Abstract
There is a strong link between perfectionism and eating disorders, yet little research to date has examined mediators of this relationship. The aim of this study was to investigate the mediating effect of anxiety on the relationship between perfectionism and eating pathology in a clinical sample (N = 370, M age = 25.04, 99 % female) of treatment-seeking eating disorder patients (bulimia nervosa—41 %; eating disorder not otherwise specified—41 %; anorexia nervosa—18 %). Results from structural equation modeling indicated that anxiety partially mediated the relationship between self-oriented perfectionism and eating disorder psychopathology. The findings suggest the role of anxiety and perfectionism within cognitive-behavioral models of eating pathology, and have implications for the treatment of eating disorders.
Similar content being viewed by others
References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, 4th ed, text rev. Washington, DC: American Psychiatric Association.
Anderson, J. C., & Gerbing, D. W. (1988). Structural equation modeling in practice: A review and recommended two-step approach. Psychological Bulletin, 103, 411–423.
Bardone-Cone, A. M. (2007). Self-oriented and socially prescribed perfectionism dimensions and their associations with disordered eating. Behaviour Research and Therapy, 45(8), 1977–1986.
Bardone-Cone, A. M., Wonderlich, S. A., Frost, R. O., Bulik, C. M., Mitchell, J. E., Uppala, S., et al. (2007). Perfectionism and eating disorders: Current status and future directions. Clinical Psychology Review, 27, 384–405.
Bastiani, A. M., Rao, R., Weltzin, T., & Kaye, W. H. (1995). Perfectionism in anorexia nervosa. International Journal of Eating Disorders, 17, 147–152.
Berg, K. C., Peterson, C. B., Frazier, P., & Crow, S. J. (2012). Psychometric evaluation of the eating disorder examination and eating disorder examination-questionnaire: A systematic review of the literature. International Journal of Eating Disorders, 45, 428–438.
Brown, T. A. (2007). Temporal course and structural relationships among dimensions of temperament and DSM-IV anxiety and mood disorder constructs. Journal of Abnormal Psychology, 116, 313–328.
Brown, T. A., & Barlow, D. (2009). A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: Implications for assessment and treatment. Psychological Assessment, 21, 256–271.
Bulik, C. M., Sullivan, P. F., Fear, J. L., & Joyce, P. R. (1997). Eating disorders and antecedent anxiety disorders: A controlled study. Acta Psychiatrica Scandinavica, 96, 101–107.
Byrne, B. M. (2001). Structural equation modeling with AMOS: Basic concepts, applications, and programming. Mahwah, NJ: Lawrence Erlbaum Associates.
Carmines, E., & McIver, J. (1981). Analyzing models with unobserved variables: Analysis of covariance structures. In G. W. Bohmstedt & E. F. Borgatta (Eds.), Social measurement (pp. 65–115). Thousand Oaks, CA: Sage Publications.
Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100, 316–336.
Cockell, S. J., Hewitt, P. L., Seal, B., Sherry, S., Goldner, E. M., Flett, G. L., et al. (2002). Trait and self-presentational dimensions of perfectionism among women with anorexia nervosa. Cognitive Therapy and Research, 26, 745–758.
Crawford, J. R., & Henry, J. D. (2003). The depression anxiety stress scales (DASS): Normative data and latent structure in a large non-clinical sample. British Journal of Clinical Psychology, 42, 111–131.
Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: A clinical review. Clinical Psychology Review, 31, 203–212.
Egan, S. J., Wade, T. D., & Shafran, R. (2012). The transdiagnostic process of perfectionism. Revista de Psicopatologia y Psicologia Clinicia (Spanish Journal of Clinical Psychology), 17(3), 294–297.
Fairburn, C., & Cooper, Z. (1993). The Eating Disorder Examination (12th Edition). In C. Fairburn & G. Wilson (Eds.), Binge-eating: Nature, assessment and treatment (pp. 317–360). New York: Guilford Press.
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41, 509–528.
Frost, R., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14, 449–468.
Garfinkel, P. E., Lin, E., Goering, P., Spegg, C., Goldbloom, D. S., Kennedy, S., et al. (1995). Bulimia nervosa in a Canadian community sample: Prevalence and comparison of subgroups. American Journal of Psychiatry, 152, 1052–1058.
Garner, D. M. (1991). Eating disorder inventory-2: Professional manual. Odessa: Psychological Assessment Resources.
Godart, N. T., Flament, M. F., Curt, F., Perdereau, F., Lang, F., Venisee, J. L., et al. (2003). Anxiety disorders in subjects seeking treatment for eating disorders: A DSM-IV controlled study. Psychiatry Research, 117, 245–258.
Halmi, K. A., Eckert, E., Marchi, P., Sampugnaro, V., Apple, R., & Cohen, J. (1991). Comorbidity of psychiatric diagnoses in anorexia nervosa. Archives of General Psychiatry, 48, 712–718.
Halmi, K. A., Sunday, S. P., Strober, M., Kaplan, A., Woodside, D. B., Fichter, M., et al. (2000). Perfectionism in anorexia nervosa: Variation by clinical subtype, obessionality, and pathological eating behaviour. American Journal of Psychiatry, 157, 1799–1805.
Heatherton, T. F., & Baumeister, R. F. (1991). Binge eating as escape from self-awareness. Psychological Bulletin, 110, 86–108.
Hewitt, P. L., & Flett, G. L. (1991). Perfectionism in the self and social contexts: Conceptualization, assessment and association with psychopathology. Journal of Personality and Social Psychology, 60, 456–470.
Hoiles, K., Egan, S. J., & Kane, R. T. (2012). The validity of the transdiagnostic cognitive behavioural model of eating disorders in predicting dietary restraint. Eating Behaviors, 13, 123–126.
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modelling, 6, 1–55.
Jöreskog, K. G., & Sörbom, D. (2007). LISREL 8.8: Structural equation modeling with the SIMPLIS command language. Chicago, USA: IL Scientific Software International.
Joyce, F., Watson, H., Egan, S. J., & Kane, R. T. (2012). Mediators between perfectionism and eating disorder psychopathology in a community sample. Eating Behaviors, 13, 361–365.
Kline, R. B. (2005). Principles and practices of structural equation modeling (2nd ed.). New York: Guilford Press.
Lampard, A. M., Byrne, S. M., McLean, N., & Fursland, A. (2011). An evaluation of the enhanced cognitive-behavioural model of bulimia nervosa. Behaviour Research and Therapy, 49, 529–535.
Landis, J., & Koch, G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159–174.
Lecrubier, Y., Sheehan, D. V., Weiller, E., Amorim, P., Bonora, I., Sheehan, K. H., et al. (1997). The mini international neuropsychiatric interview (MINI). A short diagnostic structured interview: Reliability and validity according to the CIDI. European Psychiatry, 12, 224–231.
Lethbridge, J., Watson, H. J., Egan, S., Street, H., & Nathan, P. (2011). The role of perfectionism, dichotomous thinking, shape and weight overvaluation, and conditional goal setting in eating disorders. Eating Behaviors, 12, 200–206.
Lilenfeld, L. R., Stein, D., Bulik, C. M., Strober, M., Plotnicov, K., Pollice, C., et al. (2000). Personality traits among currently eating disordered, recovered and never ill first-degree relatives of bulimic and control women. Psychological Medicine, 30, 1399–1410.
Little, T. D., Cunningham, W. A., Shahar, G., & Widaman, K. F. (2002). To parcel or not to parcel: Exploring the question, weighing the merits. Structural Equation Modeling, 9, 151–173.
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression anxiety stress scales (DASS) (2nd ed.). Sydney: The Psychology Foundation of Australia.
Micali, N., Hilton, K., Nakatani, E., Heymen, I., Turner, C., & Mataix-Cols, D. (2011). Is childhood OCD a risk factor for eating disorders later in life? A longitudinal study. Psychological Medicine, 41(12), 2507–2513.
Moor, S., Vartanian, L. R., Touyz, S. W., & Beumont, P. J. V. (2004). Psychopathology of EDNOS patients: To whom do they compare? Clinical Psychologist, 8, 70–75.
Niv, N., Kaplan, Z., Mitrani, E., & Shiang, J. (1998). Validity study of the EDI-2 in Israeli population. Israel Journal of Psychiatry and Related Science, 35, 287–292.
Pallister, E., & Waller, G. (2008). Anxiety in the eating disorders: Understanding the overlap. Clinical Psychology Review, 28, 366–386.
Pinninti, N. R., Madison, H., Musser, E., & Rissmiller, D. (2003). MINI international neuropsychiatric schedule: Clinical utility and patient acceptance. European Psychiatry, 18, 361–364.
Reyes-Rodriquez, R., Von Holle, A., Ulman, T. F., Thornton, L. M., Klump, K. L., & Bulik, C. (2011). Post traumatic stress disorder in Anorexia Nervosa. Psychosomatic Medicine, 73, 491–497.
Sassaroli, S., Lauro, L. J. R., Ruggiero, G. M., Mauri, M. C., Vinai, P., & Frost, R. (2008). Perfectionism in depression, obsessive-compulsive disorder and eating disorders. Behaviour Research and Therapy, 46, 757–765.
Sawaoka, T., Barnes, R. D., Blomquist, K. K., Masheb, R. M., & Grilo, C. M. (2012). Social anxiety and self-consciousness in binge-eating disorder: Associations with eating disorder psychopathology. Comprehensive Psychiatry, 53, 740–745.
Schwalberg, M. D., Barlow, D. H., Algar, S. A., & Howard, L. J. (1992). Comparison of bulimics, obese binge eaters, social phobics, and individuals with panic disorder on comorbidity across DSM-III-R anxiety disorders. Journal of Abnormal Psychology, 101, 675–681.
Shafran, R., Cooper, Z., & Fairburn, C. G. (2002). Clinical perfectionism: a cognitive-behavioural analysis. Behaviour Research and Therapy, 40, 773–791.
Shafran, R., Egan, S., & Wade, T. (2010). Overcoming perfectionism: A self-help guide using cognitive behavioural techniques. London, UK: Constable & Robinson.
Sheehan, D., & Lecrubier, Y. (1998). MINI international neuropsychiatric interview: English version 5.0.0. Journal of Clinical Psychiatry, 59(S20), 34–57.
Sheehan, D. V., Lecrubier, Y., Harnett Sheehan, K., Janavs, J., Weiller, E., Keskiner, A., et al. (1997). The validity of the mini international neuropsychiatric interview (MINI) according to the SCID-P and its reliability. European Psychiatry, 12, 232–241.
Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., et al. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(S20), 22–33.
Sherry, S. B., Hewitt, P. L., Besser, A., McGee, B. J., & Flett, G. L. (2004). Self-oriented and socially prescribed perfectionism in the eating disorder inventory perfectionism subscale. International Journal of Eating Disorders, 35, 69–79.
Silgado, J., Timpano, K. R., Buckner, J. D., & Schmidt, N. B. (2010). Social anxiety and bulimic behaviors: The moderating role of perfectionism. Cognitive Therapy and Research, 34, 487–492.
Steele, A., & Wade, T. D. (2008). A randomised trial investigating guided self-help to reduce perfectionism and its impact on bulimia nervosa: A pilot study. Behaviour Research and Therapy, 46, 1316–1323.
Swinbourne, J., Hunt, C., Abbott, M., Russell, J., StClare, T., & Touyz, S. (2012). The comorbidity between eating disorders and anxiety disorders. Prevalence in an eating disorder and anxiety disorder sample. Australian and New Zealand Journal of Psychiatry, 46(2), 118–131.
Watson, H. J., Raykos, B. C., Street, H., Fursland, A., & Nathan, P. R. (2011). Mediators between perfectionism and eating disorder psychopathology: Shape and weight overvaluation and conditional goal-setting. International Journal of Eating Disorders, 44, 142–149.
Wilksch, S. M., Durbridge, M. R., & Wade, T. D. (2008). A preliminary controlled comparison of programs designed to reduce risk of eating disorders targeting perfectionism and media literacy. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 937–947.
Conflict of Interest
We did not receive any grant funding for the research, and the ethical guidelines of the Australian Psychological Society were followed when conducting the research.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Egan, S.J., Watson, H.J., Kane, R.T. et al. Anxiety as a Mediator Between Perfectionism and Eating Disorders. Cogn Ther Res 37, 905–913 (2013). https://doi.org/10.1007/s10608-012-9516-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10608-012-9516-x