Examination of the Relationship Between Childhood Traumas and Dissociation, Social Appearance Anxiety and Gender Roles in People With and Without Aesthetic Surgery Experience

doi:10.21203/rs.3.rs-2340028/v1

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Research Article

Examination of the Relationship Between Childhood Traumas and Dissociation, Social Appearance Anxiety and Gender Roles in People With and Without Aesthetic Surgery Experience

https://doi.org/10.21203/rs.3.rs-2340028/v1

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Background

In the study, it was aimed to comparatively examine the relationships between childhood traumas, dissociative experiences, social appearance concerns and gender roles of people who have and do not have plastic surgery.

Methods

Socio-demographic Information Form, Childhood Trauma Scale, Dissociation Scale, Social Appearance Anxiety Scale, Gender Roles Attitude Scale were applied to 415 participants aged 18–55 residing in Istanbul. Participants in the research were reached through questionnaires created with the Google Forms application in electronic environment. Study data were evaluated with SPSS statistical analysis program. Kolmogorov Smirnov test was used for the normality distribution of the data. Normal distribution was not detected in the scales used.

Results

The relationship of the continuous variables was examined with the Spearman Correlation coefficient. According to the research findings, a positive relationship was found between childhood traumas scale scores and dissociation scale scores and social appearance anxiety scale scores of all participants, and a negative relationship with gender attitudes scale.

Conclusion

While the scores of the participants with plastic surgery experience in childhood traumas and all sub-scales, the identity confusion subscale of the dissociation scale, and the social appearance anxiety scale were higher than the participants who did not have plastic surgery, the childhood traumas of those with plastic surgery experience and the egalitarian and male gender roles were negatively correlated found to be in a relationship.

Childhood traumas dissociation

Social appearance anxiety

Gender roles

The purpose of this study is to add to the body of knowledge by exploring the potential psychological dynamics that may underlie peoples' judgements towards aesthetics. The proportion of negative life experiences and childhood traumas, dissociative experiences, social anxiety about appearance, and social roles on aesthetic decision-making were explored in comparison, and the research's findings were consistent with its hypotheses and expectations. While the scores of the participants who had plastic surgery were greater than those of the participants who had not had plastic surgery, they also experienced higher scores on the identity confusion subscale of the dissociation scale and the social appearance anxiety scale.

Today, modern medicine plays an important role in health care as well as beauty practices. The aim of aesthetic surgery, which is a method of correcting or beautifying a defected organ (1), is to provide satisfaction and psychological improvement in the person by correcting the body image of the person (2). The feature that makes aesthetic operations different from other medical operations is that the process is mostly initiated by a patient, not a doctor. While it is claimed that psychopathology is the norm in patients who apply for aesthetic surgery (3); Research shows that aesthetic operations are associated with many psychological dynamics and mental health problems (4). In this study, it is aimed to comparatively examine the effects of childhood traumas on dissociation, social appearance anxiety and gender roles in people who have had at least one plastic surgery and those who have never had plastic surgery.

Traumas with a wide spectrum such as natural disasters, wars, social violence, terrorism, accidents also include childhood traumas. (5) Traumatic events that threaten or disrupt physical, mental or emotional integrity; (52) leaves greater scars, especially when experienced in childhood, when there is insufficient protection against psychological, physical or sexual attacks. Children who are traumatized by their relatives in the place where they live (6), who are abused and neglected by their families due to wrong upbringing styles (7), and because of these preventable negative behaviors that do not occur as a result of accidents, significant disruptions in their physical and psychosocial development processes. They live (8). Field studies reveal that child abuse is complex and that children are exposed to different forms of maltreatment (9).

With condescending attitudes, ridicule, humiliation, and threats that pose a danger to the child's mental health (8) and negatively affect the child's morality and well-being (10); While the adult may abuse the child psychologically and emotionally (51), the child is physically harmed and the child's bodily integrity is endangered (8) and poses a risk of physical injury to the child (10) in physical abuse, the caregiver may also physically injure the child. All sexual behaviors involving a child, such as the use of a child as an object or tool of sexual stimulation by an older person (8), are considered sexual abuse (10), and these children are higher than the general average. They may have a history of more life stress (9), they may be exposed to similar abuse in adulthood, and they may experience significant impairment in their adjustment and functioning in adulthood (11). In the table of negligence, which occurs when the caregivers do not fulfill their responsibilities; The child can be neglected physically by depriving them of their basic needs such as nutrition, shelter, medical support, education and cleaning; When their psychological needs such as love, attention and support (12) are not met, they may also be neglected emotionally (8). The literature generally shows that abused children are exposed to several different types of abuse at the same time (13).

The traumatic effects of childhood abuse and repetitive negative early life experiences on mental health can dissociate these individuals (5). The child, who cannot escape from the trauma who has experienced physically, cannot fight and struggle but at the same time cannot accept what the person has experienced, tries to get away from the mental and physical effects of the trauma by using dissociation which is a primitive and automatic defense mechanism. When children are repeatedly exposed to traumatic experiences, they begin to use this defense in excessive and abnormal ways (6). Adding dissociative defenses to psychological pathologies caused by childhood traumas in these individuals may cause dissociation disorders to occur as comorbidities in these individuals (5). Common themes of dissociative disorders; It is a partial or complete loss of memory, identity awareness, bodily sensation and movement control (14). In the face of traumatic events, the person may become alienated from himself, feel as if he is watching himself from the outside, and completely lose his sense of self (15). With the continuous use of these defense mechanisms, self-esteem decreases in individuals who lose their sense of self and become alienated from themselves. Low self-esteem in these individuals is related to the inconsistency between the ideal self that the person wants to be and the perceived real self (16). These individuals may try to create a much stronger and more perfect self by reflecting their inadequate and weak features. With this effort, they can strive to resemble individuals who are accepted and admired by society. (17) One of the aims of the study is to investigate the relationship between the traumatic experiences in childhood and the dissociative experiences of individuals, and the individuals who develop weak personality traits such as loss of identity, self-alienation, low sense of self, low self-esteem due to dissociative defenses; It is the scientific evaluation of the prediction that there will be an attempt to have more aesthetic operations with the desire to be an ideal and accepted person.

Body image refers to the degree of satisfaction or dissatisfaction with various aspects of the body that an individual has. People who focus on their bodies focus their attention on their own subjective feelings rather than the objective size and shape of their body. (18). Negative body image can be defined as the presence of negative feelings and thoughts about the whole body or any organ of the person. Person whose body image is not positive; does not find themselves attractive enough, they may feel intense discomfort or even embarrassment about this situation (19). The tendency of most people to communicate with physically attractive people pushes individuals to strive to have an attractive appearance. This situation is defined as self-presentation in the literature. People who think that they cannot give a good physical impression in the social environments they enter may have an increase in their anxiety levels. Social physical anxiety, which is a type of social anxiety, refers to the anxiety experienced by people because of their physical appearance. The social appearance anxiety defined by Hart et al., beyond general variables such as height, muscle structure and weight, it has a detailed and holistic content that includes many features such as the shape of the individual's face, the structure of the nose, and the color of the skin (18). Social appearance anxiety can be seen as a result of a person's physical appearance and body image that is not positive (19). Self-esteem refers to self-satisfaction when one evaluates himself. Self-esteem is a lifelong phenomenon that begins in childhood with the support of the family. However, the self-esteem of children who are abused or neglected in childhood are also negatively affected (20). It has been determined that there is a direct relationship between body image and self-esteem, people with negative body image have low self-confidence, and it has been revealed that body dissatisfaction is associated with low self-esteem (18). Based on the evidence in the literature on the role of childhood traumas in the formation of psychopathology, as well as the effect on personality structuring and the role of negative life events in childhood in the formation of low self-esteem and negative body image, in this study, social appearance anxiety was found in people who had plastic surgery to approach the idealized image by changing their current image. It is another item that aims to contribute to the literature by examining whether it is higher than people who do not have aesthetic surgery and by revealing the relationship of this anxiety with negative experiences in childhood.

The biggest difference between people is that they are male or female. However, this is not just a biologically definable difference, it is a socially categorized and meaningful difference from the first years of life. Gender can be expressed as the set of positions and expectations that society deems appropriate for the individual at this level (21). Gender characteristics are constructed through the socialization process. During this process, factors such as family, school, teachers, friends and media shape the roles of both genders in their professional and social lives (22). According to gender, male and female roles are classified as traditional and egalitarian roles. In traditional roles, women and men are in non-egalitarian roles. While women are mostly seen as people who are responsible for housework and care of the family and do not have an active professional life, the primary roles of men are to be the head of the household and to be responsible for the livelihood of the household. Having egalitarian roles can only be possible by having equal rights in social life, business and education life, and sharing family responsibilities equally (23). In this study, it is aimed to determine whether gender roles are one of the determining factors on the decision of people to have plastic surgery; It is aimed to contribute to the literature on this subject by revealing the effect of these roles on the formation of people's thoughts about their bodies.

When the previous studies are examined, it is seen that strong findings have been reached on the effect of childhood traumas on personality structuring and its role in the development of psychological difficulties and psychopathology. In this study, the role of childhood traumas in people's dissociative life experiences, increase in social appearance anxiety and determination of gender roles, aims to investigate the effects of these factors on the decision of people to have plastic surgery to change their appearance. In the study, the abuse and neglect of two different groups, consisting of people who have had at least one aesthetic operation and those who have never had it, are; It is aimed to look at childhood traumas from a broader perspective by examining dissociative defenses due to weak self formation, development of anxiety and gender roles.

Aim Of The Research

In the study, the abuse and neglect of two different groups, consisting of people who have had at least one aesthetic operation and those who have never had it, are; It aims to contribute to the literature by looking at childhood traumas from a broader perspective by examining dissociative defenses due to weak self formation, anxiety development and gender roles.

Model Of The Research

The research was established with the relational screening model. In the study, it is aimed to comparatively examine the effects of childhood traumas on dissociative experiences, social appearance concerns and social identity roles of people in 2 separate groups, who have plastic surgery and those who do not.

Universe and Examples

The study was conducted in the field of psychology. The universe consists of adult individuals between the ages of 18–55 living in Istanbul. The sample of the study was planned to consist of 450 people, consisting of men and women in this age group living within the provincial border of Istanbul, but within the reach of the researcher, 425 people could be reached with the 'convenience sampling' technique. Since 10 of the participants did not have the characteristics of the target sample, they were excluded from the study and the research was carried out on a sample of 415 people.

Considering the demographic characteristics of the participants who had and did not have aesthetic surgery; 71.9% female, 28.1% male, 3.6% primary school graduate, 20.2% high school graduate, 19.3% university student, 56%, 8 of them are university graduates and above. Of this group, 39.3% were single, 56.2% were married, 4.5% were divorced. The mothers of 6.6% of those who did not have plastic surgery were illiterate, while the mothers of 47.7% were primary school graduates, mothers of 29.6% were high school graduates, and mothers of 16% had a university degree or higher. While the fathers of 1.8% of the people in this group were illiterate, 35.6% had a primary education, 33.8% had a high school graduate, 28.7% had a university or higher education. While 31.4% of those who did not have plastic surgery had a psychiatric diagnosis at any time in their lives, 68.66% did not receive any diagnosis.

Of the group participants who had aesthetic surgery, 79.8% were women and 20.2% were men. 1.2% of this group were primary school graduates, 16.7% high school graduates, 13.1% university students, and 69% university or higher education. While 33.3% of the people who had plastic surgery were single, 57.1% were married, 9.5% were divorced, 7.1% of the people in this group had an illiterate mother, 35.7% had a primary school education, 22% The mothers of .6 of them are high school graduates, and the mothers of 34.5% have a university degree or higher education. While the fathers of 1.2% of this group were illiterate, the fathers of 26.2% of them were primary school graduates, 33.3% of them had high school graduates, and 39.3% of them had a university degree or higher education. Of the participants who had aesthetic surgery, 67.9% had plastic surgery once, 15.5% twice, 4.8% 3 times, 11.9% 5 times or more. While 44% of the people in this group were diagnosed with a psychiatric disorder at some point in their lives, 56% of the group did not receive such a diagnosis.

While the average age of the participants who did not have plastic surgery was 36 (SD = 14), the average age of the participants who had aesthetic surgery was 35 (SD = 12). In both groups, 18 is the youngest age and 55 is the oldest age.

While the Childhood Trauma Scale averages of the group participants who did not have plastic surgery were (X̅=37.16, SD = 11.38), when the sub-scales were examined, the averages of Emotional Harassment (X̅=7.29, SD = 3.52), Physical Abuse (X̅=5.80, SD = 2.22), Physical Neglect mean (X̅=7.80, SD = 3.18), Emotional Neglect mean (X̅=10.52, SD = 4.82), Sexual Harassment mean (X̅=5.75, SD = 2.13), Overprotection Control mean (X̅=9.96, SD = 3.90) was found as While the averages of the Gender Roles Scale (X̅=166.32, SD = 19.59) are examined, the averages of Equalitarian Gender Role (X̅=34.61, SD = 8.86), Female Gender Role averages (X̅=33.04, SD = 5.82), Gender Role averages in Marriage are examined. (X̅=37.59, SD = 3.00), Traditional Gender Role averages (X̅=34.00, SD = 5.63), and Male Gender Role averages (X̅=27.08, SD = 3.09). While the Social Appearance Anxiety Scale mean (X̅=31.20, SD = 12.89) and the Dissociation Scale mean (X̅=1.72, SD = 0.64), when the dissociation subscales were examined; Identity Confusing means (X̅=1.60, SD = 0.66), Loss of Control averages (X̅=1.92, SD = 0.79), Amnesia averages (X̅=1.58, SD = 0.63), Absorption averages (X̅=1.80, SD = 0.73). detected.

While the average of Childhood Traumas Scale (X̅=44.71, SD = 16.18) of the group participants who had plastic surgery was examined, the averages of Emotional Harassment (X̅=8.73, SD = 3.97), Physical Abuse (X̅=6.68, SD = 3.47), Physical Neglect mean (X̅=9.36, SD = 4.62), Emotional Neglect mean (X̅=12.70, SD = 5.17), Sexual Harassment mean (X̅=7.25, SD = 3.78), Overprotection Control mean (X̅=10.99, SD = 4.04) was found as While the averages of the Gender Roles Scale (X̅=164.55, SD = 22.85) are examined, the averages of the Egalitarian Gender Role (X̅=32.26, SD = 11.28), the average of the Female Gender Role (X̅=33.44, SD = 6.13), the average of the Gender Role in Marriage are examined. (X̅=37.24, SD = 3.69), Traditional Gender Role averages (X̅=34.73, SD = 5.54), Male Gender Role averages (X̅=26.88, SD = 3.27). Social Appearance Anxiety Scale averages (X̅=34.31, SD = 12.69), Dissociation Scale averages (X̅=1.77, SD = 0.51), while when their subscales are examined, Identity Confusion averages (X̅=1.67, SD = 0.56), Loss of Control averages (X̅= 1.97, SD = 0.65), Amnesia averages (X̅=1.62, SD = 0.49), Absorption averages (X̅=1.80, SD=0.62).

Data Collection Method and Tools

Research participants were reached through online questionnaires. The questionnaires were created electronically using the Google Forms application and sent to the participants via e-mail and social media channels. Participants were informed about the study and their consent to participate was obtained through an informed consent form. The study was carried out on a voluntary basis and the identity information of the individuals was not collected in order to comply with the principle of personal confidentiality. An institutional permit is not required to carry out the study. Data collection tools used in the research are: Socio-demographic Information Form, Childhood Trauma Scale, Dissociation Scale, Social Appearance Anxiety Scale, Gender Roles Attitude Scale.

Demographic Information Form

The Demographic Information Form was developed by the researcher, and the form includes personal information about the participants such as age, gender, educational status, as well as information about the aesthetic operation experiences of the participants. At the same time, this form also questions whether the participants have received psychiatric support before.

Childhood Trauma Scale (CTQ-33)

Childhood Trauma Scale was developed by Bernstein (10); It was adapted into Turkish as CTQ-28 by Sar in 1996. CTQ-33 is the Turkish version of CTQ-28, which was revised and developed by Şar et al. (24). The scale consists of 33 items. The scale consists of emotional abuse, physical abuse, physical neglect, emotional neglect, sexual abuse and excessive protection-control subscales. The Cronbach alpha value of the scale is .87. (24)

Dissociation Scale (DIS-Q)

The Dissociation Scale was developed by Vanderlinden in 1993, and its Turkish adaptation, validity and reliability studies were performed by Şar et al. (25). The scale consists of 63 items and a 5-point Likert system was used in the scale. The Cronbach Alpha value, which indicates the internal consistency of the scale is .9.

Social Appearance Anxiety Scale (SAAS)

The Social Appearance Anxiety Inventory was developed by Hart et al. in 2008, and the validity and reliability study of its Turkish version was performed by Doğan (19). There are 16 items in the scale. The scale was created with a 5-point Likert system. The Cronbach alpha value of the scale is .93.

Gender Roles Attitude Scale (RAS)

The Gender Roles Attitude Scale was developed by Zeyneloğlu and Terzioğlu (23). There are 38 items in the scale and the scale has five sub-dimensions under the headings of 'egalitarian gender role', 'female gender role', 'gender role in marriage', 'traditional gender role' and 'male gender role'. The scale was created with a 5-point Likert system. The Cronbach alpha value of the scale is .92.

Data Analyses

“Socio-demographic Information Form, Childhood Trauma Scale, Dissociation Scale, Social Appearance Anxiety Scale, Gender Roles Scale” were administered to the participants. In the study, the data were evaluated using the SPSS statistical analysis program. The Kolmogorov Smirnov test was used to test the normality distribution of the data (because it was n ≥ 30). No normal distribution was found in all scales and subscales (p < 0.05). Kolmogorov-Smirnov test results regarding the scales are shared in Table 1. Mann-Whitney U Test and Kruskal Wallis Tests were used for difference analysis. The relationship of the continuous variables was examined with the Spearman Correlation coefficient. The analyzes were based on p < 0.05 significance and 95% confidence level.

Table 1

Comparison of Childhood Traumas, Gender Roles, Social Appearance Anxiety, Dissociation Scales of Participants with and Without Aesthetics
		N	S.O	S.T	U	Z	P
Chilhood Trauma Scale	No	331	195,86	6483,50	9884,50	-4,10	,000*
	Yes	84	255,83	21489,50
	Total	415
Emotional Abuse	No	331	196,37	64997,50	10051,50	-4,11	,000*
	Yes	84	253,84	21322,50
	Total	415
Physical Abuse	No	331	202,71	67096,50	1215,50	-2,36	,018*
	Yes	84	228,85	19223,50
	Total	415
Physical Neglect	No	331	201,29	66628,50	11682,50	-2,30	,021*
	Yes	84	234,42	19691,50
	Total	415
Emotional Neglect	No	331	197,13	6525,50	10304,50	-3,68	,000*
	Yes	84	25,83	21069,50
	Total	415
Sexual Neglect	No	331	198,83	65813,50	10867,50	-4,25	,000*
	Yes	84	244,13	20506,50
	Total	415
Overprotection Control	No	331	201,14	66578,00	11632,00	-2,32	,020*
	Yes	84	235,02	19742,00
	Total	415
Gender Role Attitudes Scale	No	331	209,00	6918,00	1357,00	-,34	,735
	Yes	84	204,05	1714,00
	Total	415
Egalitarian Gender Role	No	331	209,84	69458,00	13292,00	-,64	,525
	Yes	84	20,74	16862,00
	Total	415
Female Gender Role	No	331	205,84	68134,00	13188,00	-,73	,465
	Yes	84	216,50	18186,00
	Total	415
Gender Role in Marriage	No	331	208,29	68942,50	13807,50	-,10	,920
	Yes	84	206,88	17377,50
	Total	415
Traditional Gender Role	No	331	204,55	67704,50	12758,50	-1,17	,241
	Yes	84	221,61	18615,50
	Total	415
Male Gender Role	No	331	209,40	6931,00	1344,00	-,48	,630
	Yes	84	202,50	1701,00
	Total	415
Social Appearance Anxiety Scale	No	331	201,12	6657,00	11624,00	-2,32	,020*
	Yes	84	235,12	1975,00
	Total	415
Dissociation Scale	No	331	203,19	67257,00	12311,00	-1,62	,105
	Yes	84	226,94	19063,00
	Total	415
Identity Confusion Scale	No	331	201,96	66849,50	11903,50	-2,04	,042*
	Yes	84	231,79	1947,50
	Total	415
Loss of Control	No	331	203,39	67321,00	12375,00	-1,56	,120
	Yes	84	226,18	18999,00
	Total	415
Amnesia	No	331	202,89	67156,00	1221,00	-1,73	,084
	Yes	84	228,14	19164,00
	Total	415
Absorption	No	331	206,02	68191,00	13245,00	-,67	,501
	Yes	84	215,82	18129,00
	Total	415

*p < 0.05 Test Used: Mann Whitney- U

There was no significant difference in the cases of having aesthetics and not having aesthetics in the Gender Roles Scale and the subscales of this scale, Egalitarian, Female, Marriage, Traditional, and Male Gender Role Scales and Dissociation Scale and the subscales of this scale, Loss of Control, Absorption, Amnesia (p). >0.05).

The scores obtained by the participants from the Childhood Traumas Scale (U = 9884.50, Z=-4.10, p < 0.05) were found to be significantly different in people who had plastic surgery and those who did not. Considering the averages of the scores obtained, it was determined that the scores of the participants who marked the answer yes were higher than those who marked the answer no.

Considering the subscales of Childhood Traumas; The scores obtained from the Emotional Harassment sub-scale (U = 10051.50, Z=-4.11, p < 0.05) were found to be significantly different in people who had plastic surgery and those who did not. Considering the averages of the scores obtained, it was determined that the scores of the participants who marked the answer yes were higher than those who marked the answer no.

Similarly, Physical Harassment subscale (U = 1215.50, Z=-2.36, p < 0.05), Physical Neglect subscale (U = 11682.50, Z=-2.30, p < 0.05,), Sexual Harassment subscale (U = 10867.50, The scores obtained from the Z=-4.25, p < 0.05) and the Overprotection Control subscale (U = 11632.00, Z=-2.32, p < 0.05) were found to be significantly different in people who had plastic surgery and those who did not. Considering the averages of the scores obtained, it was determined that the scores of the participants who marked the answer yes were higher than those who marked the answer no.

The scores obtained from the Emotional Neglect subscale (U = 10304.50, Z=-3.68, p < 0.05) were found to be significantly different in people who had aesthetic surgery and those who did not. Considering the averages of the scores obtained, it was determined that the scores of the participants who marked the answer no were higher than those who marked the answer yes.

The scores obtained from the Social Appearance Anxiety Scale (U = 11624.00, Z=-2.32, p < 0.05) were found to be significantly different in people who had plastic surgery and those who did not. Considering the averages of the scores obtained, it was determined that the scores of the participants who marked the answer yes were higher than those who marked the answer no.

The scores obtained from the Identity Confusion scale (U = 11903.50, Z=-2.04, p < 0.05), which is a sub-scale of the dissociation scale, were found to be significantly different in people who had plastic surgery and those who did not. Considering the averages of the scores obtained, it was determined that the scores of the participants who marked the answer yes were higher than those who marked the answer no.

Table 2

The Relationship Between Childhood Traumas, Gender Roles, Social Appearance Anxiety, and Dissociation Scales of Participants Who Didn't Have Aesthetics (n = 331)
	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19
1- Chilhood Trauma Scale	1
2- Emotional Abuse	,73^**	1
3- Physical Abuse	,49^**	,47^**	1
4- Physical Neglect	,71^**	,32^**	,24^**	1
5- Emotional Neglect	,90^**	,57^**	,36^**	,58^**	1
6- Sexual Neglect	,38^**	,38^**	,23^**	,17^**	,18^**	1
7-Over Protection/ Control	,60^**	,62^**	,37^**	,31^**	,55^**	,20^**	1
8- Gender Role Attitudes Scale	-,12^*	,14^**	-,02	-,30^**	-,11^*	,02	,08	1
9- Egalitarian Gender Role	-,07	,14^*	,02	-,23^**	-,07	,08	,07	,80^*	1
10- Female Gender Role	-,12^*	,12^*	-,02	-,28^**	-,11	-,00	,04	,91^**	,68^**	1
11- Gender Role in Marriage	-,14^*	,11	-,00	-,27^**	-,14^**	,02	,03	,82^**	,67^**	,70^**	1
12- Traditional Gender Role	,03	,17^**	,02	-,16^**	,02	,04	,12^*	,68^**	,32^**	,58^**	,51^**	1
13- Male Gender Role	-,05	,06	,01	-,19^**	-,06	-,02	,07	,66^**	,36^**	,55^**	,50^**	,75^**	1
14- Social Appearance Anxiety Scale	,28^**	,31^**	,19^**	,10	,21^**	,23^**	,30^**	,10	,08	,09	,00	-,03	-,03	1
15- Dissociation Scale	,31^**	,37^**	,24^**	,07	,27^**	,21^**	,38^**	,10	,11	,07	,04	,01	-,01	,57^**	1
16- Identity Confusion Scale	,37^**	,40^**	,24^**	,12^*	,33^**	,22^**	,39^**	,09	,06	,06	,02	,05	,01	,57^**	,93^**	1
17- Loss of Control	,30^**	,39^**	,23^**	,04	,25^**	,23^**	,37^**	,15^**	,11^*	,11	,09	,06	,04	,55^**	,93^**	,86^**	1
18-Amnesia	,30^**	,33^**	,24^**	,06	,26^**	,23^**	,34^**	,07	,08	,03	,04	,02	,01	,50^**	,87^**	,80^**	,83^**	1
19- Absorption	,18^**	,23^**	,13^*	,03	,16^**	,09	,26^**	,04	,10	,04	-,02	-,09	-,10	,45^**	,84^**	,73^**	,66^**	,61^**	1

**p < 0.01 *p < 0.05 Test used: Pearson Correlation Test

A weak negative relationship between Childhood Traumas and Gender Role Scales (r=-.12, p < 0.05), a weak negative relationship between Childhood Traumas Scale and Female Gender Role (r=-.12, p < 0.05), a weak negative relationship between Childhood Trauma Scale and Gender Role in Marriage (r=-.14, p < 0.05), a weak positive relationship between Childhood Trauma Scale and Social Appearance Anxiety Scale (r = .28, p < 0.01), a moderately positive relationship between the Childhood Trauma Scale and the Dissociation Scale (r = .31, p < 0.01), a moderately positive relationship between the Childhood Trauma Scale and Identity Confusion (r = .37, p < 0.01), Childhood Traumas Weak positive correlation between Childhood Trauma Scale and Amnesia (r = .30, p < 0.01), Childhood Trauma Scale and Absorption (r = .18), p < 0.01), was found a weak positive relationship between them.

The relationship between the Emotional Abuse and the Gender Role Scale (r = .14, p < 0.01) is weakly positive, the relationship between the Emotional Abuse and the Egalitarian Gender Role (r = .14, p < 0.05) is weakly positive, and the Emotional Abuse and the Female Gender Role (r=. 12, p < 0.05), the relationship between Emotional Harassment and Traditional Gender Role (r = .17, p < 0.01) is weakly positive, moderate between Emotional Harassment and Social Appearance Anxiety Scale (r = .31, p < 0.01) a moderately positive relationship between Emotional Harassment and Dissociation Scale (r = .37, p < 0.01), a moderately positive relationship between Emotional Harassment and Identity Confusion (r = .40, p < 0.01), Emotional Harassment Loss of Control (r = .39, p < 0.01), a moderate positive relationship between Emotional Abuse and Amnesia (r = .33, p < 0.01), weak and positive relationship was found between absorption with Emotional Abuse (r = .23, p < 0.01).

A weak positive relationship between Physical Harassment and Social Appearance Anxiety Scale (r = .19, p < 0.01), a weak positive relationship between Physical Harassment and Dissociation Scale (r = .24, p < 0.01), Physical Abuse and Identity Confusion (r=. 24, p < 0.01), a weak positive association between Physical Abuse and Loss of Control (r = .23, p < 0.01), a weak positive association between Physical Abuse and Amnesia (r = .24, p < 0.01) A positive correlation was found between Physical Abuse and Absorption (r = .13, p < 0.05).

A weak negative relationship between Physical Neglect and Gender Roles Scale (r=-.30, p < 0.01), a weak negative relationship between Physical Neglect and Egalitarian Gender Role (r=-.23, p < 0.01), Physical Neglect and Female Gender Role (r=-.28, p < 0.01), a weak negative relationship between Physical Neglect and Gender Role in Marriage (r=-.27, p < 0.01), Physical Neglect and Traditional Gender Role (r=-.16), p < 0.01), a weak negative relationship between Physical Neglect and Male Gender Role (r=-.19, p < 0.01), a weak positive relationship between Physical Neglect and Identity Confusion (r = .12, p < 0.05) a relationship has been found.

The relationship between Emotional Neglect and Gender Roles Scale (r=-.11, p < 0.05) is weakly negative, The relationship between Emotional Neglect and Gender Role in Marriage (r=-.14, p < 0.05) is weakly negative, Emotional Neglect and Social Appearance Anxiety Scale (r=-.14, p < 0.05) are weakly negative. The relationship between r = .21, p < 0.01) is weakly positive, the relationship between Emotional Neglect and Dissociation Scale (r = .27, p < 0.01) is weakly positive, between Emotional Neglect and Identity Confusion (r = .33, p < 0.01), moderate a weak positive relationship between Emotional Neglect and Loss of Control (r = .25, p < 0.01), a weak positive relationship between Emotional Neglect and Amnesia (r = .26, p < 0.01), Emotional Neglect and Absorption (r=. 16, p < 0.01), was found a weak positive correlation between them.

The relationship between Sexual Harassment and Social Appearance Anxiety Scale (r = .23, p < 0.01) is weak and positive, The relationship between Sexual Harassment and Dissociation Scale (r = .21, p < 0.01) is weak and positive, Sexual Harassment Identity Confusion (r) = .22, p < 0.01), the relationship between Sexual Harassment and Loss of Control (r = .23, p < 0.01) was weak and positive, and between Sexual Harassment and Amnesia (r = .23, p < 0.01) have weak and positive relationship.

The relationship between Overprotection Control and Traditional Gender Role (r = .12, p < 0.05) is weak and positive, Overprotection Control and Social Appearance Anxiety Scale (r = .30, p < 0.01). The relationship between Overprotection Control and Social Appearance Anxiety Scale is weak and positive, Overprotection with Control The relationship between the Dissociation Scale (r = .38, p < 0.01) is moderate and positive, The relationship between Overprotection Control and Identity Confusion (r = .39, p < 0.01) is moderate and positive, Overprotection Control vs Loss of Control (r=. 37, p < 0.01), the relationship between Overprotection Control and Amnesia (r = .34, p < 0.01) is moderate and positive, The relationship between Overprotection Control and Absorption (r = .26, p < 0.01) has weak and positive relationship. The relationship between Loss of Control and Gender Roles Scale (r = .15, p < 0.01), while the relationship between Loss of Control and Equitable Gender Role (r = .11, p < 0.05) have weak and positive relationships.

Table 3

The Relationship Between Childhood Traumas, Gender Roles, Social Appearance Anxiety, and Dissociation Scales of Participants Who Didn't Have Aesthetics (n = 84)
	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19
1- Chilhood Trauma Scale	1
2-Emotional Abuse	,76^**	1
3-Physical Abuse	,69^**	,60^**	1
4-Physical Neglect	,78^**	,34^**	,54^**	1
5-Emotional Neglect	,88^**	,62^**	,51^**	,71^**	1
6-Sexual Abuse	,64^**	,46^**	,47^**	,44^**	,37^**	1
7-Over Protection/ Control	,44^**	,59^**	,23^*	,14	,48^**	,15	1
8- Gender Role Attitudes Scale	-,50^**	-,27^*	-,50^**	-,64^**	-,40^**	-,23^*	-,13	1	,
9- Egalitarian Gender Role	-,49^**	-,25^*	-,54^**	-,54^**	-,36^**	-,32^**	-,05	,75^**	1
10- Female Gender Role	-,42^**	-,17	-,43^**	-,58^**	-,33^**	-,14	-,02	,91^**	,65^**	1
11- Gender Role in Marriage	-,44^**	-,18	-,50^**	-,56^**	-,36^**	-,21	-,08	,84^**	,76^**	,76^**	1
12- Traditional Gender Role	-,15	-,04	-,14	-,36^**	-,07	-,03	-,07	,64^**	,17	,54^**	,44^**	1
13- Male Gender Role	-,29^**	-,26^*	-,27^*	-,28^*	-,21	-,19	-,22^*	,62^**	,34^**	,43^**	,43^**	,61^**	1
14- Social Appearance Anxiety Scale	,23^*	,27^*	,07	,07	,19	,12	,29^**	-,04	,13	-,00	-,00	-,22^*	-,08	1
15-Dissociation Scale	,28^**	,20	,13	,19	,21	,23^*	,24^*	-,15	-,02	-,07	-,010	-,27^*	-,15	,55^**	1
16- Identity Confusion Scale	,34^**	,22^*	,21	,29^**	,287^**	,25^*	,17	-,22^*	-,09	-,13	-,21	-,30^**	-,17	,54^**	,938^**	1
17- Loss of Control	,16	,14	,01	,01	,108	,12	,23^*	,01	,10	,07	,08	-,16	-,01	,55^**	,90^**	,83^**	1
18-Amnesia	,32^**	,17	,15	,28^*	,248^*	,27^*	,19	-,19	-,10	-,11	-,15	-,29^**	-,16	,59^**	,85^**	,80^**	,72^**	1
19- Absorption	,20	,17	,10	,16	,144	,20	,21	-,17	,05	-,08	-,11	-,28^**	-,22^*	,34^**	,82^**	,71^**	,58^**	,58^**	1

**p < 0.01 *p < 0.05 Test used: Pearson Correlation Test

The relationship between the Childhood Trauma Scale and the Gender Role Scale (r=-.50, p < 0.01) is moderate and negative. The relationship between the Childhood Trauma Scale and the Egalitarian Gender Role (r=-.49, p < 0.01) is moderate and negative. ,The relationship between Childhood Trauma Scale and Female Gender Role (r=-.42, p < 0.01) is moderate and negative. The relationship between Childhood Trauma Scale and Gender Role in Marriage (r=-.44, p < 0.01) is moderate and negative, The relationship between the Childhood Trauma Scale and the Male Gender Role (r=-.29, p < 0.01) is weak and negative. The relationship between the Childhood Trauma Scale and the Social Appearance Anxiety Scale (r = .23, p < 0.01) have weak and positive relationships. The relationship between the Childhood Trauma Scale and the Dissociation Scale (r = .28, p < 0.01) is weak and positive, the relationship between the Childhood Trauma Scale and Identity Confusion (r = .34, p < 0.01) is moderate and positive, Childhood Traumas’ correlation between the scale and Amnesia (r = .32, p < 0.01) have moderate and positive relationship.

The relationship between Emotional Harassment and Gender Roles Scale (r=-.27, p < 0.05) is weak and negative, The relationship between Emotional Harassment and Egalitarian Gender Role (r=-.25, p < 0.05) is weak and negative, Emotional Harassment Men The relationship between Gender Role (r=-.26, p < 0.05) is weak and negative, The relationship between Emotional Harassment and Social Appearance Anxiety Scale (r = .27, p < 0.01) is weak and positive, Emotional Harassment and Identity Confusion (r=). .22, p < 0.05) is weak and positive.

The relationship between Physical Harassment and the Gender Roles Scale (r=-.50, p < 0.01) is moderate and negative, The relationship between Physical Harassment and the Egalitarian Gender Role (r=-.54, p < 0.01) is moderate and negative, Physical Harassment and Female The relationship between Gender Role (r=-.43, p < 0.01) is moderate and negative, The relationship between Physical Abuse and Gender Role in Marriage (r=-.50, p < 0.01) is moderate and negative, Physical Abuse and Male Gender Role (r) =-.27, p < 0.05) is weak and negative.

The relationship between Physical Neglect and Gender Roles Scale (r=-.64, p < 0.01) is moderate and negative, The relationship between Physical Neglect and Equitable Gender Role (r=-.54, p < 0.01) is moderate and negative, Physical Neglect is Female with The relationship between Gender Role (r=-.58, p < 0.01) is moderate and negative, Gender Role in Marriage with Physical Neglect (r=-.56, p < 0. 01) The relationship between Physical Neglect and Traditional Gender Role (r=-.36, p < 0.01) is moderate and negative, The relationship between Physical Neglect and Male Gender Role (r=-.28, p < 0.05) is weak. and negative, The relationship between Physical Neglect and Identity Confusion (r = .29, p < 0.01) is weak and positive, The relationship between Physical Neglect and Amnesia (r = .28, p < 0.05) is weak and positive.

The relationship between Emotional Neglect and Gender Roles Scale (r=-.40, p < 0.01) is moderate and negative, The relationship between Emotional Neglect and Egalitarian Gender Role (r=-.36, p < 0.01) is moderate and negative, Emotional Neglect is female The relationship between Gender Role (r=-.33, p < 0.01) is moderate and negative, The relationship between Emotional Neglect and Gender Role in Marriage (r=-.36, p < 0.01) is moderate and negative, Emotional Neglect and Identity Confusion (r=) .287, p < 0.01), the relationship between Emotional Neglect and Amnesia (r = .248, p < 0.05) have weak and positive relationship.

The relationship between Sexual Harassment and the Gender Roles Scale (r=-.23, p < 0.05) is weak and negative, The relationship between Sexual Harassment and Equitable Gender Role (r=-.32, p < 0.01) is moderate and negative, Dissociation with Sexual Harassment The relationship between the scale (r = .23, p < 0.05) is weak and positive, the relationship between Sexual Harassment and Identity Confusion (r = .25, p < 0.05) is weak and positive, Sexual Harassment Amnesia (r = .27, p < 0.05) 0.05) is weak and positive. The relationship between Overprotection Control and Male Gender Role (r=-.22, p < 0.05) is weak and negative. The relationship between Overprotection Control and Dissociation Scale (r = .24, p < 0.05) is weak and positive. The relationship between Overprotection Control and Loss of Control (r = .23, p < 0.05) is weak and positive.

The relationship between Gender Roles Scale and Identity Confusion (r=-.22, p < 0.05) is weak and negative.

The relationship between Traditional Gender Role and Male Gender Role (r=-.22, p < 0.05) is weak and negative, The relationship between Traditional Gender Role and Dissociation Scale (r=-.27, p < 0.05) is weak and negative, with Traditional Gender Role The relationship between Identity Confusion (r=-.30, p < 0.05) is weak and negative, The relationship between Traditional Gender Role and Amnesia (r=-.29, p < 0.01) is weak and negative, Absorption with Traditional Gender Role (r=- .28, p < 0.01) is weak and negative.

The relationship between Male Gender Role and Absorption (r=-.22, p < 0.05) is weak and negative.

In this study, the role of childhood traumas in people's dissociative life experiences, increase in social appearance anxiety and determination of gender roles, aims to investigate the effects of these factors on the decision of people to have plastic surgery to change their appearance. In this section, the data obtained from the findings of the research will be evaluated in the light of the field literature and related studies.

During childhood, people are not strong enough against physical, sexual and emotional attacks. The fact that these attacks are predominantly in places where children live and the threat comes from people they are close to increases the level of children being affected by trauma (6). Child abuse jeopardizes the ongoing development process of the child and may prevent the final adaptation to life (9). Traumas related to childhood, especially the role of these traumas in the formation and severity of adult psychopathologies have been the subject of many studies (12). There is a growing recognition that early trauma is associated with psychiatric disorders in adulthood (26). According to scientific evidence; Childhood abuse, in whatever form, causes the development of psychopathology, and is also a factor in the firing, repetition, persistence and difficult extinction of these pathologies (12). Psychiatric disorders are much more severe in people who have been abused in childhood (26).

When researchers examining the relationship between childhood traumas and psychopathologies are scanned, it is possible to find many studies on dissociative disorders. During childhood, the person does not have the physical strength to physically escape from traumatic experiences and fight against trauma. In parallel, the spiritual power of the person is not high enough to accept and make sense of this trauma. The child tries to get rid of this traumatic experience with a much more primitive mechanism. Children who are repeatedly exposed to traumatic events begin to use their dissociation defense in an abnormal way (6), and dissociation disorders occur in these individuals in addition to the psychological pathologies caused by childhood traumas (5).

Consistent with the literature, in this study, it was determined that there was a positive relationship between childhood traumas and dissociation scores of both people who had plastic surgery and those who did not. To address the reasons for this; It would be correct to talk about the intense effects of negative events experienced in the first stages of life on people. Childhood and adolescence processes, which cannot be separated from each other with a clear line and are intertwined, are the periods when brain development is the fastest, and the traces left by what happened during this period are much more permanent. Although the effects of these events are very serious and intense, they have neuroendocrine and neurobiological consequences. At the same time, these traumatic events are the precursors of a lifelong psychological vulnerability and the formation of psychopathology (27). When the scientific evidence is examined, the comprehensive effects of traumas can be seen, but when the literature is reviewed, it is observed that the relationship between trauma and several psychopathologies is under the spotlight. The relationship between post-traumatic stress disorder, depression, borderline personality disorder, and dissociative disorders and childhood traumas is explained in detail (28).

When dissociative defense mechanisms are used excessively, loss of sense of self, self-alienation and a decrease in self-esteem are observed. Low self-esteem has been associated with a mismatch between the idealized self and the perceived real self (16). These people may make an effort to get rid of the features they deem inadequate in themselves and to create a new self in accordance with the idealized definition, and may want to resemble individuals admired by the society (17). In parallel; In this study, people who had plastic surgery scored significantly higher on the identity confusion scale, which is a sub-scale of dissociation, compared to people who did not have plastic surgery. A child who is deprived of love and attention, who is not approved, appreciated, belittled, humiliated, mocked, physically and sexually abused, cannot form a healthy and integrated identity, approach himself more critically, humiliate and accept himself, just like his caregivers; It can push the person into an effort to change himself to become a liked and accepted individual. The fact that the participants who had aesthetic surgery had higher scores on the identity confusion scale, which is one of the subscales of dissociation, is in line with both the literature and the predictions of the research.

Dissociative disorders are among the prominent clinical symptoms of a traumatized child caused by trauma (29). The traumatic effects of early life events such as not being able to receive treatment for a physiological or psychological disorder, not being educated, being married at an early age, being employed at a young age, and separation from children can dissociate these people (5).

Self-esteem expresses one's self-satisfaction and the constructive support of the family is very important in the formation of positive self-esteem, but the self-esteem of the child who is abused and neglected in the early period is also negatively affected (20). A direct relationship was found between self-esteem and body image, and body dissatisfaction was found to be associated with low self-esteem (18).

In this study, in accordance with the field literature, participants who had aesthetic surgery received significantly higher scores than those who did not have plastic surgery in all of the childhood traumas scale and the sub-dimensions of this scale, which are emotional abuse, physical abuse, sexual abuse, physical neglect and overprotection. In other words, according to the results of the research, the group who had plastic surgery had more childhood trauma experiences than those who did not. This result creates the opinion that the participants who had plastic surgery were exposed to more traumatic experiences in childhood and that these traumas may have caused a decrease in their basic level of structuring such as their self-confidence, self-esteem, and body satisfaction, and that these people may have decided to have cosmetic surgery for compensatory purposes.

While the role of negative life events in childhood in the formation of low self-esteem and negative body image is the subject of many studies; It has also been revealed by many studies that these people who experienced psychological trauma in childhood may prefer plastic surgery in their later lives. In a study they conducted, Ip and Ho (30) aimed to investigate the relationship between childhood psychological trauma, plastic surgery and body image. In the research, it was concluded that having plastic surgery can increase self-confidence, reduce body dissatisfaction, resolve internal conflicts and relieve psychological distress to some extent. Another result of the research is that self-esteem and body image obtained from plastic surgery can resolve the disturbing effects of childhood trauma in later life. At the same time, it was concluded that the perceived sense of beauty obtained from plastic surgery contributes to a certain level of self-confidence in the short term. The results of this study are that undergoing plastic surgery may have curative effects on childhood traumas..

Similarly, Kaptan (31), in his study on male and female participants with plastic surgery experience, found a negative relationship between the participants' childhood traumas and body images.

Didie et al. (32) examined childhood abuse and neglect in body dysmorphic disorder. Patients with BDD; 78.7% reported a history of childhood maltreatment. While 68% of the participants experienced emotional neglect, 56% experienced emotional abuse, 34.7% suffered physical abuse, 33.3% suffered physical neglect and 28% sexual abuse, 40% of the subjects experienced severe maltreatment. reported that he had been. Some patients with serious psychiatric disorders, such as body dysmorphic disorder and eating disorders, may complain of minor appearance defects or experience extreme emotional distress due to their dissatisfaction with their body image. Some patients seek cosmetic surgery, become addicted, and repeatedly demonstrate a surgical search pattern to get out of boredom. Aesthetic surgery addiction is a type of surgery addiction in which people show a compulsive need for surgical interventions (30).

Javo and Sørlie (33) found that interest in cosmetic surgery was positively associated with body dysmorphic disorder-like symptoms, body image orientation, and mockery for appearance, in a study they conducted on a sample of 1880 women aged 18–35 years living in Norway. Body image assessment and the quality of the relationship with parents were negatively related to interest in plastic surgery.

In a study conducted by Von Soest et al. (34) in Norway with 907 participants between the ages of 22–55, it was found that the history of being teased as a child had an effect on the decision of plastic surgery and body image mediated this relationship. Part of the questionnaire used in the study was designed to measure respondents' experiences and feelings about negative comments about their appearance in childhood and adolescence. The high scores these participants received; It refers to the frequency of negative comments from parents, friends and other people and the intensity of their emotional reactions to these comments.

One of the main motivations for patients to undergo cosmetic surgery is the hope of being more satisfied with their appearance and improving their psychosocial functioning. Therefore, it seems obvious that an aesthetically successful aesthetic operation will lead to improvements in basic psychological variables such as body image, self-esteem and mental health (35). Individuals' collective cognitive and emotional experiences formulate body image, which creates awareness of the body's relationship with the physical environment and allows for changes in response to new sensory inputs, and even creates new schemas (30). Body image has been suggested as a crucial factor in motivation to undergo cosmetic surgery. If the outcome of an operation is consistent with the patient's expectations, body image assessment is expected to improve as a result. Many patients point to the expected positive effects on self-esteem when explaining their desire to have plastic surgery. Therefore, plastic surgery is expected to improve not only body image but also general self-esteem (35). Plastic surgery helps to heal not only physical defects, but also psychological wounds. People undergoing plastic surgery aim to improve both their body and mind at the same time (30).

It has been the subject of many studies that childhood traumas can cause anxiety about physical appearance in people. Again, in this study, although the childhood traumas scale and social appearance anxiety scale showed a positive relationship in both people who had plastic surgery and those who did not, the social appearance anxiety scale scores of the participants who had aesthetic surgery were found to be significantly higher than those who did not have plastic surgery. The relationship between psychological difficulties such as social anxiety disorder, social appearance anxiety and traumatic experiences in childhood or cases such as deterioration in body image and low self-esteem caused by these experiences has been investigated by many researchers.

In the study by Işıkol (36), in which the relationship between social appearance esteem and self-esteem was examined, the scores of the participants in the physical appearance dimension, which is a sub-scale of the self-esteem scale, and the scores they got from the social appearance anxiety scale were found to be negatively related.

In studies conducted, the primary psychopathologies caused by childhood abuse and neglect are major depression, borderline personality disorder, dissociative disorder, OCD, post-traumatic stress disorder, substance-alcohol abuse (26); More specifically, when examined according to childhood abuse subgroups; OCD, panic disorder, agoraphobia and social anxiety disorder; it was found to be associated with physical and sexual abuse (37).

Gibb et al. (38) reported the relationship between childhood emotional abuse and social phobia in adult psychiatric patients. Emotional abuse rather than physical and sexual abuse has been reported for social phobia.

In the comparative study conducted by Margraf et al. (39), a sample of 544 patients who underwent plastic surgery and 264 participants who were interested in plastic surgery but did not undergo plastic surgery was used, and the treated participants were 3, 6, and 12 months after plastic surgery and the comparison group that did not undergo surgery was followed up after applying to the clinic. Research; It reveals the positive results of undergoing plastic surgery in areas such as anxiety, social phobia, body dysmorphia, self-esteem, attractiveness.

The social behaviors of children who are exposed to high levels of stress in the early stages of life are also affected in the short or long term, and these children experience serious problems throughout their lives (40). While childhood traumas play a role in the formation of psychopathology in individuals, traumatic events experienced at an early age also play a role in the development of children in terms of social, physical, cognitive, emotional and behavioral aspects (12). While repetitive traumas in adulthood have a disruptive effect on the personality structure, traumas experienced in childhood shape the personality structure of the child (41). Like the role of negative experiences in childhood in personality structuring, the effect of these experiences on the social roles that people will assume in life has been studied frequently in the literature.

In this study, while physical harassment was not associated with any gender role in people who had plastic surgery; emotional abuse, physical neglect, sexual abuse and emotional neglect were found to be negatively related to the egalitarian gender role. On the other hand, it is observed that the emotional abuse and overprotection control scores of people who have plastic surgery are negatively related to the male gender role. Emotional and physical neglect also showed a negative relationship with the female gender role in the participants who had plastic surgery. These relationships were either not seen at all or were seen much weaker in people who did not have plastic surgery. While there is a negative relationship between egalitarian gender role and male gender role and childhood traumas in people who have plastic surgery, such a relationship was not found in people who do not have plastic surgery. The female gender role, on the other hand, shows a negative relationship with childhood traumas in both those who have plastic surgery and those who do not, while this relationship is much stronger in the group who has plastic surgery.

There are also studies showing that attitudes towards gender roles increases with the increase in violence. In this case, it is seen that physical abuse, which is one of the childhood traumas, also strengthens the perspective on gender roles (42). In this study, childhood traumas and all subscales show a negative relationship with egalitarian gender roles. Similarly, the female gender role is also in a negative relationship, and since people who have plastic surgery report more childhood trauma, it is an understandable result that gender roles show such a relationship. However, many existing studies on this subject show a positive relationship between traumatic childhood experiences and male gender roles. In this study, it is observed that the male gender role decreases as childhood traumas increase in people who have plastic surgery. Such a relationship is not observed in the participants who do not have plastic surgery. This relationship offers quite remarkable information. It may be possible to interpret the negative relationship between childhood traumas and the male role in those who have plastic surgery, with the information obtained in different studies in this field. In fact, although the concept of gender expresses the biological separation of men and women, the concept of gender emphasizes the unequal division of femininity and masculinity in society (21). Masculine domination shaped by the superiority of men over women also decides what is feminine and what is masculine (43). But today, this standard approach has begun to change. Especially nowadays, with the prominence of metrosexual men, men also have aesthetic operations, and in recent times, men have been trying to look younger in an effort to maintain a relationship with their younger lover or spouse. (44). However, some researchers mention different factors underlying the aesthetic attitudes of men and women. These studies emphasize that women perform aesthetic surgery for the sake of their ideals of beauty, and men, with the desire to eliminate dissatisfaction arising from certain parts of their bodies. The man is beginning to emerge from the standard male mold that has traditionally been cut for him. It is also under scrutiny by studies examining the aesthetic attitudes of men that the man who has had plastic surgery may have gotten rid of the traditional male role and assumed a more metrosexual role.

According to a worldwide study, women had 86.2% of the procedures performed in that year with 20,362,655 aesthetic surgical operations in 2016, while men had 13,8% of the aesthetic operations performed with 3,264,254 procedures (44). In this study, 20% of the participants who had aesthetic surgery were male participants. When we look at the attitudes of men and women towards aesthetic operations, there are various differences. The field literature shows that the indirect effect of perceived sociocultural pressures on having plastic surgery may work differently for men and women. For women, perceived sociocultural pressures are associated with beauty ideals and internalization of beauty ideals plays a role in the formation of positive attitudes towards cosmetic surgery; In men, personal dissatisfaction with their body (or body parts) rather than the desire to reach a social ideal of attractiveness may be one of the reasons why men form positive attitudes towards cosmetic surgery (45).

The study by Menzel et al. (46) on 445 male and 1603 female American university students living in Florida was adapted to examine the role of body satisfaction, perceived pressure for plastic surgery, and internalization of social appearance ideals in understanding individuals' aesthetic surgery attitudes. According to the research results

It has been determined that while the internalization of beauty and ideals of beauty directs women's attitudes towards aesthetic surgery, body dissatisfaction affects this attitude in men.

Abbas and Karadavut (47) focused on the factors predicting the attitudes of men towards aesthetic surgery in their study only on male participants. Comparatively, in the control group consisting of 151 male patients who applied for aesthetic surgery or minimally invasive aesthetic surgery procedure and 151 healthy male volunteers who did not want any kind of aesthetic procedure collected data on body image, masculine gender role stress.

As a result of the research; They found that lower ratings on body image satisfaction and higher degrees of masculine gender role stress were significant predictors of men's attitudes towards cosmetic surgery. While the study confirmed the importance of body image dissatisfaction as an indicator of aesthetic procedure choice, the identification of a new predictor of aesthetic procedure attitudes, namely masculine gender role stress, was characterized as one of the most important aspects of the research.

Frederick et al. (48) examined the interest in plastic surgery and its relationship with gender, age, relationship status, body mass index, and body image satisfaction on a sample of 52,677 people aged 18–65 years. While 48% of the women participating in the study were interested in aesthetic surgery, this rate was determined as 23% in men. Another important result of the study is that the participants who are interested in plastic surgery report a more negative body image perception than the participants who are not interested.

Limitations of the Research

The study is limited to the data obtained from 415 individuals aged 18–55 years. In the research plan, the sample was aimed to consist of 450 people, but the target number could not be reached within the framework of the accessibility of the research and the research was carried out with a limited number of participants.

The research is limited to the data collected with the measurement tools used.

Assumptions Of The Research

It is assumed that the participants in the study answered the scales honestly and sincerely.

It is assumed that the scales used in the research are capable of measuring the concepts planned to be measured.

Suggestions Of The Research

Since the research data do not show normal distribution, it is recommended to repeat the research on a larger sample. While examining the effects of childhood traumas on adult compulsions and psychopathologies in the second study, dissociative disorders were discussed. If the research is repeated, it is thought that the inclusion of different psychopathologies in the subject and the study of other psychological difficulties that may underlie the aesthetic decision will make an important contribution to the literature.

Reconstructive surgery is defined as a procedure to correct an obvious abnormality. Reconstructive procedures such as cleft lip or palate correction can be of immense benefit to children and teenagers. In contrast, cosmetic surgery is defined as surgery to improve a "normal" appearance, such as reshaping a nose or enlarging breasts. With the support of mass media, aesthetic applications have become much more common in recent years. This high demand also makes it difficult for healthcare professionals to agree on when these operations are appropriate or necessary (3). Although the ultimate role of plastic surgery is defined as changing the patient's body image and thus improving the patient's quality of life (49), research shows a more complex relationship between plastic surgery and mental health variables such as self-image and quality of life (4). This relationship has been the subject of many studies. For example, many studies show that distorted body image and other mental health problems, rather than actual weight problems, are the main reasons for people to take extreme measures to lose weight (50).

In this study, it is aimed to contribute to the literature by examining the potential psychological dynamics underlying the aesthetic operation decisions of people. The share of negative life events and traumas in childhood, dissociative experiences, social appearance anxiety and social roles on the aesthetic decision was examined comparatively and the results of the research were compatible with the research hypotheses and predictions. Participants with plastic surgery experience reported more childhood trauma experiences. Similarly, while people who had plastic surgery reported more dissociative experiences, these experiences were mainly gathered under the heading of identity confusion. Again, social appearance anxiety scores were found to be significantly higher in people who had plastic surgery compared to those who did not. However, it has been determined that there is an inverse relationship between childhood traumas and egalitarian gender roles, male and female gender roles of people with plastic surgery experience. All these findings are thought to be related to the traumatic childhood experiences of the people and their personality structures, psychopathologies, anxiety experiences and social roles, rather than the requirements of the operations.

CTQ-33

Childhood Trauma Scale

DIS-Q

Dissociation Scale

SAAS

Social Appearance Anxiety Scale

RAS

Gender Roles Attitude Scale.

Acknowledgements

Not applicable.

Author contributions

All authors read and approved the final manuscript.

Funding

Not applicable.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics approval and consent to participate

All procedures used in studies involving human subjects follow the national research committee’s ethical standards, the 1964 Declaration of Helsinki and its revisions or comparable ethical norms. Full informed consent was given to participants of this study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests

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No competing interests reported.

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Examination of the Relationship Between Childhood Traumas and Dissociation, Social Appearance Anxiety and Gender Roles in People With and Without Aesthetic Surgery Experience

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Childhood Trauma Scale (CTQ-33)

Dissociation Scale (DIS-Q)

Social Appearance Anxiety Scale (SAAS)

Gender Roles Attitude Scale (RAS)

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