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www.PRSGlobalOpen.com 1
INTRODUCTION
There are reports of high psychological mo
idity
among people opting for a cosmetic surgery.1–9 Up to 71%
of people with personality disorders, mainly borderline-
type emotional instability disorder,2,10,11 seek aesthetic
surgical procedures with autolytic aims or unrealistic ex-
pectations about the outcomes2,7; people with personal-
ity disorders are described as demanding and i
itable.12
Generalized anxiety disorder is one of the most frequent
disorders in the Mexican population, with a prevalence of
14.3%, mainly in women between 40 and 50 years of age,13
with higher anxiety in younger women before a surgical
procedure.14–17 The majority of patients are satisfied with
the results and report an improvement in the quality of
life after cosmetic surgery.2,18–21
A positive change in physical appearance has a posi-
tive psychological effect that improves self-confidence and
self-esteem..2,17 Satisfaction with cosmetic surgery results
has also been related to age, since older patients have
more realistic expectations and are more satisfied with the
esults than younger patients..21 Some studies have found
that self-esteem is not a determining component in the
motivation for cosmetic surgery.22
This study aims to describe personality traits, level of self-
esteem, and anxiety in women undergoing cosmetic surgery
with body contouring, such as liposculpture or lipoabdomi-
noplasty with or without placement of
east implants.
PATIENTS AND METHODS
Patients and Procedure
Subjects were female patients who opted for cosmetic
and reconstructive surgery in a private practice in Mexico
City between May 2016 and May 2017 with the intention of
having a body-contouring cosmetic surgery. The investiga-
Copyright © 2019 The Authors. Published by Wolters Kluwer Health,
Inc. on behalf of The American Society of Plastic Surgeons. This
is an open access article distributed under the Creative Commons
Attribution License 4.0 (CCBY), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original
work is properly cited.
From the *Department of Psychiatry, Clínica Emocia, Mexico
City; †Department of Plastic Surgery, Clínica Perfect Surgery;
Mexico City ‡Department of Physics and Mathematics, Instituto
Tecnológico y de Estudios Superiores de Monte
ey, Mexico City
Campus; §Department of Dermatology, Clínica dermatológica
Soprano Skin, Mexico City; ¶Private practice; and ║Department of
Nutrition, Clínica Perfect Surgery, Mexico City.
Background: There are reports on high psychological mo
idity, mainly personali-
ty disorders, among people opting for cosmetic surgery. This study aims to describe
the personality traits, level of self-esteem, and anxiety in women seeking cosmetic
surgery with body contouring, such as liposculpture or lipoabdominoplasty with or
without placement of
east implants.
Methods: Subjects were 87 women between 18 and 60 years of age in Mexico City
who went to a private clinic with the intention of undergoing cosmetic surgery
with body contouring. A psychiatric interview was performed using three scales:
the Salamanca questionnaire for screening for personality disorders, the Hamilton
Anxiety Rating Scale, and the Rosenberg Self Esteem Scale.
Results: The average age was 31 years, with 35% of participants having previously
undergone body-contouring surgery. Regarding personality, the patients did not
show a psychopathology level for diagnosing a personality disorder. Regarding
anxiety, 92% of the patients showed an average level of anxiety. High level of self-
esteem was exhibited by 81 participants (93.15%), and six participants (6.9%) ex-
hibited average self-esteem. Notably, no participant exhibited low self-esteem.
Conclusions: The level of psychopathology of the patients was lower than expect-
ed, the self-esteem was not affected prior to the surgical procedure, and the level of
anxiety did not cause dysfunction. (Plast Reconstr Surg Glob Open 2019;7:e2381; doi:
10.1097/GOX XXXXXXXXXX; Published online 30 October 2019.)
Estephania Del Aguila,
Psychiatrist*
Jorge R. Martínez, MD†
José L. Pablos, MS‡
Marino Huánuco, MD§
Victor M. Encina, MD¶
Ana L. Rhenals, MD║
Personality Traits, Anxiety, and Self-esteem in
Patients Seeking Cosmetic Surgery in Mexico City
Disclosure: The authors have no financial interest to declare
in relation to the content of this article.
DOI: XXXXXXXXXX/GOX XXXXXXXXXX
Received for publication December 12, 2018; accepted June 17,
2019.
10.1097/GOX XXXXXXXXXX
Special Topic
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doi.org/10.1097/GOX XXXXXXXXXX
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PRS Global Open • 2019
2
tion procedure was explained to them, and an informed
consent was also obtained. The inclusion criteria were be-
ing a woman between 18 and 60 years of age, giving in-
formed consent to participate in the study, and knowing
how to read and write. When they met these criteria and
consented to participate in the study, they were asked for
their sociodemographic data. A single psychiatric inter-
view was performed, and three scales were applied.
Scales
Salamanca Questionnaire for Screening for Personality Disorde
It is an interviewer-administered questionnaire with 22
items, two for each personality disorder, ie, 11 personal-
ity traits/disorders that are subdivided into three groups:
group A (paranoid, schizoid, schizotypal), group B (anti-
social, narcissistic, histrionic, emotional instability border-
line subtype, emotional instability impulsive subtype), and
group C (anankastic, dependent, and anxious).23,24 These
subdivisions have been used in different classifications for
personality disorders, such as the International Statistical
Classification of Diseases and Related Health Problems
10th Revision, Diagnostic and Statistical Manual of Mental
Disorders (DSM IV), DSM IV-TR, and DSM 5, on which
this scale was based and which has thus grouped personal-
ity traits and disorders based on their similarity.24,25 Each
disorder trait has a score range from zero to six24; in this
study, a disorder was considered present with a score of
six, and a marked trait was considered present with three
to five points, while a patient “without disorder” was con-
sidered with zero to two points.
The Salamanca questionnaire was developed at the
Faculty of Medicine of the University of Salamanca, as part
of a doctoral thesis, reporting an average total score of
1.35 and co
oborating its clinical utility.24
Personality disorders are an enduring pattern of inner
experience and behavior that deviate significantly from
expectations of the individual’s culture, being inflexible
and dominant in a variety of personal and social situa-
tions, causing deterioration in their functioning.23
The main characteristics co
esponding to different
personality traits/disorders assessed by the scale are de-
scribed hereunder.24–28
Hamilton Anxiety Rating Scale
An interviewer administered a scale that aims at deter-
mining the severity of symptoms of anxiety. It consisted
of 14 items, 13 qualifying the symptoms of psychological
anxiety (psychological malaise) and somatic anxiety (anx-
iety-related physical symptoms), and one on the behavior
during the interview. Its internal consistency is 0.79–0.8,
and test-retest reliability is XXXXXXXXXX,30 Each item has a score
from zero to four (zero = no symptoms, and four = maxi-
mum intensity), with a total score range from 0 to 56 re-
sulting in an average, moderate to average, and moderate
to severe severity score.29,30
Rosenberg Self-esteem Scale
It is a self-administered scale with 10 items. Cron-
ach’s α reliability is equal to 0.754, between 0.46 and
0.67 (P < XXXXXXXXXXInternal consistency of each factor is ex-
pressed through α, Cronbach’s α 0.786–0.705. This scale
meets the criteria for validity and reliability of a quality
instrument for measuring self-esteem in the Latino popu-
lation.31
Psychiatric Assessment
A psychiatric evaluation was done to rule out a person-
ality disorder, anxiety disorder, or problems in self-esteem.
The evaluation consisted of a Semi-structured Psychiatric
Interview and Free Forum with emphasis on psychopatho-
logical exploration, complemented with application of
the scales mentioned above.
Statistical Analysis
For the variable of age, its descriptive statistics were
obtained: mean, mode, SD, and range. For the variables
of occupation, religious faith, education, nationality, drug
addictions, type of surgery planned, history of depression,
history of cosmetic surgery, history of psychological treat-
ment, and history of taking antidepressants, the distribu-
tion of observed and relative frequencies was obtained.
The medians of age were compared between occupational
types using the Kruskal-Wallis nonparametric test; previ-
ously, Shapiro-Wilk’s test of homogeneity of variances and
Kolmogorov’s test were conducted.32 For the Hamilton
Anxiety Rating Scale, the Rosenberg Self-Esteem Scale,
and the Salamanca personality disorder scale, their reli-
ability was assessed.33
For the Salamanca scale, which consists of 11 reagents,
its validity and consistency, co
esponding to the instru-
ments of this type, were also determined. Regarding validity,
a factor analysis was conducted. The scale is an instrument
that measures the latent structure of the measurements of
a psycho-social construct, such as the 11 personality traits.
This procedure consists of finding sets of variables that
characterize the latent structure under study. The method
of principal components was applied to the co
elation ma-
trix and Kaiser’s varimax rotation of factors.34
The distribution table of each personality trait and
level of presentation was obtained and classified into no
disorder, marked trait, and disorder. The table was tested
for independence of the rows and columns with Pearson’s
co
elation analysis. A Microsoft Excel database was devel-
oped with the data obtained. Processing for descriptive
statistics, Cronbach’s α, and factor analysis were per-
formed using the Statistical Package for the Social Scienc-
es software package, version 21. Co
espondence analysis
was ca
ied out using the package FactorMineR35 and fac-
torextra36 in the statistical computer program R, version
XXXXXXXXXXTables 1–3).
RESULTS
During the period from May 2016 to May 2017, a sam-
ple of 87 (n = 87) women with age ranging from 18 to
60 years was obtained, the mean being 31 years, and the
SD being 8.9 years, whereas the mode co
esponded to 26
years. Their occupations were as follows: 48.8% employed
women (waitresses, models, or personal assistants), 28.8%
self-employed women (itinerant traders or independent
professionals), 12.5% housewives, 7.5% students, 1.3% re-
tired, and 1.3% without occupation.
Del Aguila et al • Personality Traits in Cosmetic Surgery Patients
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