Clinical Perfectionism Research Articles

Cognitive Errors as Predictors of Adaptive and Maladaptive Perfectionism in Children

Cognitive distortions such as dichotomous evaluation of performance, selectively focusing on perceived failures, and discounting successes are proposed to be key maintaining mechanisms in clinical perfectionism, but no existing research has investigated the relationship between perfectionism and cognitive errors in children. The current study assessed the associations between dimensions of perfectionism as assessed by the Adaptive/Maladaptive Perfectionism Scale (AMPS) and children’s cognitive errors controlling for negative and positive affect to provide information about cognitive features associated with perfectionism in children and construct-related evidence for the AMPS. A non-clinical sample of 204 children completed the AMPS, the Children’s Negative Cognitive Errors Questionnaire, and measures of positive and negative affect. The AMPS sensitivity to mistakes scale was correlated robustly with catastrophizing, overgeneralization, personalizing, and selective abstraction. Cognitive errors were significant predictors of maladaptive perfectionism even after controlling for negative affect. However, cognitive errors did not predict adaptive perfectionism after controlling for positive affect. These findings highlight the role of negative thinking styles in maladaptive perfectionism in children and point to the potential usefulness of interventions that focus jointly on maladaptive perfectionism and negative cognitive styles.

Perfectionism and its relation to overevaluation of weight and shape and depression in an eating disorder sample

To examine the relative association between psychopathology (depression and overevaluation of weight and shape) and measures of perfectionism and self-criticism in an eating disorder sample. Participants (n = 39) completed measures of independent variables (perfectionism and self-criticism) and dependent variables (depression and overevaluation of weight and shape). Simultaneous multiple regression analyses suggest that clinical perfectionism has a unique association with depression. Self-criticism and clinical perfectionism had a stronger association with overevaluation of weight and shape than other measures of perfectionism. Clinical perfectionism and self-criticism may be of more relevance than existing measures of multidimensional perfectionism in terms of explaining maintenance of depression and overevaluation of weight and shape.

Transdiagnostic Cognitive-Behavioral Therapy for Patients With Eating Disorders: A Two-Site Trial With 60-Week Follow-Up

The aim of this study was to compare two cognitive-behavioral treatments for outpatients with eating disorders, one focusing solely on eating disorder features and the other a more complex treatment that also addresses mood intolerance, clinical perfectionism, low self-esteem, or interpersonal difficulties. A total of 154 patients who had a DSM-IV eating disorder but were not markedly underweight (body mass index over 17.5), were enrolled in a two-site randomized controlled trial involving 20 weeks of treatment and a 60-week closed period of follow-up. The control condition was an 8-week waiting list period preceding treatment. Outcomes were measured by independent assessors who were blind to treatment condition. Patients in the waiting list control condition exhibited little change in symptom severity, whereas those in the two treatment conditions exhibited substantial and equivalent change, which was well maintained during follow-up. At the 60-week follow-up assessment, 51.3% of the sample had a level of eating disorder features less than one standard deviation above the community mean. Treatment outcome did not depend on eating disorder diagnosis. Patients with marked mood intolerance, clinical perfectionism, low self-esteem, or interpersonal difficulties appeared to respond better to the more complex treatment, with the reverse pattern evident among the remaining patients. These two transdiagnostic treatments appear to be suitable for the majority of outpatients with an eating disorder. The simpler treatment may best be viewed as the default version, with the more complex treatment reserved for patients with marked additional psychopathology of the type targeted by the treatment.

Facets of self-oriented and socially prescribed perfectionism and feelings of pride, shame, and guilt following success and failure

According to traditional views of perfectionism, perfectionists are prone to experience shame and guilt and unable to experience pride. However, these views ignore that perfectionism is multidimensional and multifaceted. Consequently, the present study adopted a multidimensional approach and investigated in a sample of N = 67 university students how four facets of perfectionism – perfectionistic striving, importance of being perfect, others’ high standards, conditional acceptance – were related to pride, shame, and guilt following experimental manipulation of success and failure. Results showed that perfectionistic striving was associated with more pride following success, whereas all facets were associated with more shame and guilt following failure, particularly conditional acceptance. Furthermore, conditional acceptance was associated with less pride regardless of success or failure. Supporting views of perfectionism that differentiate between adaptive and maladaptive aspects, the findings show that individuals who strive for perfection experience more pride after success. Whereas all facets of perfectionism were related to more shame and guilt after failure, only individuals who think that others’ approval is conditional upon being perfect seem to be unable to experience pride. The findings demonstrate that perfectionistic striving per se is not maladaptive, but conditional acceptance may be an important factor in maladaptive and clinical perfectionism.

A preliminary evaluation of cognitive‐behaviour therapy for clinical perfectionism: A case series

The construct of 'clinical perfectionism' has been developed in response to criticisms that other approaches have failed to yield advances in the treatment of the type of self-oriented perfectionism that poses a clinical problem. The primary aim of this study was to conduct a preliminary investigation into the efficacy of a theory-driven, cognitive-behavioural intervention for 'clinical perfectionism'. A multiple baseline single case series design was used. A specific, 10-session cognitive-behavioural intervention to address clinical perfectionism in eating disorders was adapted to allow its use in nine patients referred with a range of axis I disorders and clinical perfectionism. The intervention led to clinically significant improvements in self-referential perfectionism from pretreatment to follow-up for six of the nine participants on two perfectionism measures and for three of the nine participants on the measure of clinical perfectionism. Statistically significant improvements from pre- to post-intervention for the group as a whole were found on all three measures. The improvements were maintained at follow-up. The finding that clinical perfectionism is improved in the majority of participants is particularly encouraging given that perfectionism has traditionally been viewed as a personality characteristic resistant to change. These preliminary findings warrant replication in a larger study.

A randomised controlled trial of cognitive-behaviour therapy for clinical perfectionism: A preliminary study

Perfectionism can be a problem in its own right and it can impede the progress of treatment of Axis I disorders. This study reports on a preliminary randomised controlled trial of cognitive-behaviour therapy (CBT) for “clinical perfectionism”. Twenty participants were randomly assigned to either immediate treatment (IT) (n=10) or a waitlist (NL) (n=10). Treatment consisted of ten sessions of CBT over eight weeks. Two participants did not complete the follow-up assessments (10%). Fifteen of the original 20 participants (75%) were clinically significantly improved after treatment and the effect size was large (1.8). Treatment gains were maintained at 8-week and 16-week follow-up.

Clinical Perfectionism: A Preliminary Qualitative Analysis

A cognitive-behavioural analysis of clinical perfectionism has recently been proposed. The aim of this study was to explore the phenomenology of clinical perfectionism and its putative maintaining mechanisms. Of the 21 participants, 15 were judged to have the core psychopathology of clinical perfectionism. The data obtained were largely consistent with the model. In particular, self-imposed dysfunctional standards, continual striving and adverse consequences appeared to be highly salient features of those people who had the core psychopathology of clinical perfectionism but not of those without. A number of other possible maintaining factors not originally described in the model were also identified.

Personal standards and evaluative concerns dimensions of “clinical” perfectionism: A reply to Shafran et al. (2002, 2003) and Hewitt et al. (2003)

Shafran, Cooper, and Fairburn (2002, 2003) provided a cognitive-behavioral analysis of “clinical” perfectionism, a construct they considered to involve both the determined pursuit of self-imposed standards and extremely vulnerable self-evaluation. They argued against a multidimensional perspective to studying perfectionism. We respond to Shafran et al. (2002, 2003) and Hewitt, Flett, Besser, Sherry, and McGee's (2003) reply to Shafran et al. (2002) by considering the theoretical, empirical, and clinical implications of findings identifying two higher-order dimensions of perfectionism reflecting personal standards (PS) and self-critical evaluative concerns. Analyses of data from two diverse study groups, a college student sample ( N=527) and a clinical sample of patients with binge eating disorder ( N=236), revealed that self-criticism accounts for the relation between perfectionism measures and depressive, anxious, and eating disorder symptoms. We conclude that possessing high PS is not by itself maladaptive. Rather, self-critical evaluative tendencies are more relevant than PS to the critical processes Shafran et al. (2002) suggested contribute to the maintenance of clinical perfectionism.

CLINICAL PERFECTIONISM: A CASE REPORT

The aim of this case report is to describe the impact of an intervention for clinical perfectionism, derived from a new cognitive-behavioural analysis, in a patient with binge-eating disorder. It was hypothesized that clinical perfectionism was contributing to the maintenance of the eating disorder, and on this basis it was predicted that reducing clinical perfectionism would improve her eating disorder psychopathology. Standardized independent assessments were found to be consistent with this hypothesis, in that clinical perfectionism and eating disorder psychopathology improved over an eight-session intervention and improvements were largely maintained at 5-month follow-up.

“Clinical perfectionism” is not “multidimensional perfectionism”: A reply to Hewitt, Flett, Besser, Sherry & McGee

“Clinical perfectionism” is not “multidimensional perfectionism”: A reply to Hewitt, Flett, Besser, Sherry & McGee

Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment

This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders. Two separate but interrelated lines of argument are developed. One is that the leading evidence-based theory of the maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms. Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes. Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders. Together, these two lines of argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa. In the final sections of the paper we describe a transdiagnostic treatment derived from the new theory, and we consider in principle the broader relevance of transdiagnostic theories of maintenance.

Clinical perfectionism: a cognitive–behavioural analysis

This paper reviews the characteristics of clinical perfectionism and proposes a new definition of the phenomenon. It is suggested that the defining feature of clinically significant perfectionism is the overdependence of self-evaluation on the determined pursuit (and achievement) of self-imposed personally demanding standards of performance in at least one salient domain, despite the occurrence of adverse consequences. It is suggested that such clinical perfectionism is maintained by the biased evaluation of the pursuit and achievement of personally demanding standards. Specifically, it is suggested that people with perfectionism react to failure to meet their standards with self-criticism. If they do meet their standards, the standards are re-evaluated as being insufficiently demanding. Anorexia nervosa and bulimia nervosa are considered to have a particular relationship to perfectionism, with both disorders often being direct expressions of perfectionism. Under these circumstances self-evaluation is dependent on the pursuit and attainment of personally demanding standards in the domain of control over eating, shape and weight. The implications of this analysis for research and practice are considered.