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Perfectionism and Eating-Related Symptoms in Young Children: A Systematic Review. Perspectives on Early Childhood Psychology and Education, 4(2), 237-262.



Perfectionism is a multidimensional personality trait that encom- passes two higher-order dimensions: Perfectionistic Strivings (i.e., the strive to achieve exceedingly high standards) and Perfectionistic Concerns (i.e., negative self-evaluation and fear of failure). Both dimensions are related to eating disorders (EDs) in clinical and community adults. The association between perfectionism and EDs has also been observed in children but, to date, no review has summarized the relevant empirical findings with children under the age of 14. English-language studies published up to 2019 were searched in online databases (PsycINFO, Medline, PsycArticle) by using the pertinent keywords. Eligible publica- tions reported at least one relationship between perfectionism and eating-related symptoms in children. Data were examined using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. For the 14 studies that were included, 11 studies provided evidence supporting the relationship between perfectionism and ED outcomes, with the majority adopting a unidimensional approach for perfectionism assessment. Among the studies that used multidimensional assessment of perfection- ism, the majority supported the involvement of perfectionistic strivings. Implications of results for children are discussed.
Perfectionism and Eating-Related Symptoms
in Young Children: A Systematic Review
Mariacarolina Vacca and Caterina Lombardo
Perfectionism is a multidimensional personality trait that encom-
passes two higher-order dimensions: Perfectionistic Strivings (i.e.,
the strive to achieve exceedingly high standards) and Perfectionistic
Concerns (i.e., negative self-evaluation and fear of failure). Both
dimensions are related to eating disorders (EDs) in clinical and
community adults. The association between perfectionism and
EDs has also been observed in children but, to date, no review
has summarized the relevant empirical findings with children
under the age of 14. English-language studies published up to
2019 were searched in online databases (PsycINFO, Medline,
PsycArticle) by using the pertinent keywords. Eligible publica-
tions reported at least one relationship between perfectionism
and eating-related symptoms in children. Data were examined
using the Quality Assessment Tool for Observational Cohort and
Cross-Sectional Studies. For the 14 studies that were included, 11
studies provided evidence supporting the relationship between
perfectionism and ED outcomes, with the majority adopting a
unidimensional approach for perfectionism assessment. Among
the studies that used multidimensional assessment of perfection-
ism, the majority supported the involvement of perfectionistic
strivings. Implications of results for children are discussed.
Keywords: perfectionism, eating symptoms, disordered eating, children,
childhood onset
238 Perspectives Volume 4, Issue 2 Fa ll 2 019 Perfectionism and Eating Symptoms in Children 239
Perfectionism is a personality trait that has been defined as
the tendency to set high standards, be excessively susceptible to
critical evaluation, and strive for flawlessness (Frost, Marten, Lahart,
& Rosenblate, 1990; Smith, Saklofske, Yan, & Sherry, 2015; Stoeber &
Otto, 2006). Empirical evidence supports a multidimensional nature
of perfectionism, leading to the distinction between two major
dimensions: the engaging in negative self-evaluation and the striv-
ing to achieve high standards of performance (Dunkley, Blankstein,
Halsall, Williams, & Winkworth, 2000; Stoeber & Gaudreau, 2017).
The first dimension, called Perfectionistic Concerns (PC) is related to
perceived stress, neuroticism, avoidant coping (Stoeber & Childs,
2010), and high levels of psychopathology symptoms (Limburg,
Watson, Hagger, & Egan, 2017). On the other hand, Perfectionistic
Striving (PS) has been generally associated with adaptive outcomes,
such as positive affect, intrinsic motivation to succeed (Eum & Rice,
2011; Taylor, Papay, Webb, & Reeve, 2016), and trait emotional intel-
ligence (Smith, Saklofske, & Yan, 2015). However, evidence also has
shown that PS might act as a risk factor for depressive symptoms
after controlling for PC (Smith et al., 2016), for suicide (Flett, Hewitt,
& Heisel, 2014), and obsessive-compulsive disorder (Soreni et al.,
2014), providing support for the notion that PS may not always be
beneficial (Limburg et al., 2017). Thus, the effects of PS appear to
be mixed since there are findings indicating that it may be both
a risk factor (Smith et al., 2016) and a protective factor (Hill, 2014)
after controlling for PC. Moreover, PS in adults consistently predicted
negative outcomes related to eating disorders (EDs; Bardone-Cone,
et al., 2007; Esposito, Stoeber, Damian, Alessandri, & Lombardo, 2017;
Stoeber, Madigan, Damian, Esposito, & Lombardo, 2017). A relatively
recent meta-analysis on the relationship between psychopathology
outcomes and perfectionism dimensions highlighted the role of PC
for most outcomes, with the exception of eating disorders symptoms
where PS and PC explained the same variance (Limburg et al., 2017).
In samples of children and adolescents, the PS dimension has been
found to encompass not only the beneficial attitude to set high
standards, but also the negative outcomes usually attributed to
the self-criticism over imperfections (McCreary, Joiner, Schmidt, &
Ialongo, 2004; O’Connor, Dixon, & Rasmussen, 2009; Sironic & Reeve,
2015). It is possible that for children and adolescents the perceived
pressures to be perfect from significant others are more relevant
than self-expectations (Muuss, 2006).
Despite the prevalent empirical support towards PS as positive
for personal growth and psychological adjustment (Stoeber, 2018),
this adaptive role needs to be reconsidered and clarified in the
specific case of Feeding and Eating Disorders (EDs). EDs are clinical
conditions characterized by persistent disturbances of eating behav-
ior that result in the altered consumption or absorption of food and
significantly impairs physical health or psychosocial functioning
(American Psychiatric Association, 2013). Present diagnostic systems
identify six main mutually exclusive syndromes: Pica, rumination
disorder, and avoidant/restrictive food intake disorder that occurs for
the first time in early childhood; Anorexia Nervosa (AN) and Bulimia
Nervosa (BN) whose peak age of onset is estimated around middle
and late adolescence (15–19 years of age); and Binge Eating Disorder
(BED) that was found to occur at age 16 (Stice, Killen, Hayward, &
Taylor, 1998). The first three syndromes may be indicated as feed-
ing disorders given their main characteristic is the disturbed eating
behavior and there are no weight and body shape concerns, while
Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder also
show a common psychopathology dealing with body image and
body dissatisfaction (Fairburn, 2008).
Epidemiological studies have suggested that the prevalence
of EDs among children and adolescents has increased significantly
in the last decades (Madden, Morris, Zurynski, Kohn, & Elliot, 2009;
Rosen, 2010) and several studies have focused on EDs with childhood
onset from 7–14 years of age (Fairburn & Brownell, 2005). EDs at
this age are more difficult to diagnose, because they often present
atypically. A case-register study found that the incidence of diagnosis
of Anorexia Nervosa was between ages 10–14 years (Micali et al.,
240 Perspectives Volume 4, Issue 2 Fa ll 2 019 Perfectionism and Eating Symptoms in Children 241
2013; as cited in Nicholls & Bryant-Waugh, 2009). Epidemiological
evidence reported the presence of binge eating and overeating was
among 6- to 13-year-old normal and overweight children (Nicholls
& Bryant-Waugh, 2009). Although epidemiological data concerning
the incidence of Bulimia Nervosa in children are not available, many
clinical referrals reported evidence in individuals between ages 7–13
years (Fairburn & Brownell, 2005).
Moreover, the adoption of dysfunctional eating behavior (i.e.,
restrictive eating, limiting food intake for controlling weight, etc.)
and body weight and shape dissatisfaction, which are widespread
in adolescent girls and adult women of western societies, develops
early in life, namely by age 6 (Harriger, & Thompson, 2012; Smolak,
2012) or earlier (Tremblay & Limbos, 2009). Longitudinal data showed
that subclinical eating disorder pathology in children predicted the
subsequent development of full syndrome EDs (Calam & Waller, 1998).
Therefore, an early detection of the risk factors for developing EDs
may improve prognosis and treatment outcomes in younger age
groups (D’Souza, Forman, & Austin, 2005; Nicholls, Lynn, & Viner, 2011).
Perfectionism is among the most relevant candidate risk factor
for these eating disorders. Individuals with ED symptoms attempt
to apply their perfectionistic standards in order to control eating,
shape, and weight (Fairburn, Cooper, & Shafran, 2003). High lev-
els of perfectionism predicted lower likelihood of remission at 12
months follow-up in a sample of ED sufferers (Johnston et al., 2018).
When researchers compared adult patients with Anorexia Nervosa
and Bulimia Nervosa to non-clinical groups and patients with other
psychiatric diagnoses, perfectionism was higher in patients with ED
(Dahlenburg, Gleaves, & Hutchinson, 2019; Kehayes, Smith, Sherry,
Vidovic, & Saklofske, 2019), thus suggesting the role of perfectionism
is also a maintaining factor for these disorders in adults (Egan, Wade,
& Shafran, 2011).
The patterns of association between perfectionism and ED
symptoms in adolescents are similar to those observed in older
age groups. Many studies have found significant cross- sectional and
prospective associations between perfectionism and ED symptoms in
non-clinical samples of children and adolescents (Campbell, Boone,
Vansteenkiste, & Soenens, 2018; Ferreiro, Seoane, & Senra, 2012). In
non-clinical, early adolescents, perfectionism increased the risk for
EDs one year later (Boone, Soenens, & Luyten, 2014). Perfectionistic
traits were associated with bulimic symptoms in a sample of adoles-
cents (with a mean age of 13.9 years) after two years (Boone, Soenens,
& Braet, 2011). Moreover, perfectionism in girls of ages 12–16 years
assessed at either Time 1 or Time 2 (two years later) predicted the
young adult onset of Anorexia Nervosa eight years after the first
assessment period (Tyrka, Waldron, Graber, & Brooks Gunn, 2002).
These finding suggest that perfectionism may be implicated in the
pathogenesis of ED symptoms. Although results are consistent for
adolescents and adults, the role of perfectionism in children’s ED
symptoms has not been widely studied. To date, no systematic review
has explicitly examined the association between perfectionism and
ED symptoms in studies focused on children. Therefore, the aim
of this research was to summarize studies that have assessed the
relationship between perfectionism and ED symptoms in children
under the age of 14 years.
Search Procedure
According to Preferred Reporting Items for Systematic Reviews
and Meta-Analyses (PRISMA; Moher, Liberati, Tetzlaff, & Altman, 2009)
recommendations, peer-reviewed articles up to 2019 on the relationship
between perfectionism and dysfunctional eating habits in childhood
were identified. Articles were searched in online databases (PsycINFO,
Medline, PsycArticle), by using the following keywords: “(perfectionism
OR perfection OR perfectionistic OR perfectionist) AND (eating disorders
OR anorexia OR bulimia OR disordered eating) AND (child OR children
OR childhood OR kid OR kids).” We read the titles of all papers gener-
ated by our search results. If the title of the paper contained words
or phrases related to perfectionism (e.g., perfectionistic tendencies/
242 Perspectives Volume 4, Issue 2 Fa ll 2 019 Perfectionism and Eating Symptoms in Children 243
dimension), eating pathology and symptoms (e.g., eating restriction, food
consumption), and childhood (e.g., youth, young, infants, pediatric), the
paper was retrieved. To be include in the review the following criteria
were satisfied: (a) Participants under 14 years of age (or studies with
sub analyses on this age group), (b) Examining either perfectionism and
eating symptoms (using validated instruments with child self-report
data and/or using a structured psychiatric interview), and (c) Reporting
of at least one indicator of the relationship between perfectionism and
eating symptoms, habits, or attitudes.
Studies published in non-English language journals and non-peer
reviewed journals were excluded. Articles that reported case reports, case
series, qualitative studies, dissertations, review papers, and conference
abstracts without published full articles were excluded. Clinical trials
were not included in this review given that we were not interested
in specific intervention effects. Because the objective of this review
was to explore if perfectionism was associated to ED symptoms in
children, we did not exclude studies merely focused on a non-dimen-
sional measurement of this relationship (e.g., canonical correlation). For
this reason, many studies showed different results depending of the
specific association considered. Given the variety of study designs, a
meta-analysis was not feasible.
Data Extraction and Risk of Bias
Data extraction was performed by the first author of this paper.
The information extracted from each study included: the references,
the study design, the sample characteristics (mean age, age range, sex,
presence of illness/psychopathology, etc.), the perfectionism measure
used, and the eating-related symptoms assessed. Data were examined
using the National Institutes of Health (NIH) Quality Assessment Tool for
Observational Cohort and Cross-Sectional Studies (Sanderson, Tatt, &
Higgins, 2007). The tools included 14 items for evaluating potential flaws
in study methods or implementation (e.g., “good, “fair, or “poor” quality).
Items reviewed included representativeness of sampling procedure,
blinding of outcome assessors, response rate, validity of measurement
methods, the provision of specific statistical parameters, and control of
potential confounding variables. The criteria were rated as either yes,
no, or “other” (i.e., cannot determine, not reported, or not applicable). A
score equal to or less than 6 indicated a poor methodological quality, a
score of 7 reflected a medium-risk quality, and a score of greater than
7 suggested a good methodological quality of studies. The maximum
score that can obtain using this tool is 14.
Study selection. A total of 399 records were identified through
electronic databases. After duplicates were removed, 288 studies were
examined. Two-hundred and ten articles were globally screened on the
inclusion and exclusion criteria, of which 196 were excluded. The main
reasons for exclusion were an incongruent age range of participants and
the lack of an indicator of the relationship between perfectionism
and ED symptoms. The remaining 14 papers were included in the
review. A summary of study selection process is outlined in Figure 1.
Records indentified through
database searching (n = 399)
Records after duplicates
removed (n=288)
Records excluded (n=78)
Full-text articles assessed for
eligibility (n = 210)
Studies included (n=14)
Dissertation (n = 21)
Book (n = 18)
Review (n = 21)
Case report (n = 9)
No English Language (n= 9)
Articles excluded, with reason
No English Language ( n=1)
Qualitative study (n = 12)
No child self-report data (n=5)
Clinical trial (n = 15)
Inclusion of adults (n = 81)
Inclusion of middle and
late adolescents (n = 74)
Lack of variables indicator (n = 8)
Identification InclusionElegibility Screening
Figure 1. Student selection flow diagram
244 Perspectives Volume 4, Issue 2 Fa ll 2 019 Perfectionism and Eating Symptoms in Children 245
Cross-Sectional Design
Years of Age Population Perfectionism Eatings Findings Quality
Faust, 1984 11–14
Mage= 13.2
N = 65
no clinical females EDI-P EDI Perfectionism was not
related to Drive for Thinness 5
Simmons et al., 2001 Mage= 12.8
(7th grade)
N = 392
no clinical females EDI-P TREI,
Perfectionism accounted for
variance in BUILT-R 6
McVey et al., 2002
Mage= 12.9
(7th and 8th
N = 363
no clinical females CAPS ChEAT
Self-Oriented Perfectionism
significantly associated with
ChEAT total score
Kirsh et al., 2007 12–14
Mage= 13.36
N = 25 females in
treatment for an ED,
25 age-matched
Self-oriented perfectionism was
found to distinguish the ED group
from their controls
Goodwin et al., 2011 Mage= 12.8
(7th grade)
N = 1,488
no clinical males
and females
cross-sectionally predicted
compulsive exercise in girls
Elizathe et al., 2016 9–13
Mage= 10.85
N = 37 females and
63 males (all over-
(total score) ChEAT
Perfectionism cross-sectionally
predicted the presence of ED in
overweight children
van Noort et al., 2018 9.2  13.9
Mage= 12.2
N = 30 females with
early-onset AN, 30
(total score) ChEDE
Patients with early-onset Anorexia
did not report higher FMPS than
healthy controls
Years of Age Population Perfectionism Eatings Findings Quality
Calam & Waller, 1998 11.9 – 13.9
Mage= 12.8
N = 92
no clinical females SCANS BITE,
Perfectionism was followed
by low levels of severity
of bulimic behaviors
Westerberg et al., 2008 11 –13 N = 567
no clinical females EDI-P ChEAT
Perfectionism year 1 was
associated with ChEAT year 3.
Perfectionism year 1 failed to
predict ChEAT year 3
Bachar et al., 2010 Mage= 12.8
(7th grade)
N = 243
no clinical females
(total score)
Perfectionism failed to 13
distinguish ED sufferers from
non-ED sufferers
Westerberg et al., 2010 9 – 13 N= 516
no clinical females EDI-P ChEAT
The relation between EDI-P
year 1 and ChEAT year was
moderated by self-esteem
Ferreiro et al., 2012 9 – 12
Mage= 10.8
N = 465 no clinical
females and 477 no
clinical males
EDI-P year 1 was associated
with ChEAT year 3. EDI-P year 1
predicted ChEAT year 3
Goodwin et al., 2014 12 – 14
Mage= 12.89
N = 148 males and
221 females CAPS CET,
SOP 9-year 1 predicted
compulsive exercise
amoung males year 3
Wade et al., 2015
Mage= 13
(7th and 8th
N = 926
no clinical females FMPS EDE-Q
Perfectionistic Concerns were
correlated with all ED variables.
PC predicted the growth of ED
through Ineffectveness
Table 1
Overview of study characteristics
Note. Abbreviation: BITE, Bulimic Investigatory Test; CAPS, Child and Adolescent Perfectionism Scale; CED, Compulsive Exercise Test; ChEAT,
Eating Attitude Test for Children; CHEDE-Q, Children’s Eating Disorders ExaminationQuestionnaire; CPQ, Child Perfectionism Questionnaire;
EAT, Eating Attitude Test; EDE-Q, Eating Disorder Examination Questionnaire; EDFHI, Eating Disorder Family History Interview; EDI, Eating
Disorder Inventory; EDI-P, Eating Disorder Inventory-Perfectionism Scale; FMPS, Frost Multidimensional Perfectionism Scale ; HFMPS, Hewitt
& Flett Multidimensional Perfectionism Scale; SOP, Self-Oriented Perfectionism; TREI, Thinness and Restricting Expectancy Inventory. Overall
judgments regarded quality ratings of good (8-14), fair (7), or poor (1-6).
246 Perspectives Volume 4, Issue 2 Fa ll 2 019 Perfectionism and Eating Symptoms in Children 247
Study characteristics. A cross-sectional design was employed
in seven articles, while the remaining were longitudinal studies (see
Table 1). Ten studies included only female participants. The number
of participants per study ranged from 25 to 1488, yet only one study
was relatively large with 1488 participants. The mean age across the
12 studies that reported mean age was 11.45 years. Most studies
were conducted on non-clinical samples, while only two studies
included patients with ED and age-matched healthy controls. The
scale most widely used for assessing disordered eating was the
Children version of Eating Attitudes Test (ChEAT; Maloney, McGuire,
& Daniels, 1988), followed by the Eating Disorder Inventory (EDI;
Garner, Olmsted, & Polivy, 1983) and the Children’s Eating Disorders
Examination-Questionnaire (ChEDE Q; Hilbert, Hartmann, & Czaja,
2008). Other assessment tools for ED symptoms were the Bulimic
Investigatory Test (BITE; Henderson & Freeman, 1987), the Thinness
and Restricting Expectancy Inventory (TREI; Atlas, Smith, & Hohlstein,
1988; Hohlstein et al., 1998; as cited in Simmons, Smith, & Hill, 2002)
and the Eating Disorder Family History Interview (EDFHI; Strober,
Perfectionism was measured through unidimensional or mul-
tidimensional instruments. Most of the studies (N = 5) that used a
unidimensional approach used the EDI-P, a subscale of the Eating
Disorder Inventory (EDI; Garner et al., 1983). The EDI-P consists of 6
items designed to evaluate the general tendency to set excessively
high standards and to be concerned about social expectations.
Another scale used to assess unidimensional perfectionism is the
Setting Conditions for Anorexia Nervosa Scale (SCANS; Slade &
Dewey, 1986). The scale includes 8 items that measure the desire
to complete tasks to the best of one’s ability. Higher scores reflect
greater levels of perfectionism. For multidimensional measures of
perfectionism, the Child and Adolescent Perfectionism Scale (CAPS;
Flett, Hewitt, Boucher, Davidson, & Munro, 2000) was used in four
studies. It includes two subscales: self-oriented perfectionism (SOP)
and socially prescribed perfectionism (SPP). The first scale reflects
the tendency to strive rigidly for perfection; on the other hand, SPP
addresses the need to meet perceived external expectations (Flett
et al., 2016). While SOP is identified as a marker of PS, SPP is an
indicator of PC (see Limburg et al., 2017). The Frost Multidimensional
Perfectionism Scale (FMPS; Frost et al., 1990) was used in two studies.
The scale included 35 items with a 5-point scale from 1 (strongly
disagree) to 5 (strongly agree). The items reflect six dimensions:
doubts about actions, concern over mistakes, personal standards,
parental expectations, parental criticism and organization. The Child
Perfectionism Questionnaire (CPQ) was used in one study. This scale
is comprised of 16 items reflecting two different dimensions of
perfectionism (Self-demands and Reactions to failure; Oros, 2003;
as cited in Elizathe, Arana, & Rutsztein, 2018). Although four studies
(Bachar, Gur, Canetti, Berry, & Stein, 2010; Elizathe et al., 2018; van
Noort et al., 2018) employed multidimensional measures to assess
perfectionism, researchers tended to use the total scores of these
scales. All studies that investigated the direction of the relationship
between perfectionism and eating disorders symptoms considered
perfectionism as a predictor and ED symptoms as the dependent
variable. Each study examined as outcomes one or more disturbed
eating attitude or behavior. Eleven out of the 14 studies included
reported at least one indicator of a significant relationship between
perfectionism and eating disorders symptoms.
Quality assessment. The quality of the papers, evaluated
through the NIH Quality Assessment Tool for Observational Cohort
and Cross-Sectional Studies (Sanderson et al., 2007), differed across
studies. Seven of them were scored as “good,” two studies reported
a medium risk of bias, and five studies showed a poor methodolog-
ical quality. The research question and the study population were
always clearly stated. Key confounding factors were assessed in eight
studies, and five studies discussed how the sample size needed to
detect a hypothesized difference in outcomes. The lowest score
estimated was 5 and the maximum was 13. The mean of the overall
quality score computed on the cross-sectional studies was 6.3 with
248 Perspectives Volume 4, Issue 2 Fa ll 2 019 Perfectionism and Eating Symptoms in Children 249
a standard deviation (SD) of 1.27. On the other hand, longitudinal
studies showed higher quality scores that those with a cross-sectional
design, with a mean of 10.1 and a SD of 1.72.
Studies adopting a cross sectional design
Half of the studies (n = 7) used cross-sectional designs to inves-
tigate associations between perfectionism and eating pathology in
children under the age of 14 years. In four studies (Elizathe et al.,
2018; Goodwin, Haycraft, Willis, & Meyer, 2011; Kirsh, McVey, Tweed, &
Katzman, 2007; McVey, Pepler, Davis, Flett, & Abdolell, 2002; Simmons
et al., 2002), a significant association between these two variables
was reported, while null association was reported in two studies
(Faust, 1984; van Noort et al., 2018). Among those studies that con-
firmed the association, three used a multidimensional approach to
evaluate perfectionistic tendencies (Goodwin et al., 2011; Kirsh et al.,
2007; McVey et al., 2002), and two studies used a one-dimensional
instrument (Elizathe et al., 2018; Simmons et al., 2002). The aspect
of perfectionism related to ED symptoms was the self-oriented per-
fectionism, one of the components of perfectionistic strivings in
non-clinical samples (McVey et al., 2002), in children with EDs (Kirsh
et al., 2007), and which predicted compulsive exercise symptoms
(Goodwin et al., 2011).
All of the studies that did not find a significant relationship
between perfectionism and ED outcomes employed the total score
of perfectionism measures (Faust, 1984; van Noort et al., 2018).
Inconsistent findings were reported for the association between
unidimensional perfectionism and drive for thinness (Faust, 1987).
Two studies were conducted on clinical samples using the EDI-P scale.
One study reported a significant relationship between perfectionism
and severity of ED symptoms (Elizathe et al., 2018), while the second
study did not report observed differences in perfectionistic traits
between ED patients and healthy controls (Van Noort et al., 2018).
A summary of the findings is provided in Table 2.
Studies adopting a longitudinal design
Seven studies used a prospective design. Five studies used the
total score to assess perfectionism, and two studies employed the
multidimensional approach. Six studies revealed that perfection-
ism significantly predicted severity of ED symptoms either when
multidimensional scales were used for measuring perfectionism
(Goodwin, Haycraft, & Meyer, 2014; Wade, Wilksch, Paxton, Byrne, &
Austin, 2015) or when a one-dimensional measure was used (Calam
& Waller, 1998; Ferreiro et al., 2012; Westerberg, Edlund, & Ghaderi,
Study PS PC Total score/
one dimension No relation
Faust, 1987
Simmons et al., 2001
McVey et al., 2002
Kirsh et al., 2007
Goodwin et al., 2011
Elizathe et al., 2016
van Noort et al., 2018
Calam & Waller, 1998
Westerberg et al., 2008
Bachar et al., 2010
Westerberg et al., 2010
Ferreiro et al., 2012
Goodwin et al., 2014
Wade et al., 2015
Table 2
Overview of the Association Between Perfectionism and ED Outcomes
Note. Abbreviation: PS, Perfectionistic Strivings; PC, Perfectionistic Concerns
250 Perspectives Volume 4, Issue 2 Fa ll 2 019 Perfectionism and Eating Symptoms in Children 251
2008; Westerberg-Jacobson, Edlund, & Ghaderi 2010). Several studies
found significant simple correlations both in the cross-sectional
and the follow-up phases, but a non-significant regression path
when assessing the predictive value of perfectionism. This pattern
suggests that the variance of ED outcomes may be explained by the
linear combination of other variables. For instance, one-dimensional
perfectionism (assessed with the EDI-P) of 13-year-old girls showed
significant and positive bivariate correlation with their ChEAT scores
three years later (Westerberg et al., 2008). However, when entered
in the regression analysis, baseline perfectionism was not a signif-
icant predictor of the girls’ eating disturbances at Year 3, because
their own Year 1 ChEAT and their fathers Year 1 EAT scores contrib-
uted most to the prediction of disturbed eating attitudes in Year
3. Westerberg et al. (2010) found that perfectionism of 13-year-old
girls was significantly correlated with their ChEAT scores eight years
later, though in the regression analysis, the “Wish to be thinner at
Year 1 and the mothers’ rating on perfectionism at Year 1 became
the strongest predictors of Year 8 ChEAT. Westerberg et al. (2010)
reported a significant positive association between the baseline EDI-P
and the ChEAT scores at Year 8 only for the girls with low self-es-
teem, suggesting that high self-esteem could buffer the relation
between perfectionism and ED symptoms. Goodwin et al. (2014)
found that self-oriented perfectionism predicted compulsive exercise,
often associated with eating pathology, even after controlling for
the baseline level of eating disturbances. Significant prospective
association was found between perfectionism assessed at baseline
and disturbed eating attitude after three years (Ferreiro et al., 2012).
One study reported the unique role of perfectionistic concerns in
predicting ED symptoms (Wade et al., 2015). More specifically, it was
found that the direct relationship between perfectionistic concerns
and the ED risk at 4 weeks, 6 months, and 12 months from baseline
was significant, but small and negative. Although in all of the other
studies perfectionism had a positive relationship to ED symptoms,
one study found the opposite pattern: perfectionism was related to
less severe bulimic behaviors (Calam & Waller, 1998). Among those
studies that used the unidimensional assessment, one study did not
find that perfectionism at Time 0 was associated with ED symptoms
at Time 1 (Bachar et al., 2010). More specifically, the authors mea-
sured perfectionism at Time 0 in 243 seventh-grade students and
compared perfectionism total score in those who did and did not
suffer from eating disorders two years later (Time 1). The number
of students examined at Time 1, however, constituted only 11 cases
and 15 non-cases.
The present systematic review investigated the relationship
between perfectionism and ED symptoms in children under 14 years
of age. Both cross-sectional and longitudinal studies were examined.
Although based on few and heterogeneous studies, results globally
suggest that, as in adulthood, the association between perfectionism
and ED symptoms is significant and positive. Most of the studies that
used a longitudinal design were rated as high-quality, while among
the cross-sectional studies, very few were rated as high-quality. Only
three studies out of 14 failed in reporting any association between
perfectionism and ED symptoms. Two of them were cross-sectional
(Faust, 1984; van Noort et al., 2018) and all had a small sample
size (see Table 1). It is possible that the lack of significant effects
is due to this small sample size. The associations found between
perfectionism and EDs may have been artificially increased due to
the use of the same questionnaire (namely the EDI; Garner et al.,
1983) for measuring both perfectionism and ED symptoms. However,
this is not likely the case, because the number of studies using this
instrument and reporting a significant association are only a small
percentage (36%) of our overall sample of studies.
The majority of the studies included in the present review used
a unidimensional approach either employing unidimensional mea-
sures (e.g., EDI-P by Garner et al., 1983; CPQ, Child Perfectionism
Questionnaire by Oros, 2003; SCANS by Slade & Dewey, 1986) or
252 Perspectives Volume 4, Issue 2 Fa ll 2 019 Perfectionism and Eating Symptoms in Children 253
computing a total score from a multidimensional questionnaire
(MPS, Hewitt, Flett, Turnbull-Donovan, & Mikail, 1991; MPS, Frost et
al., 1990). Our findings support the involvement of PS as a poten-
tial risk factor for EDs, although most of these finding come from
cross-sectional designs. Only one longitudinal study reported that
PC increased the risk of EDs, thus confirming that for ED symptoms,
the involvement of PS and PC is mixed. Two longitudinal studies that
used multidimensional questionnaires (Frost et al., 1990; Hewitt et
al., 1991) found that in one study, there was a significant relationship
between EDs and PS (Goodwin et al., 2014), and in the other study,
the significant role of PC in predicting the growth of ED symptoms
was shown (Wade et al., 2015). Studies with a longitudinal design
are especially needed to examine PS and PC because those included
in the present review were of higher quality.
Cumulative evidence has supported that perfectionism may be
best explained by a multi-factor structure, and this is needed when
examining its relationship with eating disorder features (Pearson &
Gleaves, 2006). The increasing research on perfectionism in youth
has shown that different faces of perfectionism exist in children as
in adults (Leone & Wade, 2018). For instance, it has been estimated
that 25–30% of young people present maladaptive perfectionistic
traits (as cited in Flett et al., 2016). Further research should refer to
existing multifactorial models of childhood perfectionism to describe
the degree in which its different aspects are involved in ED symptoms.
Among studies that examined the multidimensional measures,
the majority showed a significant association between self-oriented
perfectionism, one component of perfectionistic strivings, and ED
symptoms. This finding is inconsistent with a growing body of
research that suggests a relatively equal contribution of PC and PS
perfectionism to explaining variance in ED outcomes (Limburg et
al., 2017). Although PS appears to be maladaptive in the context of
eating disorder (Bardone et al., 2007), the role of PC is also relevant
(Boone, Soenens, Braet, & Goossens, 2010). A possible explanation of
this finding may be the complex nature of childhood self-oriented
perfectionism, given that it may combine many elements, includ-
ing intrinsic motivation and introjected pressures to do the best in
achievement contexts (Flett et al., 2016). Thus, it may be possible that
for children and adolescents, the perceived pressures to be perfect
from significant others are more dysfunctional than the self-imposed
high standards (Muuss, 2006).
Following this line of reasoning, it may also be that only in
adults do social pressures and self-criticism (both encompassed by
the perfectionistic concerns dimensions) become more relevant than
in childhood. Further research is needed to examine more complex
relationships and the role of possible mediators and moderators.
Only one study showed that males who reported high levels of
perfectionism were also engaged in more problematic behavior
related to ED compared to females (Goodwin et al., 2014). However,
the researchers did not assess directly eating disorders symptoms but
measured compulsive exercise as a proxy, and this is consistent with
results in adulthood where compulsive exercise has been reported to
be more frequent among males (Guidi et al., 2009; Murray, Griffiths,
Rieger, & Touyz, 2014). Moreover, different mediators and modera-
tors such as self-esteem and parenting styles might show different
relationships among males and females (Boone et al., 2014; Vohs,
Bardone, Joiner, & Abramson, 1999). Much more research is needed
to understand the characteristics and associated factors of EDs in
young males. The findings of the present systematic review strongly
suggest that the interaction between moderators and mediators
in the longitudinal influences of fear of failure and achievement
strivings on children’s health, and especially in the field of eating
disorders, needs to be further investigated.
Implications and Conclusion
Although based on few studies, these findings have some impli-
cations for intervention research and clinical practice. First, more
investigation into the nature of childhood perfectionism and EDs
emerged. The complex nature of self-oriented perfectionism, one
254 Perspectives Volume 4, Issue 2 Fa ll 2 019 Perfectionism and Eating Symptoms in Children 255
aspect of perfectionistic strivings, should be examined, especially
due to its association with ED symptoms. The way in which children
perceive their parents’ criticism and expectations has shown asso-
ciations with their own SOP (Harvey, Moore, & Koestner, 2017). An
evaluation of parent–child communication strategies could be useful
in order to examine mechanisms underlying children’s perception
of external family pressures. This issue makes relevant evaluating
children’s perception of sociocultural pressure regarding appearance.
Research showed that adolescence is a critical period in body image
development (Voelker, Reel, & Greenleaf, 2015) and that one of the
predictors of a negative body appearance is the perceived pressure
to be thin from family, friends, and the media (Rodgers, Paxton, &
McLean, 2014). Parental encouragement to control weight and shape
was found to be associated with body dissatisfaction in boys and girls
one year later (Helfert & Warschburger, 2011) and with perceived body
concerns among overweight adolescents (Helfert & Warschburger,
2013). Previous findings highlighted the role of media-internaliza-
tion in longitudinally predicting body dissatisfaction in schoolgirls
through its influence on social appearance comparison (Rodgers,
McLean, & Paxton, 2015). Moreover, the influence of friends and
peers on adolescents’ body dissatisfaction has been well supported
in literature (for a review, see Webb & Zimmer-Gembeck, 2014). We
suggest that the influence of external and sociocultural pressures on
body concerns and eating behavior may reflect the same mechanism
in children as well as in adolescents. Further research is requested
to investigate the specific role of perceived external expectation
in explaining body-related concerns and eating disturbances in
childhood. The current findings also suggest that focusing on per-
fectionism may improve treatment protocols designed for children.
Consistent with this conclusion are previous experiences indicating
that group cognitive behavioral therapy for perfectionism helped to
reduce adolescents’ criticisms about body weight and shape (Hurst
& Zimmer-Gembeck, 2015; Wilksch, Durbridge & Wade, 2008). A
program for children with perfectionism could also involve the
examination of children’s susceptibility to the cultural expectations
of thinness and perfection. A primary educational institution may
provide the promotion of students’ awareness of the influence of
sociocultural agents on the development of body image disturbance
and subsequent ED pathology.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Arlington, VA: Author.
Bachar, E., Gur, E., Canetti, L., Berry, E., & Stein, D. (2010). Selessness and perfection-
ism as predictors of pathological eating attitudes and disorders: A longitudinal
study. European Eating Disorders Review, 18(6), 496–506. doi: 10.1002/erv.984
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. doi:
Boone, L., Soenens, B., & Braet, C. (2011). Perfectionism, body dissatisfaction, and
bulimic symptoms: e intervening role of perceived pressure to be thin and thin
ideal internalization. Journal of Social and Clinical Psychology, 30(10), 1043–1068.
doi: 10.1521/jscp.2011.30.10.1043
Boone, L., Soenens, B., Braet, C., & Goossens, L. (2010). An empirical typology of
perfectionism in early-to- mid adolescents and its relation with eating disorder
symptoms. Behaviour Research and erapy, 48(7), 686–691. doi: 10.1016/j.
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), 412–418. doi: 10.1037/a0036254
Calam, R., & Waller, G. (1998). Are eating and psychosocial
characteristics in early teenage years useful predictors of eating
characteristics in early adulthood? A 7-year longitudinal study. International
Journal of Eating Disorders, 24(4), 351–362.
Campbell, R., Boone, L., Vansteenkiste, M., & Soenens, B. (2018). Psychological need
frustration as a transdiagnostic process in associations of self‐critical
perfectionism with depressive symptoms and eating pathology. Journal of Clinical
Psychology, 74(10), 1775–1790.
256 Perspectives Volume 4, Issue 2 Fa ll 2 019 Perfectionism and Eating Symptoms in Children 257
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. doi: 10.1002/eat.23009
D’Souza, C. M., Forman, S. F., & Austin, S. B. (2005). Follow-up evaluation of a high
school eating disorders screening program: knowledge, awareness and self-re-
ferral. Journal of Adolescent Health, 36(3), 208–213.
Dunkley, D. M., Blankstein, K. R., Halsall, J., Williams, M., & Winkworth, G. (2000).
e relation between perfectionism and distress: Hassles, coping, and perceived
social support as mediators and moderators. Journal of Counseling Psychology,
47(4), 437–453.
Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic pro-
cess: A clinical review. Clinical Psychology Review, 31(2), 203–212. doi: 10.1016/j.
Elizathe, L. S., Arana, F. G., & Rutsztein, G. (2018). A cross-sectional model of eating
disorders in Argentinean overweight and obese children. Eating and Weight
Disorders-Studies on Anorexia, Bulimia and Obesity, 23(1), 125–132. doi: 10.1007/
Esposito, R. M., Stoeber, J., Damian, L. E., Alessandri, G., & Lombardo, C. (2017).
Eating disorder symptoms and the 2×2 model of perfectionism: mixed
perfectionism is the most maladaptive combination. Eating and Weight Disorders-
Studies on Anorexia, Bulimia and Obesity, 1–7. doi: 10.1007/s40519-017-0438-1
Eum, K., & Rice, K. G. (2011). Test anxiety, perfectionism, goal orientation, and
academic performance. Anxiety, Stress, & Coping, 24(2), 167–178. doi:
Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. New York, NY:
Guilford Press.
Fairburn, C. G., & Brownell, K. D. (Eds.). (2005). Eating disorders and obesity: A com-
prehensive handbook. New York, NY: Guilford Press.
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. doi: 10.1016/S0005 7967(02)00088-8
Faust, J. (1987). Correlates of the drive for thinness in young female adolescents.
Journal of Clinical Child Psychology, 16(4), 313–319.
Ferreiro, F., Seoane, G., & Senra, C. (2012). Gender-related risk and protective factors
for depressive symptoms and disordered eating in adolescence: A 4-year longi-
tudinal study. Journal of Youth and Adolescence, 41(5), 607–622. doi: 10.1007/
Flett, G. L., Hewitt, P. L., Boucher, D. J., Davidson, L. A., & Munro, Y. (2000). e
Child– Adolescent Perfectionism Scale: Development, validation, and association
with adjustment (Report No. 203). North York, Ontario, Canada: York University
Psychology Department. Retrieved from
Flett, G. L., Hewitt, P. L., Besser, A., Su, C., Vaillancourt, T., Boucher, D.,...Gale,
O. (2016). e Child–Adolescent Perfectionism Scale: Development, psy-
chometric properties, and associations with stress, distress, and psychiatric
symptoms. Journal of Psychoeducational Assessment, 34(7), 634–652. doi:
Flett, G. L., Hewitt, P. L., & Heisel, M. (2014). e destructiveness of perfectionism
revisited: Implications for the assessment of suicide risk and the prevention
of suicide. Review of General Psychology, 18, 156–172.
Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). e dimensions of perfec-
tionism. Cognitive erapy and Research, 14, 449–468.
Garner, D. M., Olmsted, M. P., & Polivy, J. (1983). Development and validation
of a multidimensional eating disorder inventory for anorexia nervosa and
bulimia. International Journal of Eating Disorders, 2, 14–34. https://doi.
Goodwin, H., Haycra, E., & Meyer, C. (2014). Psychological risk factors for com-
pulsive exercise: A longitudinal investigation of adolescent boys and girls.
Personality and Individual Dierences, 68, 83–86.
Goodwin, H., Haycra, E., Willis, A. M., & Meyer, C. (2011). Compulsive exercise: e
role of personality, psychological morbidity, and disordered eating. International
Journal of Eating Disorders, 44(7), 655–660. doi: 10.1002/eat.20902
Guidi, J., Pender, M., Hollon, S. D., Zisook, S., Schwartz, F. H., Pedrelli, P.,...Petersen,
T. J. (2009). e prevalence of compulsive eating and exercise among college
students: An exploratory study. Psychiatry Research, 165(1–2), 154–162
Harriger, J. A., & ompson, J. K. (2012). Psychological consequences of obesity:
weight bias and body image in overweight and obese youth. International Review
of Psychiatry, 24(3), 247–53. doi: 10.3109/09540261.2012.678817
Harvey, B. C., Moore, A. M., & Koestner, R. (2017). Distinguishing self-oriented
perfectionism-striving and self-oriented perfectionism-critical in school-aged
children: Divergent patterns of perceived parenting, personal aect and school
performance. Personality and Individual Dierences, 113, 136–141.
258 Perspectives Volume 4, Issue 2 Fa ll 2 019 Perfectionism and Eating Symptoms in Children 259
Helfert, S., & Warschburger, P. (2011). A prospective study on the impact of peer and
parental pressure on body dissatisfaction in adolescent girls and boys. Body
Image, 8(2), 101–109.
Helfert, S., & Warschburger, P. (2013). e face of appearance-related social pressure:
Gender, age and body mass variations in peer and parental pressure during
adolescence. Child and Adolescent Psychiatry and Mental Health, 7(1), 16. doi:
Henderson, M., & Freeman, C. P. L. (1987). A self-rating scale for bulimia the “bite.
e British Journal of Psychiatry, 150(1), 18–24. doi: 10.1192/bjp.150.1.18
Hewitt, P. L., Flett, G. L., Turnbull-Donovan, W., & Mikail, S. F. (1991). e
Multidimensional Perfectionism Scale: Reliability, validity, and psycho-
metric properties in psychiatric samples. Psychological Assessment: A
Journal of Consulting and Clinical Psychology, 3(3), 464–468. http://dx.doi.
Hilbert, A., Hartmann, A. S., & Czaja, J. (2008). Child Eating Disorder Examination
Questionnaire: Psychometrische Eigenschaen der deutschsprachigen
Übersetzung. Klinische Diagnostik und Evaluation, 1, 447–464.
Hill, A. P. (2014). Perfectionistic strivings and the perils of partialling. International
Journal of Sport and Exercise Psychology, 12(4), 302–315.
Hurst, K., & Zimmer-Gembeck, M. (2015). Focus on perfectionism in female adoles-
cent anorexia nervosa. International Journal of Eating Disorders, 48(7), 936–941.
doi: 10.1002/eat.22417
Johnston, J., Shu, C. Y., Hoiles, K. J., Clarke, P. J., 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. doi: 10.1016/j.eatbeh.2018.05.008
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 Dierences, 138, 117–125. https://
Kirsh, G., McVey, G., Tweed, S., & Katzman, D. K. (2007). Psychosocial pro-
les of young adolescent females seeking treatment for an eating disorder.
Journal of Adolescent Health, 40(4), 351–356.
Leone, E. M., & Wade, T. D. (2018). Measuring perfectionism in children: a systematic
review of the mental health literature. European Child & Adolescent Psychiatry,
27(5), 553–567. doi: 10.1007/s00787-017-1078-8
Limburg, K., Watson, H. J., Hagger, M. S., & Egan, S. J. (2017). e relationship
between perfectionism and psychopathology: A meta-analysis. Journal of Clinical
Psychology, 73(10), 1301–1326. doi: 10.1002/jclp.22435
Madden, S., Morris, A., Zurynski, Y. A., Kohn, M., & Elliot, E. J. (2009). Burden of
eating disorders in 5- to 13-year-old children in Australia. Medical Journal of
Australia, 190(8), 410–414.
Maloney, M. J., McGuire, J. B., & Daniels, S. R. (1988). Reliability testing of a
childrens version of the Eating Attitude Test. Journal of the American
Academy of Child and Adolescent Psychiatry, 27(5), 541–543. https://doi.
McCreary, B. T., Joiner, T. E., Schmidt, N. B., & Ialongo, N. S. (2004). e struc-
ture and correlates of perfectionism in African American children. Journal
of Clinical Child and Adolescent Psychology, 33, 313–324. doi: 10.1207/
McVey, G. L., Pepler, D., Davis, R., Flett, G. L., & Abdolell, M. (2002). Risk and
protective factors associated with disordered eating during early ado-
lescence. e Journal of Early Adolescence, 22(1), 75–95. https://doi.
Moher, D., Liberati, A., Tetzla, J., & Altman, D. G. (2009). Preferred reporting items
for systematic reviews and meta-analyses: e PRISMA statement. Annals of
Internal Medicine, 151(4), 264–269. doi: 10.1371/journal.pmed.1000097
Murray, S. B., Griths, S., Rieger, E., & Touyz, S. (2014). A comparison of compulsive
exercise in male and female presentations of anorexia nervosa: What is the dier-
ence? Advances in Eating Disorders: eory, Research and Practice, 2(1), 65–70.
Muuss, R. E. (2006). eories of adolescence (6th ed.). New York, NY: McGraw-Hill
Nicholls, D., & Bryant-Waugh, R. (2009). Eating disorders of infancy and childhood:
denition, symptomatology, epidemiology, and comorbidity. Child and Adolescent
Psychiatric Clinics of North America, 18(1), 17–30. doi: 10.1016/j.chc.2008.07.008
Nicholls, D. E., Lynn, R., & Viner, R. M. (2011). Childhood eating disorders: British
national surveillance study. e British Journal of Psychiatry, 198(4), 295–301.
doi: 10.1192/bjp.bp.110.081356
O’Connor, R. C., Dixon, D., & Rasmussen, S. (2009). e structure and temporal sta-
bility of the Child and Adolescent Perfectionism Scale. Psychological Assessment,
21(3), 437–443. doi: 10.1037/a0016264
Pearson, C. A., & Gleaves, D. H. (2006). e multiple dimensions of perfectionism and
their relation with eating disorder features. Personality and Individual Dierences,
41(2), 225–235.
260 Perspectives Volume 4, Issue 2 Fa ll 2 019 Perfectionism and Eating Symptoms in Children 261
Rodgers, R. F., McLean, S. A., & Paxton, S. J. (2015). Longitudinal relationships among
internalization of the media ideal, peer social comparison, and body dissatisfac-
tion: Implications for the tripartite inuence model. Developmental Psychology,
51(5), 706–713. doi: 10.1037/dev0000013
Rodgers, R. F., Paxton, S. J., & McLean, S. A. (2014). A biopsychosocial model of body
image concerns and disordered eating in early adolescent girls. Journal of Youth
and Adolescence, 43(5), 814–823. doi: 10.1007/s10964-013-0013-7
Rosen, D. S. (2010). Identication and management of eating disorders in children and
adolescents. Pediatrics, 126(6), 1240–1253. doi: 10.1542/peds.2010-2821
Sanderson, S., Tatt, I. D., & Higgins, J. (2007). Tools for assessing quality and suscep-
tibility to bias in observational studies in epidemiology: a systematic review and
annotated bibliography. International Journal of Epidemiology, 36(3), 666–676.
doi: 10.1093/ije/dym018
Simmons, J. R., Smith, G. T., & Hill, K. K. (2002). Validation of eating and dieting
expectancy measures in two adolescent samples. International Journal of Eating
Disorders, 31(4), 461–473. doi: 10.1002/eat.10034
Sironic, A., & Reeve, R. A. (2015). A combined analysis of the Frost Multidimensional
Perfectionism Scale (FMPS), Child and Adolescent Perfectionism Scale (CAPS),
and Almost Perfect Scale–Revised (APS-R): Dierent perfectionist proles in
adolescent high school students. Psychological Assessment, 27(4), 1471–1483. doi:
Slade, P. D. & Dewey, M. E. (1986). Development and prelim-
inary validation of SCANS: A screening instrument for
identifying individuals at risk of developing anorexia and bulimia ner-
vosa. International Journal of Eating Disorders, 5, 517–538. https://doi.
org/10.1002/1098- 108X(198603)5:3<517::AID-EAT2260050309>3.0.CO;2-6
Smith, M. M., Saklofske, D. H., & Yan, G. (2015). Perfectionism, trait emotional intel-
ligence, and psychological outcomes. Personality and Individual Dierences, 85,
Smith, M. M., Saklofske, D. H., Yan, G., & Sherry, S. B. (2015). Perfectionistic strivings
and perfectionistic concerns interact to predict negative emotionality: Support
for the tripartite model of perfectionism in Canadian and Chinese univer-
sity students. Personality and Individual Dierences, 81, 141–147. https://doi.
Smith, M. M., Sherry, S. B., Rnic, K., Saklofske, D. H., Enns, M., & Gralnick, T. (2016).
Are perfectionism dimensions vulnerability factors for depressive symptoms aer
controlling for neuroticism? A meta-analysis of 10 longitudinal studies. European
Journal of Personality, 30(2), 201–212. doi: 10.1002/per.2053
Smolak, L. (2012). Appearance in childhood and adolescence. In N. Rumsey & D.
Harcourt (Eds.), e Oxford handbook of the psychology of appearance (pp.
123–141). New York, NY: Oxford University Press.
Soreni, N., Streiner, D., McCabe, R., Bullard, C., Swinson, R., Greco, A.,…Szatmari,
P. (2014). Dimensions of perfectionism in children and adolescents with
obsessive-compulsive disorder. Journal of the Canadian Academy of Child and
Adolescent Psychiatry, 23(2), 136–141.
Stice, E., Killen, J. D., Hayward, C., & Taylor, C. B. (1998). Age of onset for
binge eating and purging during late adolescence: A 4-year survival anal-
ysis. Journal of Abnormal Psychology, 107(4), 671–675. http://dx.doi.
Stoeber, J. (2018). e psychology of perfectionism: Critical issues, open questions,
and future directions. In J. Stoeber (Ed.), e psychology of perfectionism: eory,
research, and applications. London: Routledge.
Stoeber, J., & Childs, J. H. (2010). e assessment of self-oriented and socially pre-
scribed perfectionism: Subscales make a dierence. Journal of Personality
Assessment, 92(6), 577–585. doi: 10.1080/00223891.2010.513306
Stoeber, J., & Gaudreau, P. (2017). e advantages of partialling perfectionistic strivings
and perfectionistic concerns: Critical issues and recommendations. Personality
and Individual Dierences, 104, 379–386. doi: 10.1016/j.paid.2016.08.039
Stoeber, J., Madigan, D. J., Damian, L. E., Esposito, R. M., & Lombardo, C. (2017).
Perfectionism and eating disorder symptoms in female university students: e
central role of perfectionistic self- presentation. Eating and Weight Disorders-
Studies on Anorexia, Bulimia and Obesity, 22(4), 641–648. doi: 10.1007/
Stoeber, J., & Otto, K. (2006). Positive conceptions of perfectionism: Approaches, evi-
dence, challenges. Personality and Social Psychology Review, 10(4), 295–319. doi:
Strober, M. (1987). e eating disorders family history interview. Los Angeles, CA:
University of California Press.
Taylor, J. J., Papay, K. A., Webb, J. B., & Reeve, C. L. (2016). e good, the bad, and the
interactive: Evaluative concerns perfectionism moderates the eect of personal
strivings perfectionism on self-esteem. Personality and Individual Dierences, 95,
Tremblay, L., & Limbos, M. (2009). Body image disturbance and psychopathology
in children: Research evidence and implications for prevention and treatment.
Current Psychiatry Reviews, 5, 62–72. doi: 10.2174/157340009787315307
262 Perspectives Volume 4, Issue 2 Fa ll 2 019
Tyrka, A. R., Waldron, I., Graber, J. A., & Brooks-Gunn, J. (2002). Prospective predic-
tors of the onset of anorexic and bulimic syndromes. International Journal of
Eating Disorders, 32(3), 282–290. doi: 10.1002/eat.10094
van Noort, B. M., Lohmar, S. K., Pfeier, E., Lehmkuhl, U., Winter, S. M., & Kappel, V.
(2018). Clinical characteristics of early onset anorexia nervosa. European Eating
Disorders Review, 26(5), 519–525. doi: 10.1002/erv.261
Voelker, D. K., Reel, J. J., & Greenleaf, C. (2015). Weight status and body image
perceptions in adolescents: current perspectives. Adolescent Health, Medicine and
erapeutics, 6, 149–158. doi: 10.2147/AHMT.S68344
Vohs, K. D., Bardone, A. M., Joiner Jr, T. E., & Abramson, L. Y. (1999). Perfectionism,
perceived weight status, and self-esteem interact to predict bulimic symptoms: A
model of bulimic symptom development. Journal of Abnormal Psychology, 108(4),
695–700. 843X.108.4.695
Wade, T. D., Wilksch, S. M., Paxton, S. J., Byrne, S. M., & Austin, S. B. (2015). How
perfectionism and ineectiveness inuence growth of eating disorder risk in
young adolescent girls. Behaviour Research and erapy, 66, 56–63. https://doi.
Webb, H. J., & Zimmer-Gembeck, M. J. (2014). e role of friends and peers in adoles-
cent body dissatisfaction: A review and critique of 15 years of research. Journal
of Research on Adolescence, 24(4), 564–590.
Westerberg, J., Edlund, B., & Ghaderi, A. (2008). A 2-year longitudinal study of eating
attitudes, BMI, perfectionism, asceticism and family climate in adolescent girls
and their parents. Eating and Weight Disorders–Studies on Anorexia, Bulimia and
Obesity, 13(2), 64–72.
Westerberg-Jacobson, J., Edlund, B., & Ghaderi, A. (2010). Risk and protective fac-
tors for disturbed eating: A 7-year longitudinal study of eating attitudes and
psychological factors in adolescent girls and their parents. Eating and Weight
Disorders–Studies on Anorexia, Bulimia and Obesity, 15(4), 208–218. doi:
Wilksch, S. M., Durbridge, M. R., & Wade, T. D. (2008). A preliminary controlled
comparison of programs designed to reduce risk of eating disorders targeting
perfectionism and media literacy. Journal of the American Academy of Child and
Adolescent Psychiatry, 47(8), 939–947. doi: 10.1097/CHI.0b013e3181799f4a
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1 Objective The identification of transdiagnostic risk factors and processes that explain the comorbidity between depressive symptoms and eating disorder symptoms is critical. We examined the mediating role of the frustration of adolescents’ psychological needs for autonomy, competence, and relatedness in the association between self‐critical perfectionism, depressive symptoms and eating disorder symptoms. 2 Method A cross‐sectional study (N = 248; 58% female, mean age = 14 years) and a two‐wave longitudinal study (N = 608; 59% female; mean age = 16 years) were conducted. 3 Results At the level of inter‐individual differences and intra‐individual change, self‐critical perfectionism was a robust predictor of both symptoms. After introducing need frustration as an underlying mechanism, the relation between self‐critical perfectionism and the two types of symptoms, as well as the relation between the symptoms themselves, decreased. 4 Conclusions Need frustration represents a transdiagnostic vulnerability process that helps to explain why self‐critical perfectionism relates to depressive symptoms and eating disorder symptoms.
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The adverse consequences of perfectionism in the lives of youth (children and adolescents) are now widely recognised, including impact on mental health and general well-being. In order to develop interventions to prevent and treat perfectionism and promote resilience for children, rigorous testing and examination of theoretical models is needed as well as having access to valid and reliable assessment tools. The aim of the current literature review was to examine the validity and reliability of the measures currently being used to measure perfectionism in children under the age of 15. A systematic review of the literature identified six instruments that had been utilised in children. Preliminary support with respect to reliability and validity was established for each of these measures, and there was evidence supporting the existence of both perfectionistic striving and perfectionistic concerns in this population. However, many of the measures lacked evaluation of key psychometric properties by independent authors. Further work distinguishing adaptive and maladaptive perfectionism will be necessary to promote future interventions and treatment in this area.
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PurposeThe 2 × 2 model of perfectionism (Gaudreau and Thompson in Personal Individ Diff 48:532–537, 2010) represents an important addition to the perfectionism literature, but so far has not been studied in relation with disordered eating. Method Using the 2 × 2 model as analytic framework, this study examined responses from a convenience sample of 716 participants aged 19–68 years (71% female) investigating how self-oriented perfectionism (SOP) and socially prescribed perfectionism (SPP) predicted individual differences in eating disorder symptoms, additionally controlling for body mass index, gender, and age. ResultsResults showed a significant SOP × SPP interaction indicating that the combination of high SOP and high SPP—called “mixed perfectionism”—was associated with the highest levels of eating disorder symptoms. Conclusions The findings demonstrate the utility of the 2 × 2 model of perfectionism as an analytic framework for examining perfectionism and disordered eating. Moreover, they suggest that mixed perfectionism is the most maladaptive form of perfectionism when it comes to disordered eating, such that having high levels of SPP combined with high levels of SOP represents the most maladaptive combination of perfectionism in terms of risk of eating disorder. Level of evidenceLevel V, cross-sectional descriptive study.
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In this concluding chapter, I follow the approach of the introductory chapter in taking a personal perspective to discuss what I see are critical issues, open questions, and future directions in perfectionism research. Because all chapters of this book address open questions and future directions, I only discuss topics that the chapters did not cover or that I would like to emphasize again. These include the definition and measurement of perfectionism, the question of whether perfectionism is a trait or a disposition, the need for more longitudinal studies, and the search for mediators and moderators. Further, I make a call for more research on perfectionism going beyond self-reports and point to three areas that I believe are “under-researched”: perfectionism at work; ethnic, cultural, and national differences in perfectionism; and perfectionism across the lifespan. Moreover, I address three critical issues that I find problematic because they may present obstacles to further progress in our understanding of perfectionism: focusing on perfectionistic concerns (and ignoring perfectionistic strivings), employing cluster analyses to investigate differences in multidimensional perfectionism, and assessing perfectionism with measures that do not measure perfectionism.
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Objective: The clinical significance of 2 main dimensions of perfectionism (perfectionistic strivings and perfectionistic concerns) was examined via a meta-analysis of studies investigating perfectionism in the psychopathology literature. Method: We investigated relationships between psychopathology outcomes (clinical diagnoses of depression, anxiety disorders, obsessive-compulsive disorder, and eating disorders; symptoms of these disorders; and outcomes related to psychopathology, such as deliberate self-harm, suicidal ideation, and general distress) and each perfectionism dimension. The relationships were examined by evaluating (a) differences in the magnitude of association of the 2 perfectionism dimensions with psychopathology outcomes and (b) subscales of 2 common measures of perfectionism. Results: A systematic literature search retrieved 284 relevant studies, resulting in 2,047 effect sizes that were analysed with meta-analysis and meta-regression while accounting for data dependencies. Conclusion: Findings support the notion of perfectionism as a transdiagnostic factor by demonstrating that both dimensions are associated with various forms of psychopathology.
We live in a society in which messages associating physical attractiveness with success and happiness are pervasive. There is an epidemic of appearance concerns amongst teenagers and adults in westernised countries and body image dissatisfaction is now considered normative. Large numbers of people experience negative impacts on wellbeing and, for many adolescents, adults, and even children, appearance concerns are influential in choices about a range of health behaviours. The challenges facing them include difficulties with social encounters and the problem of having to cope with negative self-perceptions. This publication is a comprehensive reference text written by experts in the field. It examines how people feel about the way they look, and why it is that some people are happy with their appearance whilst increasing numbers are troubled by the way they look — reporting that these appearance-related concerns affect many aspects of their lives including relationships, health, and wellbeing. It considers the influence of other people and how the media affects thoughts and behaviours related to appearance. It explores the experiences of people living with a disfigurement in a society that seems to be increasingly focussed on appearance and the pursuit of an idealised image of beauty, size, and weight.
Background Case histories, theoretical accounts, and empirical studies suggest an important relationship between perfectionism and bulimic symptoms. However, whether perfectionism confers vulnerability for bulimic symptoms is unclear. Objective To address this, we conducted a meta-analysis testing if socially prescribed perfectionism, concern over mistakes, doubts about actions, personal standards, self-oriented perfectionism and EDI-perfectionism predict increases in bulimic symptoms over time. Method Our literature search yielded 12 longitudinal studies for inclusion. Samples were composed of adolescents, undergraduates, and community adults. Results Meta-analysis using random effects models showed perfectionistic concerns and EDI-perfectionism, but not perfectionistic strivings, had positive relationships with follow-up bulimic symptoms, after controlling for baseline bulimic symptoms. Conclusion Results lend credence to theoretical accounts implicating perfectionism in the development of bulimic symptoms. Our review of this literature also underscored the need for additional longitudinal studies that use multisource designs and that assess perfectionism as a multidimensional construct.
Objective: The link between perfectionism and eating disorders is well established in adults, however little research has been conducted in children and adolescents. The aim was to examine if perfectionism was a predictor of eating disorder symptoms at intake assessment, and 6 and 12 month review. Method: There were 175 children and adolescents aged 10-17 years (M = 14.47 years, SD = 1.31) who were assessed using the Eating Disorders Inventory-3 perfectionism subscale and the child adapted Eating Disorders Examination at intake, 6 and 12 months review. Results: There was a significant association between perfectionism and symptoms of eating disorders at intake assessment and at 6 and 12 month review. Higher perfectionism at intake predicted a lower likelihood of remission at 12 months. Discussion: The findings suggest that similar to adult samples, perfectionism is significantly associated with eating disorder symptoms in children and adolescents. Further research is required to examine the impact of perfectionism on eating disorder symptoms in longitudinal research with children and adolescents with eating disorders.
Parental expectations and criticism are associated with Self-Oriented Perfectionism-strivings (SOP-striving) and Self-Oriented Perfectionism-critical (SOP-critical) respectively, when retrospectively examining parenting during childhood, but have never been examined within an actual child sample. Similarly, the differential relations of SOP-striving and SOP-critical to affect and academic achievement have rarely been tested within a child sample, nor has the association of these parenting behaviors with these outcomes been explored. The present study consisted of 203 children, aged 8 to 12. Results replicated previous findings within a child sample, indicating that parental expectations are associated with SOP-striving (b=.28, p<.01), which is associated with academic achievement (b=.30, p<.001), while parental criticism is associated with SOP-critical (b=.35, p<.001), which is associated with negative affect (b=.28, p<.001). Moreover, the results reveal these parenting behaviors are related to children’s affect and academic achievements, both directly and indirectly through perfectionism. The present investigation lends credence to the Social Expectations Model (Flett, Hewitt, Oliver, & MacDonald, 2002) by providing evidence within the target population, and highlights the divergent patterns of SOP-striving and SOP-critical.