The Body Image after Mastectomy Scale (BIMS) can clinically identify psychotherapy targets for reducing body image distress following mastectomy, according to new research from the Journal of Women’s Health.
Researchers described the development and initial psychometric evaluation of the BIMS, the sole tool developed to comprehensively capture specific maladaptive behaviors and beliefs that contribute to body image distress among mastectomy patients. The BIMS is modeled after the Body Dysmorphic Disorder Symptom Scale (BDD-SS).
A total of 47 women (aged 52.26±11.58 years, 89.4% White, 61.7% married) who underwent mastectomy with breast reconstruction at Massachusetts General Hospital participated in the study. Individuals undergoing radiation or ongoing chemotherapy and women with intellectual disability, serious neurological disorder, or manic episode were excluded from the study.
Study participants completed the Mini-International Neuropsychiatric Interview (M.I.N.I. 7.02) before mastectomy. Then 3 months after surgery, they completed the BIMS and all validity measures through REDCap, a secure web application for building and managing online surveys and databases.
The BIMS asks patients to identify past-week frequency and distress of symptoms across 5 domains: body checking behaviors, behaviors to hide appearance of one’s breasts/chest, shape and weight-related behaviors, avoidance behaviors, and maladaptive beliefs regarding appearance. Overall severity of symptoms within the 5 domains is ranked from 0 to 10, with 10 signifying “very severe.” Researchers score the exam by adding the 5 domains’ scores. Presence of overall symptoms is the sum of symptoms endorsed from the 54-item test. Total points are 50 and 54, respectively.
The researchers found patients’ mean overall severity score on the BIMS was 7.47±7.64 and mean overall symptom score was 6.34±4.90. Most patients reported checking behaviors (83%) and maladaptive appearance beliefs (72.3%). Hiding behaviors were reported by 21.3% of participants.
The investigators found that internal consistency of overall severity score (z = 0.81) and overall symptom score (KR-20 = 0.83) were strong. KR-20s for domain-specific symptom scores were good for subscales with at least 8 items but poor for subscales with few items. Inter-item correlations by domain tended to be good for checking and avoidance domains. They were lower for weight/shape and beliefs domains and poor for hiding domain.
BIMS severity and symptom scores were linked with measures of body image distress and disturbance, suggesting convergent validity and discriminant validity. Scores were weakly correlated with cancer worry and perceived social support. They were moderately associated with a cancer-specific functional impairment measure.
Limitations include lack of BIMS item input from women who have undergone mastectomy and generalizability to other postmastectomy and breast cancer treatment plans and racial and socioeconomic backgrounds.
“Variability in the number and severity of BIMS items endorsed by participants suggests that not all women become stuck engaging in maladaptive symptoms that fuel body image distress after mastectomy,” the researchers noted. “To this end, the BIMS may be administered at postoperative appointments as a screening tool, to identify who is experiencing maladaptive symptoms and may be at risk for developing prolonged body image distress. Utilizing the BIMS in this way would provide a low-cost, accessible means of identifying early intervention opportunities.”
The researchers recommended doctors target patients’ maladaptive behaviors and belief through introducing ritual prevention strategies, cognitive restructuring skills, and exposure exercises. Therapists who administer the BIMS before therapy can allow patients to personalize interventions.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Weingarden H, Laky ZE, Ladis I, et al. Body image after mastectomy scale: a new measure of body image behaviors and beliefs in women following mastectomy. J Women’s Health. 2022;31(1):47-54. doi: 10.1089/jwh.2021.0131