Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.

Measuring Body Image Avoidance in Patients with Systemic Sclerosis

Jewett1,  Lisa R., Thombs2,  Brett D., Hudson2,  Marie, Heinberg3,  Leslie, Wigley4,  Fredrick M., Haythornthwaite5,  Jennifer A.

McGill University, Montreal, QC
McGill University and Jewish General Hospital. Montreal, QC
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Clevland, OH
Johns Hopkins University School of Medicine, Baltimore, MD
Johns Hopkins University, Baltimore, MD


Patients with systemic sclerosis, or scleroderma, experience substantial disfigurement, often in visible and socially relevant areas of the body. Social avoidance related to body image distress is a significant problem for individuals with acquired disfigurement from medical illness or injury. However, body image avoidance has never been systematically studied in patients with scleroderma and existing measures are designed for non-disfigured individuals with body image and/or eating concerns. The objective of this study was to compare the validity and reliability of a general Body Image Avoidance Questionnaire for Acquired Disfigurement (BIAQ-AD; N = 181) with a disease-specific measure for patients with acquired disfigurement from scleroderma (BIAQ-Scleroderma; N = 93).


203 female patients completed the BIAQ-AD, the BIAQ-Scleroderma, or both between 1997 and 2002. The BIAQ-AD was adapted from the Body Image Avoidance Questionnaire (Rosen et al., 1991) by removing weight and eating-related items, and the BIAQ-Scleroderma included items reflecting scleroderma-specific concerns (e.g., I wear long sleeves to hide skin changes). Confirmatory factor analysis and exploratory factor analysis were performed with MPLUS to determine the factor structure; internal consistency reliability was assessed using Cronbach's alpha; and concurrent validity was assessed by comparing BIAQ-AD and BIAQ-Scleroderma with the Adapted Satisfaction with Appearance Scale (ASWAP), Beck Depression Inventory (BDI) and the McGill Pain Questionnaire Short-Form (MPQ-SF).


A 1-factor model provided the most parsimonious fit for both the BIAQ-AD (c2(21) = 44.25, CFI =.98, TLI =.99, RMSEA =.08), and the BIAQ-Scleroderma (c2(19) = 53.28, CFI =.92, TLI =.94, RMSEA =.14). The BIAQ-AD (Cronbach's alpha = 0.87) correlated 0.44 with the ASWAP, 0.72 with the BDI, and 0.25 with the MPQ-SF. The BIAQ-Scleroderma (Cronbach's alpha = 0.83) correlated 0.68 with the ASWAP, 0.59 with the BDI, and 0.27 with the MPQ-SF.


The high correlation of the general measure (BIAQ-AD) with the Beck Depression Inventory suggested it overlapped with general distress substantially more than the scleroderma-specific BIAQ-Scleroderma, which better addressed distress related to body image avoidance. Therefore, the BIAQ-Scleroderma is the preferred tool for assessment of body image avoidance in patients with scleroderma. The development and validation of the BIAQ-Scleroderma is a necessary initial step towards better assessment of body image avoidance in patients with scleroderma, however, further research is needed towards the development and testing of interventions to help these patients function better socially.

To cite this abstract, please use the following information:
Jewett, Lisa R., Thombs, Brett D., Hudson, Marie, Heinberg, Leslie, Wigley, Fredrick M., Haythornthwaite, Jennifer A.; Measuring Body Image Avoidance in Patients with Systemic Sclerosis [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1145
DOI: 10.1002/art.26220

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