Perfectionism and learning experiences in dance class as risk factors for eating disorders in dancers

There is strong evidence that perfectionism is a risk factor for eating disorders. Women who engage in dance training have been reported to be at risk for eating disorders, and it has been hypothesised that expectancies about thinness and restricting food intake are formed partly as a result of exposure to thinness related learning (TRL) experiences in this environment, which may increase their risk. To clarify the relative contribution of perfectionism and learning in accounting for eating disorder symptoms in this group, 142 female ballet dancers completed an online survey. Through structural equation modelling it was found that the association between perfectionism and eating disorder symptoms was partially mediated by learning about thinness and restriction. The results suggest that eating disorder symptoms in dancers are significantly influenced by the interaction of perfectionism and learning, and future research should investigate the efficacy of prevention programs to target these risk factors in female dancers. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

A longitudinal study of perfectionism in adolescent onset anorexia nervosa‐restricting type

This longitudinal study analyses self‐reported perfectionism, eating disorders and psychiatric symptoms during recovery from anorexia nervosa (AN). With a recovered design, a group of 68 previous patients with AN was studied in two follow‐up studies, 8 and 16 years after 1st admission to Child and Adolescent Psychiatry (CAP). Levels of perfectionism stayed the same while eating disorder symptoms and psychiatric symptoms decreased during recovery. Levels of perfectionism were inversely related to duration of remission so that individuals that had short illness duration had lower levels of perfectionism at both follow‐ups. Patients with initial high levels of perfectionism may be at risk for a long illness duration which we recommend clinicians to acknowledge. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association.     

Perfectionism and eating disorders: a review of the literature

In recent years, a large number of studies have examined perfectionism and eating disorders. Perfectionism is well known to occur in anorexia nervosa, but has only more recently been recognized as also associated with bulimia nervosa. However, to date there has been no synthesis or evaluation of these studies. The purpose of this article is to review the concept of perfectionism and its assessment, and to evaluate the research that has examined perfectionism and eating disorders. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.     

Risk and protective factors for disturbed eating in adolescent girls – aspects of perfectionism and attitudes to eating and weight

The aim of this study was to longitudinally examine the role of personal standards, self‐evaluation, perceived benefits of thinness and attitudes to eating and weight in the development of healthy versus disturbed eating in adolescent girls. In a longitudinal study, girls who participated in two assessments, four to five years apart, were divided into three groups according to the attitudes to eating that they manifested at the second evaluation: those with disturbed eating patterns (DE‐group, n = 49), those with intermediate concerns about eating (IE‐group, n = 260) and those with healthy eating attitudes (HE‐group, n = 120). Variables concerning attitudes to eating and weight and physical self‐evaluation emerged as risk factors, whereas personal standards or self‐evaluation in general did not. Protective factors were a low BMI, healthy eating attitudes, an accepting attitude towards body size and a positive self‐evaluation, particularly with regard to physical and psychological characteristics. The results of this study contribute to the understanding of early risk and protective factors for eating disturbances in girls. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association.     

The development of the childhood retrospective perfectionism questionnaire (CHIRP) in an eating disorder sample

This investigation explored the prevalence and predictive value of childhood obsessive‐compulsive personality traits (OCPTs) in the development of eating disorders (EDs) using a novel retrospective questionnaire. To reduce bias associated with retrospective self‐report data, an identical informant version of the questionnaire was also utilised. Substantial test–retest and inter‐rater reliabilities were found for the questionnaire, as well as concordant validity with the semi‐structured interview from which it was derived. Participants with an ED (n = 246) endorsed more childhood behaviours reflecting OCPTs than the control group (n = 89). This was mirrored in the informant report data (n = 93). The prevalence rate for each OCPT in childhood was significantly higher in the total ED sample compared to the control group. Both proband and informant reports of childhood traits predict the later development of an ED according to a strong dose–response relationship. The potential utility of this measure in future retrospective and prospective research studies is highlighted. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association.     

Personal standards,self‐evaluation and perceived benefits of thinness in girls and young women with disturbed eating

The aim of this study was to examine personal standards, self‐evaluation and perceived benefits of thinness in Swedish females 14–21 years with disturbed eating (DE) and to compare these to a group with other psychosocial problems and to a symptom free group. Seventy subjects with DE‐group, 65 subjects with psychosocial problems and 70 symptom free subjects were compared regarding items selected from four questionnaires. High personal standards expressed in a competitive way were specific for the DE‐group. In comparison with the other groups the DE‐group also reported significantly more perceived benefits of thinness and they more frequently believed that thinness would make them more popular. The DE‐group also reported a more negative self‐evaluation, although this was a trait shared with the subjects with other psychosocial problems and consequently not specific for the DE‐group. Identifying specific factors that perpetuate DE habits is important in order to improve our understanding and enhance the treatment of eating disorders. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association.     

Are Maladaptive Schema Domains and Perfectionism Related to Body Image Concerns in Eating Disorder Patients?

Both maladaptive schemas (MS) and perfectionism have been associated with eating pathology. However, previous research has not examined these variables simultaneously and has not studied possible mediating relationships between MS and multidimensional perfectionism for body image concerns in eating disorder (ED) patients. Eighty‐eight female ED patients completed the Young Schema Questionnaire, the Frost Multidimensional Perfectionism Scale, and the Body Attitude Test. Body image concerns were found to be positively related to Personal Standards (PS) and Evaluative Concerns (EC) perfectionism and all five schema domains. PS Perfectionism was positively associated with Disconnection, Other‐directedness, and Overvigilance. EC Perfectionism was positively related to Disconnection, Impaired Autonomy, Other‐directedness, and Overvigilance. Moreover, EC perfectionism was found to be a significant mediator in the relationship between the schema domains Impaired Autonomy and Overvigilance and body image concerns. These findings denote the importance to address both core beliefs and perfectionism in ED treatment. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.     

The scars of the inner critic: perfectionism and nonsuicidal self-injury in eating disorders

Nonsuicidal self-injury (NSSI) is quite common in eating disorder (ED) patients and we wondered whether this combined self-harming behaviour is related to perfectionism, a feature often found in ED patients. In addition, we examined associations between perfectionism and functions underlying NSSI and the possible mediating role of intrapersonal perfectionism in the association between perceived parental criticism and NSSI. In a sample of 95 ED patients, 38.9% reported at least one type of NSSI, and this subgroup reported significantly higher levels of parental criticism and evaluative concerns perfectionism (ECP) compared with ED patients without NSSI. ECP was positively related to the self-punishment and cry-for-help functions of NSSI. Finally, ECP was found to mediate the association between parental criticism and NSSI symptoms. Directions for future research and practical implications are discussed.     

Perfectionism Group Treatment for Eating Disorders in an Inpatient,Partial Hospitalization,and Outpatient Setting

Perfectionism is elevated in individuals with eating disorders and is posited to be a risk factor, maintaining factor, and treatment barrier. However, there has been little literature testing the feasibility and effectiveness of perfectionism interventions in individuals specifically with eating disorders in an open group format. In the current study, we tested the feasibility of (a) a short cognitive behavioural therapy for perfectionism intervention delivered in an inpatient, partial hospitalization, and outpatient for eating disorders setting (combined N = 28; inpatient n = 15; partial hospital n = 9; outpatient n = 4), as well as (b) a training for disseminating the treatment in these settings (N = 9). Overall, we found that it was feasible to implement a perfectionism group in each treatment setting, with both an open and closed group format. This research adds additional support for the implementation of perfectionism group treatment for eating disorders and provides information on the feasibility of implementing such interventions across multiple settings. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Perfectionism and cognitive rigidity in anorexia nervosa: Is there an association?

Little is known about the relationship between neuropsychology, personality, and eating psychopathology in anorexia nervosa (AN). We aimed to investigate the interaction between set shifting and perfectionism in AN and to ascertain the role of perfectionism as a mediator between set shifting and eating psychopathology. Eighty‐five patients with AN and 71 healthy controls completed Eating Disorder Inventory‐2 (using 8 as a cut‐off for generating groups with high vs. low perfectionism), Beck Depression Inventory, Wisconsin Card Sorting Test, Trail Making Task, and Hayling Sentence Completion Task. Our findings support heightened cognitive inflexibility in individuals with AN, particularly in those with high perfectionism. Perfectionism resulted to be a mediator of the relationship between a measure of set shifting and drive for thinness, but this finding did not remain significant when including in the model only those with AN. Taken together, these data suggest a complex and nonexclusive association between set shifting, eating psychopathology, and perfectionism.     

The Treatment of Perfectionism within the Eating Disorders: A Pilot Study

The aim of this pilot study was to investigate the impact of the direct treatment of perfectionism on the outcome of perfectionism and eating disorder pathology. Sixty‐one participants, attending day hospital treatment, participated in a randomised controlled study, in which treatment as usual (TAU) was compared with TAU combined with a clinician‐lead cognitive behavioural treatment for perfectionism (TAU + P). Linear mixed model analysis revealed no significant interaction effects but significant main effects for time on variables measuring eating pathology and perfectionism. Outcomes supported the effectiveness of overall treatment but suggested that adding direct treatment of perfectionism did not enhance treatment. The results are discussed in relation to the existing literature on the treatment of perfectionism. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.     

Selflessness and perfectionism as predictors of pathological eating attitudes and disorders: A longitudinal study

This paper examines the role that selflessness and perfectionism may play as possible predictors of pathological eating attitudes and eating disorders (ED). 1057 schoolgirls (seventh to ninth grade) participated in the initial screening phase. They were administered the Eating Attitudes Test (EAT‐26), Selflessness Scale (SS) and Multidimensional Perfectionism Scale (MPS). Based on their EAT‐26 scores, 150 girls were invited to a clinical interview 2 years later (second phase). In the third phase 4 years later, 243 girls who completed the questionnaires in the seventh grade were the target of re‐administration of these scales. Seventh‐grade selflessness scores at initial screening phase predicted ED status determined in clinical interview at the 2‐year interval and abnormal eating attitudes at the 4‐year interval, above and beyond baseline seventh‐grade eating‐attitude scores. Perfectionism was not found to predict the development of neither ED nor abnormal eating attitudes. Preventional and therapeutic implications of the role of selflessness as a predisposing factor for ED are discussed. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Childhood Obsessive–compulsive Traits in Anorexia Nervosa Patients,Their Unaffected Sisters and Healthy Controls: A Retrospective Study

Although there is evidence that childhood perfectionistic traits predate the onset of eating disorders, few studies to date have examined the prevalence and clinical correlates of these traits in patients with anorexia nervosa (AN) and their unaffected sisters. The aim of this work was to study the prevalence of childhood obsessive–compulsive traits in patients with lifetime AN, their unaffected sisters and healthy women. A total of 116 AN patients, 32 healthy sisters and 119 controls were assessed by the EATATE Interview to assess traits such as perfectionism, inflexibility, rule‐bound traits, drive for order and symmetry, and excessive doubt and cautiousness. Both self‐report and maternal reports were collected. AN patients reported more childhood obsessive–compulsive traits than their healthy sisters and controls. In contrast, no differences between healthy controls and unaffected sisters emerged. In patients with AN, a dose–response relationship was found between the number of childhood obsessive–compulsive traits and psychopathology, including body image distortion, thus indicating that these traits are an important feature to be considered in assessing and treating eating disorders. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.