Lavoisy G, Guelfi J-D, Vera L, Dardennes R, Rouillon F
Service du professeur Rouillon, clinique des maladies mentales et de l'encéphale, hôpital Sainte-Anne, Paris, France.
Encephale. 2008 Dec;34(6):570-6. doi: 10.1016/j.encep.2007.11.005. Epub 2008 Apr 2.
Eating disorders are characterized by severe disturbance in eating behavior. A disturbance in perception of body shape and weight is an essential feature of both anorexia nervosa (AN) and bulimia nervosa (BN). Eating disorder patients demonstrate the same characteristic attitude about body image, such as fear of fatness or pursuit of thinness.
Moreover, perturbed body image is a common diagnostic category of anorexia and bulimia (DSM-IV-TR, CIM-10). Cooper et al. [Int J Eat Disord 6 (1987) 485-94] developed a one-dimensional, 34 items questionnaire in order to measure the worries about weight and shape of the body, called the "Body Shape Questionnaire" (BSQ). Its concurrent validity has been shown using the corporal dissatisfaction subscale of the eating disorders inventory (EDI) [Int J Eat Disord 2 (1983) 15-34], the drive for thinness and body dissatisfaction and the Eating Attitude Test (EAT) [Psychol Med 9 (1979) 273-79]. The total score of the BSQ ranges from 34 to 204. Lower scores indicate lower concerns about body shape. The BSQ provides a means of exploring the role of extreme obsession about the body's appearance in the development, pursuit and treatment of eating disorders. From this point of view, the BSQ is a tool widely used in research on the eating disorders. Recently, It has been validated in a French non-clinical population [Encephale 31 (2005) 161-73]. However, the validity of the BSQ has not been reported in patients with eating disorders in France. This was addressed in the present study.
The first aim of this study was to assess perturbed body image with the French version of the BSQ in eating disorder patients. The second aim was to assess the sensitivity to change.
The sample was composed of patients hospitalized for eating disorders (DSM-IV-TR). During their hospitalization, they were submitted to this questionnaire at the beginning and at the end of their care. The BSQ was compared with commonly used heteroquestionnaires such as the body dissatisfaction and drive for thinness subscale of the Eating Disorder Inventory (EDI-2), the Eating Attitude Test (EAT) and the Clinical Global Impression (CGI). Sensitivity to change was assessed by comparing total score at inclusion and at the end of hospitalization. Statistical analyses included Pearson's correlation coefficients, analysis of variance and t test. As Body Mass Index (BMI) can interfere with the BSQ score, it was included as confounding variables in the model in all analyses.
Forty-five patients were included in the study. There were 21 patients with restricting subtype of AN, 17 patients with purging subtype of AN and seven BN. The mean age was 27.2+/-6.8 years, the mean length of hospital stay was 3.7+/-1.4 months, and the mean duration of the disorders was 10.7+/-6.3 years. The global BSQ score was high in the three groups of patients: 131.6+/-11.2. There was no significant difference between groups. There was no influence of the BMI on the BSQ scores. Correlation coefficient was significant for all scales with the BSQ except with the CGI. The higher correlation (r) was 0.58 with the drive for thinness subscale of the EDI-2. The change in scores between Day 0 and the end of hospitalization was significant (p<0.0001).
The French version of the BSQ thus appears to be valid and accurate and should permit the study of perturbed body image in French eating disorder patients. However, sensitivity to change remains to be confirmed to evaluate response to treatment. Studies measuring this variable at different stages of the illness and recovery should be conducted.
饮食失调的特征是饮食行为严重紊乱。对身体形状和体重的认知障碍是神经性厌食症（AN）和神经性贪食症（BN）的基本特征。饮食失调患者对身体形象表现出相同的特征态度，如害怕肥胖或追求消瘦。
此外，身体形象紊乱是厌食症和贪食症常见的诊断类别（《精神疾病诊断与统计手册》第四版修订版，《国际疾病分类》第十版）。库珀等人[《国际进食障碍杂志》6（1987）485 - 94]编制了一份一维的、包含34个条目的问卷，以测量对体重和身体形状的担忧，称为“身体形状问卷”（BSQ）。其同时效度已通过进食障碍量表（EDI）[《国际进食障碍杂志》2（1983）15 - 34]的身体不满分量表、追求消瘦和身体不满以及饮食态度测试（EAT）[《心理医学》9（1979）273 - 79]得到验证。BSQ的总分范围为34至204分。分数越低表明对身体形状的关注越低。BSQ为探索对身体外观的极端痴迷在饮食失调的发生、发展和治疗中的作用提供了一种手段。从这个角度来看，BSQ是饮食失调研究中广泛使用的工具。最近，它在法国非临床人群中得到了验证[《脑》31（2005）161 - 73]。然而，BSQ在法国饮食失调患者中的效度尚未见报道。本研究旨在解决这一问题。
本研究的第一个目的是使用BSQ法语版评估饮食失调患者的身体形象紊乱情况。第二个目的是评估其对变化的敏感性。
样本由因饮食失调住院的患者（《精神疾病诊断与统计手册》第四版修订版）组成。在住院期间，他们在治疗开始时和结束时接受该问卷调查。将BSQ与常用的他评问卷进行比较，如进食障碍量表（EDI - 2）的身体不满和追求消瘦分量表、饮食态度测试（EAT）以及临床总体印象量表（CGI）。通过比较入院时和住院结束时的总分来评估对变化的敏感性。统计分析包括Pearson相关系数、方差分析和t检验。由于体重指数（BMI）可能会干扰BSQ分数，在所有分析中均将其作为混杂变量纳入模型。
45名患者纳入研究。其中21名是限制型AN患者，17名是清除型AN患者，7名是BN患者。平均年龄为27.2±6.8岁，平均住院时间为3.7±1.4个月，平均病程为10.7±6.3年。三组患者的BSQ总分均较高：131.6±11.2。组间无显著差异。BMI对BSQ分数无影响。除CGI外，所有量表与BSQ的相关系数均显著。与EDI - 2的追求消瘦分量表相关性最高（r）为0.58。入院第0天和住院结束时分数的变化具有显著性（p < 0.0001）。
因此，BSQ法语版似乎有效且准确，应能用于研究法国饮食失调患者的身体形象紊乱情况。然而，对变化的敏感性仍有待确认，以评估对治疗的反应。应开展在疾病和康复不同阶段测量该变量的研究。
