title: Contingencies of Self-Worth and Psychological Distress in Iranian Patients Seeking Cosmetic Surgery: Integrative Self-Knowledge as Mediator.
abstract: BACKGROUND
  Although previous studies have shown that people applying for cosmetic surgery experience high-intensity psychological distress, important variables that function as protective factors have rarely been the subject of study in this population. Therefore, this study aims to investigate the role of low and high self-knowledge in experiencing psychological distress and contingencies of self-worth to appearance and approval from others and to identify the mediatory role of the integrative self-knowledge in patients seeking cosmetic surgery.
  
  
  METHODS
  Eighty-eight patients seeking cosmetic surgery were selected and completed the contingencies of self-worth and integrative self-knowledge scales, as well as the depression, anxiety and stress scale. Data were analyzed using multivariate analysis of variance (MANOVA) and path analysis using 5000 bootstrap resampling.
  
  
  RESULTS
  The results of MANOVA showed that patients seeking cosmetic surgery with high self-knowledge had lower levels of depression, anxiety and stress compared to patients with low self-knowledge. They also gained lower scores in contingencies of self-worth to appearance and approval from others. The results of path analysis indicated that self-knowledge is a complete mediator in the relationship between contingencies of self-worth to appearance and approval from others and psychological distress.
  
  
  CONCLUSIONS
  Based on the results of this study, it can be concluded that self-knowledge as a protective factor plays a major role in relation to the psychological distress experienced by the patients seeking cosmetic surgery. In fact, by increasing self-knowledge among this group of patients, their psychological distress can be decreased.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Clinical Psychology, College of Education and Psychology, Shiraz University, Shiraz, Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Valikhani
authors.affiliation: Department of Clinical Psychology, College of Education and Psychology, Shiraz University, Shiraz, Iran. mgoodarzi@rose.shirazu.ac.ir.
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Goodarzi
mesh_terms: D000293:Adolescent; D000328:Adult; D001828:Body Image; D015331:Cohort Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D003906:Developing Countries; D005260:Female; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010551:Personality; D015995:Prevalence; D011584:Psychology; D012649:Self Concept; D013315:Stress, Psychological; D013518:Surgery, Plastic / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Contingencies of self-worth; Cosmetic surgery; Iranian patients seeking cosmetic surgery; Psychological distress; Self-esteem; Self-knowledge