Abstract
Perfectionism is hypothesized to contribute to the etiology of anorexia nervosa (AN). However, there is little research regarding whether individuals with AN can be classified according to maladaptive (e.g., evaluative concerns) and adaptive (e.g., high personal standards) facets of perfectionism that predict distinct outcomes and might warrant different intervention approaches. In this study, a latent profile analysis was conducted using data from adults with AN (n = 118). Frost Multidimensional Perfectionism Scale (Frost et al. Cognitive Therapy and Research, 14(5), 449–46, 1990) subscales were used to identify subgroups differing according to endorsed perfectionism features (e.g., adaptive and maladaptive perfectionism). Generalized linear models were used to compare subgroups on eating disorder and affective symptoms measured through questionnaire and ecological momentary assessment. Four subgroups were identified: (a) Low Perfectionism; (b) High Adaptive and Maladaptive Perfectionism; (c) Moderate Maladaptive Perfectionism; and (d) High Maladaptive Perfectionism. Subgroups differed on overall eating disorder symptoms (p < .001), purging (p = .005), restrictive eating (p < .001), and body checking (p < .001) frequency, depressive (p < .001) and anxiety (p < .001) symptoms, and negative (p = .001) and positive (p < .001) affect. The Low Perfectionism group displayed the most adaptive scores and the Moderate and High Maladaptive Perfectionism groups demonstrated the most elevated clinical symptoms. The High Adaptive and Maladaptive Perfectionism group demonstrated low affective disturbances, but elevated eating disorder symptoms. Results support the clinical significance of subtyping according to perfectionism dimensions in AN. Research is needed to determine if perfectionism subtyping can enhance individualized treatment targeting in AN.
Similar content being viewed by others
References
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: APA Press.
Ashby, J. S., Kottman, T., & Schoen, E. (1998). Perfectionism and eating disorders reconsidered. Journal of Mental Health Counseling, 20(3), 261–271.
Bastiani, A. M., Rao, R., Weltzin, T., & Kaye, W. H. (1995). Perfectionism in anorexia nervosa. International Journal of Eating Disorders, 17(2), 147–152.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4(6), 561–571.
Beck, A. T., Steer, R. A., & Garbin, M. G. (1988). Psychometric properties of the Beck depression inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8(1), 77–100.
Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society. Series B, Methodological, 57(1), 289–300.
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(3), 428–438.
Besharat, M. A., & Shahidi, S. (2010). Perfectionism, anger, and anger rumination. International Journal of Psychology, 45(6), 427–434.
Bieling, P. J., Israeli, A. L., & Antony, M. M. (2004). Is perfectionism good, bad, or both? Examining models of the perfectionism construct. Personality and Individual Differences, 36, 1373–1385.
Boone, L., Soenens, B., Braet, C., & Goossens, L. (2010). An empirical typology of perfectionism in early-to-mid adolescents and its relation with eating disorder symptoms. Behaviour Research and Therapy, 48(7), 686–691.
Bozdogan, H. (1987). Model selection and Akaike's information criterion (AIC): The general theory and its analytical extensions. Psychometrika, 52(3), 345–370.
Bulik, C. M., Tozzi, F., Anderson, C., Mazzeo, S. E., Aggen, S., & Sullivan, P. F. (2003). The relation between eating disorders and components of perfectionism. American Journal of Psychiatry, 160(2), 366–368.
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 & Cognitive-Behavior Therapy, 22, 237–250.
Engel, S.G., Wonderlich, S.A., Crosby, R.D., Mitchell, J.E., Crow, S., Peterson, C.B., Le Grange, D., Simonich, H.K., Cao, L., Lavender, J.M., & Gordon, K.H. (2013). The role of affect in the maintenance of anorexia nervosa: Evidence from a naturalistic assessment of momentary behaviors and emotion. Journal of Abnormal Psychology 122(3), 709–719.
Enns, M. W., Cox, B. J., & Clara, I. (2005). Perfectionism and neuroticism: A longitudinal study of specific vulnerability and diathesis- stress models. Cognitive Therapy and Research, 29(4), 463–478.
Espeset, E. M., Gulliksen, K. S., Nordbø, R. H., Skårderud, F., & Holte, A. (2012). The link between negative emotions and eating disorder behaviour in patients with anorexia nervosa. European Eating Disorders Review, 20(6), 451–460.
Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders (1st ed.). New York: The Guilford Press.
Fairburn, C. G., & Cooper, Z. (1995). The eating disorder examination, 12th Ed. In C. G. Fairburn & G. T. Wilson (Eds.), Binge eating: Nature, assessment, and treatment (pp. 317–360). New York: Guilford.
First, M., Spitzer, R., Gibbon, M., & Williams, J. (1995). Structured clinical interview for DSM–IV Axis I disorders: Patient edition (SCIDI/P). New York: Biometrics.
Fitzsimmons-Craft, E.E., Accurso, E.C., Ciao, A.C., Crosby, R.D., Cao, L., Pisetsky, E.M., Le Grange, D., Peterson, C.B., Crow, S.J., Engel, S.G., Mitchell, J.E., & Wonderlich, S.A. (2015). Restrictive eating in anorexia nervosa: Examining maintenance and consequences in the natural environment. International Journal of Eating Disorders, 48(7), 923–931.
Flett, G. L., & Hewitt, P. L. (2002). Perfectionism and maladjustment: An overview of theoretical, definitional, and treatment issues. In G. L. Flett & P. L. Hewitt (Eds.), Perfectionism: Theory, research, and treatment (pp. 5–31). Washington, DC: American Psychological Association.
Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14(5), 449–468.
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, 119–126.
Gaudreau, P., & Thompson, A. (2010). Testing a 2 × 2 model of dispositional perfectionism. Personality and Individual Differences, 48(5), 532–537.
Goldschmidt, A.B., Wonderlich, S.A., Crosby, R.D., Cao, L., Engel, S.G., Lavender, J.M., Mitchell, J.E., Crow, S.J., Peterson, C.B., & Le Grange, D. (2014). Latent profile analysis of eating episodes in anorexia nervosa. Journal of Psychiatric Research, 53, 193–199.
Halmi, K. A., Sunday, S. R., Strober, M., Kaplan, A., Woodside, D. B., Fichter, M., Treasure, J., Berrettini, W. H., & Kaye, W. H. (2000). Perfectionism in anorexia nervosa: Variation by clinical subtype, obsessionality, and pathological eating behavior. American Journal of Psychiatry, 157(11), 1799–1805.
Haynos, A. F., Berg, K. C., Cao, L., Crosby, R. D., Lavender, J. M., Utzinger, L. M., Wonderlich, S. A., Engel, S. G., Mitchell, J. E., le Grange, D., Peterson, C. B., & Crow, S. J. (2017). Trajectories of global and individual facets of negative and positive affect surrounding restrictive eating in anorexia nervosa. The Journal of Abnormal Psychology, 126(5), 495–505.
Kaye, W. H., Bulik, C. M., Thornton, L., Barbarich, N., & Masters, K. (2004). Comorbidity of anxiety disorders with anorexia and bulimia nervosa. American Journal of Psychiatry, 161(12), 2215–2221.
Kim, L. E., Chen, L., MacCann, C., Karlov, L., & Kleitman, S. (2015). Evidence for three factors of perfectionism: Perfectionistic strivings, order, and perfectionistic concerns. Personality and Individual Differences, 84, 16–22.
Lavender, J. M., Mason, T. B., Utzinger, L. M., Wonderlich, S. A., Crosby, R. D., Engel, S. G., Mitchell, J. E., le Grange, D., Crow, S. J., & Peterson, C. B. (2016). Examining affect and perfectionism in relation to eating disorder symptoms among women with anorexia nervosa. Psychiatry Research, 241, 267–272.
Lavender, J.M., Wonderlich, S.A., Crosby, R.D., Engel, S.G., Mitchell, J.E., Crow, S.J., Peterson, C.B., & Le Grange, D. (2013). Personality-based subtypes of anorexia nervosa: Examining validity and utility using baseline clinical variables and ecological momentary assessment. Behaviour Research and Therapy, 51(8), 512–517.
Pacht, A. R. (1984). Reflections on perfection. American Psychologist, 39(4), 386–390.
Rice, K. G., & Ashby, J. S. (2007). An efficient method for classifying perfectionists. Journal of Counseling Psychology, 54(1), 72–85.
Rice, K. G., & Richardson, C. M. (2014). Classification challenges in perfectionism. Journal of Counseling Psycholgy, 61(4), 641–648.
Schmidt, U., & Treasure, J. (2006). Anorexia nervosa: Valued and visible. A cognitive-interpersonal maintenance model and its implications for research and practice. British Journal of Clinical Psychology, 45(3), 343–366.
Schwarz, G. (1978). Estimating the dimension of a model. Annals of Statistics, 6(2), 461–464.
Sironic, A., & Reeve, R. A. (2015). A combined analysis of the frost multidimensional perfectionism scale (FMPS), child and adolescent perfectionism scale (CAPS), and almost perfect scale-revised (APS-R): Different perfectionist profiles in adolescent high school students. Psychological Assessment, 27(4), 1471–1483.
Slof-Op't Landt, M. C., Claes, L., & van Furth, E. F. (2016). Classifying eating disorders based on "healthy" and "unhealthy" perfectionism and impulsivity. International Journal of Eating Disorders, 49(7), 673–680.
Spielberger, C. D. (1983). Manual for the State-Trait Anxiety Inventory (STAI). Palo Alto: Consulting Psychologists Press.
Srinivasagam, N. M., Kaye, W. H., Plotnicov, K. H., Greeno, C., Weltzin, T. E., & Rao, R. (1995). Persistent perfectionism, symmetry, and exactness after long-term recovery from anorexia nervosa. American Journal of Psychiatry, 152(11), 1630–1634.
Stoeber, J., & Otto, K. (2006). Positive conceptions of perfectionism: Approaches, evidence, challenges. Personality and Social Psychology Review, 10(4), 295–319.
Vermunt, J. K., & Magidson, J. (2005). Latent GOLD 4.0. User’s guide. Belmont: Statistical Innovations, Inc..
Watson, D., & Clark, L. A. (1994) The PANAS-X: Manual for the positive and negative affect schedule- expanded form. Iowa City: Department of Psychological & Brain Sciences Publications, University of Iowa.
Wildes, J. E., & Marcus, M. D. (2013). Incorporating dimensions into the classification of eating disorders: Three models and their implications for research and clinical practice. International Journal of Eating Disorders, 46(5), 396–403.
Wonderlich, S. A., Joiner Jr., T. E., Keel, P. K., Williamson, D. A., & Crosby, R. D. (2007). Eating disorder diagnoses: Empirical approaches to classification. American Psychologist, 62(3), 167–180.
Funding
This work was supported by grants P30DK050456 from the National Institute of Diabetes and Digestive and Kidney Diseases, grants R01MH059674, T32MH082761, and K23MH112867 from the National Institute of Mental Health, and the Neuropsychiatric Research Institute.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Ann F. Haynos, Linsey M. Utzinger, Jason M. Lavender, Ross D. Crosby, Li Cao, Carol B. Peterson, Scott J. Crow, Stephen A. Wonderlich, Scott G. Engel, James E. Mitchell, Daniel Le Grange and Andrea B. Goldschmidt declare that they have no conflict of interest.
Experiment Participants
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Rights and permissions
About this article
Cite this article
Haynos, A.F., Utzinger, L.M., Lavender, J.M. et al. Subtypes of Adaptive and Maladaptive Perfectionism in Anorexia Nervosa: Associations with Eating Disorder and Affective Symptoms. J Psychopathol Behav Assess 40, 691–700 (2018). https://doi.org/10.1007/s10862-018-9672-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10862-018-9672-8