{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:36:33Z","timestamp":1790742993987,"version":"4.1.0"},"reference-count":34,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2020,4,3]],"date-time":"2020-04-03T00:00:00Z","timestamp":1585872000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>This study aimed to assess body image impairments of individuals with Marfan syndrome and to determine to what extent psychological, physical, and sociodemographic factors influence body image. We assessed the physical fitness and psychosocial health of 42 patients with Marfan syndrome at the beginning of an inpatient rehabilitation program. All participants filled out a body image questionnaire consisting of two scales: (1) Negative Body Evaluation and (2) Vital Body Dynamics. We compared body image data of the study sample with the German representative norming sample and carried out two separate regression analyses in order to determine which variables were associated with the two dimensions of patients\u2019 body image. Body image of individuals with Marfan syndrome appeared to be significantly impaired, with high percentile ranks for Negative Body Evaluation (women = 88, men = 91) and low percentile ranks for Vital Body Dynamics (women = 11, men = 4). Vital Body Dynamics was predicted by age (p = 0.016) and by depression (p &lt; 0.001), and Negative Body Evaluation was predicted by anxiety (p = 0.001). Body image in individuals with Marfan syndrome is not primarily determined by objective measures of fitness or by objective cardiac impairment but by psychological variables like depression and anxiety and by age. This finding can inform treatment and rehabilitation concepts. Accepting Marfan syndrome, including the acceptance of being visually different, may not only demand medical treatment and physical rehabilitation but also psychological treatment for depression and anxiety.<\/jats:p>","DOI":"10.3390\/jcm9041015","type":"journal-article","created":{"date-parts":[[2020,4,7]],"date-time":"2020-04-07T03:58:39Z","timestamp":1586231919000},"page":"1015","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Body Image in Patients with Marfan Syndrome"],"prefix":"10.3390","volume":"9","author":[{"given":"Laura Birke","family":"Hansen","sequence":"first","affiliation":[{"name":"Muehlenberg-Clinic for Rehabilitation, 23714 Bad Malente-Gremsm\u00fchlen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yskert","family":"von Kodolitsch","sequence":"additional","affiliation":[{"name":"Clinic of Cardiology at the University Heart Centre, University of Hamburg, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friedrich","family":"Schroeder","sequence":"additional","affiliation":[{"name":"Muehlenberg-Clinic for Rehabilitation, 23714 Bad Malente-Gremsm\u00fchlen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dieter","family":"Benninghoven","sequence":"additional","affiliation":[{"name":"Muehlenberg-Clinic for Rehabilitation, 23714 Bad Malente-Gremsm\u00fchlen, Germany"},{"name":"Clinic of Psychosomatic Medicine and Psychotherapy, University of Luebeck, 23538 Luebeck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,4,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e137","DOI":"10.1016\/S0828-282X(10)70370-6","article-title":"The prevalence and clinical impact of obesity in adults with Marfan syndrome","volume":"26","author":"Yetman","year":"2010","journal-title":"Can. J. Cardiol."},{"key":"ref_2","first-page":"137","article-title":"Perspectives on the revised Ghent criteria for the diagnosis of Marfan syndrome","volume":"8","author":"Bannas","year":"2015","journal-title":"Clin. Genet."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1080\/14779072.2019.1704625","article-title":"Features of Marfan syndrome not listed in the Ghent nosology\u2014The dark side of the disease","volume":"17","author":"Demolder","year":"2019","journal-title":"Expert Rev. Cardiovasc. Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1097\/GIM.0b013e3181ea4c1c","article-title":"Health-related quality of life in Marfan syndrome: A cross-sectional study of Short Form 36 in 84 adults with a verified diagnosis","volume":"12","author":"Johansen","year":"2010","journal-title":"Genet. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1176\/appi.psy.49.3.243","article-title":"Determinants of quality of life in Marfan syndrome","volume":"49","author":"Klersy","year":"2008","journal-title":"Psychosomatics"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1111\/cge.12422","article-title":"Systematic review of the psychosocial aspects of living with Marfan syndrome","volume":"87","author":"Velvin","year":"2015","journal-title":"Clin. Genet."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1931","DOI":"10.1002\/ajmg.a.36574","article-title":"Fatigue in adults with Marfan syndrome, occurrence and associations to pain and other factors","volume":"164","author":"Bathen","year":"2014","journal-title":"Am. J. Med. Genet. Part A"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1080\/13548500600580824","article-title":"Fatigue, cognitive functioning and psychological distress in Marfan syndrome, a pilot study","volume":"12","author":"Sorensen","year":"2007","journal-title":"Psychol. Health Med."},{"key":"ref_9","first-page":"254","article-title":"The Validation of the Body-Image Questionnaire (BIQ): A German-language instrument for assessing body image disturbances in patients with psychosomatic disorders","volume":"46","author":"Clement","year":"1996","journal-title":"Psychother. Psychosom. Med. Psychol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1177\/0192513X13519256","article-title":"Does height matter? An examination of height preferences in romantic coupling","volume":"37","author":"Yancey","year":"2016","journal-title":"J. Fam. Issues"},{"key":"ref_11","unstructured":"Cash, T.F., and Smolak, L. (2011). Exercise and changes in body image. Body Image, The Guilford Press."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1007\/s00246-012-0198-7","article-title":"Sex and age differences in body-image, self-esteem, and body mass index in adolescents and adults after sing-e-ventricle palliation","volume":"33","author":"Pike","year":"2012","journal-title":"Pediatr. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1038\/oby.2002.5","article-title":"Body image partially mediates the relationship between obesity and psychological distress","volume":"10","author":"Friedman","year":"2002","journal-title":"Obes. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1037\/hea0000283","article-title":"Shared risk factors for mood-, eating-, and weight-related outcomes","volume":"35","author":"Goldschmidt","year":"2016","journal-title":"Health Psychol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s00737-014-0416-9","article-title":"Body image satisfaction and depression in midlife women: The Sudy of Women\u2019s Health Across the Nation (SWAN)","volume":"17","author":"Jackson","year":"2014","journal-title":"Arch. Womens Ment. Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1002\/eat.10139","article-title":"The nature of body image disturbance in patients with binge eating disorder","volume":"33","author":"Masheb","year":"2003","journal-title":"Int. J. Eat. Disord."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Richard, A., Rohrmann, S., Lohse, T., and Eichholzer, M. (2016). Is body weight dissatisfaction a predictor of depression independent of body mass index, sex and age? Results of a cross-sectional study. BMC Public Health, 16.","DOI":"10.1186\/s12889-016-3497-8"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.jpsychores.2012.08.010","article-title":"Body image as a predictor of psychopathology in surgical patients with colorectal disease","volume":"73","author":"Bullen","year":"2012","journal-title":"J. Psychosom. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.bodyim.2013.09.002","article-title":"Body image in social anxiety disorder, obsessive-compulsive disorder, and panic disorder","volume":"11","author":"Aderka","year":"2014","journal-title":"Body Image"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Scheffers, M., Kalisvaart, H., van Busschbach, J.T., Bosscher, R.J., van Dujin, M.A.J., van Broeckhuysen-Kloth, S.A.N., Schoevers, R.A., and Geenen, R. (2018). Body image in patients with somatoform disorder. BMC Psychiatry, 18.","DOI":"10.1186\/s12888-018-1928-z"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Nadal, E. (2017). Body image and aging. The SAGE Encyclopedia of Psychology and Gender, SAGE.","DOI":"10.4135\/9781483384269"},{"key":"ref_22","first-page":"1438","article-title":"Body Image Attitudes: What difference does gender make?","volume":"27","author":"Muth","year":"2006","journal-title":"J. Appl. Soc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1027\/1016-9040\/a000150","article-title":"Cultural influences on body size ideals: Unpacking the impact of westernisation and modernisation","volume":"20","author":"Swami","year":"2015","journal-title":"Eur. Psychol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"864","DOI":"10.3389\/fpsyt.2019.00864","article-title":"Body dissatisfaction, importance of appearance and body appreciation in men and women over the lifespan","volume":"10","author":"Quittkat","year":"2019","journal-title":"Front. Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1186\/s13023-017-0679-0","article-title":"Inpatient rehabilitation for adult patients with Marfan syndrome: An observational pilot study","volume":"12","author":"Benninghoven","year":"2017","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1477-7525-1-29","article-title":"The hospital anxiety and depression scale","volume":"1","author":"Snaith","year":"2003","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_27","unstructured":"Herrmann-Lingen, C., Buss, U., and Snaith, R.P. (2011). Hospital Anxiety and Depression Scale\u2014Deutsche Version, Hogrefe. [3rd ed.]."},{"key":"ref_28","unstructured":"Derogatis, L.R. (1992). SCL-90-R, Administration, Scoring & Procedures Manual-II for the R(evised) Version and Other Instruments of the Psychopathology Rating Scale Series, Clinical Psychometric Research Inc."},{"key":"ref_29","unstructured":"Franke, G.H. (2013). Symptom-Checklist-90-R-Standard, Hogrefe."},{"key":"ref_30","first-page":"99","article-title":"\u00dcberpr\u00fcfung und Normierung des \u201cFragebogen zum K\u00f6rperbild\u201d (FKB-20) von Clement und L\u00f6we (1996) an einer repr\u00e4sentativen deutschen Bev\u00f6lkerungsstichprobe","volume":"15","author":"Albani","year":"2006","journal-title":"Z. Med. Psychol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1136\/jmg.2009.072785","article-title":"The revised Ghent nosology for the Marfan syndrome","volume":"47","author":"Loeys","year":"2010","journal-title":"J. Med. Genet."},{"key":"ref_32","unstructured":"German Federal Statistical Office (2018). Mikrozensus\u2014Fragen zur Gesundheit\u2014K\u00f6rperma\u00dfe der Bev\u00f6lkerung, 2017."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.jpsychires.2018.05.003","article-title":"Contributions of depression and body mass index to body image","volume":"103","author":"Paans","year":"2018","journal-title":"J. Psychiatr. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1111\/j.1365-2648.2004.03227.x","article-title":"Altered body image: Appearance-related concerns of people with visible disfigurement","volume":"48","author":"Rumsey","year":"2004","journal-title":"J. Adv. Nurs."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/4\/1015\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:15:10Z","timestamp":1760174110000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/4\/1015"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,3]]},"references-count":34,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,4]]}},"alternative-id":["jcm9041015"],"URL":"https:\/\/doi.org\/10.3390\/jcm9041015","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,3]]}}}