Abnormal Psychology

Eating Disorders 453

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self-criticism about mistakes (Antony & Swinson, 1998; Franco-Paredes et al.,

2005). Numerous studies fi nd perfectionism to be higher in people with eating dis-

orders than in people who do not have these disorders (Forbush, Heatherton, &

Keel, 2007). High scores on measures of perfectionism persist after people recover,

which suggests that this personality trait may exist before an eating disorder arises

and may increase the risk for developing such a disorder (Franco-Paredes et al.,

2005); high perfectionism may lead to an intense drive to attain a desired weight or

body shape, and thus contribute to the thoughts and behaviors that underlie an eat-

ing disorder. As illustrated in Figure 10.2, perfectionists are painfully aware of their

imperfections, which is aversive for them. This heightened awareness of personal

fl aws—real or imagined—is called aversive self-awareness and leads to signifi cant

emotional distress, which may temporarily be dulled by focusing on immediate as-

pects of the environment, such as occurs with bingeing. Thus, bingeing may provide

an escape from the emotional distress associated with perfectionism (Blackburn

et al., 2006; Heatherton & Baumeister, 1991).

People with eating disorders, more than other people, also tend to exhibit harm

avoidance—the characteristic of trying to avoid potentially harmful situations or

stimuli (Cassin & von Ranson, 2005). For instance, they are likely to be organized

planners rather than carefree and spontaneous, which minimizes their exposure to

potential danger. When people high in harm avoidance are preoccupied with stimuli

related to food, weight, or appearance (perhaps because of a social factor such as a

familial focus on such matters), they may be too concerned with their caloric intake

and be more likely to perceive threats or dangers—such as eating “too much”—that

other people don’t see.

Another aspect of personality associated wtih eating disorders is neuroticism

(see Chapter 2), which is characterized by a propensity toward anxiety and emo-

tional reactivity (Eggert, Levendosky, & Klump, 2007; Miller et al., 2006). One

Spanish study tracked females aged 12–21 who did not have an eating disorder.

Those who had high levels of neuroticism were more likely to develop an eating

disorder 18 months later (Cervera et al., 2003). People high in neuroticism may be

more sensitive to criticism in general, and when this trait is combined with other

risk factors (such as an overvaluation of weight and appearance), they may take

to heart criticisms or comments related to their weight and appearance more than

other people do (Davis, Claridge, & Fox, 2000).

Finally, people who have low self-esteem may try to raise their self-esteem by

controlling their food intake, weight, and shape, believing that such changes will

increase their self-worth (Geller et al., 2000; Striegel-Moore, Silberstein, & Rodin,

1986). For instance, they may think, “If I restrict my calories, that’ll prove that

I’m in control of myself and worthy of respect.” However, efforts to increase self-

worth in this way end up having a paradoxical effect: To the extent that attempts

10.2 • Bingeing as Escape For perfectionists, bingeing can be an escape from aversive feelings.

Being aware of imperfections (referred to as aversive self-awareness) causes emotional distress. People high

in perfectionism try to decrease the ensuing emotional distress by focusing on immediate aspects of the

environment (referred to as cognitive narrowing), which they attain through bingeing (Blackburn et al., 2006;

Heatherton & Baumeister, 1991).

Figure 10.2Figure 10.2

Perfectionism Aversive self-

awareness

Emotional

distress

Cognitive

narrowing

Binge eating