Intuitive eating, perfectionism and self-compassion within the context of chronic kidney disease and kidney transplantation

Perfectionism is characterised by excessive self-criticism and striving for excellence, but has been associated with poorer health outcomes in some clinical groups. This is sometimes buffered by self-compassion, a trait characterised by self-kindness and less self-judgement, but this has not yet been explored for kidney transplant recipients (KTRs). Three inter-connected studies were undertaken to assess how these self-attitudes were associated with stress, coping, health-related quality of life and intuitive eating for KTRs, based on an established model of perfectionism in illness:

1. A systematic review of studies that used the Intuitive Eating Scale-2 (IES-2) as it had not previously been validated for KTRs. This study:

(a) Identified that the IES-2 had not been validated in any clinical samples

(b) Showed that the measure's original factor structure lacked validity across diverse samples, identifying viable alternatives

(c) Created a comprehensive map of 50+ health correlates of the IES-2 

2. A validation of the IES-2 using interviews and surveys with KTRs, healthcare professionals and a comparison group, which:

(a) Found that the IES-2's original factor structure lacked validity

(b) Showed that an alternative factor structure identified in Study 1 { excluding a subscale that KTRs and healthcare professionals had found problematic { had excellent factorial validity

(c) Provided an amended version of the IES-2 for use with KTRs in future research and practice

3. A test of two models of perfectionism in illness, which found that maladaptive perfectionism:

(a) Had a unilaterally negative association with psychological health outcomes for KTRs

(b) Predicted lower levels of intuitive eating, with self-compassion fully mediating this relationship

(c) Impaired intuitive eating and health-related quality of life via lower self-compassion, greater stress and poorer coping

These findings have important implications for future research and practice, highlighting the need for interventions and clinical approaches that encourage self-compassion and reduce self-critical perfectionism for KTRs.