Examining affect and perfectionism in relation to eating disorder symptoms among women with anorexia nervosa

Abstract

This study examined personality and affective variables in relation to eating disorder symptoms in anorexia nervosa (AN). Women (N=118) with DSM-IV AN completed baseline questionnaires (Beck Depression Inventory, Frost Multidimensional Perfectionism Scale) and interviews (Eating Disorder Examination, Yale-Brown-Cornell Eating Disorder Scale), followed by two weeks of ecological momentary assessment (EMA) involving multiple daily reports of affective states and eating disorder behaviors. Hierarchical regression analyses were conducted using eating disorder symptoms as dependent variables (i.e., EMA binge eating, EMA self-induced vomiting, eating disorder rituals, eating disorder preoccupations, dietary restraint). Predictor variables were maladaptive perfectionism (baseline), depressive symptoms (baseline), and affect lability (EMA). Results revealed that affect lability was independently associated with binge eating, whereas depressive symptoms were independently associated with self-induced vomiting. Depressive symptoms were independently associated with eating disorder rituals, whereas both depressive symptoms and maladaptive perfectionism were independently associated with eating disorder preoccupations. Finally, maladaptive perfectionism and affect lability were both independently associated with dietary restraint. This pattern of findings suggests the importance of affective and personality constructs in relation to eating disorder symptoms in AN and may highlight the importance of targeting these variables in the context of treatment.

Subtypes of Adaptive and Maladaptive Perfectionism in Anorexia Nervosa: Associations with Eating Disorder and Affective Symptoms

“…The elevated psychopathology among the Moderate and High Maladaptive Perfectionism groups parallels prior research indicating that maladaptive characteristics of perfectionism are associated with negative outcomes in AN (Ashby et al 1998; Boone et al 2010; Bulik et al 2003; Lavender et al 2016; Slof-Op’t Landt et al 2016). In contrast, few studies have examined whether adaptive forms of perfectionism are problematic in AN.…”

“…Facets of maladaptive perfectionism (e.g., concern over mistakes and doubts about actions) have been found to differentiate individuals with eating disorders from non-clinical and psychiatric controls, while aspects of adaptive perfectionism (e.g., high personal standards) have not (Ashby et al 1998; Bulik et al 2003). Further, a recent analysis from the same dataset as used in this investigation found that a composite maladaptive perfectionism score was associated with the severity of cognitive eating disorder symptoms in AN (Lavender et al 2016). In contrast, there has been little investigation of the independent effects of adaptive components of perfectionism in AN.…”

“…Although maladaptive features of perfectionism have been linked to key symptoms among individuals with AN (Ashby et al 1998; Boone et al 2010; Bulik et al 2003; Lavender et al 2016; Slof-Op’t Landt et al 2016), little has been known regarding the influence of more adaptive features of this construct on clinical variables in AN. Additionally, there have been no investigations to determine if different individuals with AN vary on perfectionistic qualities, and whether any variations are associated with clinically meaningful outcomes.…”

“…Consistent with prior research, we hypothesized that subgroups with elevations on solely on facets of perfectionism associated with maladaptive features would have greater clinical symptoms compared to subgroups with elevations on more traditionally adaptive facets. Although several manuscripts have been published from the dataset used for these analyses, including manuscripts examining other empirically derived symptom taxonomies (Goldschmidt et al 2014; Lavender et al 2013), only one study from this sample has examined effects of perfectionism on clinical variables (Lavender et al 2016). Because that manuscript focused solely on maladaptive facets of perfectionism, and used theoretical, rather than empirical classification of maladaptive perfectionism, the current manuscript constitutes a novel contribution to this literature not captured in prior analyses.…”

The Roy Adaptation Model

“…1 For example, negative affect is a risk factor for eating pathology, 32-33 and more recent research suggests that variability in affective lability and intensity may be salient to eating disorder symptoms. 34-35 …”