PERSONALITY TRAITS AS DETERMINANTS OF BODY IMAGE AND THE MEDIATION ROLE OF PERFECTIONISM IN COSMETIC SURGERY

Individuals who score high on the agreeableness dimension are more likely to use negotiation to resolve conflict and are more likely to withdraw from social conflicts (4). As opposed to agreeableness is aggression, such individuals try to use their social power to resolve conflicts (5). High conscientiousness is characterized by ambition, accuracy, and responsibility in work and interpersonal relationships (6). On the other hand, those who achieve lower results in this dimension are not concerned about a tidy environment and a tidy schedule of activities and make decisions more impulsively (7). Neuroticism implies weaker impulse control, irrational ideas, and weaker tolerance for frustrations (4). Finally, Openness to Experience represents differences in intellectual curiosity, aesthetic sensitivity, and imagination (3).


INTRODUCTION
Cosmetic surgery is an elective medical practice, which aims to improve the physical appearance of one's body using surgical techniques (e.g., rhinoplasty) and non-surgical techniques (e.g., filler treatments) (1).
The dimensions of personality traits, singled out by Tupes and Christal are extraversion, agreeableness, conscientiousness, emotional stability, and culture (later called openness to new experiences) (2). Highly extraverted individuals enjoy socializing with others in contrast, introverted individuals tend to be socially and emotionally reserved (3).
Individuals who score high on the agreeableness dimension are more likely to use negotiation to resolve conflict and are more likely to withdraw from social conflicts (4). As opposed to agreeableness is aggression, such individuals try to use their social power to resolve conflicts (5). High conscientiousness is characterized by ambition, accuracy, and responsibility in work and interpersonal relationships (6). On the other hand, those who achieve lower results in this dimension are not concerned about a tidy environment and a tidy schedule of activities and make decisions more impulsively (7). Neuroticism implies weaker impulse control, irrational ideas, and weaker tolerance for frustrations (4). Finally, Openness to Experience repre-sents differences in intellectual curiosity, aesthetic sensitivity, and imagination (3).

Definition of body image
Grogan defined body image as "a person's perception, thoughts, and feelings about their body" (p. 3), and further defined dissatisfaction with body image (BID) as negative thoughts and feelings toward one's body (8). In a society that advocates unrealistic body ideals while imposing great value on body appearance, people do not have much choice about avoiding dissatisfaction with body image or achieving the desired body image. Not surprisingly, dissatisfaction with body image is becoming a normative dissatisfaction in contemporary society (9). Body image is influenced by an individual's physical characteristics, per- 16 17 Izvorni rad Original articles sonality, and the context in which he/she lives. Numerous studies have shown that dissatisfaction with body image is a major factor motivating people to undergo cosmetic surgery (10). Body dysmorphic disorder (BDD) is integral to body image disorder (11).

Perfectionism
Perfectionism is a multidimensional personality disposition characterized by striving for flawlessness and setting exceedingly high standards of performance accompanied by overly critical evaluations of one's behavior (12). It seems that perfectionist persons are the majority of applicants for cosmetic surgery, especially rhinoplasty, and a major portion of dissatisfaction after surgery is observed in these individuals (13). According to a study by Yavari and Jafari, there is a significant relationship between psychological needs, perfectionism, and the perception of the body image of applicants for cosmetic surgery (14). Perfectionism has been shown to have strong significant effects on body image (13,14).

Previous research on the relationship between personality traits and body image
Results of Swami Chamorro-Premuzic, et al., suggest that more conscientiousness, less agreeable, less open individuals were more likely to consider cosmetic surgery, thus centrally implicating the Big Five personality framework in such decisions (15). Openness to Experience, in particular, was a strong negative predictor of considering having cosmetic surgery. The results of the study by Danesh and Foroozandeh showed that among personality traits, only conscientiousness could predict 2.7% of body image changes (16). According to these findings, conscientiousness can play a significant role in individuals propensity to perform cosmetic surgery. The scores for the Body Cathexis Scale and the personality trait of extraversion by Öztürk were found to be higher in the rhinoplasty group than in the control group (17). Neuroticism and extraversion are associated with positive affectivity, and extraverted people are considered to be agreeable in social interactions (18).
To the results of previous research and theoretical assumptions, the relationship between personality traits and body image is expected. Considering the stated goals and earlier results of the research, the following problems and hypotheses were set: 1. To examine the relationship between body image and the big five; We expect a positive relationship between body image and the following personality traits: neuroticism, conscientiousness, extraversion, and a negative relationship between body image and agreeableness and openness to new experiences. We expect that personality traits will be significant determinants of body image. 2: Examine the mediating role of perfectionism on the relationship between personality traits and body image. We expect perfectionism to be a significant mediator of the relationship between personality traits and body image.

Sample and procedure
The study was conducted on a nonrandom sample of individuals who used different surgical treatments. Of the 380 participants who completed the questionnaires, 150 participants were included in the analysis.

INSTRUMENTS
The following instruments were used in the study: An adjective measure of the five-factor model, perfectionism scale, and Appearance Anxiety Inventory.
The adjective measure of the fivefactor model -starts from 1400 words, mostly adjectives, which are used in the Croatian language to describe various personality traits (19). Unlike questionnaires, adjective measures are much more transparent, and based on adjective items, respondents can more easily infer which traits are being tested (20). The five-factor model consists of the following subscales: extraversion ("social"), agreeableness ("benevolent"), conscientiousness ("diligent"), emotional stability ("relaxed"), and openness ("insightful"). The reliability of the type of internal consistency (Cronbach's alpha) of individual factors of the adjective measure in our study is 0.89 for extraversion, 0.74 for agreeableness, 0.66 for conscientiousness, 0.87 for neuroticism, 0.77 for openness/intellect. Burns scale of perfectionism-In the first attempts at measurement, perfectionism was seen as a one-dimensional construct focused on personal cognitions. This is how the Burns scale of perfectionism was created. It contains 10 items and measures self-directed perfectionism (21). The Burns scale of perfectionism contains 10 items, and the Likert scale of five degrees is used for answering. In the version of the scale adapted to the Croatian population, instead of degrees from +2 to -2, numerical symbols from 5 to 1 with the same meanings were used. The reliability of the internal consistency type (Cronbach alpha) in our study is 0.80.
Appearance Anxiety Inventory; AAI; Body image scale-The Appearance Anxiety Inventory is a 10-questi-on self-assessment scale that measures the cognitive and behavioral aspects of body image anxiety in general, and body dysmorphic disorder (BDD) in particular. This scale is useful as a part of the diagnostic procedure for BDD as well as monitoring symptoms during treatment. AAI was developed by Veale et al. (22). Participants responded by rounding off the corresponding number on a Likerttype scale with five degrees, and the total score was formed as the sum of all items. The Croatian version was adapted by Anđelinović and Keresteš (23). The reliability of the internal consistency type (Cronbach alpha) in our study is 0.87.

RESULTS
In the first part, we will present the results of descriptive statistics for all variables used in this study. In the second part, the main analysis will be presented, based on which we will try to answer the research problems. Table 1. shows the results of descriptive statistics of measuring instruments used in this study.
Before starting the data processing, we checked whether the results of the personality traits and the Body image scale (Appearance Anxiety Inventory) were distributed according to the normal distribution. For this purpose, we used the Kolmogorov-Smirnov (K-S) test of distribution normality. Almost all results were found to deviate to some extent from the normal distribution (see Table 1.). It was also found that the results concerning agreeableness as dimensions of the big five have the most significant deviation from the normal distributive. A Kolmogorov-Smirnov test suggests that only openness and perfectionism follow a normal distribution. Such data are expected because it is a non-clinical population. Since in this case, we have a large enough sample (N = 150), most distributions graphically resemble normal curves and their values of asymmetry and flatness are not higher than the default values, it was estimated that it is justified to use parametric statistics. We can also refer to low values of skewness and kurtosis because all variables meet the criteria for the use of parametric tests.

Relationship between personality traits and body image (Appearance Anxiety
Inventory) Table 2. provides an overview of body image correlations with the big five. To answer the first problem and examine the relationship between body image and personality traits, we calculated the Pearson correlation coefficient between these two measures. Pearson's correlation coefficient showed that body image was significantly negatively associated with extraversion, agreeableness, conscientiousness, and openness and positively associated with neuroticism. STANDARD   Also, neuroticism (β = .289; t = 3.305; p <0.001) has been shown to be the strongest predictor of body image. Table 2.
(see the Pearson correlation test in Table  2. where the association between body image and personality traits is shown and intercorrelations between perfectionism, personality traits, and body image) shows the correlations of all variables that were necessary to meet the conditions for testing the mediation effect.

HIERARCHICAL REGRESSION ANALYSIS-PERFECTIONISM
To determine whether perfectionism is a mediator of the body image relationship with the big five models, we conducted a hierarchical regression analysis. Hierarchical regression analysis shows results where the criterion is body image, the predictor is a five-factor model, and the potential mediator is perfectionism. Hierarchical regression analysis was performed in two steps. In the first step, the variables of the five-factor model were introduced, and in the second step, the variable perfectionism was introduced. Since all conditions were met for mediation testing, a hierarchical regression analysis was performed. The corrected R2 results for the second model show that approximately 30.2% of body image variability was explained by six predictors. The results of ANOVA show that this model is significant F (6;143) = 11,720; p <0.001. While in the first block extraversion (β =-.227; t = -2.617; p <0.05) was a significant predictor of body image, after the inclusion of perfectionism, extraversion (β = -.158; t = -1.909; p <0.10) decreased although is still significant, the declining significance of this predictor indicates the mediating role of perfectionism on the relationship between extraversion and body image. Also, in the first block neuroticism (β = .289; t = 3.305; p <0.001) is a significant predictor of body image, and after the inclusion of perfectionism, neuroticism (β = .134; t = 1.513; p> 0.10) became insignificant a predictor indicating the mediating role of perfectionism on the relationship between ne- Table 3. Note: B represents the standardized coefficieBetaBeta, and the T-value measures the magnitude of the difference with respect to the variation of the sample data. + The correlation is significant at the level 0.10; *The correlation is significant at the level 0.05; **The correlation is significant at the level 0.01, ***The correlation is significant at the level 0.001 Sobel Test was used to test the Significance of Mediation. Figure 1. shows the mediating effect of perfectionism on the relationship between extraversion and body image. The Sobel test showed significant mediation (-3.58; p <0.001).

Hierarchical regression analysis to determine the mediating effect of perfectionism on the relationship between the big five and body image.
The Sobel test showed significant mediation (-2.62; p <0.01). Figure 2. shows the mediating effect of perfectionism on the relationship between agreeableness and body image.
The Sobel test showed significant mediation (-1.96; p <0.05). Figure 3. shows the mediating effect of perfectionism on the relationship between conscientiousness and body image.
The Sobel test showed significant mediation (4.77; p <0.001). Figure 4. shows the mediating effect of perfectionism on the relationship between neuroticism and body image.
The Sobel test showed significant mediation (-2.32; p <0.01). Figure 5. shows the mediating effect of perfectionism on the relationship between openness and body image.
These values, together with the results of correlation analysis indicate the mediating effect of perfectionism on the relationship between personality traits and body image.

DISCUSSION AND CONCLUSION
This study aimed to examine the relationship between body image and personality traits and to examine the mediating role of perfectionism in the relationship between personality traits and body image. Below we will present the findings, limitations, implications as well as suggestions for future work.
Given that Pearson's correlation coefficient showed that all personality traits are significant determinants of body image, we can conclude that the first hypothesis has been partially confirmed. Pearson's correlation coefficient showed that body image was significantly negatively associated with extraversion (r = -.362; p <0.001), agreeableness (r = -.279, p <0.001), conscientiousness (r = -.281, p <0.001) and openness (r = -.214, p <0.01),   and positively associated only with neuroticism (r = .415, p <0.001). We expected different results compared to previous research. Results Öztürk, showed a significant positive correlation between the Body Cathexis Scale score and the personality trait of extraversion (17).
Results of Swami Chamorro-Premuzic, et al. suggest that more conscientiousness, less agreeable, less open individuals were more likely to consider cosmetic surgery, thus centrally implicating the Big Five personality framework in such decisions (15).
Given that people who achieve a high result in the dimension of conscientiousness are described as reliable, sober, and thoughtful, we can say that they are therefore less preoccupied with their appearance and that they are more accepting of themselves as they are. People who achieve a high score on the extraversion dimension are described as social, and dominant, and therefore we can say that they are less preoccupied with themselves and more focused on other people, while introverts are more preoccupied with themselves and therefore more preoccupied with their appearance. According to Klamer, among the patients who have undergone plastic surgery, neuroticism scores for the nose were the highest (24). The results of Chamorro-Premuzić et al. also obtained a positive association between neuroticism and body image (15). Chamorro-Pre-muzić explains such a finding in a way that more neurotic people are concer-ned about the consequences of cosmetic surgery and focus on potential negative effects (15).
The results of the hierarchical regression analysis showed that extraversion was significant in the first step of the analysis, but after we included perfectionism in the second step to establish the relationship between personality traits and body image, personality traits extraversion decreased although it remained significant at 0.01. The diminishing significance of this predictor indicates the mediating role of perfectionism on the relationship between extraversion and body image. Also, in the first step neuroticism was significant at the 0.001 level, but after we included perfectionism, neuroticism became insignificant at p> 0.10 indicating the mediating role of perfectionism on the relationship between neuroticism and body image. The results of hierarchical regression analysis showed that in the first step neuroticism was the strongest predictor (β = .289; t = 3.305; p <0.001) of body image, but in the second step, perfectionism became the strongest predictor of body image (β =. 365; t = 4.612; p <0.001). Although agreeableness, conscientiousness, and openness were not statistically significant in the hierarchical regression model, since both the first and second regression models were significant, all the prerequisites for conducting multiple regression were met. The results also revealed that perfectionism is a significant predictor of body image which is consistent with research by Rasooli et al., (25). Conducted mediation analysis showed a significant mediating effect of perfectionism on the relationship between all personality traits and body image. Complete mediation of perfectionism on the relationship between openness and body image was obtained, while partial mediation of perfectionism on the relationship between agreeableness and body image was shown; extraversion and body image; conscientiousness and body image; neuroticism and body image. This finding is consistent with research by Naami and Salehi whose results showed that individuals who have perfectionist tendencies are not flexible in their thoughts and emotions and cannot accept their body as it is, without judgment (26). Also, they have closed personalities with negative evaluations of their appearance, and are more likely to seek cosmetic surgery because they consider cosmetic surgery as a way that helps them to reduce their negative emotions and obtain others approval As Sherry et al., emphasize in their research, perfectionists may view cosmetic surgery as an opportunity to perfect the self and/or to change aspects of the self that cannot be altered through exercise or diet (27). Extreme perfectionism has been found to strongly and significantly increase individuas ' likelihood of undergoing cosmetic surgery.
The research conducted has several limitations.
The lack of research is certainly the nature of the study, it is a correlation study. The exact nature of the relationship can only be examined through experimental design. Based on the results of the research, we cannot conclude with certainty that certain personality traits lead to greater preoccupation with physical appearance, other variables should be considered, and it would be useful to examine some other mediators besides perfectionism. Also, future studies could use a longitudinal study to track a particular group of people over a longer period; the same group of participants monitored before and after surgery. One of the limitations of this research is that personality traits were measured by self-assessments, which could lead to socially desirable responses and motivated Figure 5. Mediation effect of perfectionism on the relationship between openness and body image . Note: *The correlation is significant at the level 0.05; **The correlation is significant at the level 0.01, ***The correlation is significant at the level 0.001 distortions of questionnaire responses, and it would be useful to include assessments of others in future research, family, close friends (5). We also suggest the use of qualitative research methods, such as in-depth interviews. The disadvantage of this research is also related to the implementation of the research. It was an online survey, so the researcher could not control the conditions in which the survey was conducted. Also, it is important to mention a slightly lower conscientiousness compared to other personality traits. Future empirical research should investigate whether lower dimensions of conscientiousness are an artifact in the study. In future research, it would be useful to include other variables in explaining body images such as self-esteem, socioeconomic status, or individual environmental factors.
Some of the recommendations for future research would be the introduction of a control group. It would also be interesting to examine different psychological variables among groups using noninvasive aesthetic treatments (dermatological treatments, cosmetic treatments, and aesthetic dental treatments). It would also be interesting to explore these variables on high school students as well as on students of different universities as unrealistic ideals of beauty have been imposed on today's generations through different social media. The recommendations also apply to the use of measuring instruments. In our research, the Burns one-dimensional scale of perfectionism was used, and the recommendation would be to use a multidimensional scale of perfectionism.
But despite these shortcomings, this research opens new directions for the study of psychological variables in cosmetic surgery and is also the first research in our area on the relationship between body image and personality traits. Because our sample is made up of participants who have had different surgical treatments, and given the huge increase in cosmetic surgery, a fuller understanding of personality influences can also allow surgeons to assess more accurately patients' suitability for surgery. It can also lead to a better understanding of the psychological aspects of cosmetic surgery and strengthen the foundation for promoting a healthier body image. NOVČANA