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The relationship between alexithymia and maladaptive perfectionism in eating disorders: A mediation moderation analysis methodology

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Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

OBJECTIVE: This work aimed to explore the relationship between alexithymia and maladaptive perfectionism in the psychological process leading to eating disorders (ED). METHOD: Forty-nine individuals with ED and 49 controls completed the Concern over Mistakes subscale of the Frost Multidimensional Perfectionism Scale, the Perfectionism subscale of the Eating Disorders Inventory, the total score of the Toronto Alexithymia Scale, and the Drive for Thinness, Bulimia, and Body Dissatisfaction subscales of the Eating Disorders Inventory. We tested a model in which alexythimia is the independent variable and perfectionism is the possible mediator or moderator. RESULTS: Analyses confirmed the assumed model. In addition, it emerged that perfectionism played a mediating or moderating role when measured by different instruments. This result suggested that different instruments measured subtly different aspects of the same construct. DISCUSSION: Results could suggest that alexithymia is a predisposing factor for perfectionism, which in turn may lead to the development of eating disorders.

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References

  1. Sifneos PE. The prevalence of alexithymic characteristics in psychosomatic patients. Psychother Psychosom 1973; 22: 255–62.

    Article  CAS  PubMed  Google Scholar 

  2. Taylor GJ. Eating disorders. In: Taylor GJ, Bagby RM, Parker JDA (Eds) Disorders of affect regulation: Alexithymia in medical and psychiatric illness. Cambridge, Cambridge University Press, 1997, pp 190–215.

    Chapter  Google Scholar 

  3. Bagby RM, Taylor GJ. Measurement and validation of the alexithymia construct. In: Taylor GJ, Bagby RM, Parker JDA (Eds) Disorders of affect regulation: Alexithymia in medical and psychiatric illness. Cambridge, Cambridge University Press, 1997, pp 26–45.

    Chapter  Google Scholar 

  4. Cochrane CE, Brewerton TD, Wilson DB, et al. Alexithymia in eating disorders. Int J Eat Disord 1993; 14: 219–22.

    Article  CAS  PubMed  Google Scholar 

  5. Schmidt U, Jiwany A, Treasure J. A controlled study of alexithymia in eating disorders. Compr Psychiatry 1993; 34: 54–8.

    Article  CAS  PubMed  Google Scholar 

  6. Bourke MP, Taylor GJ, Parker JD, et al. Alexithymia in women with anorexia nervosa. A preliminary investigation. Br J Psychiatry 1992; 161: 240–3.

    Article  CAS  Google Scholar 

  7. de Groot J, Rodin G, Olmsted M. Alexithymia, depression, and treatment outcome in bulimia nervosa. Compr Psychiatry 1995; 36: 53–60.

    Article  PubMed  Google Scholar 

  8. Taylor GJ, Parker JD, Bagby RM, et al. Relationships between alexithymia and psychological characteristics associated with eating disorders. J Psychosom Res 1996; 41: 561–8.

    Article  CAS  PubMed  Google Scholar 

  9. Speranza M, Corcos M, Loas G, et al. Depressive personality dimensions and alexithymia in eating disorders. Psychiatry Res 2005; 135: 153–63.

    Article  PubMed  Google Scholar 

  10. Beales DL, Dolton R. Eating disordered patients: Personality, alexithymia, and implications for primary care. Br J Gen Pract 2000; 50: 21–6.

    CAS  PubMed Central  PubMed  Google Scholar 

  11. Bydlowski S, Corcos M, Jeammet P, et al. Emotionprocessing deficits in eating disorders. Int J Eat Disord 2005; 37: 321–9.

    Article  PubMed  Google Scholar 

  12. Carano A, De Berardis D, Gambi F, et al. Alexithymia and body image in adult outpatients with binge eating disorder. Int J Eat Disord 2006; 39: 332–40.

    Article  PubMed  Google Scholar 

  13. De Berardis D, Carano A, Gambi F, et al. Alexithymia and its relationships with body checking and body image in a non-clinical female sample. Eat Behav 2007; 8: 296–304.

    Article  PubMed  Google Scholar 

  14. Fairburn CG, Cooper Z, Doll HA, et al. Risk factors for anorexia nervosa: three integrated case-control comparisons. Arch Gen Psychiatry 1999; 56: 468–76.

    Article  CAS  PubMed  Google Scholar 

  15. Fairburn CG, Harrison PJ. Eating disorders. Lancet 2003; 361: 407–16.

    Article  PubMed  Google Scholar 

  16. Halmi KA, Sunday SR, Strober M, et al. Perfectionism in anorexia nervosa: variation by clinical subtype, obsessionality, and pathological eating behavior. Am J Psychiatry 2000; 157: 1799–805.

    Article  CAS  PubMed  Google Scholar 

  17. Hewitt PL, Flett GL. Perfectionism in the self and social contexts: conceptualization, assessment, and association with psychopathology. J Pers Soc Psychol 1991; 60: 456–70.

    Article  CAS  PubMed  Google Scholar 

  18. Dunkley DM, Blankstein KR, Masheb RM, et al. Personal standards and evaluative concerns dimensions of “clinical” perfectionism: A reply to Shafran et al. (2002, 2003) and Hewitt et al. (2003). Behav Res Ther 2006; 44: 63–84.

    Article  PubMed  Google Scholar 

  19. Lilenfeld LR, Stein D, Bulik CM, et al. Personality traits among currently eating disordered, recovered and never ill first-degree female relatives of bulimic and control women. Psychol Med 2000; 30: 1399–410.

    Article  CAS  PubMed  Google Scholar 

  20. Bastiani A, Rao R, Weltzin T, et al. Perfectionism in anorexia nervosa. Int J Eat Disord 1995; 17: 147–52.

    Article  CAS  PubMed  Google Scholar 

  21. Kaye WH, Greeno CG, Moss H, et al. Alterations in serotonin activity and psychiatric symptoms after recovery from bulimia nervosa. Arch Gen Psychiatry 1998; 55: 927–35.

    Article  CAS  PubMed  Google Scholar 

  22. Joiner TE Jr, Heatherton TF, Rudd MD, et al. Perfectionism, perceived weight status, and bulimic symptoms: two studies testing a diathesis-stress model. J Abnorm Psychol 1997; 106: 145–53.

    Article  PubMed  Google Scholar 

  23. Hewitt PL, Flett GL, Ediger E. Perfectionism traits and perfectionistic self-presentation in eating disorder attitudes, characteristics, and symptoms. Int J Eat Disord 1995; 18: 317–26.

    Article  CAS  PubMed  Google Scholar 

  24. McLaren L, Gauvin L, Steiger H. A two-factor model of disordered eating. Eat Behav 2001; 2: 51–65.

    Article  CAS  PubMed  Google Scholar 

  25. Davis C. Body image, exercise, and eating behaviors. In: Fox KR (Ed) The Physical Self: From motivation to well-being. Illinois, Hum. Kinetics, 1997, pp 143–74.

    Google Scholar 

  26. Fairburn CG, Welch SL, Doll HA, et al. Risk factors for bulimia nervosa. A community-based case-control study. Arch Gen Psychiatry 1997; 54: 509–17.

    Article  CAS  PubMed  Google Scholar 

  27. Vohs KD, Bardone AM, Joiner TE Jr, et al. Perfectionism, perceived weight status, and selfesteem interact to predict bulimic symptoms: a model of bulimic symptom development. J Abnorm Psychol 1999; 108: 695–700.

    Article  CAS  PubMed  Google Scholar 

  28. Laquatra TA, Clopton JR. Characteristics of alexithymia and eating disorders in college women. Addict Behav 1994; 19: 373–80.

    Article  CAS  PubMed  Google Scholar 

  29. Garner DM. Eating Disorder Inventory-3 professional manual. Odessa, FL, Psychological Assessment Resources, 2004.

    Google Scholar 

  30. Lundh L, Johnsson A, Sundqvist K, et al. Alexithymia, memory of emotion, emotional awareness, and perfectionism. Emotion 2002; 2: 361–79.

    Article  PubMed  Google Scholar 

  31. Frost RO, Marten P, Lahart C, et al. The dimensions of perfectionism. Cogn Ther Res 1990; 14: 449–68.

    Article  Google Scholar 

  32. Terry-Short LA, Owens RG, Slade PD, et al. Positive and negative perfectionism. Person Indiv Diff 1995; 18: 663–8.

    Article  Google Scholar 

  33. Fairburn CG, Shafran R, Cooper Z. A cognitive behavioural theory of anorexia nervosa. Behav Res Ther 1999; 37: 1–13.

    Article  CAS  PubMed  Google Scholar 

  34. Mazzi F, Morosini P, De Girolamo G, et al. SCID-I. Structured clinical interview for DSM-IV axis I disorders (Italian version). Firenze, OS-Organizzazioni Speciali, 2000.

    Google Scholar 

  35. First MB, Spitzer RL, Gibbon M, et al. Structured clinical interview for DSM-IV axis I disorders — Clinician version (SCID-CV). Washington, DC, American Psychiatric Press, 1997.

    Google Scholar 

  36. Abood D, Black D. Health education prevention for eating disorders among college female athletes. Am J Health Behav 2000, 24: 209–19.

    Article  Google Scholar 

  37. Engström I, Kroon M, Arvidsson CG, et al. Eating disorders in adolescent girls with insulin-dependent diabetes mellitus: a population-based case-control study. Acta Paed 88: 1999; 175–80.

    Article  Google Scholar 

  38. Garner DM. Eating Disorder Inventory-2 professional manual. Odessa, FL, Psychological Assessment Resources, 1991.

    Google Scholar 

  39. Polivy J, Herman CP. Diagnosis and treatment of normal eating. J Consul Clin Psychol 1987; 55: 635–44.

    Article  CAS  Google Scholar 

  40. Bruch H. Eating Disorders: Obesity, anorexia nervosa and the person within. New York, Basic Books, 1973.

    Google Scholar 

  41. Bruch H. Treatment in anorexia nervosa. Int J Psychoanal Psychother 1982–1983; 9: 303–12.

    PubMed  Google Scholar 

  42. Russell GFM. Anorexia Nervosa: Its identity as an illness and its treatment. In: Price JH (Ed) Modern trends in psychological medicine, vol. 2. London, Butterworths, 1970.

  43. Garner DM. EDI-3. Eating Disorder Inventory-3. (Italian version: Giannini M, Pannocchia L, Dalle Grave R, Muratori F). Firenze, Giunti O.S., 2008.

  44. Taylor GJ, Bagby RM, Parker JDA. The revised Toronto Alexithymia Scale: some reliability, validity, and normative data. Psychother Psychosom 1992; 57: 34–41.

    Article  CAS  PubMed  Google Scholar 

  45. Bressi C, Taylor GJ, Parker JDA, et al. Cross validation of the factor structure of the 20-Item Toronto Alexithymia Scale: an Italian multicenter study. J Psychosom Res 1996; 41: 551–9.

    Article  CAS  PubMed  Google Scholar 

  46. Parker WD, Adkins KK. A psychometric examination of the multidimensional perfectionism scale. J Psychopathol Behav Assess 1995; 17: 305–21.

    Article  Google Scholar 

  47. Frost RO, Di Bartolo PM. Perfectionism, anxiety, and obsessive-compulsive disorder. In: Fleet GL, Hewitt PL (Ed) Perfectionism: Theory, research and treatment. Washington DC, APA, 2002, pp 341–72.

    Chapter  Google Scholar 

  48. Bardone-Cone AM, Wonderlich SA, Frost RO, et al. Perfectionism and eating disorders: Current status and future directions. Clin Psychol Rev 2007; 27: 384–405.

    Article  PubMed  Google Scholar 

  49. Muller D, Judd CM, Yzerbyt V. When moderation is mediated and mediation is moderated. J Pers Soc Psychol 2005; 89: 852–63.

    Article  PubMed  Google Scholar 

  50. Aiken LS, West SG. Multiple regression: Testing and interpreting interactions. Newbury Park, Sage, 1991.

    Google Scholar 

  51. Cohen J, Cohen P, West SG, et al. Applied multiple regression/correlation analysis for the behavioral sciences, 3rd ed. Hillsdale, Erlbaum, 2003.

    Google Scholar 

  52. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol 1986; 51: 1173–82.

    Article  CAS  PubMed  Google Scholar 

  53. Cramer EM, Appelbaum MI. Nonorthogonal analysis of variance — Once again. Psych Bull 1980; 87: 51–7.

    Article  Google Scholar 

  54. Preacher KJ, Hayes AF. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods Instrum Comput 2004; 36: 717–31.

    Article  PubMed  Google Scholar 

  55. Kawamura KY, Frost RO, Harmatz MG. The relationship of perceived parenting styles to perfectionism. Person Indiv Diff 2001; 32: 317–27.

    Article  Google Scholar 

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Authors and Affiliations

  1. “Studi Cognitivi”, Post-graduate Cognitive Psychotherapy School, Milano, Italy

    S. Marsero, G. M. Ruggiero & S. Sassaroli

  2. “Psicoterapia Cognitiva e Ricerca”, Post-graduate Cognitive Psychotherapy School, Milano, Italy

    S. Marsero, G. M. Ruggiero & S. Sassaroli

  3. Eating Disorders Unit, Ospedale San Paolo, Milano, Italy

    S. Marsero, S. Scarone & S. Bertelli

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  1. S. Marsero
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  2. G. M. Ruggiero
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  4. S. Bertelli
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  5. S. Sassaroli
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Correspondence to S. Marsero.

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Marsero, S., Ruggiero, G.M., Scarone, S. et al. The relationship between alexithymia and maladaptive perfectionism in eating disorders: A mediation moderation analysis methodology. Eat Weight Disord 16, e182–e187 (2011). https://doi.org/10.1007/BF03325130

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