Predicting Disordered Eating Behaviors Based on Perfectionism and Childhood Trauma: Presenting an Explanatory Model with Mediated Role of Internalized Shame

Document Type : Research Paper

Authors

1 Department of Psychology, Faculty of Literature, Humanities and Social Sciences, Science and Research Branch, Islamic Azad university, Tehran, Iran.

2 Department of Clinical Psychology, Faculty of Behavioral Sciences, University of Rehabilitation Sciences and Social Health, Tehran, Iran

3 Department of Psychology, Faculty of Literature, Humanities and Social Sciences, Science and Research Branch, Islamic Azad University, Tehran, Iran

Abstract

The aim of the present study was to predict disordered eating behavior via internalized shame as a mediator between perfectionism and childhood trauma. In order to accomplish this, a statistical population comprising all students enrolled in Islamic Azad Universities in Tehran during the academic year 2018-2019 was utilized to select five universities (Azad North, Center, South, Science and Research, and Medical Science). Subsequently, 400 students were selected as sample members using the available sampling method. Subsequently, 400 students were chosen using the available sampling procedure. They responded voluntarily to Eating Disordered Behavior Scale (EAT-26), Hill Perfectionism (HPI), Childhood Trauma Scale (CTQ), Internalized Shame (ISS). Finally, 324 questionnaires were incorporated. Analysis of the data was performed with SPSS-24 and Amos. The findings from the path analysis indicated that shame predicted eating disorders and mediated the relationship between childhood trauma, perfectionism, and eating disorders. Shame was identified as the mediating factor in this relationship. Individuals who experienced childhood traumatization appear to resort to compensatory behaviors, such as disordered eating, to regain a positive self-image and alleviate feelings of shame. An undesirable body image and feelings of shame can further exacerbate perfectionism, which may manifest as extreme behaviors like eating disorders as an attempt to attain an idealized appearance.

Keywords

References

 ابراهیمی، ح. ا.، دژکام، م.، و یوسفی، س. (1392). رابطه تروماهای دوران کودکی و سبک‌های دلبستگی با رفتار اقدام به خودکشی در زنان مراجعه‌کننده به بیمارستان لقمان حکیم در مقایسه با جمعیت عمومی. فصلنامۀ فرهنگی-تربیتی زنان و خانواده. 7(23)، 69-48. http://ensani.ir/file/download/article/20151011144909-9999-2.pdf
پاشا شریفی، ح.، صالحی، م.، امامی، س.، و بشردوست، س. (1390). بررسی ویژگی‌های روان‌سنجی سیاهۀ کمال‌گرایی هیل در دانشجویان. فصلنامۀ تازه‌های روان‌شناسی صنعتی/سازمانی. 2(7)، 19-9. https://dorl.net/dor/20.1001.1.28222476.1390.2.7.1.4
رجبی، غ. ر.، و عباسی، ق. ا. (1390). بررسی رابطۀ خودانتقادی، اضطراب اجتماعی و ترس از شکست با شرم درونی‌شده در دانشجویان. پژوهش‌های روان‌شناسی بالینی و مشاوره. 1(2)، 182-171. https://doi.org/10.22067/ijap.v1i2.9837
ریو، جی. ام. (1395). انگیزش و هیجان. ترجمۀ یحیی سیدمحمدی. ویراست ششم. تهران: ویرایش.
کاوه قهفرخی، م.، و تابع بردبار، ف. (1396). رابطۀ بین رفتار خوردن آشفته با طرحواره‌های ناسازگار اولیه و اضطراب در دختران نوجوان. فصلنامۀ روان‌شناسی افراد استثنایی. 7(27)، 183-161. https://doi.org/10.22054/jpe.2018.23683.1598
نوبخت، م. (1377). بررسی همه‌گیرشناسی اختلال‌های خوردن در دانش‌آموزان دختر سال دوم دبیرستان شهر تهران. پایان‌نامۀ کارشناسی ارشد روان‌شناسی. دانشکدۀ علوم تربیتی و روان‌شناسی. دانشگاه فردوسی مشهد.
مایرز، ال. اس. (1391). پژوهش چندمتغیری کاربردی (طرح و تفسیر). ترجمۀ سیمین‌دخت رضاخانی، بلال ایزانلو، ولی‌الله فرزاد، حمیدرضا حسن‌آبادی، مجتبی حبیبی و حسن پاشا شریفی. تهران: رشد.
References
Aakvaag, H. F., Thoresen, S., Wentzel-Larsen, T., Dyb, G., Røysamb, E., & Olff, M. (2016). Broken and guilty since it happened: A population study of trauma-related shame and guilt after violence and sexual abuse. Journal of Affective Disorders, 204, 16-23. https://doi.org/10.1016/j.jad.2016.06.004
Behar, R., Arancibia, M., Sepúlveda, E., & Muga, A. (2016). Child sexual abuse as a risk factor in eating disorders. Eating Disorders (1st ed.). New York: Nova Science Publishers Inc, 149-171.
Bernstein, D. P., Fink, L., Handelsman, L., & Foote, J. (1994). Childhood Trauma Questionnaire (CTQ) [Database record]. APA PsycTests. https://psycnet.apa.org/doi/10.1037/t02080-000
Chen, L. P., Murad, M. H., Paras, M. L., Colbenson, K. M., Sattler, A. L., Goranson, E. N., ... & Zirakzadeh, A. (2010). Sexual abuse and lifetime diagnosis of psychiatric disorders: Systematic review and meta-analysis. Mayo Clinic Proceedings, 85(7), 618–629. https://doi.org/10.4065/mcp.2009.0583
Claesson, K., & Sohlberg, S. (2002). Internalized shame and early interactions characterized by indifference, abandonment and rejection: Replicated findings. Clinical Psychology and Psychotherapy, 9(4), 277-284. https://psycnet.apa.org/doi/10.1002/cpp.331
Cook, D. R. (1993). Internalized shame scale manual. Menomonee, WI: Channel Press. https://www.worldcat.org/title/internalized-shame-scale-professional-manual/oclc/31622196
Czepiel, D., & Koopman, H. M. (2023). Does physical appearance perfectionism predict disordered dieting? Current Psychology, 42, 24-34. https://psycnet.apa.org/doi/10.1007/s12144-020-01308-9
Dakanalis, A., Clerici, M., Caslini, M., Favagrossa, L., Prunas, A., Volpato, C., ... & Zanetti, M. A. (2014). Internalization of sociocultural standards of beauty and disordered eating behaviours: The role of body surveillance, shame and social anxiety. Journal of Psychopathology, 20(1), 33-37. https://psycnet.apa.org/record/2014-24558-005
Dakanalis, A., Timko, C. A., Zanetti, M. A., Rinaldi, L., Prunas, A., Carrà, G., ... & Clerici, M. (2014). Attachment insecurities, maladaptive perfectionism, and eating disorder symptoms: A latent mediated and moderated structural equation modeling analysis across diagnostic groups. Psychiatry Research, 215(1), 176-184. https://doi.org/10.1016/j.psychres.2013.10.039
De Hooge, I. E., Nelissen, R., Breugelmans, S. M., & Zeelenberg, M. (2011). What is moral about guilt? Acting “prosocially” at the disadvantage of others. Journal of personality and social psychology, 100(3), 462. https://psycnet.apa.org/doi/10.1037/a0021459
Del Rosario, P. M., & White, R. M. (2006). The Internalized Shame Scale: Temporal stability, internal consistency, and principal components analysis. Personality and Individual differences, 41(1), 95-103. https://doi.org/10.1016/j.paid.2005.10.026
Dimaggio, G., & Attinà, G. (2012). Metacognitive interpersonal therapy for narcissistic personality disorder and associated perfectionism. Journal of Clinical Psychology, 68(8), 922-934. https://doi.org/10.1002/jclp.21896
Ebrahimi, H., Dejkam, M., & Yousefi, S. (2013). The relationship between childhood traumas and attachment styles with suicidal behavior in women referred to Luqman Hakim Hospital compared to the general population. Cultural and Educational Quarterly for Women, 7(23), 48-69. [In Persian]
Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: A clinical review. Clinical Psychology Review, 31(2), 203–212. https://doi.org/10.1016/j.cpr.2010.04.009
Fairbairn, W. R., (1952). Psychological Studies of the Personality. Routledge and Kegan Paul, London. https://doi.org/10.4324/9780203129449
Flett, G. L., & Hewitt, P. L. (2002). Perfectionism and maladjustment: An overview of theoretical, definitional, and treatment issues. In G. L. Flett & P. L. Hewitt (Eds.), Perfectionism: Theory, research, and treatment (pp. 5-31). Washington, DC: American Psychological Association. https://psycnet.apa.org/doi/10.1037/10458-001
Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14(5), 449-468. https://psycnet.apa.org/doi/10.1007/BF01172967
Garner, D. M., Olmsted, M. P., Bohr, Y., & Garfinkel, P.E. (1982). The eating attitudes test: psychometric features and clinical correlates. Psychological Medicine, 12(4), 871-878. https://doi.org/10.1017/s0033291700049163
Geranmayepour, S., & Besharat, M. A. (2010). Perfectionism and mental health. Procedia-Social and Behavioral Sciences, 5, 643-647. https://doi.org/10.1016/j.sbspro.2010.07.158
Guillaume, S., Jaussent, I., Maïmoun, L., Ryst, A., Seneque, M., Villain, L., ... & Courtet, P. (2016). Associations between adverse childhood experiences and clinical characteristics of eating disorders. Scientific Reports, 6, 35761. https://doi.org/10.1038/srep35761
Hay, P., & Mitchison, D. (2019). Eating disorders and obesity: the challenge for our times. Nutrients, 11(5), 1055. https://pubmed.ncbi.nlm.nih.gov/31083490/
Hill, R. W., Huelsman, T. J., Furr, R. M., Kibler, J., Vicente, B. B., & Kennedy, C. (2004). A new measure of perfectionism: The Perfectionism Inventory. Journal of Personality Assessment, 82(1), 80-91. https://doi.org/10.1207/s15327752jpa8201_13
Humphreys, K. L., LeMoult, J., Wear, J. G., Piersiak, H. A., Lee, A., & Gotlib, I. H. (2020). Child maltreatment and depression: A meta-analysis of studies using the Childhood Trauma Questionnaire. Child Abuse & Neglect, 102, 104361. https://doi.org/10.1016/j.chiabu.2020.104361
Johnson, J. G., Cohen, P., Kasen, S., & Brook, J. S. (2002). Childhood adversities associated with risk for eating disorders or weight problems during adolescence or early adulthood. American Journal of Psychiatry, 159(3), 394-400. https://doi.org/10.1176/appi.ajp.159.3.394
Jones, J. M., Bennett, S., Olmsted, M. P., Lawson, M. L., & Rodin, G. (2001). Disordered eating attitudes and behaviours in teenaged girls: a school-based study. Canadian Medical Association Journal, 165(5), 547-552. https://www.cmaj.ca/content/165/5/547.short
Karrer, Y., Halioua, R., Mötteli, S., Iff, S., Seifritz, E., Jäger, M., & Claussen, M. C. (2020). Disordered eating and eating disorders in male elite athletes: a scoping review. BMJ Open Sport & Exercise Medicine, 6(1), e000801. https://doi.org/10.1136/bmjsem-2020-000801
Kaveh, M., & Tabe Bordbar, F. (2017). The relationship between disordered eating behavior with early maladaptive schemas and anxiety in adolescent female. Psychology of Exceptional Individuals, 7(27), 161-183. https://doi.org/10.22054/jpe.2018.23683.1598 [In Persian]
Kealy, D., Rice, S. M., Ogrodniczuk, J. S., & Spidel, A. (2018). Childhood trauma and somatic symptoms among psychiatric outpatients: investigating the role of shame and guilt. Psychiatry Research, 268, 169-174. http://dx.doi.org/10.1016/j.psychres.2018.06.072
Kent, A., Waller, G., & Dagnan, D. (2000). A greater role of emotional than physical or sexual abuse in predicting disordered eating attitudes: The role of mediating variables. International Journal of Eating Disorders, 25(2), 159–167. https://doi.org/10.1002/(sici)1098-108x(199903)25:2%3C159::aid-eat5%3E3.0.co;2-f
Kiani-Sheikhabadi, M., Beigi, M., & Mohebbi-Dehnavi, Z. (2019). The relationship between perfectionism and body image with eating disorder in pregnancy. Journal of Education and Health Promotion, 8, 242. https://doi.org/10.4103/jehp.jehp_58_19
Kleine, L. L. (2010). Computational Biology: a Statistical Mechanics Perspective. Journal of the Royal Statistical Society Series A: Statistics in Society, 173(2), 462-463. https://doi.org/10.1111/j.1467-985X.2009.00634_3.x
Kong, S., & Bernstein, K. (2009). Childhood trauma as a predictor of eating psychopathology and its mediating variables in patients with eating disorders. Journal of Clinical Nursing, 18(13), 1897-1907. https://doi.org/10.1111/j.1365-2702.2008.02740.x
Le Marne, K. M., & Harris, L. M. (2016). Death anxiety, perfectionism and disordered eating. Behaviour Change, 33(4), 193-211. https://psycnet.apa.org/doi/10.1017/bec.2016.11
Lo, A., & Abbott, M. J. (2013). Review of the theoretical, empirical, and clinical status of adaptive and maladaptive perfectionism. Behaviour Change, 30(2), 96-116. https://doi.org/10.1017/bec.2013.9
Meyers, L. S. (2012). Applied multivariate research: Design and interpretation. Translated by: S. D. Rezakhani, B. Izanlo, V. Farzad, H. R. Hassanabadi, M. Habibi, & H. Pasha Sharifi. Tehran: Roshd. (In Persian)
Momeni, M., Ghorbani, A., & Arjeini, Z. (2020). Disordered eating attitudes among Iranian university students of medical sciences: The role of body image perception. Nutrition and Health, 26(2), 127-133. https://journals.sagepub.com/doi/abs/10.1177/0260106020912657
Naeimi, A. F., Haghighian, H. K., Gargari, B. P., Alizadeh, M., & Rouzitalab, T. (2016). Eating disorders risk and its relation to self-esteem and body image in Iranian university students of medical sciences. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 21, 597-605. https://link.springer.com/article/10.1007/s40519-016-0283-7
Nobakht, M. (1998). Survey of the prevalence of eating disorders in female students of the second year of high school in Tehran. Master's Thesis in Psychology. Faculty of Educational Sciences and Psychology, Ferdowsi University of Mashhad. (In Persian)
Pasha Sharifi, H., Salehi, M., Emamipour, S., & Bashardoust, S. (2011). An Investigation into Psychometric Properties of Hill’s Perfectionism Inventory. Journal of Modern Industrial/Organization Psychology, 2(7), 9-19. (In Persian)
Prnjak, K., Jukic, I., & Korajlija, A. L. (2019). How Perfectionism and Eating Disorder Symptoms Contribute to Searching Weight-Loss Information on the Internet? Medicina, 55(10), 621. https://doi.org/10.3390/medicina55100621
Puttevils, L., Vanderhasselt, M. A., & Vervaet, M. (2019). Investigating transdiagnostic factors in eating disorders: Does self‐esteem moderate the relationship between perfectionism and eating disorder symptoms?. European Eating Disorders Review: The Journal of the Eating Disorders Association, 27(4), 381–390. https://doi.org/10.1002/erv.2666
Qutteina, Y., Nasrallah, C., Kimmel, L., & Khaled, S. M. (2019). Relationship between social media use and disordered eating behavior among female university students in Qatar. Journal of Health and Social Sciences, 4(1), 59-72. http://dx.doi.org/10.19204/2019/rltn7
Rabito-Alcón, M. F., Baile, J. I., & Vanderlinden, J. (2021). Mediating factors between childhood traumatic experiences and eating disorders development: a systematic review. Children, 8(2), 114. https://doi.org/10.3390/children8020114
Rajabi, G., & Abasi, G. (2011). Examining the relationship between self-criticism, social anxiety and fear of failure with shyness in college students. Research in Clinical Psychology and Counseling, 1(2), 171-182. https://doi.org/10.22067/ijap.v1i2.9837 (In Persian)
Reeve, Johnmarshall. (2016). Understanding motivation and emotion (6th edition). Translated by Y. Seyedmohammadi. Tehran: Virayesh. (In Persian)
Rice, K. G., Bair, C. J., Castro, J. R., Cohen, B. N., & Hood, C. A. (2003). Meanings of perfectionism: A quantitative and qualitative analysis. Journal of Cognitive Psychotherapy, 17(1), 39-58. http://dx.doi.org/10.1891/jcop.17.1.39.58266
Rivière, J., & Douilliez, C. (2017). Perfectionism, rumination, and gender are related to symptoms of eating disorders: A moderated mediation model. Personality and Individual Differences, 116, 63–68. https://doi.org/10.1016/j.paid.2017.04.041
Rodríguez-Quiroga, A., MacDowell, K. S., Leza, J. C., Carrasco, J. L., & Díaz-Marsá, M. (2021). Childhood trauma determines different clinical and biological manifestations in patients with eating disorders. Eating and Weight Disorders, 26(3), 847-857. https://doi.org/10.1007/s40519-020-00922-7
Rouzitalab, T., Gargari, B. P., Amirsasan, R., Jafarabadi, M. A., Naeimi, A. F., & Sanoobar, M. (2015). The relationship of disordered eating attitudes with body composition and anthropometric indices in physical education students. Iranian Red Crescent Medical Journal, 17(11). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4698139/
Sekowski, M., Gambin, M., Cudo, A., Wozniak-Prus, M., Penner, F., Fonagy, P., & Sharp, C. (2020). The relations between childhood maltreatment, shame, guilt, depression and suicidal ideation in inpatient adolescents. Journal of Affective Disorders, 276, 667-677. https://doi.org/10.1016/j.jad.2020.07.056
Steiger, H., Richardson, J., Schmitz, N., Israel, M., Bruce, K., & Gauvin, L. (2010). Trait-defined eating-disorder subtypes and history of child abuse. International Journal of Eating Disorders. 43(5), 428-432. https://doi.org/10.1002/eat.20711
Stoeber, J. (2018). The psychology of perfectionism: An introduction. In J. Stoeber (Ed.), The psychology of perfectionism: Theory, research, applications (pp. 3-16). London: Routledge.
Stotz, S. J., Elbert, T., Müller, V., & Schauer, M. (2015). The relationship between trauma, shame, and guilt: Findings from a community-based study of refugee minors in Germany. European Journal of Psychotraumatology, 6(1), 25863. https://doi.org/10.3402/ejpt.v6.25863
Szentágotai-Tătar, A., & Miu, A. C. (2016). Individual differences in emotion regulation, childhood trauma and proneness to shame and guilt in adolescence. PloS One, 11(11), e0167299. https://doi.org/10.1371/journal.pone.0167299
Tangney, J. P. E., & Tracy, J. L. (2012). Self-conscious emotions. In: Leary M, Tangney JP, editors. Handbook of self and identity (2nd ed.). New York: Guilford; 2012. p. 446–78.
Thompson, B. (1988). Misuse of chi-square contingency-table test statistics. Educational & Psychological Research. https://psycnet.apa.org/record/1989-14227-001
Troncone, A., Cascella, C., Chianese, A., Zanfardino, A., Piscopo, A., Borriello, A., ... & Iafusco, D. (2020). Body image problems and disordered eating behaviors in Italian adolescents with and without type 1 diabetes: an examination with a gender-specific body image measure. Frontiers in Psychology, 11, 556520. https://doi.org/10.3389/fpsyg.2020.556520
Vacca, M., Ballesio, A., & Lombardo, C. (2021). The relationship between perfectionism and eating‐related symptoms in adolescents: A systematic review. European Eating Disorders Review, 29(1), 32-51. https://doi.org/10.1002/erv.2793
Ward, R. M., & Hay, M. C. (2015) Depression, coping, hassles, and body dissatisfaction: Factors associated with disordered eating. Eating Behaviors, 17, 14–18. https://doi.org/10.1016/j.eatbeh.2014.12.002
Webb, M., Heisler, D., Call, S., Chickering, S. A., & Colburn, T. A. (2007). Shame, guilt, symptoms of depression, and reported history of psychological maltreatment. Child Abuse & Neglect, 31(11-12), 1143-1153. https://doi.org/10.1016/j.chiabu.2007.09.003
Webster, T. N. (2013). Shame not the same for different styles of blame: Shame as a mediating variable for severity of childhood sexual abuse and trauma symptoms in three attribution of blame groups. Thesis for MSc.. Department of Family, Home, and Social Sciences; Family Life, Marriage and Family Therapy, Brigham Young University. https://scholarsarchive.byu.edu/etd/4046
 
Journal of Applied Psychological Research
Volume 14, Issue 3
2023
Pages 239-256

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  • Receive Date: 13 October 2021
  • Revise Date: 10 February 2022
  • Accept Date: 23 February 2022
  • First Publish Date: 10 September 2023
  • Publish Date: 23 September 2023

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