The Eating Disorder Inventory-2 Perfectionism scale: factor structure and associations with dietary restraint and weight and shape concern in eating disorders

The Eating Disorder Inventory-2 Perfectionism subscale (EDI-P) was originally construed as a unidimensional measure of perfectionism. However, research in non-clinical samples suggests that the EDI-P measures two dimensions of perfectionism: self-oriented and socially prescribed perfectionism. This study aimed to investigate the factor structure of the EDI-P in a transdiagnostic sample of females seeking treatment for an eating disorder, and to determine the unique association between EDI-P dimensions, weight and shape concern, and dietary restraint in anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified. Two hundred and ninety nine females seeking treatment for an eating disorder at an outpatient eating disorder service completed the Eating Disorder Examination and the EDI-P. Confirmatory factor analysis supported a two-factor model of the EDI-P comprising self-oriented and socially prescribed perfectionism. Self-oriented perfectionism, but not socially prescribed perfectionism, accounted for unique variance in weight and shape concern and dietary restraint in both AN and BN. Results highlight the potential importance of self-oriented perfectionism in eating disorders and support the argument that self-imposed standards are central to perfectionism in eating disorders.     

Relationships between perfectionism and specific disordered eating behaviors

OBJECTIVE: Perfectionism has been reported as a specific risk factor for anorexia nervosa and bulimia nervosa, but not binge eating disorder. This study examined whether these differences are due to differential associations between perfectionism and specific eating disorder behaviors. METHOD: Participants (N = 2,482) completed the eating disorders inventory perfectionism scale and a questionnaire assessing eating disorder symptoms. RESULTS: Perfectionism was associated with an array of disordered eating behaviors in women. However, associations were strongest for fasting and purging. Further, the association between binge eating and perfectionism was statistically mediated by fasting. In men, perfectionism was significantly associated only with fasting, and this association was greater than associations with other disordered eating behaviors. CONCLUSION: Results explain why previous studies have reported weak or inconsistent associations between perfectionism and binge eating and may inform etiological models of EDNOS characterized by fasting or purging.     

Self-oriented and socially prescribed perfectionism in the Eating Disorder Inventory Perfectionism subscale

OBJECTIVE: The purpose of this study was to demonstrate the existence and the importance of the distinction between self-oriented and socially prescribed perfectionism in the Eating Disorder Inventory Perfectionism subscale (EDI-P). METHOD: Trait perfectionism, measured by the EDI-P, and eating disorder symptoms, measured by the 26-item Eating Attitudes Test, were examined in 220 university students (110 women and 110 men) belonging to a campus-based fitness facility. RESULTS: Confirmatory factor analysis indicated that, for both genders, the EDI-P is best represented by a multidimensional factor structure with three self-oriented perfectionism items (EDI-SOP) and three socially prescribed perfectionism items (EDI-SPP). Structural equation modeling demonstrated that, for both genders, EDI-SOP and EDI-SPP are related independently to eating disorder symptoms. Moderational analysis indicated that, for women, the impact of EDI-SOP on eating disorder symptoms is dependent on the level of EDI-SPP. DISCUSSION: It is suggested that future research should acknowledge the empirical and theoretical implications of having EDI-SOP and EDI-SPP in the EDI-P. It is cautioned that EDI-SOP and EDI-SPP are a partial representation of an already published multidimensional model of trait perfectionism.     

The relation among perfectionism, obsessive-compulsive personality disorder and obsessive-compulsive disorder in individuals with eating disorders

OBJECTIVE: Perfectionism and obsessionality are core features of eating disorders (ED), yet the nature of their relation remains unknown. Understanding the relation between these traits may enhance our ability to identify relevant behavioral endophenotypes for ED. METHOD: Six-hundred seven individuals with anorexia and bulimia nervosa from the International Price Foundation Genetic Study were assessed for perfectionism, obsessive-compulsive personality disorder (OCPD), and obsessive-compulsive disorder (OCD). RESULTS: No differences were found across ED subtypes in the prevalence of OCPD and OCD, nor with the association between OCD and OCPD. Perfectionism scores were highest in individuals with OCPD whether alone or in combination with OCD. CONCLUSION: Perfectionism appears to be more closely associated with obsessive-compulsive personality symptoms rather than OCD. The pairing of perfectionism with OCPD may be a relevant core behavioral feature underlying vulnerability to ED.     

体育锻炼在女大学生完美主义与进食障碍间的调节作用

探讨女大学生完美主义和进食障碍的关系以及体育锻炼在其中的调节作用,为预防女大学生进食障碍的发生提供理论依据.方法 采用中文Frost多维度完美主义问卷、进食障碍问卷以及体育活动等级量表,对方便抽取的山东省3所高校的1 938名女大学生进行调查.结果 132名女生达到进食障碍倾向标准,患病率为5.11%.四年级女生的患病率高于其他3个年级.不同生源地、不同专业的女大学生患病率差异无统计学意义(x2值分别为1.43,1.58,P值均>0.05).超重组女大学生患病率高于正常组和偏瘦组(x2=7.15,P<0.01).完美主义能正向预测进食障碍(β=0.431,P<0.01),完美主义和体育锻炼交互项的回归系数有统计学意义(B=-0.106,P<0.01).当锻炼量较低时,完美主义对进食障碍的预测作用较大(B=0.53,t=5.93,P<0.01);锻炼量较高时,完美主义对进食障碍的影响减弱(B=0.32,t=2.37,P<0.05).结论 体育锻炼在完美主义影响进食障碍的过程中具有调节作用.     

Perfectionism traits and perfectionistic self-presentation in eating disorder attitudes,characteristics, and symptoms

Objective: The purpose of this study was to assess the association between several dimensions of perfectionism and measures of eating disorder symptoms, body image, and appearance self-esteem in college students. Method: A sample of 81 female university students completed the Multidimensional Perfectionism Scale, the Perfectionistic Self-Presentation Scale, the Eating Attitudes Test, the Bulimia Test, the Body Image Avoidance Questionnaire, and two measures of self-esteem. Results: It was found that whereas self-oriented perfectionism was related only to anorexic symptoms, the social facets of perfectionism, especially socially prescribed perfectionism and the perfectionistic self-presentation dimensions, were related to eating disorder symptoms as well as body image avoidance and self-esteem. Discussion: The findings support the usefulness of differentiating personal and interpersonal dimensions of perfectionism as well as trait versus self-presentational aspects of perfectionism in investigating personality and attitudes and behaviors related to eating disorders. © 1995 by John Wiley & Sons, Inc.     

Personality, perfectionism, and attitudes toward eating in parents of individuals with eating disorders

OBJECTIVE: This study compares personality and eating-related traits in parents of probands with eating disorders, with age-band matched healthy normal controls. METHOD: Data were abstracted from an international genetic study of anorexia nervosa. Information was available for the Multidimensional Perfectionism Scale (MPS), the Eating Disorders Inventory (EDI), and the Temperament and Character Inventory (TCI). Comparisons were done by multivariate analysis of variance. RESULTS: Mothers of probands showed elevated levels of perfectionism on the MPS and more concerns about weight and shape on the EDI compared with controls. Mothers who had daughters with diagnoses other than the restricting subtype of anorexia nervosa showed elevated levels of perfectionism on the MPS. CONCLUSION: These data are compatible with the notion that some personality traits, such as perfectionism, and weight and shape concerns may cluster in families of probands with eating disorders.     

The role of stress in the association between low self-esteem, perfectionism, and worry, and eating disorders

OBJECTIVE: Several theorists have hypothesized that stressful situations may trigger abnormal eating and even eating disorders in predisposed people. The purpose of the current study was to assess whether a stressful situation would reveal an association between perfectionism, low self-esteem, worry, and body mass index (BMI) and measures of eating disorder symptoms in female high school students. METHOD: A sample of 145 female high school students completed the Eating Disorder Inventory, the Multidimensional Perfectionism Scale, the Penn State Worry Questionnaire, and the Self Liking and Competence Scale three times--on an average school day, on the day of an examination, and on the day the subjects received the results of that examination. Linear regression analysis was performed to verify whether the dimensions of perfectionism were associated with the measures of eating disorders. RESULTS: Low self-esteem, worry, and parental criticism (a dimension of perfectionism) were associated with the measures of eating disorders only during the stressful situation, whereas concern over mistakes (another dimension of perfectionism) was associated in both stressful and nonstressful situations. DISCUSSION: The results suggest that in nonclinical female individuals, stress might bring out a previously absent association between some psychological predisposing factors for eating disorders and an actual desire or plan to lose weight. Such a finding suggests that stress may stimulate behaviors related to eating disorders in a predisposed personality.     

Specificity of self-concept disturbances in eating disorders

OBJECTIVES: The current study examined self-concept deficits among three diagnostic groups of eating-disordered patients, evaluated the relationship between self-concept deficits and depression, and addressed the specificity of self-concept deficits in eating-disordered patients. METHOD: Three groups of eating-disordered patients (anorexia nervosa, N = 33; bulimia nervosa, N = 38; binge eating disorder, N = 28) were first compared to three matched healthy control groups and then to two psychiatric comparison groups (patients with anxiety disorders, N = 37; patients with depressive disorders, N = 37). RESULTS: All three groups of eating-disordered patients displayed lower self-esteem and higher feelings of ineffectiveness compared with the healthy controls, even after controlling for depression. Differences in self-esteem and ineffectiveness were also found between eating-disordered patients and psychiatric controls. However, not all of the differences were significant. In addition, the psychiatric controls also exhibited lower self-esteem than normative samples. DISCUSSION: Findings suggest that self-concept deficits are more pronounced in eating-disordered patients but cannot be regarded as highly specific.     

Perfectionism in anorexia nervosa: a 6-24-month follow-up study

OBJECTIVE: This study examined the relationship between perfectionism and outcome in anorexia nervosa (AN). METHOD: Seventy-three patients received inpatient treatment for AN. Participants completed the Eating Disorder Inventory (EDI) at admission to (n = 55), at discharge (n = 27), and at a median of 15.9 months (n = 49) after inpatient treatment. At follow-up, participants also completed the Multidimensional Perfectionism Scale (MPS) and their scores were compared with those of healthy controls. RESULTS: EDI Perfectionism was associated with illness status. A lower EDI Perfectionism score at admission was associated with a better response to treatment, which was subsequently associated with better outcome at follow-up. Both the good and poor outcome groups had significantly higher MPS total perfectionism scores than healthy controls. DISCUSSION: The EDI measures an aspect of perfectionism that is sensitive to illness status, whereas the MPS is less dependent on clinical state and may reflect a common personality trait that persists with remission of disease.     

Complexities of measuring perfectionism: three popular perfectionism measures and their relations with eating disturbances and health behaviors in a female college student sample

The present study investigated the relationships between three popular measures of perfectionism [the Eating Disorders Inventory - Perfectionism scale (EDI-P), the Frost Multidimensional Perfectionism Scale (FMPS), and the Multidimensional Perfectionism Scale (MPS)] and measures of eating disturbances and health behaviors, in a sample of 248 female college students. Results indicated that the adaptiveness or maladaptiveness of certain perfectionism dimensions should still be questioned. Also, self-oriented and socially prescribed perfectionism (from the MPS) were consistently found to be the most important predictors of both eating disturbances and health behaviors. Surprisingly, scores on the EDI-P were not found to be significant predictors of eating disturbances when FMPS and MPS scores were included in regression analyses. Implications of the present findings are discussed.     

Stress situation reveals an association between perfectionism and drive for thinness

OBJECTIVE: Several theorists have hypothesized that stress situations may trigger abnormal eating and even eating disorders in individuals with a perfectionistic personality. The purpose of this study was to assess whether a stress situation would reveal an association between perfectionism and measures of eating disorders among female high school students. METHODS: A sample of 42 female high school students completed the Multidimensional Perfectionism Scale and the Eating Disorder Inventory three times: on an average school day, on the day of an examination, and on the day they received the evaluation of the examination. Linear regression analysis was calculated to verify whether the dimensions of perfectionism were associated with the measures of eating disorders. RESULTS: Body Dissatisfaction was associated with perfectionism on all the three occasions, whereas Drive for Thinness was associated with perfectionism only on the day the students received the results of the examination. DISCUSSION: The results suggest that among nonclinical female individuals, stress may make significant a previously absent association between perfectionism and an actual desire or plan to lose weight. Such a finding suggests that stress may stimulate behaviors related to eating disorders in individuals with a perfectionistic personality.     

Associations among postpartum depression, eating disorders, and perfectionism in a population-based sample of adult women

OBJECTIVE: The current study investigated associations among eating disorders, depressive symptoms during pregnancy and postpartum, and perfectionism in a population-based sample of women. METHOD: Females who reported > or = 1 pregnancy (N = 1,119) completed questionnaires assessing perfectionism, eating disorder symptomatology, and depression during pregnancy and postpartum. Information regarding participants' history of major depressive disorder (MDD) was also available from structured psychiatric interviews completed during a previous wave of data collection. RESULTS: Depressive symptoms during pregnancy and postpartum were high among women with a history of eating disorders. Both binge eating disorder (BED) and bulimia nervosa (BN) were positively associated with symptoms of postpartum depression (PPD), even when lifetime MDD was controlled. However, logistic regression indicated that women with a history of BN and BED are at particular risk of developing PPD symptomatology. Linear regression analyses conducted with the subset of the sample who endorsed a PPD screening item suggested that the severity of PPD symptomatology may be attributable to Concern Over Mistakes, a specific aspect of perfectionism. CONCLUSION: These results highlight the importance of assessing specific features of perfectionism. In addition, they suggest that women with BN, BED, or high Concern over Mistakes may be at particular risk of developing PPD symptoms, and could benefit from prenatal screening.     

Eating attitudes and personality variables in a nonclinical sample

The present study examined the relation of certain personality variables to eating attitudes in a nonclinical group of 119 females age 16–18 years who were recruited from two large urban high schools. The personality variables included Perfectionism, Orderliness, Achievement Orientation, Separation Difficulties, Body Image, and Sexual Inhibition. Items for Orderlines and Achievement were taken directly from the California Personality Inventory; those for the other scales were clinically derived. Final forms of the scales were determined by item analyses. Attitudes toward eating were measured by The Eating Attitudes Jest, a 40-item rating scale that has been previously utilized in studies of eating disorders. In addition to overall scores on this instrument, factor analyses yielded six clusters of items for which each subject received a score: Weight anxiety, Eating anxiety, Dieting, Social pressure to eat, Dislike of food, and Somatic symptoms. An interesting and coherent pattern of results emerged when correlational analyses were performed on the personality scales and the EAT clusters. For instance, Perfectionism was significantly associated with Weight anxiety, and Sexual Inhibition was significantly correlated with Eating anxiety. The findings are discussed with reference to confusion in the eating disorders literature on the distinction between perfectionism and obsessive-compulsive traits. They are relevant also to the prevailing view of anorexia nervosa as a perfectionistic pursuit of thinness. Our results suggest that conflict about the eating function may also be operative—a finding that is reminiscent of the position of early psychoanalytic writers.     

Features associated with excessive exercise in women with eating disorders

OBJECTIVE: Excessive exercise and motor restlessness are observed in a substantial number of patients with eating disorders. This trait has been studied extensively among animal models of activity anorexia nervosa (AN) and may hold particular interest as an endophenotype for AN. We explored features associated with excessive exercise across subtypes of eating disorders. METHOD: Participants were female probands and affected female relatives from the multi-site international Price Foundation Genetic Studies with diagnoses of AN, bulimia nervosa (BN), and both AN and BN or eating disorder not otherwise specified (ED-NOS) (N=1,857). Excessive exercise was defined based on responses to the Structured Interview for Anorexic and Bulimic Disorders (SIAB). RESULTS: Among the eating disorder diagnostic groups, excessive exercise was most common among the purging subtype of AN. Individuals who reported excessive exercise also reported lower minimum BMI, younger age at interview, higher scores on anxiety, perfectionism, and eating disorder symptom measures, more obsessions and compulsions, and greater persistence. CONCLUSION: Excessive exercise may be associated particularly with the purging subtype of AN as well as with a constellation of anxious/obsessional temperament and personality characteristics among women with eating disorders.     

The role of perfectionism, dichotomous thinking, shape and weight overvaluation, and conditional goal setting in eating disorders

This study examined the role of perfectionism (self-oriented and socially prescribed), shape and weight overvaluation, dichotomous thinking, and conditional goal setting in eating disorder psychopathology. Perfectionism and shape and weight overvaluation have had longstanding implication in the development and maintenance of eating disorders. A leading evidence-based theory of eating disorders (Fairburn, Cooper & Shafran, 2003) outlines perfectionism as a maintaining mechanism of eating disorder psychopathology and as a proximal risk factor for the development of shape and weight overvaluation. These constructs have been linked to other cognitive processes relevant to eating disorders, specifically, dichotomous thinking and conditional goal setting. Women with DSM-IV eating disorders (N = 238) were compared to women in the general community (N = 248) and, as hypothesised, scores on measures of these constructs were pronounced in the clinical sample. Hierarchical regression analyses predicting eating disorder psychopathology showed that for both groups, dichotomous thinking and conditional goal setting significantly improved model fit beyond perfectionism and shape and weight overvaluation alone. Self-oriented perfectionism, but not socially prescribed perfectionism, was relevant to eating disorder psychopathology. We discuss the implications for current treatment protocols and early intervention.     

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

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

Screening for eating disorders in a psychiatric outpatient population

Background: Some studies have found “hidden” eating disorders in psychiatric patients. However, eating behaviour, weight, and body image concerns are usually weakly assessed among psychiatric patients. Objectives: a) To analyse the prevalence of eating disorders (ED) in patients referred from primary care for psychiatric assessment; and b) to analyse the psychopathological variables associated with these disorders. Methods. Ninety-three patients underwent psychometric assessment using Derogatis’ Symptom Checklist-90-R, the Rosenberg Self-Esteem Scale, the Perceived Stress Questionnaire, the Eating Attitudes Test-40 (EAT-40), the Bulimic Investigatory Test, Edinburgh (BITE), and the Body Dissatisfaction Scale of the Eating Disorders Inventory-2. The subsequent clinical assessment, applying DSM-IV-R criteria for ED, was conducted by means of interview with those patients whose scores on the EAT-40 and BITE were above the cut-off points. Results: The assessments confirmed one case of bulimia nervosa and three of unspecified eating disorder, these accounting for 1.07% and 3.22%, respectively. Conclusion: The existence of hidden ED in psychiatric patients, especially as regards bulimic behaviour, and the correlation between eating disorder symptoms and different psychopathological variables make it important for clinicians to conduct a proper assessment when faced with “anxiety and depressive syndromes”, which are a common feature of primary care referrals for psychiatric assessment.     

Comorbidity of body dysmorphic disorder and eating disorders: severity of psychopathology and body image disturbance

OBJECTIVE: The current study examined comorbidity and clinical correlates of eating disorders in a large sample of individuals with body dysmorphic disorder (BDD). METHOD: Two hundred individuals with DSM-IV (4th ed. of the Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association; 1994) BDD completed reliable interviewer-administered and self-report measures, including diagnostic assessments and measures of body image, symptom severity, delusionality, psychosocial functioning, quality of life (QOL), and history of psychiatric treatment. RESULTS: A total of 32.5% of BDD subjects had a comorbid lifetime eating disorder: 9.0% had anorexia nervosa, 6.5% had bulimia nervosa, and 17.5% had an eating disorder not otherwise specified. Comparisons of subjects with a comorbid lifetime eating disorder (n = 65) and subjects without an eating disorder (n = 135) indicated that the comorbid group was more likely to be female, less likely to be African American, had more comorbidity, and had significantly greater body image disturbance and dissatisfaction. There were no significant group differences in BDD symptom severity, degree of delusionality, or suicidal ideation or attempts. Functioning and QOL were notably poor in both groups, with no significant between-group differences. However, a higher proportion of the comorbid eating disorder group had been hospitalized for psychiatric problems. This group had also received a greater number of psychotherapy sessions and psychotropic medications. CONCLUSION: Eating disorders appear relatively common in individuals with BDD. BDD subjects with a comorbid eating disorder differed on several demographic variables, had greater comorbidity and body image disturbance, and had received more mental health treatment than subjects without a comorbid eating disorder. These findings have important implications for the assessment and treatment of these comorbid body image disorders.     

Is migraine related to the eating disorders?

Migraine and the eating disorders, particularly bulimia nervosa, share some common demographics, phenomenology, psychopathology, and treatments. Bulimics also appear to be more sensitive to the induction of severe migrainous headaches than controls following challenge with the 5-HT agonist, m-chlorophenylpiperazine (m-CPP), but not placebo or L-tryptophan. This supports a common pathophysiological relationship involving postsynaptic 5-HT dysfunction between these disorders. In order to further explore the possible relationship between eating disorders and migraine, we administered a modified version of the Diagnostic Survey of the Eating Disorders (D5ED) and the Eating Disorders Inventory (EDI) to a group of female migraine patients attending the Medical University of South Carolina (MUSC) Neurology Clinic (n = 34). Of the 34 migraine patients surveyed, 88% reported dieting behavior, 59% reported binge eating, and 26% reported self-induced vomiting during their lifetimes. Compared to the responses of a group of normal female controls (n = 577), patients with migraine had elevated scores on four of the eight subscales of the EDI: Body Dissatisfaction (p ≤ .02), Perfectionism (p ≤ .01), Interpersonal Distrust (p ≤ .02), and Ineffectiveness (p ≤ .06). These findings support the hypothesis that common pathophysiological mechanisms, perhaps involving 5-HT dysregulation, may be involved in these two disorders. © 1993 by John Wiley & Sons, Inc.