Quality of Life Research

, Volume 25, Issue 2, pp 401–408 | Cite as

Quality of life in women with lipoedema: a contextual behavioral approach

  • Joanna E. Dudek
  • Wojciech Białaszek
  • Paweł Ostaszewski



Lipoedema is a chronic, progressive adipose disorder of unknown etiology, often underdiagnosed or misdiagnosed as obesity. It manifests itself with accumulation of the fat in lower parts of the body and associated edema and, due to numerous physical and psychological consequences, affects the quality of life (QOL) of those who suffer. The aim of this study was to investigate the psychological factors that might have an impact on the QOL of women with lipoedema from the contextual behavioral viewpoint.


In an Internet-based cross-sectional study, women suffering from lipoedema (N = 120) were asked to fill in questionnaires assessing: symptom severity, QOL (WHOQOL-BREF), satisfaction with life (SWLS), psychological flexibility (Acceptance and Action Questionnaire-II), social connectedness (Social Connectedness Scale-Revised) and other psychological factors. The majority of participants were from the USA, the UK, and Australia.


Multiple hierarchical regression analyses showed that a higher level of QOL was predicted by higher levels of psychological flexibility and social connectedness, while controlling for symptom severity. Higher level of SWL was predicted only by higher level of social connectedness.


Acceptance and Commitment Therapy with psychological flexibility as the target of change and Functional Analytic Psychotherapy with social connectedness as the target of change might be useful in treating women with lipoedema; however, further research in this area is needed. The authors conclude that psychological and biomedical interventions for women with lipoedema and their QOL merit more attention from researchers and the medical community than is currently received.


Lipoedema Quality of life Acceptance and Commitment Therapy (ACT) Functional Analytic Psychotherapy (FAP) Psychological flexibility Social connectedness 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study has been approved by the relevant research ethics committee.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Langendoen, S. I., Habbema, L., Nijsten, T. E. C., & Neumann, H. A. M. (2009). Lipoedema: From clinical presentation to therapy. A review of the literature. British Journal of Dermatology, 161(5), 980–986.CrossRefPubMedGoogle Scholar
  2. 2.
    Herbst, K. L. (2012). Rare adipose disorders (RADs) masquerading as obesity. Acta Pharmacologica Sinica, 33(2), 155–172.PubMedCentralCrossRefPubMedGoogle Scholar
  3. 3.
    Földi, M., & Földi, E. (2006). Földi’s textbook of lymphology: For physicians and lymphedema therapists (2nd ed.). Munich: Elsevier.Google Scholar
  4. 4.
    Bosman, J. (2011). Lipedema: Poor knowledge, neglect or disinterest? Journal of Lymphoedema, 6(2), 109.Google Scholar
  5. 5.
    Fife, C. E., Maus, E. A., & Carter, M. J. (2010). Lipedema: A frequently misdiagnosed and misunderstood fatty deposition syndrome. Advances in Skin & Wound Care, 23(2), 81–92.CrossRefGoogle Scholar
  6. 6.
    Seo, C. A. (2014). You mean it’s not my fault: Learning about lipedema, a fat disorder. Narrative Inquiry in Bioethics, 4(2), E6–E9.CrossRefPubMedGoogle Scholar
  7. 7.
    Hayes, S. C., Barnes-Holmes, D., & Wilson, K. G. (2012). Contextual behavioral science: Creating a science more adequate to the challenge of the human condition. Journal of Contextual Behavioral Science, 1, 1–16.CrossRefGoogle Scholar
  8. 8.
    Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and Commitment Therapy: The process and practice of mindful change (2nd ed.). New York: The Guilford Press.Google Scholar
  9. 9.
    Tsai, M., Kohlenberg, R. J., Kanter, J. W., Kohlenberg, B., Follette, W. C., & Callaghan, G. M. (2008). A guide to Functional Analytic Psychotherapy: Awareness, courage, love, and behaviorism. New York: Springer Science & Business Media.Google Scholar
  10. 10.
    Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., et al. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676–688.CrossRefPubMedGoogle Scholar
  11. 11.
    Kashdan, T. B., & Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30(7), 865–878.PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Lundgren, T., Dahl, J., & Hayes, S. C. (2008). Evaluation of mediators of change in the treatment of epilepsy with Acceptance and Commitment Therapy. Journal of Behavioral Medicine, 31(3), 225–235.CrossRefPubMedGoogle Scholar
  13. 13.
    Wicksell, R. K., Kemani, M., Jensen, K., Kosek, E., Kadetoff, D., Sorjonen, K., et al. (2013). Acceptance and Commitment Therapy for fibromyalgia: A randomized controlled trial. European Journal of Pain, 17(4), 599–611.CrossRefPubMedGoogle Scholar
  14. 14.
    Vowles, K. E., & McCracken, L. M. (2008). Acceptance and values-based action in chronic pain: A study of treatment effectiveness and process. Journal of Consulting and Clinical Psychology, 76(3), 397–407.CrossRefPubMedGoogle Scholar
  15. 15.
    Lillis, J., Luoma, J. B., Levin, M. E., & Hayes, S. C. (2010). Measuring weight self-stigma: The Weight Self-stigma Questionnaire. Obesity, 18(5), 971–976.CrossRefPubMedGoogle Scholar
  16. 16.
    Lillis, J., & Kendra, K. E. (2014). Acceptance and Commitment Therapy for weight control: Model, evidence, and future directions. Journal of Contextual Behavioral Science, 3(1), 1–7.PubMedCentralCrossRefPubMedGoogle Scholar
  17. 17.
    Pearson, A. N., Follette, V. M., & Hayes, S. C. (2012). A pilot study of Acceptance and Commitment Therapy as a workshop intervention for body dissatisfaction and disordered eating attitudes. Cognitive and Behavioral Practice, 19(1), 181–197.CrossRefGoogle Scholar
  18. 18.
    Kanter, J. W., Holman, G., Wetterneck, C. T., Tsai, M., & Kohlenberg, R. J. (2014). A new contextual behavioral model for social connection for Functional Analytic Psychotherapy. In Presented at the symposium presented at the Association for Contextual Behavioral Science 12th Annual World Conference, Minneapolis, MN.Google Scholar
  19. 19.
    Reis, H. T., & Shaver, P. R. (1988). Intimacy as an interpersonal process. In S. Duck (Ed.), Handbook of research in personal relationships (pp. 367–389). London: Wiley.Google Scholar
  20. 20.
    Seppala, E., Rossomando, T., & Doty, J. R. (2013). Social connection and compassion: Important predictors of health and well-being. Social Research, 80(2), 411–430.Google Scholar
  21. 21.
    Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7(7), e1000316. doi: 10.1371/journal.pmed.1000316.PubMedCentralCrossRefPubMedGoogle Scholar
  22. 22.
    Mangabeira, V., Kanter, J., & Del Prette, G. (2012). Functional Analytic Psychotherapy (FAP): A review of publications from 1990 to 2010. International Journal of Behavioral Consultation and Therapy, 7(2–3), 78–89.CrossRefGoogle Scholar
  23. 23.
    Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The Satisfaction with Life Scale. Journal of Personality Assessment, 49(1), 71.CrossRefPubMedGoogle Scholar
  24. 24.
    Pavot, W., & Diener, E. (2008). The Satisfaction with Life Scale and the emerging construct of life satisfaction. The Journal of Positive Psychology, 3(2), 137–152.CrossRefGoogle Scholar
  25. 25.
    The WHOQOL Group. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28(3), 551–558.CrossRefGoogle Scholar
  26. 26.
    Skevington, S. M., Lotfy, M., O’Connel, K. A., & WHOQOL Group. (2004). The World Health Organization’s WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A report from the WHOQOL group. Quality of Life Research, 13(2), 299–310.CrossRefPubMedGoogle Scholar
  27. 27.
    Berlim, M. T., Pavanello, D. P., Caldieraro, M. A. K., & Fleck, M. P. (2005). Reliability and validity of the WHOQOL BREF in a sample of Brazilian outpatients with major depression. Quality of Life Research, 14(2), 561–564.CrossRefPubMedGoogle Scholar
  28. 28.
    Gloster, A. T., Klotsche, J., Chaker, S., Hummel, K. V., & Hoyer, J. (2011). Assessing psychological flexibility: What does it add above and beyond existing constructs? Psychological Assessment, 23, 970–982.CrossRefPubMedGoogle Scholar
  29. 29.
    Lee, R. M., Draper, M., & Lee, S. (2001). Social connectedness, dysfunctional interpersonal behaviors, and psychological distress: Testing a mediator model. Journal of Counseling Psychology, 48(3), 310–318.CrossRefGoogle Scholar
  30. 30.
    Raes, F., Pommier, E., Neff, K. D., & Van Gucht, D. (2011). Construction and factorial validation of a short form of the Self-Compassion Scale. Clinical Psychology & Psychotherapy, 18, 250–255.CrossRefGoogle Scholar
  31. 31.
    Sandoz, E. K., Wilson, K. G., Merwin, R. M., & Kellum, K. (2013). Assessment of body image flexibility: The Body Image-Acceptance and Action Questionnaire. Journal of Contextual Behavioral Science, 2(1–2), 39–48.CrossRefGoogle Scholar
  32. 32.
    Evans, C., & Dolan, B. (1993). Body Shape Questionnaire: Derivation of shortened “alternate forms”. International Journal of Eating Disorders, 13(3), 315–321.CrossRefPubMedGoogle Scholar
  33. 33.
    Fairburn, C. G., & Beglin, S. J. (1994). Assessment of eating disorder psychopathology: Interview or self-report questionnaire? International Journal of Eating Disorders, 16, 363–370.PubMedGoogle Scholar
  34. 34.
    Leonard, R. C., Knott, L. E., Lee, E. B., Singh, S., Smith, A. H., Kanter, J., et al. (2014). The development of the Functional Analytic Psychotherapy Intimacy Scale. The Psychological Record, 64(4), 647–657.CrossRefGoogle Scholar
  35. 35.
    McCracken, L. M. (2013). Committed action: An application of the psychological flexibility model to activity patterns in chronic pain. The Journal of Pain, 14(8), 828–835.CrossRefPubMedGoogle Scholar
  36. 36.
    Champey, J., Corruble, E., Gottenberg, J., Buhl, C., Meyer, T., Caudmont, C., et al. (2006). Quality of life and psychological status in patients with primary Sjögren’s syndrome and sicca symptoms without autoimmune features. Arthritis Care & Research, 55(3), 451–457.CrossRefGoogle Scholar
  37. 37.
    Chen, H., Gould, M. K., Blanc, P. D., Miller, D. P., Kamath, T. V., Lee, J. H., & Sullivan, S. D. (2007). Asthma control, severity, and quality of life: Quantifying the effect of uncontrolled disease. Journal of Allergy and Clinical Immunology, 120(2), 396–402.CrossRefPubMedGoogle Scholar
  38. 38.
    Danieli, E., Airò, P., Bettoni, L., Cinquini, M., Antonioli, C. M., Cavazzana, I., et al. (2005). Health-related quality of life measured by the Short Form 36 (SF-36) in systemic sclerosis: Correlations with indexes of disease activity and severity, disability, and depressive symptoms. Clinical Rheumatology, 24(1), 48–54.CrossRefPubMedGoogle Scholar
  39. 39.
    Hahn, B. A., Kirchdoerfer, L. J., Fullerton, S., & Mayer, E. (1997). Patient-perceived severity of irritable bowel syndrome in relation to symptoms, health resource utilization and quality of life. Alimentary Pharmacology & Therapeutics, 11(3), 553–559.CrossRefGoogle Scholar
  40. 40.
    Welch, G., Weinger, K., & Barry, M. J. (2002). Quality-of-life impact of lower urinary tract symptom severity: Results from the health professionals follow-up study. Urology, 59(2), 245–250.CrossRefPubMedGoogle Scholar
  41. 41.
    Belsley, D. (1991). Conditioning diagnostics: Collinearity and weak data in regression. New York: Wiley.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Joanna E. Dudek
    • 1
  • Wojciech Białaszek
    • 1
  • Paweł Ostaszewski
    • 1
  1. 1.University of Social Sciences and HumanitiesWarsawPoland

Personalised recommendations