Original Study Body Perception, Self-Esteem, and Comorbid Psychiatric Disorders in Adolescents Diagnosed with Polycystic Ovary Syndrome Seda Ayb € uke Sari MD 1, *, Nurullah Celik MD 2 , Ayla Uzun Cicek MD 1 1 Department of Child and Adolescent Psychiatry, Cumhuriyet University, Faculty of Medicine, Sivas, Turkey 2 Department of Pediatric Endocrinology, Cumhuriyet University, Faculty of Medicine, Sivas, Turkey abstract Study Objective: To investigate adolescents with polycystic ovary syndrome (PCOS) in terms of body perception, self-esteem, and comorbid psychiatric diseases by comparing them with their healthy peers. Design: Cross-sectional design. Setting: The Department of Child and Adolescent Psychiatry and the Department of Pediatric Endocrinology outpatient clinic of Cumhuriyet University in Sivas, Turkey. Participants: Fifty female adolescents aged 12-18 years who were diagnosed as having PCOS and 37 healthyadolescents aged 12-18 years. Interventions and Main Outcome Measures: All adolescents were evaluated by a child and adolescent psychiatrist using a semistructured interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children) and asked to complete the Rosenberg Self-Esteem Scale, Children's Depression Inventory, and Body Image Scale. Results: The rate of psychiatric disorders in the PCOS group was significantly higher than in the control participants (16/50 (32%) vs 5/37 (13.5%), respectively; P 5 .046). The most common disorder was major depressive disorder. The Rosenberg Self-Esteem Scale and Body Image Scale scores of the PCOS group were lower (P 5 .03; P ! .001, respectively), and Children's Depression Inventory scores were higher (P 5 .03) than in the control group. There was no significant relationship between obesity, hirsutism, and insulin resistance with any psychiatric disorders in the PCOS group. Conclusion: Adolescents with PCOS had more psychopathology than their peers. Moreover, their self-esteem was lower and their body perceptions were more dissatisfied compared with their peers. Key Words: Polycystic ovary syndrome, Body perception, Self-esteem, Psychopathology, Adolescent Introduction Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrinopathies in adolescent girls. 1 The true incidence of PCOS in adolescents is still uncertain, but it was estimated as 1.14% in a study conducted with adolescent girls aged 15-19 years. 2 Generally, adolescents with evi- dence of oligo-ovulation and with clinical and/or biochemical hyperandrogenemia are diagnosed with PCOS. 3e7 Other hyperandrogenemia-related conditions such as hyperprolactinemia, Cushing syndrome, nonclassic congenital adrenal hyperplasia, hypothyroidism, and androgen-producing tumors should be excluded for the diagnosis. 3,4 Individuals with PCOS have several metabolic derangements including obesity, dyslipidemia, glucose intolerance, and cardiovascular disorders. 8 The relationship between PCOS and psychiatric disorders in adults has been investigated in several studies. It has been reported that individuals with PCOS have more anxi- ety disorder and major depressive disorder than control partipants. 9e11 The underlying mechanism remains uncer- tain, although it was shown that there could be a relation- ship between insulin resistance and depression. 12 It was also indicated that weight gain and obesity led to depres- sion in young women with PCOS, 13 and the symptoms accompanying PCOS such as acne, hirsutism, menstrual ir- regularity, and subfertility could cause psychiatric disorders. 14 The literature is rich in studies on psychiatric disorders in adults with PCOS, 9e11,15,16 but fewer studies have been performed for adolescents. 17e19 These studies reported that depression and anxiety were more common in girls with PCOS in comparison with their healthy peers. 17e19 To the best of our knowledge, no studies have evaluated self- esteem, body perception, and psychiatric disorders together in adolescents with PCOS. In this study, we aimed to examine adolescents with PCOS from a psychiatric point of view and to compare them with their healthy peers in terms of body perception, self- esteem, and comorbid psychiatric disorders. Materials and Methods Fifty adolescent girls aged 12-18 years who were admitted to Cumhuriyet University Medical Faculty The authors indicate no conflicts of interest. * Address correspondence to: Seda Ayb€ uke Sari, MD, Department of Child and Adolescent Psychiatry, Sivas Cumhuriyet University School of Medicine, Imaret Village, 58140, Central Sivas, Turkey; Phone þ903462581172 E-mail address: aybuke_sari@hotmail.com (S.A. Sari). 1083-3188/$ - see front matter Ó 2020 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. https://doi.org/10.1016/j.jpag.2020.08.018