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Esmaeili A, Esmaeeli ST. A life lost to anorexia nervosa: A case report of rapid progressive disease and its psychological aspects. Clin Case Rep 2024; 12:e8709. [PMID: 38566976 PMCID: PMC10985021 DOI: 10.1002/ccr3.8709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
The prevalence of anorexia nervosa has been on the rise. Exploring key factors in treating this condition as well as psychological factors influencing the onset and maintenance of the disorder can increase the chance of treatment success.
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Affiliation(s)
- Amirreza Esmaeili
- Department of Clinical Health Psychology, School of Behavioral Science and Mental HealthIran University of Medical SciencesTehranIran
| | - Soode Tajik Esmaeeli
- Fellowship of Psychosomatic Medicine, Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of MedicineIran University of Medical SciencesTehranIran
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Kealy D, Hewitt PL, Söchting I, Mikail SF, Smith MM, Flett GL, Ge S, Kristen A, Giannone Z. A comparison of the effect of two types of brief psychodynamic group therapy on perfectionism-related attitudes, self-relatedness, and self-esteem. Psychother Res 2024:1-18. [PMID: 38301604 DOI: 10.1080/10503307.2024.2308141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024] Open
Abstract
Objective: This randomized controlled trial investigated the efficacy of dynamic relational group therapy (DRT) relative to group psychodynamic supportive therapy (PST) in improving perfectionism-related attitudes and components of the perfectionistic self-relationship. Method: Based on a comprehensive conceptualization of perfectionism, 80 community-recruited, highly perfectionistic individuals were randomly allocated to 12 sessions of group DRT (n = 41; 5 groups) or group PST (n = 39; 5 groups). Patients completed measures of dysfunctional attitudes, self-criticism, self-esteem, and self-reassurance at pre-, mid-, and post-treatment, and six months post-treatment. Results: Multigroup latent growth curve modeling revealed significant (p < .05) decreases in dysfunctional attitudes, concern over mistakes, two types of self-criticism, and self-esteem problems, along with a significant increase in self-reassurance, from pre-treatment to six-month follow-up in both DRT and PST. Moderate-to-large between-group differences favoring DRT over PST were found for dysfunctional attitudes and self-reassurance. A majority of patients in both conditions maintained reliable improvement at six-month follow-up in dysfunctional attitudes, concern over mistakes, and self-criticism focused on inadequacy. Conclusion: Findings provide evidence for the use of psychodynamic group therapy approaches in treating perfectionism-related attitudes and self-relational elements of perfectionism, and support the relative efficacy of DRT for dysfunctional attitudes and self-reassurance.
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Affiliation(s)
- David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Paul L Hewitt
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Ingrid Söchting
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Samuel F Mikail
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Martin M Smith
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Gordon L Flett
- Department of Psychology, York University, Toronto, Canada
| | - Sabrina Ge
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Anna Kristen
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Zarina Giannone
- Department of Psychology, University of British Columbia, Vancouver, Canada
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Dikmeer N, Ersöz Alan B, Foto Özdemir D. The role of mindfulness on the psychological aspects of anorexia nervosa. Clin Child Psychol Psychiatry 2024; 29:15-29. [PMID: 37667411 PMCID: PMC10748460 DOI: 10.1177/13591045231190675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
OBJECTIVE Emotion regulation, perfectionism, and rumination are perpetuating factors in anorexia nervosa (AN). Mindfulness can be protective and therapeutic. We aimed to understand the relationship between these factors and mindfulness in AN. METHODS 20 adolescent girls in the acute phase of the AN, 16 in remission, and 40 in the control group were evaluated. RESULTS Mindfulness was lowest in the acute AN group. The difference in the acute AN group regarding body dissatisfaction, emotion dysregulation, perfectionism, and mindfulness disappeared after controlling for the effects of depression and anxiety. The predictors of disordered eating in the entire study population were body dissatisfaction and depressive symptoms. Emotion regulation and perfectionism were the predictors of mindfulness in the acute AN group and the entire study population. When mindfulness decreased, concerns about body shape increased in both acute AN and remission groups, while dietary restriction and disordered eating behaviors increased only in the remission group. DISCUSSION Emotion regulation difficulties in acute AN could be related to depression and anxiety. Mindfulness interventions for emotion regulation could be used for depression during the acute phase while for perfectionism in remission. Early intervention for depression and body dissatisfaction seems protective, and mindfulness could be an appropriate intervention.
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Affiliation(s)
| | - Burcu Ersöz Alan
- Department of Child and Adolescent Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dilşad Foto Özdemir
- Department of Child and Adolescent Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Lev Arey D, Sagi A, Blatt A. The relationship between exercise addiction, eating disorders, and insecure attachment styles among recreational exercisers. J Eat Disord 2023; 11:131. [PMID: 37550767 PMCID: PMC10408237 DOI: 10.1186/s40337-023-00855-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/01/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Exercise addiction (EA) and eating disorders (ED) frequently co-occur in both professional and amateur athletes, with up to 48% of individuals with EA also exhibiting symptoms of ED. Furthermore, pathological attachment styles have been linked to both EA and ED. The current study aimed to explore the unique association between types of insecure attachment styles (i.e., anxiety or avoidance) and EA and ED. METHOD Four hundred and five Israelis (199 women, 206 men) who were recreational exercisers (i.e., exercised at least four hours a week for at least one year) with ages ranging from 18 to 78 (M = 38, SD = 12.31) completed a set of questionnaires, including the Eating Attitudes Test (EAT-26), Exercise Addiction Inventory, and the Experiences in Close Relationship Scale. Path analysis was used to simultaneously examine the associations of attachment anxiety and avoidance with EA and ED symptoms. Attachment anxiety and avoidance were specified as independent variables predicting ED and EA symptoms and were entered into the analysis as two parallel dependent variables. RESULTS The results of the study indicate that attachment anxiety is positively associated with symptoms of EDs, while the association between attachment anxiety and symptoms of EA is not significant. On the other hand, attachment avoidance shows a positive association with symptoms of exercise addiction, but no significant association with symptoms of EDs is found. CONCLUSIONS These results imply that the anxious attachment regulation strategy is highly associated with body image concerns. Furthermore, individuals characterized by avoidance attachment manifest regulation strategies through excessive exercise. Scholars and practitioners could use these results to examine dispositional risk factors for insecure attachment styles and to assess specific pathologies among the population of recreational exercisers. The study also discusses limitations, future directions, and implications in detail.
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Affiliation(s)
- Dalit Lev Arey
- School of Psychology, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel.
| | - Adi Sagi
- School of Psychology, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Asaf Blatt
- School of Behavioral Sciences, College of Management Academic Studies, Rishon LeZion, Israel
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Zhao Z, Gobrogge K. Neurodevelopmental Model Explaining Associations between Sex Hormones, Personality, and Eating Pathology. Brain Sci 2023; 13:859. [PMID: 37371339 PMCID: PMC10296733 DOI: 10.3390/brainsci13060859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Clinical scientists have been investigating the relationships between sex hormones, personality, and eating disorders for decades. However, there is a lack of direct research that addresses whether personality mediates or moderates the relationships between sex hormones and eating pathology. Moreover, the neural mechanisms that underlie the interactive associations between these variables remain unclear. This review aims to summarize the associations between these constructs, describe a neural mechanism mediating these relationships, and offer clinical strategies for the early identification and intervention of eating disorders. The gathered evidence shows that aggressiveness, impulsivity, and obsessive-compulsiveness may mediate or moderate the relationships between sex hormones and eating pathology, but only among females. Furthermore, sex hormone receptor density in the mesocorticolimbic dopamine pathway may explain the neural mechanism of these associations. Future research should use more comprehensive personality measurements and assess the mediation and moderation effects of temperament while taking the hormone levels of women across menstrual cycles into account. Additionally, electroencephalography and functional magnetic resonance imaging should be implemented to directly assess brain activity and corroborate these findings.
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Affiliation(s)
- Ziyu Zhao
- Department of Psychological & Brain Sciences, Boston University, Boston, MA 02215, USA;
| | - Kyle Gobrogge
- Department of Psychological & Brain Sciences, Boston University, Boston, MA 02215, USA;
- Undergraduate Program in Neuroscience, College of Art & Sciences, Boston University, Boston, MA 02215, USA
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Babaei S, Dehghani M, Lavasani FF, Ashouri A, Mohamadi L. The effectiveness of short-term dynamic/interpersonal group therapy on perfectionism; assessment of anxiety, depression and interpersonal problems. RESEARCH IN PSYCHOTHERAPY (MILANO) 2022; 25:656. [PMID: 36629756 PMCID: PMC9893043 DOI: 10.4081/ripppo.2022.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/02/2022] [Indexed: 12/31/2022]
Abstract
Perfectionism is acknowledged as a core vulnerability and a perpetuating factor in several psychopathologies. The purpose of the present study was to investigate the effectiveness of short-term psychodynamic/interpersonal group psychotherapy for perfectionism and perfectionism-related distress such as anxiety, depression, and interpersonal problems. This study is a quasi-experimental study applying clinical trial method and contains pre-test, post-test, follow-up periods and control group. The study population included students and the sample consisted of 30 people with extreme perfectionism, who were assigned in two groups of 15 people, experimental and waiting list groups using randomized block design. Research instruments included Tehran Multidimensional Perfectionism Scale, Perfectionistic Self Presentation Scale, Perfectionistic Cognition Inventory, Beck Depression Inventory-II, Beck Anxiety Inventory and Inventory of Interpersonal Problems-32. In order to analyse the collected data, mixed analysis of variance and Repeated Measures Analysis of Variance were used in SPSS software version 22. The results show that the intervention in the experimental group compared to the waiting list group caused a clinically and statistically significant decrease in the mean scores. This result is observable and evident in all levels of perfectionism and psychological distress (anxiety, depression and interpersonal problems), except for the subscale of Non-Display of Imperfection from the Perfectionistic Self Presentation Scale. These results were preserved through the follow-up periods. These results show that short-term dynamic/interpersonal group therapy is effective in treating most of the components of perfectionism and concerning its effectiveness; it reduced psychological distress and showed that the components pertaining to perfectionism are factors of vulnerability in this regard.
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Affiliation(s)
- Shirzad Babaei
- Ph.D. Candidate in Clinical Psychology, Department of Clinical Psychology, Faculty of Behavioral Sciences and Mental Health (Tehran psychiatric institute), Iran University of Medical Sciences, Tehran, Iran.
| | - Mahmood Dehghani
- Ph.D. in Clinical Psychology, Assistant Professor, Department of Clinical Psychology, Faculty of Behavioral Sciences and Mental Health (Tehran psychiatric institute), Iran University of Medical Sciences, Tehran, Iran.
| | - Fahimeh Fathali Lavasani
- Ph.D. in Clinical Psychology, Assistant Professor, Department of Clinical Psychology, Faculty of Behavioral Sciences and Mental Health (Tehran psychiatric institute), Iran University of Medical Sciences, Tehran, Iran.
| | - Ahmad Ashouri
- Ph.D. in Clinical Psychology, Assistant Professor, Department of Clinical Psychology, Faculty of Behavioral Sciences and Mental Health (Tehran psychiatric institute), Iran University of Medical Sciences, Tehran, Iran.
| | - Leila Mohamadi
- Ph.D. in Clinical Psychology, Department of Clinical Psychology, Faculty of Behavioral Sciences and Mental Health (Tehran psychiatric institute), Iran University of Medical Sciences, Tehran, Iran.
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Bernabéu-Brotóns E, Marchena-Giráldez C. Emotional Eating and Perfectionism as Predictors of Symptoms of Binge Eating Disorder: The Role of Perfectionism as a Mediator between Emotional Eating and Body Mass Index. Nutrients 2022; 14:nu14163361. [PMID: 36014866 PMCID: PMC9415756 DOI: 10.3390/nu14163361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/11/2022] [Accepted: 08/13/2022] [Indexed: 02/07/2023] Open
Abstract
(1) Background: Perfectionism has been linked to eating disorders and might be a risk factor for the appearance of eating pathologies. The aims of this study are (a) to verify the relationship between perfectionism, emotional eating (EE), binge eating (BE), and body mass index (BMI); (b) to identify the variables that predict BE symptoms and BMI; (c) to study the role of perfectionism as a mediator between EE and BMI. (2) Methods: 312 adult participants answered a cross-sectional survey that included the Multidimensional Perfectionism Scale, the Emotional Eater Questionnaire (EEQ), the Binge Eating Scale (BES), and a sociodemographic questionnaire including BMI. (3) Results: The results suggest a direct correlation between EE, BE, and BMI, showing that EE is a powerful predictor of BE symptoms and BMI. Furthermore, two dimensions of perfectionism have a mediator role between EE and BMI, specifically doubts and actions and concern over mistakes: the presence of these two components of perfectionism reverses the relationship between EE and BMI. (4) Conclusions: These results have significant implications for the understanding of the two different (pathological) eating patterns: intake restriction and overeating and should be considered in intervention programs.
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Phillipou A, Gurvich C, Castle DJ, Rossell SL. Anorexia nervosa, weight restoration and biological siblings: Differences and similarities in clinical characteristics. Australas Psychiatry 2022; 30:458-461. [PMID: 35138958 DOI: 10.1177/10398562211067194] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) is associated with clinical characteristics including eating disorder symptomatology, negative mood states, perfectionism and cognitive inflexibility. Whether these characteristics differ across illness stages, and are also present in first-degree relatives, demonstrating heritability, is unclear. The aim of this research was to compare current AN (c-AN), weight-restored AN (wr-AN), sisters of individuals with AN (AN-sis) and healthy controls (HC) on these measures. METHOD Eighty participants (n = 20/group) completed the study. RESULTS Eating disorder symptomatology was similar among c-AN and wr-AN groups, whereas the AN-sis did not differ from either wr-AN or HC. Anxiety was significantly higher in c-AN, wr-AN and AN-sis groups, relative to HC. Increased perfectionism was identified in the c-AN and wr-AN groups compared to AN-sis and HC on the 'concern over mistakes', 'personal standards' and 'doubt and actions' subscales of the Multidimensional Perfectionism Scale. Group differences were not apparent on cognitive flexibility. CONCLUSIONS These findings suggest that anxiety may be a risk factor or linked to genetic susceptibility for AN, as well as specific aspects of perfectionism that relate to self-imposed standards.
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Affiliation(s)
- Andrea Phillipou
- Centre for Mental Health, 3783Swinburne University of Technology, Melbourne, Australia.,Department of Mental Health, 60078St Vincent's Hospital, Melbourne, Australia.,Department of Mental Health, 96043Austin Health, Melbourne, Australia
| | - Caroline Gurvich
- 90088Monash Alfred Psychiatry Research Centre, Monash University & The Alfred Hospital, Melbourne, Australia
| | - David J Castle
- Centre for Complex Interventions, 7978Centre for Addictions and Mental Health, Toronto, Canada.,Department of Psychiatry, 7938University of Toronto, Toronto, Canada
| | - Susan L Rossell
- Centre for Mental Health, 3783Swinburne University of Technology, Melbourne, Australia.,Department of Mental Health, 60078St Vincent's Hospital, Melbourne, Australia
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Katzenmajer-Pump L, Farkas BF, Varga BA, Jansma JM, Balázs J. Low Level of Perfectionism as a Possible Risk Factor for Suicide in Adolescents With Attention-Deficit/Hyperactivity Disorder. Front Psychiatry 2021; 12:707831. [PMID: 34589006 PMCID: PMC8473605 DOI: 10.3389/fpsyt.2021.707831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/17/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Suicide is one of the leading causes of death among adolescents. Although it is known that both perfectionism and attention-deficit/hyperactivity disorder ('ADHD') are important risk factors for suicide, there are no studies that have investigated the relationship between suicidal behavior and perfectionism among people with ADHD. Aim: The current study investigates the association between perfectionism and suicide in adolescents with ADHD. Method: Subjects included 88 adolescents with ADHD and 96 non-clinical control adolescents. We used the Multidimensional Perfectionism Scale to evaluate perfectionism as well as its separate traits, and the Mini International Neuropsychologic Interview Kid to evaluate psychiatric disorders and suicidal behavior. Differences between the groups were statistically evaluated using t-tests, a Poisson regression analysis with suicide as a discrete variable, and a logistic regression analysis with suicide as a binary variable. Results: Compared to the control group, the ADHD group showed a significantly lower level on the adaptive 'Organization' trait of perfectionism, but not on any other trait, and a significantly higher level of suicidal behavior. Logistic regression results indicated a significant association for perfectionism in general (OR = 0.93, p = 0.003), and for the 'Personal Standards' trait (OR: 0.82, p = 0.039). Poisson regression analysis also showed a significant association with perfectionism in general (IRR = 0.90; p < 0.001) and with the 'Personal standards' trait model (IRR = 0.81, p = 0.019). Discussion: Our results indicate that a low level of perfectionism, in particular 'Personal standards', may be a risk factor for suicidal behavior in adolescents with ADHD. We recommend that psychoeducation and therapy of adolescents with ADHD should consider focusing on adaptive perfection as a possible risk factor for suicide as well.
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Affiliation(s)
- Luca Katzenmajer-Pump
- Institute of Psychology, Eötvös Loránd University, Doctoral School of Psychology, Budapest, Hungary
| | | | - Balázs András Varga
- Institute of Psychology, Eötvös Loránd University, Doctoral School of Psychology, Budapest, Hungary
| | - Johan M Jansma
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, UMC Utrecht, Utrecht, Netherlands
| | - Judit Balázs
- Department of Developmental and Clinical Child Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Department of Psychology, Bjørknes University College, Oslo, Norway
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Datta N, Bidopia T, Datta S, Mittal G, Alphin F, Marsh EJ, Fitzsimons GJ, Strauman TJ, Zucker NL. Meal skipping and cognition along a spectrum of restrictive eating. Eat Behav 2020; 39:101431. [PMID: 32957009 DOI: 10.1016/j.eatbeh.2020.101431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 08/25/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Inadequate nutrition adversely impacts brain development and cognitive functioning (Pollitt et al., 1983). Studies examining the acute impact of eating regular meals on cognition have reported inconsistent findings, necessitating the exploration of individual differences in samples contributing to equivocal results. The present study examines the impact of skipping lunch on cognitive ability in college-aged students by including eating restraint as a moderator. METHODS Participants were 99 college-aged students (M = 19.7 years, SD = 1.5) randomized to a blinded 'lunch' or 'lunch-omission' condition, and assessed on memory, attention, processing speed, set shifting, and eating disorder symptomology. RESULTS Regressing long and short-term memory on the lunch manipulation, eating restraint scores, and their interaction revealed significant interactions: those who had lunch had superior memory performance, but only for those reporting lower levels of eating restraint. Regressing set shifting speed on the manipulation, those who had lunch had slower set shifting speed than those who skipped, but only for those reporting lower levels of eating restraint. CONCLUSIONS Results suggest that skipping lunch may have immediate consequences on cognition, however, cognitive enhancing effects may be diminished in the presence of even low levels of eating restraint. Findings highlight the significance of purported subclinical levels of eating restraint and may inform health education strategies.
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Affiliation(s)
- Nandini Datta
- Duke University Department of Psychology and Neuroscience, Durham, NC, USA.
| | - Tatyana Bidopia
- Duke University Department of Psychology and Neuroscience, Durham, NC, USA
| | - Samir Datta
- Duke University Department of Psychology and Neuroscience, Durham, NC, USA
| | - Gaurie Mittal
- Duke University Department of Psychology and Neuroscience, Durham, NC, USA
| | - Franca Alphin
- Duke University Department of Family Medicine and Community Health, Durham, NC, USA
| | - Elizabeth J Marsh
- Duke University Department of Psychology and Neuroscience, Durham, NC, USA
| | | | - Timothy J Strauman
- Duke University Department of Psychology and Neuroscience, Durham, NC, USA
| | - Nancy L Zucker
- Duke University Department of Psychology and Neuroscience, Durham, NC, USA; Duke University School of Medicine Department of Psychiatry & Behavioral Sciences, Durham, NC, USA
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Brown M, Hochman A, Micali N. Emotional instability as a trait risk factor for eating disorder behaviors in adolescents: Sex differences in a large-scale prospective study. Psychol Med 2020; 50:1783-1794. [PMID: 31379310 DOI: 10.1017/s0033291719001818] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Temperament and personality traits, including negative emotionality/neuroticism, may represent risk factors for eating disorders. Further, risk factors may differ by sex. We examined longitudinal temperament/personality pathways of risk for purging and binge eating in youth stratified by sex using data from a large-scale prospective study. METHODS Temperament, borderline personality features, sensation seeking, 'big five' personality factors, and depressive symptoms were measured at five time points from early childhood to adolescence in 5812 adolescents (3215 females; 2597 males) in the Avon Longitudinal Study of Parents and Children. We conducted univariate analyses with these predictors of binge eating and purging at 14 and 16 years for total and sex-stratified samples. We used structural equation modeling (SEM) to fit data to a path analysis model of hypothesized associations. RESULTS Of the total sample, 12.54% engaged in binge eating and 7.05% in purging by 16 years. Prevalence was much greater and increased dramatically for females from 14 years (7.50% binge eating; 2.40% purging) to 16 years (15.80% binge eating; 9.50% purging). For both sexes, borderline personality, depressive symptoms and lower emotional stability predicted eating disorder behaviors; sensation seeking and conscientiousness were also significant predictors for females. SEM identified an 'emotional instability' pathway for females from early childhood into adolescence (RMSEA = 0.025, TLI = 0.937 and CFI = 0.970). CONCLUSIONS Binge eating and purging are common in female and male adolescents. Early temperament/personality factors related to difficulty regulating emotions were predictive of later adolescent eating disorder behaviors. Results have important clinical implications for eating disorder prevention and intervention.
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Affiliation(s)
- Melanie Brown
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, NY, USA
| | - Ayelet Hochman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, NY, USA
| | - Nadia Micali
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, NY, USA
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
- Department of Women's, Child and Adolescent Health, University of Geneva, Geneva, Switzerland
- Institute of Child Health, University College, London, London, UK
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12
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Multidimensional Models of Perfectionism and Procrastination: Seeking Determinants of Both. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145099. [PMID: 32679730 PMCID: PMC7400384 DOI: 10.3390/ijerph17145099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 12/04/2022]
Abstract
Background: Perfectionism is currently conceptualized using a multidimensional model, with extensive research establishing the presence of both maladaptive and adaptive forms. However, the potential adaptability of procrastination, largely considered as a maladaptive construct, and its possible developmental connection to perfectionism remains unclear. The purpose of this study was to examine the individual differences of the multidimensional models of both perfectionism and procrastination, as well as investigating potential links between the two constructs. Methods: A convenience sample of 206 undergraduate students participated in this study. Participants completed a questionnaire consisting of 236 questions regarding the variables under investigation. Results: The adaptive model of procrastination yielded largely insignificant results and demonstrated limited links with adaptive perfectionism, while maladaptive procrastination was consistently associated with maladaptive perfectionism, lending further evidence of a unidimensional model of procrastination. Conclusions: Many previous findings regarding the multidimensional model of perfectionism were replicated, along with new contributions focusing on the dual-process model and temporal orientation.
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Habashy J, Culbert KM. The Role of Distinct Facets of Perfectionism and Sociocultural Idealization of Thinness on Disordered Eating Symptoms. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2019. [DOI: 10.1521/jscp.2019.38.4.343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Perfectionism is a multidimensional personality style implicated in risk for disordered eating (DE), yet the types of perfectionism most predictive of DE and how perfectionistic tendencies lead to the development of DE remains less clear. This study aimed to determine the types of perfectionism most strongly associated with DE and whether perceived pressures for thinness and thin-ideal internalization serve as intervening variables that explain associations between perfectionism and DE. Methods: An ethnically diverse sample of female college students (n = 154–292) completed well-validated self-report questionnaires assessing overall DE symptoms, perfectionism, and two sociocultural factors: pressures for thinness and thin-ideal internalization. Results: Only perfectionism constructs encompassed under the “maladaptive evaluative concerns” domain were significantly associated with DE. Double mediation models indicated that heightened pressures for thinness and thin-ideal internalization fully mediate perfectionism-DE associations. Discussion: Results suggest that disorder-specific risk factors related to idealization of thinness may be important for understanding how a transdiagnostic factor, like perfectionism, results in DE.
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Duffy ME, Rogers ML, Joiner TE, Bergen AW, Berrettini W, Bulik CM, Brandt H, Crawford S, Crow S, Fichter M, Halmi K, Kaplan AS, Klump KL, Lilenfeld L, Magistretti PJ, Mitchell J, Schork NJ, Strober M, Thornton LM, Treasure J, Woodside B, Kaye WH, Keel PK. An investigation of indirect effects of personality features on anorexia nervosa severity through interoceptive dysfunction in individuals with lifetime anorexia nervosa diagnoses. Int J Eat Disord 2019; 52:200-205. [PMID: 30636025 DOI: 10.1002/eat.23008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 12/08/2018] [Accepted: 12/09/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study examined a hypothesized pathway by which interoceptive dysfunction accounted for associations between personality features (harm avoidance, self-directedness, and perfectionism) and anorexia nervosa (AN) severity (indicated by drive for thinness, eating disorder-related preoccupations and rituals, and body mass index). METHOD The study sample (n = 270, mean age = 28.47, 95.2% female, 98% White/Caucasian) consisted of probands and biological relatives who met DSM-IV criteria for lifetime diagnoses of AN (omitting criterion D, amenorrhea) drawn from the Price Foundation Anorexia Nervosa Affected Relative Pairs Study (AN-ARP). Participants completed measures assessing personality, interoceptive dysfunction, and eating pathology. RESULTS Associations between personality features of low self-directedness and high perfectionism and indicators of AN severity (drive for thinness and eating disorder-related preoccupations and rituals) were significant, as were the hypothesized indirect pathways through interoceptive dysfunction. Neither harm avoidance nor body mass index was significantly related to other study variables, and the proposed indirect pathways involving these variables were not significant. DISCUSSION Findings suggest that certain personality features may relate to AN severity, in part, through their associations with interoceptive dysfunction. Future research should examine prospective associations and the value of interventions targeting interoceptive dysfunction for interrupting the link between personality and AN severity.
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Affiliation(s)
- Mary E Duffy
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Megan L Rogers
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Andrew W Bergen
- BioRealm, LLC, Walnut, California.,Oregon Research Institute, Eugene, Oregon
| | - Wade Berrettini
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Scott Crow
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota.,The Emily Program, St. Paul, Minnesota
| | - Manfred Fichter
- Roseneck Hospital for Behavioral Medicine, affiliated with the University of Munich (LMU), Germany
| | - Katherine Halmi
- New York Presbyterian Hospital-Westchester Division, Weill Medical College of Cornell University, White Plains, New York
| | - Allan S Kaplan
- Centre for Addiction and Mental Health, Department of Psychiatry, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Kelly L Klump
- Department of Psychology, Michigan State University, East Lansing, Michigan
| | - Lisa Lilenfeld
- Department of Psychology, American School of Professional Psychology at Argosy University, Arlington, Virginia
| | - Pierre J Magistretti
- Department of Psychiatry, CHUY/University of Lausenne, Switzerland.,Brain Mind Institute, Switzerland
| | - James Mitchell
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Nicholas J Schork
- Department of Quantitative Medicine, The Translational Genomics Research Institute, Phoenix, Arizona.,Human Biology, The J. Craig Venter Institute, La Jolla, California
| | - Michael Strober
- Department of Psychiatry, University of California Los Angeles, Los Angeles, California
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Blake Woodside
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Program for Eating Disorders, Toronto General Hospital, Toronto, Ontario, Canada
| | - Walter H Kaye
- Department of Psychiatry, University of California at San Diego, San Diego, California
| | - Pamela K Keel
- Department of Psychology, Florida State University, Tallahassee, Florida
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15
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Bouguettaya A, Cruwys T, Moulding R, King R, Bliuc AM. Evidence That Frame of Reference Effects Can Reduce Socially Prescribed Perfectionism. Front Psychol 2019; 9:2703. [PMID: 30687167 PMCID: PMC6333663 DOI: 10.3389/fpsyg.2018.02703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/17/2018] [Indexed: 11/17/2022] Open
Abstract
Socially prescribed perfectionism appears to drive disordered eating behaviour in young women, usually via messages from fellow women. Social psychological research suggests that framing effects can be manipulated to reduce the effect of unhealthy messages. This research used contrasting messages about perfectionism to reduce perfectionism among female dieters. We recruited 147 female dieters (M age = 25.11) for a between-subjects experimental study. While completing an online questionnaire, participants were exposed to one of three sets of blog posts, which varied in content and source. These three conditions always had one anti-perfectionism message from a woman. This was presented along with either a high perfection message from a man, a high perfectionism message from a woman, or both of these messages. After reading the blog posts, women were asked to fill out a scale assessing their levels of socially prescribed perfectionism. When participants were exposed to an anti-perfectionism message from a woman, paired with a high-perfectionism message from a man, participants showed lower socially prescribed perfectionism than when both high and anti-perfectionism messages came from two women. These findings imply that strategies designed to reduce socially prescribed perfectionism may benefit from including contrasting messages, as this may shift perceived perfectionism norms. Implications for social interventions are discussed.
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Affiliation(s)
| | - Tegan Cruwys
- Research School of Psychology, The Australian National University, Canberra, ACT, Australia
| | - Richard Moulding
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Ross King
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Ana-Maria Bliuc
- School of Social Sciences and Psychology, Western Sydney University, Penrith, NSW, Australia
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16
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Evaluating Associations Between Perfectionism, Emotion Regulation, and Eating Disorder Symptoms in a Mixed-Gender Sample. J Nerv Ment Dis 2018; 206:900-904. [PMID: 30371645 PMCID: PMC6209118 DOI: 10.1097/nmd.0000000000000895] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Prior research supports maladaptive perfectionism as a risk factor for eating disorders; however, not all individuals with elevated levels of perfectionism endorse eating pathology, suggesting additional variables may interact with perfectionism to account for this association. The current study examined the influence of difficulties in emotion regulation on the relation between perfectionism and eating disorders. Undergraduate students (N = 309, 50.7% male) from a large university completed measures of perfectionism, emotion dysregulation, and eating pathology. The results indicated that high levels of perfectionism only accounted for significant variance in eating disorder symptoms among individuals with limited access to adaptive strategies to regulate emotions, but not among those with greater access to adaptive strategies. Findings demonstrate that clinicians and researchers should consider the role of emotion regulation among individuals with elevated levels of perfectionism and eating pathology. Future research should prospectively evaluate these associations and examine mechanisms that may further elucidate these relations.
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17
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Kodama N, Moriguchi Y, Takeda A, Maeda M, Ando T, Kikuchi H, Gondo M, Adachi H, Komaki G. Neural correlates of body comparison and weight estimation in weight-recovered anorexia nervosa: a functional magnetic resonance imaging study. Biopsychosoc Med 2018; 12:15. [PMID: 30450124 PMCID: PMC6208027 DOI: 10.1186/s13030-018-0134-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 10/14/2018] [Indexed: 11/13/2022] Open
Abstract
Background The neural mechanisms underlying body dissatisfaction and emotional problems evoked by social comparisons in patients with anorexia nervosa (AN) are currently unclear. Here, we elucidate patterns of brain activation among recovered patients with AN (recAN) during body comparison and weight estimation with functional magnetic resonance imaging (fMRI). Methods We used fMRI to examine 12 patients with recAN and 13 healthy controls while they performed body comparison and weight estimation tasks with images of underweight, healthy weight, and overweight female bodies. In the body comparison task, participants rated their anxiety levels while comparing their own body with the presented image. In the weight estimation task, participants estimated the weight of the body in the presented image. We used between-group region of interest (ROI) analyses of the blood oxygen level dependent (BOLD) signal to analyze differences in brain activation patterns between the groups. In addition, to investigate activation outside predetermined ROIs, we performed an exploratory whole-brain analysis to identify group differences. Results We found that, compared to healthy controls, patients with recAN exhibited significantly greater activation in the pregenual anterior cingulate cortex (pgACC) when comparing their own bodies with images of underweight female bodies. In addition, we found that, compared with healthy controls, patients with recAN exhibited significantly smaller activation in the middle temporal gyrus corresponding to the extrastriate body area (EBA) when comparing their own bodies, irrespective of weight, during self-other comparisons of body shape. Conclusions Our findings from a group of patients with recAN suggest that the pathology of AN may lie in an inability to regulate negative affect in response to body images via pgACC activation during body comparisons. The findings also suggest that altered body image processing in the brain persists even after recovery from AN. Electronic supplementary material The online version of this article (10.1186/s13030-018-0134-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Naoki Kodama
- 1Division of Psychosomatic Medicine, Department of Neurology, University of Occupational and Environmental Health, Kitakyushu, 807-8555 Japan
| | - Yoshiya Moriguchi
- 2Department of Psychophysiology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, 187-8553 Japan
| | - Aya Takeda
- NPO Corporation Nobinokai, Yokohama, 236-0014 Japan
| | - Motonari Maeda
- 4College of Art and Design, Joshibi University of Art and Design, Sagamihara, 252-8538 Japan
| | - Tetsuya Ando
- 5Department of Psychosomatic Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, 187-8553 Japan
| | - Hiroe Kikuchi
- 6Department of Psychosomatic Medicine, Center Hospital of the National Center for Global Health and Medicine, Tokyo, 162-8655 Japan
| | - Motoharu Gondo
- 7Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582 Japan
| | - Hiroaki Adachi
- 8Department of Neurology, University of Occupational and Environmental Health, Kitakyushu, 807-8555 Japan
| | - Gen Komaki
- 9School of Health Sciences Fukuoka, International University of Health and Welfare, Fukuoka, 831-8501 Japan
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18
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Prior KL, Erceg-Hurn DM, Raykos BC, Egan SJ, Byrne S, McEvoy PM. Validation of the clinical perfectionism questionnaire in an eating disorder sample: A bifactor approach. Int J Eat Disord 2018; 51:1176-1184. [PMID: 30230573 DOI: 10.1002/eat.22892] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/30/2018] [Accepted: 05/15/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Clinical perfectionism is involved in the etiology and maintenance of eating disorders. Limited research has examined the factor structure of the Clinical Perfectionism Questionnaire (CPQ) in clinical eating disorder samples. The aim of this research was to examine the validity and reliability of the CPQ in a mixed eating disorder sample. METHOD Patients (N = 211) with an eating disorder completed the CPQ at pretreatment. A bifactor model was tested that included a general clinical perfectionism factor and two group factors; overevaluation of striving and concern over mistakes. The unique contributions that general and group factors make to the prediction of eating disorder symptoms were also investigated. Unidimensional, correlated two-factor, and bifactor models were tested using confirmatory factor analysis. RESULTS A bifactor structure for a revised 10-item version of the CPQ provided the best fit, with a strong and reliable general clinical perfectionism factor. The general clinical perfectionism factor and the overevaluation of striving group factor explained reliable variance in the CPQ, and but only the general factor predicted eating disorder symptoms. DISCUSSION The results suggested that a total score is generally appropriate for assessing clinical perfectionism in a clinical eating disorder sample.
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Affiliation(s)
| | - David M Erceg-Hurn
- School of Psychology, Curtin University, Perth, Australia.,Centre for Clinical Interventions, Perth, Australia
| | | | - Sarah J Egan
- School of Psychology, Curtin University, Perth, Australia
| | - Sue Byrne
- Centre for Clinical Interventions, Perth, Australia.,School of Psychological Science, University of Western Australia, Perth, Australia
| | - Peter M McEvoy
- School of Psychology, Curtin University, Perth, Australia.,Centre for Clinical Interventions, Perth, Australia
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19
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Phillipou A, Carruthers SP, Di Biase MA, Zalesky A, Abel LA, Castle DJ, Gurvich C, Rossell SL. White matter microstructure in anorexia nervosa. Hum Brain Mapp 2018; 39:4385-4392. [PMID: 29964345 DOI: 10.1002/hbm.24279] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/03/2018] [Accepted: 06/05/2018] [Indexed: 01/04/2023] Open
Abstract
The neurobiological underpinnings of anorexia nervosa (AN) are unclear. White matter deficits have been described in the illness, but findings are inconsistent between studies. The aim of this study was to investigate differences in white matter microstructure in AN using diffusion-weighted imaging (DWI). It was hypothesised that people with AN, relative to a healthy control (HC) group, would show decreased functional anisotropy (FA) and increased mean diffusivity (MD) in the fornix and superior longitudinal fasciculus, consistent with previous literature. Analyses were conducted on 23 females with AN and 26 age- and gender-matched HCs using tract-based spatial statistics (TBSS). The results revealed widespread FA decreases and MD increases in the AN group. Our hypothesis was largely supported, although FA differences were not specifically found in the fornix. The findings suggest extensive differences in white matter structure in AN, which may contribute to AN pathophysiology.
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Affiliation(s)
- Andrea Phillipou
- Department of Optometry & Vision Sciences, The University of Melbourne, Melbourne, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Australia.,Department of Mental Health, Austin Health, Melbourne, Australia.,Department of Mental Health, St Vincent's Hospital, Melbourne, Australia.,Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Sean P Carruthers
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,Monash Alfred Psychiatry Research Centre, Monash University & The Alfred Hospital, Melbourne, Australia
| | - Maria A Di Biase
- Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard, Medical School, Massachusetts.,Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Australia
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Melbourne, Australia
| | - Larry A Abel
- Department of Optometry & Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - David J Castle
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia.,Department of Mental Health, St Vincent's Hospital, Melbourne, Australia
| | - Caroline Gurvich
- Monash Alfred Psychiatry Research Centre, Monash University & The Alfred Hospital, Melbourne, Australia
| | - Susan L Rossell
- Department of Mental Health, St Vincent's Hospital, Melbourne, Australia.,Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,Monash Alfred Psychiatry Research Centre, Monash University & The Alfred Hospital, Melbourne, Australia
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20
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Haynos AF, Utzinger LM, Lavender JM, Crosby RD, Cao L, Peterson CB, Crow SJ, Wonderlich SA, Engel SG, Mitchell JE, Le Grange D, Goldschmidt AB. Subtypes of Adaptive and Maladaptive Perfectionism in Anorexia Nervosa: Associations with Eating Disorder and Affective Symptoms. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2018; 40:691-700. [PMID: 30636840 DOI: 10.1007/s10862-018-9672-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Perfectionism is hypothesized to contribute to the etiology of anorexia nervosa (AN). However, there is little research regarding whether individuals with AN can be classified according to maladaptive (e.g., evaluative concerns) and adaptive (e.g., high personal standards) facets of perfectionism that predict distinct outcomes and might warrant different intervention approaches. In this study, a latent profile analysis was conducted using data from adults with AN (n = 118). Frost Multidimensional Perfectionism Scale (Frost et al. Cognitive Therapy and Research, 14(5), 449-46, 1990) subscales were used to identify subgroups differing according to endorsed perfectionism features (e.g., adaptive and maladaptive perfectionism). Generalized linear models were used to compare subgroups on eating disorder and affective symptoms measured through questionnaire and ecological momentary assessment. Four subgroups were identified: (a) Low Perfectionism; (b) High Adaptive and Maladaptive Perfectionism; (c) Moderate Maladaptive Perfectionism; and (d) High Maladaptive Perfectionism. Subgroups differed on overall eating disorder symptoms (p < .001), purging (p = .005), restrictive eating (p < .001), and body checking (p < .001) frequency, depressive (p < .001) and anxiety (p < .001) symptoms, and negative (p = .001) and positive (p < .001) affect. The Low Perfectionism group displayed the most adaptive scores and the Moderate and High Maladaptive Perfectionism groups demonstrated the most elevated clinical symptoms. The High Adaptive and Maladaptive Perfectionism group demonstrated low affective disturbances, but elevated eating disorder symptoms. Results support the clinical significance of subtyping according to perfectionism dimensions in AN. Research is needed to determine if perfectionism subtyping can enhance individualized treatment targeting in AN.
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Affiliation(s)
- Ann F Haynos
- Department of Psychiatry, University of Minnesota, 2450 Riverside Ave., F253, Minneapolis, MN 55454, USA
| | - Linsey M Utzinger
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Jason M Lavender
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Ross D Crosby
- Neuropsychiatric Research Institute, Fargo, ND, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota, Fargo, ND, USA
| | - Li Cao
- Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota, 2450 Riverside Ave., F253, Minneapolis, MN 55454, USA.,The Emily Program, Minneapolis, MN, USA
| | - Scott J Crow
- Department of Psychiatry, University of Minnesota, 2450 Riverside Ave., F253, Minneapolis, MN 55454, USA.,The Emily Program, Minneapolis, MN, USA
| | - Stephen A Wonderlich
- Neuropsychiatric Research Institute, Fargo, ND, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota, Fargo, ND, USA
| | - Scott G Engel
- Neuropsychiatric Research Institute, Fargo, ND, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota, Fargo, ND, USA
| | - James E Mitchell
- Neuropsychiatric Research Institute, Fargo, ND, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota, Fargo, ND, USA
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Andrea B Goldschmidt
- Department of Psychiatry and Human Behavior, The Miriam Hospital/Weight Control and Diabetes Research Center, Warren Alpert Medical School of Brown University, Providence, RI, USA
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21
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Kendler KS, Ohlsson H, Keefe RSE, Sundquist K, Sundquist J. The joint impact of cognitive performance in adolescence and familial cognitive aptitude on risk for major psychiatric disorders: a delineation of four potential pathways to illness. Mol Psychiatry 2018; 23:1076-1083. [PMID: 28416810 PMCID: PMC5647225 DOI: 10.1038/mp.2017.78] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 02/22/2017] [Accepted: 02/24/2017] [Indexed: 12/24/2022]
Abstract
How do joint measures of premorbid cognitive ability and familial cognitive aptitude (FCA) reflect risk for a diversity of psychiatric and substance use disorders? To address this question, we examined, using Cox models, the predictive effects of school achievement (SA) measured at age 16 and FCA-assessed from SA in siblings and cousins, and educational attainment in parents-on risk for 12 major psychiatric syndromes in 1 140 608 Swedes born 1972-1990. Four developmental patterns emerged. In the first, risk was predicted jointly by low levels of SA and high levels of FCA-that is a level of SA lower than would be predicted from the FCA. This pattern was strongest in autism spectrum disorders and schizophrenia, and weakest in bipolar illness. In these disorders, a pathologic process seems to have caused cognitive functioning to fall substantially short of familial potential. In the second pattern, seen in the internalizing conditions of major depression and anxiety disorders, risk was associated with low SA but was unrelated to FCA. Externalizing disorders-drug abuse and alcohol use disorders-demonstrated the third pattern, in which risk was predicted jointly by low SA and low FCA. The fourth pattern, seen in eating disorders, was directly opposite of that observed in externalizing disorders with risk associated with high SA and high FCA. When measured together, adolescent cognitive ability and FCA identified four developmental patterns leading to diverse psychiatric disorders. The value of cognitive assessments in psychiatric research can be substantially increased by also evaluating familial cognitive potential.
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Affiliation(s)
- KS Kendler
- Department of Psychiatry, Department of Human and Molecular Genetics, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychiatry, Virginia Commonwealth University, Richmond VA, USA,Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - H Ohlsson
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - RSE Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - K Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - J Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
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22
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The Role of Division III Sports Participation in the Relationship Between Perfectionism and Disordered Eating Symptomology. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2018. [DOI: 10.1123/jcsp.2017-0013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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23
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Eating Disorders in Adolescents With Chronic Pain. J Pediatr Health Care 2017; 31:67-74. [PMID: 27021242 DOI: 10.1016/j.pedhc.2016.03.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/08/2016] [Accepted: 03/12/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Given that youth with chronic pain frequently experience disruptions in eating patterns that may place them at risk for disordered eating, the purpose of this study was to examine the clinical characteristics and illness course of adolescents with chronic pain and comorbid eating disorders. METHODS Using a retrospective chart review, 34 adolescents with chronic pain and concurrent eating disorders were identified. These adolescents were compared with 34 age-, gender-, and eating disorder symptom-matched adolescents who had an eating disorder without chronic pain. RESULTS The majority of adolescents with chronic pain and an eating disorder had a primary medical diagnosis of abdominal pain (n = 14), followed by autonomic dysfunction (n = 10) and headache (n = 6). Although in 41.2% of teens with chronic pain, eating disorder symptoms developed after the onset of their pain, 35.3% reported having eating disorder symptoms before they experienced chronic pain. Body mass index did not differ between the groups, but the duration of eating disorder symptoms was significantly longer for the chronic pain group (p < .001). DISCUSSION Despite comparable severity, eating disorders are undetected for longer periods in patients with chronic pain, which may contribute to a poorer prognosis. Implications for eating disorder conceptualization, detection, and treatment are discussed.
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24
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25
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Ferrand C, Brunet E. Perfectionism and Risk for Disordered Eating among Young French Male Cyclists of High Performance. Percept Mot Skills 2016; 99:959-67. [PMID: 15648494 DOI: 10.2466/pms.99.3.959-967] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to examine the associations between dimensions of perfectionism and eating disorder symptoms among 42 young male amateur cyclists ( M = 21.8 yr., SD = 3.7) over the three performance categories (Elite, National, Regional). They completed the Multidimensional Perfectionism Scale and the Eating Attitudes Test, and the Body Mass Index was computed. Analysis showed athletes in the performance categories did not differ on dimensions of perfectionism. Only the National category differed from the Regional and the Elite categories in log-transformed Oral Control. Regression analyses showed that Other Oriented Perfectionism significantly contributed 15%, 12%, and 14% of the variance, respectively, in the prediction of log-transformed Global EAT, Dieting, and Bulimia scores. Socially Prescribed Perfectionism was the significant predictor of log-transformed Oral Control scores, accounting for 16% of the variance. This study highlights the relevance of interpersonal facets of the perfectionism construct to eating disorder symptoms.
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Affiliation(s)
- Claude Ferrand
- Centre de Recherche et d'Innovation sur le Sport, Université Claude Bernard Lyon 1, Villeurbanne, France.
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26
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Wicksteed A. III. Manifestations of Chaos and Control in the Life Experiences of Individuals with Eating Disorders: Explorations through Qualitative Email Discourse. FEMINISM & PSYCHOLOGY 2016. [DOI: 10.1177/0959353500010004007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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27
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Levinson CA, Rodebaugh TL. Clarifying the prospective relationships between social anxiety and eating disorder symptoms and underlying vulnerabilities. Appetite 2016; 107:38-46. [PMID: 27444957 DOI: 10.1016/j.appet.2016.07.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/07/2016] [Accepted: 07/18/2016] [Indexed: 11/17/2022]
Abstract
Social anxiety and eating disorders are highly comorbid. Several explanations for these high levels of comorbidity have been theorized. First, social anxiety might be a vulnerability factor for eating disorders. Second, eating disorders might be a vulnerability factor for social anxiety. Third, the two kinds of disorders may have common, shared psychological vulnerabilities. The current study (N = 300 undergraduate women) investigates a model of social anxiety and eating disorder symptoms that examines each of these possibilities across two time points (Time 1 and six months later). We do not find support for either social anxiety or eating disorder symptoms per se predicting each other across time. Instead, we find that some underlying vulnerabilities prospectively predict symptoms of both disorders, whereas other vulnerabilities are specific to symptoms of one disorder. Specifically we find that maladaptive perfectionism is a shared prospective vulnerability for social anxiety and eating disorder symptoms. Alternatively, we find that social appearance anxiety is specific for eating disorder symptoms, whereas high standards is specific for social anxiety symptoms. These data help clarify our understanding of how and why social anxiety and eating disorder symptoms frequently co-occur.
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Affiliation(s)
- Cheri A Levinson
- University of Louisville, Department of Psychological and Brain Sciences, USA; Washington University in St. Louis, USA.
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28
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Sanchez DT, Crocker J. How Investment in Gender Ideals Affects Well-Being: The Role of External Contingencies of Self-Worth. PSYCHOLOGY OF WOMEN QUARTERLY 2016. [DOI: 10.1111/j.1471-6402.2005.00169.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The present study examined the relationship between investment in gender ideals and well-being and the role of external contingencies of self-worth in a longitudinal survey of 677 college freshmen. We propose a model of how investment in gender ideals affects external contingencies and the consequences for self-esteem, depression, and symptoms of disordered eating. Specifically, we find that the negative relationship between investment in gender ideals and well-being is mediated through externally contingent self-worth. The model showed a good fit for the overall sample. Comparative model testing revealed a good fit for men and women as well as White Americans, Asian Americans, and African Americans.
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Jafari Z, Khodarahimi S, Rasti A. Sexual Self-Esteem and Perfectionism in Women With and Without Overweight. WOMEN & THERAPY 2016. [DOI: 10.1080/02703149.2016.1116875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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La Rocque CL, Lee L, Harkness KL. The Role of Current Depression Symptoms in Perfectionistic Stress Enhancement and Stress Generation. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2016. [DOI: 10.1521/jscp.2016.35.1.64] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Phillipou A, Rossell SL, Gurvich C, Castle DJ, Troje NF, Abel LA. Body Image in Anorexia Nervosa: Body Size Estimation Utilising a Biological Motion Task and Eyetracking. EUROPEAN EATING DISORDERS REVIEW 2015; 24:131-8. [DOI: 10.1002/erv.2423] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 10/08/2015] [Accepted: 11/06/2015] [Indexed: 01/23/2023]
Affiliation(s)
- Andrea Phillipou
- Department of Optometry & Vision Sciences; The University of Melbourne; Melbourne Australia
- Department of Psychiatry; The University of Melbourne; Melbourne Australia
- Department of Mental Health; The Austin Hospital; Melbourne Australia
| | - Susan Lee Rossell
- Brain and Psychological Sciences Research Centre; Swinburne University of Technology; Melbourne Australia
- Monash Alfred Psychiatry Research Centre; Melbourne Australia
- Department of Psychiatry; St Vincent's Hospital; Melbourne Australia
| | | | - David Jonathan Castle
- Department of Psychiatry; The University of Melbourne; Melbourne Australia
- Department of Psychiatry; St Vincent's Hospital; Melbourne Australia
- Faculty of Health Sciences; Australian Catholic University; Melbourne Australia
| | | | - Larry Allen Abel
- Department of Optometry & Vision Sciences; The University of Melbourne; Melbourne Australia
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Yahghoubi H, Mohammadzadeh A. Comparison of Perfectionism and Related Positive-Negative Dimension in People With High Traits on Obsessive Compulsive and Eating Disorder Characteristics. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2015; 9:e264. [PMID: 26576174 PMCID: PMC4644621 DOI: 10.17795/ijpbs-264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 12/24/2014] [Accepted: 03/12/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Psychopathological perfectionism is often correlated with obsessive compulsive eating disorders. OBJECTIVES The purpose of this study was to investigate perfectionism in people with high traits of obsessive compulsive and eating disorder characteristics. MATERIALS AND METHODS This study was an expo fact research. The statistical population of the research comprised of male and female undergraduate students at Tabriz and Sarab branches of Payam- e- Noor University, Tabriz Islamic University and Azarbaijan Shahid Madani university in the academic year 2012 - 2013. A group of 640 university students, using the stratified random sampling method were screened by the obsessive compulsive inventory and the eating attitude test, then a group of 143 participants with high obsessive compulsive traits with another 137 participants with high eating disorder characteristics were selected and assessed with the Perfectionism Inventory. Data were analyzed using one way analysis of variance. RESULTS The results showed that perfectionism and related negative dimension are more commonly found in people with high obsessive-compulsive traits than eating disorder characteristics (P < 0.02). The results showed the highest contribution of maladaptive perfectionism in predicting obsessive-compulsive features and pathological eating attitude. Also, no difference was found between the two groups in terms of negative perfectionism. CONCLUSIONS The greater association of perfectionism with symptoms of obsessive-compulsive is consistent with its phenomenological feature. Fear of failure may motivate the behavioral components of perfectionism that aim to focus on careful checking, reassurance seeking and excessive consideration before making a decision.
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Affiliation(s)
- Hassan Yahghoubi
- Department of Psychology, Azarbaijan Shahid Madani University, Tabriz, IR Iran
| | - Ali Mohammadzadeh
- Department of Psychology, Payam- e- Noor University, Tehran, IR Iran
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Lloyd S, Schmidt U, Simic M, Tchanturia K. Self-reported and performance based perfectionism in mothers of individuals with Anorexia Nervosa: a pilot study. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2015; 29:192-9. [PMID: 26399933 DOI: 10.1007/s40211-015-0161-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 09/05/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Perfectionism is implicated in the development and maintenance of Anorexia Nervosa and there is some evidence that perfectionism may be elevated in family members. However to date there are no studies investigating behavioural aspects of perfectionism in unaffected mothers. METHODS Forty-one participants took part in this pilot study: 21 unaffected mothers of individuals with Anorexia Nervosa and 20 healthy control mothers. Participants completed two performance based tasks assessing perfectionism-a text replication task and a bead sorting task-along with self-report measures of perfectionism. RESULTS No group differences were found between unaffected AN mothers and HC mothers on performance measures of perfectionism. DISCUSSION The findings are discussed in relation to existing studies and clinical implications explored.
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Affiliation(s)
- Samantha Lloyd
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Mima Simic
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, UK. .,Illia State University, Tbilisi, Georgia.
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Chester DS, Merwin LM, DeWall CN. Maladaptive perfectionism's link to aggression and self-harm: Emotion regulation as a mechanism. Aggress Behav 2015; 41:443-54. [PMID: 26918433 DOI: 10.1002/ab.21578] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/12/2014] [Indexed: 11/11/2022]
Abstract
The negative affect that results from negative feedback is a substantial, proximal cause of aggression. People high in maladaptive perfectionism, the tendency to focus on the discrepancy between one's standards and performance, are characterized by an exaggerated negative affective response to negative feedback. This exacerbated affective response to failure may then dispose them to hurt others and themselves as aggression and self-harm are often perceived as a means to regulate negative affect. In Study 1, we demonstrated that maladaptive perfectionism was linked to greater aggressive behavior towards others after receiving negative feedback. Suggesting the presence of an emotion regulation strategy, this effect was mediated by the motivation to use aggression to improve mood. In Study 2, maladaptive perfectionism was linked to self-harm, an effect exacerbated by negative feedback and mediated by negative affect. These findings suggest that maladaptive perfectionists are at risk for greater harm towards others and the self because negative feedback has a stronger affective impact and harming others and the self is perceived a means to alleviate this aversive state.
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Affiliation(s)
- David S. Chester
- Department of Psychology; University of Kentucky; Lexington Kentucky
| | - Lauren M. Merwin
- Department of Psychology; University of Kentucky; Lexington Kentucky
| | - C. Nathan DeWall
- Department of Psychology; University of Kentucky; Lexington Kentucky
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Huber J, Salatsch C, Ingenerf K, Schmid C, Maatouk I, Weisbrod M, Herzog W, Friederich HC, Nikendei C. Characteristics of Disorder-Related Autobiographical Memory in Acute Anorexia Nervosa Patients. EUROPEAN EATING DISORDERS REVIEW 2015; 23:379-89. [PMID: 26095135 DOI: 10.1002/erv.2379] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/28/2015] [Accepted: 05/24/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE First studies revealed overgeneral autobiographical memories in anorexia nervosa (AN) patients. The aim of the present study was to investigate frequency, generalization and valence of autobiographical memories in AN patients in response to eating disorder-related cue words. METHOD Autobiographical memory was examined in 21 AN patients and 21 healthy controls (HC) using a modified version of the Autobiographical Memory Test, incorporating body-related, food-related, perfectionism-related, depression-related and neutral cues. RESULTS Anorexia nervosa patients recalled fewer and more general autobiographical memories compared with HC. For eating disorder-related cues as against neutral ones, AN patients compared with HC showed fewer memories for food-related and body-related cues, an elevated overgeneralization for food-related cues, while the valence of the retrieved memories was more negative in response to body-related cues. DISCUSSION This study detects disorder-related autobiographical memory alterations in AN, which are intensified in response to symptom-related cues. The findings are discussed with regard to their maladaptive function in emotion regulation.
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Affiliation(s)
- Julia Huber
- Department of General Internal and Psychosomatic Medicine, Centre for Psychosocial Medicine, University Hospital Heidelberg, Germany
| | - Carmen Salatsch
- Department of General Internal and Psychosomatic Medicine, Centre for Psychosocial Medicine, University Hospital Heidelberg, Germany
| | - Katrin Ingenerf
- Department of General Internal and Psychosomatic Medicine, Centre for Psychosocial Medicine, University Hospital Heidelberg, Germany
| | - Carolin Schmid
- Department of General Internal and Psychosomatic Medicine, Centre for Psychosocial Medicine, University Hospital Heidelberg, Germany
| | - Imad Maatouk
- Department of General Internal and Psychosomatic Medicine, Centre for Psychosocial Medicine, University Hospital Heidelberg, Germany
| | - Matthias Weisbrod
- Department of General Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Hospital Heidelberg, Germany.,Department of Psychiatry and Psychotherapy, SRH Clinic Karlsbad-Langensteinbach, Germany
| | - Wolfgang Herzog
- Department of General Internal and Psychosomatic Medicine, Centre for Psychosocial Medicine, University Hospital Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal and Psychosomatic Medicine, Centre for Psychosocial Medicine, University Hospital Heidelberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, LVR-Clinic Essen, Clinics and Institute of the University Duisburg-Essen, Germany
| | - Christoph Nikendei
- Department of General Internal and Psychosomatic Medicine, Centre for Psychosocial Medicine, University Hospital Heidelberg, Germany
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Wade TD, Wilksch SM, Paxton SJ, Byrne SM, Austin SB. How perfectionism and ineffectiveness influence growth of eating disorder risk in young adolescent girls. Behav Res Ther 2015; 66:56-63. [PMID: 25698165 DOI: 10.1016/j.brat.2015.01.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 10/24/2022]
Abstract
While perfectionism is widely considered to influence risk for eating disorders, results of longitudinal studies are mixed. The goal of the current study was to investigate a more complex model of how baseline perfectionism (both high personal standards and self-critical evaluative concerns) might influence change in risk status for eating disorders in young adolescent girls, through its influence on ineffectiveness. The study was conducted with 926 girls (mean age of 13 years), and involved three waves of data (baseline, 6- and 12-month follow-up). Latent growth curve modelling, incorporating the average rate at which risk changed over time, the intercept (initial status) of ineffectiveness, and baseline perfectionism, was used to explore longitudinal mediation. Personal standards was not supported as contributing to risk but results indicated that the higher mean scores on ineffectiveness over the three waves mediated the relationship between higher baseline self-critical evaluative concerns and both measures of eating disorder risk. The relationship between concern over mistakes and change in risk was small and negative. These results suggest the usefulness of interventions related to self-criticism and ineffectiveness for decreasing risk for developing an eating disorder in young adolescent girls.
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Affiliation(s)
- Tracey D Wade
- School of Psychology, Flinders University, South Australia, Australia.
| | - Simon M Wilksch
- School of Psychology, Flinders University, South Australia, Australia
| | - Susan J Paxton
- School of Psychological Science, La Trobe University, Victoria, Australia
| | - Susan M Byrne
- School of Psychology, University of Western Australia, Western Australia, Australia
| | - S Bryn Austin
- Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
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Phillipou A, Gurvich C, Castle DJ, Rossell SL. Are personality disturbances in anorexia nervosa related to emotion processing or eating disorder symptomatology? J Eat Disord 2015; 3:34. [PMID: 26435836 PMCID: PMC4591703 DOI: 10.1186/s40337-015-0071-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 09/21/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Anorexia Nervosa (AN) is a psychiatric illness associated with a number of personality disturbances. However, whether these personality characteristics are related to eating disorder symptomatology or emotion regulation is unclear. The aim of this study was to investigate these relationships. RESULTS Twenty-four individuals with AN and 25 age- and premorbid intelligence-matched controls completed the Personality Diagnostic Questionnaire, and scores were correlated with measures of emotionality and negative mood states, and eating disorder symptomatology. AN was associated with increased scores on schizoid, borderline, avoidant, dependent, obsessive compulsive, negativistic and depressive personality dimensions, relative to controls. In AN, eating disorder symptomatology did not significantly correlate with scores on any personality dimension. However, a number of personality characteristics were found to correlate with negative mood states. CONCLUSIONS The findings suggest that personality disturbances in AN are not related to disorder-specific symptoms, but are related to negative mood states.
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Affiliation(s)
- Andrea Phillipou
- Department of Optometry & Vision Sciences, The University of Melbourne, Melbourne, Australia ; Department of Psychiatry, The University of Melbourne, Melbourne, Australia ; Department of Mental Health, The Austin Hospital, Melbourne, Australia ; Department of Mental Health, St Vincent's Hospital, 46 Nicholson St, Fitzroy, VIC 3065 Australia
| | | | - David Jonathan Castle
- Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia ; Department of Psychiatry, The University of Melbourne, Melbourne, Australia ; Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Susan Lee Rossell
- Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Melbourne, Australia ; Monash Alfred Psychiatry Research Centre, Melbourne, Australia ; Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia
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Atiye M, Miettunen J, Raevuori-Helkamaa A. A meta-analysis of temperament in eating disorders. EUROPEAN EATING DISORDERS REVIEW 2014; 23:89-99. [PMID: 25546554 DOI: 10.1002/erv.2342] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 12/03/2014] [Accepted: 12/08/2014] [Indexed: 11/09/2022]
Abstract
Although suggested as an important contributor to the development and maintenance of eating disorders, temperament has not previously been studied adopting a meta-analytical approach. We therefore pooled data (N = 14 studies; N = 3315 cases, N = 3395 controls) on Cloninger's temperament traits (novelty seeking, harm avoidance, reward dependence and persistence) in anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) and eating disorders not otherwise specified. Persistence was significantly higher than in the controls in all eating disorders except for BED the highest levels being observed in AN. Correspondingly, the highest effect sizes for harm avoidance were seen in AN. Novelty seeking was significantly elevated relative to the controls only in BN. Harm avoidance was significantly lower, and reward dependence was significantly higher in individuals who had recovered from AN than in those who remained ill. Future studies with a longitudinal design are needed to explore the temporal relationships between eating disorders and temperament traits.
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Affiliation(s)
- Minna Atiye
- Hjelt Institute, Department of Public Health, University of Helsinki, Finland
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Abstract
Previous studies have identified phenotypic similarities between anorexia nervosa (AN) and body dysmorphic disorder (BDD), which share the common feature of negative body image. Studies comparing endophenotypes that may cut across both disorders-as suggested by the National Institute of Mental Health's Research Domain Criteria-are limited. Sixty-nine individuals (AN, n = 24; BDD, n = 23; mentally healthy controls [MHCs], n = 22) completed diagnostic interviews and self-reports assessing self-esteem and perfectionism. Clinical groups showed greater perfectionism in almost all subdimensions as well as poorer self-esteem compared with MHCs, with no clinical group differences when controlling for level of depression. Depression was a mediator of the relationship between symptom severity and self-esteem in both clinical groups. Comparable low self-esteem and greater perfectionism in AN and BDD corroborated existing etiological models and previous studies. Depression was a significant contributor to negative self-esteem in both disorders.
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Metral M, Guardia D, Bauwens I, Guerraz M, Lafargue G, Cottencin O, Luyat M. Painfully thin but locked inside a fatter body: abnormalities in both anticipation and execution of action in anorexia nervosa. BMC Res Notes 2014; 7:707. [PMID: 25298129 PMCID: PMC4201671 DOI: 10.1186/1756-0500-7-707] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 10/02/2014] [Indexed: 11/25/2022] Open
Abstract
Background People with anorexia nervosa (AN) usually report feeling broader than they really are. The objective of the present study was to better understand the body schema's involvement in this false self-representation in AN. We tested the potential for correction of the body schema impairment via the sensorimotor feedback provided by a real, executed action and relative to an imagined action. We also took account of the impact of the AN patients’ weight variations on the task outcomes. Methods Fourteen inpatient participants with AN and fourteen control participants were presented with a doorway-like aperture. The participants had to (i) judge whether or not various apertures were wide enough for them to pass through in a motor imagery task and then (ii) actually perform the action by passing through various apertures. Results We observed a higher passability ratio (i.e. the ratio between the critical aperture size and shoulder width) in participants with AN (relative to controls) for both motor imagery and real action. Moreover, the magnitude of the passability ratio was positively correlated with weight recovery. Conclusion The body schema alteration in AN appears to be strong enough to affect the patient's actions. Furthermore, the alteration resists correction by the sensorimotor feedback generated during action. This bias is linked to weight variations. The central nervous system might be locked to a false representation of the body that cannot be updated. Moreover, these results prompt us to suggest that emotional burden during weight recovery could also alter sensorimotor aspects of body representation. New therapeutic methods should take account of body schema alterations in AN as adjuncts to psychotherapy.
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Affiliation(s)
| | | | | | | | | | | | - Marion Luyat
- LNFP (Laboratory of Functional Neuroscience and Pathology) EA4559, F-59000 Lille, France.
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Kunstman JW, Smith AR, Maner JK. Overpowering Restriction: Power Reduces Restriction Among Self-Critical Perfectionists. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2014. [DOI: 10.1521/jscp.2014.33.7.630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Perfecting Weight Restriction: The Moderating Influence of Body Dissatisfaction on the Relationship Between Perfectionism and Weight Control Practices. BEHAVIOUR CHANGE 2014. [DOI: 10.1017/bec.2014.11] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study explored the moderating effect of body dissatisfaction (BD) on the relationship between perfectionism and weight restricting and control behaviours (WRCBs). A sample of 167 female undergraduates completed self-report measures of perfectionism, BD and WRCBs. BD was not found to moderate the relationship between either perfectionism and dieting, or perfectionism and exercise. Instead, BD uniquely predicted both dieting and exercise, as did the perfectionism dimensions of self-oriented perfectionism, concern over mistakes, parental standards, and organisation. BD moderated the relationship between perfectionism and purging for analyses involving self-oriented perfectionism, concern over mistakes, and doubts about actions, such that there was a significant positive association between perfectionism and purging when BD was high but not low. Perfectionism and BD are important in different ways to WRCBs. The importance of measuring multiple dimensions of perfectionism and differentiating between the various types of WRCBs is highlighted.
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Lindner SE, Fichter MM, Quadflieg N. Set-Shifting and its Relation to Clinical and Personality Variables in Full Recovery of Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2014; 22:252-9. [DOI: 10.1002/erv.2293] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Manfred M. Fichter
- Department of Psychiatry; University of Munich (LMU); Munich Germany
- Schoen Hospital Roseneck for Behavioral Medicine; Prien Germany
| | - Norbert Quadflieg
- Department of Psychiatry; University of Munich (LMU); Munich Germany
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Filoteo JV, Paul EJ, Ashby FG, Frank GKW, Helie S, Rockwell R, Bischoff-Grethe A, Wierenga C, Kaye WH. Simulating category learning and set shifting deficits in patients weight-restored from anorexia nervosa. Neuropsychology 2014; 28:741-51. [PMID: 24799291 DOI: 10.1037/neu0000055] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To examine set shifting in a group of women previously diagnosed with anorexia nervosa who are now weight-restored (AN-WR) and then apply a biologically based computational model (Competition between Verbal and Implicit Systems [COVIS]) to simulate the pattern of category learning and set shifting performances observed. METHOD Nineteen AN-WR women and 35 control women (CW) were administered an explicit category learning task that required rule acquisition and then a set shift following a rule change. COVIS was first fit to the behavioral results of the controls and then parameters of the model theoretically relevant to AN were altered to mimic the behavioral results. RESULTS Relative to CW, the AN-WR group displayed steeper learning curves (i.e., hyper learning) before the rule shift, but greater difficulty in learning the new categories after the rule shift (i.e., a deficit in set shifting). Hyper learning and set shifting deficits in the AN-WR group were not associated and differentially correlated with clinical measures. Hyper learning in the AN-WR group was simulated by increasing the model parameter that represents sensitivity to negative feedback (δ parameter), whereas the deficit in set shifting was simulated by altering the parameters that represent changes in rule selection and flexibility (λ and γ parameters, respectively). CONCLUSIONS These simulations suggest that multiple factors can impact category learning and set shifting in AN-WR individuals (e.g., alterations in sensitivity to negative feedback, rule selection deficits, and inflexibility) and provide an important starting point to further investigate this pervasive deficit in adult AN.
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Affiliation(s)
- J Vincent Filoteo
- Psychology and Research Service, Veterans Administration San Diego Healthcare System
| | - Erick J Paul
- Beckman Institute, University of Illinois at Urbana-Champaign
| | - F Gregory Ashby
- Department of Psychology, University of California Santa Barbara
| | - Guido K W Frank
- Department of Psychiatry, University of Colorado Anschutz Medical Campus
| | | | | | | | | | - Walter H Kaye
- Department of Psychiatry, University of California San Diego
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Boone L, Claes L, Luyten P. Too strict or too loose? Perfectionism and impulsivity: the relation with eating disorder symptoms using a person-centered approach. Eat Behav 2014; 15:17-23. [PMID: 24411744 DOI: 10.1016/j.eatbeh.2013.10.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/03/2013] [Accepted: 10/09/2013] [Indexed: 11/28/2022]
Abstract
Although both perfectionism (i.e. personal standards perfectionism and evaluative concerns perfectionism) and impulsivity have been shown to be implicated in eating disorders, no previous studies have examined the interplay between both personality dimensions in their association with eating disorder symptoms. This is the first study to investigate the relationship between empirically derived personality subtypes based on perfectionism and impulsivity and eating disorder symptoms (i.e., dietary restraint, and concerns over eating, weight and shape). Cluster analysis was used to establish naturally occurring combinations of perfectionism and impulsivity in adolescent boys and girls (N=460; M age=14.2 years, SD=.90). Evidence was obtained for four personality profiles: (1) a resilient subtype (low on perfectionism and impulsivity), (2) pure impulsivity subtype (high on impulsivity only), (3) pure perfectionism subtype (high on perfectionism only), and (4) combined perfectionism/impulsivity subtype (high on both perfectionism and impulsivity). Participants in these four clusters showed differences in terms of eating disorder symptoms in that participants with a combination of high perfectionism and high impulsivity (rather than the presence of one of these two characteristics alone) had the highest levels of ED symptoms. These findings shed new light on extant theories concerning ED.
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Affiliation(s)
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, University of Leuven, Belgium
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Belgium; Research Department of Clinical, Educational and Health Psychology, University College London, UK
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Luo J, Forbush KT, Williamson JA, Markon KE, Pollack LO. How specific are the relationships between eating disorder behaviors and perfectionism? Eat Behav 2013; 14:291-4. [PMID: 23910769 PMCID: PMC3734381 DOI: 10.1016/j.eatbeh.2013.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 02/10/2013] [Accepted: 04/30/2013] [Indexed: 10/26/2022]
Abstract
Perfectionism is associated with several mental disorders, including depression, anxiety, and eating disorders. The goal of this study was to test the specificity of the associations between perfectionism facets and eating disorder behaviors, by examining whether neuroticism and conscientiousness mediated or moderated associations between these variables. Participants from a representative community sample (N = 407; 47% female) completed questionnaires assessing perfectionism, neuroticism, conscientiousness, and eating disorder behaviors. Neuroticism partially mediated associations between binge eating, restraint, body dissatisfaction, and maladaptive perfectionism facets. Neuroticism did not mediate associations between restriction and achievement striving perfectionism facets. Conscientiousness did not mediate any associations between perfectionism facets and eating disorder behaviors, yet Doubts about Actions interacted with conscientiousness to predict body dissatisfaction. Results indicate that neuroticism is key for understanding general risk factors that lead to myriad internalizing disorders, whereas maladaptive perfectionism has limited usefulness as a specific risk factor for eating disorder behaviors. Nevertheless, there is a unique association between dietary restraint and achievement striving dimensions of perfectionism that cannot be explained by higher-order personality traits.
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Affiliation(s)
- Jing Luo
- University of Illinois – Champaign Urbana, 603 East Daniel Street, Champaign, IL 61820, USA
| | - Kelsie T. Forbush
- Purdue University, 703 Third St., Psychological Sciences Building, West Lafayette, IN 47907, USA
| | | | | | - Lauren O. Pollack
- University of Missouri—Kansas City, 5030 Cherry Street Room 113, Kansas City, Missouri 64110, USA
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Levinson CA, Rodebaugh TL, White EK, Menatti AR, Weeks JW, Iacovino JM, Warren CS. Social appearance anxiety, perfectionism, and fear of negative evaluation: distinct or shared risk factors for social anxiety and eating disorders? Appetite 2013; 67:125-33. [PMID: 23583741 DOI: 10.1016/j.appet.2013.04.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 03/27/2013] [Accepted: 04/03/2013] [Indexed: 11/16/2022]
Abstract
Social anxiety and eating disorders are highly comorbid. Social appearance anxiety (i.e., fear of negative evaluation of one's appearance), general fear of negative evaluation, and perfectionism have each been proposed as risk factors for both social anxiety disorder and the eating disorders. However, no research to date has examined all three factors simultaneously. Using structural equation modeling in two diverse samples (N=236; N=136) we tested a model in which each of these risk factors were uniquely associated with social anxiety and eating disorder symptoms. We found support for social appearance anxiety as a shared risk factor between social anxiety and eating disorder symptoms, whereas fear of negative evaluation was a risk factor only for social anxiety symptoms. Despite significant zero-order relationships, two facets of perfectionism (high standards and maladaptive perfectionism) did not emerge as a risk factor for either disorder when all constructs were considered. These results were maintained when gender, body mass index, trait negative affect, and depression were included in the model. It is possible that treating negative appearance evaluation fears may reduce both eating disorder and social anxiety symptoms.
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Affiliation(s)
- Cheri A Levinson
- Department of Psychology, Washington University, St. Louis, MO 63130, USA.
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49
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Egan SJ, Watson HJ, Kane RT, McEvoy P, Fursland A, Nathan PR. Anxiety as a Mediator Between Perfectionism and Eating Disorders. COGNITIVE THERAPY AND RESEARCH 2013. [DOI: 10.1007/s10608-012-9516-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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50
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Bernert RA, Timpano KR, Peterson CB, Crow SJ, Bardone-Cone AM, le Grange D, Klein M, Crosby RD, Mitchell JE, Wonderlich SA, Joiner TE. Eating disorder and obsessive–compulsive symptoms in a sample of bulimic women: Perfectionism as a mediating factor. PERSONALITY AND INDIVIDUAL DIFFERENCES 2013. [DOI: 10.1016/j.paid.2012.08.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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