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.     

Cognitive Errors as Predictors of Adaptive and Maladaptive Perfectionism in Children

Cognitive distortions such as dichotomous evaluation of performance, selectively focusing on perceived failures, and discounting successes are proposed to be key maintaining mechanisms in clinical perfectionism, but no existing research has investigated the relationship between perfectionism and cognitive errors in children. The current study assessed the associations between dimensions of perfectionism as assessed by the Adaptive/Maladaptive Perfectionism Scale (AMPS) and children??s cognitive errors controlling for negative and positive affect to provide information about cognitive features associated with perfectionism in children and construct-related evidence for the AMPS. A non-clinical sample of 204 children completed the AMPS, the Children??s Negative Cognitive Errors Questionnaire, and measures of positive and negative affect. The AMPS sensitivity to mistakes scale was correlated robustly with catastrophizing, overgeneralization, personalizing, and selective abstraction. Cognitive errors were significant predictors of maladaptive perfectionism even after controlling for negative affect. However, cognitive errors did not predict adaptive perfectionism after controlling for positive affect. These findings highlight the role of negative thinking styles in maladaptive perfectionism in children and point to the potential usefulness of interventions that focus jointly on maladaptive perfectionism and negative cognitive styles.     

Are perfectionism dimensions risk factors for anxiety symptoms? A meta-analysis of 11 longitudinal studies

Background: Over 50 years of theory and research implicates perfectionism in anxiety. However, it is unclear which (if any) perfectionism dimensions are risk factors for anxiety.

Objective: To address this, we conducted a meta-analysis testing whether socially prescribed perfectionism, concern over mistakes, doubts about actions, self-oriented perfectionism, and personal standards predict increases in anxiety.

Method: Our literature search yielded 11 relevant studies for inclusion, composed of children, adolescents, undergraduates, community adults, and psychiatric patients.

Results: Meta-analysis using random-effects models revealed concern over mistakes (r^+?=?.11), doubts about actions (r^+?=?.13), and personal standards (r^+?=?.08), but not socially prescribed perfectionism or self-oriented perfectionism, displayed significant small positive relationships with follow-up anxiety, after controlling for baseline anxiety.

Conclusion: Research is needed to understand the conditions under which the connection between perfectionism and anxiety becomes stronger (e.g., stress).     

Perfectionism and Deficits in Cognitive Emotion Regulation

The current study investigated the general hypothesis that perfectionists have deficits in cognitive emotion regulation. A sample of 100 students completed the Perfectionism Cognitions Inventory, the Multidimensional Perfectionism Scale, the Cognitive Emotion Regulation Questionnaire (CERQ), and a measure of depression. Correlational analyses revealed that frequent thoughts involving perfectionism were associated with maladaptive cognitive emotion regulation tendencies, including catastrophization, self-blame, rumination, and lack of positive reappraisal. Socially prescribed perfectionism was associated with the maladaptive cognitive emotion regulation strategies of self-blame, catastrophization, and rumination, and it was correlated negatively with the adaptive cognitive emotion regulation strategies of putting into perspective and positive reappraisal. Trait self-oriented perfectionism was linked with self-blame. As expected, higher levels of depression were associated with perfectionism cognitions, socially prescribed perfectionism and deficits in cognitive emotion regulation. Our findings suggest the need for interventions designed to bolster the cognitive coping skills of at-risk perfectionists. This research was supported by a major research grant from the Social Sciences and Humanities Research Council (SSHRC) of Canada. Gordon Flett was also supported by a Canada Research Chair in Personality and Health.     

Perfectionism,over commitment to work,and burnout in employees seeking workplace counselling

Perfectionism is linked to a range of psychological disorders. Burnout is an important construct in the working population and has been found to overlap with related constructs such as depression. There has been limited research conducted between perfectionism and burnout. This study aimed to examine the link between perfectionism and burnout and if procrastination and over commitment to work were mediators of the relationship. There were 69 participants recruited who were seeking counselling from a counselling firm, providing employee assistance services. The results indicated that procrastination was not a significant mediator of the relationship between concern over mistakes (CM) perfectionism and burnout. There was a significant mediating relationship found, where overcommitment to work mediated the relationship between CM perfectionism leading to burnout. The implications of the study in terms of interventions for employees suffering burnout, and directions for future research in regards to the relationship between perfectionism and burnout are considered.     

Perfectionism and negative repetitive thoughts: Examining a multiple mediator model in relation to mindfulness

Perfectionism is known to be associated with various maladaptive outcomes, yet little research has examined mechanisms underlying perfectionism or potential protective factors. This study investigated worry and rumination as mediators between perfectionism and psychological distress in university students (N = 213), and related the multiple mediator model to a five-facet conceptualization of mindfulness. Socially prescribed perfectionism was related to higher levels of distress, including negative affect, depression, anxiety, and stress, while self-oriented perfectionism and other-oriented perfectionism appeared unrelated to distress. Mindfulness facets of acting with awareness, non-judging of inner experience, and to a lesser extent non-reactivity to inner experience, were the strongest independent contributors to perfectionism, negative repetitive thoughts, and distress. Worry and rumination mediated the relationship between socially prescribed perfectionism and negative affect; however, the mediating effect of rumination was absent in those high in mindfulness. These findings suggest that a mindfulness disposition may mitigate distress related to socially prescribed perfectionism by removing the mediating effect of ruminative thought. Future research might explore a mindfulness-training program to target negative repetitive thoughts underlying socially prescribed perfectionism.     

Searching for Specificity Between Cognitive Vulnerabilities and Mood and Anxiety Symptoms

Using two large nonclinical samples (N = 725), relations between five targeted cognitive variables [intolerance of uncertainty, negative problem orientation, perfectionism/certainty, responsibility/threat estimation, and importance/control of thoughts] and mood [depression] and anxiety [social anxiety, generalized anxiety, and obsessive–compulsive] symptoms were examined. Analyses provided multiple levels of specificity, including zero-order correlations, partial correlations controlling for the effects of positive and negative affect, regression analyses, and hierarchical structural modeling. Results were that (a) intolerance of uncertainty showed relative specificity to anxiety versus depression symptoms and (b) negative problem orientation was common to mood and anxiety symptoms. Although certain analyses suggested that (c) perfectionism/certainty specifically predicted generalized anxiety and (d) both responsibility/threat estimation and importance/control of thoughts were unique predictors of obsessive–compulsive symptoms, these three cognitive variables inconsistently predicted symptom scores across the two studies. Conceptual and therapeutic implications are discussed.     

A Cognitive-Behavioral-Based Workshop Intervention for Maladaptive Perfectionism

Maladaptive perfectionism (MP) can have adverse consequences for mental and physical health and can interfere with treatment success for various conditions. Theoretical conceptualizations of MP largely surround overly rigid and self-critical thinking as well as excessively high standards. Treatment for MP thus often focuses on these cognitive aspects and has been successful, albeit lengthy. The present study evaluated a brief cognitive-behavioral workshop for those with high, moderate, and low MP, which was defined as a composite of perfectionism subscales that included concern over mistakes, doubting of actions, parental criticism, parental expectations, and discrepancy. Workshop components focused on psychoeducation about MP, setting high standards, fearing mistakes and doubting oneself, and preventing distress and maintaining gains. Ratings of MP as well as anxiety, depression, and distress were significantly lower from pre-treatment across post-treatment and 3-week and 3-month follow-up assessments for those with high and moderate MP. Participants with low MP showed no significant change over time, as expected. The workshop thus provided a useful, brief, and cost-effective intervention for MP and related distress. Clinical implications are discussed, including routine assessment of MP in clinical practice, intervention for MP early in the clinical process, specific focus on self-criticism and setting high standards, and implementation in university counseling centers. Recommendations for future research are also discussed, including dismantling of workshop components, identifying treatment mechanisms, expanding to clinical populations, evaluating more diverse samples, and understanding the possible preventative aspects of a workshop approach.     

Are Perfectionism Dimensions Vulnerability Factors for Depressive Symptoms After Controlling for Neuroticism? A Meta‐analysis of 10 Longitudinal Studies

Extensive evidence suggests neuroticism is a higher‐order personality trait that overlaps substantially with perfectionism dimensions and depressive symptoms. Such evidence raises an important question: Which perfectionism dimensions are vulnerability factors for depressive symptoms after controlling for neuroticism? To address this, a meta‐analysis of research testing whether socially prescribed perfectionism, concern over mistakes, doubts about actions, personal standards, perfectionistic attitudes, self‐criticism and self‐oriented perfectionism predict change in depressive symptoms, after controlling for baseline depression and neuroticism, was conducted. A literature search yielded 10 relevant studies (N = 1,758). Meta‐analysis using random‐effects models revealed that all seven perfectionism dimensions had small positive relationships with follow‐up depressive symptoms beyond baseline depression and neuroticism. Perfectionism dimensions appear neither redundant with nor captured by neuroticism. Results lend credence and coherence to theoretical accounts and empirical studies suggesting perfectionism dimensions are part of the premorbid personality of people vulnerable to depressive symptoms. Copyright © 2016 European Association of Personality Psychology     

Interactive Effects of Looming Cognitive Style and Maladaptive Perfectionism on Trait Anxiety

Perfectionism is suggested as a transdiagnostic factor, related to development and maintenance of many psychological disorders. Looming Cognitive Style (LCS), on the other hand, is unique to anxiety disorders, acting as a specific a cognitive vulnerability for anxiety disorders. The present study aims to assess the association of anxiety with two cognitive vulnerability factors, LCS and maladaptive perfectionism. It was hypothesized that maladaptive perfectionism will have moderator role in the relationship between LCS and anxiety. A similar relationship is not expected for depression. Data were collected from 326 university students through self-report measures of LCS, perfectionism, anxiety, and depression. Results indicated the significant moderator roles of maladaptive perfectionism in the relationship of LCS with anxiety, even when the symptoms of depression are controlled. That is, maladaptive perfectionism was associated with higher levels of anxiety especially in individuals who had higher levels of looming vulnerability. A similar moderating effect of maladaptive perfectionism was not observed for depression. The results altogether emphasize the importance of examining the interactive effects of different vulnerability factors in understanding the mechanisms through which the risk factors operate.     

Efficacy of brief guided self-help cognitive behavioral treatment for perfectionism in reducing perinatal depression and anxiety: a randomized controlled trial

Perfectionism has been proposed as a transdiagnostic process that maintains depression and anxiety through shared cognitive and behavioral processes. The purpose of this study was to investigate the efficacy of a brief, guided cognitive behavioral treatment (CBT) for perfectionism delivered via a self-help booklet in reducing perfectionism and symptoms of depression and anxiety during the antenatal period. Pregnant women in their third trimester were randomly allocated to self-help (n = 30) or waitlist control (n = 30). There were significant reductions in perfectionism and symptoms for participants who received CBT for perfectionism from pre- to post-treatment, which were maintained at 3-month follow-up, while the waitlist control group demonstrated no significant changes. Path analysis demonstrated a significant indirect effect of treatment condition on post-treatment depression and anxiety scores via perfectionism, controlling for pre-treatment scores, suggesting changes in perfectionism were associated with decreases in symptoms. The findings suggest that it would be useful for future research with larger samples to further investigate the efficacy of CBT for perfectionism for perinatal depression and anxiety.     

Emotional processing in anterior cingulate and medial prefrontal cortex

Negative emotional stimuli activate a broad network of brain regions, including the medial prefrontal (mPFC) and anterior cingulate (ACC) cortices. An early influential view dichotomized these regions into dorsal-caudal cognitive and ventral-rostral affective subdivisions. In this review, we examine a wealth of recent research on negative emotions in animals and humans, using the example of fear or anxiety, and conclude that, contrary to the traditional dichotomy, both subdivisions make key contributions to emotional processing. Specifically, dorsal-caudal regions of the ACC and mPFC are involved in appraisal and expression of negative emotion, whereas ventral-rostral portions of the ACC and mPFC have a regulatory role with respect to limbic regions involved in generating emotional responses. Moreover, this new framework is broadly consistent with emerging data on other negative and positive emotions.     

Affective Processing and Emotion Regulation in Dysphoria and Depression: Cognitive Biases and Deficits in Cognitive Control

In this article, we take a closer look at the cognitive processing of emotional material in dysphoria and depression and link cognitive biases and deficits to individual differences in emotion regulation, an important risk factor for depression. Specifically, we propose that cognitive biases are associated with individual differences in the initial appraisal and reappraisal of emotion‐eliciting events. In addition, deficits in cognitive control result in prolonged processing of negative, goal‐irrelevant aspects of information as well as in decreased accessibility of mood‐incongruent material. These deficits further affect people’s ability to regulate negative affect by setting the stage for ruminative responses and by interfering with the use of reappraisal after the onset of an emotional response. This article provides a brief summary of findings that support these propositions and outlines implications for future research on the relation among affective processing, cognitive control, and emotion regulation in dysphoria and depression.     

Perfectionism Cognitions, Rumination, and Psychological Distress

The current study examined the extent to which dimensions of perfectionism are associated with a ruminative response orientation and the experience of cognitive intrusions in response to stressful events. Our main goal was to test the hypothesis that individuals characterized by frequent automatic thoughts involving perfectionistic themes would also be characterized by a ruminative response orientation when distressed and they would report intrusive thoughts and images following the experience of a stressful event. A sample of 65 students completed several measures, including the Perfectionism Cognitions Inventory, the Multidimensional Perfectionism Scale, the Response Styles Questionnaire, the Impact of Events Scale, and indices of depression and anxiety. Correlational analyses confirmed that high scores on the Perfectionism Cognitions Inventory were correlated with a ruminative response orientation and the reported experience of intrusive thoughts and images following the experience of a stressful event. High levels of perfectionism cognitions, socially prescribed perfectionism, and rumination were also correlated with measures of depression and anxiety representingthe tripartite model. The results support the view that there is a salient cognitive aspect to perfectionism and the experience of frequent perfectionistic cognitions and related forms of rumination contribute to levels of psychological distress.     

Cognitive reappraisal and secondary control coping: associations with working memory,positive and negative affect,and symptoms of anxiety/depression

Abstract

The current study examined the relations of measures of cognitive reappraisal and secondary control coping with working memory abilities, positive and negative affect, and symptoms of anxiety and depression in young adults (N=124). Results indicate significant relations between working memory abilities and reports of secondary control coping and between reports of secondary control coping and cognitive reappraisal. Associations were also found between measures of secondary control coping and cognitive reappraisal and positive and negative affect and symptoms of depression and anxiety. Further, the findings suggest that reports of cognitive reappraisal may be more strongly predictive of positive affect whereas secondary control coping may be more strongly predictive of negative affect and symptoms of depression and anxiety. Overall, the results suggest that current measures of secondary control coping and cognitive reappraisal capture related but distinct constructs and suggest that the assessment of working memory may be more strongly related to secondary control coping in predicting individual differences in distress.     

Interference and conflict monitoring in individuals with amnestic mild cognitive impairment: A structural study of the anterior cingulate cortex

Amnestic mild cognitive impairment (aMCI) is a clinical condition characterized by memory impairment in the absence of any other cognitive impairment and is commonly associated with high conversion to Alzheimer's disease. Recent evidence shows that executive functions and selective attention mechanisms could also be impaired in aMCI. In this study, we investigated performance differences (i.e., reaction times [RTs] and accuracy) between a group of aMCI participants and a group of age‐matched healthy individuals on the attentional network task (ANT) focusing on situations with increased interference. In particular, we assessed the relationship between interference and conflict effects and grey matter volumes (GMVs) of the anterior cingulate cortex (ACC)/pre‐supplementary motor area in the entire sample because of its crucial role in conflict monitoring. When compared with controls, aMCI participants were less accurate on the ANT, showing increased interference and conflict effects, but no differences in RTs. In addition, aMCI participants exhibited lower GMV in the ACC than controls. While better accuracy for interference and conflict effects was associated with an increase of GMV in the ACC for both groups, RTs from the interference effect were negatively correlated with GMV of the ACC only in aMCI participants. In other words, lower GMV values of the ACC were paralleled with significantly impaired performance in terms of interference resolution. In conclusion, our study suggests the presence of a selective impairment in interference and conflict monitoring in aMCI, which in turn is associated with decreased GMVs in the ACC.     

Positive and Negative Family Emotional Climate Differentially Predict Youth Anxiety and Depression via Distinct Affective Pathways

A socioaffective specificity model was tested in which positive and negative affect differentially mediated relations of family emotional climate to youth internalizing symptoms. Participants were 134 7^th-9^th grade adolescents (65 girls; 86 % Caucasian) and mothers who completed measures of emotion-related family processes, experienced affect, anxiety, and depression. Results suggested that a family environment characterized by maternal psychological control and family negative emotion expressiveness predicted greater anxiety and depression, and was mediated by experienced negative affect. Conversely, a family emotional environment characterized by low maternal warmth and low positive emotion expressiveness predicted only depression, and was mediated through lowered experienced positive affect. This study synthesizes a theoretical model of typical family emotion socialization with an extant affect-based model of shared and unique aspects of anxiety and depression symptom expression.     

Examining the Role of Perfectionism and Intolerance of Uncertainty in Postevent Processing in Social Anxiety Disorder

Postevent processing (PEP) is proposed to be a key maintenance factor of social anxiety disorder (SAD; e.g., Clark and Wells 1995). The goal of the current study was to examine the independent roles of two transdiagnostic variables, namely perfectionism and intolerance of uncertainty (IU), as unique predictors of PEP in SAD above and beyond social anxiety and depressive symptoms. Fifty-six adults with SAD and high levels of speech anxiety completed measures of perfectionism, IU, social anxiety, and depression. They gave an impromptu speech to induce PEP, and completed measures assessing degree of PEP and its associated distress. Significant positive correlations were found between perfectionism and negative PEP degree and distress, as well as between IU and negative PEP distress. The perfectionism subscales of parental expectations and parental criticism significantly predicted negative PEP degree and distress over and above social anxiety and depressive symptoms. Perfectionism, as well as IU, were significantly and positively correlated with positive PEP distress, and significantly predicted positive PEP distress above and beyond social anxiety and depressive symptoms. The study design was cross-sectional; hence, experimental and longitudinal studies are needed to further understand the roles of perfectionism and IU as they relate to PEP. Individuals with SAD who are high in perfectionism or IU appear to be more prone to engaging in, or experiencing distress associated with, negative PEP. Specific strategies for decreasing negative PEP in this vulnerable population, especially for those high in perfectionism, may be necessary for optimal treatment outcome.     

Perfectionism in Pediatric Anxiety and Depressive Disorders

Although perfectionism has been identified as a factor in many psychiatric disorders across the life span, it is relatively understudied in pediatric anxiety and depressive disorders. Furthermore, there exists little cohesion among previous research, restricting the conclusions that can be made across studies. In this review, research associating perfectionism with pediatric anxiety and depression is examined and a framework is presented synthesizing research to date. We focus on detailing the current understanding of how perfectionism develops and interacts with other developmental features characteristic of anxiety and depression in children and potential pathways that result in anxiety and depressive disorders. This includes: how perfectionism is measured in children, comparisons with relevant adult literature, the development of perfectionism in children and adolescents, mediators and moderators of the link between perfectionism and anxiety and depression, and the role of perfectionism in treatment and prevention of these disorders. We also present research detailing perfectionism across cultures. Findings from these studies are beginning to implicate perfectionism as an underlying process that may contribute broadly to the development of anxiety and depression in a pediatric population. Throughout the review, difficulties, limitations, and gaps in the current understanding are presented while offering suggestions for future research.     

The role of perfectionism,agreeableness, and neuroticism in predicting dyadic adjustment

Research has suggested that perfectionism, agreeableness, and neuroticism may influence relationship adjustment; however, these personality variables have not been examined in conjunction when considering relationship adjustment. In a sample of 222 university students (95 male, 126 female), the perfectionism dimensions of concern over mistakes and parental criticism were found to be significantly negatively related to dyadic adjustment. Agreeableness and neuroticism were also significantly negatively related to dyadic adjustment, and accounted for significant variance in explaining dyadic adjustment, while perfectionism dimensions did not. The results suggest that while negative aspects of perfectionism, such as concern over mistakes, have an impact on dyadic adjustment, the personality variables of agreeableness and neuroticism have a more salient impact. The implications of these findings for research in interventions for perfectionism and relationship adjustment are discussed.