Dimensions of perfectionism and constructive thinking as a coping response

The present study examined perfectionism and general coping ability as assessed by a new measure of constructive thinking. A sample of 77 students completed the Multidimensional Perfectionism Scale (MPS) and the Constructive Thinking Inventory (CTI). The MPS provides measures of selforiented, other-oriented, and socially prescribed perfectionism, while the CTI provides various measures, including summary scores of global constructive thinking, emotional coping, behavioral coping, categorical thinking, personal superstitious thinking, naive optimism, and esoteric thinking. Subjects also completed a measure of depressive symptoms so that we could examine perfectionism and coping independent of current levels of adjustment. The main finding was that socially prescribed perfectionism was associated with less constructive thinking and more negative coping across most of the CTI subscales, and these associations remained significant after removing variance due to levels of depression symptoms. Self-oriented perfectionism was adaptive in that it was associated with active forms of behavioral coping, but it was maladaptive in that it was associated with a form of emotional coping involving reduced self-acceptance. The results are discussed in terms of their implications for the cognitive treatment of perfectionists. Queen's University This research was supported by grant #410-91-0856 from the Social Sciences and Humanities Research Council of Canada awarded to the authors     

Multidimensional perfectionism and the DSM-5 personality traits

Encouraging further research on the dimensional assessment of personality disorders (PDs), Section III of the DSM-5 introduced a hybrid model for the assessment of six PDs employing self-reports on 25 maladaptive personality traits (“DSM-5 personality traits”). Following suggestions that multidimensional perfectionism is an important characteristic across various personality disorders (Ayearst, Flett, & Hewitt, 2012), the present study investigated how personal (self-oriented) and interpersonal (other-oriented and socially prescribed) forms of perfectionism predicted the DSM-5 personality traits in a sample of 311 university students. Multiple regressions (controlling for the overlap between the different forms of perfectionism) showed that socially prescribed perfectionism positively predicted the traits defining schizotypal, borderline, avoidant, and obsessive-compulsive PD; other-oriented perfectionism positively predicted the traits defining narcissistic PD; and both socially prescribed and other-oriented perfectionism positively predicted the traits defining antisocial PD. In contrast, self-oriented perfectionism positively predicted only one of the four traits defining obsessive-compulsive PD (rigid perfectionism). Showing that multidimensional perfectionism predicted all DSM-5 traits defining the personality disorders of Section III, the findings suggest that future DSM-5 updates may profit from including interpersonal aspects of perfectionism as a diagnostic criterion.     

Dimensions of perfectionism and irrational thinking

Several authors have suggested that perfectionism is associated with irrational thinking. The purpose of the present research was to test the hypothesis that various dimensions of perfectionism are related significantly to core irrational beliefs. In Study 1, 102 subjects completed the Multidimensional Perfectionism Scale (MPS) and the Irrational Beliefs Test (IBT). The MPS provides assessments of self-oriented, other-oriented, and socially prescribed perfectionism. Analyses revealed that self-oriented perfectionism was correlated positively with the IBT high self-expectations and perfect solutions subscales. Socially prescribed perfectionism was correlated significantly with a variety of irrational beliefs including high self-expectations, demand for social approval, dependency, blame proneness, and anxious overconcern. Other-oriented perfectionism was correlated with few irrational beliefs. In Study 2, 130 subjects completed the MPS and the Survey of Personal Beliefs, a new measure of core irrational beliefs. Analyses confirmed that all three perfectionism dimensions were associated with core irrational beliefs. It is concluded that the results constitute general support for the hypothesis that cognitive aspects are important in both personal and social components of perfectionism and that perfectionists are characterized by increased levels of irrational beliefs that may contribute to maladjustment. The findings are discussed in terms of the associations among perfectionism, irrational beliefs, and maladjustment.Gordon L. Flett, Ph.D is currently an assistant professor in the Department of Psychology at York University. Paul L. Hewitt, Ph.D is a clinical psychologist at Brockville Psychiatric Hospital. He is also an assistant professor in the Department of Psychiatry at the University of Ottawa. Kirk R. Blankstein, Ph.D, is an associate professor in the Department of Psychology at Erindale College, University of Toronto. Spomenka Koledin is a former student at Erindale College, University of Toronto. Currently, she is a graduate student in the Master of Arts programme at York University.     

Perfectionism in relation to attributions for success or failure

The present study examined the association between dimensions of perfectionism and attributions for success and failure. A sample of 124 students (40 males, 84 females) completed the Multidimensional Perfectionism Scale (MPS) and the Multidimensional Multiattributional Causation Scale (MMCS). The MPS consists of three subscales measuring self-oriented perfectionism, other-oriented perfectionism, and socially pre-scribed perfectionism. The MMCS measures internal attributions (i.e., ability, effort) and external attributions (i.e., luck, contextual factors) for positive and negative hypo-thetical outcomes in the achievement and affiliation domains. The main finding of this study was that socially prescribed perfectionism was associated with a general ten-dency to attribute outcomes to external causes. This external attribution pattern was obtained for successes and failures in both the achievement and interpersonal spheres. Overall, the main results suggest that socially prescribed perfectionism is associated with perceptions of learned helplessness. The implications of these findings are dis-cussed.     

Borderline personality traits in nonclinical young adults

The main purpose of this study was to explore the dimensionality of the borderline personality disorder in nonclinical young adults by means of the Borderline Personality Questionnaire (BPQ; Poreh et al., 2006). We also studied the phenotypic expression of the borderline personality traits as a function of participants' gender and age, and the relationship between BPQ subscales and measures of depressive symptoms, anxiety, stress, hallucinatory predisposition, and paranoid ideation. The sample comprised 809 young adults, 562 (69.5%) were women, with a mean age of 20.2 years (SD = 2.9). The results indicate that the BPQ self-report has adequate psychometric properties. The levels of internal consistency for the BPQ subscales ranged between .78 and .93. Analysis of the internal structure of the BPQ subscales yielded a one-dimensional solution. In contrast, second-order principal components analysis at the item level yielded a five-dimensional solution. Likewise, statistically significant differences in the mean scores of the borderline personality traits as a function of participants' gender and age were found. The BPQ subscales correlated significantly with measures of depression, anxiety, stress, paranoid ideation, and hallucinatory predisposition. These results help to improve our understanding of the dimensional structure of the borderline personality in the general population. Future research should continue to identify participants who are at risk for the development of borderline personality disorder and facilitating the development of early detection and prevention programs.     

A psychometric examination of the multidimensional perfectionism scale

The Multidimensional Perfectionism Scale (MPS), developed by Frost, Marten, Lahart, and Rosenblate (1990), was constructed using an all female sample at an elite university. This study examined the psychometric properties of the instrument using a more typical sample (n=278) of college students from a large state university and a small liberal arts college, both located in the South. Significant differences were found on the overall MPS score as well as six of the seven subscales between this sample and that of Frostet al. No gender differences were found for any of the MPS scores. Internal reliability was found to be .88 for the total score, with subtests ranging from .57 to .95. Interscore correlations were relatively consistent with the Frostet al. sample except for a negative correlation between the PS subscale and the total score. There was a strong confirmation of the underlying factor structure reported by Frostet al. The overall impression was that the MPS is a psychometrically sound instrument of potential value in studying the construct of perfectionism.     

Self-oriented and socially prescribed perfectionism dimensions and their associations with disordered eating

This study examined the relationship between self-oriented and socially prescribed dimensions of perfectionism (using two measures of perfectionism) and disordered eating assessed across multiple time points in a sample of young women. Study participants (n=406) reported on their levels of perfectionism and on their subsequent patterns of dieting and bulimic symptoms. Self-oriented perfectionism was strongly linked to dietary restraint, whether using the theoretically derived perfectionism dimensions from the Multidimensional Perfectionism Scale (MPS) [Hewitt, P.L., & Flett, G.L. (1991a). Perfectionism in the self and social contexts: Conceptualization, assessment, and association with psychopathology. Journal of Personality and Social Psychology, 60, 456-470] or the dimensions derived from the Perfectionism subscale of the Eating Disorder Inventory (EDI) [Garner, D. M., Olmsted, M. P., & Polivy, J. (1983). Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. International Journal of Eating Disorders, 2, 15-34]. A less clear-cut pattern emerged when bulimic symptoms were investigated, with both self-oriented (MPS and EDI) and socially prescribed perfectionism (MPS) being associated with bulimic symptoms. After controlling for negative affect, only a self-oriented dimension of perfectionism predicted unique variance in bulimic symptoms. What constitutes maladaptive perfectionism, concerns about using EDI-Perfectionism dimensions interchangeably with MPS dimensions, and future directions are discussed.     

Compulsive checking and anxiety in a nonclinical sample: Differences in cognition,behavior, personality,and affect

This study addresses the question of why some highly anxious individuals exhibit excessive levels of compulsive checking behavior while other do not. To this end, nonclinical samples of compulsive checkers (n=19), (nonchecking) anxious controls (n=16), and (nonchecking) nonanxious controls (n=12) were compared on a variety of cognitive, behavioral, personality, and affective measures hypothesized to differentiate checkers from anxious controls. Results indicated that checkers exhibited higher levels of perfectionism and worry, and demonstrated greater cognitive impairment on the Wisconsin Card Sorting Test. Furthermore, performance and subjective experiences of performance appeared to be mediated by perfectionism and worry. Findings suggest that both personality and cognitive variables are important correlates of the form of anxiety-related symptomatology.     

Associations between procrastination,personality, perfectionism,self-esteem and locus of control

To date, many variables but particularly trait-like psychological constructs have been found to strongly contribute to procrastination but the complex relations among these variables collectively have received almost no attention. The purpose of the study was to provide a more profound understanding of the relations between procrastination, perfectionism, big five personality, locus of control and self-esteem. Young adults (162 women, 80 men: M?=?20.98) completed measures of academic procrastination, self-esteem, big five personality, perfectionism and locus of control. Parental criticism was a significant correlate of procrastination, while personality traits of conscientiousness, agreeableness and organisation were inversely associated with procrastination behaviour. These findings suggest that personality-based intervention approaches with the inclusion of family can be more influential in procrastination prevention and treatment.     

Perfectionism,life events,and depressive symptoms: A test of a diathesis-stress model

The present research tested the hypothesis that perfectionists who experience stress are vulnerable to depression, in part because negative life events represent a failure to maintain control over negative outcomes. In Study 1, 215 subjects completed the Multidimensional Perfectionism Scale (MPS) and control measures. The MPS assesses self-oriented, other-oriented, and socially prescribed perfectionism. It was confirmed that self-oriented and other-oriented perfectionism were associated with both higher desire for control and greater perceived personal control. Study 2 examined whether trait levels of perfectionism moderate the link between life stress and symptoms of depression. In addition, prospective analyses investigated whether perfectionism accounts for changes in levels of depressive symptomatology over time. Two samples comprised of 374 students (Sample 1) and 173 students (Sample 2) completed the MPS and measures of major life stress and depression symptoms. Subjects in Sample 2 completed these measures at two timepoints separated by a three-month interval. Regression analyses indicated that self-oriented perfectionism and life stress interact significantly to produce higher levels of depressive symptomatology. Moreover, in Sample 2, self-oriented perfectionism at Time 1 was associated with increases in depression symptoms three months later for those individuals who had experienced a major life event. The results provide support for diathesis-stress models, which maintain that perfectionists exposed to life stress are vulnerable to symptoms of depression. The results are discussed in terms of their implications for the study of personality, stress, and vulnerability to symptoms of depression. This research was supported by grants #410-89-0335, #410-91-8056, and #410-93-1256 from the Social Sciences and Humanities Research Council of Canada awarded to the authors.     

The SCL-90-R as a screening instrument for severe personality disturbance among outpatients with mood and anxiety disorders

Our objective was to examine whether the SCL-90-R, a widely used self-report measure of distress and psychopathology, could screen for personality disorders in general and for severe personality disturbance (SPD) in particular, at the time when patients seek treatment for a state (mood or anxiety) disorder. The SCL-90-R was administered to 112 consecutive outpatients with various mood and anxiety disorders. The personality severity index (PSI) score, defined as the mean value of the scores on the SCL-90-R subscales of interpersonal sensitivity, hostility, and paranoid ideation, was compared with the current symptom index (CSI) score, defined as the mean value of the scores on the remaining six SCL-90-R subscales. A positive screen was considered if PSI > CSI. SPD was defined as the presence of any DSM-III-R Cluster A and/or Cluster B personality disorder. The accuracy of the screen was verified by means of the Structured Clinical Interview for DSM-III-R Personality Disorders. The sensitivity of the PSI > CSI criterion to screen for SPD was 89.4%, while its sensitivity to screen for any DSM-III-R personality disorder was 72.9%. The SCL-90-R subscales that contributed the most to the screening discriminability of this SCL-90-R-derived screening measure were hostility, paranoid ideation, somatization, and obsessive-compulsive behavior. The SCL-90-R may be used to screen for SPD in routine work with outpatients with mood and anxiety disorders, but the results of the screening need to be verified because of the possibility of false negatives and false positives, although that possibility is apparently low. These findings may have important prognostic and treatment implications.     

Dimensions of perfectionism across the anxiety disorders

To explore the role of perfectionism across anxiety disorders, 175 patients with either panic disorder (PD), obsessive compulsive disorder (OCD), social phobia, or specific phobia, as well as 49 nonclinical volunteers, completed two measures [Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R., (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14, 449-468; Hewitt, P. L., & Flett, G. L., (1991). Perfectionism in the self and social contexts: Conceptualization, assessment and association with psychopathology. Journal of Personality and Social Psychology, 60, 456-470.] that assess a total of nine different dimensions of perfectionism. Relative to the other groups, social phobia was associated with greater concern about mistakes (CM), doubts about actions (DA), and parental criticism (PC) on one measure and more socially prescribed perfectionism (SP) on the other measure. OCD was associated with elevated DA scores relative to the other groups. PD was associated with moderate elevations on the CM and DA subscales. The remaining dimensions of perfectionism failed to differentiate among groups. The clinical implications of these findings are discussed.     

Perfectionism, life events, and depressive symptoms: A test of a diathesis-stress model

The present research tested the hypothesis that perfectionists who experience stress are vulnerable to depression, in part because negative life events represent a failure to maintain control over negative outcomes. In Study 1, 215 subjects completed the Multidimensional Perfectionism Scale (MPS) and control measures. The MPS assesses self-oriented, other-oriented, and socially prescribed perfectionism. It was confirmed that self-oriented and other-oriented perfectionism were associated with both higher desire for control and greater perceived personal control. Study 2 examined whether trait levels of perfectionism moderate the link between life stress and symptoms of depression. In addition, prospective analyses investigated whether perfectionism accounts for changes in levels of depressive symptomatology over time. Two samples comprised of 374 students (Sample 1) and 173 students (Sample 2) completed the MPS and measures of major life stress and depression symptoms. Subjects in Sample 2 completed these measures at two timepoints separated by a three-month interval. Regression analyses indicated that self-oriented perfectionism and life stress interact significantly to produce higher levels of depressive symptomatology. Moreover, in Sample 2, self-oriented perfectionism at Time 1 was associated with increases in depression symptoms three months later for those individuals who had experienced a major life event. The results provide support for diathesis-stress models, which maintain that perfectionists exposed to life stress are vulnerable to symptoms of depression. The results are discussed in terms of their implications for the study of personality, stress, and vulnerability to symptoms of depression. This research was supported by grants #410-89-0335, #410-91-8056, and #410-93-1256 from the Social Sciences and Humanities Research Council of Canada awarded to the authors.     

Subscales of the Barratt Impulsiveness Scale differentially relate to the Big Five factors of personality

The place of impulsiveness in multidimensional personality frameworks is still unclear. In particular, no consensus has yet been reached with regard to the relation of impulsiveness to Neuroticism and Extraversion. We aim to contribute to a clearer understanding of these relationships by accounting for the multidimensional structure of impulsiveness. In three independent studies, we related the subscales of the Barratt Impulsiveness Scale (BIS) to the Big Five factors of personality. Study 1 investigated the associations between the BIS subscales and the Big Five factors as measured by the NEO Five‐Factor Inventory (NEO‐FFI) in a student sample (N = 113). Selective positive correlations emerged between motor impulsiveness and Extraversion and between attentional impulsiveness and Neuroticism. This pattern of results was replicated in Study 2 (N = 132) using a 10‐item short version of the Big Five Inventory. In Study 3, we analyzed BIS and NEO‐FFI data obtained from a sample of patients with pathological buying (N = 68). In these patients, the relationship between motor impulsiveness and Extraversion was significantly weakened when compared to the non‐clinical samples. At the same time, the relationship between attentional impulsiveness and Neuroticism was substantially stronger in the clinical sample. Our studies highlight the utility of the BIS subscales for clarifying the relationship between impulsiveness and the Big Five personality factors. We conclude that impulsiveness might occupy multiple places in multidimensional personality frameworks, which need to be specified to improve the interpretability of impulsiveness scales.     

The heterogeneous structure of schizotypal personality disorder: item-level factors of the Schizotypal Personality Questionnaire and their associations with obsessive-compulsive disorder symptoms, dissociative tendencies, and normal personality

A. Raine et al.'s (1994) 3-factor scheme is currently the most widely accepted model of schizotypal personality disorder (SPD). Factor analytic studies of the Schizotypal Personality Questionnaire (SPQ; A. Raine, 1991) subscales, which represent the 9 Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for SPD, have provided the model's primary support. The use of only 9 modeled variables, however, limits the number of factors that can be extracted. To explicate this structure more fully, the authors conducted item-level factor analyses of the SPQ in a large student sample that completed the instrument twice within a 2-week interval. The authors' analyses failed to support either the 3-factor model of SPD or the 9 existing DSM-based subscales of the SPQ. Instead, 5 replicable dimensions emerged that capture recurrent symptom pairings found in the broader SPD literature: Social Anhedonia, Unusual Beliefs and Experiences, Social Anxiety, Mistrust, and Eccentricity/Oddity. These factors are only weakly correlated with each other and show differential correlational patterns with the Big Five personality traits, dissociative tendencies, and symptoms of obsessive-compulsive disorder. Moreover, they are congruent with dimensional models of personality psychopathology. Implications for SPD in DSM-V are discussed.     

Mother's personality and infant temperament

We examined if perfectionism and the perception of being an anxious person were associated with more negative infant temperament ratings by the mothers. 386 women (mean age = 30.08; standard deviation = 4.21) in their last trimester of pregnancy completed the Multidimensional Perfectionism Scale (MPS), the Beck Depression Inventory-II (BDI-II) and an item about their perception of being or not an anxious person. The Portuguese version of the Diagnostic Interview for Genetic Studies and the Operational Criteria Checklist for Psychotic Illness were used to generate diagnoses according to DSM-IV and ICD-10 criteria. After delivery, women completed eight items of the Difficult Infant Temperament Questionnaire (developed by our team) and filled in, again, the BDI-II and were interviewed with the DIGS. Women with depression (DSM-IV/ICD-10) and probable cases of depression using different cut-offs adjusted to Portuguese prevalence (BDI-II), in pregnancy and postpartum, were excluded. The Difficult Infant Temperament Questionnaire showed to have factorial validity and internal consistency. There was a statistically significant negative correlation between perfectionism total scale score and item 6 from the temperament scale (“is your baby irritable or fussy?”). Considering MPS 3-factor solution found for pregnancy there was also a statistically significant negative correlation between SOP and the same item. Women with low SOP differed from those with medium and high SOP in the total temperament score. Moreover, the low SOP group differed from the medium group on items three and four scores. There were no significant associations with SPP, which is the dimension more closely associated with negative outcomes. There was an association between anxiety trait status (having it or not) and scoring low, medium or high in the infant temperament scale. The proportion of anxious vs. non-anxious women presenting a high score on the infant temperament scale was higher (24.2% vs. 12.9%). Linear regressions showed that SOP (low vs. medium/high) offered a significant contribution to the prediction of total temperament scale score and items 3 and 4 scores, but a logistic regression did not confirm trait anxiety as a significant predictor of mother's infant temperament perception. Concluding, a major result concerns the fact that higher levels of adaptive perfectionism (i.e. SOP) are associated (and predict) a less negative view of their infant's temperament. These results on the effect of mother's anxiety and perfectionism on the child temperament perception might have treatment implications. As perfectionism is not always maladaptive, some of its positive features could be used to enhance women's self-efficacy/sense of parental competence in their role as mothers and positive affect towards their infants. Also, antenatal interventions aimed at minimising anxiety could help to optimise infant temperament outcomes, which could, eventually, also, lead to subsequent maternal and infant mental health better outcomes.     

Assessment of maladaptiveness: a core issue in the diagnosing of personality disorders.

Although an operationalized and commonly accepted definition of maladaptiveness is lacking, the delineation of personality traits as being adaptive or maladaptive is essential in diagnosing personality disorders (PDs). A way to explore the meaning of maladaptiveness is to compare how patients from all DSM-III-R PDs relate to different traits and dimensions of various dimensional models of personality. In the present study, the Karolinska Scales of Personality (KSP) were used in a sample of 94 psychiatric outpatients who were assessed according to severity of maladaption and according to type of predominant cluster type of deviant traits. Only one of four factors of the scores of the KSP subscales, "Interpersonal Aversiveness," was related to degree of maladaption, indicating high detachment, suspicion, irritability, dysphoria, and low socialization as core features of maladaptiveness. Three subscales of the KSP Socialization were all associated with maladaptiveness. However, one subscale, "Childhood Adjustment," was also related to the predominant cluster type of personality pathology.     

Obsessive compulsive personality disorder as a predictor of exposure and ritual prevention outcome for obsessive compulsive disorder

Despite elevated rates of obsessive compulsive personality disorder (OCPD) in patients with obsessive compulsive disorder (OCD), no study has specifically examined comorbid OCPD as a predictor of exposure and ritual prevention (EX/RP) outcome. Participants were adult outpatients (n = 49) with primary OCD and a Yale-Brown Obsessive Compulsive Scale (YBOCS) total score ≥ 16 despite a therapeutic serotonin reuptake inhibitor dose for at least 12 weeks prior to entry. Participants received 17 sessions of EX/RP over 8 weeks. OCD severity was assessed with the YBOCS pre- and post-treatment by independent evaluators. At baseline, 34.7% of the OCD sample met criteria for comorbid DSM-IV OCPD, assessed by structured interview. OCPD was tested as a predictor of outcome both as a diagnostic category and as a dimensional score (severity) based on the total number of OCPD symptoms coded as present and clinically significant at baseline. Both OCPD diagnosis and greater OCPD severity predicted worse EX/RP outcome, controlling for baseline OCD severity, Axis I and II comorbidity, prior treatment, quality of life, and gender. When the individual OCPD criteria were tested separately, only perfectionism predicted worse treatment outcome, over and above the previously mentioned covariates. These findings highlight the importance of assessing OCPD and suggest a need to directly address OCPD-related traits, especially perfectionism, in the context of EX/RP to minimize their interference in outcome.     

Attention,autonomic arousal,and personality in behaviorally disordered children

This study assessed the construct validity of the Revised Behavior Problem Checklist (RBPC) by measuring attention, autonomie arousal, and personality in 40 behaviorally disordered children aged 7 to 15 years. Conduct Disorder and Socialized Aggression subscales were characterized by high Psychoticism, Impulsivity, and Lie personality scores, by lower heart rate levels, and by more errors on a continuous performance reaction-time task. Conversely, Attention Problems, Anxiety Withdrawal, and Motor Excess were characterized by greater variability in reaction times. Conduct Disorder alone was related to an external locus of control, while only Attention Problems was characterized by low scores on the WISC Freedom from Distraction factor. These differential relationships suggest (a) support for the construct validity of the RBPC, (b) that antisocial behavior and hyperactivity/attention deficits are dissociated disorders, and (c) that hyperactivity/attention deficits may be characterized by fluctuations in the allocation of attentional resources rather than a core structural deficit in attention.     

The Shedler and Westen Assessment Procedure from the perspective of general personality structure

The Shedler and Westen Assessment Procedure (SWAP-200; J. Shedler & D. Westen, 2004) has received increasing support as a dimensional model of personality pathology. However, only 1 prior study has related empirically the SWAP-200 with any other measure of personality or personality disorder. The purpose of the current study was to determine whether the SWAP-200 personality disorder and personality dimension scales relate meaningfully to the domains and facets of the five-factor model (FFM; J. M. Digman, 1990) of general personality structure. Individuals (n = 94) with significant personality pathology were described on instruments of general personality and personality pathology. The results of the current study suggest that most of the SWAP-200 personality and personality disorder scales relate to the domains and facets of the FFM in a manner consistent with FFM theory and previous FFM personality disorder research. Inconsistent findings and limitations are discussed, along with suggestions for future research.