Iranian Journal of Psychiatry and Behavioral Sciences

Published by: Kowsar

Relationship of Concern About Body Dysmorphia with External Shame, Perfectionism, and Negative Affect: The Mediating Role of Self-Compassion

Aliakbar Foroughi ORCID 1 , Sajad Khanjani ORCID 2 , * and Esmaeil Mousavi Asl 2
Authors Information
1 Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
2 Department of Clinical Psychology, Center of Excellence in Psychiatry and Clinical Psychology, School of Behavioral Science and Mental Health (Institute of Tehran Psychiatry), Iran University of Medical Sciences, Tehran, Iran
Article information
  • Iranian Journal of Psychiatry and Behavioral Sciences: 13 (2); e80186
  • Published Online: July 2, 2019
  • Article Type: Original Article
  • Received: June 5, 2018
  • Revised: May 4, 2019
  • Accepted: June 23, 2019
  • DOI: 10.5812/ijpbs.80186

To Cite: Foroughi A, Khanjani S, Mousavi Asl E. Relationship of Concern About Body Dysmorphia with External Shame, Perfectionism, and Negative Affect: The Mediating Role of Self-Compassion, Iran J Psychiatry Behav Sci. Online ahead of Print ; 13(2):e80186. doi: 10.5812/ijpbs.80186.

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. Methods
4. Results
5. Discussion
  • 1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 2013. 455 p. doi: 10.1176/appi.books.9780890425596.
  • 2. Crerand CE, Franklin ME, Sarwer DB. Body dysmorphic disorder and cosmetic surgery. Plast Reconstr Surg. 2006;118(7):167-80. doi: 10.1097/01.prs.0000242500.28431.24. [PubMed: 17102719].
  • 3. Fitts SN, Gibson P, Redding CA, Deiter PJ. Body dysmorphic disorder: implications for its validity as a DSM-III-R clinical syndrome. Psychol Rep. 1989;64(2):655-8. doi: 10.2466/pr0.1989.64.2.655. [PubMed: 2710902].
  • 4. Bohne A, Keuthen NJ, Wilhelm S, Deckersbach T, Jenike MA. Prevalence of symptoms of body dysmorphic disorder and its correlates: A cross-cultural comparison. Psychosomatics. 2002;43(6):486-90. doi: 10.1176/appi.psy.43.6.486. [PubMed: 12444232].
  • 5. Cansever A, Uzun O, Donmez E, Ozsahin A. The prevalence and clinical features of body dysmorphic disorder in college students: A study in a Turkish sample. Compr Psychiatry. 2003;44(1):60-4. doi: 10.1053/comp.2003.50010. [PubMed: 12524637].
  • 6. Talaei. A , Fayazi Bordbar MR, Nasiraei A, Rezaei Ardani A. [Assessment of symptom pattern and frequency of body dysmorphic disorder in university students]. Med J Mashhad Univ Med Sci. 2009;52(1):49-56. Persian. doi: 10.22038/mjms.2009.5496.
  • 7. Kelly AC, Stephen E. A daily diary study of self-compassion, body image, and eating behavior in female college students. Body Image. 2016;17:152-60. doi: 10.1016/j.bodyim.2016.03.006. [PubMed: 27081748].
  • 8. Toole AM, Craighead LW. Brief self-compassion meditation training for body image distress in young adult women. Body Image. 2016;19:104-12. doi: 10.1016/j.bodyim.2016.09.001. [PubMed: 27664531].
  • 9. Daye CA, Webb JB, Jafari N. Exploring self-compassion as a refuge against recalling the body-related shaming of caregiver eating messages on dimensions of objectified body consciousness in college women. Body Image. 2014;11(4):547-56. doi: 10.1016/j.bodyim.2014.08.001. [PubMed: 25195124].
  • 10. Wasylkiw L, MacKinnon AL, MacLellan AM. Exploring the link between self-compassion and body image in university women. Body Image. 2012;9(2):236-45. doi: 10.1016/j.bodyim.2012.01.007. [PubMed: 22406200].
  • 11. Braun TD, Park CL, Gorin A. Self-compassion, body image, and disordered eating: A review of the literature. Body Image. 2016;17:117-31. doi: 10.1016/j.bodyim.2016.03.003. [PubMed: 27038782].
  • 12. Kelly AC, Vimalakanthan K, Miller KE. Self-compassion moderates the relationship between body mass index and both eating disorder pathology and body image flexibility. Body Image. 2014;11(4):446-53. doi: 10.1016/j.bodyim.2014.07.005. [PubMed: 25113286].
  • 13. Raque-Bogdan TL, Piontkowski S, Hui K, Ziemer KS, Garriott PO. Self-compassion as a mediator between attachment anxiety and body appreciation: An exploratory model. Body Image. 2016;19:28-36. doi: 10.1016/j.bodyim.2016.08.001. [PubMed: 27597725].
  • 14. Webb JB, Fiery MF, Jafari N. "You better not leave me shaming!": Conditional indirect effect analyses of anti-fat attitudes, body shame, and fat talk as a function of self-compassion in college women. Body Image. 2016;18:5-13. doi: 10.1016/j.bodyim.2016.04.009. [PubMed: 27236471].
  • 15. Neff KD, Dahm KA. Changing characteristics of statin-related cIMT trials from 1988 to 2006. In: Robinson M, Meier B, Ostafin B, editors. Handbook of mindfulness and self-regulation. 246. New York: Springer; 2016. p. 121-9.
  • 16. Neff KD. Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self Ident. 2003;2(2):85-101. doi: 10.1080/15298860309032.
  • 17. MacBeth A, Gumley A. Exploring compassion: A meta-analysis of the association between self-compassion and psychopathology. Clin Psychol Rev. 2012;32(6):545-52. doi: 10.1016/j.cpr.2012.06.003. [PubMed: 22796446].
  • 18. Neff KD, Kirkpatrick KL, Rude SS. Self-compassion and adaptive psychological functioning. J Res Pers. 2007;41(1):139-54. doi: 10.1016/j.jrp.2006.03.004.
  • 19. Hollis-Walker L, Colosimo K. Mindfulness, self-compassion, and happiness in non-meditators: A theoretical and empirical examination. Pers Indiv Differ. 2011;50(2):222-7. doi: 10.1016/j.paid.2010.09.033.
  • 20. Weingarden H, Renshaw KD, Wilhelm S, Tangney JP, DiMauro J. Anxiety and shame as risk factors for depression, suicidality, and functional impairment in body dysmorphic disorder and obsessive compulsive disorder. J Nerv Ment Dis. 2016;204(11):832-9. doi: 10.1097/NMD.0000000000000498. [PubMed: 26998694]. [PubMed Central: PMC5026856].
  • 21. Hanstock TL, O'Mahony JF. Perfectionism, acne and appearance concerns. Pers Indiv Differ. 2002;32(8):1317-25. doi: 10.1016/s0191-8869(01)00120-9.
  • 22. Lattimore P, Hutchinson R. Perceived calorie intake and state body-image satisfaction in women attempting weight loss: A preliminary investigation. Body Image. 2010;7(1):15-21. doi: 10.1016/j.bodyim.2009.08.002. [PubMed: 19783237].
  • 23. Ferreira C, Pinto-Gouveia J, Duarte C. Self-compassion in the face of shame and body image dissatisfaction: Implications for eating disorders. Eat Behav. 2013;14(2):207-10. doi: 10.1016/j.eatbeh.2013.01.005. [PubMed: 23557822].
  • 24. Gilbert P. The evolution of shame as a marker for relationship security: A biopsychosocial approach. In: Tracy JL, Robins RW, Tangney JP, editors. The self-conscious emotions: Theory and research. New York, NY, US: Guilford Press; 2007. p. 283-309.
  • 25. Liss M, Erchull MJ. Not hating what you see: Self-compassion may protect against negative mental health variables connected to self-objectification in college women. Body Image. 2015;14:5-12. doi: 10.1016/j.bodyim.2015.02.006. [PubMed: 25828840].
  • 26. Annesi JJ, Gorjala S. Body satisfaction and overall mood: Effects of race in exercisers with obesity. Soc Behav Pers. 2010;38(8):1105-9. doi: 10.2224/sbp.2010.38.8.1105.
  • 27. Taylor MJ, Cooper PJ. An experimental study of the effect of mood on body size perception. Behav Res Ther. 1992;30(1):53-8. [PubMed: 1540113].
  • 28. Farrell C, Lee M, Shafran R. Assessment of body size estimation: A review. Eur Eat Disord Rev. 2005;13(2):75-88. doi: 10.1002/erv.622.
  • 29. Downey CA, Chang EC. Perfectionism and symptoms of eating disturbances in female college students: Considering the role of negative affect and body dissatisfaction. Eat Behav. 2007;8(4):497-503. doi: 10.1016/j.eatbeh.2007.02.002. [PubMed: 17950939].
  • 30. Welch E, Miller JL, Ghaderi A, Vaillancourt T. Does perfectionism mediate or moderate the relation between body dissatisfaction and disordered eating attitudes and behaviors? Eat Behav. 2009;10(3):168-75. doi: 10.1016/j.eatbeh.2009.05.002. [PubMed: 19665100].
  • 31. Siegling AB, Delaney ME. Toward understanding body image importance: Individual differences in a Canadian sample of undergraduate students. Eat Disord. 2013;21(2):117-29. doi: 10.1080/10640266.2013.761083. [PubMed: 23421695]. [PubMed Central: PMC4118941].
  • 32. Choo SY, Chan CKY. Predicting eating problems among Malaysian Chinese: Differential roles of positive and negative perfectionism. Pers Indiv Differ. 2013;54(6):744-9. doi: 10.1016/j.paid.2012.11.036.
  • 33. Bartsch D. Prevalence of body dysmorphic disorder symptoms and associated clinical features among Australian university students. Clin Psychol. 2007;11(1):16-23. doi: 10.1080/13284200601178532.
  • 34. 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].
  • 35. Barnett MD, Sharp KJ. Maladaptive perfectionism, body image satisfaction, and disordered eating behaviors among U.S. college women: The mediating role of self-compassion. Pers Indiv Differ. 2016;99:225-34. doi: 10.1016/j.paid.2016.05.004.
  • 36. Kline RB. Principles and practice of structural equation modeling. Guilford publications; 2015.
  • 37. Oosthuizen P, Lambert T, Castle DJ. Dysmorphic concern: Prevalence and associations with clinical variables. Aust N Z J Psychiatry. 1998;32(1):129-32. doi: 10.3109/00048679809062719. [PubMed: 9565194].
  • 38. Jorgensen L, Castle D, Roberts C, Groth-Marnat G. A clinical validation of the dysmorphic concern questionnaire. Aust N Z J Psychiatry. 2001;35(1):124-8. doi: 10.1046/j.1440-1614.2001.00860.x. [PubMed: 11270446].
  • 39. Kisely S, Morkell D, Allbrook B, Briggs P, Jovanovic J. Factors associated with dysmorphic concern and psychiatric morbidity in plastic surgery outpatients. Aust N Z J Psychiatry. 2002;36(1):121-6. doi: 10.1046/j.1440-1614.2002.00981.x. [PubMed: 11929448].
  • 40. Rosen JC, Reiter J. Development of the body dysmorphic disorder examination. Behav Res Ther. 1996;34(9):755-66. [PubMed: 8936758].
  • 41. Kazemini M, Foroughi AA, Khanjani S, Mohammdi A. [Factor structure and psychometric properties of persian version of dysmorphic concern questionnaire]. Navid No J. 2015;18(60):56-65. Persian.
  • 42. Raes F, Pommier E, Neff KD, Van Gucht D. Construction and factorial validation of a short form of the Self-Compassion Scale. Clin Psychol Psychother. 2011;18(3):250-5. doi: 10.1002/cpp.702. [PubMed: 21584907].
  • 43. Khanjani S, Foroughi AA, Sadghi K, Bahrainian SA. [Psychometric properties of Iranian version of self-compassionscale (short form)]. Pajoohande. 2016;21(5):282-9. Persian.
  • 44. Goss K, Gilbert P, Allan S. An exploration of shame measures I: The other as Shamer scale. Pers Indiv Differ. 1994;17(5):713-7. doi: 10.1016/0191-8869(94)90149-x.
  • 45. Foroughi AA, Khanjani S, Kazemini M, Tayeri F. [Factor structure and psychometric properties of Iranian version of external shame scale]. Shenakht J Psychol Psychiatry. 2015;2(2):49-58. Persian.
  • 46. Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: The PANAS scales. J Pers Soc Psychol. 1988;54(6):1063-70. [PubMed: 3397865].
  • 47. Bakhshipour A, Dejkam M. [Confirmatory factor analysis the positive and negative affect schedule]. J Psychol. 2006;9(4):351-65. Persian.
  • 48. Najarian B, Attarian Y, Goldsmith Y. [Construction and validation of Ahvaz perfectionism scale]. J Educ Psychol. 2001;3(4):43-58. Persian.
  • 49. Lucas M, Koff E. Body image, impulse buying, and the mediating role of negative affect. Pers Indiv Differ. 2017;105:330-4. doi: 10.1016/j.paid.2016.10.004.
  • 50. Bearman SK, Martinez E, Stice E, Presnell K. The skinny on body dissatisfaction: A longitudinal study of adolescent girls and boys. J Youth Adolesc. 2006;35(2):217-29. doi: 10.1007/s10964-005-9010-9. [PubMed: 16912810]. [PubMed Central: PMC1540456].
  • 51. Keel PK, Mitchell JE, Davis TL, Crow SJ. Relationship between depression and body dissatisfaction in women diagnosed with bulimia nervosa. Int J Eat Disord. 2001;30(1):48-56. [PubMed: 11439408].
  • 52. Shafran R, Cooper Z, Fairburn CG. Clinical perfectionism: A cognitive-behavioural analysis. Behav Res Ther. 2002;40(7):773-91. [PubMed: 12074372].
  • 53. Barnard LK, Curry JF. Self-compassion: Conceptualizations, correlates, and interventions. Rev Gen Psychol. 2011;15(4):289-303. doi: 10.1037/a0025754.
  • 54. Gee A, Troop NA. Shame, depressive symptoms and eating, weight and shape concerns in a non-clinical sample. Eat Weight Disord. 2003;8(1):72-5. [PubMed: 12762628].
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