نوسانات روزانه در ابعاد کمال گرایی و ارتباط آنها با علائم اختلال تغذیه ای

Multidimensional perfectionism has been shown to play an important role in eating disorders (EDs). However, research examining this relation has primarily focused on relatively stable inter-individual differences between persons, thereby failing to examine how these variables are associated within individuals on a daily basis. This study examines how daily fluctuations in Personal Standards (PS) perfectionism and Evaluative Concerns (EC) perfectionism relate to each other and to fluctuations in ED symptoms. Adolescents (N = 275) completed questionnaires each evening during seven consecutive days. Multilevel modeling showed significant day-to-day fluctuations in PS and EC perfectionism, and showed that both dimensions are intertwined in the day. Among females, fluctuations in EC perfectionism co-varied with fluctuations in ED symptoms.

“On some days, when I wake up I tell myself that I must get the best out of that day and I make a to-do list of tasks that should be completed by the end of the day at work. On these days, I start with a lot of positive energy and motivation, but as the day unfolds I realize that my standards were too high. As a result, by the end of the day I often criticize myself for not living up to my expectations. To cope with my negative thoughts, I tend to eat foods that are high in sugar and fat.” In this stereotypical response of an eating disorder patient, it is illustrated how perfectionism can have an impact on a person’s functioning in the course of 1 day. Research increasingly shows that perfectionism indeed has important repercussions for individuals’ behavior mental health (Stoeber & Otto). However, the majority of studies on perfectionism addressed the question whether individuals with high, relative to low, levels of trait perfectionism differ from each other on a variety of outcomes (e.g., Stoeber & Otto, 2006). In contrast to such an approach, and as illustrated in the anecdotal example, in this study we examined the possibility that perfectionism does not only differ between individuals, but also differs within individuals on a day-to-day basis, with resulting implications for individuals’ day-to-day proneness for eating disorder symptoms. To accomplish this goal, both trait and state measures of perfectionism were assessed in a diary study. In doing so, we adopted a multidimensional approach to perfectionism, in which Personal Standards (PS) perfectionism (i.e. the setting and pursuit of high standards) is discerned from Evaluative Concerns (EC) perfectionism (i.e. the tendency to engage in critical self-evaluations when high standards are not met) (Dunkley, Zuroff, & Blankstein, 2006). Previous diary studies on perfectionism typically examined the relation between trait PS and EC perfectionism and daily measures of maladjustment, stress, affect, coping, and bulimic symptoms (e.g. Dunkley et al., 2012, Dunkley et al., 2003, Dunkley et al., 2006, Sherry and Hall, 2009 and Stoeber and Janssens, 2011). Although these studies provide insight in the effect of dispositional perfectionism on daily functioning, these studies did not measure daily fluctuations in perfectionism itself. As a consequence, several issues related to perfectionism and its covariation with ED symptoms have remained unanswered. In this study, the following four questions were addressed in a sample of adolescents. First, we examined whether PS and EC perfectionism fluctuate from day to day; is there significant within-person fluctuation in both perfectionism dimensions? In other words, are there days where one sets high standards for oneself, while on other days one’s standards are lower? Second, we examined whether day-to-day fluctuations in PS perfectionism would be related to fluctuations in EC perfectionism to address the dynamic interplay between both perfectionism dimensions on a daily basis. Is it the case that, on days when one sets high standards for oneself, one also tends to evaluate oneself more critically, much like both types of perfectionism have been found to be positively associated at the between-person level? Third, we examined whether daily fluctuations in PS and EC perfectionism relate to daily fluctuations in ED symptoms. Specifically, we address the question whether only daily EC perfectionism is related to daily ED symptoms or whether both the setting of high standards and a self-critical attitude in the day have an independent relation to ED symptoms? Fourth, we examined whether trait perfectionism would moderate the day-level relations. It might be the case, for instance, that daily covariations between perfectionism and ED symptoms would be more pronounced for those high on trait perfectionism. 1.1. Perfectionism as a multidimensional personality construct The conceptualization of perfectionism has evolved from a unidimensional perspective (Hollender, 1965) to a more differentiated, multidimensional perspective (Hamachek, 1978). According to the multidimensional approach, perfectionism has both maladaptive and relatively more adaptive features (Bieling et al., 2004, Frost et al., 1993 and Frost et al., 1990). Herein, we refer to these dimensions as “Personals Standards (PS) perfectionism” and “Evaluative Concerns (EC) perfectionism”. PS perfectionism includes the setting of high standards for oneself and the striving to attain perfection. It has been shown to be largely unrelated to maladjustment or even positively related to psychological well-being (e.g., Bieling et al., 2004 and Stoeber and Otto, 2006). EC perfectionism refers to a self-critical orientation including doubts about one’s competencies and negative self-evaluations. EC perfectionism has been found to yield a strong and consistent relation with a variety of indicators of ill-being, including anxiety, depression, negative affect, and eating disorder symptoms (Stoeber & Otto, 2006). Within the current perfectionism literature, perfectionism is typically conceived of as a relatively stable personality feature characterized by rather substantial and enduring inter-individual differences (Cox and Enns, 2003 and Rice and Aldea, 2006). Consistent with this assumption, longitudinal studies have shown that both perfectionism dimensions are characterized by rather high rank-order stability coefficients (Cox and Enns, 2003 and Hewitt and Flett, 1991). Still, it has been argued and found that perfectionism is susceptible to change, open to contextual influences, and shaped to some extent by interpersonal experiences (Blatt, 1995, Flett et al., 2002 and Hamachek, 1978). For instance, developmental research showed that conditional, intrusive and pressuring forms of parenting were predictive of changes in perfectionism (Soenens, Luyckx, et al., 2008). On the basis of such and other findings, perfectionism has been conceptualized as a cognitive–affective structure, that is, a mental representation established through interpersonal interactions in childhood and adolescence that dynamically interacts with life events throughout the lifespan (Zuroff, Mongrain, & Santor, 2004). This conceptualization implies that perfectionism is, to some extent, a latent personality feature that can be triggered by situational cues, suggesting that perfectionism has the potential to change in the short run. Two types of indirect evidence support this claim. First, intervention studies showed that guided self-help for perfectionism or cognitive behavioral therapy addressing perfectionism significantly decreased perfectionism levels in non-clinical individuals (Pleva & Wade, 2007), depressive patients (Egan & Hine, 2008), eating disorder patients (Glover et al., 2007 and Steele and Wade, 2008), and individuals with clinical levels of perfectionism (Riley, Lee, Cooper, Fairburn, & Shafran, 2007). Second, experimental studies have shown that perfectionism can be experimentally induced in healthy adults in the course of one day (Boone et al., 2012 and Shafran et al., 2006). Although these studies provide some evidence for the claim that perfectionism can be triggered on the short-term or even at the day-level, it remains unclear whether there are indeed naturally occurring fluctuations in perfectionism from day to day. Using a diary study, a first aim of this study was therefore to investigate the degree to which perfectionism is susceptible to daily fluctuations. Formulated more technically, we addressed the question whether, in addition to between-person variability, there also exists significant within-person variability in perfectionism. 1.2. Perfectionism and eating disorder symptoms Clinical and empirical accounts suggest strong and consistent associations between perfectionism and eating disorders (Shafran, Cooper, & Fairburn, 2002). For instance, in a clinical account of eating disorder patients Vitousek and Manke (1994) described female patients with anorexia nervosa as “perfectionistic, compliant, and isolated girls” (p. 139). Empirical research has shown that patients with anorexia nervosa (Bastiani, Rao, Weltzin, & Kaye, 1995) and bulimia nervosa (Lilenfeld et al., 2000) display elevated levels of both PS and EC perfectionism compared to healthy controls and other psychiatric groups. Further, perfectionism has been shown to relate to eating disorder symptoms in non-clinical samples (see e.g., Bardone-Cone et al., 2007 for an overview). The finding that PS perfectionism is, much like EC perfectionism, elevated among individuals with an ED diagnosis is rather surprising because PS perfectionism has been portrayed as a rather adaptive dimension of perfectionism (Stoeber & Otto, 2006). However, in studies in which the shared variance between both perfectionism components was taken into account, only EC perfectionism was found to be significantly related to ED symptoms (Bulik et al., 2003 and Soenens et al., 2008). Together then, previous work suggests that trait EC perfectionism has a consistent positive association with eating disorder pathology, whereas the associations of trait PS perfectionism are less consistent. Herein, we argue that a diary approach may shed new light on the question whether PS perfectionism is a relatively adaptive feature or whether, instead, it represents a risk factor for ED symptoms, much like EC perfectionism. First, a diary approach allows one to investigate whether PS and EC perfectionism are related to each other on a day-to-day basis. Research using trait measures of perfectionism found both dimensions of perfectionism to be highly correlated (e.g., Bardone-Cone, 2007, Boone et al., 2010 and DiBartolo et al., 2008). Extending this body of work, we investigated whether PS and EC perfectionism are associated within the day. If this turns out to be the case, this finding would suggest that the dynamics of both perfectionism dimensions are strongly intertwined, not only at the between-person level, but also at the within-person level. Specifically, on days one sets high standards for oneself, one may also experience anxiety to not achieve one’s high standards and be critical of one’s failure to do so. Second, our diary approach allows for an examination of the covariation between daily variation in both perfectionism dimensions and daily variation in ED symptoms, an issue that has, to the best of our knowledge, not been addressed yet within the perfectionism literature. A number of studies examined the relation between trait perfectionism and daily measures of binge eating (Rudiger et al., 2007 and Sherry and Hall, 2009). For instance, Sherry and Hall (2009) found that socially prescribed perfectionism (which is considered an indicator of EC perfectionism; Frost et al., 1993) related to daily measures of binge eating. One important drawback of this study is that perfectionism was only measured as a trait variable, so that the authors could not examine whether daily fluctuations in perfectionism covary with daily fluctuations in binge eating symptoms. Moreover, moderating effects of trait perfectionism on daily covariation between daily perfectionism and daily ED symptoms could not been examined. It might be the case that daily fluctuations in perfectionism only relate to daily fluctuations in ED symptoms among people high on trait levels of perfectionism. This would be because a certain threshold of perfectionism needs to be surpassed for daily perfectionism to relate to daily ED symptoms. Because individuals low in perfectionism would not reach such a critical threshold, their daily perfectionism would be unrelated to their daily ED symptoms. In contrast, if there would be no moderation by trait levels of perfectionism, this would mean that associations between daily variation in perfectionism and ED symptoms are equally strong in people high and low on trait perfectionism. More generally, a lack of moderation by trait perfectionism would suggest that processes operating at the level of inter-individual (i.e., trait) differences are somewhat disconnected from processes operating at the level of intra-individual (i.e., daily) fluctuation. This would raise the question whether different, but not necessarily fully independent, underlying mediating mechanisms are operative at the daily level compared to the trait level (e.g., thin-ideal internalization; Boone, Soenens, & Braet, 2011). Mediating processes that accumulate across longer time frames, such as the internalization of the thin ideal, may play a relatively more pronounced role at the inter-individual level compared to mediating processes that are relatively more dynamic and fluctuating in shorter time intervals. It has indeed been argued that inadequate coping with negative affect and compensatory attempts to obtain a sense of control may represent mediators that operate at the daily level (Boone et al., 2012). Although maladaptive coping can to some extent also be conceptualized as an individual-difference (i.e., trait) characteristic, research shows that maladaptive coping varies substantially from day to day and accounts for daily fluctuations in well-being and adjustment (Stoeber & Janssens, 2011). Interestingly, there are good reasons to assume that daily fluctuations in maladaptive coping may account for associations between daily fluctuations in perfectionism and psychopathology (Boone et al., 2012 and Luyten et al., 2011). 1.3. Gender differences We examined our research questions in an adolescent sample of males and females, thus allowing us to examine mean-level gender differences as well as to examine whether daily covariations between perfectionism and ED symptoms would be similar among girls and boys. It has been shown that girls experience higher levels of ED symptoms compared to boys (e.g., Hautala et al., 2008), a finding that we aimed to replicate in the current diary study. More importantly, we examined the possible moderating role of gender. Possibly, perfectionism might translate more easily into an unhealthy preoccupation with the body and with eating habits among girls than among boys because, among girls, being thin is seen more strongly as a way to achieve perfection. Among boys, other domains such as sport and school might be relatively more important in their attempt to be perfect. Research indeed shows that girls tend to attach more importance to the thin ideal compared to boys (Jones, Vigfusdottir, & Lee, 2004). However, research also suggests that males are increasingly susceptible to internalization of ideal body images and to internalization of a muscular body image in particular (Ricciardelli & McCabe, 2004). Moreover, perfectionism has been identified as an important predictor for boys’ dieting and muscle preoccupation (Saling, Ricciardelli, & McCabe, 2005), suggesting that perfectionism might also be involved in ED symptoms among boys. In this study we focused on adolescence, because it is considered a dynamic life period for the development of perfectionism, as adolescents are increasingly confronted with expectations for social and academic achievement (Flett et al., 2002). Additionally, adolescents represent a risk group for the development of ED symptoms because of the normative challenges (e.g., physical changes associated with puberty and increased desire for peer acceptance) associated with this age period (Attie and Brooksgunn, 1989 and Levine et al., 1994). 1.4. The present study The general purpose of this study was to investigate the dynamic interplay between perfectionism and ED symptoms in adolescents on a day-to-day basis. Trait levels of perfectionism were assessed before participation in the diary study. Then, during seven consecutive days adolescents reported in the evening their daily experiences of perfectionism and ED-related symptoms, including dietary restraint, binge eating, and body dissatisfaction. This study design allowed us to address the following four research questions. First, we examined whether there exists significant variation in PS and EC at the within-person level. Second, we investigated whether PS and EC perfectionism relate to each other within the day. Consistent with previous studies at the between-person-level, we expected PS and EC perfectionism to be related in the day and, hence, in the person. Third, we investigated whether daily variation in PS and EC perfectionism would relate to daily fluctuations in dietary restraint, binge eating, and body dissatisfaction. We hypothesized that EC perfectionism in particular would be positively associated with ED outcomes. Subsequently, we examined mean-level gender differences in ED symptoms, and we examined the possibility that the relation between daily perfectionism and ED symptoms would be moderated by gender. Fourth, we aimed to examine whether trait perfectionism would moderate the covariation among daily PS and daily EC perfectionism. It seems possible that the within-person covariation between both perfectionism dimensions is more pronounced among individuals scoring high on trait levels perfectionism. In contrast, among individuals scoring relatively low on perfectionism, the setting of high standards in the day might be more disconnected from the engagement in self-critical evaluations. Given the lack of previous research on this issue, we explored this moderating effect in a more explorative fashion. Further, we also examined whether trait perfectionism might moderate the covariation between daily perfectionism and ED symptoms. It might be the case that covariations between daily perfectionism and daily ED symptoms are more pronounced among those high on trait perfectionism. This is because their perfectionism is a more salient and dynamic feature of their personality functioning, such that they would more easily attain a threshold for daily perfectionism that translates into dysfunctional eating patterns.

Although perfectionism is often conceived of as a trait characteristic that varies from the one person to the other, the present study suggests that there exists substantial variation in people’s perfectonistic functioning from the one day to the next. Moreover, similar to the work at the trait-level, daily PS and EC perfectionism are highly intertwined, indicating that it is fairly difficult to not be self-critical of oneself on days one sets relatively higher standards for oneself. Finally, the daily ups and downs in females’ EC perfectionism were found to covary with their daily ups and down in ED symptoms, irrespective of whether they scored high or low on trait perfectionism. The present research suggests that perfectionism may represent a more dynamic cognitive–affective structure than thought before and future research may examine the factors that contribute to this daily oscillation in one’s perfectionistic tendencies.