Evaluation of impact of symptoms of obsession and social physical anxiety on tendency to cosmetic surgery by mediation of negative body image and neurotic defense mechanisms - The Structural Equation Modeling (SEM)


1 Instructor, Department of Psychology, Ardakan University, Ardakan, Iran

2 Professor, Department of Psychology, University of Tabriz, Tabriz, Iran


The aim of this study was to examine the mediation effect of negative body image and neurotic defense mechanisms in the relationship of symptoms of obsession and social physical anxiety with tendency to cosmetic surgery. It' method was causal-correlation descriptive. Samples (200 persons (40 males and 160 females)) were selected with available sampling method among applicants of cosmetic surgery in Yazd. The research instruments were questionnaires such as Yale- Brown Obsessive Compulsive Scale (Y-BOCS), Social Physique Anxiety Scale (SPAS), negative beliefs about appearance, defensive style and scale of acceptance to cosmetic surgery. Analysis method was structural equation modeling (ESM). Results showed that symptoms of Obsession, social physical anxiety, negative body image and neurotic defense mechanisms were related to the tendency to cosmetic surgery; so that, symptoms of obsession indirectly and through negative body image was related to tendency to cosmetic surgery; Also social physical anxiety indirectly and through negative body image and neurotic defense mechanisms was related to tendency to cosmetic surgery. Conceptual model based on structural equation model was fitted in research and comparative fit index (CFI): 0/88, increasing (IFI): 0/88, normed (NFI): 0/80 and the square root of the variance of the error of approximation (RMSEA): 0/07, showed that conceptual model, was fitted favorable.



1. Northrop, J.M. Reflecting on Cosmetic Surgery: Body image, shame and narcissism. USA and Canada, Publisher: Routledge. 2014.

2. Fraser, S. Cosmetic Surgery, Gender and Culture. New York. 2003. N.Y. 10010, PALGRAVE MACMILAN.

3. Mohammadpanah Ardakan, Yaghoubi, H. & Yousefi, R. [The Personality traits and defensive styles in volunteers of Cosmetic Surgery]. Journal Dermatology and Cosmetic 2014, 3(2): 82-72. [In Persian]

4. Davis, K. “Surgical Passing: Or Why Michael Jackson’s Nose Makes us Uneasy”, Feminist Theory 4. 2003.

5. Jones, M.R. & Heyes, C.J. “Cosmetic surgery in the age of gender”, in Cressida J. Heyes & Meredith Jones (Eds), Cosmetic Surgery: A Feminist Primer, Ashgate, England & USA. 2009.

6. Zojaji, R., Javanbakht, M., Ghanadan, A., Hosien, H., & Sadeghi, H. High prevalence of personality abnormalities in patients seeking rhinoplasty. Otolaryngol Head Neck Surgy 2007, 137(1): 83-7.

7. Moheb, N., Hosseininasab, S.D. & Kolahi, P. [A comparative study of personality disorders among volunteers of cosmetic surgery and ordinary people]. Journal of Woman and Family Studies 2010. 1(3): 91-106. [In Persian]
8. Barahmand, U., Mozdsetan, N., Narimani, M. Body dysmorphic traits and personality disorder patterns in rhinoplasty seekers, Asian Journal of Psychiatry 2010, 3: 194-199.

9. Niknam, M., Fararouyi, M., Kamkar, A., Fouladi, N. & Mohammadi, A. [The comparing perfectionism in patients using rhinoplasty with the control group in Yasouj]. Journal of Tehran University of Medical Sciences (Health payavard) 2013, 6(1): 52-60. [In Persian]
10. Khanjani, Z., Babapour, J. & Saba, G. [Evaluation and comparison of the psychological status and body image of cosmetic surgery applicants with Non- applicants]. Journal of Yazd Shahid Sdoughi University of Medical Sciences 2013, 20(2), 237-248. [In Persian]
11. American Psychiatric Association. [Diagnostic and Statistical Manual of Mental Disorders DSM-5]. 2016. Trans: Rezaei, F., Fakhraie, A., Farmand, A., Niloufari, A., Hashemi Azar, J. & Shamloo, F. Tehran: Arjmand. [In Persian]
12. Anari, A., Shafieetabar, M. & Pouretemad, H.R. [Evaluation and Comparison of social anxiety disorders and shyness in addicted and non-addicted men]. Journal of Addiction Research 2012, 5(17): 7-20. [In Persian]

13. Molt, R.W. & Conroy, D.E. "Validity and factorial invariance of the social physique anxiety scale". Medicine and science in sport and exercise 2000, 32: 1007-1017.

14. Peterson, C. "Body Image in Men: Drive for Muscularity and Social Influence, Body Image Evaluation and Investment and Psychological Well Being", University of Saskatche. 2007, 1-195.

15. Mulazimoglu-Balli, O. & et al. An examination of social physique anxiety with regard to sex and level of sport involvement, Journal of Human Kinetics 2010, 26: 115-122.

16. Brehm. B.A. Understanding Social Physique Anxiety .2005. Retrieved 2013, from: http://www.athleticbusiness.com/articles/art.

17. Kaplan H, Sadock B. [Synopsis of psychiatry behavioral sciences/clinical psychiatry]. Trans Rezaei F. Tehran: Arjmand, 2015. [In Persian]

18. Brown, Tessa R. "Does Social Physique Anxiety Affect Women’s Motivation to Exercise." Department of Psychology 2000, 219-224.

19. Nader Mohammadi, M., Assadollahi, E., & Niazfar, M. Ocial Physique Anxiety and its Relation with Body Dysmorphic Disorder, the European Journal of Social and Behavioural Sciences EJSBS 2015, 8: 1736-1746.

20. Tabachnick, B. & Fidell, L.S. Using multivariate statistics. NEWYORK: Happer Collins College. 1996.

21. Kline, R.B. Principles and practice of structural equation modeling (3rd ed). New York: The Guilford press. 2011.

22. Henderson-King, D., & Henderson-King, E. Acceptance of cosmetic surgery: Scaledevelopment and validation. Body Image 2005, 2(2): 137-149.

23. Farshidfar, Z., Dastjerdi, R., Shahabizadeh, F. Acceptance of Cosmetic Surgery: Body Image, Self Esteem and Conformity, Procedia- Social and Behavioral Sciences 2013, 84: 238-242.

24. Veale, D. & Wilson R. [Overcoming Obsessive Compulsive Disorder]. Trans Jamalfar S. Tehran: Arasbaran, 2013. [Persian]

25. Cortese J. Determinants of Social Physique Anxiety in Collegiate Female athletes. Thesis submitted to the Department of Educational Psychology and Learning Systems in partial fulfillment of the requirements for the degree of Master of Science, Florida State University. 2008.

26. Spangler DL, Stice E. Validation of the Beliefs about Appearance Scale. Cognitive Therapy and Research 2001, 25: 813-27.

27.  Mohammadpanah A, Yousefi R. [Assessment of beliefs about appearance and inferiority feeling in cosmetic surgery candidates]. Dermatology and Cosmetic 2011; 2: 85-97. [In Persian]

28. Sinha, B.K; Watson, D.C. Personality disorder clusters and the defense style questionnaire. Psychology and psychotherapy 2004, 77: 55-66.

29. Fathi Ashtiani, A. & Dastani, M. [Psychological tests: Evaluation of personality and mental health]. Tehran: Beast. 2016. [In Persian]

30. Hayashi M.I., Miyake Y., Minakawa K. Reliability and validity of the Japanese edition of the Defense Style Questionnaire 40. Psychiatry Clin Neurosci 2004, 58(2):152-156.

31. Featherstone, M. Body Modification, London: Sage. 2000.

32. Pitts, V. In the Flesh: The Cultural Politics of Body Modification, New York:Palgrave Macmillan. 2003.

33. Clark, D.A. Cognitive- behavioral therapy for OCD. New York, the Guilford Press. 2004.

34. Etu S.F. & Gray J.J. A preliminary investigation of the relationship between induced rumination and state body image dissatisfaction and anxiety. Body Image 2010, 7:82-5.

35. Tavakoli, S. & Ghasemzadeh, H. [Theories and cognitive - behavioral treatment of OCD]. Journal of Advances in Cognitive Science 2007, 8(1), 54-76. [In Persian]

36. Lee, H.J. & Kown, S.M. Two different types of obsessions: Autogenous obsessions and reactive obsessions. Behavior research and therapy 2003, 41, 11-29.

37. Haase, A.M., Prapavessis H., Owens, R.G. Perfectionism, social physique anxiety and disordered eating: A comparison of elite male and female athletes. Psychol Sport Exerc 2002; 3(4): 209-222.

38. Valizadeh, A. & Ariapour, S. The role of social physical anxiety, body image and self-esteem to predict eating disorders in female athletes, Journal of Research in Medical Sciences 2012, 14(1), 56-60. [In Persian]
39. Tuschen-Caffier B, Kuhl, S. & Bender G. Cognitive-evaluative features of childhood social anxiety in a performance task. Behav Ther Exp Psychiatr 2011. 42, 233-239.

40. Cache, T. [Guide of body image]. trans of Rayegan, N. Tehran: Danzheh. 2012. [In Persian]