Clinical perfectionism: a cognitive-behavioural analysis

Understanding eating disorder symptoms in adolescents: testing a cognitive-behavioural model of eating disorders in a community sample

Clinical perfectionism, self-esteem, mood intolerance, and interpersonal difficulties are associated with eating disorder symptoms in clinical samples. The aim of the current study was to test a model including clinical perfectionism, self-esteem, mood intolerance, and interpersonal difficulties to understand eating disorder symptoms in an adolescent community sample. Adolescents (N = 446, M age = 16.25 years, SD = 1.64; 74.2% female) completed measures of clinical perfectionism, self-esteem, mood intolerance, interpersonal difficulties, and eating disorder symptoms. Path analysis indicated clinical perfectionism, self-esteem, mood intolerance, and interpersonal difficulties were all directly associated with symptoms of eating disorders, and that clinical perfectionism was indirectly associated with eating disorders through self-esteem, mood intolerance, and interpersonal difficulties. The results indicate the cognitive-behavioural model of eating disorders can be applied to adolescents in the community with symptoms of eating disorders. Directional causality between constructs should be established to understand whether increased clinical perfectionism, and reduced self-esteem, mood intolerance, and interpersonal difficulties are vulnerabilities to the development and maintenance of eating disorders.

Nobody's "Prfect"! The effect of manipulating perfectionism on social anxiety symptoms

Social anxiety is a common experience that ranges from mild, temporary distress to excessive, persistent, and impairing fear. The current study tested whether perfectionism contributes to social anxiety symptoms and post-event processing (PEP) in the context of a contract-based manipulation to shift perfectionism. The manipulation asked participants to perform everything to a specific standard level for the following 24 hrs to shift perfectionism. Participants completed measures of social anxiety and perfectionism before delivering a speech. Next, participants were randomly assigned to 1 of 3 conditions: High Personal Standards, High Personal Standards with Evaluative Concerns (High PS+EC), and Low Personal Standards. The following day, participants completed the same measures, including a measure on PEP related to the speech. Consistent with hypotheses, results suggest that the contract manipulation significantly altered perfectionism, such that participants in the High PS+EC condition had an increase in perfectionism over time. Contrary to expectations, the contract manipulation did not affect social anxiety symptoms or PEP. Results suggest that focusing on evaluation concerns, rather than personal standards alone, may contribute to perfectionism. It is possible that a stronger or larger dose of the manipulation is needed to see effects on social anxiety symptoms.

A comparison of the effect of two types of brief psychodynamic group therapy on perfectionism-related attitudes, self-relatedness, and self-esteem

Objective: This randomized controlled trial investigated the efficacy of dynamic relational group therapy (DRT) relative to group psychodynamic supportive therapy (PST) in improving perfectionism-related attitudes and components of the perfectionistic self-relationship. Method: Based on a comprehensive conceptualization of perfectionism, 80 community-recruited, highly perfectionistic individuals were randomly allocated to 12 sessions of group DRT (n = 41; 5 groups) or group PST (n = 39; 5 groups). Patients completed measures of dysfunctional attitudes, self-criticism, self-esteem, and self-reassurance at pre-, mid-, and post-treatment, and six months post-treatment. Results: Multigroup latent growth curve modeling revealed significant (p < .05) decreases in dysfunctional attitudes, concern over mistakes, two types of self-criticism, and self-esteem problems, along with a significant increase in self-reassurance, from pre-treatment to six-month follow-up in both DRT and PST. Moderate-to-large between-group differences favoring DRT over PST were found for dysfunctional attitudes and self-reassurance. A majority of patients in both conditions maintained reliable improvement at six-month follow-up in dysfunctional attitudes, concern over mistakes, and self-criticism focused on inadequacy. Conclusion: Findings provide evidence for the use of psychodynamic group therapy approaches in treating perfectionism-related attitudes and self-relational elements of perfectionism, and support the relative efficacy of DRT for dysfunctional attitudes and self-reassurance.

The double-edged sword effects of leader perfectionism on employees' job performance: the moderating role of self-efficacy

The pursuit of perfection has become a common job requirement for modern organizations against the backdrop of increasingly fierce market competition. Drawing upon appraisal theory of emotion, we develop and test a model delineating the paradoxical role that leader perfectionism plays in predicting employee's job performance. Specifically, we propose that leader perfectionism improves job performance through increased harmonious work passion and simultaneously hinders it through enhanced performance pressure. We further propose self-efficacy as boundary condition, such that the positive path through harmonious work passion is stronger and the negative path through performance pressure is weaker for individuals with higher (vs. lower) levels of self-efficacy. Finding from a three-wave and multisource field study provides support for our hypothesized predictions. Finally, we discuss theoretical and practical implications of this study.

The Relationships Between Body-Related Emotion Intolerance and Restrictive Eating as a Function of Multidimensional Perfectionism

OBJECTIVE

Emotion intolerance and perfectionism are two maintaining mechanisms to eating disorder symptomology. However, it is unclear how these mechanisms relate to one another. This study explored whether perfectionism is a vulnerability factor for facets of restrictive eating in the context of body-related emotions.

METHODS

Female undergraduate students (N = 148) completed questionnaires assessing baseline levels of self-critical perfectionism and personal standards perfectionism. Participants then engaged in an ecological momentary assessment protocol where body-related emotion intolerance and restrictive eating facets (cognitive restraint and behavioral restriction) were assessed over 10 consecutive days. Multilevel modeling and simple slopes analysis were used to explore these moderated relationships. Within-person (Level 1 body-related emotion intolerance) and between-person (Level 2 perfectionism dimensions) relationships were examined.

RESULTS

Based on the analyses, both self-critical and personal standards perfectionism dimensions interacted with body-related emotion intolerance to predict increases in restrictive eating facets.

CONCLUSION

These findings indicate that personal standards perfectionism, though conceptualized as the less maladaptive dimension of perfectionism, should not be ignored when conceptualizing and intervening with restrictive eating. Recommendations are provided on how to refine treatment targets to be more attuned with situations that elicit body-related emotion intolerance.

Exploring the Dimensions of Perfectionism in Adolescence: A Multi-Method Study on Mental Health and CBT-Based Psychoeducation

BACKGROUND

Perfectionism in adolescents can have both adaptive and maladaptive forms, with implications for mental health and school performance. This study aimed to investigate the relationships among perfectionism, mental health factors, and emotional regulation in adolescents and to evaluate the efficacy of psychoeducational interventions.

METHODS

Two studies were conducted: (1) A cross-sectional study (n = 261) examined the correlations among perfectionism, mental health factors, and emotional regulation. (2) An experimental study (n = 115) evaluated the effects of psychoeducation on perfectionism and healthy habits compared with a control group. The measures included questionnaires on perfectionism, depression, anxiety, stress, and emotional regulation.

RESULTS

Study 1 found that maladaptive perfectionism was positively correlated with depression (r = 0.52, p < 0.001), anxiety (r = 0.48, p < 0.001), stress (r = 0.45, p < 0.001), and difficulties in emotional regulation (r = 0.39, p < 0.001). Adaptive perfectionism was negatively correlated with deficits in emotional understanding (r = -0.31, p < 0.05). Study 2 showed that psychoeducational interventions reduced maladaptive perfectionism (mean difference = -5.7, p < 0.05, Cohen's d = 0.62) and depression levels (mean difference = -3.2, p < 0.05, Cohen's d = 0.38) but increased stress in the experimental groups. No significant changes were observed in adaptive perfectionism or the anxiety level.

CONCLUSIONS

These findings highlight the complex relationships among perfectionism, mental health, and emotional regulation in adolescents. Targeted interventions can reduce maladaptive perfectionism and its associated negative effects. Further research is needed on the long-term outcomes and refinement of interventional strategies.

Trajectories of procrastination among Swedish University students over one academic year: a cohort study

BACKGROUND

Procrastination is common among university students and associated with adverse outcomes such as physical and mental health problems. According to the Temporal motivation theory procrastination may vary over time depending on the temporal proximity to goals and deadlines.

AIMS

To determine if mean procrastination levels among university students varies over an academic year, and if trajectories of procrastination are moderated by gender identity, perfectionistic strivings, and/or perfectionistic concerns.

SAMPLE

Swedish university students (n = 1410).

METHODS

The cohort was followed with web-surveys at four time-points over one academic year (Late semester, Mid semester, After semester, and Early semester). Generalized Estimating Equations were used to estimate mean levels of self-rated procrastination at the different time-points.

RESULTS

We found only small fluctuations in mean procrastination levels over the academic year. Participants with high perfectionistic concerns demonstrated higher mean procrastination levels at all time-points, but neither gender identity, perfectionistic concerns nor perfectionistic strivings affected the slope of the mean procrastination trajectories.

CONCLUSIONS

In this cohort of Swedish university students, self-rated procrastination levels were stable over the academic year. Perfectionistic concerns, but not gender identity or perfectionistic strivings, was associated with higher levels of procrastination.

The correlates of appearance focused self-concept: personality traits, self-concept, sociocultural, and early life experience factors

BACKGROUND

Theory and research indicate that an appearance focused self-concept (i.e., placing overriding importance on physical appearance for self-definition and self-worth) plays a role in the etiology and maintenance of disordered eating and eating disorders. Although the consequences of an appearance focused self-concept are palpable, less is known about its correlates. Accordingly, we examined a range of factors that may characterize appearance focused people, including personality traits (perfectionism, impulsivity, sensation-seeking, hopelessness, and anxiety sensitivity), self-concept (global self-esteem and self-concept clarity), sociocultural (thin-ideal, muscular-ideal, general attractiveness internalizations, and perceived pressure to be thin), and early life experiences (adverse childhood experiences, attachment styles) factors.

METHODS

Female undergraduate university students (N = 568; Mage = 19.58, SDage = 4.24) completed a questionnaire battery that included the Beliefs About Appearance Scale, Depressive Experiences Questionnaire-Self-Criticism-6 Scale, Frost-Multidimensional Perfectionism Scale, the Revised Almost Perfect Scale, Substance Use Risk Profile Scale, Self-Concept Clarity Scale, Rosenberg Self-Esteem Scale, Sociocultural Attitudes Towards Appearance Questionnaire-4 Scale, Adverse Childhood Experiences Questionnaire, Experiences in Close Relationships Scale Short Form, and the Dietary Restraint subscale of the Eating Disorders Examination Questionnaire.

RESULTS

Multiple regression analyses were conducted for each set of factors separately and together. For personality traits, perfectionism, impulsivity, and anxiety sensitivity were uniquely associated with appearance focused self-concept. For self-concept, global self-esteem and self-concept clarity were uniquely associated with appearance focused self-concept. For sociocultural, general attractiveness internalization, thin-ideal internalization, and perceived pressure to be thin were uniquely associated with appearance focused self-concept. For early life experiences, attachment anxiety and avoidance were uniquely associated with appearance focused self-concept. In the combined analysis, the various factors explained 54% of the variance in appearance focused self-concept. Impulsivity, global self-esteem, general attractiveness internalization, and perceived pressure to be thin were uniquely associated with appearance focused self-concept.

CONCLUSIONS

Results for global self-esteem were consistent with prior research. Findings for evaluative concerns perfectionism were inconsistent with prior research. We discuss future research directions to examine the link between evaluative concerns perfectionism and appearance focused self-concept. We also discuss how sociocultural factors (general attractiveness internalization and perceived pressure to be thin) and impulsivity may help cultivate an appearance focused self-concept, advancing knowledge on the characteristics of appearance-focused people.

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.

Personal risk factors and types of sport associated with drive for thinness and drive for muscularity in NextGen athletes

Introduction

Professional and student-athletes are at risk of developing symptoms of eating disorders (ED), including drive for thinness and muscularity due to personal risk factors (e.g., low self-esteem) and sport-specific characteristics (e.g., sport requirements). However, limited studies have focused on ED symptoms among NextGen athletes (identified in Canada as élite or relève) who compete at the provincial, national, and international levels but are not yet part of national teams. As such, they have access to fewer financial resources and support from their sport federations, which can create additional stress for these athletes. The present study aimed to identify personal risk factors and types of sports associated with (a) drive for thinness and (b) drive for muscularity in NextGen athletes.

Methods

These athletes (n = 254) aged between 14 and 25 years old completed an online questionnaire. Perfectionism, self-esteem in sport, drive for thinness, and drive for muscularity were, respectively, assessed by the Multidimensional Inventory of Perfectionism in Sport, the Sport State Self-Esteem Scale, the Eating Attitude Test-26, and the Drive for Muscularity Scale. Other personal risk factor (e.g., athletic status) were measured using in-house questions. Each personal risk factor was included in two multiple linear regressions, respectively, to determine which factors were most associated with drive for thinness and drive for muscularity.

Results

Analyses revealed that perfectionist aspirations during training were linked to a stronger desire for thinness. In addition, not being in school or not having a job were also linked to a stronger desire for thinness. Several variables were found to be associated with a greater desire for muscularity: being a male athlete, playing team sport, weight category sport or endurance sport (as opposed to esthetic sport), having elite status, being less satisfied with one's current sporting performance and having higher perfectionist aspirations during training.

Discussion

This study offers initial insights into the factors influencing EDs among NextGen athletes, which provides a foundation for deeper exploration and the creation or modification of targeted interventions. These findings can guide sport organizations in creating guidelines and programs to better support the next generation of national athletes (e.g., create programs to help athletes maintain investments outside).

Recent insights in the correlation between social media use, personality traits and exercise addiction: a literature review

Introduction and aim

The excessive involvement in physical activity without stopping in between sessions despite injuries, the continuous thinking to exercise feeling insane thoughts and experiencing withdrawal symptoms are all characteristics of the Exercise Addiction (EA), an addictive behavior. While the primary exercise addiction is directly caused by compulsive exercise, many studies highlighted the relationship between Eating Disorders (ED) and EA, defining the secondary EA. The correlation between EA, social media use (SMU) and other individual traits remains a relatively underexplored domain. Therefore, this review aimed to examine the latest evidence on the relationship between EA, SMU, and some personality traits such as perfectionism and body image.

Methods

Electronic databases including PubMed, Medline, PsycARTICLES, Embase, Web of Science were searched from January 2019 to October 2023, following the PRISMA guidelines.

Results

A total of 15 articles were examined and consolidated in this review. EA was found to be related to different individual traits such perfectionism, body dissatisfaction, depression, obsessive-compulsive personality disorders. While controversial results were found regarding the relationship between EA and SMU.

Conclusion

The interaction between mental health, exercise addiction and social media use is complex. Excessive engagement in these latter may result in negative mental health consequences despite their potential benefits. Understanding individual differences and developing effective interventions is crucial to promoting healthy habits and mitigating the EA risks, ultimately enhancing mental well-being. Further research should focus on the identification of risks and protective factors with the eventual aim of developing and implementing effective prevention strategies.

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.

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.

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.

Eating behaviours and personality characteristics of clinicians and researchers working in eating disorders

Disturbances in eating behaviours and differences in personality characteristics, such as perfectionism, cognitive flexibility, and obsessive-compulsive behaviours, are commonly reported in individuals with eating disorders (ED) and can influence the development and maintenance of EDs. The presence of these characteristics in ED professionals may also have an influence on their patients. The aim of this study was to gain a better understanding of the presence of these behaviours and characteristics in ED clinicians/researchers (EDCR). This study examined whether these constructs differed amongst 83 EDCR and 47 general mental health clinicians/researchers (MHCR), who completed an online survey, measuring eating disorder symptomology, orthorexia nervosa, perfectionism, cognitive flexibility, and obsessive-compulsive traits. Significantly less dietary restraint, eating concerns and orthorexia nervosa behaviours, but significantly poorer ability to seek out alternative solutions (i.e. a component of cognitive flexibility) were found in the EDCR group compared with the MHCR group. Moderation analysis found no effect of ED history on the relationship between eating behaviours and group. These results suggest that working in the ED field may be a protective factor against developing certain disordered eating behaviours. However, poorer cognitive flexibility may adversely impact EDCRs, and should be considered when carrying out their clinical and/or research duties.

Perfectionism as a predictor of change in digital self-guided interventions for public speaking anxiety in adolescents: A secondary analysis of a four-armed randomized controlled trial

Public Speaking Anxiety (PSA) interventions targeting adolescents exist; however, not all gain improvement. This exploratory study investigated whether PSA interventions resulted in a decrease in perfectionism and whether pre-treatment level and changes in perfectionism moderated the effects on PSA and social anxiety. The sample consisted of 100 adolescents from junior high schools randomized to four groups: 1) VR only (n = 20), 2) VR + online exposure program (n = 20), 3) online psychoeducation and online exposure program (n = 40), 4) waitlist and online psychoeducation program (n = 20). Self-reported symptoms of PSA, social anxiety, and perfectionism were measured at pre, week 3, post, and 3-months follow-up. Level and change in outcome variables were analyzed using latent growth curve modeling. Results revealed that the interventions did not lead to a reduction in perfectionism. Reduction in perfectionism was associated with a larger reduction in all outcome measures from post to follow-up. No interaction was found between pre-treatment perfectionism and PSA symptoms. High pre-treatment levels of perfectionism were associated with poorer outcomes on social anxiety symptoms from post to follow-up for online exposure groups. The results indicate that one should assess and address high pre-treatment levels of perfectionism during PSA interventions.

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.

Did Kant suffer from misophonia?

Misophonia is a disorder of decreased tolerance to specific sounds, often produced by humans but not always, which can trigger intense emotional reactions (anger, disgust etc.). This relatively prevalent disorder can cause a reduction in the quality of life. The causes of misophonia are still unclear. In this article, we develop a hypothesis suggesting that misophonia can be caused by a failure in the organization of the perceived world. The perceived world is the result of both the structure of human thought and the many conditioning factors that punctuate human life, particularly social conditioning. It is made up of abstract symbols that map the world and help humans to orient himself in a potentially dangerous environment. In this context, the role of social rules acquired throughout life is considerable. Table manners, for example, are a set of deeply regulated and controlled behaviors (it's considered impolite to eat with the mouth open and to make noise while eating), which contribute to shape the way the perceived world is organized. So it's not surprising to find sounds from the mouth (chewing etc.) among the most common misophonic sound triggers. Politeness can be seen as an act of obedience to moral rules or courtesy, which is a prerequisite for peaceful social relations. Beyond this example, we also argue that any sound can become a misophonic trigger as long as it is not integrated into the perceived ordered and harmonious world, because it is considered an "anomaly," i.e., a disorder, an immorality or a vulgarity.

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.

Hyperglycaemia aversion in type 1 diabetes: A grounded theory study

OBJECTIVE

Very little is known about the circumstances under which hyperglycaemia aversion develops and is maintained. The present study aimed to identify psychological factors involved in the process of hyperglycaemia aversion and to understand how it affects people's self-management of type 1 diabetes.

DESIGN

Qualitative, in-depth interviews were used.

METHODS

A constructivist grounded theory study, using semi-structured participant interviews, was undertaken to build a theoretical model of the process of hyperglycaemia aversion.

RESULTS

Eighteen participants were interviewed. Fifteen were considered hyperglycaemia averse and included in the analysis. A theoretical model was developed to describe and explain processes involved in hyperglycaemia aversion. Many participants held very high standards for themselves and often had a strong preference for control. While some participants described anxiety associated with higher blood glucose, the most proximal driver of their approach was self-criticism and frustration associated with not meeting their own high standards for blood glucose. A number of attentional processes and beliefs, mostly related to hypoglycaemia, maintained and reinforced their blood glucose preference. Diabetes technology served as an enabler, raiser of standards, and additional critical judge of participants' hyperglycaemia aversion.

CONCLUSIONS

The trans-diagnostic concept of emotional over-control is used to understand the proposed model of processes of hyperglycaemia aversion. The present study offers new insight which will aid clinicians in identifying and supporting those who may be at risk of psychological distress and harm associated with a preference for avoidance of higher blood glucose levels.

Why does a leader's other-oriented perfectionism lead employees to do bad things? Examining the role of moral disengagement and moral identity

Introduction

Moral disengagement is an essential concept in organizational behavioral ethics, as it is strongly related to employee behaviors and attitudes. What is not clear, however, is which leader traits are directly associated with employees' moral disengagement and which are indirectly associated with unethical behavior. This study draws on a social cognitive perspective that links leaders' other-oriented perfectionism (LOOP) with unethical employee behavior. Specifically, we propose that LOOP provides employees with excuses and encouragement to engage in unethical pro-organizational behavior (UPB).

Methods

We analyzed data collected from 266 full-time employees at two-time points, and used mediated and moderated structural equation models to test the hypotheses, and the findings largely support our claims.

Results

The results suggest that LOOP effectively promotes employees' involvement in UPB. Moderated mediation tests suggest that the positive indirect impact of LOOP on employees' unethical behavior via moral disengagement was attenuated by higher employees' moral identity.

Discussion

In summary, the results indicate that when leaders emphasize only perfection and make unrealistic demands on their employees, the latter perceive that engaging in unethical behavior is demanded by the leader, that the responsibility is not theirs, and thus they are more willing to engage in unethical behavior. This study discusses the implications of these findings from both practical and theoretical perspectives.

Associations of rumination, behavioral activation, and perceived reward with mothers' postpartum depression during the COVID-19 pandemic: a cross-sectional study

Introduction

The COVID-19 pandemic has led to increased social isolation for mothers, and rumination exacerbates postpartum depression in mothers with poor social support. Although behavioral activation can help to decrease their depressive symptoms, the mechanism by which behavioral activation reduces postpartum depression remains unclear.

Methods

We examined the effects of rumination and behavioral activation on depression in postpartum women by examining a model mediated by subjective reward perception. A questionnaire was administered to 475 postpartum women (Age: Mean = 30.74 years, SD = 5.02) within 1 year of childbirth using an Internet survey. The measurements included perinatal depression, rumination, and behavioral activation, and we assessed environmental reward. To control for confounding variables, we assessed psychiatric history, social support, parenting perfectionism, and COVID-19 avoidance.

Results

Eighty-four (17.68%) mothers had possible postpartum depression. The covariance structure analysis showed that not only was there a direct positive path from rumination to postnatal depression but also a negative path via reward perception.

Discussion

This finding indicated that the COVID-19 pandemic could have increased depression in many of the mothers. Rumination not only directly relates to postpartum depression, but it could also indirectly relate to postpartum depression by decreasing exposure to positive reinforcers. In addition, having a history of psychiatric illness increases the effect of rumination on postpartum depression. These findings suggest that psychological interventions are needed to reduce rumination and increase contact with positive reinforcements to reduce postpartum depression, especially for high-risk groups.

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).

Investigating the Theory of Clinical Perfectionism in a Transdiagnostic Eating Disorder Sample Using Network Analysis

Eating disorders are deadly psychiatric illnesses, with treatments working for less than half of individuals who seek treatment. The transdiagnostic theory of eating disorders proposes that eating disorders share similar maintaining symptoms, such as what this theory calls clinical perfectionism (i.e., high levels of concern over mistakes and personal standards). However, it has been difficult to examine the interrelationship of specific aspects of perfectionism, beyond assessing moderation effects, which have generally not found support for the theory of clinical perfectionism in eating disorders. Thus, we used network analysis to test the theory of perfectionism by testing the interrelationships between maladaptive perfectionism facets (concern over mistakes, personal standards, parental criticism, parental expectations, and personal standards) and eating disorder symptoms in 397 individuals diagnosed with an eating disorder. Concern over mistakes was a central symptom and demonstrated the strongest interrelationships with eating disorder symptoms compared to the other aspects of perfectionism, connecting to eating concerns and cognitive restraint. Objective binge eating had a strong negative connection to personal standards. We identified specific central symptoms and illness pathways of perfectionism, which partially supports the theory of clinical perfectionism. Results, if replicated, may suggest that concern over mistakes might be best reconceptualized as part of eating disorder pathology and be targeted to improve treatment outcomes for eating disorders.

Self-compassion, perfectionism, impostor phenomenon, stress and anxiety in patients with localized provoked vulvodynia

Studies have shown that psychological distress has a role in the symptomology of localized provoked vulvodynia. Therefore, psychosocial support has been presented as a valuable part of the treatment. However, little is known about which psychological variables that coincide with localized provoked vulvodynia. The purpose of this study was to identify qualities of psychological distress in patients with localized provoked vulvodynia. Patients with localized provoked vulvodynia were consecutively recruited to participate in this cross-sectional questionnaire-based study. Participants completed a self-report questionnaire measuring perfectionism, impostor phenomenon, self-compassion, anxiety and perceived stress. A sample of 30 patients were included. Questionnaire results suggestive of perfectionism was seen in 63%, impostor phenomenon in 80%, low self-compassion in 27%, anxiety in 43% and perceived stress in 23% of the participants. The level of self-compassion was higher in patients in a committed relationship. The investigated qualities appear to be more common in patients with localized provoked vulvodynia than in comparable groups. Impostor phenomenon and perfectionism were particularly common, with more than half of the study population scoring above the cutoff for clinical significance. This motivates research to investigate if interventions targeting impostor phenomenon and perfectionism, may aid in the treatment of localized provoked vulvodynia.

An experimental investigation of biased attention in non-suicidal self-injury: The effects of perfectionism and emotional valence on attentional engagement and disengagement

BACKGROUND AND OBJECTIVES

Theoretical models of non-suicidal self-injury (NSSI) propose that individuals who self-injure may find their attention more strongly captured by negative emotion, and that this intensifies distress which leads to episodes of NSSI. Elevated perfectionism is associated with NSSI, and when an individual is highly perfectionistic, a focus on perceived flaws/failures may increase risk of NSSI. We explored how history of NSSI and trait perfectionism are associated with different types of attention bias (engagement vs. disengagement) to stimuli that differ in emotional valence (negative vs positive) and perfectionism relevance (relevant vs irrelevant).

METHODS

Undergraduate university students (N = 242) completed measures of NSSI, perfectionism, and a modified dot-probe task to measure attentional engagement with and disengagement from both positive and negative stimuli.

RESULTS

There were interactions between NSSI and perfectionism in attention biases. Amongst individuals who engage in NSSI, those with elevated trait perfectionism exhibit speeded responding to and disengagement from emotional stimuli (both positive and negative). Furthermore, individuals with a history of NSSI and elevated perfectionism were slower to respond to positive stimuli, and faster to negative stimuli.

LIMITATIONS

This experiment was cross-sectional in design so does not provide information about temporal ordering of these relationships, and given the use of a community sample, would benefit from replication in clinical samples.

CONCLUSIONS

These findings lend support to the emerging idea that biased attention plays a role in how perfectionism is associated with NSSI. Future studies should replicate these findings using other behavioural paradigms and diverse samples.

Investigating differences in cognitive flexibility, clinical perfectionism, and eating disorder-specific rumination across anorexia nervosa illness states

INTRODUCTION

Cognitive inflexibility, clinical perfectionism, and eating disorder (ED)-specific rumination are common characteristics reported in anorexia nervosa (AN) and may contribute to the maintenance of the illness. It is suggested that clinical perfectionism and rumination may mediate the relationship between cognitive flexibility and AN pathology; however, research to date has not investigated all these factors together. The aim of the current study was to explore the relationships between these factors and how they may relate to ED symptoms in AN.

METHODS

Participants included 15 women with a current diagnosis of AN, 12 women who had a past diagnosis of AN and were currently weight-restored, and 15 healthy controls (HCs).

RESULTS

The results revealed that participants with both acute and weight-restored AN self-reported poorer cognitive flexibility than HCs, but the groups did not differ in performance on objective assessments of cognitive flexibility. Participants with AN also reported significantly greater clinical perfectionism and ED-specific rumination than HC. A parallel mediation analysis found that ED-specific rumination mediated the relationship between subjective cognitive flexibility and ED symptoms. Further, subjective cognitive flexibility directly influenced ED symptoms. However, the mediation model was not significant for objective cognitive flexibility.

CONCLUSION

The findings of this study have implications for potential treatment barriers and factors which might contribute to the risk of relapse.

A conditional process model of perfectionism, goal-realization, and post-competition mood

Research has recently begun to examine the relationship between multidimensional perfectionism and athletes' post-competition mood. However, to date, there have been few attempts to examine the interaction between dimensions of perfectionism or model possible explanatory processes. To address these limitations, in the current study we tested a novel conditional process model whereby the relationship between perfectionistic strivings and post-competition affect was mediated by the degree to which goals were considered to have been met (goal-realization) and that this indirect effect was, in turn, moderated by levels of perfectionistic concerns. We tested this model in a sample of 251 athletes who took part in a "Runmageddon" event - a cross-country obstacle race. Athletes completed measures of perfectionism (perfectionistic strivings and perfectionistic concerns) before the race and measures of goal-realization and mood (tense arousal, energetic arousal, and hedonic tone) between 24 and 48 h after the race. Analyses revealed that perfectionistic strivings were indirectly linked to a more unpleasant post-competition mood (higher tense arousal and lower hedonic tone) via perceptions of lower goal-realization. In addition, these two indirect effects were statistically significant only when perfectionistic concerns were medium and high. The results support the proposed conditional model and suggest the interplay between dimensions of perfectionism is important for athletes' post-competition mood, and the level of perfectionistic concerns, especially.

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.

Multidimensional Perfectionism and Facial Symmetry, Attractiveness and Approachability: Comparing Those With High Versus Low Dysmorphic Concerns

Concerns pertaining to one's physical appearance or specific body parts is not uncommon in the community. Whether such dissatisfaction is related to superior (or inferior) face perception abilities, or interacts with related constructs, such as perfectionism, is unknown. The current study aimed to investigate whether multidimensional perfectionism (e.g. involving concern over mistakes or doubts over actions) and facial ratings differed in those with high versus low dysmorphic concerns (i.e. excessive preoccupation about perceived physical flaws). Respondents (N = 343) from the community took part in an online study, comprising questionnaires assessing dysmorphic concerns and perfectionism. They also completed a face perception task involving symmetry, attractiveness and approachability ratings for a series of faces, some of which had been digitally manipulated to yield differing degrees of symmetry. Respondents were divided into those with high (n = 147) versus low (n = 196) dysmorphic concerns. Group comparisons using analyses of variance were conducted. Those with high dysmorphic concerns exhibited significantly elevated overall perfectionism (as well as on facets involving concern over mistakes, personal standards, parental perceptions and doubts over actions). No significant group differences were uncovered for the face perception task, involving ratings of symmetry, attractiveness and approachability. Perfectionism differences existed in a non-clinical sample with high dysmorphic concerns, though further work is needed to elucidate consistent patterns regarding perfectionism facets. More research examining face perception deficits on the clinical end of the body image spectrum, such as in those with body dysmorphic disorder, as well as utilising alternate task versions involving self-referential stimuli, are recommended.

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.

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.

Transdiagnostic Approach and Obsessive Compulsive Disorder

The categorical approach of traditional psychiatric nosology has been a forceful approach for a very long time for explaining psychological disorders which are defined by symptom based diagnostic categories. However, in recent years, the importance of the "transdiagnostic" approach which is a new classification system is increasing. The transdiagnostic approach aims to examine dimensionally the common cognitive, behavioral, interpersonal and biological processes underlying many psychopathologies away from the categorical approach that classifies psychopathologies according to observable symptoms. This approach intends to treat the disorders through the common underlying processes and risk factors, thus heterogeneous and comorbid symptoms are better addressed and diagnostic categories that may change during treatment are avoided. In this review study, the current problems in diagnosing based on classification and gaps in the field were examined, and the approach itself was proposed as a solution. RDoC (Research Domain Criteria) which is a new classification system for psychiatric disorders within the scope of the approach, has created a new structure using modern research approaches in genetics, neuroscience and behavioral sciences. In the present study, the definition and emergence of the transdiagnostic approach, obsessive compulsive disorder and RDoC in the context of transdiagnostic approach and transdiagnostic treatment are explained. This review is intended to be a resource for both basic psychopathology research and the development of treatment methods within the framework of a transdiagnostic approach.

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.

Feedback-related negativity in perfectionists: An index of performance outcome evaluation

It has been suggested that maladaptive perfectionists are more prone to concern over their performance outcomes than adaptive perfectionists. Performance outcome evaluation is reflected in the amplitude of feedback-related negativity (FRN) in brain electroencephalography (EEG). Hence, the amplitude of the FRN after receiving unfavorable feedback indicating a negative performance outcome may reflect personality characteristics. In other words, EEG could be a better marker of personality characteristics than self-report measures. However, the FRN component has not yet been investigated between different types of perfectionists. In the present study, group differences in the FRN were examined between two groups of adaptive and maladaptive perfectionists and a group of non-perfectionists during a monetary gambling task. We observed a larger FRN amplitude for adaptive perfectionists than for maladaptive perfectionists. This finding is consistent with previous reports that reward prediction error is reflected in the amplitude of the FRN. This difference in FRN could be interpreted as the pessimistic outcome expectation biases in maladaptive perfectionists.

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.

Mechanisms Linking Perfectionism and Social Anxiety: The Role of Hostility and Disqualification of Positive Social Outcomes

While considerable research has focused on maladaptive perfectionism as a risk factor for social anxiety, little attention has been given to the mechanisms that mediate the effects. We integrated perfectionism with the bivalent fear of evaluation model of social anxiety to investigate 2 hypothesized mechanisms: hostile attribution bias and disqualification of positive social outcomes (DPSO). Specifically, we hypothesized that individuals with maladaptive perfectionism develop hostile attribution biases which then lead to DPSO, which in turn predisposes them to social anxiety. Participants were 242 individuals from the general population who completed measures of perfectionism, hostile attribution bias, DPSO, and social anxiety. A test of multiple mediators using bootstrapping supported the hypothesized multiple mediator models. The results suggested that maladaptive perfectionism predisposes an individual to social anxiety through hostile attribution bias and DPSO. The results further suggested that DPSO but not hostile attribution bias operates as an individual mediator in the perfectionism-social anxiety relationship. The findings from this study provide support for the bivalent fear of evaluation model of social anxiety; however, the use of a cross-sectional design limited our ability to find true cause-and-effect relationships.

Identifying transdiagnostically relevant risk and protective factors for internalizing psychopathology: An umbrella review of longitudinal meta-analyses

Internalizing mental disorders are highly comorbid with one another, and evidence suggests that etiological processes contributing to these disorders often overlap. This systematic umbrella review aimed to synthesize meta-analytic evidence from observational longitudinal studies to provide a comprehensive overview of potentially modifiable risk and protective factors across the depressive, anxiety, and eating disorder psychopathology domains. Six databases were searched from inception to August 2022. Only meta-analyses of longitudinal studies that accounted for baseline psychopathology (either via exclusion of baseline cases or statistical adjustment for baseline symptoms) were included. Methodological quality of meta-analyses was evaluated using the AMSTAR 2, and quality of evidence for each analysis was rated using GRADE. Study selection, quality assessment, and data extraction were conducted in duplicate by independent reviewers. The protocol for this review was registered with PROSPERO (CRD42020185575). Sixty-one meta-analyses were included, corresponding to 137 meta-analytic estimates for unique risk/protective factor-psychopathology relationships. Most potential risk/protective factors, however, were examined only in relation to depressive psychopathology. Concern over mistakes and self-esteem were the only risk and protective factors, respectively, identified as statistically significant across depressive, anxiety, and eating disorder psychopathology domains. Eight risk factors and four protective factors also emerged as having transdiagnostic relevance across depressive and anxiety domains. Results suggest intervention targets that may be valuable for preventing/treating the spectrum of internalizing psychopathology and reducing comorbidity. However, few factors were identified as transdiagnostically relevant across all three internalizing domains, highlighting the need for more research investigating similar sets of potential risk/protective factors across internalizing domains.

Coming of age: A reflection of the first 21 years of cognitive behaviour therapy for perfectionism

It has been 21 years since the publication of the cognitive behavioural model of clinical perfectionism that underpins cognitive behaviour therapy (CBT) for perfectionism. The notion of clinical perfectionism and CBT for perfectionism has been controversial. Despite 15 randomised controlled trials which have demonstrated the efficacy of CBT for perfectionism in reducing perfectionism and symptoms of anxiety, depression and eating disorders, strong responses to this work continue to appear in the literature. In this article, we examine the evolution and controversy surrounding clinical perfectionism, the efficacy of CBT for perfectionism, and future directions for the concept of perfectionism and its treatment. Future research should aim to provide independent evaluations of treatment efficacy, compare CBT for perfectionism to active treatments, conduct dismantling trials to examine the effective components of treatment, and examine the causal processes involved in perfectionism. We provide recommendations for future pathways to support innovation in theory, understanding, and treatment of perfectionism with a view towards improving clinical outcomes.

Perfectionism-related variations in error processing in a task with increased response selection complexity

Perfectionists strive for a flawless performance because they are intrinsically motivated to set and achieve high goals (personal standards perfectionism; PSP) and/or because they are afraid to be negatively evaluated by others (evaluative concern perfectionism; ECP). We investigated the differential relationships of these perfectionism dimensions with performance, post-response adaptation, error processing (reflected by two components of the event-related potential: error/correct negativity - Ne/c; error/correct positivity - Pe/c) and error detection. In contrast to previous studies, we employed a task with increased response selection complexity providing more room for perfectionistic dispositions to manifest themselves. Although ECP was related to indicators of increased preoccupation with errors, high-EC perfectionists made more errors than low-EC perfectionists. This observation may be explained by insufficient early error processing as indicated by a reduced Ne/c effect and a lack of post-response adaptation. PSP had a moderating effect on the relationship between ECP and early error processing. Our results provide evidence that pure-EC perfectionists may spend many of their cognitive resources on error-related contents and worrying, leaving less capacity for cognitive control and thus producing a structural lack of error processing.

A Pragmatic Randomized Controlled Trial Targeting Perfectionism in Young Adolescents

Perfectionism has adverse impacts on mental health and academic outcomes. We evaluated a 5-lesson classroom intervention for young adolescents delivered by teachers for impact on perfectionism, well-being, self-compassion, academic motivation and negative affect, at post-intervention and 3-month follow-up. Classes (N = 636 students, M _age = 13.68, SD = 0.60) were randomized to intervention (n = 343) or classes as usual (n = 293). Data were analyzed using linear mixed models adjusted for baseline observation and clustering. At post-intervention no differences were found between the groups. At 3-month follow-up, anxiety showed a significant increase in the control group with no increase in the intervention group (d = 0.23; 95% CI: 0.05, 0.40); females in the control group had a significant decrease in well-being from post-intervention to 3 month follow-up compared to the intervention group (d = 0.33; 95% CI: 0.08, 0.58); students with high levels of perfectionistic concerns in the intervention had significantly lower perfectionistic strivings at 3 month follow-up than the control group ((d = 0.34, 95% CI: 0.19, 0.49). This intervention shows promising results when delivered by teachers. Australian New Zealand Clinical Trials Registry (ANZCTR) Trial Number: ACTRN12621000457842 (April 19, 2021).

Supplementary Information

The online version contains supplementary material available at 10.1007/s12310-022-09540-3.

Perfectionism: Its Structure, Transdiagnostic Nature, and Cognitive Behavioral Therapy

The term perfectionism is often characterized by insisting that everything should be perfect and flawless, believing in only one truth, and having difficulty transforming perspectives and thoughts. Although perfectionism is not a newly introduced concept in the literature, it has recently become one frequently aired both in research and daily life. The popularity of the concept in empirical studies stems from both its dual nature and its alleged roles in the origin, emergence, retention, and treatment of various psychological disorders. Indeed, despite the abundance of evidence that perfectionism is multifaceted within two major dimensions (perfectionist strivings and perfectionist concerns), it is still debated that the dimensions in different numbers better represent the construct. In addition, the relevant literature hosts diverse views and criticisms about which sub-dimensions the two higher-order dimensions will consist of, whether the conceptual content of a combination of these sub-dimensions is positive or negative, and how to calculate the total impact of the sub-dimensions. On the other hand, previous research consistently addressed the relationship of perfectionism with different psychopathologies and comorbidities. In this respect, it is also deemed important to discuss perfectionism in psychotherapy because even settling perfectionist traits may bring about improvements in more than one disorder associated with perfectionism. Thus, the Cognitive Behavioral Approach (CBT) conceptualized perfectionism (clinical perfectionism) and presented techniques for therapy. Moreover, the evidence is also proliferating for the efficiency of CBT for perfectionism. Therefore, in this article, the current literature on the structure, transdiagnostic nature and cognitive behavioral therapy of perfectionism has been reviewed.

Computerized treatment of perfectionism through mistake making: A preliminary study

BACKGROUND AND OBJECTIVES

Perfectionism has important implications for self-worth, personal standards, and psychopathology. The aim of this study was to test the efficacy of a novel two-week, computerized, exposure-based treatment for perfectionism (ETP).

METHODS

Seventy-one university students with elevated perfectionism were randomized to either the ETP group (n = 36) or the waitlist (WL) control group (n = 35). The ETP group was asked to complete the intervention at home, every three days for two weeks for a total of five treatment sessions. The tasks in the ETP condition were engineered to have participants repeatedly make mistakes. All participants returned two weeks after the baseline visit for a post-treatment assessment.

RESULTS

Compared to WL, ETP led to lower overall perfectionism, concern over mistakes, personal standards, depressive symptoms, social anxiety symptoms, and error sensitivity at post-treatment. No effects of treatment were found on trait anxiety, obsessive-compulsive symptoms, or eating disorder symptoms.

LIMITATIONS

Participants were university students of similar age and education level, which restricts generalizability. Additionally, the study relied on a waitlist control condition.

CONCLUSIONS

This study provided preliminary evidence for a novel online intervention for perfectionism.

The clinical perfectionism questionnaire: psychometric properties of the Italian version in patients with eating disorders

BACKGROUND

Problematic perfectionism has been traditionally conceptualized as a multidimensional construct, and specific instruments have been developed to capture its various dimensions. However, the Clinical Perfectionism Questionnaire (CPQ) was recently designed to measure a unidimensional construct called "clinical perfectionism", but the questionnaire has not yet been validated in Italian.

AIM

This study aimed to propose the Italian version of the CPQ and examine its psychometric properties.

METHODS

The CPQ was translated into Italian using translation and back-translation procedures. Then, it was administered to 188 Italian-speaking patients with eating disorders and 126 non-eating disorder group (excluded if the Italian version of the Eating Attitudes Test-26 was ≥ 20). The clinical group also completed the Italian versions of the Frost Multidimensional Perfectionism Scale (FMPS), the Eating Disorder Examination Questionnaire (EDE-Q), and the Brief Symptom Inventory (BSI).

RESULTS

Confirmatory factor analysis revealed a good fit for the bifactor structure of the 10-item version. Internal consistency was high for the general clinical perfectionism factor, and test-retest reliability was good. Convergent validity was acceptable for the general clinical perfectionism and 'overvaluation of striving' group factors. The CPQ showed significantly higher scores in patients with eating disorders than in the non-eating disorder group.

CONCLUSIONS

Overall, the study demonstrated the good psychometric properties of the Italian version of the CPQ, and validated its use in Italian-speaking patients with eating disorders. Although further research is required, the CPQ has promising evidence as a reliable and valid measure of clinical perfectionism in its Italian version.

LEVEL OF EVIDENCE

Level V, Descriptive study.

The role of compulsive exercise in the relationship between perfectionism and eating disorder pathology in underweight adolescents with eating disorders

Perfectionism has a strong association with eating disorders. Research in non-clinical adults has suggested that perfectionism has both direct and indirect effects on eating disorder symptoms, and that compulsive exercise is a potential mediator. The aim of this study was to understand whether perfectionism is associated with eating disorder symptoms, both directly and indirectly through compulsive exercise in underweight adolescents with eating disorders. Participants were 149 female adolescents (M = 14.90 years, age range 13-17) with eating disorders from the Helping to Outline Paediatric Eating Disorders (HOPE) Project, an ongoing, registry study of individuals consecutively referred individuals to a statewide eating disorder service. The majority had a diagnosis of anorexia nervosa restricting type (66 %), followed by unspecified feeding or eating disorder (21 %), and anorexia nervosa binge-eating purging type (13 %). To test the model, path analyses with bootstrapping were conducted. All paths were statistically significant, including the indirect effect from perfectionism to eating disorder pathology via the mediator of compulsive exercise, and the direct effect of perfectionism on eating disorder pathology. Overall, this research provides further evidence that compulsive exercise may be one factor that can explain the relationship between perfectionism and eating disorder symptoms. Future research should seek to determine the relative efficacy of approaches for the treatment of eating disorders in adolescents which target perfectionism and compulsive exercise.