Background
Sociodemographic characteristics of MDD
MDD and perfectionism
MDD and disordered eating
Perfectionism, eating attitudes, orthorexia nervosa and MDD
The present study
Methods
Study design and sampling
Minimal sample size
Measures
-
Muscle Dysmorphic Disorder Inventory (MDDI) is a 13-item questionnaire that contains three subscales directly related to MD: “drive for size” used to measure the desire to increase muscle mass, “appearance intolerance” used to measure the desire to lose fat mass, and “functional impairment” used to measure avoidance of social situations [44]. Respondents rate statements on a 1 (never) to 5 (always) scale. The three subscales’ scores are: Drive for Size (DFS, 5 items, range 5–25), Appearance Intolerance (AI, 4 items, range 4–20), and Functional Impairment (FI, 4 items, range 4–20). These three scores yield a total MDDI score ranging from 13 to 65; participants scoring 39 and more were classified as having MDD symptoms [44]. (Cronbach’s alpha for the total score in this study = 0.81).
-
Düsseldorf Orthorexia Scale (DOS) includes ten items, to which respondents answer on a four-point Likert scale where 1 = never, 2 = rarely, 3 = often, and 4 = always [45]. The Arabic version of the DOS seems to be a structurally valid and internally consistent questionnaire measuring orthorexic eating behavior in Lebanese adolescents [46] and adults [47]. Higher scores indicate higher orthorexia nervosa. (Cronbach’s alpha in this study = 0.87).
-
Eating Attitudes Test (EAT-26) is used to identify the presence of “eating disorder risk” based on attitudes, feelings and behaviors related to eating. The scale has three subscales: Dieting, Bulimia and Food Preoccupation, and Oral Control [48]. A score of 20 or above is used as a clinical cut-off and indicates inappropriate eating behaviors. All subscales can be added to give a total score, or each subscale can be used independently. The EAT-26 has been validated and translated into Arabic [49]. (Cronbach’s alpha in this study = 0.97).
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Big Three Perfectionism Scale is composed of 16 items, scored on a five-point Likert scale (1 = strongly disagree to 5 = strongly agree) [50]. It yields three subscales’ scores: rigid perfectionism, self-critical perfectionism, and narcissistic perfectionism. Higher scores reflect higher perfectionism in the three aspects. In this study, the Cronbach’s alpha values for the three scores were as follows: rigid perfectionism (α = 0.90), self-critical perfectionism (α = 0.88) and narcissistic perfectionism (α = 0.84).
Translation procedure
Statistical analysis
Results
Variable | N (%) |
---|---|
Marital status | |
Single | 313 (79.0%) |
Married | 83 (21.0%) |
Mean ± SD
| |
Age (in years) | 25.39 ± 4.96 |
Body Mass Index (kg/m2) | 24.46 ± 3.51 |
Household crowding index (person/room) | 0.81 ± 0.40 |
Physical activity index | 36.65 ± 23.77 |
Financial burden | 5.44 ± 2.97 |
Eating attitudes test score | 33.14 ± 23.17 |
Orthorexia nervosa score (DOS score) | 20.31 ± 6.30 |
Muscle Dysmorphic Disorder score | 26.88 ± 7.64 |
Bivariate analysis of factors associated with MDD
Variable | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
---|---|---|---|---|---|---|---|---|---|---|
1. MDD | 1 | |||||||||
2. Age | -0.002 | 1 | ||||||||
3. Household crowding index | 0.05 |
-0.1
| 1 | |||||||
4. Physical activity index | -0.03 | -0.08 |
-0.21
| 1 | ||||||
5. Financial burden |
0.37
|
0.11
| 0.09 |
-0.20
| 1 | |||||
6. Eating attitudes | -0.07 | -0.01 |
-0.20
|
0.24
|
-0.30
| 1 | ||||
7. Orthorexia nervosa |
0.41
| -0.03 | 0.07 | 0.02 |
0.23
|
-0.24
| 1 | |||
8. Rigid perfectionism |
0.31
|
-0.11
|
0.22
|
-0.21
|
0.37
|
-0.56
|
0.40
| 1 | ||
9. Self-critical perfectionism |
0.37
| 0.02 |
0.13
|
-0.23
|
0.37
|
-0.47
|
0.36
|
0.72
| 1 | |
10. Narcissistic perfectionism |
0.25
| 0.04 | 0.03 | -0.09 |
0.24
|
-0.35
|
0.47
|
0.61
|
0.58
| 1 |
Mediation analysis
Direct effect
|
Indirect effect
| |||||
---|---|---|---|---|---|---|
Effect
|
SE
|
p
|
Effect
|
SE
|
95% BCa
| |
Model 1: orthorexia nervosa as the mediator | ||||||
Rigid perfectionism | 0.18 | 0.10 | 0.064 | 0.22 | 0.05 | 0.13; 0.33a
|
Self-critical perfectionism | 0.28 | 0.07 | < 0.001 | 0.14 | 0.04 | 0.07; 0.21a
|
Narcissistic perfectionism | 0.04 | 0.08 | 0.640 | 0.24 | 0.05 | 0.15; 0.33a
|
Model 2: eating attitudes as the mediator | ||||||
Rigid perfectionism | 0.58 | 0.11 | < 0.001 | -0.18 | 0.06 | -0.30; -0.07a
|
Self-critical perfectionism | 0.51 | 0.08 | < 0.001 | -0.10 | 0.03 | -0.17; -0.03a
|
Narcissistic perfectionism | 0.33 | 0.08 | < 0.001 | -0.05 | 0.03 | -0.11; 0.001 |