Perceptual and Motor Skills, 2002, 94, 189-196
THE BODY-IMAGE QUESTIONNAIRE (BIQ):AN EXTENSION
MICHELE KOLECK, MARILOU BRUCHON-SCHWEITZER, FLORENCE COUSSON-GÉLIE and BRUNO QUINTARD.
Department of Psychology, University of Bordeaux 2, France[1]
Summary.- The 19-item Body-Image Questionnaire was administered to 1038 male and female French subjects. Aprincipal component analysis of their responses yielded a first axis, interpreted as a general Body Satisfaction dimension. Body Satisfaction was associated with sex, health and with current and future emotional adjustment.
In 1987, we administered a 19-item questionnaire to 619 French subjects (245 males and 374 females aged 10 to 40 yr.) to explore the dimensionality of perceptions, feelings, and attitudes expressed towards one’s body (Bruchon-Scheitzer, 1987)[2]. A principal factor analysis of the answers yielded four axis with an eigenvalue superoir to one (with 84.60% explained variance). The first one was identified as Favourable Body Image (with 29.1% explained variance) and loaded on 16 items. Varimax rotations were carried out on four axes, resulting in four meaningful factors : Accessibility / Closeness, Satisfaction / Dissatisfaction, Activity / Passivity and Relaxation / Tension.
A total FBI (Favourable Body Image) score was calculated in adding the answers to the 16 items with a loading superior to 0.30 on the first axis (the total score varied from 0 to 16)[3]. The means and standard deviations of the FBI score were calculated on 211 hospitalized patients and 200 control subjects (Bruchon-Schweitzer et al., 1995). They are presented in Table 2. The mean FBI score was lower in female than in male subjects in the hospitalized group (p.01) as in the control group (p.05). Hospitalized patients had a more unfavourable body image than healthy subjects (male: p.001), female: p..01). especially women. Furthermore, a favourable body image predicted a better recovery of the hospitalized subjects, especially among female patients. The product-moment correlations observed between FBI scores and the somatic outcome (rated by the medical staff at the end of the hospitalization) were 0.22 for the 106 male patients (p<0.05) and 0.43 for the 105 female patients (p<0.001).
The first purpose of this research was to replicate this first study with a new French sample so as to verify the stability of the factorial structure of the BIQ obtained in 1987. The second aim was to explore the relations between the body image dimensions and different personality variables and attitude response scales. The third one was to confirm the relations between a favourable body image and the adjustment to illness in different groups of patients.
METHOD
The French version of the BIQ was administered to 1038 French subjects (358 males, 680 females) : 140 cancer patients (60 males, 80 females), 142 back pain patients (77 males, 65 females), 437 students in psychology (45 males, 392 females) and 319 students in sport (176 males, 143 females)[4]. 99 of the 142 back pain patients (group A) also answered the STAI-Y (Spielberger et al., 1983 ; Bruchon-Schweitzer et al., 1993), the TAS-20 (Bagby et al., 1994) and the CES-D (Radlof, 1977) ; 430 among the 437 students in psychology (group B) also answered the E.P.I. form B (Eysenck et al., 1971) and a Social Desirability Scale (Crowne and Marlowe, 1960) ; 75 of the 80 female cancer patients (group C) also answered the STAI-Y. The 99 low back pain patients were assessed one year later on State-Anxiety (STAI) and State-Depression (CES-D). 59 female cancer patients were assessed two years later on State-Anxiety (STAI-Y) and the survival duration without relapse (in months) was measured on the whole group.
RESULTS
Construct validity :
A principal component analysis was performed on the answers of the 1038 French subjects to the 19-item BIQ. It yielded five axes (eigenvalue > 1) explaining 51.3% of the total variance. The first one, accounting for 24,3% of the total variance, was interpreted as a general Body Satisfaction factor (see Table 3). All of the 19 items had notable loadings on this general axis (>0.30). The internal consistency of the Body Satisfaction scale on the whole group was satisfactory ( = 0,82). The solutions obtained after varimax rotations (4 and 5 axes) were unclear and the four-factor structure observed in 1987 was not replicated. So we only considered the general Body Satisfaction score (BS) in the further analyses[5].
Women reported significant lower scores of body satisfaction than men in the whole population (p<0.0001) and in groups A, B, and D. Curiously, the male and female cancer patients had the higher mean score of general Body Satisfaction (see Table 4). Body Satisfaction was not associated with age in the whole population (r=-0.03, N.S.) and in each of the subgroups except in the group of male back pain patients (r=0.18, p<0.05).
Dicriminant validity :
Body Satisfaction was significantly linked to personality variables and to some response attitude scales (see Table 5). Body Satisfaction was negatively correlated with Trait-Anxiety in group A (r=-0.53, p<0.0001), group B (r=-0.20, p<0.05) and group C (r=-0.39, p<0.0001), with State-Anxiety in group A (r=-0.20, p<0.05), group B (r=-0.39, p<0.0001) and group C (r=-0.43, p<0.0001), with depression in group A (r=-0.50, p<0.0001), with alexithymia in group A (r=-0.30, p<0.01) and group B (r=-0.28, p<0.01), with Neuroticism in group B (r=-0.36, p<0.0001). Body Satisfaction was positively correlated with Extraversion in group B (r=+0.37, p<0.0001). Body satisfaction was not associated with the Lie scale of EPI in groups A and B (r=-0.12, N.S. ; r=-0.08, N.S.). Its correlation with Social Desirability, calculated in group B, was moderately positive (r=0.15, p<0.01). These results are close to those observed in 1987 with BIQ and EPI.
Predictive validity :
Body satisfaction was associated to a low score of State-Depression assessed one year later in 90 patients of the group A and to a low score of State-Anxiety assessed two years later in 59 women patients of the group C (see Table 5). The negative relation observed between BS score and survival duration without relapse two years later in 75 women patients of the group C was unsignificant.
DISCUSSION
An unidimensional structure of the body image was confirmed in the present study. The general Body Satisfaction factor (as the Favorable Body Image score in the first study) appears as a general and stable component of the body image. This dimension is probably very close to the body satisfaction as assessed by the B.C.S. (Body Cathexis Scale) of Secord and Jourard (1953), which was associated with many adaptative variables[6]. The general Body Satisfaction score will take the place of the FBI original score in future.
As in the first study, the general Body Satisfaction score (FBI score in the first study) is higher in male than in female subjects. The relative body insatisfaction of the women may reflect their higher body concerns and worries, elicited by the particular hardness of current standards of feminine beauty (Bruchon-Schweitzer, 1990). The high mean BS scores of the cancer patients is amazing, considering the deleterious effects of this disease and of the associated treatments on the patient’s body. The results concerning the breast cancer patients belong to a larger study conducted by one of the authors of this article (Cousson-Gélie, 2000). She observed some astonishing differences between breast cancer patients and control subjects: higher Body Satisfaction, higher perceived social support, and lower State-Anxiety (STAI-Y) in the first group. These counter-intuitive results may be attributed to the effects of specific defensive attitudes developed by cancer patients (denial, emotional suppression), in order to cope with acute fear and distress (Greer and Morris, 1979).
The Body Satisfaction was high in sport students and low in female back pain patients. As in our first study, the body image is generally more favorable in healthy and vigorous subjects, except in some groups using probably defensive attitudes to conceal their distress (cancer patients and male back pain patients). These results support the construct validity of the general Body Satisfaction.
The BS score varies directly with positive affectivity (extraversion) and inversely with negative affectivity assessed in the same time (neuroticism) or later (anxiety, depression). This result is in agreement with previous results (Bruchon-Schweitzer, 1987 ; Secord and Jourard, 1953). A favorable body image goes along with and predicts emotional adjustment. If the BS score is not affected by insincerity (Lie scale), it is contaminated by social desirability which is a more subtle response-shift bias (but unfortunately this correlation has been calculated in the student sample only)[7]. In the present study, BS is not associated with a good health issue (as it was the case in 1987), but only with further emotional adjustment in cancer and low back pain patients. Considering the prospective nature of the results gathered on patient subjects, we can conclude that general Body Satisfaction plays a protective role when individuals have to face a serious illness. But the links between BS and social desirability, and the pathways between personality, body image, defensive attitudes and health issues have to be explored with structural equation modeling in further studies conducted with patient groups.
TABLE 1
THE ENGLISH VERSION OF THE 19-ITEM BODY-IMAGE QUESTIONNAIRE[8]
1: very much, often ; 2: fairly, fairly often ; 3: in between, neither one ; 4: fairly, fairly often ; 5: very much, often
Bad healthPhysically attractive
Source of pleasure
Feminine
Pure, clean
Expressing fear
Empty
Something to be touched
Indifferent, cold
Expressing anger
Expressive
Something to be hidden
Calm, serene
Old
Sexy
Frail
Cheerful
Something not to be looked at
Energic / 1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5 / Healthy
Physically unattractive
Source of displeasure
Masculine
Impure, dirty
Expressing daring
Full
Something not to be touched
Tender, loving
Expressing appeasing
Unexpressive
Something to be shown
Nervous, worried
Young
Not sexy
Robust, resistant
Sad
Something to be looked at
Not energic
Cotation : In order to calculate the score of each subject :
- add the answers to the favourable items : 1, 6, 7, 9, 10, 12, 14, 16 and 18. The score to each item varies from 1 to 5.
- use the reverse scoring (5 to 1) to add the answers to the unfavourable items : 2, 3, 5, 8, 11, 13, 15, 17 and 19. The
score to each of these items varies from 5 to 1.
- for the item 4, if the respondent is a man, «masculine» is the favourable answer ; so, use the 1, 2, 3, 4, 5 scoring. If
the respondent is a woman, «feminine» is the favourable answer ; so, use the 5, 4, 3, 2, 1 scoring.
- add the 19 answers : the total score varies from 19 to 95 ; a high score corresponding to Body Satisfaction.
TABLE 2
MEANS AND STANDARD DEVIATIONS OF THE FBI ORIGINAL SCORES IN 211 HOSPITALIZED PATIENTS AND 200 CONTROL SUBJECTS
Hospitalized subjects / Control subjectsN / 106 / 113
Male / mean age / 42.6 / 32.8
FBI mean score / 10.09 / 11.72
S.D. / 3.82 / 3.39
N / 105 / 87
Female / mean age / 44.5 / 38.5
FBI mean score / 8.54 / 10.47
S.D. / 4.24 / 4.07
TABLE 3
LOADINGS OF THE 19 BIQ ITEMS ON THE FIRST AXIS (n = 1038).
BIQ items / axis 117. sad / -0.68
3. source of displeasure / -0.61
18. something to be looked at / 0.61
12. something to be shown / 0.60
2. physically unattractive / -0.58
9. tender, loving / 0.55
19. not energic / -0.55
6. expressing daring / 0.51
11. unexpressive / -0.49
15. not sexy / -0.49
8. something not to be touched / -0.44
1. healthy / 0.43
7. full / 0.43
16. robust, resistant / 0.42
13. nervous, worried / -0.40
14. young / 0.38
5. impure, dirty / -0.38
4. masculine (men) / feminine (women) / 0.34
10. expressing appeasing / 0.32
TABLE 4
MEANS AND STANDARD DEVIATIONS OF THE BS SCORE IN 142 BACK PAIN PATIENTS (GROUP A), 437 STUDENTS IN PSYCHOLOGY (GROUP B), 140 CANCER PATIENTS (GROUP C) and 319 STUDENTS IN SPORT (GROUP D)
A / B / C / D / Totaln / 77 / 45 / 60 / 176 / 318
Male / mean age / 42.4 / 24.6 / 49,7 / 19.9 / 26.9
FBI mean score / 77.18 / 73.42 / 78,33 / 77.66 / 76.25
S.D. / 9.69 / 9.44 / 8,63 / 7.29 / 8.90
n / 65 / 392 / 80 / 143 / 684
Female / mean age / 43.9 / 22.2 / 48.8 / 20.0 / 27.0
FBI mean score / 67.43 / 72.20 / 77.84 / 74.46 / 72.81
S.D. / 11.74 / 8.95 / 9.37 / 5.36 / 9.09
n / 142 / 437 / 80 / 319 / 1002
Total / mean age / 43.1 / 22.5 / 48.8 / 19.9 / 27.0
FBI mean score / 72.72 / 72.32 / 77.84 / 76.23 / 73.90
S.D. / 11.70 / 8.99 / 9.37 / 6.70 / 9.16
TABLE 5
PRODUCT-MOMENT CORRELATIONS BETWEEN BS SCORE AND VARIOUS CRITERION OF EMOTIONAL AND PHYSICAL ADJUSTMENT IN A GROUP OF 99 LOW BACK PAIN PATIENTS (A), 430 STUDENTS IN PSYCHOLOGY(B) AND 75 BREAST CANCER WOMEN (C)
General Body SatisfactionA / B / C
Trait-Anxiety (STAI-Y) / -0.53*** / -0.52*** / -0.30**
State-Anxiety (STAI-Y) / -0.20* / -0.39*** / 0.43***
State-Depression (CES-D) / -0.31** / - / -
Alexithymia (TAS-20) / -0.30** / -0.28** / -
Nevroticism (EPI) / - / -0.36*** / -
Extraversion (EPI) / - / 0.37*** / -
L scale (EPI) / -0.12 / -0,08 / -
Social desirability (SDS) / 0.15**
State-Anxiety (STAI-Y) / -0.15 / -0.38**(1)
State-Depression (CES-D) / -0.23**
Survival duration without relapse / 0.09(2)
*** : p<0.0001 ** : p<0.01* : p<0.05
(1) N = 59(2) N = 75
REFERENCES
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Bruchon-Schweitzer, M. (1987). Dimensionality of the Body Image : the BIQ. Perceptual and Motor Skills, 65, 887-892.
Bruchon-Schweitzer, M. & Paulhan, I. (1993). Manuel français de l’échelle d’Anxiété-Trait - Anxiété-Etat de C.D. Spielberger. Paris : ECPA.
Bruchon-Schweitzer, M., Quintard, B., Paulhan, I., Nuissier, J. & Cousson, F. (1995). Psychological adjustment to hospitalization : factorial structure, antecedents and outcome. Psychological Reports, 76, 1091-1100.
Crowne, D.P. and Marlowe, D. (1960). A new scale of Social Desirability independent of psychopathology. Journal of Consulting Psychology, 24, 4, 349-354.
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Greer, S., Morris, T. and Pettingale, K.W. (1979). Psychological response to breast cancer. The Lancet, 13, 785-787.
Paulhus, D.L. (1984). Two-components models of socially desirable responding. Journal of Personality and Social Psychology, 46, 3, 598-609.
Radloff, L.S. (1977). The CES-D Scale : a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 3, 385-401.
Secord, P.F. and Jourard, S.M. (1995). The appraissal of Body Cathexis : Body Cathexis and the self. Journal of Consulting Psychology, 17, 5, 343-347.
Spielberger, C.D., Gorsuch, R.L., Luschene, R., Vagg, P.R. and Jacobs, G.A. (1983). Manual for the State-Trait Anxiety Inventory (STAI, form Y).Palo Alto (CA) : Consulting Psychologists Press.
1
[1] Département de Psychologie, Université de Bordeaux 2, 3 ter, Place de la Victoire, 33076 Bordeaux Cedex, France.
[2]A total of 137 male and female high school students were interviewed in 1987, and 300 words related to their body image were elicited. These words were grouped into 13 large categories by a content analysis. Each category was illustrated by one or two bipolar items, resulting in the 19-item Body-Image Questionnaire (see Table 1).
[3]The average test-retest reliability coefficient of the 19 items was 0.67 for a 10-day interval (89 male and female students).
[4] The scales were administered to the patients during an individual encounter. The students answered these scales in groups of 20 to 25 persons.
[5] The correlation between the original FBI score and this General Body Satisfaction score, calculated on the 1038 subjects, was 0.98 (p<0.0001).
[6] In the Secord and Jourard study, men and women did not differ in their Body Cathexis mean scores but in their variability. In the present study, the female subjects had a greater mean standard deviation on Body Satisfaction score too. This result was interpreted by these authors in terms of a better body differenciation in women.
[7] In 1987, the body activity, one of the four components of Body Image, was the only factor to be linked with social desirability. Social desirability as measured by Crowne and Marlowe scale comprises two components : self-deception and impression management (Paulhus, 1984). It would be interesting to know if SD (Social Desirability) correlates with Body Satisfaction in cancer patients and if so, to know which one of the two components of SD links more with BS (self-deception, probably).
[8]These 19 items are not the original ones; they have been translated into English on purpose for this publication.