Iranian Journal of Psychiatry and Behavioral Sciences

Published by: Kowsar

Dynamic Infrastructures of Body Dysmorphic Disorder Symptoms: A Structural Equation Model

Maryam Sadighpour 1 , Abbas Ramezani Farani 2 , * , Banafsheh Gharraee 2 and Mozhgan Lotfi 3
Authors Information
1 Student Research Committee, School of Behavioral Sciences and Mental Health, Tehran Institide of Psychiatry, Iran University of Medical Siences, Tehran, Iran
2 Clinical Psychology Department, School of Behavioral Sciences and Mental Health, Tehran Institide of Psychiatry, Iran University of Medical Siences, Tehran, Iran
3 Mental Health Department, School of Behavioral Sciences and Mental Health, Tehran Institide of Psychiatry, Iran University of Medical Siences, Tehran, Iran
Article information
  • Iranian Journal of Psychiatry and Behavioral Sciences: March 31, 2019, 13 (1); e61508
  • Published Online: April 6, 2019
  • Article Type: Original Article
  • Received: September 9, 2017
  • Revised: May 27, 2018
  • Accepted: March 2, 2019
  • DOI: 10.5812/ijpbs.61508

To Cite: Sadighpour M, Ramezani Farani A, Gharraee B, Lotfi M. Dynamic Infrastructures of Body Dysmorphic Disorder Symptoms: A Structural Equation Model, Iran J Psychiatry Behav Sci. 2019 ; 13(1):e61508. doi: 10.5812/ijpbs.61508.

Copyright © 2019, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Background
2. Objectives
3. Materials and Methods
4. Results
5. Discussion
  • 1. Veale D. Body dysmorphic disorder. Postgrad Med J. 2004;80(940):67-71. [PubMed: 14970291]. [PubMed Central: PMC1742928].
  • 2. Phillips KA. The broken mirror: Understanding and treating body dysmorphic disorder. New York: Oxford University Press; 1996.
  • 3. Feusner JD, Yaryura-Tobias J, Saxena S. The pathophysiology of body dysmorphic disorder. Body Image. 2008;5(1):3-12. doi: 10.1016/j.bodyim.2007.11.002. [PubMed: 18314401]. [PubMed Central: PMC3836287].
  • 4. Didie ER, Kuniega-Pietrzak T, Phillips KA. Body image in patients with body dysmorphic disorder: Evaluations of and investment in appearance, health/illness, and fitness. Body Image. 2010;7(1):66-9. doi: 10.1016/j.bodyim.2009.09.007. [PubMed: 19942488].
  • 5. Hrabosky JI, Cash TF, Veale D, Neziroglu F, Soll EA, Garner DM, et al. Multidimensional body image comparisons among patients with eating disorders, body dysmorphic disorder, and clinical controls: A multisite study. Body Image. 2009;6(3):155-63. doi: 10.1016/j.bodyim.2009.03.001. [PubMed: 19410528].
  • 6. Thompson JK, Coovert MD, Stormer SM. Body image, social comparison, and eating disturbance: A covariance structure modeling investigation. Int J Eat Disord. 1999;26(1):43-51. [PubMed: 10349583].
  • 7. Rodgers RF, Paxton SJ, McLean SA. A biopsychosocial model of body image concerns and disordered eating in early adolescent girls. J Youth Adolesc. 2014;43(5):814-23. doi: 10.1007/s10964-013-0013-7. [PubMed: 24014348].
  • 8. Cattarin JA, Thompson JK, Thomas C, Williams R. Body image, mood, and televised images of attractiveness: The role of social comparison. J Soc Clin Psychol. 2000;19(2):220-39. doi: 10.1521/jscp.2000.19.2.220.
  • 9. van den Berg P, Paxton SJ, Keery H, Wall M, Guo J, Neumark-Sztainer D. Body dissatisfaction and body comparison with media images in males and females. Body Image. 2007;4(3):257-68. doi: 10.1016/j.bodyim.2007.04.003. [PubMed: 18089272].
  • 10. Thompson JK, Stice E. Thin-ideal internalization: Mounting evidence for a new risk factor for body-image disturbance and eating pathology. Curr Dir Psychol Sci. 2016;10(5):181-3. doi: 10.1111/1467-8721.00144.
  • 11. Vartanian LR, Froreich FV, Smyth JM. A serial mediation model testing early adversity, self-concept clarity, and thin-ideal internalization as predictors of body dissatisfaction. Body Image. 2016;19:98-103. doi: 10.1016/j.bodyim.2016.08.013. [PubMed: 27643889].
  • 12. Fingeret MC, Gleaves DH. Sociocultural, feminist, and psychological influences on women's body satisfaction: A structural modeling analysis. Psychol Women Quart. 2016;28(4):370-80. doi: 10.1111/j.1471-6402.2004.00154.x.
  • 13. Shin K, You S, Kim E. Sociocultural pressure, internalization, BMI, exercise, and body dissatisfaction in Korean female college students. J Health Psychol. 2017;22(13):1712-20. doi: 10.1177/1359105316634450. [PubMed: 26936503].
  • 14. Durkin SJ, Paxton SJ, Sorbello M. An integrative model of the impact of exposure to idealized female images on adolescent girls? Body satisfaction. J Appl Soc Psychol. 2007;37(5):1092-117. doi: 10.1111/j.1559-1816.2007.00201.x.
  • 15. Cash TF. Cognitive-behavioral perspectives on body image. In: Cash TF, Pruzinsky T, editors. Body image: A handbook of theory, research and clinical practice. New York: Guilford Press; 2002. p. 38-46.
  • 16. Boone L, Soenens B, Braet C. Perfectionism, body dissatisfaction, and bulimic symptoms: The intervening role of perceived pressure to be thin and thin ideal internalization. J Soc Clin Psychol. 2011;30(10):1043-68. doi: 10.1521/jscp.2011.30.10.1043.
  • 17. Keltner D, Capps L, Kring AM, Young RC, Heerey EA. Just teasing: A conceptual analysis and empirical review. Psychol Bull. 2001;127(2):229-48. [PubMed: 11316012].
  • 18. Helfert S, Warschburger P. A prospective study on the impact of peer and parental pressure on body dissatisfaction in adolescent girls and boys. Body Image. 2011;8(2):101-9. doi: 10.1016/j.bodyim.2011.01.004. [PubMed: 21354379].
  • 19. Blowers LC, Loxton NJ, Grady-Flesser M, Occhipinti S, Dawe S. The relationship between sociocultural pressure to be thin and body dissatisfaction in preadolescent girls. Eat Behav. 2003;4(3):229-44. doi: 10.1016/S1471-0153(03)00018-7. [PubMed: 15000967].
  • 20. Francisco R, Espinoza P, Gonzalez ML, Penelo E, Mora M, Roses R, et al. Body dissatisfaction and disordered eating among Portuguese and Spanish adolescents: The role of individual characteristics and internalisation of sociocultural ideals. J Adolesc. 2015;41:7-16. doi: 10.1016/j.adolescence.2015.02.004. [PubMed: 25754193].
  • 21. Phillips KA, Hart AS, Menard W. Psychometric evaluation of the Yale-Brown obsessive-compulsive scale modified for body dysmorphic disorder (BDD-YBOCS). J Clin Psychiatry. 2001;62(2):87-91. [PubMed: 11247107]. [PubMed Central: PMC4096700].
  • 22. Rabiee M, Khorramdel K, Kalantari M, Molavi H. [Factor structure, validity and reliability of modified Yale-Brown obsessive compulsive scale for body dysmorphic disorder in students]. Iran J Psych Clin Psychol. 2010;5(4):343-50. Persian.
  • 23. Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, et al. The Yale-Brown obsessive compulsive scale. I. Development, use, and reliability. Arch Gen Psychiatry. 1989;46(11):1006-11. [PubMed: 2684084].
  • 24. Marques L, LeBlanc N, Weingarden H, Greenberg JL, Traeger LN, Keshaviah A, et al. Body dysmorphic symptoms: Phenomenology and ethnicity. Body Image. 2011;8(2):163-7. doi: 10.1016/j.bodyim.2010.12.006. [PubMed: 21354876].
  • 25. Cash TF. Body image assessments: MBSRQ. 2012, [updated 2017]. Available from:
  • 26. Argyrides M, Kkeli N. Multidimensional body-self relations questionnaire-appearance scales: Psychometric properties of the Greek version. Psychol Rep. 2013;113(3):885-97. doi: 10.2466/03.07.PR0.113x29z6. [PubMed: 24693817].
  • 27. Sadeghi KH, Gharraee B, Fata L, Mazhari S. [Effectiveness of cognitive-behavioral therapy in treating patients with obesity]. Iran J Psych Clin Psychol. 2010;16(2):107-17. Persian.
  • 28. Rosenberg M. Rosenberg self-esteem scale (SES). 2014, [updated 2017]. Available from:
  • 29. Mohammadi N. [The preliminary study of validity and reliability of rosenberg's self-esteem scale]. J Iran Psychol. 2005;1(4). Persian.
  • 30. Hewitt PL, Flett GL. Perfectionism in the self and social contexts: Conceptualization, assessment, and association with psychopathology. J Pers Soc Psychol. 1991;60(3):456-70. [PubMed: 2027080].
  • 31. Aminizadeh S, Dolatshahi B, Pourshahbaz A, Babapour B, Yousefzadeh I, Zamanshoar E, et al. Psychometric properties of multidimensional perfectionism scale (MPS). Pract Clin Psychol. 2013;1(4).
  • 32. Besharat MA. [Exploratory analysis of the relationship between perfectionism and personality]. Stud Educ Psychol. 2005;6(1):81-96. Persian.
  • 33. Thompson JK, van den Berg P, Roehrig M, Guarda AS, Heinberg LJ. The sociocultural attitudes towards appearance scale-3 (SATAQ-3): Development and validation. Int J Eat Disord. 2004;35(3):293-304. doi: 10.1002/eat.10257. [PubMed: 15048945].
  • 34. Mohammadpanah Ardakan A, Babapour Kheir-ol-din J, Yousefi R. [Validity of Persian version of socio-cultural attitudes towards appearance questionnaire (SATAQ-3) using factor analysis]. Dermatol Cosmetic. 2014;5(1):22-32. Persian.
  • 35. Fisher E, Dunn M, Thompson JK. Social comparison and body image: An investigation of body comparison processes using multidimensional scaling. J Soc Clin Psychol. 2002;21(5):566-79. doi: 10.1521/jscp.21.5.566.22618.
  • 36. van den Berg P, Thompson JK, Obremski-Brandon K, Coovert M. The tripartite influence model of body image and eating disturbance: A covariance structure modeling investigation testing the mediational role of appearance comparison. J Psychosom Res. 2002;53(5):1007-20. [PubMed: 12445590].
  • 37. Thompson JK, Cattarin J, Fowler B, Fisher E. The perception of teasing scale (POTS): A revision and extension of the physical appearance related teasing scale (PARTS). J Pers Assess. 1995;65(1):146-57. doi: 10.1207/s15327752jpa6501_11. [PubMed: 16367650].
  • 38. Buhlmann U, Cook LM, Fama JM, Wilhelm S. Perceived teasing experiences in body dysmorphic disorder. Body Image. 2007;4(4):381-5. doi: 10.1016/j.bodyim.2007.06.004. [PubMed: 18089284].
  • 39. Stice E, Bearman SK. Body-image and eating disturbances prospectively predict increases in depressive symptoms in adolescent girls: A growth curve analysis. Dev Psychol. 2001;37(5):597-607. [PubMed: 11552756].
  • 40. Garrusi B, Garrusi S, Baneshi MR. Assessment of psychometric properties of Persian version of perceived socio-cultural pressure scale (PSPS). J Pak Med Assoc. 2013;63(4):468-71. [PubMed: 23905443].
  • 41. Brohede S, Wingren G, Wijma B, Wijma K. Validation of the body dysmorphic disorder questionnaire in a community sample of Swedish women. Psychiatry Res. 2013;210(2):647-52. doi: 10.1016/j.psychres.2013.07.019. [PubMed: 23948660].
  • 42. Mond JM. Higher BMI, lower self-esteem and more abnormal eating habits are associated with greater body dissatisfaction in adolescents. Evid Based Ment Health. 2012;15(4):104. doi: 10.1136/ebmental-2012-100828. [PubMed: 22789823].
  • 43. Bailey SD, Ricciardelli LA. Social comparisons, appearance related comments, contingent self-esteem and their relationships with body dissatisfaction and eating disturbance among women. Eat Behav. 2010;11(2):107-12. doi: 10.1016/j.eatbeh.2009.12.001. [PubMed: 20188294].
  • 44. van den Berg PA, Mond J, Eisenberg M, Ackard D, Neumark-Sztainer D. The link between body dissatisfaction and self-esteem in adolescents: Similarities across gender, age, weight status, race/ethnicity, and socioeconomic status. J Adolesc Health. 2010;47(3):290-6. doi: 10.1016/j.jadohealth.2010.02.004. [PubMed: 20708569]. [PubMed Central: PMC2923488].
  • 45. Sheffield JK, Tse KH, Sofronoff K. A comparison of body‐image dissatisfaction and eating disturbance among Australian and Hong Kong women. Eur Eat Disord Rev. 2005;13(2):112-24.
  • 46. Phillips KA. Body dysmorphic disorder: The distress of imagined ugliness. Am J Psychiatry. 1991;148(9):1138-49. doi: 10.1176/ajp.148.9.1138. [PubMed: 1882990].
  • 47. Karazsia BT, Crowther JH. Social body comparison and internalization: Mediators of social influences on men's muscularity-oriented body dissatisfaction. Body Image. 2009;6(2):105-12. doi: 10.1016/j.bodyim.2008.12.003. [PubMed: 19244001].
  • 48. Buote VM, Wilson AE, Strahan EJ, Gazzola SB, Papps F. Setting the bar: Divergent sociocultural norms for women's and men's ideal appearance in real-world contexts. Body Image. 2011;8(4):322-34. doi: 10.1016/j.bodyim.2011.06.002. [PubMed: 21775228].
  • 49. Rajagopalan J, Shejwal B. Influence of sociocultural pressures on body image dissatisfaction. Psychol Stud. 2014;59(4):357-64. doi: 10.1007/s12646-014-0245-y.
  • 50. Schaefer MK, Blodgett Salafia EH. The connection of teasing by parents, siblings, and peers with girls' body dissatisfaction and boys' drive for muscularity: The role of social comparison as a mediator. Eat Behav. 2014;15(4):599-608. doi: 10.1016/j.eatbeh.2014.08.018. [PubMed: 25218358].
  • 51. Weingarden H, Renshaw KD. Body dysmorphic symptoms, functional impairment, and depression: The role of appearance-based teasing. J Psychol. 2016;150(1):119-31. doi: 10.1080/00223980.2015.1012144. [PubMed: 25706778].
  • 52. Hartmann AS, Thomas JJ, Greenberg JL, Matheny NL, Wilhelm S. A comparison of self-esteem and perfectionism in anorexia nervosa and body dysmorphic disorder. J Nerv Ment Dis. 2014;202(12):883-8. doi: 10.1097/NMD.0000000000000215. [PubMed: 25390930].
  • 53. Buhlmann U, Etcoff NL, Wilhelm S. Facial attractiveness ratings and perfectionism in body dysmorphic disorder and obsessive-compulsive disorder. J Anxiety Disord. 2008;22(3):540-7. doi: 10.1016/j.janxdis.2007.05.004. [PubMed: 17624717].
  • 54. Higgins ET. Self-discrepancy: A theory relating self and affect. Psychol Rev. 1987;94(3):319-40. [PubMed: 3615707].
  • 55. Fitzsimmons-Craft EE, Harney MB, Koehler LG, Danzi LE, Riddell MK, Bardone-Cone AM. Explaining the relation between thin ideal internalization and body dissatisfaction among college women: The roles of social comparison and body surveillance. Body Image. 2012;9(1):43-9. doi: 10.1016/j.bodyim.2011.09.002. [PubMed: 21992811].
Creative Commons License Except where otherwise noted, this work is licensed under Creative Commons Attribution Non Commercial 4.0 International License .

Search Relations:



Create Citiation Alert
via Google Reader

Readers' Comments