This symposium will address the role of perfectionism across various types of psychopathology, informed by research conducted at Flinders University in the laboratory of Tracey Wade. The first two presentations are reviews of the literature. The first explores associations among social media, perfectionism and eating disorders, and proposes a new explanatory model. The second explores associations between perfectionism, self-criticism and self-compassion. The second two presentations discuss the findings of two randomised controlled trials. The first has a focus on decreasing disordered eating and body image problems using imagery rescripting, and also reports the impact on perfectionistic attitudes. The second looks at use of online perfectionism treatments and their impact across perfectionism, depression, anxiety, body dysmorphia, disordered eating, self-esteem, and self-compassion. There will be time for more extended discussion at the end of the presentations.

A recent meta-analysis of cross-sectional evidence found that there was a small, positive association between social media use and body image disturbance. To give additional context to this finding, we conducted a meta-analysis on the experimental and longitudinal research investigating this association. A systematic search strategy was implemented in June 2019 using the PsycINFO, MEDLINE, and Scopus online databases, finding 36 relevant experimental and longitudinal studies. The included studies suggest that social media use is causally related to poorer body image outcomes, with a minority of studies also examining its impact on disordered eating. In the literature looking into social media use and eating disorder risk, social comparison, internalisation of appearance ideals, and self-objectification are frequently considered as potential moderating or mediating mechanisms. Perfectionism is almost absent from this literature; however, recent research suggests an increase in perfectionism in youth over the last 20 years that may be driven in part by increased social media use. Perfectionism might usefully be considered in future models as an explanatory mechanism as to who is most at risk of adverse mental health outcomes when using social media. One such model concerning eating disorder risk will be proposed and some preliminary data to support the model will be summarised.

Perfectionism has been established as a transdiagnostic risk and maintaining factor for a broad array of indicators of psychological distress. More specifically, the harmful role self-criticism plays within this construct has been extensively researched, and self-compassion has been recently identified as a potential protective factor. To date however, there have been no synthesis of these research findings. The knowledge of protective and risk factors is a necessary precursor to the development of effective interventions. Thus, the aim of the current review was to examine the impact of self-compassion and self-criticism on perfectionistic strivings and perfectionistic concerns. Our systematic literature search yielded 58 studies comprised of primary and undergraduate students, clinical populations, community adults, athletes, psychology doctoral trainees, and general in-patients. Self-compassion was consistently found to partially mediate the relationship between perfectionistic concerns and indices of psychological distress. Correlational analyses revealed small-large positive associations between self-criticism and perfectionistic concerns, and medium-large negative correlations with self-compassion. Positive relationships between perfectionistic strivings and adaptive outcomes were also partially mediated by self-compassion, however measures of perfectionistic strivings generally had small-medium associations with self-criticism and were unrelated to self-compassion. Intervention studies revealed significant decreases in both perfectionism dimensions were met with increases in self-compassion. The findings suggest self-compassion is vital in buffering the harmful effects of perfectionism, whilst the association between perfectionistic strivings and self-criticism questions the notion that such strivings are adaptive. Targeting self-criticism and promoting self-compassion may ultimately benefit future psychological interventions for perfectionism to the benefit of transdiagnostic outcomes.

Perfectionism and low self-esteem have been identified as two of the main maintaining processes of eating disorders. This study examined the effectiveness of imagery rescripting, a new method to reconstruct negative core beliefs among eating disorder patients on decreasing perfectionistic attitudes and low self-esteem among young body-dissatisfied females who demonstrated an elevated risk of developing an eating disorder. One hundred and thirty young females were randomly assigned to one of the four conditions, body imagery rescripting (i.e., rescript negative body experience specific to the disorder), general imagery rescripting (i.e., rescript general negative experience not specific to the disorder), a psychoeducation and a control group. All participants received a brief intervention in the lab, and those who were in the IR conditions practised IR for five minutes each day for a week. Perfectionism and low self-esteem were measured by the Dysfunctional Attitudes Scale – Short Form 1 at baseline and one-week follow-up. Results suggested that rescripting negative event not specific to body or appearance in a self-compassionate way significantly reduced these dysfunctional attitudes with large effect sizes of 0.82 and 0.71 (completer and intent to treat Cohen’s d respectively). These findings provided preliminary support for general imagery rescripting as a superior intervention to reduce perfectionism and increase self-esteem which may then protect against the development of an eating disorder.

Findings across four different treatment studies are summarised, where all used an internet cognitive behavioural treatment for perfectionism (ICBT-P) devised by Ros Shafran, Sarah Egan and Tracey Wade. The first study (in press) examines 94 girls, aged 14-19 years, who self-identified as having difficulties with perfectionism but did not have a clinical eating disorder diagnosis and were randomly allocated into one of three groups: unguided ICBT-P, unguided ICBT for nonspecific stress management (ICBT-S), or waitlist control. The second study (in press) of 106 university students who self-identified as having problems with perfectionism explored the impact of a shorter versus longer intervention and the use of a fixed- versus free-format. The third study, published in 2019, examines a case series of 31 people with high levels of body dysmorphia, and examines outcomes at one-month follow-up. The final study is an ongoing one, with university students, and examines which types of perfectionism are most impact by ICBT-P, and what this means for development of the treatment in the future.