Predictors of Psychological Distress in Women with Endometriosis: The Role of Multimorbidity, Body Image, and Self-Criticism

Abstract

While large numbers of women report high levels of psychological distress associated with endometriosis, others report levels of distress that are comparable to those of healthy women. Thus, the aim of the current study was to develop an explanatory model for the effect of endometriosis on women’s psychological distress. Furthermore, it sought to further investigate the role of body image, self-criticism, and pain intensity on the psychological distress associated with endometriosis and establish the effect of chronic illness load on the development of this distress. This study comprised a total of 247 women aged 20–49 (M = 31.3, SD = 6.4)—73 suffering from endometriosis only, 62 suffering from endometriosis and an additional chronical illness (ACI), and 112 healthy peers (HP)—who completed the Patient Health Questionnaire, the Generalized Anxiety Disorder-Item Scale, the Body Appreciation Scale-2, and the Self-Criticism Sub-Scale. When comparing each endometriosis group to their HP’s, we found that the differences between HP and endometriosis ACI in depression and anxiety were mediated by body image (Betas = 0.17 and 0.09, respectively, p’s < 0.05) and self-criticism (Betas = 0.23 and 0.26, respectively, p’s < 0.05). When comparing endometriosis participants to endometriosis ACI participants, differences in depression were mediated by body image, self-criticism, and pain intensity (Betas = 0.12, 0.13, 0.13 respectively, p’s < 0.05), and the differences in anxiety were mediated by self-criticism and pain intensity (Betas = 0.19, 0.08, respectively, p’s < 0.05). Physicians and other health professionals are advised to detect women with endometriosis ACI who are distressed, and to offer them appropriate intervention.

“My body…tends to betray me sometimes”: a Qualitative Analysis of Affective and Perceptual Body Image in Individuals Living with Endometriosis

“…Body dissatisfaction, a proxy for negative body image, has been associated with infertility and dyspareunia in endometriosis [22], consistent with findings of research investigating body image distress in gynecological cancer [23]. Moreover, more negative body image has been associated with increased self-criticism in endometriosis populations, a factor that is incompatible with body functionality appreciation [20]. Another factor likely to exacerbate negative responses to an endometriosis-affected body is the nature of endometriosis being encased within menstrual social taboos that may increase vulnerability to body image distress due to diminished social supports [24].…”

“…Emerging research has identified considerable negative impacts of endometriosis on body image [19,20], particularly for those with extensive disease [21] and younger adults [19]. Qualitative research [22] highlights widespread negative body image impacts linked to hormonal treatment weight gain and scarring from surgery, with concealment practices (e.g., wearing loose clothing) utilized as a means of coping with these bodily changes.…”

Relationship of Body Image Concerns with some Gynecological Diseases and Chronic Fatigue Syndrome: A Review

“…Women with deep endometriosis, a severe sub-type, were found to be correlated with worse body image (Melis et al, 2015). Geller et al (2021) investigated the roles of multi-morbidity, body image, and self-criticism as predictors of psychological distress in women with endometriosis.…”

Patient-Reported Outcome Measures in Endometriosis

“…The Patient Health Questionnaire (PHQ-9) is a unidimensional depression scale for diagnosing depressive and other mental disorders [ 68 ]. The PHQ-9 has been validated in an endometriosis population, proving its good psychometric properties [ 69 ]. Its use in routine care using a digital tool has been proved in neurologic patients [ 70 ].…”

“…The General Anxiety Disorder-7 (GAD-7) scale is an instrument with an unidimensional structure that measures the severity of generalized anxiety disorders (pain disorders, social anxiety disorder, and posttraumatic stress disorder) [ 72 ]. The GAD-7 has been validated in an endometriosis population, proving its good psychometric properties [ 69 ].…”