MéthodologieÉtude de validation de la version française du Body Shape QuestionnaireValidation of the french version of the Body Shape Questionnaire
Résumé
Le but de l’étude est l’adaptation, en langue française, d’un questionnaire anglosaxon d’insatisfaction corporelle : Body Shape Questionnaire (BSQ, Cooper et al., 1987) et de tester sa fidélité et sa validité concourante sur un échantillon de 242 étudiantes. Les relations entre les catégories de poids et l’insatisfaction corporelle et les facteurs issus de l’analyse factorielle ont été explorées.Nous avons procédé au calcul des coefficients alpha, à un test de fiabilité test-retest et à une analyse factorielle. La validité concourante du BSQ a été évaluée à partir de la comparaison avec un autre test : l’Eating Disorder Inventory (EDI, Garner et Olmsted, 1984). Enfin, des analyses statistiques inférentielles (Anova) ont été réalisées.Les coefficients alpha relatifs au test/retest du BSQ sont élevés (0,95/0,94) ainsi que ceux pour le test/retest de l’EDI (0,85/0,84). Ces résultats mettent en évidence une très bonne consistance interne des 2 instruments. L’analyse factorielle en composantes principales suggère une solution à 4 facteurs : évitement et honte sociale de l’exposition du corps, insatisfaction corporelle par rapport aux parties inférieures du corps, usage de laxatifs et de vomissements pour réduire l’insatisfaction corporelle, cognitions et comportements inadaptés afin de contrôler le poids. Ces 4 facteurs expliquent 55,2 % de la variance totale. Les analyses statistiques inférentielles ont mis en évidence une relation significative entre la catégorie de poids et le score total au BSQ et entre la catégorie de poids et le score sous les facteurs 1, 2 et 4.La version française du BSQ se présente comme un instrument ayant de bonnes qualités métrologiques. Il permettrait d’explorer le rôle d’une préoccupation excessive de l’apparence du corps dans le développement, le maintien et le traitement des troubles du comportement alimentaire.
Summary
In today's societies, pressures from the idea of thinness are omnipresent and lead to a corporal dissatisfaction with an excessive preoccupation of the body's image. It seems important to have, in France, a device that can evaluate the corporal dissatisfaction degree, for the reason that the troubles of the body's image is a common diagnostical category to the anorexia and bulimia (DSM IV, 1994). Cooper et al. (1987) have developed one-dimensional questionnaire of 34 items in order to measure the worries towards the weight and the shape of the body, called the « Body Shape Questionnaire » (BSQ). Its concurrent validity has been shown with the using of the corporal dissatisfaction under-scale of the Eating Disorders Inventory (EDI ; Garner et Olmsted, 1984) and the using of the diagnositcal questionnaire : Eating Attitude Test (EAT ; Garner et Garfinkel, 1979). The BSQ gives us a way to explore the role of extreme worries towards the body's apparence in the development, the keeping and the treatment of eating disorders. From this point the BSQ is a tool widely used on an international level in researches on the eating disorders. It has been validited in Spain and in Germany whereas it has not been yet subject to a validation in France. For this reason, we proposed to use the BSQ on the french population. Methodology - The sample is made of 242 university girl students. The average age is 20.7 years old with an standard deviation of 2.26. The size and the weight helped us to calculate the Body Mass Index (BMI) which is in fact the weight divided by the size squared. The average BMI is 21.06 kg/m2 ± 2.87. Regarding the evaluating devices, the BSQ is presented as a scale of 34 items marked by 6 different points : 1 never, 2 barely, 3 sometimes, 4 often, 5 very often, 6 always. After getting the authorization form the authors to respect during these kinds of procedures, we have started validation. The corporal dissatisfaction under-scale of Eating Disorder Inventory (EDI, Garner et al., 1991) is made of 9 items and has a scale of 6 points going from « never » to « always ». In order to evaluate the accuracy of the Body Shape Questionnaire (BSQ) in France, we made a test/retest. The concurrent validity of the BSQ has been evaluated by the EDI. The 242 subjects have been asked to fill in both questionnaires during the test and the re-test (4 weeks after the test). We have evaluated the accuracy of the BSQ with the calculation of the constancy test/retest (Pearson's r) and the measure of the internal consistency (Cronbach's alpha). Then, we tested the validity regarding an external criteria. The validation procedure is based here on an examination of the correlations between the tests results (BSQ) and another measure taken as criteria (EDI). The solutions proposed by the factorial exploratory analysis have been tested by confirmatory analysis using the 2 index of adjustment : the GFI (« Goodness of Fit Index ») and the CFI (Comparative Index of Bentler) which, greater than 0.85, shows a satisfying adjustment and the RMC (redidue) which has to be less than 0.10 for a satisfying adjustment. Finally, inferential statistical analysis have studied the relations between the weight's category and the total result at the BSQ and the results of the factors sprung from factorial analysis. Results - Correlations between the items of test/re-test BSQ are greater than 0.93. The alpha coefficient is high for the test (0.95) and also for the re-test (0.94). This shows a very good internal consistency between the 34 items of the BSQ. Concerning the EDI, the correlation between the test/re-test are greater than 0.98. The alpha coefficient of Cronbach is high : 0.85 for the test and 0.84 for the re-test. The Pearson's r of the BSQ/EDI test and the BSQ/EDI re-test greater than 0.7 point out the concomitant validity of the BSQ with the EDI.We made a factorial analysis of the BSQ (test) on the 242 subjects. We used the extraction of the main components method with the extraction's rule of the curve for the real values. The transformation method used here is the normalised Varimax. The factorial analysis shows four factors with their own value greater or equal to 1 (15.1 ; 1.77 ; 1.48 ; 1.08). This solution concerning these four factors explains 55.2 % of the total variance. The oblical rotations analysis of the four factors seems to point out a high correlation between these latters (from 0.54 to 0.77), this suggests a hierarchical pattern with a single factor which is confirmed with an Cronbach's alpha of 0.95. Then, we chose to gather around each selected factors the items presenting a substantial saturation, greater than or equal to 0.5 and which are saturated by only one factor. The first factor obtained by the factorial analysis of the BSQ has been called « social avoidance and shame of the exposure of the body ». The internal coherence of this factor is satisfactory (Cronbach's alpha = 0.87). The second factor obtained has been called « body dissatisfaction compared to the lower parts ot the body (Cronbach's alpha = 0.90). The third factor has been called « using laxatives and vomiting in order to reduce body dissatisfaction » The fourth factor has been called « unsuited cognitions and behaviours in order to control the weight (Cronbach's alpha = 0.76). The solution with 1 and 4 factors has been tested by a confirmatory analysis. The adjustment parameters of the unifactorial pattern were not satisfactory (GFI = 0.76, CFI = 0.83, RMC = 0.5). The 4 factors pattern adjusted better to the data (GFI = 0.86, CFI = 0.90, RMC = 0.5).In order to determinate the differences between the weight/score categories to the BSQ) score in comparison to the 4 factors (coming from the factorial analysis), several Anova have been released as well as post-hoc tests (test of Sheffé). There is a significant effect of the weight category on the corporal dissatisfaction (BSQ result), F (2.230) = 11.34 ; p <0.0001. Scheffe's test placed in a prominent position the fact that the subjects having an overweight (99.85 ± 31.34) have a corporal dissatisfaction significantly greater than the subjects having a normal weight (74.08 ± 27.94) and presenting a thinness (63.19 ± 23.61). We pointed out a significant effect of the weight category on factor one « social avoidance and shame of the exposure of the body » “F (2.232) = 20.18 ; p < 0.001“, on factor 2 « body dissatisfaction compared to the lower parts of the body » “F (2.232) = 6.38 ; p < 0.005“ and factor 4 « reduce body dissatisfaction and unsuited cognitions and behaviours in order to control the weight » “F (2.232) = 5.67 ; p <0.005“.However, there is no effect in the weight category for factor 3 « using laxatives and cominting in order to reduce the corporal dissatisfaction » “F (2.232) = 5.67 ; p > 0.05“.Sheffe's test highlighted the fact that the subjects having overweight have a result more importan than the ones having a normal weight and presenting a thinness for factor 1.2 and 4. Discussion - The BSQ « French version » seems in fact to present the same metrical qualities than its original Anglo-Saxon and Spanish versions. The concluding results invite us to continue our study of the BSQ including in our patients, the bulimic subjects and the ones who are worried about corporal aspect. Its implications on the clinical field could be really interesting especially on people suffering from the eating disorders. Then, the BSQ could provide us a way to explore the role of an extreme worry of the body's appearance in the developement, the maintenance and the treatment of the eating disorders.
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Cited by (77)
The French day hospital program specialized in eating disorders (ED) opened in January 2018. Our study presents preliminary data on clinical profiles of patients with anorexia nervosa (AN). We describe more specifically clinical characteristics of patients with early onset AN and according to their therapeutics orientations. Then, we compare the weight gain of patients managed only in day-patient (DP) treatment with those managed initially inpatient (IP) treatment and relays in DP.
Ninety-two patients with AN, aged between 8 and 18 years, were evaluated with several questionnaires (EDI-2, EDE-Q, BSQ, EDS-R, CDI, STAI-Y, VSP-A, EPN-13).
Patients with early onset AN, n = 23 (25.3%), presented more restrictive behaviors, less marked dietary symptomatology, a lower degree of clinical perfectionism and a less marked feeling of ineffectiveness than adolescent patients with AN. Regarding the choice of hospitalization modality (DP alone or IP-DP), the only difference highlighted was the severity of patient undernutrition. Among the patients who were treated (IP-DP n = 27 vs DP alone n = 25), the weight evolution after one month and at discharge was favorable for both groups.
These preliminary data suggest the effectiveness of DP in the care of AN in children and adolescents.
Notre étude présente les données préliminaires des profils cliniques des patients avec anorexie mentale (AM) évalués et/ou pris en charge dans un hôpital de jour (HDJ) français spécialisé dans les troubles des conduites alimentaires (TCA). Nous décrirons plus spécifiquement les caractéristiques cliniques des patients avec AM prépubère et en fonction de leurs orientations thérapeutiques au terme de l’évaluation initiale. Puis nous comparons l’évolution pondérale des patients pris en charge uniquement en HDJ avec ceux pris en charge en unité d’hospitalisation temps puis relayé en HDJ (HTP-HDJ).
Quatre-vingt-deux patients avec AM âgés de huit à dix-huit ans ont été évalué à l’aide de différents questionnaires (EDI-2, EDE-Q, BSQ, EDS-R, CDI, STAI-Y, VSP-A, EPN-13).
Les patients avec AM prépubère, n = 23 (25,3 %), présentent des comportements plus restrictifs, une symptomatologie alimentaire moins marquée, un degré de perfectionnisme clinique plus faible et un sentiment d’inefficacité moins marqué que les patients adolescents avec AM. Concernant le choix de la modalité d’hospitalisation (HDJ seule ou HTP-HDJ), la seule différence mise en évidence est la sévérité de la dénutrition du patient. Parmi les patients traités (HTP-HDJ, n = 27 vs HDJ seul n = 25), l’évolution pondérale à 1 mois et à la sortie était favorable pour les deux groupes.
Ces données préliminaires suggèrent l’efficacité de l’HDJ dans la prise en charge de l’AM chez l’enfant et l’adolescent.
Osteopathy and Anorexia Nervosa: Cross-evaluations of osteopathy and psychomotricity on bodily concerns
2023, Annales Medico-PsychologiquesDans l’anorexie mentale, les préoccupations corporelles sont un enjeu clé de la pathologie, mais aussi de la thérapeutique. Il est, à ce jour, établi que la perception de soi serait modulable par des interventions centrées sur le toucher.
Dans ce contexte et avec l’appui de recherches en psychiatrie et en psychologie, nous posons la question de la place de l’ostéopathie en tant qu’aide à la remédiation physico-psychique.
Nous avons réalisé le suivi de 40 patientes souffrant de troubles du comportement alimentaire et réparties en quatre sous-groupes de dix sujets non randomisés durant dix semaines afin d’évaluer la valeur ajoutée de l’ostéopathie vis-à-vis de la psychomotricité sur les préoccupations corporelles.
À l’issue de la prise en charge, nous observons une diminution des préoccupations corporelles pour les sujets du groupe psychomotricité (p < 0,05) et ceux du groupe de double suivi ostéopathie-psychomotricité (p < 0,05). Le groupe ostéopathie ne montre pas d’amélioration suffisante vis-à-vis du groupe témoin (p > 0,34).
Les résultats et les limites de la présente étude sont discutés, ainsi que les recommandations pour des recherches ultérieures.
Anorexia nervosa is a psychosomatic disorder that mainly concerns women where body image and corporal sensations are questioned. For these patients, their morphology is an obsessional issue and they tend to ignore sensorial perceptions such as hunger or pain. Treatment remains extremely complex, in spite of the vast expanse of relevant specialities, and a close coordination of soma and psyche mediations is required. In fact, it has been proven that for anorexics, there is a strong link between the image of their degraded body and sensorial disorders. These phenomena also concern the structures of the interceptive system. Therefore, the body's perceived shape is a key issue not only in the pathology but also in the therapeutic intervention. To date, it has been established that self-perception can be modulated by interventions focused on touch. In this context and with the support of research in child psychiatry and psychology, we raise the question of the place of osteopathy as an aid in physico-psychic remediation. Our goal is to develop a therapeutic mediation covering the somatic phenomena induced by the muscular frame so as to demonstrate a possible improvement in how anorexics perceive their own morphology.
We included 40 patients suffering from eating disorders in our experiment forming a heterogeneous age-group and respecting the minimum threshold. During the ten weeks of the trial, the group was divided into 4 subgroups of 10 non-randomized participants each and based on voluntary participation with one subgroup of 10 patients as a control group, one subgroup of 10 patients treated exclusively using psychomotricity, a third subgroup of 10 patients evaluated exclusively using osteopathy, and a fourth subgroup of 10 patients using a mixed approach. We relied on the “Body Shape Questionnaire” (BSQ-34) to conduct our comparative measurements. It is a reference psychometric tool for measuring bodily concerns, and the French version has been validated and is commonly used.
At the end of our ten-week treatment period, we observed positive results for psychomotricity (P < 0.05) and a double osteopathy-psychomotricity follow-up (P < 0.05), but osteopathy alone does not show sufficient improvement compared to the control group (P > 0.34).
In view of the results obtained with our patients, the modulations of bodily concerns among those participants treated by touch appear to be effective in the intra-group, but our approach could require extended treatment for more than 10 weeks with regard to intergroup comparisons. Osteopathy must, like the other bodily mediations already involved in the follow-up of anorexia nervosa before it, establish the extent of its contribution to and value in this pathophysiology.
Use of virtual reality in eating disorders
2021, EncephaleLa réalité virtuelle permet de modéliser un environnement avec lequel un individu pourra interagir, ce qui présente de nombreux avantages en psychiatrie. Elle permet en effet d’utiliser un environnement contrôlé et sécurisé, et d’améliorer l’engagement du sujet dans les soins. Son utilisation dans les troubles des conduites alimentaires est croissante depuis plusieurs années, et les études menées jusqu’à présent mettent en avant des résultats prometteurs dans leur compréhension, évaluation et prise en charge thérapeutique. Tout d’abord, la réalité virtuelle permet d’affiner la compréhension du trouble de l’image corporelle dans l’anorexie, ou de l’anxiété et du craving dans la boulimie et les accès hyperphagiques. Elle semble également pouvoir être un outil d’évaluation du trouble de l’image corporelle similaire aux méthodes classiques, et au niveau thérapeutique, elle semble être efficace en association ou en complément d’une thérapie comportementale et cognitive. De plus, la réalité virtuelle permet de développer des techniques thérapeutiques innovantes, notamment celle de l’illusion corporelle utilisée dans l’objectif de réduire le trouble de l’image corporelle de l’anorexie, ou encore la thérapie d’exposition à des indices de consommation alimentaire par réalité virtuelle utilisée chez les patients atteints de boulimie et d’accès hyperphagiques. Bien que les résultats préliminaires soient encourageants, des études supplémentaires sont nécessaires afin de les valider, et des essais cliniques plus larges et contrôlés doivent être menés afin de confirmer l’impact positif de l’utilisation de la réalité virtuelle et des différents protocoles qui la mettent en œuvre dans la prise en charge thérapeutique des troubles des conduites alimentaires.
Virtual reality is a new technology that can be used to model an environment with which an individual can interact using all five senses. It is notably used in psychiatry for anxiety disorders and addictions, and its use in eating disorders has been growing in recent years. Indeed, virtual reality offers interesting advantages, such as its ability to personalize any environment, which is also more secure and controllable. Recent studies show promising results in the understanding, evaluation, and therapeutic management of eating disorders. The use of avatars in anorexia nervosa allows for a correct assessment of the perceptual (body image distortion) and cognitive-affective (body dissatisfaction) components of the body image disorder in a similar way to conventional methods, but also for a better understanding of them. Moreover, avatars allow the development of innovative therapeutic protocols and are thus used in the context of exposure therapy. The new body swapping protocol, based on a multisensory illusion, offers particularly promising results in the reduction of body image disorder. For bulimia nervosa and binge eating disorder, virtual reality has made it possible to better characterize the triggering mechanisms of binge eating episodes through studies that have observed different responses to food-related environments and stimuli. At the therapeutic level, virtual reality cue exposure therapy has the most empirical support. Its aim is to reduce or eliminate the anxiety and craving felt by a patient in response to exposure to food or other food-related cues by preventing the patient from consuming food, and results show clear reductions in anxiety, craving and binge eating episodes. While all these results seem to indicate a bright future for virtual reality in eating disorders, further studies are needed to validate the positive impact of its use, but also its limitations. Notably, cyber sickness could alter the smooth running of virtual reality therapy sessions by causing nausea and disorientation. Moreover, it is important to verify that a therapeutic protocol does not lose its effectiveness when it is transposed into virtual reality. However, virtual reality seems to be a therapeutic tool that is better accepted by patients, and even better by adolescents, which is very interesting for eating disorders since adolescents are the most affected. Virtual reality could therefore help motivate patients to pursue treatment and reduce the dropout rate while offering good therapeutic results. Thus, studies conducted in recent years have shown that virtual reality is a promising tool in the understanding, assessment and treatment of eating disorders, and future research should confirm this, particularly in the adolescent population.
Psychometric Analysis of the Body Shape Questionnaire in Mexican University Students
2020, Revista Colombiana de PsiquiatriaAnalizar las propiedades psicométricas, estructura interna y relación con indicadores antropométricos del Body Shape Questionnaire (BSQ) en universitarios mexicanos, partiendo de un enfoque de la invarianza de medición.
Se realizó un estudio instrumental, orientado a la evaluación de las propiedades psicométricas, validez y fiabilidad, del BSQ. Se realizó análisis de invarianza de la medición por el método de estimación mínimos cuadrados ponderados con varianza ajustada y correlaciones policóricas, previa evaluación de diferentes modelos de medición del BSQ en cada grupo. Las puntuaciones de la versión final se correlacionaron con indicadores antropométricos mediante el coeficiente de correlación de Pearson.
En el análisis dimensional, todos los modelos previos del BSQ presentan índices de ajuste favorables, aunque aquellos de un solo factor presente son los que tienen evidencia más robusta. Se aceptó la invarianza configural, lo que indica que la estructura unidimensional es común a varones y mujeres. Sin embargo, las cargas factoriales de 16 ítems fueron estadísticamente diferentes entre los grupos, por lo que se descartaron y se obtuvo una versión de 18 ítems (BSQ-18), que se considera invariante respecto al sexo. Además, hay relación directa entre las puntuaciones de la versión del BSQ-18 y el índice de masa corporal, la circunferencia de cintura y el porcentaje de grasa. En cuanto a la fiabilidad, se hallaron indicadores satisfactorios.
El BSQ-18 es aplicable tanto a varones como a mujeres y tiene indicadores de fiabilidad elevados que posibilitan su uso en entornos clínicos para la evaluación en el abordaje de trastornos de la conducta alimentaria y obesidad en jóvenes universitarios.
To analyse the psychometric properties, internal structure, and relationship with anthropometric indicators of the Body Shape Questionnaire (BSQ) among Mexican university students according to the measurement invariance approach.
An instrumental study was carried out to assess the psychometric properties, validity, and reliability of the BSQ. The analysis of the measurement invariance was performed using the Least Squares Estimation, and weighted by adjusted variance and polychoric correlations after assessing different measurement models for BSQ in each group. The scores of the final version were correlated with anthropometric indicators by the Pearson correlation coefficient.
As regards the dimensional analysis, all of the previous models for BSQ have favourable adjustment rates, although those with a single factor show more robust evidence. The configural invariance was accepted; suggesting that the one-dimensional structure is common for both men and women. However, 16-item factorial loadings were statistically different between the groups. Hence, they were discarded and an 18-item version (BSQ-18) was obtained, which is considered invariant as regards gender. In addition, there is a direct relationship between the scores of the BSQ-18 version and the body mass index, waist circumference, and fat percentage. Satisfactory indicators were found as regards stability.
The BSQ-18 can be used with men and women, and has high reliability indicators to be conducted in clinical settings to assess eating disorders and obesity among university students.
From diagnosis to symptoms
2023, SoinsLe diagnostic d’anorexie mentale est l’un des plus aisés à poser dans le sens où il s’agit d’un diagnostic positif, et non différentiel. Il se définit par peu de critères qui, ensemble, deviennent quasi pathognomoniques : une restriction excessive des apports énergétiques associée à une peur irrationnelle à l’égard du poids et une image altérée du corps. Même si le poids est au cœur des préoccupations de l’équipe médicale, il est important d’interroger la pathologie dans son histoire, afin de la remettre dans le contexte, et parfois d’appréhender la paralogique et la fonction de cette dernière dans la vie du patient. Il est nécessaire de travailler sur les émotions et les cognitions en sus des comportements.
The diagnosis of anorexia nervosa is one of the easiest to make in that it is a positive diagnosis, not a differential diagnosis. It is defined by a few criteria which together become almost pathognomonic: excessive restriction of energy intake combined with an irrational fear of weight and an altered body image. Even if weight is at the heart of the medical team’s concerns, it is important to question the pathology in its history, in order to put it in to context, and sometimes to understand the para-logic and its function in the patient’s life history. It is necessary to work on emotions and cognitions in addition to behaviour.
The impact of weight and negative body image on the body schema in undergraduate women
2024, Experimental Brain Research