The Effect of Perfectionism on Anorexic Symptoms: Mediating Effects of Body Checking and Body Avoidance Behaviors
Abstract
Perfectionism is a widely-studied transdiagnostic factor that is known to contribute to the etiology and maintenance of various mental disorders including eating disorders. However, specific mechanisms underlying the link between perfectionism and anorexia nervosa has been relatively unexplored despite empirical findings that individuals with higher levels of adaptive or maldaptive perfectionism, adaptive or maladaptive, are more likely to develop more severe anorexic symptoms. Thus, the current study examined potential mediating effects of body checking and body avoidance behaviors in the relationship between perfectionism and anorexic symptoms among female college students. A total 200 female college students completed a series of self-report inventories assessing multidimensional perfectionism, body checking behavior, body avoidance behavior, anorexic symptoms, and depression. The results indicated that body checking behavior significantly mediated the association between maladaptive perfectionism and anorexic symptoms controlling for individual variations in BMI and depression. Based on the findings, theoretical and practical implications as well as the limitations of this study are discussed.
- keywords
- 다차원적 완벽주의, 신경성 식욕부진증, 신체점검행동, 신체회피행동, multidimensional perfectionism, anorexia nervosa, body checking, body avoidance
Reference
김수영 (2016). 구조방정식 모형의 기본과 확장: MPLUS 예제와 함께. 서울: 학지사.
김지혜 (2016). 한국판 신체점검 척도(K-BCQ)의 신뢰도와 타당도 연구(석사 학위 논문). 영남대학교 석사학위논문.
이규은, 김은주, 염영희 (2005). 여대생의 신체존중감, 신체상 불일치 및 우울. 기본간호학회지, 12(2), 206-214.
이수진, 장혜인 (2017). 부적응적 완벽주의, 부정정서, 부정적 긴급성이 여자 대학생의 신경성 폭식증 증상에 미치는 영향. Korean Journal of Clinical Psychology, 36(2), 192-205.
이민규, 이영호, 박세현, 손창호, 정영조, 홍성국, ..., & 윤애리 (1998). 한국판 식사태도검사-26(The Korean Version of Eating Attitudes Test-26: KEAT-26) 표준화 연구Ⅰ: 신뢰도 및 요인분석. 한국정신신체의학, 6(2), 155-175.
이학식, 임지훈 (2017). 구조방정식 모형분석과AMOS 24. 서울: 집현재.
전겸구, 최상진, & 양병창 (2001). 통합적 한국판 CES-D 개발. 한국심리학회지: 건강, 6(1), 59-76.
한기연 (1993). 다차원적 완벽성-개념, 측정 및 부적응과의 관련성. 고려대학교 박사학위논문.
현진원 (1992). ‘완벽주의’ 성향과 평가수준이 과제 수행에 미치는 영향. 연세대학교 일반대학원 석사학위 청구 논문.
홍세희 (2000). 구조 방정식 모형의 적합도 지수 선정기준과 그 근거. Korean Journal of Clinical Psychology, 19(1), 161-177.
Antony, M. M., Purdon, C. L., Huta, V., & Swinson, R. P. (1998). Dimensions of perfectionism across the anxiety disorders1. Behaviour Research and Therapy, 36(12), 1143-1154.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders:DSM-5. American Psychiatric Pub.
Bamford, B. H., Attoe, C., Mountford, V. A., Morgan, J. F., & Sly, R. (2014). Body checking and avoidance in low weight and weight restored individuals with anorexia nervosa and non-clinical females. Eating Behaviors, 15(1), 5-8.
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.
Bastiani, A. M., Rao, R., Weltzin, T., & Kaye, W. H. (1995). Perfectionism in anorexia nervosa. International Journal of Eating Disorders, 17(2), 147-152.
Bieling, P. J., Israeli, A. L., & Antony, M. M. (2004). Is perfectionism good, bad, or both? Examining models of the perfectionism construct. Personality and Individual Differences, 36(6), 1373-1385.
Broman-Fulks, J. J., Hill, R. W., & Green, B. A. (2008). Is perfectionism categorical or dimensional? A taxometric analysis. Journal of Personality Assessment, 90(5), 481-490.
Byrne, B. M. (2012). Structural equation modeling with Mplus: Basic concepts, applications, and programming. New York, NY: Taylor & Fancis Group.
Cockell, S. J., Hewitt, P. L., Seal, B., Sherry, S., Goldner, E. M., Flett, G. L., & Remick, R. A. (2002). Trait and self-presentational dimensions of perfectionism among women with anorexia nervosa. Cognitive Therapy and Research, 26(6), 745-758.
Cooper, Z., & Fairburn, C. G. (2011). The evolution of “enhanced” cognitive behavior therapy for eating disorders: Learning from treatment nonresponse. Cognitive and Behavioral Practice, 18(3), 394-402.
Dalley, S. E., Toffanin, P., & Pollet, T. V. (2012). Dietary restraint in college women: Fear of an imperfect fat self is stronger than hope of a perfect thin self. Body Image, 9(4), 441-447.
DiBartolo, P. M., Frost, R. O., Chang, P., LaSota, M., & Grills, A. E. (2004). Shedding light on the relationship between personal standards and psychopathology: The case for contingent self-worth. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 22(4), 237-250.
DiBartolo, P. M., Li, C. Y., & Frost, R. O. (2008). How do the dimensions of perfectionism relate to mental health?. Cognitive Therapy and Research, 32(3), 401-417.
Dunkley, D. M., & Blankstein, K. R. (2000). Self-critical perfectionism, coping, hassles, and current distress: A structural equation modeling approach. Cognitive Therapy and Research, 24(6), 713-730.
Egan, S. J., Watson, H. J., Kane, R. T., McEvoy, P., Fursland, A., & Nathan, P. R. (2013). Anxiety as a mediator between perfectionism and eating disorders. Cognitive Therapy and Research, 37(5), 905-913.
Engel, S. G., Robinson, M. D., Wonderlich, S. J., Meier, B. P., Wonderlich, S. A., Crosby, R. D., ..., & Mitchell, J. E. (2006). Does the avoidance of body and shape concerns reinforce eating disordered attitudes? Evidence from a manipulation study. Eating Behaviors, 7(4), 368-374.
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.
Fairburn, C. G., Shafran, R., & Cooper, Z. (1998). A cognitive-behavioural theory of anorexia nervosa. Behaviour Research and Therapy, 37(1), 1-13.
Farrell, C., Shafran, R., & Fairburn, C. G. (2004). Mirror cognitions and behaviours in people concerned about their body shape. Behavioural and Cognitive Psychotherapy, 32(2), 225-229.
Flett, G. L., Blankstein, K. R., Hewitt, P. L., & Koledin, S. (1992). Components of perfectionism and procrastination in college students. Social Behavior and Personality: an international journal, 20(2), 85-94.
Flett, G. L., Hewitt, P. L., Blankstein, K. R., Solnik, M,, & Van Brunschot, M, (1996). Perfectionism, social problem-solving ability, and psychological distress. Journal of Rational-Emotive and Cognitive-Behaviour Therapy, 14, 245-274.
Frost, R. O., Heimberg, R. G., Holt, C. S., Mattia, J. I., & Neubauer, A. L. (1993). A comparison of two measures of perfectionism. Personality and Individual Differences, 14(1), 119-126.
Frost, R. O., & Marten, P. A. (1990). Perfectionism and evaluative threat. Cognitive Therapy and Research, 14(6), 559-572.
Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14(5), 449-468.
Garner, D. M., Olmsted, M. P., Bohr, Y., & Garfinkel, P. E. (1982). The eating attitudes test: psychometric features and clinical correlates. Psychological Medicine, 12(4), 871-878.
Gibb, B. E., Alloy, L. B., Abramson, L. Y., Beeyers, C. G., & Miller, I. W. (2004). Cognitive vulnerability to depression: A taxometric analysis. Journal of Abnormal Psychology, 113, 81-89.
Haase, A. M., Mountford, V., & Waller, G. (2011). Associations between body checking and disordered eating behaviors in nonclinical women. International Journal of Eating Disorders, 44(5), 465-468.
Halmi, K. A., Sunday, S. R., Strober, M., Kaplan, A., Woodside, D. B., Fichter, M., ..., & Kaye, W. H. (2000). Perfectionism in anorexia nervosa: variation by clinical subtype, obsessionality, and pathological eating behavior. American Journal of Psychiatry, 157(11), 1799-1805.
Hamachek, D. E. (1978). Psychodynamics of normal and neurotic perfectionism. A Journal of Human Behavior, 15, 27-33.
Heatherton, T. F., & Baumeister, R. F. (1991). Binge eating as escape from self-awareness. Psychological Bulletin, 110(1), 86.
Hebert, J. R., Clemow, L., Pbert, L., Ockene, I. S., & Ockene, J. K. (1995). Social desirability bias in dietary self-report may compromise the validity of dietary intake measures. International Journal of Epidemiology, 24(2), 389-398.
Hewitt, P. L., & Flett, G. L. (1991). Perfectionism in the self and social contexts:conceptualization, assessment, and association with psychopathology. Journal of Personality and Social Psychology, 60(3), 456.
Holahan, C. J., Moos, R. H., & Bonin, L. (1997). Social support, coping, and psychological adjustment. In Sourcebook of social support and personality (pp. 169-186). Springer, Boston, MA.
Joyce, F., Watson, H. J., Egan, S. J., & Kane, R. T. (2012). Mediators between perfectionism and eating disorder psychopathology in a community sample. Eating Behaviors, 13(4), 361-365.
Keel, P. K., Brown, T. A., Holm-Denoma, J., & Bodell, L. P. (2011). Comparison of DSM-IV versus proposed DSM-5 diagnostic criteria for eating disorders: Reduction of eating disorder not otherwise specified and validity. International Journal of Eating Disorders, 44, 553-560.
Klibert, J. J., Langhinrichsen-Rohling, J., & Saito, M. (2005). Adaptive and maladaptive aspects of self-oriented versus socially prescribed perfectionism. Journal of College Student Development, 46(2), 141-156.
Lilenfeld, L. R. R., Wonderlich, S., Riso, L. P., Crosby, R., & Mitchell, J. (2006). Eating disorders and personality: A methodological and empirical review. Clinical Psychology Review, 26(3), 299-320.
Lydecker, J. A., Cotter, E. W., & Mazzeo, S. E. (2014). Body checking and body image avoidance: Construct validity and norms for college women. Eating Behaviors, 15(1), 13-16.
Meyer, C., McPartlan, L., Rawlinson, A., Bunting, J., & Waller, G. (2011). Body-related behaviours and cognitions: Relationship to eating psychopathology in non-clinical women and men. Behavioural and Cognitive Psychotherapy, 39(5), 591-600.
Mountford, V., Haase, A., & Waller, G. (2006). Body checking in eating disorders: association between cognitions and behaviors. International Journal of Eating Disorders, 39(8), 708-715.
Paxton, S. J., & Diggens, J. (1997). Avoidance coping, binge eating, and depression: An examination of the escape theory of binge eating. International Journal of Eating Disorders, 22(1), 83-87.
Pennesi, J. L., & Wade, T. D. (2016). A systematic review of the existing models of disordered eating: Do they inform the development of effective interventions?. Clinical Psychology Review, 43, 175-192.
Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879-891.
Radloff, L. S. (1977). The CES-D scale a self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385-401.
Reas, D. L., Grilo, C. M., Masheb, R. M., & Wilson, G. T. (2005). Body checking and avoidance in overweight patients with binge eating disorder. International Journal of Eating Disorders, 37(4), 342-346.
Reas, D. L., Whisenhunt, B. L., Netemeyer, R., & Williamson, D. A. (2002). Development of the Body Checking Questionnaire: A selfreport measure of body checking behaviors. International Journal of Eating Disorders, 31(3), 324-333.
Rosen, J. C., Srebnik, D., Saltzberg, E., & Wendt, S. (1991). Development of a body image avoidance questionnaire. Psychological Assessment:A Journal of Consulting and Clinical Psychology, 3(1), 32.
Shafran, R., Cooper, Z., & Fairburn, C. G. (2002). Clinical perfectionism: A cognitive-behavioural analysis. Behaviour research and therapy, 40(7), 773-791.
Shafran, R., Fairburn, C. G., Robinson, P., & Lask, B. (2004). Body checking and its avoidance in eating disorders. International Journal of Eating Disorders, 35(1), 93-101.
Shafran, R., Lee, M., Payne, E., & Fairburn, C. G. (2006). The impact of manipulating personal standards on eating attitudes and behaviour. Behaviour Research and Therapy, 44(6), 897-906.
Shafran, R., Lee, M., Payne, E., & Fairburn, C. G. (2007). An experimental analysis of body checking. Behaviour Research and Therapy, 45(1), 113-121.
Slade, P. D., & Owens, R. G. (1998). A dual process model of perfectionism based on reinforcement theory. Behavior Modification, 22(3), 372-390.
Stice, E., Marti, C. N., & Rohde, P. (2013). Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal of Abnormal Psychology, 122(2), 445-457.
Stöber, J. (1998). The Frost Multidimensional Perfectionism Scale revisited: More perfect with four (instead of six) dimensions. Personality and Individual Differences, 24(4), 481-491.
Stöber, J., & Joormann, J. (2001). Worry, procrastination, and perfectionism:Differentiating amount of worry, pathological worry, anxiety, and depression. Cognitive Therapy and Research, 25(1), 49-60.
Terry-Short, L. A., Owens, R. G., Slade, P. D., & Dewey, M. E. (1995). Positive and negative perfectionism. Personality and Individual Differences, 18, 663-666.
Wardle, J., Haase, A. M., & Steptoe, A. (2006). Body image and weight control in young adults: international comparisons in university students from 22 countries. International Journal of Obesity, 30(4), 644.
Watson, H. J., Raykos, B. C., Street, H., Fursland, A., & Nathan, P. R. (2011). Mediators between perfectionism and eating disorder psychopathology: Shape and weight overvaluation and conditional goal‐setting. International Journal of Eating Disorders, 44(2), 142-149.
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