Abstract
Obsessive-compulsive disorder (OCD) and eating disorders (ED) share common causal factors and often represent similar entities. Studies on obsessive-compulsive disorders and eating disorders reveal a significant correlation between maladaptive perfectionism. The objective of this study is to evaluate the predictive variables of perfectionism in patients diagnosed with Anorexia Nervosa (AN), Bulimia Nervosa (BN) and OCD using a structural equation model (SEM). The sample consisted of 187 participants (60.9% women, 39.1% men) with a mean age of 26.68 (SD = 10.97). The findings reveal that the model is the same in all the disorders evaluated, achieving an adequate fit: χ2 = 7.95 (p = 0.000), RMSEA = 0.087 (95% confidence interval: 0.00 to 0.02), CFI = 0.991, TLI = 0.951 and with an overall predictive capacity of around 30% (CD = 0.318). It is recommended that future studies address the subtypes of disorders evaluated using longitudinal designs.
Introduction
Perfectionism is a maladaptive personality trait when expressed at high levels (1). Historically it has been approached negatively (2, 3), describing two major elements: (a) self-imposed high or unattainable standards; (b) negative self-evaluation in the face of mistakes and preoccupation with making them (4–6). Both elements produce displeasure and dissatisfaction with achievement (7). Despite this, an opposing viewpoint showcases positive characteristics and a sense of accomplishment for completed tasks (8), which is associated with psychological well-being (9). Both views have given rise to a bipolar classification in which it is possible to find: negative and positive perfectionism (10), or maladaptive and adaptive perfectionism (11).
The increase in studies on maladaptive or negative perfectionism may be supported by the fact that it is a risk factor for mental disorders such as suicidal ideation, depression and anxiety (12). According to international data, it is estimated that a high percentage of patients diagnosed with psychiatric disorders present characteristics of maladaptive perfectionism (13, 14).
Some approaches, such as the trans-diagnostic approach, rescue the relevance of the mediating mechanisms of perfectionism (15), to explore the psychopathological unfolding, as the main starting point in the genesis of psychiatric disorders. From this perspective, studies have found significant relationships of symptoms and signs of perfectionism comorbidity with: obsessive compulsive disorder [OCD, (16)] and eating disorders [ED, (17, 18)].
From the point of view of these disorders, empirical evidence has identified different mechanisms that have an impact on the symptomatology of maladaptive perfectionism. Among these, the clinical relevance of anxiety about perfectionistic actions (19, 20).
Precisely, it can be pointed out, the mediating character that it obtains by associating it with perfectionism, as an inherent mechanism of modulation and aggravation of symptoms both in EDs (21–23), and in OCD (13, 14, 24). Moreover, the role of emotional regulation on mental disorders, exhibits an important component in perfectionistic expressions (25), demonstrating an implication in maladaptive psychopathological genesis (26).
Also, it has been noted that goals, impulses and preoccupation with errors act as pathognomonic criteria of perfectionism, playing a maintaining role in perfectionist symptoms (25). From this line, goals manage to consolidate as the end to which a person's actions or desires are directed (27); studies have shown a close relationship, of these with perfectionism (28–32).
Accordingly, impulsive traits have been identified as increasing the risk of manifesting perfectionist behaviors (33–36); although, the quality of the results seems to depend on personal and social standards (37), as well as the evolution of the disorder. On this last point, studies have highlighted the involvement of impulsive behaviors in the course of emotion and anxiety regulation, evidencing their impact on EDs, including: anorexia nervosa (38, 39), bulimia nervosa (40, 41) and binge eating disorder (41–43). Likewise, it has been denoted as the clinical criterion of OCD in the trajectory of its symptoms (44, 45).
Meanwhile, concern over mistakes encompasses cognitive and interpersonal characteristics inherent in the course of perfectionism (46), which have been found to be related to performance parameters and fear of failure (25). Demands and satisfactions with oneself affect the individual globally and are more persistent when there is an ongoing disorder (47).
Phenotypically, certain female gender predilection in the involvement of anxiety course (48) and emotional regulation has been consolidated, coming to strengthen the psychopathological risk of maladaptive perfectionism (49).
Clearly, OCD and EDs share common causal factors and often represent similar entities. Studies on the relationship between perfectionism, obsessive-compulsive traits and eating disorders reveal a significant correlation with maladaptive perfectionism (4, 5, 50). Although perfectionism is shown to be a component that motivates the development of psychopathology and severity of the disorders, our understanding of which predictors explain perfectionism in these disorders is insufficient. Thus, we explored the predictive nature of perfectionism in patients diagnosed with OCD, AN, and BN to assist with the refinement of the behavioral endophenotypes underlying perfectionism vulnerability.
The trajectory of these studies has denoted the prediction of maladaptive perfectionism as a psychopathological criterion implicated in the genesis of OCD and ED. Given that these studies have corresponded in analyzing in isolation or partially each of its predictor variables (anxiety, emotional regulation, goals, impulses, preoccupation with errors and sex). The present research aims to study the integration of the variables by means of an integrated structural equation model, in order to know the direct and indirect effects between their relationships in a population of patients diagnosed with AN, BN and OCD.
Method
Participants
The study included a sample of patients diagnosed with OCD (n = 71), AN (n = 52), and BN (n = 64) corresponding to the psychiatric outpatient area of the “Ecuadorian Mental Health” Citizen Attention Program of the Ministry of Public Health of Ecuador was included in the study. The diagnosis of the patients was made by psychiatrists in charge of the program. The inclusion criteria for this study were an age of 17 to 40 years, the presence of diagnosis of AN, BN, and OCD according to DSM-V criteria, for the diagnosis of the severity of anorexia nervosa, low body weight defined as a BMI of ≥17 was considered. The study did not consider the subtypes of: anorexia nervosa (restrictive type and binge eating/purging type), and bulimia nervosa (restrictive and purging); exclusion criteria were psychoactive substance dependence, major medical or neurological illness and cognitive impairment. The patients included met the criteria as established by the DSM-5 for the diagnosis of OCD and ED, at least 2 months before entering the study, likewise they did not report being under the effect of any medication or psychotropic, in the development of the tests. The distribution of the participants according to their sociodemographic variants, medical illnesses and psychopathology is reported in Table 1.
Table 1
| OCD n=71 | AN n=52 | BN n=64 | χ2 | df | p | ||||
|---|---|---|---|---|---|---|---|---|---|
| Sociodemographic variables | n | % | n | % | n | % | |||
| Sex | |||||||||
| Women | 45 | 24.1 | 30 | 16.0 | 39 | 20.9 | 0.408 | 2 | 0.815 |
| Men | 26 | 13.9 | 22 | 11.8 | 25 | 13.4 | |||
| Civil status | |||||||||
| Single | 44 | 23.5 | 30 | 16.0 | 47 | 25.1 | 18.577 | 6 | 0.005 |
| Married / coupe | 17 | 9.1 | 22 | 11.8 | 16 | 8.6 | |||
| Separated/divorced | 9 | 4.8 | 0- | 0- | 1 | 0.5 | |||
| Widower | 1 | 0.5 | 0- | 0- | 0- | 0- | |||
| Education | |||||||||
| Primary | 1 | 0.5 | 0- | 0- | 4 | 2.1 | 41.776 | 6 | 0.000 |
| Secondary | 1 | 0.5 | 0- | 0- | 8 | 4.3 | |||
| University | 55 | 29.4 | 52 | 27.8 | 52 | 27.8 | |||
| Post-graduate | 14 | 7.5 | 0- | 0- | 0- | 0- | |||
| Age (years-old) | Mean | SD | Mean | SD | Mean | SD | F | df | p |
| 37.49 | 10.9 | 20.1 | 1.8 | 20 | 2.7 | 136.8 | 2 | 0.000 | |
| Clinical diseases | |||||||||
| n | % | n | % | n | % | χ2 | df | p | |
| Endocrinological diseases | 3 | 1.6 | 0- | 0- | 0- | 0- | 20.174 | 6 | 0.003 |
| Respiratory diseases | 4 | 2.1 | 0- | 0- | 1 | 0.5 | |||
| Cardiovascular disease | 6 | 3.2 | 0- | 0- | 0- | 0- | |||
| None | 58 | 31.0 | 52 | 27.8 | 63 | 33.7 | |||
| Psychopathological | |||||||||
| Mean | SD | Mean | SD | Mean | SD | F | df | p | |
| Emotional regulation | 34.4 | 5.3 | 39 | 4.9 | 38.5 | 5 | 0.380 | 2 | 0.684 |
| Anxiety | 5.6 | 2.6 | 5.5 | 2.4 | 5.4 | 2.3 | 0.099 | 2 | 0.906 |
| Goals Sub-EDRE | 12.6 | 4.5 | 13 | 4.5 | 12.8 | 4.8 | 0.028 | 2 | 0.972 |
| Impulses Sub-EDRE | 14.9 | 5.1 | 15.2 | 5.7 | 14.8 | 5.6 | 0.100 | 2 | 0.905 |
| Concern over mistakes | 8.9 | 3.2 | 9.2 | 4.1 | 9.4 | 4.3 | 0.245 | 2 | 0.783 |
Description of the sample.
OCD, Obsessive-Compulsive Disorder; AN, Anorexia nervosa; BN, Bulimia nervosa. Bold: significant difference (0.05 level). df, Degrees of freedom, SD, Standard deviation.
Instruments
Perfectionism [MPS-8; (51)]. Brief scale consists of a total of eight questions. It is scored on a Likert scale from 1 (strongly disagree) to 5 (strongly agree). Higher scores indicate more perfectionistic tendencies. Cronbach's α coefficient in the study sample presents good internal consistency (α = 0.89).
Emotional Regulation [ERQ; (52)]. Questionnaire consisting of 10 items in which the subject must express his or her degree of agreement in reference to how he or she usually regulates his or her emotions. It is scored on a seven-point Likert scale, from 1 (completely disagree) to 7 (completely agree). It presents two dimensions (cognitive reappraisal and expressive suppression). The cognitive reappraisal subscale was administered in the study, according to the authors this essentially represents emotional regulation. A Cronbach's alpha reliability of 0.84 is reported for cognitive reappraisal.
Anxiety [GADS; (53)]. Goldberg Anxiety and Depression Scale -GADS- (54). This instrument is composed of two subscales of 9 binary (yes/no) items. The first subscale for anxiety and the second subscale for depression. The anxiety scale was used in the study, presenting good internal consistency (α = 0.75). Higher scores indicate more anxious tendencies.
Preoccupation with errors [F-MPS; (4)]. Subscale of the multidimensional perfectionism scale. It consists of nine items; e.g., “I should be upset if I make a mistake.” Each item is answered using a 5-point Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly agree). Cronbach's α coefficient in the study sample presents good internal consistency (α = 0.76).
Goals [DERS; (55)]. Subscale of the Difficulties in Emotion Regulation Scale (56). It consists of three items assessing inability to engage in goal-directed behaviors when distressed. Higher scores reflect greater inability. It is answered using a 5-point Likert-type scale from 1 (almost never) to 5 (almost always).
Impulses [DERS, (55)]. Sub-scale of the Difficulties in Emotion Regulation Scale (56). It consists of three items assessing difficulties in controlling impulsive behaviors when distressed. Higher scores reflect greater incapacity. It is answered using a 5-point Likert-type scale from 1 (almost never) to 5 (almost always).
Clinical Diseases. This consisted of questions referring to medical diseases: endocrine, respiratory or cardiovascular.
In addition to the previous questionnaires, four questions referring to sociodemographic information were collected: biological sex, chronological age and educational level (primary, secondary and professional).
Procedure
The study was conducted in accordance with the latest version of the Declaration of Helsinki. The Clinical Research Ethics Committee of the Ministry of Public Health of Ecuador approved the study and signed informed consent was obtained from the volunteer participants in the psychiatric outpatient area of the “Ecuadorian Mental Health” Citizen Attention Program.
Outpatient physicians and psychiatrists invited patients in the consultation process to participate in the study by informing them that attitudes toward mental health problems were being assessed. The data collection time was 2 months. Those who gave written consent to participate were included in the study. Once this process was completed, the availability of the patients to complete the tests in the regular space of consultations and controls to the patients was scheduled together with the patients. Data collection was performed by the staff psychologist in conjunction with the attending physician. The patients who completed the measures were thanked for their time.
Treatment of Data
Data processing was performed by the Basic Psychology, Behavioral Analysis and Programmatic Development PAD-lab team. After the process of imputation of missing data and the recreation of the final data matrix. Prior to the calculations developed for the fulfillment of the proposed objectives, the fulfillment of the assumptions of: univariate and multivariate normality, homoscedasticity, collinearity and data independence will be analyzed for its corresponding estimator.
Quantitative techniques including descriptive statistics, such as means and standard deviations, were used. In developing the proposed multivariable model, a description of each study variable was necessary for theoretical formation and conceptualization. Means with 90% confidence intervals and frequencies were used in the generation of descriptive statistics for continuous and categorical variables, respectively. Structural equation modeling (SEM) is employed in this study as an analytical tool to describe the commonalities among the variables analyzed. By means of maximum likelihood estimation, the covariance matrices extracted from the AMOS results in SPSS were applied. The model was analyzed for goodness-of-fit, residual error and chi-square values within each subsample.
Goodness-of-fit is measured on the basis of the Bentler-Bonet normed fit index, the comparative fit index and the standardized residual error estimate (57). The goodness of fit for the structural equation model was assessed with the usual indices: the root mean square error of approximation (RMSEA), the Bentler Comparative Fit Index (CFI), the Tucker Lewis Index (TLI) and the standardized root mean square residual (SRMR). Adequate model fit was considered for non-significant values in the overall chi-square X test2 and if the following criteria were met (58): RMSEA < 0.10, TLI > 0.9, CFI > 0.9 and SRMR < 0.1. The overall predictive ability of the model was measured by the coefficient of determination (CD), which is interpreted similarly to the R coefficient 2 of a multivariate regression model.
Results
Sample Characteristics
Table 1 shows the description of the study participants. The sample consisted of a statistically significant higher proportion of single professionals with university degrees. The difference between groups identified a higher proportion of age and clinical illnesses (endocrine, respiratory and cardiac) in OCD patients compared to AN and BN. The psychopathological criteria evaluated did not show significant differences according to the psychiatric disorder.
Mechanisms Explaining the Level of Perfectionism in OCD, an and BN: Path Analysis
Table 2 shows the correlation matrix for the variables considered in the study. Due to the strong association between sample size and null hypothesis testing results for the correlation model, only coefficients within the mild-moderate (|R| > 0.24) to large-high (|R| > 0.37) ranges were considered as relevant. Levels of perfectionism were positively correlated with higher scores on anxiety, emotional regulation, drives, goals, and worry about mistakes.
Table 2
| 2 | 3 | 4 | 5 | 6 | 7 | ||
|---|---|---|---|---|---|---|---|
| 1 | Perfectionism | 0.200 | 0.451 | 0.410 | –0.011 | 0.437 | 0.827 |
| 2 | Anxiety | — | 0.311 | 0.301 | −0.261 | 0.364 | 0.247 |
| 3 | Emotional Regulation | — | 0.857 | –0.052 | 0.857 | 0.380 | |
| 4 | Impulses | — | –0.065 | 0.807 | 0.335 | ||
| 5 | Sex | — | –0.050 | –0.136 | |||
| 6 | Goals | — | 0.362 | ||||
| 7 | Concern over Mistakes | — |
Correlation matrix.
Bold: statistically significant correlation.
Figure 1 shows the path diagram with the standardized coefficients (Supplementary Material contains the complete model results: direct, indirect and total effects). This SEM selected in the study as the optimal model for the association data set. An adequate fit was achieved: χ2 = 7.95 (p = 0.000), RMSEA = 0.087 (95% confidence interval: 0.00 to 0.02), CFI = 0.991, TLI = 0.951. The overall predictive ability was around 30% (CD = 0.318). The global invariance test showed significant results (χ2 = 32.99, p = 0.078), suggesting that the underlying processes are similar according to psychiatric disorders. Figure 1 shows the path diagram with standardized coefficients. Solid lines represent significant coefficients (p ≤ 0.05), while dashed lines represent non-significant coefficients (p > 0.05). Supplementary Material contains the complete model results.
Figure 1
In patients diagnosed with OCD, AN, and BN, the results indicate that worry about mistakes has a direct predictive effect on perfectionism, as well as an indirect effect mediated by emotional regulation. Goals, on the other hand, have a direct predictive effect on perfectionism and an effect mediated by emotional regulation and anxiety. The effect of female sex and drives is mediated by: a) emotional regulation and b) anxiety, on perfectionism. We manage to denote the mediating role of emotional regulation and anxiety on perfectionism performance in patients diagnosed with OCD, BN and AN.
Discussion
This research aimed to study the integration of predictors of perfectionism by means of a causal integrated model in patients diagnosed with OCD and OCD (AN and BN). In these diagnosed patients, the results indicate that preoccupation with errors has a direct and predictive effect on perfectionism, as well as an indirect effect mediated by emotional regulation. Studies corroborate this endophenotypic criterion in patients with OCD (50, 59–66), in patients with AN (67–72) and patients with BN (68, 73–77). Likewise, the mediating role of emotional regulation on high levels of perfectionism applied to mental disorders is denoted (78–82).
Furthermore, our results corroborate with previous understandings on the following levels: the influence that goals manage to have on perfectionism (83–89), the effect mediated by emotional regulation (90–94) and anxiety (85, 95–97). At this point, few studies referred in OCD patients report the performance that goals exert on perfectionism levels (98, 99), as well as on AN (69, 100, 101) and BN (102, 103). However, the mediating role of emotional regulation on OCD points to indicators of (104, 105) AN (106–111), BN (108, 112–115), and anxiety (116–118).
Similarly, in our results the effect of female sex and drives act as indirect predictors (mediated) by emotional regulation and anxiety on perfectionism. This manages to denote the mediating role of emotional regulation and anxiety on perfectionism performance in patients diagnosed with OCD, BN and AN. This issue reiterates the importance of gender-specific component analysis when studying perfectionism and associated disorders (119).
The relationships of our results are similar to classic studies mentioning female gender predisposition in the prevalence of psychiatric disorders (120) such as: in OCD (121, 122), AN (123–125) and BN (126–129), denoting to be a predisposing factor mediated by anxiety and emotional regulation to perfectionism. Similarly our reports determine the effect of drives, an edonphenotypic criterion of OCD (130–133), AN (134–136), and BN (137–139) on emotional regulation and anxiety-mediated perfectionism performance.
The mediating role of emotional regulation and anxiety in mental disorders is denoted. Given that emotion regulation is an important part of daily life, it is not surprising that disturbances in emotions and their regulation can lead to discouragement or even psychopathology. In fact, the revision of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition [DSM-4]; American Psychiatric Association (140) reveals that more than 50% of Axis I disorders and 100% of Axis II disorders involve emotion regulation deficits (141). Furthermore, within some disorders, specific criteria refer to impairments in emotion regulation (142), such as the association of anxiety in repercussion of EDs and OCD (143–147).
As for EDs, our study manages to detonate that perfectionism plays a considerable role in research on the etiology of eating disorders, representing a precursor and a feature of the acute phases of certain eating disorders. For example, research has shown that perfectionism persists after long-term weight regain from AN, and is present in relatives of women with EDs. Additionally, regarding family relationships findings show clinical perfectionism as a mediator between insecure attachment to the mother and ED symptoms (148). Therefore, it is suggested that perfectionism may represent an endophenotype for determining the genetic basis of these disorders.
Although perfectionism has been implicated in the etiology of eating disorders, it has been reported to be a specific risk factor for the development of AN and BN but not binge eating disorder (BED). Research examining concurrent factors that discriminate between eating disorders suggests that women with AN tend to have significantly higher levels of perfectionism compared to women with BN. In addition, some studies have found that perfectionism further discriminates between anorexia subtypes, indicating that women with AN are more perfectionistic and rigid than their AN-attracted purging counterparts. For example, some studies of those noted have found no differences in perfectionism between AN subtypes, whereas other studies have found evidence of greater perfectionism in women with the AN-purgecompulsive subtype compared to women with the AN-restrictive subtype. It has been noted, that a propper intervention of ED, requires specifying the way in which perfectionism is presented due to the importance of the role it plays in the dynamic of those disorders (149).
Our research did not involve patients diagnosed with binge eating disorder, however, several studies have noted weak or inconsistent associations between perfectionism and binge eating. It is possible that these inconsistent associations may be explained by the presence of fasting among overeaters. However, to our knowledge, no study has examined these hypotheses directly. This could be done in future research to obtain more consistent results.
Regarding perfectionism and OCD, our results are consistent with a number of reports relating perfectionism to obsessive-compulsive symptoms (experiences of washing, checking, hoarding, and “not being right”). Gershuny and Sher (150) found higher perfectionism scores (Frost MPS) among a group of subclinical compulsive checkers compared with non-checkers, and hypothesized that perfectionism leads some people to try to exert control over events through checking rituals.
On this point, preoccupation with errors and doubts about actions have also been associated with compulsive indecisiveness (151, 152), while Coles and Hesterly (153) found positive correlations between several dimensions of perfectionism.
Research to date makes it clear that perfectionism is related to OCD. However, as suggested above, high levels of perfectionism may not be unique to OCD. The literature suggests high levels of negative perfectionism in anxious, depressive (154), eating behavior disorders (67), as well as other forms of psychopathology (155). Its contribution to the understanding of OCD may be as that of a general vulnerability factor rather than as a specific cognitive orientation (156), although to date there is little data on this possibility. In addition, the contribution of perfectionism to OCD and OCD symptoms may operate through its influence on mood (156, 157). Further research on the role of perfectionism in other forms of psychopathology will help to elucidate these issues.
From the findings presented in this study, we consider that there were also limitations such as: the clarity of the participants' diagnosis, as well as the subtype of psychopathology presented in each of the disorders evaluated and the evaluation of pathognomonic variables of ED (158) and OCD within the structural model. These limitations could be assessed in future research to make the results more consistent, even with longitudinal designs. Likewise, in future works it would be important to consistently detail the comorbidities and clinical diseases of the participants, since in our study no patient diagnosed with AN presented endocrine diseases, as usually occurs; Likewise, the marked difference between the age of the diagnosed groups was important, despite the fact that the symptomatological appearance of the disorders (EDs and OCD) usually occurs at similar ages (3, 159). This is possibly because the composition of the sample was part of a massive public health program, which neglected these data at the time of collection.
Another perspective that could be explored in the future is the relevance of gender in ED research; considering the marked theoretical and methodological gap in this field (119).
Finally, we believe that the usefulness of this research is linked to the knowledge of perfectionism as a non-adaptive criterion that exacerbates the symptomatology associated with ED and OCD. So far, no study has examined how different levels of perfectionism act as their own mechanisms within ED and OCD. Thus, our study provides a perspective that may help to deepen the understanding of the psychopathological pictures of the disorders investigated, and consequently to rethink the models of intervention in their patients according to the obtained indicators of perfectionism.
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Statements
Data availability statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
Ethics statement
The studies involving human participants were reviewed and approved by Ethics Committee for Research with Human Beings of the Catholic University of Cuenca CEISH – UCACUE. The patients/participants provided their written informed consent to participate in this study.
Author contributions
All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Supplementary material
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyt.2022.908926/full#supplementary-material
References
1.
FryPSDebatsDL. Perfectionism and the five-factor personality traits as predictors of mortality in older adults. J Health Psychol. (2009) 14:513–524. 10.1177/1359105309103571
2.
ChangSSEJainSPReimannM. The role of standards and discrepancy perfectionism in maladaptive consumption. J Assoc Consumer Res. (2021) 6:402–413. 10.1086/714384
3.
ShafranR. (2002). Eating disorders and obsessive compulsive disorder. In Cognitive approaches to obsessions and compulsions. London, UK: Pergamon (pp. 215-231). 10.1016/B978-008043410-0/50015-5
4.
FrostROMartenPA. Perfectionism and evaluative threat. Cogn Ther Res. (1990) 14:559–72.
5.
TozziFAggenSHNealeBMAndersonCBMazzeoSENealeMCet al. The structure of perfectionism: a twin study. Behav Gen. (2004) 34:483–94. 10.1023/B:BEGE.0000038486.47219.76
6.
StoeberJ. (Eds). The psychology of perfectionism: Critical issues, open questions, and future directions. In: The psychology of perfectionism: Theory, research, applications. London: Routledge (2018) 333–352. 10.4324/9781315536255
7.
LamarreCMarcotteD. Anxiety and dimensions of perfectionism in first year college students: the mediating role of mindfulness. Eu Rev App Psychol. (2021) 71:100633. 10.1016/j.erap.2021.100633
8.
GädeJCSchermelleh-EngelKKleinAG. Disentangling the common variance of perfectionistic strivings and perfectionistic concerns: a bifactor model of perfectionism. Front Psychol. (2017) 8:160. 10.3389/fpsyg.2017.00160
9.
RichardsonCMTrustyWTGeorgeKA. Trainee wellness: self-critical perfectionism, self-compassion, depression, and burnout among doctoral trainees in psychology. Counsel Psychol Quart. (2020) 33:187–98. 10.1080/09515070.2018.1509839
10.
EganSJWadeTDShafranR. Perfectionism as a transdiagnostic process: a clinical review. Clin Psychol Rev. (2011) 31:203–12. 10.1016/j.cpr.2010.04.009
11.
VanstoneDMHicksRE. Transitioning to university: coping styles as mediators between adaptive-maladaptive perfectionism and test anxiety. Personal Indivi Diff. (2019) 141:68–75. 10.1016/j.paid.2018.12.026
12.
ZhouXZhuHZhangBCaiT. Perceived social support as moderator of perfectionism, depression, and anxiety in college students. Soc Behav Personal: Int J. (2013) 41:1141–52. 10.2224/sbp.2013.41.7.1141
13.
VanzhulaIAKinkel-RamSSLevinsonCA. Perfectionism and difficulty controlling thoughts bridge eating disorder and obsessive-compulsive disorder symptoms: a network analysis. J Affect Disord. (2021) 283:302–9. 10.1016/j.jad.2021.01.083
14.
WilliamsBMLevinsonCA. Intolerance of uncertainty and maladaptive perfectionism as maintenance factors for eating disorders and obsessive-compulsive disorder symptoms. Eu Eat Disord Rev. (2021) 29:101–111. 10.1002/erv.2807
15.
MaricotoTNogueiraR. A new formula for managing family doctors' patient list in Portugal. Ciên Saúde Colet. (2021) 26:2449–58. 10.1590/1413-81232021266.1.40852020
16.
PintoYNevilleDAOttenMCorballisPMLammeVAde HaanEHFet al. Split brain: divided perception but undivided consciousness. Brain. (2017) 140:1231–7. 10.1093/brain/aww358
17.
Borda-MasMAvarguesMLLópezATorres-PérezDRio-SánchezCGregorioMA. Personality traits and eating disorders: Mediating effects of selt-esteem and perfectionism. Int J Clin Health Psychol. (2011) 11:205–27. Available online at: http://www.aepc.es/ijchp/articulos_pdf/ijchp-377.pdf
18.
NorrisAHShresthaNKAllisonGMKellerSCBhavanKPZurloJJet al. 2018 Infectious Diseases Society of America clinical practice guideline for the management of outpatient parenteral antimicrobial therapy. Clin. Infect. Dis. (2019) 68:e1–35. 10.1093/cid/ciy745
19.
BurcaşSCretuRZ. Multidimensional perfectionism and test anxiety: a meta-analytic review of two decades of research. Edu Psychol Rev. (2020) 2:3. 10.1007./s10648-020-09531-3
20.
EleyDBansalVLeungJ. Perfectionism as a mediator of psychological distress: Implications for addressing underlying vulnerabilities to the mental health of medical students. Med Teach. (2020) 59:1–7. 10.1080/0142020, 1805101
21.
DriebergHMcEvoyPMHoilesKJShuCYEganSJ. An examination of direct, indirect and reciprocal relationships between perfectionism, eating disorder symptoms, anxiety, and depression in children and adolescents with eating disorders. Eat Behav. (2019) 32:53–9. 10.1016/j.eatbeh.2018.12.002
22.
ObeidNValoisDDBedfordSNorrisMLHammondNGSpettigueW. Asceticism, perfectionism and overcontrol in youth with eating disorders. Eatg Weight Disord-Stud Anorexia, Bulimia Obes. (2021) 26:219–25. 10.1007/s40519-019-00837-y
23.
Rutter-EleyELJamesMKJenkinsPE. Eating disorders, perfectionism, and quality of life: maladaptive perfectionism as a mediator between symptoms of disordered eating and quality of life. J Nerv Ment Dis. (2020) 208:771–6. 10.1097/NMD.0000000000001241
24.
PozzaADèttoreD. “Was it real or did I imagine it?” Perfectionistic beliefs are associated with dissociative absorption and imaginative involvement in obsessive-compulsive disorder. Psychol Res Behav Manag. (2019) 12:603. 10.2147/PRBM.S212983
25.
MadiganDStoeberJCulleyTPassfieldLHillA. Perfectionism and training performance: The mediating role of other-approach goals. Eu J Sport Sci. (2018) 1391:1–9. 10.1080/17461391.2018.1508503
26.
LeoneEWadeT. (2017). Measuring perfectionism in children: a systematic review of the mental health literature. European Child & Adolescent Psychiatry, 27, 553–567. 10.1007/s00787-017-1078-8
27.
##RehgK. L.CampbellL. (Eds.). (2018). The Oxford handbook of endangered languages. Oxford University Press. 10.1093/oxfordhb/9780190610029.001.0001
28.
BarabadiEKhajavyGH. Perfectionism and foreign language achievement: The mediating role of emotions and achievement goals. Studies in Educational Evaluation. (2020) 65:100874. 10.1016/j.stueduc.2020.100874
29.
ChangESeongHLeeSM. Exploring the relationship between perfectionism and academic burnout through achievement goals: a mediation model. Asia Pacific Edu Rev. (2020) 21:409–22. 10.1007/s12564-020-09633-1
30.
KleinRGDooleyDLapierreKPituraVAAdduonoD. Trait perfectionism and competitiveness: Conceptual similarities and differences in a lab-based competitive task. Personal Individ Diff. (2020) 153:109610. 10.1016/j.paid.2019.109610
31.
LeeYJAndermanEM. Profiles of perfectionism and their relations to educational outcomes in college students: the moderating role of achievement goals. Learn Indiv Diff. (2020) 77:101813. 10.1016/j.lindif.2019.101813
32.
NorouziMPourghazAMarziyehA. The Role of mediating perfectionism in relationship goal orientation with students' responsibility. J Edu Psychol Stud. (2021) 17:154–77. 10.22111/JEPS.2020.5841
33.
ChristianCBridges-CurryZHuntRAOrtizAMLDrakeJELevinsonCA. Latent profile analysis of impulsivity and perfectionism dimensions and associations with psychiatric symptoms. J Affect Disord. (2021) 283:293–301. 10.1016/j.jad.2021.01.076
34.
PietrabissaGGulloSAiméAMellorDMcCabeMAlcaraz-IbánezMet al. Measuring perfectionism, impulsivity, self-esteem and social anxiety: cross-national study in emerging adults from eight countries. Body Image. (2020) 35: 265–78. 10.1016/j.bodyim.2020.09.012
35.
Slof-Op't LandtMCClaesLvan FurthEF. Classifying eating disorders based on “healthy” and “unhealthy” perfectionism and impulsivity. Int J Eat Disord. (2016) 49:673–80. 10.1002/eat.22557
36.
SoidlaKAkkermannK. Perfectionism and impulsivity based risk profiles in eating disorders. Int J Eat Disord. (2020) 53:1108–19. 10.1002/eat.23285
37.
WainwrightKRomanowichPBibriescasN. Relationships between perfectionism, self-report impulsivity measures and delay discounting. Int J Psychol. (2020) 2:667. 10.1002./ijop.12667
38.
BrooksSJFunkSGYoungSYSchiöthHB. The role of working memory for cognitive control in anorexia nervosa versus substance use disorder. Front Psychol. (2017) 8:1651. 10.3389/fpsyg.2017.01651
39.
FriederichHCWildBZipfelSSchauenburgHHerzogW. Anorexia Nervosa-Focal Psychodynamic Psychotherapy: Theoretical Basis and User Manual. Newburyport, MA: Hogrefe Publishing. (2019). 10.1027/00554-000
40.
GuillaumeSGayAJaussentISigaudTBillardSAttalJCourtetP. Improving decision-making and cognitive impulse control in bulimia nervosa by rTMS: an ancillary randomized controlled study. Int J Eat Disord. (2018) 51:1103–6. 10.1002/eat.22942
41.
TodiscoPMeneguzzoPVogazianosPGarollaAAntoniadesATozziF. Relation between vitamin D and impulse behaviors in patients with eating disorder: a pilot observational study. Eu Eat Disord Rev. (2020) 28:587–93. 10.1002/erv.2740
42.
BodellLPPearsonCMSmithKECaoLCrosbyRDPetersonCBet al. Longitudinal associations between emotion regulation skills, negative affect, and eating disorder symptoms in a clinical sample of individuals with binge eating. Eating Behav. (2019) 32:69–73. 10.1016/j.eatbeh.2018.12.005
43.
BoswellRGGriloCM. General impulsivity in binge-eating disorder. CNS spectrums. (2020) 4:1–7. 10.1017/S003329172100475X
44.
ChamberlainSRGrantJE. Minnesota impulse disorders interview (MIDI): Validation of a structured diagnostic clinical interview for impulse control disorders in an enriched community sample. Psychiatry Res. (2018) 265:279–83. 10.1016/j.psychres.2018.05.006
45.
FontenelleLFOostermeijerSHarrisonBJPantelisCYücelM. Obsessive-compulsive disorder, impulse control disorders and drug addiction. Drugs. (2011) 71:827–40. 10.2165/11591790-000000000-00000
46.
KehayesISmithMSherrySVidovicVSaklofskeD. Are perfectionism dimensions risk factors for bulimic symptoms? A meta-analysis of longitudinal studies. Personal Indiv Diff. (2018) 138:117–25. 10.1016/j.paid.2018.09.022
47.
HarariDSwiderBSteedLBreidenthalA. Is perfect good? A meta-analysis of perfectionism in the workplace. J App Psychol. (2018) 103:1121–44. 10.1037/apl0000324
48.
KlibertJLamisDANaufelKYanceyCTLohrS. Associations between perfectionism and generalized anxiety: examining cognitive schemas and gender. J Rational-Emotive Cognitive-Behav Therapy. (2015) 33:160–178. 10.1007/s10942-015-0208-9
49.
HoomanFMehrabizadeh HonarmandMZargarYDavodiI. The effectiveness of transdiagnostic therapy on anxiety, depression, cognitive strategies of emotional regulation, and general performance in women with comorbid anxiety and depression. J Fasa Univ Med Sci. (2016) 5:551–63.
50.
FrostROSteketeeG. Perfectionism in obsessive-compulsive disorder patients. Behav Res Therapy. (1997) 35:291–6. 10.1016/S0005-7967(96)00108-8
51.
WoodfinVBinderPEMoldeH. The psychometric properties of the frost multidimensional perfectionism scale–brief. Front Psychol. (2020) 11:1860. 10.3389/fpsyg.2020.01860
52.
GrossJJJohnOP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J Pers Soc Psychol. (2003) 85:348–62. 10.1037/0022-3514.85.2.348
53.
Reivan-OrtizGGPineda-GarciaGPariasBD. Psychometric properties of the goldberg anxiety and depression scale (gads) in ecuadorian population. Int J Psychol Res. (2019) 12:41–8. 10.21500/20112084.3745
54.
GoldbergDBridgesKDuncan-JonesPGraysonD. Detecting anxiety and depression in general medical settings. Br Med J. (1988) 297:897–9.
55.
BjurebergJLjótssonBTullMTHedmanESahlinHLundhLGet al. Development and validation of a brief version of the difficulties in emotion regulation scale: the DERS-16. J Psychopathol Behav Assessment. (2016) 38:284–96. 10.1007/s10862-015-9514-x
56.
GratzKLRoemerL. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess. (2004) 26:41–54. 10.1023/B:JOBA.0000007455.08539.94
57.
BentlerPMBonettDG. Significance tests and goodness of fit in the analysis of covariance structures. Psychol Bull. (1980) 88:588.
58.
BarrettP. Structural equation modelling: Adjudging model fit. Pers Individ Differ. (2007) 42:815–24. 10.1016/j.paid.2006.09.018
59.
AntonyMMPurdonCLHutaVSwinsonRP. Dimensions of perfectionism across the anxiety disorders. Behav Res Therapy. (1998) 36:1143–54. 10.1016/S0005-7967(98)00083-7
60.
ApaFTumkayaSYucensBKashyapH. Are “not just-right experiences” trait and/or state marker for obsessive-compulsive disorder?. Eu J Psych. (2022) 36:51–9. 10.1016/j.ejpsy.2021.09.003
61.
ChikHMWhittalMLO'NeillML. Perfectionism and treatment outcome in obsessive-compulsive disorder. Cogn Therapy Res. (2008) 32:676–88. 10.1007/s10608-007-9133-2
62.
LeeJCPradoHSDinizJBBorcatoSSilva da HounieCBAet al. Perfectionism and sensory phenomena: phenotypic components of obsessive-compulsive disorder. Comprehen Psych. (2009):50:431–6. 10.1016/j.comppsych.2008.11.007
63.
MartinelliMChassonGSWetterneckCTHartJMBjörgvinssonT. Perfectionism dimensions as predictors of symptom dimensions of obsessive-compulsive disorder. Bull Menninger Clin. (2014) 78:140–59. 10.1521/bumc.2014.78.2.140
64.
PozzaACasaleSDèttoreD. Therapists' emotional reactions to patients with obsessive–compulsive disorder: the role of therapists' orientation and perfectionism. J Rat-Emot Cog-Behav Therapy. (2022) 5:1–26. 10.1007/s10942-022-00443-5
65.
SassaroliSGallucciMRuggieroGM. Low perception of control as a cognitive factor of eating disorders. Its independent effects on measures of eating disorders and its interactive effects with perfectionism and self-esteem. J Behav Therapy Exp Psych. (2008) 39:467–88. 10.1016/j.jbtep.2007.11.005
66.
SuzukiT. Relationship between two aspects of perfectionism and obsessive-compulsive symptoms. Psychol Rep. (2005) 96:299–305. 10.2466/pr0.96.2.299-305
67.
BastianiAMRaoRWeltzinTKayeWH. Perfectionism in anorexia nervosa. Int J Eat Disord. (1995) 17:147–52. 10.1002/1098-108X(199503)17:2<147::AID-EAT2260170207>3.0.CO;2-X
68.
BulikCMTozziFAndersonCMazzeoSEAggenSSullivanPF. The relation between eating disorders and components of perfectionism. Am J Psych. (2003) 160:366–8. 10.1176/appi.ajp.160.2.366
69.
LloydSFlemingCSchmidtUTchanturiaK. Targeting perfectionism in anorexia nervosa using a group-based cognitive behavioral approach: a pilot study. European Eating Disorders Review. (2014) 22:366–72. 10.1002/erv.2313
70.
PhillipouAGurvichCCastleDJRossellSL. Anorexia nervosa, weight restoration and biological siblings: differences and similarities in clinical characteristics. Au Psych. (2022) 3:10398562211067194. 10.1177/10398562211067194
71.
Solomon-KrakusSUliaszekAASabistonCM. The differential associations between self-critical perfectionism, personal standards perfectionism, and facets of restrictive eating. Personal Indivi Diff. (2022) 184:111178. 10.1016/j.paid.2021.111178
72.
TchanturiaKLarssonEAdamsonJ. Brief group intervention targeting perfectionism in adults with anorexia nervosa: empirically informed protocol. Eu Eat Disord Rev. (2016) 24:489–93. 10.1002/erv.2467
73.
FlettGLHewittPLNeponTSherrySBSmithM. The destructiveness and public health significance of socially prescribed perfectionism: a review, analysis, and conceptual extension. Clin Psychol Rev. (2022) 53:102130. 10.1016/j.cpr.2022.102130
74.
SassaroliSRuggieroGM. The role of stress in the association between low self-esteem, perfectionism, and worry, and eating disorders. Int J Eat Disord. (2005) 37:135–41. 10.1002/eat.20079
75.
SassaroliSApparigliatoMBertelliSBoccalariLFioreFLamelaCet al. Perfectionism as a mediator between perceived criticism and eating disorders. Eat Weight Disord-Stud Anorexia Bulimia Obes. (2011) 16:37–44. 10.1007/BF03327519
76.
SassaroliSLauroLJRRuggieroGMMauriMCVinaiPFrostR. Perfectionism in depression, obsessive-compulsive disorder and eating disorders. Behav Res Therapy. (2008) 46:757–65. 10.1016/j.brat.2008.02.007
77.
WadeTDTiggemannM. The role of perfectionism in body dissatisfaction. J Eat Disord. (2013) 1:1–6. 10.1186/2050-2974-1-2
78.
FrostRODiBartoloPM. Perfectionism, anxiety, and obsessive-compulsive disorder. In Flett GL, Hewitt PL, editors. Perfectionism: Theory, research, and treatment. American Psychological Association (2002) 1:341–71. 10.1037/10458-014
79.
MartinezKGuanCWalkerDC. I'm angry that I'm not perfect! aggression mediates the relationship between perfectionism and eating pathology in men and women. Eat Weight Disord-Stud Anorexia, Bulimia Obes. (2021) 45:1–7. 10.1007/s40519-021-01319-w
80.
Rand-GiovannettiDRozzellKNLatnerJ. The role of positive self-compassion, distress tolerance, and social problem-solving in the relationship between perfectionism and disordered eating among racially and ethnically diverse college students. Eatg Behav. (2022) 44:101598. 10.1016/j.eatbeh.2022.101598
81.
RuggieroGMSassaroliS. The body of cognitive and metacognitive variables in eating disorders: need of control, negative beliefs about worry uncontrollability and danger, perfectionism, self-esteem and worry. Israel J Psych. (2018) 55:55–83.
82.
WangQWuH. The mediating role of self-compassion and its components in the relationship between maladaptive perfectionism and life satisfaction among Chinese medical students. Curr Psychol. (2022) 43:1–13. 10.1007/s12144-022-02810-y
83.
AblardKEParkerWD. Parents' achievement goals and perfectionism in their academically talented children. Journal of Youth and Adolescence. (1997) 26:651–67. 10.1023/A:1022392524554
84.
CeylanGKolsariciCMacInnisDJ. Perfectionism paradox: Perfectionistic concerns (not perfectionistic strivings) affect the relationship between perceived risk and choice. J Consum Behav. (2022) 1:1–16. 10.1002/cb.2046
85.
GutierrezLVelascoLBlancoSCatalaPPastor-MiraMAPenacobaC. Perfectionism, maladaptive beliefs and anxiety in women with fibromyalgia. An explanatory model from the conflict of goals. Personal Indivi Diff. (2022) 184:111165. 10.1016/j.paid.2021.111165
86.
HanchonTA. The relations between perfectionism and achievement goals. Personal Indivi Diff. (2010) 49:885–90. 10.1016/j.paid.2010.07.023
87.
StoeberJHaskewAEScottC. Perfectionism and exam performance: the mediating effect of task-approach goals. Personal Indiv Diff. (2015) 74:171–6. 10.1016/j.paid.2014.10.016
88.
StoeberJStollOPescheckEOttoK. Perfectionism and achievement goals in athletes: Relations with approach and avoidance orientations in mastery and performance goals. Psychol Sport Exe. (2008) 9:102–21. 10.1016/j.psychsport.2007.02.002
89.
VansteenkisteMSmeetsSSoenensBLensWMatosLDeciEL. Autonomous and controlled regulation of performance-approach goals: their relations to perfectionism and educational outcomes. Motivat Emot. (2010) 34:333–53. 10.1007/s11031-010-9188-3
90.
AbdollahiAAbu TalibM. Emotional intelligence moderates perfectionism and test anxiety among Iranian students. School Psychol Int. (2015) 36:498–512. 10.1177/0143034315603445
91.
BergmanAJNylandJEBurnsLR. Correlates with perfectionism and the utility of a dual process model. Personal Indiv Diff. (2007) 43:389–99. 10.1016/j.paid.2006.12.007
92.
PutwainDW. An examination of the self-referent executive processing model of test anxiety: control, emotional regulation, self-handicapping, and examination performance. Eu J Psychol Edu. (2019) 34:341–58. 10.1007/s10212-018-0383-z
93.
O'ConnorRCForganG. Suicidal thinking and perfectionism: The role of goal adjustment and behavioral inhibition/activation systems (BIS/BAS). J Rat-Emot Cog-Behav Therapy. (2007) 25:321–41. 10.1007/s10942-007-0057-2
94.
Nik Andam KermanshahiHSafaei RadIErfaniNYar AhmadiY. The role of negative perfectionism, difficulty in emotional regulation and self-disability in predicting academic boredom in high school male students. J School Psychol. (2021) 10:155–80. 10.22098/jsp.2021.1184
95.
CarrSWyonM. The impact of motivational climate on dance students' achievement goals, trait anxiety, and perfectionism. J Dance Med Sci. (2003) 7:105–14.
96.
EumKRiceKG. Test anxiety, perfectionism, goal orientation, and academic performance. Anxiety, Stress, & Coping. (2011) 24, 167–178. 10.1080/10615806.2010.488723
97.
HallHKKerrAWMatthewsJ. Precompetitive anxiety in sport: the contribution of achievement goals and perfectionism. J Sport Exe Psychol. (1998) 20:194–217. 10.1123/jsep.20.2.194
98.
FlettGLHewittPLOliverJMMacdonaldS. Perfectionism in children and their parents: A developmental analysis. In Flett GL, Hewitt PL, editors. Perfectionism: Theory, research, and treatment.American Psychological Association (2002) 1:89–132. 10.1037/10458-004
99.
EganSPiekJDyckMKaneR. The reliability and validity of the positive and negative perfectionism scale. Clin Psychol. (2011) 15:121–32. 10.1111/j.1742-9552.2011.00029.x
100.
DrussRGSilvermanJA. Body image and perfectionism of ballerinas: Comparison and contrast with anorexia nervosa. Gen Hosp Psych. (1979) 1:115–21. 10.1016/0163-8343(79)90056-2
101.
HewittPLFlettGLBesserASherrySBMcGeeB. Perfectionism is multidimensional: a reply to. Behav Res Therapy. (2003) 41:1221–36. 10.1016/S0005-7967(03)00021-4
102.
WatsonHJRaykosBCStreetHFurslandANathanPR. Mediators between perfectionism and eating disorder psychopathology: shape and weight overvaluation and conditional goal-setting. Int J Eat Disord. (2011) 44:142–49. 10.1002/eat.20788
103.
VohsKDBardoneAMJoiner JrTEAbramsonLY. Perfectionism, perceived weight status, and self-esteem interact to predict bulimic symptoms: a model of bulimic symptom development. J Abnorm Psychol. (1999) 108:695. 10.1037/0021-843X.108.4.695
104.
CludiusBMannsfeldAKSchmidtAFJelinekL. Anger and aggressiveness in obsessive–compulsive disorder (OCD) and the mediating role of responsibility, non-acceptance of emotions, and social desirability. Eu Arch Psych Clin Neurosci. (2021) 271:1179–91. 10.1007/s00406-020-01199-8
105.
EichholzASchwartzCMeuleAHeeseJNeumüllerJVoderholzerU. Self-compassion and emotion regulation difficulties in obsessive–compulsive disorder. Clin Psychol Psycho. (2020) 27:630–9. 10.1002/cpp.2451
106.
AzziVHallitSMalaebDObeidSBrytek-MateraA. Drunkorexia and emotion regulation and emotion regulation difficulties: the mediating effect of disordered eating attitudes. Int J Environm Res Public Health. (2021) 18:2690. 10.3390/ijerph18052690
107.
EvansLWertheimEH. Intimacy patterns and relationship satisfaction of women with eating problems and the mediating effects of depression, trait anxiety and social anxiety. J Psych Res. (1998) 44:355–65. 10.1016/S0022-3999(97)00260-2
108.
GrabhornRStennerH., Stangier U, Kaufhold J. Social anxiety in anorexia and bulimia nervosa: the mediating role of shame. Clin Psychol Psych: Int J Theory Pract. (2006) 13:12–9. 10.1002/cpp.463
109.
GuptaSZachary RosenthalMManciniADCheavensJSLynchTR. Emotion regulation skills mediate the effects of shame on eating disorder symptoms in women. Eat Disord. (2008) 16:405–17. 10.1080/10640260802370572
110.
RacineSEWildesJE. Emotion dysregulation and anorexia nervosa: an exploration of the role of childhood abuse. Int J Eat Disord. (2015) 48:55–8. 10.1002/eat.22364
111.
MasonTBLavenderJMWonderlichSACrosbyRDEngelSGMitchellJEet al. Examining a momentary mediation model of appearance-related stress, anxiety, and eating disorder behaviors in adult anorexia nervosa. Eat Weight Disord-Stud on Anorexia, Bulimia Obes. (2018) 23:637–44. 10.1007/s40519-017-0404-y
112.
EganSJWatsonHJKaneRTMcEvoyPFurslandANathanPR. Anxiety as a mediator between perfectionism and eating disorders. Cog Therapy Res. (2013) 37:905–13. 10.1007/s10608-012-9516-x
113.
Espel-HuynhHMMuratoreAFVirziNBrooksGZandbergLJ. Mediating role of experiential avoidance in the relationship between anxiety sensitivity and eating disorder psychopathology: a clinical replication. Eat Behav. (2019) 34:101308. 10.1016/j.eatbeh.2019.101308
114.
JakovinaTCrnković BatistaMRaŽić PavičićAŽurić JakovinaIBegovacI. Emotional dysregulation and attachment dimensions in female patients with bulimia nervosa. Psych Danubina. (2018) 30:72–8. 10.24869/psyd.2018.72
115.
TascaGASzadkowskiLIllingVTrinneerAGrenonRDemidenkoNet al. Adult attachment, depression, and eating disorder symptoms: the mediating role of affect regulation strategies. Personal Indiv Diff. (2009) 47:662–7. 10.1016/j.paid.2009.06.006
116.
BajcarBBabiakJ. Self-esteem and cyberchondria: the mediation effects of health anxiety and obsessive–compulsive symptoms in a community sample. Curr Psychol. (2021) 40:2820–31. 10.1007/s12144-019-00216-x
117.
KimSKMcKayDMurphyTKBussingRMcNamaraJPGoodmanWKet al. Age moderated–anxiety mediation for multimodal treatment outcome among children with obsessive-compulsive disorder: an evaluation with correspondence analysis. J Aff Disord. (2021) 82:766–75. 10.1016/j.jad.2020.12.198
118.
LiKZhangHWangBYangYZhangMLiWet al. Hippocampal functional network: The mediating role between obsession and anxiety in adult patients with obsessive-compulsive disorder. W J Biol Psych. (2020) 21:685–95. 10.1080/15622975.2020.1733082
119.
SpringmannMLSvaldiJKiegelmannM. Theoretical and methodological considerations for research on eating disorders and gender. Front Psychol. (2020) 11. 10.3389./fpsyg.2020.586196
120.
GrantBFWeissmanMM. Gender and the prevalence of psychiatric disorders. In Narrow WE, First MB, Sirovatka PJ, DA, Regier DA, editors, Age and gender considerations in psychiatric diagnosis: A research agenda for DS-V. New York, NY: American Psychiatric Publishing, Inc. (2007) 31–45.
121.
BebbingtonPE. Epidemiology of obsessive-compulsive disorder. Br J Psych. (1998) 173:2–6. 10.1192/S0007125000297833
122.
LensiPCassanoGBCorredduGRavagliSKunovacJLAkiskalHS. Obsessive–compulsive disorder. Br J Psych. (1996) 169:101–7. 10.1192/bjp.169.1.101
123.
KlumpKLBulikCMPolliceCHalmiKAFichterMMBerrettiniWHet al. Temperament and character in women with anorexia nervosa. J Nerv Mental Dis. (2000) 188:559–67. 10.1097/00005053-200009000-00001
124.
LopezCATchanturiaKStahlDTreasureJ. Central coherence in women with bulimia nervosa. Int J Eat Disord. (2008) 41:340–7. 10.1002/eat.20511
125.
ShottMEPryorTLYangTTFrankGK. Greater insula white matter fiber connectivity in women recovered from anorexia nervosa. Neuropsychopharmacology. (2016) 41:498–507. 10.1038/npp.2015.172
126.
GendallKASullivanPEJoycePRCarterFABulikCM. The nutrient intake of women with bulimia nervosa. Int J Eat Disord. (1997) 21:115–27. 10.1002/(SICI)1098-108X(199703)21:2<115::AID-EAT2>3.0.CO;2-O
127.
HartKJOllendickTH. Prevalence of bulimia in working and university women. Am J Psych. (1985) 142:851–4. 10.1176/ajp.142.7.851
128.
KeelPKHeathertonTFDorerDJJoinerTEZaltaAK. Point prevalence of bulimia nervosa in 1982, 1992, and 2002. Psychological medicine. (2006) 36:119–27. 10.1017/S0033291705006148
129.
LopezCTchanturiaKStahlDBoothRHollidayJTreasureJ. An examination of the concept of central coherence in women with anorexia nervosa. Int J Eat Disord. (2008) 41:143–52. 10.1002/eat.20478
130.
GrantJEManceboMCEisenJLRasmussenSA. Impulse-control disorders in children and adolescents with obsessive-compulsive disorder. Psych Res. (2010) 175:109–13. 10.1016/j.psychres.2009.04.006
131.
GrantJEManceboMCPintoAEisenJLRasmussenSA. Impulse control disorders in adults with obsessive compulsive disorder. J Psych Res. (2006) 40:494–501. 10.1016/j.jpsychires.2005.11.005
132.
López-IborJJ. Impulse control in obsessive-compulsive disorder: a biopsychopathological approach. Prog Neuro-Psychopharmacol Biol Psych. (1990) 3:41. 10.1016/0278-5846(90)90041-E
133.
PotenzaMNKoranLMPallantiS. The relationship between impulse-control disorders and obsessive–compulsive disorder: a current understanding and future research directions. Psych Res. (2009) 170:22–31. 10.1016/j.psychres.2008.06.036
134.
CasperRC. Personality features of women with good outcome from restricting anorexia nervosa. Psychosom Med. (1990) 35:4. 10.1097/00006842-199003000-00004
135.
RacineSEWildesJE. Emotion dysregulation and symptoms of anorexia nervosa: the unique roles of lack of emotional awareness and impulse control difficulties when upset. Int J Eat Disord. (2013) 46:713–720. 10.1002/eat.22145
136.
SohlbergS. Impulse regulation in anorexia nervosa and bulimia nervosa: Some formulations. Behav Neurol. (1991) 4:189–201. 10.1155/1991/895824
137.
NewtonJRFreemanCPMunroJ. Impulsivity and dyscontrol in bulimia nervosa: is impulsivity an independent phenomenon or a marker of severity?. Acta Psych Scandinavica. (1993) 87:389–94. 10.1111/j.1600-0447.1993.tb03393.x
138.
PyleRLMitchellJEEckertED. Bulimia: a report of 34 cases. J Clin Psych. (1981) 4:561.
139.
SchagKRennhakSKLeehrEJSkodaEMBeckerSBethgeWet al. IMPULS: impulsivity-focused group intervention to reduce binge eating episodes in patients with binge eating disorder–a randomized controlled trial. Psych Psychosom. (2019) 88:141–53. 10.1159/000499696
140.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed.American Psychiatric Association (1994).
141.
GrossJJLevensonRW. Hiding feelings: the acute effects of inhibiting negative and positive emotion. J. Abnorm. Psychol. (1997) 106:95–103. 10.1037//0021-843x.106.1.95
142.
KringAMWernerKH. Emotion regulation and psychopathology. Regulat. Emot. (2004) 378–405.
143.
BandelowBMichaelisS. Epidemiology of anxiety disorders in the 21st century. Dialog Clin Neurosci. (2015) 17:327. 10.31887/DCNS.2015.17.3/bbandelow
144.
KesslerRC. The global burden of anxiety and mood disorders: putting the European study of the epidemiology of mental disorders (ESEMeD) findings into perspective. J Clin Psych. (2007) 68:10–9.
145.
LewinsohnPMZinbargRSeeleyJRLewinsohnMSackWH. Lifetime comorbidity among anxiety disorders and between anxiety disorders and other mental disorders in adolescents. Journal of anxiety disorders. (1997) 11:377–94. 10.1016/S0887-6185(97)00017-0
146.
MohlmanJBryantCLenzeEJStanleyMAGumAFlintAet al. Improving recognition of late life anxiety disorders in diagnostic and statistical manual of mental disorders: observations and recommendations of the advisory committee to the lifespan disorders work group. Int J Ger Psych. (2012) 7:549–56. 10.1002/gps.2752
147.
RiceDPMillerLS. Health economics and cost implications of anxiety and other mental disorders in the United States. Br J Psych. (1998) 173:4–9. 10.1192/S0007125000293458
148.
CortésLMartínezCSenraC. Mediational effect of Fairburn's transdiagnostic mechanisms between attachment to the mother and eating disorder symptoms in a clinical sample. Front Psychol. (2022). 13:852997: 10.3389/fpsyg.2022.852977
149.
VaccaMMariaDMalliaALombardoLC. Perfectionism and eating behavior in the COVID-19 pandemic. Front Psychol. (2021) 12:943. 10.3389/fpsyg.2021.580943 10.3389/fpsyg.2021.580943
150.
GershunyBSSherKJ. Compulsive checking and anxiety in a nonclinical sample: Differences in cognition, behavior, personality, and affect. J Psychopathol Behav. Assess. (1995) 17:19–38.
151.
FrostROShowsDL. The nature and measurement of compulsive indecisiveness. Behav Res Therap. (1993) 31:683–72.
152.
GaytonWFClavinRHClavinSLBroidaJ. Further validation of the indecisiveness scale. Psychol Rep. (1994) 75:1631–4.
153.
ColesJWHesterlyWS. Independence of the chairman and board composition: Firm choices and shareholder value. J. Manag. (2000) 26:195–214. 10.1016/S0149-2063(99)00042-2
154.
BlattSJ. The destructiveness of perfectionism: Implications for the treatment of depression. Am Psychol. (1995) 50:1003–20.
155.
PachtAR. Reflections on perfection. Am Psychol. (1984) 39:386–90.
156.
WadeTDMartinNGTiggemannM. Genetic and environmental risk factors for the weight and shape concern characteristic of bulimia nervosa. Psychol Med. (1998) 28:761–71.
157.
KawamuraKYHuntSLFrostRODiBartoloPM. Perfectionism, anxiety, and depression: Are the relationships independent?. Cogn Ther Res. (2001) 25:291–301. 10.1023/A:1010736529013
158.
MeneguzzoPTodiscoPCollantoniEMeregalliVDal BrunDTenconiEet al. A multi-faceted evaluation of impulsivity traits and early maladaptive schemas in patients with anorexia nervosa. J Clin Med. (2021) 10:5895. 10.3390/jcm10245895
159.
PollackLOForbushKT. Why do eating disorders and obsessive–compulsive disorder co-occur?. Eat Behav. (2013) 14:211–5. 10.1016/j.eatbeh.2013.01.004
Summary
Keywords
perfectionism, anorexia nervosa, bulimia nervosa, obsessive compulsive, SEM
Citation
Reivan Ortiz GG, Rivera Tapia CJ, Elizalde Martínez BA and Icaza D (2022) Mediating Mechanisms of Perfectionism: Clinical Comorbidity of OCD and ED. Front. Psychiatry 13:908926. doi: 10.3389/fpsyt.2022.908926
Received
31 March 2022
Accepted
13 June 2022
Published
14 July 2022
Volume
13 - 2022
Edited by
Roser Granero, Universitat Autònoma de Barcelona, Spain
Reviewed by
Paolo Meneguzzo, University of Padua, Italy; Susana Valero Solis, University of Barcelona, Spain
Updates
Copyright
© 2022 Reivan Ortiz, Rivera Tapia, Elizalde Martínez and Icaza.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Geovanny Genaro Reivan Ortiz greivano@ucacue.edu.ec
This article was submitted to Computational Psychiatry, a section of the journal Frontiers in Psychiatry
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