Treatment Interventions for Perfectionism—A Cognitive Perspective: Introduction to the Special Issue

The current article provides an overview of the papers included in this special issue and includes a discussion of key issues pertaining to psychological treatments for perfectionism. We describe and review two new treatment intervention studies in this special issue that focus on perfectionism in university students as well as other contemporary research on the use of cognitive-behavioral therapy to treat perfectionists. While the significant reductions in levels of perfectionism as a result of treatment are noteworthy, we caution that perfectionism is a relatively enduring trait; thus, some perfectionists will remain treatment resistant and overall levels of perfectionism may remain relatively high even when significant improvements are realized. Moreover, we discuss the established tendency for perfectionism to be associated with residual symptoms of distress following treatment. As part of our discussion of the other articles in this special issue, we highlight cognitive factors of likely significance in the treatment of perfectionism, including the ruminative response style, the tendency to experience perfectionistic automatic thoughts, and the role of core irrational beliefs in the development of perfectionism. These articles underscore the need to consider key cognitive factors that are central to dysfunctional forms of perfectionism. This special issue on perfectionism is the third special issue on this topic to appear in the Journal of Rational-Emotive and Cognitive-Behavior Therapy under the editorialship of Windy Dryden. We are very grateful for the continuing opportunity in this journal to explore issues related to the cognitive and treatment aspects of perfectionism.     

An overview of paradoxical counseling and its congruence with biblical writings

Paradoxical counseling (PC) became popular in the second part of last century with the advent of systemic and multi-relational therapies. Since then, it has changed into a variety of behavioral techniques still in use today. How consistent or inconsistent is PC will depend a great deal upon each counselor's beliefs, including those who consider themselves pastoral counselors or Christian counselors. The authors suggest, however, that using workbooks written in both linear-straight-forward or circular-paradoxical ways as homework assignments may enlarge the expertise of a variety of counselors in ways perhaps heretofore unfamiliar to them.     

Delinquent peer affiliation and conduct problems: A twin study

Many putative environmental risks correlate with individuals' genotypes. The association between delinquent peer affiliation and conduct problems may occur because of shared genetic liability. Five hundred fifty three monozygotic and 558 dizygotic twin pairs, aged 11 to 18 years, were assessed for delinquent peer affiliation and conduct problems. The authors investigated whether genes contribute to both delinquent peer affiliation and the correlation between delinquent peer affiliations and conduct problems. Delinquent peer affiliation was influenced by genetic, shared environmental, and nonshared environmental factors; genetic factors also contributed to the correlation between delinquent peer affiliations and conduct problems, providing evidence for genotype-environment correlation. The magnitude of the genetic variance of conduct problems was contextually dependent on levels of delinquent peer affiliation and was greater at higher levels of delinquent peer affiliation.     

Cognitive And Self-Regulation Aspects Of Perfectionism And Their Implications For Treatment: Introduction To The Special Issue

The current article provides an overview of the papers included in this special issue on the cognitive and self-regulation aspects of perfectionism and their implications for treatment. Themes expressed in these papers include the association between perfectionism and deficits in cognitive self-management, the significant link between distress and automatic thoughts reflecting the need to be perfect, the importance of examining mediators and moderators of the association between perfectionism and psychological distress, and the specific role of perfectionism in suicidal tendencies and self-harm. It is also argued that certain core features of perfectionism and its associated correlates tend to impede treatment progress. Central factors associated with perfectionism that have a deleterious impact on treatment progress include the fear of failure and fear of embarrassment and exposure, a punishing orientation toward the self, pessimism and hopelessness about the possibility of recovery, and a rigid adherence to unrealistic goals and standards, including goals for treatment and recovery. We describe case studies illustrating treatment resistance among perfectionists and we reiterate the growing need for empirical research on the efficacy of clinical interventions designed for perfectionists. This article was supported by major research grants from Health Canada and the Social Sciences and Humanities Research Council (SSHRC) of Canada to the first two authors, and a Canada Research Chair in Personality & Health awarded to the first author.     

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.     

Physiological evidence that a masked unrelated intervening item disrupts semantic priming: implications for theories of semantic representation and retrieval models of semantic priming

Event-related potentials were recorded in a paradigm where an unrelated word was interposed between two related words. In one condition, the intervening item was masked and in another condition it was not. The N400 component indicated that priming of the related word was disrupted by the intervening item whether it was masked or not. The data are interpreted to be inconsistent with retrieval models of priming.     

The interpersonal expression of perfection: perfectionistic self-presentation and psychological distress

A concept involving the interpersonal expression of perfection, perfectionistic self-presentation, is introduced. It is argued that perfectionistic self-presentation is a maladaptive self-presentational style composed of three facets: perfectionistic self-promotion (i.e., proclaiming and displaying one's perfection), nondisplay of imperfection (i.e., concealing and avoiding behavioral demonstrations of one's imperfection), and nondisclosure of imperfection (i.e., evading and avoiding verbal admissions of one's imperfection). Several studies involving diverse samples demonstrate that perfectionistic self-presentation is a valid and reliable construct and a consistent factor in personal and interpersonal psychological distress. It is argued that the need to promote one's perfection or the desire to conceal one's imperfection involves self-esteem regulation in the interpersonal context.     

Testing hypotheses regarding the causes of comorbidity: examining the underlying deficits of comorbid disorders

The authors examined the validity of a method commonly used to test alternative hypotheses regarding the causes of comorbidity: the examination of underlying deficits of comorbid disorders. The authors simulated data in which the true causes of comorbidity were known, then compared the patterns of underlying deficits of the comorbid disorders found in the simulated data with the predicted results. The method of examining the underlying deficits of comorbid disorders could distinguish between several comorbidity models, including those that could not be distinguished well using other methods. The ability to distinguish the correct model decreased as the sample size and the correlation between the underlying deficits and the symptom scores decreased, suggesting that the issue of power should be considered carefully.     

Perfectionistic self-presentation, body image, and eating disorder symptoms

A specific model for eating disorder symptoms involving perfectionistic self-presentation and two different moderators (i.e., body image evaluation and body image investment) was tested. Participants completed measures of perfectionistic self-presentation, body image dysfunction, and eating disorder symptoms. Findings indicated that all three dimensions of perfectionistic self-presentation were associated with eating disorder symptoms. Results also showed that perfectionistic self-presentation predicted eating disorder symptoms in women who were dissatisfied with their bodies, but that it did not predict eating problems in women who liked their bodies and felt there was little or no discrepancy between their actual and ideal appearances. Body image investment did not moderate the relationship between perfectionistic self-presentation and eating disorder symptoms, suggesting that ego-involvement alone is insufficient to promote eating disturbance in the context of perfectionism. The importance of self-presentation components of perfectionism and specific body image difficulties in predicting eating disorder symptoms are discussed.     

Genetic and environmental influences on rumination and its covariation with depression

This study examined the extent to which rumination and depression share genetic and environmental influences in a community sample of adult twins (N = 663). Twins completed multiple rumination questionnaires, a depressive symptoms questionnaire and a diagnostic interview. Rumination was moderately heritable (h² = .37–.41 for the latent variable) and substantially influenced by nonshared environmental factors, and these results were consistent across different measures. Nonshared environmental influences on rumination were larger for women than men. Depressive symptoms and diagnosis were influenced by genetic and nonshared environmental factors (h² = .30–.45). The genetic correlations between rumination and depression were moderate to large (rA = .40–.82), suggesting that a substantial proportion of the genetic influences on rumination overlap with those on depression. Results were similar when examining self-reported depressive symptoms and interview-based diagnosis of major depressive disorder. These results highlight the importance of rumination in the integration of cognitive and genetic models of depression risk.