Treating Your Body with Kindness: Psychological Distress, Body Image, Sexual Distress and Self-Compassion in Individuals with Endometriosis

Endometriosis is a highly debilitating chronic condition, with associated symptomatology that extends beyond the physical. Understanding the psychological consequences of living with endometriosis is a critical step in developing support for this population. Preliminary research highlights that individuals with endometriosis experience psychological distress, namely heightened anxiety and depression, as well as adverse changes to body image and sexual distress. An overarching aim of this thesis is to investigate factors associated with anxiety and depression in this population. Using a cross-sectional design, the first study (N=584) aimed to delineate factors (i.e., medical, demographic, psychosocial) associated with anxiety, depression, and stress. It was found that quality of life-related psychosocial factors including self-image (a proxy for body image) and social support were more strongly associated with depression, anxiety, and stress than demographic or medical factors. In light of the findings that poor self-image is associated with psychological distress, Study 2 aimed to extend these findings by investigating the relationship between body image and other types of distress, namely sexual distress. This cross-sectional analysis (N=471) explored the association between the positive and negative dimensions of body image, and the internal resource of self-compassion, with sexual distress in endometriosis. Results demonstrated that body image disturbance was more strongly associated with sexual distress than body appreciation, and that self-compassion did not moderate the body image-sexual distress relationship. Acknowledging the very high prevalence of body image disturbance identified in Study 2, a systematic literature review (Study 3) was undertaken (n=40) to integrate and critically analyse the literature pertaining to body image within endometriosis and other chronic pelvic pain conditions more broadly. In particular, this review delineated which demographic, condition-specific (i.e., treatment-related) or psychosocial factors were related 10 to body image across these populations. Results demonstrated that in addition to anxiety and depression, relationship factors such as sexual function and sexual distress were implicated in the development of body image concerns in these chronic pelvic pain conditions, reinforcing the findings from the cross-sectional analyses in Study 2. Acknowledging a paucity of longitudinal studies pertaining to psychological distress in endometriosis, Study 4 (N=337) entailed a latent class growth analysis of longitudinal data which described trajectories of depression and anxiety in an endometriosis sample. Guided by the findings of Study 1, this analysis also aimed to delineate which specific psychosocial domains predicted trajectory class membership. This analysis resulted in three distinct trajectory groups for depression and for anxiety, with a high fluctuating depressive trajectory group and a moderately anxious trajectory group identified as being most in need of intervention-based support. Greater subjective pain and poorer perceived social support and self-image were found to be predictors of membership in these most impacted trajectory groups. In sum, this thesis challenges prior assumptions within endometriosis that physical symptomatology and pain are the main driving factors for psychological distress and highlights the importance of psychosocial factors including body image, social support, and sexual distress. These findings have implications for clinical practice with suggested potential intervention approaches discussed.