Mediating Role of Body Image Psychological Inflexibility in the Relationship Between Self-Esteem and Idiopathic Scoliosis-Related Body Image

Öz

Objective: This study aimed to examine the mediating role of body image psychological inflexibility in the relationship between self-esteem and scoliosis-related body image. Method: This cross-sectional study included 150 individuals (120 females, 30 males) aged 11–37 years with a diagnosis of idiopathic scoliosis. Participants completed the Sociodemographic and Medical Information Form, Rosenberg Self-Esteem Scale, Body Image Disturbance Questionnaire–Scoliosis, and Body Image Psychological Inflexibility Scale. Results: Self-esteem was negatively associated with body image dissatisfaction and body image psychological inflexibility, whereas body image psychological inflexibility was positively associated with the personal and social dimensions of body image. After controlling for the covariates, the indirect effect through body image psychological inflexibility was significant for both the personal and social dimensions. The models explained 37.2% of the variance in the personal dimension and 43.0% of the variance in the social dimension. Conclusion: Body image psychological inflexibility may represent an important mediating process between self-esteem and scoliosis-related body image.

Anahtar Kelimeler

• Idiopathic scoliosis
• body image
• self-esteem
• body image pssychological inflexibility

Benlik Saygısı ile İdiyopatik Skolyoza İlişkili Beden İmgesi Arasındaki İlişkide Beden İmgesi Psikolojik Katılığının Aracı Rolü

Öz

Amaç: Bu çalışmada, beden imgesi psikolojik katılığının benlik saygısı ile skolyoza ilişkin beden imgesi arasındaki aracı rolünün incelenmesi amaçlanmıştır. Yöntem: Kesitsel tasarlanan çalışmaya, idiyopatik skolyoz tanısı almış 11–37 yaşları arasındaki 150 birey (120 kadın, 30 erkek) dahil edilmiştir. Katılımcılara Sosyodemografik ve Tıbbi Bilgi Formu, Rosenberg Benlik Saygısı Ölçeği, Skolyoza İlişkin Beden İmgesi Ölçeği ve Beden İmgesi Psikolojik Katılığı Ölçeği uygulanmıştır. Bulgular: Benlik saygısı, beden imgesi memnuniyetsizliği ve beden imgesi psikolojik katılığı ile negatif; beden imgesi psikolojik katılığı ise beden imgesinin kişisel ve sosyal boyutlarıyla pozitif ilişkili bulunmuştur. Kovaryatlar incelendiğinde beden imgesi psikolojik katılığı üzerinden gerçekleşen dolaylı etkinin beden imgesinin kişisel ve sosyal boyutları için anlamlı olduğu görülmüştür. Kurulan modeller, beden imgesinin kişisel boyutundaki varyansın %37,2’sini, sosyal boyutundaki varyansın ise %43,0’ını açıklamıştır. Sonuç: Bulgular, beden imgesi psikolojik katılığı, benlik saygısı ile skolyoza ilişkin beden imgesi arasında önemli bir aracı süreç olabileceğini işaret etmektedir.

Anahtar Kelimeler

• idiyopatik skolyoz
• beden imgesi
• benlik saygısı
• beden imgesi psikolojik katılığı

Kaynakça

1. Acar S (2022) Beden İmgesi Esnekliği Ölçeğinin Türkçeye uyarlanması. Muğla Sıtkı Koçman Üniversitesi Eğitim Fakültesi Dergisi, 9:212–222.
2. Al-Musharaf S, Rogoza R, Mhanna M, Soufia M, Obeid S, Hallit S (2022) Factors of body dissatisfaction among Lebanese adolescents: The indirect effect of self-esteem between mental health and body dissatisfaction. BMC Pediatr, 22:302.
3. Albayrak S, Asık E, Aydoğdu B, Yaman A, Üstün E (2023) Ergenlerde benlik saygısı ile hayır diyebilme arasındaki ilişki. Genel Sağlık Bilimleri Dergisi, 5:135-144.
4. Allgood-Merten B, Stockard J (1991) Sex role identity and self-esteem: A comparison of children and adolescents. Sex Roles: A Journal of Research, 25:129–139.
5. Auerbach JD, Lonner BS, Crerand CE, Shah SA, Flynn JM, Bastrom T, P et al. (2014) Body image in patients with adolescent idiopathic scoliosis: validation of the body image disturbance questionnaire-scoliosis version. J Bone Joint Surg Am, 96:61.
6. Bauer JM (2021) The body image disturbance questionnaire-scoliosis better correlates to quality of life measurements than the spinal assessment questionnaire in pediatric idiopathic scoliosis. Spine Deformity, 9:1509–1517.
7. Bertuccelli M, Cantele F, Masiero S (2023) Body image and body schema in adolescents with idiopathic scoliosis: A scoping review. Adolesc Res Rev,8:97-115.
8. Brichacek AL, Neill JT, Murray K, Rieger E, Watsford C (2023) Ways of responding to body image threats: Development of the Body Image Flexibility and Inflexibility Scale for youth. J Contextual Behav Sci, 30:31-40.

9. Brichacek AL, Neill JT, Murray K, Rieger E, Watsford C (2024). The distinct affect regulation functions of body image flexibility and inflexibility: A prospective study in adolescents and emerging adults. Body Image, 50:101726.
10. Buhlmann U, Teachman BA, Naumann E, Fehlinger T, Rief W (2009) The meaning of beauty: implicit and explicit self-esteem and attractiveness beliefs in body dysmorphic disorder. J Anxiety Disord, 23:694–702.
11. Callaghan GM, Sandoz EK, Darrow SM, Feeney TK (2015) The Body Image Psychological Inflexibility Scale: development and psychometric properties. Psychiatry Res, 226:45–52.
12. Carrot B, Duclos J, Barry C, Radon L, Maria AS, Kaganski I et al. (2019) Multicenter randomized controlled trial on the comparison of multi-family therapy (MFT) and systemic single-family therapy (SFT) in young patients with anorexia nervosa: Study protocol of the THERAFAMBEST study. Trials, 20:249.
13. Cash TF, Fleming EC, Alindogan J, Steadman L, Whitehead A (2002) Beyond body image as a trait: the development and validation of the body image states scale, Eat Disord, 10:103-113.
14. Cash TF (2002) Cognitive-behavioral perspectives on body image. In Body Image: A Handbook of Theory, Research, and Clinical Practice (Eds TF Cash, T Pruzinsky):38-46. New York, Guilford Press.
15. Cash TF, Pruzinsky T (Eds.) (1990) Body Images: Development, Deviance, and Change. New York, Guilford Press.
16. Cash TF, Smolak L (2011) Conceptual foundations. In Body Image: A Handbook of Science, Practice, and Prevention, 2nd ed. (Eds TF Cash, L Smolak):3-11. New York, Guilford Press.
17. Cash TF, Szymanski ML (1995) The development and validation of the body-image ideals questionnaire. J Pers Assess, 64:466–477.
18. Cheshire J, Gardner A, Berryman F, Pynsent P (2017) Do the SRS-22 self-image and mental health domain scores reflect the degree of asymmetry of the back in adolescent idiopathic scoliosis?. Scoliosis Spinal Disord, 12:37.
19. Çuhadaroğlu F (1986) Adolesanlarda benlik saygısı. (Uzmanlık tezi). Ankara, Hacettepe Üniversitesi.
20. Danielsson AJ, Hasserius R, Ohlin A, Nachemson AL (2012) Body appearance and quality of life in adult patients with adolescent idiopathic scoliosis treated with a brace or under observation alone during adolescence. Spine, 37:755–762.
21. Dwyer PC, Snyder M, Omoto AM (2013) When stigma-by-association threatens, self-esteem helps: Self-esteem protects volunteers in stigmatizing contexts. Basic Appl Soc Psychol, 35:88-97.
22. Fallon AE, Rozin P (1985) Sex differences in perceptions of desirable body shape. J Abnorm Psychol. 94:102-105.
23. Fällström K, Cochran T, Nachemson A (1986) Long-term effects on personality development in patients with adolescent idiopathic scoliosis. Influence of type of treatment. Spine, 11:756–758.
24. Goldberg MS, Mayo NE, Poitras B, Scott S, Hanley J (1994) The ste-justine adolescent idiopathic scoliosis cohort study: part ii: Perception of health, self and body image, and participation in physical activities. Spine, 19:1562-1572.
25. Greiner KA (2002) Adolescent idiopathic scoliosis: radiologic decision-making. Am Fam Physician, 65:1817–1822.
26. Grivas TB, Vasiliadis ES, Rodopoulos G (2008) Aetiology of Idiopathic Scoliosis. What have we learned from school screening?. Stud Health Technol Inform, 140:240–244.
27. Guan Y, Lin B, Wang H, Zhao B, Lin Y (2026) A cross-sectional network analysis of appearance-related anxiety and psychosocial protective factors in adolescent idiopathic scoliosis patients: core symptoms and bridging analysis. Front Public Health, 14:1823055.
28. Guo J, Huang X, Zheng A, Chen W, Lei Z, Tang C et al. (2022) The influence of self-esteem and psychological flexibility on medical college students' mental health: a cross-sectional study. Front Psychiatry 13:836956.
29. Hayes AF (2018) Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Perspective, 2nd ed. New York, Guilford Press.
30. Kaelin AJ (2020) Adolescent idiopathic scoliosis: indications for bracing and conservative treatments. Ann Transl Med, 8:28.
31. Kara Z, Ekşi H (2021) Beden İmajı Psikolojik Katılık Ölçeği: Türkçeye uyarlama, geçerlik ve güvenirlik çalışması. 4th International European Conference on Interdisciplinary Scientific Research, August 8-9, 2021, Warsaw, Poland.
32. Koushiou M, Loutsiou A, Karekla, M (2021) Eating disorders among middle-school students: The role of psychological inflexibility and self-esteem. Int J Sch Educ Psychol 9:58–68.
33. Kuzu D (2018) Adölesan idiopatik skolyoz hastalarında ebeveyn tutumlarınının yeme tutumları üzerindeki etkisinde öz-şefkat, depresyon ve beden imgesi bozukluğunun aracılık etkisi (Doktora tezi). İstanbul, İstanbul Üniversitesi.
34. Kuzu D, Sertel Berk HÖ, Şimşek ÖF (2020) Reliability and validity of the Turkish version of the body image disturbance questionnaire-scoliosis. Spine, 45:1033–1038.
35. Kuzu D, Sertel Berk HÖ, Yıldız Aydın F (2017) Subjective well-being in idiopathic scoliosis patients. International Journal of Human and Behavioral Sciences, 3(2):1-6.
36. Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG et al. (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am, 83:1169–1181.
37. Linardon J, Anderson C, Messer M, Rodgers RF, Fuller-Tyszkiewicz M (2021) Body image flexibility and its correlates: A meta-analysis. Body Image, 37:188–203.
38. Lindeman M, Behm K (1999) Cognitive strategies and self-esteem as predictors of brace-wear noncompliance in patients with idiopathic scoliosis and kyphosis. JPediatr Orthop, 19:493–499.
39. Liskey-Fitzwater N, Moore CL, Gurel LM (1993) Clothing importance and self-perception of female adolescents with and without scoliosis. Clothing Tex Res J, 11:16-22.
40. Lonstein JE (1994) Adolescent idiopathic scoliosis, Lancet, 344:1407-1412.
41. Masheb RM, Grilo CM, Burke‐Martindale CH, Rothschild BS (2006) Evaluating oneself by shape and weight is not the same as being dissatisfied about shape and weight: a longitudinal examination in severely obese gastric bypass patients. Int Eat Disord, 39:716-720.
42. Matamalas A, Bagó J, D'Agata E, Pellise F (2014) Body image in idiopathic scoliosis: a comparison study of psychometric properties between four patient-reported outcome instruments. Health Qual Life Outcomes, 12:1-8.
43. Negrini S, Aulisa AG, Aulisa L, Circo AB, de Mauroy JC, Durmala J et al. (2012) 2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis, 7:3.
44. Özbey H, Gültekin M (2021). Lise Öğrencilerinde beden algısı ve benlik saygısı arasındaki ilişkinin medya ve farklı değişkenler açısından incelenmesi. Afyon Kocatepe Üniversitesi Sosyal Bilimler Dergisi, 23:429-441.
45. Özcan Erişgin BN, Albayrak B, Aksu A, Uzun A, Coşkun HS (2026) Clinical relationship between curve location and body image, quality of life, and depression levels in patients with adolescent idiopathic scoliosis. Journal of Turkish Spinal Surgery, 37:76-81.
46. Özmen D, Özmen E, Ergin D, Çetinkaya AC, Sen N, Dündar PE et al. (2007) The association of self-esteem, depression and body satisfaction with obesity among Turkish adolescents. BMC Public Health, 7:80.
47. Paxton SJ, Neumark-Sztainer D, Hannan PJ, Eisenberg ME (2006) Body dissatisfaction prospectively predicts depressive mood and low self-esteem in adolescent girls and boys. J Clin Child Adolesc Psychol, 35:539–549.
48. Pop C (2016) Self-Esteem and body image perception in a sample of university students. Eurasian J Educ Res, 64:31-44.
49. Rogers CB, Webb JB, Jafari N (2018) A systematic review of the roles of body image flexibility as correlate, moderator, mediator, and in intervention science (2011-2018). Body Image, 27:43–60.
50. Rosen GM, Ross AO (1968) Relationship of body image to self-concept. J Consult Clin Psychol, 32:100.
51. Rosenberg M (1965) Society and the Adolescent Self-Image. Princeton, Princeton University Press.
52. Sandoz EK, Wilson KG, Merwin RM, Kate Kellum K (2013) Assessment of body image flexibility: The Body Image-Acceptance and Action Questionnaire. J Contextual Behav Sci, 2:39–48.
53. Silberstein LR, Striegel-Moore RH, Timko C, Rodin J (1988) Behavioral and psychological implications of body dissatisfaction: Do men and women differ? Sex Roles, 19:219–232.
54. Skaftourou E, Kastrinis A, Theodosopoulos E, Apostolaki A, Dimitriadis Z (2026) Correlation of photogrammetric trunk asymmetry indices (ATSI, POTSI) with self-perceived spinal appearance in adolescents with idiopathic scoliosis. In Research into Spinal Deformities 12: Proceedings of the International Research Society of Spinal Deformities (Ed N Chockalingam):126-130. 18-20 June 2026, Novi Sad, Serbia. IOS Press
55. Slade PD (1994) What is body image? Behav Res Ther 32:497–502.
56. Tabachnick BG, Fidell LS (2013) Using Multivariate Statistics (Sixth Edition). London, Pearson.
57. Talić G, Ostojić L, Bursać SN, Nožica-Radulović T, Stevanović-Papić Đ (2016) Idiopathic scoliosis from psychopathological and mind-body medicine perspectives. Psychiatr Danub, 28:357–362.
58. Taşpolat ER, Coşkun E, Ferahman D, Taşpolat EK, Haşimoğlu A, Çalışkan Y (2026) Peer victimization and psychosocial functioning in adolescents with adolescent idiopathic scoliosis. J Adolesc Health, 79:365-372.
59. Timko CA, Juarascio AS, Martin LM, Faherty A, Kalodner C (2014) Body image avoidance: An under-explored yet important factor in the relationship between body image dissatisfaction and disordered eating. J Contextual Behav Sci, 3: 203-211.
60. Thompson JK, Van Den Berg P (2002) Measuring body image attitudes among adolescents and adults. In Body Image: A Handbook of Theory, Research, and Clinical Practice (Eds TF Cash, T Pruzinsky):142–254. New York, Guilford Press.
61. Thorsell Cederberg J, Bartels SL, Thulin M, Beeckman M, Wicksell RK, Goubert L (2024) Child and parent risk and resilience factors as predictors of long-term recovery in youth undergoing spinal fusion surgery. Clin J Pain, 40:278–287.
62. Tiggemann M (2005) Body dissatisfaction and adolescent self-esteem: Prospective findings. Body Image, 2:129–135.
63. Tiggemann M, Stevens C (1999) Weight concern across the life-span: Relationship to self-esteem and feminist identity. Int J Eat Disord, 26:103–106.
64. Tones M, Moss N, Polly DW (2006) A review of quality of life and psychosocial issues in scoliosis. Spine, 31:3027-3038.
65. Webb JB (2015) Body image flexibility contributes to explaining the link between body dissatisfaction and body appreciation in White college-bound females. J Contextual Behav Sci, 4:176–183.
66. Webb JB, Butler-Ajibade P, Robinson SA (2014) Considering an affect regulation framework for examining the association between body dissatisfaction and positive body image in Black older adolescent females: Does body mass index matter? Body Image, 11:426–437.
67. Webster J, Tiggemann M (2003) The relationship between women's body satisfaction and self-image across the life span: the role of cognitive control. J Genet Psychol, 164:241–252.
68. Weinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA (2008) Adolescent idiopathic scoliosis. Lancet, 371:1527–1537.