Structural Equation modeling of the Body Dysmorphic Disorder based on Early Mal-adaptive Schemas with Mediating Role of Self-Esteem in women with Breast Cancer

Tamannaeifar, MohammadReza; Esmikhani, Mahboobe

doi:10.30473/hpj.2026.74200.6228

Articles in Press

Document Type : Scientific Research

Authors

¹ Corresponding author, Associate Professor, Department of Psychology, Faculty of Humanities, University of Kashan, Kashan, Iran.

² M.A Student in Psychology, Department of Psychology, Faculty of Humanities, University of Kashan, Kashan, Iran.

https://doi.org/10.30473/hpj.2026.74200.6228

Abstract

Objective: Body dysmorphic disorder is a perceptual disorder in which a person is preoccupied with one or more parts of their body that they perceive as particularly ugly or misshapen. Women with body dysmorphic disorder are intensely concerned with their breasts, buttocks, thighs, and overall weight. The obsessive nature of body dysmorphic disorder can cause a person to experience repeated negative feelings and discomfort about their appearance and how others perceive them, and an overall decrease in psychological and social functioning. For example, people with body dysmorphic disorder may engage in self-checking activities, such as repeatedly looking at themselves in the mirror to assess the area(s) of concern and comparing their appearance to that of others. Body dysmorphic disorder concerns (or symptoms related to body dysmorphic disorder) are distressing and can cause significant suffering and are influenced by various factors, one of which is primary maladaptive schemas. Early maladaptive schemas serve as a framework for interpreting reality that provides a stable and coherent sense of self and the world. It is clear that early maladaptive schemas are associated with body dysmorphic disorder, but what could be important is to discover and examine the role of mediating variables in the relationship between early maladaptive schemas and body dysmorphic disorder, which in this study examined the mediating role of self-esteem, because self-esteem, in addition to being affected by the antecedents of this study, namely early maladaptive schemas, can affect dysmorphic disorder. For this reason, and based on research precedents, self-esteem can be an appropriate mediating variable in the relationshis between the variables in this study. The purpose of the present study was to investigate structural equation modeling of the body dysmorphic disorder based on early maladaptive schemas with mediating role of self-esteem in women with breast cancer. Method: The method of the present research is applied in terms of its purpose and descriptive in terms of survey type, which is considered quantitative research. The statistical population of the study was women with breast cancer referral to the oncology center of Imam Khomeini and Imam Hussein Hospital of Tehran city in autumn year 2024. The sample size was selected based on Klein's model (2023) and with subjectivw sampling of 300 women. Data collection tools include the body dysmorphic disorder scale (BDDS) of Hanley and et al (2020), Young schema questionnaire – short form version 3 (YSQ-S3) of Young (2005) and self-esteem scale (RSEs) of Rosenberg (1989). The inclusion criteria for the study were diagnosis of breast cancer, being in the radiotherapy treatment phase, having a minimum level of literacy, full consent to participate in the study, the right to withdraw from the study, having sufficient time to answer the questionnaires, and not receiving psychiatric treatment. Failure to fully answer the questionnaire questions and not having the necessary cooperation to participate in the study were exclusion criteria. For descriptive data analysis, mean and standard deviation were used; for inferential data analysis, Pearson correlation coefficient and structural equation modeling were used. Data analysis software was SPSS and AMOS version 28. Results: The number of respondents was 300, and no outliers or outliers were identified in this study. The mean age and standard deviation were 37.33 and 2.92, respectively. The results showed direct effect of early maladaptive schemas and self-esteem on body dysmorphic disorder is significant. The results also showed that self-esteem has a significant mediating role in the relationship between early maladaptive schemas with body dysmorphic disorder. Also, the final research model had a good fit (RMSEA=0.07, SRMR=0.05, p<0.05) and 84% of the variance of body dysmorphic disorder is explained. Conclusion: In explaining the mediating role of self-esteem in the relationship between early maladaptive schemas and dysmorphic disorder, it can be said that when a person experiences changes in their appearance and body due to illness and considers these changes to be a kind of defect in them, they judge their body and appearance based on this perceived defect. Therefore, it is possible that the emotions and cognitions present in the schemas of self-regulation and impaired functioning react to signs of defect and show sensitivity to appearance. Given that the activity of self-regulation and impaired functioning schemas is, to some extent, accompanied by negative judgments about themselves and the experience of feelings of failure and helplessness, this feeling of failure and helplessness can lower the self-esteem of women with breast cancer, leading them to exhibit weaker self-esteem than other women. Consequently, when women with breast cancer do not have sufficient self-esteem, they feel inadequate due to the removal of the breast and the defect in the breast area, and they believe that they have a serious and major defect in their body. In such cases, they are more likely to experience body dysmorphic disorder. It can be concluded that body dysmorphic disorder in women with breast cancer can be improved with schema therapy and self-esteem training. The present study had several limitations. First, this study was a cross-sectional design. Therefore, future studies could adopt experimental or longitudinal designs to explore the relationship between variables. Data were collected using self-report questionnaires only. Although the validity and reliability of these questionnaires have been well established, response bias or socially desirable responses may have existed in the present study. The participants in this study were a sample from Tehran, so the cross-cultural applicability of the results is limited. Given that this study was conducted among women with breast cancer, future studies could also collect data from different groups of women with other chronic physical illnesses to gain more insight into the factors affecting dysmorphic disorder. The results of the present study have theoretical and practical implications. Theoretically, this study using a mediation model may help to understand the mechanisms involved and affecting dysmorphic disorder. Also, the results of the present study showed that early maladaptive schemas and self-esteem are key factors for predicting body dysmorphic disorder. Therefore, it can be concluded that body dysmorphic disorder can be improved in women with breast cancer with schema therapy and self-esteem training.

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Structural Equation modeling of the Body Dysmorphic Disorder based on Early Mal-adaptive Schemas with Mediating Role of Self-Esteem in women with Breast Cancer

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Articles in Press, Accepted Manuscript Available Online from 10 June 2026

Articles in Press, Accepted Manuscript
Available Online from 10 June 2026