Mental health disorders-should we screen all our patients?

Understanding the precise interplay between mental and physical health, as related to specific gynecological diseases, is crucial to providing high-quality, comprehensive, and effective care to our patients. A large body of literature provides evidence for the association of infertility, polycystic ovary syndrome, endometriosis and fibroids with anxiety, depression, eating disorders, sexual dysfunction, and/or reduced health related quality of life. Although the precise etiology of these associations is not clear, chronic pain, hormonal changes, body image distress, feelings of helplessness and high stress levels have all been described as possible mediators. Lack of early diagnosis and management of mental health conditions is known to impact compliance with office visits, diagnostic testing and treatment leading to overall reduced quality of life. As part of a holistic approach, we need to develop evidence-based guidelines for screening high-risk patients and increase collaboration between gynecologists and mental health professionals to offer seamless care. This goal may be aspirational as there are several patient- and provider-related challenges to offering comprehensive care to this patient population. Embracing novel technology-based opportunities and incorporating connected healthcare delivery models will help us meet these growing challenges.

Body Image among Girls in Indonesia: Associations with Disordered Eating Behaviors, Life Engagement, Desire for Cosmetic Surgery and Psychosocial Influences.

Body image is an important risk factor for mental and physical health during adolescence. Nonetheless, few studies have empirically investigated body image among girls in Southeast Asia. This cross-sectional study examined the prevalence of body esteem (a holistic measure of body image assessing the degree of satisfaction with one's appearance, weight, and shape), associated behavioral outcomes, and potential psychosocial influences on body image among Indonesian girls to inform future intervention efforts. Girls across Indonesia with internet access (N = 318, Mage = 13.59 years) completed a questionnaire that assessed body image, disordered eating behaviors, appearance-related life engagement, desire for cosmetic surgery, appearance ideal internalization, media literacy, appearance-related teasing, and self-esteem. The younger girls' (10-13 years) responses were analyzed separately from those of the older girls (14-17 years). Over half of the girls did not have high body esteem. Approximately a quarter of the girls across both age groups reported restricting their food intake, emotionally eating, and/or engaging in excessive exercise, and over half desired cosmetic surgery. Disordered eating behaviors and a desire for cosmetic surgery were negatively correlated with body esteem. Hierarchical regression analyses found BMI, internalization, appearance-related teasing, and self-esteem were uniquely associated with body esteem among younger girls. Appearance-related teasing and self-esteem were positively associated with body esteem among older girls. These findings suggest body image interventions may be important for this population, with appearance-related teasing and self-esteem potentially useful targets for intervention efforts. Further prospective research to investigate these findings would be beneficial for a deeper understanding of body image risk factors for girls across Indonesia.

Comparing and self-objectifying: The effect of sexualized imagery posted by Instagram Influencers on women's body image.

Influencers are prominent figures on social media with a large number of followers who promote products, companies, and/or lifestyles. Some Influencers endorse lingerie and bikini products and there is growing concern about the overtly sexualized nature of the imagery they post to social media. This study aimed to experimentally examine the impact of exposure to images of female Influencers dressed in either fashionable clothes (fashion condition) or in lingerie/bikini garments posed in a suggestive manner (sexualized condition) on women's negative mood and body dissatisfaction relative to control (fashion products). Young women (N = 230, aged 17-25years) were recruited online and randomly allocated to one of the conditions. They completed pre/post state measures of mood and body dissatisfaction, as well as measures of state appearance comparison and self-objectification. Planned comparisons revealed that viewing images of Influencers led to greater negative mood, body dissatisfaction, self-objectification, and appearance comparison than viewing control images. Viewing sexualized images also led to greater negative mood, body dissatisfaction, and appearance comparison than did viewing standard fashion images. State appearance comparison was found to mediate these differences. The findings highlight the negative impact of sexualized images on social media and the need for enhanced regulation in relation to Influencer advertising.

The Effect of Mindfulness-Based Sexual Counseling on Sexual Distress, Attitude Toward Sexuality, and Body Image Concerns in Pregnant Women: A Randomized Controlled Trial.

INTRODUCTION: Sexual distress during pregnancy can cause a negative attitude toward sexuality during pregnancy, and this can be seen especially in conjunction with body image concerns. This study was conducted to determine the effects of mindfulness-based sexual counseling (MBSC) on sexual distress, attitudes toward sexuality, and body image concerns in pregnant women. METHODS: A randomized controlled trial was conducted in a sample of women who experienced sexual distress presenting to a Healthy Living Center in eastern Turkey. Women (N = 134) were randomly assigned to receive a 4-week, 8-session counseling program based on mindfulness (experimental group; n = 67) or treatment as usual (control group; n = 67). The primary outcome of the study, sexual distress, was assessed using the Female Sexual Distress Scale-Revised. Secondary outcomes included attitude toward sexuality, assessed using the Attitude Scale toward Sexuality during Pregnancy, and body image concerns, using the Body Image Concerns during Pregnancy Scale. Outcomes were compared postintervention, correcting for baseline using analysis of covariance. The study was registered with ClinicalTrials.gov (NCT04900194). RESULTS: Mean scores for sexual distress (7.69 vs 17.36; P < .001) and body image concerns (57.76 vs 73.88; P < .001) decreased significantly in the mindfulness group compared with the control group. Similarly, mean scores for attitudes toward sexuality significantly improved in the mindfulness group compared with the control group (133.52 vs 105.78; P < .05). DISCUSSION: MBSC is a promising strategy to help women experiencing sexual distress during pregnancy to reduce their levels of sexual distress, raise their positive attitudes toward sexuality, and lower their body image concerns. Larger clinical trials of MBSC are recommended to support introduction of MBSC into clinical practice.

Caring for myself while I'm growing somebody else: Mindful self-care buffers between pregnancy body disconnection and distress.

Pregnancy embodiment describes the way a pregnant individual inhabits their body, including disconnection and connection, likely influencing both distress and well-being. Emerging work indicates that acceptance of pregnancy-related bodily change may support well-being, particularly when co-occurring with self-care behaviors. Yet, specific associations of pregnant embodiment and intentional, individualized self-care practices (mindful self-care; MSC) with well-being and distress remain unexamined. The present study tested independent and interactive associations between MSC and positive embodiment (body agency), and negative embodiment (body estrangement), respectively, with maternal distress and well-being in a sample of US pregnant women (N = 179; Mage = 31.3 years, aged 21-43; 85.6 % White, 4.9 % Hispanic/Latinx). Challenge and threat/harm appraisals of the COVID-19 pandemic were included in the model to represent responses to the unique sociohistorical context. Measurement-corrected path analytic models explained a substantial proportion of variation in well-being and a smaller proportion in prenatal distress. Among those with higher MSC, the association between body estrangement and prenatal distress was weaker. Results support mindful self-care as protective for pregnancy distress in the setting of body disconnection. Future individualized health promotion might consider how high-stress contexts influence application of self-care practices and impact distress and well-being during pregnancy.

Body image dissatisfaction: A novel predictor of poor quality of life in epilepsy.

OBJECTIVE: People with epilepsy have long reported reduced quality of life (QoL) compared to healthy peers. This initial study seeks to broaden our understanding of QoL in adults with epilepsy, by examining the adverse impact of body image dissatisfaction for the first time. This aim stems from the observation that both seizures and their medical treatment can cause unwanted changes to physical appearances, such as weight change, hirsutism, and acne. METHOD: Sixty-three adults with epilepsy and 48 age- and gender-matched healthy controls were recruited from a tertiary epilepsy program and targeted social media. Participants completed an online suite of well-validated questionnaires canvassing state (current) and trait (long-term) aspects of body image dissatisfaction, mood, QoL, and medical history. RESULTS: People with epilepsy reported significantly elevated levels of trait body image dissatisfaction compared to controls across the dimensions of appearance evaluation, body areas satisfaction, and self-classified weight (p = 0.02); but did not differ from controls on state body image dissatisfaction (p > 0.05). All facets of body image dissatisfaction in participants with epilepsy were strongly associated with reduced QoL, together with heavier body weight, depressive symptoms, medical comorbidities, and a belief that epilepsy hindered their ability to attain a healthier physique. Multiple regression revealed that body image dissatisfaction was the strongest unique contributor to poor QoL in the epilepsy group (ß = 0.46, p ≤ 0.001), above and beyond the contribution of current depressive symptoms (ß = 0.34, p ≤ 0.01). SIGNIFICANCE: This is the first study to highlight the high rates of body image dissatisfaction among adults with epilepsy, and the significantly detrimental impact it has on patient well-being. It also opens novel avenues for psychological interventions in epilepsy, that focus on enhancing positive body image as a means of holistically improving the often-poor psychological outcomes for people with this condition.

Longitudinal associations between mindfulness and changes to body image in first-time parent couples.

Pregnancy and postpartum are associated with declines in body image. Research on postpartum body image focuses almost exclusively on the person who gave birth and studies examining protective factors for postpartum body image are scarce. We assessed 257 new-parent couples from mid-pregnancy to 6-months postpartum to examine whether mindfulness-a recognized contributor to psychological well-being-buffered against declines in both partners' perceptions of mothers' body. Mothers' positive body image and partners' perception of mothers' body were collected at four time-points (second and third trimester; 3- and 6-months postpartum); both partners' mindfulness facets-observing, describing, awareness acting, non-judgement, and non-reactivity-were assessed in the second trimester. Dyadic latent growth curve modeling revealed that both partners' perceptions of mothers' body were positively correlated at all moments; however, mothers' positive body image worsened over time, whereas partners' perception of mothers' body remained stable. Mindfulness facets were positively associated with mothers' positive body image (observe, describe, and non-judging) and fathers' (non-judging) perceptions of mothers' body in pregnancy. Mothers' mindfulness facets (acting with awareness, non-judging) were associated with subsequent trajectories of their own body image. By identifying mindfulness facets as targetable protective factors during pregnancy, these findings have implications for future research and interventions focused on perinatal body image.

Imagery versus captions: The effect of body positive Instagram content on young women's mood and body image.

Body positive social media content aims to positively impact young women's body image and mood by challenging traditionally narrow beauty ideals. This online experiment investigated the effect of viewing body positive Instagram posts on young women's body image and mood, whilst focusing on understanding the impact of the images and captions in the posts. Overall, 195 young women (18-30 years old) were randomly assigned to view either body positive (consisting of images and captions), body positive captions only, body positive images only, or thin-ideal Instagram posts. Positive mood increased in all conditions pre to post exposure. Further, body satisfaction and negative mood improved pre-post exposure for all body positive conditions. However, when controlling for trait body appreciation significant effects only remained for the combined image and caption body positive condition. There were no significant differences in positive mood, state body appreciation, self-objectification, or broad conceptualisations of beauty between the three body positive exposure conditions. Therefore, to improve body satisfaction and mood, body positive content should include a combination of images and captions.

Self-compassion and body image in pregnancy and postpartum: A randomized pilot trial of a brief self-compassion meditation intervention.

The current study evaluated the efficacy of a three-week self-compassion (SC) meditation intervention in improving body image and SC during pregnancy and postpartum. Participants (n = 71; age = 31.92 ± 3.98 years; white = 61, 85.9%; intervention = 35, 49.3%; pregnant = 33, 46.5%; postpartum = 38, 53.5%) were recruited from a health coaching program and 35 were randomly assigned into a three-week SC meditation intervention while 36 were randomly assigned to a waitlist control condition. Linear regressions using full-information maximum likelihood estimation examined the effect of intervention group on body image and SC outcomes controlling for baseline level of outcome, pregnancy or postpartum status, previous meditation experience, and physical activity. Results indicated women in the intervention group reported significantly reduced body shame and body dissatisfaction and improved body appreciation and self-compassion compared to women in the control group. Implementation of a brief SC meditation intervention during pregnancy and postpartum has potential to improve mental health outcomes related to body image. Future work should replicate this study with a larger, more diverse sample of women.

Efficacy of Eat Breathe Thrive: A randomized controlled trial of a yoga-based program.

Evidence positions yoga as a promising intervention for enhancing positive embodiment and supporting the prevention of, and recovery from, eating disorders (EDs) by reducing ED symptomatology and building skills that facilitate an ongoing, embodied sense of wellbeing. However, yoga-based programs are few and rigorous literature on their efficacy is limited. This study examined the efficacy and feasibility of a yoga-based program called Eat Breathe Thrive (EBT) which aims to prevent EDs and support embodiment. Participants (N = 168, 93.5 % women) from a community sample in the United States and United Kingdom, ages 18-65, were randomly allocated to a 2-h, 7-week EBT program or waitlist-control condition. Compared to controls, EBT participants experienced significant decreases in ED behaviors, depression, and difficulties regulating emotions. They reported significantly greater use of mindfulness skills, such as interoceptive awareness, mindful self-care, and mindful eating. After a single session, participants reported immediate improvement in their sense of well-being, indicating increased state positive embodiment. Most effects were sustained at 6-month follow-up. The majority of individuals attended most sessions. Self-reported treatment integrity was excellent. Directions for future research are proposed. Results support the efficacy and feasibility of an integrated yoga intervention that fosters positive ways of inhabiting the body.

Yoga and nonsuicidal self-injury: Mediational effects of self-compassion and body appreciation.

Non-suicidal self-injury (NSSI) is a prevalent maladaptive body-focused behavior among youth and young adults. Yoga is associated with improved mindfulness, body image, and self-compassion; all of which are associated with decreased NSSI. This study evaluated the relationship between yoga and NSSI frequency, and if the relationship would be mediated by mindfulness, self-compassion, and/or body appreciation. Participants were recruited from a random sample of university students via email and included those with some yoga experience (N = 384; Mage = 19.98, SD = 2.20). Participants completed an anonymous online survey assessing their levels of yoga participation, NSSI, mindfulness, self-compassion, and body appreciation. Bias corrected serial mediation regression models indicated the relationship between yoga participation and NSSI frequency was significantly mediated by self-compassion followed by body appreciation. Body appreciation was also a significant single mediator of yoga's relationship with NSSI. Mindfulness was not a significant mediator in any of the analyzes. Yoga practice is associated with reduced NSSI behaviors through its positive relationships with body appreciation and self-compassion. Body appreciation appears to be an important mechanism underlying the link between yoga participation and NSSI behavior suggesting that interventions promoting positive body image, such as yoga, could be innovative strategies for clinicians to consider.

Eating and body image characteristics of those who aspire to the slim-thick, thin, or fit ideal and their impact on state body image.

The slim-thick ideal is characterized by a small waist and flat stomach, but large hips, thighs, and butt. Little research to date has examined the impact of this body-ideal on women's body image. The purpose of the current study was to investigate: 1) the impact of slim-thick, thin-, and fit-ideal imagery on women's body image, 2) the body ideals women most aspire to, and 3) eating and body image characteristics of women who aspire to each ideal. Participants were 123 female undergraduate students. Results revealed that experimental exposure to slim-thick- and fit-ideal imagery resulted in lower body satisfaction. Participants reported aspiring more to the fit and slim-thick-ideal than to the thin-ideal, and rated the slim-thick-ideal as the most attractive and desirable. Women who aspired to the thin- or slim-thick-ideal reported the greatest overall disordered eating. Women who aspired to the slim-thick-ideal reported greater dietary restraint, eating, shape and weight concerns, appearance ideal internalization, body image investment, and physical appearance perfectionism than those who aspired to the fit-ideal. Findings show that beauty ideals are shifting away from the thin-ideal toward a slim-thick-ideal. Slim-thick internalization may be harmful to women's well-being and should be addressed in body image and eating disorders interventions.

Cutaneous Body Image: How the Mental Health Benefits of Treating Dermatologic Disease Support Military Readiness in Service Members.

It is well established that many common skin diseases may result in mild to severe cosmetic disfigurement. Similarly, patients with these conditions have an increased risk for depression, anxiety, feelings of stigmatization, and self-harm ideation. There also is an increased risk for hospitalizations for mental health in patients with acne, rosacea, and hidradenitis suppurativa (HS). Cutaneous body image (CBI) is an individual's mental perception of the condition of their hair, nails, and skin. A positive CBI may be related to increased quality of life, and a negative CBI may be associated with poorer outcomes, such as insomnia, worsened overall morbidity of dermatologic disease, and intentional self-injury. For military service members who face a multitude of operational demands and who must be ready to "fight tonight," a holistic approach that addresses both physical and mental health is critical. Military dermatologists have the tools and expertise available to treat cutaneous disease, which by extension may improve body image, quality of life, and morale in military service members. Herein, we discuss how dermatologic treatments that often are thought of as nonessential cosmetic therapies can positively influence CBI and thus increase military readiness.

"Eat clean, train mean, get lean": Body image and health behaviours of women who engage with fitspiration and clean eating imagery on Instagram.

The present study examined the relationship between posting or viewing fitspiration and clean eating imagery in relation to body image, disordered eating, and compulsive exercise among women. Participants (269 women aged 18-30 years) who posted and/or viewed fitspiration, clean eating or travel imagery on Instagram completed an online cross-sectional questionnaire. Results showed engaging with fitspiration and clean eating material (either posting or viewing) was significantly positively associated with increased levels of compulsive exercise and athletic-ideal internalization. However, only viewing (not posting) fitspiration and clean eating content was significantly related to thin-ideal internalization and disordered eating symptomatology. Athletic-ideal internalization mediated the relationships between posting fitspiration/clean eating and disordered eating symptomatology and compulsive exercise. Both thin-ideal internalization and athletic-ideal internalization mediated the relationship between viewing fitspiration/clean eating material and disordered eating and compulsive exercise. Overall, the findings suggest that viewing fitspiration and clean eating content on Instagram is negatively associated with thin-ideal internalization and disordered eating symptomatology, however the same relationships do not exist for people who frequently post these types of material. The mediational pathways provide a nuanced understanding of how engaging with fitspiration and clean eating material on social media influences female users' body image and health behaviour.

Investigating the effects of fit-normative and weight-inclusive Instagram images on women's exercise motivations.

Exposure to "fitspiration" may promote exercising for maladaptive weight and appearance reasons in young women. Fitness content depicting higher-weight bodies could promote exercise for adaptive non-appearance motives, and body compassion might protect against the negative effects of "fitspiration" exposure. Two pre-registered experimental studies examined (i) the effects of exposure to fit-normative vs. weight-inclusive Instagram images on young women's exercise intentions and motivations, and (ii) tested trait body compassion as a moderator of the relationships between image exposure and psychosocial exercise outcomes. Using an online experimental paradigm, young adult women were randomized to view Instagram images representing fit-normative, weight-inclusive, or control conditions and completed state measures of exercise intention and motivation. Study 1 (n = 228) employed a post-test design and found no significant effects of condition on exercise outcomes, nor an effect of body compassion. Using a pre- and post-experimental design in Study 2 (n = 797), participants in the weight-inclusive condition exhibited significantly greater increases in exercise intention and fitness/health motivation, while those in the fit-normative condition exhibited greater increases in weight/appearance motivation, compared to controls. Body compassion was not a significant moderator of the associations between exposure to weight-inclusive vs. fit-normative images and exercise outcomes. Exposure to fit-normative Instagram content may encourage dysfunctional exercise motives in young women. Weight-inclusive imagery may more effectively inspire adaptive exercise intentions and motivations, and future research should investigate how it may be leveraged to improve psychosocial exercise outcomes.

Positive body image, intuitive eating, and psychosocial functioning among older women: Testing an integrated model.

BACKGROUND: Research on the body image and eating behaviors of older women is scarce. Moreover, the scant existing research has lacked a focus on positive dimensions, such as positive reappraisal and acceptance, body appreciation, appearance satisfaction, and intuitive eating among older women. Therefore, the aim of the present study was to examine a model of the relationships among these positive dimensions and psychological functioning in older women. METHODS: A sample of 171 women aged 60-75 years were recruited through social media to respond to a survey assessing body image, eating behaviors, and psychological wellbeing. RESULTS: The final model was a good fit to the data. In this model, positive reappraisal and acceptance of age-related appearance changes was associated with higher body appreciation, in turn associated with higher body image related quality of life, higher levels of intuitive eating, and lower levels of depressive symptoms. CONCLUSION: Positive body image and positive reappraisal of aging-related changes in appearance are associated with psychological wellbeing among older women. Longitudinal data are needed to clarify the direction of these relationships and inform interventions. Body image remains an important dimension among older women and should be accounted for in broader health promotion efforts among this group.

Exploring the impact of a gratitude-focused meditation on body dissatisfaction: Can a brief auditory gratitude intervention protect young women against exposure to the thin ideal?

This study aimed to determine if a brief gratitude-focused meditation would significantly impact body dissatisfaction, and whether it would serve as a protective factor from exposure to thin idealized images in a sample of undergraduate women. 176 participants (Mage= 19.75) engaged in either a gratitude meditation, mindfulness meditation, or listened to a recording of a history textbook. Women were subsequently exposed to a set of neutral images or thin ideal images. Women reported significant decreases in state body dissatisfaction following all auditory conditions, regardless of auditory content. Decreased levels of body dissatisfaction persisted through exposure to neutral images, but not through exposure to thin ideal images. Results indicated that both the gratitude and mindfulness interventions were effective in eliciting a significant increase in self-reported levels of gratitude and mindfulness compared to controls. The results of the study suggest that auditory micro-interventions can decrease body dissatisfaction in young adult women. However, further investigation into the optimal modality, length, and frequency of micro-interventions aimed at buffering the negative effects of idealized thin image exposure on women is needed.

Digital modification and body image on social media: Disclaimer labels, captions, hashtags, and comments.

Social media have become a major part of contemporary life. They are also a potent source of idealized and unrealistic imagery. Contributing to the lack of realism is the ability to digitally modify photos by applying a filter or editing software. One strategy suggested to counteract the negative consequences of idealized imagery on body image is the addition of a disclaimer label informing the viewer when an image has been digitally altered. The present paper brings together and presents an overview of the existing research on the consequences for body image of digital manipulation and the addition of disclaimers in a variety of types to images on social media. It concludes that disclaimers are an ineffective means of protecting body satisfaction against exposure to idealized social media images. Based on the overview, nine avenues for future research are identified.

Beauty and the big business: A qualitative investigation of the development and implementation of the CVS Beauty Mark.

Detrimental effects of retouched media imagery on body image among women have led to calls to increase transparency regarding the use of digital modification. CVS Health, a large US-based beauty retailer, announced in 2018 its intention to implement across its beauty department imagery two labels: a "Beauty Mark" label to indicate a retouch-free image, and a second label disclosing digital modification. The aim of the present study was to explore the motivations, facilitators, and barriers to its implementation. In-depth individual interviews (n = 11) were conducted with professionals involved in the conceptualization, development, artistic vision, and implementation of the initiative. Thematic analysis revealed three themes: (1) CVS's perception that the campaign as a good fit; (2) the marketing of "empowerment" to generate profit as well as a desired outcome; and (3) desire to exemplify a value-driven company model and contribute sustainably to broader values such as diversity and body positivity. These findings may help to identify ways in which to create larger scale change within media imagery.

Breaking the Binary: The Approach to Chest Masculinizing Gender-Affirming Surgery in Trangender Men.

BACKGROUND: The purpose of mastectomy for the transgender patient is to produce a masculine appearance of the chest. A number of algorithms have been proposed for selecting the surgical technique. A holistic and surgical approach to transgender men includes our experience-based classification system for selecting the correct surgical technique. OBJECTIVES: To present and discuss the Transgender Standard of Care and our personal experience. METHODS: Data were collected from the files of female-to-male transgender persons who underwent surgery during 2003-2019. Pictures of the patients were also analyzed. RESULTS: Until May 2021, 342 mastectomies were performed by the senior author on 171 patients. The 220 mastectomies performed on 110 patients until November 2019 were included in our cohort. Patient age was 13.5 to 50 years (mean 22.5 ± 6.1). The excision averaged 443 grams per breast (range 85-2550). A periareolar approach was performed in 14 (12.7%), omega-shaped resection (nipple-areola complex on scar) in 2 (1.8%), spindle-shaped mastectomy with a dermal nipple-areola complex flap approach in 38 (34.5%), and a complete mastectomy with a free nipple-areola complex graft in 56 (50.9%). Complications included two hypertrophic scars, six hematomas requiring revision surgery, three wound dehiscences, and three cases of partial nipple necrosis. CONCLUSIONS: A holistic approach to transgender healthcare is presented based on the World Professional Association for Transgender Health standard of care. Analysis of the data led to Wolf's classification for female-to-male transgender mastectomy based on skin excess and the distance between the original and the planned position of the nipple-areola complex.