Perfectionism as a transdiagnostic process: A clinical review

Is repeated mistake-making an effective treatment strategy for perfectionism? Findings from a randomized controlled trial

BACKGROUND AND OBJECTIVES

Perfectionism has been linked to self-criticism, procrastination, and psychological disorders. In a previous study, an exposure-based treatment for perfectionism (ETP), which included exposures targeted at concern over mistakes, showed positive outcomes when compared to waitlist. The aim of this study was to further investigate ETP by comparing it to a stress-management condition and assessing durability of treatment effects by conducting a one-month follow-up assessment.

METHODS

Eighty-five individuals with elevated perfectionism were randomly assigned to receive ETP (n = 43) or a stress management treatment (n = 42). ETP involved repeatedly practicing mistake-making by completing computerized tasks engineered to cause individuals to make mistakes. The stress management condition included listening to videos and answering questions about healthy habits, such as diet, exercise, and sleep, as well as viewing calming videos. Participants completed eight treatment sessions as well as baseline, post-test, and one month follow-up self-report questionnaires.

RESULTS

Contrary to predictions, compared to ETP, stress management led to significantly lower overall perfectionism, depression, generalized anxiety, and social anxiety at post and significantly lower depression, generalized anxiety, and social anxiety at follow-up. Further, individuals who completed ETP did not habituate to the exposure tasks, but distress increased from the first to the last treatment session.

LIMITATIONS

The duration of treatment was relatively brief.

CONCLUSIONS

This study highlights the importance of using active psychological control conditions in treatment outcome studies and the need to test various components of treatments for perfectionism to observe what may be effective or even potentially iatrogenic.

Going it alone: Examining interpersonal sensitivity and hostility as mediators of the link between perfectionism and social disconnection

OBJECTIVE

Perfectionism is linked to a variety of mental health conditions in university students. The Perfectionism Social Disconnection Model posits that perfectionistic individuals exhibit off-putting interpersonal behaviors (i.e., rejection sensitivity and hostility), which lead to social disconnection, and in turn contribute to psychological distress. Although several longitudinal studies have found that social disconnection mediates the link between perfectionistic traits and psychological distress, less is known about how perfectionism leads to social disconnection. The present study aimed to address this gap.

METHODS

A sample of 877 university students completed one survey a month for three consecutive months.

RESULTS

Our random-intercept cross-lagged panel model results showed significant positive associations between the random intercepts of socially prescribed and self-oriented perfectionism with rejection sensitivity, hostility, and loneliness, with stronger associations for socially prescribed perfectionism. In addition, the random intercept of other-oriented perfectionism showed positive associations with hostility but not rejection sensitivity or loneliness. Moreover, almost all cross-lagged paths were nonsignificant.

CONCLUSION

Collectively, these findings indicate that although perfectionistic traits may be associated with rejection sensitivity and hostility to varying degrees at the between-person level, these behaviors may not cause social disconnection at the within-person level.

Striving for the perfect diet? The mediating role of perfectionism in the relationship between obsessive compulsive symptoms and traits of Orthorexia Nervosa

BACKGROUND

Orthorexia Nervosa (ON) is a disordered eating style involving an unhealthy obsession with 'healthy' or 'clean' eating. Its aetiology is still poorly understood and is not yet recognised in diagnostic manuals. While ON has been associated with Obsessive Compulsive (OC) symptoms and perfectionism, no study to date has looked at the relationship between OC symptoms and ON tendencies via perfectionism, or the influence of two facets of perfectionism in this relationship, namely evaluative concern and achievement striving. Examining the potential role of perfectionism helps to understand the aetiology of ON as well as inform potential treatments tailored specifically for ON and comorbid OC symptoms.

METHODS

In this cross sectional study, we tested 507 participants (n = 70 males, n = 69 at risk of ON) on questionnaires measuring OC symptoms, perfectionism and ON symptoms. We ran two mediation analyses to look at the overall relationship between perfectionism and OC and ON symptoms (Model 1) as well as the specific contribution of evaluative concern and achievement striving in the relationship between OC and ON symptoms (Model 2).

RESULTS

We found that perfectionism partially mediated the relationship between OC and ON symptoms. Specifically, we found that while achievement striving and evaluative concern were associated with OC symptoms, only achievement striving was significantly associated with ON symptoms, mediating the relationship between OC and ON symptoms.

CONCLUSIONS

This study highlighted the role of one key facet of perfectionism (achievement striving) in the aetiology of ON. The role of achievement striving was indicated as a transdiagnostic construct explaining the link between ON and OC symptoms. These findings are discussed in terms of their implications for treatment models, specifically in terms of the potential role of targeting perfectionism in ON treatment.

Correlates of depression in individuals with obsessive compulsive disorder

The existing literature examining the correlates of depression in individuals with obsessive compulsive disorder (OCD) is characterized by inconsistent results. The aim of the current study was to replicate and extend the literature by exploring whether various clinical and demographic factors are related to the occurrence of depression in a large sample (N = 243) of individuals with OCD (M age = 33.00; SD = 12.47; 74% female). Individuals with OCD who had elevated comorbid depressive symptoms [Patient Health Questionnaire-9 item (PHQ-9) ≥10] scored significantly higher on all OCD symptom subtypes (p range < .001-.048), had greater obsessive and compulsive severity (ps < .001), scored higher on perfectionism (p < .001), and had higher disgust sensitivity and propensity scores (ps < .001) compared with individuals who did not have comorbid depressive symptoms (PHQ-9 < 10). Of these variables, obsession severity (β = 0.22, p = .004), OCD contamination subtype (β = 0.16, p = .032) and perfectionism (β = 0.25, p < .001) were found to be associated with depressive symptoms on the PHQ-9. The findings of this study contribute to the understanding of factors which are associated with depression comorbidity in individuals with OCD.

Telehealth-Delivered Radically Open Dialectical Behavior Therapy for Adolescents (RO DBT-A): A Pilot Mixed-Methods Study

OBJECTIVE

Disorders related to overcontrol frequently first appear during adolescence, are highly comorbid, and show limited treatment response, necessitating the adaptation of radically open dialectical behavior therapy (RO DBT; a transdiagnostic treatment targeting overcontrol) for adolescents (RO DBT-A). This study tested the preliminary efficacy of telehealth-delivered RO DBT-A in a heterogeneous clinical sample of youths.

METHODS

The sample consisted of 20 female participants ages 13-21 with elevated overcontrol; most were White (75%) and non-Hispanic/Latino (80%). RO DBT-A was provided over 20 weeks via skills group and individual sessions (N=13 participants). Participants seeking other treatment or no treatment formed the control group (N=7). Outcomes included self-reported symptoms and overcontrol. Follow-up interviews were analyzed by using inductive, contextualist thematic analysis to examine participant perceptions and reasons for dropout.

RESULTS

The RO DBT-A group showed significant improvements in depression (t=-1.78, df=10, p=0.011) and quality of life (QOL; Wilcoxon W=75, p=0.021) compared with the control group. From baseline to posttreatment, youths receiving RO DBT-A demonstrated significant improvements in maladaptive overcontrol (t=2.76, df=12, p=0.043), anxiety (t=2.91, df=12, p=0.043), depression (Wilcoxon signed rank V=82.5, p=0.043), and QOL (t=-3.01, df=12, p=0.043). Qualitative analysis revealed themes related to treatment barriers, facilitators, and timing.

CONCLUSIONS

The findings provide preliminary evidence supporting telehealth-delivered RO DBT-A in targeting overcontrol, decreasing symptomatology, and improving QOL in a heterogeneous clinical sample of youths. Qualitative follow-ups highlighted that dropout was driven by barriers related to therapy (e.g., structure- and therapist-related issues) and the timing of RO DBT-A compared with other treatments.

Similarities and differences between eating disorders and obsessive-compulsive disorder in childhood and adolescence: a systematic review

Background

The developmental age, comprising childhood and adolescence, constitutes an extremely important phase of neurodevelopment during which various psychiatric disorders can emerge. Obsessive-Compulsive Disorder (OCD) and Eating Disorders (ED) often manifest during this critical developmental period sharing similarities but also differences in psychopathology, neurobiology, and etiopathogenesis. The aim of this study is to focus on clinical, genetic and neurobiological similarities and differences in OCD and ED.

Methods

This study is based on a PubMed/MEDLINE and Cochrane Central Register for Controlled Trial (CENTRAL). The research adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Results

The aforementioned search yielded an initial collection of 335 articles, published from 1968 to September 2023. Through the application of inclusion and exclusion criteria, a total of 324 articles were excluded, culminating in a final selection of 10 articles.

Conclusions

Our findings showed both differences and similarities between OCD and ED. Obsessive-compulsive (OC) symptoms are more prevalent in ED characterized by a binge/purge profile than in those with a restrictive profile during developmental age. OC symptomatology appears to be a common dimension in both OCD and ED. When presents, OC symptomatology, exhibits transversal characteristic alterations in the anterior cingulate cortex and poorer cognitive flexibility. These correlations could be highlighted by genetic overlaps between disorders. A comprehensive definition, integrating psychopathological and neurobiological aspects could significantly aid treatment selection and thereby influence the prognosis of these patients.

Exploration of the Mediating Role of Self-Compassion and Mindfulness on Orthorexia Nervosa and Perfectionism

Orthorexia Nervosa (ON) is characterized by an excessive preoccupation with healthy eating, accompanied by increasingly restrictive dietary practices over time. In light of the increased attention to ON, it is noteworthy that the existing body of research, specifically with regard to mindfulness and self-compassion remains constrained in scope and depth. A total of 151 participants over the age of 18 completed scales measuring Orthorexia, Self-Compassion, Mindfulness, and Perfectionism. The findings revealed that individuals exhibiting high levels of ON tended to have low levels of self-compassion and mindfulness, along with high levels of perfectionism. Furthermore, the results indicated that self-compassion and mindfulness acted as mediators in the relationship between perfectionism and orthorexia nervosa. These findings deepen our comprehension of orthorexia and underscore the role of self-compassion and mindfulness, or their absence, as mediating factors in this context. The implications of these results and potential future directions are discussed.

Examining Predictors of Psychological Distress Among Youth Engaging with Jigsaw for a Brief Intervention

Risk factors for psychological distress among help-seeking youth are poorly understood. Addressing this gap is important for informing mental health service provision. This study aimed to identify risk factors among youth attending Jigsaw, a youth mental health service in Ireland. Routine data were collected from N = 9,673 youth who engaged with Jigsaw (Mean age = 16.9 years, SD = 3.14), including presenting issues, levels of psychological distress, age, and gender. Confirmatory Factor Analysis identified thirteen factors of clustering issues. Several factors, including Self-criticism and Negative Thoughts, were strongly associated with items clustering as psychological distress, however these factors were poorly predictive of distress as measured by the CORE (YP-CORE: R2 = 14.7%, CORE-10: R2 = 6.9%). The findings provide insight into associations between young people's identified presenting issues and self-identified distress. Implications include applying appropriate therapeutic modalities to focus on risk factors and informing routine outcome measurement in integrated youth mental health services.

Perfect Enough to Sleep? Perfectionism and Actigraphy-Determined Markers of Insomnia

OBJECTIVES

Perfectionism is an important factor in insomnia development and maintenance. Previous studies exploring the relationship between perfectionism and insomnia have predominantly relied on self-reported sleep measures. Therefore, this study sought to assess whether actigraphy-measured sleep parameters were associated with perfectionism.

METHODS

Sixty adults (85% females, mean age 30.18 ± 11.01 years) were sampled from the Australian general population. Actigraphy-derived objective sleep measures, subjective sleep diary measures, the Frost Multidimensional Perfectionism Scale (FMPS), Hewitt-Flett Multidimensional Perfectionism Scale (HFMPS) and Depression, Anxiety and Stress Scale 21 (DASS-21) were collected.

RESULTS

High perfectionism levels were associated with poor sleep, but these relationships differed between objective and subjective measures. Perfectionism via FMPS total score and subscales of Concern over Mistakes, Doubts about Actions, Personal Standards and Self-oriented Perfectionism correlated with subjective sleep onset latency and sleep efficiency with moderate effects (r = .26 to .88). In contrast, perfectionism via HFMPS total score and subscales of Socially Prescribed Perfectionism and Parental Expectations predicted objective sleep onset latency and sleep efficiency. Additionally, stress mediated the relationships between objective sleep efficiency and Concern over Mistakes and Doubts about Actions.

CONCLUSIONS

Perfectionism demonstrated stronger associations with subjective than objective sleep measures. Higher Parental Expectations and Socially Prescribed Perfectionism may increase one's vulnerability to objectively measured poor sleep. Therefore, perfectionism may be important in preventing and treating insomnia.

Risk and resilience in eating disorders: differentiating pathways among psychosocial predictors

OBJECTIVE

Eating disorders (EDs) represent a rising global health concern. The current study takes a multivariate approach to examine psychological (i.e., perfectionism, anxiety sensitivity [AS], emotion dysregulation) and sociocultural factors (i.e., body dissatisfaction) that may relate to risk and resilience in EDs.

METHODS

Participants were 698 undergraduate students (Mage = 21, SDage = 4.02), mainly female (71%) and Hispanic (61.6%), who participated in an online survey assessing perfectionism, emotion dysregulation, AS, body dissatisfaction, and eating behaviors.

RESULTS

The results from structural equation model analyses revealed differential associations with disordered eating (DE) outcomes. Self-oriented perfectionism and dysmorphic appearance concerns were associated with increased dieting/carb restriction, desire for thinness, and binging tendencies. Specifically, emotional nonacceptance and lack of emotional awareness showed associations with elevated risk for dieting/carb restriction and purging tendencies, respectively. Conversely, lack of emotional clarity showed a protective pathway to these risk behaviors. Anxiety sensitivity cognitive concerns related to higher purging tendencies, while AS social concerns related to lower purging and binging tendencies.

DISCUSSION

Findings highlight the differential pathways of psychosocial risk and resilience for EDs. Subscales of emotional dysregulation and AS showed risk as well as resilience associations with DE outcomes. This information is key for advancing transdiagnostic prevention and intervention to reduce the rising rates of EDs.

Starving off death: Mortality salience impacts women's body image and disordered eating

From a Terror Management perspective, the pursuit of thinness that characterizes eating disorders (EDs) is arguably a culturally endorsed way to mitigate death anxiety. In the present studies, we used the mortality salience (MS) paradigm to examine whether priming death increases ED symptoms. We recruited two samples of women from undergraduate (Study 1, N = 120), and clinically relevant (Study 2, N = 154) populations. After priming, participants completed measures of potential confounds (e.g., neuroticism, affect). Next, we assessed ED attitudes and behavior using a portion size estimation task, and measures of body dissatisfaction and eating intention. Study 1 findings were inconsistent with the claimed role of death anxiety in ED related behavior. However, in Study 2, MS priming led to increased dissatisfaction with current thinness and smaller portion sizes for high-fat compared to low-fat food. Overall, the results suggest that death anxiety may, at least partially, drive ED symptoms.

Reading tea leaves or tracking true constructs? An assessment of personality-based latent profiles in eating disorders

Background

Eating disorder (ED) subtyping studies have often extracted an undercontrolled, an overcontrolled and a resilient profile based on trait impulsivity and perfectionism. However, the extent to which methodological choices impact the coherence and distinctness of resulting subtypes remains unclear.

Objective

In this paper, we aimed to assess the robustness of these findings by extracting personality-based subtypes on a sample of ED patients (N = 221) under different analytic conditions.

Methods

We ran four latent profile analyses (LPA), varying the extent to which we constrained variances and covariances during model parametrization. We then performed a comparative analysis also including state ED symptom measures as indicators. Finally, we used cross-method validation via k-means clustering to further assess the robustness of our profiles.

Results

Our results demonstrated a four-profile model based on variances in impulsivity and perfectionism to fit the data well. Across model solutions, the profiles with the most and least state and trait disturbances were replicated most stably, while more nuanced variations in trait variables resulted in less consistent profiles. Inclusion of ED symptoms as indicator variables increased subtype differentiation and similarity across profiles. Validation cluster analyses aligned most with more restrictive LPA models.

Conclusion

These results suggest that ED subtypes track true constructs, since subtypes emerged method-independently. We found analytic methods to constrain the theoretical and practical conclusions that can be drawn. This underscores the importance of objective-driven analytic design and highlights its relevance in applying research findings in clinical practice.

Treating perfectionism via the Internet: a randomized controlled trial comparing cognitive behavior therapy to unified protocol

Perfectionism can be problematic when your self-worth is dependent on achievements and leads to inflexible standards, cognitive biases, and rigid behaviors. Cognitive behavior therapy for perfectionism is shown to be effective, including for targeting psychiatric symptoms and when delivered via the Internet (iCBT-P). However, few studies have compared it to an active comparator. The current study randomly assigned 138 participants seeking help for perfectionism to iCBT-P or Internet-based Unified Protocol (iUP). Both treatments provided guidance on demand from a therapist and were eight weeks in duration. The results indicated large within-group effects of Cohen's d 2.03 (iCBT) and 2.51 (iUP) on the Clinical Perfectionism Questionnaire at post-treatment, and maintained effects at 6- and 12-month follow-up, but no between-group difference (β = 0.02, SE = 1.04, p = .98). Secondary outcomes of depression, anxiety, quality of life, self-compassion, procrastination, and stress ranged from small to large, with no differences between the conditions. Both treatments were deemed credible, relevant, of high quality, and well-adhered by the participants. Further research needs to be conducted, but the findings could indicate a lack of specificity, perhaps suggesting there is no need to differentiate between different treatments that are transdiagnostic in nature.

Mediators during a Multimodal intervention for stress-induced exhaustion disorder

Our understanding of the underlying psychological processes of development, maintenance, and treatments for stress-induced exhaustion disorder (ED) remains limited. Therefore, the current study aimed to explore whether sleep concerns, pathological worry, perfectionistic concerns, and psychological flexibility mediate change in exhaustion symptoms during a Multimodal intervention for ED based on Cognitive behavioral therapy principles. Participants (N = 913) were assessed at three time points, and mediation was explored using a two-criteria analytical model with linear mixed-effects models (criterion one) and random intercepts cross-lagged panel modeling (criterion 2). Criterion one for mediation was successfully met, as the findings indicated significant associations between time in treatment, with all suggested mediators, and exhaustion symptoms (significant ab-products). However, criterion two was not satisfied as changes in the mediators did not precede changes in exhaustion symptoms. Therefore, mediation could not be established. Instead, changes in the suggested mediators appeared to result from changes in exhaustion symptoms. Consequently, sleep concerns, pathological worry, perfectionistic concerns, and psychological flexibility appear to improve in conjunction with exhaustion symptoms during treatment, where improvement in exhaustion is indicated as the main driving factor, based on this exploratory analysis. The implications of these findings are contextualized within a broader framework of process-based therapy.

Perfectionism, self-esteem, and affective symptoms in anorexia nervosa subtypes: A network analysis of French inpatients

OBJECTIVE

Previous studies have highlighted the relevance of perfectionism, self-esteem, and anxio-depressive symptoms in anorexia nervosa (AN). However, the relationships between these factors and cardinal eating disorders (ED) symptoms remain unclear, particularly in AN subtypes. This study aimed to examine their interconnections using network analysis.

METHOD

The sample included n = 338 inpatients with AN who completed the Eating Disorder Examination Questionnaire, Frost Multidimensional Perfectionism Scale, Rosenberg Self-Esteem Scale, and Hospital Anxiety and Depression Scale. Using network analysis, we estimated three networks: full sample, AN-restrictive (AN-R) and AN-binge/purging (AN-BP) subtypes. We estimated central and bridge symptoms using expected influence and conducted an exploratory network comparison test to compare AN subtypes.

RESULTS

Overvaluation of Weight and Shape, Concern over Mistakes, and Personal Standards were consistently central in all networks. The most central bridge symptoms across all networks were Concern over Mistakes and Self-Esteem. Concern over Mistakes bridged perfectionism and ED symptoms, while Self-Esteem was highly connected to all symptom clusters. Anxiety was significantly more central in the AN-R network compared to the AN-BP network.

CONCLUSIONS

The present study contributes to a growing body of network studies suggesting that nodes related to perfectionism are just as central as cardinal ED symptoms, indicating the relevance of perfectionism in ED pathology. The high bridge centrality of self-esteem suggests that it may be an important link between perfectionism, mood, and ED symptoms. Future research should investigate the efficacy of targeting multiple psychological factors in the treatment of AN, as well as their potential transdiagnostic relevance.

A pilot feasibility and acceptability trial of an internet indicated prevention program for perfectionism to reduce eating disorder symptoms in adolescents

PURPOSE

Perfectionism is a transdiagnostic risk factor for eating disorders. Treating perfectionism can reduce symptoms of eating disorders. No research has examined an indicated prevention trial using internet-based Cognitive-Behavioural Therapy for Perfectionism (ICBT-P) in adolescent girls at elevated risk for eating disorders. Our aim was to conduct a preliminary feasibility trial using a co-designed ICBT-P intervention. It was hypothesised that a higher proportion of participants in the ICBT-P condition would achieve reliable and clinically significant change on perfectionism, eating disorders, anxiety and depression, compared to waitlist control.

METHODS

Twenty-one adolescent girls with elevated symptoms of eating disorders (M age = 16.14 years) were randomised to a 4-week online feasibility trial of a co-designed ICBT-P prevention program or waitlist control. Qualitative surveys were used to gain participant perspectives.

RESULTS

The ICBT-P condition had a higher proportion of participants achieve reliable change and classified as recovered on perfectionism and symptoms of eating disorders and anxiety, compared to waitlist control. Qualitative findings indicated that 100% of participants found the program helpful.

CONCLUSION

The results indicate ICBT-P is a feasible and acceptable program for adolescent girls with elevated eating disorder symptoms. Future research is required to examine outcomes in a randomised controlled trial.

LEVEL OF EVIDENCE

Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

TRIAL REGISTRATION NUMBER

This trial was prospectively registered with Australian and New Zealand Clinical Trials Registry (ACTRN12620000951954P) on 23/09/2020.

Reactive and control processes in the development of internalizing and externalizing problems across early childhood to adolescence

Reactive and control processes - e.g., negative emotionality and immediacy preference - may predict distinct psychopathology trajectories. However, externalizing and internalizing problems change in behavioral manifestation across development and across contexts, thus necessitating the use of different measures and informants across ages. This is the first study that created developmental scales for both internalizing and externalizing problems by putting scores from different informants and measures onto the same scale to examine temperament facets as risk factors. Multidimensional linking allowed us to examine trajectories of internalizing and externalizing problems from ages 2 to 15 years (N = 1,364) using near-annual ratings by mothers, fathers, teachers, other caregivers, and self report. We examined reactive and control processes in early childhood as predictors of the trajectories and as predictors of general versus specific psychopathology in adolescence. Negative emotionality at age 4 predicted general psychopathology and unique externalizing problems at age 15. Wait times on an immediacy preference task at age 4 were negatively associated with age 15 general psychopathology, and positively associated with unique internalizing problems. Findings demonstrate the value of developmental scaling for examining development of psychopathology across a lengthy developmental span and the importance of considering reactive and control processes in development of psychopathology.

Comparisons between atypical anorexia nervosa and anorexia nervosa: Psychological and comorbidity patterns

OBJECTIVE

Literature comparing "atypical" anorexia nervosa (atypical AN) and anorexia nervosa (AN) suggests these diagnoses share significant similarities in eating disorder (ED) pathology and psychiatric comorbidities. This study evaluated potential differences in ED pathology, psychiatric comorbidity, associated mechanisms (i.e., ED fears and perfectionism), and demographic factors (i.e., ethnicity and age) between individuals with atypical AN and AN.

METHOD

Data from seven protocols were combined for a total 464 individuals diagnosed with atypical AN (n = 215) or AN (n = 249). Between-group differences in ED severity and behaviors, psychiatric comorbidities, ED fears, perfectionism, and demographic factors were assessed using t-tests, Wilcoxon rank-sum tests, and Fisher's exact test.

RESULTS

Participants with atypical AN reported higher levels of overvaluation of weight and shape than those with AN. Participants with AN scored higher on food-related fears (anxiety about eating, food avoidance behaviors, and feared concerns) and fears of social eating, as well as obsessive-compulsive symptoms. Participants with AN were more likely to identify as Asian or Pacific Islander. No other statistically significant differences were found between groups for overall ED severity, ED behaviors, psychiatric comorbidities, general ED fears, perfectionism, or demographic factors.

DISCUSSION

Overall, results support previous literature indicating limited differences between individuals with atypical AN and AN, though individuals with atypical AN reported more overvaluation of weight and shape and those with AN reported higher food and social eating fears and obsessive-compulsive symptoms. Relatively few overall differences between atypical AN and AN highlight the importance of exploring dimensional conceptualizations of AN as an alternative to the current categorical conceptualization.

PUBLIC SIGNIFICANCE

This study assessed differences among individuals with atypical anorexia nervosa and anorexia nervosa in eating disorder severity and behaviors, comorbid psychiatric diagnoses, associated mechanisms, and demographic factors. Few differences emerged, though participants with atypical anorexia nervosa reported more overvaluation of weight and shape, while those with anorexia nervosa reported more food and social eating fears and higher obsessive-compulsive symptoms. Results support exploration of these diagnoses as a spectrum disorder.

Direct, indirect, and reciprocal associations between perfectionism, compulsive exercise and eating disorder pathology in adolescents with eating disorders

BACKGROUND

There is a strong association between perfectionism and eating disorders. In a cognitive-behavioural model of compulsive exercise it has been suggested there are reciprocal associations between perfectionism, eating disorder pathology, and compulsive exercise. No study has examined if there is an indirect association between perfectionism and compulsive exercise through eating disorder pathology, which would inform a preliminary understanding of the cognitive-behavioural model of compulsive exercise.

METHODS

The sample included 301 adolescent females diagnosed with eating disorders (age M = 14.89, SD = 0.85, range 13-17). We tested models of direct and indirect associations of compulsive exercise in the relationship between perfectionism and eating disorder pathology, and direct and indirect associations of eating disorder pathology in the relationship between compulsive exercise and perfectionism.

RESULTS

Perfectionism was directly associated with eating disorder pathology and compulsive exercise. Perfectionism was indirectly associated with eating disorder pathology through compulsive exercise. Perfectionism also had an indirect association with compulsive exercise through eating disorder pathology.

DISCUSSION

The findings suggest it would be useful for future prospective research to examine the cognitive-behavioural model of compulsive exercise in adolescents with eating disorders. Compulsive exercise and perfectionism may be useful targets for future research to improve eating disorder treatment. Level of evidence Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Cognitive bias modification for perfectionism and intolerance of uncertainty: A randomized controlled trial

This study investigated the efficacy of combined cognitive bias modification (CBM) on perfectionism and intolerance of uncertainty. Fifty-four university students scoring over 70.5 on the Brief Symptom Measure were randomly assigned to experimental and placebo control groups. The CBM intervention was administered online for 4 weeks. Assessments were given at baseline, after the 4-week intervention, and 1 month post-intervention. Results showed a statistically significant decrease in two dimensions of perfectionism, concern over mistakes and parental criticism, and intolerance of uncertainty of those in the experimental group, compared to those in the control group. The findings related to the interpretation of perfectionism revealed a significant interaction effect of time and direction of sentences for the experimental group. Lastly, the experimental group's interpretation bias scores for intolerance of uncertainty showed a statistically significant increase after the intervention compared to those in the control group. The study's findings provide preliminary support for the effectiveness of CBM on perfectionism and intolerance of uncertainty.

The relationships between perfectionism and symptoms of depression, anxiety and obsessive-compulsive disorder in adults: a systematic review and meta-analysis

Perfectionism is a transdiagnostic process associated with depression, anxiety, and obsessive-compulsive disorder (OCD). The focus of this systematic review and meta-analysis was to examine evidence for the association between perfectionistic strivings and perfectionistic concerns with symptoms of depression, general anxiety, social anxiety, task anxiety, and OCD in adults. A total of 416 studies were included, with 113,118 participants aged 17 to 90 years (M = 23.83). Perfectionistic concerns had significant medium correlations with anxiety, OCD and depressive symptoms (pooled r = .38 to .43). Perfectionistic strivings had significant, small correlations with OCD, depression and all anxiety outcomes (pooled r = .10 to .21), except social anxiety where there was no association. Results demonstrate perfectionistic concerns have a stronger relationship with psychological distress than perfectionistic strivings, but strivings are significantly related to distress. Future research should examine the causal relationships between perfectionism dimensions and psychopathology.

A meta-analysis of disordered eating and its association with self-criticism and self-compassion

OBJECTIVE

Future treatments for eating disorders (ED) need to be enhanced by targeting maintaining mechanisms. Literature suggests self-criticism and self-critical perfectionism act as key mechanisms exacerbating ED, and self-compassion protects against self-criticism. This meta-analysis examines associations between self-criticism and self-critical perfectionism on disordered eating (DE), and reviews how self-compassion and self-criticism relate to each other with respect to DE.

METHOD

Searches across three databases yielded 135 studies across 42,952 participants. Heterogeneity, publication bias, and quality assessments were analyzed. Moderation analyses between self-criticism measures, self-compassion measures, between clinical and nonclinical samples, and between cross-sectional and experimental studies were also conducted.

RESULTS

Random-effects models showed a medium positive link between self-criticism and DE (r = .37), and 10 subgroups pertaining to various measures of self-criticism utilized in literature showed small to large positive links with DE (r = .20-.52). Preliminary evidence also suggests negative relationships between self-compassion and DE (r = -.40 to -.43) and negative relationships between self-compassion and self-criticism (r = -.04 to -.88).

DISCUSSION

Greater levels of self-criticism is linked with greater levels of DE and reduced levels of self-compassion, suggesting a need to tackle self-criticism and nurture self-compassion in standard treatments for ED. Understanding these interactions better in conjunction with dismantling intervention studies can help develop more effective and efficient interventions targeting self-criticism and self-compassion for people with DE.

PUBLIC SIGNIFICANCE STATEMENT

Higher levels of self-criticism are linked with higher levels of DE and lower self-compassion. Self-compassion interventions could be more effective and efficient in reducing ED symptoms if self-criticism is tackled early in such treatments.

Applying process-oriented hypnosis to treat perfectionism-related depression

This paper brings together concepts, tools, and case examples that provide guidance for ways to use process-oriented clinical hypnosis to shift perfectionistic tendencies to help resolve depression and enhance well-being. Perfectionism is a transdiagnostic risk factor for clinical and subclinical suffering of many types including depression. Over time, perfectionism is becoming more widespread. Perfectionism-related depression can be effectively treated when clinician attention is directed toward core skills and themes. Case examples illustrate how to help clients moderate overly extreme thinking, create and use realistic standards, and develop and apply a balanced self-evaluation. A variety of clinician styles and approaches, especially when tailored to individual client characteristics, preferences, and needs, are compatible with process-oriented hypnotic interventions for perfectionism and depression.

Performing well but not appreciating it - A trait feature of anorexia nervosa

Background

Despite advances in the etiology of anorexia nervosa (AN), a large subgroup of individuals does not profit optimally from treatment. Perfectionism has been found to be a risk factor predicting the onset, severity, and duration of AN episodes. To date, perfectionism has been studied predominantly by the use of self-report questionnaires, a useful approach that may, however, be impacted by demand characteristics, or other distortions of introspective or metacognitive access.

Methods

Here we circumvent these problems via a behavioral paradigm in which participants perform a modified Go/NoGo task, whilst self-evaluating their performance. We compared a group of 33 adolescent females during their first episode of AN (age = 16.0) with 29 female controls (age = 16.2), and 23 adolescent girls recovered from AN (age = 18.3) with 23 female controls (age = 18.5). The controls were closely matched by intelligence quotient and age to the two clinical groups.

Results

First-episode AN and control participants performed equally well on the task (reaction time and errors of commission), whereas the recovered group displayed significantly faster reaction times but incurred the same error rate. Despite performing at least as good as and predominantly better than control groups, both clinical groups evaluated their performances more negatively than controls.

Conclusion

We offer a novel behavioral method for measuring perfectionism independent of self-report, and we provide tentative evidence that this behavioral manifestation of perfectionism is evident during first-episode AN and persists even after recovery.

A pilot study of the perceptions and acceptability of guidance using artificial intelligence in internet cognitive behaviour therapy for perfectionism in young people

Perfectionism is a transdiagnostic process associated with a range of psychological disorders. Cognitive Behaviour Therapy for Perfectionism (CBT-P) has been demonstrated as efficacious across guided and unguided internet delivered interventions in reducing perfectionism and psychopathology. The aim of this pilot study was to understand perceptions and acceptability of an artificial intelligence supplemented CBT-P intervention (AI-CBT-P) in young people with lived experience of anxiety and depression (n = 8; age range 19-29 years, M = 24 years, SD = 3.77; 50 % female, 38 % male, 12 % non-binary). Young people reported that they were frequent users of artificial intelligence for study, work and general information, were positive about the intervention and using artificial intelligence for guidance in a self-help intervention, but also noted several concerns. Young people perceived numerous benefits to AI-CBT-P, including ease of access, low cost, lack of stigma and benefits for individuals with social anxiety. Overall, young people appear to be interested in, and have a positive view of, AI-CBT-P. Further research is now required to examine the feasibility and acceptability of the intervention.

A randomized clinical trial of a gamified app for the treatment of perfectionism

OBJECTIVES

Perfectionism is a common transdiagnostic problem that may lead to substantial distress and functional impairments. Cognitive behavioural therapy (CBT) is an effective treatment for perfectionism. However, the existing significant barriers to access and utilization of mental health services, including among college students, demand the development of low-intensity accessible interventions. The aim of the present study was to evaluate the effectiveness of a low-intensity CBT-based self-help gamified app developed specifically for perfectionism in a sample of college students.

METHODS

Participants completed assessments of perfectionism, related symptoms, emotional burden and functional impairments at pretreatment, posttreatment and at one-month follow-up.

RESULTS

Compared with the waitlist condition (n = 35), the app condition (n = 35) demonstrated a significant and greater reduction in perfectionism, obsessive-compulsive symptoms, functional impairments and subjective ratings of emotional burden.

CONCLUSIONS

Results suggest that a brief, daily app-based game-like intervention targeting maladaptive perfectionistic beliefs may be a viable, low-cost alternative to traditional CBT treatments for vulnerable populations on college campuses.

New understandings meet old treatments: putting a contemporary face on established protocols

In the twenty years since the publication of the most widely used treatment manuals describing evidence-based therapies for eating disorders, there have been some substantial advances in the field. New methods of delivering treatments have been trialled and our perception of mental health has advanced; significant cultural changes have led to shifts in our societal landscape; and new technologies have allowed for more in-depth research to be conducted. As a result, our understanding of eating disorders and their treatment has broadened considerably. However, these new insights have not necessarily been translated into improved clinical practice. This paper highlights the changes we consider to have had the greatest impact on our work as experienced clinical psychologists in the field and suggests a list of new learnings that might be incorporated into clinical practice and research design.

The relationship between perfectionism and interpersonal sensitivity with self-compassion in university students: the mediation of repetitive negative thinking

Self-compassion is a construct of positive psychology related to personality and cognitive factors. Perfectionism and interpersonal sensitivity are prevalent personality traits among university students and are associated with low self-compassion. Further research is required to comprehend how these mechanisms work in creating self-compassion. Consequently, the current study investigated the direct and indirect relationship between perfectionism and interpersonal sensitivity with self-compassion via repetitive negative thinking. To this end, a sample of 450 students studying in Tehran during the 2022 academic year was selected as the study sample. The results indicated that perfectionism and interpersonal sensitivity demonstrate a negative direct relationship with self-compassion, while perfectionism and interpersonal sensitivity exhibit an indirect relationship with self-compassion via repetitive negative thinking. Based on the findings, it can be concluded that the relationship between perfectionism and interpersonal sensitivity with self-compassion is not straightforward and that repetitive negative thinking can mediate this relationship. The results can be used to improve methods for increasing self-compassion and paying attention to personality, and cognitive factors can be an important step toward more effective self-compassion interventions.

Perfectionism as a moderator of the relationship between orthorexia nervosa and obsessive-compulsive symptoms

PURPOSE

Orthorexia nervosa (ON), a proposed disorder describing an obsessive focus on "healthy" eating, is characterised as having overlapping symptoms with obsessive-compulsive disorder. However, ON/obsessive-compulsive (OC) symptom relationships are inconsistently reported. The current study aimed to investigate if the contribution of OC symptoms and beliefs explain variability in ON symptoms and determine if perfectionism, a transdiagnostic factor, moderates the ON/OC symptom relationship.

METHODS

The study comprised 190 participants (Mage = 28.63, SDage = 9.88; 80% female) recruited via an undergraduate research programme, social media, advocacy organisations, and a participant registry. Participants completed an online questionnaire assessing ON, OC, and perfectionism symptoms.

RESULTS

A linear regression analysis found OC symptoms and beliefs explained 22.9% variability in ON symptoms (p < 0.001, f2 = 0.38) and perfectionism moderated the ON/OC symptom relationship, where higher levels of perfectionism with higher levels of OC symptoms was associated with higher levels of ON symptoms, explaining 2.2% variability (p = .01, f2 = 0.03).

CONCLUSION

OC symptoms appear more common in ON than previous studies indicate. However, the interaction between perfectionism and OC symptoms may drive obsessions in ON. Findings help refine our current understanding of ON phenomenology with implications for ON treatment development. Future research should further explore perfectionism in ON phenomenology.

LEVEL OF EVIDENCE

Level V (Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees).

Which Symptoms Bridge Symptoms of Depression and Symptoms of Eating Disorders?: A Network Analysis

ABSTRACT

Depression is a common comorbid mental illness in eating disorders (EDs). Network theory focuses on interactions between symptoms, but findings from network analyses of EDs and depression need to be replicated to make reliable claims about the nature of symptomatic interplay. We used cross-sectional data of 366 online-recruited participants with clinically elevated ED symptomatology and constructed a regularized partial correlation network with ED and depression symptoms. To determine each symptom's influence, we calculated expected influence (EI) and bridge EI to identify symptoms that bridged symptoms of depression and ED. Concerns that others see one eat, fear of weight gain, and fear of loss of control over eating were especially important among the ED symptoms. Loss of interest and feeling sad were the key depression symptoms. Eating in secret and low self-esteem emerged as potential bridge symptoms between clusters. These findings regarding bridge symptoms partially overlap with prior network analyses in nonclinical and clinical samples. Future studies that investigate symptom interplay via a longitudinal design to deduce causality are needed.

Perfectionism and alcohol-related problems: The role of procrastination

OBJECTIVE

College drinking is a significant individual and societal problem, and thus, identifying risk factors to alcohol-related problems has been an important line of inquiry. Adding to this rich literature, the current study examined whether perfectionism dimensions were associated with alcohol-related problems and whether a poor self-regulation process linked these associations.

PARTICIPANTS

A total of 410 university students completed measures pertaining to perfectionism, procrastination, and negative consequences of alcohol use.

METHODS

Parallel mediation models were tested.

RESULTS

There was support for an indirect effect in the association between perfectionistic concerns and alcohol-related problems through susceptibility to temptation but not through pure procrastination or irrational procrastination. Perfectionistic strivings dimension was not associated with alcohol-related problems and this relation was not mediated by any procrastination dimensions.

CONCLUSIONS

Building internal resources to better resist immediately gratifying yet long-run detrimental behavioral habits is important, especially so for highly self-critical students.

EFL learners' problematic use of social media usage, classroom anxiety, perfectionism, and language attainment: correlations and perceptions

BACKGROUND

The effect of social media (SM) on university students' educational progress and mental health has been studied in various contexts. However, the correlation between Chinese EFL learners' use of SM (problematic and non-problematic) and their language achievement, foreign language anxiety, and perfectionism requires further investigation.

OBJECTIVES

To address this gap, a mixed-method research design was utilized. This study recruited 480 English language learners from Ningbo University of Finance and Economics in China using convenience sampling.

METHOD

SM usage questionnaires, a perfectionism scale, a foreign language anxiety scale, self-assessment grids (CEFR) developed by the Council of Europe, and an interview checklist were used to collect data. Descriptive statistics (mean and SD) and Pearson correlation coefficient for each question were analyzed using SPSS. Thematic analysis was used to analyze the interviews.

RESULTS

The results revealed that problematic use of social media is associated with several negative consequences, such as low language achievement, high foreign language anxiety level, high academic burnout, and negative aspects of perfectionism.

CONCLUSIONS AND IMPLICATIONS

These findings have theoretical and practical implications for language learners and teachers. The results can inform language educators about the potential negative effects of problematic SM use on language learning outcomes, mental health, and well-being. It is important to raise awareness of problematic SM use and to promote healthy SM habits among language learners. Additionally, the study highlights the importance of promoting the non-problematic use of SM as a potential resource to enhance language learning outcomes.

Psychometric properties of an Arabic translation of the Big Three Perfectionism Scale-Short Form (BTPS-SF) in a community sample of adults

BACKGROUND

Despite the high clinical relevance of the perfectionism construct as a transdiagnostic contributor to different mental health symptoms, and the recent burgeoning of research in this area across cultures in the past two decades, the Arab region was one of the cultural settings experiencing the slowest progress in this line of research. This study aimed to make a meaningful contribution to the literature by validating an Arabic-language version of the 16-item Big Three Perfectionism Scale-Short Form (BTPS-SF). In particular, we sought to examine structure and concurrent validity, internal consistency, and measurement invariance across gender groups.

METHOD

A web-based, convenience sampling method was adopted to collect a sample of Arabic-speaking adults from the general population of Lebanon (N = 515; aged 27.55 ± 10.92 years; 69.9% females). The forward-backward method was applied in translating the Arabic version of the BTPS-SF.

RESULTS

The examination of the internal structure, using Confirmatory Factor Analysis (CFA), demonstrated that the three-factor model (i.e., rigid, self-critical, and narcissistic perfectionism) fitted well to the data. All three factors of the Arabic 16-item BTPS-SF yielded excellent reliability estimates, with both Cronbach's alpha and McDonald's omega ranging from 0.83 to 0.86. Multi-group CFA revealed that fit indices showed no significant difference in model fit at the configural, metric, and scalar levels, thus suggesting that the factor loadings, pattern structure, and item intercepts are invariant across gender groups. Finally, BTPS-SF subscales scores correlated positively with psychological distress (i.e., depression, stress and anxiety), and inversely with subjective well-being, indicating an acceptable concurrent validity.

CONCLUSION

The present findings allow us to conclude that the Arabic BTPS-SF permits to capture reliably and validly three main factors of perfectionism. We hope that providing this psychometrically sound scale will encourage its large use not only in empirical research, but also in clinical applications, including psychological screening and treatment monitoring.

Perfection is a sad and lonely place: A study of existential vulnerability in the life stories of persons struggling with perfectionism

Under what life conditions do individuals turn to perfectionistic striving and ideals as a solution? The present paper examines how people with perfectionism narrate their relationship to our shared existential vulnerability; that we are vulnerable as human beings, and that the ways we relate to this vulnerability have consequences for psychological health. In the present qualitative study, we explored the life narratives told by nine students with perfectionism, drawing on semi-structured life-story interviews. We conducted an explorative-reflexive thematic analysis and identified five themes: 1) Outside-Feeling Alienated, 2) Relating to Chaos, 3) Trying to Control the Painful and Uncontrollable, 4) Islands of Just Being and Positive Contact, and 5) Heading Toward a Balance Between Doing and Being. Their perfectionism can be seen as a way of handling existential vulnerability at a point in their lives where relational resources needed to stay firm in a vulnerable state are lacking. Perfectionistic themes influence their personal identity in the domain of narrative constructions, values, belongingness, and embodiment. Accomplishments were dominant themes in the plots of their narrative self-constructions and values. They felt their "self-made" identities kept others at a distance. However, we also found strivings for a more fulfilling life with broader self-definitions.

Internet interventions for perfectionism: a meta-analysis and proposals for the college setting

ObjectiveSuh et al (2019) found that treatments for perfectionism, even online, reduce perfectionism and concomitant psychopathology. This meta-analysis investigated the efficacy of Internet interventions and psychotherapeutic interventions for perfectionism as potential tools for overburdened college counseling centers where perfectionism is particularly prevalent. Method: PubMed, MEDLINE, and PsycINFO were searched for relevant treatment studies. Comprehensive Meta-analysis V3 was used to compute and pool effect sizes for perfectionism and concomitant psychopathology. Results: Psychological interventions (N = 18) for perfectionism yielded significant reductions in perfectionistic strivings (g = .394; n = 16), concerns (g = .603; n = 17), and clinical perfectionism (g = .960; n = 8). Effect sizes were small-to-medium for depression (g = .601; n = 12), anxiety (g = .399; n = 13), and eating disorder symptoms (g = .477; n = 7). Effect sizes were similar for Internet-mediated and non-Internet-mediated interventions. Most interventions used 8-10-session cognitive-behavioral therapy of perfectionism. Conclusion: Internet interventions for perfectionism reduce perfectionism and concomitant psychopathology. College counseling centers could eventually use them to reduce demand for in-person services.

A randomized controlled trial to evaluate the efficacy of metacognitive training for older adults with depression (MCT-Silver) in Portugal: study protocol

Introduction

Depression is one of the most common psychological disorders in later life. Although psychological interventions are recommended by treatment guidelines, most older adults with depression remain untreated. The aim of this study is to evaluate the efficacy of the Portuguese version of Metacognitive Training for Depression in later life (MCT-Silver).

Methods

This is a study protocol of an observer-blind, parallel-group, randomized controlled trial to compare the efficacy of MCT-Silver with a treatment as usual (TAU) control group among older adults (age 65 years and older) with depressive symptoms according to the Montgomery-Asberg Depression Scale. Participants will be tested at three assessment time points (baseline, immediately following the intervention [8 weeks], and 3 months after the intervention). The primary outcome is change in self-rated depression symptoms assessed by the Beck Depression Inventory (BDI-II). Secondary outcomes include clinician-rated depression, self-esteem, dysfunctional beliefs, metacognitive beliefs, ruminations, attitudes toward aging and quality of life. A self-designed subjective appraisal rating scale consisting of 21-items will be used to assess participant acceptance of MCT-Silver.

Discussion

MCT-Silver is an innovative intervention, which aims to reduce dysfunctional thoughts as well as depression-related behaviors and coping strategies through the metacognitive perspective. Until now, the training has only been tested in Germany. It is expected that after 8 weeks of treatment and 3 months later, the experimental group will demonstrate significant reductions in depressive symptoms, metacognitive beliefs, dysfunctional attitudes and ruminative responses compared to the TAU group. Moreover, quality of life, self-esteem, and attitudes towards aging will be significantly improved in MCT-Silver compared to the TAU group.

Clinical trial registration

ClinicalTrials.gov, NCT05640492.

Examining the Relationship Between Maladaptive Perfectionism and Social Anxiety: The Mediating Role of Self-Compassion

Previous studies have indicated a relationship between perfectionism and social anxiety symptoms, but the mechanisms between these concepts are not well-defined yet. This study focused on the mediator role of self-compassion in the relationship between maladaptive perfectionism and social anxiety symptoms controlling self-esteem. It is hypothesized that maladaptive perfectionism would be related to lower levels of self-compassion and lower levels of self-compassion related to greater social anxiety symptoms controlling self-esteem. The sample consisted of 389 university students who completed a battery of instruments, including measures of The Liebowitz Social Anxiety Scale (LSAS), The Big Three Perfectionism Scale (BTPS), The Self-Compassion Scale (SCS), and The Rosenberg Self-Esteem Scale (RSES). Simple mediation analyses with bootstrapping demonstrated that self-compassion has a significant mediator role in the relationship between maladaptive perfectionism and social anxiety when self-esteem is not included in the model. However, results also revealed that the indirect effect of self-compassion is no longer significant when self-esteem is included in the model as a covariate. Findings suggest that self-compassion has no mediator role independent from self-esteem in the context of perfectionism and social anxiety.

Psychometric Properties of the Big Three Perfectionism Scale: Rasch Analysis

The Big Three Perfectionism Scale (BTPS) is one of commonly used measures for assessing individuals' perfectionism. The main purpose of this current study was to assess the psychometric properties of the Big Three Perfectionism Scale (BTPS) within the framework of the Rasch model. The sample consisted of 502 adolescents (53% males and 47% females). This study revealed were several important findings. First, adolescents interpreted the categories of the rating scales of the BTPS as intended and items demonstrated good targeting with the operating ranges from - 4.79 to 4.47 logits for rigid perfectionism, from - 3.84 to 3.76 logits for self-critical perfectionism and from - 4.04 to 3.92 logits for narcissistic perfectionism. Second, rigid perfectionism, self-critical perfectionism and narcissistic perfectionism exhibited unidimensionally, providing justification for the use of summed scores for each scale. Third, the average item difficulty of facets was different within each scale, with the facets of self-worth contingencies, socially prescribed perfectionism and other-oriented perfectionism being more difficult to endorse in their belonging scale. Fourth, there were no DIF items across sex, suggesting that items in three scales functioned equally across boys and girls. Fifth, rigid perfectionism (r = 0.15) and self-critical perfectionism (r = 0.55) were positively associated with neuroticism, but self-critical perfectionism (r = - 0.24) and narcissistic perfectionism (r = - 0.29) were negatively related with agreeableness. Finally, sex moderated the associations between rigid perfectionism and neuroticism. In sum, the findings in this study enhance psychometric properties of the BTPS.

Associations between perfectionism and symptoms of anxiety, obsessive-compulsive disorder and depression in young people: a meta-analysis

Perfectionism is a transdiagnostic process contributing to the onset and maintenance of anxiety, obsessive-compulsive disorder (OCD) and depression. The aim of this systematic review and meta-analysis was to examine the association between perfectionism, and symptoms of anxiety, OCD and depression among young people aged 6-24 years. A systematic literature search retrieved a total of 4,927 articles, with 121 studies included (Mpooled age = ~17.70 years). Perfectionistic concerns demonstrated significant moderate pooled correlations with symptoms of anxiety (r = .37-.41), OCD (r = .42), and depression (r = .40). Perfectionistic strivings demonstrated significant, small correlations with symptoms of anxiety (r = .05) and OCD (r = .19). The findings highlight the substantial link between perfectionistic concerns and psychopathology in young people, and to a smaller extent perfectionistic strivings, anxiety, and OCD. The results indicate the importance of further research on early intervention for perfectionism to improve youth mental health.

The development of co-designed parent-supported cognitive behaviour therapy for perfectionism in adolescents with eating disorders: initial feasibility and acceptability

BACKGROUND

Perfectionism is significantly associated with symptoms of eating disorders in adolescents. Studies to date have not examined parent-supported CBT for perfectionism in eating disorders (CBT-P-ED). We co-designed the treatment and conducted a feasibility trial.

METHODS

Eight parents of adolescents with eating disorders (M age = 48.75 years, 100% female) engaged in three co-design workshops to create a parent-supported CBT-P-ED self-help intervention. A further 10 parents (M age 41.8 years, 50% female) and their adolescent offspring (n = 10, M age 15.4 years, 60% female, 50% with self-reported diagnosis of anorexia nervosa) participated in a feasibility trial and provided feedback on the intervention.

RESULTS

The parents who engaged in the co-design workshops suggested several areas to optimise the perfectionism intervention, including using plain language, the impact of parental perfectionism, how to engage with their adolescent in treatment and the importance of increasing eating disorder specific material. Feedback from the feasibility trial suggested that the intervention was acceptable and feasible with 100% of parents and adolescents saying it was useful, and no attrition.

CONCLUSIONS

Parent-supported CBT-P-ED appears to be feasible. Future research is now required in a randomised controlled trial.

The association between eating disorders and perfectionism in adults: A systematic review and meta-analysis

OBJECTIVE

Dimensions of perfectionism are associated with the onset and maintenance of eating disorder pathology in both clinical and non-clinical samples. The aim of this study was to conduct a systematic review and meta-analysis of the association between perfectionism and eating disorders in adults.

METHOD

A literature search was conducted using the PsycINFO, Medline, Scopus, Embase, Web of Science and ProQuest databases. Ninety-five studies met the inclusion criteria and included a total sample of 32,840 participants (clinical eating disorder diagnosis N = 2414, non-clinical N = 30,428). Correlation coefficients (r) for the association between eating disorders and perfectionism were pooled. A meta-analysis to determine the association between two dimensions of perfectionism and eating disorder symptoms was conducted. Subgroup analyses were conducted with studies using clinical samples, and studies using the Eating Disorder Examination Questionnaire.

RESULTS

The pooled effect size for the association between perfectionistic concerns and eating disorder symptoms was r = 0.33 [0.30, 0.37]; and r = 0.20 [0.14, 0.25] for the association between perfectionistic strivings and eating disorder symptoms. In the clinical subgroup analyses the effect sizes were r = 0.40 [0.22, 0.58]; and r = 0.35 [0.26, 0.44] respectively. Medium to high heterogeneity was identified across all subgroup analyses and a significant level of publication bias was also identified.

DISCUSSION

The findings indicate both perfectionistic strivings and perfectionistic concerns have significant associations with eating disorders, and further support the argument that both dimensions of perfectionism are important factors in the prevention and treatment of eating disorders.

Perfectionism and eating disorders in children and adolescents: A systematic review and meta-analysis

There is a consistent link between perfectionism and eating disorders, however no meta-analysis to date has synthesized this literature in children and adolescents. We hypothesized that there would be significant, small pooled correlations between perfectionism dimensions and eating disorder symptoms in children and adolescents. Published, peer-reviewed articles with standardised measures of perfectionism and eating disorder symptoms were included. Articles were excluded if the age range was over 18 years. Overall, 39 studies were included (N = 13,954 participants, M age = 13.7 years). Total perfectionism (r = 0.25), perfectionistic strivings (r = 0.21), and perfectionistic concerns (r = 0.31) had significant positive associations with eating disorder symptoms. Most studies were rated as fair or good quality. Limitations included high heterogeneity, insufficient studies to investigate age as a moderator, the inclusion of only English articles, and predominately cross-sectional studies which precluded causal inference. Higher perfectionism was associated with greater eating disorder symptoms in children and adolescents. Future research should focus on longitudinal studies of eating disorder symptoms in children and adolescents.

The relationship between clinical perfectionism and nonsuicidal self-injury: The roles of experiential avoidance, self-esteem, and locus of control

OBJECTIVES

Perfectionism is linked to nonsuicidal self-injury (NSSI). Individuals with elevated perfectionism tend to avoid undesirable emotions and experience lower self-esteem, which are associated with NSSI. However, it is unclear if these mechanisms explain the link between clinical perfectionism and NSSI, and if locus of control is involved. We aimed to explore whether experiential avoidance and self-esteem would mediate the relationship between clinical perfectionism and NSSI, and if locus of control would moderate links between clinical perfectionism and both experiential avoidance and self-esteem.

METHOD

As part of a larger study, 514 Australian university students (Mage  = 21.15 years, SD = 2.40; 73.5% female) completed an online survey of NSSI, clinical perfectionism, experiential avoidance, self-esteem, and locus of control.

RESULTS

Clinical perfectionism was associated with NSSI history, but not with recent NSSI or past year NSSI frequency. Lower self-esteem, but not experiential avoidance, mediated links between clinical perfectionism and NSSI history, recent NSSI, and NSSI frequency. More external locus of control was associated with NSSI, experiential avoidance, and lower self-esteem, but locus of control did not moderate pathways between clinical perfectionism and experiential avoidance or self-esteem.

CONCLUSION

University students reporting elevated clinical perfectionism may have a tendency to experience lower self-esteem which is associated with NSSI history, recency, and severity.

Parenting styles and obsessive-compulsive symptoms in college students: the mediating role of perfectionism

Introduction

Obsessive-compulsive symptoms is a common psychological phenomenon among early adulthood college students, which are closely related to their parents' parenting styles. Theoretical and some empirical studies have suggested the mediating role of perfectionism in this process, but this has not been confirmed, and the binary perspective of positive-negative perfectionism has not been addressed in this issue.

Methods

This study aimed to investigate the mediating role of perfectionism in the relationship between parenting styles and obsessive-compulsive symptoms among college students. A total of 661 college students participated in this study.

Results

Negative perfectionism mediated the relationship between negative parenting style and obsessive-compulsive symptoms among college students. Negative parenting style predicted obsessive-compulsive symptoms through its positive predictive effect on negative perfectionism. However, the mediating effect of positive perfectionism was not significant in this process.

Discussion

This study provides further evidence of the mechanisms underlying the occurrence of obsessive-compulsive symptoms, and offers new ideas for interventions for OCD.

Validation of the short version of the obsessive compulsive spectrum questionnaire

Aim

In the recent years, a rising amount of research has stressed the importance of a dimensional perspective on mental disorders. In particular, the conceptualization of an obsessive-compulsive spectrum appears to be in line with the very first descriptions of Obsessive-Compulsive Disorder and has been partially acknowledged by the inclusion of the "OCD-spectrum related syndromes and disorders" section in the DSM-5. The goal of the current study is to ascertain the psychometric characteristics of the Obsessive-Compulsive Spectrum-Short Version (OBS-SV), a novel questionnaire designed to measure the complete range of obsessive-compulsive symptoms, from severe full blown to subthreshold ones.

Methods

Forty three subjects with a clinical diagnosis of OCD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5); 42 subjects with a clinical diagnosis of social anxiety disorder (SAD), and 60 individuals without current or lifetime mental disorders (HC) were recruited from the Psychiatric Clinic of the University of Pisa. Subjects were assessed with the SCID-5, the Yale Brown Obsessive Compulsive Scale (Y-BOCS) and the OBS-SV.

Results

OBS-SV showed strong test-retest reliability for both the total and the domains scores, as well as a high level of internal consistency. The Pearson's coefficients for the OBS-SV domain scores ranged from 0.771 to 0.943, and they were positively and strongly linked with one another (p < 0.001). The OBS-SV total score had a strong correlation with each of the OBS-SV domain scores. All correlation coefficients between OBS-SV and additional measures of OCS were observed to be strong, significant and positive. Both OBS-SV domain and overall score differences between diagnostic groups were found to be statistically significant. From HCs, to the SAD, up to the OC group, which had the highest values, the OBS-SV total score grew dramatically and progressively.

Conclusion

The OBS-SV demonstrated significant convergent validity with other dimensional OCD measures, excellent internal consistency, and test-retest reliability. Across the three diagnostic categories, the questionnaire functioned differently, with a rising score gradient from healthy controls through SAD patients to OCD subjects.

Transdiagnostic factors predicting the 2-year disability outcome in patients with anxiety and depressive disorders

BACKGROUND

Both anxiety and depressive disorders are associated with significant long-term disability. Since experienced impairments vary between patients independent of diagnosis and disease severity, identifying transdiagnostic factors that predict the course of disability may provide new targets to reduce disability. This study examines transdiagnostic factors predicting the 2-year disability outcome in patients with anxiety and/or depressive disorders (ADD), focusing on potentially malleable factors.

METHODS

Six hundred fifteen participants with a current diagnosis of ADD from the Netherlands Study of Depression and Anxiety (NESDA) were included. Disability was assessed at baseline and after 2 years of follow-up, using the 32-item WHODAS II questionnaire. Transdiagnostic predictors of 2-year disability outcome were identified using linear regression analysis.

RESULTS

In univariable analyses, transdiagnostic factors associated with the 2-year disability outcome were locus of control (standardized β = -0.116, p = 0.011), extraversion (standardized β = -0.123 p = 0.004) and experiential avoidance (standardized β = 0.139, p = 0.001). In multivariable analysis, extraversion had a unique predictive value (standardized β = -0.143 p = 0.003). A combination of sociodemographic, clinical and transdiagnostic variables resulted in an explained variance (R2) of 0.090). The explained variance of a combination of transdiagnostic factors was 0.050.

CONCLUSION

The studied transdiagnostic variables explain a small but unique part of variability in the 2-year disability outcome. Extraversion is the only malleable transdiagnostic factor predictive of the course of disability independent of other variables. Due to the small contribution to the variance in the disability outcome, the clinical relevance of targeting extraversion seems limited. However, its predictive value is comparable to that of accepted disease severity measures, supporting the importance of looking beyond using disease severity measures as predictors. Furthermore, studies including extraversion in combination with other transdiagnostic and environmental factors may elucidate the unexplained part of variability of the course of disability in patients with ADD.

Development and validation of the ambiguous scenario task for perfectionistic concerns for university students

BACKGROUND AND OBJECTIVES

Interpretation biases (IBs) are found in a range of psychological disorders, and the transdiagnostic role of IBs has gained increasing attention. Among the variants, IBs of perfectionism (e.g., interpreting a trivial error as equivalent to complete failure) are understood to be a central transdiagnostic phenotype. Perfectionism is a multidimensional construct and the dimension of perfectionistic concerns has been found to be most closely related to psychopathology. Therefore, capturing IBs that are specifically related to perfectionistic concerns (not perfectionism in general) is of particular importance in studying pathological IBs. Thus, we developed and validated the Ambiguous Scenario Task for Perfectionistic Concerns (AST-PC) to be used in university students.

METHODS

We created two versions of the AST-PC and administered each version to one of two independent student samples (i.e., Version A to n = 108 and Version B to n = 110). We then examined the factor structure and associations with established questionnaires of perfectionism, depression, and anxiety.

RESULTS

The AST-PC showed good factorial validity, confirming the hypothesized three-factor structure: perfectionistic concerns, adaptive, and maladaptive (but not perfectionistic) interpretations. The interpretations related to perfectionistic concerns showed good correlations with questionnaires of perfectionistic concerns, depressive symptoms, and trait anxiety.

LIMITATIONS

Additional validation studies are required to establish the temporal stability of the task scores and their sensitivity to experimental induction and clinical intervention. Additionally, IBs of perfectionism should be investigated within a broader transdiagnostic context.

CONCLUSIONS

The AST-PC demonstrated good psychometric properties. Future applications of the task are discussed.

The Effect of Perfectionism on Consumers’ Intentions to Purchase Imperfect Products

Perfectionism is an important personality trait that affects people’s behavior, especially consumption behavior. In our study, we aimed to investigate whether perfectionists show different preferences in their consumption choices compared with non-perfectionists and to explore the potential psychological mechanisms mediating this effect. Through four studies, we found that perfectionists are less likely to buy imperfect products, including those that are close to expiry and that have defective functioning, flawed appearance, and incomplete after-sales service than non-perfectionists, and are more likely to avoid choosing imperfect products. In addition, we found a mediating effect of dichotomous thinking and intolerance of uncertainty on this effect to explain the behavioral preferences of perfectionists in their purchasing choices. Manufacturers and marketers can benefit from the results of this study by implementing targeted production requirements and marketing strategies based on the consumer behavior preferences of perfectionists.

Perfectionism as Possible Predictor for Treatment Success in Mindfulness-Based Cognitive Therapy and Metacognitive Training as Third-Wave Treatments for Obsessive-Compulsive Disorder

Background

Identifying predictors of treatment outcome can guide treatment selection and optimize use of resources. In patients affected by obsessive-compulsive disorder (OCD), perfectionism has emerged as one possible predictor, with some data suggesting that cognitive-behavioral therapy outcomes are poorer for more perfectionistic patients. Findings so far are inconsistent, however, and research has yet to be extended to newer treatment approaches.

Methods

We administered measures of concern over mistakes, clinical perfectionism, as well as OCD and depression symptom severity to a sample of OCD patients in out-patient group treatments (N = 61), namely, metacognitive training (MCT-OCD) or mindfulness-based cognitive therapy (MBCT) for OCD. Hierarchical data over time was submitted to multi-level analysis.

Results

Neither concern over mistakes nor clinical perfectionism at baseline predicted OCD symptoms across time points. However, concern over mistakes at baseline did significantly predict comorbid depressive symptoms. Furthermore, exploratory analysis revealed change in clinical perfectionism during treatment as a predictor of OCD symptoms at follow-up.

Conclusion

These results suggest that initial concern over mistakes may not prevent patients with OCD from benefitting from third-wave treatments. Change in clinical perfectionism may present a putative process of therapeutic change. Limitations and avenues for future research are discussed.