Body Image Distortion, Depression Are Linked, Cushing’s Disease Study Shows

In Cushing’s disease (CD), depression is correlated with body image distortion and lower self-esteem, according to an Indian study. Physicians should be attentive to symptoms of mental disturbances in CD patients to provide them a better prognosis.

The research, “A Study on Psychiatric Disorders, Body Image Disturbances, and Self-Esteem in Patients of Cushing’s Disease,” was published in the Indian Journal of Endocrinology and Metabolism. The work was developed at King Edward Memorial (KEM) Hospital and Seth Gordhandas Sunderdas Medical College in Mumbai, India.

Hormonal changes related to Cushing’s disease predispose patients to psychiatric and neurocognitive conditions, mainly depression and anxiety. The rates for each vary across studies, but depression is prevalent.

Many of these conditions are reversible upon treatment of the disease-causing excess cortisol (also called hypercortisolism).

Besides mood changes, hypercortisolism can also cause weight gain in the abdomen, face, neck and upper back; increased acne; facial hair growth; purple stretch marks (striae) on the abdomen, thighs, breasts and shoulders; plus skin darkening on the neck. This can lead to an unrealistic view of how patients see themselves, often called body image distortion.

In this study, researchers sought to determine the prevalence and type of psychiatric conditions, body image disturbances, and level of self-esteem in CD patients.

A total of 35 CD patients were recruited and assessed using the Structured Clinical Interview for DSM-IV, Beck Depression Inventory (BDI), Rosenberg Self-Esteem Scale, and Body Image Concern Inventory.

Results showed that 65% of the patients had a psychiatric disturbance. Out of those, 91% (a total of 21 patients) had major depressive disorder.

“When the 21 patients having depression were assessed on the BDI for the severity of depressive symptoms, then 13 (61.9%) of them had borderline clinical depression followed by 6 (28.57%) patients who had moderate depression, whereas severe and extreme depression were seen in 1 (4.76%) patient each,” they reported.

Half the patients had an inaccurate perception of body image and 60% had low self-esteem.

“Most of our patients were dissatisfied with their appearances and would buy cosmetic items to camouflage those flaws. They also reported that they avoided engaging in social activities and often would miss family gatherings as they felt ashamed of some aspect of their body and expressed others looked more attractive than them.”

Depression was negatively correlated with self-esteem. Depressive “patients usually have feelings of hopelessness, worthlessness, and uselessness,” which negatively affects how a person perceives their overall self-worth and can explain the poor self-esteem seen in the study.

Researchers also reported that body image distortion goes hand in hand with depression.

“It is important for the physician to be aware about the signs and symptoms of mental disturbances like depression and anxiety which are commonly seen in CD. Self-esteem, body image and depression can have a cause-and-effect relationship resulting in worsening of the mental and emotional well-being, indicating the need for proper assessment,” the investigators concluded.