Perfectionism, rumination, and gender are related to symptoms of eating disorders: A moderated mediation model

Risk and resilience in eating disorders: differentiating pathways among psychosocial predictors

OBJECTIVE

Eating disorders (EDs) represent a rising global health concern. The current study takes a multivariate approach to examine psychological (i.e., perfectionism, anxiety sensitivity [AS], emotion dysregulation) and sociocultural factors (i.e., body dissatisfaction) that may relate to risk and resilience in EDs.

METHODS

Participants were 698 undergraduate students (Mage = 21, SDage = 4.02), mainly female (71%) and Hispanic (61.6%), who participated in an online survey assessing perfectionism, emotion dysregulation, AS, body dissatisfaction, and eating behaviors.

RESULTS

The results from structural equation model analyses revealed differential associations with disordered eating (DE) outcomes. Self-oriented perfectionism and dysmorphic appearance concerns were associated with increased dieting/carb restriction, desire for thinness, and binging tendencies. Specifically, emotional nonacceptance and lack of emotional awareness showed associations with elevated risk for dieting/carb restriction and purging tendencies, respectively. Conversely, lack of emotional clarity showed a protective pathway to these risk behaviors. Anxiety sensitivity cognitive concerns related to higher purging tendencies, while AS social concerns related to lower purging and binging tendencies.

DISCUSSION

Findings highlight the differential pathways of psychosocial risk and resilience for EDs. Subscales of emotional dysregulation and AS showed risk as well as resilience associations with DE outcomes. This information is key for advancing transdiagnostic prevention and intervention to reduce the rising rates of EDs.

The Relationship between the Family Environment and Eating Disorder Symptoms in a Saudi Non-Clinical Sample of Students: A Moderated Mediated Model of Automatic Thoughts and Gender

Eating disorders are a global burden and present personal, family, and societal costs. Most evidence in the literature is based on the relationship between a poor family environment and eating disorders, and the evidence of gender interaction in eating disorders is inconsistent. This study aimed to investigate the relationship between family environment and eating disorder symptoms, the mediating role of negative automatic thoughts, and the moderating role of gender using a non-clinical sample of students. A sample of 440 (70.9% females, aged 18-21) participated in this study. They completed the Eating Attitudes Test (EAT-26), the Automatic Thoughts Questionnaire (ATQ negative), and the Brief Family Relationship Scale (BFRS). PROCESS MACRO was used to study these relationships. The main findings revealed that family environment was negatively associated with eating disorder symptoms and that this relationship was mediated by automatic thoughts. Moreover, gender moderated those relationships, and more intensely in females. The results of this study indicate that the prevention of eating disorders should be directed at training individuals to challenge negative thoughts and encourage healthy individuals to be gender mindful.

The association between eating disorders and perfectionism in adults: A systematic review and meta-analysis

OBJECTIVE

Dimensions of perfectionism are associated with the onset and maintenance of eating disorder pathology in both clinical and non-clinical samples. The aim of this study was to conduct a systematic review and meta-analysis of the association between perfectionism and eating disorders in adults.

METHOD

A literature search was conducted using the PsycINFO, Medline, Scopus, Embase, Web of Science and ProQuest databases. Ninety-five studies met the inclusion criteria and included a total sample of 32,840 participants (clinical eating disorder diagnosis N = 2414, non-clinical N = 30,428). Correlation coefficients (r) for the association between eating disorders and perfectionism were pooled. A meta-analysis to determine the association between two dimensions of perfectionism and eating disorder symptoms was conducted. Subgroup analyses were conducted with studies using clinical samples, and studies using the Eating Disorder Examination Questionnaire.

RESULTS

The pooled effect size for the association between perfectionistic concerns and eating disorder symptoms was r = 0.33 [0.30, 0.37]; and r = 0.20 [0.14, 0.25] for the association between perfectionistic strivings and eating disorder symptoms. In the clinical subgroup analyses the effect sizes were r = 0.40 [0.22, 0.58]; and r = 0.35 [0.26, 0.44] respectively. Medium to high heterogeneity was identified across all subgroup analyses and a significant level of publication bias was also identified.

DISCUSSION

The findings indicate both perfectionistic strivings and perfectionistic concerns have significant associations with eating disorders, and further support the argument that both dimensions of perfectionism are important factors in the prevention and treatment of eating disorders.

Forgive, Let Go, and Stay Well! The Relationship between Forgiveness and Physical and Mental Health in Women and Men: The Mediating Role of Self-Consciousness

BACKGROUND

The current study assessed forgiveness (positive forgiveness and reduced unforgiveness), self-consciousness (rumination and reflection), and physical and mental health. The aim of the study was to check if self-consciousness mediates the relationship between dispositional forgiveness and health.

METHODS

To address this link, we conducted 2 studies (N = 484 in Study 1 and N = 249 in Study 2). Data were collected separately for Study 1, as well as Study 2. We used in both studies the Heartland Forgiveness Scale and the Rumination-Reflection Questionnaire, and additionally, the General Health Questionnaire-28 in Study 1 and the Scales of Psychological Well-Being in Study 2.

RESULTS

The results indicated that rumination was an effective mediator between positive forgiveness and mental health (B = 0.14, CI95% = [0.064, 0.234]), reduced unforgiveness and physical health (B = -0.13, CI95% = [-0.182, -0.088]), and both rumination and reflection between reduced unforgiveness and mental health (B = 0.13 CI95% = [0.051, 0.226]), positive forgiveness (B = -0.09 CI95% = [-0.135, -0.052]), and physical health.

CONCLUSION

The mediating role of ruminations was more frequently observed in females. The study highlighted the indirect effect between forgiveness and health. Rumination and reflection are mediators between forgiveness and health.

Examining the relationship of eating disorder symptoms and perfectionism in men and women using two assessments of eating pathology

Eating disorder (ED) pathology in men is not as well understood or studied as ED pathology in women. One potential reason for this is that most of the traditional assessments used for EDs were developed for and validated with exclusively female samples, meaning that symptoms in men are not as well represented or measured. There are consistent associations between perfectionism and ED symptoms in women, but less is known regarding how these relationships function in men. This study examined whether the relationship of perfectionism to ED symptoms varies by gender using the Eating Disorder Examination-Questionnaire (EDE-Q) and the Eating Pathology Symptom Inventory (EPSI). The EPSI has multiple dimensions that may better capture the presentation of ED symptoms in men. Participants were recruited from a large public university and through Amazon MechanicalTurk. Participants completed a survey battery that included the two eating measures and the self-oriented perfectionism scale from the Hewitt and Flett Multidimensional Perfectionism Scale. Data were analyzed using independent samples t-tests and structural equation modeling. There were significant positive associations between self-oriented perfectionism and all dimensions measured by the EDE-Q and the EPSI. The models were invariant across gender. Implications for further research were discussed.

Emotion regulation, perfectionism, and eating disorder symptoms in adolescents: the mediating role of cognitive eating patterns

Poor emotion regulation, along with elevated perfectionism, is recognised as a risk factor for the development of eating disorder (ED) symptoms. Therefore, the aim of our study was to examine the relationship between emotion regulation difficulties and perfectionism with ED symptoms, while controlling for emotional eating, uncontrolled eating, and cognitive restraint as mediators. In total, 482 adolescents (246 girls and 236 boys; M = 15.00, SD = 0.31) participated in this study. Based on the participants' body height and weight measured by the medical team during their regular preventive health examinations, the body mass index (BMI) was calculated. Participants also answered the Difficulties in Emotion Regulation Scale, Multidimensional Perfectionism Scale, Three-Factor Eating Questionnaire, and Eating Disorder Examination Questionnaire. According to the results obtained, adolescent girls in our sample reported more difficulties in emotion regulation, more uncontrolled and emotional eating, and more ED symptoms. A significant direct effect was found for difficulties in emotion regulation and ED symptoms but not for perfectionism. In addition, only emotional eating and cognitive restraint (not uncontrolled eating) mediated the relationship between difficulties in emotion regulation and perfectionism and ED symptoms. The results suggest that difficulties in emotion regulation may be more important than perfectionism in explaining ED symptoms in a sample of healthy adolescents. When adolescents experience problems in emotion regulation in combination with emotional or uncontrolled eating, they might be at a higher risk of experiencing concerns about weight and a variety of other ED symptoms, and this should be considered when planning preventive interventions for adolescents.

I'm angry that I'm not perfect! aggression mediates the relationship between perfectionism and eating pathology in men and women

PURPOSE

The link between maladaptive perfectionism and eating disorder (ED) pathology is well-established, yet less is known about factors that contribute to this relationship. The current study examined the mediating effect of aggression on the relationship between maladaptive perfectionism and ED pathology in a mixed-gender sample.

METHODS

Three-hundred and thirty-six participants (47.3% women) with a mean age of 35.75 (SD = 10.00) were recruited online through Amazon Mechanical Turk. Self-reported data were collected on ED pathology (Eating Disorder Examination-Questionnaire), perfectionism (Frost Multidimensional Perfectionism Scale), aggression (Buss-Perry Aggression Questionnaire), and demographic information.

RESULTS

Mediation analyses were performed separately for men and women using the SPSS PROCESS macro (Hayes in Introduction to mediation, moderation, and conditional process analysis: a regression-based approach, Guilford Press, New York, 2018). To test gender differences for specific model parameters, multiple-group structural equation modeling was used. Findings indicate that aggression partially mediated the relationship between maladaptive perfectionism and ED pathology in both men and women. There were no significant gender differences in the strength of the indirect effect or direct effect of perfectionism on ED pathology.

CONCLUSIONS

Findings from this study suggest that aggression may partially account for the relationship between maladaptive perfectionism and ED pathology. Additional research is needed to determine the temporal sequence of maladaptive perfectionism and aggression as it relates to ED pathology. Nonetheless, given their interrelationships, treatment research may benefit from examining interventions targeting aggression as a potential avenue for reducing ED symptoms.

LEVEL OF EVIDENCE

Level V, cross-sectional study.

Perfectionistic Concerns and Mobile Phone Addiction of Chinese College Students: The Moderated Mediation of Academic Procrastination and Causality Orientations

This study aimed to investigate the effect of perfectionistic concerns (PC) on mobile phone addiction (MPA) and the mediating role of academic procrastination (AP), as well as the moderating role of causality orientations (autonomous/controlled/impersonal orientation). A cross-sectional sample of 625 Chinese college students (20.8% male, mean age = 20.47 years old) completed measures of PC, AP, causality orientations, and MPA. We analyzed the survey data using structural equation modeling (SEM) in Mplus 8.0. PC was positively related to MPA. In addition, AP partially mediated this association. The hypothesized moderating effect of autonomous orientation and controlled orientation was not supported. Impersonal orientation moderated the second stage of the mediating effect of AP on the PC-MPA link in that the mediating effect was positive when impersonal orientation was high, while the mediating effect was not significant when impersonal orientation was low. The findings confirm the importance of investigating how individual difference (i.e., PC) contributes to MPA. The implications of the findings for relieving MPA or preventing college students from developing MPA are also discussed deeply and thoroughly.

Interactional Effects of Multidimensional Perfectionism and Cognitive Emotion Regulation Strategies on Eating Disorder Symptoms in Female College Students

Given the inconclusive findings regarding the relation between perfectionism and eating disorder symptoms, it is important that we determine whether this relation is modulated by emotion dysregulation, which is a prominent risk factor for eating disorders. We sought to identify specific cognitive emotion regulatory strategies—rumination, self-blame, and catastrophizing—that interact with multidimensional perfectionism to shape eating disorder symptoms (i.e., shape, weight, eating concerns, and dietary restraint). Using latent moderated structural equation modeling, we analyzed data from 167 healthy young female adults. We found that only rumination significantly moderated the relation between socially prescribed perfectionism and eating disorder symptoms. However, this was not observed for self-oriented perfectionism or other regulatory strategies. These findings held true when a host of covariates were controlled for. Our findings underscore the crucial role of rumination, a modifiable emotion regulatory strategy, in augmenting the relation between socially prescribed perfectionism and eating disorder symptoms in young women.

Perfectionism in Adolescence: Associations With Gender, Age, and Socioeconomic Status in a Norwegian Sample

Background: Perfectionism in adolescence has received increased attention, but few studies have examined this in non-clinical samples. This study investigated perfectionism among adolescents from the general population in relation to demographic factors.

Methods: The present study is cross-sectional and draws on the epidemiological youth@hordaland study. The sample consisted of 10.217 adolescents aged 16–19 years (52.9% girls). Self-reported perfectionism was assessed by the EDI-P scale from the Eating Disorder Inventory with two dimensions of perfectionism, namely self-oriented (SOP) and socially prescribed (SPP) perfectionism, and a total score. Perfectionism was analyzed in relation to age, gender, and socioeconomic status (SES) by perceived economic well-being and parental education level. Chi-squared tests, t-tests, and regression analyses were performed.

Results: There were few gender differences on the mean scores on perfectionism, with similar levels on the total score of EDI-P and SOP, while girls scored slightly higher on SPP (p < 0.001). The latter gender difference represented a small effect size (Cohen's d = 0.053). Chi-square analyses with perfectionism split at the 90th percentile across gender showed that there were significantly more girls than boys among the high scorers both for EDI-P, EDI-SOP, and EDI-SPP. There were no significant differences between levels of perfectionism between the three age groups. The logistic regression analyses adjusted by age and gender showed that adolescents with a better perceived economic well-being had increased odds of high perfectionism. This was evident for overall EDI-P (OR = 1.760, 95% CI = 1.493–2.076), SOP (OR = 1.543, 95% CI = 1.292–1.843), and SPP (OR = 1.836, 95% CI = 1.559–2.163). Parental education was not significantly associated with perfectionism scores among the adolescents.

Conclusions: The levels of perfectionism were relatively similar between the genders in the present study, besides slightly higher SPP among girls than boys. There were also significantly more girls than boys among the high scorers on overall perfectionism, SOP, and SPP, respectively. High perfectionism was related to SES for perceived economic well-being, but not for parental education level. Implications for further research and clinical interventions were suggested.

Young women's body image following upwards comparison to Instagram models: The role of physical appearance perfectionism and cognitive emotion regulation

The present study examined whether trait physical appearance perfectionism moderates young women's body image following upwards appearance comparison to idealized body images on social media, and whether cognitive coping mediates the relationship between physical appearance perfectionism and resulting body image from social comparison processes. Female undergraduate students (N = 142) were randomly assigned to either 1) compare the size of their body parts to the body parts of attractive Instagram models, or 2) an appearance-neutral control condition. All participants completed measures of trait physical appearance perfectionism, pre and post measures of state body image, and state cognitive coping processes. Appearance comparison to the models resulted in lowered confidence and increased appearance and weight dissatisfaction. High trait physical appearance perfectionism predicted lower confidence and higher weight dissatisfaction and appearance dissatisfaction, and these relationships were mediated by engagement in rumination and catastrophizing. Clinical implications of the findings are discussed.

Rumination and perceived social support from significant others interact to predict eating disorder attitudes and behaviors in university students

University students are at a greater risk for eating disorder attitudes and behaviors (EDAB) compared to the general population. This study examined the roles of rumination and perceived social support (PSS) from three domains in the occurrence of EDAB. Participants: A sample of students (N= 300) attending a rural Midwestern university. Methods: Participants completed online surveys which collected demographic information and assessed eating disorders, rumination, and PSS. Pearson's correlation and moderated regression were performed for analysis. Results: Of the sample, 63.6% of participants identified as women, 34.8% as men, and 1.7% with another gender. PSS from family and friends was negatively associated with EDAB. Rumination was positively associated with EDAB. High rumination and high PSS from significant others interacted to predict eating, shape, and weight concerns, but not dietary restraint. Conclusions: Findings support incorporating screening tools for PSS and rumination at on-campus counseling sessions to identify students at risk for EDAB.

The boundary conditions by which body-esteem leads to eating disorders risk among adolescents

Adolescents are believed to be susceptible to eating disorders (EDs) due to their serious fear of appearance evaluation from society. Related to this, low body-esteem has been found to be common among individuals with EDs. The present study mainly aimed to explore how emotional intelligence (EI), gender, and body size influence the relationship between body-esteem and EDs risk among adolescents. 128 middle school students classified as obese and 128 age-and gender-matched normal weight controls were included. All participants were asked to fill out self-report measures of body-esteem, EI, and EDs risk. The results showed that (1) both gender and body size directly influenced body-esteem and EDs risk; (2) EI acted as a moderator between body-esteem and EDs risk; and (3) both gender and body size interacted with EI and body-esteem to influence EDs risk. These findings contribute to our understanding of boundary conditions by which low body-esteem leads to EDs among adolescents, and help us to correspondingly conduct targeted intervention of adolescents' EDs.

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.

A naturalistic investigation of cognitive-affective dysfunction in anorexia nervosa: The role of inefficiency

OBJECTIVE

Research has shown that rumination and negative affect are elevated in patients with anorexia nervosa (AN), but the underlying origins remain unclear. Drawing from the theoretical framework of the Goal Progress Theory of rumination, we propose that heightened feelings of "inefficiency" (i.e., low self-efficacy) in AN might play an important role in these dysfunctional cognitive-affective processes.

METHOD

Thirty-two weight-recovered participants with a history of AN and 32 healthy control participants filled out questionnaires regarding rumination and affect six times a day over a period of 2 weeks via ecological momentary assessment in real-life.

RESULTS

Analyses via hierarchical as well as conceptual process modeling suggest that while inefficiency is generally associated with more rumination and negative affect, additional amplifying mechanisms between these variables exist specifically in recovered participants with a history of AN.

DISCUSSION

Inefficiency as a core aspect of AN appears to trigger dysfunctional cognitive-affective processes which may contribute to vulnerability for AN.

The shield of self-compassion: A buffer against disordered eating risk from physical appearance perfectionism

General perfectionistic tendencies as well as perfectionism focussed specifically on one's physical appearance have been implicated as risk factors for disordered eating. This study extends previous research on protective factors by investigating self-compassion as a moderator of the relationship between both general and physical-appearance-perfectionism and disordered eating. A cross-sectional online survey assessed general perfectionism, physical-appearance-perfectionism, disordered eating symptoms, self-compassion and negative affect in female UK university students (N = 421). Results showed physical-appearance-perfectionism explained variance (15%) in disordered eating symptoms above general perfectionism and negative affect. Both perfectionistic concerns about and strivings for appearance perfection were significant unique predictors of disordered eating. Self-compassion moderated the relationship between both perfectionistic concerns and strivings of physical-appearance-perfectionism, but not general perfectionism, and disordered eating. This study suggests both perfectionistic concerns about and strivings for appearance perfection represent potential risk factors for disordered eating among female university students and that self-compassion may reduce their impact.

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.

The Association of Rumination and Perfectionism to Social Anxiety

Objective: Evaluative concerns perfectionism is related to both rumination and social anxiety. However, the mediating role of rumination between two types of perfectionism-namely, evaluative concerns perfectionism and personal standards perfectionism-and social anxiety has yet to be studied. Therefore, the objective of this study was to examine the mediating role of rumination on the association between perfectionism and social anxiety. Methods: A cross-sectional study was conducted among 450 Malaysian undergraduate students using self-report questionnaires. Results: Structural equation modeling (SEM) revealed that evaluative concerns perfectionism and rumination were significant positive predictors of social anxiety. Multimodel analysis revealed that rumination partially mediated the association between evaluative concerns perfectionism and social anxiety. Conclusions: The results suggested that evaluative concerns perfectionists were more likely to engage in rumination and were consequently more likely to experience social anxiety.

Effects of induced rumination on body dissatisfaction: Is there any difference between men and women?

BACKGROUND AND OBJECTIVES

Rumination is a factor in the development and maintenance of body dissatisfaction. However, no study has yet investigated the impact of the type of rumination on body image. The first aim of this study was to examine whether the induction of analytic-abstract vs. concrete-experiential rumination affects body dissatisfaction following an induction of negative body image. The second objective was to examine gender differences in these effects.

METHODS

Following induction of negative body image, 102 university undergraduates were randomly assigned to one of three experimental conditions-distraction, concrete rumination or abstract rumination.

RESULTS

As expected, there were significant main effects of gender and condition, and a significant interaction between gender and condition on change in body dissatisfaction. In women abstract rumination predicted the highest increase in body dissatisfaction, whereas concrete rumination predicted the highest increase in body dissatisfaction in men.

LIMITATIONS

Given that our sample consisted of undergraduate students, our findings cannot be generalized to clinical sample suffering from eating disorder.

CONCLUSIONS

The different types of rumination seem to impact differentially body dissatisfaction in men and women.