Enduring value of perfectionism and maturity fears for predicting eating disorder maintenance over 10‐, 20‐, and 30‐year follow‐up

Abstract

Objective The Eating Disorder Inventory provides a theoretically informed multidimensional assessment of eating disorder symptoms and associated psychological factors widely used to examine the development and maintenance of eating disorders. Yet, mixed findings for some factors raise questions about whether their prognostic value varies as a function of duration of follow‐up or type of eating pathology studied. Method The current study compared prognostic value of perfectionism, maturity fears, and interpersonal distrust as predictors of restrictive versus bulimic symptom patterns at 10‐, 20‐, and 30‐year follow‐up in N = 127 individuals diagnosed with eating disorders at baseline. Multivariable regression analyses and statistical comparison of effect sizes were used. Results Drive for Thinness at 10‐ and 30‐year follow‐up was predicted by higher Perfectionism and higher Maturity Fears at baseline. Baseline Maturity Fears also predicted higher Drive for Thinness at 20‐year follow‐up and higher Bulimia at 10‐ and 20‐year follow‐up. Interpersonal Distrust did not demonstrate prognostic significance in multivariable models. Comparisons of effect sizes support that some differences in statistical significance reflect differences in prognostic value of psychological factors. Discussion Both duration of follow‐up and type of pathology impact the predictive value of psychological factors and have important implications for understanding illness maintenance. Findings support the utility of targeting Perfectionism for restrictive symptoms. Developing interventions focused on Maturity Fears may provide a novel approach to reducing both restrictive and bulimic symptoms.

‘In an otherwise limitless world, I was sure of my limit.’† Experiencing Anorexia Nervosa: A phenomenological metasynthesis

“…Motivation to recover is frequently low, due to perceived benefits of restrictive eating behaviors ( 28 ). The illness has been associated with high maturity fear, intolerance of uncertainty, perfectionism, anxiety, trauma, cognitive rigidity and alexithymia ( 13 , 26 , 29 – 36 )—however, these associations are typically measured quantitatively and thus limited to binary, researcher-derived constructs (impacting interpretive potential). Deriving a more nuanced understanding of these cognitions from the words of those who experience them may be vital to the development of novel therapeutic techniques that enhance interoception, motivation for change and self-efficacy and to understanding why existing treatments aren’t successful for many individuals.…”

From symptoms to subjective and bodily experiences: the contribution of the Psychodynamic Diagnostic Manual (PDM-2) to diagnosis and treatment monitoring in eating disorders

“…Some empirical research has found that perfectionistic traits are significant predictors of ED symptom severity and a maintaining factor for partial or full-blown EDs over time, even at 10-year [85], 12-year [86], and 30-year follow-ups [87]. Perfectionism has also been shown to predict worse therapeutic outcomes at a 16-year follow-up [88].…”

“…Perfectionism has also been shown to predict worse therapeutic outcomes at a 16-year follow-up [88]. Furthermore, some longitudinal studies have shown that greater maturity fears at baseline predict a higher drive for thinness and more bulimic symptoms at 10-year, 20-year, and 30-year follow-ups [87], as well as worse AN outcomes at a 20-year follow-up [89]. Finally, body checking (i.e., scrutinizing one's body in a mirror, checking the fit of clothes, measuring body parts) has emerged as both a maintaining factor of eating pathologies and a trans-diagnostic treatment target [90].…”