The Relationship Between Early Maladaptive Schema Domains and Body Image Concern: The Mediating Role of Self-Esteem Among Women Seeking Cosmetic Surgery in Tehran
Keywords:
body image concern, cosmetic surgery, Early maladaptive schemas, esteem, selfAbstract
Introduction and Aim: Body image concern among women seeking cosmetic surgery may be associated with deep cognitive structures, negative self-evaluation, and dependence on external approval. This study aimed to determine the relationships between early maladaptive schema domains and body image concern, with self-esteem as a mediator, among women seeking cosmetic surgery in Tehran.
Methodology: This descriptive-correlational study was conducted using structural equation modeling. The statistical population included all women seeking cosmetic surgery who attended cosmetic surgery clinics in Tehran during the autumn and winter of 2025–2026, from whom 540 participants were selected through convenience sampling. Data were collected using the Body Image Concern Inventory, the Young Schema Questionnaire–Short Form, Third Edition, and the Rosenberg Self-Esteem Scale. The five schema domains of disconnection and rejection, impaired autonomy and performance, impaired limits, other-directedness, and overvigilance and inhibition were entered separately into the model. Data were analyzed using Pearson correlation coefficients, confirmatory factor analysis, structural equation modeling, and bootstrapping with 5,000 resamples.
Findings: The results showed that all five early maladaptive schema domains were positively and significantly associated with body image concern and negatively and significantly associated with self-esteem. Self-esteem also negatively and significantly predicted body image concern. The structural model demonstrated acceptable fit, with a chi-square to degrees-of-freedom ratio of 2.343, a comparative fit index of 0.946, an incremental fit index of 0.947, a root mean square error of approximation of 0.050, and a standardized root mean square residual of 0.047. Bootstrap analysis indicated that self-esteem had a significant partial mediating role in the relationships between all five schema domains and body image concern. The schema domains collectively explained 42.1% of the variance in self-esteem, while the schema domains together with self-esteem explained 63.2% of the variance in body image concern.
Conclusion: Early maladaptive schema domains may increase body image concern both directly and indirectly through reduced self-esteem among women seeking cosmetic surgery. Therefore, preoperative psychological screening and interventions aimed at modifying maladaptive schemas and strengthening self-esteem may help reduce excessive appearance concerns and improve decision-making among cosmetic surgery applicants.
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Copyright (c) 2025 Nafiseh Yousefi, Ahmad Ghazanfari, Fariba Kiani (Author)
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