ArticlePDF Available

Perfectionism, worry, rumination, and distress: A meta-analysis of the evidence for the perfectionism cognition theory

Authors:

Abstract

The perfectionism cognition theory (PCT) provides a theoretical account of the cognitive mechanisms of perfectionism, with an emphasis on the function of cognitive perseveration. The framework of PCT provides three central themes: (1) that both self-oriented perfectionism (SOP) and socially prescribed perfectionism (SPP) are correlated with rumination and worry; (2) that perfectionists are more likely to suffer from interrelated forms of cognitive perseveration; (3) that rumination and worry are important variables that contribute to vulnerability to emotional distress and physical illness. A meta-analysis was performed to examine the three themes of PCT. The results suggested that both SOP and SPP were positively correlated with worry and rumination. Moderator analyses suggested that both SOP and SPP are correlated with various forms of cognitive perseveration and meta-analytic mediation models suggested worry and rumination contribute to the relationship between perfectionism and distress. The findings of this meta-analysis provide evidence to support the three themes of PCT and shed light on the mechanisms and processes of perfectionism cognition.
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
Perfectionism, Worry, Rumination, and Distress: A Meta-Analysis of the Evidence for
the Perfectionism Cognition Theory
Abstract
The perfectionism cognition theory (PCT) provides a theoretical account of the
cognitive mechanisms of perfectionism, with an emphasis on the function of cognitive
perseveration. The framework of PCT provides three central themes: (1) that both
self-oriented perfectionism (SOP) and socially prescribed perfectionism (SPP) are
correlated with rumination and worry; (2) that perfectionists are more likely to suffer
from interrelated forms of cognitive perseveration; (3) that rumination and worry are
important variables that contribute to vulnerability to emotional distress and physical
illness. A meta-analysis was performed to examine the three themes of PCT. The
results suggested that both SOP and SPP were positively correlated with worry and
rumination. Moderator analyses suggested that both SOP and SPP are correlated with
various forms of cognitive perseveration and meta-analytic mediation models
suggested worry and rumination contribute to the relationship between perfectionism
and distress. The findings of this meta-analysis provide evidence to support the three
themes of PCT and shed light on the mechanisms and processes of perfectionism
cognition.
Keywords: rumination, worry, cognitive perseveration, perfectionism cognition
theory
1
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
1. Introduction
During the past two decades, important studies have provided empirical evidence
for and theoretical models of perfectionism (e.g. Frost, Marten, Lahart, & Rosenblate,
1990; Hewitt & Flett, 1991; Stoeber & Otto, 2006). Researchers have agreed that
perfectionism is a vulnerability factor for psychological issues like depression and
anxiety (e.g. Flett, Madorsky, Hewitt, & Heisel, 2002; Frost & DiBartolo, 2002).
Recently, Flett, Nepon and Hewitt (2016) proposed the perfectionism cognition theory
(PCT) to provide a theoretical account of the cognitive mechanisms of perfectionism,
with an emphasis on the function of cognitive perseveration. As two comparable
forms of cognitive perseveration, rumination and worry play an important role in the
perfectionism-distress link because perfectionists who are at risk of mental health
issues tend to ruminate and worry. Therefore, the correlation between cognitive
perseveration and perfectionism could shed light on the cognitive processes and
mechanisms of perfectionism.
1.1. Perfectionism
Perfectionism is defined as the setting of and striving for excessively high
standards of personal performance and overly critical evaluation of oneself (Frost et
al., 1990). Early researchers treated perfectionism as a unitary construct, describing
perfectionism as a fear of failure due to poor self-esteem (Beck, 1976; Ellis, 1962;
Missildine, 1963), and early unidimensional perfectionism measurements, such as the
perfectionism subscales of the Eating Disorder Inventory (Garner, Olmstead, &
Polivy, 1983) and the Burns Perfectionism Scale (Burns, 1980), were adopted.
2
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
Hamachek (1978) was the first to propose a multifarious conceptualisation of
perfectionism and to suggest that the different dimensions of perfectionism have
significant functional influence on positive and negative outcomes. Consequently,
researchers developed multidimensional perfectionism measurements that provided
theoretical and empirical advances in terms of the multidimensional construct of
perfectionism (Stoeber & Otto, 2006).
The Multidimensional Perfectionism Scale (MPS-F) was the first
multidimensional perfectionism measurement to assess six dimensions of
perfectionism, including personal standards, organisation, concern over mistakes,
doubts about actions, parental expectations, and parental criticism (Frost et al., 1990).
The MPS-F has been widely used due to its good psychometric properties (Frost &
DiBartolo, 2002). Hewitt and Flett (1991) subsequently looked at the clinical features
of perfectionism and reviewed the relevant literature and developed the
Multidimensional Perfectionism Scale (MPS-HF; Hewitt & Flett, 1991). The MPS-
HF emphasises the importance of both intrapersonal and interpersonal factors and has
three dimensions: self-oriented perfectionism (SOP), socially prescribed
perfectionism (SPP), and other-oriented perfectionism (OOP). Other
multidimensional perfectionism measurements that assess traits of perfectionism have
also emerged, such as the Almost Perfect Scale-Revised (APS-R; Slaney, Rice,
Mobley, Trippi, & Ashby, 2001), the Perfectionism Inventory (PI; Hill et al., 2004),
and the Perfectionism Questionnaire (PQ; Rhéaume, Ladouceur, & Freesto, 2000).
3
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
This meta-analysis adopted MPS-HF as the measurement for perfectionism, because
the PCT focuses on SOP and SPP.
In the multidimensional model of perfectionism proposed by Hewitt and Flett
(1991), the three forms of perfectionism relate to beliefs, motivations, and behaviours.
Self-oriented perfectionists believe that becoming perfect is important to themselves
and set very high personal standards. If a self-oriented perfectionist fails to meet these
standards, they will criticise themselves. In comparison, socially prescribed
perfectionists believe that becoming perfect is important to others and that they need
to be perfect for others. If socially prescribed perfectionists fail to meet their high
expectations, they believe that they will be criticised by others.
In both SOP and SPP, there is an element of self-criticism, whereas other-
oriented perfectionists set high standards for others and expect others to become
perfect. If others fail to meet these standards, other-oriented perfectionists will
criticise them. Therefore, SOP and SPP focus on criticism of the self, whereas OOP
focuses on criticism of others (Hewitt & Flett, 2004). It is clear that concerns about
criticism of the self are correlated with various forms of perseverative cognition (Flett
et al., 2016), therefore, the framework of PCT focuses on SOP and SPP, but not OOP.
SOP has both adaptive and maladaptive features. On the one hand, self-oriented
perfectionists strive for high standards by using adaptive strategies, such as
achievement motivation (Klibert, Langhinrichsen-Rohling, & Saito, 2005), self-
efficacy (Mills & Blankstein, 2000), and positive affect (Frost, Heimberg, Holt,
Mattia, & Neubauer, 1993). On the other hand, SOP is also found to correlate with
4
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
depressive symptoms (e.g. Hewitt & Flett, 1991; Olson & Kwon, 2008) as unrealistic
self-standards and harsh evaluations of the self may generate stress associated with
failure and negative emotions. In contrast, SPP is only associated with negative
psychological outcomes, such as depressive symptoms (Klibert, Langhinrichsen-
Rohling, & Saito, 2005), trait anger (Dunkley & Blankstein, 2000), suicide proneness
(Blankstein, Lumley, & Crawford, 2007), and procrastination (Xie, Yang, & Chen,
2018).
1.2. Worry and rumination
Worry and rumination are similar, but distinguishable forms of perseverative
cognition. Worry is defined as thoughts and images about affectively negative and
relatively uncontrollable future events (Borkovec, Ray, & Stober, 1998; Borkovec,
Robinson, Pruzinsky, & DePree, 1983). Rumination is characterised by repetitive,
intrusive, and past-oriented cognitions about negative experiences (Papageorgiou &
Siegle, 2003). Worry and rumination have similar thought processes (i.e. repetitive
and negative) and are both chronic (Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008),
but the type of goal orientation associated with them differs. Worry is more future-
oriented, while rumination is considered to be much more past-oriented (Watkins,
Moulds, & Mackintosh, 2005). It should also be noted that worry is focused on
events, while rumination is focused on feelings (Nolen-Hoeksema, Wisco, &
Lyubomirsky, 2008).
Self-report questionnaires are typically adopted to assess worry and rumination.
The most common measurement of worry is the Penn State Worry Questionnaire
5
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
(PSWQ; Meyer, Miller, Metzger, & Borkovec, 1990), which is widely used to assess
trait worry. Similarly, the Intolerance of Uncertainty Scale (IUS; Buhr & Dugas,
2002) assesses worry-related cognitive factors. The most common measurements of
rumination are the Response Styles Questionnaire (RSQ; Nolen-Hoeksema &
Morrow, 1991) and the Ruminative Response Scale (RRS; Treynor, Gonzalez, &
Nolen-Hoeksema, 2003), which require participants to recall depressive experiences
and to assess the degree of their ruminative symptoms. Although these two
questionnaires are the most widely used, researchers also have developed other self-
report questionnaires of rumination (Whitmer & Gotlib, 2013), such as the
Rumination-Reflection Questionnaire (RRQ; Trapnell & Campbell, 1999) and
Rumination About an Interpersonal Offense (RIO; Wade, Vogel, Liao, & Goldman,
2008).
Individual differences and situational characteristics have been found to be the
determinants of perseverative cognition. Low self-confidence in problem-solving
abilities causes worrisome thinking (Davey, 1994) and a low internal locus of control
causes rumination (Watson , Clark, & Tellegen, 1984). Gender is a common factor
that impacts on the ruminative response style according to the response styles theory
(RST; Nolen-Hoeksema, 1987) and Nolen-Hoeksema, Girgus, and Seligman (1991)
found that women are more likely to be ruminative. Personality traits like neuroticism
and perfectionism are found to be important predictors of perseverative cognition
(Blankstein & Lumley, 2008; Wänke & Schmid, 1996). Several models of
perseverative cognition also highlight the importance of goals as the failure of goal
6
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
attainment leads to repetitive thought, which is likely to continue until the goal is
achieved (Higgins & Carver, 1990; Martin & Tesser, 1996). These models suggest that
the disruption of goals that are important to an individual’s life is more likely to cause
perseverative cognition.
Several findings have provided evidence that perseverative cognition is
correlated with distress and that it can maintain and exacerbate negative affect in
several ways. Repetitive thoughts make individuals dwell on their problems rather
than solve them or reduce the difficulties they face, which causes a high level of
perceived stress (Just & Alloy, 1997; Nolen-Hoeksema, 2000). Perseverative
cognition can prolong negative affect as individuals tend to interpret their life events
in an irrational and negative way (Nolen-Hoeksema, Morrow, & Fredrickson, 1993).
Distress can also trigger worry and rumination, which then makes individuals feel
more distressed, leading to an emotional and cognitive vicious cycle (Spasojević &
Alloy, 2001). Lyubomirsky and Tkach (2004) suggested that the correlation between
perseverative cognition and distress is due to impaired motivation, biased memory,
and poor health behaviours.
1.3. Perfectionism Cognition Theory
PCT is a theoretical model that provides a framework for perfectionism to
explicate its cognitive processes and mechanisms (Flett et al., 2016). This model
highlights the importance of two forms of perseverative cognition: worry and
rumination. The framework of PCT provides three central themes: (1) that both SOP
and SPP are correlated with rumination and worry; (2) that perfectionists are more
7
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
likely to suffer from interrelated forms of cognitive perseveration; (3) that rumination
and worry are important variables that contribute to vulnerability to emotional distress
and physical illness.
The first theme of PCT focuses on the relationship between perfectionism and
perseverative cognition and suggests that perfectionists are more likely to be chronic
overthinkers. Perfectionists fear negative evaluations by themselves and others, which
can be magnified by worry and rumination. It is clear that evaluation fears, which
activate various forms of cognitive perseveration, can contribute to the relationship
between perfectionism and cognitive perseveration. Self-evaluative and socially
evaluative concerns are important to the nature of perfectionism and provide a
theoretical account of perseverative cognition among perfectionists. The findings of
empirical studies have provided evidence that both SOP and SPP are correlated with
worry and rumination in college and community samples (Olson & Kwon, 2008;
Randles, Flett, Nash, McGregor, & Hewitt, 2010; Senra, Merino, & Ferreiro, 2017;
Wilson, Hunter, Rasmussen, & McGowan, 2015).
Although there are evidences supported the links between perfectionism and
perseverative cognition, the magnitude of the correlation is still unclear. Meta-analysis
is a statistical method to aggregate and synthesize the existing findings from those
studies which focus on a particular topic (Glass, 1976). From this perspective, meta-
analysis is an appropriate method to evaluate the magnitude of correlations between
perfectionism and perseverative cognition. However, to the best of our knowledge,
there is no meta-analysis in terms of perfectionism and perseverative cognition.
8
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
Therefore, the first aim of this study is to meta-analysis method to evaluate the
magnitude of the four comparable correlations between perfectionism and
perseverative cognition (SOP and worry, SPP and worry, SOP, and rumination, and
SPP and rumination).
The second theme of PCT assumes that both SOP and SPP are correlated with
various forms of cognitive perseveration. Flett et al. (2016) used case studies to
survey several types of cognitive perseveration, including mistake rumination, post-
event overthinking, and social comparison rumination, which can exacerbate and
prolong the stress and distress of perfectionists. A range of stressors can elicit various
types of cognitive perseveration that make perfectionists more likely to be concerned
about possible or actual failures. The constant pressure from the physical and social
environment can impair cognitive capacity in chronically stressed perfectionists and
empirical studies indicate that perfectionists are prone to many types of cognitive
perseveration (see Cox & Chen, 2014; Hewitt & Flett, 2007; Treynor, Gonzalez, &
Nolen-Hoeksema, 2003).
Clinical cases of perfectionists can provide evidence regarding the link between
perfectionism and various forms of cognitive perseveration, but research comparing
these links is minimal. There are various types of cognitive perseveration, therefore, it
is necessary to compare the correlations between perfectionism and the multiple types
of overthinking. To assess different forms of cognitive perseveration, researchers
adopt different measurements of worry and rumination, as mentioned above.
Moderator analysis can examine every group of correlation that depends on the
9
0
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
measurements of the included studies. Therefore, the second aim of this study is to
evaluate the correlations between perfectionism and the various forms of cognitive
perseveration.
The third theme of PCT states that worry and rumination can contribute to both
mental and physical health outcomes in perfectionists. Perseverative cognition causes
perfectionists to have more intense negative emotions and stress reactions, which can
lead to perseverating perfectionists having reduced attention and cognitive capacity
and suffering from emotional and physical exhaustion. The cognitive perseveration
hypothesis proposed by Brosschot, Gerin and Thayer (2006) highlights the role of
perseverative cognition in response to a variety of stressors and suggests that worry
and rumination prolong stress-related responses and lead to poor health outcomes.
Many existing studies show that worry and rumination are correlated to psychological
distress among perfectionists (Blankstein & Lumley, 2008; Cox & Chen, 2014;
Nepon, Flett, Hewitt, & Molnar, 2011), but the correlation between cognitive
perseveration and physical illness among perfectionists has not been explored
empirically. Therefore, the present meta-analysis only focuses on the mental health of
perseverating perfectionists.
PCT highlights two contributors (rumination and worry) to the perfectionism
cognitive process and suggests that they mediate the link between perfectionism and
distress. O’Connor, O’Connor and Marshall (2007) found that rumination mediates
the correlation between SOP/SPP and depression and hopelessness, while Short and
Mazmanian (2013) found that both rumination and worry mediate the correlation
10
1
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
between SPP and negative affect. To the best of our knowledge, however, there is a
lack of studies that explore the mediating role of worry in the link between SOP and
mental health. To illuminate the mechanisms of perfectionism cognition, it is therefore
necessary to explore whether worry and rumination mediate the link between
SOP/SPP and psychological distress.
PCT is a theoretical model of cognitive perfectionism’s processes and
mechanisms that provides a better understanding of the role of cognitive perseveration
in perfectionists’ psychological and physical health. The three aims of the present
meta-analysis reflect the three themes of the PCT. The first aim is to evaluate the
magnitude of the correlation between perfectionism and perseverative cognition. The
second aim is to examine the correlations between two dimensions of perfectionism
and the various forms of cognitive perseveration. The third aim is to examine the
mediating roles of cognitive perseveration between multidimensional perfectionism
and distress.
2. Methods
2.1. Literature search
The literature search was conducted using seven databases (ERIC, MEDLINE,
ProQuest Dissertations and Thesis, PsycARTICLES, PsycINFO, PubMed, and Web of
Science) and by using the following search terms: (perfectionism or perfection or
perfectionist or perfectionistic) and (rumination or ruminate or ruminative or worry
or overthinking or repetitive thought or repetitive think or cognitive perseveration).
The publication date was limited to between 1991 and 2018 because the MPS-HF was
11
2
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
first developed in 1991 (Hewitt, et al., 1991). In addition, one chapter of the book by
Flett et al. (2016) that first proposed PCT was reviewed and the reference list was
examined for potential studies. Finally, we contacted several authors via email to
request potential studies and unpublished data sets. The literature search was finalised
in March 2018.
2.2. Inclusion criteria
Each study included in this meta-analysis had to meet four inclusion criteria: the
MPS-HF had to have been used to measure perfectionism; at least one form of
cognitive perseveration, including rumination and worry, had to have been measured;
the correlation coefficient r had to have been reported; and the study had to be written
in English. If a published study and an unpublished study (dissertation) used the same
data set, the published study was included. After screening the full text of the articles,
15 studies met the inclusion criteria. The study selection procedure (see Fig.1)
followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-
Analyses) guidelines (Moher, Liberati, Tetzlaff, & Altman, 2009).
Insert Fig. 1 about here
Fig.1. The PRISMA diagram (Moher et al., 2009).
2.3. Coding
Two authors coded the effect sizes and the characteristics of studies
independently. Any disagreement in the coding was resolved before conducting any
analyses. The correlation coefficient r was coded as the measure of effect size and
every study included in this meta-analysis had to have reported at least one effect size.
12
3
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
We extracted four comparisons of the correlation between perfectionism and cognitive
perseveration: (i) SOP and worry (k = 7, n = 1278); (ii) SPP and worry (k = 7, n =
1278); (iii) SOP and rumination (k = 30, n = 5339); (iv) SPP and rumination (k = 31, n
= 5387). Mean age, percentage of females, country of origin, publication type,
rumination measures, worry measures, depression measures, and anxiety measures
were coded for moderators. Table 1 shows the studies included in this meta-analysis
and their corresponding study characteristics. To test the mediation model, we coded
four correlation matrices: (i) SOP, worry, depression, and anxiety (k = 7, n = 1278);
(ii) SPP, worry, depression, and anxiety (k = 7, n = 1278); (iii) SOP, rumination,
depression, and anxiety (k = 36, n = 6285); (iv) SPP, rumination, depression, and
anxiety (k = 37, n = 6333).
Insert Table 1 about here
2.4. Data analysis
2.4.1. Overall estimated effect sizes. A meta-analysis is used to estimate the
effect sizes from a series of empirical studies addressing the same question (Field &
Gillett, 2010). We conducted the current meta-analysis by using the correlation
coefficient r as the measure of effect size. Although Hedges and Olkin (1985)
suggested that Fisher’s r-to-z transformation can be performed for combining
correlation coefficients, researchers do not completely agree with this procedure (see,
Field, 2001; Hafdahl, 2009; Hunter & Schmidt, 1990). As a meta-analytic mediation
model requires raw correlation matrices, the correlations in this meta-analysis were
not transformed to Fisher’s z for the sake of consistency. In addition, the 95%
13
4
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
confidence intervals of the overall mean effect sizes were reported. Fixed-effects
models are adopted for studies with homogeneity, whereas random-effects models are
adopted for studies with heterogeneity (Cooper, Hedges, & Valentine, 2009). A
significant Q value represents the statistical heterogeneity between studies and
indicates the variation among the effect sizes. I2 reflects the percentage of total
variability due to heterogeneity (Higgins, Thompson, Deeks, & Altman, 2003).
As studies with significant findings are more likely to be published than those
with findings supporting the null hypothesis (Field & Gillett, 2010), publication bias
should be estimated in a meta-analysis. Three strategies were adopted to assess
publication bias in the current meta-analysis. Firstly, Duval and Tweedie’s (2000) trim
and fill method was used to assess the symmetry of the effect size distributions in the
funnel plot. This method estimates the number of missing studies according to the
most extreme results in the meta-analysis and recalculates the estimated effect size to
make the funnel plot more symmetrical. Publication bias exists when the estimated
effect size changes significantly after using the trim and fill method.
Secondly, the fail-safe N method was used to assess publication bias by
calculating the number of studies that would be needed to change the conclusion from
significant to non-significant (Vevea &Woods, 2005). If the fail-safe N is greater than
5k + 10 (k is the number of effect sizes), the result can be considered robust. Thirdly,
Begg’s adjusted rank test (Begg & Mazumdar, 1994) and Egger’s linear regression
test (Egger, Smith, Schneider, & Minder, 1997) were examined for each meta-
analysis. Begg’s adjusted rank test computes Kendall’s tau for the correlation between
14
5
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
the effect size and the sample size and Egger’s linear regression test assesses the
asymmetry of the funnel plots for every effect size. When the statistical p value is less
than .05, it indicates that there is publication bias in the meta-analysis. The metafor
package (Viechtbauer, 2010) was performed for overall effect sizes analyses in the R
environment.
2.4.2. Moderator analyses. Moderators were tested for in the correlations
between perfectionism and cognitive perseveration. As two types of moderators
(categorical and continuous) exist, we conducted corresponding analyses to examine
the moderators that accounted for the heterogeneity in the true effects. Subgroup
analyses were conducted for categorical moderators and meta-regressions were
conducted for continuous moderators (Borenstein, Hedges, Higgins, & Rothstein,
2009). Moderator analyses were also carried out in the metafor package.
2.4.3. Meta-analytic mediation model. To examine the mediating role of
cognitive perseveration between multidimensional perfectionism and distress, we
proposed four mediation models. In these models, two dimensions of perfectionism
(SOP and SPP) were the independent variables, rumination and worry were the
mediating variables, and distress was the dependent variable. Distress was a latent
variable loading from depression and anxiety as these are the most common distress
symptoms. Four correlation matrices were extracted to test the mediation models.
Two-stage structural equation modelling (TSSEM) was performed to test these
four mediation models (Cheung, 2015; Cheung & Chan, 2005; Cheung & Chan,
2009). TSSEM combines meta-analysis procedure and structural equation modelling.
15
6
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
In the first stage, the pooled correlation matrix is estimated and the homogeneity of
the correlation matrices is tested. In the second stage, the proposed model is tested by
using the fixed-effects model and the random-effects model according to the results of
the homogeneity test from the first stage. The path coefficients and the standard errors
of those path coefficients were calculated to conduct the Sobel test, the Aroian test,
and the Goodman test for the mediation tests. The metaSEM package (Cheung, 2015)
and the lavaan package (Rosseel, 2012) were used to test the mediation effect in the R
environment.
3. Results
3.1. Study characteristics
Fifteen articles were included in the current meta-analysis (see Table 1) and four
published articles reported seven samples for the effect sizes of the SOP-worry link
and the SPP-worry link. A total of 1,278 participants with a mean age of 22.18 (78%
female) were from one country (Canada). The 12 articles (two unpublished
dissertations and 10 published journals) reported 30 samples for the effect size of the
SOP-rumination link. A total of 5,339 participants with a mean age of 25.62 (70%
female) were from four countries (Canada, Spain, UK, and USA). Thirteen articles
(two unpublished dissertations and 11 published journals) reported 31 samples for the
effect size of the SPP-rumination link. A total of 5,387 participants with a mean age of
25.61 (70% female) were from five countries (Australia, Canada, Spain, the UK, and
the USA). The number of effect sizes for the SPP-rumination link was larger than that
16
7
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
for the SOP-rumination link because one article reported only one dimension of
perfectionism (SPP).
3.2. Overall estimated effect sizes
Each comparison of the two dimensions of perfectionism and the two forms of
cognitive perseveration were examined. Table 2 shows the overall mean effect sizes
(with corresponding confidence interval), the estimates of heterogeneity (Q value and
I2), and the results of the publication bias tests, i.e. results of Duval and Tweedie’s
(2000) trim and fill method, fail-safe N, and estimates of Begg’s adjusted rank test and
Egger’s linear regression test.
Insert Table 2 about here
3.2.1. SOP and worry. The overall mean correlation between SOP and worry
was significant: r = 0.33, with a 95% CI from 0.28 to 0.38, p < 0.001 under the fixed-
effects model. The results of the homogeneity tests showed existing homogeneity
across studies (Q = 5.00, p = 0.54, I2 = 0). There were no missing studies according to
Duval and Tweedie’s (2000) trim and fill method (ka = 0) and the overall mean
correlation remained the same (rb = 0.33, p < 0.001). The result of fail-safe N was 416,
which suggested that the result was robust. The results of Begg’s adjusted rank test
(Kendall's tau = -0.24, p = 0.56) and Egger’s linear regression test (z = -0.32, p =
0.75) were not significant, suggesting that there was no potential publication bias.
3.2.2. SPP and worry. The overall mean correlation between SPP and worry
was significant: r = 0.43, with a 95% CI from 0.38 to 0.47, p < 0.001 under the fixed-
effects model. The results of the homogeneity tests showed existing homogeneity
17
8
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
across studies (Q = 6.46, p = 0.54, I2 = 18%). There were no missing studies
according to Duval and Tweedie’s (2000) trim and fill method (ka = 0) and the overall
mean correlation remained the same (rb = 0.43, p < 0.001). The result of fail-safe N
was 878, which suggested that the result was robust. The results of Begg’s adjusted
rank test (Kendall's tau = -0.14, p = 0.77) and Egger’s linear regression test (z = -0.03,
p = 0.98) were not significant, suggesting that there was no potential publication bias.
3.2.3. SOP and rumination. The overall mean correlation between SOP and
rumination was significant: r = 0.20, with a 95% CI from 0.17 to 0.22, p < 0.001
under the fixed-effects model. The results of the homogeneity tests showed existing
homogeneity across studies (Q = 40.97, p = 0.07, I2 = 34%). Three studies were
imputed by Duval and Tweedie’s (2000) trim and fill method, but the interpretation of
the overall mean correlation did not change (rb = 0.19, p < 0.001). The result of fail-
safe N was 2,379, which suggested that the result was robust. The results of Begg’s
adjusted rank test (Kendall's tau = -0.01, p = 0.91) and Egger’s linear regression test
(z = 1.36, p = 0.17) were not significant, suggesting that there was no potential
publication bias.
3.2.4. SPP and rumination. The overall mean correlation between SPP and
rumination was significant: r = 0.32, with a 95% CI from 0.27 to 0.36, p < 0.001
under the random-effects model. The results of the homogeneity tests showed existing
heterogeneity across studies (Q = 97.56, p < 0.001, I2 = 69%). Nine studies were
imputed by Duval and Tweedie’s (2000) trim and fill method, but the interpretation of
the overall mean correlation did not change (rb = 0.27, p < 0.001). The result of fail-
18
9
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
safe N was 6,941, which suggested that the result was robust. The results of Begg’s
adjusted rank test (Kendall's tau = -0.02, p = 0.92) and Egger’s linear regression test
(z = 0.83, p = 0.40) were not significant, suggesting that there was no potential
publication bias.
3.3. Moderator analyses
Several moderator analyses were conducted to examine the moderation effects of
mean age, percentage of females, country of origin, publication type, and measures
using the mixed-effects model. A summary of coefficients (k, N, r, 95% CI, df, and
Qwithin) among categorical moderators is shown in Table 3. A summary of coefficients
(intercept, ß, SE, 95% CI for ß, and Z) among continuous moderators is shown in
Table 4. Publication type significantly moderated the correlation between SOP and
rumination (Qwithin = 7.36, p < 0.01) and country significantly moderated the
correlation between SPP and rumination (Qwithin = 21.11, p < 0.001).
Insert Table 3 about here
Insert Table 4 about here
3.4. Mediation analysis
To explore the mediating role of cognitive perseveration between perfectionism
and distress, corresponding correlation matrices were extracted (as mentioned in the
coding procedure). Four mediation models were proposed using TSSEM. In the first
stage, the correlations among variables were calculated using the same method as the
estimation of effect sizes. In addition, the homogeneity of the correlation matrices was
19
0
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
estimated by the value of fit indices, including the chi-square test (
2), degree of
freedom (df), the root-mean-square error of approximation (RMSEA), the
standardised root mean square residual (SRMR), and the comparative fit index (CFI).
In the second stage, the fit indices of the mediation models were estimated to test
these four proposed models. To examine the significance of the indirect effects, raw
regression coefficients for the associations and their standard errors were calculated to
conduct the Sobel test, the Aroian test, and the Goodman test.
3.4.1. Mediating role of worry between SOP and distress. In the first stage, all
the correlations among variables were significant, indicating that it was appropriate to
conduct TSSEM. The model-fitting statistics (
2 = 7.26, df = 10, RMSEA = 0.00,
SRMR = 0.03, CFI = 1.00) indicated homogeneity of the correlation matrices,
therefore, the TSSEM analysis used a fixed-effects model in both stages. In the
second stage, the fit indices of the mediation model were
2 = 0.62, df = 1, RMSEA =
0.00, SRMR = 0.02, and CFI = 1.00, indicating that the proposed model fitted the data
very well. Fig. 2 shows the proposed mediation model and the corresponding
parameters. The results show that the indirect effect of SOP on distress via worry
(Sobel test = 7.77, p < 0.001; Aroian test = 7.76, p < 0.001; Goodman test = 7.79, p <
0.001) was significant, indicating that worry plays a mediating role in the relationship
between SOP and distress.
Insert Fig. 2 about here
20
1
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
Fig.2. Path model of the mediating role of worry in the relationship between SOP and
distress. N (sample size) = 1278.
3.4.2. Mediating role of worry between SPP and distress. In the first stage, all
the correlations among variables were significant, indicating that it was appropriate to
conduct TSSEM. The model-fitting statistics (
2 = 8.35, df = 10, RMSEA = 0.00,
SRMR = 0.04, CFI = 1.00) indicated homogeneity of the correlation matrices,
therefore, the TSSEM analysis used a fixed-effects model in both stages. In the
second stage, the fit indices of the mediation model were
2 = 1.35, df = 1, RMSEA =
0.02, SRMR = 0.02, and CFI = 1.00, indicating that the proposed model fitted the data
very well. Fig. 3 shows the proposed mediation model and the corresponding
parameters. The results show that the indirect effect of SPP on distress via worry
(Sobel test = 6.80, p < 0.001; Aroian test = 6.79, p < 0.001; Goodman test = 6.81, p <
0.001) was significant, indicating that worry plays a mediating role in the relationship
between SPP and distress.
Insert Fig. 3 about here
Fig.3. Path model of the mediating role of worry in the relationship between SPP and
distress. N (sample size) = 1278.
3.4.3. Mediating role of rumination between SOP and distress. In the first
stage, all the correlations among variables were significant, indicating that it was
21
2
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
appropriate to conduct TSSEM. The model-fitting statistics (
2 = 590.60, df = 125,
RMSEA = 0.15, SRMR = 0.12, CFI = 0.84) indicated heterogeneity of the correlation
matrices, therefore, the TSSEM analysis used a random-effects model in both stages.
In the second stage, the fit indices of the mediation model were
2 = 4.17, df = 1,
RMSEA = 0.02, SRMR = 0.04, and CFI = 1.00, indicating that the proposed model
fitted the data very well. Fig. 4 shows the proposed mediation model and the
corresponding parameters. The results show that the indirect effect of SOP on distress
via worry (Sobel test = 6.84, p < 0.001; Aroian test = 6.82, p < 0.001; Goodman test =
6.85, p < 0.001) was significant, indicating that rumination plays a mediating role in
the relationship between SOP and distress.
Insert Fig. 4 about here
Fig.4. Path model of the mediating role of rumination in the relationship between SOP
and distress. N (sample size) = 6285.
3.4.4. Mediating role of rumination between SPP and distress. In the first
stage, all the correlations among variables were significant, indicating that it was
appropriate to conduct TSSEM. The model-fitting statistics (
2 = 609.13, df = 128,
RMSEA = 0.15, SRMR = 0.12, CFI = 0.88) indicated heterogeneity of the correlation
matrices, therefore, the TSSEM analysis used a random-effects model in both stages.
In the second stage, the fit indices of the mediation model were
2 = 1.13, df = 1,
22
3
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
RMSEA = 0.00, SRMR = 0.02, and CFI = 1.00, indicating that the proposed model
fitted the data very well. Fig. 5 shows the proposed mediation model and the
corresponding parameters. The results show that the indirect effect of SPP on distress
via worry (Sobel test = 6.48, p < 0.001; Aroian test = 6.47, p < 0.001; Goodman test =
6.50, p < 0.001) was significant, indicating that rumination plays a mediating role in
the relationship between SPP and distress.
Insert Fig. 5 about here
Fig.5. Path model of the mediating role of rumination in the relationship between SOP
and distress. N (sample size) = 6333.
4. Discussion
The overall purpose of the present study was to examine the three themes of PCT
by conducting a meta-analysis. The specific aims were to evaluate the magnitude of
the correlations between perfectionism and perseverative cognition, to examine the
correlations between two dimensions of perfectionism and various forms of cognitive
perseveration, and to examine the mediating roles of cognitive perseveration between
multidimensional perfectionism and distress. Correspondingly, we first calculated the
overall estimated effect sizes of four comparable correlations between perfectionism
and cognitive perseveration. We then analysed two moderators, especially the
measurements of worry and rumination, and finally examined four mediation models
to test the roles of worry and rumination in the relationships between SOP and SPP
and psychological distress.
23
4
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
This study is the first meta-analytic review of the relationship between
perfectionism and cognitive perseveration and finds that both SOP and SPP are
positively correlated with worry and rumination. These results are consistent with the
previous qualitative summary (Flett et al., 2016) and provide further evidence to
support the first theme of PCT. The findings also suggest that according to Cohen’s
(1992) guidelines, SOP has a medium positive relationship with worry and a small-to-
medium positive relationship with rumination, while SPP has a medium-to-large
positive relationship with worry and a medium positive relationship with rumination.
As described above, both SOP and SPP capture the evaluation fears that activate
worry and rumination. Perfectionists tend to perceive constant pressure in their life,
focus on negative events, fear being criticised, and subsequently worry about the
future and ruminate about the past (Flett & Hewitt, 2002; Hewitt & Flett, 1996).
The present understanding of perfectionism dimensions indicates that
perfectionism involves two higher order dimensions: perfectionistic strivings (PS) and
perfectionistic concerns (PC) (see Stoeber & Otto, 2006). SOP as an indicator of PS is
regarded as an adaptive form of perfectionism correlated with positive characteristics,
whereas SPP as an indicator of PC is regarded as a maladaptive form of perfectionism
correlated with negative characteristics. The results of this study indicate that SOP
and SPP have a positive relationship with worry and rumination, however, which is
not consistent with this model of perfectionism. Some other models of perfectionism
also regard SOP as adaptive dimension of perfectionism (see Bieling, Israeli, &
Antony, 2004; Dunkley & Blankstein, 2000). Stoeber and Otto (2006) outlined that
24
5
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
PS and PC are typically correlated and they show considerable overlap. Consequently,
PS (an equivocal dimension) links to both adaptive and maladaptive outcomes.
To investigate this problem, the relationships between the dimensions of
perfectionism and the outcomes were examined in three reviews of perfectionism by
conducting both bivariate and partial correlations (i.e. controlling for correlations in
different dimensions of perfectionism) (Gotwals, Stoeber, Dunn, & Stoll, 2012; Hill &
Curran, 2015; Stoeber & Otto, 2006). To compare the partial correlation coefficients
with the bivariate correlation coefficients, researchers could understand correlations
between PS and PC. In the future, researchers may take the results of partial
correlations among dimensions of perfectionism into consideration to explore the
effects of the pure dimensions of perfectionism. Moreover, PCT states that other
elements of evaluative concerns perfectionism (concerns over mistakes and doubts)
are correlated with worry and rumination, therefore future studies can adopt various
measurements of perfectionism to examine the relationship between two higher order
dimensions (PS and PC) and cognitive perseveration. The Big Three Perfectionism
Scale (BTPS) developed by Smith and colleagues (2016) could provide an
understanding of the correlations between SOP and rumination and worry.
Specifically, the BTPS disentangles SOP from self-worth contingencies and this might
make sense of the link between the rigid insistence of perfectionists and rumination
and worry.
In terms of moderation, the current study examined two moderators: measures of
worry and rumination. The results of the subgroup analyses suggest that most
25
6
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
correlations between perfectionism and various forms of cognitive perseveration are
positively significant, although two correlations were not significant when studies
adopted CERQ as the rumination measure. The findings of this meta-analysis provide
evidence that partly supports the second theme of PCT. Some forms of cognitive
perseveration mentioned in PCT have not been examined in the current study,
however, because there is a lack of specific measurements for these types of cognitive
perseveration.
In the four comparisons of the correlation between perfectionism and cognitive
perseveration, only the correlation between SPP and rumination showed existing
heterogeneity across studies. Country may alter this relationship, indicating that the
link between SPP and rumination in English-speaking countries is stronger than in
Spain. This could be because Senra, Merino and Ferreiro (2017) adopted the Spanish
version of the MPS and the RRS in which some items of measurement might be
adjusted for Spanish, or because cultural differences impact this relationship. It is
evident that perfectionism and its correlates show cultural variations (e.g. Stoeber,
Kobori, & Tanno, 2013). Considering the cultural differences in the link between
perfectionism and cognitive perseveration, future studies could compare the influence
of Western and Eastern culture on this relationship.
In terms of mediation, the current study examined four mediation models and
found that worry and rumination have mediating roles in the relationship between
perfectionism and distress. The findings of this meta-analysis provide evidence to
support the third theme of PCT, which states that worry and rumination contribute to
26
7
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
the link between perfectionism and distress. The findings are partly inconsistent with
the previous research, however. For example, Short and Mazmanian (2013) found that
worry and rumination mediate the relationship between SPP and negative affect, but
that SOP was not significantly correlated with distress. In contrast to the findings of
Short and Mazmanian, some studies provide evidence that the link between SOP and
distress is significant (e.g. Hewitt & Flett, 1991; Olson & Kwon, 2008). This meta-
analysis synthesises several studies and finds a significantly positive relationship
between SOP and distress and a mediating role of rumination and worry in this
relationship. The results of the meta-analytic mediation model illuminate the
mechanisms of perfectionism cognition and provide a better understanding of the link
between perfectionism and distress.
To examine the mediating roles of worry and rumination in the link between
perfectionism and distress, longitudinal studies would be appropriate to test mediation
models and help understand causality. Olson and Kwon (2008) designed a four-week
longitudinal study to examine perfection, rumination, and depression, and found that
perfectionism interacted with rumination and stress and could predict depression.
More longitudinal studies like this are needed as they could help identify the
dynamics of the perfectionism-distress relationship and might clarify the cognitive
process over time.
In fact, the third theme of PCT proposes that cognitive perseveration not only
contributes to psychological distress, but also contributes to physical illness among
perfectionists. The cognitive perseveration hypothesis mentioned in the introduction
27
8
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
suggests that cognitive perseveration may negatively impact physical health by
prolonging the stress response (Brosschot, Gerin, & Thayer, 2006). Several studies
provide evidence that cognitive perseveration is correlated with poor physical well-
being, e.g. cardiovascular disease (Brosschot, Van, & Thayer, 2007; Chalmers,
Quintana, Abbott, & Kemp, 2014), an impoverished immune system (Thomsen et al.,
2004), and poor sleep quality (Zoccola, Dickerson, & Lam, 2009). To the best of our
knowledge, however, only one study has explored the link between perfectionism and
health symptoms from a cognitive perspective that highlights the role of
perfectionistic automatic thoughts (Flett, Molnar, Nepon, & Hewitt, 2012). Future
studies could explore the contributory roles of worry and rumination in the
relationship between perfectionism and physical illness.
It should be noted that this meta-analysis has some limitations. Firstly, all the
studies included examined perfectionism using the MPS-HF (Hewitt & Flett, 1991),
because PCT focuses on SOP and SPP. PCT also states that other elements of
evaluative concerns perfectionism, such as concern over mistakes (COM) and doubts
about actions (DAA), are correlated with worry and rumination, but the current study
did not examine other dimensions of perfectionism. Future studies could examine
other dimensions of perfectionism by using several different measurements. Secondly,
all the studies included in this meta-analysis were done with non-clinical sample.
When researchers try to study perfectionism in clinical samples, they prefer to use the
MPS-F because of it’s good psychometric properties (Frost & DiBartolo, 2002).
Theoretically, the PCT could provide an explanation for both clinical and non-clinical
28
9
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
samples, so future studies could examine the PCT in clinical samples. Thirdly,
although the number of studies in this area is growing, the literature is relatively small
and only 15 articles met the inclusion criteria for this meta-analysis. Lastly, the
mediation analyses required correlation matrices for perfectionism, worry, rumination,
depression, and anxiety, but some of the included research used more than one
measurement to evaluate a variable. This would lead to a large inflation of effect
sizes, which should be taken into consideration when interpreting the results.
To conclude, the current study provides evidence for the three themes of PCT.
Firstly, it was found that both SOP and SPP were positively correlated with worry and
rumination. Specifically, SOP had medium and small-to-medium positive
relationships with worry and rumination, respectively, while SPP had medium-to-
large and medium positive relationships with worry and rumination, respectively.
Secondly, there was evidence that both SOP and SPP were correlated with various
forms of cognitive perseveration. Thirdly, the mediation results suggested that worry
and rumination have mediating roles in the relationship between perfectionism and
distress. In other words, cognitive perseveration contributes to mental health
outcomes among perfectionists. Overall, the findings of this meta-analysis support the
main arguments of PCT and shed light on the mechanisms and processes of
perfectionism cognition.
29
0
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
References
*Reference marked with asterisk indicate studies included in the meta-analysis
Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York:
International Universities Press.
Begg, C. B., & Mazumdar, M. (1994). Operating characteristics of a rank correlation
test for publication bias. Biometrics, 1088-1101. doi:10.2307/2533446
Bieling, P. J., Israeli, A. L., & Antony, M. M. (2004). Is perfectionism good, bad, or
both? Examining models of the perfectionism construct. Personality and
Individual Differences, 36, 1373–1385. doi: 10.1016/S0191-8869(03)00235-6
*Blankstein, K. R., & Lumley, C. H. (2008). Multidimensional perfectionism and
ruminative brooding in current dysphoria, anxiety, worry, and anger. Journal of
Rational-Emotive and Cognitive-Behavior Therapy, 26(3), 168-193. doi:
10.1007/s10942-007-0068-z
Blankstein, K. R., Lumley, C. H., & Crawford, A. (2007). Perfectionism,
hopelessness, and suicide ideation: revisions to diathesis-stress and specific
vulnerability models. Journal of Rational-Emotive and Cognitive-Behavior
Therapy, 25(4), 279-319. doi: 10.1007/s10942-007-0053-6
Borenstein M, Hedges L. V, Higgins J. P. T, Rothstein H. R. (2009). Introduction to
Meta-analysis. Chichester, UK: John Wiley.
Borkovec, T. D., Ray, W. J., & Stober, J. (1998). Worry: a cognitive phenomenon
intimately linked to affective, physiological, and interpersonal behavioral
processes. Cognitive Therapy & Research, 22(6), 561-576. doi:
10.1023/A:1018790003416
30
1
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
Borkovec, T. D., Robinson, E., Pruzinsky, T., & Depree, J. A. (1983). Preliminary
exploration of worry: some characteristics and processes. Behaviour Research
and Therapy, 21(1), 9-16. doi: 10.1016/0005-7967(83)90121-3
Brosschot, J. F, Gerin, W., & Thayer, J. F. (2006). The preservative cognition
hypothesis: A review of worry, prolonged stress-related physiological activation,
and health. Journal of Psychosomatic Research, 60, 113–124. doi
10.1016/j.jpsychores.2005.06.074
Brosschot, J. F., Van, D. E., & Thayer, J. F. (2007). Daily worry is related to low heart
rate variability during waking and the subsequent nocturnal sleep period.
International Journal of Psychophysiology Official Journal of the International
Organization of Psychophysiology, 63(1), 39-47. doi:
10.1016/j.ijpsycho.2006.07.016
Buhr, K., & Dugas, M. J. (2002). The Intolerance of Uncertainty Scale: psychometric
properties of the English version. Behaviour Research and Therapy, 40, 931–
945. doi: 10.1016/S0005-7967(01)00092-4
*Buhr, K., & Dugas, M. J. (2006). Investigating the construct validity of intolerance of
uncertainty and its unique relationship with worry. Journal Of Anxiety Disorders,
20(2), 222-236. doi: 10.1016/j.janxdis.2004.12.004
Burns, D. (1980). The perfectionist’s script for self-defeat. Psychology Today, 34–51.
Chalmers, J. A., Quintana, D. S., Abbott, M. J. A., & Kemp, A. H. (2014). Anxiety
disorders are associated with reduced heart rate variability: a meta-analysis.
Frontiers in Psychiatry, 5(80), 80. doi; 10.3389/fpsyt.2014.00080
31
2
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
Cheung, M. W. L. (2015). metaSEM: An R package for meta-analysis using structural
equation modeling. Frontiers in Psychology, 5:1521. doi:
10.3389/fpsyg.2014.01521
Cheung, M. W. L., & Chan, W. (2005). Meta-analytic structural equation modeling: a
two-stage approach. Psychological methods, 10(1), 40. doi: 10.1037/1082-
989X.10.1.40
Cheung, M. W. L., & Chan, W. (2009). A two-stage approach to synthesizing
covariance matrices in meta-analytic structural equation modeling. Structural
Equation Modeling, 16(1), 28-53. doi: 10.1080/10705510802561295
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159. doi:
10.1037/0033-2909.112.1.155
Cooper, H., Hedges, L. V., & Valentine, J. C. (2009). The handbook of research
synthesis and meta-analysis (2nd ed.). New York: Russell Sage Foundation.
*Cox, S. L., & Chen, J. (2015). Perfectionism: A contributor to social anxiety and its
cognitive processes. Australian Journal of Psychology, 67(4), 231-240. doi:
10.1111/ajpy.12079
Davey, G. C. L. (1994). Worrying, social problem-solving abilities, and social
problem-solving confidence. Behaviour Research and Therapy, 32(3), 327. doi:
10.1016/0005-7967(94)90130-9
Dunkley, D. M., & Blankstein, K. R. (2000). Self-critical perfectionism, coping,
hassles, and current distress: A structural equation modeling approach. Cognitive
Therapy and Research, 24(6), 713–730. doi: 10.1023/A:1005543529245
32
3
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
Duval, S., & Tweedie, R. (2000). A nonparametric “trim and fill” method of
accounting for publication bias in meta-analysis. Journal of the American
Statistical Association, 95(449), 89-98. doi: 10.1080/01621459.2000.10473905
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997). Bias in meta-analysis
detected by a simple, graphical test. Bmj, 315(7109), 629-634. doi:
10.1136/bmj.315.7109.629
Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stuart.
Field AP, & Gillett R. (2011). How to do a meta-analysis. British Journal of
Mathematical and Statistical Psychology, 63(3), 665-694. doi:
10.1348/000711010X502733
Field, A. P. (2001). Meta-analysis of correlation coefficients: a Monte Carlo
comparison of fixed- and random-effects methods. Psychological Methods, 6(2),
161–180. doi: 10.1037/1082-989X.6.2.161
Flett, G. L., & Hewitt, P. L. (2002). Perfectionism and maladjustment: An overview of
theoretical, definitional, and treatment issues. In G. L. Flett & P. L. Hewitt
(Eds.), Perfectionism: Theory, research, and treatment. Washington, DC:
American Psychological Association.
*Flett, G. L., Madorsky, D., Hewitt, P. L., & Heisel, M. J. (2002). Perfectionism
cognitions, rumination, and psychological distress. Journal of Rational-Emotive
and Cognitive-Behavior Therapy, 20(1), 33-47. doi: 10.1023/A:1015128904007
Flett, G. L., Molnar, D. S., Nepon, T., & Hewitt, P. L. (2012). A mediational model of
perfectionistic automatic thoughts and psychosomatic symptoms: The roles of
33
4
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
negative affect and daily hassles. Personality and Individual Differences, 52,
565–570. doi: 10.1016/j.paid.2011.09.010
Flett, G. L., Nepon, T., & Hewitt, P. L. (2016). Perfectionism, Worry, and Rumination
in Health and Mental Health: A Review and a Conceptual Framework for a
Cognitive Theory of Perfectionism. Perfectionism, Health, and Well-Being.
Springer International Publishing.
*Fracalanza, K., Koerner, N., Deschenes, S. S., & Dugas, M. J. (2014). Intolerance of
uncertainty mediates the relation between generalized anxiety disorder symptoms
and anger. Cognitive Behaviour Therapy, 43(2), 122-132. doi:
10.1080/16506073.2014.888754
Frost, R. O., & DiBartolo, P. (2002). Perfectionism, anxiety and obsessive compulsive
disorder. In G. Flett & P. Hewitt (Eds.), Perfectionism: Theory, research, and
treatment. Washington, DC: American Psychological Association Press.
Frost, R. O., Heimberg, R. G., Holt, C. S., Mattia, J. I., & Neubauer, A. L. (1993). A
comparison of two measures of perfectionism. Personality and Individual
Differences, 14, 119–126. doi: 10.1016/0191-8869(93)90181-2
Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of
perfectionism. Cognitive Therapy and Research, 14(5), 449-468. doi:
10.1007/BF01172967
Garner, D., Olmstead, M., & Polivy, J. (1983). Development and validation of a
multidimensional eating disorder inventory for anorexia nervosa and bulimia.
34
5
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
International Journal of Eating Disorders, 2, 15–34. doi: 10.1002/1098-
108X(198321)2:2%3C15::AID-EAT2260020203%3E3.0.CO;2-6
Glass, G. V. (1976). Primary, secondary, and meta-analysis of research. Educational
Researcher, 5(10), 3-8. doi: 10.3102/0013189X005010003
Gotwals, J. K., Stoeber, J., Dunn, J. G. H., & Stoll, O. (2012). Are perfectionistic
strivings in sport adaptive? A systematic review of confirmatory, contradictory,
and mixed evidence. Canadian Psychology, 53(53), 263-279. doi:
10.1037/a0030288
Hafdahl, A. R. (2009). Improved Fisher z estimators for univariate random-effects
meta-analysis of correlations. British Journal of Mathematical and Statistical
Psychology, 62, 233–261. doi: 10.1348/000711008X281633
Hamachek, D. E. (1978). Psychodynamics of normal and neurotic perfectionism.
Psychology, 15, 27–33.
Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. New
Directions for Program Evaluation, 1984(24), 25-42. doi: 10.1016/B978-0-08-
057065-5.50022-1
Hewitt PL, & Flett GL. (1991). Perfectionism in the self and social contexts:
conceptualization, assessment, and association with psychopathology. Journal of
Personality and Social Psychology, 60(3), 456-70. doi: 10.1037/0022-
3514.60.3.456
Hewitt, P. L., & Flett, G. L. (1996). Personality traits and the coping process. In M.
Zeidner & N. S. Endler (Eds.), Handbook of coping: Theory, research,
applications. Oxford, England: John Wiley & Sons.
35
6
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
Hewitt, P. L., & Flett, G. L. (2004). Multidimensional perfectionism scale (MPS):
Technical manual. Toronto: Multi-Health Systems.
Hewitt, P. L., & Flett, G. L. (2007). When does conscientiousness become
perfectionism? Traits, self-presentation styles, and cognitions suggest a persistent
psychopathology. Current Psychiatry, 6(7), 49-56.
Higgins, J. P., Thompson, S. G., Deeks J. J., & Altman, D. G. (2003). Measuring
inconsistency in meta-analyses. Bmj, 327(7414), 557-560. doi:
10.1136/bmj.327.7414.557
Higgins, E. T., & Carver, C. S. (1990). Principles of self-regulation. New York:
Guilford.
Hill, A. P., & Curran, T. (2015). Multidimensional Perfectionism and Burnout: A
Meta-Analysis. Personality and Social Psychology Review, 20(3), 269-288. doi:
10.1177/1088868315596286
Hill, R. W., Huelsman, T. J., Furr, M., Kibler, J., Vicente, B. B., & Kennedy, C.
(2004). A new measure of perfectionism: The Perfectionism Inventory. Journal
of Personality Assessment, 82, 80–91. doi: 10.1207/s15327752jpa8201_13
Hunter, J. E., & Schmidt, F. L. (1990). Methods of meta-analysis: correcting error
and bias in research findings. Newbury Park: Sage.
Just, N., & Alloy, L. B. (1997). The response styles theory of depression. Journal of
Abnormal Psychology, 106. doi: 10.1037/0021-843X.106.2.221
Klibert, J. J., Langhinrichsen-Rohling, J., & Saito, M. (2005). Adaptive and
maladaptive aspects of selforiented versus socially prescribed perfectionism.
36
7
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
Journal of College Student Development, 46, 141–156. Doi:
10.1353/csd.2005.0017
*Laderoute, K. T. (2008). Perfectionism as a vulnerability factor for psychological
distress: Exploring the roles of self-consciousness and perceived discrepancies.
Unpublished doctoral dissertation, York University.
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., & Ioannidis, J. P.
A., et al. (2009). The prisma statement for reporting systematic reviews and
meta-analyses of studies that evaluate health care interventions: explanation and
elaboration. Epidemiology Biostatistics and Public Health, 6(4), e1-e34. doi:
10.1371/journal.pmed.1000100
Lyubomirsky, S., & Tkach, C. (2004). The consequences of dysphoric rumination. In
C. Papageorgiou & A. Wells (Eds.), Depressive rumination: Nature, theory, and
treatment. New York: Wiley.
Martin, L. L., & Tesser, A. (1996). Clarifying our thoughts. In R. S. Wyer, Jr. (Ed.),
Advances in social cognition ruminative thoughts. Hillsdale, NJ, US: Lawrence
Erlbaum Associates, Inc.
Metzger, R. L., Miller, M. L., Cohen, M., Sofka, M., & Borkovec, T. D. (1990). Worry
changes decision making: the effect of negative thoughts on cognitive
processing. Journal of Clinical Psychology, 46(1), 78-88. doi: 10.1002/1097-
4679(199001)46:1<78::AID-JCLP2270460113>3.0.CO;2-R
Mills, J. S., & Blankstein, K. R. (2000). Perfectionism, intrinsic vs extrinsic
motivation, and motivated strategies for learning: a multidimensional analysis of
37
8
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
university students. Personality and Individual Differences, 29(6), 1191-1204.
doi: 10.1016/S0191-8869(00)00003-9
Missildine, W. H. (1963). Your inner child of the past. New York: Simon and Schuster.
*Nepon, T., Flett, G. L., Hewitt, P. L., & Molnar, D. S. (2011). Perfectionism, negative
social feedback, and interpersonal rumination in depression and social anxiety.
Canadian Journal of Behavioural Science / Revue canadienne des sciences du
comportement, 43(4), 297-308. doi: 10.1037/a0025032
Nolen-Hoeksema, S. (1987). Sex differences in unipolar depression: evidence and
theory. Psychological Bulletin, 101(2), 259. doi: 10.1037/0033-2909.101.2.259
Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and
mixed anxiety/depressive symptoms. Journal of Abnormal Psychology, 109(3),
504-511. doi: 10.1037/0021-843X.109.3.504
Nolen-Hoeksema, S., & Morrow, J. (1991). A prospective study of depression and
distress following a natural disaster: the 1989 loma prieta earthquake. Journal of
Personality and Social Psychology, 61, 105-121. doi: 10.1037/0022-
3514.61.1.115
Nolen-Hoeksema, S., Girgus, J. S., & Seligman, M. E. (1991). Sex differences in
depression and explanatory style in children. Journal of Youth & Adolescence,
20(2), 233-245. doi: 10.1007/BF01537610
Nolen-Hoeksema, S., Morrow, J., & Fredrickson, B. L. (1993). Response styles and
the duration of episodes of depressed mood. Journal of Abnormal Psychology,
102(1), 20-28. doi: 10.1037/0021-843X.102.1.20
38
9
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
Nolenhoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking
rumination. Perspectives on Psychological Science A Journal of the Association
for Psychological Science, 3(5), 400-424. doi: 10.1111/j.1745-
6924.2008.00088.x
*O'Connor, D. B., O'Connor, R. C., & Marshall, R. (2007). Perfectionism and
psychological distress: Evidence of the mediating effects of rumination.
European Journal of Personality, 21(4), 429-452. doi: 10.1002/per.616
*Olson, M. L., & Kwon, P. (2008). Brooding perfectionism: Refining the roles of
rumination and perfectionism in the etiology of depression. Cognitive Therapy
And Research, 32(6), 788-802. doi: 10.1007/s10608-007-9173-7
Papageorgiou, C., & Siegle, G. J. (2003). Rumination and depression: advances in
theory and research. Cognitive Therapy and Research, 27(3), 243-245. doi:
10.1023/A:1023918331490
*Randles, D., Flett, G. L., Nash, K. A., McGregor, I. D., & Hewitt, P. L. (2010).
Dimensions of perfectionism, behavioral inhibition, and rumination. Personality
and Individual Differences, 49(2), 83-87. doi: 10.1016/j.paid.2010.03.002
Rhéaume, J., Ladouceur, R., & Freeston, M. H. (2000). The prediction of obsessive–
compulsive tendencies: Does perfectionism play a significant role? Personality
and Individual Differences, 28, 583–592. doi: 10.1016/S0191-8869(99)00121-X
Rosseel, Y. (2012). Lavaan: an R package for structural equation modeling. Journal of
Statistical Software, 48(2), 1-36. doi: 10.18637/jss.v048.i02
39
0
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
*Rudolph, S. G., Flett, G. L., & Hewitt, P. L. (2007). Perfectionism and deficits in
cognitive emotion regulation. Journal of Rational-Emotive & Cognitive-
Behavior Therapy, 25(4), 343-357. doi: 10.1007/s10942-007-0056-3
*Rudowski, M. (2010). Exploring the effects of brooding rumination as a mediator in
the relationship between positive and negative perfectionism and depressive
symptoms in a clinical population. Unpublished bachelor thesis, University of
Michigan
*Senra, C., Merino, H., & Ferreiro, F. (2017). Exploring the link between
perfectionism and depressive symptoms: contribution of rumination and defense
styles. Journal of Clinical Psychology, 74(3). doi: 10.1002/jclp.22571
*Short, M. M., & Mazmanian, D. (2013). Perfectionism and negative repetitive
thoughts: Examining a multiple mediator model in relation to mindfulness.
Personality and Individual Differences, 55(6), 716-721. doi:
10.1016/j.paid.2013.05.026
Slaney, R. B., Rice, K. G., Mobley, M., Trippi, J., & Ashby, J. S. (2001). The revised
almost perfect scale. Measurement and Evaluation in Counseling and
Development, 34(3), 130–145.
Smith, M. M., Saklofske, D. H., Stoeber, J., & Sherry, S. B. (2016). The big three
perfectionism scale: a new measure of perfectionism. Journal of
Psychoeducational Assessment, 34(7), 670-687. doi:
10.1177/0734282916651539
40
1
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
Spasojević, J., & Alloy, L. B. (2001). Rumination as a common mechanism relating
depressive risk factors to depression. Emotion, 1(1), 25-37. DOI: 10.1037/1528-
3542.1.1.25
Stoeber, J., & Otto, K. (2006). Positive conceptions of perfectionism: approaches,
evidence, challenges. Personality and Social Psychology Review An Official
Journal of the Society for Personality and Social Psychology Inc, 10(4), 295.
doi: 10.1207/s15327957pspr1004_2
Stoeber, J., Kobori, O., & Tanno, Y. (2013). Perfectionism and self‐conscious
emotions in British and Japanese students: predicting pride and embarrassment
after success and failure. European Journal of Personality, 27(1), 59-70. doi:
10.1002/per.1858
Thomsen, D. K., Mehlsen, M. Y., Hokland, M., Viidik, A., Olesen, F., & Avlund, K.,
et al. (2004). Negative thoughts and health: associations among rumination,
immunity, and health care utilization in a young and elderly sample.
Psychosomatic Medicine, 66(3), 363. doi: 10.1097/00006842-200405000-00012
Trapnell, P. D., & Campbell, J. D. (1999). Private self-consciousness and the five-
factor model of personality: distinguishing rumination from reflection. Journal
of Personality and Social Psychology, 76(2), 284-304. doi: 10.1037/0022-
3514.76.2.284
Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered:
A psychometric analysis. Cognitive Therapy and Research, 27, 247–259. doi:
10.1023/A:1023910315561
41
2
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
Vevea, J. L., & Woods, C. M. (2005). Publication bias in research synthesis:
sensitivity analysis using a priori weight functions. Psychological Methods,
10(4), 428. doi: 10.1037/1082-989X.10.4.428
Viechtbauer, W. (2010). Conducting Meta-Analyses in R with the metafor Package.
Journal of Statistical Software, 36(3). doi: 10.18637/jss.v036.i03
Wade, N. G., Vogel, D. L., Liao, Y. H., & Goldman, D. B. (2008). Measuring state-
specific rumination: development of the rumination about an interpersonal
offense scale. Journal of Counseling Psychology, 55(3), 419-426. doi:
10.1037/0022-0167.55.3.419
Wänke, M., & Schmid, J. (1996). Rumination: When all else fails. In R. S. Wyer, Jr.
(Ed.), Advances in social cognition ruminative thoughts. Hillsdale, NJ, US:
Lawrence Erlbaum Associates, Inc.
Watkins, E., Moulds, M., & Mackintosh, B. (2005). Comparisons between rumination
and worry in a non-clinical population. Behaviour Research & Therapy, 43(12),
1577-1585. doi: 10.1016/j.brat.2004.11.008
Watson, D., Clark, L. A., & Tellegen, A. (1984). Cross-cultural convergence in the
structure of mood: A Japanese replication and a comparison with U.S. findings.
Journal of Personality and Social Psychology, 47(47), 127-144. doi:
10.1037/0022-3514.47.1.127
Whitmer, A. J., & Gotlib, I. H. (2013). An attentional scope model of rumination.
Psychological Bulletin, 139(5), 1036-1061. doi: 10.1037/a0030923
42
3
PERFECTIONISM, WORRY, RUMINATION, AND DISTRESS
*Wilson, C., Hunter, S. C., Rasmussen, S., & McGowan, A. (2015). They made you
perfect: A test of the Social Reaction Model of Perfectionism. Aggressive
Behavior, 45(1), 421-431. doi: 10.1002/ab.21572
Yu Xie, Jiyu Yang, & Faxiang Chen. (2018). Multidimensional Perfectionism and
Procrastination: A Meta-Analysis of Main, Moderator, and Mediator Effects.
Social Behavior and Personality, 46(3), 395-408. doi: 10.2224/sbp.6680
Zoccola, P. M., Dickerson, S. S., & Lam, S. (2009). Rumination predicts longer sleep
onset latency after an acute psychosocial stressor. Psychosomatic Medicine,
71(7), 771-775. doi: 10.1097/PSY.0b013e3181ae58e8
43
... The cognitive theory of perfectionism proposes that perfectionists are likely to engage in perseverative cognitions such as worry (Flett et al., 2016a, b;Xie et al., 2019). Previous research has supported the relationship between perfectionism and worry (Egan et al., 2007;Handley et al., 2014;Stöber & Joormann, 2001;Xie et al., 2019). ...
... The cognitive theory of perfectionism proposes that perfectionists are likely to engage in perseverative cognitions such as worry (Flett et al., 2016a, b;Xie et al., 2019). Previous research has supported the relationship between perfectionism and worry (Egan et al., 2007;Handley et al., 2014;Stöber & Joormann, 2001;Xie et al., 2019). Perfectionism is defined as the setting of excessively high standards of performance along with a tendency to overly criticize the self (Frost et al., 1990). ...
... These constructs create concerns about failure and self-representations which can result in different types of distress, such as worry (Buhr & Dugas, 2006) and anxiety (Flett et al., 1989). According to the cognitive theory of perfectionism, perfectionists are chronic overthinkers who tend to experience repetitive and automatic thoughts about their perfectionistic needs, excessive rumination about mistakes, and perseverative worry about negative future events (Flett et al., 2016a, b;Xie et al., 2019). The cognitive theory of perfectionism also postulates that perseverative worry and rumination render perfectionists vulnerable to stress responses and negative emotions such as anxiety and depression (Xie et al., 2019). ...
Article
Full-text available
Past research has primarily focused on the main effect of perfectionism on worry among children and neglected potential moderating processes. The purpose of the present study is to examine the moderating effects of mothers’ parenting styles (authoritative, authoritarian and permissive parenting styles) in the association between self-oriented perfectionism and worry among children in Hong Kong. This study adopted a cross-sectional survey design. A total of 292 children (142 female, 48.6%) aged between 8–12 years (M = 9.60, SD = 0.68) completed a self-report questionnaire. The results of a hierarchical moderated regression analysis revealed that mothers’ authoritative and permissive parenting styles significantly moderated the relationship between self-oriented perfectionism and worry. Specifically, mothers’ authoritative parenting exhibited a buffering effect while mothers’ permissive parenting exhibited a strengthening effect. No significant moderating effect was found for mothers’ authoritarian parenting. These findings suggest that interventions targeting authoritative parenting practices may be effective in ameliorating the impact of children’s self-oriented perfectionism on worry.
... Likewise, self-oriented perfectionism negatively predicts subjective well-being via low self-compassion, but positively predicts subjective well-being via compassion for others (Stoeber et al., 2019). Moreover, self-oriented perfectionism is related to high levels of distress via worry and rumination (Xie et al., 2019). In contrast to PS, research has consistently shown that PC is strongly linked to anxiety disorders, depressive symptoms, and eating disorders (Stoeber and Otto, 2006;Limburg et al., 2017). ...
... Maladaptive thoughts about the self are characterized by rumination, self-doubt, low self-efficacy, and negative self-appraisal. Research showed that PC was significantly related to rumination (Abdollahi, 2019;Xie et al., 2019). Meanwhile, self-doubt, low self-efficacy, and negative self-appraisal are central features of PC (Bieling et al., 2004;Rice et al., 2012). ...
Article
Full-text available
This study aimed to investigate the effect of perfectionistic concerns (PC) on mobile phone addiction (MPA) and the mediating role of academic procrastination (AP), as well as the moderating role of causality orientations (autonomous/controlled/impersonal orientation). A cross-sectional sample of 625 Chinese college students (20.8% male, mean age = 20.47 years old) completed measures of PC, AP, causality orientations, and MPA. We analyzed the survey data using structural equation modeling (SEM) in Mplus 8.0. PC was positively related to MPA. In addition, AP partially mediated this association. The hypothesized moderating effect of autonomous orientation and controlled orientation was not supported. Impersonal orientation moderated the second stage of the mediating effect of AP on the PC–MPA link in that the mediating effect was positive when impersonal orientation was high, while the mediating effect was not significant when impersonal orientation was low. The findings confirm the importance of investigating how individual difference (i.e., PC) contributes to MPA. The implications of the findings for relieving MPA or preventing college students from developing MPA are also discussed deeply and thoroughly.
... Meta-analysis has confirmed a robust association between perfectionism and rumination (r = 0.20-0.32; Xie et al., 2019). Further, rumination on perfectionistic content explains variance in negative affect above and beyond the variance explained by trait perfectionism (Flett et al., 2002;O'Connor et al., 2007). ...
... Further, rumination on perfectionistic content explains variance in negative affect above and beyond the variance explained by trait perfectionism (Flett et al., 2002;O'Connor et al., 2007). The idea that individuals with elevated perfectionism ruminate on their perceived failures and flaws may offer an explanation for the common finding that perfectionism acts via rumination to increase negative affect (Xie et al., 2019). ...
Article
Objective: Using the Emotional Cascade Model as a theoretical framework, this study tested whether the relationship between perfectionism and non-suicidal self-injury (NSSI) operates through rumination and negative affect. Additionally, we tested whether the associations between perfectionism and both rumination and negative affect are moderated by attention control. Methods: Using a correlational cross-sectional design, adults aged 18-25 with (N = 197) and without (N = 271) a history of NSSI completed measures of perfectionism, rumination, negative affect, attention control, and NSSI. Results: Perfectionism was directly associated with increased odds of NSSI, and indirectly associated with odds of NSSI through rumination and negative affect. The relationship between perfectionism and rumination was moderated by attention focusing, such that the relationship was stronger for individuals who were higher in attention focusing. Conclusion: Integrating perfectionism and attention with existing models of NSSI may improve understanding of the factors contributing to NSSI and offers insights into future clinical directions.
... Regarding relations with relevant outcomes, many meta-analyses show substantial links of perfectionism traits with psychopathology and psychological maladjustment. For example, perfectionistic concerns traits and perfectionistic self-strivings traits are related to anorexia nervosa (Dahlenburg et al., 2019), worry and rumination (Xie et al., 2019), suicide ideation , and various other forms of psychopathology (Limburg et al., 2017). Also longitudinally, perfectionistic self-strivings traits and perfectionistic concerns traits predict increases in depression (Smith et al., 2021) and anxiety symptoms (Smith, Vidovic, et al., 2018). ...
... Additionally, previously identified links between perfectionism traits and borderline personality disorder (e.g., Hemmati et al., 2020) suggest positive relations with the ICD-11 borderline pattern descriptor. Finally, the various associations of perfectionism traits, particularly perfectionistic concerns traits, with intrapersonal (e.g., Xie et al., 2019) and interpersonal difficulties (cf. the perfectionism social disconnection model; Hewitt et al., 2006) indicate positive relations with general personality dysfunction. Yet, to date, relations of perfectionism traits with measures of general personality dysfunction have not been investigated. ...
Article
The International Classification of Diseases 11th Revision (ICD-11) contains a dimensional model of personality disorder. Beyond general personality dysfunction, this model accommodates six personality descriptors depicting maladaptive personality characteristics. Perfectionism is a well-researched multidimensional personality disposition with strong links to psychological maladjustment. Yet, it is unclear how multidimensional perfectionism is conceptually and empirically represented in the ICD-11. In this questionnaire study, we assessed relations between the ICD-11 personality disorder model and perfectionism traits. In two community samples (NSample 1 = 293, NSample 2 = 308), all perfectionism traits, except other-oriented perfectionism, substantially correlated with the six ICD-11 personality descriptors and personality dysfunction. Additionally, two perfectionism traits displayed small incremental utility for explaining personality dysfunction beyond the ICD-11 personality descriptors. This study shows that perfectionism traits are related but not redundant to the ICD-11 personality descriptors. We discuss implications for the measurement and potential gradual refinement of the ICD-11 personality disorder model based on our findings and previous perfectionism research.
... A high level of rumination is associated with neuroticism as well as symptoms of depression and anxiety (Trapnell & Campbell, 1999;Wolfradt et al., 2014). Conclusions of additional research indicate that self-rumination is intertwined with a tendency to evoke negative memories (Lyubomirsky et al., 1998), to create negative interpretations (Garrido, 2018), and also that it focuses the individual on feelings and intensifies mental stress (Xie et al., 2019). Self-reflection, on the other hand, manifested in a tendency for constructively discovering oneself, is associated with openness to experience (Trapnell & Campbell, 1999). ...
... It is associated with physiological symptoms (e.g., insomnia, headache, lack of energy) and harms social functioning and daily life (Reitzel et al., 2017). Concern regarding stressful situations is an inappropriate coping mechanism that undermines physical and mental health (Xie et al., 2019). An individual with health concerns has worries about his health's physical, mental and social aspects. ...
Article
Full-text available
This study aimed to compare the effectiveness of intervention including health-oriented lifestyle training and existential therapy on distress tolerance, health concerns, and blood pressure in elderly people with hypertension. The research method was quasi-experimental. This study was performed on 120 older women with hypertension referred to Mehr hospital of Ahvaz, Iran in 2019. They were selected by convenience sampling method and randomly divided into three groups. The first experimental group received 12 sessions of 60 min on a health-oriented lifestyle. The second group received ten sessions of 60 min on existential therapy. The control group did not receive an intervention program. The research instrument included the Distress Tolerance Scale (DTS), Anxious Thoughts Inventory (AnTI), and Sphygmomanometer. Multivariate analysis of covariance (MANCOVA) was performed in SPSS software version 21.0 to analyze the data. The results showed that health-oriented lifestyle training effectively reduced blood pressure but had no effect on distress tolerance. Also, existential therapy significantly increased distress tolerance in the elderly but did not affect blood pressure. Moreover, there was no significant difference between health-oriented lifestyle and existential therapy regarding health concerns’ effectiveness. The results showed that health-oriented lifestyle training and existential therapy effectively increased distress tolerance and health concerns, and improved blood pressure in older women with hypertension. Therefore, it is recommended that clinical psychologists and therapists use health-oriented lifestyle training and existential therapy as adjuncts to other therapies to improve the psychological health of clients.
... In their study with a clinical sample of 345 people primarily diagnosed with anxiety disorders and obsessive-compulsive disorder, Bieling et al. (2004) identified a significant relationship between perfectionism levels and comorbidity rates, underlining the possible role of perfectionism as a transdiagnostic process (Egan et al., 2011). Perfectionist personality tendencies were found to be associated with IOU (Reuther et al., 2013) and RNT (Xie et al., 2019). Individuals with a high tendency towards perfectionism may have difficulty tolerating the unknown given their desire to be complete and clear and may also tend to think ruminatively, focusing on their imperfect past lives. ...
Article
Full-text available
In recent years, the literature has shifted its focus from disorder-specific approaches to transdiagnostic factors. Transdiagnostic approaches argue that prevalent comorbidities in such psychiatric disorders as major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and anxiety disorder can be linked with the common personality factors and cognitive mechanisms predisposing the occurrence of such disorders. Ultimately, the present study investigated the relationship between neuroticism, perfectionism, repetitive (negative) thinking (RNT), and intolerance of uncertainty (IOU), and the symptoms of OCD and MDD. The study included a total of 197 people into three clinical groups: those diagnosed only with MDD, patients only with OCD, and those with both OCD and MDD. We administered six relevant scales to the participants. The results revealed neuroticism and perfectionism were associated with MDD symptoms through RNT and OCD symptoms through IOU. In other words, neuroticism and perfectionism explained both OCD and MDD symptoms in different ways; while IOU explained only OCD symptoms, RNT explained only MDD symptoms. The paper concluded with a discussion of the findings through theoretical implications and put forward some recommendations.
... These are three important cognitive approaches that may moderate connections between psychological wellbeing, resilience-based coping, and sleep quality. Research suggests that the experience of both rumination and worry magnify negative life components and minimize positive areas of life [35,36]. Such maladaptive negative focus is associated with reduced wellbeing [36,37]. ...
Article
Full-text available
The current study evaluated the impact of psychological wellbeing on sleep quality during the onset of the COVID-19 pandemic. A novel empirical model tested variables that mediate and moderate this impact. First, a relationship was established between psychological wellbeing during the COVID-19 pandemic and sleep quality. Second, resilience-based coping associated with the COVID-19 pandemic was tested as a mediator of the impact of psychological wellbeing on sleep quality. Third, dispositional rumination, mindfulness, and worry were compared as moderators of the impact of psychological wellbeing on sleep quality. Fourth, a moderated mediated model was tested for each moderator. Online survey data was collected from 153 adults in the United States. Results demonstrated that coping with the COVID-19 pandemic partially mediated the impact of psychological wellbeing on sleep quality. Worry, but not rumination or mindfulness, moderated the impact. A moderated mediation model failed to demonstrate significance, indicating that the data are best represented by distinct mediation and moderation models. Thus, interventions aimed at improving sleep quality should prioritize concurrent reduction in worry and increase in resilience-based coping strategies. This study provides practical and theoretical contribution to the literature by demonstrating relationships between key variables and contextualizing how the model can be used for assessments and interventions during widespread crises.
... Not only is self-insecurity strongly associated with repetitive thinking, but also it is more strongly associated with repetitive thinking than are constructs potentially related to selfinsecurity (e.g. perfectionism; Xie et al., 2019). ...
Article
Full-text available
Studies have found that self-security, defined as the acceptance of one’s own weaknesses, is associated with many important outcomes. The present research examined the link between self-insecurity (the rejection of one’s own weaknesses) and unpleasant repetitive thinking, a transdiagnostic process that appears to be a major risk factor for internalizing psychopathology. In Study 1, we examined the link at two levels: between-individuals (N = 158 undergraduates) and within-individuals (using daily diary methods). At both levels, self-insecurity was significantly associated with repetitive thinking, even after simultaneously accounting for neuroticism/NA and self-esteem. Study 2 (N = 280 undergraduates) replicated Study 1’s findings. Additionally, Study 2 assessed repetitive thinking using reports by participants’ close others: self-insecurity was significantly associated with close-others-reported repetitive thinking.
Article
Perfectionism is a multidimensional personality construct with various components. Socially prescribed perfectionism (i.e., perceived social pressures and expectations to be perfect) is one key element. This trait dimension represents a chronic source of pressure that elicits feelings of helplessness and hopelessness at extreme levels. Unfortunately, at present, the destructiveness of socially prescribed perfectionism has not been fully recognized or extended conceptually despite the extensive volume of research on this dimension. To address this, we first trace the history and initial conceptualization of socially prescribed perfectionism. Next, we summarize and review findings that underscore the uniqueness and impact of socially prescribed perfectionism, including an emphasis on its link with personal, relationship, and societal outcomes that reflect poor mental well-being, physical health, and interpersonal adjustment. Most notably, we propose that socially prescribed perfectionism is a complex entity in and of itself and introduce new conceptual elements of socially prescribed perfectionism designed to illuminate further the nature of this construct and its role in distress, illness, dysfunction, and impairment. It is concluded that socially prescribed perfectionism is a significant public health concern that urgently requires sustained prevention and intervention efforts.
Article
Full-text available
As results of researchers’ examination of the relationship between perfectionism and procrastination have often been inconsistent, we conducted a meta-analysis of the relationship between procrastination and multidimensional perfectionism. Results indicated that perfectionistic strivings were negatively linked to procrastination, whereas perfectionistic concerns were positively linked to procrastination. Gender, and the measures of perfectionism and procrastination were found to moderate the relationship between procrastination and multidimensional perfectionism. We found that self-efficacy played a mediating role in the relationship between self-oriented perfectionism and procrastination. Our findings fill a gap in the literature and provide confirmatory evidence that the temporal motivational theory can be applied to gain further understanding of the perfectionism–procrastination relationship. © 2018 Scientific Journal Publishers Limited. All Rights Reserved.
Article
Full-text available
Objective: This study investigated the mediating and moderating roles of emotion-focused coping strategies (rumination and immature defenses) in the relationship between perfectionism and depressive symptoms in a Spanish community sample. Method: 438 participants (67.4% female; mean age = 36.94 years) completed self-reports assessing perfectionism, rumination, immature defenses and depression. Multiple mediation, moderation and moderated mediation analyses were conducted. Results: Brooding-rumination and immature defenses mediated the relationship between perfectionism and depressive symptoms. Also, brooding-rumination moderated the impact of perfectionism on depressive symptoms. The mediating effect of brooding in the relationship between perfectionism and depressive symptoms turned out to be moderated by immature defenses, such that the vulnerability link between perfectionism and depressive symptoms through brooding was stronger in individuals scoring high on immature defenses. Conclusion: Brooding-rumination and immature defenses may be essential mechanisms to explain the paths and conditions whereby maladaptive perfectionism gives rise to depression.
Article
Full-text available
This article introduces a new measure of dispositional perfectionism: the Big Three Perfectionism Scale (BTPS). The BTPS assesses three higher-order global factors (rigid perfectionism, self-critical perfectionism, narcissistic perfectionism) via 10 lower-order perfectionism facets (self-oriented perfectionism, self-worth contingencies, concern over mistakes, doubts about actions, self-criticism, socially prescribed perfectionism, other-oriented perfectionism, hypercriticism, grandiosity, entitlement). The present investigation examined the structure of the BTPS using exploratory factor analysis in Study 1 (288 undergraduates), and confirmatory factor analyses in Study 2 (352 community adults) and Study 3 (290 undergraduates). Additionally, in Study 3 the relationships among the BTPS, other measures of perfectionism, and the five-factor model of personality were investigated. Overall, findings provide first evidence for the reliability and validity of the BTPS as a multidimensional measure of perfectionism.
Article
The development and validation of a new measure, the Eating Disorder Inventory (EDI) is described. The EDI is a 64 item, self-report, multiscale measure designed for the assessment of psychological and behavioral traits common in anorexia nervosa (AN) and bulimia. The EDI consists of eight subscales measuring: Drive for Thinness, Bilimia, Body Dissatisfaction, Ineffectiveness, Perfectionism, Interpersonal Distrust, Interoceptive Awareness and Maturity Fears. Reliability (internal consistency) is established for all subscales and several indices of validity are presented. First, AN patients (N=113) are differentiated from femal comparison (FC) subjects (N=577) using a cross-validation procedure. Secondly, patient self-report subscale scores agree with clinician ratings of subscale traits. Thirdly, clinically recovered AN patients score similarly to FCs on all subscales. Finally, convergent and discriminant validity are established for subscales. The EDI was also administered to groups of normal weight bulimic women, obese, and normal weight but formerly obese women, as well as a male comparison group. Group differences are reported and the potential utility of the EDI is discussed.
Chapter
In this chapter, we examine the tendency for vulnerable perfectionists to obsessively ruminate and cognitively perseverate in response to stress and to feelings of distress, and we introduce a cognitive theory of perfectionism. Our analysis includes an overview of the studies showing that various elements of trait perfectionism are associated with worry and ruminative brooding in maladaptive ways, which have significant implications for the onset and persistence of health and mental health problems. The vulnerability of both self-oriented perfectionism (SOP) and socially prescribed perfectionism (SPP) is jointly emphasized, as it is shown that both SOP and SPP are linked consistently with worry and rumination. The costs and consequences of this excessive cognitive perseveration are outlined within the context of a conceptual framework for our proposed cognitive theory of perfectionism. A central premise of perfectionism cognition theory is that certain perfectionists are chronically engaged in overthinking. We propose an expanded conceptualization of rumination in perfectionism that includes the tendency for perfectionists to experience frequent automatic thoughts about their need to be perfect and to engage in excessive mistake rumination, failure perseveration, and social comparison rumination. Our analysis of “perseverating perfectionists” emphasizes that their propensity to engage in various forms of ruminative thinking is deeply rooted in self and identity issues involving chronic self-uncertainty, self-doubt, a need for self-validation, and a chronic self-focus on the acceptability of dispositional characteristics. The role of cognitive perseveration in the health and mental health problems of vulnerable perfectionists is discussed.