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Perfektionismus und die Folgen – psychische Störungen und andere belastende Auswirkungen
Abstract
Perfektionismus ist zwar selbst keine psychische Störung, kann die körperliche und psychische Gesundheit aber schmerzlich beeinträchtigen. Manchem Forscher gilt er als ein einflussreiches Risiko für fast alle Achse-I-Störungen, ein sogenannter transdiagnostischer Faktor. Besonders die Verbindungen zu Zwangsstörungen, sozialen Phobien, Depressionen und Essstörungen haben sich als sehr eng herausgestellt. Sie und andere gesundheitliche Auswirkungen des Perfektionismus werden in diesem Kapitel vorgestellt. Außerdem wird der Frage nachgegangen, welche unterschiedlichen Formen von Perfektionismus Psychotherapeuten bei welcher Diagnose zu erwarten haben. Dazu werden für die wichtigsten Diagnosen die typischen Perfektionismus-Profile vorgestellt.
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This study of university students (64 men and 99 women) examined both dispositional and situational influences of self-critical (SC) perfectionism on stress and coping, which explain its association with high negative affect and low positive affect. Participants completed questionnaires at the end of the day for 7 consecutive days. Structural equation modeling indicated that the relation between SC perfectionism and daily affect could be explained by several maladaptive tendencies associated with SC perfectionism (e.g., hassles, avoidant coping, low perceived social support). Multilevel modeling indicated that SC perfectionists were emotionally reactive to stressors that imply possible failure, loss of control, and criticism from others. As well, certain coping strategies (e.g., problem-focused coping) were ineffective for high-SC perfectionists relative to low-SC perfectionists.
Background
Thinking about suicide is an indicator of suicide risk. Suicide rates are higher among doctors than in the population. The main aims of this study are to describe the changes in the lifetime prevalence of suicidal feelings from 2000 to 2010 and the possible predictors of serious suicidal thoughts in 2010 among Norwegian doctors. Differences in lifetime prevalence of suicidal feelings between Norwegian doctors in 2010 and German doctors in 2006 will be also described.
Methods
Longitudinal and cross-sectional study based on questionnaire data from 2000 and 2010, including approximately 1,600 Norwegian doctors. In Germany, cross-sectional study based on questionnaire data from 2006 among a sample of 3,295 doctors. The main outcome measures were the lifetime prevalence of suicidal feelings (felt life was not worth living, wished own death, had thoughts of taking own life).
Results
The prevalences in 2000 and 2010 of ever had feelings of life not worth living were 48 (44 to 52) % and 45 (41 to 49) %, of ever wished own death 27 (23 to 30) % and 23 (20 to 26) %, and of ever had thoughts of taking own life 29 (16 to 33) % and 24 (21 to 27) %. Paired t-tests among those who responded both in 2000 and 2010 show significant reductions for felt life not worth living (t = −3.4; p = 0.001), wished own death (t = −3.1; p = 0.002) and had thoughts of taking own life (t = −3.5; p < 0.0001). In 2010, significant predictors of serious suicidal thoughts in a multivariate model were low subjective well-being (OR 0.68; 95% CI 0.52-0.90), poor or average self-rated health (2.36; 1.25-4.45) and high psychosocial work stress (1.92; 1.06-3.46), controlled for age, gender, speciality and job satisfaction. Norwegian doctors in 2010 compared with their German counterparts in 2006 reported quite similar prevalences of suicidal feelings.
Conclusions
Suicidal feelings among Norwegian doctors decreased from 2000 to 2010. Individual and work-related factors may to certain explain these findings. Compared with other professionals in Norway and doctors in Germany, Norwegian doctors showed no higher risk of suicidal thoughts.
Background
Body dissatisfaction is a robust risk factor for disordered eating and is thought to be especially problematic in the presence of high levels of perfectionism. The aim of the current study was to investigate what types of perfectionism were associated with body dissatisfaction. Participants were 1083 women aged 28 to 40 years, with a mean age of 35 years (SD=2.11). Self-reports on perfectionism (using the Frost Multidimensional Perfectionism Scale), weight, height, desired weight, and current and ideal figural stimuli were analysed for the current study. Two measures of body dissatisfaction were utilised: discrepancy between the current and desired weight, and discrepancy between the current and ideal figural stimuli.
Results
Linear regressions controlling for current body mass index (BMI)/current silhouette examined the relationship between desired BMI/silhouette and simultaneous entry of the 6 subscales of the perfectionism measure. A lower desired BMI was associated with higher levels of Concern over Mistakes and Organisation, and a smaller ideal silhouette was associated with higher levels of Concern over Mistakes and Doubt about Actions and Organisation.
Conclusions
These findings confirm the pertinence of different dimensions of perfectionism to body dissatisfaction, and suggest avenues to explore in terms of universal prevention work.
There is a strong link between perfectionism and eating disorders, yet little research to date has examined mediators of this relationship. The aim of this study was to investigate the mediating effect of anxiety on the relationship between perfectionism and eating pathology in a clinical sample (N = 370, M age = 25.04, 99 % female) of treatment-seeking eating disorder patients (bulimia nervosa—41 %; eating disorder not otherwise specified—41 %; anorexia nervosa—18 %). Results from structural equation modeling indicated that anxiety partially mediated the relationship between self-oriented perfectionism and eating disorder psychopathology. The findings suggest the role of anxiety and perfectionism within cognitive-behavioral models of eating pathology, and have implications for the treatment of eating disorders.
Perfectionists have excessively high standards and thus are prone to experience dissatisfaction and embarrassment. But what if they achieve perfection? The present study investigated in a sample of 194 university students how self-oriented and socially prescribed perfectionism predicted emotional reactions (satisfaction, dissatisfaction, pride, embarrassment) to imagined situations in which students achieved either perfect or flawed outcomes. Self-oriented perfectionism showed positive correlations with satisfaction and pride after perfect outcomes, and positive correlations with dissatisfaction and embarrassment after flawed outcomes. In contrast, socially prescribed perfectionism showed positive correlations with dissatisfaction after both perfect and flawed outcomes. Moreover, socially prescribed perfectionism moderated the relationship of self-oriented perfectionism with satisfaction and pride after perfect outcomes: Self-oriented perfectionism predicted higher satisfaction and pride only in students with low levels of socially prescribed perfectionism. The findings show that perfectionists high in self-oriented perfectionism, but low in socially prescribed perfectionism may experience more pride and greater satisfaction than nonperfectionists, but only when they achieve perfection.
Perfectionism affects all areas of life, including romantic relationships. However, little is known about how dyadic perfectionism (perfectionism in dyadic relationships) affects students’ romantic relationships. Focusing on two central aspects of dyadic perfectionism—partner-oriented perfectionism (perfectionistic expectations towards one’s partner) and partner-prescribed perfectionism (perceived perfectionistic expectations from one’s partner)—this study examined partner and actor effects of dyadic perfectionism in 58 university students and their partners (N = 116 participants) using multilevel analyses. Results showed significant partner and actor effects. Participants’ partner-oriented perfectionism had a positive effect on their partner’s partner-prescribed perfectionism and a negative effect on their own relationship satisfaction and longterm commitment. Participants’ partner-prescribed perfectionism also had a negative effect on their own relationship satisfaction. The findings show that dyadic perfectionism in students’ romantic relationships puts pressure on the partner and negatively affects the perception of the quality of the relationship regarding satisfaction and longterm commitment.
Contemporary cognitive models of obsessive-compulsive disorder (OCD) suggest that three types of dysfunctional beliefs contribute to the development and maintenance of obsessivecompulsive (OC) symptoms. These are beliefs characterized by themes of (a) inflated personal responsibility and the overestimation of threat (RT), (b) perfectionism and the intolerance of uncertainty (PC), and (c) overimportance of one's thoughts and the need to control these thoughts (ICT). To better understand the relationship between symptoms and beliefs, we applied structural equation modeling to belief and symptom data from a large (N = 5,015) nonclinical sample. RT significantly predicted each of the six main types of OC symptoms (checking, hoarding, neutralizing, obsessing, ordering, and washing), beyond the effects attributable to ICT and PC. PC predicted ordering rituals beyond the effects due to ICT and RT. ICT predicted obsessing, neutralizing, and washing compulsions, beyond the effects attributable to RT and PC. The three types of beliefs were strongly correlated with one another, which is consistent with previous theorizing that one type of belief (e.g., RT) influences another (e.g., ICT), which in turn influences OC symptoms (i.e., the indirect effects of beliefs on symptoms). However, there are competing explanations for the strong correlations among beliefs. Research designs are proposed for disentangling the various explanations of the high correlation among beliefs.
This study investigated links between three forms of perfectionism and beliefs associated with fear of failure (FF). College
students (N=372) enrolled in physical activity classes completed the Multidimensional Perfectionism Scale and Performance Failure Appraisal
Inventory in a single session. After controlling for other forms of perfectionism, only socially prescribed perfectionism
(SPP) was strongly associated with beliefs that failure led to aversive interpersonal consequences (i.e., important others
losing interest, upsetting important others). Other-oriented perfectionism (OOP) exhibited a weak negative relation with beliefs
that failure would lead to devaluation of one’s self-estimate; individuals who held the highest standards for others’ behavior
had the weakest beliefs that failure would lead to them devaluing their self-estimate. Self-oriented perfectionism (SOP) was
not associated with any beliefs that failure led to aversive consequences; however, when SOP and OOP were simultaneously elevated,
they contributed positively to fears of experiencing shame and embarrassment (above and beyond main effects of SPP). Collectively
these findings indicated that FF was not ubiquitous with all forms of perfectionism because the specific beliefs about the
consequences of failure that underlie different forms of perfectionism varied tremendously.
Clinically significant perfectionism is defined as patterns of perfectionism which are over-represented in clinical samples
and under-represented in non-clinical samples. The present study contrasted two hypotheses about what characterizes clinically
significant perfectionism: the two-factor theory and perfectionism/acceptance theory. First, a person-oriented approach by
means of cluster analysis was used to identify typical patterns of perfectionism. These clusters were then cross-tabulated
with two clinical samples (patients with social phobia and patients with panic disorder) and a non-clinical sample. The results
showed that patterns of clinically significant perfectionism combined high Concern over Mistakes (CM) and Doubts about Action
(DA) with high Personal Standards (PS) (and to a lesser extent also high Organization)––which is consistent with perfectionism/acceptance
theory, but at odds with the two-factor theory. The results illustrate the value of a person-oriented methodological approach
as a complement to the traditional variable-oriented approach.
This study examined the relationship between perfectionism, as measured by the Multidimensional Perfectionism Scale (MPS;
[R. O. Frost etal. (1990) Cognitive Therapy and Research, 14, 449–468], and treatment outcome in obsessive compulsive disorder (OCD). Patients (n=118) participated in group [McLean etal. (2001) Journal of Consulting and Clinical Psychology, 69, 205–214] or individual [Whittal etal. (2005) Behaviour Research and Therapy, 43, 1559–1576] cognitive therapy (CT) or exposure and response prevention (ERP) for OCD. Doubts about Actions (DA), a subscale
of the MPS, uniquely predicted worse treatment outcome in the Yale-Brown Obsessive-compulsive Scale (YBOCS; [Goodman etal.
(1989) Archives of General Psychiatry, 40, 1006–1011]) total score and compulsions subscale. Interactions between Concern over Mistakes (CM; another MPS subscale)
and DA, as well as DA alone, predicted poorer treatment outcome in patients who received ERP. Contrary to expectations, MPS
total score was not related to treatment response. Moreover, levels of perfectionism did not change over the course of treatment,
regardless of the type of treatment received. Implications for treatment in OCD are discussed.
According to traditional views of perfectionism, perfectionists are prone to experience shame and guilt and unable to experience pride. However, these views ignore that perfectionism is multidimensional and multifaceted. Consequently, the present study adopted a multidimensional approach and investigated in a sample of N = 67 university students how four facets of perfectionism – perfectionistic striving, importance of being perfect, others’ high standards, conditional acceptance – were related to pride, shame, and guilt following experimental manipulation of success and failure. Results showed that perfectionistic striving was associated with more pride following success, whereas all facets were associated with more shame and guilt following failure, particularly conditional acceptance. Furthermore, conditional acceptance was associated with less pride regardless of success or failure. Supporting views of perfectionism that differentiate between adaptive and maladaptive aspects, the findings show that individuals who strive for perfection experience more pride after success. Whereas all facets of perfectionism were related to more shame and guilt after failure, only individuals who think that others’ approval is conditional upon being perfect seem to be unable to experience pride. The findings demonstrate that perfectionistic striving per se is not maladaptive, but conditional acceptance may be an important factor in maladaptive and clinical perfectionism.
Perfectionists have been described as people who want to be perfect in all domains of their lives. Few studies to date, however, have investigated what domains people are perfectionistic in. Using two samples (109 university students, 289 Internet users), the present study investigated how being perfectionistic in 22 domains of life was related to perfectionism, age, gender, and satisfaction with life. Across samples, work and studies were the domains that most participants reported being perfectionistic in, followed by bodily hygiene, spelling, and presentation of documents. Whereas age, gender, and satisfaction with life showed significant relationships with selected domains of life, perfectionism showed significant positive correlations with the overall score (number of domains affected by perfectionism) and with being perfectionistic in individual domains. Further analyses showed that self-oriented perfectionism, rather than socially prescribed perfectionism, was responsible for these correlations. The findings indicate that, in most domains, being perfectionistic is internally motivated and not externally motivated. Moreover, they show that, while some perfectionists may be perfectionistic across domains, most perfectionists are perfectionistic only in selected domains.
Perfectionism is a transdiagnostic construct associated with a range of diagnoses, including depression, eating disorders and obsessive compulsive disorder. Treatments that directly target perfectionist cognitions have been shown to successfully reduce associated pathologies. However, the way in which they do this is not clear. We set out to assess the role of one candidate mechanism of action, namely the cognitive process of interpretation of ambiguity. In one experiment we looked for associations between biased interpretation and perfectionism. In a second, we manipulated interpretations, thereby providing a strong test of their aetiological significance. Results from the first experiment confirmed the presence of biased interpretation in perfectionism and demonstrated that these are highly specific to perfection relevant information, rather than reflecting general negativity. The second experiment succeeded in manipulating these perfection relevant interpretations and demonstrated that one consequence of doing so is a change in perfectionist behaviour. Together, these data experimentally demonstrate that biased interpretation of perfection relevant ambiguity contributes to the maintenance of perfectionism, but that it is also possible to reverse this. Clinical implications include the identification of one likely mechanism of therapeutic change within existing treatments, as well as identification of an appropriate evidence-based focus for future treatment development. Targeting underlying functional mechanisms, such as biased interpretation, has the potential to offer transdiagnostic benefits.
Differentiating perfectionistic strivings and perfectionistic concerns, the present study examined how perfectionism predicts what coping strategies people use, when dealing with failures, and how perfectionism and coping influence people's satisfaction. A sample of 149 students completed daily reports for 3-14 days, reporting the most bothersome failure they experienced during the day, what strategies they used to cope with the failure, and how satisfied they felt at the end of the day. Multilevel regression analyses showed that perfectionistic concerns predicted more frequent use of self-blame, less frequent use of active coping and acceptance, and higher satisfaction at the end of the day, whereas perfectionistic strivings predicted less frequent use of self-blame and higher satisfaction. Although positive reframing, acceptance, and humor predicted higher satisfaction for all students, further analyses showed that positive reframing coping was particularly helpful for students high in perfectionistic concern. The findings suggest that accommodative coping strategies are generally helpful in dealing with personal failures, with positive reframing being a coping strategy that works particularly well for people high in perfectionistic concerns (who are prone to dissatisfaction) to achieve higher satisfaction at the end of the day.
Perfectionism may be a premorbid risk factor for eating disorders. Evidence of familial transmission suggests features of perfectionism may be genetically determined. This study examines the structure of perfectionism using classical twin design models.
Independent (IP) and common (CP) pathway models are used to investigate the extent to which genetic and environmental factors can help to identify and differentiate three behavioral domains of perfectionism as measured by a shortened version of the Multidimensional Perfectionism Scale (MPS) [Frost et al. (1990). Cognit. Ther. Res. 14: 449-468]. Three of the original subscales were included: Personal standards (PS), Doubts about actions (DA), Concern over mistakes (CM). We studied a sample of 1022 paired and unpaired female twins from the Mid-Atlantic Twin Registry.
MZ correlations were consistently higher than DZ twin correlations for all three composite subscales. The multivariate independent pathway model provided a better fit to the twin correlations then did the more parsimonious common pathway model suggesting the pattern of familial resemblance for the three subscales is not well characterized by a unidimensional perfectionism factor. CM phenotypic variance was completely accounted for by common heritability influences in both the IP and CP models. Based on the IP model results, there was evidence that PS and CM but not DA shared some common genetic effects, with DA and CM sharing some common environmental factors.
These multivariate twin modeling results support conceptualizations of perfectionism as a multidimensional construct. The biometric structural results for the three subscales examined here suggest CM is the core feature of Perfectionism with DA and PS serving as indicators of CM. Although not the best fitting model, the common pathway model estimated this behavioral domain to be isomorphic with the construct of perfectionism. The better fitting independent pathway model provided evidence of non-trivial differences in the pattern of heritability for CM, DA, and PS.
It is not unusual to open the daily newspaper to see headlines “Female stars relegated to the underclass” referring to the “…discrimination that resulted in Australia’s women Olympic basketball players flying to London in economy class, while the men travelled in business class” (The Age, July, 20, 2012, p. 1). Then two pages further on, “Most women say ‘I do’ to husband’s name”. Reporting on a recent study by sociologist, it was stated that the vast majority of women take their husband’s name at marriage with 90 % of children also having their father’s, not their mother’s, surname (The Age, July, 20, 2012, p. 5). Then a week later, “Women’s work never done and pay still lousy”. Reporting information from the Bureau of Statistics, the headline pointed out that “Men are better paid, but women are better educated. Men dominate the top executive jobs, at least in business, while women do most of the unpaid work at home” (The Age, July, 28, 2012, p. 5). One cannot but wonder what this differential treatment of men and women in our society can have on women’s self-image and their self-acceptance. History and the research literature in fact paint a complex picture of gender self-image and self-acceptance.
In the last several years, there has been a growing interest in the study and understanding of personality disorders. Patients with personality disorders have been part of the clinician’s case load since the beginning of the recorded history of psychotherapy; the general psychotherapeutic literature on the treatment of personality disorders, however, has emerged more recently and is growing quickly. The main theoretical orientation in the present literature is psychoanalytic (Abend, Porder, & Willick, 1983; Chatham, 1985; Goldstein, 1985; Gunderson, 1984; Horowitz, 1977; Kernberg, 1975, 1984; Lion, 1981; Masterson, 1978, 1980, 1985; Reid, 1981; Saul & Warner, 1982). Millon (1981) is one of the few volumes in the area of personality disorders that offers a behavioral focus, and the volume by Beck, Freeman and associates (1989) will be the first to offer a specific cognitive-behavioral focus. This is of interest, in that leading cognitive therapists have been, and remain, interested in “personality disorder” and “personality change” (Hartman & Blankenstein, 1986). When Beck (1963a,b) and Ellis (1957a, 1958) first introduced cognitive approaches, they drew upon the ideas of “ego analysts,” derived from Adler’s critiques of early Freudian psychoanalysis. Though their therapeutic innovations were seen as radical, their earliest cognitive therapies were, in many ways, “insight therapies” in that the therapy was assumed to change a patient’s overt “personality,” whether or not the therapy changed some hypothesized underlying personality. Although Beck and Ellis were among the first to use a wide array of behavioral treatment techniques, including structured in vivo homework, they have consistently emphasized the therapeutic impact of these techniques on cognitive schemata and have argued in favor of the integration of behavioral techniques into therapy within a broad framework that has some roots in prior analytic practice (Beck, 1976; Ellis & Bernard, 1985); they and their associates have emphasized the impact of treatment for particular types, or styles, of cognitive errors on dysfunctional self-concepts, as well as on presenting focal problems (Beck & Freeman, 1989; Ellis, 1985; Freeman, 1987).
describe the key phenomenological differences between shame and guilt / review the extant theoretical and empirical literature relating shame and guilt to depression / describe results from several independent studies bearing on the relationship of shame and guilt to depression
study 1 demonstrates that the states of shame, guilt, and depression represent distinct phenomenological experiences / studies 2 and 3, however, indicate that a dispositional tendency to experience shame, but not guilt, is an important correlate of depressive symptomatology, above and beyond that accounted for by attributional style / [subjects were aged 17–64 years] (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The transdiagnostic approach to theory and treatment of psychological disorders is gaining increasing interest. A transdiagnostic process is one that occurs across disorders and explains their onset or maintenance. The purpose of this review is to provide evidence that perfectionism is a transdiagnostic process that it is elevated in anxiety disorders, eating disorders, depression, obsessive compulsive personality disorder and somatoform disorders. Data are also reviewed to show that perfectionism can explain aetiology as it is a prospective predictor of depression and eating disorders. Perfectionism is also demonstrated to predict poorer outcome to treatment for anxiety disorders, eating disorders and depression, suggesting the need for specific treatment of perfectionism. Evidence is provided to demonstrate that perfectionism can be successfully treated with cognitive behavioural therapy which results in reduction in psychopathologies. Clinical guidelines are outlined to assist in treatment planning for individuals with elevated perfectionism.
Metakognitionen bei Zwangsstörungen: In der aktuellen Literatur zu Zwang werden kognitive Theorien als bedeutsam für die Erklärung der Entstehung und Aufrechterhaltung der Zwangsstörung erachtet. Bei Wells (2000) sind dies Metakognitionen auf einer mittleren Abstraktionsebene, die "Denken über das Denken" beinhalten. In der vorliegenden Studie wurden auf der Grundlage vorhandener Literatur zehn für Zwang relevante Themenbereiche ausgewählt und dazu Items auf einer mittleren Abstraktionsebene - Einstellungen zu Gedanken und Gefühlen - formuliert. In einer Pilotstudie wurden die Items abgeändert und schließlich das Inventar "Zwangsaufrechterhaltende Überzeugungen zu Gedanken und Gefühlen" ZAGG erstellt. Zunächst wurde anhand der Daten von 215 Personen mit Zwangsstörung eine Faktorenanalyse durchgeführt mit anschließender Itemreduktion und Skalenbildung. Anschließend wurde der ZAGG-Fragebogen auf Reliabilität, externe Validität, Änderungssensitivität, Zusammenhang mit Therapieerfolg und Spezifität untersucht. In diese Berechnungen gingen die Daten von 40 Zwangspatienten, 40 Patienten mit Agoraphobie/Panikstörung, 40 Patienten mit Depression sowie 39 gesunden Kontrollpersonen ein. Besonderheit dabei war der Ausschluss von Komorbidität der jeweils anderen Erkrankungen. Ergebnisse der Studie: 1) In der Faktorenanalyse ergaben sich 5 Dimensionen, davon enthalten 3 dysfunktionale und 2 positive Einstellungen gegenüber Gedanken/Gefühlen. Die Skalen sind: (1) Schuld/Scham, (Angst, Selbstwert) (2) Kontrolle (Verantwortung, Perfektionismus) und (3) Zweifel (an Gedächtnis und Sinneswahrnehmungen), (4) Akzeptanz (gegenüber anderen) und (5) Gelassenheit (gegenüber eigenen Gedanken/Gefühlen). 2) Alle Skalen erwiesen sich als konsistent und stabil bei einem Retest-Intervall von 5 Tagen. Außerdem zeigten sie sich in hohem Maße änderungssensitiv durch die Therapie. 3) Bezüglich aller weiteren Daten unterschieden sich pathologische (Skalen 1-3) von gelassenen Einstellungen (Skalen 4+5): die Skalen Schuld, Kontrolle und Zweifel zeigten überwiegend Zusammenhänge mit der Zwangssymptomatik, insbesondere mit Zwangsgedanken. Die konvergente Validität ist gut, außerdem bestehen deutliche Zusammenhänge mit dem Therapieerfolg. Die diskriminante Validität ist nicht zufriedenstellend, die Zusammenhänge mit Ängstlichkeit und Depressivität sind genauso hoch wie mit Maßen der Zwangssymptomatik. 4) Bezüglich der Spezifität zeigte sich für diese Skalen folgendes: Gesunde haben deutlich niedrigere Werte als alle klinischen Gruppen. Die Angstpatienten wiederum haben höhere Werte als die gesunden, jedoch signifikant niedrigere Werte als Depressive und Zwangspatienten. Zwischen Zwangspatienten und Depressiven gibt es keine Unterschiede. Die Skalen Schuld, Zweifel und Kontrolle erweisen sich somit als zwangs- und depressionsrelevant. 5) Die Skalen Akzeptanz und Gelassenheit erweisen sich weder als valide, noch als psychopathologisch relevant. Diskussion und Ausblick: Die Ergebnisse weisen auf eine Gültigkeit der Theorie von Wells für Zwang und Depression hin. Die Bedeutung für aktuelle Modelle der Depression wird diskutiert. Die größere kognitive Ähnlichkeit der Zwangsstörung mit Depression als mit Agoraphobie/Panikstörung gibt Anstoß für weitere Untersuchungen zur kognitiven Verwandtschaft der drei Erkrankungen.
Socially anxious individuals tend to have elevated levels of perfectionism and engage in excessive rumination following social situations. The present research aimed to examine perfectionism, in both state and trait forms, as a predictor of post-event rumination. Socially anxious students (N = 104) completed measures of trait perfectionism prior to, and state perfectionism following, an anxiety inducing speech task. Post-event rumination was assessed 2 days later. State and trait perfectionism were significant predictors of post-event rumination (2 days later), while controlling for baseline social anxiety, depression and state anxiety. These results support the need to target perfectionism in treatments for social anxiety disorder.
The current study extended research linking trait perfectionism with health symptoms by examining perfectionism from a cognitive perspective focused on perfectionistic automatic thoughts in psychosomatic symptoms. It was postulated that a cognitive preoccupation with needing to be perfect is a specific form of rumination implicated in health problems. In addition, we evaluated daily hassles and negative affect as possible mediators of the link between perfectionistic automatic thoughts and psychosomatic symptoms. A sample of 228 participants completed the Perfectionism Cognitions Inventory and measures of daily hassles, positive affect, negative affect, and psychosomatic symptoms. As expected, perfectionistic automatic thoughts were linked significantly with psychosomatic symptoms, daily hassles, and trait negative affect. Tests of mediational effects indicated that daily hassles and negative affect mediated the link between perfectionistic automatic thoughts and psychosomatic symptoms and this pattern held for both men and women. The results indicate that people with frequent thoughts about needing to be perfect are susceptible to experiencing more frequent psychosomatic symptoms and should benefit from stress reduction training and cognitive-behavioral interventions focused on reducing these thoughts.
Transdiagnostic cognitive-behavioral therapy (CBT) for anxiety and depression has been of growing interest in psychotherapy research. In this article we discuss several fundamental issues raised by contributors to this special issue on transdiagnostic CBT for emotional disorders. Although researchers have tended to assume that interventions are transdiagnostic because they are labeled as such, the actual boundary between transdiagnostic and disorderspecific treatments may be far less clear than previously acknowledged. Nevertheless, there are many reasons to advocate for greater attention to a transdiagnostic perspective, not the least being the large shared variance in the emotional disorders, which is often overlooked in contemporary disorder-specific CBT protocols. Evidence of the efficacy of transdiagnostic CBT for anxiety and depression is limited, and issues facing comparative outcome and process studies are discussed. The article concludes by suggesting a programmatic framework for advancing a theory-driven, empirically based psychotherapy research agenda that could lead to the development of a truly integrated, transdiagnostic CBT for anxiety and depression.
Provides an overview of the numerous approaches to the study of perfectionism and related conceptual issues, which have a direct bearing on the findings from research into the role of perfectionism in maladjustment. This chapter also discusses such issues as the negative and positive aspects of perfectionism and conceptual and empirical significance of distinguishing the actual standards that influence behavior versus the evaluative reactions involving the attainment of these standards. It concludes with a summary of research on perfectionism from a treatament perspective as well as a description of some of the problems associated with treating perfectionists either for the perfectionism itself, or related disorders. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This online patient workbook is a radical departure from disorder-specific treatments of various emotional disorders, and is designed to be applicable to all anxiety and unipolar mood disorders, as well as other disorders with strong emotional components, such as many somatoform and dissociative disorders. It covers the Unified Protocol (UP), which capitalizes on the contributions made by cognitive-behavioral theorists by distilling and incorporating the common principles of CBT present in all evidenced based protocols for specific emotional disorders, as well as drawing on the field of emotion science for insights into deficits in emotion regulation. It discusses the seven modules of UP, and focuses on four core strategies: becoming mindfully aware of emotional experience; reappraising rigid emotion laden attributions; identifying and preventing behavioral and emotional avoidance; and facilitating exposure to both interoceptive and situational cues associated with emotional experiences.
Understanding comorbidity is an important challenge for psychopathology researchers and diagnostic systems given the repeated finding of very high comorbidity rates among Axis I disorders in psychiatric samples. This paper proposes that perfectionism may be a critical factor for understanding levels of comorbidity, and a conceptual argument for the importance of perfectionism as an explanatory construct for comorbidity is advanced. The link between perfectionism and comorbidity in a large sample of patients (N = 345) who attended an anxiety disorders clinic is examined using a variety of methods. Diagnoses were established using the Structured Clinical Interview for DSM-IV (SCID-IV), and perfectionism was assessed using both the Hewitt and Flett and Frost Multidimensional Perfectionism Scales. Overall, scores on both the Hewitt and Flett and Frost perfectionism scales were correlated with the number of diagnoses, and a logistic regression analysis, controlling for current symptoms, showed that maladaptive evaluative concerns perfectionism in particular predicted higher levels of comorbidity.
Coaching makes exciting claims about helping clients to realize their potential but the ‘unexciting’ side of coaching is often
tackling the same goal-blocking problems found in therapy. REBT can be used by coaches to extend and deepen their understanding
of psychological issues such as procrastination which is the subject of this article. A definition of procrastination is offered
along with views on what causes it and descriptions of six fundamental procrastination styles. A coaching case study is used
to guide the reader through the ABCDE model of psychological disturbance and change as well as examining some of the pitfalls
involved in tackling procrastination.
This study is a replication and extension of previous research investigating the relationship between specific, maladaptive aspects of perfectionism and social phobia. The Multidimensional Perfectionism Scale (MPS-F; R. O. Frost, P. Marten, C. Lahart, & R. Rosenblate, 1990) was administered to a consecutive series of adult outpatients (N = 61) attending a group-based cognitive–behavioral treatment program for social phobia. MPS-F variables, Concern over Mistakes (CM) and Doubts about Actions (DA), were both associated with social anxiety severity at pretreatment. Despite the theoretical relevance of the CM dimension to social anxiety, the relationship between these two constructs did not remain significant once neuroticism and depression were controlled. Contrary to predictions, CM failed to predict treatment outcome beyond pretreatment social anxiety. Results are discussed in terms of the overlap between perfectionistic concern about mistakes and fear of negative evaluation in social phobia.
The current research examined the associations among perfectionistic automatic thoughts, trait perfectionism, negative automatic
thoughts, and bulimic automatic thoughts. A non-clinical sample of 94 undergraduate women completed the Perfectionism Cognitions
Inventory, the Multidimensional Perfectionism Scale, the Automatic Thoughts Questionnaire, and the Bulimic Automatic Thoughts
Test. Correlational tests revealed that two automatic thoughts measures (perfectionistic automatic thoughts and negative automatic
thoughts) and two trait perfectionism measures (self-oriented and socially prescribed perfectionism) were associated significantly
with bulimic automatic thoughts with the strongest association being between perfectionistic automatic thoughts and bulimic
automatic thoughts. Regression analyses showed that perfectionistic thoughts predicted unique variance in bulimic thoughts
beyond variance attributable to trait perfectionism and negative automatic thoughts. The findings are discussed in terms of
the need to incorporate an explicit focus on perfectionistic automatic thoughts into treatment interventions and conceptual
models of perfectionism and eating disorders.
KeywordsAutomatic thoughts–Cognitions–Perfectionism–Bulimia–Anorexia–Self-schema
The current study investigated the role of contingent self-worth in perfectionism and depression. It was hypothesized that
perfectionism is associated with depression because perfectionists base their self-worth on being successful and on the need
to be actively working toward their goals. A sample of 170 female university students completed measures of conditional self-worth,
perfectionism traits, perfectionism cognitions, and depressive symptoms. Structural equation modeling revealed that a factor
interpreted as Evaluative Concerns Perfectionism was associated strongly with contingent self-worth, which was, in turn, related
to depressive symptomatology. In addition, contingent self-worth mediated the association between perfectionism cognitions
and depression. Other analyses revealed that measures of self-oriented perfectionism that are often viewed as highly similar
actually differed in terms of their associations with contingent self-worth. The theoretical and practical implications of
the associations between perfectionism and contingent self-worth are discussed.
This study further evaluates the efficacy of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP). A diagnostically heterogeneous clinical sample of 37 patients with a principal anxiety disorder diagnosis was enrolled in a randomized controlled trial (RCT) involving up to 18 sessions of treatment and a 6-month follow-up period. Patients were randomly assigned to receive either immediate treatment with the UP (n=26) or delayed treatment, following a 16-week wait-list control period (WLC; n=11). The UP resulted in significant improvement on measures of clinical severity, general symptoms of depression and anxiety, levels of negative and positive affect, and a measure of symptom interference in daily functioning across diagnoses. In comparison, participants in the WLC condition exhibited little to no change following the 16-week wait-list period. The effects of UP treatment were maintained over the 6-month follow-up period. Results from this RCT provide additional evidence for the efficacy of the UP in the treatment of anxiety and comorbid depressive disorders, and provide additional support for a transdiagnostic approach to the treatment of emotional disorders.
This study was designed to determine whether perfectionism, as assessed by the revised almost perfect scale (APS-R; R. B.
Slaney, M. Mobley, J. Trippi, J. S. Ashby, & D. G. Johnson, 1996), was a significant predictor of obsessive-compulsive (OC)
symptoms in a non-clinical sample of 308 university students. Perfectionistic discrepancy emerged as a general predictor of
obsessive thought difficulties and compulsive checking behavior. Excessive concerns about making mistakes also emerged as
a significant specific predictor of obsessive cognitive but not behavioral symptoms after other dimensions of perfectionism
were controlled. An interaction effect indicated that students with high discrepancy but low standards were more likely to experience OC-related washing symptoms than other students. The general effects of perfectionism
on OC symptoms, the specific effects of certain perfectionism dimensions over others, and other perfectionism research results,
implicate APS-R discrepancy as a core dimension of maladaptive perfectionism and APS-R high standards as either benign or
protective in the associations with OC symptoms.
This study compared 16 women who had undergone cosmetic surgery (i.e., patients) to 16 women who had not (i.e., controls). Patients and controls were matched on relevant demographics (e.g., age). Socially prescribed perfectionism (i.e., perceiving that others demand perfection of oneself) and perfectionistic self-promotion (i.e., assertively promoting one’s supposed perfection to others) were significantly elevated in patients relative to controls. Extreme perfectionism was also shown to substantially
increase the likelihood of undergoing cosmetic surgery. Results are discussed with respect to perfectionists’ cognitive style, interpersonal needs, chronic dissatisfaction, and hyper-competitive orientation. Perfectionism is considered as a possible contraindication for cosmetic surgery.
This study investigated the relationship between premorbid and postmorbid perfectionism, fatigue, and severity of depression in 43 CFS patients and 80 university students. Perfectionism in CFS patients and students was measured by the Multidimensional Perfectionism Scale (MPS-F; Frost, R. O., Marten, P., Lahart, C. M., & Rosenblate, R., 1990). CFS patients also retrospectively reported premorbid levels of perfectionism using a modified MPS-F. Results showed that CFS patients reported higher premorbid and postmorbid levels of both adaptive and maladaptive perfectionism compared to normal controls, although CFS attenuated certain aspects of perfectionism. Perfectionism was associated with severity of depression in CFS patients, even after controlling for demographic variables and concurrent levels of fatigue. Perfectionism was also associated with severity of fatigue in students, but not in CFS patients. Overall, results suggest that there may be no simple dichotomous distinction between adaptive and maladaptive perfectionism. Theoretical and clinical implications of these findings are discussed.
The associations between perfectionism, anger, somatic health, and positive affect were examined in 184 Swedish adults from a randomly selected population sample. Somewhat unexpectedly, trait anger was found to be associated with self-oriented perfectionism rather than with socially prescribed perfectionism. Both socially prescribed perfectionism and self-oriented perfectionism showed weak positive correlations with self-reported somatic complaints, particularly symptoms of tension and fatigue, and more clearly in women than in men, whereas other-oriented perfectionism appeared as a predictor of whether the participants were undergoing medical treatment or not. Finally, the results did not support the notion of self-oriented perfectionism representing a positive, adaptive dimension of perfectionism; on the contrary, this dimension was found to be negatively associated with positive affect.
Considerable theory and anecdotal evidence has suggested that patients with Obsessive-Compulsive Disorder (OCD) are more perfectionistic. Evidence with non-clinical populations supports this hypothesis. However, no data are available on levels of perfectionism among patients diagnosed with OCD. The present study extends findings on perfectionism and OCD by comparing perfectionism levels of OCD-diagnosed patients with those of non-patients and a group of patients diagnosed with panic disorder with agoraphobia (PDA). As predicted, patients with OCD had significantly elevated scores on Total Perfectionism, Concern Over Mistakes, and Doubts About Actions compared to non-patient controls. However, they did not differ from patients with PDA on Total Perfectionism or Concern Over Mistakes. Patients with OCD did have higher Doubts About Actions scores than those with PDA. The implications for the role of perfectionism in OCD and other anxiety disorders are discussed.
Research findings on the specific relationships between beliefs and OCD symptoms have been inconsistent, yet the existing studies vary in their approach to measuring the highly heterogeneous symptoms of this disorder. The Dimensional Obsessive-Compulsive Scale (DOCS) is a new measure that allows for the assessment of OCD symptom dimensions, rather than types of obsessions and compulsions per se. The present study examined the relationship between OCD symptom dimensions and dysfunctional (obsessive) beliefs believed to underlie these symptom dimensions using a large clinical sample of treatment-seeking adults with OCD. Results revealed that certain obsessive beliefs predicted certain OCD symptom dimensions in a manner consistent with cognitive-behavioral conceptual models. Specifically, contamination symptoms were predicted by responsibility/threat estimation beliefs, symmetry symptoms were predicted by perfectionism/certainty beliefs, unacceptable thoughts were predicted by importance/control of thoughts beliefs and symptoms related to being responsible for harm were predicted by responsibility/threat estimation beliefs. Implications for cognitive conceptualizations of OCD symptom dimensions are discussed.
Cognitieve gedragsmodellen dichten een belangrijke rol toe aan disfunctionele gedachten in het ontstaan en voortbestaan van obsessief compulsieve stoornis, ook wel dwangstoornis genoemd. In de studies in dit proefschrift is de relatie tussen disfunctionele gedachten en obsessief-compulsieve stoornis nader onderzocht. In een behandelstudie werden veranderingsprocessen tijdens cognitieve therapie onderzocht bij een kleine groep patiënten. De resultaten laten zien dat de geloofwaardigheid van disfunctionele gedachten afneemt bij succesvolle behandeling. Echter, in tegenstelling tot de verwachtingen gebaseerd op het cognitieve gedragsmodel, bleken deze veranderingen niet altijd samen te hangen met veranderingen in angst en gedrag. Tevens vielen individuele verschillen op in het patroon van verandering (gradueel versus dynamisch). In het vragenlijstonderzoek bij grote groepen patiënten werden significante associaties gevonden tussen cognitieve thema’s en verschillende symptoom dimensies. Tevens konden er subgroepen worden onderscheiden op basis van de relevantie van cognitieve thema’s, waaronder een groep (38.4%) patiënten die geen verhoogde scores op disfunctionele gedachten liet zien. De onderscheiden subgroepen waren in lijn met het recente idee dat er een tweedeling gemaakt kan worden tussen dwangklachten gerelateerd aan verantwoordelijkheid, controle en mogelijke schadelijke consequenties en dwangklachten die lijken voort te komen uit een behoefte dat dingen precies goed zijn. Concluderend kunnen we stellen dat disfunctionele gedachten betrokken lijken te zijn bij het veranderingsproces tijdens cognitieve gedragstherapie en bijdragen aan een betekenisvolle indeling van obsessief-compulsieve subgroepen. Tot slot onderstrepen de studies in dit proefschrift het belang van specifieke aandacht voor de betekenis van individuele verschillen.
Perfectionism is a risk and maintaining factor for eating disorders, anxiety disorders and depression. The objective of this paper is to review the four bodies of evidence supporting the notion that perfectionism is a transdiagnostic process. First, a review of the literature was conducted that demonstrates the elevation of perfectionism across numerous anxiety disorders, depression, and eating disorders compared to healthy controls. Data is presented that shows perfectionism increases vulnerability for eating disorders, and that it maintains obsessive-compulsive disorder, social anxiety and depression as it predicts treatment outcome in these disorders. Second, evidence is examined showing that elevated perfectionism is associated with co-occurrence of psychopathology. Third, the different conceptualisations of perfectionism are reviewed, including a cognitive-behavioural conceptualisation of clinical perfectionism that can be utilised to understand this transdiagnostic process. Fourth, evidence that treatment of perfectionism results in reductions in anxiety, depression and eating pathology is reviewed. Finally, the importance of clinicians considering the routine assessment and treatment of perfectionism is outlined.
This paper reviews the characteristics of clinical perfectionism and proposes a new definition of the phenomenon. It is suggested that the defining feature of clinically significant perfectionism is the overdependence of self-evaluation on the determined pursuit (and achievement) of self-imposed personally demanding standards of performance in at least one salient domain, despite the occurrence of adverse consequences. It is suggested that such clinical perfectionism is maintained by the biased evaluation of the pursuit and achievement of personally demanding standards. Specifically, it is suggested that people with perfectionism react to failure to meet their standards with self-criticism. If they do meet their standards, the standards are re-evaluated as being insufficiently demanding. Anorexia nervosa and bulimia nervosa are considered to have a particular relationship to perfectionism, with both disorders often being direct expressions of perfectionism. Under these circumstances self-evaluation is dependent on the pursuit and attainment of personally demanding standards in the domain of control over eating, shape and weight. The implications of this analysis for research and practice are considered.
This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders. Two separate but interrelated lines of argument are developed. One is that the leading evidence-based theory of the maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms. Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes. Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders. Together, these two lines of argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa. In the final sections of the paper we describe a transdiagnostic treatment derived from the new theory, and we consider in principle the broader relevance of transdiagnostic theories of maintenance.
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