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The unique contribution of perfectionistic cognitions to anxiety disorder symptoms in a treatment-seeking sample
Abstract
Perfectionistic cognitions are thinking patterns that reflect excessive striving and are associated with emotional disorders in nonclinical samples. Despite literature connecting trait perfectionism with psychological disorders, much remains unknown about how perfectionistic cognitions relate to anxiety disorder symptoms in clinical populations. This is the first study to our knowledge that investigates how symptoms of anxiety and related symptoms are influenced by the frequency of perfectionistic cognitions when controlling for well documented correlates of anxiety. Perfectionistic cognitions, depressive symptoms, emotion regulation, anxiety sensitivity, and anxiety symptom severity were assessed prior to starting treatment in 356 treatment-seeking patients diagnosed with an anxiety or anxiety-related disorder at a specialty anxiety clinic. Perfectionistic cognitions were significantly correlated with all anxiety symptom measures as well as measures of depression, emotion regulation and anxiety sensitivity (range of rs =.22-.68). Hierarchical regression analyses revealed that when controlling for depressive symptoms, anxiety sensitivity, and emotion regulation, perfectionistic cognitions significantly and uniquely contribute to the variance of GAD (p <.01) and PTSD (p <.05) symptoms but not other anxiety-related symptoms (all ps >.05). Regardless of specific diagnoses, treatment-seeking individuals reporting frequent perfectionistic thoughts are more likely to report more severe symptoms of PTSD and GAD.
... As such, special attention should be paid to Perfectionistic Automatic Thoughts (PATs), which are understood as automatic reflections that are based on the desire to be perfect (Flett et al., 1998(Flett et al., , 2012Esteve-Faubel et al., 2020). These thoughts have a negative influence at the academic (Desnoyers and Arpin-Cribbie, 2015;Flett et al., 2019), physical (Flett et al., 1998(Flett et al., , 2012Kirtley et al., 2015), social (Aparicio-Flores et al., 2020c), and emotional level (Flett et al., 1998;Macedo et al., 2017;Aydin and Yerin-Güneri, 2020;Esteve-Faubel et al., 2020;Tyler et al., 2021). For this reason, it would be necessary to reflect on the connection that exists between AMA and PATs in order to determine whether AMA can positively influence strategies that enhance these perfectionistic reflections. ...
... However, while music performances can generate high levels of stress and anxiety due to PATs (Flett et al., 2016;Aydin and Yerin-Güneri, 2020;Tyler et al., 2021), several studies claim that people with high levels of stress or emotionally negative experiences tend to listen more to music as a way of controlling their mood (Getz et al., 2012(Getz et al., , 2014 because music listening has the power to decrease tension, anxiety, and stress (Lim and Bang, 2018). In other words, performing, and doing so on a crowded stage, is not the same as listening to music with the purpose of achieving a state of relaxation. ...
... In other words, performing, and doing so on a crowded stage, is not the same as listening to music with the purpose of achieving a state of relaxation. Similarly, neither music performance nor listening, which have a positive or negative impact on the anxiety caused by perfectionism (Flett et al., 1998;Sarikaya and Kurtaslan, 2018;Aydin and Yerin-Güneri, 2020;Tyler et al., 2021), are the same as AMA. ...
Aesthetic-musical awareness demarcates a person's own perception of their ability to connect with music and the emotions it evokes. This may imply a benefit for the affective state of the individual. Therefore, the aim of this study was to observe whether there are statistically significant differences in emotional intelligence, perceived academic self-efficacy, and perfectionistic automatic thoughts when there are high and low scores in aesthetic-musical awareness in late adolescence. Likewise, we also aimed to determine whether emotional intelligence, perceived academic self-efficacy, and perfectionistic automatic thoughts are predictors of high aesthetic-musical awareness. To this end, a sample of 798 Spanish students between 17 and 23 years of age (Mage = 18.5 years) was used. Statistically significant differences were found for the dimensions of each variable when there were high and low scores in aesthetic-musical awareness (scores between d = −0.31 and −0.40), with higher mean scores for emotional intelligence, perceived academic self-efficacy, and perfectionistic automatic thoughts being present in the group with high aesthetic-musical awareness. Likewise, it was observed that the probability of presenting high scores in aesthetic-musical awareness was higher when there was an increase in emotional intelligence, perceived academic self-efficacy, and perceived automatic thoughts. In conclusion, the results found demonstrate that both emotional intelligence, perceived academic self-efficacy, and the presence of perfectionistic automatic thoughts influence on whether an individual has greater aesthetic-musical awareness. Taking into account previous studies that show how music influences the well-being of the person, these findings show a favorable link for the design of programs that benefit the emotional state of adolescents.
... 40, nº 2 (may) honey & McEvoy, 2012ahoney & McEvoy, , 2012bMcEvoy & Erceg-Hurn, 2016;McEvoy & Mahoney, 2011Naragon-Gainey & Watson, 2018;Paulus et al., 2015;Toro-Tobar et al., 2019 with a high mean quality (84.77%). Fourthly, the role of anxiety sensitivity was found transdiagnostic in several studies (n = 6, 11.32%) (Boswell et al., 2013;Duyser et al., 2020;McEvoy & Brans, 2013;Paulus et al., 2015;Tyler et al., 2021;Zvielli et al., 2012) with a mean quality score of 93.75% ...
... Therefore, there is not enough evidence to allow us to state their transdiagnostic value so firmly. Thus, some of them (n = 5, 9.43%) focused the emotion regulation (Anderson et al., 2021;Faustino, 2021;Lukat et al., 2017;Tyler et al., 2021; others (n = 3, 5.66%) examined the experiential avoidance coping (Naragon-Gainey & Watson, 2018;Spinhoven et al., , 2015 and only one (1.89%) analyzed and found the role of tolerance of distress in the appearance of anxiety and depressive disorders (Macatee et al., 2020). ...
Comorbidity is more the rule than the exception in mental health, specifically in the case of anxiety and depression. Transdiagnostic models studied the underlying processes to improve mental health treatment and understating. Objective: This systematic review searchs for evidence on transdiagnostic risk factors for anxiety and depression in the clinical population diagnosed with these psychopathological conditions, by analysing the different types or categories of factors identified. Methods: A systematic review was registered in PROSPERO (registration number CRD42022370327) and was designed according to PRISMA-P guidelines. Two independent reviewers with field knowledge assessed the study quality to reduce bias. Results: Fifty-three articles were examined, and the transdi-agnostic variables were grouped into three categories: psychological, biological , and sociocultural. Conclusions: The most studied category was that of psychological variables, especially cognitive processes, negative affect, and neuroticism, intolerance of uncertainty, anxiety sensitivity. Biological and sociocultural factors require more study to support their transdiagnos-tic approach.
... Besides that, it should be noted that it is of great importance to study perfectionism in view of its relationship with mental health outcomes, that is, its associations with several psychopathologies (Kothari et al., 2019). Previous studies have demonstrated associations with eating disorders (Vanzhula et al., 2021), obsessive-compulsive personality disorders (Sametoğlu et al., 2021), anxiety, depression (Tyler et al., 2020), post-traumatic stress disorder (Cohen & Zerach, 2020), among others, and perfectionism has further presented correlations with suicidal ideation (Robinson et al., 2021). Together, these findings point towards the relevance of the present study in the national context. ...
... Notwithstanding the aforementioned limitations, the present findings have implications for both research and professional practice. First, perfectionism has been consistently associated with mental health outcomes, such as eating disorders, depression, anxiety disorders, personality disorders, suicide ideation, burnout, social isolation, and disconnection, among others Kothari et al., 2019;Robinson et al., 2021;Sametoğlu et al., 2021;Tyler et al., 2020). Therefore, expanding research on this construct can benefit society as a whole and practitioners working in clinical settings. ...
The aim of the present study was to investigate validity evidence based on internal structure and the relationship with other variables of the Brazilian version of the Hewitt and Flett Multidimensional Perfectionism Scale (H&F-MPS). To this end, a sample comprising 368 participants with a mean age of 31.17 years (SD=11,34), 74% female, answered the H&F-MPS perfectionism scale and instruments that measure personality and psychological inflexibility. Findings indicated a factor structure of three dimensions, like the original scale, good discriminative item parameters, highly satisfactory reliability indexes, and significant correlations of the hypothesized directions with Openness to Experiences, Neuroticism, and Conscientiousness factors from the personality measure, as well as with the psychological flexibility measure.
... Compared to trait measures of perfectionism, there are fewer research studies examining individual differences in PCs with respect to psychological distress. Yet, extant research supports the proposition that PCs are associated with psychological distress among young adults both within and across time (Besser et al., 2020) and among clinical samples (Flett et al., 2007;Tyler et al., 2021). Further, research has demonstrated that PCs uniquely contribute to distress over and above trait measures of perfectionism (Cassale et al., 2020;Flett et al., 1998;Tyler et al., 2021). ...
... Yet, extant research supports the proposition that PCs are associated with psychological distress among young adults both within and across time (Besser et al., 2020) and among clinical samples (Flett et al., 2007;Tyler et al., 2021). Further, research has demonstrated that PCs uniquely contribute to distress over and above trait measures of perfectionism (Cassale et al., 2020;Flett et al., 1998;Tyler et al., 2021). Consequently, to expand our understanding of how perfectionism contributes to psychological distress during the global pandemic, this study focused on cognitive aspects of perfectionism by concentrating on the frequency with which individuals experience PCs. ...
This study employed a two-wave cross-lagged panel analysis to examine associations between perfectionistic cognitions, anxiety, and depression pre-pandemic to during the pandemic in a sample of 171 (57% female, n = 98) emerging adults. Results demonstrated that perfectionistic cognitions decreased, anxiety increased, and depressive symptoms did not change pre-pandemic to during the pandemic. Cross-lagged results indicated that pre-pandemic perfectionistic cognitions predicted higher levels of anxiety symptoms (but not depressive symptoms) during the pandemic after accounting for pre-pandemic levels of anxiety and depressive symptoms. These results held with the inclusion of covariates (i.e., sex, age, education, exposure to COVID-19, whether or not participants knew someone diagnosed with COVID-19, had lost income due to the pandemic, and how often they thought about COVID-19). Psychological distress (i.e., anxiety and depressive symptoms) pre-pandemic did not predict perfectionistic cognitions during the pandemic after accounting for pre-pandemic levels of perfectionistic cognitions. Results support assertions that individuals with heightened levels of perfectionism are at an increased risk for poorer mental health during the pandemic. Findings underscore the importance of assessing perfectionistic cognitions for the prevention and treatment of anxiety symptoms among emerging adults during and post-pandemic.
... Jeremy Tyler с соавторами в своём исследовании подтверждает значительную взаимосвязь между перфекционистскими когнициями ("Я должен быть лучшим", "Независимо от того, сколько я делаю, этого всегда недостаточно", "Моя работа должна быть безупречной" и т. п.) и симптомами тревожных расстройств, помимо таких факторов, как чувствительность к тревоге, регуляция эмоций и депрессивные симптомы, которые являются хорошо установленными коррелятами этих тревожных расстройств. Это означает, что стремлению к совершенству может усилить симптомы тревожности, особенно у тех, кто переживает травму или хроническое беспокойство [50]. Руминативные мысли и чувствительность к тревоге могут быть ключевыми механизмами, связывающими перфекционизм с тревожными расстройствами [51]. ...
The aim of the empirical study presented in this thesis was to identify and describe the relationship between personality traits and eating behavior in middle-aged women, based on the analysis of risk factors for the development of eating disorders.
... El perfeccionismo es una disposición de la personalidad (Stoeber, 2018) que se ha relacionado con la etiología y el mantenimiento de diferentes patologías tales como los trastornos alimentarios (Kehayeset al., 2019;Stoeber et al., 2017), de ánimo (Smith et al., 2018a;Smith et al., 2018b;Smith et al., 2020) o de ansiedad (Smith et al.,2018c;Tyler et al., 2021). Por este motivo, se ha argumentado que el perfeccionismo constituye una disposición o rasgo de personalidad transdiagnóstico (Egan et al., 2011). ...
Transdiagnostic models conceive mental disorders as a result of difficulties in using coping strategies. Personality dispositions such as perfectionism, self-criticism and cognitive mechanisms of emotional regulation such as rumination have been the subject of research due to their clinical implications. The present study aims to investigate the clinical relevance of the relationship between the profiles of perfectionism, self-criticism and rumination. The sample is made up of 200 Psychology majors (83.5% women and 16.5% men) between 21 and 61 years of age. An exploratory, non-experimental, cross-sectional, differences between groups and explanatory design was used. There are different profiles of perfectionists: adaptive, maladaptive and non-perfectionist. One-way ANOVA parametric test was used for statistical analysis. The results indicate that adaptive perfectionists have the lowest mean scores on the values ?? of self criticism, psychological distress and rumination, followed by the group of non perfectionists, while the group of maladaptive perfectionists (23.5% of the sample) has the highest scores. high in these variables. In conclusion, the discrepancy perceived in maladaptive perfectionists triggers a hypercritical and dichotomous self evaluation of the self, which increases the perceived psychological discomfort. Likewise, the coping response to this discomfort is rumination, a maladaptive cognitive mechanism of emotional regulation that, in addition to being ineffective, maintains and amplifies psychological discomfort.
... However, temporally, the reverse association was observed, such that elevated GAD predicted future higher ratings on difference from others (independence). This finding might be explained by intolerance of uncertainty and perfectionism, i.e., both characteristics that have been linked to GAD symptoms (Gentes & Ruscio, 2011;Tyler et al., 2021). Interpersonal worries are common in GAD (Roemer et al., 1997). ...
BACKGROUND: Specific components of independent and interdependent self-construal have been associated with psychopathology. However, most studies on this topic have been cross-sectional, precluding causal inferences. We used contemporaneous and temporal cross-lagged network analysis to establish weak causal influences in understanding the association between self-construal and psychopathology components. METHODS: Middle-aged and older community-dwelling adults (n = 3,294) participated in the Midlife Development in the United States study across two time-points, spaced nine years apart. Six self-construal (interdependence: connection to others, commitment to others, receptiveness to influence; independence: behavioral consistency, sense of difference from others, self-reliance) and three psychopathology nodes (major depressive disorder (MDD), generalized anxiety disorder (GAD), and panic disorder (PD) symptom severity) were examined. All network analyses controlled for age, sex, race, and number of chronic illnesses as covariates. RESULTS: Contemporaneous and temporal networks yielded relations between elevated MDD and PD and increased receptiveness to influence. Heightened GAD symptom severity was associated with future increased difference from others and decreased connection to others, commitment to others, and receptiveness to influence. Higher MDD, GAD, and PD severity were associated with future lower self-reliance. Network comparison tests revealed no consistent network differences across sex and race. LIMITATIONS: DSM-III-R measures of MDD, GAD, and PD were used. Results may not generalize to culturally diverse racial groups. CONCLUSIONS: Changes in self-construal may result from increased MDD, GAD, and PD severity. Findings suggest the importance of targeting common mental health symptoms to positively influence how individuals view the self and others in various social contexts.
... For instance, one general trend is that cognitive aspects of psychopathology tend to increase from childhood to adolescence, as a young person's cognitive style becomes much more self-aware, abstract, and complex. These include the cognitive symptoms of depression (e.g., feelings of worthlessness, difficulty making decisions, negative cognitive style; Alloy et al., 2012;Sonuga-Barke et al., 2016), anxiety (e.g., worry, perfectionism;Tyler et al., 2021), and obsessive-compulsive disorder (e.g., more abstract categories of obsessions, mental rituals; Mancebo et al., 2008). Because of these natural developmental progressions in cognitive functioning, assessment approaches need to be modified to incorporate a young person's perceptions in a more detailed, rich manner. ...
One of the major developments in the field of child psychopathology has been further understanding the effects of age on symptom presentation. Also, various disorders tend to present at different ages. Symptoms may also change over time within disorders. Therefore, important factors in clinical case conceptualization include the age of onset of symptoms, the typical developmental course of symptoms, and contextual factors that might exert differential influence in childhood and adolescence. Further, research points to the importance of recognizing heterogeneity within diagnostic categories and clinical outcomes. These and other relevant issues will be discussed.KeywordsDevelopmental psychopathologyEquifinalityMultifinalityHeterogeneityDevelopmental courseOnsetDevelopmental contextComorbidity
... These findings are in keeping with research that has also illustrated that perfectionism cognitions are related to deficits in emotion regulation (Rudolph et al., 2007), coping (Kobori et al., 2011), and cognitive self-management (e.g., Flett et al., 2007). In addition, on the more extreme and clinical end, the experience of frequent perfectionism cognitions is related to a host of anxiety-related disorders, including generalised anxiety disorder, obsessive compulsive disorder, and social anxiety disorder (e.g., Tyler et al., 2021). ...
Whether an athlete is participating at youth level, professional level or is retired, athletes are vulnerable to psychological distress. Psychological distress is more likely to occur for those who are deselected from clubs, become injured, or experience adverse life events. Personality may be a determining factor for how athletes experience these situations. One personality characteristic related to psychological distress, both inside and outside sport, is perfectionism. Perfectionism is a trait or disposition reflecting a powerful need to be perfect (Hewitt & Flett, 1991). A number of different models and measures exist. However, arguably, the most complete theoretical model of perfectionism is Hewitt and Flett’s (1991) multidimensional model of perfectionism as it provides the most comprehensive account of perfectionistic behaviour available. This model differentiates three forms of perfectionism: self-oriented, socially prescribed, and other-oriented. The chapter will provide an explanation of Hewitt and Flett’s multidimensional model of perfectionism along with a brief review of the research conducted in sport that pertains to the three dimensions of the model. Perfectionism also includes a salient cognitive component whereby thinking patterns unique to perfectionism are a central and defining feature of perfectionism. Certain dimensions of perfectionism (self-oriented perfectionism and socially prescribed perfectionism) are characterised by self-critical appraisal in response to imperfection and a tendency to be cognitively preoccupied with failure (Hewitt & Flett, 1991). Consequently, people higher in perfectionism have been described as chronic over-thinkers and “perseverating perfectionists,” due to their tendency to engage in repetitive, maladaptive thinking about not reaching perfectionistic standards or about the need to attain standards in the future (Flett, Nepon, & Hewitt, 2016). This chapter will describe the cognitive elements of perfectionism based on Perfectionism Cognitions Theory (PCT; Flett, Hewitt, Nepon, & Besser, 2018). A review of the studies examining perfectionistic cognitions in sport will then be provided. The chapter concludes by outlining the limited interventions that exist to manage perfectionistic cognitions and providing practical ways to manage perfectionistic cognitions.
... These results are consistent with numerous previous studies (1,8). In order to explain these findings, in individuals with elevated levels of perfectionism, traumatic experiences can be responded quite negatively; since these individuals have a strong need for control and are often extremely stressed by activities beyond their control (30). Indeed, perfectionists acutely feel situations that evoke feelings of helplessness and a feeling of not being in control (e.g., the COVID-19 pandemic) (31). ...
Introduction: Elevated narcissism in young people often sets up a cascade of interpersonal and mental health challenges which needs to understand its concomitants. This study aimed to explain the structural model of narcissism based on early trauma, family function and perceived parenting styles with the mediating role of perfectionism.
Methods: This was an analytical cross-sectional study. The statistical population of the present study consisted of 20-45 year-old males and females referring to psychological clinics of Tehran in 2018-19. A sample of 350 people was also selected using convenience sampling method. Narcissistic Personality Inventory (NPI), the Childhood Trauma Questionnaire (CTQ), the McMaster family assessment device, and Perceptions of Parents Scale (POPS) were used to collect the data. The data were analyzed by descriptive statistics, including mean, standard deviation, skewness, and kurtosis using SPSS-22 software and structural equation modeling was used by Amos-24 doftware. The level of significant was (p
... This premise is in keeping with the perseverative cognition hypothesis (i.e., the notion that rumination extends the stress response, J o u r n a l P r e -p r o o f therefore conferring increased risk for health problems; Verkuil, Brosschot, Gebhardt, & Thayer, 2011). While individual differences in perfectionistic cognitions are relatively understudied with respect to health, early empirical research supports this premise showing that perfectionistic cognitions are linked to psychosomatic symptoms in young adults (Flett, Molnar, Nepon, & Hewitt, 2012) and uniquely contribute to distress (Casale, Fioravanti, Rugai, Flett, & Hewitt, 2020;Tyler, Mu, McCann, Belli, & Asnaani, 2020). Therefore, to expand our understanding of how perfectionism contributes to health, the present study concentrated uniquely on individual differences in the frequency with which individuals experience ruminative and automatic thoughts centering on the necessity to be perfect and their abiding sense of failure. ...
Previous research has demonstrated that perfectionism is implicated in poorer health and earlier mortality. However, to our knowledge, research has not yet determined how individual differences in perfectionistic cognitions are related to intermediary health markers such as inflammation. Thus, within the theoretical frameworks of the perfectionism diathesis-stress model (Hewitt & Flett, 1993) and the cognitive theory of perfectionism (Flett, Hewitt, Nepon, & Besser, 2018; Flett, Nepon, & Hewitt, 2016) the aims of our study were to test whether individual differences in perfectionistic cognitions were associated with low-grade inflammation via c-reactive CRP and IL-6 biomarkers and whether these relationships varied as a function perceived stress. The sample included 248 Canadian young adults (52% female, Mage = 22.89, SD = 1.53) who completed surveys assessing key constructs such as perfectionistic cognitions and perceived stress along with providing assessments of body fat percentage and serum samples of IL-6 and CRP. Regression analyses indicated that perfectionistic cognitions were not related to IL-6 under any conditions of stress. However, under high levels of stress perfectionistic cognitions were associated with elevated levels of CRP and these findings held after accounting for the effects of smoking status, body fat percentage, and respondent sex. The present work adds to the growing body of evidence supporting links between personality and inflammation. These findings raise the possibility that experiencing more frequent thoughts centered on the need to be perfect when coupled with higher levels of stress may set the stage for greater vulnerability for chronic inflammation.
Perfectionism cognitions are associated with cognitive biases (including memory), depression, and anxiety. Memory biases related to perfectionism may contribute to perfectionism’s role as a transdiagnostic risk factor and high comorbidity rates. However, very limited research exists on the relationship between perfectionism and memory. The current study examined (1) if perfectionism cognitions are related to memory performance, and (2) if perfectionism cognitions are related to sensitivity or decision bias. A convenience sample of 191 university students completed a recognition task with perfectionism-relevant, negative, positive, and neutral stimuli, and the Perfectionism Cognitions Inventory. The results showed perfectionism cognitions were correlated with and predicted memory accuracy for perfectionism-relevant and negative words only, suggesting individuals higher in perfectionism cognitions may exhibit an enhanced memory for perfectionism-relevant and negative stimuli. Signal detection analysis showed higher perfectionism cognitions were also related to (1) a higher memory discriminative ability, and (2) a more liberal response bias, for perfectionism words only. Furthering our understanding of how perfectionism cognitions impact cognitive processes is an important step to identify potential mechanisms in the relation between perfectionism cognitions and distress, and identify targets for intervention.
In this study, we sought to examine associations between dimensions of trait perfectionism and posttraumatic stress disorder (PTSD) symptoms among a community sample of adults who experienced at least one traumatic event and determine whether the associations between trait perfectionism dimensions and PTSD symptomatology varied as a function of perceived control. A sample of 161 (57% women; M = 33.24 years, SD = 10.84 years) community adults who experienced at least one traumatic event in their lives completed self-report measures of trait perfectionism, perceived control, personality, and PTSD symptomatology. Results from multiple regression analyses indicated that socially prescribed perfectionism was associated with higher levels of PTSD symptomatology. However, this finding was qualified by a significant interaction with perceived control such that higher levels of socially prescribed perfectionism were associated with greater PTSD symptomatology only under conditions of low perceived control. Findings underscore the importance of individual differences in socially prescribed perfectionism and perceived control for PTSD symptomatology.
Worrying about the negative consequences of appearing imperfect to others (i.e., perfectionistic self-presentation) is conceptually related to social anxiety. Mackinnon, Battista, Sherry and Stewart (2014) tested whether perfectionistic self-presentation could predict social anxiety beyond several important covariates using a 21-day daily measurement approach. We sought to replicate Mackinnon et al.’s (2014) findings using the same daily diary methodology. Participants included 263 young adults (79.9% women; M age = 21.4) who completed a series of questionnaires once per day for 21 days. Participants completed measures of perfectionistic self-presentation, perfectionism cognitions, social anxiety, depressed mood and socially prescribed perfectionism. Intraclass correlations suggested measures had both within-subjects and between-subjects variability. Confirmatory factor analyses supported the a-priori factor structures at both levels. Using multilevel structural equation modeling, we showed that perfectionistic self-presentation predicted social anxiety even when controlling for socially prescribed perfectionism, depressed mood and perfectionism cognitions at both levels, replicating Mackinnon et al (2014). Our replication suggests that perfectionistic self-presentation is an important predictor of daily social anxiety. Intervention efforts may wish to target perfectionistic self-presentation in order to better help treat those with social anxiety. Open data/methods: https://osf.io/ty2aj/.
Anxiety sensitivity (AS), a fear of arousal-related sensations, is prevalent in a number of disorders. We examined the relationship between internalizing symptoms and the anxiety sensitivity components of physical, social, and cognitive concerns in a sample of 165 patients seeking treatment in a clinic specializing in cognitive behavioral therapy for anxiety-related disorders. Social anxiety symptoms were associated with greater social concerns. Cognitive concerns were characteristic of both depression and generalized anxiety symptoms, suggesting these two classes of symptoms may share AS symptomatology. Physical concerns were specifically related to panic symptoms. Although obsessive–compulsive symptoms were related to cognitive concerns using univariate regression, these symptoms were not strongly related to any of the anxiety sensitivity components when the correlation between disorders was taken into account. Thus, within the internalizing symptoms studied here, the anxiety sensitivity domains were most relevant to panic, social anxiety, generalized anxiety, and depressive symptoms and less related to obsessive–compulsive symptoms.
From the 1980’s onwards, neoliberal governance in the US, Canada, and the UK has emphasized competitive individualism and people have seemingly responded, in kind, by agitating to perfect themselves and their lifestyles. In this study, we examine whether cultural changes have coincided with an increase in multidimensional perfectionism in college students over the last 27 years. Our analyses are based on 164 samples and 41,641 American, Canadian, and British college students, who completed the Multidimensional Perfectionism Scale (Hewitt & Flett, 1991) between 1989 and 2016 (70.92% female, Mage = 20.66). Cross-temporal meta-analysis revealed that levels of self-oriented perfectionism, socially prescribed perfectionism, and other-oriented perfectionism have linearly increased. These trends remained when controlling for gender and between-country differences in perfectionism scores. Overall, in order of magnitude of the observed increase, our findings indicate that recent generations of young people perceive that others are more demanding of them, are more demanding of others, and are more demanding of themselves.
This study investigated the relationship between dimensions of perfectionism and anxiety sensitivity. The study group is composed by 398 (211 female; 187 male) students who were studying at the pedagogical formation certificate program at Mugla Sitki Kocman University. The data were collected by using the Frost Multidimensional Perfectionism Scale and Anxiety Sensitivity Index-R. Pearson product-moment correlation analysis was employed to study the relationships between anxiety sensitivity and dimensions of perfectionism; structural equation modeling was also used for explaining the predictive role of dimensions of perfectionism on anxiety sensitivity. Concern over mistakes, personal standards, parental expectations, parental criticism, doubts about actions, and organization dimensions of perfectionism were found to be significantly correlated to anxiety sensitivity. A significant impact of six dimensions of perfectionism on anxiety sensitivity was detected. The theoretical implications of the link between perfectionism and anxiety sensitivity were discussed.
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.
Anxiety sensitivity (AS), the feared consequences of anxious arousal, is known to be related to posttraumatic stress symptoms (PTSS) concurrently and longitudinally. However, no studies have demonstrated whether AS prior to a Criterion A traumatic event predict later PTSS. The present study evaluated whether pre-shooting AS predicted PTSS following a campus shooting, as well as whether pre-shooting AS interacted with shooting exposure to predict PTSS. Participants comprised undergraduates (N = 71) who completed a self-report battery upon enrolling in Introductory Psychology. After a campus shooting later in the semester, they were invited to complete measures of PTSS and level of exposure to the shooting. Pre-shooting levels of AS significantly predicted PTSS after the shooting. This effect was qualified by a significant AS by shooting exposure interaction, such that those with high AS whom were exposed to the shooting reported the greatest levels of PTSS. Though all three of the pre-shooting physical, cognitive, and social AS subfactors demonstrated main effects significantly predicting post-shooting PTSS, only AS physical concerns significantly interacted with shooting exposure. The implications of this study concerning AS as a causal risk factor for PTSD are discussed.
The aim of this study was to evaluate the psychometric properties of the Posttraumatic Diagnostic Scale for DSM-5 (PDS-5), a self-report measure of posttraumatic stress disorder (PTSD) based on diagnostic criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Participants were 242 urban community residents, veterans, and college undergraduates recruited from 3 study sites who had experienced a DSM-5 Criterion A traumatic experience. The PDS-5 demonstrated excellent internal consistency (α = .95) and test-retest reliability (r = .90) and good convergent validity with the PTSD Checklist-Specific Version (r = .90) and the PTSD Symptom Scale-Interview Version for DSM-5 (PSSI-5; r = .85). The PDS-5 also showed good discriminant validity with the Beck Depression Inventory-II and the State-Trait Anxiety Inventory-Trait scale (all ZH > 3.05, ps < .01). There was 78% agreement between the PDS-5 and the PSSI-5. Receiver operating characteristic analysis yielded a cutoff score of 28 for identifying a probable PTSD diagnosis. The PDS-5 is a valid and reliable measure of DSM-5 PTSD symptomatology. (PsycINFO Database Record
Response to psychological treatment for Obsessive-Compulsive Disorder (OCD) varies, and dropout and relapse rates remain troubling. However, while studies examining symptom reductions are favourable, outcomes are less encouraging when outcome is defined in terms of clinically significant change. Moreover, there is little understanding of what predicts treatment outcome. This study examined demographic, symptomatic and cognitive predictors of outcome in 79 participants undertaking individualised cognitive-behavioural therapy for OCD. After investigating differences between treatment completers and non-completers, we examined treatment response as defined by post-treatment symptom severity and clinically reliable change, as well as predictors of treatment response. Completers were less likely to present with co-morbidity. The treatment was highly efficacious irrespective of whether completer or intention-to-treat analysis was undertaken, with 58% of treatment completers considered “recovered” at post-treatment. Lower pre-treatment levels of OCD symptoms and greater perfectionism/intolerance of uncertainty were the best unique predictors of OCD severity outcomes at post-treatment. Changes in obsessional beliefs were associated with symptomatic change, although only perfectionism/intolerance of uncertainty was a significant unique predictor of post-treatment change. Recovery status was predicted only by pre-treatment OCD severity. In helping to identify those at risk for poorer outcomes, such research can lead to the development of more effective interventions.
Using outpatients with anxiety and mood disorders (N = 350), the authors tested several models of the structural relationships of dimensions of key features of selected emotional disorders and dimensions of the tripartite model of anxiety and depression. Results supported the discriminant validity of the 5 symptom domains examined (mood disorders; generalized anxiety disorder, GAD; panic disorder; obsessive-compulsive disorder; social phobia). Of various structural models evaluated, the best fitting involved a structure consistent with the tripartite model (e.g., the higher order factors, negative affect and positive affect, influenced emotional disorder factors in the expected manner). The latent factor, GAD, influenced the latent factor, autonomic arousal, in a direction consistent with recent laboratory findings (autonomic suppression); Findings are discussed in the context of the growing literature on higher order trait dimensions (e.g., negative affect) that may be of considerable importance to the understanding of the pathogenesis, course, and co-occurrence of emotional disorders.
The present study aimed to identify mechanisms of change in individuals with moderately severe obsessive-compulsive disorder (OCD) receiving cognitive therapy (CT). Thirty-six adults with OCD received CT over 24 weeks. At weeks 0, 4/6, 12, 16/18, and 24, independent evaluators assessed OCD severity, along with obsessive beliefs and maladaptive schemas. To examine mechanisms of change, we utilized a time-varying lagged regression model with a random intercept and slope. Results indicated that perfectionism and certainty obsessive beliefs and maladaptive schemas related to dependency and incompetence significantly mediated (improved) treatment response. In conclusion, cognitive changes in perfectionism/certainty beliefs and maladaptive schemas related to dependency/incompetence precede behavioral symptom reduction for OCD patients. Targeting these mechanisms in future OCD treatment trials will emphasize the most relevant processes and facilitate maximum improvement.
The correlation between obsessive-compulsive disorder (OCD) and perfectionism is well documented, yet it remains unclear if dimensions of perfectionism vary as a function of OCD symptom dimensions. To this end, the present study investigated the unique associations between dimensions of perfectionism (i.e., concern over mistakes, doubts about actions, personal standards, parental criticism, parental expectations, and organization) and OCD symptom dimensions (i.e., hoarding, washing, checking, ordering, obsessing, and neutralizing). The study included adult patients with OCD (N = 46) from a residential OCD treatment program. Consistent with previous research, doubts about actions was a significant predictor of overall OCD severity and OCD checking symptoms. The organization dimension of perfectionism was a significant predictor of OCD ordering symptoms. The current study provides evidence for the unique relationships between OCD symptoms and perfectionism dimensions that encourage a movement toward greater phenotypic specificity within existing models of OCD.
The relationships between perfectionism, pathological worry and generalised anxiety disorder (GAD) were investigated in a clinical sample presenting for treatment of perfectionism.
This study explored the utility of perfectionism in predicting pathological worry in a sample of individuals with elevated perfectionism and GAD (n = 36). Following this, the study examined whether perfectionism could predict a principal GAD diagnosis in the full sample (n = 42).
Scores on the perfectionism dimensions Concern over Mistakes, Personal Standards, and Clinical Perfectionism significantly predicted pathological worry among participants with GAD after controlling for gender and depression. The perfectionism dimension Doubts about Actions significantly predicted whether individuals from the full sample received a principal diagnosis of GAD.
These findings support certain dimensions of perfectionism having significant associations with pathological worry and GAD.
Panic disorder (PD) is a highly prevalent and disabling mental health problem associated with different factors including perfectionism, stress, physiological anxiety, and anxiety sensitivity regarding physical concerns; however, no studies have analyzed the joint relationship between these factors and PD in a multi-factor model using structural equation modeling. Method: A cross-sectional study was carried out to collect data on these factors and self-reported DSM-IV past-year PD symptoms in a large sample of the general population (N=936). Results: Perceived stress had a significant effect in increasing physiological anxiety, which in turn had an important association with physical concerns. Perfectionism and perceived stress had an indirect relation with past year PD via the mediator role of physiological anxiety and physical concerns. Physical concerns, on one hand, seemed to mediate the impact between perfectionism and PD and, on the other, partially mediated the role between physiological anxiety and PD. Conclusions: Although there is considerable evidence on the association between each of these factors and PD, this model can be considered a broader and productive framework of research on the nature and treatment of PD.
Objective:
This study assessed a mediational model in which negative automatic thoughts and anxiety sensitivity were hypothesized to mediate the relationship between perfectionism cognitions and depressive and anxiety symptoms.
Participants:
Participants were undergraduate students from an urban Canadian university. The data were collected from July 2009 to August 2010.
Methods:
In a cross-sectional evaluation, 992 undergraduate participants completed questionnaires that assessed perfectionism cognitions, negative automatic thinking, anxiety sensitivity, and anxiety and depressive symptoms.
Results:
Mediational analysis confirmed the role of anxiety sensitivity and negative automatic thoughts in mediating the association between perfectionistic cognitions, anxiety symptoms, and depressive distress. Furthermore, in line with previous studies, nearly a third of students displayed an elevated prevalence of anxiety and depressive symptoms.
Conclusions:
This study further clarified the associations and mediating relationships among mood states associated with perfectionism.
Background:
To date no research has investigated the link between Post Traumatic Stress Disorder (PTSD) and perfectionism in a clinical sample.
Aims:
The aim of the current study was to examine whether there is a relationship between PTSD and perfectionism. This is important to address as many studies have demonstrated a link between other anxiety disorders, eating disorders, depression and perfectionism. The research also aimed to examine whether rumination was a mediator of the relationship between PTSD and perfectionism.
Method:
The sample consisted of 30 participants who were currently in treatment for PTSD.
Results:
The results suggest that perfectionism and PTSD symptoms were significantly correlated. In addition, rumination was a significant mediator of the relationship between Concern over Mistakes and PTSD.
Conclusions:
These findings help increase understanding about the relationships of perfectionism and rumination in PTSD and have implications for the treatment of PTSD.
This chapter describes the Beck Depression Inventory-Second edition (BDI-II), Beck Hopelessness Scale (BHS), and Beck Scale for Suicide Ideation (BSS). Given that the BDI-II is the most widely used of these measures, coupled with the fact that comprehensive reviews of this revised instrument have yet to appear in the literature, the primary focus of this chapter concerns the examination of the BDI-II. However, the remaining scales that we review are used widely as well, especially in the assessment of depression. Although we do not review the Beck Anxiety Inventory (BAI), which is another of the most commonly used Beck scales, readers are directed to some recent review papers (see Steer & Beck,1997; Wilson, de Beurs, Palmer, & Chambless, 1999). We begin with a review of the principal features, test development, psychometric characteristics, research status, and applicability of each of these instruments. We also discuss the limitations of these measures, mention age and cross-cultural factors, highlight accommodations made for persons with disabilities, address legal and ethical issues, and summarize each instrument's current research status. Following this examination, we underscore how these measures may be used in clinical practice. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The current study investigated the associations among trait perfectionism, perfectionistic self-presentation, negative social feedback, interpersonal rumination, depressive symptoms, and social anxiety. New measures of negative social feedback and interpersonal rumination were used to evaluate their relevance to the social aspects of perfectionism and their roles in distress. A sample of 155 undergraduate students completed the Multidimensional Perfectionism Scale, the Perfectionistic Self-Presentation Scale, the Social Feedback Questionnaire, Rumination About an Interpersonal Offense, and measures of depressive symptoms and social anxiety. The results confirmed that socially prescribed perfectionism and perfectionistic self-presentation were associated significantly with negative social feedback and rumination following interpersonal events (i.e., being hurt, humiliated, mistreated). Also, depressive symptoms and social anxiety were associated significantly with negative social feedback, interpersonal rumination, trait perfectionism, and perfectionistic self-presentation. Additional analyses indicated that negative social feedback and interpersonal rumination mediated the links between components of the perfectionism construct and distress. Overall, our findings suggest that self-reported receipt of frequent negative feedback from others and engaging in rumination about an interpersonal event play important roles in the distress experienced by certain individuals with high levels of perfectionism. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Previous perfectionism measures have not been evaluated for use with clinical samples. This research examined the psychometric properties of the Multidimensional Perfectionism Scale (MPS), a 45-item measure of self-oriented, other-oriented, and socially prescribed perfectionism. Study 1 provided normative data for various patient groups and demonstrated the stability of the MPS subscales in psychiatric patients. Study 2 showed that the MPS subscales have adequate concurrent validity, are not influenced by response biases, and that the items require a Grade 6–7 reading level. Overall, the MPS appears to be a useful measure for individuals with various clinical disorders. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The current study investigated the extent to which dimensions of perfectionism are associated with components of the anxiety sensitivity construct. A sample of 177 undergraduate students completed the Multidimensional Perfectionism Scale, the Perfectionism Cognitions Inventory, the Perfectionistic Self-Presentation Scale, and the Expanded Anxiety Sensitivity Index developed by Taylor and Cox (1998). The results confirmed that automatic thoughts involving perfectionism and the interpersonal aspects of the perfectionism construct are associated with anxiety sensitivity. Examination of the Anxiety Sensitivity Index factors showed that perfectionism cognitions were associated primarily with anxiety sensitivity involving fears of cognitive dyscontrol, while socially prescribed perfectionism and perfectionistic self-presentation were associated primarily with fears of publicly observable anxiety reactions in a manner suggesting that the interpersonal perfectionism dimensions are linked closely with an anxious sensitivity to negative social evaluation and subsequent panic attacks. The theoretical and treatment implications of the link between perfectionism and anxiety sensitivity are discussed.
The current study examined the extent to which dimensions of perfectionism are associated with a ruminative response orientation and the experience of cognitive intrusions in response to stressful events. Our main goal was to test the hypothesis that individuals characterized by frequent automatic thoughts involving perfectionistic themes would also be characterized by a ruminative response orientation when distressed and they would report intrusive thoughts and images following the experience of a stressful event. A sample of 65 students completed several measures, including the Perfectionism Cognitions Inventory, the Multidimensional Perfectionism Scale, the Response Styles Questionnaire, the Impact of Events Scale, and indices of depression and anxiety. Correlational analyses confirmed that high scores on the Perfectionism Cognitions Inventory were correlated with a ruminative response orientation and the reported experience of intrusive thoughts and images following the experience of a stressful event. High levels of perfectionism cognitions, socially prescribed perfectionism, and rumination were also correlated with measures of depression and anxiety representingthe tripartite model. The results support the view that there is a salient cognitive aspect to perfectionism and the experience of frequent perfectionistic cognitions and related forms of rumination contribute to levels of psychological distress.
The construct of emotion regulation has been increasingly investigated in the last decade, and this work has important implications
for advancing anxiety disorder theory. This paper reviews research demonstrating that: 1) emotion (i.e., fear and anxiety)
and emotion regulation are distinct, non-redundant, constructs that can be differentiated at the conceptual, behavioral, and
neural levels of analysis; 2) emotion regulation can augment or diminish fear, depending on the emotion regulation strategy
employed; and 3) measures of emotion regulation explain incremental variance in anxiety disorder symptoms above and beyond
the variance explained by measures of emotional reactivity. The authors propose a model by which emotion regulation may function
in the etiology of anxiety disorders. The paper concludes with suggestions for future research.
Background:
Numerous randomized controlled trials (RCTs) have examined the efficacy of cognitive behavioral therapy (CBT) in reducing anxiety symptoms. However, relatively fewer studies have examined the effectiveness of CBT in naturalistic treatment settings. There is even less known about the mechanisms underlying successful outcomes in naturalistic samples receiving CBT. This study aimed to examine the absolute and relative mediation of emotion regulation (ER) difficulties and anxiety sensitivity (AS) on anxiety symptom reduction.
Methods:
Participants were treatment-seeking patients (N = 247) at an outpatient anxiety clinic. Measures of difficulties in ER, AS, and disorder specific symptoms were administered at baseline, mid, and post-treatment. A composite anxiety score was calculated to measure anxiety disorder symptom severity across anxiety-related diagnoses.
Results:
Individual mediation models revealed that both AS and ER significantly mediated the reduction in anxiety-related symptoms over the course of treatment. A multiple mediation model found that ER was the strongest mediator (indirect effect = -1.030, 95% CI = -2.172 to -0.153). Further analyses revealed that the ER subscale of impulse control difficulties (e.g., the tendency to avoid when confronted with a feared stimulus) was the strongest mediator (indirect effect = -0.849, 95% CI = -1.913 to -0.081).
Limitations:
This study relied solely on self-report measures of ER, AS, and anxiety pathology, and did not have a control group.
Conclusions:
These results suggest that improvement in the ability to control impulses may act as a mechanism of anxiety symptom reduction and may be important to target in CBT with naturalistic samples.
Perfectionistic automatic thoughts have been linked with depressive symptoms in numerous cross-sectional studies, but this link has not been assessed in longitudinal research. An investigation with two timepoints was conducted to test whether perfectionistic automatic thoughts, as assessed by the Perfectionism Cognitions Inventory (PCI), are contributors to subsequent depression or vice versa. The possible role of a third factor (major life events stress) was also evaluated. A sample of 118 university students completed the PCI, the Center for Epidemiologic Studies Depression Scale (CES-D), and the Life Experiences Survey on two occasions with a 5-month interval. A cross-lagged analysis using structural equation modeling showed that above and beyond within-time associations and across-time stability effects, perfectionism automatic thoughts contributed to subsequent depressive symptoms and not vice versa. Negative life events stress was correlated significantly with both depressive symptoms and perfectionism automatic thoughts but did not have an influence on Time 2 depressive symptoms or on perfectionistic automatic thoughts. Our discussion focuses on perfectionistic automatic thoughts as a contributor to depressive vulnerability according to the perfectionism cognition theory.
Although the relationship between perfectionism and suicidal ideation is well established, little is known about the pathways through which perfectionism and suicidal ideation are linked. Therefore, the current study explored emotion dysregulation as an indirect effect of the relationship between perfectionism and suicidal ideation. Among university students (N = 130), we found that perfectionistic concerns and perfectionistic strivings were positively associated with suicidal ideation and that emotion dysregulation accounted for these relationships. Furthermore, two specific components of emotion dysregulation, emotional clarity and access to emotion regulation strategies, uniquely accounted for the relationship between perfectionistic concerns and suicidal ideation. Access to emotion regulation strategies uniquely accounted for the relationship between perfectionistic strivings and suicidal ideation. This is the first study to identify the role of emotion dysregulation as a key pathway that accounts for the relationship between perfectionism and suicidal ideation. Limitations, future research directions, and implications for reducing suicidal ideation among perfectionistic individuals are discussed.
Despite considerable data from randomized controlled trials supporting use of behavioral therapies for anxiety disorders and anxiety-related disorders, there is a relative scarcity of data demonstrating that such findings are generalizable to patients in nonresearch settings, and a lack of standardized repeated outcome measurement in such settings. Using one of the largest examinations of naturalistic outcomes of behavioral therapies in treatment-seeking patients (N = 489), we examined the clinical characteristics and treatment outcomes of patients seeking treatment for anxiety and anxiety-related disorders in the past 3 years. Patients seeking treatment at a clinic specializing in cognitive-behavioral therapy (CBT) completed self-report questionnaires via an electronic data capture system and diagnostic interview at baseline, and were reassessed at mid- and posttreatment. Patients with anxiety and related disorders were assessed for changes in symptom severity and secondary outcomes (impairment/functioning, quality of life, and depression) over the course of therapy. Patients showed clinically significant and statistically reliable improvement in anxiety symptom severity scores over treatment (p < .001), after controlling for number of sessions received. Patients also showed significant improvement in depression, quality of life, and functioning (p values ≤ .001). We also found significant improvement in disorder-specific symptoms, including obsessive-compulsive disorder, posttraumatic stress disorder, generalized anxiety disorder, and social anxiety disorder (p values ≤ .001). Importance of, and ways to facilitate, integration of more routine assessment of a broader range of symptoms via online assessment systems and methods to better determine the effectiveness of CBT in naturalistic clinics are discussed.
Extreme perfectionism has been linked with distress and dysfunction. This association is reflected by the recent development of the Big Three Perfectionism Scale (BTPS), which has superordinate trait-based scales that assess 3 broad elements—rigid, self-critical, and narcissistic perfectionism. We examined psychometric features of the BTPS as well as the links between the BTPS and indexes of distress. A sample of 602 undergraduates completed the BTPS, the Perfectionistic Self-Presentation Scale, the Perfectionism Cognitions Inventory, and measures of social anxiety and depression. Support was obtained for the psychometric qualities of the BTPS. All 3 superordinate trait factors were associated with social anxiety and depression. Analyses also established that rigid perfectionism, self-critical perfectionism, and narcissistic perfectionism are associated with perfectionistic cognitions and perfectionistic self-presentation. In addition, the results of a series of regression analyses established that perfectionistic self-presentation and perfectionistic cognitions accounted for significant unique variance in distress beyond the variance attributable to rigid, narcissistic, and self-critical perfectionism. Overall, our results suggest that the BTPS has significant promise as a predictor of various forms of dysfunction, but the cognitive and self-presentational aspects of the perfectionism construct are also uniquely relevant and not redundant with the BTPS superordinate trait factors
The purpose of this study was to identify whether maladaptive perfectionism predicts elevated symptoms of anxiety in a sample of primarily Puerto Rican middle school students. Participants included students (N = 128) from Grades 6 through 8 (48% male; average age = 11.9 years) who attended an urban, bilingual, public, charter school. Results suggested both general and specific links between maladaptive perfectionism and anxiety disorder symptoms. More specifically, socially-prescribed perfectionism (SPP) uniquely predicted symptoms of panic whereas self oriented perfectionism (SOP) uniquely predicted symptoms of social anxiety across the sample. These findings provide support for the previously established connection between various anxiety symptoms and perfectionism and demonstrate that such a connection exists in Latino adolescents. Given the strong relationship between different types of maladaptive perfectionism and anxiety, theoretical and cultural considerations should be considered to help better understand the nature of how perfectionism is linked to anxiety disorder manifestations. Future studies implementing more control and longitudinal designs may be useful to better understand how perfectionism may function as a transdiagnostic mechanism in the development and maintenance of anxiety in adolescents, and specifically those who identify as Latino.
Prior research supports maladaptive perfectionism as a risk factor for eating disorders; however, not all individuals with elevated levels of perfectionism endorse eating pathology, suggesting additional variables may interact with perfectionism to account for this association. The current study examined the influence of difficulties in emotion regulation on the relation between perfectionism and eating disorders. Undergraduate students (N = 309, 50.7% male) from a large university completed measures of perfectionism, emotion dysregulation, and eating pathology. The results indicated that high levels of perfectionism only accounted for significant variance in eating disorder symptoms among individuals with limited access to adaptive strategies to regulate emotions, but not among those with greater access to adaptive strategies. Findings demonstrate that clinicians and researchers should consider the role of emotion regulation among individuals with elevated levels of perfectionism and eating pathology. Future research should prospectively evaluate these associations and examine mechanisms that may further elucidate these relations.
Given recent attention to emotion regulation as a potentially unifying function of diverse symptom presentations, there is a need for comprehensive measures that adequately assess difficulties in emotion regulation among adults. This paper (a) proposes an integrative conceptualization of emotion regulation as involving not just the modulation of emotional arousal, but also the awareness, understanding, and acceptance of emotions, and the ability to act in desired ways regardless of emotional state; and (b) begins to explore the factor structure and psychometric properties of a new measure, the Difficulties in Emotion Regulation Scale (DERS). Two samples of undergraduate students completed questionnaire packets. Preliminary findings suggest that the DERS has high internal consistency, good test–retest reliability, and adequate construct and predictive validity.
Recent studies proposed that maladaptive cognitive emotion regulation (CER) is associated with negative dimensions of perfectionism and mediates the relationship between this trait and negative affect dimensions. In the present longitudinal study, our aim was to examine whether and which perfectionism cognitions and CER strategies would mediate the relationship between perfectionism traits and psychological distress, controlling for perceived stress, social support and outcome measure at one year before.
At T0 and after approximately one year (T1), 258 college students (79.8% female) filled in the Portuguese validated versions of self-report questionnaires to evaluate perfectionism trait dimensions (perfectionistic concerns and perfectionistic strivings), perfectionism cognitions, CER dimensions, perceived stress, social support and psychological distress (depression, hostility-anxiety, and amiability-vigor).
We found that higher perfectionistic concerns at T0 contribute significantly, after one year, to maladaptive perfectionism cognitions, which in turn are associated with higher levels of catastrophizing and rumination, and altogether will ultimately contribute to greater anxiety/hostility (total indirect effect: 0.03; 95% CI: 0.01 to 0.07) and depression (total indirect effect: 0.06; 95% CI: 0.02 to 0.13).
In this cognitive setting, perfectionist individuals may benefit from psychological interventions to reduce their tendency to use maladaptive CER strategies.
Perfectionism is known to be highly prevalent in obsessive-compulsive disorder (OCD). This review seeks to explore perfectionism in OCD and related disorders, particularly in relation to treatment, in order to inform treating clinicians. We also evaluate the potential role of perfectionism in the maintenance of OCD. Evidence supports perfectionism as a transdiagnostic process central to the psychopathology of OCD and other mental illnesses. Treatment outcomes in EX/RP for OCD are diminished in the presence of perfectionism, which is thought to be due to inherent treatment interfering features of perfectionism. Successful OCD treatment has been shown to decrease perfectionistic thinking, though data are mixed on whether reducing perfectionism mediates subsequent reductions in OCD symptoms. Short-term cognitive behavioral protocols for perfectionism are reviewed here and recommendations are made for the treatment of perfectionism in the context of OCD and related disorders.
There is now a voluminous literature on the role of perfectionism in psychopathology, but one topic has been almost entirely neglected – how perfectionists respond following exposure to traumatic stressors. The relatively few research studies conducted thus far are summarized below. First, however, we note some of the reasons why there should be a positive association between perfectionism and post-traumatic symptoms. Traumatic experiences may be responded to quite negatively by people with elevated perfectionism because perfectionists often have a strong need for control and they are highly stressed by events beyond their control (for a discussion see Hewitt & Flett, 2002). Moreover, perfectionists tend to feel overly responsible and have a propensity to experience self-blame and self-criticism following negative outcomes and events. The vulnerable perfectionist who actually makes a serious mistake that escalates into a traumatic experience is someone who most likely will find it quite difficult to stop ruminating and he or she will find it difficult to live with the mistake and their sense of inefficacy.
Background:
There is limited evidence on suicidality and its associated factors in patients with obsessive-compulsive disorder (OCD). The present study investigated the potential contributing traits such as alexithymia and perfectionism and clinical risk factors including symptom dimensions associated with high suicidality in OCD patients.
Methods:
A total of 81 patients with OCD were included (mean age: 28.89 years, SD=7.95 years, 62% men). Suicidal risk was assessed using the Scale for Suicide Ideation and history taking. To assess alexithymia and perfectionism, the Toronto Alexithymia Scale-20 and the Measure of Constructs Underlying Perfectionism were applied. Clinical characteristics of OCD were assessed with the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Obsessive-Compulsive Scale, and the Montgomery-Asberg Depression Rating Scale. Among OCD patients, 37% had a history of previous suicidal attempt, and 56.8% had current suicidal ideation.
Results:
Those with lifetime suicide attempts scored significantly higher for alexithymia and ego-dystonic perfectionism than those without such history. In the binary logistic regression analysis, high score for alexithymia and the responsibility for harm, injury, or bad luck were significant determinants for lifetime suicide attempts. As for current suicide ideation, ego-dystonic perfectionism and the dimension of unacceptable thought were significant predictors of suicidal risk.
Limitations:
The classification of suicidal risk and personality traits relied on self-report measures.
Conclusion:
The present findings indicate that personality traits such as alexithymia and perfectionism may contribute to high suicidality in patients with OCD, and patients suffering with unacceptable thoughts need to be assessed more carefully for warning signs of suicide.
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.
Anxiety sensitivity (AS) is associated with various forms of psychopathology. The most common measure of AS is the anxiety sensitivity index-3 (ASI-3). The current study examined the psychometric properties and factor structure of the ASI-3 in an acute and comorbid population seeking treatment for a broad range of psychopathology (N=382). Results confirmed a bi-factor structure and suggested that the ASI-3 demonstrates adequate psychometric properties in a transdiagnostic sample. The ASI-3 also showed adequate sensitivity to change over the course of partial hospital treatment. Findings regarding associations between specific anxiety disorders and subscales of the ASI-3 are discussed. Overall, the current results support the use of the ASI-3 to assess AS in heterogeneous treatment-seeking samples. This work is of particular utility for researchers examining the concept of AS transdiagnostically.
Sample size determination is an important and often difficult step in planning an empirical study. From a statistical perspective, sample size depends on the following factors: type of analysis to be performed, desired precision of estimates, kind and number of comparisons to be made, number of variables to be examined, and heterogeneity of the population to be sampled. Other important considerations include feasibility, such as ethical limitations on access to a population of interest and the availability of time and money. The primary assumption of the book is that, within the context of ethical and practical limitations, efforts to obtain samples of appropriate size and quality remain an important and viable component of social science research. This text describes the following available approaches for estimating sample size in social work research and discusses their strengths and weaknesses: power analysis; heuristics or rules-of-thumb; confidence intervals; computer-intensive strategies; and ethical and cost considerations. In addition, strategies for mitigating pressures to increase sample size, such as emphasis on model parsimony (e.g., fewer dependent and independent variables), simpler study designs, an emphasis on replication, and careful planning of analyses are discussed. The book covers sample-size determination for advanced and emerging statistical strategies, such as structural equation modeling, multi-level analysis, repeated measures MANOVA, and repeated measures ANOVA which are not discussed in other texts.
Objective
Perfectionism has long been known to correlate with eating disturbance (ED). One mechanism through which this personality tendency may lead to ED is through increasing one’s daily perfectionistic thoughts. This study examined the mediating role of perfectionistic thinking in the personality perfectionism – ED relationship among both male and female college students, and included measures assessing both typically-male and typically-female ED symptoms.
Method
A majority-White sample of 140 males and 329 females completed online versions of the Multidimensional Perfectionism Scale (Hewitt & Flett, 1991), Perfectionism Cognitions Inventory (Flett, Hewitt, Blankstein, & Gray, 1998), Drive for Muscularity Scale (McCreary, Sasse, Saucier, & Dorsch, 2004), items from the Eating Disorder Examination Questionnaire (Fairburn, 2008), and other measures. Regression tests examined the hypothesized role of perfectionistic cognitions as a mediator, including participant age, BMI, and positive and negative affect as covariates.
Results
Among women, relationships between both self-oriented (Sobel’s statistic = -4.63, p < .001) and socially prescribed perfectionism (Sobel’s statistic = -5.77, p < .001) and dieting behavior were fully mediated by increased perfectionistic thinking. Among men, however, the relationship between only self-oriented perfectionism and bulimic (but not dieting) behavior, was fully mediated by increased perfectionistic thinking (Sobel’s statistic = -2.53, p = .01).
Conclusions
Perfectionistic cognitions play an important linking role between personality perfectionism and ED, and can illuminate important differences by gender in eating disturbance. Such findings can improve validity of ED assessment in both genders, and provide a clear pathway to interventions to decrease ED in both genders.
Perfectionistic self-presentation is thought to confer risk for social anxiety. Although this relationship is thought to occur dynamically from moment-to-moment, no research has yet tested this relationship using experience sampling methods. The present study stringently tested whether perfectionistic self-presentation predicted social anxiety beyond several important covariates using a 21-day experience sampling design. A sample of 165 undergraduates (75.6% women) completed a series of questionnaires each day for 21 days using palm pilots. Generalizability theory and multilevel factor analyses suggested daily measures of perfectionistic self-presentation, social anxiety, perfectionism cognitions, and depressed mood evidence within-subjects and between-subjects variability, can be measured reliably, and represent distinct factors, allowing hypothesis testing. Multilevel regressions showed perfectionistic self-presentation predicted social anxiety at the between-subjects and within-subjects levels, even when controlling for socially prescribed perfectionism, perfectionism cognitions, and depressed mood. Overall, perfectionistic self-presentation emerged as a robust predictor of daily social anxiety, clearly extending prior cross-sectional research on this topic. By understanding how perfectionism operates from day-to-day, we can better understand the processes that give rise to social anxiety, and ultimately how to devise more effective ways to help people suffering from social anxiety.
The present study examined trait perfectionism, automatic perfectionistic thoughts, rumination, worry, and depressive symptoms in early adolescents. A group of 81 elementary school students in Grades 7 and 8 completed 5 questionnaires: the Child-Adolescent Perfectionism Scale, the Perfectionism Cognitions Inventory, the Children’s Response Styles Questionnaire, the Penn State Worry Questionnaire for Children, and the Center for Epidemiologic Studies Depression Scale. The correlational results revealed associations between both trait perfectionism and perfectionistic automatic thoughts and the indices of depression and worry. Rumination was associated with perfectionistic automatic thoughts, self-oriented perfectionism, depression, and worry. Tests of mediation indicated that rumination mediated the association between perfectionism and depressive symptoms, thus highlighting the role of maladaptive forms of cognitive reactivity in perfectionism. The findings suggested that perfectionistic children and youth are at-risk due to cognitive vulnerabilities and they should benefit from programs focused jointly on reducing perfectionism, associated cognitive tendencies, and susceptibility to depression and worry.
Background:
Intolerance of uncertainty (IU) and perfectionism have both been shown to predict severity of obsessive-compulsive disorder (OCD) symptoms in populations diagnosed with OCD, as well as analogue samples. According to cognitive models of OCD, symptoms are maintained by dysfunctional beliefs including IU and perfectionism. The purpose of the current study is to extend research on the cognitive theory of OCD by describing how dysfunctional thoughts interact with each other.
Methods:
In an analogue sample for OCD (N = 475), undergraduate students completed measures online pertaining to IU (IU scale), perfectionism (Frost Multidimensional Perfectionism Scale), and OCD symptoms and severity (Florida Obsessive-Compulsive Inventory).
Results:
The proposed model of IU fully mediating the relationship between perfectionism and OCD severity was supported using structural equation modeling (SEM) analysis. Bootstrapping testing within AMOS 20 and Sobel tests further corroborated full mediation.
Conclusions:
Results from the current study suggest that IU fully mediates the relationship between perfectionism and severity of OCD symptoms. This finding has an impact for understanding the nature and treatment of OCD with perfectionism as a primary symptom. Findings suggest that in order to address perfectionism, it is necessary to first treat cognitions and obsessions associated with IU and that this practice would lessen distress and interference associated with perfectionistic obsessions.
Because self-report information obtained from individuals with addictive disorders is subject to bias and random error, recommendations are offered about how to improve the accuracy of verbal report methods, based on a heuristic model of the question-answering process. By focusing on the way in which questions are asked and responded to, some logical inferences can be made about the sources of invalidity and the means to correct them. The model takes into account respondent characteristics, task variables, motivation, and cognitive processes within a general social context. Ways of minimizing response bias and enhancing validity are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The current study investigated the general hypothesis that perfectionists have deficits in cognitive emotion regulation. A
sample of 100 students completed the Perfectionism Cognitions Inventory, the Multidimensional Perfectionism Scale, the Cognitive
Emotion Regulation Questionnaire (CERQ), and a measure of depression. Correlational analyses revealed that frequent thoughts
involving perfectionism were associated with maladaptive cognitive emotion regulation tendencies, including catastrophization,
self-blame, rumination, and lack of positive reappraisal. Socially prescribed perfectionism was associated with the maladaptive
cognitive emotion regulation strategies of self-blame, catastrophization, and rumination, and it was correlated negatively
with the adaptive cognitive emotion regulation strategies of putting into perspective and positive reappraisal. Trait self-oriented
perfectionism was linked with self-blame. As expected, higher levels of depression were associated with perfectionism cognitions,
socially prescribed perfectionism and deficits in cognitive emotion regulation. Our findings suggest the need for interventions
designed to bolster the cognitive coping skills of at-risk perfectionists.
Two studies were conducted to examine the psychometric properties and correlates of the Perfectionism Cognitions Inventory
(PCI) when administered to clinical samples. The PCI is a 25-item measure of automatic thoughts with themes involving perfectionism
and beliefs that perfection should be attained. Analyses indicated that the PCI is unidimensional and it has adequate internal
consistency. Correlational analyses confirmed that the PCI is associated with psychological distress and deficits in cognitive
self-management, including lack of self-reinforcement, lack of a positive self-focus, and perfectionistic inflexibility. Moreover,
tests of incremental validity revealed that the PCI accounts for unique variance in levels of anxiety and depression symptoms
after removing variance attributable to trait perfectionism dimensions. Overall, the findings suggest that automatic thoughts
involving perfectionistic themes can be assessed in a reliable and valid manner in clinical samples. Moreover, it is important
to assess perfectionism cognitions as a supplement to trait perfectionism measures when evaluating the role of perfectionism
in psychological distress and associated deficits in cognitive self-control.
The current paper describes the results of an experiment in which 200 students who varied in levels of trait perfectionism
performed a laboratory task and then were assessed in terms of levels of state affect, state self-esteem, and state automatic
thoughts. Independent variables included task difficulty (high versus moderate level of difficulty) and performance feedback
independent of their actual level of performance (positive or negative). Analyses also examined objective levels of performance
(i.e., the number of errors on the task) and initial confidence in performance. Analyses showed that the experience of state
automatic thoughts involving perfectionism was associated with negative automatic thoughts, negative affective reactions,
and lower state self-esteem. Analyses of changes in mood and self-esteem showed generally that participants high in socially
prescribed perfectionism had increased levels of dysphoria and anxiety and lower levels of state self-esteem following the
experience of negative performance feedback or after having a relatively poor performance. Analyses of the physiological measures
found increased systolic blood pressure among self-oriented perfectionists who had poorer performance and among socially prescribed
perfectionists who had received negative feedback about their performance. The results for heart-rate changes yielded a less
clear pattern, though there was evidence that participants with high socially prescribed perfectionism had increased heart
rate if they received negative feedback and were relatively low in confidence. Collectively, these findings illustrate that
how perfectionists react in challenging situations varies as a function of actual performance, performance feedback, and feelings
of personal efficacy.