Perfectionism and health functioning in women with fibromyalgia

Perfectionism and performance in sport: Exploring non-linear relationships with track and field athletes

The relationship between perfectionism - perfectionistic strivings and perfectionistic concerns - and athletic performance is contested and inconsistent. The present study explored the possibility that one explanation for this inconsistency is the assumption that the relationship is linear. In two samples, we tested alternative non-linear relationships between perfectionism and real-world competitive athletic performance. Sample one comprised 165 Swedish track and field athletes (57 % competing in female category, 42 % in male category; Mage = 16.93 years) and sample two comprised 157 British track and field athletes (55 % competing in female category, 43 % in male category; Mage = 18.42 years). Testing for linear and non-linear relationships, we found a quadratic effect whereby higher perfectionistic strivings had both positive increasing (i.e., U-shape; sample 1) and positive decreasing (i.e., inverted U-shape; sample 2) relationships with performance. We conclude that there may be circumstances when perfectionistic strivings contribute to better and worse sport performance, and that this relationship can be curvilinear.

A motivational approach to perfectionism and striving for excellence: Development of a new continuum-based scale for post-secondary students

Perfectionism has been the object of many disputes. One such debate pertains to the nature of perfectionistic strivings. Whereas perfectionistic concerns (PC) have been shown to correlate with negative outcomes, perfectionistic strivings (PS) have been associated with mixed outcomes. This view of perfectionism assumes a motivational perspective; however, commonly used questionnaires assess motivation only implicitly. To create a more explicit measure of motivation as regard perfectionism, we aimed to assess perfectionism in post-secondary education based on Deci and Ryan's self-determination continuum. We posit that introjected motivation represents the variance common to both dimensions of perfectionism. External motivation is considered to be specific to PC and identified motivation to PS. Amotivation represents a lack of meaningful striving. Intrinsic motivation, lacking perfectionism's pressure, is conceptualized to be a self-determined form of striving for excellence. We further posited that this continuum is implicitly underlain by a continuum of self-definition as defined by Blatt. The resulting questionnaire showed an adequate structure with ESEM, followed a simplex structure, and had adequate reliabilities (Study 1a/Study 2). It also showed adequate convergent validity (Study 1b/Study 2). Finally, the questionnaire proved to be invariant over a 6-week period (Study 2). Results suggest that the degree of active goal pursuit, in addition to standards setting, could be a distinguishing characteristic between dimensions of perfectionism as well as striving for excellence.

Perfectionistic cognitions, Interleukin-6, and C-Reactive protein: A test of the perfectionism diathesis stress model

Previous research has demonstrated that perfectionism is implicated in poorer health and earlier mortality. However, to our knowledge, research has not yet determined how individual differences in perfectionistic cognitions are related to intermediary health markers such as inflammation. Thus, within the theoretical frameworks of the perfectionism diathesis-stress model (Hewitt and Flett, 1993) and the cognitive theory of perfectionism (Flett et al., 2018; Flett et al., 2016) the aims of our study were to test whether individual differences in perfectionistic cognitions were associated with low-grade inflammation via c-reactive CRP and IL-6 biomarkers and whether these relationships varied as a function perceived stress. The sample included 248 Canadian young adults (52% female, Mage ​= ​22.89, SD ​= ​1.53) who completed surveys assessing key constructs such as perfectionistic cognitions and perceived stress along with providing assessments of body fat percentage and serum samples of IL-6 and CRP. Regression analyses indicated that perfectionistic cognitions were not related to IL-6 under any conditions of stress. However, under high levels of stress perfectionistic cognitions were associated with elevated levels of CRP and these findings held after accounting for the effects of smoking status, body fat percentage, and respondent sex. The present work adds to the growing body of evidence supporting links between personality and inflammation. These findings raise the possibility that experiencing more frequent thoughts centered on the need to be perfect when coupled with higher levels of stress may set the stage for greater vulnerability for chronic inflammation.

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Perfectionistic cognitions were related to elevated levels of CRP under high levels of perceived stress.

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Perfectionistic cognitions were not related to CRP under low or moderate levels of perceived stress.

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Perfectionistic cognitions were not related to IL-6 under any conditions of stress.

Holistic Treatment of Fibromyalgia Based on Physiopathology: An Expert Opinion

Patients suffering from fibromyalgia have many vexing symptoms; in contrast, physicians do not have a logical physiopathological framework to explain the multiple complaints. The objective of this writing is to discuss a patient-centered holistic fibromyalgia therapy based on a coherent physiopathological model.The rationale proposing fibromyalgia as stress-related sympathetically maintained neuropathic pain syndrome has solid research foundations. Autoimmunity is evident in a subset of fibromyalgia cases. Dorsal root ganglia are likely the crucial sympathetic-nociceptive short circuit sites. Skin biopsy and corneal confocal microscopy have demonstrated small nerve fiber pathology in fibromyalgia cases.Patient empowerment through information and symptom validation is the first step for a successful fibromyalgia therapy.

POINTS TO HIGHLIGHT

Fibromyalgia is a genuine painful neuropathic pain syndrome. In fibromyalgia stress becomes pain. Autonomic (sympathetic) dysfunction explains the multiplicity of fibromyalgia symptoms.The well-informed patient (and her/his family) must take on the leading role in her/his own rehabilitation. Fibromyalgia treatment often requires important lifestyle changes. Physicians and allied health care personnel facilitate this adjustment. Specific fibromyalgia drivers are discussed. Common modern bad habits alter autonomic nervous system balance and worsen fibromyalgia symptoms. Currently used drugs for fibromyalgia are rudimentary and with low retention rates. Autoimmune fibromyalgia requires focused therapeutic approach.

CONCLUSION

A patient-centered holistic therapy aimed to regain autonomic nervous system resilience remains the most effective fibromyalgia therapy.

FUTURE DIRECTIONS

Corneal confocal microscopy will likely become an objective fibromyalgia diagnostic and follow-up procedure. More specific analgesic antineuropathic medications for fibromyalgia are on the horizon.

Associations Between Posttraumatic Stress Symptoms, Anxiety Sensitivity, Socially Prescribed Perfectionism, and Severity of Somatic Symptoms Among Individuals with Fibromyalgia

OBJECTIVES

The contribution of psychological risk factors to the intensification of pain experienced among individuals with fibromyalgia syndrome (FMS) is relatively under-studied. The present study aims to explore associations between FMS-related somatic symptom severity and two personality tendencies: anxiety sensitivity (AS) and socially prescribed perfectionism (SPP). Furthermore, the relative contributions of these personality tendencies are examined vis-à-vis the experience of potentially traumatic events (PTEs) and the psychopathology of posttraumatic stress symptoms (PTSS).

METHODS

A volunteer sample of 117 Israeli adults with FMS responded to online validated self-report questionnaires regarding their PTEs, PTSS, somatic symptom severity, FMS, AS, and SPP in a cross-sectional study.

RESULTS

Participants' self-reported PTSS rates (61.5%) were high. AS and SPP were positively related to somatic symptom severity. Interestingly, we found that PTSS positively predicted the severity of somatic symptoms above and beyond the contributions of AS and SPP.

CONCLUSIONS

The present study supports the assumption that psychological risk factors may affect the expression of somatic symptoms and the interpretation of pain stimulus arising in the body that might eventually be experienced as excessively painful. The study also suggests that above and beyond psychological risk factors, PTSS may express a high predominance and affect pain perception among participants with FMS.

Two-factor higher-order model of perfectionism in Iranian general and clinical samples

BACKGROUND

Studies in Western cultures have shown that perfectionism is conceptualized by two-factor higher-order model including perfectionistic strivings and perfectionistic concerns. However, little is known about the construct of perfectionism in Eastern societies. Thus, we examined the two-factor higher-order model of perfectionism in Iranian general and clinical samples.

METHODS

We recruited a general population sample (n = 384) and patients with major depressive disorder, obsessive compulsive disorder, social anxiety disorder, and eating disorders (n = 152) from Tehran, Iran from September 2016 to December 2017. They completed the Clinical Perfectionism Questionnaire, Perfectionism Inventory, and Depression, Anxiety, Stress Scale-21.

RESULTS

The two-factor higher-order model of perfectionism showed adequate fit with data for females from the general population and clinical sample. Data for males were only available from the general population, and the model showed adequate fit with the data first after removing the Rumination scale of the perfectionistic concerns. The perfectionistic strivings dimension showed no or negative association with depression, anxiety, and stress symptoms, but perfectionistic concerns dimension showed positive correlation with these indices in all samples for both males and females.

CONCLUSIONS

The results support the two-factor higher-order model of perfectionism in samples of Iranian females from the general population and clinical sample. However, the results were different for males from the general population. In other words, the modified two-factor higher-order model showed acceptable fit with the data for males from the general population only after removing the Rumination scale from perfectionistic concerns. These differences among males and females were discussed.

Perfectionism and Pain Intensity in Women with Fibromyalgia: Its Influence on Activity Avoidance from The Contextual Perspective

Given the scarcity of studies regarding perfectionism from a contextual perspective, this study aims to analyze its role in the relationship between pain and activity avoidance and its differential effect among patients with different fibromyalgia severity. A cross-sectional study with 228 women with fibromyalgia classified into two disease severity groups (low/moderate vs. high) was carried out. Moderation analyses were conducted; perfectionism was used as moderator, pain (in high and low pain situations) as independent variable, and activity avoidance as the outcome. Among the high disease severity group, analyses showed direct contributions of perfectionism (p < 0.001) but not of pain (p > 0.05); moderation effects were found in high pain situations (p = 0.002) (for low levels of perfectionism, a positive association was found between pain intensity and avoidance). Among the low severity group, direct effects of perfectionism (p < 0.05) and pain intensity (p = 0.04) were found (although the latter only for high pain situations); moderation effects were found in high pain situations (p = 0.018) (for high levels of perfectionism a positive and significant association was found between pain intensity and avoidance). Perfectionism has been found to be a key variable in the differential relationship between pain intensity (in high pain situations) and activity avoidance in groups with high and low disease severity.

Heavy Study Investment in Italian College Students. An Analysis of Loscalzo and Giannini's (2017) Studyholism Comprehensive Model

Loscalzo and Giannini (2017) recently proposed the construct of studyholism (or obsession toward study) and a theoretical model highlighting its potential antecedents and outcomes. This study aims to analyze some of these antecedents and outcomes by means of a path analysis including both studyholism and study engagement. The participants are 1,958 Italian college students aged between 18 and 60 years (M age = 23.53 ± 4.43) and heterogeneous as far as their year and major of study are concerned, as well as concerning the city in which they attended their courses. They filled some instruments that allow evaluating studyholism and study engagement, along with individual and situational antecedents (e.g., worry and overstudy climate) and outcomes (e.g., sleep quality, study-relationships conflict, dropout intention). In addition to the path model we performed aiming to test the direct effects we hypothesized, we performed two MANOVAs for analyzing if there were differences on the antecedents and outcomes among the four kinds of student suggested by Loscalzo and Giannini (2017; i.e., engaged studyholics, disengaged studyholics, engaged students, and detached students). The results of this study support Loscalzo and Giannini's (2017) conceptualization of studyholism as an internalizing disorder, since worry is the strongest predictor of studyholism (β = .67, p < .001). In addition, in line with Loscalzo and Giannini's (2017) theorization, we found some differences among the four kinds of student on both the antecedents and outcomes we analyzed. This study has critical theoretical, preventive, and clinical implications. It supports the definition of studyholism as an OCD-related disorder. Also, about preventive implications, it shows that interventions aiming to favor students' wellbeing should target also engaged students, since study engagement predicts social impairment as well as studyholism. Finally, it suggests that in a clinical setting, it is important to distinguish between disengaged studyholics and engaged studyholics as they have different relationships with some antecedents and outcomes; also, they both have functional impairment, even if in different areas.

A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review

BACKGROUND

Functional cognitive disorder (FCD) describes cognitive dysfunction in the absence of an organic cause. It is increasingly prevalent in healthcare settings yet its key neuropsychological features have not been reported in large patient cohorts. We hypothesised that cognitive profiles in fibromyalgia (FM), chronic fatigue syndrome (CFS) and functional neurological disorders (FNDs) would provide a template for characterising FCD.

METHODS

We conducted a systematic review of studies with cognition-related outcomes in FM, CFS and FND.

RESULTS

We selected 52 studies on FM, 95 on CFS and 39 on FND. We found a general discordance between high rates of subjective cognitive symptoms, including forgetfulness, distractibility and word-finding difficulties, and inconsistent objective neuropsychological deficits. Objective deficits were reported, including poor selective and divided attention, slow information processing and vulnerability to distraction. In some studies, cognitive performance was inversely correlated with pain, exertion and fatigue. Performance validity testing demonstrated poor effort in only a minority of subjects, and patients with CFS showed a heightened perception of effort.

DISCUSSION

The cognitive profiles of FM, CFS and non-cognitive FND are similar to the proposed features of FCD, suggesting common mechanistic underpinnings. Similar findings have been reported in patients with mild traumatic brain injury and whiplash. We hypothesise that pain, fatigue and excessive interoceptive monitoring produce a decrease in externally directed attention. This increases susceptibility to distraction and slows information processing, interfering with cognitive function, in particular multitasking. Routine cognitive processes are experienced as unduly effortful. This may reflect a switch from an automatic to a less efficient controlled or explicit cognitive mode, a mechanism that has also been proposed for impaired motor control in FND. These experiences might then be overinterpreted due to memory perfectionism and heightened self-monitoring of cognitive performance.

Emotional intelligence as a moderator between perfectionism and happiness

Happiness plays a key role in influencing adolescent performance in a variety of contexts. The present study was designed to investigate the relationships between perfectionism, emotional intelligence, and happiness and to test the moderating role of emotional intelligence in the relationship between perfectionism and happiness among Malaysian adolescents. The participants were 412 Malaysian high-school students from Selangor, all of whom completed self-report questionnaires. Structural equation modeling (SEM) was used to examine whether students with high levels of personal standards perfectionism, low levels of evaluative concerns perfectionism, and high levels of emotional intelligence reported higher levels of happiness. Multigroup analyses showed that emotional intelligence emerged as a significant moderator in the link between evaluative concerns perfectionism and happiness. These findings highlight the importance of emotional intelligence in mitigating the devastating effects of evaluative concerns perfectionism on happiness.

Determinants of representational and behavioral hyperactivity in patients with fibromyalgia syndrome

Fibromyalgia is associated with a premorbid hyperactivity. This study examines how contextual and personality factors contribute to premorbid hyperactivity. A total of 45 patients completed questionnaires. The results show that the number of children and the basic bodily needs neglect (and their interaction) explain nearly 50 percent of the variance of hyperactivity. The neglect toward bodily needs completely mediates the relation between self-oriented perfectionism and hyperactivity. This study suggests that hyperactivity itself would not have a pathological value, but that the neglect of basic bodily needs would represent a vulnerability factor in a hyperactive premorbid lifestyle in fibromyalgia patients.

Personality traits in psychogenic nonepileptic seizures (PNES) and psychogenic movement disorder (PMD): Neuroticism and perfectionism

OBJECTIVE

Psychogenic movement disorder (PMD) and psychogenic nonepileptic seizures (PNES) are two subtypes of conversion disorder (CD). In this case-control study, we asked whether these subtypes varied as a function of personality and history of childhood abuse.

METHODS

Fifty-nine patients with PMD from the Human Motor Control Section Clinic at the National Institutes of Health, 43 patients with PNES from the Rhode Island Hospital Neuropsychiatry and Behavioral Neurology Division, and 26 healthy volunteers (HC) received a battery of neurological, psychiatric and psychological assessments, including the NEO Personality Inventory Revised (NEO PI-R), the Childhood Trauma Questionnaire (CTQ), and the Traumatic Life Events Questionnaire (TLEQ).

RESULTS

One-way ANOVA between the three groups indicated significant differences in overall domains of Neuroticism (p=0.001) and Conscientiousness (p=0.009): Patients with PNES reported significantly greater levels of Neuroticism (p=0.002) and lower levels of Conscientiousness (p=0.023) than patients with PMD. Levels of Neuroticism remained significantly higher in both PMD and PNES than HC following correction for multiple comparisons. Patients with PNES reported greater levels of depressive and anxiety symptoms, overall psychopathology, greater history of sexual abuse, greater levels of alexithymia, higher levels of dissociative symptoms, and an earlier age at which they experienced their most distressing traumatic event than patients with PMD.

CONCLUSIONS

These findings suggest that personality traits, type of abuse and age of onset of trauma varies as a function of CD subtype. Patients with PNES rated greater Neuroticism and lower Conscientiousness than patients with PMD. These differing psychological profiles may inform differing treatment approaches such as psychological therapies for PNES and physiotherapy (with/without psychotherapy) for PMD.

The relationship of perfectionism with psychological symptoms in cancer patients and the contributing role of hyperarousability and coping

OBJECTIVE

Significant levels of anxiety, depression and insomnia symptoms are found in cancer patients. Perfectionism, arousability and coping have been associated with these psychological symptoms in the general population but their role among cancer patients remains to be assessed. This study examined the longitudinal relationships between perfectionism and psychological symptoms (anxiety, depression, insomnia), and the intermediate role of the arousability trait and coping strategies.

DESIGN

Participants (N = 853) completed the Multidimensional Perfectionism Scale, the Coping with Health Injuries and Problems questionnaire and the Arousal Predisposition Scale at the perioperative period (T1), and the Hospital Anxiety and Depression Scale and the Insomnia Severity Index two months later (T2).

RESULTS

Higher levels of perfectionism (T1) were correlated with greater symptoms of anxiety, depression and insomnia (T2). Moderated mediation models indicated that arousability contributed to the association of perfectionism with all symptoms, with stronger associations found in men than in women. Coping was a significant pathway between perfectionism and anxiety, with associations of a comparable magnitude across sexes.

CONCLUSION

If these results are replicated by future longitudinal studies, they would suggest that perfectionist cancer patients are at a higher risk of experiencing psychological symptoms, partly through their hyperarousability and the coping strategies they use.

The relationship between perfectionistic self-presentation and reactions to impairment and disability following spinal cord injury

Univariate and multivariate relationships between perfectionistic self-presentation and reactions to impairment and disability following spinal cord injury were examined. A total of 144 adults with spinal cord injury ( M = 48.18 years old, SD = 15.96) completed self-report measures. Analyses revealed that, after controlling for time since injury and gender, perfectionistic self-presentation predicted six of eight reactions, shock, depression and internalised anger particularly strongly. In addition, at multivariate level, perfectionistic self-presentation was positively related to non-adaptive reactions and negatively related to adaptive reactions. The findings suggest that perfectionistic self-presentation may contribute to poorer psychosocial adaptation to spinal cord injury.

The association between metacognitions and the impact of Fibromyalgia in a German sample

OBJECTIVES

Fibromyalgia is a chronic condition of unknown aetiology, characterised by widespread pain, sleep disturbances, and fatigue. In this paper we examined the relationship metacognitions and the impact of Fibromyalgia in a German sample, detailing the translation and validation of a self-report metacognitive instrument.

METHODS

The Metacognitions about Symptoms Control Scale (MaSCS) was translated into German using the back-forward translation process. A total of 348 patients (316 female and 26 male) with Fibromyalgia contributed data to the study to test the structure and psychometric properties of the MaSCS.

RESULTS

Confirmatory factor analyses, informed by modification indices, resulted in a 16-item scale consisting of two factors pertaining to positive and negative metacognitions about symptoms control. Further analyses revealed that both factors had good internal consistency. Correlation analyses established convergent validity, indicating that both factors were significantly associated with: (1) established positive and negative metacognitions scales; and (2) with symptoms severity in Fibromyalgia. Regression analyses revealed that positive metacognitions about symptoms control significantly predicted impairment in physical functioning while negative metacognitions about symptoms control significantly predicted the overall Fibromyalgia impact value, when controlling for stress, anxiety, and depression and a general metacognitions.

CONCLUSION

The findings support the potential relevance of metacognitions, and utility of the German version of MaSCS, in examining the role of metacognitions in Fibromyalgia and other chronic health conditions.

How attempts to meet others' unrealistic expectations affect health: health-promoting behaviours as a mediator between perfectionism and physical health

The traits of perfectionism have been associated with health and longevity. Theoretically and empirically, health behaviours are considered a primary mechanism through which such associations of personality and health occur. However, scant evidence to date indicates behaviours did not mediate between perfectionism and health as anticipated. The aim of the current research was therefore to rigorously examine whether health behaviours mediated associations of perfectionism and physical health-related quality of life (HRQL). A sample of 263 students completed questionnaires measuring subtypes of perfectionism, HRQL, self-efficacy and health-promoting behaviours. Hierarchical regression analyses investigated predictors of physical HRQL and health-promoting behaviours. Non-parametric bootstrapping techniques assessed whether health-promoting behaviours mediated significant associations between perfectionism and physical HRQL. Socially prescribed perfectionism (SPP) significantly predicted poorer physical HRQL, and this association was mediated by health-promoting behaviours, a unique finding. Self-oriented perfectionism did not significantly predict physical HRQL, but was linked with more numerous health-promoting behaviours. In conclusion, results suggest that individuals higher in SPP, who are overly concerned with evaluation by others and with meeting perceived unrealistically high standards of performance, performed fewer health-promoting behaviours, and this mediated the association between SPP and poorer physical HRQL. More broadly, perfectionism predicted physical HRQL and engagement or lack thereof in health-promoting behaviours and should be considered as part of health promotion strategies.

Central sensitization syndrome and the initial evaluation of a patient with fibromyalgia: a review

In both primary care and consultative practices, patients presenting with fibromyalgia (FM) often have other medically unexplained somatic symptoms and are ultimately diagnosed as having central sensitization (CS). Central sensitization encompasses many disorders where the central nervous system amplifies sensory input across many organ systems and results in myriad symptoms. A pragmatic approach to evaluate FM and related symptoms, including a focused review of medical records, interviewing techniques, and observations, is offered here, giving valuable tools for identifying and addressing the most relevant symptoms. At the time of the clinical evaluation, early consideration of CS may improve the efficiency of the visit, reduce excessive testing, and help in discerning between typical and atypical cases so as to avoid an inaccurate diagnosis. Discussion of pain and neurophysiology and sensitization often proves helpful.

Evaluation of personality profile in patients with fibromyalgia syndrome and healthy controls

OBJECTIVES

Fibromyalgia syndrome (FMS) is associated with widespread musculoskeletal pain disorder characterized by various symptoms. Our aim was to compare the personality profiles and psychological aspects between FMS patients and control subjects. Additionally, we evaluated the FMS symptoms, pain and functional status. A total of 72 female patients with FMS and 64 age- and sex-matched healthy controls were included.

METHODS

Visual Analog Scale (VAS), to assess pain and sleep quality, and Fibromyalgia Impact Questionnaire (FIQ), to evaluate the functional status, were used in both groups. We assessed the psychological status with Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and the personality profiles were evaluated with Minnesota Multiphasic Personality Inventory (MMPI).

RESULTS

Total BDI and BAI scores of FMS patients were higher than control subjects (p < 0.01, p < 0.01). In terms of psychopathology, hysteria parameters of MMPI were significantly higher in FMS. MMPI parameters except lie, infrequency, masculinity femininity and hypomania parameters (p > 0.05) were significantly higher in FMS group than the control group.

CONCLUSIONS

The results of the present study suggest that there is a relationship between the psychological state and personality characteristics in FMS. Much more research is needed to better define the role of personality characteristics in the pathogenesis and symptoms of FMS.

Perfectionism, Type D personality, and illness-related coping styles in cardiac rehabilitation patients

This study investigated the associations among trait perfectionism, perfectionistic self-presentation, Type D personality, and illness-specific coping styles in 100 cardiac rehabilitation patients. Participants completed the Multidimensional Perfectionism Scale, the Perfectionistic Self-Presentation Scale, the Type D Scale-14, and the Coping with Health Injuries and Problems Scale. Correlational analyses established that emotional preoccupation coping was associated with trait perfectionism, perfectionistic self-presentation, and Type D personality. Perfectionism was linked with both facets of the Type D construct (negative emotionality and social inhibition). Our results suggest that perfectionistic Type D patients have maladaptive coping with potential negative implications for their cardiac rehabilitation outcomes.