Exploring body image perception in people with multiple sclerosis: the role of self-esteem and disease burden

Multiple sclerosis (MS) may affect physical functioning, self-perception, and psychosocial well-being. Although body image may be understood as a fundamental element of the psychological experience of people with MS (PwMS), it has not been sufficiently investigated in MS. This study aimed to explore body image perception and its contributors among PwMS.

This cross-sectional study enrolled 100 PwMS from the Isfahan Hakim MS Database between November 2025 and March 2026. Data were collected using demographic and clinical questionnaires and validated Persian versions of the Body Appreciation Scale (BAS), Rosenberg Self-Esteem Scale (RSES), Multiple Sclerosis Impact Scale-29 (MSIS-29), and Patient Determined Disease Steps Scale (PDDS). The generalized linear model was applied to identify candidate predictors of body image in PwMS.

PwMS were predominantly female (77%), with a mean age of 34.4 years, and most had relapsing-remitting MS (85%). In multivariable analyses, higher self-esteem consistently emerged as the strongest independent predictor of more favorable body image (B = 1.05, p < 0.001). Shorter disease duration (B = -0.02, p = 0.036), older age at disease onset (B = 0.12, p = 0.049), lower psychological impact (B = -0.18, p = 0.023), and lower overall MS impact (B = -0.06, p = 0.047) were also independently associated with better body image.

Body image perception in PwMS is influenced by psychological resources and perceived disease burden, beyond neurological disability alone. Integrating interventions such as self-esteem-enhancing and psychologically supportive into MS care may improve patient-centered outcomes.