Perfectionism in adolescents with eating disorders
Perfectionism in adolescents with eating disorders
Main Article Content
Abstract
Perfectionism has been considered a significant risk factor for psychopathology and a typical personality characteristic in people suffering from eating disorders (ED). This study aims to know the relationship between perfectionism and depressive symptomatology, self-esteem and body dissatisfaction in adolescents diagnosed with ED. The sample was composed by 100 adolescents (M age = 14.91, SD = 1.094) diagnosed with ED who went outpatiently to a specific child-juvenile ED unit of the National Health System. All patients completed the perfectionism scale of the Inventory of Eating Disorders (EDI-3), the Spanish Child Depression Questionnaire (CEDI-II), the Rosenberg Self-Esteem Scale (RSES), and the Body Form Questionnaire (BSQ-34). Results indicate that the perfectionism scale of EDI-3 correlates significantly positively with CEDI-II (r =, 336, p =, 001) and BSQ-34 (r =, 199, p =, 45), and in a negative way with the RSES (r = -, 337, p =, 001). Adolescents diagnosed with ED who score higher on perfectionism show greater depressive symptoms and body dissatisfaction, and lower self-esteem. We believe that emphasizing the treatment of perfectionism could result in a psychopathological improvement of these patients.
References
American Psychiatric Association, APA (2002). DSM-IV-TR. Manual diagnostic y estadístico de
los trastornos mentales. Texto revisado. Barcelona: Masson.
Bardone-Cole, A.M., Wonderlich, S.A., Frost, R.O., Bulik, C.M., Mitchell, J.E., Uppala, S., y
Simonich, H. (2007). Perfectionism and eating disorders: Current status and future
directions. Clinical Psychology Review, 27, 384-405. doi:10.1016/j.cpr.2006.12.005
Brockman, R., Ciarrochi, J., Parker, P., y Kashdan, T. Emotion regulation strategies in daily life:
mindfulness, cognitive reappraisal and emotion suppression. Cognitive Behaviour
Therapy, 46(2), 91-113. doi:10.1080/16506073.2016.121826
Burns, D.D. (1980). Feeling good: the new mood therapy. New York: New American Library.
Casale, S., Fioravanti, G., Rugai, L., Flett, G.L., y Hewitt, P.L. (2019). What lies beyond the
superordinate trait perfectionism factors? The perfectionistic self-presentation and
perfectionism cognitions inventory versus the big three perfectionism scale in predicting
depression and social anxiety. Journal of Personality Assessment, 24.
doi:10.1080/00223891.2019.1473429
Castro, J., Gila, A., Gual, P., Lahortiga, F., Saura, B., y Toro, J. (2004). Perfectionism dimensions
in children and adolescents with anorexia nervosa. Journal of Adolescent Health, 35,
382-398. doi:10.16/j.jadohealth.2003.11.094
Cha, M. (2016). The mediation effect of mattering and self-esteem in the relationship between
socially prescribed perfectionism and depression: Based on the social disconnection
model. Personality and Individual Differences, 88, 148-159.
doi:10.1016/j.paid.2015.09.008
Cooper, P.J., Taylor, M.J., Cooper, Z., y Fairburn, C.G. (1987). The development and validation of
the Body Shape Questionnaire. International Journal of Eating Disorders, 6, 485-494.
Cooper, P.J., y Taylor, M.J. (1988). Body image disturbance in bulimia nervosa. British Journal of
Psychiatry, 153, 32-36.
Dallegrave, R., Calugi, S., El Ghoch, M., Conti, M., y Fairburn, C.G. (2014). Inpatient cognitive
behaviour therapy for adolescents with anorexia nervosa: Inmediate and longer term
effects. Frontiers in Psychiatry, 5. doi:10.3389/fpsyt.2014.00014
Dallegrave, R., Calugi, S., Sartirana, M., y Fairburn, C.G. (2015). Transdiagnostic cognitive
behaviour therapy for adolescents with and eating disorder who are not underweight.
Behavior Research and Therapy, 73, 79-82. doi:10.1016/j.brat.2015.07.014
Drieberg, H., McEvoy, P.M., Hoiles, K.J., Shu, C.Y., y Egan, S.J. (2019). An examination of
direct, indirect and reciprocal relationships between perfectionism, eating disorder
symptoms, anxiety, and depression in children and adolescents with eating disorders.
Eating Behaviors, 32, 53-59. doi:10.1016/j.eatbeh.2018.12.002
Elousa, P., López-Jáuregui, A., y Sánchez-Sánchez, F. (2010). Manual técnico con la adaptación
al euskera del Eating Disorder Inventory-3. Madrid: TEA Ediciones.
Fairburn, C.G., Cooper, Z., y Shafran, R. (2003). Cognitive behavior therapy for eating disorders:
A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41,
509-528. doi:10.1016/S0005-7967(02)00088-8
Flett, G.L., Hewitt, P.L., Boucher, D.J., Davidson, L.A., y Munro, Y. (1997). The ChildAdolescent Perfectionism Scale: Development, validation and association with
adjustment. Ontario, Canada: York University.
Friborg, O., Clausen, L., y Rosenvinge, J.H. (2013). A five-item screening version of the Eating
Disorder Inventory (EDI-3). Comprehensive Psychiatry, 54, 1222-1228.
doi:10.1016/j.comppsych.2013.05.004
Garner, D. (2004). Eating Disorder Inventory-3. Professional Manual. Lutz, FL: Psychological
Assessment Resources, Inc.
Hollander, M.H. (1978). Perfectionism, a neglected personality trait. Journal of Clinical
Psychiatry, 39(5), 384-390.
Johnston, J., Shu, C.Y., Hoiles, K.J., Clarke, P.J.F., Watson, H.J., Dunlop, P.D., y 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.etbeh.2018.05.008
Kerr, C., Watkins, B., y Jones, F. (2016). Inflated responsibility and perfectionism in child and
adolescent anorexia. Advances on Eating Disorders, 4(3), 309-314.
doi:10.1080/21662630.2016.1217494
Kirsh, G., Mcvey, G., Tweed, S., y Katzam, D.K. (2007). Psychosocial profiles of young
adolescent females seeking treatment for an eating disorder. The Journal of Adolescent
Health, 40(4), 351-356. doi:10.1016/j.jadohealth.2006.11.003
Kovacs, M. (1992). Children’s Depression Inventory, CDI. Toronto: Multi-Health Systems, Inc.
Levin, M.E., Luoma, J.B., y Haeger, J.A. (2015). Decoupling as a mechanism of change in
mindfulness and acceptance: a literatura review. Behavior Modification, 39(6), 870-911.
doi:10.1177/0145445515603707
Limburg, K., Watson, H.J., Hagger, M.S., y Egan, S.J. (2017). The relationship between
perfectionism and psychopathology: A meta-analysis. Journal of Clinical Psychology,
73, 1301-1326. doi:10.1002/jclp.22435
Marshall, S.L., Parker, P.D., Ciarrochi, J., Sahdra, B., Jackson, C.J., y Heaven, P.C. (2015). Selfcompassion protects against the negative effects of low self-esteem: A longitudinal study
in a large adolescent sample. Personality and Individual Differences, 74, 116-121.
doi:10.1016/j.paid.2014.09.013
Moroz, M., y Dunkley, D.M. (2015). Self-critical perfectionism and depressive symptoms: Low
self-esteem and experiential avoidance as mediators. Personality and Individual
Differences, 87, 147-179. doi:10.1016/j.paid.2015.07.44
Nilsson, K., Sundbom, E., y Hagglof, B. (2008). A longitudinal study of perfectionism in
adolescent onset anorexia nervosa-restricting type. European Eating Disorders Review,
16(5), 386-394. doi:10.1002/erv.850
Phillips, R., Stewart, S.M., Presnell, K., Simmons, A., Kennard, B.D., Liss, D., y Setliff, S. (2010).
Psychological variables impacting weight gain rapidity in adolescents hospitalized for
eating disorders. European Eating Disorders Review, 18(5), 376-384.
doi:10.1002/erv.998
Puttevils, L., Vanderhasselt, M., y Vervaet, M. (2019). Investigating transdiagnostic factors in
eating disorders: Does self-esteem moderate the relationship between perfectionism and
eating disorder symptoms? European Eating Disorders Review, 7. doi:10.1002/erv.2666
Raich, R.M., Mora, M., Soler, A., Ávila, C., Clos, I., y Zapater, L. (1996). Adaptación de un
instrumento de evaluación de la insatisfacción corporal. Clínica y Salud, 7, 51-66.
Rodríguez-Sacristán, J., Cadorze, D., Rodríguez, J., Gómez-Añón, M. L., Benjumea, P., y Pérez, J.
(1984). Sistemas objetivos de medida: experiencia con el Inventario Español de
Depresiones Infantiles (CEDI). Modificado de Kovacs y Beck. Revista de Psiquiatría
Infanto-Juvenil, 3, 65-74.
Rosenberg, M. (1965). La autoimagen del adolescente y la sociedad. Buenos Aires: Paidós.
Shafran, R., Cooper, Z., y Fairburn, C. G. (2002). Clinical perfectionism: A cognitive-behavioural
analysis. Behaviour Research and Therapy, 40, 773-791. doi:10.1016/S0005-
7967(01)00059-6.
Smith, M.M., Sherry, S.B., Mushquash, A.R., Saklofske, D.H., Gautreau, C.M., y Nealis, L.J.
(2017). Perfectionism erodes social self-esteem and generates depressive symptoms:
Studying mother-daughter dyads using a daily diary design with longitudinal follow-up.
Journal of Research in Personality, 71, 72-79. doi:10.1016/j.jrp.2017.10.001
Taylor, E.P., Couper, R., y Butler, C.M. (2017). Adolescent perfectionism: Structural features of
the Frost Multidimensional Perfectionism Scale and correlates with attachment and
psychopathology. Psychology and Psychotherapy: Theory, Research and Practice,
90(4), 686-704. doi:10.1111/papt.12133
Teixeira, M.D., Pereira, A.T., Marques, M.V., Saraiva, J.M., y de Macedo, A.F. (2016). Eating
behaviors, body image, perfectionism, and self-esteem in a simple of Portuguese girls.
Revista Basileira de Psiquiatria, 38(2), 135-140. doi:10.1590/1516-4446-2015-1723
Vall, E., y Wade, T.D. (2017). Predictors and moderators of outcomes and readmission for
adolescent inpatients with anorexia nervosa: A pilot study. Clinical Psychologist, 21(2),
143-152. doi:10.1111/cp.12091
Vázquez, A., Jiménez, R., y Vázquez, R. (2004). Escala de Autoestima de Rosenberg. Fiabilidad y
validez en población clínica. Apuntes de Psicología, 22, 247-255.
Vohs, K.D., Voelz, Z.R., Pettit, J.W., Bardone, A.M., Katz, J., Abramson, L.Y., … Joiner, T.F.J.
(2001). Perfectionism, body dissatisfaction, and self-esteem: An interactive model of
bulimic symptom development. Journal of Social and Clinical Psychology, 20(4),
476-497. doi:10.1521/jscp.20.4.476.22397
Yang, H., Yang, Y., Xu, L., Wu, Q., Xu, J., Weng, E., … Cai, S. (2017). The relation of physical
appearance perfectionism with body dissatisfaction among school students 9-18 years of
age. Personality and Individual Differences, 116, 399-404. doi:10.1016/j.paid.2017.
05.005
los trastornos mentales. Texto revisado. Barcelona: Masson.
Bardone-Cole, A.M., Wonderlich, S.A., Frost, R.O., Bulik, C.M., Mitchell, J.E., Uppala, S., y
Simonich, H. (2007). Perfectionism and eating disorders: Current status and future
directions. Clinical Psychology Review, 27, 384-405. doi:10.1016/j.cpr.2006.12.005
Brockman, R., Ciarrochi, J., Parker, P., y Kashdan, T. Emotion regulation strategies in daily life:
mindfulness, cognitive reappraisal and emotion suppression. Cognitive Behaviour
Therapy, 46(2), 91-113. doi:10.1080/16506073.2016.121826
Burns, D.D. (1980). Feeling good: the new mood therapy. New York: New American Library.
Casale, S., Fioravanti, G., Rugai, L., Flett, G.L., y Hewitt, P.L. (2019). What lies beyond the
superordinate trait perfectionism factors? The perfectionistic self-presentation and
perfectionism cognitions inventory versus the big three perfectionism scale in predicting
depression and social anxiety. Journal of Personality Assessment, 24.
doi:10.1080/00223891.2019.1473429
Castro, J., Gila, A., Gual, P., Lahortiga, F., Saura, B., y Toro, J. (2004). Perfectionism dimensions
in children and adolescents with anorexia nervosa. Journal of Adolescent Health, 35,
382-398. doi:10.16/j.jadohealth.2003.11.094
Cha, M. (2016). The mediation effect of mattering and self-esteem in the relationship between
socially prescribed perfectionism and depression: Based on the social disconnection
model. Personality and Individual Differences, 88, 148-159.
doi:10.1016/j.paid.2015.09.008
Cooper, P.J., Taylor, M.J., Cooper, Z., y Fairburn, C.G. (1987). The development and validation of
the Body Shape Questionnaire. International Journal of Eating Disorders, 6, 485-494.
Cooper, P.J., y Taylor, M.J. (1988). Body image disturbance in bulimia nervosa. British Journal of
Psychiatry, 153, 32-36.
Dallegrave, R., Calugi, S., El Ghoch, M., Conti, M., y Fairburn, C.G. (2014). Inpatient cognitive
behaviour therapy for adolescents with anorexia nervosa: Inmediate and longer term
effects. Frontiers in Psychiatry, 5. doi:10.3389/fpsyt.2014.00014
Dallegrave, R., Calugi, S., Sartirana, M., y Fairburn, C.G. (2015). Transdiagnostic cognitive
behaviour therapy for adolescents with and eating disorder who are not underweight.
Behavior Research and Therapy, 73, 79-82. doi:10.1016/j.brat.2015.07.014
Drieberg, H., McEvoy, P.M., Hoiles, K.J., Shu, C.Y., y Egan, S.J. (2019). An examination of
direct, indirect and reciprocal relationships between perfectionism, eating disorder
symptoms, anxiety, and depression in children and adolescents with eating disorders.
Eating Behaviors, 32, 53-59. doi:10.1016/j.eatbeh.2018.12.002
Elousa, P., López-Jáuregui, A., y Sánchez-Sánchez, F. (2010). Manual técnico con la adaptación
al euskera del Eating Disorder Inventory-3. Madrid: TEA Ediciones.
Fairburn, C.G., Cooper, Z., y Shafran, R. (2003). Cognitive behavior therapy for eating disorders:
A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41,
509-528. doi:10.1016/S0005-7967(02)00088-8
Flett, G.L., Hewitt, P.L., Boucher, D.J., Davidson, L.A., y Munro, Y. (1997). The ChildAdolescent Perfectionism Scale: Development, validation and association with
adjustment. Ontario, Canada: York University.
Friborg, O., Clausen, L., y Rosenvinge, J.H. (2013). A five-item screening version of the Eating
Disorder Inventory (EDI-3). Comprehensive Psychiatry, 54, 1222-1228.
doi:10.1016/j.comppsych.2013.05.004
Garner, D. (2004). Eating Disorder Inventory-3. Professional Manual. Lutz, FL: Psychological
Assessment Resources, Inc.
Hollander, M.H. (1978). Perfectionism, a neglected personality trait. Journal of Clinical
Psychiatry, 39(5), 384-390.
Johnston, J., Shu, C.Y., Hoiles, K.J., Clarke, P.J.F., Watson, H.J., Dunlop, P.D., y 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.etbeh.2018.05.008
Kerr, C., Watkins, B., y Jones, F. (2016). Inflated responsibility and perfectionism in child and
adolescent anorexia. Advances on Eating Disorders, 4(3), 309-314.
doi:10.1080/21662630.2016.1217494
Kirsh, G., Mcvey, G., Tweed, S., y Katzam, D.K. (2007). Psychosocial profiles of young
adolescent females seeking treatment for an eating disorder. The Journal of Adolescent
Health, 40(4), 351-356. doi:10.1016/j.jadohealth.2006.11.003
Kovacs, M. (1992). Children’s Depression Inventory, CDI. Toronto: Multi-Health Systems, Inc.
Levin, M.E., Luoma, J.B., y Haeger, J.A. (2015). Decoupling as a mechanism of change in
mindfulness and acceptance: a literatura review. Behavior Modification, 39(6), 870-911.
doi:10.1177/0145445515603707
Limburg, K., Watson, H.J., Hagger, M.S., y Egan, S.J. (2017). The relationship between
perfectionism and psychopathology: A meta-analysis. Journal of Clinical Psychology,
73, 1301-1326. doi:10.1002/jclp.22435
Marshall, S.L., Parker, P.D., Ciarrochi, J., Sahdra, B., Jackson, C.J., y Heaven, P.C. (2015). Selfcompassion protects against the negative effects of low self-esteem: A longitudinal study
in a large adolescent sample. Personality and Individual Differences, 74, 116-121.
doi:10.1016/j.paid.2014.09.013
Moroz, M., y Dunkley, D.M. (2015). Self-critical perfectionism and depressive symptoms: Low
self-esteem and experiential avoidance as mediators. Personality and Individual
Differences, 87, 147-179. doi:10.1016/j.paid.2015.07.44
Nilsson, K., Sundbom, E., y Hagglof, B. (2008). A longitudinal study of perfectionism in
adolescent onset anorexia nervosa-restricting type. European Eating Disorders Review,
16(5), 386-394. doi:10.1002/erv.850
Phillips, R., Stewart, S.M., Presnell, K., Simmons, A., Kennard, B.D., Liss, D., y Setliff, S. (2010).
Psychological variables impacting weight gain rapidity in adolescents hospitalized for
eating disorders. European Eating Disorders Review, 18(5), 376-384.
doi:10.1002/erv.998
Puttevils, L., Vanderhasselt, M., y Vervaet, M. (2019). Investigating transdiagnostic factors in
eating disorders: Does self-esteem moderate the relationship between perfectionism and
eating disorder symptoms? European Eating Disorders Review, 7. doi:10.1002/erv.2666
Raich, R.M., Mora, M., Soler, A., Ávila, C., Clos, I., y Zapater, L. (1996). Adaptación de un
instrumento de evaluación de la insatisfacción corporal. Clínica y Salud, 7, 51-66.
Rodríguez-Sacristán, J., Cadorze, D., Rodríguez, J., Gómez-Añón, M. L., Benjumea, P., y Pérez, J.
(1984). Sistemas objetivos de medida: experiencia con el Inventario Español de
Depresiones Infantiles (CEDI). Modificado de Kovacs y Beck. Revista de Psiquiatría
Infanto-Juvenil, 3, 65-74.
Rosenberg, M. (1965). La autoimagen del adolescente y la sociedad. Buenos Aires: Paidós.
Shafran, R., Cooper, Z., y Fairburn, C. G. (2002). Clinical perfectionism: A cognitive-behavioural
analysis. Behaviour Research and Therapy, 40, 773-791. doi:10.1016/S0005-
7967(01)00059-6.
Smith, M.M., Sherry, S.B., Mushquash, A.R., Saklofske, D.H., Gautreau, C.M., y Nealis, L.J.
(2017). Perfectionism erodes social self-esteem and generates depressive symptoms:
Studying mother-daughter dyads using a daily diary design with longitudinal follow-up.
Journal of Research in Personality, 71, 72-79. doi:10.1016/j.jrp.2017.10.001
Taylor, E.P., Couper, R., y Butler, C.M. (2017). Adolescent perfectionism: Structural features of
the Frost Multidimensional Perfectionism Scale and correlates with attachment and
psychopathology. Psychology and Psychotherapy: Theory, Research and Practice,
90(4), 686-704. doi:10.1111/papt.12133
Teixeira, M.D., Pereira, A.T., Marques, M.V., Saraiva, J.M., y de Macedo, A.F. (2016). Eating
behaviors, body image, perfectionism, and self-esteem in a simple of Portuguese girls.
Revista Basileira de Psiquiatria, 38(2), 135-140. doi:10.1590/1516-4446-2015-1723
Vall, E., y Wade, T.D. (2017). Predictors and moderators of outcomes and readmission for
adolescent inpatients with anorexia nervosa: A pilot study. Clinical Psychologist, 21(2),
143-152. doi:10.1111/cp.12091
Vázquez, A., Jiménez, R., y Vázquez, R. (2004). Escala de Autoestima de Rosenberg. Fiabilidad y
validez en población clínica. Apuntes de Psicología, 22, 247-255.
Vohs, K.D., Voelz, Z.R., Pettit, J.W., Bardone, A.M., Katz, J., Abramson, L.Y., … Joiner, T.F.J.
(2001). Perfectionism, body dissatisfaction, and self-esteem: An interactive model of
bulimic symptom development. Journal of Social and Clinical Psychology, 20(4),
476-497. doi:10.1521/jscp.20.4.476.22397
Yang, H., Yang, Y., Xu, L., Wu, Q., Xu, J., Weng, E., … Cai, S. (2017). The relation of physical
appearance perfectionism with body dissatisfaction among school students 9-18 years of
age. Personality and Individual Differences, 116, 399-404. doi:10.1016/j.paid.2017.
05.005