Body image disturbance is frequent among individuals undergoing cosmetic surgery and core to the pathology of eating disorders (ED); however, there is little research examining cosmetic surgery in ED. This study examined body image related measures, ED behaviors, and depression as predictors of attitudes toward cosmetic surgery in 129 women with ED. Patients who had undergone surgery (n = 16, 12%) were compared to those who had not. Having a purging diagnosis, linking success to appearance, and making physical appearance comparisons were predictive of more favorable cosmetic surgery attitudes. All of those who had undergone surgery had purging diagnoses and, on average, were older, had higher BMIs, and were more likely to make physical appearance comparisons and know someone who had undergone surgery. In ED, acceptance and pursuit of cosmetic surgery appears to be related to social group influences more than weight and shape disturbance, media influences, or mood.
The pursuit of cosmetic surgery has risen sharply in recent years. Between 2000 and 2010, cosmetic surgery volume increased by almost 70% in the United States, with the documented number of surgical and minimally invasive treatments for women, who make up 90% of all surgical cases, approximating 11.5 million in 2010 (American Society of Plastic Surgeons, 2011). Body image evaluation (i.e., the level to which one is dissatisfied with one's body) and body image investment (i.e., the degree to which one's self-esteem is derived from one's body image) have been proposed as the main factors driving pursuit of cosmetic procedures (Sarwer & Crerand, 2004). Studies of college women have found that both body dissatisfaction and psychological investment in appearance are related to more favorable views of cosmetic surgery, with one study identifying increased body image investment as the strongest predictor of cosmetic surgery attitudes (Cash et al., 2005 and Sarwer et al., 2005). Another study found that more pronounced body image concerns and greater acceptance of cosmetic surgery in one's social environment were the strongest predictors of motivation to undergo cosmetic surgery in Norwegian women (von Soest, Kvalem, Skolleborg, & Roald, 2006).
Disturbance in body image is an essential feature of anorexia nervosa and bulimia (American Psychiatric Association, 2000). Interestingly, although the relationship between body image disturbance and eating disorders (ED) is well documented (Cash & Deagle, 1997), as is the role of body image in the pursuit of cosmetic surgery (Cash et al., 2005, Sarwer and Crerand, 2004, Sarwer et al., 2005 and von Soest et al., 2006), little research exists on the topic of ED and cosmetic surgery. Extant literature includes mostly case studies (McIntosh et al., 1994, Willard et al., 1996 and Yates et al., 1988), with authors suggesting that motivation for cosmetic surgery in persons with ED is directly related to body image disturbance (McIntosh et al., 1994). It has further been suggested that surgery temporarily diminishes underlying depressive symptoms in bulimia (Yates et al., 1988) and that surgical fat removal may be a variant of purging behavior (Willard et al., 1996). To the best of our knowledge, there has been no empirical research describing attitudes toward cosmetic surgery or past experience with cosmetic surgery in individuals with diagnosed ED. The current study aimed to determine the relationship between cosmetic surgery attitudes and experience and body image related measures, disordered eating behaviors, and depressive symptomatology among women with ED. We hypothesized that more favorable cosmetic surgery attitudes and past experience with cosmetic surgery would be associated with increased body image concerns, purging behaviors, and depression.
