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PERFECTIONISTIC CONCERNS AND BINGE EATING
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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, 233–255.
Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism.
Cognitive Therapy and Research, 14, 449–468.
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, 15–34.
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, 456–470.
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, 1198–1202.
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, 690–709.
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, 123–131.
Stoeber, J., & Otto, K. (2006). Positive conceptions of perfectionism: Approaches, evidence,
challenges. Personality and Social Psychology Review, 10, 295–319.
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, 119–124.
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, 687–705.
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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.
.86
.81
.95
.82
Perfectionistic
concerns
(Wave 2)
Perfectionistic
concerns
(Wave 3)
Perfectionistic
concerns
(Wave 4)
Perfectionistic
concerns
(Wave 1)
Binge
eating
(Wave 1)
.91
.96
.04
.04
.03
.45
.09
.10
.11
.69
.75
.93
.95
Binge
eating
(Wave 2)
Binge
eating
(Wave 3)
.76
Binge
eating
(Wave 4)
.79