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The interaction of perfectionism, perceived weight status, and self-esteem to predict bulimic symptoms: The role of ‘benign’ perfectionism

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Abstract

The present study sought to replicate an interactive model of global perfectionism, perceived weight status, and self-esteem in predicting bulimic symptom development in a sample of young women [Bardone-Cone, et al. (2006). Predicting bulimic symptoms: An interactive model of self-efficacy, perfectionism, and perceived weight status. Behaviour Research and Therapy, 44, 27–42; Vohs, K. D., et al. (1999). Perfectionism, perceived weight status, and self-esteem interact to predict bulimic symptoms: A model of bulimic symptom development. Journal of Abnormal Psychology, 108, 695–700; Vohs, K. D., et al. (2001). Perfectionism, body dissatisfaction, and self-esteem: An interactive model of bulimic symptom development. Journal of Social and Clinical Psychology, 20, 476–497]. The aim was to investigate the role of ‘problematic’ and ‘benign’ perfectionism within this model, using data from 95 female university students over a 3-month period. Contrary to hypotheses, multivariate analyses revealed a significant three-way interaction only between ‘benign’ perfectionism, perceived weight status and self-esteem in predicting change in bulimic symptoms over a 3-month period. The predictive effect of the interaction between ‘benign’ perfectionism and perceived weight status on bulimic symptoms was strongest for women with high self-esteem, for whom feeling overweight and having perfectionistic attitudes preceded increased bulimic symptoms. These findings suggest that high self-esteem is insufficient to protect against the development of bulimic symptoms when both the perception of oneself as being overweight, and high levels of perfectionistic standards, are present. It would appear that the role of perfectionism within the context of disordered eating is complex.

Introduction

In recent years, perfectionism has been hypothesised to play a causal role in eating disorders, though the exact nature of this relationship remains unclear (Franco-Paredes, Mancilla-Diaz, Vazquez-Arevalo, Lopez-Aguilar, & Alvarez-Rayon, 2005). Perfectionistic tendencies may be associated with a self-evaluation that tends to be reliant on the continual pursuit of, and ability to uphold, personally demanding standards. When an eating disorder is present, these standards are likely to pertain particularly to the domain of control over eating, shape, and weight, where the individual maintains a rigid desire to attain high standards of thinness and control (Shafran, Cooper, & Fairburn, 2002). Furthermore, it has been suggested that an eating disorder may exist as an expression of perfectionism where this trait may precede the clinical disorder. If this is the case, it is likely that the individual will also exhibit perfectionistic tendencies in other (more global) domains (Shafran et al., 2002).

While there exists much cross-sectional research in support of an association between global perfectionism and disordered eating, the longitudinal (and therefore antecedent) relationship between these variables remains somewhat unclear (Shafran & Mansell, 2001), particularly in the case of bulimic symptoms. In reviewing the empirical findings of risk factors for eating disorders, a recent paper concluded that, at present, perfectionism could only be considered a “correlate” rather than a “risk factor” of Bulimia Nervosa (BN; Jacobi, Hayward, de Zwaan, Kraemer, & Agras, 2004). Given on the one hand the paucity of evidence-based findings regarding the direct association between perfectionism and bulimic symptoms and, on the other hand, the theoretical conceptualizations of the importance of perfectionism in the development of an eating disorder (Fairburn, Cooper, & Shafran, 2003), researchers have started questioning whether the role of global perfectionism in the development of bulimic symptoms might exist only in combination with other variables (Stice, 2002).

Perfectionism within the context of an interactive model has recently been shown to predict bulimic symptoms (e.g., Bardone-Cone, Abramson, Vohs, Heatherton, & Joiner, 2006; Joiner, Heatherton, Rudd, & Schmidt, 1997; Vohs, Bardone, Joiner, Abramson, & Heatherton, 1999; Vohs et al., 2001). Vohs et al. (1999) postulated that self-esteem moderated the previously found relationship between bulimic symptoms and the interaction between perfectionism and perceived weight status (e.g., Joiner et al., 1997). That is, for perfectionistic individuals with high self-esteem, it was predicted that the unmet goal (i.e., feeling overweight) would be viewed as only a temporary, changeable situation rather than as a fixed state that could be changed given an acceptable level of effort. Thus, these individuals might work to achieve their weight goal. For perfectionists with low self-esteem who might experience difficulty in achieving their weight goal, this stressor is likely to be resolved in less productive ways (e.g., bulimic symptoms).

This model has been confirmed in three longitudinal studies of university students. Using a sample of 342 women, Vohs et al. (1999) found a significant interaction between perfectionism, weight perceptions, and self-esteem in predicting subsequent bulimic symptoms over a 9-month follow-up. Bulimic symptoms were greater for those who had higher perfectionism, perceptions of being overweight, and lower self-esteem at baseline. In a replication of this model, in a sample of 70 women, the interaction of perfectionism, body dissatisfaction, and self-esteem was associated with bulimic symptoms 5 weeks later (Vohs et al., 2001). Individuals who reported higher perfectionism, increased body dissatisfaction, and low self-esteem at Time 1 had more bulimic symptoms at Time 2, even after statistically controlling for the effects of depression and anxiety. A more recent replication, using a sample of 406 young women, also found an interaction between perfectionism, weight perception, and self-efficacy to predict binge eating (Bardone-Cone et al., 2006). Women with high perfectionism, perceptions of being overweight, and low self-efficacy at Time 1 reported the most binge eating episodes 11 weeks later. In contrast to the two previous studies, where bulimic symptoms were measured using the Eating Disorder Inventory (EDI: Garner, Olmstead, & Polivy, 1983), binge eating was assessed using the Eating Disorder Examination questionnaire (Fairburn & Beglin, 1994), widely considered to be a more accurate diagnostic measure than the EDI.

Following from these promising findings, an independent research group attempted to replicate the Vohs, Bardone, Joiner, Abramson, & Heatherton (1999), Vohs et al. (2001) model with a younger female sample (mean age of 13 years) over a 1-year follow-up period (Shaw, Stice, & Springer, 2004). However, these researchers were unable to replicate the three-way interaction. Consequently, Shaw et al. concluded that the previously observed interaction may not be a robust finding, and that alternative multivariate models of bulimic pathology need to be investigated. It is possible that developmental processes need to be considered within the interactive model, given that perfectionism only starts to reach its peak in 15-year olds (Marshall, Gardiner, & Greely, 2004).

To date, all tests of the interactive model have used the unidimensional EDI measure of perfectionism (Garner et al., 1983), despite perfectionism being conceptualized in many different ways and a current debate regarding this construct as a unidimensional versus multidimensional construct (see Dunkley, Blankstein, Masheb, & Grilo, 2006; Hewitt, Flett, Besser, Sherry, & McGee, 2003; Shafran et al., 2002). Some theorists (e.g., Bieling, Israeli, & Antony, 2004) argue that there exist at least two types of perfectionism; perfectionism that is problematic for people (e.g., where high standards might be pursued despite significant adverse consequences), and perfectionism that is benign for people (e.g., the setting of normal high standards). A consistent finding, based on factor analyses, is that the Concern Over Mistakes (CM) and Personal Standards (PS) subscales of the Multidimensional Perfectionism Scale (MPS; Frost, Marten, Lahart, & Rosenblate et al., 1990) load highly on these types of ‘problematic’ and ‘benign’ perfectionism, respectively (Ashby, Kottman, & Schoen, 1998; Frost, Heimberg, Holt, Mattia, & Neubauer, 1993; Terry-Short, Owens, Slade, & Dewey, 1995). The CM subscale assesses negative reactions to making mistakes and a self-evaluative tendency to equate mistakes with being a failure as a person, whereas the PS subscale reflects the setting of high standards and goals for oneself.

Similar to the research using measures of global perfectionism, the associations between disordered eating and specific types of perfectionism have not been conclusive. Both the CM subscale and the PS subscale have been shown to be elevated in women with BN and in women who have recovered from BN compared with healthy controls (Lilenfeld et al., 2000). Two studies have shown a cross-sectional association between eating pathology and the CM, but not the PS, subscale (Bulik et al., 2003; Minarik & Ahrens, 1996). Given these research findings and the weight of current evidence involving the relationship between self-critical evaluative concerns and psychopathology in binge-eating disorder (e.g., Dunkley et al., 2006), it would seem that ‘problematic’ perfectionism (CM perfectionism) might be more closely associated with disordered eating than ‘benign’ perfectionism, though the role of ‘benign’ perfectionism is less well understood. Thus, we hypothesise that CM perfectionism will be more likely to be a significant predictor in an interactive model than PS perfectionism.

Different types of perfectionism, and their relationships with bulimic symptoms, have not yet been examined within an interactive model. Thus, consistent with the conclusions of Shaw et al. (2004), who suggested testing alternative variations of the interactive model, the aim of the current research was to evaluate the Vohs, Bardone, Joiner, Abramson, & Heatherton (1999), Vohs et al. (2001) three-way interaction using specific components of perfectionism. It is hypothesised that the magnitude of the three-way interaction between perfectionism, perceived weight status, and self-esteem in predicting bulimic symptoms would be strongest when investigating perfectionism as a ‘problematic’ construct compared to investigating perfectionism as a ‘benign’ construct.

Section snippets

Participants

Females aged 18 years or over were recruited from a pool of volunteer first year university Psychology students. At Time 1 (T1), 133 participants completed the questionnaire, of which 108 (81.2% of initial sample) consented to participate in the 3-month follow-up at Time 2 (T2). Of the 108 consenting participants, 95 (71.4% of initial sample) completed the T2 assessment. The longitudinal sample therefore consisted of 95 participants (mean age=22.08 years, SD=7.16). Independent samples t-tests

Descriptive analyses

All results presented are for the longitudinal sample (n=95). As might be expected in a non-clinical sample, the distributions of bulimic symptoms at T1 and T2 were positively skewed. T1 and T2 bulimic symptoms were both transformed using a log transformation (Tabachnick & Fidell, 2001).

On average, there was no statistically significant change in bulimic symptoms across the three-month period (t=-1.02, p>.05) from T1 (M=2.17, SD=.79) to T2 (M=2.12, SD=.81).1

Discussion

The aim of the present study was to investigate the Vohs, Bardone, Joiner, Abramson, & Heatherton (1999), Vohs et al. (2001) model for bulimic symptomatology in a female university population using measures of ‘problematic’ perfectionism (e.g., CM) and ‘benign’ perfectionism (e.g., PS), rather than a measure of global perfectionism. In contrast to our prediction, the multivariate analyses revealed a significant three-way interaction only between PS perfectionism, perceived weight status, and

Acknowledgements

This research was supported by Flinders RSM grants to AS and NC. We would like to thank the participants who gave of their time to be part of this study. We would also like to thank Paul Williamson and Kylie Lange for their statistical advice.

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