Perfectionism in anorexia nervosa: A 6–24 month follow-up study
Abstract
Objective This study examined the relationship between perfectionism and outcome in anorexia nervosa (AN). Method Seventy-three patients received inpatient treatment for AN. Participants completed the Eating Disorder Inventory (EDI) at admission to (n = 55), at discharge (n = 27), and at a median of 15.9 months (n = 49) after inpatient treatment. At follow-up, participants also completed the Multidimensional Perfectionism Scale (MPS) and their scores were compared with those of healthy controls. Results EDI Perfectionism was associated with illness status. A lower EDI Perfectionism score at admission was associated with a better response to treatment, which was subsequently associated with better outcome at follow-up. Both the good and poor outcome groups had significantly higher MPS total perfectionism scores than healthy controls. Discussion The EDI measures an aspect of perfectionism that is sensitive to illness status, whereas the MPS is less dependent on clinical state and may reflect a common personality trait that persists with remission of disease.
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In people with AN who are anxious, harm-avoidant, and perfectionistic, the reinforcement from dietary rules may strongly contribute to illness persistence.
“For individuals with AN who tend to be anxious, highly harm avoidant (Sancho, Arija, & Canals, 2008), and perfectionistic (Egan et al., 2007; Sutandar-Pinnock, Woodside, Carter, Olmstead, & Kaplan, 2003), the reinforcing properties of dietary rules may be an important factor influencing illness intractability.”
From A Pilot Study of an Acceptance-Based Separated Family Treatment for Adolescent Anorexia Nervosa (2013) · cites this paper as Sutandar-Pinnock, Woodside, Carter, Olmstead, & Kaplan, 2003
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“Perfectionism has been considered also by other authors [78], demonstrating that some of its aspects could represent a transitional status associated to pathology and are no longer present in recovered AN individuals.”
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“On the other hand, Ward et al. (1998) found recovered anorexics’ levels of harm avoidance to be in the normal range, Sutandar-Pinnock et al. (2003) found their level of perfectionism as measured by the Eating Disorders Inventory (though not by another scale) to be similar to that of controls, and…”
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“Similarly, high levels of perfectionism have been associated with worse response in patients with major depressive disorder [13] and anorexia nervosa [14].”
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“Indeed, lower levels of perfectionism appear to be associated with better response to treatment and better outcome at followup (e.g., Sutandar-Pinnock et al. 2003; Anderluh et al. 2009).”
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“Individuals with eating disorders have shown higher levels of perfectionism than healthy controls [8,9].”
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“…has found high levels of perfectionism in acute AN (Dahlenburg et al., 2019; Halmi et al., 2000; Lindner et al., 2014; Moor et al., 2004; Sutandar-Pinnock et al., 2003; Vall & Wade, 2015; Wade et al., 2008) and indicates that people with acute and weight-restored AN experience a…”
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How specific are the relationships between eating disorder behaviors and perfectionism?
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“Perfectionism can impede treatment progress and lead to poorer outcomes in treatment of patients with chronic pain [5], depression [6], and anorexia nervosa [7,8].”
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“In addition, perfectionism has been found to impact treatment outcome, being predictive of poorer treatment prognosis and higher treatment attrition rate (Bizeul et al., 2001; KeskiRahkonen et al., 2014; Sutandar-Pinnock et al., 2003).”
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“Furthermore, high levels of per-fectionism appear to be a negative predictor of treatment outcomes, especially in patients with anorexia nervosa [11, 12].”
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“These patients may have an almost delusional view of their bodies, an inability to identify feelings and needs, and a sense of ineffectiveness often accompanied by perfectionism [17-22].”
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“All in all, our findings are only partially in line with studies proposing perfectionism as hampering treatment outcome (Mitchell et al., 2013; Sutandar-Pinnock et al., 2003).”
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Psychological Profiles of Women with a Past or Present Diagnosis of Anorexia Nervosa
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“Several studies have shown that personality traits such as novelty seeking (30), and perfectionism (31, 32) are in fact predictive of prognosis.”
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“Perfectionism, a trait associated with neuroticism (Enns, Cox, Sareen, & Freeman, 2001) has also been shown to be predictive of treatment outcome at follow-up in AN (Sutandar-Pinnock et al., 2003).”
BackgroundVariability in College Student Suicide
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“, 2006) that tend to persist after ED recovery (von Ranson et al., 1999; Sutandar-Pinnock et al., 2003).”
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“Further, research has found an association between perfectionism motives and anorexia/bulimia ( Sutandar-Pinnock et al, 2003 ).”
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The relationship between perfectionism and discounting measures
Wainwright, K., & Romanowich, P. (2016) · Personality and Individual Differences · doi:10.1016/j.paid.2016.06.042 · Cited by 3 · see citing works
Utilité d’un carnet de suivi quotidien dans la thérapie de l’anorexie mentale
Monthuy-Blanc, J., Ninot, G., Morin, A., Pauzé, R., Guillaume, S., Rouvière, N., & Campredon, S. (2008) · doi:10.1016/j.jtcc.2008.10.005 · Cited by 5
“[14] Sutandar-Pinnock K, Woodside BD, Carter JC, Olmsted MP, Kaplan AS.”
BackgroundFantozzi, P., Billeci, L., Muratori, P., Maestro, S., Muratori, F., Chakrabarti, B., & Calderoni, S. (2024) · Journal of Eating Disorders · doi:10.1186/s40337-024-01075-z · Cited by 4 · see citing works
“Perfectionism represents a risk and maintenance factor for AN [81, 82] and is also configured as a predictor of worse prognosis and frequent dropouts in the treatment [83, 84].”
BackgroundDelaquis, C. P., Godart, N., Fatseas, M., & Berthoz, S. (2023) · Children · doi:10.3390/children10040730 · Cited by 4 · see citing works
“Items are rated on a five-point Likert scale and demonstrate sound psychometric properties in patients with AN [51].”
BackgroundClaus, N., Miegel, F. S., Jelinek, L., Landmann, S., Moritz, S., Külz, A. K., Rubel, J. A., & Cludius, B. (2023) · Cognitive Therapy and Research · doi:10.1007/s10608-023-10361-0 · Cited by 4 · see citing works
Petersson, S., Brudin, L. H., Clinton, D. N., Perseius, K., & Norring, C. E. A. (2018) · Journal for Person-Oriented Research · doi:10.17505/jpor.2018.01 · Cited by 3 · see citing works
Paredes, K. F., Diaz, J. M., Arévalo, R. V., Rayón, G. L. A., & Aguilar, X. L. (2010) · Universitas Psychologica · doi:10.11144/javeriana.upsy10-3.ppic · Cited by 4 · see citing works
Hwang, A. D., & Spangler, D. L. (2016) · Eating Behaviors · doi:10.1016/j.eatbeh.2015.12.003 · Cited by 3 · see citing works
Watkins, B. (2011) · Wiley eBooks · doi:10.1002/9781119998402.ch2 · Cited by 3 · see citing works
Lee, Y.-R., & Kim, N.-J. (2015) · The Journal of the Korea Contents Association · doi:10.5392/jkca.2015.15.01.233 · Cited by 2 · see citing works
Zur Auswirkung der Angst anorektischer Patientinnen auf die allgemeine Befindlichkeit
Persch, F. (2009) · OPen Access Repositorium der Universität Ulm (OPARU) (Ulm University) · doi:10.18725/oparu-1614 · Cited by 1 · see citing works
Thirty-year outcome of anorexia nervosa: healthcare use and disability.
Dobrescu, S. R., Dinkler, L., Gillberg, I., Gillberg, C., Råstam, M., Bolin, K., & Wentz, E. (2025) · The British journal of psychiatry : the journal of mental science · doi:10.1192/bjp.2025.10494
“44,45 One possible reason why individuals with premorbid perfectionism use less healthcare is that they may follow treatment recommendations more closely, making them less likely to relapse.”
Claus, N., Scheunemann, J., Arlt, S., Peth, J., Gallinat, J., Cludius, B., & Jelinek, L. (2025) · Journal of Clinical Psychology · doi:10.1002/jclp.70027
“…various disorders, such as anxiety disorders (Ashbaugh et al. 2007; Mitchell et al. 2013), eating disorders (Bizeul et al. 2001; De Cuyper et al. 2019; Sutandar ‐ Pinnock et al. 2003; Welch et al. 2020), and obsessive ‐ compulsive disorder (Chik et al. 2008; Kyrios et al. 2015; Manos et al. 2010).”
Anorexie mentale et EMDR : un cas clinique
Zaccagnino, M., Cussino, M., Callerame, C., Civilotti, C., & Fernández, I. (2018) · Journal of EMDR Practice and Research · doi:10.1891/1933-3196.12.4.e64
Lee, S., & 오, 미. (2016) · Korean Journal of Health Psychology · doi:10.17315/kjhp.2016.21.2.009
- Authors
- Sutandar‐Pinnock, K., Blake Woodside, D., Carter, J. C., Olmsted, M. P., & Kaplan, A. S.
- Affiliations
- University Health Network (CA)
- Venue
- International Journal of Eating Disorders
- Publisher
- Wiley
- Published
- 2003-02-25
- Volume
- 33
- Issue
- 2
- Pages
- 225-229
- ISSN
- 0276-3478 (ISSN-L)
- 1098-108X
- OpenAlex
- W2141028945
- Cited by
- 146
- References
- 0
- Citations by year
- 2025: 3 · 2024: 4 · 2023: 4 · 2022: 2 · 2021: 5 · 2020: 1 · 2019: 2 · 2018: 3 · 2017: 6 · 2016: 11 · 2015: 7 · 2014: 13 · 2013: 8 · 2012: 7
- FWCI
- 7.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Eating Disorders (publishedVersion)
- PubMed (publishedVersion)
- Library and Archives Canada (Government of Canada) (submittedVersion)
- TSpace (University of Toronto) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Clinical Psychology › Perfectionism, Procrastination, Anxiety Studies
- Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
- Keywords
- perfectionism, anorexia nervosa, treatment outcomes, inpatient care, Eating Disorder Inventory, Multidimensional Perfectionism Scale, personality traits, remission
- MeSH terms
- Adult, Anorexia Nervosa, Female, Follow-Up Studies, Humans, Male, Personality Disorders, Surveys and Questionnaires, Severity of Illness Index
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