Leslie J. Heinberg

Exacting beauty: Theory, assessment and treatment of body image disturbance

The Scope of Body Image Disturbance - the Big Picture An Overview of Assessment and Treatment Strategies Sociocultural Theory - the Media and Society Social Comparison Processes Appearance-Related Feedback Interpersonal Factors Peers, Parents and Perfect Strangers Feminist Perspectives Sexual Abuse and Sexual Harassment Behavioural Aspects of Disturbance - Conditioning, Context and Avoidance Cognitive Processing Models Future Directions - Integrative Theories, Multidimensional Assessment and Multicomponent Interventions.

Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: Cosponsored by american association of clinical endocrinologists, The obesity society, and american society for metabolic & bariatric surgery*

The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re‐evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type‐2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE‐TOS‐ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.

Development and validation of the Sociocultural Attitudes Towards Appearance Questionnaire

The Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ) was developed to assess womens recognition and acceptance of societally sanctioned standards of appearance. In Study 1, factor analyses revealed two clearcut factors: awareness/acknowledgment of a societal emphasis on appearance and an internalization/acceptance of these standards. These findings were cross-validated in Study 2, resulting in a six-item Awareness subscale (alpha = .71) and an eight-item Internalization subscale (alpha = .88). Study 3 obtained good convergence between both scales and multiple indices of body image and eating disturbance. Regression analyses indicated that both factors accounted for unique variance associated with body image and eating dysfunction, however, internalization of standards was a stronger predictor of disturbance. The SATAQ should prove useful for researchers and clinicians interested in body image and eating disorders.

The Media's Influence on Body Image Disturbance and Eating Disorders: We've Reviled Them, Now Can We Rehabilitate Them?

Survey, correlational, randomized control, and covariance structure modeling investigations indicate that the media are a significant factor in the development and maintenance of eating and shape-related disorders. One specific individual difference variable, internalization of societal pressures regarding prevailing standards of attractiveness, appears to moderate or even mediate the medias effects on womens body satisfaction and eating dysfunction. Problematic media messages inherent in existing media portrayals of eating disorders are apparent, leading researchers to pinpoint intervention strategies that might counteract such viewpoints. Social activism and social marketing approaches are suggested as methods for fighting negative media messages. The media itself is one potential vehicle for communicating productive, accurate, and deglamorized messages about eating and shape-related disorders.

The urogenital and rectal pain syndromes

&NA; Pain syndromes of the urogenital and rectal area are well described but poorly understood and underrecognized focal pain syndromes. They include vulvodynia, orchialgia, urethral syndrome, penile pain, prostatodynia, coccygodynia, perineal pain, proctodynia and proctalgia fugax. The etiology of these focal pain syndromes is not known. A specific secondary cause can be identified in a minority of patients, but most often the examination and work‐up remain unrevealing. Although these patients are often depressed, rarely are these pain syndromes the only manifestation of a psychiatric disease. This review article presents an overview of the neuroanatomy of the pelvis, which is a prerequisite to trying to understand the chronic pain syndromes in this region. We then discuss the clinical presentation, etiology and differential diagnosis of chronic pain syndromes of the urogenital and rectal area and review treatment options. The current knowledge of the psychological aspects of these pain syndromes is reviewed. Patients presenting with these pain syndromes are best assessed and treated using a multidisciplinary approach. Currently available treatment options are empirical only. Although cures are uncommon, some pain relief can be provided to almost all patients using a multidisciplinary approach including pain medications, local treatment regimens, physical therapy and psychological support, while exercising caution toward invasive and irreversible therapeutic procedures. Better knowledge of the underlying pathophysiological mechanisms of the urogenital and rectal pain syndromes is needed to allow investigators to develop treatment strategies, specifically targeted against the pathophysiological mechanism.

Coping with pain: What works, under what circumstances, and in what ways?

Geissen Robinson, and Riley present a stimulating conceptual model of coping with chronic pain in which the authors argue that maladaptive beliefs and coping are primary determinants of adjustment and influence adaptive beliefs and coping through their influence on perceptions of control. We discuss some aspects of the model that require further refinement. First, the assessments of beliefs, appraisals, and coping need to be independent of outcome, obviating the use of “adaptive” and “maladaptive” in conceptual models. Unqualified statements about the universal adaptiveness, or maladaptiveness, of appraisal and coping strategies are likely to be unusual, since some strategies may result in higher emotional adjustment but not physical adjustment or vice versa. Second, beliefs, appraisals, and coping are distinct conceptual dimensions. Conceptual models that delineate relevant dimensions of these constructs rather than unify these partially independent constructs will likely have greater utility. Third, broadening the conceptualization of pain appraisal to include the individuals interpretation of the meaning of the pain is likely to provide expanded understanding of the pain coping process. Fourth, factors active in the individuals environment, particularly social relationships, need to be integrated into any comprehensive model of coping with chronic pain. And fifth, the bidirectional relationships between beliefs, appraisals, and coping need to be integrated into conceptual models. These processes are interrelated and feed back to one another as the individual struggles to cope with the challenges and threat posed by pain. The inherent complexity of coping with pain requires conceptualizations that address its transactional nature and methodologies that capture this dynamic process. Our comments direct future investigators to address when coping works, in what way it works, and for whom it works.

Pain coping strategies predict perceived control over pain

&NA; Perceptions of control over pain and specific pain coping strategies are associated with a number of positive outcomes in patients with chronic pain conditions. Transactional models of stress have emphasized coping as a process that is both determined by, and influences appraisals of control. While perceptions of control and coping efforts are associated with better adjustment, little is known about the specific coping strategies that contribute to perceptions that pain is controllable. One hundred and ninety‐five (65% female) individuals with chronic pain conditions admitted to an inpatient unit completed the Multidimensional Pain Inventory, the Survey of Pain Attitudes and the Coping Strategies Questionnaire. Stepwise multiple regression analyses were used to predict perceived pain control from measures of pain severity and coping. After controlling for pain severity and education, coping self‐statements and reinterpreting pain sensations predicted greater perceptions of control over pain, whereas ignoring pain sensations predicted lower perceptions of control over pain. The coping strategies did not interact with pain severity in predicting perceptions of control. Coping flexibility, or the number of pain coping strategies reported at a high frequency, also predicted perceptions of control over pain and did not interact with pain severity. The present findings suggest that, regardless of pain severity, the use of specific cognitive pain coping strategies may increase perceptions of control over pain. Since the existing coping literature largely identifies maladaptive pain coping strategies, it is especially critical to establish which pain coping strategies are adaptive. Specific cognitive strategies, particularly coping self statements, are important components for cognitive‐behavioral interventions for chronic pain management. Future research will need to determine whether other adaptive cognitive strategies such as reinterpreting pain sensations can be increased with cognitive interventions, since this strategy is infrequently used.

Visible vs hidden scars and their relation to body esteem

This study examined the relationship among burn scarring, severity and visibility, and body esteem. Previous work addressing this question has relied on case studies and small samples. We mailed a survey to 2500 members of a national burn survivor support group. Survivors were asked to complete and

Effect of early body image dissatisfaction on subsequent psychological and physical adjustment after disfiguring injury.

Objective The impact of body image dissatisfaction on quality of life after severe burn injury was investigated after controlling for other determinants of outcome (ie, injury, distress, and preburn quality of life). Methods The postburn quality of life (2-months postdischarge) of groups with and without body image dissatisfaction was studied after controlling for preburn quality of life (measured 2–3 days postadmission). The patient population (N = 86) was 77.9% men, had an average total body surface area burned of 17.02%, and average full-thickness burn of 6.09%. Forty percent had facial injuries, 68.6% required surgery, most were injured by flame (39.5%), and 76.8% were employed. Results Multivariate analysis of covariance (covarying preburn level of Mental quality of life, facial injury, and size of burn) contrasting body image dissatisfaction groups found significantly lower psychosocial adjustment at 2-month follow-up in those with greater body image dissatisfaction (multivariate F = 3.61;p < .01). A second MANCOVA (covarying the preburn level of Physical quality of life and both facial injury and size of burn) found significantly lower physical functioning at 2-month follow-up in those with greater body image dissatisfaction (multivariate F = 2.78;p < .03). Adding two more covariates (depression and posttrauma distress) eliminated the effect of body image dissatisfaction on postburn Physical but not Mental adjustment. Conclusions Body image dissatisfaction affects quality of life after severe burn injury. Distress moderates this impact on aspects of physical but not psychosocial health.

Development and Validation of the Satisfaction with Appearance Scale: Assessing Body Image among Burn-Injured Patients.

The Satisfaction With Appearance Scale (SWAP) is a 14-item questionnaire, assessing both the subjective appraisal and social-behavioral components of body image among burn survivors. Burn survivors requiring hospitalization (n = 165) completed a packet of psychometric instruments, including the SWAP at 1-week postdischarge. The SWAP demonstrated a high level of intemal consistency (Cronbachs alpha, r a = .87; the mean interitem correlation, r ii = .32, the mean item-total correlation, r ii = .53). Eighty-four participants were retested approximately 2 months after the initial assessment to evaluate test-retest reliability (r ii , = .59). A principal-components analysis with a varimax rotation yielded 4 easily interpretable factors accounting for 66% of the total variance. The correlations of the SWAP total score with other selected psychometric measures provided evidence for both convergent and discriminant validity. This initial evaluation of the SWAP suggests that it is both a reliable and valid measure of body image for a burn-injured population.