The Eating Disorders Continuum Self-Esteem, and Perfectionism

By Peck, Lisa D.; Lightsey, Owen Richard, Jr. | Journal of Counseling and Development : JCD, Spring 2008 | Go to article overview

The Eating Disorders Continuum Self-Esteem, and Perfectionism


Peck, Lisa D., Lightsey, Owen Richard, Jr., Journal of Counseling and Development : JCD


Clients with eating disorders are a critical problem for mental health professionals. Between 1% and 3% of women have anorexia nervosa or bulimia nervosa (American Psychiatric Association [APA], 2000), and up to 61% experience subclinical eating disorders (Mintz & Betz, 1988). Characterized by a preoccupation with and distorted attitude toward weight, food, and dieting, eating disorders are found more typically in White, middle- to upper-class females but appear to be on the rise in other ethnic and social groups (Caldwell, Brownell, & Wilfley, 1997). Persons who have an eating disorder often experience other problems, such as perfectionism, low self-esteem, anxiety, and depression (Bastiani, Rao, Weltzin, &Kaye, 1995; Beren & Chrisler, 1990; Dancyger & Garfinkel, 1995; Dykens & Gerrard, 1986).

There is considerable debate about how to classify individuals who present with eating disordered behavior. The best known system of classification for eating disorders in the mental health field is the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; APA, 2000), which has highly specific criteria for eating disorder diagnostic categories. An alternative conceptualization to discreet diagnostic categories is a continuum model, which ranges from the absence of eating disordered behavior to severe eating disordered behavior (Mintz & Betz, 1988; Stice, Killen, Hayward, & Taylor, 1998). Eating disordered behaviors such as dieting, restricting intake of food, and purging that do not meet the threshold for a DSM-IV-TR (APA, 2000) diagnosis are also assessed to determine placement on the continuum. Through various studies and theoretical perspectives, many authors have integrated the two conceptualizations of eating disorders (Gleaves, Lowe, Green, Cororve, & Williams, 2000; Lowe et al., 1996; Mintz, O'Halloran, Mulholland, & Schneider, 1997; Shisslak, Crago, & Estes, 1995; Stice et al., 1998; Tylka & Subich, 1999).

In an attempt to synthesize the then current classification system (DSM-IV; APA, 1994) and the eating disorders continuum research, Mintz et al. (1997) derived the self-report Questionnaire for Eating Disorders Diagnosis (QEDD), which provides researchers with a tool to classify women along a continuum into three ordered categories of eating disturbances, all based on DSM-IV criteria: eating disordered, symptomatic, and asymptomatic. The eating disordered category includes all forms of Anorexia Nervosa, Bulimia Nervosa, and the Eating Disorder Not Otherwise Specified diagnostic category. The symptomatic category includes persons who do not meet full DSM-IV diagnostic criteria for the eating disordered group but still exhibit some eating disordered behaviors. Finally, the asymptomatic group includes persons who exhibit no symptoms of eating disturbances. Mintz et al.'s continuum provides the framework for the current research.

Tylka and Subich (1999) expanded Mintz et al.'s (1997) attempts to validate the QEDD and the eating disorders continuum by comparing continuum placement with scores on another well-known eating disorders instrument, the Eating Disorders Inventory-2 (EDI-2; Garner, 1991). Using Mintz et al.'s tripartite continuum, Tylka and Subich compared EDI-2 subscale scores of women who fit into the three groups (asymptomatic, symptomatic, or eating disordered) and found that all subscales except one (i.e., Perfectionism) differed across continuum groups. Trend analyses indicated that all subscales except Perfectionism increased linearly across the continuum.

In the current study, we attempted to replicate and extend Tylka and Subich's (1999) study by replacing the Perfectionism subscale of the EDI-2 with a multidimensional perfectionism measure by (a) including a measure of self-esteem and (b) conducting alternative analyses (i.e., discriminant analysis). First, we provide an overview of the research on the eating disorders continuum. …

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