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Effect of Early Body Image Dissatisfaction on Subsequent Psychological and Physical Adjustment After Disfiguring Injury

From the Johns Hopkins University School of Medicine, Baltimore Regional Burn Center, Johns Hopkins Bayview Medical Center, Baltimore, MD.

Address reprint requests to: James A. Fauerbach, Ph.D., Department of Psychiatry, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224. Email: jfauerba{at}jhmi.edu

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.

Key Words: body image • disfigurement • burns • quality of life • morbidity

Abbreviations: BID = Body Image Dissatisfaction, significant distress relatedto body image (ie, above the median SWAP); non-BID = not havingappreciable body image dissatisfaction (ie, scoring below the medianSWAP); DTS = Davidson Trauma Scale; MANCOVA = multivariateanalysis of covariance; TBSA = total body surface area; TBSA-FT = total body surface area with a full-thickness burn; SF-36 = The SF-36 Health Survey; SWAP = Satisfaction WithAppearance Scale.

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