Dottorato in PSICOLOGIA DINAMICA E CLINICA

Titolo della tesi: L’immagine corporea nei contesti ospedalieri: prospettive di ricerca nell’obesità e nel carcinoma mammario.

Body image is a complex and multidimensional construct comprising thoughts, emotions, perceptions, and evaluations related to one's own body. The analysis and support of body image in hospital settings emerge as critical to the psychophysical well-being of patients. It is crucial to recognize the role of body image in these settings and to include it in a biopsychosocial approach to address challenges related to psychophysical well-being and different care pathways. In particular, the role of body image in specific conditions such as obesity and breast cancer will be described, considering the impact of body changes through surgical treatments. The first objective of the study presented was to investigate the role of body image perception with respect to body weight in relation to aspects of psychophysical health at a preliminary stage of the bariatric care pathway. Then, the second objective of the study was to investigate the change in the perception of body image within one year after the operation and which psychological factors may have influenced this perception in people who have undergone bariatric surgery. The second study presented, on the other hand, will show, in descriptive terms, the course of the first experimental patient study in which the efficacy of a psychological-clinical intervention supported by the technique of expressive writing on the post-operative course in terms of mental and physical health in patients undergoing post-oncological breast reconstruction is evaluated. Through a methodology of descriptive observations and advanced statistical methods, including correlation analysis, analysis of variance, and hierarchical regressions, the aim is to obtain meaningful and informative results. The main findings of the first study indicate that body image, rather than BMI, is a significant predictor of post-operative psychological health. In particular, higher body image satisfaction is associated with better mental health, whereas BMI has no significant predictive ability on this aspect. Furthermore, it was observed that body dissatisfaction improves in the first nine months after surgery, but decreases slightly after one year. This initial improvement could be attributable to rapid post-operative weight. The second study observed a reduction in illness-related distress and body-related discomfort, although not clinically significant. However, anxiety symptoms remained stable and depressive levels were absent. Satisfaction with the outcome of surgery was mixed. There was no significant improvement in the perception of the reconstructed breast's appearance, suggesting that aesthetic expectations may not have been fully met. In addition, cortisol levels decreased slightly, suggesting a possible improvement in inflammation levels. Challenges emerged in recruiting patients and the need to expand the number of psychological sessions to better monitor participants' psycho-physical well-being. The importance of body image emerges in patients who undergoing bariatric surgery and mastectomy with breast reconstruction, where having realistic expectations of their body and on surgical treatment play a crucial role in determining the success of treatment and long-term psychological well-being. In conclusion, the perception of one's body image, concerns and expectations about it can negatively impact the psychological health of patients, influencing various aspects such as emotional state, treatment adherence, post-operative recovery, and overall quality of life. It is essential to consider body image as a central element in bariatric surgery and post-mastectomy breast reconstruction to ensure comprehensive and integrated patient-centered care pathway with these medical conditions.