2013. Vol.4, No.12, 950-955
Published Online December 2013 in SciRes (
Open Access
Competitive Orientations and Men’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 September 26th, 2013; revised October 27th, 2013; accepted November 25th, 2013
Copyright © 2013 Bill Thornton et al. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited. In accordance of the Creative Commons Attribution License all Copyrights ©
2013 are reserved for SCIRP and the owner of the intellectual property Bill Thornton et al. All Copyright ©
2013 are guarded by law and by SCIRP as a guardian.
As with women, men are experiencing increased pressure to achieve media-conveyed societal ideals for
appearance and their consideration of cosmetic surgery as a means to enhance their appearance for com-
petitive advantage in social and career realms has been increasing. This study considered individual dif-
ferences in competitive orientations and the acceptance of cosmetic surgery among men. Hypercompeti-
tiveness (psychologically unhealthy) was predictive of acceptance of cosmetic surgery even after age,
self-esteem, body mass index, and body dysmorphia were taken into account. Personal development
competitiveness (psychologically healthy) was negatively associated with body dysmorphia and was not
predictive of acceptance of cosmetic surgery among men. These results for men, along with previous re-
search among women (Thornton et al., 2013), indicate that a hypercompetitive orientation contributes to
the consideration of cosmetic surgery independent of body image concerns for both men and women.
Keywords: Appearance; Attractiveness; Body Image; Competitiveness; Hypercompetitiveness; Cosmetic
Physical appearance is well-documented as being an impor-
tant characteristic for both women and men and has implications
for both intrapersonal well-being and interpersonal interactions
(Hatfield & Sprecher, 1986; Jackson, 1992; Langlois et al.,
2000). Historically, women are presumed to compete intrasex-
ually on the basis of their appearance (Buss, 1989; Darwin, 1871;
Fisher & Cox, 2011). As such, it is a woman’s appearance, not
her accomplishments, that has been her most valued asset for
social and economic survival within a culture (Brownmiller,
1984; Rothblum, 1994; Wolf, 1991).
From an early age women are exposed to the sociocultural
expectations with regard to their appearance. These norms are
pervasively conveyed in the media and frequently depict unat-
tainable standards for appearance on which a woman’s worth is
based (American Psychological Association, 2007). In addition,
there is often the not so subtle implication that women must
strive to be more competitive through efforts that enhance their
attractiveness (Bessenoff, 2006; Derenne & Beresin, 2006).
Not only are these “appearance standards” used to evaluate
others, but also they may be internalized and women begin to
self-objectify and critically evaluate themselves on the basis of
these same standards (Franzoi, 1995; Fredrickson & Roberts,
1997). It is these external and internal pressures that are believed
to have resulted in heightened feelings of inadequacy and anxi-
ety among women with regard to their physical appearance and
body-image and contributes to the prevalence of body dysmor-
phia and disordered eating among women (Derenne & Beresin,
2006; Veale, 2004). Appearance concerns also underlie wo-
men’s acceptance of cosmetic surgery as a means to boost their
self-esteem and enhance their social and career potential (Cal-
laghan, Lopez, Wong, Northcross, & Anderson, 2011; Calogero,
Pina, Park, & Rahemtulla, 2010; Henderson-King & Brooks,
In contrast to the emphasis placed on women’s appearance, a
man’s interpersonal and social attractiveness has traditionally
relied more on his apparent skills, abilities, and accomplish-
ments rather than physical appearance (Jackson, 1992; Sherrow,
2001). Intrasexual competition among men is based on a display
of resource acquisitions (Buss, 1989) and derogation of other
men’s abilities and achievements (Buss & Dedden, 1990).
However, while objectifying women has had a long history,
there has been noted an increasingly obvious trend for objecti-
fying men on the basis of their appearance (Faludi, 1999; Moradi
& Huang, 2008; Pope, Phillips, & Olivardia, 2000; Sherrow,
2001). Indeed, just as the media has conveyed the cultural
standards of appearance for women, men have been increasingly
defined by their looks, particularly a youthful appearance and a
lean, muscular body (Faludi, 1999; Moradi & Huang, 2008;
Sherrow, 2001).
As with women, men (and boys) may come to internalize
these standards and engage in self-objectification (Moradi &
Huang, 2008). Although not to the same degree as women, men
are increasingly experiencing appearance and body image con-
cerns (Thompson & Cafri, 2007; Thompson, Schaefer, &
Menzel, 2012) with implications for diminished self-esteem,
depression, body dysmorphia, disordered eating, and the un-
healthy use of steroids and supplements in order to achieve a
lean muscularity (Agliata & Tantleff-Dunn, 2004; Cash, 2000;
Davis, Karvinen, & McCreary, 2005; Moradi & Huang, 2008;
Muth & Cash, 1997; Pope, Gruber, Choi, Olivardi, & Phillips,
Men’s appearance concerns also have implications for con-
sidering cosmetic surgery to improve appearance and enhance
their social and career potential. The American Society of Plastic
Surgeons (ASPS, 2012) reported that, of the 20.2 million pro-
cedures performed in the United States, 72% were cosmetic
surgeries or minimally invasive procedures undertaken to im-
prove one’s appearance, enhance self-esteem, and increase
social and career opportunities. Although men are in the minor-
ity with regard to undergoing these procedures (9%), the number
of procedures among men has increased 22% since 2000.
Among the top procedures are those for facial rejuvenation (e.g.,
facelift, eyelids, botox, skin peel) and achieving a leaner body
(e.g., liposuction and breast reduction).
Competitive Orientation and Acceptance of
Cosmetic Su rgery
Horney (1937) had distinguished between two different types
of competitiveness. For instance, hypercompetitiveness was
considered a psychologically unhealthy competitive orientation
based in neurosis. In contrast, a psychologically healthy com-
petitive orientation, subsequently referred to as personal de-
velopment competitiveness, reflects less concern with task out-
come (i.e., win or lose), but more on the self-discovery, self-
improvement, and personal growth and development that can be
gained through competition.
Hypercompetitive Orientation. As originally described by
Horney (1937), hypercompetitiveness is an indiscriminate need
to compete and win at all costs as a neurotic means to maintain
and enhance an otherwise fragile self-esteem. Based in child-
hood experiences, this need stems from having authoritarian
parents who are abusive and demeaning, and who strongly em-
phasize personal success in an achievement-oriented society.
Thus, by manipulating, controlling, derogating, or otherwise
overcoming others, the hypercompetitive individual is able to
deal with feelings of inadequacy. Research has noted that hy-
percompetitiveness is indeed a neurotic predisposition and as-
sociated with low self-esteem, high anxiety, narcissism, the need
to control and dominate others, deceitful and unscrupulous be-
havior, and willingness to strategically manipulate impressions
for self-aggrandizement (e.g., Dru, 2003; Ross, Rausch, &
Canada, 2003; Ryckman, Hammer, Kaczor, & Gold, 1990;
Ryckman, Libby, van den Borne, Gold, & Lindner, 1997; Ryck-
man, Thornton, & Butler, 1994; Ryckman, Thornton, Gold, &
Burckle, 2002; Thornton, Lovley, Ryckman, & Gold, 2009;
Watson, Morris, & Miller, 1998).
Personal Devel opment Competitive Orientation. In contrast, a
personal development competitive orientation is an alternative
psychologically healthy perspective. This is characterized by
competition with others, not against others; less interest on
extrinsic outcomes (i.e., win/lose), but more intrinsic interest in
the task itself and the self-evaluation and personal growth gained
through competition. Horney (1937) posited that positive child-
hood experiences with warm, supportive parents would enable
healthy interpersonal relationships and the participation in
competitive pursuits with a sense of mutual respect and trust of
others. Research has noted that this competitive orientation is
related to different psychological and social health indicators,
including high self-esteem, achievement and affiliation, em-
pathic, altruistic, and forgiving, but not associated with neuroti-
cism, dominance, and aggressiveness (e.g., Collier, Ryckman,
Thornton, & Gold, 2010; Ryckman & Hamel, 1992; Ryckman,
Hammer, Kaczor, & Gold, 1996; Ryckman, Libby, van den
Borne, Gold, & Lindner, 1997).
Among women, these two competitive orientations have been
shown to relate differentially to disordered eating (Burkle,
Ryckman, Gold, Thornton, & Audesse, 1999) as well as body
dysmorphia and the acceptance and consideration of cosmetic
surgery (Thornton, Ryckman, & Gold, 2013). In particular,
Thornton et al. reported hypercompetitiveness to be positively
related to both body dysmorphia and acceptance of cosmetic
surgery, but hypercompetitiveness proved to be a stronger pre-
dictor of cosmetic surgery than body dysmorphia. In contrast,
personal development competitiveness was negatively related,
although not significantly so, to both body dysmorphia and
consideration of cosmetic surgery. As such, hypercompetitive
women may have a greater need to achieve unrealistic standards
of appearance in a neurotic striving to overcome feelings of
inferiority and gain advantage over female rivals in physical
attractiveness; thus, the greater acceptance of cosmetic surgery
as a means to enhance one’s appearance for such purpose.
As with women, males today may feel increasingly pressured
to achieve media-conveyed societal ideals for appearance and
are showing an increased consideration of cosmetic surgery as a
means to enhance their appearance, and perhaps their competi-
tiveness in personal, social, and career realms. The present
research was conducted to examine the relationship hypercom-
petitiveness and personal development competitiveness have
with body dysmorphia and the acceptance of cosmetic surgery
among men.
Participants and Procedure
Participants consisted of a nonclinical sample of 131 Cauca-
sian male undergraduates at a public university in the north-
eastern United States. Their mean age was 24.27 (SD = 6.49);
ages ranged from 18 to 47. In exchange for extra credit in their
psychology course, the students completed a set of question-
naires for the stated purpose of obtaining baseline data for
comparison purposes in subsequent research. In addition to
assessments of competitive orientations, body-image, and atti-
tudes toward cosmetic surgery (described below), students pro-
vided height and weight with which to compute a body mass
index (BMI; mean BMI was 25.08, and ranged from 17 to 31).
Assessment Instruments
Hypercompetitive Attitude (HCA). The 26-item HCA scale is
a reliable and valid assessment of individual differences in
hypercompetitive attitudes (Ryckman et al., 1990). Sample items
are “Winning in competition 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 respond 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
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internal consistency of this scale in the present study was ade-
quate (α = 0.80).
Personal Development Competitive Attitude (PDCA). The
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 attain-
ment (Ryckman et al., 1996). Sample items are “I value compe-
tition 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.” Individual items are re-
sponded to on a 5-point scale, strongly disagree (1) to strongly
agree (5). Scores can range from 15 to 75, with higher scores
indicative of a greater personal development competitive atti-
tude. The internal consistency of this scale in the present study
was adequate (α = 0.85).
Situational Inventory of Body-Image Dysphoria (SIBID). The
20-item SIBID is a reliable and valid assessment of individual
differences with regard to people experiencing negative feelings
about their bodies (Cash, 2002). Sample items are “I have neg-
ative emotional experiences when I look in the mirror,” and “I
have negative emotional 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
dysphoria. This scale had adequate internal consistency in the
present study (α = 0.97).
Acceptance of Cosmetic Surgery (ACS). The 15-item ACS
scale is a reliable and valid assessment of individuals’ attitudes
regarding acceptance of, and propensity for, cosmetic surgery (D.
Henderson-King & E. 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 myself,” and “If
I was offered cosmetic surgery for free, I would consider chang-
ing a part of my appearance that I do not like.” Items are re-
sponded to 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 = 0.95).
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 reflecting one’s per-
ceived level of social comfort and competence. Sample 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) characteristic of me. Scores
could range from 16 to 80 with higher scores indicative of
greater social self-esteem. Internal consistency of this measure
in the present study was adequate (α = 0.75).
Correlat ional Analys e s
Pearson correlation coefficients were computed among the
different variables and are presented in Table 1. Men’s age
correlated positively with BMI (r = 0.23, p < 0.01). While older
men had higher BMIs, their age was not related to situational
body dysmorphia (r = 0.06). As might be expected, BMI and
body dysmorphia were positively related, but not significantly so
(r = 0.15). And, while older males generally had higher social
self-esteem (r = 0.27, p < 0.01), they also were more favorably
disposed toward cosmetic surgery (r = 0.33, p < 0.001), the latter
Table 1.
Intercorrelations among study variables.
Age - 0.23b0.27b0.06 0.33c 0.07 0.06
BMI - 0.02 0.15 0.06 0.22a0.16
TSBI - 0.32c 0.20a 0.05 0.47c
SIBID - 0.42b 0.13 0.30c
ACS - 0.28b0.17
HCA - 0.28b
Note: n = 131. ap < 0.05; bp < 0.01; cp < 0.001.
consistent perhaps with a youth-oriented cultural atmosphere.
Acceptance of cosmetic surgery was also significantly related
to body dysmorphia (r = 0.42, p < 0.001), but not BMI (r = 0.06).
A similar pattern had been observed previously among women
(Thornton et al., 2013). Interestingly, both hypercompetitive-
ness and personal development competitiveness were positively
correlated with cosmetic surgery acceptance (rs = 0.28, p < 0.01
and 0.17, p < 0.05, respectively). The positive relationship be-
tween personal development, an otherwise healthy competitive
orientation, and acceptance of cosmetic surgery was unexpected.
This is in contrast to a negative relationship reported for women
(Thornton et al., 2013) and may be due to a positive relationship
between hypercompetitiveness and personal development com-
petitiveness among men in the present study (r = 0.28, p < 0.01).
Regression Analysis
To consider further the two competitive orientations and ac-
ceptance of cosmetic surgery, a hierarchical regression analysis
was conducted with attitudes toward cosmetic surgery as the
criterion. These results are summarized in Table 2. Men’s age,
BMI, and social self-esteem were entered as an initial block to
control statistically for individual differences on these variables
(R2 = 0.12); F(3,127) = 5.83, p < 0.001. This was then followed
by a stepwise consideration of body dysmorphia, hypercom-
petitiveness, and personal development competitiveness. Body
dysmorphia was identified as the next best significant con-
tributor to the prediction equation (R2 = 0.34, p < 0.001), F(4,126)
= p < 0.001. Hypercompetitiveness was able to contribute further
to the regression (R2 = 0.38), F(5,125) = 15.49, p < 0.001. Per-
sonal development competitiveness was excluded from entry as
it did not contribute significantly to the regression.
Both correlational and regression analyses in the present study
demonstrate that the two competitive orientations differ in their
relationship to body dysmorphia and attitudes toward cosmetic
surgery for men. While hypercompetitiveness was not related to
body dysmorphia, it did relate positively with attitudes toward
cosmetic surgery. In contrast, personal development competi-
tiveness was negatively related to body dysmorphia, but was not
significantly related to cosmetic surgery. Moreover, hypercom-
petiveness was found to be a significant predictor of acceptance
of cosmetic surgery while personal development competitive-
ness failed to be of predictive utility in this regard, an outcome
that is comparable to previous reports on women (Thornton et al.,
Dissatisfaction with one’s physical appearance is typically
associated with favorable attitudes toward cosmetic surgery
Open Access
Table 2.
Regression analysis for acceptance of cosmetic surgery.
Variable β t R2 ΔR2
Step 1 0.12b
Age 0.30 3.35b
BMI 0.01 0.07
TSBI 0.12 1.37
Step 2 0.34b 0.22
Age 0.23 2.99a
BMI 0.07 0.94
TSBI 0.30 3.74b
SIBID 0.53 6.52b
Step 3 0.38b 0.04
Age 0.25 3.09b
BMI 0.11 1.51
TSBI 0.28 3.61b
SIBID 0.48 6.31b
HCA 0.51 2.84a
Note: Variable excluded at Step 3: PDCA, β = 0.15, t < 1.8, ns. ap < 0.01; bp <
(Calogero et al., 2010; Slevec & Tiggemann, 2010). Interest-
ingly, Menzel et al. (2011) have reported body dissatisfaction to
be a stronger determinant of attitudes toward cosmetic surgery
among men rather than women. The present findings with men
are consistent with this notion in that body dysmorphia entered
the regression prior to hypercompetitiveness, whereas in previ-
ous research with women (Thornton et al., 2013), body dys-
morphia entered the regression following the inclusion of hy-
The increased emphasis on males’ appearance and the pres-
sure on males to achieve some cultural ideal has been attributed,
in part, to the increasing equality between men and women in the
workplace (Pope et al., 2000). Women have become more able
to compete directly with men for power and resources rather
than having to “attract a mate” using their appearance. Tradi-
tionally, men could rely on skills, abilities, and a display of
status and resources to be competitive in the interpersonal mar-
ketplace, however, manhood is becoming increasingly defined
by youthful appearance and fitness and conveyed through
glamorous depictions that objectify and dehumanize, the same
issues that were demeaning for women (Faludi, 1999). Never-
theless, self-promotion based on their physical attractiveness,
body image, and fitness remains a prime strategy among women,
and is a common strategy among men as well, in intrasexual
competition for the attention of prospective mates (Fisher & Cox,
2011). It would appear that a hypercompetitive orientation may
very well contribute further to consideration of enhanced ap-
pearance through cosmetic surgery for both women and men
independent of body image concerns.
In their consideration of social and psychological factors that
may contribute to favorable attitudes and behavior toward cos-
metic surgery, Menzel et al. (2011) noted the need to identify
such characteristics so that clinicians and surgeons might take
them into account when determining the suitability of those
seeking to undergo such procedures. While surgical and mini-
mally invasive procedures may be of psychological and social
benefit to those with subclinical (mild-moderate) appearance
concerns (Margraf, Meyer, & Lavallee, 2013), such treatments
do not reduce the appearance concerns of those with body
dysmorphic disorder, and may actually intensify their concerns
(Crerand, Franklin, & Sarwer, 2006; Crerand, Menard, & Phil-
lips, 2010). Following cosmetic treatments, those with body
dysmorphic disorder frequently develop or shift their preoccu-
pation to other appearance concerns (Tignol, Biraben-Got-
zamanis, Martin-Guehl, & Grabot, 2007; Veale, 2000) and re-
petitively undergo cosmetic treatments to correct their perceived
appearance defects (Crerand et al., 2010).
Body dysmorphic disorder may be an obvious contraindica-
tion to cosmetic surgery. Considering the maladaptive nature of
hypercompetitiveness, it also may be a personality trait of con-
cern in this regard. With a neurotic need to compete and win at
all costs in order to cope neurotically with feelings of inade-
quacy and feel good about themselves, the appearance domain
may be one more arena in which hypercompetitive individuals
must strive to best others. With the additional pressure of in-
trasexual competition among both men and women, a hyper-
competitive orientation may contribute further to consideration
of cosmetic surgery in order to be more competitive and ulti-
mately “win” in their social and career endeavors. And, like
those with body dysmorphic disorder, hypercompetitive indi-
viduals may never be satisfied with the results and seek addi-
tional treatments in a constant effort to maintain or enhance their
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