INTRODUCTION
Individuals universally pursue their perception of beauty and strive to become more attractive [1]. Young adults often adhere to beauty ideals regarding their appearance, with women aspiring to the thin beauty ideal and men to the muscular ideal, resulting in increased self-esteem with higher satisfaction with their body [2]. However, at times, excessive concern about one’s appearance, dissatisfaction with the body, and consequent emotional and psychological distress can occur [3]. Studies targeting the general population indicate that 70%-80% of individuals express dissatisfaction with some aspect of their bodies [4,5]. Considering findings ranging from 11%-72% in women and 8%-61% in men, body dissatisfaction appears pervasive in our society [6].
Body dissatisfaction serves as a risk factor for various mental health issues such as eating disorders [7], mood disorders [8], sexual dysfunction [9], and body dysmorphic disorder [10]. Personality traits influence self-perception [11], making individual personality characteristics crucial in understanding body dissatisfaction [12]. Specifically, personality traits like narcissism [13,14], perfectionism [13,15], obsession [14,16], avoidance [15,17], and low self-esteem [18] have been linked to body dissatisfaction. Studies utilizing the Big Five personality model (neuroticism, extraversion, openness, agreeableness, and conscientiousness) consistently report that high neuroticism and low extraversion are associated with negative body image [19,20].
Recent research highlights that difficulties in impulse control, particularly in managing anger, mediated the impact of this discrepancy on body dissatisfaction [21]. Although studies have established a link between body image and aggressive behavior in adolescents [22,23], further investigation is needed to understand if anger acts as a psychological factor influencing body dissatisfaction in adults.
Individuals dissatisfied with their bodies tend to engage in continuous comparisons of their own and others’ appearances, sustaining dissatisfaction by perceiving others as having better physical features. This process of upward comparison leads to negative affect and guilt [24]. Coping styles, strategies for regulating emotions and managing negative situations [25], are determined by personality traits, influencing the choice of coping strategies [26] and play a crucial role in determining responses to upward comparison. Coping styles are classified into adaptive and maladaptive categories [27]. Adaptive coping styles involve actively overcoming negative situations, seeking help [28], and are associated with high conscientiousness, optimism and agreeableness [26,29,30]. In contrast, maladaptive coping styles involve avoiding problem-solving, pouring excessive negative emotions, self-blaming [28,31], and are linked to high neuroticism [26,29,30]. Moreover, maladaptive coping styles are associated with body dissatisfaction and maladaptive eating attitudes and behaviors, emphasizing the importance of adaptive coping in dealing with stress [31-33].
Studies on depression and personality traits indicate that maladaptive personality traits impact the onset of depressive symptoms [34], have negative outcome [35], and are related to treatment responsiveness [36]. Likewise, evaluating personality traits related to body dissatisfaction can aid in formulating treatment plans and predicting outcomes for individuals with body dissatisfaction.
In this study, we aimed to investigate whether there exist personality traits, including personality measures, anger expression and coping style, related to body dissatisfaction among young adults in Korea. We will categorize participants into three personality types based on their personality profiles and attempt to comprehend the correlation between personality types and the level of body dissatisfaction specific to each personality type.
METHODS
Participants
Participants were recruited from the Daejeon and Chungcheong regions for this study above from October 2021 to November 2023, with a total of 345 individuals signing up. The inclusion criteria were as follows: Korean-speaking adults aged 19 years or older. The exclusion criteria included individuals who did not consent to participate, those with impairments in consciousness, vision, or hearing that would interfere with the assessment. Since this study targeted the general adult population, the presence or absence of psychiatric diagnoses at the time of assessment was not considered. The research received approval from the IRB of Chungnam National University Hospital with the committee’s reference number 2022-07-086, and all participants provided informed written consent prior to the assessment.
Measures
Demographic data
Participants were provided with a questionnaire regarding each participant’s information including age, sex, height (cm) and weight (kg) for body mass index (BMI).
Body Dysmorphic Disorder Examination-Self Report
The Body Dysmorphic Disorder Examination-Self Report (BDDE-SR), a modified version of an interview measure developed by Rosen and Reiter [37], standardized for the Korean adolescent by Kim et al. [38] and adult population by Kim et al. [39] was utilized in this study. The BDDE-SR comprises three parts and part 3 was used in our investigation. Participants responded to a total of 30 items concerning their least satisfying body area over the past month. Except for items 16a and 16b, all questions were rated on a Likert scale ranging from 0 to 6 points, reflecting the severity of symptoms. The total score ranged from 0 to 168 points, with higher scores indicating more severe symptoms. However, there is no established cutoff point for diagnosing Body Dysmorphic Disorder.
HEXACO-Personality Inventory-Revised
The HEXACO, developed by Lee and Ashton [40] to assess personality across six independent dimensions, was adapted and validated in the Korean version by Yoo et al. [41]. Various versions of the HEXACO have been published, varying in the number of items. The six dimensions include Honesty-Humility, Emotionality, eXtraversion, Agreeableness, Conscientiousness, and Openness, with evaluations conducted on a 5-point Likert scale. In this study, the HEXACO-Personality Inventory-Revised, a shortened scale comprising a total of 60 items [42], was utilized.
Paranoia, borderline features and antisocial features subscales of Personality Assessment Inventory
The personality assessment developed by Morey [43] consists of 4 validity scales, 11 clinical scales, 5 treatment consideration scales, and 2 interpersonal scales. It employs a 4-point Likert scale, with ratings ranging from 0 to 3. In this study, the version translated and validated by Kim et al. [44,45] was utilized. Among the eleven clinical scales, we focused on paranoia (PAR), borderline features (BOR), and antisocial features (ANT), which are relevant to personality. Each scale comprises 24 items. The PAR scale can be further divided into three sub-scales: hypervigilance (PAR-H), persecution (PAR-P), and resentment (PAR-R). The BOR scale includes affective instability (BOR-A), identity problems (BOR-I), negative relationships (BOR-N), and self-harm (BOR-S). The ANT scale is composed of antisocial behaviors (ANT-A), egocentricity (ANT-E), and stimulus-seeking (ANT-S).
State-Trait Anger Expression Inventory
This is a scale developed by Spielberger [46] to measure the experience and expression of anger. Anger experience is further classified into two categories: state anger (SA), which represents the individual’s fluctuating intensity of anger depending on situations or times, and trait anger (TA), which is an individual’s dispositional tendency to experience SA. Anger expression is further divided into three categories: anger in (AI), which measures the frequency of suppressing anger, anger out (AO), which measures the frequency of expressing anger towards others, and anger control (AC), which measures the frequency of attempting to control anger. It is evaluated on a 4-point Likert scale, and in this study, the Korean version of the State-Trait Anger Expression Inventory (STAXI) developed by Chon [47] was used.
The Ways of Coping Checklist
This is a coping style scale developed by Lazarus and Folkman [48]. Stress coping strategies are categorized into four types: problem-focused coping, which aims to overcome elements of distress or frustration and change the source of the problem or environment; seeking social support, which involves seeking necessary information and help; emotion-focused coping, which involves avoiding the problem or becoming absorbed in one’s emotions or thoughts for emotional relief; and wishful thinking, which involves coping by imagining an ideal situation rather than focusing on the stressor. Problem-focused coping and seeking social support are considered active coping, while emotion-focused coping and wishful thinking are classified as passive coping. The scale is rated on a 5-point Likert scale ranging from 1 to 5. In this study, the Korean version of the Ways of Coping Checklist (WCCL) translated by Lee and Kim [49] was utilized.
Statistical analysis
The data analysis methods employed in this study are as follows: first, descriptive statistics, frequency analysis, and independent sample t-tests were conducted to assess the levels among key variables, such as demographic data (age, sex, and BMI), body dissatisfaction (BDDE-SR) scores, and personality traits (HEXACO, 3 subscales of PAI, coping mechanisms and anger dimensions) for the study participants. Second, Pearson’s correlation analysis was performed to examine the correlations between demographic data, personality traits, and body dissatisfaction. Regression analysis was then conducted to identify variables predicting high levels of body dissatisfaction. Third, utilizing the K-Means cluster analysis, participants were divided into three groups based on their personality profiles. Differences in body dissatisfaction across the three clusters were examined. Bonferroni post hoc test was employed to assess the effectiveness of the clustering. Statistical analyses were conducted using Statistical Package for the Social Science (version 29), and all significance levels were set up at p<0.05.
RESULTS
Demographic and personality characteristics of the participants
The demographic and personality characteristics of the 345 participants are described in Table 1. There were 128 male participants (37.1%) and 217 female participants (62.9%), with a mean age of 24.47 years (SD=4.84). The average age of male participants was 24.99 years (SD=2.92) and that of female participants was 24.16 years (SD=5.67). The average BMI was 22.33 kg/m2 (SD=3.92) overall, 24.22 kg/m2 for males (SD=3.93) and 21.18 kg/m2 for females (SD=3.45). The overall BDDE-SR score for all participants was 27.76 (SD=20.64). There was no significant correlation between body dissatisfaction and age (r=-0.086, p=0.114), and between body dissatisfaction and BMI (r=0.056, p=0.302). When comparing body dissatisfaction between genders using a t-test, females (30.80±21.87) showed a higher level of dissatisfaction compared to males (22.59±17.24; t=-3.86, p<0.001). Furthermore, in females, there was an increase in body dissatisfaction with an increase in BMI (r=0.151, p=0.029), whereas in males, there was no significant correlation between BMI and body dissatisfaction (r=0.134, p=0.132). Stimulus seeking of ANT and AC of STAXI were higher in males than females, while emotionality of HEXACO, identity problem of BOR, wishful thinking and emotion focused coping of WCCL, TA and AI of STAXI were higher in females than males.
Correlations of each personality measures with BDDE-SR score and regression for BDDE-SR
The correlation between subscales of personality measures and BDDE-SR is presented in Table 2. BDDE-SR showed positive correlations with HEXACO’s emotionality (r=0.232, p<0.001), PAR of PAI (r=0.275, 0.299, 0.328, p<0.001, <0.001, <0.001, respectively), BOR of PAI (r=0.393, 0.430, 0.375, 0.269, p<0.001, <0.001, <0.001, <0.001, respectively), and ANT of PAI (r=0.129, 0.264, 0.151, p<0.001, 0.016, 0.005, respectively), WCCL’s emotion focused coping (r=0.157, p=0.004), and STAXI’s SA, TA, AO, and AI (r=0.173, 0.141, 0.121, 0.367, p=0.001, 0.009, 0.024, <0.001, respectively). Additionally, there were negative correlations with WCCL’s problem-focused coping (r=-0.125, p=0.020) and HEXACO’s extraversion and agreeableness (r=-0.264, -0.122, p<0.001, 0.024, respectively). Pearson’s correlation coefficients between all personality measures were calculated and summarized in Figure 1.
Following the correlation test, we extracted variables that showed significant correlations and conducted a regression analysis to identify predictors for body dissatisfaction. Significant contributors were found in the BOR-I subscale of PAI (β=0.265, t=4.644, p<0.001), AI subscale of STAXI (β=0.203, t=3.799, p<0.001), and PAR-R subscale of PAI (β=0.168, t=3.240, p<0.01). To assess validity of this model, adjusted R2 was calculated (Table 3).
Three distinctive personality types based on personality measures and comparison of BDDE-SR score between the clusters
The participants were divided into three clusters based on personality traits using K-Means cluster analysis, and one-way ANOVA with Bonferroni correction was applied to examine significant differences among the clusters in terms of the means and variances of personality measures. The three clusters consisted of 88 participants in cluster 1, 154 participants in cluster 2, and 103 participants in cluster 3. The BDDE-SR mean score in cluster 2 (20.44±16.86) was significantly lower than that in cluster 1 (30.94±21.26) and cluster 3 (35.98±21.60) (Figure 2 and Supplementary Table 1). Across the three clusters, significant differences were observed in nine variables from subscales of personality measures, including HEXACO’s conscientiousness (F=37.343, p<0.001), persecution (F=27.624, p<0.001) in PAI’s PAR, affective instability (F=56.669, p<0.001), identity problems (F=46.518, p<0.001), and negative relationships (F=49.853, p<0.001) in PAI’s BOR, wishful thinking (F=106.790, p<0.001) for coping in WCCL, and TA (F=9.625, p<0.001), AO (F=20.335, p<0.001), and AI (F=76.428, p<0.001) in STAXI.
DISCUSSION
This study explored the association between various personality traits, including anger expression and coping style, and body dissatisfaction. Additionally, it classified personality types into three clusters to investigate their relationship with body dissatisfaction.
In our study, a few personality variables differed between gender. This was consistent with previous studies about gender differences in HEXACO [50], BOR of PAI [51], WCCL [52,53], and STAXI [54]. Especially, the higher scores in female in emotionality of HEXACO and identity problem of BOR and TA of STAXI, which is also known as anger temperament, may indicate that females were more likely to report the affective symptoms [55]. Such results may be in line with the high prevalence of borderline personality disorder in female [56]. AI of STAXI was also higher in female which means they are preventing anger from being expressed, but still experiencing it internally [46]. Whereas males may tend to regulated their anger (higher score in AC of STAXI) by searching for exciting and sensational experiences (higher score in ANT-S of PAI) [45,46].
On the other hand, body dissatisfaction scores were higher in females than males, which was consistent with previous researches [57-60] indicating that women tend to have a more negative view of their appearance. Reasons for women’s greater dissatisfaction with their bodies include tendencies to scrutinize their body, experience body shame, lower body esteem [61], and the absence of the ability to self-enhance desirable features, which are more prevalent in men [62].
In females, body dissatisfaction increased with an increase in BMI, while in males, there was no correlation. This may be related to the tendency of males to underestimate their weight and desire to gain weight [63] and the tendency of females to desire weight loss [64].
The personality traits predicting the body dissatisfaction in this study were identity problems, anger inhibition, and resentment. Higher scores in the identity problems domain were associated with a tendency to feel uncertain about major life issues, lose a sense of purpose, and exhibit tendencies toward emptiness, boredom, and dissatisfaction [45]. Higher scores in the AI domain were linked to internalizing anger without expressing it and turning it inward [46]. Additionally, higher resentment scores were associated with feeling insulted or slighted and harboring resentment in response [45]. Therefore, it can be speculated that individuals who experience uncertainty in life, internalize anger, and tend to attribute their unhappiness to others are more likely to perceive dissatisfaction with their bodies.
Furthermore, participants were categorized into three groups based on their personality profiles, and significant differences were observed in more than two groups for all personality traits. Specifically, conscientiousness, persecutory ideation, emotional instability, identity problems, negative interpersonal relationships, wishful thinking, TA, anger expression, and AC all showed significant differences among the groups. Notably, cluster 1 exhibited generally introverted and not conscientious traits with the lowest scores in coping with stress and controlling anger tendencies. Cluster 2 displayed socially positive traits such as honesty-humility, extraversion, agreeableness, and conscientiousness, while also presenting lower socially aversive characteristics which include suspicion, persecutory ideation, distrust, resentment, emotional and AC difficulties, and engaging in ambivalent interpersonal relationships. In contrast, cluster 3 was characterized by emotional, openness, high anger intensity and frequency, a tendency to express anger both internally and externally, and passive coping with stress. Additionally, cluster 3 scored highest on characteristics associated with aversive social behavior.
Classifying characteristics intuitively for each cluster using terms adapted from Galen’s temperamental categories [65], named after bodily humors, could be considered: cluster 1 represents a “phlegmatic and melancholic” personality, cluster 2 a “sanguine” personality, and cluster 3 a “choleric” personality.
Concerning body dissatisfaction across clusters, significant differences were found only between cluster 2 and the others, suggesting that individuals with a sanguine personality, characterized by extroversion, conscientiousness, and positive interpersonal relationships, tend to perceive their bodies less negatively. Notably, many individuals with the same BDDE-SR score were classified into different clusters. This indicates that individuals that we previously considered identical, at least superficially on a quantitative scale, have substantially different characteristics that can be grouped into subpopulations. With further research, such subpopulations may show different disease progression and treatment response, leading to a change in the way we approach BDD patients in the future. For example, patients in certain clusters may have a tendency for better therapeutic alliance formation, trying less to hide their problems, and better response to supportive psychotherapy and psychoeducation. While patients in other clusters may require more specific therapy such as emotional regulation therapy, cognitive behavioral therapy, or interpersonal therapy.
This study has several limitations. First, it is a cross-sectional study, and therefore, the temporal relationship between personality types and body dissatisfaction cannot be ascertained. To address this limitation, longitudinal research is needed to examine the association between baseline and follow-up observations of personality and body dissatisfaction, allowing for a better understanding of the impact of personality on body dissatisfaction. Second, although the measures used in this study have been widely validated for reliability and validity, being self-report surveys, responses may vary based on the participants’ state. Third, the study did not assess psychiatric symptoms such as depressive or anxiety symptoms, and it is plausible that these symptoms could influence survey responses, self-evaluation, stress coping mechanisms, and other factors [66-68].
Despite the limitations above, the analysis results aligned with previous findings from other countries, demonstrating that body dissatisfaction is more pronounced in females and that there is a positive association between BMI and body dissatisfaction in females. Additionally, through cluster analysis, distinct personality trait groups showing significant differences in body dissatisfaction were intuitively classified. Notably, even with similar BDDE-SR scores, there were cases where personality traits differed. This highlights the importance of considering individual personality traits when managing body dissatisfaction, suggesting the need for diverse strategies based on personality traits, which may lead to different outcomes and prognoses.
In conclusion, our study analyzed the relationship between body dissatisfaction and personality traits in the Korean young adult population and found a significant correlation between specific personality traits and body dissatisfaction. There were significant differences in the level of body dissatisfaction among distinct personality clusters. This suggests that individuals dissatisfied with their bodies may exhibit varied patterns and outcomes based on their personality types.
Subsequent research should focus on investigating if the personality clusters identified in this study generalizes in the patient group. Generalization would require replication across various institutions or regions and the inclusion of patient groups. Considering the potential variations in the progression and management outcomes of body dissatisfaction based on personality types, it is imperative to incorporate personality traits into treatment planning for more effective interventions.
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