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Frontiers in Psychology | www.frontiersin.org 1 December 2019 | Volume 10 | Article 2698
BRIEF RESEARCH REPORT
published: 03 December 2019
doi: 10.3389/fpsyg.2019.02698
Edited by:
Andrea Phillipou,
Swinburne University of Technology,
Australia
Reviewed by:
Toni Pikoos,
Swinburne University of Technology,
Australia
Gemma Sharp,
Monash University,
Australia
*Correspondence:
Amanda Nerini
nerini@psico.uni.it
Specialty section:
This article was submitted to
Eating Behavior,
a section of the journal
Frontiers in Psychology
Received: 03 October 2019
Accepted: 15 November 2019
Published: 03 December 2019
Citation:
Nerini A, Matera C, Di Gesto C,
Policardo GR and Stefanile C (2019)
Exploring the Links Between
Self-Compassion, Body
Dissatisfaction, and Acceptance
of Cosmetic Surgery in Young
Italian Women.
Front. Psychol. 10:2698.
doi: 10.3389/fpsyg.2019.02698
Exploring the Links Between Self-
Compassion, Body Dissatisfaction,
and Acceptance of Cosmetic Surgery
in Young Italian Women
AmandaNerini1
*, CamillaMatera1, CristianDiGesto2, GiuliaRosaPolicardo2 and
CristinaStefanile2
1
Department of Education, Languages, Intercultures, Literatures and Psychology, University of Florence, Florence, Italy,
2 Department of Health Sciences, University of Florence, Florence, Italy
This study aimed to examine the association between positive (self-kindness, common
humanity, and mindfulness) and negative (isolation, self-judgment, and over-identication)
components of self-compassion, and both body dissatisfaction and acceptance of cosmetic
surgery among women, through the mediation (for the negative components) of internalization
and physical appearance comparison. The participants were 220 young Italian women
aged 19–31 (M= 21) years, who completed a questionnaire assessing the variables of
interest. Path analysis indicated that higher mindfulness was directly linked to lower
acceptance of cosmetic surgery. Mindfulness presented the strongest link with cosmetic
surgery, as it was directly associated with acceptance of cosmetic surgery for both social
and interpersonal motivations and with consideration of undergoing some cosmetic
procedures. Common humanity and self-kindness were related to acceptance of cosmetic
surgery for social reasons. Over-identication seemed to beassociated with body
dissatisfaction and acceptance of cosmetic surgery both directly and indirectly through
internalization and physical appearance comparison. Self-judgment and isolation did not
present a signicant association with either body dissatisfaction or acceptance of cosmetic
surgery. These ndings conrm that psychological assessment of women who are interested
in cosmetic surgery is highly recommended. Interventions should not consider self-
compassion as a whole, but they should rather focus on some of its components. The role
of over-identication seems to beespecially pivotal, as higher scores on this dimension
are linked to higher levels of body dissatisfaction and greater acceptance of cosmetic surgery.
Keywords: self-compassion, body dissatisfaction, cosmetic surgery, physical appearance comparison,
internalization
INTRODUCTION
Cosmetic surgery is an optional, or medically unnecessary, procedure (Diaz, 2012) requested
by a patient to correct imperfections and improve appearance (Barone et al., 2016).
Some studies have shown a positive link between body dissatisfaction and acceptance
of cosmetic surgery among women, suggesting that people may consider cosmetic surgery
Nerini et al. Compassion, Body Image, Cosmetic Surgery
Frontiers in Psychology | www.frontiersin.org 2 December 2019 | Volume 10 | Article 2698
as a means to obtain both intrapsychic benefits (e.g., higher
self-esteem) and social rewards deriving from appearing
more attractive to others (Markey and Markey, 2009; Slevec
and Tiggemann, 2010; Menzel et al., 2011; Lunde, 2013).
Nevertheless, some experimental evidence suggests that
body image quality of life and self-esteem do not increase
in women who have undergone some cosmetic surgical
procedures, even though their body dissatisfaction can
decrease (Sobanko et al., 2018).
Italy ranks sixth in the list of countries with the largest
number of women who underwent cosmetic surgical procedures
in 2016 (International Society of Aesthetic Plastic Surgery,
2017). Such an interest in cosmetic practices can derive from
the emphasis that the Italian society places on physical appearance
(Dakanalis etal., 2015; Barcaccia etal., 2018). A study conducted
by Mondini et al. (1996) revealed that cosmetic surgery was
already present in the Italian mass media two decades ago. It
was typically presented as an eective manipulation strategy
that might help women to achieve common aesthetic standards
that are dicult to be reached with natural methods.
What factors might beassociated with women’s consideration
of cosmetic surgery? rough the present study, we aimed to
examine if an attitude of kindness and understanding toward
oneself in the face of inadequacies, failures, and personal
diculties—which is called self-compassion (Ne, 2003)—can
be signicantly associated with lower body dissatisfaction and
lower acceptance of cosmetic surgery among women. Indeed,
self-compassion was found to mitigate the maladaptive outcomes
of poor body image (Braun et al., 2016).
Self-compassion enhances one’s ability to respond to threats
and environmental stressors (such as pressures related to
one’s physical appearance) in a nonreactive and nonjudgmental
manner (Ferreira etal., 2013). is is due to a lower tendency
to self-criticize, which may reduce the extent to which people
perceive negative thoughts and feelings as severe, making
them more easily acceptable (Ne, 2003). Self-compassion
entails three positive (self-kindness, common humanity, and
mindfulness) and three negative components (self-judgment,
isolation, and over-identication) (Ne, 2016). According to
Ne (2003), self-kindness refers to an attitude of care and
understanding toward oneself in the face of suering. Common
humanity allows one to perceive and classify personal
experiences of failure as elements shared by humanity.
Mindfulness is a state of awareness, attention, and acceptance
of one’s negative thoughts and feelings in a balanced and
nonjudgmental way. Self-judgment is the tendency to disapprove
and harshly judge one’s aws and inadequacies. Isolation,
which is the perception of being the only one suering or
making mistakes, occurs when people tend to feel separate
and cuto from the rest of the world while thinking about
their own inadequacies. Over-identication is the excessive
identication with and absorption in one’s feelings and
emotions, and it involves the tendency to obsess and xate
on everything that is wrong. High levels of self-compassion
can be therefore expressed in terms of high self-kindness,
common humanity, and mindfulness, and low self-judgment,
isolation, and over-identication.
e positive and negative components do not seem completely
symmetrical. Much research (Gilbert, 2005; Smith and Zautra,
2008; Longe et al., 2010; Costa et al., 2016; Brenner et al.,
2017) has suggested that the positive components combine
into one factor, whereas the negative components combine
into another one (called self-criticism). Distinct processes and
internal systems seem to be activated by these two factors
(Brenner et al., 2017). e former could be considered a
resilience factor (Ne and McGehee, 2010), which might allow
people to relax and engage in behaviors that foster health and
well-being (Gilbert, 2005), whereas self-criticism might represent
a vulnerability factor (Dunkley etal., 2009), which could make
people more severe toward their own failures and inadequacies
(Gilbert et al., 2011). Notably, ompson and Zuro (2004)
identied two distinct forms of self-criticism, which are
comparative and internalized self-criticism. Comparative self-
criticism is a negative view of the self in comparison with
others, whereas internalized self-criticism is a negative view
of the self in comparison with internal standards, which are
oen high and hardly achievable. According to this perspective,
the negative components of self-compassion seem to behighly
related to internalization and physical appearance comparison,
which are two key processes responsible for body dissatisfaction
and acceptance of cosmetic surgery (Keery etal., 2004; Stefanile
et al., 2009; Menzel et al., 2011; Rodgers et al., 2011; Nerini,
2015; Nerini et al., 2016). e internalization of social ideals
can bedened as the internal incorporation of societal standards
of attractiveness to the point that these values become guiding
principles (ompson et al., 2004). Physical appearance
comparison is the tendency to evaluate dimensions of the self,
such as body image, through comparison with others (ompson
etal., 1991). Women who internalize beauty ideals may bemore
likely to engage in physical appearance comparison to establish
if they meet shared cultural standards of beauty (Clay et al.,
2005; Durkin et al., 2007; Matera etal., 2013a). Internalization
and physical appearance comparison could therefore mediate
the relationship between the negative components of self-
compassion (self-criticism) and both body dissatisfaction and
acceptance of cosmetic surgery.
Most studies on the association between self-compassion
and body dissatisfaction treated self-compassion as a global
construct, neglecting its multidimensional nature. To the best
of our knowledge, the only study that examined the relationship
between all the dimensions that comprise self-compassion and
body image is the one by Wasylkiw et al. (2012). e authors
found self-judgment to be the only signicant predictor of
body preoccupation in undergraduate women. e few additional
studies that viewed self-compassion as a multidimensional
construct examined the role of only some of its components
(Dijkstra and Barelds, 2011; Webb and Forman, 2013;
Ferreira et al., 2014; Rodgers et al., 2017).
Only two studies examined the relationship between self-
compassion and acceptance of cosmetic surgery, examining
only a single subcomponent of self-compassion (mindfulness).
Manshadi et al. (2014) investigated body satisfaction and
mindfulness in cosmetic surgery candidates in comparison with
people who have not undergone cosmetic surgical procedures.
Nerini et al. Compassion, Body Image, Cosmetic Surgery
Frontiers in Psychology | www.frontiersin.org 3 December 2019 | Volume 10 | Article 2698
Cosmetic surgery patients had less positive body satisfaction
and lower levels of mindfulness. Naami and Salehi (2016)
showed a signicant negative relationship between mindfulness
and acceptance of cosmetic surgery in high school students.
THE PRESENT STUDY
e present study aimed to test a model in which self-compassion,
conceived as a multidimensional construct, was associated with
body dissatisfaction and acceptance of cosmetic surgery via
internalization and physical appearance comparison. Wepredicted
that the positive components (self-kindness, common humanity,
and mindfulness) would be directly associated with body
dissatisfaction and acceptance of cosmetic surgery. e more
women can respond to threats or environmental stressors in
a nonreactive and nonjudgmental manner, the more favorably
they might look at their bodies. Such a mental state may
be associated with lower dissatisfaction with one’s body and
lower acceptance of cosmetic surgery as an appearance
enhancement strategy (Hypothesis 1). Based on previous research
ndings (ompson and Zuro, 2004), the negative components
were hypothesized to be related to both body dissatisfaction
and acceptance of cosmetic surgery by fostering both
internalization of societal standards of beauty and comparisons
with the appearance of others (Hypothesis 2). We also posited
a link from internalization to physical appearance comparison
(Nerini et al., 2014; Matera et al., 2015; Stefanile et al., 2015),
and from body dissatisfaction to acceptance of cosmetic surgery
(Markey and Markey, 2009; Slevec and Tiggemann, 2010; Menzel
etal., 2011; Lunde, 2013). Body mass index (BMI) was included
to control for its eect, and the components of self-compassion
were allowed to covary.
METHODS
Participants
e participants included 220 Caucasian Italian university
women aged 19–31 years (M = 21, SD = 1.88). e mean
BMI of the sample was 21.02 (SD = 3.17), ranging between
14.2 and 35.2. Most of the participants (82.7%) lived in central
Italy, 10% in northern Italy, and 6.8% in southern Italy or on
islands. Most of them (94.5%) reported being unmarried,
whereas 5.5% reported being married or cohabiting. Regarding
education, 91.3% of them had high school diplomas, 7.8%
had bachelor’s degrees, and 0.9% had master’s degrees. Most
of the participants (96.3%) dened themselves as students,
whereas 3.7% dened themselves as workers (1.8% were
occasional employees, 0.9% part-time employees, 0.5% full-time
employees, and 0.5% were looking for a rst job). In terms
of sexual orientation, 94.5% of them reported being heterosexual.
Measures
Self-Compassion
e Italian version (Petrocchi etal., 2013) of the Self-Compassion
Scale (Ne, 2003) is a 26-item scale that was used to measure
the six components of self-compassion along a ve-point Likert
scale (1 = almost never; 5 = almost always). Self-kindness
refers to one’s ability to be caring and understanding with
oneself (four items, e.g., “When I’m going through a very
hard time, I give myself the caring and tenderness I need”;
alpha=0.83). Self-judgment refers to one’s tendency to beharshly
self-critical (ve items, e.g., “When I see aspects of myself
that Idon’t like, Iget down on myself”; alpha=0.88). Common
humanity entails the ability to remind oneself that suering
is part of human nature (ve items, e.g., “When Ifeel inadequate
in some way, Itry to remind myself that feelings of inadequacy
are shared by most people”; alpha = 0.77). Isolation is the
lack of awareness that all human beings experience suering
and failure (four items, e.g., “When I fail at something that’s
important to me, Itend to feel alone in my failure”; alpha=0.84).
Mindfulness involves awareness of, attention to, and acceptance
of one’s painful experiences in a balanced and nonjudgmental
way (four items, e.g., “When I fail at something important to
me, I try to keep things in perspective”; alpha = 0.74). Over-
identication refers to the excessive identication with and
absorption in one’s feelings and emotions (four items, e.g.,
“When I’m feeling down, I tend to obsess and xate on
everything that’s wrong”; alpha= 0.77). Higher scores on self-
kindness, common humanity, and mindfulness, and lower scores
on self-judgment, isolation, and over-identication represented
higher levels of self-compassion.
Internalization
e internalization-general subscale of the Italian version
(Stefanile et al., 2019) of the Sociocultural Attitudes Toward
Appearance Questionnaire-4 Revised (Schaefer et al., 2017)
was used to assess the degree to which one has internalized
sociocultural ideals regarding beauty. is 10-item subscale
(e.g., “It is important to me to be attractive”) ranges from 1
(denitively disagree) to 5 (denitively agree). Higher scores
represented greater levels of internalization (alpha = 0.86).
Physical Appearance Comparison
We adopted an Italian version (Stefanile et al., 2010) of the
Physical Appearance Comparison Scale (ompson etal., 1991)
to assess the level to which people make social comparisons
related to their appearance. is four-item scale (e.g., “In social
situations, I sometimes compare my gure to the gures of
other people”) ranges from 1 (never) to 5 (always). Higher
scores represented greater levels of physical appearance
comparisons (alpha = 0.86).
Body Dissatisfaction
We used the Italian version (Matera et al., 2013b) of the
Body Shape Questionnaire-14 (Dowson and Henderson, 2001)
to assess body dissatisfaction. e scale has 14 items (e.g.,
“I felt ashamed of my body”) rated along a six-point Likert
scale (1 = never; 6 = always). e questionnaire asks the
participants to respond on the basis of the past 2 weeks prior
to administration. High scores indicated greater levels of general
body dissatisfaction (alpha = 0.95).
Nerini et al. Compassion, Body Image, Cosmetic Surgery
Frontiers in Psychology | www.frontiersin.org 4 December 2019 | Volume 10 | Article 2698
Acceptance of Cosmetic Surgery
We measured acceptance of cosmetic surgery with the Italian
version (Stefanile et al., 2014) of the Acceptance of Cosmetic
Surgery Scale (Henderson-King and Henderson-King, 2005).
is scale has 15 items with a three-factor structure: the
Intrapersonal subscale measures attitudes related to the self-
oriented benets of cosmetic surgery (ve items; e.g., “Cosmetic
surgery can bea big benet to people’s self-image”; alpha=0.93),
the Social subscale assesses social motivations for having cosmetic
surgery (ve items; e.g., “If it would benet my career, I would
think about having plastic surgery”; alpha = 0.83), and the
Consider subscale measures the probability that a participant
would consider having cosmetic surgery (ve items; e.g., “In
the future, I could end up having some kind of cosmetic
surgery”; alpha = 0.92). e scale ranges from 1 (denitively
disagree) to 7 (denitively agree). High scores indicated high
levels of acceptance of cosmetic surgery.
Sociodemographic Details and Body Mass Index
Each participant reported her age, sex, sexual orientation, race,
educational level, occupational status, and relationship status.
We calculated BMIs (kg/m2) using the participants’ reported
weights and heights.
Procedure
Using opportunistic sampling techniques, werecruited the study
participants from the School of Psychology at the university
with which the authors were aliated. During regular
undergraduate and graduate classes, we asked the students to
take part in a study on body image. Participation in the study
was voluntary, and we did not provide incentives to the
participants. To be eligible for the study, the participants were
needed to be 18years or older women. We obtained informed
consent from each participant prior to administering the
questionnaire. Participants completed measures in paper-and-
pencil format. e questionnaire was anonymous, did not ask
for any personally identiable information, and took about
30 min to complete. e Ethical Committee of the University
of Florence approved the study procedures.
Data Analysis
We examined the t of three models, in which the self-compassion
dimensions were posited as predictors of the three ACSS subscales
respectively (Model 1: Intrapersonal; Model 2: Social; Model 3,
Consider); the role of internalization, physical appearance
comparison, and body dissatisfaction was considered in each
model. Less than 1% of the data was missing. We used a mean
imputation process to replace the missing values. All the
assumptions for path analysis were satised (Streiner, 2005).
e hypotheses were tested using Amos (version 22; IBM SPSS,
Chicago, IL); weused bootstrapping to test mediation by estimating
the presence and size of the indirect (i.e., mediated) eects
(Rucker et al., 2011). e sample size in the present study was
bigger than the recommended size of 200 participants (We st on
and Gore, 2006). Weadopted the maximum likelihood procedure
to derive the parameter estimates and used the following
goodness-of-t indices: the χ2/df ratio, a good score of which
is 2 or below; the comparative t index (CFI); the Tucker-Lewis
index (TLI); the incremental t index (IFI), the value of which
should be higher than 0.95; the normed t index (NFI), a good
score of which is more than 0.90; the root mean square error
of approximation (RMSEA); a 90% condence interval for RMSEA
(RMSEA 90% CI); and the standardized root mean square
residual (SRMR). RMSEA and SRMR are considered acceptable
if they are 0.08 or lower (Hooper et al., 2008).
RESULTS
Tabl e 1 shows the descriptive statistics (means and standard
deviations) and the intercorrelations among the variables.
e data are normally distributed (skewness <1.54; kurtosis
<4.11), as the skews for all variables are lower than 2 and
kurtosis is lower than 7 (West et al., 1995).
e three models (Figures 1–3) tted very well with the
data [Model 1, Intrapersonal: χ2 =25.25, p=0.19; χ2/df =1.26;
RMSEA = 0.04 (CI = 0.00; 0.07); SRMR = 0.04; CFI = 0.99;
TLI=0.99; IFI =0.99; NFI =0.98: Model 2, Social: χ2= 31.30,
p = 0.05; χ2/df = 1.56; RMSEA = 0.05 (CI = 0.00; 0.08);
SRMR=0.04; CFI=0.99; TLI = 0.97; IFI = 0.99; NFI =0.97.
Model 3, Consider: χ2 = 28.17, p = 0.10; χ2/df = 1.41;
RMSEA = 0.04 (CI = 0.00; 0.08); SRMR = 0.04; CFI = 0.99;
TLI=0.98; IFI=0.99; NFI=0.98]. Covariances ranged between
0.23 (p < 0.001) and 0.63 (p < 0.001).
Hypothesis 1 was partially conrmed. None of the positive
components were signicantly related to body dissatisfaction,
whereas mindfulness was signicantly related to acceptance of
cosmetic surgery in each model. Self-kindness and common
humanity were signicantly associated with acceptance of
cosmetic surgery for social reasons (Model 2), but not with
either acceptance of cosmetic surgery for intrapersonal reasons
(Model 1) or consideration of undergoing some cosmetic
procedures (Model 3). Notably, the relationship between self-
kindness and acceptance of cosmetic surgery for social reasons
(Model 2) was a negative one.
In line with Hypothesis 2, the bootstrapping procedure
(Preacher and Hayes, 2008) showed that the indirect eect of
over-identication on body dissatisfaction through internalization
and physical appearance comparison was signicant in the
three models (0.188; 95% CI: 0.082; 0.296). Over-identication
was related to acceptance of cosmetic surgery for intrapersonal
reasons only via internalization (0.121; 95% CI: 0.048; 0.236),
and was related to both acceptance of cosmetic surgery for
social reasons and consideration of cosmetic surgery through
internalization, physical appearance comparison, and body
dissatisfaction (Social: 0.106; 95% CI: 0.049; 0.204; Consider:
149; 95% CI: 0.068; 0.259).
Isolation was associated with physical appearance comparison,
but not with internalization. Contrary to Hypothesis 2, the
indirect eect of isolation on body dissatisfaction (0.091; 95%
CI: −0.012; 0.207), acceptance of cosmetic surgery for social
reasons (0.051; 95% CI: −0.009; 0.122), or consideration of
cosmetic surgery (0.062; 95% CI: −0.016; 0.157) was not signicant.
Nerini et al. Compassion, Body Image, Cosmetic Surgery
Frontiers in Psychology | www.frontiersin.org 5 December 2019 | Volume 10 | Article 2698
Isolation was not indirectly related to acceptance of cosmetic
surgery for intrapersonal reasons, as the latter was not associated
with either physical appearance comparison or body dissatisfaction.
Self-judgment was not signicantly related to any other variable.
e three models accounted for much of the variance in
body dissatisfaction (48%) and for a satisfactory percentage
of the variance of acceptance of cosmetic surgery (Intrapersonal:
17%; Social: 22%; Consider: 29%).
DISCUSSION
Our ndings showed that the positive and negative components
of self-compassion were not completely symmetrical. Mindfulness
presented the strongest link with cosmetic surgery, as it was
directly associated with acceptance of cosmetic surgery for both
social and interpersonal motivations and with consideration of
undergoing some cosmetic procedures. Mindfulness may provide
TABLE1 | Means (M), standard deviations (SD), and intercorrelations between all variables.
1 2 3 4 5 6 7 8 9 10 11 12 M (SD)
1. Self-kindness 12.54
(0.80)
2. Self-judgment −0.67*** 1 3.23
(0.92)
3. Common humanity 0.57*** −0.32*** 1 2.83
(0.80)
4. Isolation −0.50*** 0.69*** −0.33*** 1 3.00
(0.97)
5. Mindfulness 0.75*** −0.52*** 0.56*** −0.56*** 1 2.91
(0.78)
6. Over-identication −0.54*** 0.72*** −0.35*** 0.75*** −0.58*** 1 3.54
(0.87)
7. Social comparison −0.32*** 0.45*** −0.19** 0.49*** −0.35*** 0.51*** 1 3.03
(0.99)
8. Internalization −0.24*** 0.34*** −0.23*** 0.35*** −0.30*** 0.44*** 0.61*** 1 3.51
(0.75)
9. Body dissatisfaction −0.24*** 0.38*** −0.23*** 0.42*** −0.32*** 0.45*** 0.54*** 0.44*** 1 3.04
(1.34)
10. Social −0.15* 0.28*** −0.24*** 0.36*** −0.29*** 0.33*** 0.35*** 0.31*** 0.31*** 1 1.77
(1.07)
11. Consider −0.19** 0.27*** −0.21** 0.32*** −0.32*** 0.28*** 0.44*** 0.41*** 0.36*** 0.64*** 1 3.09
(1.87)
12. Intrapersonal −0.13* 0.16* −0.15* 0.22*** −0.23*** 0.23*** 0.31*** 0.34*** 0.24*** 0.49*** 0.67*** 1 3.85
(1.60)
13. BMI −0.05 −0.02 −0.10 0.04 −0.12 0.04 −0.03 −0.07 0.38*** −0.06 −0.07 −0.11 21.03
(3.17)
N=220; *p<0.05; **p<0.01; ***p<0.001.
FIGURE1 | Final model intrapersonal.
Nerini et al. Compassion, Body Image, Cosmetic Surgery
Frontiers in Psychology | www.frontiersin.org 6 December 2019 | Volume 10 | Article 2698
greater distress tolerance (Schoenefeld and Webb, 2013; Webb
and Forman, 2013) and higher cognitive and emotional exibility,
making people less interested in cosmetic surgery to enhance
their appearance (Manshadi et al., 2014; Naami and Salehi,
2016). Common humanity and self-kindness were related to
acceptance of cosmetic surgery for social reasons. Women who
reminded themselves that suering is part of human nature
(i.e., common humanity) were less likely to evaluate cosmetic
surgery as a means of appearing more attractive to others and
gaining social rewards. Surprisingly, an attitude of care and
understanding toward oneself (i.e., self-kindness) was associated
with higher acceptance of cosmetic surgery for social reasons.
Even if the simple correlation between the two variables was
negative, when all the components of self-compassion were
accounted for, the sign of this relationship changed. Probably,
the simple correlation and the overlap among the dimensions
of self-compassion did not permit to examine the unique eect
of self-kindness; only aer controlling for the shared variance
among all the components, the unique eect of self-kindness
could be disentangled. Women who can support themselves
kindly seem to be more likely to view cosmetic surgery as a
reasonable way to provide themselves satisfaction when they
experience diculties and sorrow in social contexts or during
social interactions. Cosmetic surgery might be conceived as a
way to take care of oneself in order to obtain external rewards,
such as positive feedback and material advantages. Indeed, many
people nowadays choose cosmetic surgery as a generous life-
changing gi (American Society of Plastic Surgeons, 2017).
Contrary to Hypothesis 1, none of the positive components
was associated with body dissatisfaction.
In accord with Hypothesis 2, the excessive identication
with and absorption in one’s feelings and emotions (i.e.,
FIGURE3 | Final model consider.
FIGURE2 | Final model social.
Nerini et al. Compassion, Body Image, Cosmetic Surgery
Frontiers in Psychology | www.frontiersin.org 7 December 2019 | Volume 10 | Article 2698
over-identication) seemed to be associated with the likelihood
of internalizing sociocultural standards of appearance. is
process, in turn, might increase body dissatisfaction and
acceptance of cosmetic surgery both directly and indirectly
through physical appearance comparison, which could help
establish if one is eectively meeting internalized sociocultural
standards of beauty (Clay et al., 2005; Durkin et al., 2007;
Matera etal., 2013a); if physical appearance comparison discloses
that a woman does not match the size and shape of other
people, that woman may experience body dissatisfaction.
In our models, self-judgment did not present a signicant
association with either body dissatisfaction or acceptance of
cosmetic surgery. It seems that it is not the tendency to
disapprove and harshly judge one’s aws and inadequacies,
but the excessive identication with and absorption in these
feelings of inadequacies, that may be relevant for women’s
body dissatisfaction. In addition, isolation was not associated
with either body dissatisfaction or acceptance of cosmetic
surgery, although it was signicantly related to physical
appearance comparison. Women who felt separate and cuto
from the rest of the world probably felt more depressed and
hopeless, and were more likely to compare their appearance
with that of others with the aim of verifying their status and
feeling less isolated. In other words, in this case physical
appearance comparison might not have the aim of restoring
one’s body image, but it could beperformed in order to improve
one’s perception of being connected to others.
is study has some limitations. First, because of the
correlational nature of this research, we cannot make causal
inferences. Second, we assessed acceptance, but not eective
engagement, of cosmetic surgery. Perspective and experimental
studies must clarify the causal relationship between the variables
and must examine the relationship between attitudes and the
actual decision to undergo cosmetic surgical procedures. ird,
this study is not exhaustive of potential variables that may
protect women from body dissatisfaction and consideration of
cosmetic surgery. Future studies could examine if public self-
awareness, which is related to both self-compassion (Ne and
Vonk, 2009) and acceptance of cosmetic surgery (Matera etal.,
2015), might bea relevant mediator of the relationship between
these two variables. Moreover, weused a convenience sample,
so our ndings are not generalizable to the entire population.
ese ndings conrm that psychological assessment of
women who are interested in cosmetic surgery is highly
recommended (Mulkens et al., 2012; Brunton et al., 2014).
Indeed, cosmetic surgery does not necessarily help women to
improve their body image (Sarwer, 2018; Sobanko etal., 2018).
If women seek cosmetic surgery without changing their attitude
toward the self, they will probably report low self-esteem also
aer undergoing surgery, which could lead them to look for
further cosmetic procedures, without ever feeling comfortable
with their own body image. Before undergoing cosmetic
procedures, surgeons might propose alternative strategies, such
as self-compassion trainings, that could help women to change
the way they relate to their body. Based on our ndings, this
kind of training should not consider self-compassion as a whole,
but it should rather focus on some of its components. e
role of over-identication seems to be especially pivotal, as
higher scores on this dimension are linked to higher levels of
body dissatisfaction and greater acceptance of cosmetic surgery.
To reduce women’s tendency to excessively identify with their
feelings and emotions could either dissuade women from
undertaking unnecessary surgical interventions or reduce the
likelihood that poor body image is experienced even aer some
cosmetic procedures are eectively undertaken. Higher levels
of mindfulness and common humanity could decrease women’s
acceptance of cosmetic surgery as well, at least for social reasons,
even though these dimensions appeared to be unrelated to
women’s satisfaction with their body. e association between
self-kindness and acceptance of cosmetic surgery might befurther
explored before considering the advantages and disadvantages
of trainings that specically focus on this dimension.
DATA AVAILABILITY STATEMENT
e datasets generated for this study are available on request
to the corresponding author.
ETHICS STATEMENT
e studies involving human participants were reviewed and
approved by Ethical Committee of the University of Florence
(Italy). e patients/participants provided their written informed
consent to participate in this study.
AUTHOR CONTRIBUTIONS
All authors listed have made a substantial, direct and intellectual
contribution to the work, and approved it for publication.
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Conflict of Interest: e authors declare that the research was conducted in
the absence of any commercial or nancial relationships that could beconstrued
as a potential conict of interest.
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