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The role of social comparative orientation in social anxiety among breast cancer survivors: a moderated mediation model of body image and self-concept clarity

BMC Psychiatry volume 25, Article number: 389 (2025) Cite this article

Abstract

Background

It is well known that social rehabilitation is an important part of the overall recovery of breast cancer survivors. Previous research has demonstrated that social anxiety is prevalent among breast cancer survivors, which is not only a significant psychological issue, but also impairs survivors’ social rehabilitation and diminishes their quality of life. Therefore, understanding the factors and mechanisms influencing social anxiety in breast cancer survivors is crucial. This study aimed to investigate the mediating and moderating effects of body image and self-concept clarity on social comparison orientation and social anxiety in breast cancer survivors.

Methods

The convenience sampling method was employed to survey 382 breast cancer survivors. The sample comprised participants aged 30–69 years: 69 − 56 years(28.01%), 45–55 years (39.53% ), and 30–44 years (32.46%). Data was collected using a general information questionnaire, the Social Anxiety Scale, the Body Image Scale, the Social Comparison Orientation Scale, and the Self-Concept Clarity Scale. The SPSS macro program PROCESS plug-in was utilized for mediation and moderation analyses.

Results

This study revealed a partial mediation effect of body image between social comparison orientation and social anxiety (β = 0.100, 95% CI [0.052, 0.162]), accounting for 27% of the total variance. Furthermore, self-concept clarity moderates the influence of social comparison orientation on social anxiety through body image. Specifically, as self-concept clarity increases, the influence of social comparison orientation on body image is gradually weakened, and the impact of body image on social anxiety becomes progressively weaker.

Conclusions

Social comparison orientation influences the social anxiety of breast cancer survivors through body image. Self-concept clarity exerts a moderating effect, attenuating the influence of social comparison orientation on body image and body image on social anxiety. The findings provide a theoretical and practical foundation for research on the social rehabilitation of breast cancer survivors.

Clinical trial number

Not applicable.

Peer Review reports

Introduction

Data from the International Agency for Research on Cancer (IARC) indicate that breast cancer is the most common cancer in women, with incidence rates on the rise [1]. Recent advancements in early screening, diagnosis, and treatment have significantly improved breast cancer survival, with the 5-year survival rate reaching 80.0% [2]. Consequently, an increasing number of survivors now live with breast cancer as a chronic condition. Social reintegration is a critical component of their overall recovery [3]. Social anxiety(SA)refers to an individual’s intense emotional response, characterized by anxiety, tension, fear, and avoidance behavior, in interpersonal situations [4]. Severe social anxiety is not only a consequence of social isolation but also a serious mental health issue that can severely diminish quality of life [5]. While previous studies have highlighted significant social anxiety among breast cancer survivors, focusing primarily on psychological factors (e.g., stigma, psychological resilience) [6, 7]; however, significant gaps remain regarding the understanding of socio-environmental dynamics. Specifically, few studies have examined how the interaction between the macro-level social environment and micro-level psychological cognition influences social anxiety among breast cancer survivors. Therefore, this study aims to examine internal factors within the context of the social environment, exploring specific pathways influencing social anxiety.

To clarify how the social environment influences social emotions among breast cancer survivors, this study applied social comparison theory. According to this theory, individuals process social information and compare aspects such as body image and ability with others, using them as reference points when objective self-evaluation is unavailable [8]. Social comparison orientation (SCO) refers to an individual’s propensity to compare their characteristics with those of others [9]. Breast cancer survivors actively seek information about others during diagnosis and treatment, often using others for self-assessment [10]. In such a comparative environment, negative self-evaluation can lead to negative social emotions and cognitive outcomes. Garanya et al. found that individuals with a high social comparison orientation are more likely to experience psychological issues, such as anxiety, in the workplace [11]. Another study [12] revealed that middle school students with a higher social comparison orientation exhibited higher levels of social anxiety during social interactions. Overall, the effect of social comparison on social anxiety has been demonstrated in many groups; however, few studies have specifically focused on breast cancer survivors or explored the underlying mechanisms involved.

Previous studies have indicated that body image is an essential factor that cannot be ignored when examining the influence of social comparison orientation on social anxiety [13]. Body image is the product of the interaction between body and mind, representing an internal cognitive description of one’s physical appearance [14]. The sociocultural model of body image highlights the critical role of social and cultural factors in shaping body image and attitudes. For instance, family, peers, and media are primary influences on body image [15]. In today’s visually driven social media environment, women’s body image is often shaped by idealized sociocultural norms [16]. After treatment, breast cancer survivors may undergo physical changes such as breast loss, limb dysfunction, hair loss, and edema, which starkly contrast with the “ideal” female image promoted by modern society [17]. This contrast often triggers unconscious social comparisons, leading to negative self-perception and negative evaluation of one’s physical appearance.

This cognitive bias not only worsens body image disturbances among breast cancer survivors but may also trigger various psychological issues, hindering their social readjustment. The cognitive-behavioral model [18] of social anxiety posits that individuals with social anxiety evaluate the discrepancy between their own performance and others’ expected standards during social interactions, which informs their self-impressions. In other words, when an individual holds a negative self-perception of their physical appearance, this perception may be amplified in social situations, triggering social anxiety. Garcia et al. conducted a longitudinal study of breast cancer survivors undergoing chemotherapy, finding significant declines in both social functioning and body image [19]. Breast cancer surgery or treatment can alter or damage female secondary sexual characteristics, leading survivors to perceive their appearance as inconsistent with social standards, which fosters negative body image and social anxiety [20]. Recognizing the profound impact of body image issues on breast cancer survivors, Sebri et al. emphasized the importance of psychological interventions aimed at improving body image, such as cognitive behavioral therapy and mindfulness training, which effectively alleviate emotional distress associated with negative body image among breast cancer survivors and consequently enhance their quality of life [21]. Based on the above theories and studies, we hypothesize that body image may mediate the relationship between social comparison orientation and social anxiety.

However, this mechanism may be influenced by individual cognitive factors. According to cognitive anxiety theory, the core of this mechanism lies in an individual’s cognitive biases in self-information processing, wherein distorted cognition contributes to anxiety by leading to irrational self-evaluations and perceptions [22]. Self-concept clarity refers to the clarity, accuracy, and stability of an individual’s self-cognitive content [23]. The threat and treatment of cancer make breast cancer survivors more sensitive and vulnerable. After experiencing physical changes, shifts in life roles, and future uncertainties, they are prone to self-concept confusion, negative self-evaluation, and are more likely to seek external information in social interactions [24]. Research has indicated that Self-concept clarity affects an individual’s processing of external information. Individuals with low Self-concept clarity are more likely to engage in appearance comparisons, leading to dissatisfaction with their body image [25]. Thus, breast cancer survivors with high Self-concept clarity may be less prone to social comparison due to a stable self-perception and, consequently, may exhibit lower concern about body image. Self-concept clarity is an intrinsic psychological resource that buffers the negative effects of self-concept differentiation, providing unique stress-buffering and psychological protection [26]. Studies show that individuals with high self-concept clarity are less likely to experience body image dissatisfaction and have lower levels of anxiety [27]. Thus, breast cancer survivors with high Self-concept clarity, even when faced with negative body image, may experience lower levels of social anxiety due to their stable self-concept.

According to cognitive behavioral theory (CBT), individual emotions, such as social anxiety, are primarily driven by cognitive processes. Negative cognition often involves biased attention to external information or irrational self-evaluation [28]. Social comparison orientation refers to the cognitive processing of external information, such as others’ appearance and evaluations, which, when distorted, can lead to negative self-perception and self-evaluation [29]. Body image refers to an individual’s internal cognitive evaluation of their own body or appearance. When negative, it can further trigger adverse emotional reactions, such as anxiety [30]. Self-concept clarity serves as a cognitive resource. Individuals with a clear self-concept can interpret external information more objectively and adaptively, thereby reducing the risk of anxiety caused by negative cognition [31]. Therefore, in this process, self-concept clarity plays a crucial regulatory role.

The primary objective of this study was to investigate the mechanisms underlying the effects of social comparison orientation, body image, and self-concept clarity on social anxiety among breast cancer survivors. Specifically, this study aimed to: (1) examine the relationship between social comparison orientation and social anxiety among breast cancer survivors; (2) investigate the mediating role of body image in the relationship between social comparison orientation and social anxiety; (3) analyze the moderating effect of self-concept clarity on the relationships among social comparison orientation, body image, and social anxiety.

To achieve these objectives, a theoretical hypothesis model (Fig. 1) was developed, and the following hypotheses were formulated: The body image of breast cancer survivors mediates the relationship between social comparison orientation and social anxiety. Additionally, self-concept clarity moderates the effects of social comparison orientation on body image, as well as the effects of body image on social anxiety.

Fig. 1
figure 1

The hypothesized moderated mediation model

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Methods

Research participants

This study employed a convenience sampling method to recruit breast cancer survivors from the breast surgery ward, breast surgery clinic, and cancer treatment ward of three hospitals in Nantong City, Jiangsu Province, from October 2023 to June 2024. Inclusion criteria: (1) Breast cancer survivors diagnosed via pathology or immunohistochemistry; (2) Aged ≥ 18 years; (3) Normal communication abilities; (4) Educational attainment of at least primary school level; (5) Comprehension of the research content, voluntary participation, and provision of written informed consent. Exclusion criteria: (1) Presence of mental illness or cognitive dysfunction; (2) Diagnosis of bilateral breast cancer, other malignancies, or severe physical diseases; (3) Inability to communicate or cooperate effectively; (4) Participation in other scientific research projects during the same period.

Research procedures

(1) Ethical Approval: Prior to formal data collection, the research proposal was reviewed and approved by the Ethics Committee of the Affiliated Hospital of Nantong University (Ethics approval number: 2023-K066-01).

(2) Subject Recruitment: After obtaining permission from the heads of relevant departments, the research team introduced the study’s purpose, content, and participation procedures to potential participants individually. Researchers emphasized the voluntary and confidential nature of participation, along with potential risks and benefits. Data collection commenced upon obtaining written informed consent.

(3) Data Collection: Researchers distributed questionnaires in person, which were completed on-site by participants and collected immediately. During the investigation, researchers were available to clarify any questions from participants, ensuring their correct understanding and enhancing the accuracy and completeness of their responses.

A total of 413 questionnaires were distributed, of which 31 were excluded due to missing information or obvious inconsistencies. Ultimately, 382 valid questionnaires were included, yielding an effective response rate of 92.5%.

Measures

General information questionnaire

The general information questionnaire, developed by the research team, encompasses key demographic details. Included surgery、age、duration of illness、educational level、per capita income、place of residence、stage of disease、comorbid diseases、living style、occupational status.

Interaction anxiousness scale (IAS)

The scale, revised by Chinese scholar Peng Chunzi et al. [3], consists of 15 items designed to measure individuals’ social anxiety levels. A 5-point Likert scale is used, with 1 representing “non-conformity” and 5 representing “complete conformity”. The total score ranges from 15 to 75, with higher scores indicating more severe social anxiety. After revision, the convergent validity was satisfactory (the correlation between IAS and SAD scores at r = 0.66, and the correlation between IAS and SAS scores at r = 0.29, both at P < 0.001). The Cronbach’s α coefficient for this study was 0.950.

Body image scale(BIS)

Developed by Hopwood et al. [33], the scale includes 10 items commonly used to assess negative body image in cancer survivors, using a 4-point scale ranging from 0 (not at all) to 3 (very much). The total score is the sum of the 10 items, ranging from 0 to 30, with higher scores indicating more severe symptoms. The BIS has been widely used among breast cancer survivors in China and has demonstrated good reliability. Additionally, the convergent validity was satisfactory, with Pearson’s r coefficients between the BIS and the physical, psychological, social, and environmental dimensions of WHOQOL-BREF, as well as the total score of EQ-5D, being − 0.42, -0.53, -0.37, -0.35, and − 0.32, respectively [34]. The Cronbach’s α coefficient for this study was 0.946.

Social comparison orientation scale (SCOS)

Wang Mingji et al. [35] translated the scale to assess the intensity of individual social comparison orientation, comprising two dimensions: ability and concept, with 11 items in total. Each item is scored on a 5-point Likert scale, ranging from “very inconsistent” to “very consistent,” yielding a total score between 11 and 55. The scale has demonstrated good reliability and validity within Chinese cultural contexts, and the model fit was satisfactory (χ²/df = 3.74, RMSEA = 0.04, NFI = 0.95, GFI = 0.96, CFI = 0.96). The Cronbach’s α coefficient for this study was 0.960.

Self-concept clarity (SCC)

Originally developed by Campbell et al., the scale was revised by Chinese scholar Niu Gengfeng et al. [36] to assess the clarity and consistency of individual self-concept. The scale consists of 12 items rated on a 5-point Likert scale, ranging from “very inconsistent” to “very consistent.” Reverse items were scored accordingly, with the total score ranging from 12 to 60. Higher scores indicate greater self-concept clarity. The revised scale exhibited a good model fit (χ²/df = 3.57, RMSEA = 0.06, NFI = 0.92, GFI = 0.94, CFI = 0.94). The Cronbach’s α coefficient for this study was 0.965.

Statistical analysis

Firstly, data were analyzed using SPSS 27.0. Measurement data were described using means and standard deviations, while categorical data were presented as frequencies or percentages. Then, Pearson correlation analysis was then conducted to assess the relationships between the variables. Third, all continuous variables were standardized. Model 4 of the PROCESS macro in SPSS was used to examine mediation effects, while Model 58 was employed to assess moderated mediation effects [37]. Finally, moderating variables were dichotomized into high (one standard deviation above the mean) and low (one standard deviation below the mean) groups for simple slope analysis. A 95% confidence interval (CI) was estimated using 5000 bootstrap samples, and significance was tested at a two-tailed α level of 0.05.

Ethics statement

This study was approved by the Ethics Committee of Nantong University Hospital (2023-K066-01).

Results

Common method bias testing

Prior to the analysis, confirmatory factor analysis (CFA) was conducted to assess common method bias by constraining the model to a single-factor solution [38]. The model fit indices were poor (χ²/df = 9.981, RMSEA = 0.154, NFI = 0.385, AGFI = 0.184, CFI = 0.409), indicating that common method bias was not a significant concern in this study.

Descriptive statistics

The mean social anxiety score of breast cancer survivors was 54.61 ± 12.74, with no statistically significant differences observed in relation to education level, family income, place of residence, Pathological stage and co-existing diseases (P > 0.05). However, statistically significant differences were found with respect to age, duration of illness, type of surgery, occupational status and living style (P < 0.05). Refer to Table 1 for details.

Table 1 Comparison of marital adjustment scores of breast cancer survivors with different demographic characteristics(n = 382)
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Correlations of the investigated variables

Social comparison orientation and body image were all positively correlated with social anxiety, whereas self-concept clarity was negatively correlated with social comparison orientation, body image, and social anxiety, as presented in Table 2.

Table 2 Pearson correlations between the main variables (n = 382)
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Mediation analysis

The variables were standardized prior to analysis. First, Model 4 of the PROCESS macro was employed to conduct a simple mediation effect test. After controlling variables such as surgery type, age, duration of illness, living style, and occupational status, the results indicated that: Social comparison orientation was significantly positively associated with body image (β = 0.336, t = 6.925, P < 0.001). Additionally, body image was significantly positively associated with social anxiety (β = 0.299, t = 5.825, P < 0.001), and social comparison orientation was also significantly positively associated with social anxiety (β = 0.275, t = 5.376, P < 0.001). This indicates that body image partially mediates the relationship between social comparison orientation and social anxiety. Refer to Table 3 for further details.

Table 3 Direct、Indirect and total effect
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Moderated mediation analysis

Next, Model 58 in the PROCESS macro was employed to conduct a moderated mediation effect test. The results indicated that after controlling variables such as surgery type, age, duration of illness, living style, and occupational status, the interaction between self-concept clarity and social comparison orientation had significant effects on body image (β = -0.130, t = -3.883, P < 0.001). The interaction between self-concept clarity and body image also had a significant effect on social anxiety (β = -0.181, t = -5.169, P < 0.001), indicating that self-concept clarity moderated both the first and second halves of the mediating pathway in the “social comparison orientation – body image – social anxiety” relationship, as illustrated in Table 4.

To further analyze the moderating effect, a decomposition diagram was constructed. Figure 2 illustrates that when self-concept clarity is high (M + 1SD), social comparison orientation exerts a significant influence on body image (β = 0.149, t = 2.317, P < 0.05). Conversely, when self-concept clarity is low (M-1SD), the influence of social comparison orientation on body image remains significant (β = 0.408, t = 7.546, P < 0.05). However, as self-concept clarity increased, the influence of social comparison orientation on body image diminished. Figure 3 demonstrates that when self-concept clarity is high (M + 1SD), body image exerts a significant impact on social anxiety (β = 0.122, t = 2.060, P < 0.05). Similarly, when self-concept clarity is low (M-1SD), the influence of body image on social anxiety remains significant (β = 0.485, t = 7.695, P < 0.05), indicating that as self-concept clarity increased, the influence of body image on social anxiety among survivors significantly weakened. Thus, the results support the hypothesis.

Table 4 Moderated mediation effect analyses
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Fig. 2
figure 2

Self-concept clarity moderates effects in social comparison orientation and body image

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Fig. 3
figure 3

Self-concept clarity moderates effects in body image and social anxiety

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Discussion

To explore the specific mechanisms underlying the relationship between social comparison orientation and social anxiety in breast cancer survivors, we constructed a moderated mediation model. Our study identified a significant association between social comparison orientation and social anxiety among breast cancer survivors, suggesting that individuals with a higher tendency for social comparison may be more susceptible to experiencing social anxiety. This result aligns with the findings of Okano et al. [39], which suggest that higher levels of social comparison in breast cancer survivors are more likely to lead to social anxiety. Individuals with a high social comparison orientation tend to experience greater self-uncertainty, and frequent social comparisons are closely linked to mental health issues [40]. Individuals with a high social comparison orientation are more prone to contrast effects in upward comparisons and assimilation effects in downward comparisons, both of which contribute to negative emotions [41]. For breast cancer survivors, changes in body image and social roles resulting from surgery and treatment contribute to a “negative bias” in social and interpersonal interactions, which heightens the likelihood of social comparison. Survivors often compare their current life circumstances and physical appearance to idealized norms, leading to feelings of uncertainty and inferiority. These comparisons can lead to anxiety, nervousness, and fear, resulting in a reduction in prosocial behavior and even avoidance of social interactions [42]. Additionally, neuroscientific studies [43] indicate that social comparison orientation may have potential links to mental health and cognitive function. Higher levels of social comparison orientation have been associated with weaker structural and functional connectivity between the ventral striatum and the medial prefrontal cortex, two brain regions that play a key role in the regulation of emotions, social interactions, and reward processing mechanisms.

After establishing the association between social comparison orientation and social anxiety, we further examined the role of body image in this relationship. In line with the study’s hypothesis, our findings demonstrate that body image mediates the relationship between social comparison orientation and social anxiety. Specifically, social comparison orientation exerts a significant influence on body image, which in turn affects social anxiety. The significant positive correlation between social comparison orientation and body image aligns with previous studies [44]. Other studies have also indicated that the social environment influences breast cancer survivors’ perceptions of their body image [45]. According to the information processing model [46], body self-schema plays a crucial role in shaping body image. Body self-schema represents not only the internal cognitive structure of an individual’s body, but also the outcome of interactions with the external world. For breast cancer survivors, the context of social comparison can easily activate their body self-schema, influencing their perception of body image. As a result, they tend to focus more on changes or perceived defects in their physical appearance, leading to a negative body image [47]. A meta-analysis by Bonfanti et al. indicated that social comparison orientation was significantly positively associated with body image concerns, and a higher tendency for social comparison was significantly linked to negative body image [48].

We also identified a significant positive correlation between body image and social anxiety, which aligns with the findings of previous studies [49]. Cognitive behavioral theory [28]posits that emotional changes are closely linked to cognitive evaluations, with irrational beliefs leading to adverse emotional reactions and maladaptive behaviors. Breast cancer survivors’ perceptions of their appearance and social function are altered due to the impact of diagnosis and treatment [19], making them more susceptible to cognitive distortions involving being scrutinized and judged in social situations [50]. As a result, these negative body image perceptions contribute to heightened social anxiety. In conclusion, a higher tendency for social comparison among breast cancer survivors is associated with a more negative body image perception, which, in turn, is linked to increased social anxiety.

Further studies have demonstrated that self-concept clarity moderates the effect of social comparison orientation on social anxiety via body image. Firstly, in the pathway from social comparison orientation to body image, compared to survivors with low self-concept clarity, those with high self-concept clarity exhibited a “weakened” risk effect of social comparison orientation on body image. Social cognitive theory [51] emphasizes the interaction between individual cognition, the environment, and behavior. For survivors with high self-concept clarity, within the context of social comparison, the tendency for social comparison has less influence on their body image perception, as they possess a more stable sense of identity, characteristics, and values, and are more resistant to external influences [52]. Conversely, individuals with low self-concept clarity may be more prone to internalizing negative external evaluations, which could further heighten their risk of developing a negative body image.

Secondly, in the pathway from body image to social anxiety, survivors with high self-concept clarity “mitigated” the risk effect of body image on social anxiety compared to those with low self-concept clarity. Self-consistency theory [53] posits that individuals strive to maintain a stable self-perception to avoid cognitive dissonance. Breast cancer survivors with high self-concept clarity have a more coherent body perception and overall self-concept. Even when confronted with negative body image following diagnosis and treatment, they are able to separate body image from their overall self-concept, thereby not over-emphasizing the role of body image in self-evaluation. As a result, such inconsistencies have a minimal impact on their social emotions [54]. In contrast, individuals with low self-concept clarity are more prone to cognitive dissonance when their body image is challenged, due to their unstable self-perception, which leads to increased social anxiety [55]. In other words, self-concept clarity serves as a “buffer” in the pathway where social comparison orientation influences social anxiety through body image. Enhancing self-concept clarity may serve as a potential intervention mechanism for mitigating social anxiety.

Limitations and future research

This study has several limitations. First, the sample was drawn from a single region, thereby restricting the generalizability of the findings. Future research should include more diverse samples to improve sample representativeness. Second, the cross-sectional design and reliance on self-reported questionnaires may introduce biases, thereby influencing causal inferences and compromising measurement accuracy. Longitudinal studies and further validation of measurement tools are needed to mitigate these biases. Third, key psychosocial factors, such as stage of treatment and marital status, were not accounted for in the analysis. Future research should incorporate a broader range of variables to offer a more holistic perspective on social anxiety among breast cancer survivors. Lastly, the study exclusively employed PROCESS for mediation and moderation analyses, and the dichotomization of moderating variables may have led to information loss and reduced statistical power. Future studies should consider using structural equation modeling (SEM) to enhance analytical rigor and reduce potential biases.

Clinical implications

Social anxiety is prevalent among breast cancer survivors, as noted both in this study and in previous research [56]. Healthcare teams should prioritize psychosocial interventions for breast cancer survivors and integrate social rehabilitation into their recovery process. Our findings suggest that social comparison orientation affects social anxiety through body image, but self-concept clarity may buffer this negative effect. Body image is a critical factor in the social recovery of breast cancer survivors. A comprehensive psychological support system should be established to promote a healthy and positive body image. For example, cognitive behavioral therapy, psychological health education [57], image counseling, and exercise rehabilitation interventions can help breast cancer survivors accept and adapt to physical changes, actively engage in social life, and regain their sense of personal value. Moreover, it is essential to focus on the self-concept clarity of breast cancer survivors. Training programs, such as cognitive behavioral education [58] and mindfulness education, should be offered to help survivors reduce cognitive confusion and instability, enhance self-awareness and identity, improve mental health, and promote social rehabilitation.

Conclusion

This study investigates the mechanisms influencing social anxiety in breast cancer survivors within a social context. It highlights the role of social comparison orientation in contributing to social anxiety through its impact on body image, and demonstrates that self-concept clarity moderates this relationship. Specifically, self-concept clarity buffers the positive predictive effect of social comparison orientation on social anxiety. These findings offer a multi-dimensional intervention framework and provide a theoretical foundation for the psychosocial rehabilitation of breast cancer survivors.

Data availability

The datasets generated for this study are available upon request to the corresponding author.

References

  1. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. Global cancer statistics 2022: Globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA-Cancer J Clin. 2024;74(3):229–63.

    Article  PubMed  Google Scholar 

  2. Ong SK, Haruyama R, Yip CH, Ngan TT, Li J, Lai D, Zhang Y, Yi S, Shankar A, Suzanna E, et al. Feasibility of monitoring global breast cancer initiative framework key performance indicators in 21 Asian National cancer centers alliance member countries. EClinicalmedicine. 2024;67:102365.

    Article  PubMed  Google Scholar 

  3. Sheppard DM, Frost D, Jefford M, O’Connor M, Halkett G. Beyond cancer’: a study protocol of a multimodal occupational rehabilitation programme to support breast cancer survivors to return work. BMJ Open. 2019;9(12):e32505.

    Article  Google Scholar 

  4. Morrison AS, Heimberg RG. Social anxiety and social anxiety disorder. Annu Rev Clin Psycho. 2013;9(1):249–74.

    Article  Google Scholar 

  5. Maleki G, Zabihzadeh A, Richman MJ, Demetrovics Z, Mohammadnejad F. Decoding and reasoning mental States in major depression and social anxiety disorder. BMC Psychiatry. 2020;20(1):463.

    Article  PubMed  PubMed Central  Google Scholar 

  6. MAo X, Guo J. Stigma, psychological resiliency level and Lts Lmpact on social anxiety folpatients with breast cancer. J Yueyang Vocat Tech Coll. 2019;34(01):43–7.

    Google Scholar 

  7. FANG N. Social anxiety of breast cancer patients after modified radical mastectomyand its influencing factors. Chin Clin Nurs. 2024;16(01):49–51.

    Google Scholar 

  8. Goethals G. Social comparison theory. Pers Soc Psychol Bull. 1986;12(3):261–78.

    Article  Google Scholar 

  9. Savchenko T, Samoylenko E, Korbut A. Psychometric properties of instruments of measurement of social comparison orientation. EKSP Psikhologiya. 2019;12(2):112–30.

    Google Scholar 

  10. Kimiafar K, Sarbaz M, Shahid Sales S, Esmaeili M, Javame Ghazvini Z. Breast cancer patients’ information needs and information-seeking behavior in a developing country. Breast. 2016;28:156–60.

    Article  PubMed  Google Scholar 

  11. Garanyan N, Sharapova A. Workplace anxiety: the role of social comparison strategies. Konsult Psikhol Psik. 2022;30(4):124–42.

    Google Scholar 

  12. Lee Y, Park J. Effects of social comparison orientation on social anxiety in middle school students and moderating role of maladaptive cognitive emotion regulation strategies. Korean J Child Stud. 2019;40(1):39–50.

    Article  Google Scholar 

  13. Hai R, Yang Y. Social network site appearance comparison’s prediction of anxiety among Chinese females: the mediation effect of body area satisfaction, overweight preoccupation, and Self-Esteem. Front Psychiatry. 2022;13:775782.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ábrahám I, Jambrik M, John B, Németh AR, Franczia N, Csenki L. [Body image and body image distortion]. Orvosi Hetilap. 2017;158(19):723–30.

  15. Rodgers RF, Fischer LE, Murray SB, Franko DL. Integrating fear of fatness into Sociocultural models of body image and eating concerns. Eat Behav. 2022; 46(null):101653.

  16. Kim H. What do others’reactions to body posting on Instagram tell Us? The effects of social media comments on viewers’body image perception. New Media Soc. 2021;23(12):3448–65.

    Article  Google Scholar 

  17. Hasan S, Chew KS, Balang RV, Wong S. Beyond the scars: a qualitative study on the experiences of mastectomy among young women with breast cancer in a country with crisis. BMC Womens Health. 2023;23(1):596.

  18. Shahbazirad A, Ghadampour E, Ghazanfari F, Momeni K. Model Of Social Anxiety Disorder: A Structural Equation Modeling Of Cognitive, Meta-Cognitive, Behavioral Aspects. Psychologia. 2016;59(4):202–14.

    Article  Google Scholar 

  19. Garcia S, Coelho R, Santos P, Maftum M, Mantovani M, Kalike L. Changes in social function and body image in women diagnosed with breast cancer undergoing chemotherapy. Acta Sci-Health Sci. 2017;39(1):57.

    Article  Google Scholar 

  20. Koçan S, Gürsoy A. Body image of women with breast cancer after mastectomy: A qualitative research. J Breast Health. 2016;12(4):145–50.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sebri V, Pravettoni G. Tailored psychological interventions to manage body image: an opinion study on breast cancer survivors. Int J Environ Res Public Health. 2023;20(4):2991.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Gústavsson SM, Salkovskis PM, Sigurðsson JF. Cognitive analysis of specific threat beliefs and safety-seeking behaviours in generalised anxiety disorder: revisiting the cognitive theory of anxiety disorders. Behav Cogn Psychoth. 2021;49(5):526–39.

    Article  Google Scholar 

  23. Campbell J, Trapnell P, Heine S, Katz I, Lavallee L, Lehman D. Self-concept clarity: measurement, personality correlates, and cultural boundaries. J Pers Soc Psychol. 1996;70(1):141–56.

    Article  Google Scholar 

  24. Levesque JV, Gerges M, Girgis A. Psychosocial experiences, challenges, and coping strategies of Chinese-Australian women with breast cancer. Asia-Pac J Oncol Nurs. 2020;7(2):141–50.

    Article  Google Scholar 

  25. Vartanian LR, Pinkus RT, Fardouly J. Self-concept clarity and appearance comparisons in everyday life. Body Image. 2025;52:101820.

    Article  PubMed  Google Scholar 

  26. Coutts JJ, Al-Kire RL, Weidler DJ. I can see (myself) clearly now: exploring the mediating role of self-concept clarity in the association between self-compassion and indicators of well-being. PLoS ONE. 2023;18(6):e286992.

    Article  Google Scholar 

  27. Zhang T, Su D, Li S, Yang Y, Li H. Person-centered evaluation of positive body image among Chinese nursing students: associations with body appreciation, self-concept clarity, and negative affect. Front Psychol. 2023;13:1088702.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Trent ES, Storch EA. Cognitive behavioral therapy for anxiety disorders. Psychiatric Clin. 2024;47(4):673–88.

    Google Scholar 

  29. Yu Y, Sun H. Shyness and self-consistency and congruence among Chinese adolescents: mediating role of social comparison orientation and moderating role of self-focused attention. Front Psychol. 2024;15:1418123.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Simbar M, Nazarpour S, Majd HA, Andarvar KD, Torkamani ZJ, Rahnemaei FA. Is body image a predictor of women’s depression and anxiety in postmenopausal women? BMC Psychiatry 2020. 20 2020:10.

  31. Perrykkad K, Hohwy J. How selves differ within and across cognitive domains: self-prioritisation, self-concept, and psychiatric traits. BMC Psychol. 2022;10(1):165.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Peng C, Gong Y, Zhu X. The applicabiliy of interaction anxiousness scale in Chinese undergraduate students. Chin Mental Health J. 2004(01):39–41.

  33. Hopwood P, Fletcher I, Lee A, Al GS. A body image scale for use with cancer patients. Eur J Cancer. 2001;37(2):189–97.

    Article  CAS  PubMed  Google Scholar 

  34. Wu T, Fang S, Wang J, Kuo Y. Psychometric validation of the Body Image Scale in patients with breast cancer. 2023.

  35. Wang M, Wang L, Shi J. Reliability and Vaiidatioa of the social comparison orientation scale. Chinese Mental Health J. 2006;(05):302–5.

  36. Niu G, Sun X, Zhou Z, Tian Y, Liu Q, Lian S. The effect of adolescents’ social networking site use on Self-concept clarity: the mediating role of social comparison. J Psychol Sci. 2016;39(01):97–102.

    Google Scholar 

  37. Hayes AF. An index and test of linear moderated mediation. Multivar Behav Res. 2015;50(1):1–22.

    Article  Google Scholar 

  38. Kock F, Berbekova A, Assaf AG. Understanding and managing the threat of common method bias: detection, prevention and control. Tourism Manage. 2021;86:104330.

    Article  Google Scholar 

  39. Okano H, Nomura M. Examining social anxiety and dual aspects of social comparison orientation: the moderating role of self-evaluation of social skills. Front Psychol. 2023;14:1270143.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Yang G, Wang Z, Wu W. Social comparison orientation and mental health: the mediating role of psychological capital. Soc Behav Personal. 2021;49(1):1–11.

    Article  Google Scholar 

  41. Wang JL, Wang HZ, Gaskin J, Hawk S. The mediating roles of upward social comparison and Self-esteem and the moderating role of social comparison orientation in the association between social networking site usage and subjective Well-Being. Front Psychol. 2017;8:771.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Yun Y, Ahn J. Exploring factors influencing body acceptance in women with breast cancer: A cross-sectional study. Eur J Oncol Nurs. 2025;74:102802.

  43. Jung WH, Kim H. Intrinsic functional and structural brain connectivity in humans predicts individual social comparison orientation. Front Psychiatry. 2020;11:809.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Oh M, Yon LJ. The Relationship between Socially Prescribed Perfectionism and Body image dissatisfaction of High School Girl’s by Types of High School: Mediating effect of Body Comparison and Social Comparison Orientation. secondary education research 2016, 64(1):99–130.

  45. Aguilar Cordero MJ, Neri Sánchez M, Mur Villar N, Gómez Valverde E. [Influence of the social context on the body image perception of women undergoing breast cancer surgery]. Nutr Hosp. 2013;28(5):1453–7.

    CAS  PubMed  Google Scholar 

  46. Tamburrino M. Body image: a handbook of theory, research, and clinical practice. Jama-J Am Med Assoc. 2003;289(14):1861–2.

    Article  Google Scholar 

  47. Brunet J, Price J, Harris C. Body image in women diagnosed with breast cancer: a grounded theory study. Body Image. 2022;41:417–31.

    Article  PubMed  Google Scholar 

  48. Bonfanti RC, Melchiori F, Teti A, Albano G, Raffard S, Rodgers R, Coco GL. The association between social comparison in social media, body image concerns and eating disorder symptoms: A systematic review and meta-analysis. Body Image. 2025;52:101841.

    Article  PubMed  Google Scholar 

  49. Arıkan F, Kartöz F, Karakuş Z, Altınışık M, Özer Z, Korcum Şahin AF. Body image and social appearance anxiety in patients with cancer undergoing radiotherapy: Across-sectional study. BMC Psychol. 2024;12(1):363.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Smissen DVD, Lugtenberg M, Enting M, Beerepoot L, Mols F, Brouwers E, Wasowicz D, Joosen M. Getting back on track after treatment of cancer: A qualitative interview study of cancer survivors’ experiences. PLoS ONE. 2025;20(1):e313984.

    Article  Google Scholar 

  51. Schunk D, DiBenedetto M. Motivation and social cognitive theory. Contemp Educ Psychol. 2020;60:101832.

    Article  Google Scholar 

  52. Afriyanti E. B Wenni 2018 The effect of spiritual emotional freedom technique (SEFT) on the self concept of breast cancer patients with mastectomy. Jkp 6 3 243–52.

    Google Scholar 

  53. Wu L, Birtch T, Chiang F, Zhang H. Perceptions of negative workplace gossip: A Self-Consistency theory framework. J Manage. 2018;44(5):1873–98.

    Google Scholar 

  54. Pintado S. Self-concept and emotional well-being in patients with breast cancer. Revista Iberoamericana De Psicología Y Salud. 2017;8(2):76–84.

    Article  Google Scholar 

  55. Todorov N, Sherman KA, Kilby CJ, Breast CNA. Self-compassion and hope in the context of body image disturbance and distress in breast cancer survivors. Psycho‐oncology 2019; 28(10):2025–2032.

  56. Wang S, Hua Y, Zhang Y, Guo D, Tian L. Trajectories and influencing factors of social anxiety in postoperative breast cancer patients. BMC Psychiatry. 2024;24(1):357.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Lewis-Smith H, Diedrichs PC, Harcourt D. A pilot study of a body image intervention for breast cancer survivors. Body Image. 2018;27(null):21–31.

    Article  PubMed  Google Scholar 

  58. Asadi S, Gholizadeh Z. The effectiveness of cognitive behavior therapy on Self-Concept in women with breast cancer. AJLSR. 2016;4(2):60–6.

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank all patients who voluntarily participated in this study.

Funding

Science and Technology Project of Affiliated Hospital of Nantong University (Tfh2212);Research Project of Nantong Municipal Health Commission (QNZ2023016); Social and People’s Livelihood Science and Technology Projects of Nantong (MS22022063).

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  1. Xiaofeng Chen: First author.

Authors and Affiliations

  1. Department of Thyroid and Breast Surgery, School of Nursing and Rehabilitation, Affiliated Hospital of Nantong University, Nantong University, Nantong, 226001, China

    Xiaofeng Chen

  2. Department of Rheumatology, Medical School of Nantong University, Affiliated Hospital of Nantong University, Nantong University, Nantong, 226001, China

    Chen Dong & Zhifeng Gu

  3. Department of Thyroid and Breast Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, China

    Yuan Zhuang, Lihua Lu, Ping Lu & Yiju Li

  4. Department of Nursing, Research Center of Nursing, Medical School of Nantong University, Affiliated Hospital of Nantong University, Nantong University, Nantong, 226001, China

    Chen Shen

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Contributions

Xiaofeng Chen: Conceptualization, Methodology, Writing - Original Draft; Chen Shen: Writing - Review & Editing, Project administration; Zhifeng Gu: Supervision, Project administration; Chen Dong: Formal analysis, Resources; Yuan Zhuang, Lihua Lu and Ping Lu: Investigation, Data Curation; Yiju Li: Resources, Data Curation.

Corresponding authors

Correspondence to Zhifeng Gu or Chen Shen.

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Ethics approval and consent to participate

The studies involving human participants were reviewed and approved by the Ethical Committee of Affiliated Hospital of Nantong University (2023-K066-01), and the study procedures adhere to the principles of the Declaration of Helsinki. The participants provided their written informed consent to participate in this study.

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The authors declare no competing interests.

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Chen, X., Dong, C., Zhuang, Y. et al. The role of social comparative orientation in social anxiety among breast cancer survivors: a moderated mediation model of body image and self-concept clarity. BMC Psychiatry 25, 389 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12888-025-06821-4

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BMC Psychiatry

ISSN: 1471-244X

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