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11
Perfectionism
and
in
Stress
Processes
Psychopathology
Paul
L.
Hewitt
and
Gordon
L.
Flett
The marked increase in research on the perfectionism construct over the
past decade reflects the importance of the concept. The research from var-
ious laboratories has shown the clinical relevance
of
the construct not only
in association with
a
variety
of
phenomena, including anxiety, depression,
eating disorders, personality disorders, interpersonal problems, and mar-
ital difficulties, but also
for
how perfectionistic behavior can influence the
clinical assessment process (Habke, 1997) and treatment issues (Blatt,
1995; Hewitt, Flynn, Mikail,
&
Flett, 2001b). Although an impressive list
of psychopathological correlates
of
perfectionism has been developed, most
of the research has been conducted without explicit reference to models of
perfectionistic behavior and how perfectionism comes to be associated with
those disorders. The purpose of this chapter
is
not only
to
describe our
multidimensional conceptualization
of
perfectionism traits but also
to
out-
line
a
model that examines how perfectionism functions as both
a
medi-
ating and
a
moderating variable in influencing stress and producing or
maintaining various psychological disorders and symptoms. Finally, be-
cause most
of
the research on perfectionism has focused on depression as
an outcome, we discuss some of that research
to
illustrate the associations
among perfectionism traits, stress, and psychopathology.
Dimensions
of
Perfectionism
In response
to
dissatisfaction with the unidimensional conceptualizations
of
perfectionism that appeared sporadically in the literature over the
years, both
our
research group (Hewitt
&
Flett, 1989, 1991a, 1991b; Hew-
itt,
Mittelstaedt,
&
Wollert, 1989) and the research group led by Frost and
colleagues
(Frost,
Marten, Lahart,
&
Rosenblate, 1990) have conceptual-
ized perfectionism
as
a
multidimensional construct. Although the concep-
tualizations differ, the need
to
differentiate facets of perfectionistic behav-
ior is
a
common theme. In addition, the models suggest that focusing solely
on the cognitive components
was
too
restrictive and that interpersonal and
motivational factors must be taken into account (see Hewitt
&
Flett, 1990,
1991b).
255
http://dx.doi.org/10.1037/10458-011
Perfectionism: Theory, Research, and Treatment, edited by G. L. Flett and P. L.
Hewitt
Copyright © 2002 American Psychological Association. All rights reserved.
Copyright American Psychological Association. Not for further distribution.
256
HEWITT
AND
FLETT
Our work
has
focused on three major
trait
dimensions of perfection-
ism: Self-oriented perfectionism, other-oriented perfectionism, and socially
prescribed perfectionism (Hewitt
&
Flett, 1991b). The dimensions are per-
sonality traits in the sense that they are stable, ingrained personality
styles. Moreover, they are regarded
as
distinguishable dimensions that are
each associated with different psychopathological states. Although the be-
haviors exhibited are frequently the same
or
similar among the dimen-
sions (e.g., motivation
to
actually
be
perfect, maintenance of markedly un-
realistic expectations, stringent and critical evaluations, and equating
performance with worth), the distinguishing features among the dimen-
sions involve either whom the perfectionistic expectations derive from (i.e.,
self
or
others)
or
to whom the perfectionistic behaviors are directed (i.e.,
toward self or others).
Self-oriented perfectionism
is
an intraindividual dimension involving
perfectionistic behaviors
that
both derive from the self and are directed
toward the self. That is, the person with self-oriented perfectionism de-
rives his
or
her own perfectionistic expectations and requires only him-
or
herself
to
be perfect. The important facets of self-oriented perfectionism
include strong motivations for the self to be perfect, maintaining unreal-
istic
self-expectations in the face of failure, stringent self-evaluations that
focus on one’s own flaws and shortcomings, and generalization of unreal-
istic expectations and evaluations across behavioral domains. This dimen-
sion
is
related
to
disorders and symptoms that involve the self-concept,
such as depression and eating disorders.
Other-oriented perfectionism
is an interpersonal dimension of perfec-
tionism that also stems from the self, but perfectionistic demands are di-
rected toward others. That
is,
other-oriented perfectionism entails strong
motivations for having others be perfect (e.g., one’s children, spouse, sub-
ordinates, employees, and
so
forth), unrealistic expectations, and stringent
evaluations of others. Other-oriented perfectionists require others to be
perfect in many domains of functioning. This dimension may not neces-
sarily produce self-related disorders
or
symptoms for the perfectionist him-
or herself, but
it
should produce dissatisfaction
or
difficulties for the tar-
gets of the other-oriented perfectionist. Such perfectionists may experience
distress
to
the extent that the standards they prescribe for others involve
a
failure on the part of others
to
provide the other-oriented perfectionist
with social support
or
recognition. Similarly, other-oriented perfectionists
may experience difficulties to the extent that the targets of the perfection-
istic
expectancies feel criticized and express their resentment about being
treated in
a
hostile manner. Thus, the other-oriented perfectionist may
experience interpersonal problems and the loss
of
important relationships.
Socially prescribed perfectionism
is
another interpersonal dimension.
It
involves perfectionistic demands that are perceived
to
derive from oth-
ers yet are directed toward the self. For example, socially prescribed per-
fectionism involves the belief in one’s inability
to
meet the perceived per-
fectionistic demands and expectations imposed by others. Thus, socially
prescribed perfectionism entails the perception that others impose un-
realistic demands and perfectionistic motives for oneself and will be sat-
Copyright American Psychological Association. Not for further distribution.
PERFECTIONISM
AND
STRESS PROCESSES
257
isfied only when those demands are met. This dimension of perfectionism
is
a
self-related dimension in the sense that
it
involves concern with one's
own lack of perfection; thus,
it
should be associated with self-related dis-
orders and symptoms. Perhaps more important, however, is the strong
concern over obtaining and maintaining the approval and care
of
other
people and
a
sense of belonging that could be attained
if
it
were possible
to
be perfect in the eyes
of
others.
The three perfectionism dimensions
act
as core vulnerability factors
and are associated differentially with various types
of
psychopathology
(see Hewitt
&
Flett, 1991b). The dimensions may be involved in either the
direct onset of psychological disorders
or
the exacerbation
of
symptom se-
verity because they reflect specific vulnerabilities to particular disorders
that become manifest in the presence
of
specific environmental events,
situations, or personality features. The
trait
facets also can function
to
maintain elevated levels
of
symptoms by influencing coping mechanisms
or
by influencing how the person actually deals with stressful events
or
symptoms. Hence, we suggest that the
trait
dimensions can play
a
medi-
ating or
a
moderating role in the development and maintenance of psy-
chopathology by influencing perceived stressful failures.
Our Multidimensional Perfectionism Scale' (MPS; Hewitt
&
Flett,
1989, 1991b) was developed to assess those dimensions. The measure was
created in accordance with widely accepted test construction approaches
(e.g., Jackson, 1970); item content was based on case descriptions and
theories in the literature
as
well
as
on the clinical experience of Paul
Hewitt, who has worked extensively with perfectionistic people. Items
were retained or rejected on the basis
of
several criteria; for instance,
items were discarded
if
they had content that might actually represent
symptoms
of
depression
or
stress-related reactions. Items were retained
in the final version
of
the MPS only after passing several statistical
cri-
teria (see Hewitt
&
Flett, 1991b, for
a
detailed description).
Perfectionism
and
Stress
in
Psychopathology
A
primary assumption guiding our work with the MPS
is
that perfection-
istic behavior
is
associated with psychopathology through
its
association
with and influence on stress. Perfectionists are more likely than nonper-
fectionists to experience various kinds of stress in
a
variety
of
forms, in-
cluding the experience
of
daily hassles and
a
constant pressure
to
attain
high standards that emanate from inside
or
outside the self. Perfectionists
who already are experiencing
a
high level
of
daily pressures will be par-
ticularly vulnerable
to
the disruptive effects associated with the experi-
ence
of
negative life events.
The connection between perfectionism and stress in influencing psy-
chopathology can be quite complex.
For
example,
trait
dimensions of per-
'Unless otherwise noted,
all
references to the MPS refer to the version developed
by
Hewitt
&
Flett
(1991b).
Copyright American Psychological Association. Not for further distribution.
258
HEWITT
AND
FLEW
Table
11.1.
and Psychopathology
Stress
mechanism Description
Stress generation
Hypothesized Stress Mechanisms in Perfectionism
A
tendency
to
engage in behavior, make choices, or pur-
sue unrealistic goals that creates stressful events
or
circumstances
A
future orientation that involves
a
preoccupation with
possible stressors and problems of personal importance
A
tendency to activate maladaptive tendencies (e.g., a
ru-
minative response orientation) that maintain and pro-
long stressful episodes
The magnification of stress due to self-defeating styles of
cognitive appraisal (e.g., interpreting minor mistakes
and setbacks as personal failures of great importance,
overgeneralizing negative outcomes
to
aspects of the
self, and
so
forth) and maladaptive coping
and
problem-solving skills
Stress anticipation
Stress perpetuation
Stress enhancement
fectionism can play
a
moderating role in producing psychopathological
states by enhancing
or
exacerbating the aversiveness
of
experienced
stressors
or
failures. Perfectionistic behavior also can play
a
mediating
role in
its
association with psychopathology by influencing the generation
of
stressful failures, the perpetuation
of
the negative effects of stressors
or failures, and the anticipation
of
future stressors and failures.
Our approach in this chapter is generally consistent with the frame-
work put forth by Bolger and Zuckerman
(19951,
who acknowledged that
personality factors are involved both in the amount of exposure
to
stress-
ors
and in differences in stress reactivity (i.e., coping choice and coping
effectiveness). According
to
our formulation, perfectionism can influence
or interact with stress to produce
or
maintain psychopathological states
in
at
least four ways:
(a)
stress generation, (b) stress anticipation,
(c)
stress
perpetuation, and (d) stress enhancement.
A
description
of
each mecha-
nism and related processes
is
presented in Table
11.1.
Stress generation,
stress anticipation, and stress perpetuation all relate
to
the degree
or
amount of stress exposure, whereas stress enhancement involves the man-
ner in which
a
person reacts
to
stress. We maintain that perfectionists are
prone to experiencing psychological distress because they experience high
levels of stress exposure and have maladaptive ways of reacting to that
stress. The following sections describe the role of perfectionism in each of
the four stress processes along with summaries
of
the research in each
area.
Perfectionism and Stress Generation
In recent years, research on stress and maladjustment has expanded con-
siderably by addressing the possibility that certain people are susceptible
to
adjustment problems because they have
a
personality orientation that
Copyright American Psychological Association. Not for further distribution.
PERFECTIONISM AND STRESS PROCESSES
259
is
associated with increased exposure to stress. That
is,
some people take
an active role in creating
or
generating stress
for
themselves and for those
around them. People can create stressful circumstances
for
themselves in
various ways, such
as
by associating with “difficult” people
or
engaging in
excessive reassurance seeking
to
the point that
it
alienates possible pro-
viders of support (see Depue
&
Monroe, 1986; Hammen, 1991). Monroe
and Simons (1991) have suggested that
a
personality vulnerability factor
actually may create the stress with which the vulnerability factor then
interacts, producing depression.
We believe that perfectionists, relative
to
nonperfectionists, are ex-
posed to
a
greater number
of
stressful or failure events simply as
a
result
of their unrealistic approach to life. In addition to the usual stressors or
failures that can befall any person, stressors
or
failures actually will be
produced by people who are perfectionistic because they seek perfection in
many
or
all spheres
of
behavior. Perfectionistic behavior can generate
stress that stems, in part, from perfectionists’ tendencies
to
stringently
evaluate themselves and others, focus on negative aspects of performance,
and experience little satisfaction.
Differences should be evident among the various dimensions of per-
fectionism in terms of their role in the generation
of
stress.
A
person with
a
high level of self-oriented perfectionism can turn
a
relatively successful
experience into
a
personal failure by striving
for
impossibly high stan-
dards and becoming dissatisfied and disappointed by the level
of
perfor-
mance. For example, the excessively perfectionistic student who views an
A+
in
a
course
as
his or her expected performance will view anything but
the
A+
as
a
failure and will experience stress
as
a
result. The tenor who
sings beautifully throughout an
aria
but falters only slightly during the
high
C
will view the entire piece
of
work as
a
total failure. In addition,
even
if
a
perfectionistic person performs some task flawlessly, little sat-
isfaction may be experienced because he or she still views the performance
at least somewhat
as
a
failure.
As
an illustration, one
of
Hewitt’s patients
obtained
a
coveted
A+
in a difficult course he was taking; after receiving
the
A+,
he continued to denigrate himself, stating that he should have
been able to get the
A+
without studying
so
hard and that his situation
simply reflected that he was not
as
bright
as
he thought he should be.
Thus, in this situation, even the
A+
was not seen
as
a
success that pro-
duced satisfaction because the amount
of
effort required then became an
issue. This example underscores the point that extreme perfectionists may
be self-critical either
for
failing
to
attain an impossible goal
or
for
expend-
ing
too
much effort in an attempt
to
reach this goal.
Several studies have shown that highly perfectionistic people experi-
ence greater dissatisfaction with their performance than do people who
are not highly perfectionistic (e.g., Frost
&
Henderson, 1991).
For
example,
Flynn, Hewitt, Flett, and Weinberg
(2001)
found that people scoring high
on self-oriented perfectionism experienced less satisfaction with perfor-
mance on
a
challenging task than those low on self-oriented perfectionism
did, even after controlling for actual performance. Likewise, in
a
sample
of
professional artists, Mor, Day, Flett, and Hewitt (1995) found that both
Copyright American Psychological Association. Not for further distribution.
260
HEWITT
AND
FLETT
self-oriented and socially prescribed perfectionism were associated with
decreased goal satisfaction and less happiness over performances, even
though many
of
the perfectionists were highly accomplished professionals
with international reputations.
The goals that perfectionists pursue should be associated with the
generation of stress because extreme perfectionists pursue standards that
are beyond attainment. Research in achievement settings has confirmed
that some people tend to pursue
goals
that involve the creation of dis-
crepancies between those goals and current levels
of
performance (Phillips,
Hollenbeck,
&
Ilgen,
1996).
Although
trait
perfectionism and discrepancy
creation has not been investigated directly, a tendency for self-oriented
perfectionists
to
create discrepancies would be in keeping with general
evidence that people with high levels of achievement motivation tend
to
set more difficult goals than do people with lower levels of achievement
motivation, even though they do not differ in performance level (Phillips
et al.,
1996).
Much
of
the stress generation in achievement situations can be traced
back
to
the perfectionists’ unwillingness
to
lower their expectations, even
when provided with feedback suggesting that lowering the standard
is
the
prudent thing
to
do. In an unpublished study, we established
a
link be-
tween perfectionism and goal inflexibility by administering our perfection-
ism measure, along with Brandtstadter and Renner’s
(1990)
measures of
flexible goal adjustment and tenacious goal pursuit,
to
a
sample of
294
university students. Significant negative correlations were evident be-
tween flexible goal adjustment and self-oriented perfectionism
(r
=
-
.18,
p
<
.Ol),
other-oriented perfectionism
(r
=
-.26,
p
<
.Ol),
and socially pre-
scribed perfectionism
(r
=
-.32,
p
<
.Ol).
Tenacious goal pursuit was as-
sociated with self-oriented perfectionism
(r
=
.35,
p
<
.Ol)
and other-
oriented perfectionism
(r
=
.18,
p
<
.Ol).
The link between perfectionism and an unwillingness
to
change goals
may reflect
a
tendency
for
perfectionists
to
be high in cognitive rigidity.
Ferrari and Mautz
(1997)
used
a
measure of behavioral rigidity and
showed that attitudinal inflexibility was associated with all three MPS
dimensions. They suggested that this inflexibility could undermine per-
fectionists’ ability to cope effectively with change. We suggest further that
goal inflexibility and cognitive inflexibility may create stress and problem-
atic
situations for extreme perfectionists.
Not only
is
it
the case that perfectionists may be unwilling or unable
to modify their goals,
it
also appears that perfectionists may sometimes
make things difficult for themselves in an attempt
to
provide themselves
with an excuse
for
failing. That is, perfectionists may add
to
their diffi-
culties by engaging in self-handicapping behavior in task situations. Ex-
perimental research by Hobden and Pliner
(1995)
found that both self-
oriented and socially prescribed perfectionism were associated with
self-handicapping behavior-in other words, perfectionists appear
to
take
a
situation and make
it
more difficult
for
themselves. This behavior can
be regarded
as
taking
a
relatively less threatening situation and making
it
more threatening and stressful. Subsequent research has confirmed that
Copyright American Psychological Association. Not for further distribution.
PERFECTIONISM
AND
STRESS PROCESSES 261
socially prescribed perfectionism and self-oriented perfectionism are
as-
sociated with
trait
self-handicapping (Sherry, Flett,
&
Hewitt, 2001).
Another way
to
generate stress is for people such
as
perfectionists
to
put too much pressure on themselves. Beck (1993) alluded
to
this form
of
stress as the
internal stressor,
which includes “the demands the individ-
uals place on themselves, their repetitive self-nagging, and their self-
reproaches” (p.
350).
According
to
Beck, internal stressors are common
among people who set high goals
for
themselves and drive themselves
to
achieve those goals.
Weiten (1988, 1998) conducted research on pressure
as
a
particular
form
of
stress and discussed two subtypes of pressure:
(a)
pressure to suc-
cessfully perform tasks and carry out responsibilities and (b) pressure
to
conform to expectations about how one ought
to
think and
act.
Weiten
(1988) noted that although pressure typically stems from interpersonal
sources,
it
also
is
important
to
consider self-imposed pressure. Accordingly,
Weiten’s Pressure Inventory (1988) includes
a
subscale that measures put-
ting pressure on oneself.
If perfectionism
is
linked with stress generation, then
it
should be
associated with self-imposed pressure. Recently, we examined this hypoth-
esis by administering Weiten’s Pressure Inventory, a daily hassles inven-
tory, and
a
battery of perfectionism measures to 100 university students
(see Flett, Parnes,
&
Hewitt, 2001). The correlational findings are shown
in Table 11.2, which show that almost all the perfectionism measures were
correlated significantly with levels of pressure and self-imposed pressure.
Our new measure of automatic, perfectionistic thoughts, the Perfectionism
Cognitions Inventory (Flett, Hewitt, Blankstein,
&
Gray, 1998), had the
strongest associations with the measures of pressure and of self-imposed
pressure. Thus,
it
appears that many perfectionists experience significant
levels
of
self-imposed pressure
as
they strive to meet impossibly high
Table
11.2.
Correlations Between Stress
and
Perfectionism Measures
Perfectionism scale
Stress measure
Pressure Self-pressure Hassles
Self-oriented Perfectionism‘
Other-Oriented Perfectionism’
Socially Prescribed Perfectionism’
Perfectionism Cognitions’
Concern Over Mistakes3
High Standards3
Doubts About Actions3
Organization3
Parental Expectations3
Parental Criticism3
.29**
.08
.45***
.65***
.38***
31*w
.34***
-.23*
.27**
.41***
-
~
.30**
.17
.33***
.52***
.37***
.26**
,15
..24*
.18
.37***
~~
.19
.07
.39***
.47***
.25*
.08
.24*
.16
.22*
.47***
Note.
‘From the Multidimensional Perfectionism Scale (Hewitt
&
Flett, 1991b).
‘From the Perfectionism Cognitions Inventory (Flett et
al.,
1998).
3From the Multidimensional Perfectionism Scale (Frost et al., 1990).
*p
<
.05.
**p
c
.01.
***p
<
,001.
Copyright American Psychological Association. Not for further distribution.
262
HEWITT
AND
FLEW
goals;
that
pressure
is
associated with an internal dialogue that involves
thoughts about the inability to attain perfection.
Most
of our discussion has focused thus
far
on self-oriented perfec-
tionism, but the interpersonal dimensions
of
perfectionism are especially
important because they may contribute to stress by leading to interper-
sonal conflict and other interpersonal problems. Other-oriented perfection-
ists are highly focused on other people’s shortcomings and will create in-
terpersonal discord
if
their disappointment with others
is
openly
expressed.
A
tendency to be openly critical
of
others will cause extensive
tension in relationships, as in
a
case study
of
a
45-year-old businessman
who had chronic hypertension:
[He] interpreted anything less than optimum efficiency
on
the part of
his employees
as
“negligence,” and he would experience hostility toward
that employee. Since he considered
it
unwise to scold his employees,
he carried a constant load of hostility. Thus, any performance below his
standards (mistakes, delays, etc.) would contribute to the
stress
he ex-
perienced. (Beck, 1993, p. 365)
Some would interpret this stress as originating in the poor performance
of the employees, but we view this
as
stress that emanates from the self
because
its
origin
is
the intolerant, other-oriented standards of the per-
fectionist.
Similarly, socially prescribed perfectionism may contribute to conflict
and interpersonal problems because socially prescribed perfectionists are
highly sensitive
to
criticism and high in interpersonal sensitivity (see
Hewitt
&
Flett, 1991b, 1993). Mounting evidence supports the role of in-
terpersonal sensitivity in vulnerability to depression (see Boyce, Hickie,
&
Parker, 1991; Boyce, Parker, Barnett, Cooney,
&
Smith, 1991). Recently,
we evaluated the link between perfectionism and interpersonal sensitivity
by administering the MPS and the Interpersonal Sensitivity Measure
(IPSM; Boyce
&
Parker, 1989) to 196 undergraduate students (Flett,
Velyvis,
&
Hewitt, 2001). Socially prescribed perfectionism was associated
with total IPSM scores
(T
=
.32,
p
<
.001)
and various facets of interper-
sonal sensitivity, including separation anxiety
(T
=
.41,
p
<
.001),
a
fragile
inner self
(T
=
.32,
p
<
.OOl), and interpersonal awareness
(T
=
.29,
p
<
.OOl).
No
such associations were evident in this sample for self-oriented
or
other-oriented perfectionism and levels
of
interpersonal sensitivity.
The data indicate that socially prescribed perfectionists who have
a
high level of interpersonal sensitivity are especially likely to overreact
to
perceived slights and may even respond
to
ambiguous feedback from an-
other person as
if
it
were negative. One possibility
is
that people charac-
terized by elevated socially prescribed perfectionism and interpersonal
sensitivity will interpret ambiguous interpersonal feedback in
a
threat-
ening manner and will turn
a
relatively benign situation into
a
stressful
encounter. Socially prescribed perfectionists also could generate stress
for
themselves by engaging in excessive reassurance seeking, which would be
a reflection
of
the dependency needs associated with this perfectionism
Copyright American Psychological Association. Not for further distribution.
PERFECTIONISM
AND
STRESS PROCESSES
263
dimension (see Hewitt
&
Flett,
1993).
In fact,
the
established association
between socially prescribed perfectionism and frequent negative social
in-
teractions (see Flett, Hewitt, Garshowitz,
&
Martin,
1997)
may be
a
by-
product of core interpersonal needs
that
actually produce interpersonal
problems or losses
that
again precipitate
a
depressive episode.
Finally, an indirect link between perfectionism and stress generation
may occur because the three MPS dimensions
are
associated with chronic
forms of depression (Hewitt, Flett, Ediger, Norton,
&
Flynn,
1998).
Work
by Hammen
(1991)
and others
has
shown that chronic forms of depression
are
associated with
stress
generation.
Although several possible links exist between perfectionism and stress
generation, only indirect evidence presently supports the link between per-
fectionism and generation of interpersonal stress.
As
noted earlier, perfec-
tionism
is
likely to create stress through
its
association with self-defeating
tendencies such
as
inflexibility and self-handicapping. Some evidence of
stress generation was obtained in
a
prospective study conducted in our
laboratory (Hewitt, Flett,
&
Ediger,
1996).
A
sample of
124
psychiatric
patients completed the MPS;
3
months later, they completed the Life
Events Inventory (Cochrane
&
Robertson,
1973)
with respect to the pre-
ceding
3
months.
Two
independent
raters
indicated which events on the
inventory were independent (i.e., definitely not self-generated, such
as
the
death of
a
family member) and which were possibly dependent (i.e., pos-
sibly generated
as
a
result of the participant’s personality, such
as
being
fired from
a
job). We found that, although self-oriented perfectionism was
correlated significantly with the number of possibly dependent events,
it
was not correlated with independent events. Similarly, socially prescribed
perfectionism was correlated with the number of possibly dependent
events but not with independent events. Finally, other-oriented perfection-
ism was not associated with either dependent or independent events. The
data provide some initial support for the idea that perfectionists may gen-
erate some of their own stress.
Recent research in our laboratory
is
focusing on
the
associations
among perfectionism, interpersonal problems, and depression. One recent
study examined this
issue
in
a
sample of
72
people undergoing group treat-
ment for difficulties stemming from perfectionism (Hewitt, Flynn, Mikail,
&
Flett, 2001a). Measures of
trait
perfectionism, interpersonal problems,
and depression were administered prior to the beginning of treatment.
Analyses confirmed that interpersonal problems mediated the link be-
tween socially prescribed perfectionism and depression, and
the
general
pattern of findings was consistent with the view that perfectionistic be-
havior can produce interpersonal problems that, in turn, contribute to de-
pression.
A
goal for future research
is
to explore those associations in pro-
spective research.
Perfectionism and the Anticipation
of
Stress
The second mechanism we have proposed
is
the tendency for perfectionists
to
anticipate stress or failure and then respond
as
though the anticipated
Copyright American Psychological Association. Not for further distribution.
264 HEWITT
AND
FLEW
stress has already occurred. The notion of anticipatory stress
is
based on
the observation that certain people experience stress not only
as
it
hap-
pens but also in the here-and-now because they actively anticipate the
experience
of
future stressors of importance (see Peacock
&
Wong, 1996).
This form of stress stems from intrapersonal
factors
involving the person’s
future orientation (see Wong, 1993). The anticipated experience
of
nega-
tive emotions in response to possible stress can have
a
profound influence
on the willingness
to
pursue goals and subsequent goal-based emotions
(see Bagozzi, Baumgartner,
&
Pieters, 1998).
A
growing body
of
evidence indicates that certain perfectionists are
preoccupied with the possibility that stressful events will occur and do not
necessarily do anything
to
prevent the stress. Perfectionism has been
linked with persistent worry and fear
of
failure (Flett, Hewitt, Blankstein,
&
Mosher, 1991;
Frost
et al., 1990); although the fear
of
failure
is
primarily
a reflection of the achievement orientation of perfectionists, anticipated
stress also may reflect the interpersonal orientation of perfectionists. In
this instance, anticipated stress would involve negative expectations
among socially prescribed perfectionists about the likelihood of criticism
and other forms of mistreatment.
As
indicated above, several studies have demonstrated that various
facets
of
perfectionism are associated with
a
fear
of
failure, a motivation
that reflects the anticipation of failure in performance. In
a
study
of
female
athletes,
Frost
and Henderson (1991) assessed cognitive reactions
to
ath-
letic competition and found that perfectionistic athletes had more
of
a
failure orientation toward athletic performances. Similarly, Flett, Hewitt,
Blankstein, and Mosher (1991) showed that the three
trait
MPS dimen-
sions were associated with decreased tolerance and fear of failure. In
a
study
of
perfectionism and procrastination, Flett, Blankstein, Hewitt, and
Koledin (1992) found that the
trait
dimensions
of
perfectionism were as-
sociated with a pervasive fear
of
failure that seemed to drive the dilatory
behavior. Moreover, in one
of
the only existing tests of perfectionism and
the anticipation of future stress, Fry (1995) found that perfectionistic
women executives were more likely than other groups
of
women executives
to
anticipate that the future would bring stressful mistakes.
The anticipation
of
future negative events can be viewed as
a
form
of
pessimism
or
hopelessness that involves expectations about negative
oc-
currences in the future. This hopelessness over future events
is
seen
as
a
central component in several theories of depression. For example, in Beck’s
(1967) cognitive theory
of
depression, negative expectations regarding the
future, the self, and the world are said
to
be key factors in the development
of depression. Moreover, in the model described by Brown and Harris
(1978),
the specific and generalized hopelessness that arises from impor-
tant losses are integral in producing depressive episodes. Finally, in their
model of hopelessness depression, Abramson, Metalsky, and Alloy (1989)
pointed
to
the importance
of
specific and generalized hopelessness in pro-
ducing and exacerbating depression.
We have noted elsewhere that socially prescribed perfectionism has
an inherent element
of
helplessness and hopelessness associated with
it
Copyright American Psychological Association. Not for further distribution.
PERFECTIONISM
AND
STRESS PROCESSES
265
(e.g., Flett, Hewitt, Blankstein,
&
Koledin, 1991; Hewitt
&
Flett, 1991a,
1991b). A significant proportion of socially prescribed perfectionists seem
to be people who not only anticipate the possibility of negative events but
also become quite certain that such events will indeed be experienced. The
perceived certainty of those events makes them especially stressful.
An-
dersen (1990) has labeled this phenomenon the “inevitability of future suf-
fering.” If negative events are perceived
as
certain
to
occur and
a
person
perceives that he
or
she
is
unable to do anything to avoid those negative
events (i.e., low self-efficacy), then
it
is likely that the same person will
experience hopelessness and related symptoms of hopelessness depression
(see Abramson et al., 1989).
As noted above, socially prescribed perfectionism is the perfectionism
dimension that should be linked most closely with negative expectations
about the future. Theoretical descriptions of the cognitive aspects of con-
cepts, such as attachment style (Bowlby, 1980) and relational schemata
(Baldwin, 1992), include the notion that certain people have
a
working
model that includes expectations about future interpersonal events and an
insecure attachment style that includes the expectation of negative inter-
personal events involving abandonment and rejection. Similarly, socially
prescribed perfectionism can be conceptualized
as
a
social-cognitive var-
iable that includes negative expectations about the likelihood of being the
target of criticism and mistreatment due
to
the certainty of experiencing
unfair expectancies in the future. In essence, then, we are suggesting that
socially prescribed perfectionism includes
a
“negative future events”
schema that
is
chronically accessed among depressed people.
Empirical research has confirmed the association between socially pre-
scribed perfectionism and negative outcome expectancies. Research with
university students indicates that socially prescribed perfectionism
is
as-
sociated with
trait
pessimism as assessed by the Life Orientation Test (see
Martin, Flett, Hewitt, Krames,
&
Szantos, 1996). This study also found
that levels of self-reported depressive symptoms are higher among socially
prescribed perfectionists with low levels of general self-efficacy (i.e., beliefs
that one cannot control important outcomes).
Other empirical research on hopelessness and the
trait
dimensions
of
perfectionism has shown that socially prescribed perfectionism is
as-
sociated consistently with hopelessness in all the studies that have tested
this association, including research with adult psychiatric patients, ado-
lescents, and university students (Chang
&
Rand, 2000; Dean
&
Range,
1996; Dean, Range,
&
Goggin, 1996; Hewitt, Flett,
&
Turnbull-Donovan,
1992; Hewitt, Newton, Flett,
&
Callander, 1997; Hewitt, Norton, Flett,
Callander,
&
Cowan, 1998; Ohtani
&
Sakurai, 1995). The studies’ un-
equivocal findings suggest that socially prescribed perfectionism
is
indeed
an aspect of perfectionism associated with generalized hopelessness.
The association between other dimensions of perfectionism and hope-
lessness is less clear.
For
example, Sakurai and Ohtani (1997) developed
a
multidimensional measure of self-oriented perfectionism that measures
four components-desire for perfection, concern over mistakes, high per-
sonal standards, and doubting of actions. They found in
a
sample of 178
Copyright American Psychological Association. Not for further distribution.
266
HEWITT
AND
FLETT
Japanese students that concern over mistakes and doubts about actions
were associated positively with hopelessness, whereas high personal stan-
dards were associated negatively with hopelessness.
In contrast
to
the many studies of perfectionism and hopelessness,
relatively few studies have investigated whether perfectionists anticipate
a
greater number of difficulties when asked
to
make predictions about the
likelihood of experiencing negative events. Hewitt, Flett, and Weber (1994)
provided initial evidence of an association between perfectionism and an-
ticipated stressful events: They reported that both socially prescribed per-
fectionism and self-oriented perfectionism were associated with predic-
tions of the likelihood of attempting suicide in the future.
Flett, Levy, and Hewitt (2001) directly investigated the proposed as-
sociation between perfectionism and depressive predictive certainty. In
this research,
a
sample of 100 university students completed the MPS,
indices of depression and anxiety, and
a
battery
of
measures assessing
current stress and anticipated stress in the future. Current stress was
assessed by having participants complete
a
measure of current daily has-
sles and the Inventory
of
Negative Social Interactions (Lakey, Tardiff,
&
Drew, 1994). Future stress was assessed by having participants complete
measures of expected hassles over the next
3
months, expected negative
social interactions over the next
3
months, and depressive predictive cer-
tainty. Analyses
of
measures of current stress showed that socially pre-
scribed perfectionism was correlated with daily hassles and that both
so-
cially prescribed perfectionism and self-oriented perfectionism were
associated with the frequency of negative social interactions.
A
similar
pattern emerged for future hassles and future negative social interactions;
that
is,
socially prescribed perfectionism was associated with future has-
sles and future negative social interactions, and self-oriented perfection-
ism was associated with future negative social interactions. Finally, higher
levels of depressive predictive certainty were associated with both socially
prescribed perfectionism and self-oriented perfectionism. Taken together,
the findings indicate that perfectionists experience elevated levels of
stress, which
is
accompanied by
a
tendency
to
anticipate chronic stress,
including negative social interactions in the future. For some perfection-
ists, an element of predictive certainty
is
associated with these cynical
perceptions. Thus,
it
appears that certain perfectionists do indeed have
a
negative future-event schema (Andersen, Spielman,
&
Bargh, 1992; Reich
&
Weary, 1998) and a sense
of
the inevitability of future suffering,
as
described by Andersen (1990).
Additional evidence of
a
link between perfectionistic tendencies and
the anticipation of stress was obtained in our ongoing investigation
of
per-
sonality and coping with the transition
to
parenthood. Our sample of
150
women in the final month of their pregnancies were asked
to
estimate how
much stress would be experienced during the rest of the pregnancy and
during the first few postpartum months. Participants also indicated how
much threat was associated with eight possible negative events taken from
a
perinatal stress measure, including pregnancy complications, delivery
complications, change in relationships, and
a
change in professional
or
job
Copyright American Psychological Association. Not for further distribution.
PERFECTIONISM
AND
STRESS PROCESSES
267
status. The items were adapted from
a
recent study of coping with preg-
nancy (see Bernazzani, Saucier, David,
&
Borgeat, 1997). The results
showed that the
trait
MPS
dimensions had little association with these
measures; however, the
trait
MPS
dimensions were associated with
a
mea-
sure of concern with parenting mistakes, which was patterned after the
Frost
et
al. (1990) general measure of concern over mistakes. In turn, this
measure of concern with parenting mistakes was associated with negative
predictions about the stress during the remainder of the pregnancy
(r
=
.26,
p
<
.Ol),
anticipated stress during the initial postpartum months
(r
=
.28,
p
<
.OOl>, and
a
composite threat index
of
possible stressors
(r
=
.33,
p
<
.OOl).
Thus, the findings suggest that the link between
trait
perfec-
tionism and anticipated stress about becoming a parent is mediated by an
excessive concern with making parenting mistakes.
Perfectionism and Stress Perpetuation
Various dimensions
of
perfectionism are associated with the perpetuation
or maintenance
of
stress
or
failures and the attendant distress because
perfectionistic people are characterized
by
maladaptive styles that have
the effect
of
prolonging stressful episodes. Much research supports this
idea.
Three interrelated cognitive tendencies appear
to
be
at
work here.
First,
the trait dimensions
of
perfectionism are associated with self-blame
and perseveration regarding failure (e.g., Hewitt
&
Flett, 1991b; Hewitt,
Flett, Turnbull-Donovan,
&
Mikail, 19911, both
of
which are inappropriate
methods
of
dealing cognitively with stress and failures. This tendency
to
engage in failure perseveration would contribute
to
both prolonging and
exacerbating the experience of stress.
Second, certain perfectionists have
a
cognitive style that involves the
frequent experience of automatic, perfectionistic thoughts. Recently, we
have shown that perfectionists experience negative automatic thoughts
with perfectionistic themes and that the frequent experience of perfection-
ism cognitions
is
associated with psychological distress in the form
of
dys-
phoria and anxiety, with the tendency to perseverate when confronted with
a
personal failure (see Flett et al., 1998). Our research with the Perfec-
tionism Cognitions Inventory is based on the premise that certain perfec-
tionists are prone to experiencing perfectionistic thoughts and that one of
the contributing factors
is
the experience
of
negative life outcomes that
highlight the discrepancy between the actual self and the ideal, perfect
self. Blatt and Shichman (1983) observed that introjective people ruminate
excessively about failures
to
meet personal standards and maintain
a
sense
of
control. A tendency
to
ruminate about an inability to attain per-
fectionistic standards
is
also in keeping with evidence indicating that the
ideal self can operate
as
a
self-schema that facilitates the recall
of
perfec-
tionistic content (Hewitt
&
Genest, 1990). According
to
Hewitt and Genest,
the ideal self-schema
is
especially likely
to
encode and process information
that indicates that perfection has not been attained. In the current
for-
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268
HEWITT
AND
FLETT
mulation, stress is
a
signal that one’s life is not perfect; the stress will be
prolonged by automatic thoughts involving the failure
to
attain perfection.
It has been suggested (see Flett et al., 1998) that once
a
failure
or
stressful event occurs, perfectionistic people will engage in rumination re-
lating to their needs
to
be perfect and that by doing
so,
they will contin-
ually highlight the discrepancy between their real and ideal selves. The
effect
of
this repetitive tendency
is
to increase the salience
of
the discrep-
ancj-
.Lid
maintain depressive symptoms (Strauman, 1989). Flett et al.
(1998) found that elevated automatic perfectionistic cognitions were in-
deed associated with depression symptoms in four separate samples, in-
cluding
a
clinical sample
of
psychiatric patients. Moreover, the perfection-
istic
cognitions continued to be significant predictors
of
depression after
partialing out other perfectionism
traits
and personality variables. The
findings suggest that ruminations regarding themes of perfection are
as-
sociated with depression and may help maintain
or
even exacerbate the
distress that follows from the experience
of
stressful events.
Third, we maintain that the ruminative style exhibited by certain per-
fectionists includes that described in the work by Nolan-Hoeksema and
her associates, who identified
a
ruminative response orientation that con-
tributes
to
the persistence of pathological states-notably, depression (see
Nolen-Hoeksema, Morrow,
&
Frederickson, 1993). Rather than engage in
task-focused attempts
to
alleviate distress
or
distract themselves, those
with the ruminative orientation tend
to
focus cognitively on their experi-
ence
of
distress and ruminate about the nature and causes
of
that distress.
A
recent study by Flett and Hewitt (2000) generated empirical evi-
dence that certain perfectionists have the ruminative response orientation
to depression. In this research,
a
sample
of
146 women in their final month
of pregnancy and
138
fathers-to-be completed the MPS, the Perfectionism
Cognitions Inventory, and
a
measure
of
concern over parenting mistakes.
Participants also completed
a
battery
of
coping measures, including Butler
and Nolen-Hoeksema’s (1994) measure
of
ruminative response style and in-
dices of stress, depression, and anxiety. Initial analyses of the data show that
a
ruminative response orientation
to
depression
was
associated significantly
with self-oriented perfectionism, socially prescribed perfectionism, perfec-
tionism cognitions, and concern over parenting mistakes in both women
and men
(r
values ranged from .26
to
.49). The data suggest that elements
of perfectionism may be associated with persistent depression through an
association with a maladaptive, ruminative response orientation.
In addition to cognitive features
of
perfectionism that may influence
stress perpetuation, interpersonal styles
of
perfectionists can influence the
perpetuation and maintenance
of
stress.
For
example, one form
of
dealing
appropriately with stressors
or
with distress involves accessing social sup-
port networks (Finch, Okun, Pool,
&
Ruehlman, 1999)
or
seeking profes-
sional help
for
personal difficulties (see Bergin
&
Garfield, 1994). We have
suggested that
a
major facet
of
perfectionistic behavior is a general in-
ability
to
demonstrate
or
admit
to
one’s imperfection (Hewitt et al., 2001a).
We have found that perfectionistic people find
it
quite difficult
to
ask oth-
ers for help
or
support; any request
for
help will communicate to others
Copyright American Psychological Association. Not for further distribution.
PERFECTIONISM
AND
STRESS PROCESSES
269
that
the perfectionist
is
not perfectly able to cope, has personal problems,
or
is
generally not the perfect person he or she has been trying to portray.
Thus, perfectionistic people can lose opportunities to obtain social support
or engage in obtaining information or professional help that may be useful
in solving problems (e.g., Belsher
&
Costello,
1991).
Not accessing support
or professional help, of course, prolongs or even exacerbates the distress,
both of which result in maintaining the difficulties or symptoms the person
is
experiencing.
Although no extensive research has been conducted on perfectionism
dimensions and either social or professional support, evidence for the prop-
ositions described above can be found in several sources. With respect to
seeking social forms of support, Hewitt, Flett, and Endler
(1995)
reported
that socially prescribed perfectionism in women was associated with de-
creased social diversion,
a
form of coping that involves seeking people out
in order to deal with problems. Similarly, Flett, Blankstein, Hewitt, and
Obertynski
(1994)
found that self-oriented and other-oriented perfection-
ism were associated with low social support from friends and that socially
prescribed perfectionism was associated with low support from family,
friends, and significant others. Finally, Hewitt, Flynn, Flett, Nielsen,
Parking, Han, and Tomlin
(2001)
administered measures of social support
and perfectionism to one of several samples of university students. Socially
prescribed perfectionism was associated with low support from family and
with low availability of supportive people, but self-oriented and other-
oriented perfectionism were not associated with perceived social support.
This study also yielded several findings
that
are directly relevant to
the issue of whether perfectionists will seek treatment when distressed.
We used
a
multidimensional measure by Fischer and Turner
(1970)
to
assess attitudes and behaviors regarding seeking professional help
for
dis-
tress. Across student and community samples, the three
trait
MPS dimen-
sions were associated with negative attitudes such
as
decreased recogni-
tion of need for help, stigma tolerance, interpersonal openness, and
confidence in mental health professionals. Moreover, all three dimensions
were associated with
greater
fears of psychotherapy and dysfunctional
help-seeking attitudes. Finally, analyses that focused on
a
subset of people
(n
=
31)
who had sought help
at
some point revealed that socially pre-
scribed perfectionism was associated negatively
(I"
=
-50)
with ratings of
comfort in seeking help and positively with ratings of difficulty continuing
with treatment
(r
=
.54).
Self-oriented and other-oriented perfectionism
also were associated with increased ratings of difficulty continuing with
treatment. The findings from this work support the idea that
p
Jple who
score high
on
perfectionism
traits
tend to be less open to seeking profes-
sional help for psychological problems and that perfectionism can have
a
deleterious influence on the continuation of the treatment among those
who actually receive help. The results are in keeping with previous re-
search indicating that perfectionists may have
a
negative orientation to-
ward treatment and the establishment of
a
working alliance with their
therapists (see Blatt
&
Zuroff, chapter
16,
this volume).
A
corollary of the proposed link with stress perpetuation
is
that
per-
Copyright American Psychological Association. Not for further distribution.
270
HEWITT
AND
FLETT
fectionism
is
a
personality construct that
is
likely associated with long-
lasting and pernicious forms of maladjustment, such
as
chronic depres-
sion. Hewitt et al.
(1998)
evaluated the association between
trait
perfectionism and chronic symptoms of depression by having
a
sample of
121
current and formerly depressed patients complete the
MPS;
the Beck
Depression Inventory,
as
a
measure of concurrent depression symptoms;
and the General Behavior Inventory (Depue, Krauss, Spoont,
&
Arbisi,
19891,
a
measure of chronicity of unipolar and bipolar depression symp-
toms. Regression analyses showed that only self-oriented perfectionism
accounted
for
significant variance in chronic unipolar symptoms, after
con-
trolling for chronic bipolar, state unipolar, and other perfectionism dimen-
sions. In predicting chronic bipolar symptoms, other-oriented and socially
prescribed perfectionism both accounted
for
unique variance. The results
supported the position that self-oriented perfectionism may function
as
a
vulnerability
factor
in unipolar depression and
is
associated with persis-
tent and chronic unipolar depression symptoms. In contrast, the interper-
sonal
trait
dimensions appeared
to
be associated with persistence of manic
symptoms.
Some evidence, then, indicates that perfectionism
is
associated with
cognitive and interpersonal factors involved in the perpetuation
of
stress
and related forms of distress. Moreover, perfectionism
is
associated with
chronic dysphoria and,
at
least
to
some degree, this association likely re-
flects persistent and high exposure to stress.
Perfectionism and Stress Enhancement
Research on stress generation and stress reactivity by Bolger and Zuck-
erman
(1995)
demonstrated that, although stress generation accounts
for
substantial variation in adjustment outcomes, stress reactivity
is
even
more important. The individual differences in stress reactivity account
for
substantially more variance in poor psychological adjustment. In Bolger
and Zuckerman's formulation, stress reactivity includes the coping choices
made in response to stress and coping effectiveness (i.e., the extent to
which coping works by reducing the negative outcomes
of
the stressful
event).
We have conducted extensive research on the association between per-
fectionism and stress reactivity,
as
measured by coping choices. This re-
search
is
based on the assumption that perfectionists have
a
difficult time
accepting failure and have strong negative reactions
to
the actual or per-
ceived experience
of
stressful events. In essence, the presence of perfec-
tionism serves to enhance or intensify the negative impact of stress, which
may lead to maladjustment.
The enhancement
of
the aversiveness
of
stressors can occur because
of
the manner in which
a
person evaluates and appraises the meaning of
a
particular life event (Folkman, Lazarus, Gruen,
&
DeLongis,
1986).
This
is
especially the case with ego-involving stressful events (Hewitt
&
Flett,
1993):
Stressors that are perceived
as
more important to the self tend to
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PERFECTIONISM
AND
STRESS PROCESSES
271
elicit more extreme reactions (Gruen, Folkman,
&
Lazarus,
1988).
Recent
research has confirmed the depressogenic effects
of
events that are seen
as
high in personal, contextual threat involving core aspects of the self
(see Kendler, Karkowski,
&
Prescott,
1998).
In the case of perfectionism, stressors that are congruent with
a
par-
ticular perfectionistic style are experienced
as
more aversive than noncon-
gruent stressors are: The congruent stressors are ego involving, and the
aversive negative impact is enhanced, leading
to
increased symptomatol-
ogy
(Hewitt
&
Dyck,
1986;
Hewitt
&
Flett,
1993).
This tendency to magnify
the negative impact
of
stress stems from equating perfect performance
with self-worth, whereby performances other than perfect are interpreted
as
significant failures and
as
indications of one’s worthlessness. Moreover,
these particular types of disruptions, stressors,
or
failures are interpreted
as
a
lack of competence or
as
an inability
to
control outcomes that inter-
feres with the all-important attainment of perfection.
It follows that perfectionists will have especially strong responses to
the extent
that
stressors are appraised
as
being relevant and important
to
the self-concept. Given that self-oriented perfectionism involves attain-
ing self-related achievement goals
of
importance, achievement stressors or
failures should be experienced
as
particularly aversive, relative to other
stressors. In contrast, because socially prescribed perfectionism involves
maintaining others’ approval and
a
sense
of
belonging by being perfect,
stressors that impinge on one’s ability
to
meet others’ expectations may be
experienced
as
more aversive than other stressors. This may be especially
the case for the person who perceives that others are placing great worth
or meaning on
a
particular event, performance, or task.
If
a
link exists between perfectionism and stress enhancement, then
it
should be the case that
a
person will experience
a
particular event
or
stressor
as
more distressing if he
or
she
is
perfectionistic. Recently, Flynn
et
al.
(2001)
assessed the link between stress reactivity and self-oriented
perfectionism. It was found that people high in self-oriented perfectionism
rated
a
difficult intellectual task as more distressing and rated their
own
performance
as
less satisfactory than did those low in self-oriented per-
fectionism. The relationships held even when actual performance levels
were controlled.
Similarly, Fry
(1995)
suggested that perfectionists view stressful
events as more ego-involving, thereby increasing their perception of the
stressfulness of those events. Fry compared women executives who had
high
or
low levels
of
perfectionism and found that highly perfectionistic
women executives rated their events
as
higher in “primary centrality’’ (i.e.,
the perception that
a
stressful event has significant personal conse-
quences). In related research,
Frost
et al.
(1995)
had students engage in
either
a
relatively easy or
a
more challenging Stroop task and found that
compared with low-scoring participants, those who scored high on the Con-
cern Over Mistakes subscale reacted
to
the challenging condition in which
more mistakes were made with more negative mood, lowered confidence,
and
a
greater sense that they should have done better (also see
Frost
et
al.,
1997).
These investigations provide evidence that perfectionism can
Copyright American Psychological Association. Not for further distribution.
272
HEWITT
AND
FLEW
influence the aversiveness of events
or
performances and augment dis-
tress.
A
heightened level of stress reactivity also would be expected given
that elements
of
perfectionism are associated with a tendency to engage
in overgeneralization,
a
maladaptive cognitive orientation in which neg-
ative outcomes are seen globally as reflecting the entire self (Beck,
1967).
Thus,
a
mistake in one area becomes translated into
a
sweeping negative
self-judgment in many or all areas of functioning. Research with subclin-
ical and clinical participants has identified
a
characteristic tendency for
perfectionists
to
overgeneralize failure
to
all aspects
of
the self (Flett,
RUSSO,
&
Hewitt,
1994;
Hewitt et al.,
1991;
Hewitt, Mittelstaedt,
&
Wol-
lert,
1989).
Most of our discussion on stress enhancers has focused thus
far
on
self-oriented perfectionism. Regarding the interpersonal dimensions,
stress enhancement is
a
reflection of the high level of interpersonal sen-
sitivity that
is
at
the core
of
socially prescribed perfectionism. Clearly, the
acute interpersonal sensitivity inherent in socially prescribed perfection-
ism (see Hewitt
&
Flett,
1991b)
suggests that such people will be highly
reactive
to
evaluative feedback from others.
Although past research has established that perfectionism
is
associ-
ated with depression symptoms, research that simply confirms the asso-
ciation between perfectionism and depression does not shed light on the
mechanisms involved in producing
or
exacerbating depression symptoms.
We have posited
a
diathesis-stress conceptualization
of
the relationships
between dimensions
of
perfectionism and depression that
is
consistent
with the stress-enhancement component
of
our model (Hewitt
&
Dyck,
1986;
Hewitt
&
Flett,
1993).
Self-oriented perfectionism and socially pre-
scribed perfectionism are proposed
as
vulnerability factors in depression;
a
precipitating event, such as
a
stressful event or
a
perceived failure ex-
perience, must occur
for
depression
to
ensue. Moreover, as discussed
above, stressors that are congruent with either self-oriented perfectionism
(i.e., self-related achievement stressors)
or
socially prescribed perfection-
ism (i.e., social stressors) will be experienced
as
more aversive than non-
congruent stressors because the congruent stressors are ego-involving; the
aversive negative impact will be enhanced, thereby leading
to
depression
symptoms (Hewitt
&
Dyck,
1986;
Hewitt
&
Flett,
1993).
This specific-
vulnerability hypothesis
is
based on an extension of Oatley and Bolton’s
(1985)
contention that stressors are especially likely
to
produce depression
if
those stressors pose
a
particular threat
to
a central aspect of the self.
Although some early research on the topic found evidence that
atti-
tudes related
to
self-oriented perfectionism interacted with general stress
to
predict depression (e.g., Hewitt
&
Dyck,
1986;
Hewitt et al.,
1989),
re-
cent work addressed the specific-vulnerability hypothesis with respect
to
perfectionism traits and depression. Hewitt and Flett
(1993)
assessed lev-
els of self-oriented and socially prescribed perfectionism, specific daily
stressors, and concurrent depression symptom severity in
a
sample
of
peo-
ple with unipolar depression and in a heterogeneous sample
of
psychiatric
patients.
In the sample
of
those with unipolar depression, self-oriented
Copyright American Psychological Association. Not for further distribution.
PERFECTIONISM
AND
STRESS PROCESSES
273
perfectionism interacted only with self-related achievement hassles to pre-
dict concurrent depression; socially prescribed perfectionism interacted
only with social
hassles
to predict concurrent depression. In both cases,
high levels of perfectionism and stress resulted in increased depression.
The data support the diathesis-stress model and suggest that
the
two
perfectionism dimensions interact only with congruent stressors to predict
concurrent symptom severity. In this study, the same measures were used
in
a
heterogeneous sample of psychiatric patients in an attempt to repli-
cate the results
(see
Hewitt
&
Flett, 1993). The findings involving self-
oriented perfectionism were replicated in the sample, thereby further sup-
porting the specific-vulnerability hypothesis. In contrast, the findings with
socially prescribed perfectionism were not replicated; in fact,
it
was found
that socially prescribed perfectionism interacted with both achievement
and interpersonal stressors in the heterogeneous clinical sample. The find-
ings suggest
that
first, self-oriented perfectionism acts
as
a
diathesis that
is
robust across clinical samples and that elevated depression will ensue
only in the presence of achievement stressors. Conversely, the findings
with socially prescribed perfectionism seem to indicate
that
the findings
of congruency are specific to people diagnosed with depression or that spe-
cific stressors are not always necessary for socially prescribed perfection-
ism to be related to depression (Hewitt
&
Flett, 1991a).
Although the findings of the above studies provided consistent support
for the idea that self-oriented perfectionism
is
a
relevant factor in depres-
sion, the findings were based on concurrent relationships.
An
important
way to support the notion that self-oriented perfectionism and socially
prescribed perfectionism are vulnerability factors to depression is to
use
a
longitudinal research design. Flett, Hewitt, Blankstein, and Mosher
(1995),
in
a
college student sample, conducted an initial test of the issue
of whether perfectionism
is
a
vulnerability factor that predicts depression
symptoms over time. Both self-oriented and socially prescribed perfection-
ism were correlated with concurrent levels of depressive symptoms, but
only self-oriented perfectionism predicted increases in levels of depressive
symptoms over
a
3-month time period after controlling for initial levels of
depression severity. The findings indicated
that
self-oriented perfectionism
is
a
relevant personality variable in depression both concurrently and over
time but
that
socially prescribed perfectionism may be more relevant for
concurrent levels of depression. In another study, Hewitt et
al.
(1996)
as-
sessed whether the perfectionism dimensions interacted with specific
stressors to predict depression over time in
a
large heterogeneous sample
of depressed patients. The participants completed measures of perfection-
ism and depression
at
Time
1
and measures of specific life-event stress
(for the 4-month lag) and depression 4 months later. After controlling for
depression
at
Time 1, self-oriented perfectionism interacted only with
achievement stress to predict depression
at
Time
2,
suggesting again that
self-oriented perfectionism confers
a
vulnerability to depression that
is
evident over time. Socially prescribed perfectionism did not interact with
achievement or social stress to predict depression
at
Time
2.
The results
indicate
that
self-oriented perfectionism may be the perfectionism dimen-
Copyright American Psychological Association. Not for further distribution.
274
HEWITT
AND
FLETT
sion that is most important
as
a
stress-vulnerability
factor
in depression
(Hewitt
&
Flett, 1993).
In another study, Joiner and Schmidt (1995) attempted to replicate
Hewitt et a1.k (1996) findings in
a
sample of college students. They used
six
items culled from the Eating Disorders Inventory (Garner, Olmstead,
&
Polivy, 1983) to represent measures
of
self-oriented perfectionism and
socially prescribed perfectionism. They found that both self-oriented and
socially prescribed perfectionism interacted with stress
to
predict depres-
sion over time, although no evidence supported the specific-vulnerability
hypothesis. This study provided some support for our general diathesis-
stress model but little support was found for the predicted specific inter-
actions between the two perfectionism dimensions and congruent stress.
The differences between studies could be the result
of
several factors, in-
cluding sample differences and differences in the measures of perfection-
ism.
More recently, Hewitt et al. (in press) examined perfectionism, stress,
depression, anxiety, and anger in
a
sample
of
114 children and adolescents.
Correlational analyses indicated that self-oriented perfectionism was
as-
sociated significantly with depression and anxiety and that socially pre-
scribed perfectionism was associated significantly with depression, anxi-
ety, interpersonal stress, anger suppression, and outwardly directed anger.
Regression analyses showed further that self-oriented perfectionism in-
teracted with achievement stress and interpersonal stress to predict levels
of
depression.
The studies described above are consistent with our contention that
perfectionism (i.e., self-oriented perfectionism and, perhaps, socially pre-
scribed perfectionism) may be associated with depression through their
influence on stress. The findings are in keeping with the idea that perfec-
tionistic behavior may enhance
or
exacerbate the negative effects
of
stress
and, in this case, produce an increase in depression symptoms.
Although support
is
growing
for
the diathesis-stress model (see also
Cheng, 2001), not all research provides evidence for
it.
For instance, Dean
and Range (1996) conducted
a
test
of
the diathesis-stress model
as
part
of their research on an escape theory
of
perfectionism and suicide. Their
cross-sectional research with 132 clinical outpatients found that neither
self-oriented perfectionism nor socially prescribed perfectionism interacted
with negative life events
to
predict depression. One possible problem with
the study
is
that
it
was based on
a
measure
of
negative life events that
asked participants
to
recall events over
a
long period (i.e., 2 years),
so
the
accuracy of the life events measured
is
questionable.
Recently, Chang and Rand (2000) found partial support for
a
diathesis-stress model
of
perfectionism and distress. They administered
the MPS (Hewitt
&
Flett, 1991b) and the four-item short form of the Per-
ceived Stress Scale
(PSS;
Cohen, Kamarck,
&
Mermelstein, 1983)
to
a
sample of 256 college students. The PSS measures self-reported stress over
the
past
month. The same respondents completed measures
of
hopeless-
ness
and the Depression, Hostility, and Anxiety subscales of the Symptom
Check List-90-Revised (SCL-90-R; Derogatis, 1983) approximately 4
to
5
Copyright American Psychological Association. Not for further distribution.
PERFECTIONISM
AND
STRESS PROCESSES
275
weeks later. The three SCL-90-R subscales were combined into a measure
of general distress. Chang and Rand found no significant interactions in-
volving self-oriented
or
other-oriented perfectionism; however, socially pre-
scribed perfectionism and perceived stress interacted such that greater
distress was reported by people with elevated perfectionism and stress
scores.
Unfortunately, the results
of
this study are difficult
to
interpret in
at
least two respects. First, as a measure of stress, the PSS has been
criti-
cized because
it
includes item content that reflects both distress and in-
ability
to
cope (for
a
summary, see Hewitt, Flett,
&
Mosher, 1992). Second,
Chang and Rand (2000) did not readminister the
PSS
at
the second time
point,
so
no apparent measure of the stress experienced was obtained
at
the time when the distress measures were obtained. Nevertheless, the
Chang and Rand study attests
to
the general usefulness of
a
diathesis-
stress approach when conceptualizing perfectionism and distress.
The observations outlined above about the nature and assessment of
stress lead us
to
an important caveat: Existing research is limited by the
fact that all previous studies used self-report measures of stress and that
thus far, no research has investigated the perfectionism-stress association
with an interviewer-based measure
of
stress. In addition, relatively little
research has examined perfectionism, stress, and depression in clinically
diagnosed depressives. Clearly, longitudinal research using more sophis-
ticated methods of assessment
is
needed
to
more rigorously test the
diathesis-stress model.
Perfectionism and Coping Responses to Stress
It
has been suggested that people with excessive levels
of
perfectionism
traits
use deficient forms
of
problem solving and maladaptive styles
of
coping when attempting to deal with stressful circumstances (Hewitt et
al., 1995); in this way, the impact
of
stressors can become magnified. In
one of the
first
attempts
to
assess perfectionism and coping styles, Flett,
Hewitt, Blankstein, Solnik, and Van Brunschot
(
1996) administered the
MPS
and
a
measure
of
social problem-solving (D’Zurilla
&
Nezu, 1990).
Both self-oriented perfectionism and other-oriented perfectionism were as-
sociated with positive problem-solving orientations, whereas socially pre-
scribed perfectionism was associated with negative problem-solving
ori-
entations.
In one
of
our initial studies (Flett, Hewitt, Blankstein,
&
O’Brien,
1991), we had
a
sample of students complete the MPS,
a
measure
of
learned resourcefulness
or
general coping ability, and measures of depres-
sion and self-esteem. Self-oriented and other-oriented perfectionism, but
not socially prescribed perfectionism, were associated with increased
learned resourcefulness. Collectively, the Flett et al. (1991, 1996) studies
suggest that, although evidence indicates that socially prescribed perfec-
tionism is associated with maladaptive coping styles that may maintain
maladjustive states such
as
depression, self-oriented and other-oriented
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276
HEWITT
AND
FLETT
perfectionism are associated with relatively more adaptive forms of coping
that,
at
least
theoretically, should help reduce stress and not produce or
maintain symptoms. The findings with self-oriented perfectionism appear
to be
at
odds with our model
that
the coping styles of perfectionism help
to perpetuate stress and, by doing
so,
produce or maintain symptoms.
Finally, in another study with college students, Flett, RUSSO, and
Hewitt
(1994)
administered the MPS and the Constructive Thinking In-
ventory (Epstein,
1992),
a
measure that includes subscale measures of
both adaptive (e.g., active behavioral coping) and maladaptive coping (e.g.,
emotional coping). Once again, socially prescribed perfectionism was
as-
sociated with less adaptive coping and more maladaptive coping, and
less
constructive thinking. Self-oriented perfectionism was associated both
with active forms of behavioral coping and with maladaptive coping, in
the form of emotional coping and reduced self-acceptance. Finally, other-
oriented perfectionism was associated with low self-acceptance but active
forms of behavioral coping.
In the one study assessing perfectionism and coping in
a
clinical sam-
ple, Hewitt, Flett, and Endler
(1995)
examined
the
perfectionism dimen-
sions and coping styles
as
assessed by the Coping Inventory of Stressful
Situations (Endler
&
Parker,
1990)
in
a
heterogeneous clinical sample. Ev-
idence for maladaptive coping was found with both self-oriented and socially
prescribed perfectionists. Self-oriented perfectionism was associated with
increased levels of emotion-oriented coping for women, and socially pre-
scribed perfectionism was associated with low levels of social diversion in
women and increased emotion-focused coping in men. Other-oriented per-
fectionism was associated with increased task-oriented coping.
The studies described above indicate that self-oriented perfectionism
might involve both adaptive (i.e., task-focused coping strategies) and mal-
adaptive coping (i.e., emotion-oriented strategies) components. Although
the maladaptive components are consistent
with
our contentions, the find-
ings involving adaptive forms of coping
are
not
so
consistent. The issue of
whether
a
particular coping
is
adaptive or maladaptive
is
complex. Re-
search testing the goodness-of-fit hypothesis underscores the need to ex-
amine coping within the context of situational and task parameters. In-
vestigations by Compas and associates (Compas, Malcarne,
&
Fondacaro,
1988;
Forsythe
&
Compas,
1987)
indicated that task-focused coping
is
adaptive when confronted with controllable situations but maladaptive
when confronted with uncontrollable situations. Problem-focused efforts
to deal with uncontrollable situations ultimately prove to be self-defeating.
Flett et
al.
(1994)
suggested that the link between self-oriented per-
fectionism and adaptive coping may reflect, in part, the persistence of self-
oriented perfectionists in dealing with issues or completing
tasks.
Cer-
tainly, persistence and perseveration have been associated with
self-oriented and socially prescribed perfectionism (Hewitt et
al.,
1991).
The recent Flynn et al.
(2001)
study, however, sheds some light on the
supposed adaptiveness of the coping of self-oriented perfectionists. Flynn
et
al.
(2001)
found that self-oriented perfectionism was associated both
with emotion-oriented and task-oriented coping. Moreover,
it
was found
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PERFECTIONISM
AND
STRESS PROCESSES
277
that self-oriented perfectionism interacted with task-oriented coping; that
is,
those high in self-oriented perfectionism and high in task-oriented cop-
ing showed both increased and more enduring heart-rate elevations. In
contrast, those low in perfectionism and high in task-oriented coping did
not show increased heart rates. The findings imply either that the stress
response remains elevated in self-oriented perfectionists when using task-
oriented coping or that self-oriented perfectionists are trying more actively
to
succeed on tasks.
Additional analyses revealed that higher heart rates were detected
among participants high in self-oriented perfectionism and the thought
the task was irrelevant
or
invalid. In contrast, elevated heart rates were
not experienced by participants who were low in self-oriented perfection-
ism and the thought the task was irrelevant. The findings indicate that
although self-oriented perfectionists may use what are defined as gener-
ally adaptive coping strategies, using those strategies in certain situations
actually may perpetuate
or
accentuate distress because self-oriented per-
fectionists may put
a
great deal of effort into tasks that are irrelevant or
unimportant. They may not know when
to
stop the task focus
or
may use
task-oriented strategies indiscriminately or in inappropriate situations in
which a task-focused approach may be maladaptive.
Finally, other-oriented perfectionism seems not
to
be consistently as-
sociated with particular coping styles. In some cases,
it
is
associated with
task-oriented coping, and in others, with emotion-oriented coping; in most
cases, however,
it
is not associated with any particular coping style. One
reason may be,
as
we have argued, that
it
is
the person who
is
the target
of the other-oriented perfectionist who requires coping strategies in rela-
tion
to
perfectionistic behavior (Hewitt, Flett,
&
Mikail, 1995). Additional
research
is
needed to clarify the link between other-oriented perfectionism
and coping. Specifically, research remains
to
be conducted on how other-
oriented perfectionists cope when they are disappointed by other people
who do not meet their excessive expectations.
Bolger and Zuckerman (1995) incorporated
a
focus on coping effec-
tiveness as part
of
the link between personality and stress reactivity. Un-
fortunately, little research has investigated the issue
of
whether perfec-
tionism has
a
direct impact on coping effectiveness. Nevertheless, the
studies conducted thus far have provided some evidence supporting the
idea that perfectionism moderates the association between coping and mal-
adjustment.
For instance, the Hewitt, Flett, and Endler (1995) study described
above found that self-oriented perfectionism moderated the association be-
tween emotion-oriented coping and depression. Analyses indicated that pa-
tients who were characterized jointly by elevated levels
of
self-oriented per-
fectionism and emotion-oriented coping reported the highest depression
scores. Similarly, Flett, Hewitt, Blankstein, and O'Brien (1991) found that
socially prescribed perfectionism moderated the association between
learned resourcefulness and depression. The study found that the highest
depression scores were associated with low levels
of
learned resourcefulness
and high levels of socially prescribed perfectionism. Although both studies
Copyright American Psychological Association. Not for further distribution.
278
HEWITT
AND
FLEW
indicated that the presence of both increased perfectionism and maladap-
tive coping tends
to
result in increased depression symptoms, caution
is
needed in generalizing the results because this issue has not been inves-
tigated systematically from
a
longitudinal perspective.
Perfectionism and Treatment
Given the stated link between perfectionism and elevated levels
of
stress
generation and stress reactivity, perfectionists should be candidates
for
stress management, stress inoculation training, or other forms of treat-
ment that focus directly on teaching coping strategies.
For
example, treat-
ments that focus on enhancing problem-solving and coping skills might be
quite beneficial in reducing stress reactions and the accompanying symp-
toms. Although those approaches may be useful in dealing with the se-
quelae
or
outcomes of perfectionistic behavior and may help perfectionists
cope with attendant stress,
it
is extremely important
to
recognize that
perfectionism is a deeply ingrained core vulnerability
factor
and that the
negative impact
of
this intransigent personality style
is
the true source
of
the stress that people experience. We believe that the best treatment
choice involves psychotherapy that focuses on the core issues in perfec-
tionism (see Hewitt, Flynn, Mikail,
&
Flett, 2001b). This approach in-
volves an intensive course
of
treatment (see also Blatt,
1995)
that focuses
on the motivations
for
and the precursors of perfectionistic behavior in an
attempt
to
deal with the source
of
the perfectionism.
Our approach focuses on the interpersonal precursors
of
perfectionism
and fragile identity issues as the most relevant factors in treating perfec-
tionism. These interpersonal precursors involve core needs of the person
(i.e., the need
to
obtain respect, caring, and love and
to
avoid censure,
humiliation,
or
punishment) that propel perfectionistic behavior in an ef-
fort
to
create an acceptable identity. Our approach focuses on the
factors
that motivate the perfectionism in the
first
place because dealing with
or
focusing on stress, cognitions and attitudes,
or
critical evaluations may
not change the specific underlying issues that create difficulties. Clearly,
the treatment is quite challenging given the reticence
of
perfectionists
to
seek professional help and
to
maintain compliance and therapeutic rela-
tionships. In addition, perfectionists’ fears associated with changing their
perfectionistic tendencies and the serious psychopathology that sometimes
can result from the perfectionism can complicate treatment.
A
complete
description of the interpersonal psychotherapy treatment approach that
we have used is beyond the scope
of
this chapter; see Hewitt et al. (2001b)
for a detailed description.
Conclusion
We
have suggested that perfectionistic behavior
is
associated with mal-
adjustment and distress, in part, because
of
its
influence on stress and
Copyright American Psychological Association. Not for further distribution.
PERFECTIONISM
AND
STRESS PROCESSES 279
failure
as
well
as
on coping mechanisms. Although research on this con-
struct
has been increasing,
as
attested by the various chapters in this
volume,
it
is
evident from our analysis that many issues remain
to
be
addressed.
For
example,
at
the outset of this chapter we mentioned that
perfectionism can play both
a
moderating and
a
mediating role in relation
to
stress and psychopathology. Most of the existing research has focused
on the moderating role of perfectionism in the stress-pathology link (i.e,,
the stress-enhancement component) by looking
at
the interaction
of
per-
fectionism and stress in predicting various outcomes; little work has as-
sessed the mediating role
of
perfectionism in the perpetuation, anticipa-
tion, and generation of stress.
Two
recent studies suggested that
mediational models involving perfectionism and stress are highly relevant
(see Blankstein
&
Dunkley, chapter
12,
this volume; Chang,
20001,
so
a
dual focus on mediators and moderators
is
appropriate. Moreover, in com-
plex models, such
as
the model whereby perfectionism can both generate
and interact with stressors in producing psychopathology (e.g., Monroe
&
Simons, 1991), fairly sophisticated research strategies need
to
be used.
In summary, we have proposed a model of perfectionism and psycho-
pathology in which different facets of perfectionistic behavior
or
different
kinds of perfectionism influence stressful events, circumstances, or fail-
ures and produce or maintain psychopathological states through that in-
fluence. Although much research has accumulated over the past decade,
research
is
needed that is theory-driven and based on
a
framework
or
theory of the mechanisms involved. We hope that our model will spawn
this kind of research and that, ultimately, insights will be gained about
how
to
best help people who have decidedly distressing lives
as
a result
of their perfectionistic tendencies.
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