This study examined the serial mediating effects of appearance anxiety and body appreciation in the relationship between intersecting childhood adversity and cosmetic surgery desire in emerging adulthood. The worldwide rise in cosmetic surgery interest, projected to continue beyond 2026, highlights the importance of understanding how early-life adversities influence appearance-related attitudes.
From an ecological systems perspective, children are embedded in multiple environments that shape their psychological development. Adverse experiences within the family (microsystem) may interact with bullying victimization at school (another microsystem), creating cross-contextual stress amplification. This intersection of family- and school-based adversity may foster appearance-related insecurity and influence later cosmetic surgery intentions. Although cosmetic surgery can temporarily enhance confidence and body image, it also carries potential complications, failures, or dissatisfaction.
A total of 320 emerging adults (aged 18-29 years) completed an online survey distributed via social media. The study employed the Childhood Trauma Questionnaire-Short Form, Multidimensional Bullying Victimization Scale, Appearance Anxiety Inventory, Body Appreciation Scale-2, and Acceptance of Cosmetic Surgery Scale to investigate the relationships between adverse childhood experiences, together with multidimensional bullying victimization, and cosmetic surgery desire.
The findings indicate that higher levels of childhood adversity are associated with greater exposure to bullying, increased appearance anxiety, reduced body appreciation, and a stronger desire for cosmetic surgery. Appearance anxiety and body appreciation functioned as significant parallel mediators, highlighting the emotional and perceptual pathways through which early adverse experiences may shape body-related decisions in emerging adulthood.
This study underscores the importance of preventing family violence and school bullying and addressing appearance-related distress to foster positive body image. The results provide insights for developing prevention and intervention strategies targeting the long-term consequences of intersecting childhood adversity and appearance anxiety.