Assessing Body Image in Multiple Sclerosis: Adaptation and Validation of the Modified Body Image Scale

Multiple sclerosis (MS) is frequently associated with physical, cognitive, and emotional changes, including functional loss, which may significantly affect body image (BI) perception. However, a BI questionnaire specifically adapted for use with people with MS (PwMS) is currently lacking. This study aims to adapt and validate the original Italian version of the Body Image Scale (BIS) for the MS population and to examine its psychometric properties.

A three-phase adaptation process was conducted, involving a panel of MS experts and PwMS to ensure coherence with MS clinical characteristics, as well as item relevance and clarity. The psychometric properties of the modified BIS (mBIS) were evaluated, including content validity, construct validity, internal consistency, test-retest reliability, and minimal detectable change (MDC).

The modified version of the BIS was established. A total of 208 PwMS (mean age (SD): 50.9 (14.6) years; females: 144; mean self-reported EDSS (SD): 4.0 (1.96)) completed an online survey. The one-factor structure was confirmed (CFI = 0.977, TLI = 0.968, SRMR = 0.059), with high internal consistency (McDonald's ω = 0.963; Cronbach's α = 0.942); and good test-retest reliability (ICC = 0.88). The mBIS showed a moderate correlation with anxiety (r = 0.52), a high correlation with depression (r = 0.67), and a low negative correlation with interoceptive awareness (r = -0.24) (all p < 0.001). The MDC was 6.73 and SEM for total score was 2.88. The mean (SD) mBIS score was 12.9 (9.0).

This study supports the validity and reliability of the mBIS as a tool for assessing BI in PwMS. The findings highlight the relevance of BI concerns in MS and their potential role in psychological well-being.