Background/Purpose: A common and distressing manifestation of systemic sclerosis (SSc, or scleroderma) is disfigurement in socially relevant areas of the body, including the face and hands. Disease-related changes in appearance have been associated with body image dissatisfaction and social anxiety. Although there have been studies identifying correlates of body image dissatisfaction, there is a need for an examination that considers the complex relationships among the personal and social aspects of appearance changes. The present study used latent profile analysis (LPA) to identify body image typologies based on variables representing body image and social anxiety. Identified groups were compared on key sociodemographic, medical, and psychosocial variables.

Methods: The sample consisted of 942 patients with physician-confirmed SSc enrolled in the Scleroderma Patient-centered Intervention Network (SPIN) Cohort who completed study questionnaires from April 2014 through October 2016. Patients in the SPIN Cohort were enrolled at 28 centers from Canada, the United States, and the United Kingdom. The sample was randomized into two groups (Sample 1: N = 469; Sample 2: N = 473) in order to conduct the analysis and provide an opportunity to replicate the findings. For the first aim, exploratory LPA was used to derive categorical latent variables that signified profiles of similarly scoring individuals using three indicators of subjective body image (i.e., dissatisfaction with appearance, social discomfort, and body concealment) and three indicators of social anxiety (i.e., social interaction anxiety, social appearance, anxiety, and fear of negative evaluation). For the second aim, differences in groups derived from the LPA were examined for select sociodemographic, medical, and psychosocial variables.

Results: The combined samples were predominantly female (87.4%) and White (79.8%), with limited disease (59%) and an average age of 55 years. In both samples, a two-profile solution was derived. These two classes were substantively analyzed for patterns of scores and termed the Appearance Comfortable (n = 336 and n = 375 in Samples 1 and 2, respectively) and Appearance Distressed (n = 133 and n = 98 in Samples 1 and 2, respectively) groups. In both samples, younger age, diffuse disease subtype, and the presence of hypo/hyper-pigmentation were associated with membership in the Appearance Distressed group. The mean modified Rodnan skin scores for patients in the Appearance Comfortable groups were 7.05 (SD = 7.3) and 7.67 (SD = 8.3) in Samples 1 and 2, respectively. The mean modified Rodnan skin scores for patients in the Appearance Distressed groups were 9.83 (SD = 9.6) and 9.60 (SD = 9.7), in Samples 1 and 2 respectively. Additionally, patients in the Appearance Distressed group had significantly higher scores on measures of depressive and anxious symptoms and disability.

Conclusion: This analysis was the first study to identify typologies of patients based on indicators of body image in any disfiguring condition. Two distinct groups were identified distinguishing between an Appearance Comfortable group and an Appearance Distressed group. The results also elucidated variables that can indicate likely group membership.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/latent-profile-analysis-derived-typologies-of-systemic-sclerosis-patients-using-body-image-indicators-a-scleroderma-patient-centered-intervention-network-spin-cohort-study/