Body Image in Patients with Posttraumatic Stress Disorder after Childhood Sexual Abuse and Co-Occurring Eating Disorder

Abstract

Background: Body image is a multidimensional construct with cognitive-affective, behavioral and perceptive components. Survivors of childhood sexual abuse report a disturbance of the cognitive-affective component of their body image but not of the perceptive component. It has not yet been examined whether and how the behavioral component is affected. Also, it is still unknown whether the disturbances might be due to the influence of co-occurring eating disorders. Sampling and Methods: The cognitive-affective and behavioral components of the body image of 84 female participants with posttraumatic stress disorder (PTSD) after childhood sexual abuse (31 with a co-occurring eating disorder) and 53 healthy participants were assessed via the Dresden Body Image Inventory (Dresdner Körperbildfragebogen-35, DKB-35) and the Body Image Avoidance Questionnaire (BIAQ). Results: PTSD patients reported significantly higher negative scores on all DKB-35 subscales (p < 0.001) and the BIAQ (p = 0.002; p < 0.001). Results remained consistent after accounting for the influence of co-occurring eating disorders (p = 0.021; p = 0.001; p < 0.001). Conclusions: Results show for the first time that the behavioral component of the body image is impaired in female patients with PTSD in addition to the cognitive-affective component. This is not solely due to a comorbid eating disorder. The effect of established treatments on the body image of PTSD patients should be evaluated and new treatment modules should be developed and tested, if necessary.

Negative body experience in women with early childhood trauma: associations with trauma severity and dissociation

“…These results confirm findings in earlier studies that trauma that trauma history is associated with both body satisfaction (Wenninger & Heiman, 1998) and body attitude (Dyer et al, 2013; Sack et al, 2010). Sack et al (2010) reported that women with a background of sexual trauma showed a significantly lower body attitude than non-sexually traumatized patients.…”

“…Wenninger and Heiman (1998) reported that women who had been sexually abused in childhood ( n  = 57) scored significantly lower on perceived physical health and on the subscale sexual attractiveness of the Body-Esteem Scale (Franzoi & Shields, 1984) than the control sample ( n  = 47). Dyer et al (2013) studied differences in body attitude in a group of 84 females in treatment for PTSD related to childhood sexual abuse and in a control group of 53 healthy participants. They used the Dresden Body Image Questionnaire (DBIQ-35; Pöhlmann, Roth, Brähler, & Joraschky, 2014) to measure body attitude, and the Body Image Avoidance Questionnaire (BIAQ; Rosen, Srebnik, Saltzberg, & Wendt, 1991) to assess the frequency with which one engages in avoidance behaviours related to body experience.…”

Impact of DSM-5 PTSD and gender on impaired eating behaviors in 512 Italian earthquake survivors

“…In this regard, it is also important to notice that the greater endorsement of all MOODS-SR EB in L'Aquila survivors with PTSD with respect to those without, could suggest high rates of comorbidity with ED, as reported in previous studies (Gleaves et al, 1998;Reyes-Rodriguez et al, 2011). These symptoms, in fact, belong to the clinical picture of ED, like other eating symptoms that can often be found in subjects with PTSD: feeling guilty after overeating (Godfrey et al, 2013), eating in response to stress (Talbot et al, 2013), and impairment in behavioral component of body image (Dyer et al, 2013). Nevertheless, a major limitation of the present study is the lack of information on ED comorbidity, thus we cannot determine whether PTSD survivors presented a full-blown or sub-threshold comorbidity with EDs.…”

Why Some Patients Are Unhappy

“…59,[65][66][67] If abuse and neglect create body shame and therefore motivate patients to undergo plastic surgery, as we postulate, several trauma-related phenomena that plastic surgeons observe could be better explained: patients are poor historians of their surgery and do not remember what they have been told 80 ; they dislike multiple body areas 55,56,81-84 ; they cannot remember or dissociate from their prior surgical complications and therefore cannot accurately assess surgical risks 85 ; they are inappropriately anxious, untrusting, and require endless reassurance 60,72,[86][87][88][89][90][91] ; they are compelled to undergo more surgery despite good outcomes ("compulsive reenactment") 72,78,92 ; they indulge in selfdestructive behavior 72 or substance abuse 72 ; they blame surgeon or staff for events that cannot be controlled ("scapegoating") 93 or put themselves unnecessarily at risk ("revictimization") 75 ; and they may claim that they have been mistreated or victimized by the surgeon. 58,59,[65][66][67][68]70,75,[94][95][96][97] It is easy to imagine how the tormenting cacophony of these memory and processing disturbances could create the behavior that we clinicians interpret as depressed or demanding conduct, and that gives secondary rhinoplasty patients such unflattering reputations.…”