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Perfectionism, social exclusion, and anorexia nervosa symptoms McGee, Brandy Jennifer

Abstract

Anorexia nervosa affects between 0.5% and 1% of the population and kills young women at a rate 10 times higher than the normal population (DSM-IV-TR; American Psychiatric Association, 2003; Hoek, 2006). Perfectionism has long been recognized as a risk factor for the disorder, but that relationship is not well understood. We conducted a longitudinal experimental study to examine the effect of multidimensional perfectionism on state symptoms of anorexia nervosa under conditions of social acceptance, social exclusion, and a control condition. In addition to testing a diathesis-stress model of anorectic symptoms, we also explored whether rejected affect mediated that relationship. The concurrent results indicated that both trait perfectionism and perfectionistic self-presentation were predictive of affective, cognitive, and self-evaluative symptoms of anorexia. However, only perfectionistic self-promotion and nondisplay of imperfection predicted concurrent symptoms beyond the variance accounted for by the Big Five personality traits. The longitudinal findings suggested that perfectionistic self-presentation predicted a worsening of cognitive and self-evaluative anorectic symptoms over time. By itself, neither trait perfectionism, nor perfectionistic self-presentation was predictive of concurrent eating behavior or change in eating behavior over time. Tests of the diathesis-stress model indicated that both trait perfectionism and perfectionistic self-presentation interacted with level of belongingness to predict change in state symptoms of anorexia nervosa. However, the different dimensions of perfectionism were predictive o f different aspects of the anorectic experience. For example, socially prescribed perfectionism interacted with social feedback condition to predict increasing dietary restriction, whereas self-oriented perfectionism interacted with social feedback condition to predict change in state self-esteem, and perfectionistic self-promotion interacted with level of belongingness to predict a worsening of anorectic thoughts. Moreover, with one exception, social acceptance had a negative effect for highly perfectionistic individuals. Tests of the mediated moderation model revealed that rejected affect mediates the relationship between perfectionistic self-promotion and anorectic thoughts about rigid weight regulation in the context of social exclusion. The results are discussed with respect to existing models of anorectic symptom development and implications for treatment and future research.

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