ArticlePDF Available

Are perfectionistic concerns an antecedent of or a consequence of binge eating, or both? A short-term four-wave longitudinal study of undergraduate women

Authors:
PERFECTIONISTIC CONCERNS AND BINGE EATING
1
Are perfectionistic concerns an antecedent of or a consequence of binge eating, or both?
A Short-Term Four-Wave Longitudinal Study of Undergraduate Women
Martin. M. Smitha*, Simon B. Sherryb,c,, Chantal M. Gautreaub, Sherry H. Stewartb,c, Donald H.
Saklofskea, and Aislin R. Mushquashd
3500 WORDS (excluding title page)
aDepartment of Psychology, The University of Western Ontario, 1151 Richmond Street, London,
Ontario, Canada N6A 5C2
bDepartment of Psychology and Neuroscience, Dalhousie University, 1355 Oxford Street, PO
BOX 15000, Halifax, Nova Scotia, Canada B3H 4R2
cDepartment of Psychiatry, Dalhousie University, 5909 Veteran’s Memorial Lane, Halifax, Nova
Scotia, Canada B3H 2E2
dDepartment of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, Ontario,
Canada P7B 5E1
*Corresponding author. Tel.: +1-519-661-2100; fax: 519-661-3461
E-mail address: msmit454@uwo.ca (M. M. Smith).
Smith, M.M., Sherry, S.B., Gautreau, C.M., Stewart, S.H., Saklofske, D.H., & Mushquash, A.R. (in press). Are
perfectionistic concerns an antecedent of or a consequence of binge eating, or both? A short-term four-wave
longitudinal study of undergraduate women. Eating Behaviors.
PERFECTIONISTIC CONCERNS AND BINGE EATING
2
Abstract
The perfectionism model of binge eating (PMOBE) posits perfectionistic concerns are a
vulnerability factor for binge eating. And evidence indicates perfectionistic concerns and binge
eating correlate positively. Yet the direction of this relationship is unclear. In particular, it is
unclear if perfectionistic concerns represent an antecedent of binge eating (a vulnerability effect
with perfectionistic concerns predicting increases in binge eating), a consequence of binge eating
(a complication effect with binge eating predicting increases in perfectionistic concerns), or both
(reciprocal relations with perfectionistic concerns predicting increases in binge eating and vice
versa). To address these questions, we studied 200 undergraduate women using a 4-week, 4-
wave cross-lagged design. Consistent with the PMOBE, perfectionistic concerns predicted
increased binge eating (vulnerability effect). Conversely, binge eating did not predict increased
perfectionistic concerns (complication effect). Findings support the long-held theory that
perfectionistic concerns are part of the premorbid personality of women vulnerable to binge
eating.
Keywords: perfectionism, binge eating, longitudinal, cross-lagged analysis
PERFECTIONISTIC CONCERNS AND BINGE EATING
3
1. Introduction
Binge eatingrapidly and uncontrollably eating large amounts of food in a short period
of timeis a common, costly, and impairing problem (Wonderlich, Gordon, Mitchell, Crosby, &
Engel, 2009). It can lead to weight gain, obesity, and related medical conditions such as type 2
diabetes (Bulik, Sullivan, & Kendler, 2002). Binge eating is also tied to smoking and excessive
drinking (Keel, Baxter, Heatherton, & Joiner, 2007; Rush, Becker, & Curry, 2009). Moreover,
binge eating typically peaks for women during university, with evidence suggesting
approximately 32% of female undergraduates’ binge eat (Keel, Baxter, Heatherton, & Joiner,
2007). Accordingly, researchers and clinicians are increasingly interested in testing explanatory
models to inform prevention and intervention efforts.
Although there are numerous reasons why female undergraduates binge eat,
perfectionism has been theorized to play a role. Sherry and Hall’s (2009) perfectionism model of
binge eating (PMOBE) asserts socially-based pressures to be perfect (perfectionistic concerns)
confer vulnerability for binge eating. Likewise, evidence indicates people with higher
perfectionistic concerns binge eat more than people with lower perfectionistic concerns (e.g.,
Mushquash & Sherry, 2013). And yet, whether perfectionistic concerns are an antecedent of
binge eating, a consequence of binge eating, or both is unclear. We addressed this ambiguity by
testing a reciprocal relations model in a sample of 200 female undergraduates, using a 4-week, 4-
wave cross-lagged design.
1.1. Perfectionism
Perfectionism refers to a dispositional tendency to rigidly strive for flawlessness, set
excessively high personal standards, and experience overly negative reactions to perceived
setbacks and failures (Frost, Marten, Lahart, & Rosenblate, 1990; Hewitt & Flett, 1991).
PERFECTIONISTIC CONCERNS AND BINGE EATING
4
Extensive evidence suggests the majority of common variance among lower-order perfectionism
dimensions is accounted for by two higher-order factors: perfectionistic strivings and
perfectionistic concerns (Stoeber & Otto, 2006). Perfectionistic strivings encompass a family of
traits incorporating the tendency to demand perfection of oneself (self-oriented perfectionism;
Hewitt & Flett, 1991) and the propensity to hold unrealistically high personal expectations
(personal standards; Frost et al., 1990). Perfectionistic concerns comprise a constellation of traits
involving the tendency to perceive others as demanding perfection (socially prescribed
perfectionism; Hewitt & Flett, 1991), have overly negative reactions to perceived failures
(concerns over mistakes; Frost et al., 1990), and doubts about performance abilities (doubts
about actions; Frost et al., 1990). Given evidence suggesting perfectionistic concerns are
uniquely important to binge eating (Sherry & Hall, 2009), we focused solely on perfectionistic
concerns.
1.2. Clarifying perfectionistic concerns relationship with binge eating
Sherry and Hall’s (2009) perfectionism model of binge eating (PMOBE) views people
with high perfectionistic concerns as actively creating conditions in their daily lives that are
conducive to binge eating (e.g., restricting their diet). Consistent with the PMOBE, Boone,
Soenens, Vansteekiste, and Braet (2012) found that experimentally inducing perfectionistic
concerns caused undergraduates higher levels of restraint and binge eating 24 hours following
the manipulation. Likewise, Short, Mushquash, and Sherry (2013) demonstrated that doubts
about actions, a core component of perfectionistic concerns, predicted increased binge eating in a
sample of undergraduates. Thus, although not tested directly, prior findings align with the
PMOBE (Boone et al., 2012; Short et al., 2013). Even so, alternatives to the PMOBE are rarely,
if ever, tested.
PERFECTIONISTIC CONCERNS AND BINGE EATING
5
Indeed, Heatherton and Baumeister’s (1991) escape theory asserts binge eating provides
temporary relief from aversive self-awareness by shifting attention away from higher level
abstract thinking to the immediate environment. And, according to the escape model, following a
binge, upon return of self-awareness, emotional distress increases. It is thus plausible that,
contrary to the PMOBE, binge eating may predispose perfectionistic concerns. To illustrate,
consider that binge eating is tied to weight gain (Bulik et al., 2002), which could augment a
subjective sense of falling short of other’s body ideals (i.e., perfectionistic concerns).
Alternatively, consider that undergraduate women prone to binge eating typically try to resist
future binges and experience intense regret following a binge, which might also foster
perfectionistic concerns. Yet, such complication effects, with binge eating predicting
perfectionistic concerns but not the reverse, have not been tested. Moreover, focusing
exclusively on unidirectional relationships negates the possibility that perfectionistic concerns
and binge eating might represent a vicious bidirectional cycle. Still, no study has explored
potential reciprocal relations between perfectionistic concerns and binge eating. As such, it is
currently unclear whether perfectionistic concerns are an antecedent of binge eating (i.e.,
perfectionistic concerns predicting increases in binge eating), a consequence of binge eating (i.e.,
binge eating predicting increases in perfectionistic concerns), or both (i.e., perfectionistic
concerns predicting increases in binge eating and vice versa).
1.3. The present study
Understanding the directionality of perfectionistic concerns relationship with binge
eating is vital to assessing, treating, and preventing binge eating. And yet, the direction of this
relationship is unclear. Our study addressed this gap by integrating vulnerability effects
(perfectionistic concerns predicting binge eating) and complication effects (binge eating
PERFECTIONISTIC CONCERNS AND BINGE EATING
6
predicting perfectionistic concerns) into a reciprocal relations model (see Figure 1). We
evaluated this model in 200 undergraduate women, using a 4-week, 4-wave cross-lagged design.
Perfectionistic concerns and binge eating were measured as latent variables. Based on past
research (e.g., Mushquash & Sherry, 2013), we expected first-order auto-regressive paths for
perfectionistic concerns (capturing inter-individual stability) to show the highest stability, and
first-order auto-regressive paths for binge eating to show a relatively lower level of stability (vs.
perfectionistic concerns). As well, building on theory (Sherry & Hall, 2009) and evidence
(Boone et al., 2012; Short et al., 2013), we hypothesized perfectionistic concerns would predict
increased binge eating over time. Furthermore, we tested if binge eating predicted increased
perfectionistic concerns over time; as our study is the first to test this potential complication
effect, we considered this test exploratory.
2. Method
2.1. Participants
A sample of 200 undergraduate women was recruited from the Department of
Psychology’s subject pool. Participants averaged 19.9 years of age (SD = 3.02) and were
primarily of European descent (88.0%). Our sample is comparable with other undergraduate
samples (e.g., Mushquash & Sherry, 2013).
2.2. Measures
2.2.1. Perfectionistic concerns
Perfectionistic concerns were measured as a latent variable using the following
indicators: the 5-item short form of Hewitt and Flett’s (1991) Multidimensional Perfectionism
Scale’s socially prescribed perfectionism subscale (HFMPS-SPP; e.g., “My family expects me to
be perfect”), the 5-item short form of Frost, Marten, Lahart, and Rosenblate’s (1990)
PERFECTIONISTIC CONCERNS AND BINGE EATING
7
Multidimensional Perfectionism Scale’s concern over mistakes subscale (FMPS-COM; e.g.,
“The fewer mistakes I make, the more people will like me”), and the 4-item short form of the
FMPS doubts about actions subscale (FMPS-DAA; e.g., “I have doubts about the simple
everyday things I do”). Participants responded to HFMPS-SPP using a 7-point scale ranging
from 1 (strongly disagree) to 7 (strongly agree). Participants responded to the FMPS-COM and
FMPS-DAA using a 5-point scale ranging from 1 (strongly disagree) to 5 (strongly agree).
Research supports the internal consistency and validity of these subscales in undergraduate
samples (Sherry et al., 2013). Alpha’s showed good reliabilities in the present study (i.e., .82-.91;
see Supplementary Table 1).
2.2.2. Binge eating
Binge eating was measured as a latent variable using the following indicators: Thelen,
Farmer, Wonderlich, and Smith’s (1991) 9-item Bulimia Test-Revised (BULIT-R) binge eating
subscale (e.g., “I ate a lot of food when I wasn’t even hungry”), Garner, Olmstead, and Polivy’s
(1983) 4-item Eating Disorder Inventory Bulimia Scale (EDIB; e.g., “I stuffed myself with
food”), and Stice, Telch, and Rizvi’s (2000) 7-item Eating Disorder Diagnostic Scale (EDDS)
binge eating subscalee (e.g., “There were times when I ate much more rapidly than normal”).
Participants responded to the BULIT-R using a 5-point scale from 1 (no symptoms) to 5 (severe
symptoms). Participants responded to the EDIB and the EDDS using a 7-point scale from 1
(strongly disagree) to 7 (strongly agree). Research supports the reliability and factorial validity
of these subscales (Sherry & Hall, 2009). Alpha’s indicated good reliabilities in our study (.84-
.92; see Supplementary Table 1).
2.3. Procedure
PERFECTIONISTIC CONCERNS AND BINGE EATING
8
Participants were recruited using the participant subject pool. Participants first came to
the lab and completed measures of perfectionistic concerns and binge eating. Next, participants
returned to the lab at three subsequent time points and completed identicial measures. On
average, 7.0 days elapsed between each measurement occasion. Participants were compensated
$10 and three credit points towards a psychology course following Wave 4. Of the 200
participants that completed Wave 1, 99.0% completed Wave 2, 94.5% completed Wave 3, and
95.5% completed Wave 4.
2.4. Data analytic strategy
Confirmatory factor analysis and structural equation modeling were conducted using
AMOS 7.0. All analyses employed maximum likelihood estimation. As well, for all models,
residuals for the same indicator measured at different times were allowed to correlate across the
four measurement occasions (Little, 2013). Following Cheung and Rensvold (2002), CFI was
used for nested-model comparisons; these authors found CFI differences (ΔCFI) of less than .01
provided strong support that two nested-models do not differ significantly. In addition, the
following approximate fit indices were used for model evaluation: the comparative fit index
(CFI), the incremental fit index (IFI), and the root-mean-square error of approximation
(RMSEA). CFI and IFI values in the range of .95 or above suggest good model fit and values
between .90 and .95 suggest acceptable model fit (Hu & Bentler, 1998). The RMSEA is an
indicator of the level of misfit per degrees of freedom, with values of .08 or below being
acceptable and values of .05 or less indicating good model fit (Little, 2013).
Prior to structural equation modeling, we used a confirmatory factor analysis framework
to test whether perfectionistic concerns’ and binge eating’s indicators were factorially invariant
across measurement occasions. Specifically, we first evaluated a configural model, with no
PERFECTIONISTIC CONCERNS AND BINGE EATING
9
constraints placed on any parameters. Next, we examined factorial invariance by making each
corresponding factor loading mathematically equivalent and using ΔCFI to determine whether
this resulted in a significant decrement in fit.
A structural equation modeling framework was then used to evaluate latent construct
relations, as well as the stability of perfectionistic concerns and binge eating across time.
Specifically, we compared the fit of two models, again using ΔCFI, to determine whether
variation exists in auto-regressive paths and cross-lagged paths across measurement occasions
(excluding Time 1). First, we evaluated the fit of the baseline structural model with freely
estimated autoregressive paths and cross-lagged paths for latent parameters across time.
Subsequently, we evaluated latent construct relations by constraining corresponding auto-
regressive paths and cross-lagged paths to equality (Little, 2013).
3. Results
3.1. Missing data
Missing data rates were low (2.88%). Little’s (1988) MCAR test revealed data were
missing completely at random (χ2 (122) = 132.89, p > .05). Participants who dropped out were
not significantly different (p > .05) on any of the study variables from participants who
completed all four waves. Thus, missing data were dealt with using full information maximum
likelihood estimation.
3.2. Descriptive statistics and bivariate correlations
Means, standard deviations, and alpha reliabilities are presented in supplementary Table
1; bivariate correlations are presented in suplmentary Table 2. Means were within one standard
deviation of those from prior studies using undergraduates (e.g., Sherry et al., 2013; Sherry &
Hall, 2009), suggesting our means are comparable to earlier research. Perfectionistic concerns
PERFECTIONISTIC CONCERNS AND BINGE EATING
10
and binge eating’s manifest indicators were significantly correlated with each other across
waves, with one exceptionsocially prescribed perfectionism at Wave 1 did not significantly
correlate with the BULIT-R or the EDDS at Time 1, or the EDDS at Wave 3 (see supplementary
Table 2). Nonetheless, overall the correlations suggest value in testing our model. Test-retest
correlations were strong, ranging from .66 to .91 for perfectionistic concerns indicators and from
.72 to .81 for binge eating indicators.
3.3. Factorial invariance
The configural model showed good fit: χ2(188) = 272.64, p < .001, RMSEA = .048 (90%
CI [.04, .06]), CFI = .987, and IFI = .987. Thus, the relation between each indicator and its latent
construct had equivalent patterns of fixed and free loadings across the four time points.
Additionally, constraining corresponding factor loadings to be equal across measurement
occasions did not lead to a significant decrement in fit: ΔCFI = .007. Accordingly, this increased
confidence that the same constructs were being measured across time. For subsequent analyses,
we used the factorially-invariant model as it provided comparable fit and a more parsimonious
solution.
3.4. Latent construct relations
We evaluated latent construct relations using structural equation modeling. The fit of the
baseline structural model (see Figure 1) with freely-estimated autoregressive and cross-lagged
paths was acceptable to good: χ2(212) = 371.24, p < .001, RMSEA = .061 (90% CI [.05, .07]),
CFI = .975, and IFI = .975. Constraining similar autoregressive paths and similar cross-lagged
paths to equality across the four waves did not result in a significant decrement in fit: ΔCFI =
.000. Thus results suggest that equality constraints were empirically justified, and that predictive
relations (autoregressive and cross-lagged) between each consecutive time point were
PERFECTIONISTIC CONCERNS AND BINGE EATING
11
statistically equivalent. Results also revealed autoregressive paths for perfectionistic concerns
and binge eating were significant and strongly stable for perfectionistic concerns, and
moderately-to-strongly stable for binge eating (see Figure 1). Moreover, as anticipated,
perfectionistic concerns predicted significant increases in binge eating. However, binge eating
did not predict significant change in perfectionistic concerns (see Figure 1).
4. Discussion
Binge eating is a cyclical, recurrent, and self-perpetuating behavior that negatively
impacts health, well-being, and functioning (Keel et al., 2007; Rush et al., 2009). To break this
cycle, it is crucial that we understand binge eating’s antecedents. Sherry and Hall’s (2009)
perfectionism model of binge eating (PMOBE) purports to bring us closer to this goal. In
particular, the PMOBE asserts perfectionistic concerns place people at risk for increased binge
eating. And, in line with the PMOBE, research indicates perfectionistic concerns and binge
eating correlate positively (e.g., Mushquash & Sherry, 2013). However, questions abound
regarding directionality. For instance, are perfectionistic concerns an antecedent of binge eating
or a consequence of binge eating? Alternatively, might perfectionistic concerns and binge eating
represent a vicious bidirectional cycle, such that perfectionistic concerns predict increased binge
eating, which in turn predict increased perfectionistic concerns? We attempted to answer these
important questions using a four-week, four-wave cross-lagged design.
Consistent with conceptualizations of perfectionistic concerns as a stable trait
(Mushquash & Sherry, 2013), findings indicated perfectionistic concerns autoregressive paths
were significant and highly stable. Additionally, in line with research suggesting binge eating is
persistent (Mushquash & Sherry, 2013), binge eating’s autoregressive paths were significant and
moderately-to-strongly stable. Moreover, as hypothesized, perfectionistic concerns conferred risk
PERFECTIONISTIC CONCERNS AND BINGE EATING
12
for, but were not complicated by, binge eating. Thus, in accordance with the PMOBE,
undergraduate women with high perfectionistic concerns appear to think, feel, and behave in
ways that engender binge eating. Indeed, given intense perceived social pressures, female
undergraduates with high perfectionistic concerns experience a subjective sense of disappointing
others (Sherry & Hall, 2009), which in turn might predispose binge eating as a means of
escaping painful self-awareness (Heatherton & Baumeister, 1991).
Nonetheless, we found no evidence supporting complication effects (i.e., binge eating
predicting perfectionistic concerns, but not the reverse). Likewise, we found no evidence
supporting reciprocal relations (i.e., perfectionistic concerns predicting binge eating and vice
versa). However, as the first to investigate the directionality of the perfectionistic concerns-binge
eating link, we recommend our null findings be interpreted cautiously.
4.1. Limitations and future directions
Our study used a mono-source design, which are problematic when studying personality
traits, such as perfectionism, that can involve self-presentational bias. Future studies could
reduce this potential bias by including informant reports. Additionally, the elapsed time between
waves was relatively short and perfectionistic concerns auto-regressive paths were highly stable.
Consequently, there may have been little room for binge eating to influence perfectionistic
concerns. Future research might address this by using a longer time lag between waves.
4.3. Concluding remarks
Our novel, four-week, four-wave cross-lagged study is the first to test the directionality
of perfectionistic concerns’ relationship with binge eating. In accordance with prior theory
(Sherry & Hall, 2009), our findings suggest perfectionistic concerns are a persistent vulnerability
for, but not a complication of, binge eating.
PERFECTIONISTIC CONCERNS AND BINGE EATING
13
References
Boone, L., Soenens, B., Vansteenkiste, M., & Braet, C. (2012). Is there a perfectionist in each of
us? An experimental study on perfectionism and eating disorder symptoms. Appetite,
59, 531-540.
Bulik, C. M., Sullivan, P. F., & Kendler, K. S. (2002). Medical and psychiatric morbidity in
obese women with and without binge eating. International Journal of Eating Disorders,
32, 72-78.
Cheung, G., & Rensvold, R. (2002). Evaluating goodness-of-fit indices for testing measurement
invariance. Structural Equation Modeling, 9, 233255.
Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism.
Cognitive Therapy and Research, 14, 449468.
Garner, D. M., Olmstead, M. P., & Polivy, J. (1983). The development and validation of a
multidimensional eating disorder inventory for anorexia and bulimia. International
Journal of Eating Disorders, 1, 1534.
Heatherton, T. F., & Baumeister, R. F. (1991). Binge eating as escape from self-awareness.
Psychological Bulletin, 110, 86-108.
Hewitt, P., & Flett, G. (1991). Perfectionism in the self and social contexts: Conceptualization,
assessment, and association with psychopathology. Journal of Personality and Social
Psychology, 60, 456470.
Hu, L. T., & Bentler, P. M. (1998). Fit indices in covariance structure modeling: Sensitivity of
underparameterized model misspecification. Psychological Methods, 3, 424-453.
Keel, P. K., Baxter, M. G., Heatherton, T. F., & Joiner Jr, T. E. (2007). A 20-year longitudinal
study of body weight, dieting, and eating disorder symptoms. Journal of Abnormal
Psychology, 116, 422.
PERFECTIONISTIC CONCERNS AND BINGE EATING
14
Little, R. (1988). A test of missing completely at random for multivariate data with missing
values. Journal of the American Statistical Association, 83, 11981202.
Little, T. D. (2013). Longitudinal structural equation modeling. New York: Guilford Press.
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, 171-179.
Rush, C. C., Becker, S. J., & Curry, J. F. (2009). Personality factors and styles among college
students who binge eat and drink. Psychology of Addictive Behaviors, 23, 140.
Sherry, S. B., & Hall, P. A. (2009). The perfectionism model of binge eating: Tests of an
integrative model. Journal of Personality and Social Psychology, 96, 690709.
Sherry, S. B., Nealis, L., Macneil, M., Stewart, S. H., Sherry, D. L., & Smith, M. (2013).
Informant reports add incrementally to the understanding of the perfectionism
depression connection: Evidence from a prospective longitudinal study. Personality and
Individual Differences, 54, 957-960.
Short, M. M., Mushquash, A. R., & Sherry, S. B. (2013). Perseveration moderates the
relationship between perfectionism and binge eating: A multi-method daily diary study.
Eating Behaviors, 14, 394-396.
Stice, E., Telch, C. F., & Rizvi, S. L. (2000). Development and validation of the Eating
Disorder Diagnostic Scale: A brief self-report measure of anorexia, bulimia, and
binge-eating disorder. Psychological Assessment, 12, 123131.
Stoeber, J., & Otto, K. (2006). Positive conceptions of perfectionism: Approaches, evidence,
challenges. Personality and Social Psychology Review, 10, 295319.
PERFECTIONISTIC CONCERNS AND BINGE EATING
15
Thelen, M. H., Farmer, J. W., Wonderlich, B., & Smith, M. (1991). A revision of the Bulimia
Test: The BULIT-R. Psychological Assessment, 3, 119124.
Wonderlich, S. A., Gordon, K. H., Mitchell, J. E., Crosby, R. D., & Engel, S. G. (2009). The
validity and clinical utility of binge eating disorder. International Journal of Eating
Disorders, 42, 687705.
PERFECTIONISTIC CONCERNS AND BINGE EATING
16
Figure 1. Hypothesized reciprocal relations model showing cross-lagged structural analyses with paths constrained to equality across
waves. Ovals represent latent variables. Horizontal arrows represent autoregressive paths; diagonal arrows represent cross-lagged
paths. Double-headed black arrows represent significant correlations (p < .05); single-headed black arrows represent significant paths
(p < .05); single headed gray arrows represent non-significant paths (p > .05). Path coefficients are standardized. Italicized numbers in
the upper right corner of ovals represent the amount of variance explained by associated exogenous variables. Unstandardized path
coefficients were constrained to equality; however, standardized path coefficients may still vary slightly. Cross-wave correlated errors
were specified a priori. Error terms are not displayed.
Perfectionistic
concerns
(Wave 2)
Perfectionistic
concerns
(Wave 3)
Perfectionistic
concerns
(Wave 4)
Perfectionistic
concerns
(Wave 1)
Binge
eating
(Wave 1)
Binge
eating
(Wave 2)
Binge
eating
(Wave 3)
Binge
eating
(Wave 4)
... Whereas the cross-sectional evidence cited above implicates perfectionism as a descriptively transdiagnostic factor, we can approach an understanding of the causal mechanics by using longitudinal evidence and exploring temporal relations between variables. Previous longitudinal studies have shown that perfectionism, predominately perfectionistic concerns, predicts symptoms of both OCD (Hawley et al., 2021) and eating disorders, such as drive for thinness or binge eating (Dickie et al., 2012;Kehayes et al., 2019;Smith et al., 2017). However, evidence has been inconsistent on whether predictive effects of perfectionism are unidirectional (i.e. ...
... The sample consisted of 499 participants. A priori power analysis was based on previous studies on the relationship between perfectionism and eating disorders (Bardone-Cone et al., 2017;Boone et al., 2014;Campbell et al., 2018;Smith et al., 2017) and used computer-generated random data in variable sample sizes assuming previously reported effect sizes (Smith et al., 2017). In order to reach a power of 0.80, results indicated a required sample size of N = 350 (under α = 0.05). ...
... The sample consisted of 499 participants. A priori power analysis was based on previous studies on the relationship between perfectionism and eating disorders (Bardone-Cone et al., 2017;Boone et al., 2014;Campbell et al., 2018;Smith et al., 2017) and used computer-generated random data in variable sample sizes assuming previously reported effect sizes (Smith et al., 2017). In order to reach a power of 0.80, results indicated a required sample size of N = 350 (under α = 0.05). ...
Article
Full-text available
Perfectionism has been suggested as a risk factor relevant to multiple psychological disorders, including obsessive-compulsive disorder (OCD) and eating disorders (ED). However, it remains unclear how perfectionism contributes to general and specific psychopathology. Disorder-specific processes (e.g. body dissatisfaction, responsibility) between perfectionism and subsequent symptoms may offer an explanation. The current study examined longitudinal associations between perfectionism, body dissatisfaction or responsibility, and symptoms of ED or OCD. A community sample of 499 women (18–30) completed a three-wave online study, assessing perfectionism, ED and OCD symptoms, body dissatisfaction, and responsibility/threat overestimation. Temporal relations between perfectionism and symptoms were analyzed using a structural equation model. Effects of body dissatisfaction and responsibility/threat overestimation were analyzed using multiple hierarchical regressions. Results showed that perfectionism predicted subsequent OCD symptoms, but not ED symptoms. ED symptoms, but not OCD symptoms, predicted subsequent perfectionism. No interaction effects between perfectionism and the disorder-specific processes were found. Instead, body dissatisfaction independently contributed to both ED and OCD symptoms, whereas inflated responsibility/threat overestimation predicted specifically OCD symptoms. To conclude, perfectionism appears to increase the risk of psychological symptoms. However, in this sample this was specific to OCD symptoms. Given ED symptoms predicted later perfectionism, bidirectional effects need to be considered.
... Moreover, the model also fails in clarifying the role of other indicators of Perfectionistic Concerns different from Socially Prescribed Perfectionism and Concern Over Mistakes, in the development of binge eating. For example, research has shown that Doubts About Actions (understood as the tendency to believe that projects are not completed to satisfaction, [39] is consistently linked with binge eating behaviors [64,88,89,92]. Therefore, is the Perfectionistic Concerns second-order factor which best explains the relationship between perfectionism and binge eating, or are other specific indicators (i.e., Socially Prescribed Perfectionism, Doubts About Actions, and Concern Over Mistakes) more closely related to it? ...
Article
Full-text available
Background Perfectionism is considered a vulnerability factor for eating disorders. However, the role of perfectionism in binge eating needs clarification due to notably inconsistencies between studies. The purpose to this study was to conduct a systematic review and meta-analysis to estimate the perfectionism-binge eating association. Method Systematic review was performed according to the PRISMA 2020 statement. Four databases (Web of Science, Scopus, PsycINFO and Psicodoc) were searched to identify studies published until September 2022. The literature search yielded 30 published articles (N = 9392) that provided 33 independent estimations of the correlation between the two variables. Results Random-effects meta-analysis revealed a small-to-moderate positive average effect size between general perfectionism and binge eating (r+ = .17) with a large heterogeneity. Perfectionistic Concerns showed a significant small-to-moderate relationship with binge eating (r+ = .27), whereas Perfectionistic Strivings presented a negligible relationship with binge eating (r+ = .07). Moderator analyses showed that the age, the type of the sample, the study design, and the tools for assessing both variables were statistically associated with the perfectionism-binge eating effect sizes. Conclusions Our findings suggest that Perfectionism Concerns are closely associated with binge eating symptomatology. This relationship might be moderated by certain variables, especially by the clinical or non-clinical nature of the sample and the instrument employed to assess binge eating.
... Mackinnon et al. (2011) found subsequently that concern over mistakes (which is strongly correlated with SPP; Smith et al., 2016) indirectly predicted binge eating behaviors in a 3-wave, 3-week longitudinal study of 200 undergraduate women. While initial evidence for SPP predicting binge eating behaviors is strong (see also Smith et al., 2017), there is also some evidence that both SPP and SOP predict binge eating behaviors at the weekly level . Key tests remain to be conducted despite consistent empirical support that high SPP is a vulnerability for binge eating behaviors. ...
Article
Full-text available
Existing research on perfectionism and binge eating suggests that socially prescribed, self-oriented, and other-oriented perfectionism (Socially Prescribed Perfectionism, SPP; Self-Oriented Perfectionism, SOP; and Other-Oriented Perfectionism, OOP) are differentially related to binge eating. However, previous studies have largely utilized cross-sectional methodology. The present study used a 20-day daily diary methodology to examine associations between daily levels of perfectionistic dimensions and next-day binge eating behaviors with a nonclinical sample of emerging adults (N = 263). Zero-inflated negative binomial regression models indicated that daily SPP (but not SOP or OOP) predicted a greater intensity of next-day binge eating behaviors in the count portion of the model; however, daily levels of perfectionistic dimensions did not predict the presence/absence of next-day binge eating behaviors in the zero-inflated portion of the model. Additionally, analyses examining the reverse causal direction (i.e., binge eating behaviors predicting higher next-day perfectionism) failed to provide evidence that the occurrence or intensity of binge eating behaviors predicts next-day levels of SPP, SOP, or OOP. Overall, at a daily level, SPP appears to be a vulnerability factor for binge eating behaviors. It may be helpful for clinicians to target state-levels of SPP to reduce harmful binge eating behaviors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Article
Full-text available
Objective Future treatments for eating disorders (ED) need to be enhanced by targeting maintaining mechanisms. Literature suggests self‐criticism and self‐critical perfectionism act as key mechanisms exacerbating ED, and self‐compassion protects against self‐criticism. This meta‐analysis examines associations between self‐criticism and self‐critical perfectionism on disordered eating (DE), and reviews how self‐compassion and self‐criticism relate to each other with respect to DE. Method Searches across three databases yielded 135 studies across 42,952 participants. Heterogeneity, publication bias, and quality assessments were analyzed. Moderation analyses between self‐criticism measures, self‐compassion measures, between clinical and nonclinical samples, and between cross‐sectional and experimental studies were also conducted. Results Random‐effects models showed a medium positive link between self‐criticism and DE ( r = .37), and 10 subgroups pertaining to various measures of self‐criticism utilized in literature showed small to large positive links with DE ( r = .20–.52). Preliminary evidence also suggests negative relationships between self‐compassion and DE ( r = −.40 to −.43) and negative relationships between self‐compassion and self‐criticism ( r = −.04 to −.88). Discussion Greater levels of self‐criticism is linked with greater levels of DE and reduced levels of self‐compassion, suggesting a need to tackle self‐criticism and nurture self‐compassion in standard treatments for ED. Understanding these interactions better in conjunction with dismantling intervention studies can help develop more effective and efficient interventions targeting self‐criticism and self‐compassion for people with DE. Public Significance Statement Higher levels of self‐criticism are linked with higher levels of DE and lower self‐compassion. Self‐compassion interventions could be more effective and efficient in reducing ED symptoms if self‐criticism is tackled early in such treatments.
Article
Anxiety sensitivity (AS) – characterized by a persistent fear that arousal-related bodily sensations will lead to serious cognitive, physical, and/or social consequences – is associated with various psychopathologies, including depressive symptoms and binge eating. This 3-week, 3-wave longitudinal study examined the relation between AS (including its global AS factor and lower-order AS cognitive, physical, and social concern dimensions), depressive symptoms, and binge eating among 410 undergraduates from two universities. Using generalized estimating equation models, we found that global AS, AS social concerns, and depressive symptoms predicted binge eating during any given week. Mediation analyses showed that global AS (as a latent variable with its lower-order AS dimensions as indicators), AS cognitive concerns, and AS physical concerns at Wave 1 predicted subsequent increases in depressive symptoms at Wave 2, which, in turn, led to increases in binge eating at Wave 3. Findings contribute to a better understanding of the interplay between AS, depressive symptoms, and binge eating, highlighting the role of binge eating as a potential coping mechanism for individuals with high AS, particularly in managing depressive symptoms. This study underscores the importance of AS-targeted intervention and prevention efforts in addressing depressive symptoms and binge eating.
Article
Objective: Dimensions of perfectionism are associated with the onset and maintenance of eating disorder pathology in both clinical and non-clinical samples. The aim of this study was to conduct a systematic review and meta-analysis of the association between perfectionism and eating disorders in adults. Method: A literature search was conducted using the PsycINFO, Medline, Scopus, Embase, Web of Science and ProQuest databases. Ninety-five studies met the inclusion criteria and included a total sample of 32,840 participants (clinical eating disorder diagnosis N = 2414, non-clinical N = 30,428). Correlation coefficients (r) for the association between eating disorders and perfectionism were pooled. A meta-analysis to determine the association between two dimensions of perfectionism and eating disorder symptoms was conducted. Subgroup analyses were conducted with studies using clinical samples, and studies using the Eating Disorder Examination Questionnaire. Results: The pooled effect size for the association between perfectionistic concerns and eating disorder symptoms was r = 0.33 [0.30, 0.37]; and r = 0.20 [0.14, 0.25] for the association between perfectionistic strivings and eating disorder symptoms. In the clinical subgroup analyses the effect sizes were r = 0.40 [0.22, 0.58]; and r = 0.35 [0.26, 0.44] respectively. Medium to high heterogeneity was identified across all subgroup analyses and a significant level of publication bias was also identified. Discussion: The findings indicate both perfectionistic strivings and perfectionistic concerns have significant associations with eating disorders, and further support the argument that both dimensions of perfectionism are important factors in the prevention and treatment of eating disorders.
Article
Perfectionism is linked to a range of psychopathology, including binge eating. Our study enhanced understanding of the role maternal perfectionistic concerns play in the maintenance of binge eating in emerging adult daughters. A sample of 73 mother-daughter dyads (mean age = 49.51 years for mothers and 19.89 years for daughters) reported on perfectionistic concerns (composite of doubt about actions and concern over mistakes), binge eating, and binge drinking (composite of frequency, severity, and perceptions). Using actor-partner interdependence modelling, mothers' and daughters' perfectionistic concerns were positively associated with their own binge eating (actor effects). Mothers' perfectionistic concerns were positively associated with daughters' binge eating (partner effect), but not vice versa. Perfectionistic concerns did not show significant actor or partner associations with binge drinking, supporting the specificity of our model. Findings suggest binge eating has characterological and interpersonal antecedents.
Article
Full-text available
Research suggests that trait perfectionism and perfectionistic self-presentation are related to orthorexia - a pathological obsession with correct nutrition. However, no studies have examined these relationships over time or compared the influence of the two aspects of perfectionism on orthorexia. In the present study we sought to address these two issues. Gym members who engaged in high degrees of exercise were recruited via social media platforms. They completed an online questionnaire that included the Multidimensional Perfectionism Scale-Short Form, Perfectionistic Self-Presentation Scale, and the Eating Habits Questionnaire on two occasions: 177 participants (Mean age = 31.6 years) initially completed the questionnaire and 82 completed the questionnaire six weeks later. A series of multiple regression analyses revealed that (i) trait perfectionism predicted an increase in orthorexia symptomatology over time with socially prescribed perfectionism and other-oriented perfectionism unique predictors of orthorexia, (ii) perfectionistic self-presentation predicted orthorexia over time with nondisplay of imperfection a unique predictor of orthorexia, and (iii) when considered alongside each other, only trait dimensions of perfectionism were unique predictors of orthorexia. The present study provides further evidence that perfectionism is related to orthorexia. In addition, the study also provides preliminary evidence that more engrained trait aspects of perfectionism are more predictive of intensifying orthorexia over time than the self-presentational aspects of perfectionism.
Article
Full-text available
The present study examined psychometric properties of a 20-item Spiritual/Religious Perfectionism Scale (SRPS-20) in adult students. The aim of the study was developmental-applied and the method of gathering data was field research. The statistical population of the study 1 consisted of adult students, both under graduated and graduated, from the University of Tehran in the academic year of 2018-2019. The statistical population of the study 2 consisted of adults from general population living in Tehran in the years of 2018 and 2019. Factor structure of the SRPS-20 investigated using exploratory factor analyses in study 1 (368 university students) as well as using confirmatory factor analyses in study 2 (384 community adults). Convergent and discriminant validity of the SRPS-20 were examined through its correlations with measures of ego strength, mental health, and positive/negative affects in the 2 studies based on Ego Strength Scale (Besharat, 2016), Mental Health Inventory (Veit & Ware, 1983), and Positive and Negative Affects Schedule (Watson, Clarke & Tellegen, 1988), respectively. Internal consistency and test-retest reliability of the SRPS-20 were also investigated in the 2 studies. The results of both exploratory and confirmatory factor analyses supported a general factor structure for the SRPS-20. The convergent and discriminant validity of the SRPS-20 were supported by an expected pattern of correlations between the scale and the measures of ego strength, psychological well-being, psychological distress, and positive and negative affects. Based on the preliminary evidence provided by the present study it can be concluded that the SRPS-20 is a reliable and valid scale to measure spiritual/religious perfectionism. Keywords Spiritual/Religious Perfectionism Scale (SRPS-20) exploratory factor analysis confirmatory factor analysis scale psychometrics
Article
Full-text available
Background and aims Perfectionism, a focused self-concept, and erroneous beliefs have been implicated in the development and maintenance of various disordered behaviors. However, researchers have yet to examine how these factors combine to explain different disordered behaviors. Herein, we addressed this gap and hypothesized a moderated-mediation model whereby perfectionism fosters the development of disordered behaviors through a focused self-concept. Critically, the effect of a focused self-concept on disordered behaviors is specific to people with erroneous beliefs about their disordered behaviors. The model was tested in the contexts of disordered gambling and disordered eating, particularly dietary restraint. Method In Study 1, participants were community members who gamble ( N = 259). In Study 2, participants were university women ( N = 219). In both studies, participants completed self-report measures of all constructs that are both reliable and valid. Results In Study 1, as expected, there was a positive association between perfectionism and disordered gambling, which was mediated by financially focused self-concept. This mediation was only observed among participants who scored high on illusion of control and belief in luck. Likewise, in Study 2, there was a positive association between perfectionism and dietary restraint, which was mediated by appearance focused self-concept. The mediation effect was only observed among participants who believed that maladaptive dietary restraint behaviors were safe and efficacious. Discussion and Conclusions The findings support the transdiagnostic utility of our model, which may help explain an array of disordered behaviors, including other addictive behaviors as well as behaviors that involve rigid adherence to rules and control.
Article
Full-text available
This article introduces a new measure of dispositional perfectionism: the Big Three Perfectionism Scale (BTPS). The BTPS assesses three higher-order global factors (rigid perfectionism, self-critical perfectionism, narcissistic perfectionism) via 10 lower-order perfectionism facets (self-oriented perfectionism, self-worth contingencies, concern over mistakes, doubts about actions, self-criticism, socially prescribed perfectionism, other-oriented perfectionism, hypercriticism, grandiosity, entitlement). The present investigation examined the structure of the BTPS using exploratory factor analysis in Study 1 (288 undergraduates), and confirmatory factor analyses in Study 2 (352 community adults) and Study 3 (290 undergraduates). Additionally, in Study 3 the relationships among the BTPS, other measures of perfectionism, and the five-factor model of personality were investigated. Overall, findings provide first evidence for the reliability and validity of the BTPS as a multidimensional measure of perfectionism.
Article
Full-text available
Perfectionism is a putative risk factor for depressive symptoms. However, most research in this area uses cross-sectional designs (which fail to address temporal precedence) and mono-source designs (which are influenced by various biases). The present study overcomes these limitations by using a novel design involving both self-and informant reports of self-critical perfectionism (i.e., negative reactions to per-ceived failures, concern over others' criticism and expectations, doubts about performance abilities, and intense self-rebuke). It was hypothesized that self-and informant reports of self-critical perfection-ism would correlate moderately and that self-and informant reports of self-critical perfectionism would predict increases in depressive symptoms over time. A sample of 155 target participants and 588 infor-mants was recruited and studied using a prospective longitudinal design. All study hypotheses were supported, including evidence that self-and informant reports of self-critical perfectionism each add incrementally to the understanding of the self-critical perfectionism–depressive symptoms connection. Informant reports may provide a more complete picture of the self-critical perfectionist and her or his vulnerability to depressive symptoms.
Article
A common concern when faced with multivariate data with missing values is whether the missing data are missing completely at random (MCAR); that is, whether missingness depends on the variables in the data set. One way of assessing this is to compare the means of recorded values of each variable between groups defined by whether other variables in the data set are missing or not. Although informative, this procedure yields potentially many correlated statistics for testing MCAR, resulting in multiple-comparison problems. This article proposes a single global test statistic for MCAR that uses all of the available data. The asymptotic null distribution is given, and the small-sample null distribution is derived for multivariate normal data with a monotone pattern of missing data. The test reduces to a standard t test when the data are bivariate with missing data confined to a single variable. A limited simulation study of empirical sizes for the test applied to normal and nonnormal data suggests that the test is conservative for small samples.
Article
The development and validation of a new measure, the Eating Disorder Inventory (EDI) is described. The EDI is a 64 item, self-report, multiscale measure designed for the assessment of psychological and behavioral traits common in anorexia nervosa (AN) and bulimia. The EDI consists of eight subscales measuring: Drive for Thinness, Bilimia, Body Dissatisfaction, Ineffectiveness, Perfectionism, Interpersonal Distrust, Interoceptive Awareness and Maturity Fears. Reliability (internal consistency) is established for all subscales and several indices of validity are presented. First, AN patients (N=113) are differentiated from femal comparison (FC) subjects (N=577) using a cross-validation procedure. Secondly, patient self-report subscale scores agree with clinician ratings of subscale traits. Thirdly, clinically recovered AN patients score similarly to FCs on all subscales. Finally, convergent and discriminant validity are established for subscales. The EDI was also administered to groups of normal weight bulimic women, obese, and normal weight but formerly obese women, as well as a male comparison group. Group differences are reported and the potential utility of the EDI is discussed.
Article
This article covers both the historical and modern developments in structural equation modeling. The material is divided into what can be referred to as the ‘first generation’ and the ‘second generation’ of structural equation modeling. Topics discussed under the first generation include the history of structural equation modeling estimation, testing, and assessment of assumptions. Topics covered in the second generation include multilevel structural equation modeling and latent variable growth curve modeling.
Article
This article proposes that binge eating is motivated by a desire to escape from self-awareness. Binge eaters suffer from high standards and expectations, especially an acute sensitivity to the difficult (perceived) demands of others. When they fall short of these standards, they develop an aversive pattern of high self-awareness, characterized by unflattering views of self and concern over how they are perceived by others. These aversive self-perceptions are accompanied by emotional distress, which often includes anxiety and depression. To escape from this unpleasant state, binge eaters attempt the cognitive response of narrowing attention to the immediate stimulus environment and avoiding broadly meaningful thought. This narrowing of attention disengages normal inhibitions against eating and fosters an uncritical acceptance of irrational beliefs and thoughts. The escape model is capable of integrating much of the available evidence about binge eating.