence of BID, the CDRS was used to
determine the participants’ ideal body image, visual BID, 3.2. Characteristics of ALEs in the sample
non-visual BID, and actual shape according to their BMI. As shown in Figure 1, patients in the ED group (black
The body that patients “see” was “separated” from the column) had a higher proportion of interpersonal ALEs

Volume 2 Issue 4 (2024) 3 doi: 10.36922/jcbp.4662