Distortion of body image perception in the Prader-Willi syndrome: Relationship with the perceptual reasoning index

Self-perception of body image has been scarcely evaluated in people with Prader-Willi syndrome (PWS), who, in addition to intellectual disability, are often obese. Therefore, we explored whether people with PWS can accurately identify their true image and how this self-perception is impacted by their neuropsychological profile.

This observational study included patients with PWS with regular attendance to transdisciplinary treatment at a center specialized in the management of rare diseases. All patients were evaluated with the Stunkard scale (including silhouettes ranging from extremely skinny to extremely obese) and the WISC-IV and WAIS-III questionnaires, specifically the perceptual reasoning index (PRI).

Among the 21 participants, 62% misperceived their body image, most underestimating their body dimensions (actual BMI 28.0±8.3kg/m² vs self-perceived BMI 23.2±4.7kg/m², p=0.03). While BMI differences between accurate and inaccurate body image perception were nonsignificant (accurate 26.6±8.8kg/m² vs inaccurate 28.9±8.1kg/m², p=0.56), individuals with accurate perception showed both higher PRI scores (accurate 67.6±8.2 vs inaccurate 60.2±7.2, p=0.043) and, to a lesser extent, intelligence quotients (IQ) (accurate 60.0±4.9 vs inaccurate 55.0±7.5, p=0.079).

In this study, we identified distortion of body image perception as a very common finding among PWS patients, in most cases as underestimation, and influenced by the neuropsychological profile.