A longitudinal study of perfectionism and orthorexia in exercisers.

Research suggests that trait perfectionism and perfectionistic self-presentation are related to orthorexia - a pathological obsession with correct nutrition. However, no studies have examined these relationships over time or compared the influence of the two aspects of perfectionism on orthorexia. In the present study we sought to address these two issues. Gym members who engaged in high degrees of exercise were recruited via social media platforms. They completed an online questionnaire that included the Multidimensional Perfectionism Scale-Short Form, Perfectionistic Self-Presentation Scale, and the Eating Habits Questionnaire on two occasions: 177 participants (Mean age = 31.6 years) initially completed the questionnaire and 82 completed the questionnaire six weeks later. A series of multiple regression analyses revealed that (i) trait perfectionism predicted an increase in orthorexia symptomatology over time with socially prescribed perfectionism and other-oriented perfectionism unique predictors of orthorexia, (ii) perfectionistic self-presentation predicted orthorexia over time with nondisplay of imperfection a unique predictor of orthorexia, and (iii) when considered alongside each other, only trait dimensions of perfectionism were unique predictors of orthorexia. The present study provides further evidence that perfectionism is related to orthorexia. In addition, the study also provides preliminary evidence that more engrained trait aspects of perfectionism are more predictive of orthorexia over time than the self-presentational aspects of perfectionism.

Comparisons and Conversions: A Methodological Note and Caution for Meta-Analysis in Sport and Exercise Psychology.

Meta-analysis is a powerful tool in sport and exercise psychology. However, it has a number of pitfalls, and some lead to ill-advised comparisons and overestimation of effects. The impetus for this research note is provided by a recent systematic review of meta-analyses that examined the correlates of sport performance and has fallen foul of some of the pitfalls. Although the systematic review potentially has great value for researchers and practitioners alike, it treats effects from correlational and intervention studies as yielding equivalent information, double-counts multiple studies, and uses an effect size for correlational studies (Cohen's d) that provides an extreme contrast of unclear practical relevance. These issues impact interpretability, bias, and usefulness of the findings. This methodological note explains each pitfall and illustrates use of an appropriate equivalent effect size for correlational studies (Mathur and VanderWeele's d) to help researchers avoid similar issues in future work.

Athlete Burnout Symptoms Are Increasing: A Cross-Temporal Meta-Analysis of Average Levels From 1997 to 2019.

With the increasing prevalence of mental health difficulties in sport, athletes may be at greater risk of burnout than ever before. In the present study, we tested this possibility by examining whether average athlete burnout levels have changed over the past 2 decades, from 1997 to 2019. A literature search returned 91 studies (N = 21,012) and 396 effect sizes. Findings from cross-temporal meta-analysis suggested that burnout symptoms have increased over the past 2 decades. Specifically, we found that athletes' mean levels of reduced sense of athletic accomplishment and sport devaluation have increased. As burnout symptoms are now typically higher among athletes than in the past, we can expect more athletes to be prone to the negative effects of burnout. Sport is therefore in urgent need of prevention and intervention strategies to stop and reverse this trend.

Perfectionistic self-presentation and orthorexia in exercisers.

PURPOSE: The present study aimed to provide the first examination of whether perfectionistic self-presentation-an interpersonal expression of perfectionism-is related to orthorexia. METHODS: We recruited a sample of 150 exercisers (Mean age = 27.7 years). Participants completed the Perfectionistic Self-Presentation Scale and the ORTO-15 on a single occasion. RESULTS: Two dimensions of perfectionistic self-presentation-perfectionistic self-promotion and nondisplay of imperfection-showed significant positive correlations with orthorexia. In addition, in multiple regression analyses controlling for the overlap between dimensions, perfectionistic self-promotion emerged as the strongest and only significant predictor of orthorexia. CONCLUSION: Perfectionistic self-presentation is positively associated with orthorexia in exercisers. Perfectionistic self-promotion-a need to portray an image of perfection to others-is primarily responsible for this relationship. LEVEL OF EVIDENCE: Cross-sectional study, Level V.

Development of perfectionism in junior athletes: Examination of actual and perceived parental perfectionism.

Initial research suggests that parental perfectionism is central to the development of athlete perfectionism. However, it is unclear whether perceived or actual parental perfectionism is most important. The present study aimed to address this issue in two ways. First, we re-examined the predictive ability of actual versus perceived parental perfectionism on athlete perfectionism. Second, for the first time, we tested whether perceived parental perfectionism mediated the relationship between actual parental perfectionism and athlete perfectionism. A sample of 150 junior athletes and their parents completed measures of perfectionism (perfectionistic strivings and perfectionistic concerns). Junior athletes completed two measures, one of their own perfectionism and one of perceptions of their parents' perfectionism. Parents completed one measure of their own perfectionism. Regression analyses showed that perceived parental perfectionism predicted athlete perfectionism over and above actual parental perfectionism. Mediation analyses provided support for our proposed model. Overall, the findings suggest that both actual and perceived parental perfectionism are important in the development of perfectionism in junior athletes.

Perfectionism and Precompetition Emotions in Youth Footballers: A Three-Wave Longitudinal Test of the Mediating Role of Perfectionistic Cognitions.

Perfectionism is related to precompetition emotions in athletes. However, it is unclear why this is the case. In the present study, the authors sought to determine whether perfectionistic cognitions explain this relationship and mediate the relationships between self-oriented perfectionism (SOP), socially prescribed perfectionism (SPP), and general precompetition emotions and multidimensional anxiety and anger. The authors adopted a three-wave longitudinal design and examined between- and within-person effects in a sample of 352 youth footballers (Mage = 14.03 years, SD = 2.30). At the between-person level, perfectionistic cognitions mediated the relationships between SOP, SPP, and all general precompetition emotions plus multidimensional anxiety and anger. At the within-person level, perfectionistic cognitions mediated the relationships between SOP, SPP, and general anxiety and anger plus multidimensional anxiety and anger. Our findings imply that athletes higher in SOP and SPP experience more anxiety and anger when the frequency of perfectionistic cognitions increases in the lead-up to competition.

Development of Perfectionism in Junior Athletes: A Three-Sample Study of Coach and Parental Pressure.

Perfectionism predicts cognitions, emotions, and behaviors in sport. Nonetheless, our understanding of the factors that influence its development is limited. The authors sought to address this issue by examining the role of coach and parental pressure in the development of perfectionism in sport. Using 3 samples of junior athletes (16-19 years; cross-sectional n = 212, 3-month longitudinal n = 101, and 6-month longitudinal n = 110), the authors examined relations between coach pressure to be perfect, parental pressure to be perfect, perfectionistic strivings, and perfectionistic concerns. Mini meta-analysis of the combined cross-sectional data (N = 423) showed that both coach pressure and parental pressure were positively correlated with perfectionistic strivings and perfectionistic concerns. In contrast, longitudinal analyses showed that only coach pressure predicted increased perfectionistic strivings and perfectionistic concerns over time. Overall, our findings provide preliminary evidence that coaches may play a more important role in the development of junior athletes' perfectionism than parents.

A Test of Perfectionistic Vulnerability Following Competitive Failure Among College Athletes.

Perfectionism purportedly bestows vulnerability to distress through an interaction with achievement and interpersonal stress. The authors test this by assessing athletes' perfectionism and subsequent self-conscious emotion following repeated competitive failure. A total of 60 college athletes undertook three 4-min competitive sprint trials on a cycle ergometer and were instructed that they had performed the worst of all competitors on each occasion. Measures of perfectionism (self-oriented and socially prescribed) were taken at baseline and measures of pride, guilt, and shame were taken at baseline and three times following each successive failure. Across the successive failures, self-oriented perfectionism predicted within-person trajectories of decreasing pride and increasing guilt. Socially prescribed perfectionism predicted within-person trajectories of increasing shame and guilt. Furthermore, a combination of high self-oriented and high socially prescribed perfectionism predicted the steepest within-person increases in shame and guilt. Findings support an achievement-specific vulnerability hypothesis whereby those higher in perfectionism experience pronounced distress following competitive failure.

Multidimensional Perfectionism and Burnout: A Meta-Analysis.

A meta-analysis of research examining the relationships between multidimensional perfectionism and burnout is provided. In doing so, relationships before and after controlling for the relationship between dimensions of perfectionism were examined along with whether relationships were moderated by domain (work, sport, or education). A literature search yielded 43 studies (N = 9,838) and 663 effect sizes. Meta-analysis using random-effects models revealed that perfectionistic strivings had small negative or non-significant relationships with overall burnout and symptoms of burnout. By contrast, perfectionistic concerns displayed medium-to-large and medium positive relationships with overall burnout and symptoms of burnout. After controlling for the relationship between dimensions of perfectionism, "pure" perfectionistic strivings displayed notably larger negative relationships. In terms of moderation, in some cases, perfectionistic strivings were less adaptive and perfectionistic concerns more maladaptive in the work domain. Future research should examine explanatory mechanisms, adopt longitudinal designs, and develop interventions to reduce perfectionistic concerns fueled burnout.

A Three-Wave Longitudinal Test of Self-Determination Theory's Mediation Model of Engagement and Disaffection in Youth Sport.

Research adopting self-determination theory (SDT) supports a mediation model whereby coach motivational styles (autonomy support and interpersonal control) predict athletes' engagement and disaffection in youth sport via the satisfaction and frustration of psychological needs (autonomy, competence, and relatedness). Our study extends this research by examining SDT's mediation model longitudinally with three waves of data. Two hundred fifty-two youth sports participants (Mage = 12.98; SD = 1.84; range = 11-17; female n = 67) completed measures of study variables at the start, middle, and end of a competitive soccer season. Cross-lagged path analyses revealed that associations between the two coach motivational styles and athletes' engagement were mediated by psychological need satisfaction. Furthermore, a positive reciprocal association between psychological need satisfaction and engagement emerged over time. This study therefore supports the temporal assumptions underpinning SDT's mediation model but, importantly, evidences a mutually reinforcing interplay between athletes' psychological needs and their engaged behavior.

Relationships between the coach-created motivational climate and athlete engagement in youth sport.

Youth sport is a source of well-being for adolescents, yet experiences vary and attrition can be high. We sought to better understand the coach behaviors that foster positive experiences in youth sport by examining relationships between the motivational climate and athlete engagement (viz., confidence, dedication, enthusiasm, and vigor). We reasoned that a mastery climate (emphasis on effort and learning) would correspond with higher engagement, whereas a performance climate (emphasis on ability and outcome) was expected to correspond with lower engagement. Two-hundred sixty adolescent soccer players completed measures of engagement and perceived coach motivational climate. All dimensions of engagement were positively predicted by a mastery climate. Furthermore, cognitive aspects of engagement were positively predicted by a performance climate. Canonical correlation analysis indicated that a composite of engagement was positively associated with a mastery climate. Results suggest that a mastery climate offers a means of promoting higher levels of overall engagement.

Team perfectionism and team performance: a prospective study.

Perfectionism is a personality characteristic that has been found to predict sports performance in athletes. To date, however, research has exclusively examined this relationship at an individual level (i.e., athletes' perfectionism predicting their personal performance). The current study extends this research to team sports by examining whether, when manifested at the team level, perfectionism predicts team performance. A sample of 231 competitive rowers from 36 boats completed measures of self-oriented, team-oriented, and team-prescribed perfectionism before competing against one another in a 4-day rowing competition. Strong within-boat similarities in the levels of team members' team-oriented perfectionism supported the existence of collective team-oriented perfectionism at the boat level. Two-level latent growth curve modeling of day-by-day boat performance showed that team-oriented perfectionism positively predicted the position of the boat in midcompetition and the linear improvement in position. The findings suggest that imposing perfectionistic standards on team members may drive teams to greater levels of performance.

A longitudinal examination of the relationship between perfectionism and motivational climate in dance.

The present study examined the relationship between dance-related perfectionism and perceptions of motivational climate in dance over time. In doing so, three possibilities were tested: (a) perfectionism affects perceptions of the motivational climate, (b) perceptions of the motivational climate affect perfectionism, and (c) the relationship is reciprocal. Two hundred seventy-one young dancers (M = 14.21 years old, SD = 1.96) from UK Centres for Advanced Training completed questionnaires twice, approximately 6 months apart. Cross-lagged analysis indicated that perfectionistic concerns led to increased perceptions of an ego-involving climate and decreased perceptions of a task-involving climate over time. In addition, perceptions of a task-involving climate led to increased perfectionistic strivings over time. The findings suggest that perfectionistic concerns may color perceptions of training/performing environments so that mistakes are deemed unacceptable and only superior performance is valued. They also suggest that perceptions of a task-involving climate in training/performing environments may encourage striving for excellence and perfection without promoting excessive concerns regarding their attainment.

Factorial validity and measurement invariance of the Athlete Burnout Questionnaire (ABQ).

The Athlete Burnout Questionnaire (ABQ) is the gold standard measure for burnout in athletes. However, previous assessments of factorial validity have: (a) tested overly restrictive measurement models; (b) provided mixed support for factorial validity; and (c) not been applied to assess measurement invariance across gender, sport type, or age. To address these issues, we used ABQ data provided by 914 athletes (Mage = 21.75 years, SD = 8.79) and examined factorial validity using confirmatory factor analysis (CFA) and exploratory structural equation modelling (ESEM) techniques. We also examined measurement invariance of the ABQ data across reported gender (female, male), sport type (individual, team), and age (≤18 years, >18 years) groups. The analyses revealed that an ESEM model provided superior fit over the corresponding CFA model. In terms of measurement invariance, support was provided for the equivalence of the ABQ across each group. This means that researchers using the ABQ can collect data across these groups and examine potential differences with confidence that the ABQ is approximately invariant. In all, we provide evidence that the majority of ABQ items are key target construct indicators and the burnout construct (as measured by the ABQ) has the same structure and meaning to different athlete groups.

Drug-coated balloons for coronary artery disease: An updated review with future perspectives.

Since the advent of coronary stents, two of the most common long-term complications after percutaneous coronary intervention (PCI) are in-stent restenosis (ISR) and stent thrombosis (ST). Although the rates of ST have been nearly abolished and ISR rates have declined with the current gold-standard second-generation drug-eluting stents (DES), late ISR of DES remains a valid concern in the field of interventional cardiology. The drug-coated balloon (DCB) is a non-stent technology that relies on the concept of targeted homogeneous drug delivery from an inflated balloon to restore luminal vascularity, treat atherosclerosis, and overcome some limitations of PCI, including ISR and prolonged dual antiplatelet therapy to prevent ST by leaving nothing behind. Most clinical evidence on coronary DCBs predominantly comes from small, randomized data and registries using paclitaxel DCBs for ISR and de novo lesions in the coronary space. Since 2014, outside the United States, DCBs have been approved for the treatment of ISR, with a class I recommendation by the European Society of Cardiology. The Food and Drug Administration very recently approved the Agent DCB to treat ISR in patients with coronary artery disease in the US. Additionally, recent randomized clinical data also showed DCB's safety and efficacy for the treatment of de novo small-vessel disease and high-bleeding-risk patients, while their role for other clinical situations including acute coronary syndrome, large-vessel disease, bifurcation lesions, and long-diffuse distal lesions is currently under investigation. Herein, we review the evidence-based role of DCBs in the treatment of coronary lesions and offer future perspectives.

Perfectionism and performance in sport: Exploring non-linear relationships with track and field athletes.

The relationship between perfectionism - perfectionistic strivings and perfectionistic concerns - and athletic performance is contested and inconsistent. The present study explored the possibility that one explanation for this inconsistency is the assumption that the relationship is linear. In two samples, we tested alternative non-linear relationships between perfectionism and real-world competitive athletic performance. Sample one comprised 165 Swedish track and field athletes (57 % competing in female category, 42 % in male category; Mage = 16.93 years) and sample two comprised 157 British track and field athletes (55 % competing in female category, 43 % in male category; Mage = 18.42 years). Testing for linear and non-linear relationships, we found a quadratic effect whereby higher perfectionistic strivings had both positive increasing (i.e., U-shape; sample 1) and positive decreasing (i.e., inverted U-shape; sample 2) relationships with performance. We conclude that there may be circumstances when perfectionistic strivings contribute to better and worse sport performance, and that this relationship can be curvilinear.

From chest pain to coronary functional testing: Clinical and economic impact of coronary microvascular dysfunction.

BACKGROUND: Coronary functional testing to formally diagnose coronary microvascular dysfunction (CMD) reduces cardiovascular events and alleviates angina. This study aims to investigate the extensive and complex journey that patients with CMD undergo, from the onset of chest pain to eventual diagnosis. METHODS: Data from the Coronary Microvascular Disease Registry (CMDR) were analyzed, including information on the date of first documentation of chest pain, number of non-invasive and invasive tests the patient underwent, emergency department visits, and hospitalizations. In addition, we estimated the total cost per patient. A total of 61 patients with CMD diagnosis were included in this analysis. RESULTS: Most patients in our cohort were older than 50 years of age. The median time from initial chest pain symptoms to diagnosis was 0.62 (interquartile range [IQR]: 0.06-2.96) years. During this period, patients visited the emergency department a median of 1.0 (IQR: 0.0-2.0) times. Diagnostic tests included 3.0 (IQR: 2.0-6.0) electrocardiograms, 3.0 (IQR: 0.0-6.0) high-sensitivity troponin tests, and 1.0 (IQR: 1.0-2.0) echocardiograms. Prior to diagnosis of CMD, 13 (21.3 %) patients had left heart catheterization without coronary functional testing. Non-invasive testing for ischemia was conducted in 43 (70.5 %) patients. Alternative non-cardiac diagnoses were given to 11 (18.0 %) patients during the diagnostic process, with referrals made to gastroenterology for 16 (26.2 %) and pulmonology for 10 (16.4 %) patients. The cost was almost $2000/patient. CONCLUSION: Timely identification of CMD offers promising opportunities for prompt symptom alleviation, accompanied by reduced visits to the emergency department, cardiovascular testing, invasive medical procedures, and consequently reduced healthcare expenses.

The mediating role of psychological need satisfaction in relationships between types of passion for sport and athlete burnout.

Research indicates that obsessive and harmonious passion can explain variability in burnout through various mediating processes (e.g., Vallerand, Paquet, Phillippe, & Charest, 2010). The current study extended previous research (Curran, Appleton, Hill, & Hall, 2011; Gustafsson, Hassmén, & Hassmén, 2011) by testing a model in which the effects of passion for sport on athlete burnout were mediated by psychological need satisfaction. One hundred and seventy-three academy soccer players completed self-report measures of passion for sport, psychological need satisfaction, and athlete burnout. Results indicated that psychological need satisfaction mediated the relationship between harmonious passion and athlete burnout but not obsessive passion and athlete burnout. The findings indicate that the inverse relationship between harmonious passion and burnout can be explained by higher levels of psychological need satisfaction. However, this was not the case for obsessive passion, which was not associated with psychological need satisfaction or most symptoms of athlete burnout.

Perfectionism and burnout in junior soccer players: a test of the 2 x 2 model of dispositional perfectionism.

Research examining the perfectionism-burnout relationship has typically focused on the main effects of single dimensions of perfectionism. The purpose of the current study was to extend this research by examining the interactive effects of dimensions of perfectionism in predicting symptoms of athlete burnout. In doing so, the hypotheses of the recently developed 2 × 2 model of dispositional perfectionism were tested in regards to differences between subtypes of perfectionism. One hundred sixty-seven junior male soccer players were recruited from English professional soccer clubs and completed paper-and-pencil measures of perfectionism and symptoms of athlete burnout. Moderated hierarchical regression provided support for the hypotheses of the 2 × 2 model for some but not all symptoms of burnout. Overall, the findings suggest that the 2 × 2 model may offer a useful framework through which to explain the interactive effects of dimensions of perfectionism on athlete burnout.

A conditional process model of children's behavioral engagement and behavioral disaffection in sport based on self-determination theory.

The potential benefits of children's engagement in sport for their psychological, social, and physical health are well established. Yet children may also experience psychological and social impairments due, in part, to a variety of detrimental coach behaviors. In the current study, we proposed and tested a conditional process model of children's self-reported behavioral engagement and behavioral disaffection in sport based on self-determination theory. Results from a sample of 245 youth soccer players suggested that structure from coaches related positively to behavioral engagement and negatively to behavioral disaffection, and that these relations were mediated by athletes' basic psychological need satisfaction. Importantly, and in line with our hypotheses, these indirect effects were moderated by autonomy support from coaches, such that the mediation was evident only among those who reported higher levels of autonomy support. These findings underscore the importance of coaches' providing guidance, expectations, and feedback (i.e., structure) in a way that respects athletes' volition (i.e., autonomy support).