{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T19:59:34Z","timestamp":1792612774310,"version":"4.5.0"},"reference-count":48,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,30]],"date-time":"2022-12-30T00:00:00Z","timestamp":1672358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Science Centre","award":["2019\/33\/B\/HS6\/03009"],"award-info":[{"award-number":["2019\/33\/B\/HS6\/03009"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>(1) Background: Body image is being defined as the picture of our own body in our mind with its size and shape, and with a perceptive and attitudinal evaluation of this body. It appears to be a complex clinical construct predisposing an individual to developing and maintaining anorexia nervosa (AN), as well as having considerable impact on prolonging the duration of this illness and its relapse risk. The aim of the research work was to assess whether the symptomatology of eating disorders, level of depression, and mental pain are associated with body image, and examine the influence of a distorted body image as well as eating disorders and depression symptoms on mental pain in AN; (2) Methods: A total of 36 women diagnosed with AN and 69 healthy controls (HC) participated in this study. All participants completed a battery of the following scales: EAT-26, BSQ-34, BIDQ, BDD-YBOCS, CESDR, and the Mental Pain Scale; (3) Results: Results show statistically significantly greater body image disturbances and higher level of depression and mental pain intensity in the AN compared to the HC group. Regression analysis indicates a greater impact of distorted body image, eating disorders, and depression symptoms on mental pain in AN; (4) Conclusions: As assumed, distorted body image and mental pain are central components of AN that should be especially emphasized in the therapeutical process of treating AN. Future research should focus on the etiopathogenesis of distorted body image in relation to the chronicity of mental pain and depression in AN, and address these outcomes in clinical practice to minimize suicide risk in this high-risk group of patients.<\/jats:p>","DOI":"10.3390\/ijerph20010718","type":"journal-article","created":{"date-parts":[[2023,1,2]],"date-time":"2023-01-02T04:17:38Z","timestamp":1672633058000},"page":"718","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Distorted Body Image and Mental Pain in Anorexia Nervosa"],"prefix":"10.3390","volume":"20","author":[{"given":"Natalia","family":"Ciwoniuk","sequence":"first","affiliation":[{"name":"Institute of Psychology, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1254-4446","authenticated-orcid":false,"given":"Magdalena","family":"Wayda-Zalewska","sequence":"additional","affiliation":[{"name":"Institute of Psychology, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarzyna","family":"Kucharska","sequence":"additional","affiliation":[{"name":"Institute of Psychology, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.bodyim.2004.10.001","article-title":"Measuring \u2018\u2018negative body image\u2019\u2019: Validation of the Body Image Disturbance Questionnaire in a nonclinical population","volume":"5","author":"Cash","year":"2004","journal-title":"Body Image"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Grogan, S. (2021). Body image: Understanding body dissatisfaction in men, women, and children, Routledge.","DOI":"10.4324\/9781003100041"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"13","DOI":"10.12740\/APP\/102833","article-title":"Distorted body image in women and men suffering from Anorexia Nervosa\u2014A literature review","volume":"21","author":"Kostecka","year":"2019","journal-title":"Arch. Psychiatry Psychother."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/00006842-196203000-00009","article-title":"Perceptual and Conceptual Disturbances in Anorexia Nervosa","volume":"24","author":"Bruch","year":"1962","journal-title":"Psychosom. Med."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Publishing. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1007\/s40519-019-00725-5","article-title":"Body image disturbance in children and adolescents with anorexia nervosa and bulimia nervosa: A systematic review","volume":"25","author":"Sattler","year":"2020","journal-title":"Eat. Weight Disord. Stud. Anorexia Bulim. Obes."},{"key":"ref_7","first-page":"176","article-title":"Obraz cia\u0142a i jego zaburzenia. Aspekty teoretyczne w kontek\u015bcie wybranych jednostek psychopatologicznych","volume":"12","author":"Nitsch","year":"2012","journal-title":"Psychiatr. Psychol. Klin."},{"key":"ref_8","first-page":"287","article-title":"Poznawcze aspekty obrazu cia\u0142a u kobiet a zaburzenia od\u017cywiania","volume":"60","author":"Izydorczyk","year":"2009","journal-title":"Endokrynol. Pol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/0005-7967(96)00024-1","article-title":"Development of the Body Dysmorphic Disorder Examination","volume":"34","author":"Rosen","year":"1996","journal-title":"Behav. Res. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.psc.2006.02.001","article-title":"Body Dysmorphic Disorder","volume":"29","author":"Castle","year":"2006","journal-title":"Psychiatry Clin. N. Am."},{"key":"ref_11","first-page":"14","article-title":"Dysmorfofobia przed wysta\u0328pieniem i jako sk\u0142adowa innych zaburze\u0144 psychicznych","volume":"6","author":"Wojtczak","year":"2006","journal-title":"Psychiatr. Psychol. Klin."},{"key":"ref_12","unstructured":"Namys\u0142owska, I., Paszkiewicz, E., and Siewierska, A. (2000). Gdy Odchudzanie Jest Chorob\u0105. Anoreksja i Bulimia, WAB."},{"key":"ref_13","first-page":"337","article-title":"Zaburzenia od\u017cywiania","volume":"59","year":"2010","journal-title":"Kosmos. Probl. Nauk Biol."},{"key":"ref_14","unstructured":"Brytek-Matera, A. (2008). Obraz Cia\u0142a\u2013Obraz Siebie. Wizerunek W\u0142asnego Cia\u0142a w Uj\u0119ciu Psychospo\u0142ecznym, Difin."},{"key":"ref_15","first-page":"118","article-title":"Wybrane zagadnienia dotycz\u0105ce neurobiologii jad\u0142owstr\u0119tu psychicznego","volume":"8","year":"2013","journal-title":"Neuropsychiatr. Neuropsychol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1080\/00797308.1963.11822933","article-title":"Thoughts about development and individuation","volume":"18","author":"Mahler","year":"1963","journal-title":"Psychoanal. Study Child"},{"key":"ref_17","unstructured":"Bowlby, J. (1973). Attachment and Loss (t. II), Hogarth Press and the Institute of Psychoanalysis."},{"key":"ref_18","first-page":"109","article-title":"B\u00f3l Psychiczny\u2014Konceptualizacja i Narz\u0119dzia Pomiaru","volume":"10","author":"Chodkiewicz","year":"2013","journal-title":"Psychiatria"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Shneidman, E. (1996). The Suicidal Mind, Oxford University Press. [1st ed.].","DOI":"10.1093\/oso\/9780195103663.001.0001"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"369","DOI":"10.12740\/PP\/OnlineFirst\/59448","article-title":"Polish Adaptation of the Psychache Scale by Ronald Holden and Co-workers","volume":"51","author":"Chodkiewicz","year":"2017","journal-title":"Psychiatr. Pol."},{"key":"ref_21","first-page":"135","article-title":"A Difficulty in the Path of Psychoanalysis","volume":"Volume XVII","author":"Freud","year":"1955","journal-title":"The Standard Edition of the Complete Psychological Works of Sigmund Freud, (1917\u20131919): \u201cAn Infantile Neurosis\u201d and Other Works"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1177\/0748175609333562","article-title":"Differentiating Between Depression, Hopelessness, and Psychache in University Undergraduates","volume":"42","author":"DeLisle","year":"2009","journal-title":"Meas. Evaluation Couns. Dev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1037\/h0087144","article-title":"Development and preliminary validation of a scale of psychache","volume":"33","author":"Holden","year":"2001","journal-title":"Can. J. Behav. Sci.\/Rev. Can. Des Sci. Du Comport."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1080\/15325024.2011.572044","article-title":"Toward a Unifying Definition of Psychological Pain","volume":"16","author":"Meerwijk","year":"2011","journal-title":"J. Loss Trauma"},{"key":"ref_25","first-page":"144","article-title":"Zachowania autodestruktywne u dziewcz\u0105t z rozpoznaniem jad\u0142owstr\u0119tu psychicznego","volume":"5","author":"Reszka","year":"2008","journal-title":"Psychiatria"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1001\/archgenpsychiatry.2011.74","article-title":"Mortality Rates in Patients with Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies","volume":"68","author":"Arcelus","year":"2011","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.jand.2017.09.003","article-title":"Adolescent Anorexia: Guiding Principles and Skills for the Dietetic Support of Family-Based Treatment","volume":"119","author":"Lian","year":"2019","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1176\/appi.ajp.159.3.408","article-title":"Self-Injurious Behavior in Women with Eating Disorders","volume":"159","author":"Paul","year":"2002","journal-title":"Am. J. Psychiatry"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1111\/sltb.12459","article-title":"Psychological Impairment as a Predictor of Suicide Ideation in Individuals with Anorexia Nervosa","volume":"49","author":"Bodell","year":"2019","journal-title":"Suicide Life-Threat. Behav."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1002\/1098-108X(198707)6:4<485::AID-EAT2260060405>3.0.CO;2-O","article-title":"The development and validation of the body shape questionnaire","volume":"6","author":"Cooper","year":"1987","journal-title":"Int. J. Eat. Disord."},{"key":"ref_31","first-page":"17","article-title":"A severity rating scale for body dysmorphic disorder: Development, reliability, and validity of a modified version of the Yale\u2013Brown Obsessive Compulsive Scale","volume":"33","author":"Phillips","year":"1997","journal-title":"Psychopharmacol. Bull."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1017\/S0033291700049163","article-title":"The eating attitudes test: Psychometric features and clinical correlates","volume":"12","author":"Garner","year":"1982","journal-title":"Psychol. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"54","DOI":"10.12740\/APP\/63647","article-title":"Analysis of the EAT-26 in a non-clinical sample","volume":"18","author":"Rogoza","year":"2016","journal-title":"Arch. Psychiatry Psychother."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.12740\/PP\/61614","article-title":"Assessment of depressiveness in population. Psychometric evaluation of the Polish version of the CESD-R","volume":"50","author":"Koziara","year":"2016","journal-title":"Psychiatr. Pol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1007\/s00737-016-0687-4","article-title":"Computerized assessment of body image in anorexia nervosa and bulimia nervosa: Comparison with standardized body image assessment tool","volume":"20","author":"Caspi","year":"2017","journal-title":"Arch. Womens Ment. Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"219","DOI":"10.3389\/fpsyg.2019.00219","article-title":"Anorexia Nervosa and a Lost Emotional Self: A Psychological Formulation of the Development, Maintenance, and Treatment of Anorexia Nervosa","volume":"10","author":"Oldershaw","year":"2019","journal-title":"Front. Psychol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1002\/eat.20879","article-title":"The long-term efficacy of three psychotherapies for anorexia nervosa: A randomized, controlled trial","volume":"44","author":"Carter","year":"2011","journal-title":"Int. J. Eat. Disord."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1192\/bjp.bp.112.112078","article-title":"Out-patient psychological therapies for adults with anorexia nervosa: Randomised controlled trial","volume":"201","author":"Schmidt","year":"2012","journal-title":"Br. J. Psychiatry"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/S0140-6736(13)61746-8","article-title":"Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): Randomised controlled trial","volume":"383","author":"Zipfel","year":"2014","journal-title":"Lancet"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.brat.2015.04.010","article-title":"A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders","volume":"70","author":"Fairburn","year":"2015","journal-title":"Behav. Res. Ther."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"205","DOI":"10.12740\/PP\/64580","article-title":"Outcome, comorbidity, and prognosis in anorexia nervosa","volume":"51","author":"Jagielska","year":"2017","journal-title":"Psychiatr. Pol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"316","DOI":"10.2174\/1871530318666180213111637","article-title":"Anorexia Nervosa and Comorbid Psychopathology","volume":"18","author":"Marucci","year":"2018","journal-title":"Endocr. Metab. Immune Disord. Drug Targets"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1037\/pst0000064","article-title":"The Relationship of Body Image With Symptoms of Depression and Anxiety in Patients With Anorexia Nervosa During Outpatient Psychotherapy: Results of the ANTOP Study","volume":"53","author":"Junne","year":"2016","journal-title":"Psychotherapy"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1002\/eat.23095","article-title":"Residual eating disorder symptoms and clinical features in remitted and recovered eating disorder patients: A systematic review with meta-analysis","volume":"52","author":"Tomba","year":"2019","journal-title":"Int. J. Eat. Disord."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1002\/eat.10228","article-title":"Body checking and its avoidance in eating disorders","volume":"35","author":"Shafran","year":"2004","journal-title":"Int. J. Eat. Disord."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.eatbeh.2013.10.011","article-title":"Body checking and avoidance in low weight and weight restored individuals with anorexia nervosa and non-clinical females","volume":"15","author":"Bamford","year":"2014","journal-title":"Eat. Behav."},{"key":"ref_47","unstructured":"Cash, T., Pruzinsky, T., Cash, T.F., and Pruzinsky, T. (2002). Body Image: A Handbook of Theory, Research, and Clinical Practice, Guilford Press."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Tomba, E., Tecuta, L., Gardini, V., and Lo Dato, E. (2021). Mental Pain in Eating Disorders: An Exploratory Controlled Study. J. Clin. Med., 10.","DOI":"10.3390\/jcm10163584"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/1\/718\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:48:43Z","timestamp":1760147323000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/1\/718"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,30]]},"references-count":48,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["ijerph20010718"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20010718","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,30]]}}}