Abstract
This study examined the relationship between perfectionism and eating pathology, and investigated the mediating role of body dissatisfaction and alexithymia in the relationship. Two studies were employed in the current research. A large sample (N = 2420) with cross-sectional data was used to determine the relationship between perfectionism and eating pathology, whereas three-wave longitudinal data (N = 312) with three-month intervals were used to examine the mediation models. The results indicated that: (1) Perfectionism was significantly associated with eating pathology, after controlling for relevant demographic factors. (2) Both body dissatisfaction and alexithymia fully mediated the relationship between perfectionism and eating pathology in the single mediation models. (3) Body dissatisfaction emerged as the stronger mediator in the relationship in the parallel mediation model. The results indicated that among Chinese college students, perfectionism had an indirect effect on eating pathology, through body dissatisfaction and alexithymia, and body dissatisfaction was shown to be a stronger pathway. The current findings highlighted the need to focus on college students with higher levels of perfectionism and mitigate the risk of eating pathology by improving body image and enhancing emotion awareness and expression.
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Part of the datasets generated during and/or analyzed during the current study are available at https://osf.io/m8vu6/.
References
Alfalahi, M., Mahadevan, S., Balushi, R., Chan, M. F., Saadon, M. A., Al-Adawi, S., & Qoronfleh, M. W. (2021). Prevalence of eating disorders and disordered eating in Western Asia: A systematic review and meta-Analysis.Eating Disorders,1–30.
Bagby, R. M., Taylor, G. J., & Parker, J. D. A. (1994). The twenty-item Toronto Alexithymia Scale—II. Convergent, discriminant, and concurrent validity. Journal of Psychosomatic Research, 38(1), 33–40.
Bardone-Cone, A. M., Abramson, L. Y., Vohs, K. D., Heatherton, T. F., & Joiner, T. E. Jr. (2006). Predicting bulimic symptoms: an interactive model of self-efficacy, perfectionism, and perceived weight status. Behaviour Research and Therapy, 44(1), 27–42.
Bardone-Cone, A. M., Wonderlich, S. A., Frost, R. O., Bulik, C. M., Mitchell, J. E., Uppala, S., & Simonich, H. (2007). Perfectionism and eating disorders: current status and future directions. Clinical Psychology Review, 27(3), 384–405.
Boone, L., Braet, C., Vandereycken, W., & Claes, L. (2013). Are maladaptive schema domains and perfectionism related to body image concerns in eating disorder patients? European Eating Disorders Review, 21(1), 45–51.
Boone, L., Soenens, B., & Braet, C. (2011). Perfectionism, body dissatisfaction, and bulimic symptoms: the intervening role of perceived pressure to be thin and thin ideal internalization. Journal of Social and Clinical Psychology, 30(10), 1043–1068.
Boone, L., Soenens, B., & Luyten, P. (2014). When or why does perfectionism translate into eating disorder pathology? A longitudinal examination of the moderating and mediating role of body dissatisfaction. Journal of Abnormal Psychology, 123(2), 412.
Casale, S., Biondi, V., & Pacini, S. (2011). Drive for thinness and bulimia: Directive and interactive effect of body dissatisfaction and perfectionism. Counseling: Giornale Italiano Di Ricerca e Applicazioni.
Cash, T. F. (1990). The multidimensional body-self relations questionnaire. Unpublished Test Manual, Old Dominion University, Norfolk, VA.
Chang, E. C., Chang, R., & Sanna, L. J. (2012). A test of the usefulness of perfectionism theory across cultures: does perfectionism in the US and Japan predict depressive symptoms across time? Cognitive Therapy and Research, 36(1), 1–14.
Chang, E. C., Yu, T., Chang, O. D., & Jilani, Z. (2016). Evaluative concerns and personal standards perfectionism as predictors of body dissatisfaction in asian and european american female college students. Journal of American College Health, 64(7), 580–584.
Cole, D. A., & Maxwell, S. E. (2003). Testing mediational models with longitudinal data: questions and tips in the use of structural equation modeling. Journal of Abnormal Psychology, 112, 558–577. https://doi.org/10.1037/0021-843X.112.4.558
Collaborators, G. B. D. 2015 O. (2017). Health effects of overweight and obesity in 195 countries over 25 years. New England Journal of Medicine, 377(1), 13–27.
Culbert, K. M., Sisk, C. L., & Klump, K. L. (2021). A narrative review of sex differences in eating disorders: is there a biological basis? Clinical Therapeutics, 43(1), 95–111.
da Silva, A. N., Vasco, A. B., & Watson, J. C. (2017). Alexithymia and emotional processing: a mediation model. Journal of Clinical Psychology, 73(9), 1196–1205.
Dahlenburg, S. C., Gleaves, D. H., & Hutchinson, A. D. (2019). Anorexia nervosa and perfectionism: a meta-analysis. International Journal of Eating Disorders, 52(3), 219–229. https://doi.org/10.1002/eat.23009
De Berardis, D., Serroni, N., Campanella, D., Carano, A., Gambi, F., Valchera, A., Conti, C., Sepede, G., Caltabiano, M., & Pizzorno, A. M. (2009). Alexithymia and its relationships with dissociative experiences, body dissatisfaction and eating disturbances in a non-clinical female sample. Cognitive Therapy and Research, 33(5), 471–479.
Dickie, L., Wilson, M., McDowall, J., & Surgenor, L. J. (2012). What components of Perfectionism Predict Drive for Thinness? Eating Disorders, 20(3), 232–247. https://doi.org/10.1080/10640266.2012.668484
Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: a clinical review. Clinical Psychology Review, 31(2), 203–212.
Etherson, M. E., Curran, T., Smith, M. M., Sherry, S. B., & Hill, A. P. (2022). Perfectionism as a vulnerability following appearance-focussed social comparison: a multi-wave study with female adolescents. Personality and Individual Differences, 186, 111355.
Fairburn, C. G., & Beglin, S. J. (1994). Assessment of eating disorders: interview or self-report questionnaire? International Journal of Eating Disorders, 16(4), 363–370.
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41(5), 509–528. https://doi.org/10.1016/S0005-7967(02)00088-8
Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14(5), 449–468.
Fuller-Tyszkiewicz, M., Rodgers, R. F., Maïano, C., Mellor, D., Sicilia, A., Markey, C. H., Aimé, A., Dion, J., Pietrabissa, G., & Coco, G. L. (2022). Testing of a model for risk factors for eating disorders and higher weight among emerging adults: baseline evaluation. Body Image, 40, 322–339.
Getz, M. J. (2014). The M yth of C hinese B arbies: eating disorders in C hina including H ong K ong. Journal of Psychiatric and Mental Health Nursing, 21(8), 746–754.
Gross, J. J. (2002). Emotion regulation: affective, cognitive, and social consequences. Psychophysiology, 39(3), 281–291.
Gu, L., Chen, J., Huang, Y., Kang, Q., Huang, J., He, Y., & Xiao, Z. P. (2017). Validity and reliability of the Chinese version of the Eating Disorder Examination Questionnaire 6.0 in female patients with eating disorders.Chinese Mental Health Journal.
Hasking, P., & Claes, L. (2020). Transdiagnostic mechanisms involved in nonsuicidal self-injury, risky drinking and disordered eating: Impulsivity, emotion regulation and alexithymia. Journal of American College Health, 68(6), 603–609.
Hayes, A. F. (2017). Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. Guilford publications.
Hemming, L., Taylor, P., Haddock, G., Shaw, J., & Pratt, D. (2019). A systematic review and meta-analysis of the association between alexithymia and suicide ideation and behaviour. Journal of Affective Disorders, 254, 34–48.
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(3), 456.
Honkalampi, K., Jokela, M., Lehto, S. M., Kivimäki, M., & Virtanen, M. (2022). Association between alexithymia and substance use: A systematic review and meta-analysis.Scandinavian Journal of Psychology.
Hund, A. R., & Espelage, D. L. (2006). Childhood emotional abuse and disordered eating among undergraduate females: mediating influence of alexithymia and distress. Child Abuse & Neglect, 30(4), 393–407.
Johnston, J., Shu, C. Y., Hoiles, K. J., Clarke, P. J. F., Watson, H. J., Dunlop, P. D., & Egan, S. J. (2018). Perfectionism is associated with higher eating disorder symptoms and lower remission in children and adolescents diagnosed with eating disorders. Eating Behaviors, 30, 55–60.
Keel, P. K., & Klump, K. L. (2003). Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology. Psychological Bulletin, 129(5), 747.
Kehayes, I. L. L., Smith, M. M., Sherry, S. B., Vidovic, V., & Saklofske, D. H. (2019). Are perfectionism dimensions risk factors for bulimic symptoms? A meta-analysis of longitudinal studies. Personality and Individual Differences, 138, 117–125. https://doi.org/10.1016/j.paid.2018.09.022
Li, X., Li, B., Lu, J., Jin, L., Xue, J., & Che, X. (2020). The relationship between alexithymia, hostile attribution bias, and aggression. Personality and Individual Differences, 159, 109869.
Limburg, K., Watson, H. J., Hagger, M. S., & Egan, S. J. (2017). The relationship between perfectionism and psychopathology: a meta-analysis. Journal of Clinical Psychology, 73(10), 1301–1326.
Lombardi, A., Gambaro, E., Prosperini, P., Antona, M., Delicato, C., Feggi, A., Rizza, M. C., Palazzolo, A., Binda, V., Chieppa, N., Do, F., Gramaglia, C., & Zeppegno, P. (2015). Feeling through the body: Alexithymia and eating disorders. European Psychiatry, 30(S1), 1. https://doi.org/10.1016/S0924-9338(15)31047-6
Mäkinen, M., Puukko-Viertomies, L. R., Lindberg, N., Siimes, M. A., & Aalberg, V. (2012). Body dissatisfaction and body mass in girls and boys transitioning from early to mid-adolescence: additional role of self-esteem and eating habits. Bmc Psychiatry, 12(1), 1–8.
Malivoire, B. L., Kuo, J. R., & Antony, M. M. (2019). An examination of emotion dysregulation in maladaptive perfectionism. Clinical Psychology Review, 71, 39–50.
Mushquash, A. R., & Sherry, S. B. (2013). Testing the perfectionism model of binge eating in mother–daughter dyads: a mixed longitudinal and daily diary study. Eating Behaviors, 14(2), 171–179.
Napolitano, F., Bencivenga, F., Pompili, E., & Angelillo, I. F. (2019). Assessment of knowledge, attitudes, and behaviors toward eating disorders among adolescents in Italy. International Journal of Environmental Research and Public Health, 16(8), 1448.
Nowakowski, M. E., McFarlane, T., & Cassin, S. (2013). Alexithymia and eating disorders: a critical review of the literature. Journal of Eating Disorders, 1(1), 1–14.
Palmeroni, N., Luyckx, K., Verschueren, M., & Claes, L. (2020). Body dissatisfaction as a mediator between identity formation and eating disorder symptomatology in adolescents and emerging adults. Psychologica Belgica, 60(1), 328.
Pandey, R., Saxena, P., & Dubey, A. (2011). Emotion regulation difficulties in alexithymia and mental health. Europe’s Journal of Psychology, 7(4), 604–623.
Parling, T., Mortazavi, M., & Ghaderi, A. (2010). Alexithymia and emotional awareness in anorexia nervosa: time for a shift in the measurement of the concept? Eating Behaviors, 11(4), 205–210.
Pearson, C. M., Miller, J., Ackard, D. M., Loth, K. A., Wall, M. M., Haynos, A. F., & Neumark-Sztainer, D. (2017). S tability and change in patterns of eating disorder symptoms from adolescence to young adulthood. International Journal of Eating Disorders, 50(7), 748–757.
Pike, K. M., & Dunne, P. E. (2015). The rise of eating disorders in Asia: a review. Journal of Eating Disorders, 3(1), 1–14.
Preece, D. A., Mehta, A., Becerra, R., Chen, W., Allan, A., Robinson, K., Boyes, M., Hasking, P., & Gross, J. J. (2022). Why is alexithymia a risk factor for affective disorder symptoms? The role of emotion regulation. Journal of Affective Disorders, 296, 337–341.
Rikani, A. A., Choudhry, Z., Choudhry, A. M., Ikram, H., Asghar, M. W., Kajal, D., Waheed, A., & Mobassarah, N. J. (2013). A critique of the literature on etiology of eating disorders. Annals of Neurosciences, 20(4), 157.
Robinson, K., & Wade, T. D. (2021). Perfectionism interventions targeting disordered eating: a systematic review and meta-analysis. International Journal of Eating Disorders, 54(4), 473–487.
Serra, R., Kiekens, G., Vanderlinden, J., Vrieze, E., Auerbach, R. P., Benjet, C., Claes, L., Cuijpers, P., Demyttenaere, K., & Ebert, D. D. (2020). Binge eating and purging in first-year college students: prevalence, psychiatric comorbidity, and academic performance. International Journal of Eating Disorders, 53(3), 339–348.
Shafran, R., Cooper, Z., & Fairburn, C. G. (2002). Clinical perfectionism: a cognitive–behavioural analysis. Behaviour Research and Therapy, 40(7), 773–791.
Sifneos, P. E. (1996). Alexithymia: past and present. The American Journal of Psychiatry (153 vol., pp. 137–142). American Psychiatric Assn. Issue Suppl.
Steele, A. L., O’Shea, A., Murdock, A., & Wade, T. D. (2011). Perfectionism and its relation to overevaluation of weight and shape and depression in an eating disorder sample. International Journal of Eating Disorders, 44(5), 459–464.
Stoeber, J., Kobori, O., & Tanno, Y. (2013). Perfectionism and self–conscious emotions in british and japanese students: Predicting pride and embarrassment after success and failure. European Journal of Personality, 27(1), 59–70.
Sun, S., He, J., Fan, X., Chen, Y., & Lu, X. (2020). Chinese media coverage of eating disorders: disorder representations and patient profiles. International Journal of Eating Disorders, 53(1), 113–122.
Tong, J., Miao, S., Wang, J., Yang, F., Lai, H., Zhang, C., Zhang, Y., & Hsu, L. K. (2014). A two-stage epidemiologic study on prevalence of eating disorders in female university students in Wuhan, China. Social Psychiatry and Psychiatric Epidemiology, 49(3), 499–505.
Trindade, A. P., Appolinario, J. C., Mattos, P., Treasure, J., & Nazar, B. P. (2018). Eating disorder symptoms in brazilian university students: a systematic review and meta-analysis. Brazilian Journal of Psychiatry, 41, 179–187.
Vanzhula, I. A., Kinkel-Ram, S. S., & Levinson, C. A. (2021). Perfectionism and difficulty controlling thoughts bridge eating disorder and obsessive-compulsive disorder symptoms: a network analysis. Journal of Affective Disorders, 283, 302–309.
Wade, T. D., O’Shea, A., & Shafran, R. (2016). Perfectionism and eating disorders. Perfectionism, health, and well-being (pp. 205–222). Springer.
Wang, C. S., & Wang, C. H. (2004). The revision of the translated multidimensional body-self relations Questionnaire. Bulletin of Sport and Exercise of Taiwan, 5, 101–126.
Weiner, B. A., & Carton, J. S. (2012). Avoidant coping: a mediator of maladaptive perfectionism and test anxiety. Personality and Individual Differences, 52(5), 632–636.
Yi, J., Yao, S., & Zhu, X. (2003). The chinese version of the TAS-20: Reliability and validity. Chinese Mental Health Journal.
Zi, F., & Zhou, X. (2006). The Chinese frost multidimensional perfectionism scale: An examination of its reliability and validity. Chinese Journal of Clinical Psychology.
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This study was supported by the Social Science Foundation of Jiangsu Province (Project No. 2019SJB922).
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Po Hu and Tong Xie contributed equally to the study and, therefore, share first authorship.
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Hu, P., Xie, T., Qian, W. et al. The relationship between perfectionism and eating pathology: the mediating roles of body dissatisfaction and alexithymia. Curr Psychol 42, 30939–30948 (2023). https://doi.org/10.1007/s12144-022-04068-w
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DOI: https://doi.org/10.1007/s12144-022-04068-w