Exploring positive and negative body image and health-related quality of life in women with endometriosis: a latent profile analysis

Abstract

Study question: What are the profiles of body image (both negative and positive) and their associations with health-related quality of life (HRQoL) and endometriosis-related symptoms in women with endometriosis?

Summary answer: Three distinct body image profiles were identified, which significantly differed in HRQoL dimensions and both number and types of endometriosis-related symptoms.

What is known already: Endometriosis is a chronic health condition characterized by multiple symptoms, which lead to a diminished HRQoL. Body image is a critical concern for women with endometriosis due to the impact of the illness and its treatments on their bodies.

Study design, size, duration: This cross-sectional study involved 270 Italian women who self-reported a diagnosis of endometriosis. They were recruited through the social media pages of Italian endometriosis organizations between March and September 2023.

Participants/materials, setting, methods: The mean age of the participants was 36.4 years (SD = 7.46, range = 18-56), while the mean time since diagnosis was 347 months (SD = 80). The main endometriosis diagnosis was deep endometriosis (58.1%), and the main method of diagnosis was a clinical method (70.7%). The participants completed a socio-demographic and medical history schedule, as well as the following self-report questionnaires: Functionality Appreciation Scale, Body Appreciation Scale-2, Endometriosis Health Profile-30, and Body Image Scale. Latent Profile Analysis (LPA), ANOVA, and chi-square tests were employed to analyze the data. In particular, given the data-driven nature of LPA, no a priori hypotheses were formulated regarding the number or pattern of the profiles.

Main results and the role of chance: The LPA revealed three profiles: 'Low body appreciation and strong body dissatisfaction' (47.8%), 'Strong body appreciation and low body dissatisfaction' (17%), and 'Moderate body appreciation and body dissatisfaction' (35.2%). ANOVA showed differences in all HRQoL dimensions and number of endometriosis-related symptoms among profiles, with women in the 'Strong body appreciation and low body dissatisfaction' profile exhibiting better HRQoL and fewer endometriosis-related symptoms compared to the other profiles (P<0.001). Finally, chi-square tests revealed that participants in the 'Low body appreciation and strong body dissatisfaction' profile were significantly more likely to report painful and a-specific symptoms compared to participants in the other profiles.

Limitations, reasons for caution: The study's cross-sectional design precludes any conclusions about causality. Furthermore, the absence of a control group of women without endometriosis makes it unclear whether the identified body image profiles are specific to endometriosis or represent broader patterns in the general population. Also, since LPA is inherently exploratory, these results offer only preliminary insights into how negative and positive body image may interact and relate to HRQoL and endometriosis-related symptoms in women with endometriosis. Additionally, the use of self-referral through endometriosis organizations, combined with the absence of sexuality-based demographics and other potentially relevant psychological and biological variables, may limit both the generalizability and the comprehensiveness of our results. Finally, the exclusive use of self-report questionnaires, which are subject to biases, and the inclusion of a small proportion of participants who reported seeking psychological consultation for a possible eating disorder may have influenced the results.

Wider implications of the findings: Positive body image may act as a protective buffer against negative HRQoL outcomes and these results may be useful for developing psychological interventions aimed at promoting psychological and physical well-being in women with endometriosis.

Study funding/competing interest(s): This research received no specific funding. The authors report no conflicts of interest.

Trial registration number: N/A.

Keywords: body image; chronic illness; endometriosis; health-related quality of life; latent profile analysis.