Body image victimization experiences and appearance anxiety in cosmetic surgery: the serial mediating roles of body image shame and body compassion

BACKGROUND: The growing popularity of cosmetic surgery over the past two decades reflects increasing concern with physical appearance. However, many individuals do not experience the expected psychological benefits following cosmetic procedures. body image victimization experiences, particularly those involving peers or caregivers, may play a critical role in shaping body-related shame and appearance anxiety later in life. OBJECTIVES: This study aimed to investigate the relationship between body image victimization experiences and appearance anxiety among individuals seeking cosmetic surgery, with a focus on the serial mediating roles of body image shame and body compassion. METHODS: A total of 409 patients attending cosmetic surgery clinics in Tehran were recruited through convenience sampling. Participants completed standardized self-report measures assessing appearance anxiety, body image victimization experiences, body image shame, and body compassion. Data were analyzed using IBM SPSS Statistics version 24. Simple and serial mediation models were tested using bootstrapping procedures, with age and gender entered simultaneously as covariates in all analyses. RESULTS: Body image victimization experiences were positively associated with appearance anxiety. Body image shame was positively associated with appearance anxiety, whereas body compassion was negatively associated with appearance anxiety. Mediation analyses indicated that body image shame and body compassion were statistically associated with the relationship between body image victimization experiences and appearance anxiety within the tested models. These associations remained significant after controlling for age and gender. CONCLUSIONS: The findings are consistent with theoretical models suggesting that body image shame and body compassion may be relevant psychological correlates of appearance anxiety among individuals seeking cosmetic procedures. However, given the cross-sectional design, causal inferences cannot be drawn. Longitudinal and experimental studies are needed to clarify the temporal ordering of these variables and to determine their potential relevance for future interventions.