Perfectionism and Se PDF

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VOHS ET AL.Interactive model of bulimic symptomatology

PERFECTIONISM, BODY DISSATISFACTION,AND SELF-ESTEEM: AN INTERACTIVE MODEL OFBULIMIC SYMPTOM DEVELOPMENT

KATHLEEN D. VOHSCase Western Reserve University

ZACHARY R. VOELZ AND JEREMY W. PETTITFlorida State University

ANNA M. BARDONEUniversity of Wisconsin-Madison

JENNIFER KATZWashington State University

LYN Y. ABRAMSONUniversity of Wisconsin-Madison

TODD F. HEATHERTONDartmouth College

THOMAS E. JOINER, JR.Florida State University

The hypothesis that perfectionism, body dissatisfaction, and self-esteeminteract topredict bulimic symptom development was tested. This study replicates and ex-tends previous findings (Vohs, Bardone, Joiner, Abramson, & Heatherton, 1999)demonstrating that the joint operation of perfectionism, perceived overweight sta-tus, and low self-esteem accounts, at least in part, for bulimic symptom develop-ment. Within the context of a longitudinal design, the current study, which useddifferent measurement approaches and operationalizations than Vohs and col-

leagues,providedstrongsupport forthe models ability topredict bulimic symptom

476

Journal of Social and Clinical Psychology, Vol. 20, No. 4, 2001, pp. 476-497

This research wassupportedin part by a grant to Todd F. Heatherton from theRockefellerCenter for the Social Sciences at Dartmouth College; a National Institute of Mental HealthGrant MH 43866 to Lyn Y. Abramson; a National Institute of Mental Health GrantR0356912 to Thomas E. Joiner, Jr.; anda National Science FoundationFellowship to AnnaM. Bardone.

Address correspondence to Kathleen Vohs, Department of Psychology, Case WesternReserve University, 11220 Bellflower Rd., Cleveland, OH 44106-7123; E-mail:[email protected].


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development. Moreover, we tested whether the model displayed symptom speci-ficity to bulimic symptoms, as opposed to anxiety and depressive symptoms. Al-though we found support for the models specificity with regard to anxiety

symptoms,development of depressive symptoms wasalso predictedby themodel.Ourfindings refine therole of socialpsychological variables, such as perfectionismand self-esteem, in predicting bulimic symptoms and concomitant conditions.

Theorists, researchers, and practitioners have long believed that perfec-tionism is an integral component of eating disorders. Perfectionism, thedesire to attain idealistic goals without failing (Brouwers & Wiggum,1993; Slade, Newton, Butler, & Murphy, 1991), seems to drive disorderedeatingbehaviors. Accordingly,many theories posit a link between perfec-

tionismand eatingdisorders (Bastiani, Rao, Weltzin, & Kaye, 1995; Bruch,1973; Davis, 1997; Hewitt, Flett, & Ediger, 1995). Despite such theories,previous attempts to empirically validate the relationship between per-fectionism and eating disorders have been equivocal (Fryer, Waller, &Kroese, 1997; Minarik & Ahrens, 1996; Pliner & Haddock, 1996).

Recently, Joiner, Heatherton, Rudd, and Schmidt (1997) and Vohs,Bardone, Joiner, Abramson, and Heatherton (1999) proposed and vali-dated a model of bulimic symptom development that conceptualizesperfectionism as the predisposing factor in a vulnerability-stress inter-action. Joiner et al. (1997) and Vohs et al. (1999) found that high levels ofperfectionism predict development of bulimic symptoms only whencombined with perceptions of being overweight. Vohs et al. (1999) re-fined the vulnerability-stressargument by delineating the roleof self-es-

teem as a moderator, showing that lowself-esteemwomenaremost sus-ceptible to the perfectionism perceived overweight interaction. Thecurrent paper extends the perfectionism perceived weight status self-esteem model by using different measurement approaches on asample of participants that differed substantially from those in Vohs etal. (1999). Additionally, the models symptom specificity is tested usingstandard measures of anxiety and depression. Convergent results withthe findings of Vohs et al. (1999) would lend credence to the model,which could then be considered a robust predictor of bulimic symptomdevelopment.

PREVIOUS RESEARCH ON THE INTERRELATIONSHIP OF

PERFECTIONISM AND BULIMIC SYMPTOMS

Eating disorders, which are characterized by a rigid desire to attain im-possible standards of thinness,embody the nature of perfectionism.Pre-

INTERACTIVE MODEL OF BULIMIC SYMPTOMATOLOGY 477


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vious research has not delineated the exact role of perfectionism ineating disorders, especially as it relates to bulimic symptoms. Althoughsome investigations have reported a correlation between perfectionismand bulimic symptoms (Joiner et al., 1997; Rosch, Crowther, & Graham,1991; Steiger, Leung, Puentes-Neuman, & Gottheil, 1992), others havefailed to find a significant relationship (Blouin, Bushnik, Braaten, &Blouin, 1989; Frye et al., 1997; Hurley, Palmer, & Stretch, 1990).

One possible explanation for the inconsistent relationship betweenperfectionism and bulimic symptoms is that perfectionism is a multifac-etedconstruct(Frost, Marten, Lahart, & Rosenblate,1990;Hewitt& Flett,1991). Nevertheless, research using multidimensional models has alsofailed toclarify theexactnature of theperfectionism-bulimia link. Forin-stance, Minarik andAhrens (1996)foundthat twosubscales of theMulti-

dimensional Perfectionism Scale (MPS; Frost et al., 1990), Concern OverMistakes and Doubts About Actions, were significantly associated withmeasuresof disorderedeating patterns in nonclinical women. However,Minarik andAhrensdidnotfind an association between disordered eat-ing measures and other dimensions of perfectionism, such as PersonalStandards. Pliner and Haddock (1996) used an experimental setting toexamine goal-setting behaviors in relation to self-oriented and sociallyprescribed perfectionism. Although Pliner and Haddock found thatwomen with high scores on the Eating Attitudes Test (EAT; Garner,Olmstead, Bohr, & Garfinkel, 1982) exhibited more socially-prescribedperfectionism than women with low scores on the EAT, the two groupsdid not differ in self-oriented perfectionism. Additionally, research em-

phasizing positive (or adaptive) versus negative (or maladaptive) as-pects of perfectionism has failed to yield clear findings. For instance,Terry-Short, Owens, Slade,andDewey (1995) found that relative to con-trols, eating-disordered patients reported higher levels of both positiveand negative forms of perfectionism.

In summary, previousresearch,whichwas generallyconductedusingcorrelational and atheoretical designs, had yieldedinconsistent findingsregarding the relationship between perfectionism and disordered eat-ing. Despite its seemingly obvious connection, the role of perfectionismin predicting bulimic symptoms had been elusive.

PERFECTIONISM, PERCEIVED WEIGHT STATUS, ANDSELF-ESTEEM PREDICT BULIMIC SYMPTOMS

Joiner et al. (1997) reconceptualized perfectionismas a predisposingfac-torin a vulnerability-stress modelofbulimic symptoms.In theirstudy of

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undergraduate women, Joiner et al. predicted and found that womenwithperfectionistic tendenciesexhibitedbulimic symptoms onlyin con-

junctionwith a self-perception of being overweight.Furthermore, Joineret al. tested whether perceived weight status (a dichotomous variablecreated from participants self-categorization of body weight) or actualweight status producedbulimicsymptomswhencombinedwithperfec-tionism. Their results demonstrate that only the perceivedweightstatus

perfectionism interaction predicts bulimic symptom development.Vohs et al. (1999) proposed that a moderating factor must exist to distin-

guish perfectionisticwomen who counter feeling overweightwith goal-di-rected (i.e., weight-loss) behaviors from those who engage in counterpro-ductive behaviors, such as binge eating. They posited that self-esteemmoderates the two-way interaction of perfectionism perceived weightstatus. Because self-esteem encompasses both cognitive expectations ofsuccessaswell aspositive feelingsabouttheself(Heatherton & Vohs,2000),Vohs etal.predictedthatself-esteem modifies responses toself-perceptionsof being overweight. They hypothesized that perfectionistic high self-es-teem women would engage in goal-directed behaviors, whereasperfectionistic lowself-esteemwomenwouldengageincounterproductive

behaviors. Using a longitudinal design over an average of nine months,theyfound thattheperfectionismperceived weightinteraction predictedincreased bulimic symptoms among low self-esteem women, but notamong high self-esteem women; even when high self-esteem women dis-played the same vulnerability-stress conditions of perfectionism and per-ceivedoverweightas lowself-esteemwomen, theydid notshowsimilarin-

creasesinbulimic symptoms. Moreover,thepredictabilityof thethree-wayinteraction of perfectionism perceived weight status self-esteem onTime 2 bulimic symptoms was independent of Body Mass Index (BMI)scores and Time 1 bulimic symptoms.

THE CURRENT STUDY

Despite empiricalsupport fortheinteractive model of bulimic symptomdevelopment (Joiner et al., 1997; Vohs et al., 1999), some questions re-main. Forinstance, although Vohs etal.(1999) proposeda general modelof bulimic symptom development, the robustness of their longitudinalmodel has not been assessed using a variety of measurement ap-proaches, distinct samples, or across different time frames. To test the

strength of the model, the current study differs from Vohs et al. in themajority of these parameters.

The present study improves upon the Vohs et al. (1999) study in foursignificantways. First,the samples selectedforeachstudydiffer: Vohs et



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al. tested the interactive model on a sample of women attending a selec-tive Northeastern college (see Vohs, Heatherton, & Herrin, 2001),whereas the current study tests the interactive model on a sample ofwomen from a Southern state university. Testing the model on a differ-entsample of participantsprovides information on themodels general-izability. Second, the current study uses a different time periodbetweenassessments to examine the models ability to detect change over ashorter period of time. Vohs et al. examined change in bulimic symp-toms from participants senior year of high school to first year of college(high school and college assessments were separated by an average ofnine months), whereas the current study assesses changes in bulimicsymptoms over five weeks. Testing themodels ability to predict changeover only five weeks is a strong test of the models sensitivity. Third, the

present study varies measurement approaches and operationalizationof predictor variables. Whereas Vohs et al. measured self-esteem usingthe State Self-Esteem Scale (SSES; Heatherton & Polivy, 1991), the cur-rent study uses theRosenberg Self-Esteem Scale (RES; Rosenberg, 1965).Moreover, previous research using the interactive model hasoperationalized the stressor variable as perceived weight status (i.e.,overweight vs. not overweight; Joiner et al., 1997; Vohs et al., 1999),whereas the present study operationalizes the stressor variable as bodydissatisfaction. The use of different constructs and operationalizationstest the models construct validity, thereby allowing for a better under-standing of the core aspects of the model.

Fourth, the current study tests the models symptom specificity, an is-

sue not addressed in the studies by Joiner et al. (1997) and Vohs et al.(1999). It is possible that perfectionism, bodydissatisfaction,and self-es-teem combine to predict psychological disorders in addition to bulimia.In particular, many studies have implicated mood disturbances, such asdepression and anxiety, in the development of bulimic symptoms (for adiscussion of bulimia as a mood disorder; see Benkert, Wetzel, &Szegedi, 1993; seealso Frost et al., 1990; Minarik & Ahrens, 1996; Steiger,Leung, Puentes-Neuman, & Gottheil, 1992). Similarly,previousresearchhas related perfectionism to the development of depression and anxietysymptoms (Hewitt & Flett, 1991). Therefore, the current study uses thethree-way interaction of perfectionism body dissatisfaction self-es-teem to predict changein anxiety anddepressive symptoms as a methodof assessingthe models symptomspecificity.Without tests of symptom

specificity, it is unclear whether the model is specific to bulimic symp-tomsorisamoregeneralmodelthatcanpredictavarietyofsymptoms.

In summary, thecurrent study seeks to provide further empiricalvali-dation of the interrelationships among perfectionism, body dissatisfac-tion, self-esteem, and bulimic symptoms and does so by varying the

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methods used to test the model. The current study also allows for an ex-amination of the models symptom specificity, an important consider-ation. The present study advances our knowledge of the models abili-ties and allows for a test of its robustness.

METHOD

PARTICIPANTS

Participants were 70 women from an Introductory Psychology class at aSouthernstateuniversity.The majority of participants weresingle (98%)and between 18 and 20 years of age (89%). Ethnic breakdown was as fol-

lows: Caucasian (72%); Asian American (11%); Hispanic (11%); AfricanAmerican (5%); 1% were classified as Other. Participants were givenclass credit in return for their participation under conditions of full in-formed consent.

PROCEDURE

At initial assessment (Time 1), participants were informed that theywould be filling outquestionnaires about their personal feelings and at-titudes andwere asked to returnin five weeks fora secondsession (Time2). At both Time 1 and Time 2 assessments, participants completed the

same packetof materials, which consistedof theBeck Depression Inven-tory (BDI; Beck, Rush, Shaw, & Emery, 1979), the Beck Anxiety Inven-tory (BAI; Beck & Steer, 1993), and the Eating Disorders Inventory (EDI;Garner, Olmstead, & Polivy, 1983). The EDI consists of 64 items thatform eight subscales: Bulimia, Drive for Thinness, Body Dissatisfaction,Perfectionism, Interpersonal Distrust, Maturity Fears, InteroceptiveAwareness, and Ineffectiveness. All subscales were scored continu-ously,usingtheentireresponsescaleratherthan setting thethree lowestvaluesto 0. The current study focused on the subscalesof Perfectionism,Body Dissatisfaction, and Bulimia.

PREDICTOR VARIABLES

We measured perfectionism using the EDI-Perfectionism subscale,which is comprised of six items to which participants respond using a6-pointscale (1= never;6 = always).Theperfectionism subscale includes



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questions such as, I hate being less than best at things. Higher scoresindicate higher perfectionism.

The EDI-Perfectionism subscale has been established as a reliable andvalid measure. internal consistency coefficient in the current study was.86, similar to that reported in Vohs et al. (1999). Additionally, Joiner andSchmidt (1995) found that this subscale yields adequate test-retest reli-ability (.64 and .68, repectively). Last, the EDI-Perfectionism subscale re-lates to other constructs (e.g., depression) in a manner consistent withstudies using other perfectionism measures (Joiner & Schmidt, 1995).

To broaden the theoretical underpinnings of the model, we used theBody Dissatisfaction subscale of the EDI as the stressor variable hy-pothesized to activate perfectionistic tendencies. Body dissatisfactionreplaces perceived weight status, which was the operationalization of

thestressor variable in Joiner et al.(1997) andVohs et al. (1999). Vohset al. found that perceived weight status (overweight vs. not over-weight, a dichotomous variablederived fromparticipantsself-catego-rization of weight) was highly negatively correlated with body satis-faction, r(339) = -.61. The EDI-Body Dissatisfaction subscale asksparticipants to respond to nine items that assess satisfaction with sizeand shape of specific parts of the body, such as I think my hips are too

big, using a scale ranging from 1 to 6, where 1 = always and 6 = never.Coefficient in this sample was .75. Lowerscores indicate greater bodydissatisfaction.

Self-esteem was measured using the RSE (Rosenberg, 1965). The RSEis a reliable, valid, and commonly used 10-item scale (Blascovich &

Tomaka, 1991). Participants are asked to respond using a four-pointscale (1 = strongly disagree; 4 = strongly agree) to questions such as Onthe whole, I am satisfied with myself. Coefficient in this sample was.83, similar to that reported by Blascovich and Tomaka (1991). HigherRSE scores indicate higher self-esteem.

DEPENDENT MEASURES

To assess the robustness of the interactive model, we used theEDI-Bulimia subscale as our measure of bulimic symptoms. Using ascale ranging from 1 to 6 (where 1 = never and 6 = always), participantsrated their agreement with seven statements designed to assess

bingeing (e.g., I eat moderately in front of others and stuff myself whentheyare gone,) and purging (e.g., I have the thought of trying to vomit

in order to lose weight.). Coefficient was .77. Higher scores indicatemore severe bulimic symptoms.

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To assess the symptom specificity component, we testedthe model onstandard measures of depression and anxiety symptoms. Depressivesymptoms were assessed using the BDI (Beck et al., 1979), a 21-itemself-report inventory comprised of items that are rated on a 0 to 3 scale.Although the BDI is not indicative of the full clinical syndrome of de-pression, it is a reliable and well-validated measure of depressivesymptomatology (for a review see Beck, Steer, & Garbin, 1988). Coeffi-cientwas.84. Higherscoresindicate higherlevelsof depressive symp-toms.

To assessanxiety symptoms, we used theBeck Anxiety InventoryBAI(Beck & Steer, 1993). The BAI is a 21-item self-report inventory that as-sessesgeneralsymptomsofanxiety.Individualitemsareratedona0to3scale. In a variety of clinical and nonclinical populations, the BAIs reli-

ability, convergence with other anxiety measures, and discriminant va-lidity with respect to depression measures have been supported (Beck,Epstein, Brown,& Steer, 1988; Beck & Steer, 1993; Clark & Watson, 1991;Steer, Rissmiller, Ranieri, & Beck, 1993). Coefficient was .90. Higherscores indicate higher levels of anxiety symptoms.

RESULTS

DESCRIPTIVE ANALYSES

Means and standard deviations for Time 1 measures of perfectionism,

body dissatisfaction, and self-esteem, as well as assessments of bulimic,depressive, and anxiety symptoms at Times 1 and 2 are presented in Ta-ble 1. Zero-order correlations between all measures are also given in Ta-ble 1. As can be seen, EDI-Bulimia scores at Time 2 were weaklycorrelated with EDI-Perfectionism scores at Time 1, r(68) = -.14,p = ns,and EDI-Body Dissatisfaction scores at Time 1, r(68) = .08,p =ns.Time2EDI-Bulimia scores were modestly related to RSE scores at Time 1, r(68)= -.39,p = .001 (similar to that reported in Vohs et al., 1999), in that lowerself-esteem was related to higher bulimic symptoms. In examining thecorrelations among predictor variables, we found a moderate correla-tionbetweenscores ontheEDI-Perfectionism andEDI-BodyDissatisfac-tion subscales, r(68) = .37,p = .001, such that higher perfectionism wasrelated to less body dissatisfaction. We found lower correlations be-

tween EDI-Perfectionism and RSE scores, r(68) = .28, p


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weak correlation between EDI-Bulimia and BDI scores at both assess-ments, r(68)=.10atTime1and r(68)=.16atTime2,bothps = ns, whereaswe found a moderate correlation between EDI-Bulimia and BAI scores,

r(68) = .43 atTime1 and r(68) = .35 at Time 2, bothps.23are significantat the.05 level; correlations> .30aresignificantatthe.01

level; correlations > .37 are significant at the .001 level.


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Prediction of Bulimic Symptoms by the Interaction of Perfectionism,Body Dissatisfaction, and Self-Esteem. Following the procedures used

by Joiner et al. (1997) and Vohs et al. (1999), as well as those recom-mendedbyCohenandCohen(1983), weconducteda hierarchicalmulti-ple regression/correlation procedure on Time 2 EDI-Bulimia scores totest our predictions. Where appropriate, skewed variables were squareroot transformed (i.e., Time 1 EDI-Perfectionism, Time 1 and Time 2EDI-Bulimia; forsimilar operations seeJoineret al., 1997 and Vohs et al.,1999), followingprocedures suggestedby Cohenand Cohen(1983). Thetwo- and three-way interaction terms were calculated by multiplyingTime 1 scores on a given measure with Time 1 scores on a second mea-sure (or the multiplication of scores on three Time 1 measures, as in thecase of thethree-wayinteraction of Time 1 scoresof perfectionism, body

dissatisfaction, and self-esteem)to yield onevariable that represents thecombination of two or more variables.

Our primary regression analysis centered on Time 2 EDI-Bulimiascoresas predictedby Time 1 assessments of perfectionism, body dissat-isfaction, and self-esteem while controlling for Time 1 EDI-Bulimiascores, as wellas Time 1 and Time 2 BDI and BAI scores. This method ofanalysis assesses the predictability of perfectionism, body dissatisfac-tion, and self-esteem on bulimic symptom development independentofdepression and anxiety symptoms.

For the first step, Time 1 EDI-Bulimia scores were entered into the re-gression equation with Time 2 EDI-Bulimia scores as the dependentmeasure.This step created a residualchangescoreof bulimic symptoms.

Next, we simultaneously entered Time 1 and Time 2 BDI and BAI scoresto statistically control for the effects of depression and anxiety symp-toms on EDI-Bulimia scores. At Step 3, we simultaneously entered Time1 EDI-Perfectionism, EDI-Body Dissatisfaction,and RSE scores to assessthe simple effects of the predictor variables. At the next step, Step 4, wesimultaneously entered Time 1 two-way interactions of EDI-Perfection-ism EDI-Body Dissatisfaction, EDI-Perfectionism RSE, andEDI-Body DissatisfactionRSE as a set. Lastly, inStep 5,we entered thethree-way interaction of EDI-Perfectionism EDI-Body Dissatisfaction RSE at Time 1. The three-way interaction is the critical test of our pre-diction thatperfectionism, bodydissatisfaction, and self-esteem interactto predict changes in bulimic symptoms independent of depression andanxiety symptoms. Table 2 displays the steps detailed above and the re-

sults.As seen in Table 2, theregressionanalysisrevealedsupport for ourhy-

pothesis that perfectionism, body dissatisfaction, and self-esteem inter-actto predict bulimic symptoms. Theonly significant predictors of Time2 EDI-Bulimia scores are Time 1 EDI-Bulimia scores, pr = .66,p


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486

Table2.Perfectionism,BodyDissatisfaction,Self-EsteemandTheirThree-WayInteraction

PredictingTime2EDI-BulimiaScores

Orderof

entryofset

Predictorsinset

Fforset

tforwithinset

predictors

df

Partial

correlation

ModelR2

(

R2)

1.

Time1EDI-Bulimia

51.63

7.19***

1,68

.66

.66

(.66)

2.

BDI,BAIcovariates

1.33

4,64

.31

.69

(.03)

Time1BDI

.38

.05

Time2BDI

-.09

-.01

Time1BAI

.32

.04

Time2BAI

1.16

.14

3.

Maineffects

.37

3,61

.15

.69

(.00)

EDI-Perfectionism

-.57

-.07

EDI-BD

.71

.09

RSE

-.62

-.08

4.

Two-wayinteractions

.37

3,58

.15

.70

(.01)

Perfectionism

EDI-BD

.79

.10

Perfectionism

RSE

-.48

-.05

EDI-BD

RSE

.28

.04

5.

Three-wayinteraction

4.38*

1,57

.27

.73

(.03)

Perfectionism

EDI-BD

RSE

2.09*

.27

Note.Perfectionism,bodydissatisfaction,andself-esteemrefertoT

ime1assessments.RSEstandsforRosenbergSelf-

EsteemScale(Rosenberg,1965);higherscoresrepr

esent

higherself-estee

mlevels.EDIstandsforEatingDisorderInventory

(Garner,Olmstead,&Polivy,1983).EDI-BDstand

sfortheBodyDissatisfactionsubscaleoftheEDI;lower

scoresindicateg

reaterbodydissatisfaction.PerfectionismrepresentsscoresontheEDI-Perfectionismscale;highersc

oresindicategreaterperfectionism.BDIstandsfor

Beck

DepressionInve

ntory(Becketal.,1979).BAIstandsforBeckAnxietyInventory(Beck&Steer,1993).

R2

=changeinR

2w

iththeadditionofeachstepintheregression.P

artial

correlation=PR

/pr,wherePR=multiplepartialcorrelationsfora

setofpredictorsandpr=partialcorrelationforw

ithinsetpredictors.*p

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Perfectionism and Se PDF