Subtypes of Adaptive and Maladaptive Perfectionism in Anorexia Nervosa: Associations with Eating Disorder and Affective Symptoms

Perfectionism is hypothesized to contribute to the etiology of anorexia nervosa (AN). However, there is little research regarding whether individuals with AN can be classified according to maladaptive (e.g., evaluative concerns) and adaptive (e.g., high personal standards) facets of perfectionism that predict distinct outcomes and might warrant different intervention approaches. In this study, a latent profile analysis was conducted using data from adults with AN (n?=?118). Frost Multidimensional Perfectionism Scale (Frost et al. Cognitive Therapy and Research, 14(5), 449–46, 1990) subscales were used to identify subgroups differing according to endorsed perfectionism features (e.g., adaptive and maladaptive perfectionism). Generalized linear models were used to compare subgroups on eating disorder and affective symptoms measured through questionnaire and ecological momentary assessment. Four subgroups were identified: (a) Low Perfectionism; (b) High Adaptive and Maladaptive Perfectionism; (c) Moderate Maladaptive Perfectionism; and (d) High Maladaptive Perfectionism. Subgroups differed on overall eating disorder symptoms (p?<?.001), purging (p?=?.005), restrictive eating (p?<?.001), and body checking (p?<?.001) frequency, depressive (p?<?.001) and anxiety (p?<?.001) symptoms, and negative (p?=?.001) and positive (p?<?.001) affect. The Low Perfectionism group displayed the most adaptive scores and the Moderate and High Maladaptive Perfectionism groups demonstrated the most elevated clinical symptoms. The High Adaptive and Maladaptive Perfectionism group demonstrated low affective disturbances, but elevated eating disorder symptoms. Results support the clinical significance of subtyping according to perfectionism dimensions in AN. Research is needed to determine if perfectionism subtyping can enhance individualized treatment targeting in AN.     

Intrafamilial Sexual Abuse: Family-of-Origin and Family-of-Procreation Characteristics of Female Adult Victims

We examined connections between incest victims' family-of-origin and family-of-procreation characteristics in a sample of 40 American women who were in treatment for childhood or adolescent experiences of victimization. Retrospective data on their families-of-origin were collected along with their perceptions of current relationships with family members in the three-generational system. Results showed a close association between family-of-origin and family-of-procreation characteristics, especially in the areas of intergenerational intimacy, intergenerational fusion/individuation, and personal authority. A number of significant correlations were also found between subjects' past and present relationships with family-of-origin members and the dimensions of moral and religious orientation, achievement, and intellectual and cultural orientation, conflict, and control in their family-of-procreation. Some aspects of individual adjustment, including alienation, emotional discomfort, and defensiveness, were strongly related to various family-of-origin and family-of-procreation characteristics.     

Ecological momentary assessment of bulimia nervosa: Does dietary restriction predict binge eating?

The purpose of this study was to examine the relationship between caloric restriction (CR) and binge eating (BE) using ecological momentary assessment (EMA). Participants included 133 women with bulimia nervosa (BN) who completed an EMA protocol for 2 weeks. Logistic regression analyses tested whether CR increased the probability of BE episodes. The results revealed that the odds of BE increased on the day that restriction occurred as well as on the following day. In addition, both restriction and BE on one day predicted the likelihood of BE the subsequent day, but restriction for two days prior to the episode failed to add additional information for predicting BE. These findings support the cognitive behavioral therapy (CBT) model of BN, suggesting that self-reported dietary restriction is predictive of subsequent BE episodes, and that reducing dietary restriction in treatment may lead to improvements in bulimic symptoms.     

Emotional states preceding and following acts of non-suicidal self-injury in bulimia nervosa patients

Bulimia nervosa and non-suicidal self-injury (NSSI) co-occur at high rates, and both have been conceptualized as maladaptive emotion regulation strategies. Treatments focusing on emotion regulation have been designed for both problem behaviors, yet, there exists very little research examining the temporal emotional states surrounding acts of NSSI. Using ecological momentary assessment (EMA) methodology, the current study examined the temporal association between positive and negative emotional states prior to and consequent to acts of NSSI within a subset of bulimia nervosa patients. Results indicate significant increases in negative affect, and decreases in positive affect, prior to an NSSI act. Post-NSSI, positive affect significantly increased while negative affect remained unchanged. The findings offer partial support for an emotion regulation paradigm to understanding NSSI within bulimic populations and implications for treatment are discussed.     

Withdrawal,matching, withdrawal-matching,and variable-matching strategies in reducing attack-instigated aggression

Several studies have investigated strategies that a participant in dyadic aggression may use to reduce the aggression of the other participant. In one set of these studies the subject is instigated to aggression by an opponent who sets maximum shocks for the subject to receive during the first block of six trials. Following attack-instigation, opponents shift to withdrawal and matching strategies for 18 trials. The withdrawal strategy is an abrupt shift to the lowest levels of shock possible. The matching strategy is the exact matching by an opponent of the shock set by the subject on the previous trial. With these procedures the withdrawal strategy has been the most effective method to reduce aggression. These results led to the suggestion that the effectiveness of the withdrawal strategy may be due to immediate, unambiguous communication by the opponent of his willingness to reduce attack. This hypothesis was tested in the present study by creating a matching condition modified to include immediate, unambiguous communication of willingness to reduce attack. In this withdrawal-matching condition the opponent followed attack with two trials of the lowest levels of shock before shifting to a matching strategy. Although the withdrawal-matching strategy did not lead to shock settings that were significantly lower than the matching strategy, there was evidence that subjects interacting with withdrawal-matching opponents did reduce their shock settings from block 1 to block 4 more rapidly than subjects interacting with matching opponents. A variable matching strategy was also used to provide a more realistic analogy of matching in the mundane world. While subjects with variable-matching opponents also did not set shock levels during blocks 2, 3, and 4 that were significantly lower than the matching strategy, there was evidence that subjects in this condition reduced their shock levels more rapidly than subjects with matching opponents. Although the effects were not as strong as expected, the results do provide some support for the interpretation that the effectiveness of the withdrawal strategy may be due to unambiguous communication of willingness by the opponent to reduce his or her aggression. The effectiveness of the variable-matching strategy was attributed to interrupting the tendency of the subject and his or her opponent to match each other's responses. Consistent with earlier attack-instigated aggression studies, the withdrawal strategy in the present study led to a rapid reduction in aggression.     

Perceptions of parental relationships in the eating disorders: the relevance of depressed mood

Recent studies have suggested that subtypes of eating-disordered persons differ in their perceptions of their family environments. This study used Benjamin's (1983) Structural Analysis of Social Behavior to examine how depressed mood influenced eating-disordered subjects' ratings of their parental relationships. The results indicated that when level of mood disturbance was statistically controlled, there were no significant differences in parent ratings among restricting anorexics, bulimic-anorexics, bulimics, and normal control subjects. The results are discussed in terms of the possible relations of mood, eating disorder, and perception of family relationships.     

Evidence-based mental health interventions for traumatized youth: a statewide dissemination project

Psychological trauma in childhood has been shown to increase a variety of psychological disturbances and psychiatric disorders. Although evidence-based treatments for children who have been traumatized exist, they are infrequently used by clinicians treating children. The present paper describes the creation of the Treatment Collaborative for Traumatized Youth (TCTY) which is a statewide partnership in North Dakota designed to disseminate efficacious treatments for traumatized children and monitor outcomes across a broad, rural, geographic expanse. The paper reviews the dissemination strategy developed by the TCTY, reports outcomes regarding both clinicians and child participants, and highlights problems identified in the project and solutions that were generated.     

Sexual trauma and personality: developmental vulnerability and additive effects.

Two types of sexual trauma, sexual abuse in childhood and rape in adulthood, were investigated in terms of possible effects on personality. Four groups of participants were studied: women who had experienced sexual abuse in childhood, women who had experienced rape as adults, women who had experienced both of these sexual traumas, and a control group of women who had experienced no sexual trauma. Personality functioning was assessed using the Dimensional Assessment of Personality Pathology. Groups who had experienced childhood sexual abuse displayed the highest degree of personality disturbance; however, the additive effects of repeated sexual trauma were limited. These findings may reflect the outcome of specific adversity in childhood on the psychobiological constructs underlying personality.