Skip to main content
SpringerLink
Log in

Exploring the Relationship Between Social Anxiety and Bulimic Symptoms: Mediational Effects of Perfectionism Among Females

  • Original Article
  • Published:
Cognitive Therapy and Research Aims and scope Submit manuscript

Abstract

Previous findings indicate that social anxiety and bulimia co-occur at high rates; one mechanism that has been proposed to link these symptom clusters is perfectionism (Silgado et al. in Cogn Ther Res 34(5):487–492, 2010). We tested meditational models among 167 female undergraduates in which maladaptive evaluative perfectionism concerns (MEPC; i.e., critical self-evaluative perfectionism) mediated the relationship between social anxiety and bulimic symptoms. Results from a first model indicated that MEPC mediated the relationship between fear of public scrutiny and bulimia symptoms. This indirect effect was significant above and beyond the indirect effects of maladaptive body-image cognitions and perfectionism specific to pure personal standards. A second model was tested with MEPC mediating the relationship between social interaction anxiety and bulimia symptoms. Similar results were obtained; however, in this model, a significant direct effect remained after partialing out the indirect effect of the mediators. Theoretical implications are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. This macro is available at no cost, and may be downloaded from the following link: http://www.afhayes.com/spss-sas-and-mplus-macros-and-code.html.

  2. Body-image cognitive distortions and personal standards were entered into the model but not examined directly because we were interested in determining the unique indirect effect of maladaptive perfectionism between social interaction anxiety and bulimia symptoms, above and beyond negative body-image cognitions and pure personal standards.

  3. One reviewer commented that an interactive relationship (similar to that which was reported by Silgado et al. 2010) may provide a viable alternative framework by which to consider the relationship between SAD, perfectionism, and bulimia symptoms. Specifically, Silgado et al. reported that perfectionism moderated the relationship between SAD and bulimia such that individuals high in both SAD and perfectionism reported the highest levels of bulimia symptoms. In response to this comment, the authors of the present study conducted moderation analyses in an attempt to replicate the results of Silgado et al. but did not find a significant SA by perfectionism interaction term predicting bulimia symptoms.

References

  • Antony, M. M., Purdon, C. L., Huta, V., & Swinson, R. P. (1998). Dimensions of perfectionism across the anxiety disorders. Behaviour Research and Therapy, 36, 1143–1154. doi:10.1016/S0005-7967(98)00083-7.

    Article  PubMed  CAS  Google Scholar 

  • Ashbaugh, A., Antony, M. M., Liss, A., Summerfeldt, L. J., McCabe, R. E., & Swinson, R. P. (2007). Changes in perfectionism following cognitive-behavioral treatment for social phobia. Depression and Anxiety, 24, 169–177. doi:10.1002/da.20219.

    Article  PubMed  Google Scholar 

  • Bieling, P. J., Israeli, A., Smith, J., & Antony, M. M. (2003). Making the grade: The behavioral consequences of perfectionism in the classroom. Personality and Individual Differences, 35, 163–178. doi:10.1016/S0191-8869(02)00173-3.

    Article  Google Scholar 

  • Brewerton, T. D., Lydiard, R. B., Herzog, D. B., Brotman, A., O’Neil, P., & Ballenger, J. C. (1995). Comorbidity of axis I psychiatric disorders in bulimia nervosa. Journal of Clinical Psychiatry, 56, 77–80.

    PubMed  CAS  Google Scholar 

  • Buckner, J. D., Silgado, J., & Lewinsohn, P. M. (2010). Delineation of differential temporal relations between specific eating and anxiety disorders. Journal of Psychiatric Research, 44, 781–787. doi:10.1016/j.jpsychires.2010.01.014.

    Article  PubMed  Google Scholar 

  • Bulik, C., Sullivan, P., Carter, A., & Joyce, P. (1996). Lifetime anxiety disorders in women with bulimia nervosa. Comprehensive Psychiatry, 37, 368–374. doi:10.1016/S0010-440X(96)90019-X.

    Article  PubMed  CAS  Google Scholar 

  • Cash, T. F., & Szymanski, M. L. (1995). The development and validation of the body-image ideals questionnaire. Journal of Personality Assessment, 64, 466. doi:10.1207/s15327752jpa6403_6.

    Article  PubMed  CAS  Google Scholar 

  • DiBartolo, P. M., Frost, R. O., Chang, P., LaSota, M., & Grills, A. E. (2004). Shedding light on the relationship between personal standards and psychopathology: The case for contingent self-worth. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 22, 241–254.

    Google Scholar 

  • DiBartolo, P. M., Li, C. Y., & Frost, R. O. (2008). How do the dimensions of perfectionism related to health? Cognitive Therapy and Research, 32(3), 401–417. doi:10.1023/B:JORE.0000047310.94044.ac.

    Article  Google Scholar 

  • Efron, B., & Tibshirani, R. (1993). An introduction to the bootstrap. Boca Raton, FL: Chapman & Hall.

    Google Scholar 

  • Egan, S. J., & Hine, P. (2008). Cognitive behavioural treatment of perfectionism: A single case experimental design series. Behaviour Change, 25, 245–258. doi:10.1375/bech.25.4.245.

    Article  Google Scholar 

  • Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: A clinical review. Clinical Psychology Review, 31, 203–212. doi:10.1016/j.cpr.2010.04.009.

    Article  PubMed  Google Scholar 

  • Frost, R. O., Heimberg, R. G., Holt, C. S., Mattia, J. I., & Neubauer, A. L. (1993). A comparison of two measures of perfectionism. Personality and Individual Differences, 14(1), 119–126. doi:10.1016/0191-8869(93)90181-2.

    Article  Google Scholar 

  • Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14(5), 449–468. doi:10.1007/BF01172967.

    Article  Google Scholar 

  • Garner, D. M., Olmstead, M. P., & Polivy, J. (1983). Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. International Journal of Eating Disorders, 2(2), 15–34. doi:10.1002/1098-108X(198321)2:2<15:AID-EAT2260020203>3.0.CO;2-6.

    Article  Google Scholar 

  • Glover, D. S., Brown, G. P., Fairburn, C. G., & Shafran, R. (2007). A preliminary evaluation of cognitive-behaviour therapy for clinical perfectionism: A case series. British Journal of Clinical Psychology, 46, 85–94. doi:10.1348/014466506X117388.

    Article  PubMed  Google Scholar 

  • Godart, N. T., Flament, M. F., Perdereau, F., & Jeammet, P. (2002). Comorbidity between eating disorders and anxiety disorders: A review. International Journal of Eating Disorders, 32(3), 253–270. doi:10.1002/eat.10096.

    Article  PubMed  CAS  Google Scholar 

  • Heatherton, T. F., & Baumeister, R. F. (1991). Binge eating as escape from self-awareness. Psychological Bulletin, 110, 86–108. doi:10.1037//0033-2909.110.1.86.

    Article  PubMed  CAS  Google Scholar 

  • Heatherton, T. F., Nichols, P., Mahamedi, F., & Keel, P. (1995). Body weight, dieting, and eating disorder symptoms among college students, 1982 to 1992. The American Journal of Psychiatry, 152(11), 1623–1629.

    PubMed  CAS  Google Scholar 

  • Heimberg, R. G., Brozovich, F. A., & Rapee, R. M. (2010). A cognitive behavioral model of social anxiety disorder: Update and extension. In S. G. Hofmann & P. M. DiBartolo (Eds.), Social anxiety: Clinical development, and social perspectives (pp. 395–422). London: Academic Press.

    Google Scholar 

  • Heimberg, R. G., Juster, H. R., Hope, D. A., & Mattia, J. I. (1995). Cognitive-behavioral group treatment: Description, case presentation, and empirical support. In M. B. Stein (Ed.), Social phobia: Clinical and research perspectives (pp. 293–321). Arlington, VA: American Psychiatric Association.

  • Hinrichson, H., Wright, F., Waller, G., & Meyer, C. (2003). Social anxiety and coping strategies in the eating disorders. Eating Behaviors, 4, 117–126. doi:10.1016/S1471-0153(03)00016-3.

    Article  Google Scholar 

  • Hope, D. A., Heimberg, R. G., Juster, H. R., & Turk, C. L. (2000). Managing social anxiety: A cognitive-behavioral therapy approach (client workbook). New York, NY: Oxford University Press.

    Google Scholar 

  • Jakatdar, T. A., Cash, T. F., & Engle, E. K. (2006). Body-image thought processes: The development and initial validation of the assessment of body-image cognitive distortions. Body Image, 3, 325–333. doi:10.1016/j.bodyim.2006.09.001.

    Article  PubMed  Google Scholar 

  • Kaye, W., Bulik, C., Thornton, L., Barbarich, N., Masters, K., & the Price Foundation Collaborative Group. (2004). Co-morbidity of anxiety disorders with anorexia and bulimia nervosa. The American Journal of Psychiatry, 161, 2215–2221.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62(6), 617–627. doi:10.1001/archpsyc.62.6.617.

    Article  PubMed  Google Scholar 

  • Lundh, L. D., & Öst, L. G. (2001). Attentional bias, self-consciousness and perfectionism in social phobia before and after cognitive-behaviour therapy. Scandinavian Journal of Behaviour Therapy, 30, 4–16. doi:10.1080/028457101300140428.

    Google Scholar 

  • Mattick, R. P., & Clarke, J. C. (1998). Development and validation if measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455–470.

    Article  PubMed  CAS  Google Scholar 

  • Maxwell, S. E., & Cole, D. A. (2007). Bias in cross-sectional analyses of longitudinal mediation. Psychological Methods, 12(1), 23–44. doi:10.1037/1082-989X.12.1.23.

    Article  PubMed  Google Scholar 

  • Pallister, E., & Waller, G. (2008). Anxiety in the eating disorders: Understanding the overlap. Clinical Psychology Review, 28, 366–386. doi:10.1016/j.cpr.2007.07.001.

    Article  PubMed  Google Scholar 

  • Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–891. doi:10.3758/BRM.40.3.879.

    Article  PubMed  Google Scholar 

  • Riley, C., Lee, M., Cooper, Z., Fairburn, C. G., & Shafran, R. (2007). A randomised controlled trial of cognitive-behaviour therapy for clinical perfectionism: A preliminary study. Behaviour Research and Therapy, 45, 2221–2231. doi:10.1016/j.brat.2006.12.003.

    Article  PubMed  Google Scholar 

  • Rodebaugh, T. L., Heimberg, R. G., Brown, P. J., Fernandez, K. C., Blanco, C., Schneier, F. R., et al. (2011). More reasons to be straightforward: Findings and norms for two scales relevant to social anxiety. Journal of Anxiety Disorders, 25(5), 623–630.

    Article  PubMed  Google Scholar 

  • Rodebaugh, T. L., Woods, C. M., & Heimberg, R. G. (2007). The reverse of social anxiety is not always the opposite: The reverse-scored items of the social interaction anxiety scale do not belong. Behavior Therapy, 38, 192–206. doi:10.1016/j.beth.2006.08.001.

    Article  PubMed  Google Scholar 

  • Shafran, R., Cooper, Z., & Fairburn, C. G. (2002). Clinical perfectionism: A cognitive-behavioural analysis. Behaviour Research and Therapy, 40, 773–791.

    Article  PubMed  Google Scholar 

  • Shumaker, E. A., & Rodebaugh, T. L. (2009). Perfectionism and social anxiety: Rethinking the role of high standards. Journal of Behavior Therapy and Experimental Psychiatry, 40(3), 423–433. doi:10.1016/j.jbtep.2009.04.002.

    Article  PubMed  Google Scholar 

  • 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(5), 487–492. doi:10.1007/s10608-009-9278-2.

    Article  Google Scholar 

  • Steele, A., Corsini, N., & Wade, T. D. (2007). The interaction of perfectionism, perceived weight status, and self-esteem to predict bulimia symptoms: The role of ‘benign’ perfectionism. Behaviour Research and Therapy, 45(7), 1647–1655.

    Article  PubMed  Google Scholar 

  • Steele, A. L., & 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. doi:10.1016/j.brat.2008.09.006.

    Article  PubMed  Google Scholar 

  • Swinbourne, J. M., & Touyz, S. W. (2007). The co-morbidity of eating disorders and anxiety disorders: A review. European Eating Disorders Review, 15, 253–274. doi:10.1002/erv.784.

    Article  PubMed  Google Scholar 

  • Vohs, K. D., Bardone, A. M., Joiner, T. E., & Abramson, L. Y. (1999). Perfectionism, perceived weight status, and self-esteem interact to predict bulimic symptoms: A model of bulimic symptom development. Journal of Abnormal Psychology, 108(4), 695–700. doi:10.1037//0021-843X.108.4.695.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors have no conflict of interest to report.

Author information

Authors and Affiliations

  1. Ohio University, 200 Porter Hall, Athens, OH, 45701, USA

    Andrew R. Menatti, Justin W. Weeks & Maggie M. McGowan

  2. Washington University in St. Louis, St. Louis, MO, USA

    Cheri A. Levinson

Authors
  1. Andrew R. Menatti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Justin W. Weeks
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cheri A. Levinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maggie M. McGowan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Justin W. Weeks.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Menatti, A.R., Weeks, J.W., Levinson, C.A. et al. Exploring the Relationship Between Social Anxiety and Bulimic Symptoms: Mediational Effects of Perfectionism Among Females. Cogn Ther Res 37, 914–922 (2013). https://doi.org/10.1007/s10608-013-9521-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10608-013-9521-8

Keywords

Search

Navigation