Shooroki Motahhareh Kargar, Choobforoushzadeh Azadeh, Ardakan Azra Mohammadpanah
Department of Psychology, Faculty of Humanities and Social Sciences, Ardakan University, Ayatollah Khatami Blvd, Ardakan City, Iran.
BMC Psychol. 2025 Jul 28;13(1):841. doi: 10.1186/s40359-025-03204-y.
Body dysmorphic disorder (BDD) is a prevalent concern among adolescent girls. Childhood experiences of security or insecurity are recognized as significant foundational factors influencing body image and, consequently, the development of BDD. Adolescents with a history of childhood trauma may face an elevated risk of developing psychiatric conditions, including obsessive-compulsive disorder and BDD. This study, therefore, aimed to predict BDD symptoms based on childhood trauma, with self-compassion acting as a mediating factor. This framework integrates principles from cognitive-behavioral theory and attachment theory. Specifically, cognitive distortions stemming from cognitive-behavioral patterns, coupled with diminished self-esteem and self-worth as conceptualized by attachment theory, are believed to contribute to lower self-compassion, subsequently leading to a higher incidence of BDD symptoms.
A cross-sectional design employing structural equation modeling (SEM) was utilized to construct an optimal model for BDD symptoms, where the mediating role of self-compassion was tested in the relationship between childhood trauma and BDD symptoms. The study population comprised female students aged 16 to 22 in the cities of Meybod and Ardakan during the 2023-2024 academic year. A non-random convenience sample of 300 participants was selected. Data were collected using the Childhood Trauma Questionnaire (CTQ), the Yale-Brown Obsessive Compulsive Scale-Modified for BDD (BDD-YBOCS), and the Self-Compassion Scale (SCS). Statistical analyses, including Pearson's correlation coefficient and stepwise multiple regression, were performed using SPSS-26 software. SEM analyses were conducted using AMOS-24 software.
The study's results indicated several significant relationships among the variables. Childhood trauma was found to have a significant negative direct effect on self-compassion (β=-0.704, p < 0.001), suggesting that higher levels of trauma are associated with lower self-compassion and vice versa. Conversely, childhood trauma exhibited a significant positive direct effect on BDD symptoms (β = 0.321, p < 0.001), indicating that increased trauma predicts more severe BDD symptoms. Furthermore, self-compassion demonstrated a considerable negative direct impact on BDD symptoms (β=-0.765, p < 0.001), implying that low self-compassion is linked to increased BDD symptomatology and vice versa. Crucially, the Sobel test statistic of 3.216 (exceeding the critical value of 1.96) confirmed that self-compassion significantly mediated the relationship between childhood trauma and BDD symptoms (β = 0.538, p < 0.001). This mediation model suggests that self-compassion plays a vital role in explaining how childhood trauma contributes to the development of BDD symptoms.
The finding demonstrates a robust model fit, confirming self-compassion's mediating role in the association between childhood trauma and BDD symptoms. Consequently, interventions aimed at enhancing self-compassion, such as group education programs and therapeutic approaches grounded in self-compassion therapy delivered in established treatment centers, could effectively mitigate the impact of childhood trauma. Such interventions are anticipated to lead to a reduction in BDD symptomatology, particularly by decreasing cognitive distortions related to body image and fostering greater self-acceptance.
身体变形障碍（BDD）是青春期女孩中普遍存在的问题。童年时期的安全感或不安全感经历被认为是影响身体形象的重要基础因素，进而影响BDD的发展。有童年创伤史的青少年可能面临患精神疾病的风险增加，包括强迫症和BDD。因此，本研究旨在基于童年创伤预测BDD症状，自我同情作为中介因素。该框架整合了认知行为理论和依恋理论的原则。具体而言，源于认知行为模式的认知扭曲，再加上依恋理论所概念化的自尊和自我价值的降低，被认为会导致自我同情水平降低，进而导致BDD症状的发生率更高。
采用横断面设计并运用结构方程模型（SEM）构建BDD症状的最优模型，在该模型中测试自我同情在童年创伤与BDD症状之间关系中的中介作用。研究对象为2023 - 2024学年在迈博德和阿尔达坎市年龄在16至22岁的女学生。选取了300名参与者的非随机便利样本。使用儿童创伤问卷（CTQ）、耶鲁 - 布朗强迫症量表 - BDD修订版（BDD - YBOCS）和自我同情量表（SCS）收集数据。使用SPSS - 26软件进行统计分析，包括皮尔逊相关系数和逐步多元回归。使用AMOS - 24软件进行SEM分析。
研究结果表明变量之间存在若干显著关系。发现童年创伤对自我同情有显著的负向直接影响（β = -0.704，p < 0.001），表明创伤程度越高，自我同情水平越低，反之亦然。相反，童年创伤对BDD症状有显著的正向直接影响（β = 0.321，p < 0.001），表明创伤增加预示着更严重的BDD症状。此外，自我同情对BDD症状有相当大的负向直接影响（β = -0.765，p < 0.001），这意味着低自我同情与BDD症状增加相关，反之亦然。至关重要的是，索贝尔检验统计量为3.216（超过临界值1.96），证实自我同情显著中介了童年创伤与BDD症状之间的关系（β = 0.538，p < 0.001）。该中介模型表明，自我同情在解释童年创伤如何导致BDD症状发展方面起着至关重要的作用。
研究结果表明模型拟合良好，证实了自我同情在童年创伤与BDD症状关联中的中介作用。因此，旨在增强自我同情的干预措施，如团体教育项目以及在既定治疗中心采用基于自我同情疗法的治疗方法，可有效减轻童年创伤的影响。预计此类干预措施将导致BDD症状减轻，特别是通过减少与身体形象相关的认知扭曲并促进更大程度的自我接纳。
