Biosci. Biotech. Res. Comm. 10(3): 497-503 (2017)
Investigations on the relationship between perfectionism
and psychological needs with the perception of body
image in cosmetic surgery applicants
Soodabeh Yavari
* and Asghar Jafari
MA Student of Counseling and Guidance, Faculty of Human Science, Abhar Branch, Islamic Azad
University, Abhar, Iran
PhD, Faculty Member of Shahid Beheshti University, Tehran, Iran
Physical appearance is an important part of the body image because it is the  rst source of information which others use it for
social interactions with that individual. Every year tens of thousands are doing cosmetic surgery in order to eliminate dissatis-
faction with their appearance and sometimes to increase self-esteem. The aim of this research was to investigate the relation-
ship between perfectionism and psychological needs with the perception of body image in cosmetic (plastic) surgery applicants.
Research population consists of all the men and women who were applicants for cosmetic surgery and had recourse to beauty
clinic of Imam Khomeini hospital, Tehran, Iran. 200 individual samples were selected by availability sampling method. The method
of this paper was descriptive-analytical and data collection is done using questionnaire. data were analyzed using SPSS. Results
showed that there was a relationship between perfectionism and psychological needs with the perception of body image of cos-
metic surgery applicants. Psychological and perfectionism needs and also the perception of body image of women are different
from men’s. In addition, the negative characteristics of perfectionism have a larger share in cosmetic surgery applicants’ prediction
of body image perception.
*Corresponding Author:
Received 1
June, 2017
Accepted after revision 25
Sep, 2017
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DOI: 10.21786/bbrc/10.3/24
Soodabeh Yavari and Asghar Jafari
Physical appearance is an important part of the body
image because it is the  rst source of information which
others use it for social interactions with that individual.
There is no of cial statistics on cosmetic surgery in Iran.
According to unof cial statistics, every year, more than
36 thousands of Iranians do facial cosmetic surgery.
Among the performed cosmetic surgeries in Iran, rhino-
plasty is in the  rst place. According to unof cial sta-
tistics, from the numerical aspect of rhinoplasty, Iran is
the  rst in the world. After Iran, countries such as Amer-
ica, England, and partly France are in the next ranks.
Approximate statistics were only unof cial sources of
cosmetic surgery. Those people, who desire to do these
types of surgery but fear, should be added to this statis-
tics. The concept of an individual’s perception of their
body is an important part of their self-concept. The
body is the most visible part of ego and consciousness.
Body image is person’s internal visualization of external
appearance which includes representation of physical,
cognitive and attitudinal dimensions. The main dimen-
sions of this attitude consist of components like evalua-
tion and individual investment in dealing with schemes
of appearance and emotion which reveal the importance
of internalized appearance, (Sarwer, 2003, Cash, 2004,
Borzekowski, 2005, Balali, 2010, Weiss, 2013, Nerini,
In the twentieth century, especially in recent dec-
ades, new concepts of beauty have emerged and beauty
is de ned as a collection of components such as  t-
ness, makeup, clothes, attractiveness, and integrity. The
combination of beauty and industrial and also medi-
cal achievements has caused that now, beauty is not a
natural and biological characteristic anymore and it is
an adventitious trait. Nowadays, cosmetic surgery is as
one of the most common surgical procedure on a global
level that the use of which is growing. The main purpose
of cosmetic surgery is improving the appearance of the
person who has the abnormal appearance. When peo-
ple  nd out their physical properties are not in accord-
ance with those norms, may be offended and consider
the surgery as the  nal solution. Now, cosmetic surgery
becomes an agent charming and luxury-oriented means
to different people, and this has led to the establishment
of people’s unrealistic expectations and distortion of the
facts about its true nature, (Hilhorst, 2002, Pearl, 2003,
Hwang, 2004 Wolf, 2013).
These days, cosmetic surgery is taken into consid-
eration for creating beauty and desired image, so the
image of beauty as God’s natural creation is drawn to
adventitious and clinical beauty. With the increasing
demand for plastic surgery, several studies of this  eld
have introduced some effective factors on the desire to
these types of surgery. These factors are dissatisfaction
with body image, low attractiveness, psychological fac-
tors, body dysmorphic disorder, precedent of previous
cosmetic surgery, social and interpersonal factors such
as annoying appearance from the perspective of others,
surgical precedent of family and friends, cultural factors,
the impact of mass media advertising on TV, satellite,
magazines, movie stars, stress pressure, medical System
and beauty industries. At the end of the twentieth cen-
tury, a major concern about body image was clearly felt,
(Garrusi, 2013).
This concern has mainly surrounded women. Women
whose body image has much importance for them, dis-
content and dissatisfaction of appearance is associated
with their dissatisfaction of themselves and in general,
with their life. Orientation about beauty is in all social
situations. There is an irrational but  rm belief that
attractive people possess the other ideal characteristics
such as intelligence, adequacy, social skills, con dence
and even much moral values. Of course not surprising
that physical attractiveness is very important; however,
this as well as concerns about physical appearance is
not limited to this century and at any time and historical
period has been important and some criteria are deter-
mined for beauty and ugliness. Efforts of individuals
across the life is attempting to what look like to show
themselves in the best possible way. Physical appearance
affect on others, even if it be accepted that these effects
can be changed after the formation of communication
(Rumsey, 2004).
Ben eld and McCabe declared that body image has
three dimensions: perceptual-evaluation, emotional and
behavioral dimension. Perceptual-evaluation dimen-
sion refers to individuals’ measurement and evaluation
of their body. Feelings and emotions which individual
experiences from her body lies in emotional dimension;
and behavioral dimension focuses on the effect of per-
sons’ thoughts and emotions about their body on their
behavior (Ban eld, 2002).
Body image is consisting of two aspects: perceptual
aspect (individual’s evaluation of her body sizes) and
emotional-cognitive aspect (person’s attitude toward
her limbs). According to available  ndings, the assump-
tion is that when persons know their body lower than
ideal criteria, may encounter with inappropriate feelings
and attitudes about themselves like low self-esteem or
depression (Pesa, 2000) and in some cases even causes
a dropout. Cash introduced evaluation, emotion, and
investment as three main dimensions of body image
dimensions (Cash, 2004).
Socio-cultural theory as a prominent theory in the
eld of body image, and by raising the social and cul-
tural variables on body image disorders, has received
much empirical and research support. Of course, most
Soodabeh Yavari and Asghar Jafari
of the studies have focused on women’s social and psy-
chological variables. This focus probably is due to the
high prevalence of body dissatisfaction and body image
disorders in women and young girls. The investigation
found that the incidence of physical ideal for women
is associated with their increasing body dissatisfac-
tion (Hargreaves, 2006). Studies show that awareness
and internalization of women’s ideal are predictors of
body dissatisfaction, body image, and a decrease of self-
esteem. Cosmetic surgery includes carrying out all cos-
metic surgery, including nose, eyelids, eyebrows, cheeks,
forehead, neck and body beauty which may change
(such as removing fat) or improve (e.g. dentures). Gen-
erally, cosmetic surgery refers to surgeries without the
special medical necessity that is done solely for cosmetic
purposes (Tavassoli, 2012).
Surgical breast implants in the United States is eight
times since 1992. Also in 2001, 1.6 million people have
been surgery Botox injections therein. This rise of sta-
tistics is also seen among the male population. In 2002,
the number of men who use Botox injection for less
showing their age has increased 88% and men who have
undergone rhinoplasty surgery has increased 47% (Ibid).
For years, the negative image of the body has known as
one of the reasons for resorting to plastic surgery. But
few types of research have studied body image after sur-
gery longitudinally. Sarwar and his colleagues in 2002
evaluated body image of patients before and after of
cosmetic surgery (Heyes, 2016). A signi cant decrease
of patients’ dissatisfaction of operated limb than before
the cosmetic surgery was reported. They also suffer less
embarrassment in front of others’ attention to that spe-
ci c limb or talking about it. But there was no change
in studied women’s general body image. These results
represented that people who undergo cosmetic surgery
are rarely signi cant changes in their general discon-
tent. Therefore, cosmetic surgery is a therapeutic plan
for people who are dissatis ed with just one part of their
body and face (Sarwer, 2003).
Many factors can contribute to the negative image
of the body, including physiological factors (such as
body mass index), psychological factors (like perfection-
ism, low self-esteem) and socio-cultural factors (such
as family, peers, and media). In the contexts of perfec-
tionism, both one-dimensional and multi-dimensional
approach to perfectionism can be seen (McGee, 2005).
Person-centered divisions of perfectionism are normal –
neurotic, satisfying- dissatisfying, and negative or posi-
tive perfectionism (Stoeber, 2007; Besharat, 2007). In the
framework of person-centered approach, in addition to
neurotic, abnormal and damaging roles of perfectionism
which are more known, its normal and desirable and also
positive effects are con rmed and clari ed (Slade, 1998).
According to this division, a normal perfectionist enjoys
effort and competition for superiority and perfection
and at the same time accept personal limits, although
neurotic perfectionist due to unrealistic expectations, do
not be satis ed with her performance (McGee, 2005).
Positive perfectionism: positive perfectionism (strive
for positive progress) is to Try to achieve high per-
sonal standards without self-criticism. This aspect is
not related to negative characteristics such as anxiety;
positive perfectionism mainly focuses on expectations
regarding progress, competition, capability, the excite-
ment of a work and satisfaction. On the other hand,
positive perfectionism is achieved by attaining positive
and motivation to access a certain goal so that it has
promising results (Haas, 2008). Despite the negative per-
fectionists (neuroticism), positive perfectionists (normal)
at the same time that impose high personal standards for
themselves, they can accept personal and environmen-
tal limitations and know their success, even if they do
not meet their personal standards exactly. This group of
perfectionists in an effort to succeed and achieving the
goals, in terms of the ability to accept personal limita-
tions and environmental barriers, can experience a sense
of satisfaction more (Besharat, 2007).
Negative perfectionism: negative perfectionism
dimension contains that form of perfectionism which
explains perfectionism concerns such as too much
attention to mistakes, doubts about negative actions
and reactions. This dimension is associated with anxi-
ety (Stoeber, 2007). Negative perfectionism is focused
on emotions like not meeting expectations of the indi-
vidual about herself and others, condemning, feeling
guilty, shame and defeating (Haas, 2008). In addition,
these persons strictly avoid failure and are vulnerable to
criticism of others. This group of perfectionists treats the
various spheres of social activity and relations as threat-
ening, procrustean and not supportive (Besharat, 2007).
The major difference between abnormal and dysfunc-
tional perfectionism and positive and normal perfection-
ism is that in the  rst group despite con icting evidence,
perfectionist tendencies are continued (Figure 1).
The concept of basic psychological needs is com-
pletely different with the theory of personal efforts and
wishes. Although people know the motivations as a
provision of basic needs, but it is clear that there are
many incentives that do not comply with the standards
of welfare; in fact, it may be harmful. In the other words,
may some incentives mislead the people about what can
resolve their requirements and it means misleading their
deviation of welfare? Even when people can satisfy their
motivations, again the motivation can be harmful to the
welfare if it barricades satisfying the needs of autonomy
and communication (Ryan, 2000; Sheldon, 2001). Unfor-
tunately, from the past till now there is little consensus
about the criteria of psychological needs, where they
Soodabeh Yavari and Asghar Jafari
originated, whether thy are result of learning in child-
hood or cultural differences, whether they are inherent
and universal and have been established by evolution
in man; These are questions that need to be asked about
(Sheldon, 2001). In this part, the importance of three
psychological needs namely autonomy, competence, and
relatedness are investigated. When people  nd them-
selves in an environment that helps them to develop
their psychological needs and also fosters them, positive
emotions, optimal experience, and healthy growth are
its consequences. Psychological needs are important for
the study of motivated behavior. The energy of psycho-
logical needs is pioneering. Psychological requirements
induce a desire to seek the environment that is expected
to bring up our needs (Azin, 2014).
Autonomy (independency): independency means per-
son’s need to electoral right and self-initiate for duties.
For example, when people from the satisfaction and
enthusiasm, spend their time and energy to study in
order to feel autonomy (Ryan, 2000). Need to autonomy
is a need to self-following and having the electoral right
at the beginning maintenance and tuning the activities.
Autonomy will happen when people feel the responsibil-
ity for their behavior, and con dent in their choices and
also the ability of eligible performance, (Sheldon, 2001).
Autonomy means feeling volition, having authority of
doing things, innate tendency for self-organized behav-
ioral experience (Sheldon, 2001). Autonomy is related to
freedom and experience of solidarity in personal behav-
Competence (adequacy): all people try and want to
be competent. All want to have fruitful interaction with
their environment and this interest is expanded to all
aspects of life such as school, workplace, relations, and
at the time of recreation and sport. All like to develop
some skills and enhance abilities and talents. When a
challenge is faced, all attention is focused on it. When
the opportunities to develop the skills and talents is
given all would like to progress. In these circumstances,
the result is a sense of satisfaction. In the other word,
human needs to competence; need to competence means
the ability of a person in doing duties and that person
have how much ability to achieve the desired objectives
(Mulder, 2007).
Relatedness (continuity): relatedness is a need to emo-
tional bonding with others and this need also expresses
the desire of being emotional and being involved in
intimate relationships. The requirement to relatedness
causes to leading to people who certainly care about
the well-being of a person and eschewing of people
who do not care about her welfare. Need to relatedness
is de ned as ensuring communication with others and
need to make self-experience as an individual worthy of
love and respect. In the other words, individual requires
to have a relationship with others and be supported by
them (Johnston, 2010).
FIGURE 1. Perfectionism features
Soodabeh Yavari and Asghar Jafari
Table 1. Summary of multiple regression analysis
Model R R
Justi ed R
Standard error
1 0.54 0.29 0.27 26.14
Table 2. Summary results of analysis of variance for signi cance of regression model
Source of changes Sum of squares Degrees of freedom Mean square F Signi cance level
Regression 49602.9 5 9920.58 14.51 0.001
remaining 116898.72 171 683.61
Total 166501.62 176
Table 3. Summary of regression coef cients for psychological and perfectionism needs
Final model
coef cient (B)
coef cient (Beta) t
Signi cance
Autonomy 0.13 0.36 0.03 1.35 0.72
Competence 0.48 0.40 0.10 1.20 0.23
Dependence 0.56 0.31 0.13 1.81 0.07
1.21 0.36 0.24 3.34 0.001
-0.68 0.13 -0.37 -5 0.001
The method of this paper is descriptive–analytical and
data collection is done using questionnaire. For this pur-
pose, 200 men and women who were an applicant of
cosmetic surgery and had come to beauty clinic of Imam
Khomeini hospital in Tehran and were chosen using
availability sampling method. And also analyzing data
is done using the SPSS19 software.
In order to a comprehensive analysis of data, a statisti-
cal method of multiple regressions was used and data
was investigated based on  ndings and hypotheses. First
hypothesis: psychological and perfectionism needs pre-
dict the cosmetic surgery applicants’ perception of body
image. For determining the relationship between psy-
chological and perfectionism needs and cosmetic sur-
gery applicants’ perception of body image, multivariate
regression is used whose digest is reported in Table 1.
explain 20% of changes in cosmetic surgery applicants’
perception of body image.
As it is shown in Table 2, in the regression model,
psychological needs (autonomy, competence, and
dependence) and perfection (positive and negative) has a
signi cant relationship (F=14.51, P<0.01) with cosmetic
surgery applicants’ perception of body.The criterion
variable: perception of body image.Results of the Table
3 indicate the share of each variable in the prediction
of perception of body image model. As it is observable,
positive and negative perfectionism factors have a sig-
ni cant share in the prediction of “body image percep-
tion” and the largest coef cients of beta equal to -0.37
belongs to negative perfectionism. In the other words,
“negative perfectionism” factor has a stronger role in
the prediction of “body image perception” in cosmetic
surgery applicants.
Second hypothesis: psychological needs, perfection-
ism, and perception of body image of women and men
who are an applicant of cosmetic surgery are different.
At  rst, the assumption of equality of variances for psy-
chological needs, perfectionism, and perception of body
image was examined. As it is shown in Table 4, there
is an equal assumption for psychological needs, perfec-
tionism, and perception of the body of men and women
applicants of cosmetic surgery.
After determining variances equality assumption, for
comparing scores of psychological needs, perfection-
ism, and perception of body image of women samples,
student’s t-test was used for groups apart which results
are reported in the table. According to Table 5, because
signi cance level of “t” value (which is calculated by
comparing psychological needs, perfectionism, and per-
ception of image body of samples) is more than 0.05, the
fourth hypothesis was not con rmed. Therefore, it can
Predictor variables: psychological and perfectionism
needs Criterion variable: perception of body image. As
can be seen in the table, the intensity of the relationship
between psychological needs (autonomy, competence,
and dependence) and perfectionism (positive and nega-
tive) and cosmetic surgery applicants’ perception of the
body was calculated. Its value obtained 0.54 and they
Soodabeh Yavari and Asghar Jafari
be said that there is no signi cance relationship between
men’s and women’s (applicants of cosmetic surgery) psy-
chological needs, perfectionism, and perception of body.
According to the  ndings of this research, the  rst
hypothesis was con rmed, and it was concluded that
there is a signi cant relationship between psychological
needs, perfectionism, and perception of body image of
cosmetic surgery applicants. In addition, from predictive
variables, “negative perfectionism” factor has a more
effective role in the prediction of perception of body
image in cosmetic surgery applicants. This result cor-
responded with  ndings of Hass, and Von Soest (2009)
(Haas, 2008; Von Soest, 2009). Results of these studies
have shown that there is a relationship among cosmetic
surgery applicants’ psychological needs, perfectionism,
and perception of body image. The same as this research
that has shown that negative perfectionism feature has
more share in the prediction of body image in cosmetic
surgery applicants. Since perfectionism increases the
anxiety level and negative perfectionism leads people to
the inef cient and non-constructive behaviors, so it fur-
ther strengthens the basic needs of the motivational and
psychological tendency of people. In people who do not
have a favorable understanding of their own appearance,
choosing cosmetic surgery without a justi able medical
reason is a solution based on emotional copying style
(Nerini, 2014). It seems that the main motivational factor
for this action is a failure to satisfy basic psychological
needs. Awareness of this discontent is possible with a
focus on “self”. Intellectual challenges such as how peo-
ple think about us and our belief about how they will
behave have important implications on how we think
about ourselves. When a person expects to be rejected
for the sake of some of her features, she can choose
between several different possible answers that choos-
ing cosmetic surgery is one of these responses. Also in
the second hypothesis, it was concluded that there are
differences between men’s and women’s (cosmetic sur-
gery applicants) psychological needs, perfectionism, and
perception of body.
On the basis of  ndings of this research, the fourth
hypothesis was not con rmed and it was concluded that
there is no signi cant difference among psychological
needs, perfectionism and perception of the body of sam-
ples. This result corresponds with study results of Pasha,
Naderi and Akbari (2009) and sarwer (2005) (Naderi,
2008; Sarwer, 2005). Basic psychological requirements
and perfectionism characteristic of people, over time
and in the process of mental transformation, leading to
the formation and evolution of the cognitive, emotional
and behavioral characteristics. Accordingly, these fac-
tors will create inef cient perceptions of people toward
themselves and their environment and will have con-
cerns and con icts about their appearance in the future.
Therefore, men and women who were applicants of
cosmetic surgery, in most cases did it in uenced by the
same motivational factors (Webb, 2015).
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Variables F
Signi cance
Autonomy 0.16 0.68
Competence 0.33 0.56
Dependence 0.03 0.86
Positive 0.58 0.29
Negative 0.17 1.85
Perception of
body image
0.74 0.10
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