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

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Abstract

Perfectionism is hypothesized to contribute to the etiology of anorexia nervosa (AN). However, there is little research regarding whether individuals with AN can be classified according to maladaptive (e.g., evaluative concerns) and adaptive (e.g., high personal standards) facets of perfectionism that predict distinct outcomes and might warrant different intervention approaches. In this study, a latent profile analysis was conducted using data from adults with AN (n = 118). Frost Multidimensional Perfectionism Scale (Frost et al. Cognitive Therapy and Research, 14(5), 449–46, 1990) subscales were used to identify subgroups differing according to endorsed perfectionism features (e.g., adaptive and maladaptive perfectionism). Generalized linear models were used to compare subgroups on eating disorder and affective symptoms measured through questionnaire and ecological momentary assessment. Four subgroups were identified: (a) Low Perfectionism; (b) High Adaptive and Maladaptive Perfectionism; (c) Moderate Maladaptive Perfectionism; and (d) High Maladaptive Perfectionism. Subgroups differed on overall eating disorder symptoms (p < .001), purging (p = .005), restrictive eating (p < .001), and body checking (p < .001) frequency, depressive (p < .001) and anxiety (p < .001) symptoms, and negative (p = .001) and positive (p < .001) affect. The Low Perfectionism group displayed the most adaptive scores and the Moderate and High Maladaptive Perfectionism groups demonstrated the most elevated clinical symptoms. The High Adaptive and Maladaptive Perfectionism group demonstrated low affective disturbances, but elevated eating disorder symptoms. Results support the clinical significance of subtyping according to perfectionism dimensions in AN. Research is needed to determine if perfectionism subtyping can enhance individualized treatment targeting in AN.

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Funding

This work was supported by grants P30DK050456 from the National Institute of Diabetes and Digestive and Kidney Diseases, grants R01MH059674, T32MH082761, and K23MH112867 from the National Institute of Mental Health, and the Neuropsychiatric Research Institute.

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Authors and Affiliations

  1. Department of Psychiatry, University of Minnesota, 2450 Riverside Ave., F253, Minneapolis, MN, 55454, USA

    Ann F. Haynos, Carol B. Peterson & Scott J. Crow

  2. Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA

    Linsey M. Utzinger

  3. Department of Psychiatry, University of California, San Diego, San Diego, CA, USA

    Jason M. Lavender

  4. Neuropsychiatric Research Institute, Fargo, ND, USA

    Ross D. Crosby, Li Cao, Stephen A. Wonderlich, Scott G. Engel & James E. Mitchell

  5. Department of Psychiatry and Behavioral Science, University of North Dakota, Fargo, ND, USA

    Ross D. Crosby, Stephen A. Wonderlich, Scott G. Engel & James E. Mitchell

  6. The Emily Program, Minneapolis, MN, USA

    Carol B. Peterson & Scott J. Crow

  7. Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA

    Daniel Le Grange

  8. Department of Psychiatry and Human Behavior, The Miriam Hospital/Weight Control and Diabetes Research Center, Warren Alpert Medical School of Brown University, Providence, RI, USA

    Andrea B. Goldschmidt

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  1. Ann F. Haynos
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  12. Andrea B. Goldschmidt
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Correspondence to Ann F. Haynos.

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Conflict of Interest

Ann F. Haynos, Linsey M. Utzinger, Jason M. Lavender, Ross D. Crosby, Li Cao, Carol B. Peterson, Scott J. Crow, Stephen A. Wonderlich, Scott G. Engel, James E. Mitchell, Daniel Le Grange and Andrea B. Goldschmidt declare that they have no conflict of interest.

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Haynos, A.F., Utzinger, L.M., Lavender, J.M. et al. Subtypes of Adaptive and Maladaptive Perfectionism in Anorexia Nervosa: Associations with Eating Disorder and Affective Symptoms. J Psychopathol Behav Assess 40, 691–700 (2018). https://doi.org/10.1007/s10862-018-9672-8

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