Psychology
2013. Vol.4, No.1, 67-72
Published Online January 2013 in SciRes (http://www.scirp.org/journal/psych) http://dx.doi.org/10.4236/psych.2013.41009
Competitive Orientations and Women’s Acceptance of
Cosmetic Surgery
Bill Thornton1, Richard M. Ryckman2, Joel A. Gold2
1Department of Psychology, University of Southern Maine, Portland, USA
2Department of Psychology, University of Maine, Orono, USA
Received November 17th, 2012; revised December 15th, 2012; accepted January 5th, 2013
Women are presumed to compete intrasexually primarily on the basis of physical attractiveness. As such,
in efforts to enhance their appearance, women may strive to achieve unrealistic cultural ideals of attrac-
tiveness promulgated in the media with potentially negative implications (e.g., body dysmorphic disorder,
eating disorders, and cosmetic surgery). The present study considered the implications of two forms of
competitive orientation on women’s acceptance of cosmetic surgery. Findings indicated that a hypercom-
petitive orientation (psychologically unhealthy) was a better predictor of acceptance of cosmetic surgery
than body dysmorphia. Personal development competitiveness (psychologically healthy) was not related
to either body dysmorphia or cosmetic surgery acceptance. Implication of these results and direction for
further research are considered.
Keywords: Appearance; Attractiveness; Body Image; Competitiveness; Cosmetic Surgery
Introduction
Physical attractiveness in general, and body satisfaction in
particular, have long been identified as significant components
of a woman’s self-concept and have important implications for
interpersonal relations (Hatfield & Sprecher, 1986; Franzoi &
Shields, 1984). Women in Western societies are exposed to
sociocultural norms for an ideal appearance from an early age
and come to place an inordinate value on their physical ap-
pearance as a means of achieving success in competition
against other females for desirable mates. As Brownmiller
(1984) observed, “How one looks is the chief weapon in fe-
male-against-female competition. Appearance, not accomplish-
ment, is the feminine demonstration of desirability and worth”
(p. 50).
Indeed, Darwin (1871) had observed that such intrasexual
competition whereby women compete with other women
through their appearance was a behavioral adaptation for at-
tracting mates. Because males place high value on a woman’s
physical attractiveness with regard to mate selection (Buss,
1989), women therefore would be expected to, and are reported
to, compete intrasexually through self-promotion involving the
enhancement of one’s physical characteristics or appearance
(Fisher, 2004; Fisher & Cox, 2011). Considering “the politics
of appearance,” a woman’s appearance may be her most im-
portant commodity for social and economic survival within a
culture (Chapkis, 1986; Rothblum, 1994; Seid, 1994; Wolf,
1991).
The mass media (magazines, television, movies, and internet)
are pervasive and continual purveyors of this not-so-implicit
message for women to aspire to a cultural ideal of attractiveness
and to be competitive through efforts that enhance their attrac-
tiveness (Bessenoff, 2006; Derenne & Beresin, 2006). These
ideals may become internalized and women may come to
self-objectify and begin to critically evaluate themselves on the
basis of these “appearance standards” (Franzoi, 1995; Fredrick-
son & Roberts, 1997). Such pressures, both external and inter-
nal, may create an onerous burden for women and further exac-
erbate their feeling inadequate, anxious, and even depressed
about their appearance and/or body when they do not measure
up to these idealized cultural standards. As such, the emphasis
on women’s appearance may not only contribute to the over-
representation of women for body-image disorders and eating
disorders (Derenne & Beresin, 2006; Striegel-Moore & Cache-
lin, 1999; Veale, 2004), but also to increased acceptance and
consideration of cosmetic surgery in order to enhance their
self-esteem and improve their social and career potential (Cal-
laghan, Lopez, Wong, Northcross, & Anderson, 2011; Calogero,
Pina, Park, & Rahemtulla, 2010; Henderson-King & Brooks,
2009).
The American Society of Plastic Surgeons (ASPS, 2011) re-
ported recently that there were 19.3 million cosmetic and re-
constructive surgery procedures performed annually in the
United States. The majority of these were cosmetic surgeries
(72%), elective procedures performed to improve appearance
and self-esteem, and the majority of these were performed by
women (91%); and there’s been a 90% increase in such en-
hancements since 2000. The top five procedures were breast
augmentation, facelifts, nose, liposuction, and tummy tucks.
Reconstructive surgeries (28%), on the other hand, are per-
formed for physical reasons to improve function and appear-
ance due to congenital or developmental deformities, infection
or disease, or trauma. While gender differences in these proce-
dures were not reported on, it presumably was not as disparate
as with elective cosmetic surgery.
However, considering the implications of “competition” in
this regard, Burckle, Ryckman, Gold, Thornton, and Audesse
(1999) made an important point that not every form of competi-
tive orientation may predispose women to have negative emo-
tional reactions to one’s own body that result in feelings of

B. THORNTON ET AL.
inadequacy, anxiety, and/or depression leading to disordered
eating. Following Horney’s (1937) distinction between two
competitive orientations, one that is psychologically unhealthy
(i.e., hypercompetitiveness) and the other that is psychologi-
cally healthy (i.e., personal development competitiveness),
Burckle et al. observed that a hypercompetitive orientation was
associated with disordered eating, whereas a personal develop-
ment competitive orientation was not. The interest of the pre-
sent study was to examine further the relationship these differ-
ent competitive orientations have with body dysmorphia and
attitudes toward cosmetic surgery for purposes of appearance
enhancement among women.
Hypercom p et itive Orientation
According to Horney (1937), hypercompetitiveness is the
neurotic need by individuals to be successful in various en-
deavors and life areas “at all costs” and entails a willingness to
manipulate and exploit other people in the pursuit of attaining a
personal goal. She believed that such an extreme competitive
attitude was an “unfailing center of neurosis” and highly detri-
mental to the individual’s personality development and func-
tioning. Horney proposed that this hypercompetitive orientation
originated in childhood as a result of verbally and/or physically
abusive relationships with authoritarian parents and was cou-
pled with a strong parental emphasis on personal success in an
achievement-oriented society such as ours. She maintained that
children subjected to such abuse experienced feelings of pow-
erlessness and insignificance which lead them to develop a
need to win at all costs in order to feel more powerful and good
about themselves. Also, by derogating, manipulating, and/or
controlling others, hypercompetitive individuals are able to
cope neurotically with their feelings of inadequacy and main-
tain an otherwise fragile self-esteem.
Research has indicated that hypercompetitive individuals are
indeed highly neurotic and that these neurotic tendencies are
based in anger and hostility toward others (Ross, Rausch, &
Canada, 2003). In addition, they evidence other negative, un-
healthy personality and social characteristics including low
self-esteem, high anxiety, narcissism, dogmatism, a need to
control and dominate, strategically manipulate self-impressions,
and Machiavellianism (Dru, 2003; Ryckman, Hammer, Kaczor,
& Gold, 1990; Ryckman, Libby, van den Borne, Gold, &
Lindner, 1997; Ryckman, Thornton, & Butler, 1994; Ryckman,
Thornton, Gold, & Burckle, 2002; Thornton, Lovley, Ryckman,
& Gold, 2009; Watson, Morris, & Miller, 1998). Thus, it is not
surprising that hypercompetitiveness has negative implications
for romantic, family, and peer relationships (Ryckman, Thorn-
ton, Gold, & Burckle, 2002; Thornton, Ryckman, & Gold,
2011a). Moreover, in relation to two components of the Type A
behavior pattern that have differential implications for achieve-
ment performance and health, hypercompetitiveness is not re-
lated to Achievement Strivings or actual academic achievement,
but was positively correlated with Impatience-Irritability, the
“toxic factor” as far as increased risk for coronary heart disease
is concerned, and greater self-reported health problems (Thorn-
ton, Ryckman, & Gold, 2011b).
Personal Development Co mpetitive Orientation
In contrast to hypercompetitiveness, personal development
competitiveness reflects an alternative healthy, positive com-
petitive orientation (Ryckman & Hamel, 1992; Ryckman et al.,
1996, 1997). Those characterized by this competitive orienta-
tion are highly motivated to win and succeed; however, it
would not be at any cost or at the expense of others. Indeed,
these individuals compete with (rather than against) others in
order to achieve their personal goals, and they focus less on the
task outcome (i.e., win or lose) and more on the enjoyment
inherent in the task itself (i.e., task mastery and the self-dis-
covery, self-improvement, and personal growth gained through
competition). As with hypercompetitiveness, Horney (1937)
traced the origin of these healthy competitive strivings to early
childhood experiences where children were afforded warm,
supportive, yet authoritative (not authoritarian) treatment by
their parents. Because their parents were responsive, trustwor-
thy, and satisfied their need for basic security, she posited such
children would be open to developing trusting and affectionate
attitudes toward others. As such, they should be capable of
healthy interpersonal relationships and be able to focus on the
achievement of their competitive goals within a context of mu-
tual respect and trust of others.
Indeed, this personal development competitive orientation is
associated with various indicators of psychological and social
health. Research has shown it correlates positively with per-
sonal and social self-esteem, achievement, affiliation, concern
for the welfare of others, the ability to be altruistic in social
relationships and the ability to forgive others for transgressions;
and it is negatively correlated with neuroticism, dominance, and
aggressiveness (Collier, Ryckman, Thornton, & Gold, 2010;
Ryckman & Hamel, 1992; Ryckman, Hammer, Kaczor, & Gold,
1996; Ryckman, Libby, van den Borne, Gold, & Lindner, 1997).
Individuals with this perspective are clearly motivated to exert
maximum effort to win in competition, but in an honest and
straightforward manner. They view other competitors as facili-
tators who provide them with opportunities for self-discovery
and personal growth and development (Burkle et al., 1999).
And, with regard to the Type A behavior pattern, personal de-
velopment competitiveness correlates positively with the Achi-
evement Strivings component, as well as actual academic achi-
evement; it does not correlate with Impatience-Irritability (the
“toxic factor”), but is negatively associated with self-reported
health problems (Thornton et al., 2011b).
Competitive Orientation , B o dy Dys morphia, and
Acceptance of Cosmetic Surgery
Just as there are many negative personality and social impli-
cations for individuals who have a hypercompetitive orientation,
there are also many positive attributes and implications for
those having the more psychologically healthy personal devel-
opment competitive attitude. It is interesting to note that many
of the negative personality attributes associated with hyper-
competitiveness have been reported among women prone to
disordered eating (Burckle et al., 1999) and vain, materialistic
women who are favorably disposed toward cosmetic surgery
(Henderson-King & Henderson-King, 2005; Henderson-King
& Brooks, 2009). Moreover, given the emphasis placed on
appearance in competing against other women for the attention
of men, women engaged in intrasexual competition utilize
many of the same behaviors as hypercompetitive individuals,
including self-promotion, demeaning and derograting a rival,
bullying, and exclusion (Fisher & Cox, 2011).
All things considered, hypercompetitive women may be pre-
68

B. THORNTON ET AL.
disposed to work toward unrealistic standards of physical ap-
pearance in order to overcome their feelings of inadequacy by
achieving superiority over female rivals in physical appearance.
As such, hypercompetitiveness was expected to be positively
associated with greater body dysmorphia as well as greater
acceptance of cosmetic surgery for enhancing one’s appearance.
In contrast, those characterized by a personal development
competitive orientation are not likely to see other females as
rivals for male companionship who must be surpassed at all
costs. Thus, personal development competitive attitudes would
be unrelated, or perhaps negatively related, to body image dys-
phoria and cosmetic surgery acceptance.
Method
Participants and Procedure
Participants consisted of a nonclinical sample of 139 Cauca-
sian female undergraduates at a public university in the north-
eastern United States. Their mean age was 24.35 (SD = 7.98)
and ages ranged from 18 to 58. In group sessions participants
completed a set of questionnaires for the stated purpose of ob-
taining baseline data for comparison purposes in subsequent
research. In addition to assessments of competitive orientations,
body-image, and attitudes toward cosmetic surgery (described
below), students provided height and weight with which to
compute a body mass index (BMI; mean BMI was 24.64, and
ranged from 17 to 42). Participation was voluntary and in ex-
change for extra credit in their psychology course.
Assessment Instruments
Hypercompetitive Attitude (HCA). The 26-item HCA scale is
a reliable and valid instrument that assesses individual dif-
ferences in hypercompetitive attitudes (Ryckman et al., 1990;
Ryckman et al., 1994). Sample items are “Winning in compete-
tion makes me feel more powerful as a person,” and “If you
don’t get the better of others, they will surely get the better of
you.” Participants responded to items on a 5-point Likert scale,
ranging from strongly disagree (1) to strongly agree (5). Scores
can range from 26 to 130, with higher scores indicating a
stronger hypercompetitive orientation. The internal consistency
of this scale in the present study was adequate (α = .73).
Personal Development Competitive Attitude (PDCA). This
15-item PDCA scale is a reliable and valid assessment of a
psychologically healthy competitive orientation concerned
more with personal growth and development than individual
attainment (Ryckman et al., 1996; Ryckman et al., 1997). Sam-
ple items are “I value competition because it helps me to be the
best that I can be,” and “I enjoy competition because it brings
me and my competitors closer together as human beings.” Indi-
vidual items are responded to on a 5-point scale, strongly dis-
agree (1) to strongly agree (5). Scores can range from 15 to 75,
with higher scores indicative of a greater personal development
competitive attitude. The internal consistency of this scale in
the present study was adequate (α = .90).
Situational Inventory of Body-Image Dysphoria (SIBID). The
20-item short form of the SIBID is a reliable and valid instru-
ment that assesses individual differences in the extent to which
people experience negative feelings about their bodies (Cash,
2002). Sample items are “I have negative emotional experi-
ences when I look in the mirror,” and “I have negative emo-
tional experiences when I am trying on new clothes at the
store.” Items are responded to using a 5-point scale ranging
from never (0) to almost always (4). Scores can range from 20
to 80, with higher scores reflecting greater body-image dyspho-
ria. This scale had adequate internal consistency in the present
study (α = .97).
Acceptance of Cosmetic Surgery (ACS). The ACS scale is a
reliable and valid 15-item measure that assesses participants’
attitudes regarding acceptance of, and propensity for, cosmetic
surgery (Henderson-King & Henderson-King, 2005). Sample
items are “I would consider having cosmetic surgery as a way
to change my appearance so that I would feel better about my-
self,” and “If I was offered cosmetic surgery for free, I would
consider changing a part of my appearance that I do like.” Par-
ticipants responded to the items on a 5-point scale ranging from
not at all (1) to very much (5). Scores can range from 15 to 75,
with higher scores indicating greater acceptance of, and interest
in having, cosmetic surgery. The internal consistency of the
scale in the present study was adequate (α = .95).
Social Self-Esteem. The Texas Social Behavior Inventory
(TSBI; Helmreich & Stapp, 1974) is a reliable and valid 16-
item assessment of an individual’s self-esteem as a function of
one’s perceived level of social comfort and competence. Sam-
ple items are “I feel secure in social situations,” and “I enjoy
social gatherings with other people.” Item responses used a 5-
point scale ranging from not at all (1) to very much (5) charac-
teristic of me. Scores could range from 16 to 80 with higher
scores indicative of greater social self-esteem. Internal consis-
tency of this measure in the present study was adequate (α
= .86).
Social Desirability (SD) Assessment. Reynolds’ (1982) 13-
item short-form of the Marlowe-Crowne SD scale (Crowne &
Marlowe, 1964) is a reliable and valid instrument that measures
individual differences in approval seeking by endorsing state-
ments that are socially desirable. Sample items are “I am al-
ways willing to admit it when I make a mistake” and “I’m al-
ways courteous, even to people who are disagreeable.” Indi-
vidual items were responded to on a 5-point scale, ranging from
strongly agree (1) to strongly disagree (5). Total scores could
range from 13 to 65, with higher scores indicative of a greater
need for approval and the tendency to respond in a socially
desirable manner. Internal consistency of the scale in present
study was adequate (α = .77).
Results
Correlat ional Analyses
Pearson correlation coefficients were computed among the
different variables and are presented in Table 1. Social desir-
ability response bias was apparent for individual difference
assessments. As such, those with a greater predisposition to
respond in a socially desirable manner were likely to report
somewhat higher self-esteem (r = .35, p < .001) and more of a
personal development competitive orientation (r = .17, p < .05),
both of which are positive attributes. In contrast, those predis-
posed to social desirability tended to under-report on negative
attributes such as body dysmorphia (r = −.27), acceptance
of/interest in cosmetic surgery (r = −.28), and hypercompeti-
tiveness (r = −.42; all ps < .001. In consideration of the rela-
tionships between the different individual difference variables,
partial correlations controlling for social desirability response
bias did not differ appreciably (in magnitude or significance)

B. THORNTON ET AL.
70
Table 1.
Intercorrelations among study variables.
SD AGE BMI TSBI SIBID ACSS HCA PDCA
SD - .16 .07 .35c −.27c −.28c −.42c .17a
AGE - .30c .30c −.16 −.01 −.32c .12
BMI - .05 .16 −.04 −.10 −.02
TSBI - −.46c −.07 −.16 −.34c
SIBID - .24b .23b −.14
ACSS - .32c −.11
HCA - .08
Note: n = 139. ap < .05; bp < .01; cp < .001.
from the zero-order correlations presented in Table 1.
An interesting pattern of associations was apparent involving
women’s age. While older women tended to have a greater
BMI (r = .30, p < .001), they also had somewhat less situational
body dysmorphia (r = −.16, p = .06) and higher social self-
esteem (r = .30, p < .001). However, BMI and self-esteem were
not related at all (r = .05), yet self-esteem negatively correlated
with body dysmorphia (r = −.46, p < .001). These findings are
rather anomalous given the concern women express about their
appearance and weight across the life span (e.g., Pliner, Chaikin,
& Flett, 1990) and that women’s self-esteem is highly related to
body satisfaction (e.g., Franzoi & Shields, 1984). However,
older women were also less hypercompetitive (r = −.32, p
< .001) and may have less concern with intrasexual competition.
Indeed, hypercompetitiveness was correlated positively with
both body dysphoria (r = .23, p < .01) and acceptance of cos-
metic surgery (r = .24, p < .01). This, perhaps, suggests that
intrasexual competitional issues may be less of a concern for
older women, yet remain an area of apprehension among
younger women. Finally, age was essentially unrelated to per-
sonal development competitiveness (r = .12), and personal de-
velopment competitiveness was unrelated to body dysphoria (r
= −.14) and acceptance of cosmetic surgery (r = .11) as conjec-
tured earlier (ps > .05).
Regression Analysis
In further consideration of the distinction between the two
competitive orientations and acceptance of cosmetic surgery, a
hierarchical regression analysis was conducted with attitudes
toward cosmetic surgery as the criterion. These results are pre-
sented in Table 2. Initially, social desirability, age, BMI, and
social self-esteem were entered as a block to control statistic-
cally for individual differences on these variables (R2 = .08, p
< .01), although social desirability was the only statistically
significant contributor (t = −3.24, p < .01). This was followed
by a stepwise consideration of body dysmorphia, hypercom-
petitiveness, and personal development competitiveness. Hy-
percompetitiveness was identified as the next best significant
contributor to the prediction equation (R2 = .14, p < .001), and
was then followed by the inclusion of body dysmorphia which
also enhanced the regression (R2 = .18, p < .001). Personal de-
velopment competitiveness did not contribute significantly to
the regression and was excluded from entry.
Discussion
The results of the present study, both in correlations and re-
gression, clearly indicate that the two competitive orientations
are differentially related to acceptance of cosmetic surgery
among women. As expected, hypercompetitiveness was posi-
tively related to cosmetic surgery acceptance, whereas personal
development competitiveness was unrelated in this regard. This
distinction is consistent with that reported previously with re-
gard to disordered eating (Burckle et al., 1999) and suggests
that hypercompetitive women may be predisposed to compete
intrasexually on the basis of appearance in ways that are poten-
tially harmful to themselves in a quest to achieve unrealistic
expectations regarding one’s appearance.
The present results also indicated that women’s negative
emotional feelings about their body image were more strongly
accepting of cosmetic surgery to help improve their appearance
and functioning. This is consistent with other research whereby
cosmetic surgery is viewed as a means to enhance their
self-esteem and improve their social and career potential (e.g.,
Callaghan et al., 2011; Calogero et al., 2010; Henderson-King
& Henderson-King, 2005; Sarwer & Crerand, 2004). However,
what is most interesting is that hypercompetitiveness was
shown to be a better predictor of cosmetic surgery acceptance
than body dysphoria. This suggests that the desire to compete
against and triumph over other women (i.e., rivals) in the race
for physical appearance superiority is paramount for them, and
independent of whether they experience body dysphoria or not.
While the findings of the present study have extended our
knowledge of the areas in which hypercompetitive women play
out their need to compete and “win at all costs” in an intrasex-
ual arena against potential female rivals on the basis of physical
attractiveness, the study has several limitations that must be
acknowledged. In particular, the research was correlational in
nature, not causal; and the sample here consisted of university
women who were homogeneous in regard to race and social
class. Thus, research among a variety of other populations of
women is needed to increase our confidence in the generaliza-
bility of the present findings.
Given the maladaptive nature of hypercompetitiveness, one in-
teresting question that emerges centers on the issue of identifying

B. THORNTON ET AL.
Table 2.
Regression analysis for acceptance of cosmetic surgery.
VARIABLE β t R2 ΔR2
Step 1 .08b
Age .05 .49
BMI −.03 −.37
SD −.29 −3.24b
TSBI .02 0.22
Step 2 .14c .06
Age .13 1.37
BMI −.03 −0.41
SD −.17 −1.83
TSBI .00 0.01
HCA .29 3.12b
Step 3 .18c .04
Age .14 1.50
BMI −.08 −0.96
SD −.15 −1.66
TSBI .09 0.94
HCA .26 2.81b
SIBID .22 2.34a
Note: Variable excluded at Step 3: PDCA, β =.12, t < 1.3, ns. ap < .05; bp < .01; cp
< .001.
the conditions under which individuals’ hypercompetitiveness can
be reduced or eliminated. In the current study, the finding that
hypercompetitiveness was negatively related to age suggests a
potentially interesting avenue for future research. Allport (1961)
surmised that many people free themselves of earlier selfish
motives as they age and begin a movement toward psychologi-
cal maturity, developing and refining personality characteristics
that are antithetical to those characteristic of hypercompetitive-
ness. Whereas hypercompetitive individuals are defensive in
their relations to others and lack insight into themselves, they
typically are unable to form healthy interpersonal relationships,
treating family, friends, and others generally with mistrust,
hostility, arrogance, criticism, and impatience. Allport’s mature
people have more accurate, realistic perceptions of their abili-
ties and limitations and are better able to deal effectively with
life’s difficulties, relate to others, and have real concern for the
welfare of others (see Ryckman, 2013). Future research could
examine the relationships among competitive attitudes and
various characteristics of psychological maturity as a function
of age. Relatedly, examination of the social conditions that
contribute to the development or reduction of maladaptive com-
petitive attitudes would seem indicated as well.
Moreover, given the present results speak of women, perhaps
future research should consider similar implications of hyper-
competitiveness for men. Although concerns with physical
attracttiveness and body-appearance are more characteristic
among women, there may be increased incidence in body-im-
age disturbances, disordered eating (including supplement and
steroid use), and utilizing cosmetic surgery for appearance and
self-esteem enhancement among men associated, in part, with
men become increasingly evaluated on the basis of their ap-
pearance rather than their achievements with increased empha-
sis in the various media on men’s appearance and methods for
enhancing it (Derenne & Beresin, 2006; Hesse-Biber, 1996).
As with women, men may not only feel less attractive and
have reduced self-esteem following exposure to images of at-
tractive males, but also have increased self-consciousness and
heightened social-anxiety (Thornton & Moore, 1993). And,
while women may report the experience more often than men,
self-objectification, appearance and body-image concerns and
self-evaluations, and consequent negative implications for self-
esteem, body dysmorphia, and dietary abuse are evident among
men as well (Cash, 2000; Moradi & Huang, 2008; Muth &
Cash, 1997). As for implications for the consideration of cos-
metic surgery for appearance and social/career enhancement,
the proportion of men undergoing such elective procedures has
increased 16% since 2000 (ASPS, 2011). It would appear that
striving to achieve a societal ideal of male attractiveness may
have similarly negative consequences for men as well. In this
regard, further research might consider whether men’s competi-
tive orientations, particularly hypercompetitiveness, have simi-
lar associations with a predisposition to cosmetic surgery.
In conclusion, with the societal/media emphasis on physical
attractiveness for women, and the internalization of these cul-
tural expectations, attractiveness remains a primary means of
intrasexual competition among women in general. In particular,
the present findings indicate that a hypercompetitive orientation
may contribute further to women’s efforts to enhance their
physical appearance in ways that may prove detrimental to
themselves. Consideration as to how such a maladaptive orien-
tation and consequent behaviors may be tempered or reduced
certainly seems warranted. And, perhaps attention should be
directed toward men to see whether similar relationships may
be emerging for them as increased societal/media emphasis on
a masculine appearance ideal intensifies.
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