This week's journal club article, "Perfectionism as a transdiagnostic process: A clinical review" (Egan, Wade, & Shafran 2011) can be found here.
A few definitions to get us started:
- Transdiagnostic – a risk factor or maintaining mechanism for multiple disorders
- Clinical perfectionism – “overdependence on self-evaluation on the determined pursuit of personally demanding, self-imposed standards in at least one high salient domain, despite adverse consequences” (Shafran 2002). Perfectionism is maladaptive when a person bases their self-worth on achievement.
Perfectionism: personality characteristic, set of cognitive behavioral features, symptom of psychopathology, or process?
- Process – an aspect of cognition or behavior that may contribute to the maintenance of a psychological disorder
Measures/Dimensions of Perfectionism
- Frost Multidimensional Perfectionism Scale (FMPS)
- Personal Standards (PS)
- Concern over Mistakes (CM)
- Doubts about Actions (DA)
- Parental Expectations (PE)
- Parental Criticism (PC)
- Organization (O)
- Hewitt Multidimensional Perfectionism Scale (HMPS)
- Factor analysis of both scales:
- Maladaptive evaluative concerns (CM, DA, PC, PE, self-oriented)
- Positive achievement striving (PS, O, other-oriented)
Elevated perfectionism across disorders:
- Eating disorders (CM, PS)
- Depression (self-oriented, socially-prescribed)
- Bipolar disorder (vulnerability for mood swings)
- Suicidal ideation and behavior (socially-prescribed)
- OCD (CM, PS, DA, socially-prescribed)
- Interferes with ability to engage in ERP, predicts treatment outcome
- Social anxiety (CM, DA, socially-prescribed)
- Improvements in perfectionism after treatment
- Panic disorder (socially-prescribed)
- OCPD (perfectionism is a criteria for diagnosis; rigidity)
Transdiagnostic approach can explain comorbidity due to shared:
- Maintenance mechanisms
- included in multiple cognitive behavior models of disorders (social phobia, OCD, eating disorders)
- Risk factors
Negative impact on treatment outcome (depression, eating disorders)
- Interferes with therapeutic alliance
- Poorer social networks
- Poorer ability to cope with life stress
Treatment of perfectionism reduces symptoms across disorders (depressions, anxiety, eating disorders)
- Case conceptualization
- Address specifically and early in treatment – especially if barrier to change
- How to treat – increase motivation to change, self monitor maintenance mechanisms, address cognitive biases and self-criticisms
- The article suggests treating perfectionism early in treatment if it is interfering with treatment of the presenting problem. Has this ever come up with a client you've seen? How have you addressed it, if at all?
- Data on treatment of perfectionism seem a little weak – several studies showed no significant difference across treatments or between treatment/waitlist. Is treating perfectionism separately worth it? Is the effectiveness really that different than CBT for anxiety/depression?
- Do you agree that perfectionism should be addressed as a process, rather than as a "personality characteristic, set of cognitive behavioral features, or symptom of psychopathology?" Why or why not?
- Perfectionism is referenced in depression, eating disorders, and some anxiety disorders. Are there any other disorder in which perfectionism might play a role?
- In general, what are your thoughts on a transdiagnostic approach to psychopathology? Does this seem like an avenue worth pursuing in treatment outcome research?