May 21, 2007
Research Examines Connections Between Eating Disorders, Perfectionism
Researchers at the University of Iowa are exploring the link between perfectionism and behaviors associated with eating disorders like fasting, purging and binge eating.
Kelsie Forbush, a doctoral student in psychology, discovered that perfectionism is most highly associated with fasting and purging, and least associated with binge eating. Her work helps explain why perfectionism is considered a risk factor for anorexia and bulimia, in which fasting and purging are common, but not for binge eating disorder, in which fasting and purging are absent.
"In Western cultures, people often endorse aesthetic ideals emphasizing thinness. These cultural messages might lead to fasting and purging among women with perfectionistic approaches to such ideals," Forbush said. "However, because binge eating is associated with weight gain, it makes sense that binge eating would not be directly associated with perfectionism among women pursuing that thin ideal."
Forbush is the lead author of "Relationships Between Perfectionism and Specific Disordered Eating Behaviors," a paper published recently in the International Journal of Eating Disorders. Co-authors were Pamela Keel, associate professor of psychology in the UI College of Liberal Arts and Sciences, and Todd Heatherton, a professor in the Department of Psychological and Brain Sciences at Dartmouth College.
Forbush analyzed a cross-section of data from a 20-year study Keel and Heatherton are conducting on the health and eating patterns of students at a prestigious college in the Northeast. In the springs of 1982, 1992 and 2002, 1,732 women and 750 men answered questions about whether they had engaged in fasting, binging, self-induced vomiting, diuretic abuse or laxative abuse to control weight.
Participants also completed a questionnaire assessing their level of perfectionism, which is defined as having unrealistically high standards -- more than just being conscientious and organized -- and being upset if those standards can't be met. Forbush used a statistical formula to compare the strength of relationships between the eating behaviors and the personality traits.
Some past studies suggest that women with the restrictive subtype of anorexia (those who limit their food intake) tend to be more perfectionistic than those with the binge-purge subtype (those who eat large quantities of food, then engage in compensatory behaviors, like using diuretics or laxatives, vomiting or exercising excessively). Other studies suggested the opposite, or found no difference in levels of perfectionism among the subtypes of anorexics. The findings of Forbush's study help explain the discrepancy, given that both fasting and purging were associated with high levels of perfectionism.
The authors believe it is the first study to compare associations between perfectionism and specific eating behaviors, instead of associations between perfectionism and eating disorder diagnoses.
Because it focused on behaviors, it's useful for people trying to understand atypical forms of eating disorders, called "eating disorders not otherwise specified (EDNOS)," Forbush said. People suffering from EDNOS engage in a variety of eating-disorder behaviors but don't fit the criteria for a specific disorder.
Understanding atypical forms of eating disorders is important, researchers said, because most people who suffer from an eating disorder suffer from an atypical form, rather than anorexia or bulimia. Forbush cites recent statistics from the United Kingdom, which suggest that in outpatient treatment settings for eating disorders, EDNOS cases account for an average of 60 percent of all cases, while anorexia accounts for 14.5 percent and bulimia for 25.5 percent.
Future research could extend this work by examining prospective associations between perfectionism and the later development of specific eating disorder symptoms, said Keel, Forbush's faculty advisor for the research.
The research was funded by a portion of a grant Keel received from the National Institute of Mental Health to fund the 20-year longitudinal study.
STORY SOURCE: University of Iowa News Services, 300 Plaza Centre One, Suite 371, Iowa City, Iowa 52242-2500
CONTACTS: Program: Kelsie Forbush, 319-335-2416, email@example.com, or Pamela Keel, 319-335-2444, firstname.lastname@example.org; Media: Joe Nugent, email@example.com, 319-384-0070; Writer: Nicole Riehl