Clinical perfectionism: a cognitive-behavioural analysis

The Big Three Perfectionism Scale–Short Form (BTPS-SF): Development of a Brief Self-Report Measure of Multidimensional Perfectionism

The Big Three Perfectionism Scale (BTPS) is a 45-item self-report measure of perfectionism with three overarching factors: rigid, self-critical, and narcissistic perfectionism. Our objective was to create a brief version of the BTPS, the Big Three Perfectionism Scale–Short Form (BTPS-SF). Sixteen items were selected, and confirmatory factor analysis using a large sample of Canadian university students ( N = 607) revealed the BTPS-SF had acceptable model fit. Moreover, the BTPS-SF displayed strong test–retest reliability. The relationships of the BTPS-SF factors with depression, anxiety, stress, emotional intelligence, personality, resiliency, and elements of subjective well-being also suggested adequate criterion validity. Overall, results suggest the BTPS-SF represents an efficient, easily administered, and novel means of assessing multidimensional perfectionism.

Does perfectionism impact adherence to homework assignment? A preliminary pilot study of perfectionism and procrastination of CBT homework

Background:

Homework assignments are generally viewed as an important factor of cognitive behaviour therapy (CBT).

Aim:

This study examined whether perfectionists procrastinate homework assignments.

Method:

Thirty-eight university students attended two sessions, 7 days apart from each other. After completing perfectionism scales at the first session, they were asked to complete homework tasks from a self-help wellbeing booklet and return the booklet at session 2.

Results:

Only maladaptive facets of perfectionism correlated with most of the behavioural measures of procrastination. Moreover, those high in maladaptive perfectionism set and completed fewer planned activities to improve their mood.

Conclusions:

These findings suggest that perfectionism may affect how clients set their homework, and perfectionism may interfere with the homework assignments of CBT.

Attributes of children and adolescents with avoidant/restrictive food intake disorder

BACKGROUND

Avoidant/Restrictive Food Intake Disorder (ARFID) is a comparatively new DSM-5 diagnosis. In an effort to better understand this heterogeneous patient group, this study aimed to describe the physical and psychological attributes of children and adolescents with ARFID, and to compare them to patients with full-threshold or atypical anorexia nervosa (AN).

METHODS

Children and adolescents aged 7-to-19 years (N = 193) were examined upon presenting at a pediatric eating disorder center between July 2015 and December 2017. Data included diagnosis assessed via the semi-structured Eating Disorder Examination interview along with measures of anthropometrics, depression, anxiety, self-esteem, perfectionism and clinical impairment.

RESULTS

Compared to AN and atypical AN (n = 87), patients with ARFID (n = 106) were significantly younger (12.4 vs. 15.1 years, p < .0001), male (41% vs. 15%, p < .0002), and were more likely to be diagnosed with at least one co-morbid DSM-5 diagnosis (75% vs. 61%, p = .04). Patients with ARFID were less likely to be bradycardic (4.7% vs. 24.1%, p < .0001), amenorrheic (11.1 and 34.7%, p = .001), admitted to the hospital (14.2% vs. 27.6%, p = .02), and have a diagnosis of depression (18.9% vs. 48.3%, p < .0001). Patients with ARFID were significantly less likely to experience acute weight loss vs. chronic weight loss as compared with those with AN or atypical AN (p = .0001). On self-report measures, patients with ARFID reported significantly fewer symptoms of depression, anxiety, perfectionism, clinical impairment, concerns about weight and shape, and higher self-esteem than patients with AN or atypical AN (all ps < .0001). No differences were observed by race, anxiety disorder, orthostatic instability, suicidal ideation, and history of eating disorder treatment.

CONCLUSIONS

Study results highlight the clinical significance of ARFID as a distinct DSM-5 diagnosis and the physical and psychological differences between ARFID and AN/atypical AN. The novel finding that ARFID patients are more likely than those diagnosed with AN to experience chronic, rather than acute, weight loss suggests important related treatment considerations.

A randomised controlled trial of guided internet-based cognitive behavioural therapy for perfectionism: Effects on psychopathology and transdiagnostic processes

BACKGROUND AND OBJECTIVES

Perfectionism is a transdiagnostic process that has been associated with a range of psychopathology and also with other transdiagnostic processes. We have previously shown that guided internet-based cognitive behavioural therapy (ICBT) can reduce symptoms of dysfunctional perfectionism, however, no impact was observed on symptoms of depression and anxiety. Here we explore the impact of guided ICBT for perfectionism on symptoms of other associated psychopathology, specifically obsessive-compulsive disorder (OCD) and eating disorders, and also on other associated transdiagnostic processes (self-esteem, intolerance of uncertainty, and self-compassion).

METHODS

Participants who presented with clinical levels of perfectionism were randomised to an experimental group that received the intervention (n = 62), or a wait list control group (n = 58). Questionnaires assessing symptoms of OCD, eating disorders, self-esteem, intolerance of uncertainty, and fear of self-compassion were completed pre-intervention, post-intervention (12 weeks), and at follow-up (24 weeks). Between group effect sizes are reported.

RESULTS

The intervention led to significant decreases in symptoms of OCD (d = -0.9; CI: -1.4, -0.4) and eating disorders (d = -0.6; CI: -1.0, -0.1), and had an impact on other transdiagnostic processes resulting in increased self-esteem (d = 0.7; CI: 0.2, 1.2), decreases in intolerance of uncertainty (d = -0.9; CI: -1.4, -0.4), and fear of self-compassion (d = -0.8; CI: -1.3, -0.3). At follow-up changes were maintained in symptoms of OCD (d = -1.3; CI: -1.8, -0.8), disordered eating (d = -0.7; CI: -1.2, -0.2), intolerance of uncertainty (d = -0.8; CI: -1.2, -0.3), and fear of self-compassion (d = -1.0; CI: -1.5, -0.5).

CONCLUSIONS

Guided ICBT for perfectionism improves associated psychopathology and transdiagnostic processes. ClinicalTrials.gov registration no. NCT02756871.

Internet-delivered cognitive behavioural therapy for perfectionism: Targeting dysmorphic concern

Perfectionism is an important transdiagnostic risk factor for several psychopathologies. As such, treatments targeting perfectionism have gained increased attention over recent years. While perfectionism is postulated to be an important underlying mechanism for dysmorphic concern, no research has explored the benefits of targeting perfectionism to reduce dysmorphic concern. The current study evaluated the use of Internet-delivered cognitive behavioural therapy for perfectionism (ICBT-P) with 31 participants (28 women) with high levels of dysmorphic concern to examine the impact on perfectionism, dysmorphic concern, body image disturbance, negative affect, and selective attention towards appearance-based stimuli. Using a case series design, observations were collected at baseline, at the end of a 4-week pre-treatment phase, after the 8-week ICBT-P, and 1-month post-treatment. Intent-to-treat analyses showed significant improvement from baseline to end-of-treatment and follow-up on most of the variables, with a large effect size decrease in dysmorphic concern, and decreased selective attention to BDD-body, BDD-positive, and BDD-negative words. The results of this study support the use of ICBT-P as an efficacious treatment worthy of further examination in populations who experience high levels of dysmorphic concern.

Perfectly imperfect: The use of cognitive bias modification to reduce perfectionism

BACKGROUND AND OBJECTIVES

Perfectionism is a transdiagnostic risk and maintenance factor for psychopathology. The current study developed and evaluated a cognitive bias modification, interpretation retraining (CBM-I) intervention targeting maladaptive perfectionistic beliefs.

METHODS

Participants were undergraduate students randomized to complete the perfectionism CBM-I (n = 33) or control condition task (n = 36) at two time points. Additionally, participants completed measures of perfectionistic interpretations and trait perfectionism, as well as an impossible anagram task designed to elicit perfectionistic concerns.

RESULTS

Results indicated that after the intervention, participants who completed the perfectionism CBM-I endorsed fewer perfectionistic interpretations than participants in the control condition. Furthermore, although the study groups self-reported comparably low confidence in their anagram task performance, participants who completed the perfectionism CBM-I reported wanting to re-do significantly fewer anagrams than participants in the control condition, suggesting greater acceptance of imperfect performance following the intervention. Moreover, supporting a key hypothesized mechanism of effect in CBM-I, reductions in perfectionistic interpretations mediated the effect of condition on the desire to re-do anagram task items.

LIMITATIONS

The study results should be viewed in light of limitations, including the short time-span of the study, and the use of a relatively small, non-clinical, and demographically homogenous convenience sample.

CONCLUSIONS

Further research and development of the perfectionism CBM-I intervention are needed, but the present findings add to a nascent evidence base that suggests CBM-I holds promise as an accessible and transdiagnostic intervention for perfectionism.

Attention biases in perfectionism: Biased disengagement of attention from emotionally negative stimuli

BACKGROUND AND OBJECTIVES

Perfectionism is associated with the development and maintenance of several psychological disorders. Consequently, efforts to better understand perfectionism have potential transdiagnostic impact. One mechanism proposed to underlie perfectionism is an attention bias towards information signalling threats to perfectionism whereby people with elevated perfectionism selectively attend to threatening stimuli.

METHOD

The present study assessed whether two core dimensions of perfectionism, perfectionistic strivings and perfectionistic concerns, are characterised by a threat-related attention bias, and whether this bias was characterised by attention being more rapidly captured by the stimuli (engagement bias), or of greater difficulty to disengage attention (disengagement bias). Participants (N = 108) completed measures of perfectionistic strivings and concerns, and symptoms of psychological distress before completing a modified dot-probe task to measure attention biases. Attention bias index scores were calculated across three factors: engagement bias vs disengagement bias, perfectionism relevant vs irrelevant stimuli, and negative vs positive emotional stimuli.

RESULTS

Overall, perfectionistic concerns were associated with a disengagement bias for negative stimuli, regardless of whether stimuli were perfectionism relevant or not. No other significant main or interaction effects were observed.

LIMITATIONS

The study was cross-sectional in design, and no temporal or causal inferences could be made. Additionally, participants were from a community sample and therefore replication is required in clinical populations.

CONCLUSION

These findings demonstrate that individuals higher in perfectionistic concerns experience difficulty withdrawing their attention from emotionally negative stimuli. These findings contribute new information to our theoretical understandings of perfectionism and provide support for the cognitive-behavioural model of perfectionism.

Youth with Avoidant/Restrictive Food Intake Disorder: Examining Differences by Age, Weight Status, and Symptom Duration

The primary purpose of this study was to examine differences among youth with avoidant/restrictive food intake disorder (ARFID) by age, weight status, and symptom duration. A secondary goal was to report the frequencies of ARFID using DSM-5 clinical presentations (i.e., fear of aversive consequences, lack of interest in food, sensory sensitivities). Participants (N = 102), ages 8-18 years, were recruited through an eating disorder service within a pediatric hospital. They were evaluated using semi-structured interviews and questionnaires. Patients were assigned to groups according to age, weight status, and symptom duration. Frequencies of clinical presentations, including combinations of DSM-5 categories, were also examined. Our findings suggest that adolescents presented with higher rates of Depression (p = 0.04). Youth with chronic ARFID symptoms presented with significantly lower weight (p = 0.03), and those with acute symptoms rated significantly higher suicidal ideation and/or self- harm (p = 0.02). Half of patients met criteria for more than one ARFID symptom presentation. This study provides preliminary evidence that youth with ARFID differ in clinical presentation depending on age, weight status, and symptom duration, and highlights safety concerns for those with acute symptoms of ARFID. High rates of overlapping symptom presentations might suggest a dimensional approach in the conceptualization of ARFID.

The Role of Perfectionism and Controlling Conditions in Norwegian Elite Junior Performers' Motivational Processes

Conceptualized within the framework of self-determination theory, the aim of the current study was to investigate the relation between perfectionistic concerns and (a) controlled (non-self-determined) motivation and (b) performance anxiety through basic psychological need frustration (frustration of competence, autonomy, and realtedness), and if these relations would be moderated by controlling teaching/coaching conditions. We used a cross-sectional moderated mediation design and purposefully selected Norwegian elite junior performers (N = 171; mean age = 17.3; SD age = 0.94) from talent development schools, who completed an online questionnaire to report their perceptions of the study variables. Associations were examined using structural equation modeling. The results showed that perfectionistic concerns were positively associated with controlling conditions, basic needs frustration, controlled motivation, and performance anxiety. Reported controlling teaching/coaching conditions moderated the positive indirect relationship between perfectionistic concerns and (a) controlled motivation and (b) performance anxiety through competence need frustration. Specifically, these indirect associations were evident for performers reporting moderate or high levels of controlling teaching/coaching conditions. In contrast, there were no indirect associations via competence need frustration for those performers who reported low levels of controlling conditions. In conclusion, the results indicate that perfectionistic concerns appear to be a vulnerability factor that exposes elite junior performers to higher risks of entering a debilitative motivational process. This seems especially likely when exposed to controlling teaching/coaching conditions. Coaches and teachers working with elite junior performers should avoid using controlling mechanisms and instead foster autonomous functioning.

Relationship Between Perfectionism and Depression Among Chinese College Students With Self-Esteem as a Mediator

Objectives

This study is designed to examine the mediating role of self-esteem (SE) in the relationship between perfectionism and depression among a nonclinical sample of 918 Chinese college students.

Methods

Participants completed a questionnaire battery that included measures of perfectionism (Almost Perfect Scale-Revised), depression (Center for Epidemiologic Studies Depression), and self-esteem (The Rosenberg Self-Esteem Scale).

Results

The results showed that maladaptive perfectionism significantly and positively predicted depression, while adaptive perfectionism and self-esteem negatively predicted depression. More importantly, self-esteem partially mediated the prediction of depression from both adaptive perfectionism and maladaptive perfectionism.

Conclusion

Self-esteem was a significant mediator on the relationship between perfectionism and depression. Elevating student self-esteem may be a way of reducing depression, particularly among maladaptive perfectionists.

An examination of emotion dysregulation in maladaptive perfectionism

Maladaptive perfectionism has been shown to be associated with undesirable outcomes, such as elevated negative emotions and psychopathological traits. Perhaps unsurprisingly, there is preliminary evidence that maladaptive perfectionism is also related to emotion dysregulation. However, the nature of emotion dysregulation in perfectionism has not been characterized. In this review, Gross and Jazaieri's (2014) clinically-informed framework of emotion dysregulation is used to review the evidence of emotion dysregulation in maladaptive perfectionism. Specifically, this paper reviews evidence of problematic emotional experiences and unhelpful emotion regulation strategies in maladaptive perfectionism and discusses how poor emotional awareness and emotion regulation goals may also contribute to emotion dysregulation. A conceptual model of these components of emotion dysregulation in maladaptive perfectionism is proposed in which heightened negative affect in response to threatened perfectionistic standards is posited to be at the core of emotion dysregulation, and implicit and explicit unhelpful emotion regulation strategies and poor emotion regulation goals are suggested to contribute to further dysregulation and elevated negative affect. Clinical implications, limitations in the extant research, and future directions are discussed.

Perfectionism and Social Problem Solving as Predictors of Nonsuicidal Self-Injury in Ethnoracially Diverse College Students: Findings Controlling for Concomitant Suicide Risk

The present study was designed to examine the extent to which perfectionism and social problem solving add to the prediction model of nonsuicidal self-injury (NSSI), independent of suicide risk, in a sample of 386 ethnoracially diverse college students. Moreover, the authors were interested in whether social problem solving, beyond perfectionism, would account for additional variance in their prediction model. Results indicated that social problem solving did account for significant variance in the prediction model of NSSI, above and beyond perfectionism. Moreover, on controlling for suicide risk, a possible confound for NSSI behaviors, social problem solving was found to account for an additional 4.0 percent of unique variance in the prediction of NSSI, beyond that accounted for by perfectionism. The present findings have theoretical implications for the literature on perfectionism and social problem solving, specifically in relation to NSSI. In addition, the present findings have practical implications for social workers who work with college students engaging in NSSI behaviors.

Biased interpretation in perfectionistic concerns: an experimental investigation

BACKGROUND AND OBJECTIVES

Perfectionism is associated with the development and maintenance of several disorders. Given the importance of perfectionism understanding the biased information processes that underpin it is critical. The present study tested the hypothesis that heightened concern over mistakes subscale scores of the Frost Multidimensional Perfectionism Scale are characterized by a tendency to impose emotionally negative interpretations on perfectionism-relevant situations.

METHOD AND DESIGN

Seventy-six non-clinical, general population participants' were presented with interpretations of scenarios where a protagonist was described as achieving well above what was required, but fell short of their own high standard. Using a within-subjects, quasi-experimental design, we assessed interpretations of these scenarios by examining the degree to which participants rated test sentences as being likely implications of the original scenarios.

RESULTS

A generalized linear mixed model revealed higher concern over mistakes scores were associated with an increased tendency to rate negative target test sentences as being similar to the original perfectionism-relevant scenarios, and a reduced tendency to rate positive target test sentences as being similar to these original scenarios.

CONCLUSIONS

The findings provide support for the cognitive-behavioral model of perfectionism. These findings support the inclusion of strategies in cognitive-behavioral treatment of perfectionism to reduce interpretation bias.

Patients' experiences attributed to the use of Passiflora incarnata: A qualitative, phenomenological study

ETHNOPHARMACOLOGICAL RELEVANCE

Passiflora incarnata Linnaeus (Passiflora incarnata) was established as a medicinal plant in Europe in the middle of the 19th century. Since then, it has been used for the treatment of anxiety, sleep disorders and restlessness in Western European phytotherapy. This study provides insights into how Passiflora incarnata is currently used and experienced as a medicinal plant by German-speaking patients in Switzerland.

AIM

This qualitative study aimed to explore patients' experiences and the values, views and interpretive processes that formed their perceptions of the use of an ethanolic extract of Passiflora incarnata.

METHODS

A total of 8 patients participated in this exploratory, qualitative observational study. The patients filled in pre- and posttreatment questionnaires, kept diaries and were interviewed in a face-to-face setting. For the data analysis, descriptive statistics, qualitative content analysis, narrative inquiry and documentary methods were applied.

RESULTS

This is the first qualitative study of patients' real-life experiences with an ethanolic extract of Passiflora incarnata. We identified three distinct types of patient biographical narratives attributed to different experiences when using Passiflora incarnata. Patients with type 1 narratives described moving from a performance orientation to resetting priorities and attaining calmness. Patients with type 2 narratives maintained a performance orientation while adopting calmness. Patients with type 3 narratives maintained a performance orientation and suffered from persistent illness.

CONCLUSION

The distinct biographical narratives of the patients associated with their specific experiences of taking Passiflora incarnata provide an additional perspective on the use of Passiflora incarnata as a medicinal plant.

Personality Variables and Eating Pathology

Personality variables have long been implicated in the onset and maintenance of eating disorders, as well as in symptom divergence between anorexia nervosa and bulimia nervosa. Clinical observations are broadly supported by the data, with restricting anorexia nervosa associated with higher levels of constraint and Persistence, and binge-purge behaviors linked to the tendency to take impulsive action when emotionally distressed. Considerable heterogeneity is found within diagnostic categories, however, suggesting that different personality structures may predispose individuals to develop disordered eating through alternative pathways.

Internet-based cognitive behavioral therapy of perfectionism: Comparing regular therapist support and support upon request

Perfectionism may be a clinically relevant problem on its own or as part of the etiology and maintenance of psychiatric disorders, e.g., anxiety disorders, depression, and eating disorders. Cognitive behavior therapy has been shown to be a promising treatment for managing perfectionism and its associated problems, including when being administered via the Internet, i.e., Internet-based cognitive behavioral therapy (ICBT). In the current study, seventy-eight self-referred participants underwent ICBT after an initial eight-week wait-list period, i.e., second wave of treatment. These were randomized to receive regular support from a therapist (ICBT-support) or ICBT with support on request (ICBT-request), in an eight-week treatment of perfectionism. Assessments of perfectionism were made at pre-, mid-, and post-treatment, as well as six-month follow-up, using the Frost Multidimensional Perfectionism Scale, subscale Concern over Mistakes. Mixed effects models revealed large symptom reductions for both conditions; Concern over Mistakes, Cohen's d = 1.40, 95% Confidence Interval (CI) [0.85, 1.95] for ICBT-support, and d = 1.00, 95% CI [0.51, 1.47] for ICBT-request. The effects were maintained at six-month follow-up and there were no differences between the conditions in terms of the results, opened modules, or completed exercises. A total of 28 out of 70 participants (42.4%; ICBT-support, 37.8%; ICBT-request) were classified as improved at post-treatment. Both types of ICBT may thus be beneficial in treating perfectionism, suggesting that just having the opportunity to ask for support from a therapist, when regular support is not provided, could be sufficient for many participants undergoing ICBT. However, the study was underpowered to detect differences between the conditions. The lack of a cutoff also makes it difficult to differentiate a dysfunctional from a functional population in terms of perfectionism. In addition, the study design could have affected the participants' motivational level from start, given their initial eight-week wait-list period. Recommendations for future studies include recruiting a larger sample size, a clearer cutoff for perfectionism, and the use of a non-inferiority test with a predetermined margin of change.

Examining the Relationships Between Perfectionism and Obsessive-Compulsive Symptom Dimensions Among Rural Veterans

Perfectionism, a trait-like individual difference variable reflecting the tendency to set extremely high standards along with critical evaluations of one's own behavior, has long been regarded as a risk and maintenance factor for obsessive-compulsive disorder (OCD). However, research exploring the relationship between these constructs is mixed. One explanation for these equivocal findings is the heterogeneous nature of OCD. Indeed, there is increasing evidence for distinct symptom dimensions that are more homogenous than the broad OCD phenotype. The current study examined the associations between self-reported perfectionism and OCD symptom dimensions controlling for probable depression status. The sample included 67 rural veterans. Results revealed a unique association between perfectionism and the unacceptable thoughts dimension of OCD. These findings are consistent with a growing body of literature demonstrating that OCD symptom dimensions have unique underlying dysfunctional beliefs.

Evidence That Frame of Reference Effects Can Reduce Socially Prescribed Perfectionism

Socially prescribed perfectionism appears to drive disordered eating behaviour in young women, usually via messages from fellow women. Social psychological research suggests that framing effects can be manipulated to reduce the effect of unhealthy messages. This research used contrasting messages about perfectionism to reduce perfectionism among female dieters. We recruited 147 female dieters (M age = 25.11) for a between-subjects experimental study. While completing an online questionnaire, participants were exposed to one of three sets of blog posts, which varied in content and source. These three conditions always had one anti-perfectionism message from a woman. This was presented along with either a high perfection message from a man, a high perfectionism message from a woman, or both of these messages. After reading the blog posts, women were asked to fill out a scale assessing their levels of socially prescribed perfectionism. When participants were exposed to an anti-perfectionism message from a woman, paired with a high-perfectionism message from a man, participants showed lower socially prescribed perfectionism than when both high and anti-perfectionism messages came from two women. These findings imply that strategies designed to reduce socially prescribed perfectionism may benefit from including contrasting messages, as this may shift perceived perfectionism norms. Implications for social interventions are discussed.

An examination of direct, indirect and reciprocal relationships between perfectionism, eating disorder symptoms, anxiety, and depression in children and adolescents with eating disorders

OBJECTIVE

Perfectionism is a transdiagnostic factor across eating disorders, anxiety, and depression. Previous research has shown anxiety mediates the relationship between perfectionism and eating disorders in adults. The aim of this study was to investigate the relationships between anxiety/depression, perfectionism and eating disorder symptoms in children and adolescents with eating disorders.

METHOD

Structural equation modeling was used to investigate three models in a clinical sample of children and adolescents (N = 231, M age = 14.5, 100% female): (1) anxiety and depression as mediators of the relationship between perfectionism and eating disorder symptoms, (2) eating disorder symptoms as a mediator of the relationship between perfectionism and anxiety and/or depression, and (3) perfectionism as a mediator of the relationship between anxiety/depression and eating disorders.

RESULTS

Results indicated that both models 1 and 2 fit the data well, while model 3 provided a poor fit. These findings suggest that in clinical populations of children and adolescents, anxiety and depression mediate the relationship between perfectionism and eating disorder symptoms, and there is also a reciprocal relationship whereby eating disorders mediate the association between perfectionism, and anxiety and/or depression.

DISCUSSION

The results highlight the importance of further research to determine whether targeting perfectionism is helpful in the treatment of eating disorders and comorbid anxiety and depression in young people. It would be useful for clinicians to consider assessing for and treating perfectionism directly when it is elevated in children and adolescents with eating disorders.

Testgüte einer deutschen Version des Mehrdimensionalen Perfektionismus Kognitions-Inventars (MPCI-G)

Zusammenfassung. Gegenstand der vorliegenden Arbeit ist die Entwicklung einer deutschsprachigen Version des Mehrdimensionalen Perfektionismus Kognitions-Inventars (MPCI-G [G = German]). In einer ersten Studie wurde die faktorielle Validität des MPCI-G überprüft. Auf Basis der Ergebnisse aus Studie 1 wurde der MPCI-G revidiert (MPCI-G-R). In Studie 2 wurden die Reliabilität, faktorielle und Konstruktvalidität des MPCI-G-R untersucht. Die Ergebnisse aus konfirmatorischen Faktorenanalysen, Korrelations- und multiplen Regressionsanalysen sprechen für die Reliabilität, faktorielle und Konstruktvalidität der 3 (korrelierten) Dimensionen perfektionistischer Kognitionen: Personal Standards (PSK), Concern over Mistakes (CMK) und Pursuit of Perfection Kognitionen (PPK). Unter anderem fanden sich differentielle Zusammenhänge der 3 Dimensionen mit dispositionellem Perfektionismus (Perfectionistic Strivings und Concerns), Affekt (schlechte Stimmung und Unruhe), Depressivität und der Zielsetzung für eine bevorstehende Prüfungsphase. Die reliable und valide multidimensionale Erfassung perfektionistischer Kognitionen, die zwischen eher positiven (PSK) und negativen Dimensionen (CMK und PPK) differenziert, stellt eine wertvolle Ergänzung zur Erforschung des dispositionellen Perfektionismus dar, welche das Verständnis dafür fördern kann, wie Dimensionen des dispositionellen Perfektionismus mit psychischem und physischem Wohlbefinden zusammenhängen.

The self and eating disorders

In our review, we focus on self-related constructs in the context of eating disorders with four aims. First, we examine a variety of self-related constructs that have been theoretically and empirically linked to the development and course of eating disorders. In addition to the more well-researched constructs of self-esteem and self-efficacy, we also report on findings related to selflessness, contingent self-worth, self-objectification, ego-syntonicity, self-concept clarity, self-compassion, social comparison, self-oriented perfectionism/self-criticism, and narcissism. Second, we discuss self-related constructs that may be especially relevant to comorbidities common among those with eating disorders. Third, we review intervention and prevention programs where self-related constructs play a prominent role. Lastly, we share future research directions regarding self-related constructs and eating disorders that we believe will advance a deeper understanding of the role of the self in the eating disorders.

Validation of the clinical perfectionism questionnaire in an eating disorder sample: A bifactor approach

OBJECTIVE

Clinical perfectionism is involved in the etiology and maintenance of eating disorders. Limited research has examined the factor structure of the Clinical Perfectionism Questionnaire (CPQ) in clinical eating disorder samples. The aim of this research was to examine the validity and reliability of the CPQ in a mixed eating disorder sample.

METHOD

Patients (N = 211) with an eating disorder completed the CPQ at pretreatment. A bifactor model was tested that included a general clinical perfectionism factor and two group factors; overevaluation of striving and concern over mistakes. The unique contributions that general and group factors make to the prediction of eating disorder symptoms were also investigated. Unidimensional, correlated two-factor, and bifactor models were tested using confirmatory factor analysis.

RESULTS

A bifactor structure for a revised 10-item version of the CPQ provided the best fit, with a strong and reliable general clinical perfectionism factor. The general clinical perfectionism factor and the overevaluation of striving group factor explained reliable variance in the CPQ, and but only the general factor predicted eating disorder symptoms.

DISCUSSION

The results suggested that a total score is generally appropriate for assessing clinical perfectionism in a clinical eating disorder sample.

Clinical Perfectionism, Dissatisfaction With Standards, and Raising the Bar: Validation of the Response to Goal Achievement Scale

OBJECTIVES

To examine the factor structure and psychometrics of a new self-report scale measuring cognitive and behavioral reactions to goal achievement (Reactions to Goal Achievement Scale; RGAS), and to examine its relationship to other measures of clinical perfectionism in two samples. Self-reported reasons for setting higher standards following successful goal achievement were also examined.

METHODS

The RGAS, Clinical Perfectionism Questionnaire (CPQ) and Frost Multidimensional Perfectionism Scale (FMPS) were administered to a sample on Amazon Mechanical Turk (N = 264) and to a sample of overweight individuals (N = 65).

RESULTS

Exploratory and confirmatory factor analyses suggested two factors, entitled dissatisfaction with success (DS) and increase in standards (IS). The RGAS was associated with subscales of the CPQ and FMPS. In addition, participants indicated many reasons for setting higher standards following success.

CONCLUSION

The RGAS is a new instrument for measuring both cognitive and behavioral responses to success in clinical perfectionism. Setting higher standards may not be an indication of perfectionism, as there appear to be many reasons people set higher standards.

Recalled Parenting Practices and Psychological Distress in Turkish Emerging Adults: The Role of Self-Criticism

Research investigating the development of psychological problems among children has typically focused on the role of parenting practices. The purpose of this study was to investigate the direct effects of recalled parenting practices (emotional warmth, rejection, and overprotection) on psychological distress and indirect effects through self-criticism. Participants were 410 undergraduate students (290 females and 120 males) with a mean age of 20.10 ( SD = 1.65). Participants completed the measure of My Memories of Upbringing—Egna Minnen Betraffande Uppfostra; Forms of Self Criticizing/Attacking and Self Reassuring Scale; and Depression, Anxiety, and Stress Scale as self-report measures. Results provided evidence for highly similar patterns of associations among parenting practices, self-criticism, and psychological distress for both maternal and paternal models. Findings showed that parental emotional warmth and rejection were directly related to self-criticism and were indirectly related to psychological distress through self-criticism. Only maternal rejection was directly related to psychological distress. However, maternal and paternal overprotection was not related to psychological distress either directly or indirectly. Moreover, maternal and paternal parenting practices explained 61% and 58% of the variance in psychological distress, respectively. The findings of the present study highlighted the importance of self-criticism and past memories of parenting as intervention targets to support well-being of young people.

Perfectionism in Eating Disorders: Are Long-Term Outcomes Influenced by Extent and Changeability in Initial Perfectionism?

Purpose

Perfectionism has been found to predict outcomes in the treatment of eating disorders (ED). In the present study, we took advantage of longitudinal data to: a) investigate whether there are different patterns of perfectionism during the first six months after admission in a clinical sample of patients with ED, and b) describe how these patterns are related to long-term outcome.

Methods

A sample of patients (N=294) from the Coordinated Evaluation and Research at Specialized Units for Eating Disorders database was divided into clusters according to perfectionism patterns measured with the EDI-2 perfectionism scale at baseline, and six months in treatment. Cluster analysis was performed on the extent and perseverance/changeability of self-oriented and socially described perfectionism. Outcome was measured with the EDI-2 and the SCL-63. Frequencies of eating disorder diagnoses were investigated.

Results

Five clusters were identified. Low perfectionism was associated with lower levels of ED and psychiatric symptomatology at baseline. There were no significant differences between clusters on outcome variables at 36-month follow-up.

Conclusions

Results indicated better psychiatric and psychological health three years after the initial measure. Patterns of relations between the extent and possible changes of perfectionism, measured with the EDI-P at baseline and after six months, did not appear to be associated with long-term outcomes on psychiatric health ratings.

Perfectionism is associated with higher eating disorder symptoms and lower remission in children and adolescents diagnosed with eating disorders

OBJECTIVE

The link between perfectionism and eating disorders is well established in adults, however little research has been conducted in children and adolescents. The aim was to examine if perfectionism was a predictor of eating disorder symptoms at intake assessment, and 6 and 12 month review.

METHOD

There were 175 children and adolescents aged 10-17 years (M = 14.47 years, SD = 1.31) who were assessed using the Eating Disorders Inventory-3 perfectionism subscale and the child adapted Eating Disorders Examination at intake, 6 and 12 months review.

RESULTS

There was a significant association between perfectionism and symptoms of eating disorders at intake assessment and at 6 and 12 month review. Higher perfectionism at intake predicted a lower likelihood of remission at 12 months.

DISCUSSION

The findings suggest that similar to adult samples, perfectionism is significantly associated with eating disorder symptoms in children and adolescents. Further research is required to examine the impact of perfectionism on eating disorder symptoms in longitudinal research with children and adolescents with eating disorders.

Measuring perfectionism in children: a systematic review of the mental health literature

The adverse consequences of perfectionism in the lives of youth (children and adolescents) are now widely recognised, including impact on mental health and general well-being. In order to develop interventions to prevent and treat perfectionism and promote resilience for children, rigorous testing and examination of theoretical models is needed as well as having access to valid and reliable assessment tools. The aim of the current literature review was to examine the validity and reliability of the measures currently being used to measure perfectionism in children under the age of 15. A systematic review of the literature identified six instruments that had been utilised in children. Preliminary support with respect to reliability and validity was established for each of these measures, and there was evidence supporting the existence of both perfectionistic striving and perfectionistic concerns in this population. However, many of the measures lacked evaluation of key psychometric properties by independent authors. Further work distinguishing adaptive and maladaptive perfectionism will be necessary to promote future interventions and treatment in this area.

Exercise Caution: Questions to Ask Adolescents Who May Exercise Too Hard

When the primary goal of exercise is to compensate for food intake and to alter body shape and weight, it is considered compulsive and may be harmful. Compulsive exercise (CE) is important in the pathogenesis of eating disorders (EDs). Many healthy adolescents engage in CE too, and this may indicate a risk for EDs. Our aim was to learn more about ED risk factors tied to CE and to try to isolate questions to ask in order to probe for high ED risk in adolescents engaging in CE. Using two well-established instruments (the Structural Analysis of Social Behavior and the Eating Disorders Examination Questionnaire), we studied associations between ED variables and CE in healthy adolescent boys and girls. We examined gender-specific items to generate the best possible fit for each gender. Individuals with CE displayed significantly greater ED pathology and more self-criticism, and this pattern was stronger in girls than in boys. Risk factors for ED among individuals with CE differed slightly for boys and girls. We put forward a set of gender-specific questions that may be helpful when probing for ED risk among adolescents engaging in CE.

Cognitive Behavioral Therapy for Maladaptive Perfectionism in Medical Students: A Preliminary Investigation

OBJECTIVES

Maladaptive perfectionism is associated with psychological distress and psychopathology. Medical students have been found to be particularly prone to maladaptive perfectionism. Recent research has indicated that Cognitive Behavioral Therapy (CBT) that targets unhealthy perfectionism leads to reductions in perfectionism and related distress. This preliminary investigation aimed to evaluate the efficacy of a CBT program directed at medical students who had significant levels of maladaptive perfectionism. The impact on associated psychological distress was also assessed.

METHODS

The study used a case series methodology with an A-B design plus follow-up. First-year medical students who screened positive for maladaptive perfectionism and consented for the study (N = 4) were assessed at baseline to evaluate the levels of maladaptive perfectionism, anxiety, and depression. They participated in an eight-session CBT program for reducing maladaptive perfectionism after a waiting period. Assessments were repeated post CBT and at 3- and 6-month follow up periods.

RESULTS

Results indicated positive and durable effects on maladaptive perfectionism among program participants.

CONCLUSION

The current research provides promising results for the use of CBT in at risk medical students with maladaptive perfectionism.

Factor Structure and Psychometric Properties of Perfectionism Inventory: Developing 3-Factor Version

The paper presents the results of confirmatory factor analysis of the Perfectionism Inventory in the sample of 625 subjects (which included patients with affective spectrum disorders and healthy controls from the general population). Three factorial structure of the instrument has been identified: 1) perceived evaluations concerns along with unfavorable social comparisons; 2) high personal standards; 3) negative selectivity and imperfection concentration. The scales exhibit high internal con sistency. The results yield significant positive correlations between factors 1 and 3 and psychopathological symptoms (SCL-90-r). The Personal Standards subscale revealed no correlations with measures of psychopathological symptoms. Patients score higher on subscales 1 and 3 than the controls, whereas subscale 2 again didn’t show any differences. The results are discussed in the context of adaptive and maladaptive perfectionism dimensions.

The phenomenology of self-critical thinking in people with depression, eating disorders, and in healthy individuals

OBJECTIVES

To explore the phenomenology of self-criticism, and the relationship with constructs such as rumination and perfectionism.

DESIGN

The study followed a three-group (Depression, n = 26; Eating Disorder, n = 26; Non-clinical, n = 26) mixed methods design.

METHOD

Participants completed a set of questionnaires and were interviewed about the occurrence, impact, and content of self-critical thinking, along with their beliefs about self-criticism.

RESULTS

Both clinical groups reported more frequent, persistent, and less controllable self-criticism compared to controls, present on average 50-60% of the time. They reported a negative impact on mood, and a moderately severe impact on daily activities. They indicated greater desire to change self-criticism whilst judging it more difficult to reduce. Habitual self-criticism was highly correlated with lower self-esteem, lower self-compassion, greater rumination, and greater negative perfectionism. Compared to those with depression, the eating disorder group reported harsher self-criticism, felt it was more part of their personality, and was more beneficial.

CONCLUSIONS

The findings highlight the importance of exploring people's beliefs about their self-criticism, and imply that treatment for self-criticism may be more challenging with people with eating disorders than people with depression.

PRACTITIONER POINTS

This study highlights that self-criticism is common in depression and eating disorders and that some people find this a significant problem in its own right. Careful assessment of self-criticism is recommended when working with these clinical presentations, which should include the perceived positive consequences and desire to change.

Adolescent perfectionism: Structural features of the Frost Multidimensional Perfectionism Scale and correlates with attachment and psychopathology

OBJECTIVES

Perfectionism is recognized as a significant risk factor for psychopathology. Emerging research links attachment to perfectionism in adult and college-age samples. The Frost Multidimensional Perfectionism Scale (FMPS) has been used in adults and adolescents with a variety of factor structures found. This study sought to establish the factor structure in a general adolescent sample prior to testing for associations between perfectionism, attachment, and psychopathology in the same sample.

DESIGN

A cross-sectional survey design was used. Confirmatory factor analysis, and correlational and regression analyses were employed.

METHODS

A total of 290 adolescents, aged 12-18 years, were recruited from a state secondary school. All completed the FMPS along with brief measures of attachment and psychopathology.

RESULT

Exploratory and confirmatory factor analyses failed to replicate previously published models, and a new six-item, 1-factor model representing perfectionism was found instead. This new variable was then used to establish a role for perfectionism and attachment anxiety in predicting internalizing problems. Perfectionism also correlated with conduct problems and hyperactivity.

CONCLUSION

This study established a novel factor structure for the FMPS, allowing proof of principle of the role of perfectionism in a relationship with attachment and psychopathology, which after replication, may inform new interventions for perfectionism. Caution is noted about the use of extant perfectionism measures that are not properly developmentally informed and which do not capture the dynamic nature of adolescence and adolescent perfectionism.

PRACTITIONER POINTS

Perfectionism is a feature of adolescent psychopathology, including internalizing and externalizing problems. Perfectionism is associated with attachment anxiety and together contributes to internalizing problems. Current conceptualizations of perfectionism may not capture the specific developmental and dynamic aspects of adolescence and should not be regarded as a stable personality trait.

Mindfulness-Based Cognitive Therapy Versus Pure Cognitive Behavioural Self-Help for Perfectionism: a Pilot Randomised Study

This pilot study compared mindfulness-based cognitive therapy (MBCT) with a self-help guide based on cognitive behaviour therapy (CBT) for university students experiencing difficulties due to perfectionism. Participants were randomised to an MBCT intervention specifically tailored for perfectionism or pure CBT self-help. Questionnaires were completed at baseline, 8 weeks later (corresponding to the end of MBCT) and at 10-week follow-up. Post-intervention intention-to-treat (ITT) analyses identified that MBCT participants (n = 28) had significantly lower levels of perfectionism and stress than self-help participants (n = 32). There was significant MBCT superiority for changes in unhelpful beliefs about emotions, rumination, mindfulness, self-compassion and decentering. At 10-week follow-up, effects were maintained in the MBCT group, and analyses showed superior MBCT outcomes for perfectionism and daily impairment caused by perfectionism. Pre-post changes in self-compassion significantly mediated the group differences in pre-post changes in clinical perfectionism. Greater frequency of mindfulness practice was associated with larger improvements in self-compassion. MBCT is a promising intervention for perfectionist students, which may result in larger improvements than pure CBT self-help. The findings require replication with a larger sample.

How can we conceptualize behavioural addiction without pathologizing common behaviours?

Following the recent changes to the diagnostic category for addictive disorders in DSM-5, it is urgent to clarify what constitutes behavioural addiction to have a clear direction for future research and classification. However, in the years following the release of DSM-5, an expanding body of research has increasingly classified engagement in a wide range of common behaviours and leisure activities as possible behavioural addiction. If this expansion does not end, both the relevance and the credibility of the field of addictive disorders might be questioned, which may prompt a dismissive appraisal of the new DSM-5 subcategory for behavioural addiction. We propose an operational definition of behavioural addiction together with a number of exclusion criteria, to avoid pathologizing common behaviours and provide a common ground for further research. The definition and its exclusion criteria are clarified and justified by illustrating how these address a number of theoretical and methodological shortcomings that result from existing conceptualizations. We invite other researchers to extend our definition under an Open Science Foundation framework.

Enhanced cognitive behavioral therapy for eating disorders adapted for a group setting

OBJECTIVE

This randomized control trial is an evaluation of the effectiveness of enhanced cognitive behavioral treatment (CBT-E) for eating disorders adapted for a group setting. The study aimed to examine the effects of group CBT-E on eating disorder psychopathology and additional maintaining pathology.

METHOD

A transdiagnostic sample of individuals with eating disorders with a BMI ≥ 18 kg/m² (N = 40) were randomized to an immediate-start or delayed-start condition so as to compare therapeutic effects of group CBT-E with a waitlist control. Global Eating Disorder Examination Questionnaire (EDE-Q) scores, BMI, and measures of Clinical Perfectionism, Self-Esteem, Interpersonal Difficulties, and Mood Intolerance were measured across the 8-week control period, throughout the group treatment and at 3-months post-treatment.

RESULTS

Over 70% of those who entered the trial completed treatment. The first eight weeks of group CBT-E were more effective at reducing Global EDE-Q scores than no treatment (waitlist control). By post-treatment, good outcome (a Global EDE-Q within 1 SD of Australian community norms plus BMI ≥ 18.5) was achieved by 67.9% of treatment completers and 66.7% of the total sample. Symptom abstinence within the previous month was reported by 14.3% of treatment completers and 10.3% of the total sample. Significant reductions in Clinical Perfectionism, Self-Esteem, Interpersonal Difficulties, and Mood Intolerance were also observed.

DISCUSSION

This study demonstrated that a group version of CBT-E can be effective at reducing eating disorder psychopathology in a transdiagnostic sample of individuals with eating disorders. Group CBT-E could provide a means of increasing availability of evidence-based treatment for eating disorders.