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It is widely reported that image-based sexual abuse (IBSA) victimization is linked to a wide range of detrimental outcomes, including anxiety, depression, and suicidal ideation. However, knowledge about what shapes victims' experiences remains limited. To explore underlying mechanisms of harm in IBSA incidents, the present study drew on the concept of appraisal to elucidate the various meanings that victims attach to IBSA. For this purpose, we carried out a reflexive thematic analysis of 20 individual in-depth interviews with young male and female victims (ages 16-26) of IBSA. Using this approach, we developed four overarching themes that capture participants' experiences of being (1) robbed of bodily autonomy, (2) stripped of privacy, (3) subjected to public scrutiny, and (4) trapped in a state of uncertainty. By delineating the different ways that participants appraised and experienced each of these "layers of victimization," our findings show how the harms of IBSA may be shaped by a complex constellation of situational, personal, and cultural structures and conditions. Importantly, as some of these mechanisms are socially constructed, our findings indicate that efforts aimed at reducing negative outcomes of IBSA should address the interpersonal and cultural context of these incidents, including bystander responses to intimate image dissemination.

Background: Little is known about longer-term adherence to recommended physical activity (PA) and dietary behaviors after metabolic and bariatric surgery (MBS) and whether adherence is associated with weight recurrence., Objectives: To explore (1) changes in and associations between adherence to PA and general dietary recommendations after MBS and (2) whether PA and dietary behaviors interact to predict weight recurrence., Setting: University hospital; public practice., Methods: Participants completed ActiGraph PA monitoring, dietary questionnaire, and weighing 1 and 5 years after surgery. Parametric and non-parametric tests evaluated changes in and associations between adherence to PA and dietary recommendations. Multiple linear regression explored associations of adherence and weight recurrence 5 years post-surgery., Results: A total of 73 participants (66% loss to follow-up, 80.8% females) were included. From 1 to 5 years after surgery, adherence to PA recommendations did not change (23.5% versus 20.5%, P = .824), whereas adherence to dietary recommendations decreased (P = <.001). Adherence to PA recommendations is positively associated with eating fruits and vegetables and limiting intake of sugar and fat at 1 year (P < .05) and negatively associated with choosing meat with less fat at 5 years (P = .018). Adherence to PA and dietary behaviors did not independently contribute or interact to predict weight recurrence., Conclusions: Adherence to recommendations was poor. Dietary adherence decreased from 1 to 5 years post-surgery, whereas PA adherence remained stable. PA adherence was positively associated with adherence to some dietary recommendations at 1 year but not at 5 years. Neither behavioral adherences were associated with weight recurrence. Additional research is needed to understand how to improve adherence and its relationship with other health outcomes after MBS., (Copyright © 2024 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Few studies have investigated how the plethora of contemporary social media (SM) platforms relate to, and influence eating disorder (ED) pathology, appearance ideals and pressure to conform to these ideals in youth., Methods: In this study, 1558 girls (53%) and boys (47%), predominantly within the 16-19 age range, completed an online questionnaire assessing SM use and perceived influence on appearance, ED pathology, internalization of appearance ideals and perceived appearance pressure., Results: Results showed that ED pathology was common, particularly in girls, and that internalization of body ideals was gender specific, a thin ideal being more prevalent in girls, and a muscular ideal being more common in boys. Results also showed a strong association between ED pathology and perceived pressure to conform to these appearance ideals. One fourth of the participants reported spending four hours or more on SM daily, and 80% of girls reported that SM, particularly Instagram and TikTok, had a negative influence on how they felt about their appearance. These girls had significantly higher levels of ED pathology and reported higher levels of appearance pressure from the media., Conclusion: A clear pattern of associations between photo- and video specific SM platforms, ED pathology, internalization of body ideals and perceived pressure was found in this study. Adolescent girls appeared to be particularly at risk. The results illustrate an imperative need to keep addressing the potential risks of SM use in adolescents, and to continue monitoring the effect of SM on young people's view of themselves, their appearance, and their eating habits. Future studies should attempt to identify aspects of SM use that may be particularly detrimental for girls and boys in their formative years, but also those that may enhance adolescents' satisfaction and appreciation of their body and appearance., Trial Registration: The study is registered in the Open Science Framework (Identifier: 10.17605/OSF.IO/5RB6P https://doi.org/10.17605/OSF.IO/5RB6P )., (© 2024. The Author(s).)

Background: During pregnancy and early motherhood, risks of relapse and worsening are high for women with a history of eating disorders (EDs), as are adverse sequelae for their babies. However, systematic descriptions of the processes that these women undergo through pregnancy, birth, and early motherhood are lacking, as are good descriptions of the various trajectories these women follow through pregnancy and early motherhood. This study addresses both these knowledge gaps., Methods: We used a longitudinal research interview design, recruiting a non-clinical sample of 24 women with a history of severe EDs from routine pregnancy controls in five public, local, family health care centers in Norway. The participants were interviewed twice, first during pregnancy and then 4-6 months after delivery. Data were analyzed according to grounded theory. The focus was on modeling the trajectories of EDs through pregnancy, birth, and early motherhood. All the participants were diagnosed (DSM-5) using the Eating Disorder Examination and then completed the Eating Disorder Examination Questionnaire., Results: Five perceived trajectories through pregnancy and early motherhood were identified: "The mastering mother," in which an ED pathology seems to be absent through pregnancy and early motherhood; "The inadequate mother," in which the ED pathology worsens before pregnancy, through pregnancy, and early motherhood; "The overwhelmed mother," in which the ED worsens during pregnancy and early motherhood; "The depressed mother," in which the ED is put on hold during pregnancy, but worsens in early motherhood; and "The succeeding mother," in which the ED worsens during pregnancy, but reduces in early motherhood., Discussion: ED trajectories through pregnancy and early motherhood vary greatly among women with a history of EDs. This may indicate different psychological dynamics through these phases. A model with five trajectories captures a large degree of the variation. The model may help clinicians' preparedness when dealing with these patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Sommerfeldt, Skårderud, Kvalem, Gulliksen and Holte.)

Background: Menstruation is a central part of the everyday life of most women, and menstrual attitudes may impact health and well-being., Objectives: This article aimed to map menstrual attitudes among adult women and examine factors associated with these attitudes, such as aspects of menarche and current menstruation, and rarely studied factors, such as genital self-image and sexual openness., Study Design: A cross-sectional online survey., Method: A sample of 1470 women, aged 18-50 years, were recruited through social media sites. The Menstrual Self-Evaluation Scale was used to measure three different attitudes: menstruation as natural, shameful, and bothersome. Multiple linear regression analysis was used to investigate the relationship between each attitude and factors related to menarche and current menstruation, contraceptive use, genital self-image (assessed by Female Genital Self-Image Scale ), and sexual openness ( Personal Comfort with Sexuality Scale ). Sociodemographic variables were included into the models as covariates., Results: Agreeing with the attitude of menstruation as something natural was predicted primarily by positive emotions at menarche, experiencing less menstrual pain, using no or nonhormonal contraception, and having a positive genital self-image. Perceiving menstruation as bothersome was predicted by a lower educational level, experiencing stronger menstrual pain, having more perimenstrual psychological symptoms, and using hormonal contraceptives. Menstruation as something shameful was chiefly predicted by lower sexual openness and a negative genital self-image., Conclusion: Many women held attitudes about menstruation as both something natural and bothersome. Menarche and current menstruation experiences, and contraceptive method, played central roles in shaping attitudes toward menstruation as natural and bothersome. Viewing menstruation as shameful stood out from other attitudes by indicating a triad of self-objectified shame that includes menstruation, sexuality, and genital self-image. Further research into the relationships between menstruation, contraceptive use, sexuality, and body image is needed to enhance our understanding of women's menstrual health.

Objectives: The aims of this study were to investigate modifications in pain sensitivity after RYGB and to explore associations between pain sensitivity and weight loss, chronic abdominal pain, total body pain, anxiety, depression, and pain catastrophizing., Methods: In total, 163 patients with obesity were examined with a cold pressor test for pain sensitivity before and two years after RYGB. Two aspects of pain sensitivity were registered: Pain intensity (numeric rating scale, range 0-10) and pain tolerance (seconds). Associations between pain sensitivity and the explanatory variables were assessed with linear regression., Results: Two years after RYGB the pain intensity increased (mean ± SD 0.64 ± 1.9 score units, p<0.001). Pain tolerance decreased (7.2 ± 32.4 s, p=0.005). A larger reduction in body mass index was associated with increased pain intensity, β=-0.090 (95 % CI -0.15 to -0.031, p=0.003), and decreased pain tolerance β=1.1 (95 % CI 0.95 to 2.2, p=0.03). Before surgery, participants with chronic abdominal pain reported 1.2 ± 0.5 higher pain intensity (p=0.02) and had 19.2 ± 9.3 s lower pain tolerance (p=0.04) than those without abdominal pain. No differences in pain sensitivity were observed between participants who did or did not develop chronic abdominal pain after RYGB. Pain sensitivity was associated with symptoms of anxiety but not with pain catastrophizing, depression or bodily pain., Conclusions: The pain sensitivity increased after RYGB and was associated with larger weight loss and anxiety symptoms. Changes in pain sensitivity were not associated with development of chronic abdominal pain after RYGB in our study., (© 2023 Walter de Gruyter GmbH, Berlin/Boston.)

Background: Increasing physical activity and limiting sedentary time may minimize weight recurrence after bariatric surgery. However, few studies have evaluated potential associations of objectively-measured physical activity and sedentary time with post-surgical weight recurrence over time., Aims: To evaluate associations of change in physical activity and sedentary time with weight recurrence after bariatric surgery., Methods: Participants from the Oslo Bariatric Surgery Study, a prospective cohort study, wore an ActiGraph monitor for seven days at 1- and 5 years after surgery to assess daily physical activity and sedentary time. Participants' weight was measured at in-person clinic visits. Chi-square Test and Paired-samples T-test evaluated group differences and change over time, while Pearson's Correlation, multiple logistic and linear regression investigated associations between variables., Results: Five years after surgery 79 participants (70.5% response rate, 81% female) (mean (sd) age: 54.0 (±9.3), BMI: 32.1 (±4.7)) had valid monitor data. Participants increased their sedentary time (71.4 minutes/day (95% CI: 54.2-88.6, p = <0.001)) and reduced daily steps (-1411.1 (95% CI: 737.8-208.4), p = <0.001), light physical activity (-54.1 min/day (95% CI: 40.9-67.2, p = <0.001)), and total physical activity (-48.2 (95% CI: 34.6-63.3), p = <0.001) from 1- to 5 years after surgery. No change was found for moderate-to-vigorous intensity physical activity. No associations were found between changes in steps, physical activity or sedentary time and weight recurrence., Conclusion: Participants increased sedentary time and decreased light- and total physical activity between 1- and 5 years post-surgery. Overall, changes in physical activity and sedentary time were not associated with weight recurrence. Interventions to help patients increase physical activity and limit sedentary time after bariatric surgery are needed., (© 2023. The Author(s).)

Background: There is a higher prevalence of eating disorders among women seeking in vitro fertilization (IVF). Women with a history of eating disorders may be particularly vulnerable to eating disorder relapse during IVF, pregnancy, and early motherhood. The experience of these women during this process has hardly been studied scientifically, despite its high clinical relevance. The overall aim of this study is to describe how women with a history of eating disorders experience the process of becoming a mother through IVF, pregnancy, and the postpartum period., Methods: We recruited women with a history of severe anorexia nervosa who had undergone IVF ( n = 7) at public family health centers in Norway. Semi-openly, the participants were interviewed extensively first during pregnancy, and then 6 months after birth. The 14 narratives were analyzed using interpretative phenomenological analyses (IPA). All participants were required to complete the Eating Disorder Examination Questionnaire (EDE-Q) and were diagnosed (DSM-5) by using the Eating Disorder Examination (EDE), during both pregnancy and postpartum., Results: All participants experienced a relapse of an eating disorder during IVF. They perceived IVF, pregnancy, and early motherhood to be overwhelming, confusing, a source of severe loss of control, and a source of body alienation. There were four core phenomena that were reported that were strikingly similar across all participants: "anxiousness and fear," "shame and guilt," "sexual maladjustment," and "non-disclosure of eating problems." These phenomena persisted continuously throughout IVF, pregnancy, and motherhood., Conclusion: Women with a history of severe eating disorders are highly susceptible to relapse when undergoing IVF, pregnancy, and early motherhood. The process of IVF is experienced as extremely demanding and provoking. There is evidence that eating problems, purging, over-exercising, anxiousness and fear, shame and guilt, sexual maladjustment, and non-disclosure of eating problems continue throughout IVF, pregnancy, and the early years of motherhood. Therefore, it is necessary for healthcare workers providing services to women undergoing IVF to be attentive and intervene when they suspect a history of eating disorders., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Sommerfeldt, Skårderud, Kvalem, Gulliksen and Holte.)

Purpose: Head and neck cancer (HNC) patients are at risk of long-term body image distress (BID). We aimed to investigate the severity of BID in long-term HNC survivors and to explore the associations between sociodemographic and clinical factors, patient-reported late effects, and cancer-related body image (BI) concerns., Methods: This cross-sectional study included quality of life and BI assessment in an 8-year (SD = 1.58) follow-up after treatment among 258 HNC survivors. Multinomial logistic regression analysis was used to investigate the relationship between three groups of BI concerns (no concerns, mild to moderate concerns, and BID) and patient-reported late effects. Sociodemographic and clinical variables were included in the model as covariates., Results: A total of 51.2% of participants had mild to moderate BI concerns, and 9.5% reported BID. Compared to those with no BI concerns, participants with BID were more likely to live without a partner, to have had radiotherapy and surgery, and to report worse emotional functioning and higher oral and throat pain. Compared to participants with no BI concerns, those with mild to moderate concerns reported higher oral and throat pain and speech problems., Conclusions: Some level of cancer-related BI concerns persisted in the majority of HNC survivors many years after treatment, while a small proportion of survivors experienced BID. BI concerns were associated with treatment modality and patients' daily functioning and symptoms., Implications for Cancer Survivors: Insight into factors associated with BI problems may help to identify survivors at risk and may facilitate closer follow-up of survivors in need., (© 2022. The Author(s).)

This article aims to determine the prevalence of sending nude pictures/videos in the Norwegian population and investigates gender differences regarding consensual, unsolicited, and coerced experiences. Data were obtained from a probability-based web survey of 2181 men and 1967 women between 18 and 89 years old. The majority of participants expressed relatively accepting attitudes toward sending nude pictures/videos, and men expressed more positive attitudes than women. Twenty-nine percent of participants reported having lifetime experience with sending nude pictures/videos, and sending nude pictures/videos was more common in younger individuals than older individuals. More women than men claimed that they sent their most recent nude picture to a committed partner, and twice as many men than women had sent a nude picture to a stranger or a person they only had contact with on the Internet. In addition, more than twice as many women than men reported consensual sending nude pictures/videos, and more men than women sent unsolicited pictures/videos. Consensual sending nude pictures/videos was characterized by the presence of men and women within committed relationships. In Norway, sending nude pictures/videos seems to be a way of being sexual in the context of committed relationships., Competing Interests: Conflict of interestThe authors do not have any conflicts of interest to report., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022, Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: Being pregnant is a vulnerable period for women with a history of eating disorders. A central issue in eating disorders is searching control of one's body and food preferences. Pregnancy implies being increasingly out of control of this. Treatment and targeted prevention start with the patient's experience. Little is known about how women with a history of eating disorder experience being pregnant., Method: We interviewed 24 women with a history of eating disorder at the time of pregnancy, recruited from five public pregnancy controls at local family health centers in Norway. Interviews were analyzed by means of ideal type analysis, with a particular focus on how the participants experienced pregnancy and perceived triggers in possible experiences of relapse or worsening during pregnancy. All participants completed the Eating Disorder Examination Questionnaire (EDE-Q) and were diagnosed (DSM-5) by using the Eating Disorder Examination (EDE)., Results: On becoming pregnant, 23 of the 24 participants experienced worsening or relapse of their disorder. This occurred both at first time and after several pregnancies, and either interviewed early or late in pregnancy. Ideal type analyses indicated seven different personal features associated with worsening or relapse: the "chaotic" "rigid" "perfect" "worried" "shameful" "motherhood fearing" and "the mother with lost identity" Perceived triggers of worsening or relapse were: "loss of control" "unpredictability" "competition" "change of appearance" "shame and nausea" and "loss of identity.", Conclusion: Pregnancy is a vulnerable period for women with a history of eating disorders. A great variation in personal psychological dynamics seems to interact with perceived triggers in worsening or relapse of eating disorder. Our findings have important implications in understanding mechanisms of relapse in pregnancy, preventing relapse and help tailoring adequate intervention., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Sommerfeldt, Skårderud, Kvalem, Gulliksen and Holte.)

Purpose: After bariatric surgery, body contouring surgery (BCS) is thought to improve body image, weight loss, and mental health. Many patients desire but do not undergo BCS after bariatric surgery. This patient subset has rarely been studied. The present study compares bariatric surgery patients that, at 5 years after surgery, desires, have undergone or have no desire for BCS regarding pre- and post-surgery body image and mental health, including within-group changes over time., Materials and Methods: Data were collected from participants (N = 216) pre-bariatric surgery and at 1- and 5-year post-surgery. Health care providers measured body mass index (BMI). All other data were collected via self-report (questionnaires)., Results: At 5-year post-surgery, 30.6% had undergone BCS, 17.1% did not desire it, and 52.3% desired BCS. Patients who subsequently desired BCS scored lower on body satisfaction pre-surgery than the other groups. They also reported less resilience pre-surgery and more depressive symptoms at all times compared to participants with BCS. For five-year post-surgery, patients who desired BCS had lower body satisfaction levels than patients with BCS and were more bothered with excess skin relative to the two other groups. Body satisfaction improved in all three groups from baseline to five years and in most patients with BCS. Mental health improved only in patients with BCS., Conclusion: This study emphasizes the relevance of identifying participants who desire but have not undergone BCS. The study suggests that BCS is associated with improved body image and mental health., (© 2022. The Author(s).)

A visible difference to the face or body may challenge adolescents' adjustment and engagement in life activities, where some require psychosocial support. However, evidence is limited for whether existing interventions for this adolescent group reduce social or appearance-related distress. We therefore conducted a parallel-group, randomised control trial to evaluate the effectiveness of Young Person's Face IT, a self-guided web-based psychosocial intervention developed for adolescents with a visible difference who experience distress. Adolescents (N = 189, aged 11-18) from two countries (Norway and the Netherlands), were randomly allocated to an intervention group or care as usual (CAU). Outcomes were body esteem, social anxiety, perceived stigmatisation, and life disengagement. Compared with CAU, participants who completed Young Person's Face IT showed reductions in social anxiety symptoms (η p 2  = 0.06). No significant improvements were found for the other outcomes. This study endorses web-based psychosocial support in reducing social anxiety in adolescents distressed by a visible difference. Future studies are needed to confirm the effectiveness of Young Person's Face IT and to explore potential long-term effects., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The purpose of this study was to examine Norwegians' reports of seven varied sexual acts. Data were obtained from a questionnaire survey of a probability-based web sample of 2,181 men and 1,967 women aged 18-89 years. Among seven acts of sexual variety, the most common sexual experiences were trying to watch pornography with a partner, engaging in sex in unusual places, and using sex toys. Older age was negatively associated with all sexual behaviors. Regarding more unorthodox acts of sexual variety, heterosexual men's sexual preferences involved having and desiring group sex, whereas heterosexual women's sexual experiences and desires involved having sex in unusual places. Lesbian, gay, bisexual (LGB) individuals generally showed greater curiosity or experience of having group sex and engaging in BDSM (bondage, discipline, dominance and submission, and sadomasochism) activities than heterosexual adults. However, while LGB men had a high preference for group sex activities, LGB women had more positive attitudes toward BDSM activity. Individuals appear to accumulate more acts of sexual variety over time, thus making the incorporation of sexual variety a function of age. This study supports the idea that sexual variety has expanded among those born from 1960 onwards.

Online interventions have the potential to reach individuals who are otherwise difficult to engage due to stigma and sensitive topics. However, these individuals also tend to be hard to recruit in clinical trials, a crucial step in order to provide evidence-based interventions. This highlights a need for more information about efficient recruitment strategies for difficult-to-engage groups. The present study aimed to share the systematised experiences of recruiting adolescents with a visible difference to an online psychosocial intervention RCT. With the intention to recruit 160 participants (age 12-17), recruitment efforts were nationwide and included multiple arenas (e.g., hospitals, schools, social media), and methods (e.g., in-consultation, targeted letters, posters). Ultimately, 102 participants were recruited, and results showed that recruitment involving patient organisations, hospital departments, and specialised resource centres were most successful in reaching participants. The most efficient recruitment strategy was targeted letters sent home to eligible patients/members, as 78% of the participants were recruited this way. Media and social media recruitment efforts yielded comparatively few participants. No participants were recruited through schools and educational health care services, primary health care services, or municipal and regional authorities. Our results are discussed in relation to barriers with recruiting difficult-to-engage groups to RCTs, providing useful recruitment tools to future similar studies. For instance, future studies are recommended to utilise targeted approaches over general population approaches. Also, results from recruitment efforts should routinely be reported, as this ultimately will provide more general strategies for effective recruitment and support studies in reaching recruitment goals., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

Background: Mammography screening is the main method for early detection of breast cancer in Norway. Few studies have focused on psychological determinants of both attendance and non-attendance of publicly available mammography screening programs. The aim of the current study, guided by the Extended Parallel Process Model, was to examine how psychological factors influence defensive avoidance of breast cancer screening and intention to attend mammography., Methods: Cross-sectional survey data from a community sample of women living in Norway aged ≥ 18 (N = 270), and without a history of breast cancer, was collected from September 2018 to June 2019 and used to investigate the relationships between the Extended Parallel Process Model (EPPM) constructs and two outcomes: defensive avoidance of breast cancer screening and intention to attend mammography within the next two years. After adjusting for confounding factors, the hierarchical multiple linear regression analyses was conducted to assess the ability of the independent variables based on the EPPM to predict the two outcome variables. Significance level was chosen at p < 0.05., Results: Multivariate analyses showed that defensive avoidance of breast cancer screening was predicted by lower perceived susceptibility to breast cancer (β =  - 0.22, p = 0.001), lower response efficacy of mammography screening (β =  - 0.33, p = 0.001), higher breast cancer fear (β = 0.15, p = 0.014), and checking breasts for lumps (β =  - 0.23, p = 0.001). Intention to attend mammography within the next two years was predicted by higher response efficacy of mammography screening (β = 0.13, p = 0.032), having a lower educational level (β =  - 0.10, p = 0.041), and regular previous mammography attendance compared to never attending (β = 0.49, p = 0.001)., Conclusions: The study revealed that defensive avoidance of breast cancer screening and intention to attend mammography were not predicted by the same pattern of psychological factors. Our findings suggest future health promotion campaigns need to focus not only on the psychological factors that encourage women's decision to attend the screening, but also to counter factors that contribute to women's decision to avoid it.

Severe obesity has been associated with reduced performance on tests of verbal memory in bariatric surgery candidates. There is also some evidence that bariatric surgery leads to improved verbal memory, yet these findings need further elucidation. Little is known regarding postoperative memory changes in the visual domain and how patients subjectively experience their everyday memory after surgery. The aim of the current study was to repeat and extend prior findings on postoperative memory by investigating visual, verbal, and self-reported everyday memory following surgery, and to examine whether weight loss and somatic comorbidity predict memory performance. The study was a prospective, observational study in which participants ( n = 48) underwent cognitive testing at baseline, 1 and 2 years after bariatric surgery. Repeated measures analyses of variance revealed significantly poorer visual and verbal memory performance at the 1-year follow-up, with performance subsequently returning to baseline levels after 2 years. Verbal learning and self-reported everyday memory did not show significant postoperative changes. Memory performance at 1 year was not significantly predicted by weight loss, changes in C-reactive protein levels or postoperative somatic comorbidity (Type 2 diabetes, sleep apnea, and hypertension). The study demonstrated poorer visual and verbal memory performance at 1-year follow-up that returned to baseline levels after 2 years. These findings are in contrast to most previous studies and require further replication, however, the results indicate that postoperative memory improvements following bariatric surgery are not universal. Findings suggest that treatment providers should also be aware of patients potentially having poorer memory at 1 year following surgery., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Walø-Syversen, Kvalem, Kristinsson, Eribe, Rø, Brunborg and Dahlgren.)

Objective: Executive function (EF) and, in particular, inhibitory control have been associated with weight loss (WL) in behavioural WL treatment for obesity. Few studies have focused on the relationship between preoperative inhibitory control and post-operative WL following bariatric surgery, and the potential mediating role of maladaptive eating behaviours is unclear. The aim of this study was to investigate preoperative executive function as a predictor of WL at 1 year following bariatric surgery. Additionally, we aimed to explore the mediating role of postoperative compulsive grazing in the relationship between inhibitory control and WL., Method: A prospective observational study in which participants completed neuropsychological testing 30 days before and 1 year following surgery (n = 61/80; 76% follow-up). Participants were 80% female, with an average age of 41 years. Approximately 54% underwent gastric bypass, 26% gastric sleeve and 20% had one anastomosis gastric bypass. Regression analyses were employed to examine the relationship between preoperative EF and percentage total weight loss (%TWL), and structural equation modelling was used to examine compulsive grazing as a mediator., Results: After adjusting for control variables, preoperative inhibitory control explained 8% of the variance in %TWL (p ≤ 0.05). Preoperative working memory was not significantly associated with %TWL. Postoperative compulsive grazing was significantly associated with %TWL (p ≤ 0.05), but did not mediate the association between preoperative inhibitory control and %TWL., Conclusion: The results suggest that preoperative inhibitory control performance is a relevant predictor of postoperative WL and that compulsive grazing is a maladaptive eating behaviour that warrants clinical attention after surgery., (© 2020 Eating Disorders Association and John Wiley & Sons Ltd.)

The impacts of body dissatisfaction have been widely studied among adolescent girls, but much less in women in mid-life. In this study, we evaluated the associations between body dissatisfaction, psychological health and behaviors used to manage age-related changes, in an online survey of 331 women aged 45-65. Body dissatisfaction, importance of appearance and aging anxiety were associated with higher depression scores. Moreover, importance of appearance and aging anxiety were associated with the probability of using "anti-aging" behaviors. It seems that with age, for a subgroup of women, the pressure to stay young may be added to that of staying thin.

Cosmetic breast surgery experience and a wide range of mental health, psychosocial, and sociodemographic variables were assessed in the population-based Norwegian Mother and Child Cohort Study ( N  = 78,252). Breast augmentation patients reported elevated mental health problems. Factors in the domains of physical appearance, drug use, relationships, and exposure to abuse were all related to breast augmentation. Adjusting for such factors reduced the relationships between breast augmentation surgery and all mental health problems to non-significance. Results indicate that the increased prevalence of mental health problems among breast augmentation patients has to be understood from multiple perspectives involving several psychosocial domains.

Background: Attention to and interpretation of symptoms are influenced by psychologic and contextual factors. Preoperative anxiety, and to some extent depression, has been found to predict the perceived impact of somatic symptoms 1 year after Roux-en-Y gastric bypass. Postoperative changes in negative affect may possibly both influence and be influenced by the perception of somatic symptoms., Objectives: This study aimed to explore whether preoperative anxiety and depressive symptoms correlated with perceived impact of somatic symptoms 3 years after Roux-en-Y gastric bypass. Second, we aimed to examine the 3-year trajectory of depressive and anxiety symptoms, and their interaction with perceived somatic symptoms postoperatively., Setting: University hospital., Methods: Presurgery, 1-, and 3-year postsurgery data were collected from 169 participants (62.4% follow-up). Anxiety and depressive symptoms were assessed at all time points. The participants reported the degree of perceived impact of various somatic symptoms 1 and 3 years after surgery. A cross-lagged, autoregressive regression analysis was employed to examine the mutual interaction of trajectories over the follow-up period., Results: Fatigue (30.8%) and dumping (23.7%) were common high-impact symptoms 3 years postoperatively. Higher baseline anxiety was associated with higher impact of fatigue, pain, and diarrhea, while depressive mood was related to higher impact of diarrhea at 3-year follow-up. Higher anxiety/depression symptoms were bidirectionally related to higher perceived total symptom impact at both 1 and 3 years postoperatively, controlling for percent total weight loss. Higher perceived impact of somatic symptom burden at 1 year after surgery predicted a significant increase in depressive symptoms the next 2 years., Conclusion: Baseline anxiety was associated with higher perceived impact of several somatic symptoms 3 years after Roux-en-Y gastric bypass. Higher total symptom burden (pain, fatigue, dumping, diarrhea, and vomiting) at 1 year after surgery predicted increase in depression over the next 2 years. The results underscore the importance of managing somatic symptoms after surgery to prevent patients' distress., (Copyright © 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

The Breast Size Satisfaction Survey (BSSS) was established to assess women's breast size dissatisfaction and breasted experiences from a cross-national perspective. A total of 18,541 women were recruited from 61 research sites across 40 nations and completed measures of current-ideal breast size discrepancy, as well as measures of theorised antecedents (personality, Western and local media exposure, and proxies of socioeconomic status) and outcomes (weight and appearance dissatisfaction, breast awareness, and psychological well-being). In the total dataset, 47.5 % of women wanted larger breasts than they currently had, 23.2 % wanted smaller breasts, and 29.3 % were satisfied with their current breast size. There were significant cross-national differences in mean ideal breast size and absolute breast size dissatisfaction, but effect sizes were small (η 2  = .02-.03). The results of multilevel modelling showed that greater Neuroticism, lower Conscientiousness, lower Western media exposure, greater local media exposure, lower financial security, and younger age were associated with greater breast size dissatisfaction across nations. In addition, greater absolute breast size dissatisfaction was associated with greater weight and appearance dissatisfaction, poorer breast awareness, and poorer psychological well-being across nations. These results indicate that breast size dissatisfaction is a global public health concern linked to women's psychological and physical well-being., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Body image issues can affect all domains of sexual functioning. The aim of this study was to examine how, in a sociocultural context where physical and sexual attractiveness is equated with young and slim body ideals, appearance dissatisfaction and importance are related to sexual satisfaction in older adults in four European countries. A cross-sectional survey with probability samples of the population aged 60-75 years was used. Only respondents with a partner were included in this paper, and the countries included Norway ( n  = 957), Denmark ( n  = 846), Belgium ( n  = 612), and Portugal ( n  = 367). Sexual satisfaction, appearance dissatisfaction, and importance were assessed, and frequency of intercourse/kissing and cuddling, relationship satisfaction, age, and body mass index were all used as control variables. Belgian men scored significantly lower on sexual satisfaction, while there was no difference in sexual satisfaction in women. Appearance dissatisfaction was lower in Scandinavian women and men, and in Belgian men, and appearance salience was lower in Norwegian men and women, and in Portuguese women. Linear regression analysis revealed that, adjusting for confounders, appearance dissatisfaction was significantly related to sexual satisfaction in Scandinavian women and men, as well as in Belgian men. Compared to research on younger adults, appearance evaluation appeared to play an equally important role in sexual satisfaction in older adults in our study. The variation in appearance dissatisfaction in older adults across European countries is a novel finding that needs to be examined further., (© Springer Nature B.V. 2019.)

The aim of the current study was to explore whether developmental trajectories of body satisfaction from adolescence to young adulthood predicted measures of sexual satisfaction in young adulthood, even when controlling for important covariates such as gender, weight development, relationship status, mental health, and frequency of sexual intercourse and masturbation. Data were collected from a population-based prospective cohort of Norwegian adolescents ( n  = 2,587) over a period of 13 years in four waves (1992, 1994, 1999, and 2005; mean age = 14.9 in 1992, 57.3% women). Latent growth curves were estimated for body satisfaction and body mass index (BMI). Men reported higher sexual satisfaction, sexual activity, baseline body satisfaction, and BMI than women. The developmental trajectories revealed a slight increase in body satisfaction and BMI from adolescence to young adulthood in both genders. Moreover, structural equation models showed that baseline body satisfaction in both genders predicted sexual satisfaction as a young adult, independent of relationship status and frequency of sexual activity. Neither the development of BMI nor of body satisfaction predicted sexual satisfaction. The results elucidate the vital role of body satisfaction in sexual satisfaction in adults and the importance of addressing body dissatisfaction in childhood.

Background: Individual differences in executive function may influence eating behavior, weight loss (WL), and WL maintenance in obesity treatment. Executive function, which designates top-down cognitive control processes, has been related to eating behaviors which may impact weight, and has been found to be predictive of WL in both behavioral WL programs and after bariatric surgery. Currently, we lack knowledge on the role of executive function in the period before bariatric surgery. If executive function impacts eating behavior and WL in the preoperative period, it may be a target for clinical attention in this stage., Objectives: We aimed to examine the relationship between objective performance-based measures of executive function, eating patterns, and WL in the preoperative period., Method: Baseline data in an ongoing observational longitudinal study of bariatric surgery patients were used. Eighty patients completed neuropsychological testing and self-report questionnaires 4 weeks prior to surgery., Results: We found that working memory predicted WL before surgery and inhibitory control predicted adherence to dietary recommendations., Conclusion: Our study indicates that executive function may play a role in short-term WL and dietary adherence prior to surgery, suggesting that executive function in the preoperative period deserves an extended research focus., (© 2019 The Author(s) Published by S. Karger AG, Basel.)

Background: The experience of symptoms after bariatric surgery, such as pain, dumping, and fatigue, may affect behavior, quality of life, and the need for healthcare consultations. Attention to and interpretation of symptoms are influenced by psychological and contextual factors. Prospective studies of psychological factors predicting physical symptom perception after bariatric surgery are scarce., Objectives: To explore associations of preoperative negative affect and history of stressful and traumatic events with frequency and intensity of self-reported symptoms 1 year after Roux-en-Y gastric bypass (RYGB)., Setting: University hospital., Methods: Questionnaire data were collected before and 1 year after RYGB from 230 patients. Negative affect and stressful events were measured preoperatively. The participants reported the number and impact of various physical symptoms postoperatively., Results: The most common symptoms reported to have a high impact on behavior were fatigue (32.8%) and dumping (28.4%). Reporting more symptoms was associated with preoperative anxiety (r = .22, P = .001) and the number of stressful life events (r = .21, P = .002). Participants with a probable preoperative anxiety disorder reported a higher impact of fatigue, pain, dumping, and diarrhea after surgery, while those with a probable mood disorder and a history of traumatic sexual/violent events reported a higher impact of dumping., Conclusion: Preoperative anxiety symptoms and stressful experiences were associated with a higher perceived impact of symptoms, such as dumping, fatigue, and pain after RYGB. The evaluation of psychological characteristics associated with symptom perception may be relevant when managing symptoms that are not responsive to other treatment measures., (Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Most patients do not meet the recommended level of physical activity after bariatric surgery, and psychological factors underlying postoperative physical activity remain poorly understood. This study aimed at identifying self-regulatory predictors of physical activity after bariatric surgery., Methods: Questionnaire data including self-regulation variables and the short-version of the International Physical Activity Questionnaire were obtained in a prospective cohort of 230 patients 1 year after Roux-en-Y gastric bypass. The study sample consisted of participants consenting to wear an ActiGraph GT3X+ accelerometer for seven consecutive days, 18-24 months after surgery (n = 120)., Results: A total of 112 participants with complete self-report data provided valid accelerometer data. Mean age was 46.8 years (SD = 9.3), and 81.3% was women. Preoperative and postoperative BMI was 44.8 ± 5.5 and 30.6 ± 5.0 kg/m 2 , respectively. Total weight loss was 28.9% (SD = 7.5). By objective measures, 17.9% of the participants met the recommended level of moderate-to-vigorous-intensity of physical activity of ≥150 min/week, whereas 80.2% met the recommended level according to self-reported measures. Being single, higher education level, and greater self-regulation predicted objective physical activity in multivariate regression analysis. Greater self-regulation also predicted self-reported physical activity. Weight loss 1 year after surgery was not associated with self-reported or objectively measured physical activity., Conclusions: Despite large differences between accelerometer-based and subjective estimates of physical activity, the associations of self-regulatory factors and weight loss with postoperative physical activity did not vary depending on mode of measurement. Self-regulation predicted both objective and self-reported physical activity. Targeting patients' self-regulatory ability may enhance physical activity after gastric bypass.

During adolescence, romantic relationships are a key developmental milestone. Coupled with the increasing salience of appearance and social acceptance, adolescents with an appearance-altering condition may feel particularly vulnerable when it comes to romantic relationships. This study aimed to explore the prevalence of romantic experiences among adolescents with a cleft lip and/or palate (CL/P), and to investigate how these experiences could be related to depressive symptoms and global self-worth. The study included 661 Norwegian adolescents with CL/P, who were compared to a large national sample. The prevalence of romantic relationships was lower among adolescents with CL/P compared to the reference group, although the overall impact on depressive symptoms and global self-worth appeared to be low. This study is one of few to explore the impact of a congenital visible condition on experiences of romantic relationships and provides preliminary insight into a significant, yet complex topic., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

This study examines the development of global self-esteem and self-esteem in 6 specific domains across adolescence and young adulthood. Using a cohort-sequential design, we analyzed longitudinal data on 3,116 Norwegian men and women from 13 to 31 years of age by means of growth curve modeling. Questionnaire data provided information on global self-esteem and self-esteem in social, academic, athletic, and appearance domains. Data on important life outcomes was provided by register linkages. Results showed increasing levels of global self-esteem and self-esteem in most domains with increasing age. Being male, higher parental education, and reported higher levels of parental care were related to higher levels of global self-esteem and self-esteem in several domains. Self-esteem in the appearance domain showed high and stable correlations with global self-esteem, whereas in social domains, correlations with global self-esteem increased over age, with a particularly steep increase for romantic appeal self-esteem. As to the prospective relationship between self-esteem and important life outcomes, results showed that participants high in academic self-esteem attained higher education levels and higher income, but most of the relationship was explained by covariates such as parents' socioeconomic status and school grades. Low global self-esteem predicted later prescription of antidepressants, even after controlling for covariates. This study is the first to provide a comprehensive picture of the development of global and domain-specific self-esteem throughout adolescence and young adulthood using long-term longitudinal data. The results underscore the importance of examining development of self-esteem in specific domains in addition to global self-esteem., ((c) 2016 APA, all rights reserved).)

Background: Little is known about the psychological prerequisites for weight loss maintenance after bariatric surgery. A first step in investigating whether existing knowledge of conservative weight loss treatment is applicable for lifestyle interventions postoperatively is to compare specific psychological characteristics at baseline. The aim of this study was to compare patients scheduled for bariatric surgery with patients receiving conservative treatment for morbid obesity on measures of behavioral and psychosocial characteristics considered predictors of their adoption of and adherence to long-term lifestyle recommendations., Methods: Baseline clinical and questionnaire data from the prospective "Oslo Bariatric Surgery Study" were used to examine potential differences between bariatric surgery patients (n = 301) and patients receiving conservative weight loss treatment (n = 261)., Results: The surgical group was characterized by their younger age (43.8 vs. 46.2 years, p <0.01), higher percentage of women (79.1 vs. 70.1 %, p <0.05), and higher Body Mass Index (BMI; 45.0 vs. 41.9 kg/m(2), p <0.001). A multiple logistic regression analysis, adjusting for group differences in BMI, gender, and age, showed that the surgical group had higher self-efficacy (Odds ratio; OR = 3.44, 95 % Confidence interval; CI 1.65, 7.14), more positive outcome expectations (OR = 1.53, 95 % CI 1.23, 1.89), and plans that were more explicit for changing their eating behaviors (OR = 1.80, 95 % CI 1.06, 1.93). The surgical patients were also less ready to change physical activity levels (OR = 0.59, 95 % CI 0.48, 0.73), had tried more types of unhealthy weight loss methods in the past (OR = 1.16, 95 % CI 1.01, 1.33), drank soda more frequently (OR = 1.24, 95 % CI 1.02, 1.50), had fewer binge eating episodes (OR = 0.38, 95 % CI 0.20, 0.71), and had more depressive symptoms (OR = 1.19, 95 % CI 1.09, 1.29)., Conclusions: Patients opting for bariatric surgery had more positive expectations of the treatment outcomes and stronger beliefs in their ability to achieve these outcomes. Those starting conservative treatment had stronger beliefs in readiness to change physical activity levels. Future studies should explore the effect of interventions for bariatric surgery patients, promoting postoperative physical activity and stress realistic outcome expectations. The potential effects of incorporating this knowledge in intervention strategies remain to be explored.

The purpose of this study was to explore the relationship between perception of own appearance, Internet pornography consumption, preferences for pornographic actors' appearance, and sexual self-esteem in gay and bisexual men in Norway. An online survey of 477 gay and bisexual men showed that, despite the prevailing muscular and lean gay body ideal, many men with less ideal bodies also preferred to watch pornographic actors with body types similar to their own. Self-perceived attractiveness, having an ideal body type, and viewing Internet pornography in longer sessions each made a unique contribution to higher self-esteem as a sexual partner. Preferring to watch pornographic actors with ideal bodies was not related to sexual self-esteem. The findings underscore the importance for gay or bisexual men of both self-perceived attractiveness and being athletic or young and fit, for a positive self-evaluation of sexual performance and competence.

Background: Preoperative weight loss is encouraged before bariatric surgery, as it is associated with improved surgical conditions. It has also been related to better postoperative outcomes, but this relationship is less clear. However, little is known about what predicts weight loss preoperatively, so the aim was to identify psychosocial and clinical predictors of preoperative weight loss., Methods: Weight was measured at the first visit, the time of surgery approval, and on the day of surgery in 286 bariatric surgery patients (227 women). A questionnaire consisting of multiple psychosocial measures was completed before surgery., Results: Preoperatively, patients experienced a mean weight loss of 3.8 %. Men lost significantly more weight than women (mean = 5.4, SD = 6.0 vs. mean = 3.4, SD = 5.8, t = -2.3, p < 0.05), and 43.2 % of the patients lost ≥ 5% of their body weight. A high weight loss goal (β = 0.20, p < 0.001), frequent self-weighing (β = 0.18, p < 0.002), and being close to or at highest lifetime weight when applying for surgery (β = -0.30, p < 0.0001) were identified as predictors of weight loss, after controlling for body mass index (BMI), gender, and length of preoperative time period., Conclusions: A relatively low proportion of patients lost the recommended weight preoperatively. Our results indicate that patients benefit from monitoring weight preoperatively and that allowing patients to keep their high weight loss goals may contribute to higher weight loss. Further investigation of these predictors could provide valuable knowledge regarding how to support and motivate patients to lose weight preoperatively.

Objective: Explore psychological functioning in adolescents with a cleft at age 16 from a broad perspective, including cognitive, emotional, behavioral, appearance-related, and psychosocial adjustment. High-risk groups were identified within each area of adjustment to investigate whether vulnerable adolescents were found across domains or whether risk was limited to specific areas of adjustment., Methods: Cross-sectional data based on psychological assessments at age 16 (N = 857). The effect of gender, cleft visibility, and the presence of an additional condition were investigated on all outcome variables. Results were compared with large national samples., Measures: Hopkins Symptom Checklist, Harter Self-Perception Scale for Adolescents, Child Experience Questionnaire, and Satisfaction With Appearance scale., Results: The main factor influencing psychological adjustment across domains was gender, with girls in general reporting more psychological problems, as seen in reference groups. The presence of an additional condition also negatively affected some of the measures. No support was found for cleft visibility as a risk factor except for dissatisfaction with appearance. Correlation analyses of risk groups seem to point to an association between social and emotional risk and between social risk and dissatisfaction with appearance. Associations between other domains were found to be weak., Conclusions: The results point to areas of both risk and strength in adolescents born with a cleft lip and/or palate. Future research should investigate how protective factors could counteract potential risk in adolescents with a cleft.

The purpose of this study was to investigate the hypothesis that the effect of body dissatisfaction on disordered eating behavior is mediated through self-esteem and depression. If the effect of body dissatisfaction on disordered eating can be explained by self-esteem and depression, treatment may benefit from focusing more on self-esteem and depression than body dissatisfaction. We also hypothesized body image importance to be associated with lower self-esteem, stronger symptoms of depression, and more disordered eating. The results showed that the effect of body dissatisfaction on disorder eating was completely mediated, whereas the effect of body image importance was partly mediated. Both self-esteem and depression were significant mediators. Body image importance and self-esteem had a direct effect on restrained eating and compensatory behavior. Depression had a direct effect on binge eating. This effect was significantly stronger among women. Depression also had a direct effect on restrained eating. This effect was positive among women, but negative among men. The results support emotion regulation and cognitive behavioral theories of eating disorders, indicating that self-esteem and depression are the most proximal factors, whereas the effect of body dissatisfaction is indirect. The results point out the importance of distinguishing between different symptoms of bulimia. Depression may cause binge eating, but compensatory behavior depends on self-esteem and body image importance. The results suggest that women may turn to both binge eating and restrained eating to escape awareness of negative emotions, whereas men focus on eating to a lesser extent than women. Existing treatment focuses on eating behavior first and mechanisms such as self-esteem and depression second. The results from this study suggest that an earlier focus on self-esteem and depression may be warranted in the treatment of disordered eating., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

In this project, we examined the effect of a 4-month intervention with horses on perceived social support, self-esteem and general self-efficacy among Norwegian adolescents aged 12-15 years. The intervention took place at farm-based stables and included work with the horses and riding. A waiting-list crossover design was used and the participants answered questionnaires at three time periods. Study I ( N = 49) examined the effect of the intervention compared with the control group. Study II ( N = 41) examined the relationship between the same psychological variables and change in mastering skills with horse. The intervention group reported a significant increase in perceived social support compared with the control group. There were no differences in self-esteem and general self-efficacy between the groups. The results from study II showed that a lower level of perceived social support prior to the intervention predicted an increase in mastering skills with the horse during the intervention.

Objective: To study the predictors of change in leisure time physical activity (LTPA) from adolescence to young adulthood., Method: A nationally representative sample of 3,251 Norwegian students between 12 and 19 years of age were initially surveyed, and follow-up surveys were conducted three times over a 13-year period. The initial response rate was 97%, and retention rates for the three follow-up sessions were 92%, 84%, and 82%, respectively. Four groups of predictors were assessed: sociodemographics, such as gender, age, parental socioeconomic status, pubertal status, and grades; previous LTPA, such as the amount of LTPA and sports club membership; athletic self-concept and depressive symptoms; and other health behaviors, such as smoking, dieting, and body mass. Autoregressive cross-lagged analyses were supplemented with latent growth-curve analyses., Results: Membership in a sports club and a positive athletic self-concept in adolescence predicted a high level of LTPA in adulthood, whereas smoking tobacco, high BMI, and depressive symptoms in adolescence predicted low levels of LTPA., Conclusions: Engaging adolescents in organized sports and enhancing adolescents' athletic self-concept may increase the number of adults who are physically active. Preventive efforts to reduce tobacco consumption, obesity, and depression in adolescence may also contribute to an increase in adult LTPA., (PsycINFO Database Record (c) 2013 APA, all rights reserved.)

Background: There is limited information about psychological predictors of cosmetic surgery and how cosmetic surgery influences subsequent changes in mental health and overall appearance satisfaction. To date, there is a lack of studies examining this issue, whereby representative population samples are assessed at an age before cosmetic surgery is typically conducted and followed up after such surgery has commonly been performed., Method: We obtained data from a survey study following 1597 adolescent females from a representative Norwegian sample over a 13-year period. Participants provided information on cosmetic surgery, appearance satisfaction, mental health, risky sexual behavior, drug use and conduct problems at two time-points (overall response rate 67%)., Results: Of all participants, 78 (4.9%) reported having undergone cosmetic surgery, of whom 71 were operated on during the course of the study and seven before the first data collection. Symptoms of depression and anxiety [odds ratio (OR) 1.66, 95% confidence interval (CI) 1.07-2.57] and a history of deliberate self-harm (OR 2.88, 95% CI 1.46-5.68), parasuicide (OR 3.29, 95% CI 1.53-7.08) and illicit drug use (OR 2.46, 95% CI 1.07-5.82) predicted prospective cosmetic surgery. Moreover, those who underwent surgery during the course of the study experienced a greater increase than other females in symptoms of depression and anxiety (t=2.07, p=0.04) and eating problems (t=2.71, p<0.01). Patients' use of alcohol also increased more than among non-patients (t=2.47, p=0.01)., Conclusions: A series of mental health symptoms predict cosmetic surgery. Cosmetic surgery does not in turn seem to alleviate such mental health problems.

The Edmonton Symptom Assessment System (ESAS) is a well-known self-reporting tool for symptom assessment in palliative care. Research has shown that patients experience difficulties in the scoring and interpretation, which may lead to suboptimal treatment. The aims were to examine how palliative care cancer patients interpreted and responded to the ESAS. Eleven patients (3 F/8 M), median age 65 (34-95) with mixed diagnoses were interviewed by means of cognitive interviewing, immediately after having completed the ESAS. The highest mean scores were found with tiredness (6.3) and oral dryness (5.7). The results showed that sources of error were related to interpretation of symptoms and differences in the understanding and use of the response format. The depression and anxiety symptoms were perceived as difficult to interpret, while the appetite item was particularly prone to misunderstandings. Contextual factors, such as mood and time of the day, influenced the answers. Lack of information and feedback from staff influenced the scores. Some patients stated that they scored at random because they did not understand why and how the ESAS was used. The patients' interpretation must be considered in order to minimize errors. The ESAS should always be reviewed with the patients after completion to improve symptom management, thereby strengthening the usability of the ESAS.

Background: Most studies examining psychosocial changes after cosmetic surgery have short follow-up periods and therefore provide limited information about long-term effects of such surgery. Moreover, studies that identify whether preexisting patient characteristics are associated with poor psychosocial outcomes after cosmetic surgery are lacking. The current study provides information about both of these issues., Methods: Questionnaire data from 130 female Norwegian cosmetic surgery patients were obtained before and 5 years after surgery. The questionnaire consisted of measures on appearance satisfaction, self-esteem, psychological problems, and patients' evaluation of the outcome of surgery. Data from a representative sample of 838 Norwegian women, aged 22 to 55 years, were used for comparison purposes., Results: Analyses revealed an improvement in both general appearance satisfaction and satisfaction with the body part operated on 5 years after surgery. A small increase in self-esteem was observed as well. High rates of preoperative psychological problems and low self-esteem were related to more negative changes in some of the psychosocial measures after surgery compared with patients with better psychological health. Furthermore, factors associated with the actual decision to undergo surgery were related to changes in psychological health and patients' evaluation of the outcome of surgery., Conclusions: This study indicates that cosmetic surgery has positive long-term effects on appearance-related variables. However, surgeons should be particularly aware of patients with psychological problems, as these may compromise patient satisfaction with the effects of cosmetic surgery. Factors affecting the decision itself to undergo cosmetic surgery may also be relevant for subsequent psychosocial outcomes., Clinical Question/level of Evidence: Therapeutic, II.

This study examined the temporal relationship between body evaluation and coital onset. In a population-based longitudinal study, 1449 Norwegian girls and boys between 12 and 15 years of age were followed at 4 waves over a span of 13 years. Body evaluation was used in order to predict coital onset besides romantic appeal and psychological problems. For girls early in adolescence, body evaluation did not influence the probability of coital onset during the first 2-year period. In the subsequent 5-year period, body dissatisfaction increased the probability for coital onset when romantic appeal was held constant. Body evaluation did not influence the odds of coital onset among boys. The findings imply that the pattern of association between body evaluation and coital onset differs according to the timing of coital onset for girls. Future research needs to distinguish body image from romantic appeal in relation to first time sexual experiences., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

This study investigated the role of friendships and social acceptance in self-perceptions of appearance and depressive symptoms, comparing adolescents with and without a facial difference. Adolescents with a visible cleft (n=196) were compared with adolescents with a non-visible cleft (n=93), and with a comparison group (n=1832). Boys with a visible difference reported significantly more positive perceptions of friendships and less depressive symptoms than the comparison group. These results were interpreted in the context of indicators of emotional resilience. The objective measure of facial difference did not explain levels of depressive symptoms, while subjective measures did. Subjective ratings of appearance mediated the association between social acceptance and depressive symptoms in all samples. Gender did not contribute in explaining the paths between friendships, appearance, and depressive symptoms. The associations between perceptions of social acceptance, appearance, and emotional distress, support the possible utility of strengthening social experiences in preventing and treating appearance-concerns., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Background: This study aims to investigate whether cosmetic surgery has an effect on an individual's body image, general self-esteem, and psychological problems. Further tests were conducted to assess whether the extent of psychological problems before surgery influenced improvements in postoperative psychological outcomes., Methods: Questionnaire data from 155 female cosmetic surgery patients from a plastic surgery clinic were obtained before and approximately 6 months after surgery. The questionnaire consisted of measures on body image, self-esteem, and psychological problems. Pre- and postoperative values were compared. Pre- and postoperative measures were also compared with the data compiled from a representative sample of 838 Norwegian women, aged 22-55, with no cosmetic surgery experience., Results: No differences in psychological problems between the presurgery patient and comparison samples were found, whereas differences in body image and self-esteem between the sample groups were reported in an earlier publication. Analyses further revealed an improvement in body image (satisfaction with own appearance) after surgery. A significant but rather small effect on self-esteem was also found, whereas the level of psychological problems did not change after surgery. Postoperative measures of appearance satisfaction, self-esteem, and psychological problems did not differ from values derived from the comparison sample. Finally, few psychological problems before surgery predicted a greater improvement in appearance satisfaction and self-esteem after surgery., Conclusions: The study provides evidence of improvement in satisfaction with own appearance after cosmetic surgery, a variable that is thought to play a central role in understanding the psychology of cosmetic surgery patients. The study also points to the factors that surgeons should be aware of, particularly the role of psychological problems, which could inhibit the positive effects of cosmetic surgery.

This study investigates how personality traits in combination with frequency of and emotional reaction to negative comments about appearance while growing up are related to appearance evaluation and orientation among adult women. Nine hundred and seven participants from a representative sample of Norwegian women aged 22-55, answered questions measuring body image, personality (Big Five), and history of experiencing negative comments about appearance. Results indicated that only emotional reaction to negative comments about appearance significantly predicted both appearance evaluation and orientation, while frequency of negative comments did not. Being extrovert predicted more positive appearance evaluation and being more appearance oriented than being introvert. Scoring high on neuroticism was related to negative appearance evaluation and high appearance orientation. The findings demonstrate the importance of differentiating between the frequency and the emotional impact of teasing as well as including personality traits when studying body image.

Background: The present study investigates psychological factors expected to predict the motivation to undergo cosmetic surgery. It is hypothesized that body image, self-esteem, teasing history, acceptance of cosmetic surgery in the individual's environment, and self-monitoring relate to motivation to have cosmetic surgery., Methods: Questionnaire data were obtained from 907 participants who responded to a survey distributed to a representative sample of Norwegian women aged 22 to 55 years. A second sample of 195 female prospective cosmetic surgery patients was recruited from a plastic surgery clinic. Measures of the hypothesized predictor variables were obtained from both samples. Surgery motivation was operationalized in two different ways. First, the women in the first sample were asked to indicate whether they wished to undergo cosmetic surgery, such that women who wished to have surgery could be compared with those who did not. Second, prospective patients were compared with women from the first sample who indicated that they did not wish to have cosmetic surgery., Results: Analyses revealed all predictor variables but self-esteem to be related to either the wish or the decision to undergo surgery, or to both. Social acceptance of cosmetic surgery and body image were the strongest predictors of cosmetic surgery motivation., Conclusions: The study gives new insights into psychological factors predicting cosmetic surgery motivation. Furthermore, the influence of social factors on cosmetic surgery motivation is emphasized, and it is suggested that these factors be included in future research designs.

Background: There are few data on the frequency of cosmetic surgery among Norwegian women., Material and Methods: A random sample of 2000 Norwegian women aged 22 to 55 received a questionnaire on cosmetic surgery, demographic data, self-esteem, and to what extent people around them accepted cosmetic surgery., Results: The response rate was 46% (907 women). Of these, 7.7% indicated that they had undergone cosmetic surgery, while 22.6% wished to do so. Other people's degree of acceptance predicted both the wish to undergo cosmetic surgery and already conducted surgery. Low self-esteem was correlated with a wish to undergo surgery, though women who had done surgery had no lower self-esteem than non-patients., Interpretations: Although the response rate was relatively low, this study gives the first reliable data on the frequency of cosmetic surgery in Norway. The results indicate that other people's degree of acceptance of cosmetic surgery is a predictor of such surgery being chosen.

The purpose of this paper is to study alcohol consumption among Norwegian adolescents at their most recent experience of sexual intercourse. The material comprises a stratified sample of 920 adolescents aged 16-20 years in a Norwegian county (52.3% of the girls and 41.4% of the boys had coital experience). Data were collected by means of questionnaires; 21.0% of the adolescents reported sex under influence of alcohol. A logistic regression analysis showed that the best predictors of sex under influence of alcohol were intercourse location, sexual enjoyment and sexual intercourse motivated by "Don't know, it just turned out that way". Adolescents who had their most recent experience of intercourse away from home, who had problems enjoying sex and/or who said it just turned out that way, were more likely than others to have had sex under influence of alcohol. A multivariate logistic regression analysis showed that among adolescents who reported that the intercourse took place away from their homes, the odds ratio (OR) for sex under influence of alcohol increased by 8.7. Those who had consumed alcohol before sex, more often than non-drinkers, tended to enter into sexual intercourse motivated by factors external to their own person. This tendency was more pronounced among boys than girls.

The impact of gender differences in sexual socialization on early sexual experiences among Norwegian adolescents is discussed. The material comprises a stratified sample of 920 adolescents ages 16-20 years in a Norwegian county. Data were collected by means of questionnaires. Of the respondents, 55.5% were girls and 44.5% were boys. 52.3% of girls and 41.4% of the boys had coital experience. The most common reasons for having had the first sexual intercourse were being in love, curiosity or excitement, and sexual arousal. Findings from a discriminant analysis showed that emotional reasons were more important to girls, whereas boys seemed more practical in sexual matters. More boys than girls reported that the reason for having had their most recent intercourse was that the partner wanted it. This indicates that if girls do not want sex, boys seldom use pressure. Girls set the premises for sexual interaction but are not as sexually skilled as boys.

A school-based sex education program was developed in order to prevent sexually transmitted diseases and unwanted pregnancies. A Solomon four-group design, with random assignment to the different conditions, was used to evaluate an intervention based on cognitive social learning theory and social influence theory. The main goal of the intervention was to increase use of condoms. A stratified sample of 124 classes (2,411 students) was drawn at random from all the upper secondary schools (high schools/colleges) in one county in Norway. The results indicate a consistent interaction between pretest and intervention, which seems to have an effect on condom use. Pretest or intervention alone did not contribute to this effect. The interaction effect appeared among the students with few sexual partners. Several possible explanations to the observed interaction effect and the implication for future interventions are discussed.

Gender and birth cohort differences and the influence of social background variables on the coital debut age were investigated in the general population of Norway. The data derive from a 1987 questionnaire on sexual behavior mailed to a random sample of 10,000 Norwegians of both sexes, ages 18 through 60; 63% responded to the questionnaire. 94.5% reported that they had experienced intercourse. The median coital debut age was 18.2 years. There were both cohort and gender differences. Younger cohorts have lower coital debut ages, and women younger than 35 years experienced their first intercourse at an earlier age than men in the same age group. When each independent variable was analyzed separately, there were substantial differences between educational levels and social classes with respect to age of coital debut. Multivariate analysis of six separate cohorts revealed independent effects of gender in the two youngest cohorts, whereas educational level had significant independent effects in all but the oldest cohort. Social class did not reveal any independent effect on coital debut age. Population density of the place of residence of the respondents was not substantially related to age of coital debut. Seen together, the independent variables explain about 13% of the variance in coital debut age (by multiple regression).

In a questionnaire survey on sexual behaviour, a random sample of 10,000 Norwegians aged 18 through 60 were asked about use of condoms during their last intercourse. The response rate was 62.7%. Except as regards level of education, the response group was fairly representative of the population with respect to socio-demographic variables. About 12% reported use of condom. Among subjects who reported extra-marital partners, about 7% used condoms (both with their permanent and their extra-marital partner), whereas about 12% of subjects who did not have extramarital sex used condoms. 15% of the single persons reported use of condom. Apparently, the use of condoms is not related to sexual behaviour correlated with risk of HIV-infection, such as the number of partners and knowledge about the partner. Neither is perceived risk, as measured by HIV-testing behaviour, related to the use of condoms.