Subtypes of Adaptive and Maladaptive Perfectionism in Anorexia Nervosa: Associations with Eating Disorder and Affective Symptoms
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.
KeywordsAdaptive perfectionism Maladaptive perfectionism Anorexia nervosa Eating disorder
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.
Compliance with Ethical Standards
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.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: APA Press.Google Scholar
- Ashby, J. S., Kottman, T., & Schoen, E. (1998). Perfectionism and eating disorders reconsidered. Journal of Mental Health Counseling, 20(3), 261–271.Google Scholar
- Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society. Series B, Methodological, 57(1), 289–300.Google Scholar
- Engel, S.G., Wonderlich, S.A., Crosby, R.D., Mitchell, J.E., Crow, S., Peterson, C.B., Le Grange, D., Simonich, H.K., Cao, L., Lavender, J.M., & Gordon, K.H. (2013). The role of affect in the maintenance of anorexia nervosa: Evidence from a naturalistic assessment of momentary behaviors and emotion. Journal of Abnormal Psychology 122(3), 709–719.CrossRefPubMedPubMedCentralGoogle Scholar
- Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders (1st ed.). New York: The Guilford Press.Google Scholar
- Fairburn, C. G., & Cooper, Z. (1995). The eating disorder examination, 12th Ed. In C. G. Fairburn & G. T. Wilson (Eds.), Binge eating: Nature, assessment, and treatment (pp. 317–360). New York: Guilford.Google Scholar
- First, M., Spitzer, R., Gibbon, M., & Williams, J. (1995). Structured clinical interview for DSM–IV Axis I disorders: Patient edition (SCIDI/P). New York: Biometrics.Google Scholar
- Fitzsimmons-Craft, E.E., Accurso, E.C., Ciao, A.C., Crosby, R.D., Cao, L., Pisetsky, E.M., Le Grange, D., Peterson, C.B., Crow, S.J., Engel, S.G., Mitchell, J.E., & Wonderlich, S.A. (2015). Restrictive eating in anorexia nervosa: Examining maintenance and consequences in the natural environment. International Journal of Eating Disorders, 48(7), 923–931.CrossRefPubMedPubMedCentralGoogle Scholar
- Flett, G. L., & Hewitt, P. L. (2002). Perfectionism and maladjustment: An overview of theoretical, definitional, and treatment issues. In G. L. Flett & P. L. Hewitt (Eds.), Perfectionism: Theory, research, and treatment (pp. 5–31). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
- Goldschmidt, A.B., Wonderlich, S.A., Crosby, R.D., Cao, L., Engel, S.G., Lavender, J.M., Mitchell, J.E., Crow, S.J., Peterson, C.B., & Le Grange, D. (2014). Latent profile analysis of eating episodes in anorexia nervosa. Journal of Psychiatric Research, 53, 193–199.CrossRefPubMedPubMedCentralGoogle Scholar
- Halmi, K. A., Sunday, S. R., Strober, M., Kaplan, A., Woodside, D. B., Fichter, M., Treasure, J., Berrettini, W. H., & 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.CrossRefPubMedGoogle Scholar
- Haynos, A. F., Berg, K. C., Cao, L., Crosby, R. D., Lavender, J. M., Utzinger, L. M., Wonderlich, S. A., Engel, S. G., Mitchell, J. E., le Grange, D., Peterson, C. B., & Crow, S. J. (2017). Trajectories of global and individual facets of negative and positive affect surrounding restrictive eating in anorexia nervosa. The Journal of Abnormal Psychology, 126(5), 495–505.CrossRefPubMedGoogle Scholar
- Lavender, J. M., Mason, T. B., Utzinger, L. M., Wonderlich, S. A., Crosby, R. D., Engel, S. G., Mitchell, J. E., le Grange, D., Crow, S. J., & Peterson, C. B. (2016). Examining affect and perfectionism in relation to eating disorder symptoms among women with anorexia nervosa. Psychiatry Research, 241, 267–272.CrossRefPubMedPubMedCentralGoogle Scholar
- Lavender, J.M., Wonderlich, S.A., Crosby, R.D., Engel, S.G., Mitchell, J.E., Crow, S.J., Peterson, C.B., & Le Grange, D. (2013). Personality-based subtypes of anorexia nervosa: Examining validity and utility using baseline clinical variables and ecological momentary assessment. Behaviour Research and Therapy, 51(8), 512–517.CrossRefPubMedPubMedCentralGoogle Scholar
- 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): Different perfectionist profiles in adolescent high school students. Psychological Assessment, 27(4), 1471–1483.CrossRefPubMedGoogle Scholar
- Spielberger, C. D. (1983). Manual for the State-Trait Anxiety Inventory (STAI). Palo Alto: Consulting Psychologists Press.Google Scholar
- Vermunt, J. K., & Magidson, J. (2005). Latent GOLD 4.0. User’s guide. Belmont: Statistical Innovations, Inc..Google Scholar
- Watson, D., & Clark, L. A. (1994) The PANAS-X: Manual for the positive and negative affect schedule- expanded form. Iowa City: Department of Psychological & Brain Sciences Publications, University of Iowa.Google Scholar