Clinical perfectionism: a cognitive-behavioural analysis

Predictors of excessive exercise in anorexia nervosa

OBJECTIVE

The aim of the present study was to replicate and amalgamate findings from previous research into a comprehensive regression model predicting excessive exercise in individuals with anorexia nervosa (AN).

METHOD

Participants were 153 patients admitted to an inpatient treatment program for AN. Excessive exercise status was defined as a minimum of 1 hour of obligatory exercise aimed at controlling shape and weight, 6 days per week in the month before admission.

RESULTS

Thirty-four percent (n = 52) of participants met criteria for excessive exercise. A logistic regression was conducted with excessive exercise status as the dependent variable and a number of variables previously found to be predictors of excessive exercise entered as independent variables on the same step. The overall regression model was statistically significant (P < .0005) and explained 31% of the variance in exercise status. Higher levels of dietary restraint (P = .03), depression (P = .04), and self-esteem (P = .02); lower levels of obsessive-compulsive symptomatology (P = .04); and the restricting subtype of AN (P = .03) were significantly associated with excessive exercise.

CONCLUSIONS

Excessive exercise is associated with a number of independent psychologic and behavioral variables, some that suggest a negative impact and others that suggest positive effects.

Cognitive behavioral therapy for eating disorders

Cognitive behavioral therapy (CBT) is the leading evidence-based treatment for bulimia nervosa. A new "enhanced" version of the treatment appears to be more potent and has the added advantage of being suitable for all eating disorders, including anorexia nervosa and eating disorder not otherwise specified. This article reviews the evidence supporting CBT in the treatment of eating disorders and provides an account of the "transdiagnostic" theory that underpins the enhanced form of the treatment. It ends with an outline of the treatment's main strategies and procedures.

Relations among media influence, body image, eating concerns, and sexual orientation in men: A preliminary investigation

The current study explored the relation between sexual orientation, media persuasion, and eating and body image concerns among 78 college men (39 gay; 39 straight). Participants completed measures of sexual orientation, eating disorder symptoms, appearance-related anxiety, perceived importance of physical attractiveness, perceptions of media influence, and media exposure. Gay men scored significantly higher on drive for thinness, body dissatisfaction, and body image-related anxiety than their straight counterparts. Additionally, perceptions of media influence were higher for gay men, and significantly mediated the relation between sexual orientation and eating and body image concerns. Sexual orientation also moderated the relation between perceived media influence and beliefs regarding the importance of physical attractiveness, as this relation was significant for gay men, but not straight men. The current findings suggest that gay men's increased vulnerability to media influence partially accounts for the relatively high rate of eating pathology observed in this population.

Personality and perfectionism in chronic fatigue syndrome: a closer look

OBJECTIVE

To test the hypothesis that people with chronic fatigue syndrome (CFS) would differ significantly from a healthy control group on measures of general personality and perfectionism, specifically on measures of neuroticism and unhealthy perfectionism.

METHOD

A total of 27 female CFS outpatients and 30 female healthy controls completed questionnaires, including the NEO Personality Inventory-Revised, the Multi-dimensional Perfectionism Scale and measures of anxiety and depression.

RESULTS

The CFS group was significantly more fatigued, anxious and depressed than healthy controls. They scored significantly higher on neuroticism and unhealthy perfectionism. Healthy and unhealthy perfectionism were positively correlated in the CFS group, but not in the control group.

CONCLUSION

The present study confirms the link between neuroticism and fatigue and finds a link between unhealthy perfectionism and fatigue. A 'healthy trait', such as healthy perfectionism, when coupled with evaluative concerns is not necessarily healthy in a fatigued population. Researchers and clinicians should note the context in which apparently benign traits are expressed, and how they interact with other traits.

Exploring domain-specific perfectionism

The main objective of this research was to explore the extent to which perfectionism is a general personality trait across areas of functioning rather than a context-specific trait. The study also explored the degree to which domain-specific contingent self-worth, perceived competence, and task value were associated with domain-specific perfectionism. In a sample of 187 academically talented youth, a comparison of perfectionistic tendencies and cognitive appraisal processes in the school versus sports domain revealed significantly higher levels of perfectionism, perceptions of competence, task value, and contingent self-worth in the school domain. Hierarchical regression analysis showed a significant main effect for contingencies of self-worth on perfectionistic tendencies in both the school and sports domains. The results argue for the centrality of contingent self-worth to the understanding of perfectionism.

The impact of perfectionism and anxiety traits on action monitoring in major depressive disorder

Perfectionism and anxiety features are involved in the clinical presentation and neurobiology of major depressive disorder (MDD). In MDD, cognitive control mechanisms such as action monitoring can adequately be investigated applying electrophysiological registrations of the error-related negativity (ERN) and error positivity (Pe). It is also known that traits of perfectionism and anxiety influence ERN amplitudes in healthy subjects. The current study explores the impact of perfectionism and anxiety traits on action monitoring in MDD. A total of 39 MDD patients performed a flankers task during an event-related potential (ERP) session and completed the multidimensional perfectionism scale (MPS) with its concern over mistakes (CM) and doubt about actions (DA) subscales and the trait form of the State Trait Anxiety Inventory. Multiple regression analyses with stepwise backward elimination revealed MPS-DA to be a significant predictor (R²:0.22) for the ERN outcomes, and overall MPS (R²:0.13) and MPS-CM scores (R²:0.18) to have significant predictive value for the Pe amplitudes. Anxiety traits did not have a predictive capacity for the ERPs. MPS-DA clearly affected the ERN, and overall MPS and MPS-CM influenced the Pe, whereas no predictive capacity was found for anxiety traits. The manifest impact of perfectionism on patients’ error-related ERPs may contribute to our understanding of the action-monitoring process and the functional significance of the Pe in MDD. The divergent findings for perfectionism and anxiety features also indicate that the wide range of various affective personality styles might exert a different effect on action monitoring in MDD, awaiting further investigation.

An empirical typology of perfectionism in early-to-mid adolescents and its relation with eating disorder symptoms

Although the association between perfectionism and eating disorder (ED) symptoms is well-established, debate remains about the relative contribution of two central dimensions of perfectionism, that is, Personal Standards (PS) perfectionism and Evaluative Concerns (EC) perfectionism, in the prediction of ED symptoms. This study used cluster analysis to establish naturally occurring combinations of PS and EC perfectionism in early-to-mid adolescents (N = 656; M age = 13.9 years). Evidence was obtained for four perfectionism profiles: (1) maladaptive perfectionism (high PS and high EC), (2) pure evaluative concerns perfectionism (high EC only), (3) adaptive perfectionism (high PS, low EC), and (4) non-perfectionism (low on both PS and EC). A comparison of participants in these four clusters in terms of ED symptoms suggests that a combination of high personal standards and evaluative concerns (rather than the presence of one of these two dimensions alone) is most strongly related to ED symptoms.

An eating disorder-specific model of interpersonal psychotherapy (IPT-ED): causal pathways and treatment implications

Several studies support the efficacy of interpersonal psychotherapy (IPT) in the treatment of eating disorders. Treatment outcomes are likely to be augmented through a greater understanding, and hence treatment targeting, of the mechanisms whereby IPT induces therapeutic gains. To this end, the present paper seeks to develop a theoretical model of IPT in the context of eating disorders (IPT-ED). After providing a brief description of IPT, the IPT-ED model is presented and research supporting its theorized mechanisms is summarized. This model proposes that negative social evaluation plays a pivotal role as both a cause (via its detrimental impact on self evaluation and associated affect) and consequence of eating disorder symptoms. In the final section, key eating disorder constructs (namely, the developmental period of adolescence, clinical perfectionism, cognitive dysfunction, and affect regulation) are re-interpreted from the standpoint of negative social evaluation thereby further explicating IPT's efficacy as an intervention for individuals with an eating disorder.

Perceived expectations in daily life among adolescent girls suffering from an eating disorder: a phenomenographic study

The aim of this study was to describe the variation of perceived expectations in daily life of adolescent girls suffering from eating disorders. Eighteen interviews with girls between the age of 15 and 19 years were analyzed according to the phenomenographic approach. The results could be summarized into three categories: expectations from others, self-imposed expectations, and conflicting expectations. Each of these could be further subdivided into two conceptions. Conflicting and unattainable expectations were severe stressors in the participants' lives. Many participants had problems identifying expectations that were not explicit. The participants internalized these expectations and interpreted them to be self-imposed. Clinical implications are suggested.

Do perfectionists raise their standards after success? An experimental examination of the revaluation of standard setting in perfectionism

Setting high standards is one of the core aspects of perfectionism. Shafran, Cooper, and Fairburn (2002) proposed that individuals with self-imposed perfectionism raise their standards after they successfully meet them. This study examines whether individuals with self-imposed perfectionism raise their goal after the feedback of success. Fifty-three college students, whose self-oriented perfectionism (SOP; Hewitt & Flett, 1991) was assessed, performed a task with a goal, and received feedback of success. Following the feedback, they were asked to choose (a) the same goal or (b) a more difficult goal for the next task. The logistic regression analysis revealed that the greater the SOP, the more likely the participants were to choose the difficult goal. The theoretical and clinical implications for the standard setting of perfectionism were discussed.

Perfectionism, self-efficacy, and depression: preliminary analysis of the Japanese version of the Almost Perfect Scale-Revised

The Almost Perfect Scale-Revised is a self-report measure of perfectionism. The present study examined the psychometric properties of the scale's Japanese version and its relation to self-efficacy and depression. Japanese university students (N = 249) completed the Japanese version of the Almost Perfect Scale-Revised along with the General Self-Efficacy Scale-12 and the Self-Rating Depression Scale. Exploratory factor analysis indicated three factors: Discrepancy, High Standards, and Order. Estimates of internal consistency reliability for the three subscales were high. Confirmatory factor analysis of the Almost Perfect Scale-Revised in another group of Japanese university students (N = 206) supported the 3-factor structure. Cluster analyses using the three subscales yielded four clusters. In addition to adaptive perfectionists, maladaptive perfectionists, and nonperfectionists, identified in previous studies, a normal perfectionists group was identified, with mean scores similar to those of the total sample and depression and self-efficacy scores close to those of nonperfectionists. Adaptive perfectionists, characterized by high scores on High Standards and Order and low scores on Discrepancy, also had higher scores on self-efficacy and lower scores on depression than maladaptive perfectionists and even nonperfectionists. The influence of Japanese culture is discussed.

Predicting depression, anxiety and self-harm in adolescents: the role of perfectionism and acute life stress

Despite the growing evidence that perfectionism is associated with adolescent psychological distress, few studies have investigated this relationship prospectively with measures designed for use in adolescent populations. In the present study, within a diathesis-stress framework, we investigated the extent to which perfectionism and acute life stress predict depression, anxiety and self-harm among adolescent school children (n = 515) over a 6 month period (Time 1-Time 2). Socially prescribed perfectionism (SPP), self-oriented perfectionism-critical (SOP-critical) and the associated interactions with acute life stress differentially predicted anxiety, depression and self-harm. Acute life stress was an independent predictor of depression, anxiety and self-harm. SPP predicted depression and interacted with acute life stress to predict self-harm. SOP-critical and the SOP-critical by acute life stress interaction predicted anxiety. Self-oriented perfectionism-striving (SOP-striving) did not predict any of the Time 2 measures of distress. The dimensions of perfectionism are differentially associated with psychological distress. Tailored clinical interventions focused on adolescent perfectionism should offer promise in tackling psychological morbidity in adolescence.

The roles of persistence and perseveration in psychopathology

Two constructs were hypothesized to be of importance in psychological disorders: persistence (the ability to keep going to reach a goal, even when the task is difficult or drawn out) and perseveration (the tendency to continue a behavior, even when it ceases to be effective or rewarding). These are contrasted with perfectionism (having high standards for oneself or others). A measure was developed to address these constructs (the Persistence, Perseveration and Perfectionism Questionnaire; PPPQ). The PPPQ was administered to 325 nonclinical participants, alongside a measure of psychological disturbance. Factor analysis resulted in a 22-item version of the measure, consisting of subscales with good psychometric properties corresponding to the 3 theoretical constructs. Persistence was associated with lower levels of psychopathology, whereas perseveration was associated with higher levels of psychopathology. Perfectionism was weakly associated with psychopathology. Further work is needed to develop these constructs with clinical groups, but the findings support the hypothesis that persistence is an adaptive construct whereas perseveration is maladaptive.

Perfectionism and social anxiety: rethinking the role of high standards

Some researchers contend that high standards are an essential component of social anxiety. We tested this hypothesis in two independent samples. The consistent finding across samples was that higher scores on measures of high standards from two perfectionism scales predicted lower scores for social anxiety measures. These findings suggest lower, not higher, standards are involved in social anxiety, but more research is needed to clarify the implications of perfectionism, particularly the maladaptive form, in the context of social anxiety.

Perfectionism in obsessive-compulsive and eating disorders

OBJECTIVE: The main aims of this article are twofold. First, to assess perfectionism dimensions in obsessive-compulsive disorder and eating disorders in comparison with psychiatric control (depression/anxiety) and non-clinical control groups. Second, to examine if perfectionism is specifically related to these different clinical conditions. METHOD: Thirty-nine outpatients with obsessive-compulsive disorder, 24 outpatients with eating disorders, 65 outpatients with a diagnosis of depression and/or anxiety, and 70 non-clinical participants completed the Portuguese version of the Multidimensional Perfectionism Scale. RESULTS: Compared to non-clinical subjects, individuals of all clinical samples had significantly higher scores on Multidimensional Perfectionism Scale total score, Self-Oriented and Socially-Prescribed Perfectionism. There were no significantly differences in Self-Oriented Perfectionism and Multidimensional Perfectionism Scale total score in all the three clinical samples. Subjects from the eating disorders sample had significantly higher scores of Socially-Prescribed Perfectionism in comparison to obsessive-compulsive disorder and psychiatric control samples. CONCLUSION: Perfectionism showed to be related with this broad range of psychopathologies. However, the differences between eating disorders versus obsessive-compulsive disorder and psychiatric control on Socially-Prescribed Perfectionism warrant further investigation in order to clarify the specificity of this perfectionism dimension in eating disorders.

Does perfectionism mediate or moderate the relation between body dissatisfaction and disordered eating attitudes and behaviors?

A link between perfectionism and disordered eating has been documented in previous studies. The purpose of the current study was to expand our knowledge of the specific role of perfectionism in disordered eating by examining perfectionism as a mediator or a moderator in the relation between body dissatisfaction and disordered eating (assessed using the EAT-26 and its subscales, and the Binge Scale). We sampled a large ethnically diverse sample of university women (N=520) using two measures of perfectionism: the Eating Disorder Inventory Perfectionism subscale (EDI-P) and the Multidimensional Perfectionism Scale (H-MPS). In general, socially prescribed and self-oriented perfectionism, but not other-oriented perfectionism, were correlated with disordered eating attitudes and behaviors, except binge eating. Furthermore, perfectionism was found to partially mediate and moderate the relation between body dissatisfaction and disordered eating, however the strength of these associations differed depending on both the particular measure of perfectionism (EDI-P versus H-MPS) and the specific dimension of perfectionism (self-oriented, socially prescribed, other-oriented) used in the analyses. The findings are discussed in relation to the need for more informed and theoretically sound models of the development and maintenance of disordered eating.

Perceived incompetence moderates the relationship between maladaptive perfectionism and disordered eating

Maladaptive perfectionism and perceived incompetence are two factors associated with disordered eating. In this study, we examined whether perceived incompetence moderated the relationship between maladaptive perfectionism and disordered eating. Three hundred fifteen college women completed surveys assessing eating habits and levels of perceived incompetence and perfectionism. Results supported a moderating effect of perceived incompetence such that as levels of perceived incompetence increased, the relationship between maladaptive perfectionism and disordered eating became increasingly strong. These results imply that clinicians may want to focus efforts on helping clients learn to set healthy goals and improve their perception of competence in life domains.

Perfectionism and achievement goals in young Finnish ice-hockey players aspiring to make the Under-16 national team

Research on perfectionism suggests that is it useful to differentiate between perfectionistic strivings and perfectionistic concerns. Regarding the 2x2 achievement goal framework, the usefulness of this differentiation was recently demonstrated in a study with university student athletes (Stoeber, Stoll, Pescheck, & Otto, 2008, Study 2), in which it was found that perfectionistic strivings were associated with mastery-approach and performance-approach goals and perfectionistic concerns with mastery-avoidance, performance-approach, and performance-avoidance goals. Because the study was largely exploratory and only used non-elite athletes, the aim of the present research was to replicate and extend these findings by investigating a sample of 138 young, elite ice-hockey players, while adding further measures of perfectionism and using structural equation modelling (SEM) to confirm the relationships between perfectionistic strivings, perfectionistic concerns, and the 2x2 achievement goals. The SEM results showed that, in elite athletes also, perfectionistic strivings are associated with mastery-approach and performance-approach goals, whereas perfectionistic concerns are associated with mastery-avoidance, performance-approach, and performance-avoidance goals. Our findings corroborate the importance of differentiating between perfectionistic strivings and perfectionistic concerns when studying perfectionism in sports, because only perfectionistic concerns (and not perfectionistic strivings) are associated with maladaptive patterns of achievement goals.

Structure of diagnostic and statistical manual of mental disorders, fourth edition criteria for obsessive-compulsive personality disorder in patients with binge eating disorder

OBJECTIVE

To examine 1-, 2-, and 3-factor model structures through confirmatory analytic procedures for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) obsessive-compulsive personality disorder (OCPD) criteria in patients with binge eating disorder (BED).

METHOD

Participants were consecutive outpatients (n = 263) with binge eating disorder and were assessed with semi-structured interviews. The 8 OCPD criteria were submitted to confirmatory factor analyses in Mplus Version 4.2 (Los Angeles, CA) in which previously identified factor models of OCPD were compared for fit, theoretical relevance, and parsimony. Nested models were compared for significant improvements in model fit.

RESULTS

Evaluation of indices of fit in combination with theoretical considerations suggest a multifactorial model is a significant improvement in fit over the current DSM-IV single- factor model of OCPD. Though the data support both 2- and 3-factor models, the 3-factor model is hindered by an underspecified third factor.

CONCLUSION

A multifactorial model of OCPD incorporating the factors perfectionism and rigidity represents the best compromise of fit and theory in modelling the structure of OCPD in patients with BED. A third factor representing miserliness may be relevant in BED populations but needs further development. The perfectionism and rigidity factors may represent distinct intrapersonal and interpersonal attempts at control and may have implications for the assessment of OCPD.

Low perception of control as a cognitive factor of eating disorders. Its independent effects on measures of eating disorders and its interactive effects with perfectionism and self-esteem

OBJECTIVE

There is a large body of research about perfectionism and low self-esteem in eating disorders (ED). However, little is known about the influence in ED of a distorted cognition in the domain of control: the perception of low control. The present study examined the main and interactive effects of concern over mistakes (an important dimension of perfectionism), self-esteem, and perception of control on drive for thinness, bulimia, and body dissatisfaction.

METHOD

Forty individuals with ED and 55 controls completed the Multidimensional Perfectionism Scale, the Anxiety Control Questionnaire, the Rosenberg self-esteem scale, and the three symptomatic scales of the Eating Disorder Inventory, which are drive for thinness, bulimia and body dissatisfaction. Multiple linear regression was used to test the hypothesis that perception of low control has a significant effect on the symptomatic scales of the EDI.

RESULTS

The ED group had significantly lower perception of control and self-esteem and higher concern over mistakes, drive for thinness, bulimia, and body dissatisfaction than the control group. Analysis of interactive effects suggested that a combination of a low perception of control and a low self-esteem seems to moderate the effects of concern over mistakes on drive for thinness, bulimia, and body dissatisfaction.

DISCUSSION

ED are associated with a tendency to worry about mistakes, a low sense of self-esteem, and a low perception of control over internal feelings and external events. Perception of control and self-esteem seems to moderate the predictive power of concern mistakes on symptoms of ED. The results suggest that a low perception of control is an important cognitive factor in ED.

Perfectionism in school teachers: relations with stress appraisals, coping styles, and burnout

Many school teachers suffer from stress and burnout, and perfectionism is a personality characteristic that has been associated with increased stress, maladaptive coping, and burnout. Recent findings, however, show that perfectionism has both positive and negative facets. To investigate how these facets are related to stress, coping, and burnout in teachers, a sample of 118 secondary school teachers completed multidimensional measures of perfectionism, stress appraisals, coping styles, and burnout. Multiple regression analyses showed that striving for perfection was positively related to challenge appraisals and active coping and inversely to threat/loss appraisals, avoidant coping, and burnout whereas negative reactions to imperfection were positively related to threat/loss appraisals, avoidant coping, and burnout and inversely to challenge appraisals and active coping. Perceived pressure to be perfect showed differential relationships depending on the source of pressure: Whereas pressure from students was positively related to loss appraisals and pressure from students' parents was positively related to burnout, pressure from colleagues was inversely related to threat appraisals and burnout. The findings suggest that striving for perfection and perceived pressure from colleagues do not contribute to stress and burnout in teachers, whereas negative reactions to imperfection and perceived pressure from students and students' parents may be contributing factors.

Cognitive Behaviour Therapy for Eating Disorders

The eating disorders provide one of the strongest indications for cognitive behaviour therapy (CBT). This bold claim arises from two sources: first, the fact that eating disorders are essentially cognitive disorders and second, the demonstrated effectiveness of CBT in the treatment of bulimia nervosa, which has led to the widespread acceptance that CBT is the treatment of choice. In this paper the cognitive behavioural approach to the understanding and treatment of eating disorders will be described. A brief summary of the evidence for this account and of the data supporting the efficacy and effectiveness of this form of treatment will be provided. Challenges for the future development and dissemination of the treatment will be identified.

Perfectionism, Depression, Loneliness, and Life Satisfaction

This study investigates the cross-cultural construct validity of perfectionism using the Chinese translation of the Almost Perfect Scale—Revised (APS-R; Slaney, Mobley, Trippi, Ashby, & Johnson, 1996) with 509 Chinese high school students from Hong Kong. The factor structure of the Chinese APS-R and correlations between the APS-R subscales and measures of Depression, Satisfaction with Life, and Loneliness are examined. Participants are grouped into three clusters—adaptive and maladaptive perfectionists and nonperfectionists. A comparison of group means revealed that adaptive perfectionists reported higher Satisfaction with Life scores and lower Depression scores than the other two groups. This sample of Chinese students also reported higher Discrepancy scores compared to U.S. students' scores in previous studies. Similarities and differences in comparison to previous studies using U.S. participants are examined. Finally, the limitations of this study and implications for future research with Chinese participants are discussed.

Compulsive exercise to control shape or weight in eating disorders: prevalence, associated features, and treatment outcome

OBJECTIVE

The study was aimed at assessing the prevalence of compulsive exercising to control shape and weight in eating disorders (EDs) and its relationship with treatment outcome.

METHOD

Compulsive exercising to control shape and weight, defined according to a modified version of the Intense Exercising to Control Shape or Weight section of the Eating Disorder Examination (EDE), was assessed in 165 consecutive ED inpatients entering a protocol based on the transdiagnostic cognitive behavior theory and treatment of EDs. Baseline assessment also included anthropometry, the global EDE interview, the Beck Depression Inventory, the State-Trait Anxiety Inventory (STAI), the Eating Disorders Inventory-Perfectionism Scale, and the Temperament and Character Inventory.

RESULTS

Of the patients, 45.5% were classified as compulsive exercisers, the prevalence being highest (80%) in restricting-type anorexia nervosa (AN), lowest in EDs not otherwise specified (31.9%), and intermediate in binge/purging AN (43.3%) and in purging-type bulimia nervosa (39.3%). Compulsive exercising to control shape and weight was independently predicted by the EDE restraint score (odds ratio, 1.32; 95% confidence interval, 1.06-1.64; P = .014) after adjustment for ED; the total amount of exercise was associated with EDE restraint, as well as with the Temperament and Character Inventory reward dependence. At follow-up, an improved EDE global score was predicted by lower baseline values, higher baseline STAI and STAI improvement, and lower amount of exercise in the last 4 weeks. Voluntary treatment discontinuation was not predicted by baseline exercise.

DISCUSSION

Compulsive exercising to control shape and weight is a behavioral feature of restricting-type AN, associated with restraint and temperament dimensions, with influence on treatment outcome.

Examining a psychosocial interactive model of binge eating and vomiting in women with bulimia nervosa and subthreshold bulimia nervosa

The current study tested a psychosocial interactive model of perfectionism, self-efficacy, and weight/shape concern within a sample of women with clinically significant bulimic symptoms, examining how different dimensions of perfectionism operated in the model. Individuals with bulimia nervosa (full diagnostic criteria or subthreshold) completed measures of bulimic symptoms, multidimensional perfectionism, self-efficacy, and weight/shape concern. Among those who were actively binge eating (n=180), weight/shape concern was associated with binge eating frequency in the context of high perfectionism (either maladaptive or adaptive) and low self-efficacy. Among those who were actively vomiting (n=169), weight/shape concern was associated with vomiting frequency only in the context of high adaptive perfectionism and low self-efficacy. These findings provide support for the value of this psychosocial interactive model among actively binge eating and purging samples and for the importance of considering different dimensions of perfectionism in research and treatment related to bulimia nervosa.

Perfectionism and the five-factor model of personality

In this study of the discriminant, convergent, and incremental validity of the Almost Perfect Scale-Revised (APS-R), university students completed the APS-R, additional measures of perfectionism, the NEO Five-Factor Inventory-Form S, and measures of self-esteem and depression. The results revealed expected significant, but not completely overlapping, associations between the APS-R Discrepancy subscale scores and the Five-Factor Model of Personality (FFM) dimension of Neuroticism, and between the APS-R High Standards and Order subscales and the FFM dimension of Conscientiousness. The incremental validity of APS-R scores over FFM dimensions was supported in analyses of self-esteem but not depression. The implications of these findings for further psychometric and clinical studies of perfectionism and facets of FFM dimensions are discussed.

Shared temperament risk factors for anorexia nervosa: a twin study

OBJECTIVE

To answer two questions about the nature of the relationship between anorexia nervosa (AN) and dimensional temperament traits: Which traits are comorbid with AN? Which traits share transmitted liabilities with AN?

METHODS

A community sample of 1002 same-gender female twins was selected with respect to participation in two earlier waves of data collection. Measures of eating disorder diagnoses and features were ascertained through interview and continuous measures of temperament were ascertained from self-report measures.

RESULTS

Four temperaments were comorbid with AN, namely, higher levels of perfectionism (concern over mistakes, personal standards, doubt about actions), and higher need for organization. Comparison between the female co-twins of AN probands and controls (who had never had an eating disorder) showed that the former group reported higher levels of personal standards, organization, and reward dependence. The association between personal standards and reward dependence remained when controlling for the temperament of the proband or control in monozygotic twins.

CONCLUSIONS

The evidence overall supports the suggestion that AN may represent the expression of a common underlying familial liability to a temperament style that reflects a striving for perfectionism, a need for order, and a sensitivity to praise and reward. The nature of the shared risk factors is likely to be, in part, genetic.

Perceived parental psychological control and eating-disordered symptoms: maladaptive perfectionism as a possible intervening variable

Recent developmental theorizing conceptualizes perfectionism as a mediator of the relation between intrusive parenting and psychopathology. Research addressing this hypothesis in relation to eating disorders (EDs), however, is lacking. This case-control study (a) examined mean-level differences between ED patients and normal controls in psychologically controlling parenting and perfectionism and (b) addressed the intervening role of perfectionism in associations between psychological control and ED symptoms, distinguishing between maladaptive and relatively more adaptive types of perfectionism. Hypotheses were examined in a sample of normal controls (N = 85) and a sample of ED patients (N = 60). Findings indicate that ED patients and bulimics in particular show elevated levels of paternal (but not maternal) psychological control and elevated levels of maladaptive perfectionism compared with normal controls. Mediation analyses show that maladaptive perfectionism is a significant intervening variable between parental psychological control and ED symptoms. Directions for future research on controlling parenting, perfectionism, and ED are outlined.

The relations between perfectionism and suicidality: a systematic review

Since the 1980s, there has been a 300 percent increase in the number of published papers on perfectionism. Given the inconsistent findings in the literature, this systematic review examines, for the first time, the nature of the relationship between perfectionism and suicidality. To this end, the three main psychological and medical databases (PsychInfo 1887-May 2006, Medline 1966-May 2006 and Web of Knowledge 1981-May 2006) were searched. Twenty nine papers of perfectionism and suicidality were found. There is considerable evidence that selfcritical evaluative concerns perfectionism (i.e., socially prescribed perfectionism, self-criticism, concern about mistakes, and doubts about action) is correlated with suicidality. The methodological implications for future research are examined. In addition, the clinical implications for treatment and how these findings relate to the current conceptual debate on the nature of perfectionism are discussed.

Does regional brain perfusion correlate with eating disorder symptoms in anorexia and bulimia nervosa patients?

OBJECTIVE

Using single photon emission computed tomography (SPECT), we sought brain perfusion correlates of eating disorder symptoms in anorexia and bulimia nervosa patients.

METHOD

We investigated 67 female eating disordered (ED) patients. Eating disorder symptoms were measured by the Eating Disorders Inventory (EDI). Determination of brain areas in which regional perfusion co-varied with drive for thinness, bulimia, body dissatisfaction, ineffectiveness, perfectionism, interpersonal distrust, interoceptive awareness and maturity fears was done by open explorative correlation analysis using Statistical Parametrical Mapping (SPM).

RESULTS

A significant positive correlation between scores on body dissatisfaction and ineffectiveness, and brain perfusion in the prefrontal and parietal cortex was demonstrated. There were no correlations between other eating disorder symptoms and brain perfusion.

CONCLUSION

Based on the finding of an association between regional brain flow and body dissatisfaction and ineffectiveness, we argue that neurobiological findings in ED patients may not only reflect emotional and behavioural factors but cognitive-evaluative features as well.

Eating disorder pathology among overweight treatment-seeking youth: Clinical correlates and cross-sectional risk modeling

Preliminary research suggests that pediatric overweight is associated with increased eating disorder pathology, however, little is known about which overweight youth are most vulnerable to eating disorder pathology. We therefore investigated 122 overweight treatment-seeking youth to describe eating disorder pathology and mental health correlates, and to identify psychopathological constructs that may place overweight youth at increased risk for eating disorder pathology. Youth participated in a comprehensive assessment of eating disorders, mood and anxiety disorders, general psychopathology, and risk variables involving semi-structured clinical interviews and self- and parent-report questionnaires prior to the initiation of weight-loss treatment. Ten youth met criteria for an eating disorder, and over one-third endorsed recent binge eating. Eating disorder pathology was associated with depressive and anxious symptoms (p's<0.001). Structural equation modeling indicated increased negative affect, teasing experience, and thin-ideal internalization, and decreased perfectionism were associated with increased eating disorder pathology. Findings corroborate earlier work indicating that eating disorder pathology is elevated and clinically significant in overweight treatment-seeking youth, bolstering the need for mental health assessment of such individuals. Cross-sectional modeling proposed key variables that relate to eating disorder pathology in overweight treatment-seeking youth, which following prospective replication, may inform the development of effective interventions for overweight and eating disorders.

A randomised controlled trial of cognitive-behaviour therapy for clinical perfectionism: a preliminary study

Perfectionism can be a problem in its own right and it can impede the progress of treatment of Axis I disorders. This study reports on a preliminary randomised controlled trial of cognitive-behaviour therapy (CBT) for "clinical perfectionism". Twenty participants were randomly assigned to either immediate treatment (IT) (n=10) or a wait list (NL) (n=10). Treatment consisted of ten sessions of CBT over eight weeks. Two participants did not complete the follow-up assessments (10%). Fifteen of the original 20 participants (75%) were clinically significantly improved after treatment and the effect size was large (1.8). Treatment gains were maintained at 8-week and 16-week follow-up.

Links between eating disorder symptom severity and psychiatric comorbidity

Patients with eating disorders (ED) frequently exhibit additional psychiatric disorders. This study aimed to examine whether psychiatric comorbidity in ED patients is associated with increased severity of ED symptoms in a sample of 277 women with a current ED (84 anorexia nervosa, 152 bulimia nervosa, 41 eating disorders not otherwise specified). Psychiatric comorbidity of Axes I and II was determined using the Structured Clinical Interview (SCID) for DSM-IV. Severity of ED-related symptoms was assessed using interviewer-rated scales from the Structured Interview for Anorexia and Bulimia Nervosa (SIAB). Affective and anxiety-related disorders of both axes were linked with increased intensity of weight- and appearance-related fears and concerns. Frequency of binge-eating and frequency of purging both were associated with Axis I anxiety disorders, substance-related disorders, and Cluster B personality disorders. Frequency of dieting was related to anxiety disorders on both axes. Multivariate analyses revealed that Axis I anxiety disorders were more closely linked with severity of ED symptoms than affective or substance-related disorders. The results showed that psychiatric comorbidity of both axes is linked with increased severity of ED symptoms and that there are associations between specific ED symptoms and specific forms of comorbidity.