July 17, 2015

Journal Club Week 4: Perfectionism as a transdiagnostic process: A clinical review

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)
    • Self-oriented
    • Other-oriented
    • Socially-prescribed
  • 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)
  • Anxiety
    • 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)
Clinical implications:
  • 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
Discussion Qs:
  1. 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?
  2. 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?
  3. 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?
  4. Perfectionism is referenced in depression, eating disorders, and some anxiety disorders. Are there any other disorder in which perfectionism might play a role?
  5. In general, what are your thoughts on a transdiagnostic approach to psychopathology? Does this seem like an avenue worth pursuing in treatment outcome research? 

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