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. 2025 Apr 17;25(1):389.
doi: 10.1186/s12888-025-06821-4.

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

Xiaofeng Chen #  1 , Chen Dong  2 , Yuan Zhuang  3 , Lihua Lu  3 , Ping Lu  3 , Yiju Li  3 , Zhifeng Gu  4 , Chen Shen  5
Affiliations

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

Xiaofeng Chen et al. BMC Psychiatry. .

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.

Keywords: Body image; Breast cancer; Moderated mediation; Self-concept clarity; Social anxiety; Social comparison orientation.

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Conflict of interest statement

Declarations. 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. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The hypothesized moderated mediation model
Fig. 2
Fig. 2
Self-concept clarity moderates effects in social comparison orientation and body image
Fig. 3
Fig. 3
Self-concept clarity moderates effects in body image and social anxiety
See this image and copyright information in PMC

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