Flawless beyond reach and reason : Aspects of Perfectionism in Eating Disorders

Sammanfattning: Eating disorders (EDs) are common and serious psychiatric disorders causing significant physical and psychological suffering, for both those afflicted and their significant others. Although there has been considerable research on EDs throughout the years, there is still much left to be desired for successful treatment.Perfectionism has been suggested to play a crucial role in the development and maintenance of EDs. Perfectionism has also been suggested to interfere with treatment, and to predict treatment outcome. This thesis aims to illuminate aspects of perfectionism in patients with eating disorders.In Study I the relationship between perfectionism and Sense of Coherence (SOC) in a sample of patients with EDs was investigated. A high extent of perfectionism was significantly correlated to a weak SOC. Socially Prescribed Perfectionism (SPP) was correlated to all SOC components, while Self-Oriented Perfectionism (SOP) was solely correlated to the Manageability component. The results suggested that SOP might be a more healthy aspect of perfectionism compared to SPP. Also, SPP could be more strongly related to psychiatric co-morbidity.In Study II it was explored whether there were different patterns for the extent of SPP and SOP, perseverance/changeability of perfectionism, and how such patterns were related to long-term outcomes. Study data from a large, clinical, and national database was used. Five clusters were found. Persistent SOP was more strongly related to ED symptoms and psychiatric symptoms at baseline compared to other perfectionism patterns. There were no significant differences in outcomes between clusters three years after the initial measure. Patterns of relationships between the extent and possible changes of perfectionism measured with the Perfectionism Scale in the Eating Disorder Inventory (EDI-P) at baseline, and after six months, did not appear to be associated with long-term outcomes in psychiatric health ratings.In Study III semi-structured interviews with 15 patients were conducted and analysed. The narratives were compared with scorings on the EDI-P. No differences were found in the narratives related to EDI perfectionism scores or ED diagnoses. Seven themes were found: The origins of perfectionism, Top performance, Order and self-control, A perfect body, Looking good in the eyes of others, A double-edged coping strategy, and A Sisyphean task. The women in this study did not emphasize their weights or bodies as the main goal of their perfectionistic strivings. Core descriptions were order, self-control, and top performances. All participants described their awareness of the impossibility of reaching perfectionism. Scorings of SOP were significantly higher compared to SPP. The results showed that psychometric measures do not always capture patient definitions of perfectionism, but considering that perfectionism serves as a means to, among other things, regulate affects, and may lead to an exacerbation of an eating disorder, and the development of obsessive-compulsive symptoms, it is important to investigate the definitions of perfectionism. All studies in the present thesis were clinical, naturalistic, and, thus, transdiagnostic. The results showed that perfectionism in patients with EDs is a complex construct, suggesting that perfectionism should be regarded as a compensatory strategy with affect-regulating functions, in line with ED symptoms.