Too strict or too loose? Perfectionism and impulsivity: the relation with eating disorder symptoms using a person-centered approach

Toward a memory perspective on eating psychopathology: An investigation of the types of childhood and adolescence memories that are associated with eating disorder symptoms

The cognitive mechanisms through which specific life events affect the development and maintenance of eating disorders (ED) have received limited attention in the scientific literature. The present research aims to address this gap by adopting a memory perspective to explore the type of life events associated with eating psychopathology and how these events are encoded and reconstructed as memories. Two studies (n = 208 and n = 193) were conducted to investigate the relationship between specific memories and eating disorder psychopathology. Study 1 focused on parent-related memories, while Study 2 examined childhood/adolescence memories. Results from both studies revealed that need thwarting and shame in memories were associated with eating disorder symptoms, but only when individuals drew symbolic connections between these memories and food or eating behavior. Moreover, need thwarting and shame in such memories were associated with other eating and body image outcomes, including uncontrolled eating and body esteem. These results also held after controlling for a host of known predictors of eating disorder psychopathology, such as BMI, perfectionism, or thin ideal internalization. Overall, the present findings suggest that the reprocessing of memories symbolically and idiosyncratically linked to food and eating behavior might be a fruitful clinical intervention.

Reading tea leaves or tracking true constructs? An assessment of personality-based latent profiles in eating disorders

Background

Eating disorder (ED) subtyping studies have often extracted an undercontrolled, an overcontrolled and a resilient profile based on trait impulsivity and perfectionism. However, the extent to which methodological choices impact the coherence and distinctness of resulting subtypes remains unclear.

Objective

In this paper, we aimed to assess the robustness of these findings by extracting personality-based subtypes on a sample of ED patients (N = 221) under different analytic conditions.

Methods

We ran four latent profile analyses (LPA), varying the extent to which we constrained variances and covariances during model parametrization. We then performed a comparative analysis also including state ED symptom measures as indicators. Finally, we used cross-method validation via k-means clustering to further assess the robustness of our profiles.

Results

Our results demonstrated a four-profile model based on variances in impulsivity and perfectionism to fit the data well. Across model solutions, the profiles with the most and least state and trait disturbances were replicated most stably, while more nuanced variations in trait variables resulted in less consistent profiles. Inclusion of ED symptoms as indicator variables increased subtype differentiation and similarity across profiles. Validation cluster analyses aligned most with more restrictive LPA models.

Conclusion

These results suggest that ED subtypes track true constructs, since subtypes emerged method-independently. We found analytic methods to constrain the theoretical and practical conclusions that can be drawn. This underscores the importance of objective-driven analytic design and highlights its relevance in applying research findings in clinical practice.

Self-regulation profiles reflecting distinct levels of eating disorder and comorbid psychopathology in the adult population: A latent profile analysis

OBJECTIVE

Previous research showed that individuals with eating disorders (EDs) can be subtyped by their levels of psychopathology and self-regulation abilities. However, nothing is known about whether self-regulation abilities are solely suited to depict the heterogeneity in ED and comorbid psychopathology in nonclinical samples. Therefore, this study sought to explore self-regulation profiles and their ability to discriminate ED, depression and anxiety disorders, and personality dysfunction in the adult population.

METHODS

Within a German representative sample, N = 2391 adults (18-92 years) were examined using latent profile analysis to identify profiles based on established cognitive and emotional self-regulation scales including attention control, cognitive reappraisal, and difficulties in identifying feelings. Profiles were validated with ED, depression, anxiety, and personality dysfunction measures.

RESULTS

The final solution selected as best balancing goodness of fit and interpretability included four profiles-High-Functioning, Moderate-Functioning, Dysregulated, and Alexithymic-with high explanatory power of R²  = .99. Profiles were characterized primarily by differences in difficulties in identifying feelings followed by differences in attention control and differed significantly regarding ED, depression and anxiety disorders, and personality dysfunction, with the Dysregulated profile showing the most unfavorable correlates.

CONCLUSIONS

This study uniquely revealed that low cognitive and emotional self-regulation were indicators for ED, depression, anxiety, and personality dysfunction in the adult population. Future research should investigate whether the identified profiles predict the development of ED and comorbid psychopathology longitudinally.

PUBLIC SIGNIFICANCE

Individuals with eating disorders present with difficulties in cognitive and emotional self-regulation, likely maintaining their symptoms. This representative study in the German adult population sought to build profiles based on cognitive and emotional self-regulation that differed in eating disorder and comorbid psychopathology. We discuss the potential to detect individuals with elevated eating disorder and comorbid psychopathology based on the identified profiles in nonclinical settings.

Bottom-up transdiagnostic personality subtypes are associated with state psychopathology: A latent profile analysis

Introduction

Personality-based profiling helps elucidate associations between psychopathology symptoms and address shortcomings of current nosologies. The objective of this study was to bracket the assumption of a priori diagnostic class borders and apply the profiling approach to a transdiagnostic sample. Profiles resembling high-functioning, undercontrolled, and overcontrolled phenotypes were expected to emerge.

Methods

We used latent profile analysis on data from a sample of women with mental disorders (n = 313) and healthy controls (n = 114). 3-5 profile solutions were compared based on impulsivity, perfectionism, anxiety, stress susceptibility, mistrust, detachment, irritability, and embitterment. The best-fitting solution was then related to measures of depression, state anxiety, disordered eating, and emotion regulation difficulties to establish clinical significance.

Results

A 5-profile solution proved best-fitting. Extracted profiles included a high-functioning, a well-adapted, an impulsive and interpersonally dysregulated, an anxious and perfectionistic, and an emotionally and behaviorally dysregulated class. Significant differences were found in all outcome state measures, with the emotionally and behaviorally dysregulated class exhibiting the most severe psychopathology.

Discussion

These results serve as preliminary evidence of the predictive nature and clinical utility of personality-based profiles. Selected personality traits should be considered in case formulation and treatment planning. Further research is warranted to replicate the profiles and assess classification stability and profiles' association with treatment outcome longitudinally.

Latent profile analysis of impulsivity and perfectionism dimensions and associations with psychiatric symptoms

BACKGROUND

Impulsivity and perfectionism are transdiagnostic personality factors that have been studied extensively and shown to relate to externalizing and internalizing pathology respectively. Typically, these personality factors are antithesized, with impulsivity characterized by lack of control and perfectionism characterized by rigid overcontrol.

METHODS

The current study (N = 1,353 undergraduate students) used latent profile analysis to identify subgroups based on impulsivity and perfectionism dimensions and tested the relations of these subgroups with the symptomatology of ten prevalent types of psychopathology (depression, worry, social anxiety, attention-deficit hyperactivity disorder inattentive subtype, attention-deficit hyperactivity disorder impulsive-hyperactive subtype, alcohol use, obsessive-compulsive disorder, posttraumatic stress disorder, restrictive eating pathology, and binge eating pathology).

RESULTS

The latent profile analysis identified four meaningful subgroups: high perfectionism, high impulsivity, combined impulsivity and perfectionism, and low impulsivity and perfectionism. The combined group was the most prevalent, comprising almost half of the sample. Further, the perfectionism group had the highest scores for obsessive-compulsive disorder, worry, and restrictive eating pathology, the impulsivity group had the highest scores for alcohol use disorder, and the combined group had the highest or second-highest scores across all types of psychopathology.

LIMITATIONS

Limitations include the undergraduate sample, self-report, cross-sectional study design, and high bivariate residuals.

CONCLUSIONS

These findings suggest impulsivity and perfectionism can co-occur. Further, the co-occurrence of these personality traits may heighten risk for psychopathology and help explain comorbidity across internalizing and externalizing disorders. Future research should continue to investigate the presentation, prevalence, and treatment for individuals high in both perfectionism and impulsivity.

Transdiagnostic vulnerability factors in eating disorders: A network analysis

OBJECTIVE

Eating disorder (ED) symptoms and transdiagnostic vulnerability characteristics play a crucial role in the aetiology and maintenance of EDs. Over the last decade, researchers have started to model complex interrelations between symptoms using network models, but the literature is limited in that it has focused solely on symptoms and investigated-specific disorders while ignoring transdiagnostic aspects of mental health.

METHOD

This study tackles these challenges by investigating network relations among core ED symptoms, comorbid clinical symptoms (depression and anxiety) and empirically supported vulnerability and protective mechanisms (personality traits, maladaptive cognitive schemata, perfectionism and resilience) in a sample of 2302 treatment-seeking ED patients. We estimated a regularized partial correlation network to obtain conditional dependence relations among all variables. We estimated node centrality (interconnectivity) and node predictability (the overall magnitude of symptom inter-relationships).

RESULTS

The findings indicate a central role of overvigilance, excessive focus on inhibiting emotions and feelings, interoceptive awareness and perfectionism.

CONCLUSIONS

These results suggest that excessive control of bodily aspects by dietary restraint (possibly through inhibition) and interoceptive awareness may be important constructs that warrant future research in understanding vulnerability in EDs. We provide all code and data via the Open Science Framework.

The relationship between perfectionism and eating-related symptoms in adolescents: A systematic review

The clinical significance of two major aspects of perfectionism, perfectionistic strivings (PS) and perfectionistic concerns (PC), in eating disorders (EDs) symptoms was well-established among adults. However, no systematic review has assessed evidence examining associations between both unidimensional and multidimensional perfectionism and EDs in early and middle adolescence. For this aim, three online databases (PsycINFO, Medline and PsycArticle) were searched for articles published until January 2019, and observational studies were considered. Study quality was systematically appraised, and results were summarized using a narrative synthesis approach. Fifty-one cross-sectional and 28 longitudinal studies were included. Most studies supported the relationship between perfectionism and EDs, with the majority adopting a unidimensional approach for assessing perfectionism. Among studies that employed multidimensional measures of perfectionism, the majority (n = 11) of evidence supported the relationship between eating symptoms and PC, while fewer (n = 5) studies provided significant unique associations with PS. These findings are consistent with the body of research suggesting the strength of the relationship between PC and EDs was greater than between PS and EDs. It was recommended that preventive interventions should be primarily focused on reducing self-critical perfectionism, since it resulted to be the most relevant perfectionistic dimension in the development of eating symptoms in adolescents.

Perfectionism and impulsivity based risk profiles in eating disorders

OBJECTIVE

The categorical classification of eating disorders (ED) has several limitations, for example, high symptom variability within the diagnosis and limited predictive validity for treatment response. An alternative is classifying individuals with ED based on personality traits, which can reflect underlying etiological mechanisms. We aimed to find latent profiles based on facets of maladaptive and adaptive perfectionism, impulsivity and ED symptoms.

METHOD

The sample comprised of 274 women-164 had an ED diagnosis and 110 were controls. Two separate latent profile analyses were performed-one on the mixed sample (controls and individuals with ED) and the other on the sample of individuals with ED only.

RESULTS

We identified a five-class model to be the best fit for the mixed sample. The classes were: (a) moderately impulsive, (b) high functioning, (c) purely perfectionistic, (d) emotionally dysregulated, (e) behaviorally dysregulated. Among the individuals with ED, a four-class solution was found to be the best fit. The classes were very similar in their response patterns on indicator variables to response patterns observed in the mixed sample, except the emotionally and behaviorally dysregulated classes that formed into one class.

DISCUSSION

In addition to the well-known high-functioning, overcontrolled and undercontrolled classes, two to three undercontrolled classes (moderately impulsive, behaviorally, and emotionally dysregulated class) emerged. Those classes differentiated on perfectionism and impulsivity levels as well as on ED symptom severity and psychiatric comorbidities-all of which may influence maintenance of ED, appropriate treatment choice and therefore treatment response.

Relationships between perfectionism, self-report impulsivity measures and delay discounting

Perfectionism and impulsivity are multidimensional constructs. While different perfectionism dimensions are exclusively measured through self-reports, different impulsivity dimensions can be measured through self-report or behaviour via preferences for different rewards. This study explored differential associations between perfectionism and impulsivity based on both dimension and measurement modality (self-report/behavioural). We then examined whether adaptive or maladaptive perfectionism would be differentially associated with impulsivity. Two-hundred and six students completed two perfectionism and three impulsivity measures (two self-report; one behavioural). Two self-report impulsivity measures were associated with specific perfectionism dimensions, whereas the behavioural measure was not associated with perfectionism. Maladaptive perfectionism was associated with decreasing impulsivity, whereas adaptive perfectionism was associated with increasing impulsivity. Perfectionism related to impulsivity differently depending on how each construct was measured.

Structure and validity of the Clinical Perfectionism Questionnaire in female adolescents

BACKGROUND

Perfectionism is a transdiagnostic risk factor across psychopathology. The Clinical Perfectionism Questionnaire (CPQ) was developed to assess change in order to provide clinical utility, but currently the psychometric properties of the CPQ with adolescents is unknown.

AIMS

To assess the factor structure and construct validity of the CPQ in female adolescents.

METHOD

The CPQ was administered to 267 females aged 14-19 years of age. Confirmatory factor analysis (CFA) was used to examine the validity of the two-factor model and a second-order factor model. Pearson correlations were used to evaluate the relationships between the CPQ and a wide range of measures of perfectionism, psychopathology and personality traits.

RESULTS

The study demonstrated internal consistency, construct validity and incremental validity of the CPQ in a sample of female adolescents. The CFA in the present study confirmed the two-factor model of the CPQ with Factor 1 relating to perfectionistic strivings and Factor 2 representing perfectionistic concerns. The second-order two factor model indicated no deterioration in fit.

CONCLUSIONS

The two-factor model of the CPQ fits with the theoretical definition of clinical perfectionism where the over-dependence of self-worth on achievement and concern over mistakes are key elements. The CPQ is suitable for use with female adolescents in future research that seeks to better understand the role of perfectionism in the range of mental illnesses that impact youth.

Pilot study of a personality-based approach to assessing eating disorder and Obsessive Compulsive Disorder symptom risk in college men and women

Objective: To conduct a pilot test of the validity of using empirically derived personality types to characterize eating disorder (ED) risk in college students and resolve discrepancies regarding the role of perfectionism and obsessive-compulsive disorder (OCD) symptoms.Participants: Man and woman undergraduate students (N = 169) at a small, private university. Data were collected from February to May 2016 and 2018. Methods: Participants completed self-report measures of personality (perfectionism, impulsivity, and effortful control) and psychopathology (EDs, OCD). Results: Our analyses replicated three validated personality types: overcontrolled, undercontrolled, and resilient. Analysis of variances demonstrated perfectionism, ED, and OCD symptoms were significantly elevated in the overcontrolled subtype. There was no interaction by sex. Conclusions: These findings suggest that personality types may be useful for classifying ED risk and OCD symptoms in college students across sexes. Further study and relevance to prevention and intervention efforts to reduce the burden of EDs on college campuses will be discussed.

Impulsiveness and Cognitive Patterns. Understanding the Perfectionistic Responses in Spanish Competitive Junior Athletes

Introduction

High performance sport requires that the athletes maintain a constant intensity and control of their personal resources, as well as a balance between self-regulation and performance. Likely, such requirements involve the influence of their beliefs regarding the tasks to be performed to improve the confidence in their own resources to face the competition. Theoretical arguments provide new insights for understanding multidimensional perfectionism and its relationships with other variables such as affective experiences, among others. In this study, perfectionism was conceptualized as a “stable personality disposition,” whereas the impulsiveness components were defined as “representing psychological mechanisms (or processes)” underlying the relationships between perfectionism and athletic experiences.

Aim

This study aims to establish and show profiles of perfectionist beliefs and impulsive responses according to sport modality and the relationships between all these variables. Team athletes were expected to show more functional resources than those in combat or endurance sports.

Methods

The psychological responses of 487 athletes (273 boys; 214 girls) practicing high-performance sport were examined. A non-randomized, cross-sectional design was used. Self-reports were used to measure impulsiveness, perfectionism and competence self-perceptions.

Results

Athletes with functional responses of impulsivity and perfectionism showed higher perceived self-competence. Athletes with more reflective thoughts, more careful planning and generally less sensitive to rewards and behaviors were more self-regulated and planned (functional impulsivity) and showed more moderate relationships between the most dysfunctional perfectionist beliefs and self-competence. In addition, perfectionism seems to be useful to the striver athletes that want to be the best, and they are focused on and committed to future goals and performance and self-improvement. It is important for coaches and athletes to understand how the processes of self-regulation (impulsivity) and self-knowledge (perfectionism) could be formed to try to offer better opportunities for building psychological resources that enhance high-performance mental abilities.

Investigating transdiagnostic factors in eating disorders: Does self-esteem moderate the relationship between perfectionism and eating disorder symptoms?

OBJECTIVE

According to Fairburns transdiagnostic model of eating disorders (EDs), high levels of perfectionism and low self-esteem are two core traits across EDs. This study investigates the role of self-esteem as a transdiagnostic moderator of the relationship between perfectionism and ED symptoms across EDs.

METHOD

A large group of patients (n = 732) completed several questionnaires measuring perfectionism, self-esteem, and disordered eating symptomatology, more specifically, drive for thinness (DFT) and body dissatisfaction (BD).

RESULTS

Across EDs, self-esteem served as a moderator for the association between perfectionism and DFT. However, by testing the model for DFT in each ED separately, the effect only remained in patients with anorexia nervosa and ED not otherwise specified. When testing the model for BD, no moderation effect was found in any of the included EDs.

CONCLUSIONS

This study found that the interaction between perfectionism and self-esteem on DFT can be seen as transdiagnostic, although this effect is not found in each ED separately. These results suggest that ED treatment should consider to not only focus on transdiagnostic factors but also look at the specific impairments of each individual ED.

Too Imperfect to Fall Asleep: Perfectionism, Pre-sleep Counterfactual Processing, and Insomnia

Previous research suggests that certain dimensions of perfectionism are associated with insomnia. However, the exact processes whereby perfectionism may influence sleep have as yet remained unexplored. The present study tested the hypothesis that perfectionistic individuals are particularly prone to engage in counterfactual thinking and to experience counterfactual emotions (regret, shame, and guilt) at bedtime, which have been shown to impair sleep. One hundred eighty university students completed questionnaires on perfectionism, counterfactual processing, and insomnia severity. Analyses revealed that three dimensions of perfectionism were significantly related to insomnia severity: Concern over mistakes and doubts about action showed positive correlations, whereas organization showed a negative correlation. Moreover, the frequency of counterfactual thoughts and emotions at bedtime largely mediated the effects of these dimensions of perfectionism on insomnia severity. These findings highlight how personality-related patterns of behavior may translate into affective arousal at bedtime, thereby increasing the risk of insomnia.

A Psychometric Examination of the Pathological Obsessive Compulsive Personality Scale (POPS): Initial Study in an Undergraduate Sample

Obsessive-compulsive personality disorder (OCPD) has been subject to numerous definition and classification changes, which has contributed to difficulties in reliable measurement of the disorder. Consequently, OCPD measures have yielded poor validity and inconsistent prevalence estimates. Reliable and valid measures of OCPD are needed. The aim of the current study was to examine the factor structure and psychometric properties of the Pathological Obsessive Compulsive Personality Scale (POPS). Participants (N = 571 undergraduates) completed a series of self-report measures online, including the POPS. Confirmatory factor analysis was used to compare the fit of unidimensional, five factor, and bifactor models of the POPS. Convergent and divergent validity were assessed in relation to other personality dimensions. A bifactor model provided the best fit to the data, indicating that the total POPS scale and four subscales can be scored to obtain reliable indicators of OCPD. The POPS was most strongly associated with a disorder-specific measure of OCPD, however there were also positive associations with theoretically disparate constructs, thus further research is needed to clarify validity of the scale.

A Meta–Analytic and Conceptual Update on the Associations between Procrastination and Multidimensional Perfectionism

The equivocal and debated findings from a 2007 meta–analysis, which viewed perfectionism as a unidimensional construct, suggested that perfectionism was unrelated to procrastination. The present meta–analysis aimed to provide a conceptual update and reanalysis of the procrastination–perfectionism association guided by both a multidimensional view of perfectionism and self–regulation theory. The random–effects meta–analyses revealed a small to medium positive average effect size ( r = .23; k = 43, N = 10 000; 95% confidence interval (95% CI) [0.19, 0.27]) for trait procrastination and perfectionistic concerns and a small to medium negative average effect size ( r = −.22; k = 38, N = 9544; 95% CI [−0.26, −0.18]) for procrastination and perfectionistic strivings. The average correlations remained significant after statistically accounting for the joint variance between the two perfectionism dimensions via semi–partial correlations. For perfectionistic concerns, but not perfectionistic strivings, the effects depended on the perfectionism measure used. All effects did not vary by the trait procrastination measure used or the respondent's sex. Our findings confirm that from a multidimensional perspective, trait procrastination is both positively and negatively associated with higher–order perfectionism dimensions and further highlights the value of a self–regulation perspective for understanding the cognitive, affective and behavioural dynamics that characterise these traits. Copyright © 2017 European Association of Personality Psychology

Classifying eating disorders based on "healthy" and "unhealthy" perfectionism and impulsivity

OBJECTIVE

Perfectionism and impulsivity are associated with eating disorders (EDs). The current study examines whether clinically relevant subgroups of women with EDs can be identified based on "healthy" and "unhealthy" perfectionism and impulsivity.

METHOD

Latent profile analyses (LPA) were performed on data of 844 patients (DSM-IV diagnosis: 381 anorexia nervosa, 146 bulimia nervosa, 56 binge-eating disorder, 261 ED not otherwise specified). "Healthy" and "unhealthy" forms of perfectionism and impulsivity were assessed by the Frost Multidimensional Perfectionism Scale and the Dickman Impulsivity Inventory, respectively. The Eating Disorder Examination Questionnaire was completed to assess ED psychopathology. Furthermore, in 229 patients additional ED symptoms, depression, self-esteem, obsessive-compulsive symptoms, and personality features were assessed.

RESULTS

The LPA revealed four profiles; 1. "Healthy Impulsivity" (HI; n = 191), 2. "Unhealthy Impulsivity" (UI; n = 238), 3. "Healthy and Unhealthy Perfectionism" (HP + UP; n = 153), 4. "Healthy Perfectionism" (HP; n = 262). Patients belonging to the "HP + UP" and the "UI" classes reported higher levels of ED psychopathology. More severe comorbid symptoms (depressive, obsessive-compulsive and self-esteem) were found in the patients belonging to the "HP + UP" class. Patients from the "HP + UP" and "HP" classes had higher scores for the personality features Harm Avoidance, Persistence and Cooperativeness.

DISCUSSION

Women with EDs could be meaningfully grouped according to perfectionism and impulsivity. These findings can be used to improve treatment matching and intervention strategies. The use of dimensional features, like perfectionism and impulsivity, in ED research, may enable the identification of fundamental underlying mechanisms and provide more insight into potential mechanisms that may drive or maintain disordered eating. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:673-680).

Assessing the roles of impulsivity, food-related cognitions, BMI, and demographics in the dual pathway model of binge eating among men and women

The dual pathway model is a widely accepted model of binge eating that focuses on the role of sociocultural factors, negative affect, and dietary restraint. However, less is known about demographic (e.g., gender and ethnicity) differences in the model and the role of other variables in the model. To further our understanding of the dual pathway model of binge eating, the current study examined the role of demographics (i.e., gender, race, BMI, parental education and obesity), impulsivity, and food-related cognitions in the dual pathway model. A sample of college students completed a battery of measures. Multi-group structural equation modeling was used to evaluate the dual pathway model separately for men and women. Results supported the dual pathway model of binge eating among men and women, and also supported food-related cognitions as an important variable prior to binge eating. In other words, body shame was associated with more dietary restraint and negative affect, and in turn, dietary restraint and negative affect were associated with increased negative food-related cognitions. Then, food-related cognitions predicted binge eating. Additionally impulsivity was related to body shame, negative affect, and food-related cognitions, but was unrelated to binge eating after controlling for the other variables. Racial differences existed among women in BMI and body shame, but there were no racial differences among men. Our results suggest that the dual pathway model adequately explains binge eating among men and women, but that food-related cognitions may be an imporant anteceden to binge eating.

Empirically derived subtypes of full and subthreshold anorexia nervosa in adolescent females: understanding general psychopathology and treatment implications

The aim of this study was to derive clinically relevant subtypes of anorexia nervosa (AN) and subthreshold AN using general psychopathology variables and to determine how they differ on eating pathology. Participants were 39 adolescent females aged 13 to 18 years, diagnosed with AN or subthreshold AN. Cluster analysis revealed two subtypes that differed significantly in eating pathology. Cluster 1 patients were typically underweight with no clinical elevations on eating or psychopathology measures. Cluster 2 patients were mostly of healthy weight with greater eating and psychological problems. Findings allow clinicians to classify and understand AN beyond diagnostic criteria, and implement interventions that consider presentation beyond eating pathology.