Dimensions of perfectionism in subtypes of anorexia nervosa, atypical anorexia nervosa, and bulimia nervosa

Abstract

Objective: Perfectionism is implicated in the development and maintenance of eating disorders (EDs), yet its dimensions across ED diagnoses and behavioral presentations remain underexplored.

Method: This study examined differences in Personal Standards and Concern Over Mistakes, two subscales of the Frost Multidimensional Perfectionism Scale, among individuals with anorexia nervosa (AN), atypical anorexia nervosa (AAN), and bulimia nervosa (BN) and between restricting and binge-eating/purging behavioral presentations. Participants included 546 individuals (Mage = 30.1, 97 % female) meeting DSM-5 criteria for AN, AAN, or BN, with behavioral presentations categorized as restricting (AN/AAN-restricting; n = 260) or binge-eating/purging (BN and AN/AAN-binge-eating/purging; n = 286).

Results: Personal Standards were higher in AN and AAN compared to BN (ds = 0.38-0.42), but no differences emerged between AN and AAN. Similarly, restricting presentations had higher Personal Standards scores than binge-eating/purging presentations (d = 0.32). However, Concern Over Mistakes did not differ across diagnoses or behavioral presentations.

Discussion: These results highlight the nuances of perfectionism in EDs, extending prior work by comparing AN, AAN, and BN and behavioral presentations. Higher Personal Standards in restrictive EDs may suggest a tendency toward rigid goal-setting and high self-imposed standards, which may contribute to dietary restraint and strict self-control. The lack of differences in Concern Over Mistakes suggests the transdiagnostic relevance of self-critical perfectionism across EDs. These findings underscore the importance of considering both shared and distinct perfectionism dimensions to understand ED psychopathology and individual differences. Future studies should investigate the utility of dimension-specific perfectionism interventions for EDs.

Keywords: Anorexia nervosa; Atypical anorexia nervosa; Binge-eating/purging subtype; Bulimia nervosa; Clinical perfectionism; Restricting subtype.