Stoebe (2018)

THE PSYCHOLOGY OF
PERFECTIONISM
This milestone text provides a comprehensive and state-of-the art overview of

perfectionism theory, research, and treatment from the past 25 years, with
contributions from leading researchers in the field.
The book examines new theories and perspectives including the social
disconnection model of perfectionism and the 2 × 2 model of perfectionism. It also
reviews empirical findings, with a special focus on stress, vulnerability, and
resilience, and examines perfectionism in specific populations. Finally, it considers
how perfectionism relates to physical health and psychophysiological processes and
introduces new approaches to effective prevention and treatment.
By increasing our understanding of perfectionism as a complex personality
disposition and providing a framework for future explorations, this landmark
publication aims to promote further research in this field. It will be invaluable
reading for academics, students, and professionals in personality psychology, clinical
and counseling psychology, applied psychology, and related disciplines.
Joachim Stoeber is a Professor of Psychology at the University of Kent. With a

background in personality and individual differences, his focus of the past 15 years
has been perfectionism research demonstrating that perfectionism is not an
exclusively maladaptive characteristic, but has aspects that can be adaptive. He has
published numerous journal articles and book chapters on the topic and is one of
the leading experts on perfectionism.
THE PSYCHOLOGY OF
PERFECTIONISM
Theory, Research, Applications
Edited by Joachim Stoeber

First published 2018
by Routledge
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CONTENTS
Acknowledgmentsix
Contributorsxi
Introduction 1
1 The Psychology of Perfectionism: An Introduction 3

Joachim Stoeber
PART I
Perspectives on Perfectionism 17
2 Perfectionism: A Motivational Perspective 19

Joachim Stoeber, Lavinia E. Damian, and Daniel J. Madigan
3 The 2 × 2 Model of Perfectionism: Assumptions, Trends,

and Potential Developments 44
Patrick Gaudreau, Véronique Franche, Kristina Kljajic, and
Gabrielle Martinelli
4 Perfectionism and Personality 68

Joachim Stoeber, Philip J. Corr, Martin M. Smith, and
Donald H. Saklofske
vi Contents
5 Perfectionism Cognition Theory: The Cognitive Side of

Perfectionism 89
Gordon L. Flett, Paul L. Hewitt, Taryn Nepon, and Avi Besser
PART II
Perfectionism in Special Populations 111
6 Perfectionism and Anxiety in Children 113

Nicholas W. Affrunti and Janet Woodruff-Borden
7 Perfectionism in Gifted Students 134

Kristie L. Speirs Neumeister
8 Perfectionism in Sport, Dance, and Exercise 155

Andrew P. Hill, Gareth E. Jowett, and
Sarah H. Mallinson-Howard
PART III
Vulnerability and Resilience 175
9 Perfectionism and Interpersonal Problems: Narcissistic and

Self-Critical Perfectionism 177
Simon B. Sherry, Sean P. Mackinnon, and Logan J. Nealis
10 Perfectionism and Health: The Roles of Health Behaviors

and Stress-Related Processes 200
Danielle S. Molnar, Fuschia M. Sirois, Gordon L. Flett,
William F. Janssen, and Paul L. Hewitt
11 Perfectionism and Daily Stress, Coping, and Affect:

Advancing Multilevel Explanatory Conceptualizations 222
David M. Dunkley
12 Perfectionism and Emotion Regulation 243

Kenneth G. Rice, Hanna Suh, and Don E. Davis
Contents vii
PART IV
Prevention and Treatment 263
13 Prevention of Perfectionism in Youth 265

Tracey D. Wade
14 Cognitive-Behavioral Treatment for Perfectionism 284

Sarah J. Egan and Roz Shafran
15 Perfectionism in the Therapeutic Context:

The Perfectionism Social Disconnection Model 306
Paul L. Hewitt, Gordon L. Flett, Samuel F. Mikail,
David Kealy, and Lisa C. Zhang
PART V
Conclusions 331
16 The Psychology of Perfectionism: Critical Issues,

Open Questions, and Future Directions 333
Joachim Stoeber
Author Index 353

Subject Index 368
ACKNOWLEDGMENTS
I would like to thank Gordon Flett for encouraging me to pursue the idea of
editing a general compendium on perfectionism taking inspiration from his and
Paul Hewitt’s 2002 book Perfectionism: Theory, research, and therapy (American
Psychological Association). Further, I would like to thank Lavinia Damian and
Daniel Madigan for help in proofreading Chapters 1 and 16 (noting, however, that
any remaining errors are my sole responsibility). Finally, I would like to say many
thanks to everyone who contributed to this book (see list of contributors): This
book would not have been possible without your excellent work and your help
and support!
CONTRIBUTORS
Nicholas W. Affrunti, MA, Department of Psychological and Brain Sciences,

University of Louisville, Louisville, USA
Avi Besser, PhD, Center for Research in Personality, Life Transitions, and Stressful
Life Events, Sapir Academic College, Sderot, Israel
Philip J. Corr, PhD, Department of Psychology, City, University of London,

London, UK
Lavinia E. Damian, PhD, Department of Psychology, Babeş-Bolyai University,

Cluj-Napoca, Romania
Don E. Davis, PhD, Department of Counseling and Psychological Services, Georgia

State University, Atlanta, USA
David M. Dunkley, PhD, Department of Psychiatry, Lady Davis Institute, Jewish

General Hospital, Montreal, Canada; Department of Psychiatry and Department of
Psychology, McGill University, Montreal, Canada
Sarah J. Egan, PhD, School of Psychology and Speech Pathology, Curtin

University, Perth, Australia
Gordon L. Flett, PhD, Department of Psychology and LaMarsh Centre for Child
and Youth Research, York University, Toronto, Canada
Véronique Franche, BA, School of Psychology, University of Ottawa,

Ottawa, Canada
xii Contributors
Patrick Gaudreau, PhD, School of Psychology, University of Ottawa, Ottawa,

Canada
Paul L. Hewitt, PhD, Department of Psychology, University of British Columbia,

Vancouver, Canada
Andrew P. Hill, PhD, School of Sport, York St John University, York, UK
William F. Janssen, BA, Department of Child and Youth Studies, Brock University,
St. Catharines, Canada
Gareth E. Jowett, PhD, Carnegie School of Sport, Leeds Beckett University,

Leeds, UK
David Kealy, PhD, Department of Psychiatry, University of British Columbia,

Vancouver, Canada
Kristina Kljajic, BA, School of Psychology, University of Ottawa, Ottawa, Canada
Sean P. Mackinnon, PhD, Department of Psychology and Neuroscience,

Dalhousie University, Halifax, Canada
Daniel J. Madigan, MSc, School of Sport, York St John University, York, UK
Sarah H. Mallinson-Howard, PhD, School of Sport, York St John University,

York, UK
Gabrielle Martinelli, BA, School of Psychology, University of Ottawa, Ottawa,

Canada
Samuel F. Mikail, PhD, Mental Health, Sun Life Financial, Toronto, Canada
Danielle S. Molnar, PhD, Department of Child and Youth Studies, Brock

University, St. Catharines, Canada; Research Institute on Addictions, University at
Buffalo, Buffalo, USA
Logan J. Nealis, BA, Department of Psychology and Neuroscience, Dalhousie

University, Halifax, Canada
Taryn Nepon, MA, Department of Psychology, York University, Toronto, Canada
Kenneth G. Rice, PhD, Center for the Study of Stress, Trauma, and Resilience,
Department of Counseling and Psychological Services, Georgia State University,
Atlanta, USA
Contributors xiii
Donald H. Saklofske, PhD, Department of Psychology, University of Western

Ontario, London, Canada
Roz Shafran, PhD, UCL Great Ormond Street Institute of Child Health, London,
UK
Simon B. Sherry, PhD, Department of Psychology and Neuroscience, Dalhousie

University, Halifax, Canada
Fuschia M. Sirois, PhD, Department of Psychology, University of Sheffield,

Sheffield, UK
Martin M. Smith, MSc, Department of Psychology, University of Western

Ontario, London, Canada
Kristie L. Speirs Neumeister, PhD, Teachers College, Ball State University,

Muncie, USA
Joachim Stoeber, PhD, School of Psychology, University of Kent, Canterbury,

UK
Hanna Suh, PhD, Department of Counseling, School, and Educational Psychology,

University at Buffalo, Buffalo, USA
Tracey D. Wade, PhD, School of Psychology, Flinders University, Adelaide,

Australia
Janet Woodruff-Borden, PhD, Department of Psychological and Brain Sciences,

University of Louisville, Louisville, USA
Lisa C. Zhang, MA, Department of Psychology, University of British Columbia,

Vancouver, Canada
Introduction
1
THE PSYCHOLOGY OF
PERFECTIONISM
An Introduction
Joachim Stoeber
Overview
Perfectionism is a multidimensional personality disposition characterized by striving
for flawlessness and setting exceedingly high standards of performance accompanied
by overly critical evaluations of one’s behavior. Perfectionism is a complex
characteristic. It comes in different forms and has various aspects. This chapter has
a dual purpose: It aims to serve as an introduction to The Psychology of Perfectionism
(the edited book you are holding in your hands) and an introduction to the
psychology of perfectionism (what the book is about). To these aims, I first present
a brief history of perfectionism theory and research. Then I introduce the two-
factor theory of perfectionism—differentiating perfectionistic strivings and
perfectionistic concerns—with the intention to provide readers with a conceptual
framework that may serve as a “compass” guiding them through the different
models and measures of perfectionism they will encounter in this book. Going
beyond the two-factor model, I next introduce three aspects of perfectionism that
are important for a comprehensive understanding of perfectionism: other-oriented
perfectionism, perfectionistic self-presentation, and perfectionism cognitions. The
chapter will conclude with a brief overview of the organization of the book and
the contents of the individual chapters.
A Caveat
There is, however, a caveat. This introductory chapter is unlikely to present an
unbiased account of perfectionism research. Perfectionism is a multifaceted
personality characteristic, and—as the chapters of the book will demonstrate—
different researchers have different views of perfectionism. Accordingly, the present
chapter reflects the personal views I have acquired over the near 20 years since I
4 Stoeber
took the first stab at perfectionism research (Stöber, 1998), and they are views that
the authors of the other chapters may share, share in parts, or not share. However,
readers should also be aware that, despite differences in the views of perfectionism,
there is lots of common ground. I personally like to think that—if we as
perfectionism researchers take everything that is published on perfectionism into
account—95% of our views are in agreement. The problem is that we can
passionately disagree about the remaining 5%, making the discrepancies appear
much larger (and perhaps more important) than they actually are. But enough of
the preliminaries. Let’s get started! And what would be a better start than having a
look at the origins of perfectionism theory and how perfectionism research
developed?
A Brief History of Perfectionism Theory and Research

The origins of perfectionism research are based in psychodynamic theory,
particularly in the writings of two prominent psychoanalytic theorists: Alfred
Adler (1870–1937) and Karen Horney (1885–1952). Horney (1950) described
perfectionism as “the tyranny of the should” (p. 64) and regarded it as a highly
neurotic personality disposition void of any positive aspects. In comparison,
Adler had a more differentiated view of perfectionism. In fact, Akay-Sullivan,
Sullivan, and Bratton (2016) recently pointed out that Adler may be regarded as
one of the first to have a multidimensional view of perfectionism recognizing
adaptive and maladaptive aspects in relation to mental health. According to
Adler, “the striving for perfection is innate in the sense that it is a part of life, a
striving, an urge, a something without which life would be unthinkable”
(Ansbacher & Ansbacher, 1956, p. 104), but individuals attempt to achieve the
goal of perfection differently, and their individual attempts can be differentiated
by their functional and dysfunctional behaviors toward this goal (Akay-Sullivan
et al., 2016).
Then came many years that did not see much progress in perfectionism theory
except for a few psychiatric writings on perfectionism (e.g., Hollender, 1965;
Missildine, 1963) leading Hollender (1978) to make the observation that
perfectionism was “a neglected personality trait.” The same year, however, an
influential theoretical article on perfectionism was published. Hamachek (1978)
suggested that two forms of perfectionism should be differentiated: a positive form
he labeled “normal perfectionism” whereby individuals enjoy pursuing their
perfectionistic strivings, and a negative form labeled “neurotic perfectionism”
whereby individuals suffer from their perfectionistic strivings. Furthermore, two
years later, the first self-report measure of perfectionism was published—Burns’
(1980) Perfectionism Scale—followed by another measure three years later—the
perfectionism subscale of the Eating Disorder Inventory (Garner, Olmstead, &
Polivy, 1983)—and empirical research into perfectionism could begin in earnest.
The problem with these measures, however, was that they conceptualized
perfectionism as a one-dimensional construct. Moreover, the measures followed
Perfectionism: An Introduction 5
Horney’s conception of perfectionism as a highly neurotic disposition. Accordingly,

they exclusively captured neurotic and dysfunctional aspects of perfectionism
reflecting the at the time prominent view that perfectionism was a “kind of
psychopathology” (Pacht, 1984, p. 387). This view, however, must not have been
very inspiring because publications on perfectionism in the 1980s continued to be
few and far between (see Figure 1.1).
But all this changed at the beginning of the 1990s, and dramatically so. The
reason for this was that two research teams (independently of each other) published
multidimensional models of perfectionism and associated multidimensional
measures. Frost, Marten, Lahart, and Rosenblate (1990) published a model
differentiating six dimensions of perfectionism: personal standards, concern over
mistakes, doubts about actions, parental expectations, parental criticism, and
organization. Personal standards reflect perfectionists’ exceedingly high standards
of performance. Concern over mistakes captures perfectionists’ fear about making
mistakes and the negative consequences that mistakes have for their self-evaluation,
whereas doubts about actions capture a tendency toward indecisiveness related to
an uncertainty about doing the right thing. In contrast, parental expectations and
parental criticism refer to perfectionists’ perceptions that their parents expected
them to be perfect and were critical if they failed to meet these expectations.
Finally, organization captures tendencies to be organized and value order and
neatness. At the same time, Hewitt and Flett (1990, 1991) published a model
differentiating three forms of perfectionism: self-oriented, other-oriented, and
socially prescribed. Self-oriented perfectionism comprises internally motivated
beliefs that striving for perfection and being perfect are important. Self-oriented
perfectionists expect to be perfect. In contrast, other-oriented perfectionism
comprises internally motivated beliefs that it is important for others to strive for
perfection and be perfect. Other-oriented perfectionists expect others to be perfect.
Finally, socially prescribed perfectionism comprises externally motivated beliefs
that striving for perfection and being perfect are important to others. Socially
prescribed perfectionists believe that others expect them to be perfect (Hewitt &
Flett, 1991, 2004).
Perfectionistic Strivings and Perfectionistic Concerns

Whereas the two models suggest different dimensions (and the different dimensions
stress different aspects of multidimensional perfectionism), there are common
aspects as Frost, Heimberg, Holt, Mattia, and Neubauer (1993) demonstrated in a
seminal article. Frost and colleagues subjected the nine dimensions of the two
models to a factor analysis (Kline, 1994), and two higher-order dimensions
emerged. One dimension (Dimension 1) combined personal standards, organization,
self-oriented perfectionism, and other-oriented perfectionism. The other dimension
(Dimension 2) combined concern over mistakes, doubts about actions, parental
expectations, parental criticism, and socially prescribed perfectionism. What is
more, when the two dimensions were correlated with measures of positive affect,
300
250
200
150
Number of publications
100
50
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
Year
FIGURE 1.1 umber of publications in the Web of ScienceTM Core Collection database with “perfectionis*” in topic (2016 = estimated).
N
1990/1991 are highlighted as the years when the first multidimensional conceptions of perfectionism were published (Frost et al.,
1990; Hewitt & Flett, 1990, 1991).
negative affect, and depression, Dimension 1 showed a positive correlation with

positive affect (and nonsignificant correlations with negative affect and depression)
whereas Dimension 2 showed positive correlations with negative affect and
depression (and a nonsignificant correlation with positive affect). Consequently,
Frost and colleagues labeled Dimension 1 “positive striving” and Dimension 2
“maladaptive evaluation concerns,” and so the two-factor model of perfectionism
was born.
The two-factor structure of perfectionism and the two higher-order dimensions
proved to be reliable (e.g., Bieling, Israeli, & Antony, 2004). Further, the structure
replicated across different multidimensional measures of perfectionism (e.g., R. W.
Hill et al., 2004) and also emerged when items taken from various multidimensional
measures were combined (Stairs, Smith, Zapolski, Combs, & Settles, 2012).1
Consequently, the two-factor model can be regarded as a conceptual framework
providing guidance for understanding the different, sometimes opposing,
relationships that various dimensions of perfectionism show with indicators of
psychological adjustment and maladjustment. Following Frost et al.’s (1993)
suggestion that one dimension was “positive” and the other “maladaptive,” a
practice developed whereby researchers gave the two dimensions labels with
evaluative connotations such as adaptive and maladaptive perfectionism, healthy
and unhealthy perfectionism, positive and negative perfectionism, and functional
and dysfunctional perfectionism. Fortunately, this practice is declining and
nowadays the two dimensions are usually referred to as personal standards
perfectionism and evaluative concerns perfectionism (Dunkley, Blankstein, Halsall,
Williams, & Winkworth, 2000) or perfectionistic strivings and perfectionistic
concerns (Stoeber & Otto, 2006). This is preferable because the question of
whether, and to what degree, the two dimensions are adaptive (healthy, positive,
functional) or maladaptive (unhealthy, negative, dysfunctional) should be an
empirical question (see also Gaudreau, 2013). Further, I personally prefer referring
to the two dimensions as perfectionistic strivings and perfectionistic concerns to
indicate that they are two dimensions of the same construct (perfectionism), and
not two different forms of perfectionism.
Table 1.1 shows what aspects of different multidimensional models of
perfectionism—represented by subscales from the associated multidimensional
measures—are regarded as indicators (or “proxies”) of perfectionistic strivings and
perfectionistic concerns across different multidimensional measures of perfectionism.
Consequently, the table may serve as a compass guiding readers through the
different models and measures of perfectionism they will encounter in the various
chapters of this book. However, when inspecting the table, attentive readers may
wonder what happened to other-oriented perfectionism, parental expectations,
parental criticism, and organization all of which were originally included in the
two-factor model (Frost et al,. 1993). The answer (in a nutshell) is that other-
oriented perfectionism is better regarded as a form of perfectionism outside the
two-factor model because it is directed at others, not the self (Stoeber, 2014, 2015).
Parental expectations and criticism are better regarded as developmental antecedents
8 Stoeber
TABLE 1.1 Measures of Perfectionistic Strivings and Perfectionistic Concerns
Subscales representing indicators (“proxies”) of …
Measure Reference Perfectionistic strivings Perfectionistic concerns
FMPS Frost et al. (1990) Personal standards Concern over

mistakes
Pure personal standardsa Concern over
mistakes + doubts
about actionsb
HF-MPS Hewitt and Flett Self-oriented perfectionismc Socially prescribed
(1991, 2004) perfectionism
APS-R Slaney et al. (2001) High standards Discrepancy
PI R. W. Hill et al. (2004) Striving for excellence Concern over
mistakes
MIPS Stoeber et al. (2007) Striving for perfection Negative reactions to
imperfection
Note: Measures are listed in chronological order of their first publication. FMPS = Frost
Multidimensional Perfectionism Scale, HF-MPS = Hewitt–Flett Multidimensional Perfectionism
Scale, APS-R = Almost Perfect Scale–Revised, PI = Perfectionism Inventory, MIPS =
Multidimensional Inventory of Perfectionism in Sport (for examples of adaptations outside sport,
see Stoeber & Rambow (2007) and Stoeber & Rennert (2008)).
a See DiBartolo et al. (2004).
b See Stöber (1998).
c Particularly the subscale capturing perfectionistic striving (see Stoeber & Childs, 2010).
Source: Table adapted from Stoeber and Damian (2016) and Stoeber and Madigan (2016).
of perfectionistic strivings and concerns, rather than defining components (Damian,

Stoeber, Negru, & Băban, 2013; Rice, Lopez, & Vergara, 2005). And organization
was never regarded as a core dimension of perfectionism to begin with (cf. Frost et
al., 1990), and there are factor analyses showing organization and order to form a
third factor separate from perfectionistic strivings and concerns (Kim, Chen,
MacCann, Karlov, & Kleitman, 2015; Suddarth & Slaney, 2001).
The two-factor model of perfectionism—differentiating perfectionistic strivings
and perfectionistic concerns—represents an important framework for understanding
how perfectionism can be adaptive and maladaptive (see Chapters 2–3, 8, and
11–12). Moreover, it represents the foundation of the 2 × 2 model of perfectionism
(Gaudreau & Thompson, 2010) which examines how within-person combinations
of high versus low perfectionistic strivings × high versus low perfectionistic
concerns differ with respect to psychological adjustment and maladjustment (as
detailed in Chapter 3). There are, however, important aspects of perfectionism
going beyond perfectionistic strivings and perfectionistic concerns that need to be
taken into account for a comprehensive understanding of perfectionistic behavior
(cf. Hewitt, Flett, & Mikail, 2017): other-oriented perfectionism, perfectionistic
self-presentation, and perfectionism cognitions.
Beyond Perfectionistic Strivings and Perfectionistic Concerns

Other-oriented perfectionism was introduced to perfectionism theory and research
over 25 years ago and is an essential part of the tripartite model of perfectionism
(Hewitt & Flett, 1990, 1991). Despite this, other-oriented perfectionism did not
receive the same attention from research on multidimensional perfectionism as
self-oriented and socially prescribed perfectionism, and in fact was often disregarded
(Stoeber, 2014). This, however, has changed in recent years which saw a
reinvigorated interest in other-oriented perfectionism. There are a number of
contributing factors. First, other-oriented perfectionism plays an important role in
the perfectionism social disconnection model (Hewitt, Flett, Sherry, & Caelian,
2006) and its recent extensions (see Chapters 9 and 15). Second, it is a key aspect
of all forms of perfectionism where perfectionistic expectations of others are
important, such as dyadic perfectionism (Stoeber, 2012) and team perfectionism
(A. P. Hill, Stoeber, Brown, & Appleton, 2014). Moreover, the interest in so-called
“dark personality traits” (Marcus & Zeigler-Hill, 2015) has directed attention to
other-oriented perfectionism because of its associations with the dark triad—
narcissism, Machiavellianism, and psychopathy—as a consequence of which,
other-oriented perfectionism is now regarded as a dark form of perfectionism
(Marcus & Zeigler-Hill, 2015; Stoeber, 2014). Finally, other-oriented perfectionism
is a defining component of narcissistic perfectionism which is an emerging construct
in perfectionism research (Nealis, Sherry, Lee-Baggley, Stewart, & Macneil, 2016;
Smith, Saklofske, Stoeber, & Sherry, 2016; see also Chapter 9). Hence, other-
oriented perfectionism is better regarded as a separate form of perfectionism outside
the two-factor model of perfectionism (Stoeber, 2014, 2015).
Perfectionistic self-presentation (Hewitt et al., 2003) is an aspect of perfectionism
that goes beyond perfectionism as a personality disposition (or “trait”) by examining
the motivational principles underlying perfectionism from a self-regulation
perspective (Higgins, 1998).2 According to Hewitt and colleagues (2003),
perfectionistic self-presentation has two central aims: to promote the impression
that one is perfect, and to prevent the impression that one is not. To capture these
aims, Hewitt and colleagues developed a measure differentiating three aspects:
perfectionistic self-promotion, nondisplay of imperfection, and nondisclosure of
imperfection. Perfectionistic self-promotion is promotion-focused and driven by
the need to appear perfect by impressing others, and to be viewed as perfect via
displays of faultlessness and a flawless image. In contrast, nondisplay of imperfection
and nondisclosure of imperfection are prevention-focused. Nondisplay of
imperfection is driven by the need to avoid appearing as imperfect. It includes the
avoidance of situations where one’s behavior is under scrutiny if this is likely to
highlight a personal shortcoming, mistake, or flaw. In comparison, nondisclosure
of imperfection is driven by a need to avoid verbally expressing or admitting to
concerns, mistakes, and perceived imperfections for fear of being negatively
evaluated. Studies have shown that perfectionistic self-presentation explains
variance in psychological maladjustment beyond dispositional perfectionism and,
10 Stoeber
perhaps more importantly, may explain why dispositional perfectionism is associated

with psychological maladjustment (e.g., Hewitt et al., 2003; Hewitt, Habke, Lee-
Baggley, Sherry, & Flett, 2008; Stoeber, Madigan, Damian, Esposito, & Lombardo,
in press). Perfectionistic self-presentation—which represents the interpersonal
expression of perfectionism (Hewitt et al., 2003)—is clearly an important aspect of
perfectionism that needs to be taken into account when regarding perfectionism
and maladjustment and how perfectionism affects interpersonal relations and the
therapeutic process (see Chapter 15).
Finally, there are perfectionism cognitions. Perfectionism cognitions (also called
perfectionistic cognitions) are automatic perfectionistic thoughts reflecting the
need to be perfect and concerns about one’s inability to achieve perfection (Flett,
Hewitt, Blankstein, & Gray, 1998). Like perfectionistic self-presentation,
perfectionism cognitions are an important addition to perfectionism theory and
research and have explained variance in psychological maladjustment beyond
dispositional perfectionism (e.g., Flett et al., 1998; Flett et al., 2012; Flett, Hewitt,
Whelan, & Martin, 2007). Following Cattell and Kline (1977) in differentiating
states and traits in the study of personality, perfectionism cognitions can be
regarded as representing the “states” aspect of perfectionism. Further, there is
evidence suggesting that—like dispositional perfectionism and perfectionistic
self-presentation—perfectionism cognitions should be conceptualized as multi
dimensional differentiating perfectionistic strivings and concerns (Stoeber, Kobori,
& Brown, 2014a; Stoeber, Kobori, & Tanno, 2010), but this conceptualization is
still debated (Flett & Hewitt, 2014; Stoeber, Kobori, & Brown, 2014b). What
is not debated is that perfectionism cognitions form an essential part of the
“perfectionism puzzle” without which we cannot achieve a comprehensive
understanding of perfectionism, as is detailed in Chapter 5 of this book.
The Psychology of Perfectionism

Turning to the structure of the book and the individual chapters, the book is
organized into four parts. Part I comprises four chapters providing different
perspectives on perfectionism. Chapter 2 (Stoeber, Damian, and Madigan) presents a
motivational perspective on perfectionism examining how perfectionistic strivings
and perfectionistic concerns relate to achievement motivation and self-determination.
Chapter 3 (Gaudreau, Franche, Kljajic, and Martinelli) provides an account of the 2
× 2 model of perfectionism as an analytic framework examining the unique,
combined, and interactive effects of perfectionistic strivings (personal standards
perfectionism) and perfectionistic concerns (evaluative concerns perfectionism).
Chapter 4 (Stoeber, Corr, Smith, and Saklofske) examines multidimensional
perfectionism from the perspective of personality theory regarding how self-oriented,
other-oriented, and socially prescribed perfectionism relate to key dimensions of
personality. Chapter 5 (Flett, Hewitt, Nepon, and Besser) makes the “case for
cognition” by taking a look at perfectionism from a cognitive perspective providing
a detailed examination of, and new perspectives on, perfectionism cognitions.
Part II presents three chapters reviewing the research literature on perfectionism

in special populations. Chapter 6 (Affrunti and Woodruff-Borden) examines
perfectionism in children and the role that perfectionism and associated factors
play in childhood anxiety disorders. Chapter 7 (Speirs Neumeister) provides a
comprehensive review of research on perfectionism in gifted students examining
the development, incidence, and outcomes of perfectionism in these students.
Chapter 8 (A. P. Hill, Jowett, and Mallinson-Howard) examines perfectionism
in sport, dance, and exercise providing an overview of recent findings in these
areas and the differential effects of perfectionistic strivings and perfectionistic
concerns.
Part III comprises four chapters examining the relationships that multidimensional
perfectionism shows with vulnerability and resilience. Chapter 9 (Sherry,
Mackinnon, and Nealis) provides an account of perfectionism and interpersonal
problems, with a special focus on self-critical perfectionism and narcissistic
perfectionism. Chapter 10 (Molnar, Sirois, Flett, Janssen, and Hewitt) looks at
perfectionism and health, presenting a comprehensive review of how perfectionism
relates to, and affects, health-behaviors and stress-related processes. Continuing
with the topic of stress, Chapter 11 (Dunkley) examines the relationships of
perfectionism, daily stress, coping, and affect from a multilevel perspective including
a case study to illustrate the relationships. Concluding Part III, Chapter 12 (Rice,
Suh, and Davis) focuses on perfectionism and emotion regulation from the
perspective of attachment theory, person-centered theory, and self psychology. In
addition, the chapter presents a research agenda aimed at strengthening
perfectionistic resilience and lowering perfectionistic risk, thus presenting a perfect
transition to the final part of the book.
Part IV, the final part of the book, presents three chapters on the prevention and
treatment of perfectionism. Chapter 13 (Wade) focuses on the prevention of
perfectionism in youth, examining factors that contribute to the development of
perfectionism in children and adolescents and how understanding these factors may
help prevent perfectionism. Chapter 14 (Egan and Shafran) provides a
comprehensive overview of cognitive-behavioral therapy (CBT) for perfectionism
including key CBT techniques for addressing perfectionism and a review of studies
examining the effectiveness of CBT in reducing perfectionism. Chapter 15
(Hewitt, Flett, Mikail, Kealy, and Zhang) employs the perspective of the
perfectionism social disconnection model as a theoretical framework for taking a
look at perfectionism in the therapeutic context and how perfectionism impacts
therapeutic interventions and outcomes.
The book concludes with a chapter (Chapter 16) that—following the same
approach as the present chapter—provides a personal account of what I consider
critical issues in perfectionism research and open questions that perfectionism
research still needs to answer. In addition, the chapter suggests future directions
that I hope perfectionism theory and research will take into consideration.
12 Stoeber
Concluding Comments
Perfectionism is a common personality characteristic that can affect all domains of life
(Stoeber & Stoeber, 2009). At the same time, it is a complex, multidimensional
characteristic that comes in different forms and has various aspects, some of which
may be harmless, benign, or even adaptive whereas others are clearly maladaptive,
unhealthy, and dysfunctional (Enns & Cox, 2002; Stoeber & Otto, 2006). All this
makes perfectionism a fascinating research topic, and perfectionism theory and
research has become an important area of psychological inquiry. However, with
scientific publications on perfectionism soaring and hundreds of journal articles being
published each year (see Figure 1.1), everyone who is not an expert on perfectionism
may find it difficult to keep track of the major developments and findings in
perfectionism theory and research. Moreover, the last comprehensive volume
presenting an overview of the psychology of perfectionism was published 15 years
ago (Flett & Hewitt, 2002). Since then, over 2,500 articles on perfectionism have
been published (see again Figure 1.1) not only presenting new empirical findings but
also new theoretical developments, conceptual frameworks, and analytic approaches
as well as further additions to the canon of models and measures of perfectionism.
The present book aims to provide help and guidance in this situation by
presenting researchers, students, and practitioners with an up-to-date account of
the main topics and issues of perfectionism theory and research. Written by the
leading experts in the field, the chapters of the book provide a comprehensive
overview of the psychology of perfectionism and the major advances that
perfectionism research has made in the past 25 years. In addition, all chapters
include discussions of open questions thus providing directions for future theory
and research. Finally, I hope that the book provides inspirations for further
psychological inquiry so we continue to make progress in our understanding of
what perfectionism is, what it does, where it comes from, and—where perfectionism
causes suffering and distress—how to prevent it and treat it.
Notes
1 In fact, the two dimensions even emerged in perfectionism measures conceptualized to
be one-dimensional (e.g., Sherry, Hewitt, Besser, McGee, & Flett, 2004; Stoeber &
Damian, 2014)!
2 Chapter 16 presents a brief discussion of whether perfectionism is a trait or a disposition
explaining why I think that the term “dispositional perfectionism” is preferable to “trait
perfectionism” (see also Gaudreau & Thompson, 2010).
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PART I
Perspectives on
Perfectionism
2
PERFECTIONISM
A Motivational Perspective
Joachim Stoeber, Lavinia E. Damian, and

Daniel J. Madigan
Overview
The chapter presents a review of the research literature examining perfectionism
from a motivational perspective. Taking the two-factor model of perfectionism—
differentiating the two higher-order dimensions of perfectionistic strivings and
perfectionistic concerns—as a basis, we present analyses of the differential
relationships that the two dimensions show with key motivational constructs
focusing on achievement motivation and self-determination theory. As regards
achievement motivation, we examine the relationships with achievement motives
(hope of success and fear of failure) and achievement goals (task and ego goals,
2 × 2 and 3 × 2 achievement goals). As regards self-determination theory, we
examine the relationships with autonomous and controlled motivation and with
the different regulatory styles associated with intrinsic motivation, extrinsic
motivation, and amotivation. Based on the findings of our review, we propose that
the differential motivational qualities of perfectionistic strivings and perfectionistic
concerns are important to understand why perfectionism is a “double-edged
sword” that may energize or paralyze people, motivating some perfectionists to
engage and others to disengage. We conclude that perfectionism research may
profit from seeing perfectionism from a motivational perspective, perhaps even
regard perfectionism as a motive disposition (need for perfection) whereby
perfectionistic strivings represent the approach-oriented and autonomous aspects,
and perfectionistic concerns the avoidance-oriented and controlled aspects.
Introduction
Perfectionism comes in different forms each having different aspects and is therefore
best conceptualized as a multidimensional construct (Frost, Marten, Lahart, &
20 Stoeber, Damian, & Madigan
Rosenblate, 1990; Hewitt & Flett, 1991). Moreover, research on multidimensional

perfectionism has shown that the different forms and aspects of perfectionism—
when examined together using factor analyses—form two higher-order dimensions
(Frost, Heimberg, Holt, Mattia, & Neubauer, 1993; see also Bieling, Israeli, &
Antony, 2004). The two dimensions have been given different names, but are
nowadays mostly referred to as personal standards perfectionism and evaluative
concerns perfectionism (Dunkley, Blankstein, Halsall, Williams, & Winkworth,
2000) or—as we prefer to call them—perfectionistic strivings and perfectionistic
concerns (Stoeber & Otto, 2006).
The differentiation of perfectionistic strivings and perfectionistic concerns is
central to the understanding of multidimensional perfectionism. The reason is that
only perfectionistic concerns are consistently associated with characteristics,
processes, and outcomes indicative of psychological maladjustment (e.g.,
neuroticism, avoidant coping, negative affect). In contrast, perfectionistic strivings
are often associated with characteristics, processes, and outcomes indicative of
psychological adjustment (e.g., conscientiousness, problem-focused coping,
positive affect). In this chapter, we want to show that the dual nature of
perfectionism—illustrated by strivings and concerns often showing differential (and
sometimes opposing) relationships with psychological adjustment and
maladjustment—is also reflected in the two dimensions’ relationships with
motivational qualities.
Different studies use different measures of multidimensional perfectionism each
having different subscales, which can be confusing for readers who are not experts
in perfectionism research. Consequently, we followed previous reviews (e.g.,
Gotwals, Stoeber, Dunn, & Stoll, 2012; Jowett, Mallinson, & Hill, 2016) and did
not detail what specific subscales the reviewed studies employed. Instead, we
regarded specific subscales as indicators (“proxies”) of perfectionistic strivings and
perfectionistic concerns (see Chapter 1, Table 1.1, for details) so we could focus on
the differential relationships that perfectionistic strivings and perfectionistic
concerns showed with motivational constructs, starting with achievement
motivation.
Achievement Motivation
Achievement Motives
Motives are a key variable in the study of motivation. Research on motives
differentiates three basic motives or needs—the achievement motive (need for
achievement), the affiliation motive (need for affiliation), and the power motive
(need for power)—of which the achievement motive has been the most researched
in the past 50 years (McClelland, Atkinson, Clark, & Lowell, 1953) and is the most
relevant for perfectionism. Achievement motives can be described as stable individual
differences in learned, affectively charged anticipatory responses to achievement
situations that energize and direct people’s behaviors (McClelland, 1985). Regarding
Perfectionism: A Motivational Pespective 21
achievement motives, research traditionally differentiates two basic motives: hope

of success (motivating people to achieve success) and fear of failure (motivating
people to avoid failure) (Atkinson, 1957; DeCharms & Davé, 1965).
Reviewing the literature, we found nine studies investigating the relationships
of perfectionism and fear of failure that reported bivariate correlations (Conroy,
Kaye, & Fifer, 2007; Frost & Henderson, 1991; Gucciardi, Mahoney, Jalleh,
Donovan, & Parkes, 2012; A. P. Hill, Hall, & Appleton, 2010; Kaye, Conroy, &
Fifer, 2008; Quested, Cumming, & Duda, 2014; Sagar & Stoeber, 2009; Stoeber
& Becker, 2008; Stoeber & Rambow, 2007), but only three that also included
hope of success (Frost & Henderson, 1991; Stoeber & Becker, 2008; Stoeber &
Rambow, 2007). Regarding the bivariate correlations, the findings show a clear
differential pattern for hope of success, but not for fear of failure. As regards hope
of success, all three studies found perfectionistic strivings to show positive
correlations. In comparison, only one study found perfectionistic concerns to
show a positive correlation with hope of success (Frost & Henderson, 1991)
whereas the other two found nonsignificant correlations. For fear of failure, five
studies found perfectionistic strivings to show positive correlations (Conroy et al.,
2007; Frost & Henderson, 1991; Gucciardi et al., 2012; Kaye et al., 2008; Sagar
& Stoeber, 2009) and four found nonsignificant correlations (A. P. Hill et al.,
2010; Quested et al., 2014; Stoeber & Becker, 2008; Stoeber & Rambow, 2007).1
By comparison, all studies found perfectionistic concerns to show positive
correlations with fear of failure except for one that found a nonsignificant
correlation (Stoeber & Becker, 2008).
Whereas the inspection of bivariate correlations and counting and comparing
numbers of significant versus nonsignificant correlations is an appropriate method for
getting a first impression of the differential relationships of perfectionistic strivings
and perfectionistic concerns, the method has two serious limitations. First, it does not
take into account any differences in the size of the correlations and thus ignores the
strengths of the relationships. Second, and perhaps more importantly, it does not take
the overlap between perfectionistic strivings and perfectionistic concerns into
account, which can be considerable (see Stoeber & Gaudreau, 2017; Stoeber & Otto,
2006). Consequently, one should also consider differences in the size of the
correlations and look for statistical analyses that control the overlap between the two
dimensions (such as partial correlations, multiple regression analyses, and structural
equation modeling) and examine the unique relationships that perfectionistic strivings
and perfectionistic concerns show with key motivational constructs.
Consequently, we reinspected the nine studies and found that, when both
perfectionism dimensions showed positive correlations with fear of failure,
perfectionistic concerns usually showed larger correlations than perfectionistic
strivings, suggesting that the former have stronger and more consistent links with
fear of failure than the latter. Further, in the studies that statistically controlled the
two dimensions’ overlap (Sagar & Stoeber, 2009; Stoeber & Becker, 2008; Stoeber
& Rambow, 2007), perfectionistic strivings ceased to show any positive relationships
with fear of failure. On the contrary, in two of the three studies perfectionistic
strivings now showed negative relationships with fear of failure (Sagar & Stoeber,
2009; Stoeber & Becker, 2008).
The different patterns of bivariate versus unique relationships suggest that the
overlap with perfectionistic concerns may be responsible for perfectionistic
strivings’ positive relationships with fear of failure, and may even suppress possible
negative relationships with fear of failure (cf. Stoeber & Gaudreau, 2017). By
contrast, nothing changed in the pattern of relationships that perfectionistic
concerns showed when the overlap with perfectionistic strivings was controlled.
Perfectionistic concerns continued to show positive relationships with fear of
failure and all its dimensions. Further, perfectionistic concerns continued to show
nonsignificant relationships with hope of success whereas perfectionistic strivings
continued to show positive relationships.
Achievement Goal Orientations

Whereas the traditional approach in research on achievement motivation focuses
on motives and investigates differences in how strongly individuals are motivated
and energized, the contemporary approach focuses on goal orientations and
investigates differences in why individuals are motivated to achieve (Elliot,
1997). Over the years, research on achievement goal orientations has progressed
from a two-component model to a tripartite model, a 2 × 2 model, and—as the
latest development—a 3 × 2 model. Our understanding of how perfectionistic
strivings and perfectionistic concerns are related to achievement goal orientations
(for brevity reasons consecutively referred to as “achievement goals”) has
progressed accordingly, so our review will follow the progression of achievement
goal theory.
The Two-Component Model

As regards the two-component model of achievement goals, the vast majority of
studies examining multidimensional perfectionism followed Duda and Nicholls’
(1992) model which differentiates two goals: task goals and ego goals. The two
goals have different foci and different functionalities. When pursuing task goals,
people are focused on meeting the demands of the task, exerting effort, and
developing their competence. Hence task goals are considered to represent
adaptive achievement motivations. By contrast, when pursuing ego goals, people
are focused on demonstrating superior competence with respect to others or
normative standards, which may result in greater apprehension about one’s
ability, but can also lead to higher performance. Hence, we consider ego goals as
mixed adaptive–maladaptive achievement motivations, but agree that they are
maladaptive in combination with low levels of task goals (see Duda, 2005, for
a review).
Reviewing the literature, we found eight studies that examined the relationships
of perfectionistic strivings and concerns with task and ego goals and reported
bivariate correlations (Appleton, Hall, & Hill, 2009; Dunn, Causgrove Dunn, &
Syrotuik, 2002; Hall, Kerr, Kozub, & Finnie, 2007; Hall, Kerr, & Matthews, 1998;
Lemyre, Hall, & Roberts, 2008; McArdle & Duda, 2004; Nerland & Sæther, 2016;
Ommundsen, Roberts, Lemyre, & Miller, 2005). As regards task goals, the majority
of studies found perfectionistic strivings to show positive correlations except for
two studies that found nonsignificant correlations (Lemyre et al., 2008; Nerland &
Sæther, 2016). In comparison, the majority of studies found perfectionistic concerns
to show nonsignificant correlations with task goals, except for three studies that
found negative correlations (Dunn et al., 2002; Lemyre et al., 2008; Ommundsen
et al., 2005). For ego goals, all studies found perfectionistic strivings to show
positive correlations. The same applied to perfectionistic concerns, with the
exception of one study that found perfectionistic concerns to show a nonsignificant
correlation with ego goals (Appleton et al., 2009).
Unfortunately, none of the eight studies used statistical analyses examining the
unique relationships of perfectionistic strivings and perfectionistic concerns.
However, there are two recent reviews that have done just that. The first review
(Gotwals et al., 2012) focused on perfectionistic strivings and therefore only
computed partial correlations of perfectionistic strivings controlling the overlap
with perfectionistic concerns. The second review (Jowett et al., 2016) also
computed partial correlations for perfectionistic concerns controlling the overlap
with perfectionistic strivings. As regards task goals, the reviews showed that
controlling the overlap did not change the pattern of significant relationships found
in the bivariate correlations, except that the positive relationships of perfectionistic
strivings tended to become larger when the overlap with perfectionistic concerns
was controlled. In contrast, the relationships of perfectionistic concerns tended to
become smaller (if positive) or larger (if negative) when the overlap with
perfectionistic strivings was controlled. The opposing pattern of these tendencies
suggests the presence of mutual suppression effects whereby perfectionistic concerns
suppress adaptive aspects of perfectionistic strivings, and perfectionistic strivings
suppress maladaptive aspects of perfectionistic concerns (R. W. Hill, Huelsman, &
Araujo, 2010; see Stoeber & Gaudreau, 2017, for a detailed discussion of these
effects). For ego goals, the reviews found that, in the majority of studies,
perfectionistic strivings showed significant positive relationships even when the
overlap with perfectionistic concerns was controlled. This indicates that the links
perfectionistic strivings show with ego goals cannot be explained by their overlap
with perfectionistic concerns. In contrast, perfectionistic concerns tended to show
smaller positive relationships with ego goals when the overlap with perfectionistic
strivings was controlled (and some of the relationships even became nonsignificant).
This suggests that perfectionistic concerns often show links with ego goals because
of their overlap with perfectionistic strivings. Otherwise, the pattern of unique
relationships dovetailed with the pattern of bivariate correlations indicating that
perfectionistic strivings show more consistent and stronger positive relationships
with ego goals than perfectionistic concerns.
The 2 × 2 Model

One reason why perfectionistic strivings and concern fail to show a clear-cut
differential pattern of relationships with ego goals may be that Duda and Nicholls’
(1992) model does not differentiate approach and avoidance orientations. According
to the dual-process theory of perfectionism (Slade & Owens, 1998), approach
versus avoidance is an important distinction for understanding differences between
positive and negative aspects of perfectionism because positive aspects (such as
those associated with perfectionistic strivings) are suggested to drive approach
behaviors whereas negative aspects (such as those associated with perfectionistic
concerns) drive avoidance behaviors. Consequently, differentiating approach and
avoidance is important not only for understanding different forms of achievement
motivation (Elliot, 1997). It is also important for understanding the multidimensional
nature of perfectionism and the differential motivational qualities of different
perfectionism dimensions.
Whereas the differentiation of approach and avoidance has been applied to ego
goals (Skaalvik, 1997), it never really caught on in the two-component model
examining task and ego goals. However, the differentiation became central in the
closely related model examining mastery and performance goals. People who pursue
mastery goals (which are comparable to task goals) tend to see achievement situations
as opportunities to improve their ability. They focus on learning new skills or
improving old ones, and regard failures and mistakes as providing important information
on how to improve. In comparison, people who pursue performance goals (comparable
to ego goals) tend to see achievement situations as opportunities to prove their ability.
Their goal is to demonstrate ability relative to others, show others what they have
learned, and—if possible—outperform others (Maehr & Meyer, 1997).
The differentiation of approach and avoidance was first applied to performance
goals resulting in the tripartite model differentiating performance-approach,
performance-avoidance, and mastery goals (Elliot & Harackiewicz, 1996). Later it
was also applied to mastery goals resulting in the 2 × 2 model of achievement goals
(Elliot & McGregor, 2001; Pintrich, 2000). The model distinguishes two goal
dimensions—definition (performance versus mastery) and valence (approach versus
avoidance)—and consequently differentiates four goals: performance-approach,
mastery-approach, performance-avoidance, and mastery-avoidance. Performance-
approach goals represent the motivation to demonstrate normative competence
(e.g., striving to do better than others) and mastery-approach goals the motivation
to achieve absolute or intrapersonal competence (e.g., striving to master a task). In
contrast, performance-avoidance goals represent the motivation to avoid
demonstrating normative incompetence (e.g., striving to avoid doing worse than
others) and mastery-avoidance goals the motivation to avoid absolute or
intrapersonal incompetence (e.g., striving to avoid doing worse than one has done
previously) (Conroy, Elliot, & Hofer, 2003).
Twenty-two studies have examined multidimensional perfectionism and the
goals of the 2 × 2 model and reported bivariate correlations (Bong, Hwang, Noh,
& Kim, 2014; Damian, Stoeber, Negru, & Băban, 2014; Eum & Rice, 2011;
Fletcher, Shim, & Wang, 2012; Gucciardi et al., 2012; Kaye et al., 2008; Kim,
Chen, MacCann, Karlov, & Kleitman, 2015; Madjar, Voltsis, & Weinstock, 2015;
Shih, 2012, 2013; Speirs Neumeister & Finch, 2006; Speirs Neumeister, Fletcher,
& Burney, 2015; Stoeber, Stoll, Pescheck, & Otto, 2008, Studies 1–2; Stoeber,
Stoll, Salmi, & Tiikkaja, 2009; Stoeber, Uphill, & Hotham, 2009, Studies 1–2; Van
Yperen, 2006; Vansteenkiste et al., 2010; Verner-Filion & Gaudreau, 2010; Wang,
Fu, & Rice, 2012; Zarghmi, Ghamary, Shabani, & Varzaneh, 2010).2 All studies
found perfectionistic strivings to show positive correlations with performance-
approach goals. Furthermore, all studies found perfectionistic concerns to show
positive correlations, with one exception: In Zarghmi et al.’s (2010) study, one
indicator of perfectionistic concerns showed a nonsignificant correlation. For
performance-avoidance goals, most studies found perfectionistic strivings to show
positive correlations, but five found nonsignificant correlations (Kaye et al., 2008;
Kim et al., 2015; Stoeber et al., 2008, Studies 1–2; Stoeber, Uphill, & Hotham,
2009). The same applied to perfectionistic concerns, except that for perfectionistic
concerns only two studies found nonsignificant correlations (Stoeber et al., 2008,
Study 2; Zarghmi et al., 2010). As regards mastery-approach goals, the pattern was
different. Whereas all studies found perfectionistic strivings to show positive
correlations (with the one exception of Vansteenkiste et al., 2010), less than half of
the studies found perfectionistic concerns to show positive correlations with
mastery-approach goals, and more than half found nonsignificant correlations. In
comparison, mastery-avoidance goals showed a similar pattern as performance-
avoidance goals. Most studies found perfectionistic strivings to show positive
correlations with mastery-avoidance goals except for five studies that found
nonsignificant correlations (Eum & Rice, 2011; Kaye et al., 2008; Kim et al., 2015;
Stoeber et al., 2008, Study 2; Zarghmi et al., 2010). In contrast, all studies found
perfectionistic concerns to show positive correlations with mastery-avoidance
goals, except for two that found nonsignificant correlations (Kim et al., 2015;
Speirs Neumeister et al., 2015).
As with the previous motivational constructs, the differential pattern of
relationships that perfectionistic strivings and concerns showed with the 2 × 2
achievement goals became much clearer when the overlap between the two
perfectionism dimensions was controlled and unique relationships were examined.
Of the twenty-two studies reviewed above, nine examined unique relationships
(Bong et al., 2014; Damian et al., 2014; Speirs Neumeister et al., 2015; Stoeber et
al., 2008, Studies 1–2; Stoeber, Stoll, et al., 2009; Vansteenkiste et al., 2010;
Verner-Filion & Gaudreau, 2010; Zarghmi et al., 2010). As regards performance-
approach goals, both perfectionistic strivings and perfectionistic concerns showed
positive relationships across the studies, with two exceptions: Stoeber et al. (2008,
Study 1) found a nonsignificant relationship for perfectionistic strivings, and
Zarghmi et al. (2010) found a nonsignificant relationship for perfectionistic
concerns. Still, overall the pattern of relationships suggests that both perfectionism
dimensions have links with performance-approach goals. For perfectionistic
strivings and performance-avoidance goals, six studies found nonsignificant

relationships, three found positive relationships (Damian et al., 2014; Speirs
Neumeister et al., 2015; Verner-Filion & Gaudreau, 2010), and one found a
negative relationship (Stoeber et al., 2008, Study 1). In contrast, perfectionistic
concerns showed positive relationships with performance-avoidance goals across
all studies, except for two that found nonsignificant relationships (Speirs
Neumeister et al., 2015; Stoeber et al., 2008, Study 1). This pattern suggests that
perfectionistic concerns are consistently linked with performance-avoidance
goals, but not perfectionistic strivings. In contrast, all studies found perfectionistic
strivings to show positive relationships with mastery-approach goals, and
perfectionistic concerns to show nonsignificant relationships. The pattern was
reversed for mastery-avoidance goals. All studies found perfectionistic strivings to
show nonsignificant relationships whereas perfectionistic concerns showed
positive relationships, except for two studies that found positive relationships for
perfectionistic strivings and a nonsignificant relationship for perfectionistic
concerns (Damian et al., 2014; Speirs Neumeister et al., 2015). Overall, however,
the pattern of relationships suggests that perfectionistic strivings are linked with
mastery-approach goals whereas perfectionistic concerns are linked with mastery-
avoidance goals.
The 3 × 2 Model

The 2 × 2 model has been criticized because mastery goals fail to differentiate
whether an individual’s goals focus on the task (improving task performance) or on
the self (improving one’s personal performance). To address this criticism, Elliot,
Murayama, and Pekrun (2011) introduced the 3 × 2 model of achievement goals
differentiating approach and avoidance for task, self, and other goals. In this model,
other-approach and other-avoidance goals correspond to performance-approach
and performance-avoidance goals of the 2 × 2 model. Task-approach, self-
approach, task-avoidance, and self-avoidance goals go beyond the 2 × 2 model
allowing an assessment of whether mastery-approach and mastery-avoidance goals
are task-focused or self-focused.
So far, only two studies have investigated how perfectionistic strivings and
concerns relate to the goals of the 3 × 2 model. The first study (Stoeber, Haskew,
& Scott, 2015) presented undergraduates with a text to study for a mock exam to
take within the next few days, and then asked students for their goals regarding
this exam. As expected, perfectionistic strivings showed positive correlations
with all approach goals (task-, self-, and other-approach) whereas perfectionistic
concerns did not show any significant correlations with the approach goals.
Unexpectedly, perfectionistic strivings also showed positive correlations with all
avoidance goals (task-, self-, and other-avoidance), and perfectionistic concerns
showed a positive correlation with other-approach goals. Unfortunately, the
study did not control for the overlap between perfectionistic strivings and
concerns, so we do not know how much the overlap was responsible for the
unexpected pattern of correlations. But there is another study on perfectionism

and the 3 × 2 achievement goals in sport controlling for the overlap (Madigan,
Stoeber, & Passfield, 2017), and this study found a pattern of relationships more
in line with expectations. Perfectionistic strivings showed unique positive
relationships with all approach goals (task-, self-, and other-approach) and unique
negative relationships with task- and self-avoidance goals. In contrast,
perfectionistic concerns showed positive relationships with all avoidance goals
(task-, self-, and other-avoidance) and negative relationships with task- and self-
approach goals, confirming the findings with the 2 × 2 model that perfectionistic
strivings are mainly approach-oriented whereas perfectionistic concerns are
mainly avoidance-oriented.
Summary
Our review of the studies examining multidimensional perfectionism and
achievement motivation shows that perfectionistic strivings and perfectionistic
concerns—the two higher-order dimensions of multidimensional perfectionism—
have distinct motivational qualities. This is in particular the case when the overlap
of the two dimensions is controlled statistically and unique relationships are
examined (cf. Stoeber & Gaudreau, 2017). In line with Slade and Owens’ (1998)
dual-process model of perfectionism, perfectionistic strivings are mainly approach-
oriented showing unique positive relationships with hope of success (when
regarding achievement motives) and mastery-approach and performance-approach
goals (when regarding achievement goals). In contrast, perfectionistic concerns are
mainly avoidance-oriented showing unique positive relationships with fear of
failure (regarding achievement motives) and mastery-avoidance and performance-
avoidance goals (regarding achievement goals).
There are, however, two motivational qualities in which the two perfectionism
dimensions show similar profiles. The first is performance-approach goals,
because perfectionistic concerns—even though mainly avoidance-oriented—also
show unique positive relationships with performance-approach goals, which
cannot be explained by the dual-process model of perfectionism. The relationships,
however, can be explained by the hierarchical model of achievement motivation
(Elliot, 1997). According to this model, performance-approach goals are
motivated by both hope of success and fear of failure, which would explain why
both perfectionistic strivings (associated with hope of success) and perfectionistic
concerns (associated with fear of failure) show positive relationships with
performance-approach goals. Further, performance-approach goals may have
two orientations: a normative orientation (outperforming others, comparing
one’s performance to others’ performance) and a competence-demonstration
orientation (demonstrating competence, trying to show others that one is better
than others). Only the former is achievement motivated whereas the latter is
mainly self-presentational (Senko, Hulleman, & Harackiewicz, 2011), and this
may explain why both perfectionism dimensions link with performance-approach
goals. Perfectionistic strivings may link with performance-approach goals because

they have achievement-motivated aspects, whereas perfectionistic concerns may
link with these goals because they have self-presentational aspects. Support for
this possible explanation comes from research on perfectionism and social goals
that found perfectionistic concerns to show positive correlations with
demonstration-approach goals, but not perfectionistic strivings (Shim & Fletcher,
2012; Stoeber, 2014a).
The second motivational quality is ego goals. Whereas only perfectionistic
strivings show unique positive relationships with task goals, both perfectionistic
strivings and perfectionistic concerns show unique positive relationships with
ego goals (even though the relationships of perfectionistic strivings are stronger
and more consistent). The possible explanation for this overlap may be that
theory and research on ego goals do not differentiate approach and avoidance.
Therefore, ego goals (which are comparable to performance goals) may not only
contain qualities of performance-approach goals, but also qualities of performance-
avoidance goals. This mixture of qualities may explain why both perfectionism
dimensions show positive relationships with ego goals, and underscores the
importance of differentiating approach and avoidance orientations in achievement
motivation.
Furthermore, the differentiation of approach and avoidance is important to
understand why perfectionistic strivings can be adaptive. Even though we agree
with Gaudreau and colleagues (see Chapter 3) that achievement goals are inherently
complex processes, the degree of self-determination in achievement goals should
be taken into account (e.g., Vansteenkiste et al., 2010). Also, the adaptiveness of
performance-approach and mastery-approach goals may be situation-dependent
(e.g., performance-approach goals should be more adaptive in exams/competitions,
mastery-approach goals in learning/training). In addition, there is substantial
evidence that, all things being equal, performance- and mastery-approach goals are
adaptive and performance- and mastery-avoidance goals maladaptive (e.g., Moller
& Elliot, 2006). Moreover, performance-approach goals can explain why athletes
high in perfectionistic strivings outperform athletes low in perfectionistic strivings
in competitions (Stoeber, Uphill, & Hotham, 2009). Similarly, task-approach goals
can explain why students high in perfectionistic strivings outperform students low
in perfectionistic strivings in exams (Stoeber et al., 2015). But what about
perfectionistic strivings’ positive relationships with ego goals, which are regarded as
mixed adaptive–maladaptive? Here it is important to note that perfectionistic
strivings show positive relationships not only with ego goals, but also with task
goals. Whereas the pursuit of ego goals can be maladaptive, it has been suggested
that task goals are usually adaptive and may buffer or neutralize the maladaptive
effects of ego goals (Duda, 2005). Consequently, even when we do not differentiate
approach and avoidance, perfectionistic strivings (showing positive relationships
with ego goals and task goals) are associated with a more adaptive pattern of
achievement goals than perfectionistic concerns (showing positive relationships
with ego goals, but not with task goals).
Self-Determination Theory
Self-determination theory (Deci & Ryan, 1985) postulates that an individual’s level
of self-determined motivation is reflected by the extent to which the individual’s
behavior is regulated by processes that are congruent with the self. Ryan and Deci
(2000) suggest that a continuum of behavioral regulation exists that ranges from
non-self-determined to self-determined motivation (see Figure 2.1). Self-
determination theory differentiates three forms of motivation: intrinsic motivation,
extrinsic motivation, and amotivation. These forms are associated with different
regulatory styles: intrinsic motivation with intrinsic regulation, extrinsic motivation
with external, introjected, identified, and integrated regulation, and amotivation
with non-regulation (see again Figure 2.1). Hence, the theory conceptualizes
extrinsic motivation as a composite of four regulatory styles differing in self-
determination and perceived locus of causality. External regulation is the least self-
determined regulation, and the perceived locus of causality is external and has no
internal aspects. External regulation is characterized by passive compliance and
feelings of alienation, and actions are performed only to gain external rewards and
avoid external punishments. Introjected regulation is more self-determined than
external regulation, and the perceived locus is predominantly external (but has
some internal aspects). Introjected regulation is characterized by values, standards,
and expectations—originating from socialization (parents, teachers, society)—that
have been “taken in,” but are not fully accepted as one’s own. Here, actions are
performed to gain internal rewards (e.g., feelings of pride) and avoid internal
punishments (e.g., feelings of anxiety, guilt, and shame). Identified regulation is even
more self-determined than introjected regulation, and the perceived locus is
predominantly internal (but still has external aspects). Identified regulation is
characterized by personal importance and conscious valuing of reasons for doing an
activity. Here values, standards, and expectations are perceived as personal.
Integrated regulation is the most self-determined regulatory style associated with
extrinsic motivation, and the perceived locus of causality is internal. Integrated
regulation is characterized by congruence and awareness of reasons and by goals
being in synthesis with the self. Here personal values, standards, and expectations
are fully integrated in the self.
The most self-determined form of regulation, however, is intrinsic regulation
which is the regulatory style of intrinsic motivation and characterized by personal
interest, inherent satisfaction, and enjoyment. As with integrated regulation, the
perceived locus of control is internal, but—differently from integrated regulation—
actions are not performed for the expected outcomes, but for their inherent
enjoyment. Intrinsic motivation is task-focused, not outcome-focused. By contrast,
amotivation is unfocused and is associated with non-regulation and a perceived locus
of control that is impersonal. Amotivation is characterized by feelings of
incompetence, not valuing activities, and a perceived lack of control. People who
are amotivated either do not act or “just go through the motions” (Ryan & Deci,
2000, p. 72).
Motivation
Non-self-determined Self-determined
Extrinsic Intrinsic
Amotivation motivation motivation
Non- External Introjected Identified Integrated Intrinsic

regulation regulation regulation regulation regulation regulation
Perfectionistic concerns Perfectionistic strivings
Perfectionism
FIGURE 2.1 erfectionism and the self-determination continuum. Perfectionistic concerns are mainly associated with amotivation, external
P
regulation, and introjected regulation. In contrast, perfectionistic strivings are mainly associated with intrinsic motivation, integrated
regulation, and identified regulation but may also show associations with introjected and external regulation. (The motivation part
of the figure was adapted from Ryan & Deci, 2000, Figure 1.)
Numerous studies have investigated the relationships of multidimensional

perfectionism and self-determination differing in the degree to which individual
differences in the three motivations and the six regulatory styles of the self-
determination continuum were analyzed. Unfortunately, some studies did not
differentiate the three forms of motivation but only reported correlations with a
global self-determination index combining intrinsic motivation, extrinsic
motivation, and amotivation and so were not included in our analyses (e.g.,
Burnam, Komarraju, Hamel, & Nadler, 2014; Gaudreau, Franche, & Gareau,
2016). Other studies examined extrinsic motivation without differentiating the
more self-determined from the less self-determined regulatory styles that comprise
extrinsic motivation, and so were also not included (e.g., Chen, Kuo, & Kao,
2016; Mills & Blankstein, 2000). The reason is that differentiating regulatory styles
in extrinsic motivation is important for understanding the different motivational
qualities of perfectionistic strivings and perfectionistic concerns, as the studies on
autonomous versus controlled motivation demonstrate.
Autonomous Versus Controlled Motivation

In research on autonomous versus controlled motivation, autonomous motivation
is usually operationalized as the combination of intrinsic motivation and identified
regulation (also including integrated regulation, if assessed) whereas controlled
motivation is operationalized as the combination of introjected and external
regulation (sometimes also including amotivation). Reviewing the literature on
perfectionism and motivation, we found 11 studies that examined autonomous and
controlled motivation and reported bivariate correlations.3 As regards autonomous
motivation, all studies found perfectionistic strivings to show positive correlations
(Barcza-Renner, Eklund, Morin, & Habeeb, 2016; Gaudreau & Antl, 2008; Harvey
et al., 2015; Jowett, Hill, Hall, & Curran, 2013; Madigan, Stoeber, & Passfield,
2016; Miquelon, Vallerand, Grouzet, & Cardinal, 2005, Studies 1–2; Mouratidis &
Michou, 2011; Vansteenkiste et al., 2010). In comparison, only two studies found
perfectionistic concerns to show positive correlations with autonomous motivation
(Madigan et al., 2016; Vansteenkiste et al., 2010) whereas six found nonsignificant
correlations (Gaudreau & Antl, 2008; Jowett et al., 2013; Madigan et al., 2016;
Miquelon et al., 2005, Studies 1–2; Mouratidis & Michou, 2011) and one even
found a negative correlation (Barcza-Renner et al., 2016). For controlled motivation,
all studies found perfectionistic concerns to show positive correlations (Barcza-
Renner et al., 2016; Gaudreau & Antl, 2008; Jowett et al., 2013; Madigan et al.,
2016; Miquelon et al., 2005, Studies 1–2; Mouratidis & Michou, 2011; Stoeber &
Eismann, 2007; Vansteenkiste et al., 2010). In comparison, only seven studies found
perfectionistic strivings to show positive correlations with controlled motivation
(Barcza-Renner et al., 2016; Gaudreau & Antl, 2008; Jowett et al., 2013; Madigan
et al., 2016; Mouratidis & Michou, 2011; Nguyen & Deci, 2016; Vansteenkiste et
al., 2010) and four found nonsignificant correlations (Harvey et al., 2015; Miquelon
et al., 2005, Studies 1–2; Stoeber & Eismann, 2007).
Counting significant bivariate correlations, however, gives a distorted picture of

how perfectionistic strivings are related to controlled motivation. First, when
perfectionistic strivings showed positive correlations with controlled motivation,
they were usually smaller than those of perfectionistic concerns. Second, studies
that statistically controlled the overlap between perfectionistic strivings and
concerns found perfectionistic strivings to show unique positive relationships only
with autonomous motivation, but not with controlled motivation (Gaudreau &
Antl, 2008; Jowett et al., 2013; Madigan et al., 2016; Mouratidis & Michou, 2011;
Miquelon et al., 2005, Studies 1–2; Vansteenkiste et al., 2010). Moreover, the
same studies found perfectionistic concerns to show unique positive relationships
only with controlled motivation, but not with autonomous motivation. Whereas
this pattern of relationships suggests that perfectionistic strivings link with
autonomous motivation (but not controlled motivation) and perfectionistic
concerns link with controlled motivation (but not autonomous motivation), the
picture for perfectionistic strivings is more complex as the studies examining
individual regulatory styles from the full self-determination continuum show.
The Full Self-Determination Continuum

Various studies have examined multidimensional perfectionism and self-
determination differentiating amotivation, external regulation, introjected
regulation, identified regulation, integrated regulation, and/or intrinsic motivation.4
As regards amotivation, five studies found perfectionistic strivings to show negative
correlations (Appleton & Hill, 2012; Chang, Lee, Byeon, Seong, & Lee, 2016;
Longbottom, Grove, & Dimmock, 2012; Madigan et al., 2016; Stoeber, Davis, &
Townley, 2013) and five found nonsignificant correlations (Barcza-Renner et al.,
2016; A. P. Hill, 2014; Longbottom et al., 2012; Madigan et al., 2016, Time 1;
McArdle & Duda, 2004). In comparison, eight studies found perfectionistic
concerns to show positive correlations with amotivation (Appleton & Hill, 2012;
Barcza-Renner et al., 2016; Chang et al., 2016; A. P. Hill, 2014; Longbottom et
al., 2012; Madigan et al., 2016; McArdle & Duda, 2004; Stoeber et al., 2013) and
only one found nonsignificant correlations (Madigan et al., 2016). Clearly,
amotivation is the domain of perfectionistic concerns, and antithetical to
perfectionistic strivings. Moreover, the opposing pattern of relationships is often
enhanced when the overlap between perfectionistic strivings and concerns is
controlled. Perfectionistic concerns tend to show stronger positive relationships,
and perfectionistic strivings stronger negative relationships with amotivation when
unique relationships are regarded (e.g., A. P. Hill, 2014).
For external regulation,5 five studies found perfectionistic strivings to show
positive correlations (Appleton & Hill, 2012; Chang et al., 2016; Gucciardi et al.,
2012; A. P. Hill, 2014; McArdle & Duda, 2004) and four found nonsignificant
correlations (Flett et al., 2016; Longbottom et al., 2012; Stoeber et al., 2013;
Stoeber, Feast, & Hayward, 2009). In comparison, nine studies found perfectionistic
concerns to show positive correlations with external regulation (Appleton & Hill,
2012; Chang et al., 2016; Flett et al., 2016; Gucciardi et al., 2012; A. P. Hill, 2014;
Longbottom et al., 2012; McArdle & Duda, 2004; Stoeber et al., 2013; Stoeber,
Feast, & Hayward, 2009) and only one found a nonsignificant correlation (Chang
et al., 2016). This pattern suggests that perfectionistic concerns show stronger
positive links with external regulation than perfectionistic strivings. Still, the
number of studies linking perfectionistic strivings with external regulation is
noteworthy.
Turning to introjected regulation, all studies found perfectionistic strivings to show
positive correlations (Appleton & Hill, 2012; Chang et al., 2016; A. P. Hill, 2014;
Flett et al., 2016; Longbottom et al., 2012; McArdle & Duda, 2004; Stoeber et al.,
2013; Stoeber, Feast, & Hayward, 2009). In comparison, eight studies found
perfectionistic concerns to show positive correlations with introjected regulation
(Appleton & Hill, 2012; Chang et al., 2016; Flett et al., 2016; A. P. Hill, 2014;
Longbottom et al., 2012; McArdle & Duda, 2004; Stoeber et al., 2013; Stoeber,
Feast, & Hayward, 2009) and one found a nonsignificant correlation (Chang et al.,
2016). However, an inspection of the size of the correlations indicated that—in the
majority of studies—perfectionistic concerns tended to show stronger positive
relationships with introjected regulation than perfectionistic strivings (see also
Jowett et al., 2016), indicating that perfectionistic concerns have stronger links
with introjected regulation than perfectionistic strivings.
Regarding identified regulation, seven studies found perfectionistic strivings to
show positive correlations (Chang et al., 2016; Flett et al., 2016; Longbottom et
al., 2012; McArdle & Duda, 2004; Stoeber et al., 2013; Stoeber & Eismann, 2007;
Stoeber, Feast, & Hayward, 2009) and three found nonsignificant correlations
(Appleton & Hill, 2012; A. P. Hill, 2014; Longbottom et al., 2012). In comparison,
only one study found perfectionistic concerns to show a positive correlation with
identified regulation (Appleton & Hill, 2012) whereas eight found nonsignificant
correlations (Chang et al., 2016; Flett et al., 2016; A. P. Hill, 2014; Longbottom et
al., 2012; McArdle & Duda, 2004; Stoeber et al., 2013; Stoeber & Eismann, 2007;
Stoeber, Feast, & Hayward, 2009) and one even found a negative correlation
(Chang et al., 2016). This indicates that identified regulation is more the domain
of perfectionistic strivings than perfectionistic concerns.
Unfortunately, only one study examined multidimensional perfectionism and
integrated regulation (Stoeber et al., 2013). It found perfectionistic strivings to show
a positive correlation whereas perfectionistic concerns showed a nonsignificant
correlation.
In contrast, numerous studies examined perfectionism and intrinsic motivation,
and the pattern of relationships is very clear. Thirteen studies found perfectionistic
strivings to show a positive correlation with intrinsic motivation (Appleton & Hill,
2012; Chang, Lee, Byeon, & Lee, 2015; Chang et al., 2016; Flett et al., 2016;
Gucciardi et al., 2012; A. P. Hill, 2014; Longbottom et al., 2012; McArdle &
Duda, 2004; Mills & Blankstein, 2000; Quested et al., 2014; Stoeber et al., 2013;
Stoeber & Eismann, 2007; Stoeber, Feast, & Hayward, 2009) whereas only two
found nonsignificant correlations (Longbottom et al., 2012; Mills & Blankstein,
2000). In comparison, no study found perfectionistic concerns to show any positive

correlations with intrinsic motivation. Instead, all studies found nonsignificant
correlations (Appleton & Hill, 2012; Chang et al., 2015; Chang et al., 2016; Flett
et al., 2016; Gucciardi et al., 2012; A. P. Hill, 2014; Longbottom et al., 2012;
McArdle & Duda, 2004; Quested et al., 2014; Stoeber et al. 2013; Stoeber &
Eismann, 2007; Stoeber, Feast, & Hayward, 2009) except for one that found a
negative correlation (Longbottom et al., 2012).
Whereas the positive relationships that perfectionistic strivings showed with
intrinsic motivation, integrated regulation, and identified regulation replicate the
relationships from the studies examining autonomous motivation (combining
intrinsic motivation, integrated regulation, and identified regulation), this is not
the case for the positive relationships that perfectionistic strivings showed with
introjected and external regulation because the latter remained significant when
the overlap with perfectionistic concerns was controlled. Also, when revisiting the
two reviews we consulted earlier in this chapter (Gotwals et al., 2012; Jowett et al.,
2016), we found that controlling for perfectionistic concerns tended to attenuate
the positive correlations between perfectionistic strivings and introjected regulation,
but in three of the studies the correlations remained significant. The same pattern
was found with external regulation. This suggests that the motivational profile
associated with perfectionistic strivings extends beyond internally and mostly
internally motivated regulations into regulations that are more externally motivated.
Summary
Our review of the studies examining multidimensional perfectionism from the
perspective of self-determination theory shows that perfectionistic strivings and
perfectionistic concerns have distinct motivational qualities also with regard to self-
determined motivation, which are particularly pronounced when the unique
relationships of the two perfectionism dimensions are examined (cf. Stoeber &
Gaudreau, 2017). Perfectionistic strivings are mainly associated with motivations
and regulatory styles characterized by higher degrees of self-determination such as
intrinsic motivation, integrated regulation, and identified regulation. In contrast,
perfectionistic concerns are mainly associated with motivations and regulatory
styles characterized by lower degrees of self-determination such as amotivation,
external regulation, and introjected regulation. However, perfectionistic strivings
may also show positive relationships with introjected and external regulation even
when the overlap with perfectionistic concerns is controlled, suggesting that the
motivational qualities of perfectionistic strivings may reach into the domain of less
self-determined regulation (see Figure 2.1).
As to reasons why this is the case, we can only speculate. One possibility is that
the pattern of strivings and concerns showing positive relationships with external
and introjected regulation can be explained by the fact that both regulations are
focused on rewards and punishments: External regulation aims to achieve external
rewards and avoid external punishments, and introjected regulation aims to achieve
internal rewards and avoid internal punishments. Unfortunately, external and

introjected regulation do no differentiate approach (achieve rewards) and avoidance
(avoid punishments). Consequently, it could be that perfectionistic strivings (which
are mainly approach-oriented) link with external and introjected regulation because
they are geared toward achieving external and internal rewards, whereas
perfectionistic concerns (which are mainly avoidance-oriented) link with external
and introjected regulation because they are geared toward avoiding external and
internal punishments. This explanation would also be supported by studies
examining perfectionism and reinforcement sensitivity (Stoeber & Corr, 2017; see
also Chapter 4) that found perfectionistic strivings to show strong links with all
goal- and reward-oriented aspects of the behavioral approach system (BAS) whereas
perfectionistic concerns showed strong links with the behavioral inhibition system
(BIS) which is aimed at avoiding punishment. The goal- and reward-oriented
aspect of the BAS may drive perfectionistic strivings toward external and introjected
regulation because of the reward aspects of these regulatory styles, whereas the BIS
may drive perfectionistic concerns toward external and introjected regulation
because of the punishment-avoidance aspects of these regulatory styles.
Limitations and Future Research

Whereas this review presents a comprehensive account of research on
multidimensional perfectionism and motivation regarding how perfectionistic
strivings and concerns relate to achievement motivation and self-determination, it
is important to note some limitations. First, approximately half of the studies we
reviewed were conducted in the sport domain (see reference list). Whereas we are
uncertain if this is a limitation or not—because our impression is that perfectionistic
strivings and concerns show by and large the same motivational profiles across
domains (e.g., university versus sport) and samples (e.g., students versus athletes)—
future research may profit from examining whether there are systematic differences
between different domains and samples (cf. A. P. Hill & Curran, 2016). Second,
and more importantly, there are other important dimensions, forms, and aspects of
perfectionism that our review did not cover such as other-oriented perfectionism
(Hewitt & Flett, 1991), perfectionistic self-presentation (Hewitt et al., 2003), and
hybrid forms of perfectionism like narcissistic and self-critical perfectionism (see
Chapter 9). Further, the review provides a comprehensive coverage of achievement
motives and achievement goals, but there are other motives and goals that may play
a role for our understanding of multidimensional perfectionism. For example,
research on motives traditionally differentiates three basic motives: achievement,
affiliation, and power. Whereas achievement plays an important role for many
aspects of perfectionism, affiliation and power may also play important roles
particularly if we regard interpersonal aspects of perfectionism (see again Chapter 9
as well as Chapter 15). Furthermore, besides achievement goals, social goals may
play a role (Shim & Fletcher, 2012; Stoeber, 2014a). Consequently, future research
may profit from going beyond achievement when examining motives and goals,
and investigate differences in the motivational qualities of different forms,

dimensions, and aspects of multidimensional perfectionism.
Finally, like most studies on perfectionism, nearly all the studies we reviewed
were cross-sectional and thus cannot tell us whether perfectionism affects
motivation, motivation affects perfectionism, whether there are reciprocal effects,
or whether perfectionism and motivation are mere correlates. However, preliminary
findings from longitudinal studies we conducted suggest that perfectionism affects
motivation (and not vice versa). In one study, for example, we found that
perfectionistic strivings predicted longitudinal increases in school engagement
(Damian, Stoeber, Negru-Subtirica, & Băban, 2017). In another study, we found
that perfectionistic strivings predicted longitudinal increases in autonomous
motivation whereas perfectionistic concerns predicted longitudinal increases in
controlled motivation (Madigan et al., 2016). Both studies tested for reverse and
reciprocal effects, but did not find any such effects. Whereas these findings are
encouraging, more—and more systematic—research using longitudinal designs is
needed to unravel the temporal and causal relationships between perfectionism and
motivation.
Conclusion
Perfectionism is a multidimensional personality disposition that comes in different
forms and has different aspects, and whereas many aspects of perfectionism are
maladaptive, some aspects of perfectionism can be adaptive (Enns & Cox, 2002).
To understand this dual nature of perfectionism regarding adaptive and maladaptive
aspects and why perfectionism can be a “double-edged sword” (Stoeber, 2014b),
the two-factor model of perfectionism—differentiating the two higher-order
dimensions of perfectionistic strivings and perfectionistic concerns—has been
extremely useful (Stoeber & Otto, 2006; see also Gotwals et al., 2012; Jowett et al.,
2016; and Chapter 3).
As the present chapter demonstrates, this is also the case when perfectionism is
examined from a motivational perspective and the relationships of perfectionistic
strivings and concerns with achievement motivation and self-determination are
regarded. The reason is that perfectionistic strivings and concerns have different
motivational qualities. Whereas there are some overlapping qualities, the two
dimensions clearly have distinctive “motivational footprints.” The motivations
associated with perfectionistic concerns are mainly avoidance-oriented and lack
self-determination—and often motivation is lacking altogether (amotivation). In
contrast, the motivations associated with perfectionistic strivings are mainly
approach-oriented and largely self-determined and involve both ego goals and task
goals. And in individualistic, highly demanding, and competitive achievement-
oriented societies, such motivations should be adaptive.
These differences in motivational qualities are not only important to understand
the dual nature of perfectionism. They are also important to explain the different,
sometimes opposing, relationships that the two perfectionism dimensions show
with achievement-related processes and outcomes and with indicators of

psychological adjustment and maladjustment. For example, differences in
achievement motives and achievement goals can explain why people high in
perfectionistic strivings show higher performance, but not people high in
perfectionistic concerns (Stoeber, 2012). Differences in hope of success can explain
why only people high in perfectionistic strivings raise their aspiration levels after
success (Stoeber, Hutchfield, & Wood, 2008) in line with Atkinson’s (1957) classic
model of motivation and task choice. Furthermore, differences in approach
motivation and self-determined motivation can explain why people high in
perfectionistic strivings make progress in important goals they set themselves,
whereas people high in perfectionistic concerns do not (Powers, Koestner, &
Topciu, 2005). Finally, differences in self-determined motivation can explain why
perfectionistic concerns are associated with high levels of burnout whereas
perfectionistic strivings are associated with low levels (A. P. Hill & Curran, 2016;
Madigan et al., 2016). The latter findings suggest that differences in motivational
qualities may also explain why perfectionistic strivings are often associated with
psychological adjustment whereas perfectionistic concerns are associated with
psychological maladjustment.
Based on the findings of our review, we assert that research would profit from
taking a motivational perspective on multidimensional perfectionism. In particular,
research may want to pay closer attention to the motivational qualities associated
with perfectionism and the differential motivational profiles of perfectionistic
strivings and perfectionistic concerns. Perhaps perfectionism should even be
regarded as a motive disposition (need for perfection) whereby perfectionistic
strivings represent the approach-oriented aspects (hope of perfection, perfection-
approach goals) that feel self-determined and autonomous whereas perfectionistic
concerns represent the avoidance-oriented aspects (fear of imperfection,
imperfection-avoidance goals) that do not feel self-determined, but controlled and
may leave some perfectionists disengaged and amotivated.
Notes
1 A. P. Hill et al. (2010) examined self-oriented perfectionism as an indicator of
perfectionistic strivings differentiating perfectionistic striving and importance of being
perfect, so our analysis focused on perfectionistic striving (see Chapter 1, Table 1.1,
Note c).
2 Note that a number of studies did not examine all four goals (e.g., the studies following
the tripartite model); some studies included multiple indicators of perfectionistic strivings
and perfectionistic concerns; and with Van Yperen’s (2006) study, our analysis focused
on perfectionistic striving (cf. Note 1).
3 However, not all studies included all four variables: perfectionistic strivings, perfectionistic
concerns, autonomous motivation, and controlled motivation.
4 A number of studies employed multiple measures of perfectionistic strivings and
perfectionistic concerns or multiple measures of self-determined motivation that
sometimes showed different correlations. Consequently, some studies appear twice

when listing the findings.
5 Note that some studies examined external regulation, but called it extrinsic regulation.
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3
THE 2 × 2 MODEL OF
PERFECTIONISM
Assumptions, Trends, and Potential
Developments
Patrick Gaudreau, Véronique Franche, Kristina Kljajic, and

Gabrielle Martinelli
Overview
We will start this chapter with an overview of the 2 × 2 model of perfectionism
(Gaudreau & Thompson, 2010). Then we will use a nomological approach to
revisit the empirical studies in a way that will delineate both trends and unexpected
findings from the literature on the 2 × 2 model. We will also elaborate on some
recent advances and potential areas of development within the theory. Lastly, we
will conclude with final remarks to inform parents, teachers, coaches, and
psychologists who are in need of a practical theory to know what to expect when
working with individuals who have developed many of the characteristics of a
perfectionist.
Introduction
Imagine that you are a parent, a teacher, a coach, or a school psychologist and that
one of your protégés appears to have developed many of the characteristics of a
perfectionist. Based on your observations, you are concerned because your
protégé appears to be striving toward exceedingly high standards of achievement.
He seems to be under constant pressure to perform exceptionally well and is
overly concerned about mistakes and falling short of expectations. He rarely feels
satisfied about his achievement and believes that others are expecting perfection
from him. Your growing concern for his well-being prompts you to look into
studies in psychology to understand what researchers and practitioners know
about perfectionism. Instead of finding concrete answers, chances are you are left
puzzled about the current state of research. Is perfectionism harmful, harmless, or
helpful? Are the effects of perfectionism different across individuals, life domains,
and situations? Given the complicated state of the evidence on perfectionism, we
The 2 × 2 Model of Perfectionism 45
believe a good theory should be the roadmap to scientific inquiry and practical
interventions.
A few years ago, we decided to develop and test the 2 × 2 model of perfectionism
(Gaudreau & Thompson, 2010) to offer guidelines to differentiate four ways of
being a perfectionist. Recently, we made efforts to explicate (e.g., Gaudreau &
Verner-Filion, 2012) and clarify (Gaudreau, 2013) the key assumptions of the
theory. We also proposed methodological guidelines (Gaudreau, 2012) and
alternative methods (Franche & Gaudreau, 2016; Franche, Gaudreau, & Miranda,
2012; Gaudreau, 2015) to probe the four hypotheses of the model. Along with
members of our research team, several interested colleagues carried out studies to
examine how different ways of being a perfectionist can exert distinct influences
on psychological adjustment. Initial criticisms (Stoeber, 2012) eventually led their
way to clarifications (Gaudreau, 2012, 2013) and renewed enthusiasm for the
model (e.g., Stoeber, 2014). Following the growing number of studies testing the
2 × 2 model, time has come to critically re-examine the current state of evidence
to nurture the iterative development of a “progressive and advancing research
program” (Eysenck, 1987, p. 49).
Overview of the 2 × 2 Model of Perfectionism

The 2 × 2 model is based on a bidimensional conceptualization of perfectionism
that differentiates personal standards perfectionism (PSP) and evaluative concerns
perfectionism (ECP). We proposed that PSP and ECP cohabit within every
individual, albeit to a different degree across individuals. Instead of solely focusing
on the respective effects of each of the two dimensions, we used the analogy of a
Latin square design to define and compare four different ways of being a
perfectionist: non-perfectionism (low PSP and ECP), pure PSP (high PSP and low
ECP), pure ECP (low PSP and high ECP), and mixed perfectionism (high PSP
and ECP).
These ways of being a perfectionist can be derived using mathematical
abstractions (Gaudreau, 2012) but we also contend that they are part of a salient
and accessible system of mental representations about the self (Gaudreau, 2015).
Therefore, individuals should possess sufficient self-knowledge to describe their
way of being a perfectionist with relative certainty. On the one hand, individuals
should possess accessible mental representations that help them differentiate
whether they are typically non-perfectionist (i.e., low PSP and ECP) or
perfectionist. On the other hand, perfectionism should take on a differentiated
color depending on whether individuals think they are perfectionistic
predominantly because of their own personal standards (pure PSP) or because of
evaluative concerns (pure ECP). These two prototypically contrasted ways of
being a perfectionist also need to be differentiated from a more nuanced and
potentially complex form of perfectionism in which individuals think they are
perfectionistic because of a mixture of personal standards and evaluative concerns
(mixed perfectionism).
46 Gaudreau, Franche, Kljajic, & Martinelli
In the 2 × 2 model of perfectionism, we relied on the word “subtypes” as a

diminutive of the expression “within-person combinations of PSP and ECP”
rather than as a word to describe naturally existing categories or types of
perfectionism. More importantly, we proposed that the four subtypes of
perfectionism should be distinctively associated with antecedents, processes, and
outcomes. Given that the controversy on the harmfulness or helpfulness of
perfectionism surrounds predominantly the subtype of pure PSP, we proposed
three alternative versions of Hypothesis 1 to acknowledge that pure PSP could be
associated with better (Hypothesis 1a), worse (Hypothesis 1b), or similar (Hypothesis
1c) outcomes compared to non-perfectionism. Findings supporting Hypothesis 1a
would be consistent with the perspective and empirical results showing that PSP
can be positively associated with desirable outcomes (Gotwals, Stoeber, Dunn, &
Stoll, 2012; Stoeber, 2011). Findings supporting Hypothesis 1b would be consistent
with the viewpoint and research findings suggesting a positive association between
PSP and detrimental outcomes (e.g., Flett & Hewitt, 2014; O’Connor, 2007).
Lastly, findings supporting Hypothesis 1c would be consistent with the perspective
that PSP is neither helpful nor harmful (Bieling, Israeli, & Antony, 2004). We
remain convinced that each of these three alternative hypotheses are needed to
examine the conditions in which pure PSP is more likely to be beneficial or
damaging compared to non-perfectionism.
In the second hypothesis, we proposed that pure ECP should be associated with
worse outcomes than non-perfectionism. Most researchers would unequivocally
assert that the core characteristics of ECP (e.g., socially prescribed perfectionism,
concern over mistakes, doubts about actions) are negatively linked to psychological
adjustment and positively linked to psychological maladjustment (e.g., Gotwals et
al., 2012; Hill & Curran, 2016). Consistent with these findings, we proposed that
pure ECP should be the most damaging subtype of perfectionism.
In the last two hypotheses, we proposed that mixed perfectionism should be
associated with better outcomes than pure ECP (Hypothesis 3) but worse
outcomes than pure PSP (Hypothesis 4). Individuals with mixed perfectionism
tend to set and strive toward the attainment of outstandingly high standards of
perfectionism and flawlessness because of the personal importance and valuation
attached to these standards. Meanwhile, these individuals also have doubts
regarding their ability to attain extremely high standards of excellence and they
seem to embrace perfectionistic standards because they believe that significant
others expect them to be perfect. Thus, this subtype is a more nuanced and
complex expression of perfectionism characterized by a combination of high PSP
and ECP, forming a person-environment congruence (Gaudreau, 2016) in which
the high expectations from significant others are partially internalized in the self.
As a result, we proposed that mixed perfectionism should be associated with
better outcomes than the least internalized form of perfectionism (i.e., pure
ECP), but with worse outcomes than the most internalized form of perfectionism
(i.e., pure PSP).
Overview of Studies on the 2 × 2 Model of Perfectionism

In a previous review of the 2 × 2 model in sport, exercise, and dance, we conducted
a study-by-study analysis to facilitate comparison while highlighting both
consistencies and unexpected findings in the observed effects (Gaudreau, 2016). In
the current chapter, we will summarize two meta-observations that emerged while
reflecting upon the extant literature on the 2 × 2 model. Then, we will review the
empirical studies with a thematic rather than a study-by-study approach to shed
light on the nomological network of the four subtypes of perfectionism.
Meta-Observations About the Extant Literature
Variable-Centered Versus Person-Centered Approach

In our research program, we tested the hypotheses of the 2 × 2 model with a
variable-centered approach (e.g., multiple regressions, structural equation
modeling). Until recently, we considered this approach as preferable to a person-
centered approach, but not necessary to test the 2 × 2 model (e.g., Gaudreau,
2013, 2016). After further considerations, however, we now believe that the
person-centered approach often offers an ambiguous and unsatisfactory platform to
investigate the hypotheses of the 2 × 2 model.1 Accordingly, some of the clusters
or latent classes emerging from these analyses have not been properly aligned with
the operational definitions of the four subtypes proposed in the 2 × 2 model. For
example, researchers comparing mixed perfectionism and pure ECP should
examine individuals with comparably high levels of ECP. However, across studies
that used cluster and latent class analyses, ECP was significantly higher in mixed
perfectionism than in pure ECP (Boone, Soenens, Braet, & Goossens, 2010;
Cumming & Duda, 2012; Inglés, García-Fernández, Vicent, Gonzálvez, &
Sanmartín, 2016; Li, Hou, Chi, Liu, & Hager, 2014; Quested, Cumming, & Duda,
2014; Shim & Fletcher, 2012; Sironic & Reeve, 2012; Wang, Slaney, & Rice,
2007). This is problematic because such a cluster composition distorts the empirical
investigation of Hypothesis 3 by artificially increasing the likelihood that mixed
perfectionism will be related to the worst outcomes.
Furthermore, based on the operational definitions of non-perfectionism and
pure PSP, researchers should compare individuals with comparably low levels of
ECP. ECP levels have been significantly lower in non-perfectionism than in pure
PSP (Boone et al., 2010; Cumming & Duda, 2012; Inglés et al., 2016; Li et al.,
2014; Quested et al., 2014; Sironic & Reeve, 2012). As a result, researchers
compared non-perfectionism with a subtype of individuals who possessed a
moderate rather than a low level of ECP. Such comparisons provided misleading
and rather uninformative tests of the hypotheses of the 2 × 2 model.
Some researchers might argue that the underlying issue stems from our
conceptualization of subtypes of perfectionism. Stated another way, some might
suggest that cluster compositions are representative of the population, whereas the
subtypes of perfectionism in the 2 × 2 model are inaccurate portrayals of

perfectionism in everyday life. We respectfully disagree with this standpoint by
firstly delineating some problems with the person-centered approach and then
explaining some advantages of the variable-centered approach.
The number of possible within-person combinations of PSP and ECP is
countless. Trying to regroup individuals into homogeneous and mutually exclusive
subgroups results in cluster compositions that not only vary in terms of subtypes
(i.e., within-person combinations) but also in terms of quantity or level of PSP and
ECP. Moreover, these between-person differences in the various combinations of
PSP and ECP are often unaccounted for within each of the subtypes identified in
cluster compositions or latent classes. At best, results reflect the most prototypical
members within each of the clusters without considering that each individual also
possesses his or her own within-person combination of the two dimensions of
perfectionism. Even if these problems could be addressed, the main issue remains
that the centroids created by the person-centered approach are not an accurate
portrayal of the four subtypes proposed in the 2 × 2 model. Hence, the four
theoretically driven hypotheses in the 2 × 2 model do not appear to be properly
tested with such analyses.
By contrast, when using the variable-centered approach, researchers can
investigate the associations between subtypes of perfectionism and outcomes—a
desideratum often thought as only achievable in person-centered modeling (Bauer
& Shanahan, 2007)—by estimating the interactive/moderating and unique/main
effects of the two dimensions of perfectionism. Using the estimates of these
interactive/moderating (e.g., Gaudreau & Thompson, 2010) or unique/additive/
main effects (e.g., Gaudreau, 2012), researchers can compare the predicted
outcomes of distinct intersecting points along the continuous distributions of PSP
and ECP. In other words, the 2 × 2 model offers a formalized system of hypotheses
to compare the predicted outcomes of four theoretically driven intersecting points
(i.e., subtypes of perfectionism). For these reasons, the variable-centered approach
offers the most trustworthy platform to directly examine hypotheses of the 2 × 2
model. Therefore, the present review will exclude studies that used the person-
centered approach (Arana & Furlan, 2016; Boone et al., 2010; Cumming & Duda,
2012; Inglés et al., 2016; Li et al., 2014; Purrezaian, Purrezaian, Golzari, & Borjali,
2015; Quested et al., 2014; Shim & Fletcher, 2012; Sironic & Reeve, 2012; Wang
et al., 2007) and focus exclusively on the studies that relied on the variable-centered
approach.2
Types of Dependent Variables

Perfectionism research has flourished and researchers have studied an extended list
of dependent variables. The diversity of life problems (e.g., mental issues, physical
illness, romantic difficulties) that are seemingly linked with perfectionism is
noteworthy. The numerous phenomena that have been associated with (i.e., cross-
sectional links) and influenced by (i.e., longitudinal links) PSP, ECP, or both
illustrate the wide-ranging generalizability and practical importance of research on

perfectionism. Perfectionism is a meaningful personality disposition that cannot be
reduced to a few, weak, or relatively circumscribed effects. However, the
proliferation of dependent variables linked to perfectionism creates interesting
challenges that require thoughtful theoretical considerations.
First, clearly identifying the theoretically plausible correlates of perfectionism
before conducting a study would be desirable. Without such theoretical specificity,
researchers might start exploring the links between perfectionism and any variable
in a way that will promote spurious correlations or findings that could entirely be
explained by other personal, contextual, or situational sources of influence.
Furthermore, if we delineate the anticipated effect sizes (i.e., small, medium, or
large) between perfectionism and various types of dependent variables, we could
identify the main cognitive, emotional, behavioral, and physiological processes
primarily activated by perfectionism.
Second, researchers should try to distinguish the types of dependent variables
that are being studied (i.e., antecedents, processes, or outcomes). Up to now, most
researchers treated dependent variables as if they were all outcomes. Some of the
variables might be better conceived as covariates (e.g., self-esteem, neuroticism),
antecedents (conscientiousness; see Stoeber, Otto, & Dalbert, 2009), or mediators
(e.g., coping, emotion regulation, self-determination, goals) of perfectionism.
Proposing mediation models—or at least a clearer nomological network—could
help us understand the mechanisms through which perfectionism influences
various outcomes.
Third, researchers should be aware that perfectionism could influence adjustment
across shorter and longer periods of time. Perfectionism might not always directly
influence the long-term development of life problems. The predictive potential of
perfectionism might work its way through contemporaneous effects (e.g., cross-
sectional), the stability and/or intensification of these contemporaneous effects
(e.g., relationships between perfectionism and health remain stable or progressively
strengthen over time), or the more typical cross-lagged developmental effects
(Sameroff, 2009). Despite our desire to acquire knowledge on the long-term effects
of perfectionism, we should also recognize the importance of cross-sectional and
short-term developmental studies. Indeed, by examining the contemporaneous
links of perfectionism with cognitive, emotional, behavioral, and physiological
processes, we may gain insights into the various ways in which perfectionism
directly and indirectly influences the immediate occurrence and development of
life problems.
Finally, stronger evidence appears to support the four hypotheses of the 2 × 2
model when predicting positively laden compared to negatively laden outcomes
(e.g., Damian, Stoeber, Negru, & Băban, 2014; Gaudreau, 2016). At first glance,
such findings indicate that certain subtypes of perfectionism positively associated
with indicators of psychological adjustment (e.g., pure PSP compared to non-
perfectionism; mixed perfectionism compared to pure ECP) might not significantly
reduce psychological maladjustment. This interpretation, primarily based on the
distinction between adjustment and maladjustment, is potentially too simplistic. In

the current review, we therefore examine the predictive validity (and the lack
thereof) of the 2 × 2 model using an approach that distinguished different subsets
of dependent variables.
The Current Review: A Nomological Analysis

Since the start of the new millennium, researchers have paid growing attention to
psychological health (Seligman & Csíkszentmihályi, 2000). The absence of mental
diseases does not necessarily mean that individuals are happy and thriving. The
2 × 2 model has emerged within this zeitgeist. In this section, we will review the
evidence for the associations of subtypes of perfectionism with psychological
adjustment, psychological maladjustment, and achievement-related outcomes.
Furthermore, outcomes and processes should be differentiated insofar as outcomes
denote the psychological states of individuals whereas processes characterize the
potential motivational, cognitive, and behavioral pathways between perfectionism
and outcomes. Consistent with a transactionalist approach (e.g., Lazarus &
Folkman, 1984; Sameroff, 2009), we assume that several of the relationships
between antecedents, processes, and outcomes are likely to operate with reciprocal
and recursive feedback loops. Hence, the nomological network proposed in this
chapter (see Figure 3.1) should be interpreted as a flexible roadmap to organize the
extant literature.
Subtypes of Perfectionism and Outcomes
Psychological Adjustment
In this section, we will review the associations between subtypes of perfectionism
and various indicators of well-being (e.g., positive affect, vitality, life satisfaction,
joy). Further, we will review the associations with positive self-evaluations (e.g.,
self-concept, self-esteem) and interpersonal adjustment (e.g., friendship, conflict
resolution).
Well-Being
Studies with university students (Franche & Gaudreau, 2016; Franche et al., 2012;
Gaudreau, 2015; Gaudreau, Franche, & Gareau, 2016; Gaudreau & Thompson,
2010), athletes or sport participants (Crocker, Gaudreau, Mosewich, & Kljajic, 2014;
Gaudreau & Verner-Filion, 2012 ; Mallinson, Hill, Hall, & Gotwals, 2014), adolescents
(Damian et al., 2014), and students in physical education (Méndez-Giménez,
Cecchini-Estrada, & Fernández-Río, 2014) investigated the associations between
subtypes of perfectionism and well-being. Six studies measured positive affect and life
satisfaction whereas two studies assessed vitality and joy/enjoyment. Results of these
studies mostly provided support for Hypotheses 1a, 2, 3, and 4 of the 2 × 2 model.
FIGURE 3.1 hematic organization of the known correlates of the four subtypes of perfectionism within a nomological network of processes and
T
outcomes.
PSP = personal standards perfectionism, ECP = evaluative concerns perfectionism.
Pure PSP was associated with higher positive affect (d = 0.08 to 0.89), life
satisfaction (d = 0.13 to 0.32), academic satisfaction (d = 0.43 to 0.88), vitality (d =
0.12 to 1.01), and joy/enjoyment (d = 0.38 to 0.79) than non-perfectionism
(Hypothesis 1a). Pure PSP was also associated with higher positive affect (d = 0.24
to 0.70; with the exception of a –0.13 in Gaudreau & Verner-Filion, 2012), life
satisfaction (d = 0.43 to 0.70), academic satisfaction (d = 0.01 to 0.58), vitality (d =
0.20 to 0.47), and joy/enjoyment (d = 0.40 to 0.65) than mixed perfectionism
(Hypothesis 4). Weaker effects were found in the study of Gaudreau and Verner-
Filion (2012) in which athletes assessed their well-being in the last practice before
competition. Such findings are noteworthy as they suggest that the relative
advantages of pure PSP might vanish when participants are experiencing challenges
and stressors of the final preparatory phase before performance evaluations. Also,
support for Hypothesis 4 was not found with Asian-Canadian students (Franche
et al., 2012). In this case, the holistic integration of self-oriented standards and
socially driven traditional values appears to have created a personality–culture fit
that could explain why mixed perfectionism was not associated with significantly
lower academic satisfaction than pure PSP.
Across these studies, researchers also found that pure ECP is potentially the most
detrimental subtype of perfectionism. Compared to both non-perfectionism
(Hypothesis 2) and mixed perfectionism (Hypothesis 3), pure ECP was associated
with lower positive affect (d = –0.24 to –1.17), life satisfaction (d = –0.29 to
–1.09), academic satisfaction (d = –0.60 to –1.06; with the exception of a 0.01 in
the Asian-Canadian students), vitality (d = –0.69 to –1.01), and joy/enjoyment
(d = –0.28 to –0.79). These findings provided consistent support for a rather
unique hypothesis of the 2 × 2 model, that is, the idea that pure ECP (rather than
mixed perfectionism) is the least adaptive way of being a perfectionist.
Positive Self-Evaluations
Self-worth, self-esteem, and self-concept have been related to a myriad of good life
outcomes (e.g., Judge & Bono, 2001; Marsh, Xu, & Martin, 2012). Results of a
study on self-esteem provided strong support (d = 0.67 to 2.59) for Hypotheses 1a,
2, 3, and 4 of the 2 × 2 model with a sample of female undergraduate students
(Taylor, Papay, Webb, & Reeve, 2016).
The multidimensional hierarchical model of self-concept (Marsh et al., 2012)
offers a promising framework to evaluate how and under which circumstances
perfectionism influences self-evaluations. Accordingly, individuals’ self-concept
can be boosted when they participate in social environments in which they are the
“big fish in a little pond” (Marsh et al., 2008). Future work could investigate
whether the self-concept of some subtypes of perfectionism is enhanced or
diminished in situations in which the individual is either a big fish in a little pond
or a small fish in a big pond. Moreover, both internal (e.g., I am better in
mathematics than English) and external (e.g., I am better than others in mathematics
but not in English) frames of reference shape the evaluation of domain-specific
self-concepts (e.g., Möller, Pohlmann, Köller, & Marsh, 2009). Given that certain
subtypes of perfectionism could activate favorable or unfavorable individual and
social comparison, future studies could examine if internal and external frames of
reference might explain why subtypes of perfectionism are distinctively associated
with self-evaluations.
Interpersonal Adjustment
Mental representations of perfectionism are inherently tied to and developed
through social interactions and expectations. As such, several researchers have
suggested that perfectionism plays an important role in the development of positive
and negative social relationships (e.g., Sherry, Mackinnon, & Gautreau, 2016; see
also Chapter 9).
A recent study of Mallinson and colleagues (2014) conducted with young sport
participants provided support for Hypotheses 1a, 2, 3, and 4 of the 2 × 2 model on
three of six characteristics of friendship experience in sport (i.e., enhancement and
supportiveness of self-esteem, loyalty and intimacy, and companionship and
pleasant play). The effect sizes varied from moderate-to-strong (d = 0.41 to 0.84).
Some of the results concerning sharing things in common and conflict resolution
did not reach statistical significance, but all effects were in the expected direction.
Accordingly, there was a small to moderate advantage of pure PSP compared to
non-perfectionism on sharing things in common (d = 0.33) and conflict resolution
(d = 0.28) as well as a small advantage of pure PSP over mixed perfectionism on
these two characteristics (d = 0.13; d = 0.23). Overall, these findings indicate that
subtypes of perfectionism are distinctively associated with important characteristics
of friendship during adolescence.
Achievement-Related Outcomes
Achievement can be evaluated with subjective (e.g., making progress on personal
goals) and objective (e.g., grades) indicators. Studies examining grade-point average
(Franche et al., 2012; Gaudreau, 2012) and goal progress of university students
(Gaudreau, 2015; Gaudreau & Thompson, 2010) and athletes (Crocker et al.,
2014) as well as a study looking at physical fitness/ability of adolescents in physical
education (Méndez-Giménez et al., 2014) provided support for the 2 × 2 model.
Pure PSP related to higher achievement than non-perfectionism (d = 0.39 to 0.97;
Hypothesis 1a) and mixed perfectionism (d = 0.15 to 0.56; Hypothesis 4). Pure
ECP was associated with lower achievement compared to both non-perfectionism
(d = –0.34 to –0.77; Hypothesis 2) and mixed perfectionism (d = –0.43 to –1.07;
Hypothesis 3). Overall, achievement outcomes is potentially the research area
in which Hypotheses 1a, 2, 3, and 4 of the 2 × 2 model received the most
consistent support.
Psychological Maladjustment
Negative affectivity has been studied in samples of university students (Franche &
Gaudreau, 2016; Gaudreau & Thompson, 2010), adolescents (Damian et al., 2014),
and varsity athletes (Crocker et al., 2014). Non-perfectionism was associated with
lower negative affect than pure ECP (d = –0.44 to –1.39; Hypothesis 2) but not
systematically higher negative affect than pure PSP (d = 0.02 to 0.17), thus
sometimes providing evidence for Hypothesis 1a or 1c but never 1b. Mixed
perfectionism was associated with significantly higher negative affect than pure
PSP (d = 0.44 to 1.22; Hypothesis 4) but not systematically lower negative affect
than pure ECP (d = –0.02 to –0.35; Hypothesis 3).
Although moderate-to-strong effects were found for Hypotheses 2 and 4, the
smaller effects found for Hypotheses 1a and 3 are intriguing. On the one hand, the
nonsignificant differences between pure PSP and non-perfectionism (Hypothesis
1) seem to generalize across different types of emotional states, namely social
anxiety (d = 0.09; Levinson et al., 2015), depression (d = 0.13; Douilliez & Lefèvre,
2011), and a measure of negative emotionality that combined depression, anxiety,
and distress (Smith, Saklofske, Yan, & Sherry, 2015). On the other hand, the
evidence regarding Hypothesis 3 has been stronger for social anxiety (d = 0.44;
Levinson et al., 2015) than for depression (d = 0.22; Douilliez & Lefèvre, 2011)
with both normative and clinical samples. This important finding suggests that
individuals with pure ECP (compared to mixed perfectionism) might experience
more negative emotionality when the emotional state elicits higher arousal (i.e.,
social anxiety) compared to lower arousal (i.e., depression; Russell, 1980). Future
research is needed to measure various indicators of negative emotions and
maladjustment across lower (e.g., boredom, sadness, shame) and higher (e.g., anger,
worry) levels of arousal to allow a more direct test of this possible interpretation of
the results.
Researchers also paid attention to three key indicators of athlete burnout—
emotional/physical exhaustion, sport devaluation, and reduced sense of
accomplishment—in a cross-sectional study with junior soccer players (Hill, 2013)
and a three-month longitudinal study with university athletes training in various
sports (Madigan, Stoeber, & Passfield, 2016). Results generally supported
Hypotheses 1a, 2, 3, and 4 of the model to predict overall burnout. Interestingly,
however, the level of support for some hypotheses differed across the three
indicators of burnout. It appears that pure PSP (compared to non-perfectionism)
has a stronger protective effect on reduced sense of accomplishment (d = –0.64 to
–0.85) and sport devaluation (d = –0.31 to –0.49) than on emotional/physical
exhaustion (d = –0.21 to –0.22). Athletes episodically experience performance
plateaus and blockages in the pursuit of their goals due to fatigue, injuries, or their
coach’s decision not to make them play. Athletes with pure PSP were more likely
to make greater progress in the pursuit of their goals compared to athletes with
other subtypes of perfectionism (Crocker et al., 2014). Hence, athletes with pure
PSP might be less exposed to inconvenient situations that can create a reduced
sense of accomplishment and sport devaluation. Striving toward exceedingly high

standards, however, can be demanding and fatiguing, which might eventually limit
the protective role of pure PSP on emotional/physical exhaustion. Future work is
required to replicate and extend these findings with individuals engaged in other
achievement-related activities (e.g., students, employees, coaches).
Subtypes of Perfectionism and Processes

Less research has examined the processes of perfectionism. In this section, we will
review the associations between subtypes of perfectionism and two motivational
processes, emotion regulation, and coping processes.
Motivational Processes
Perfectionism and motivation are intertwined in many ways (cf. Chapter 2).
Individuals with different subtypes of perfectionism are likely to perform their
activities for different reasons and to pursue different goals. In this section, we will
review the studies testing the 2 × 2 model within the confines of self-determination
theory (Deci & Ryan, 2008) and achievement goal theory (e.g., Elliot &
McGregor, 2001).
Self-Determination
In three studies with university students, we showed that subtypes of perfectionism
were associated with different levels of internalization or self-determination
(Gaudreau, 2015; Gaudreau et al., 2016; Gaudreau & Thompson, 2010).
University students with pure PSP performed their school activities for reasons
that were more self-determined (e.g., pleasure, importance, coherence with the
self, instead of avoidance of guilt/shame, social pressure) than students with non-
perfectionism (d = 0.32 to 0.60; Hypothesis 1a). Mixed perfectionism has been
characterized as a form of partially internalized perfectionism (Gaudreau &
Thompson, 2010). Consistent with this rationale, students with mixed
perfectionism pursued their school activities with more self-determination than
students with pure ECP (d = 0.47 to 1.37; Hypothesis 3) and less self-determination
than students with pure PSP (d = –0.55 to –0.95; Hypothesis 4). Pure ECP
(compared to non-perfectionism) was associated with lower self-determination (d
= –0.59 to –1.96; Hypothesis 2). We also found that self-determination for school
activities significantly mediated the associations between subtypes of perfectionism
and academic satisfaction of university students (Gaudreau et al., 2016). For
example, pure PSP was positively related to academic satisfaction because students
with pure PSP were pursuing their school activities with more self-determined
motivation, which in turn was positively associated with academic satisfaction. In
contrast, pure ECP was negatively related to academic satisfaction because students
with pure ECP were doing their school activities with lower self-determination.
Overall, these findings give credence to the potential utility of separating

perfectionism, processes, and outcomes in a clearer nomological network (see
Figure 3.1).
Achievement Goals
One study investigated how achievement goals of university students are
distinctively associated with subtypes of perfectionism (Speirs Neumeister, Fletcher,
& Burney, 2015). On the basis of the 2 × 2 model, we might expect that the
associations between subtypes of perfectionism and approach and avoidance goals
would follow the pattern of findings observed for adjustment and maladjustment,
respectively. However, the findings of Speirs Neumeister and colleagues proved to
be somewhat challenging and complex to interpret.
Students with non-perfectionism pursued less approach and avoidance goals
than their pure PSP counterparts (Hypothesis 1). Moreover, students with non
perfectionism pursued less performance-approach and performance-avoidance
goals than students with pure ECP (Hypothesis 2), although both subtypes did not
differ in their level of mastery-approach and mastery-avoidance goals. For better or
worse, students with non-perfectionism are likely to possess a relatively less salient
and dominant need for achievement than their perfectionistic counterparts. As
such, the limited need for achievement of the non-perfectionist students could be
the pivotal factor responsible for the unexpected findings that pure PSP related to
more avoidance goals and that pure ECP related to more performance-approach
goals than non-perfectionism.
Several results of this study contradicted the hypotheses of the 2 × 2 model. For
example, students with mixed perfectionism pursued more approach and avoidance
goals than students with pure ECP (Hypothesis 3). Furthermore, students with
mixed perfectionism pursued more performance-approach and performance-
avoidance goals than students with pure PSP (Hypothesis 4), although both
subtypes were not significantly different in their level of mastery-approach and
mastery-avoidance goals. Achievement goals are inherently complex processes
within which different needs, temperamental influences, and underlying
motivations can be differently expressed for different individuals (Elliot & Church,
1997). Goals that are positively associated with psychological adjustment are often
unrelated to achievement whereas goals that are positively associated with
achievement are often unrelated to psychological adjustment (e.g., Huang, 2011;
Van Yperen, Blaga, & Postmes, 2014). The interplay of goal endorsement and goal
self-determination (e.g., Elliot & Church, 1997; Gaudreau & Braaten, 2016;
Vansteenkiste, Lens, Elliot, Soenens, & Mouratidis, 2014) might be insightful to
clarify the relationships between subtypes of perfectionism and achievement goals.
Before that, researchers should remain prudent in interpreting the observed effects
between subtypes of perfectionism and achievement goals as evidence for or against
the 2 × 2 model.
Emotion Regulation and Coping Processes

If you are a sport fan, you have probably observed that some coaches are particularly
good at reappraising their emotions and controlling their outward and inward
expression of anger. If you attentively listened to post-game interviews, you may
also have noticed that some athletes perceive the demands of a sport competition
as challenging and controllable and that they use some problem-focused coping
strategies. Appraisals and coping are known to be influenced by personality
(Connor-Smith & Flachsbart, 2007), and perfectionism plays an important role in
emotion regulation and coping processes (see also Chapters 11 and 12). Two
studies using the 2 × 2 model were conducted on the emotion regulation strategies
of sport coaches (Hill & Davis, 2014) and the cognitive appraisals and coping
strategies of university athletes (Crocker, et al., 2014). Some support was found for
Hypotheses 1a, 2, 3, and 4 of the model.
In the study conducted with university athletes, none of the hypotheses of the
2 × 2 model were supported to predict problem-focused and emotion-focused
coping (Crocker et al., 2014). Only Hypotheses 2 and 4 were supported to predict
threat appraisal and avoidance-focused coping. Appraising the situation as a threat
is generally an indication that the demands of the situation exceed the resources of
the individuals. Individuals with such a pattern of appraisals generally tend to use
avoidance-focused coping (Crocker, Tamminen, & Gaudreau, 2015). Hence,
athletes with lower ECP might perceive the competition as less threatening and
thus use less avoidance-focused coping than their counterparts with higher ECP.
Coping is a hierarchical and multidimensional construct. In this study, coping was
measured using a questionnaire assessing broad coping dimensions. Several coping
strategies, such as relaxation, thought control, and mental imagery are generally
used for problem-focused and emotion-focused reasons. As such, these coping
strategies are better defined and conceptualized as engagement or task-oriented
coping because they help the individuals manage both the situational demands and
their resulting thoughts, emotions, and physical reactions (Crocker et al., 2015).
Future studies should therefore examine coping using questionnaires capable of
differentiating coping strategies from broad coping dimensions.
Results concerning emotion suppression of coaches were mixed and ambiguous
(Hill & Davis, 2014). Although contradicting Hypotheses 1a and 1b, both non-
perfectionism and pure PSP were associated with comparably low usage of emotion
suppression. Coaches with pure PSP also used lower suppression than those with
mixed perfectionism (Hypothesis 4). Contrary to Hypothesis 3, mixed perfectionism
was associated with higher usage of emotion suppression than pure ECP. At first
glance, this particular finding seems to suggest that mixed perfectionism is more
maladaptive than pure ECP. However, suppression in the domain of coaching
might enable coaches to maintain composure and a relatively neutral attitude when
interacting with their athletes and managing the demands of competitive sports.
Prudence is warranted before interpreting these findings as evidence against the
2 × 2 model because suppression of emotions might be a reflection of the need for
coaches to develop a broader and more diversified repertoire of emotion regulation

strategies to handle various personal, professional, social, and environmental
demands.
Recent and Potential Extensions of the 2 × 2 Model
A Recent Extension: The Multi-Domain Multilevel Model

of Perfectionism
Perfectionism has traditionally been defined as a personality trait with consistency
across contexts and situations as well as stability across time. Several studies reviewed
in this chapter (e.g., Damian et al., 2014; Douilliez & Lefèvre, 2011; Franche et al.,
2012; Gaudreau, 2012; Gaudreau et al., 2016; Gaudreau & Thompson, 2010;
Gaudreau & Verner-Filion, 2012; Hill & Davis, 2014; Speirs Neumeister et al.,
2015; Taylor et al., 2016) used general questionnaires to evaluate the dispositional
perfectionism of individuals across all domains of life. In these studies, general
perfectionism was used to predict general (e.g., depression), contextual (e.g., grade-
point average), and situational outcomes (e.g., positive affect during a competition).
In recent years, researchers proposed that personality characteristics—like
perfectionism—can exhibit both stability and change as well as consistency and
variability (e.g., Beal, Weiss, Barros, & MacDermid, 2005; Fleeson, 2001). Echoing
this idea, some researchers adapted and developed domain-specific questionnaires
of perfectionism (e.g., Dunn, Craft, Causgrove Dunn, & Gotwals, 2011) and
several studies reviewed in this chapter (Crocker et al., 2014; Hill, 2013; Madigan
et al., 2016; Mallinson et al., 2014; Méndez-Giménez et al., 2014) measured the
perfectionism of individuals within a particular domain to predict their domain-
specific processes and outcomes.
In a recent extension of the 2 × 2 model (Franche & Gaudreau, 2016), we
contended that dispositional and domain-specific perfectionism should be
integrated into a unified model to capture both the variability and consistency of
perfectionism. On the one hand, we proposed that individuals’ perfectionism
should vary across life domains.3 On the other hand, we proposed that the
aggregated score of a person’s perfectionism across life domains should offer a
window into his/her general tendency or predisposition toward perfectionism. To
borrow the statistical analogy of central tendency and variance, the general/
dispositional perfectionism of a person represents the mean of a distribution
obtained through a sample of his/her domain-specific scores of perfectionism.
In Figure 3.2, we illustrate the case of three prototypical individuals with their
own PSP across four life domains. The size of the circle depicts the extent to which
a person has PSP in his or her life. A smaller and a bigger circle respectively
indicates that a person is lower (see Person A) and higher (see Person C) than the
population mean of general PSP (see Person B). As such, general PSP varies across
individuals (i.e., between-person differences). The pie chart within each circle
depicts the extent to which an individual has PSP in each of the four domains of
FIGURE 3.2 hree prototypical individuals with low, medium, and high general
T
personal standards perfectionism (PSP) with their own within-person
variations of domain-specific PSP.
his or her life. Not only can we observe that the perfectionism of an individual
varies across the domains of his or her life (i.e., within-person differences), but we
can also note that each individual is likely to have his or her unique configuration
of domain-specific perfectionism. In our recent extension of the 2 × 2 model, we
proposed that both the between-person and the within-person differences should
be studied as part of an integrative multi-domain multilevel model of perfectionism
(Franche & Gaudreau, 2016).
We tested these propositions in a study in which university students were asked
to evaluate their perfectionism in seven life domains of importance for emerging
adults (i.e., school, romance, friendship, family, parenting, leisure, work). Results
of multilevel analyses demonstrated that 50% of variance in socially prescribed
perfectionism (SPP, a cardinal feature of ECP) and 61% in self-oriented
perfectionism (SOP, a cardinal feature of PSP) was attributable to variability across
life domains (i.e., within-person). Furthermore, participants were asked to evaluate
their goal progress, vitality, positive affect, negative affect, and perceived stress in
each life domain. Here again, a large proportion of the variance in the domain-
specific outcomes was attributable to within-person variability across life domains.
Of particular interest, results of multilevel analyses provided strong support for the
hypotheses of the 2 × 2 model at both the between-person and the within-person
levels of analysis with positively laden outcomes (see Franche & Gaudreau, 2016).
Interestingly, however, the findings with negatively laden outcomes (i.e., negative
affect and stress) did not always support the hypotheses and were not always
comparable across levels of analysis. For example, pure SOP (compared to non-
perfectionism) and mixed perfectionism (compared to pure SPP) were associated
with increased levels of stress at the within-person level (support for Hypothesis 1b
and contradiction of Hypothesis 3) and similar levels of stress at the between-
person level (no support for Hypotheses 1a, 1b, and 3).
Overall, the findings of our first multi-domain multilevel extension of the 2 × 2
model outlined the importance to study how perfectionism varies between
individuals and within the same individual across multiple life domains. Holding
this integrative approach—that accounts for both the consistency and variability in
perfectionism—is both theoretically defendable and methodologically possible.
Hence, future research is needed to keep on investigating this extension of the
2 × 2 model to inform clinical psychologists and academic counselors that not all
perfectionists are equally perfectionistic in all domains of their lives.
A Potential Area of Development

Soon after the first article on the 2 × 2 model (Gaudreau & Thompson, 2010), a
critical comment from Stoeber (2012) highlighted a potential issue regarding the
competing perspectives of Hypothesis 1. The solution proposed—to avoid
contradictions in the model—was to specify for whom or under which circumstances
Hypotheses 1a and 1b would be respectively supported (Stoeber, 2012). When the
theoretical framework was still in its infancy, the decision was made to postpone
the inclusion of moderating hypotheses to facilitate the empirical investigation of
the model (Gaudreau, 2013). Given the considerable number of studies that have
now tested the 2 × 2 model, the timing seems appropriate to revisit Hypothesis 1
to outline a possible mechanism that could offer a synthesis to explicate when pure
PSP should be associated with better outcomes than non-perfectionism (Hypothesis
1a) and when non-perfectionism should be associated with better outcomes than
pure PSP (Hypothesis 1b).
The environment in which the individual evolves is likely to comprise a number
of characteristics that may contribute to enhance, reduce, buffer, or even cancel the
effects of PSP on psychological adjustment. As such, past findings have pointed
toward a paradoxical relationship between PSP and adjustment, which might
support the idea that stressful events or other stressors could potentially moderate
this relationship. For example, pure PSP (compared to non-perfectionism) appears
to be sometimes associated with higher positive affect and academic satisfaction
(e.g., Gaudreau & Thompson, 2010) without systematically being associated with
lower symptoms of depression (e.g., Douilliez & Lefèvre, 2011) and negative affect
(e.g., Crocker et al., 2014). A diathesis-stress model of perfectionism and
psychopathology (e.g., Flett, Hewitt, Blankstein, & Mosher, 1995) might partially
explain these complex relationships. Within this model, perfectionism is
conceptualized as a vulnerability factor that should lead to the onset or maintenance
of psychopathology, but only in the presence of a stressor (e.g., failures, negative
life events, high daily pressure; Flett et al., 1995; Hewitt & Flett, 2002). In other
words, perfectionism should interact with stressful events to diminish psychological

adjustment.
Despite its appeal, the diathesis-stress model of perfectionism and
psychopathology focuses primarily on the negative consequences of perfectionism.
However, as shown in this review, pure PSP was often associated with better
adjustment, achievement, and lower maladjustment than non-perfectionism.
Hence, we propose that a differential susceptibility hypothesis (Belsky, Bakermans-
Kranenburg, & van Ijzendoorn, 2007; Belsky & Pluess, 2009) potentially provides
the needed synthesis to explicate why pure PSP is often associated with positive
outcomes while sometimes being associated with negative or less desirable
outcomes compared to non-perfectionism. The differential susceptibility
hypothesis stipulates that some individuals are more susceptible to the influences
of the environment than others (i.e., instead of just being more vulnerable, as
suggested in the diathesis-stress model). Accordingly, these individuals may not
only be more influenced negatively by an adverse environment, but they may
also be more influenced positively by a supportive environment or by the absence
of adversity. After experiencing success or episodes of perfect achievement, PSP
has been shown to positively correlate with satisfaction and pride; in contrast,
PSP has been shown to positively correlate with dissatisfaction and shame after
failures or episodes of flawed achievement (Stoeber, Kempe, & Keogh, 2008;
Stoeber & Yang, 2010). This hypothesis also appears consistent with the
proposition of Flett and Hewitt (2005, 2014) that perfectionists might be
protected from negative outcomes under certain circumstances such as when
they experience success. Therefore, we suggest that pure PSP might be more
susceptible to the negative and positive influences of the environment compared
to non-perfectionism (see Figure 3.3).
The rationale of a differential susceptibility hypothesis would further support
the argument that perfectionism is a double-edged sword (Stoeber, 2014). Initially,
Stoeber (2014) proposed that PSP would typically be associated with positive
outcomes, whereas ECP would generally be related to negative outcomes. We
would like to add that—within the 2 × 2 model—pure PSP could be considered a
double-edged sword depending on the context. Under the normal circumstances
of everyday life (e.g., when people experience only few stressors, which are easily
handled) and/or in the presence of supportive environments, pure PSP could be
significantly associated with better outcomes than non-perfectionism, thus
supporting Hypothesis 1a. However, in situations of profound or chronic distress
(e.g., when stressors accumulate or disturb the normal functioning of individuals),
and/or in the presence of adverse environments, pure PSP could be significantly
associated with worse outcomes than non-perfectionism, supporting Hypothesis
1b. As shown in Figure 3.3, the seemingly contradictory Hypotheses 1a and 1b (see
Stoeber, 2012) would be respectively supported in different situations that would
match the pattern of a differential susceptibility hypothesis. Future work is
encouraged to empirically examine this new idea.
FIGURE 3.3 ypothetical illustration of a differential susceptibility hypothesis. At a

H
normal level of stress or when exposed to environmental support, pure
PSP should be associated with higher adjustment than non-perfectionism,
thus supporting Hypothesis 1a. At an extremely high level of stress or
when exposed to environmental adversity, pure PSP should be associated
with lower adjustment than non-perfectionism, thus supporting Hypothesis
1b. PSP = personal standards perfectionism.
Conclusion
As shown in this chapter, the 2 × 2 model of perfectionism has generated an
active stream of research looking at processes, adjustment, maladjustment, and
achievement-related outcomes (see Figure 3.1). Researchers have conducted
studies with different populations (e.g., athletes, students) of varying age groups
(e.g., adolescents, young adults). A reasonable amount of support has been obtained
for the four hypotheses of the model but more research is needed to clarify when
and for whom each of the four ways of being a perfectionist (i.e., subtypes of
perfectionism) is associated with better or worse processes and outcomes.
One of the frequent questions we receive from clients, practitioners, and
reporters is whether pure PSP should be promoted as a healthy way of being a
perfectionist. We live in a world in which many individuals and organizations are
wholeheartedly interested in getting an edge to secure a comfortable position
against their competitors. At first glance, pure PSP might appear like a promising
avenue to attain highly difficult personal goals without having to pay severe
psychological costs. Despite the current state of evidence, we prefer that practitioners
err on the side of prudence by not promoting perfectionism as a way of securing
desirable outcomes over the long haul. As proposed in Figure 3.3, pure PSP might
confer some relative advantages when individuals are navigating their ship on
rather smooth and dormant oceans. However, strong winds and waves might
appear unexpectedly on the horizon. Most individuals, across their lifetime, will
have to face both transitional (e.g., transitioning from being a student to an
employee) and acute periods of stress (e.g., physical illness, death of a relative).
Further, many individuals will experience at least one episode of acute mental
distress in their lifetime (Kessler & Bromet, 2013). When the going gets tough, the
relative advantages of pure PSP might vanish or even transform into harmful and
distressful consequences. Pure PSP seems to naturally exist in a significant portion
of university students with estimates ranging from 37 to 46% (Gaudreau, 2015).
This naturally existing subtype does not need encouragement or promotion.
Individuals with such a way of being a perfectionist might live a healthy and
productive life for as long as their transitional and acute periods of stress remain
under a certain level of control. For such individuals, it might be useless to try to
reduce their pure PSP. Too many questions are still left unanswered to know with
certainty whether or not we should try to modify the PSP of otherwise physically
and psychologically healthy and productive individuals. Rather than trying “to fix
what is not broken,” parents, coaches, teachers, and psychologists should look out
for signs that an individual might be physically or mentally suffering because of his
or her way of being a perfectionist. In such cases, or whenever in doubt, individuals
should seek the appropriate guidance of a properly trained psychologist.
Notes
1 Our analysis did not include studies in which groups of perfectionism were created using
median split (Purrezaian et al., 2015) or clinical cutoff points (Arana & Furlan, 2016). In
both studies, the authors did not report the mean scores of PSP and ECP across the four
subgroups of perfectionism, thus preventing a critical analysis of the fit between
subgroups’ composition and the operational definitions of the subtypes of perfectionism
in the 2 × 2 model.
2 Our argument should not be taken as a general criticism of person-centered approaches.
Our concern is limited to their applicability to directly compare the subtypes proposed
in the 2 × 2 model of perfectionism.
3 This model could be applied to study within-person variations of perfectionism across
situations within a life domain or the within-person variations of perfectionism across
days (Boone et al., 2012).
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4
PERFECTIONISM AND
PERSONALITY
Joachim Stoeber, Philip J. Corr, Martin M. Smith, and
Donald H. Saklofske
Overview
This chapter provides a synopsis of research on where multidimensional
perfectionism “fits” within the broader framework of contemporary personality
theory. Focusing on Hewitt and Flett’s (1991) model of perfectionism—
differentiating self-oriented, other-oriented, and socially prescribed perfectionism—
the chapter presents a summary and critical discussion of how multidimensional
perfectionism relates to the dimensions and facets of two major structural models
of personality (the five-factor model and the HEXACO model) and one
neuropsychological model of personality (reinforcement sensitivity theory).
Implications of the findings for multidimensional theories and models of
perfectionism, as well as future perfectionism research, are discussed.
Introduction
Perfectionism is best conceptualized as a multidimensional personality disposition,
which is important because perfectionism’s multiple dimensions show different,
sometimes opposite, relationships with adaptive and maladaptive psychological
processes and outcomes (see Chapters 1–3). For a complete understanding of
multidimensional perfectionism, however, it is important to know not only how
different perfectionism dimensions are related to processes and outcomes, but also
how they are related to stable personality characteristics. Furthermore, it is
important to know where perfectionism and its different dimensions “fit” within
broader frameworks of personality.
To provide answers to these questions, we reviewed the research literature
looking for studies that have investigated perfectionism’s relationships with
structural (trait) and neuropsychological models of personality. In this search, we
Perfectionism and Personality 69
focused on Hewitt and Flett’s (1991) tripartite model of multidimensional

perfectionism which differentiates three forms of perfectionism: self-oriented,
other-oriented, and socially prescribed. Self-oriented perfectionism reflects beliefs
that striving for perfection and being perfect are important. Self-oriented
perfectionists have exceedingly high personal standards, expect to be perfect, and
are highly self-critical if they fail to meet these demands. In contrast, other-oriented
perfectionism reflects beliefs that it is important for others to strive for perfection
and be perfect. Other-oriented perfectionists have exceedingly high standards for
others, expect others to be perfect, and are highly critical of others who fail to meet
these expectations. Finally, socially prescribed perfectionism reflects beliefs that
striving for perfection and being perfect are important to others. Socially prescribed
perfectionists believe that exceedingly high standards are being imposed on them.
They believe others expect them to be perfect, and think that others will be highly
critical of them if they fail to meet their expectations (Hewitt & Flett, 1991, 2004).
There were a number of reasons why we focused on Hewitt and Flett’s (1991)
model. First, the model is one of the most widely used in perfectionism research,
and there are many studies that have investigated how this model’s dimensions
relate to broader personality dimensions. Second, the model includes the two
superordinate dimensions that can be regarded as key indicators of perfectionistic
strivings and perfectionistic concerns. Self-oriented perfectionism is a key indicator of
perfectionistic strivings, and socially prescribed perfectionism a key indicator of
perfectionistic concerns (Frost, Heimberg, Holt, Mattia, & Neubauer, 1993;
Stoeber & Otto, 2006). Consequently, examining how self-oriented and socially
prescribed perfectionism relate to personality gives us an indication of how
perfectionistic strivings and perfectionistic concerns—and other dimensions that
are key indicators of perfectionistic strivings and perfectionistic concerns—relate to
personality. Third, perfectionism is a personality characteristic that has personal and
social aspects (which we will see is important when examining perfectionism’s
relationships with personality), and Hewitt and Flett’s model clearly differentiates
personal and social aspects. Moreover, the model was the first to suggest that other-
oriented perfectionism is an important dimension of perfectionism, which is
recently seeing a reinvigorated interest from psychological research. Moreover,
other-oriented perfectionism plays a central role in dyadic perfectionism (Stoeber,
2012) and is a defining component of narcissistic perfectionism (see Chapter 9).
Hence, we wanted to make sure that other-oriented perfectionism played a
prominent role in our review of how perfectionism relates to personality, which
should begin with looking at structural models of personality.
Structural Models of Personality

Structural models of personality aim to describe personality in terms of underlying
traits, that is, broad descriptions of individual differences between people that
refer to consistent patterns in the way people behave, feel, and think that are
consistent over time and situations (McAdams, 2006; Pervin, Cervone, & John,
70 Stoeber, Corr, Smith, & Saklofske
2005). These models aim to provide a complete description of personality, that is,
they seek to capture all relevant traits. At the same time, the models aim to be
economical and avoid redundancy, and they try to do so by capturing broad, non-
overlapping traits that are relevant to most people most of the time. To find these
traits, structural models of personality rely on a statistical procedure called “factor
analysis” (Ashton, 2013).1
The Five-Factor Model (FFM)

The five-factor model (FFM) of personality is a structural model of personality that
evolved from psycholexical analyses of traits (e.g., Allport & Odbert, 1936;
Norman, 1963) followed by factor analyses (Ashton, 2013; Pervin et al., 2005).
According to the “lexical hypothesis,” the descriptive terms for all traits that are
relevant to describe individual differences are communicated between people (e.g.,
“Sam is organized”) and are therefore represented in their language’s lexicon as
adjectives (e.g., “organized”). Consequently, a list of all adjectives in a lexicon will
contain descriptors of all relevant traits and—once synonyms and rarely used
adjectives are removed—can be administered as self-report questionnaires to large
samples of participants with instructions to rate how accurately each adjective
describes them. These ratings are then subjected to factor analyses with the aim to
find the basic dimensions (“factors”) that explain individual differences in people’s
self ratings. The resulting factors then represent the structure of personality.
Beginning with numerous earlier studies of personality trait descriptions
following, for example, Cattell (1943), Norman (1963), and Eysenck (1991; see
also Bowden, Saklofske, van de Vijver, Sudarshan, & Eysenck, 2016), converging
evidence published by a number of prominent personality researchers showed a
growing agreement on a model (the FFM) according to which five broad
dimensions are sufficient to describe the basic structure of personality: neuroticism,
extraversion, openness to experience (or openness for short), agreeableness, and
conscientiousness (McCrae & Costa, 1999; see John & Srivastava, 1999, for a
comprehensive review of the history of the FFM). These five personality
dimensions—also referred to as the “Big Five”—are sometimes described as bipolar
dimensions (e.g., neuroticism versus emotional stability, extraversion versus
introversion) or may appear under different names (e.g., extraversion may be called
surgency, openness may be called intellect), but they all represent essentially the
same five broad dimensions of personality as the FFM. Consequently, our review
used the FFM as a frame of reference.
According to Pervin et al. (2005), the five factors can be described as follows.
Neuroticism captures individual differences in psychological maladjustment versus
emotional stability and identifies individuals who are prone to psychological
distress, dysfunctional beliefs, and maladaptive coping responses. Typical adjectives
describing people high in neuroticism are moody, nervous, anxious, touchy, and
emotional (Saucier & Goldberg, 1996). Extraversion captures individual differences
in the quantity and intensity of interpersonal interaction, activity level, need for
stimulation, and—importantly—the capacity for joy. Typical adjectives describing

people high in extraversion are talkative, sociable, assertive, enthusiastic, and
energetic. Openness captures individual differences in the proactive seeking and
appreciation of experience for its own sake and the toleration for and exploration
of the unfamiliar. Typical adjectives describing people high in openness are
inquisitive, intellectual, philosophical, innovative, and unconventional.
Agreeableness captures individual differences in the quality of people’s interpersonal
orientation along a continuum from social antagonism to compassion. (Note the
difference to extraversion which captures the quantity of interpersonal interactions.)
Typical adjectives describing people high in agreeableness are kind, warm,
considerate, helpful, and generous. Finally, conscientiousness captures individual
differences in the degree of organization, persistence, and goal-directed behavior.
Typical adjectives describing people high in conscientiousness are organized,
responsible, thorough, efficient, and self-disciplined.
Multidimensional Perfectionism and the FFM
FFM Dimensions
To gauge how multidimensional perfectionism relates to the broad dimensions of
the FFM, we reviewed the literature for studies published or in press that examined
self-oriented, other-oriented, and/or socially prescribed perfectionism and reported
bivariate correlations with any or all dimensions of the FFM (Campbell & Di
Paula, 2002; Davis, Karvinen, & McCreary, 2005; Dunkley, Blankstein, & Berg,
2012; Dunkley & Kyparissis, 2008; Enns & Cox, 1999; Enns, Cox, & Clara, 2005;
Hewitt & Flett, 2004; Hewitt, Flett, & Blankstein, 1991; Hill, McIntire, &
Bacharach, 1997; Molnar, Sadava, Flett, & Colautti, 2012; Nathanson, Paulhus, &
Williams, 2006; Rice, Ashby, & Slaney, 2007; Sherry, Hewitt, Flett, Lee-Baggley,
& Hall, 2007; Sherry, Hewitt, Sherry, Flett, & Graham, 2010; Smith, Sherry,
Rnic, Saklofske, Enns, & Gralnick, 2016; Stairs, Smith, Zapolski, Combs, &
Settles, 2012; Stoeber, in press; Stoeber, Otto, & Dalbert, 2009).2 When
summarizing these findings in the following sections, we adopted Cohen’s (1992)
guidelines and regarded correlations with absolute values of .10, .30, and .50 as
small, medium-sized, and large. In addition, we referred to medium-sized and
large correlations as “substantial.”
As regards neuroticism, socially prescribed perfectionism was the only
perfectionism dimension of Hewitt and Flett’s (1991) model that consistently
showed substantial positive correlations, suggesting that socially prescribed
perfectionism is a neurotic form of perfectionism (cf. Hamachek, 1978). In
comparison, self-oriented perfectionism did not always show positive correlations
with neuroticism. Whereas a number of studies found positive correlations (e.g.,
Enns & Cox, 1999; Molnar et al., 2012; Smith, Sherry, Rnic, et al., 2016), other
studies found nonsignificant correlations (e.g., Hewitt & Flett, 2004; Hill, McIntire,
& Bacharach, 1997; Stoeber et al., 2009). Moreover, the studies that found positive
correlations consistently found these correlations to be smaller than those for

socially prescribed perfectionism (e.g., Rice et al., 2007; Smith, Sherry, Rnic, et
al., 2016). This indicates that—although self-oriented perfectionists may have
neurotic tendencies—neuroticism is not characteristic of self-oriented perfectionism
to the same degree as it is characteristic of socially prescribed perfectionism. In
contrast, other-oriented perfectionism usually showed near-zero correlations with
neuroticism (e.g., Hewitt & Flett, 2004; Hill, McIntire, & Bacharach, 1997; Rice
et al., 2007).
For extraversion, approximately half of the reviewed studies found socially
prescribed perfectionism to show negative correlations (e.g., Molnar et al., 2012;
Sherry et al., 2007; Stoeber et al., 2009) whereas the other half found nonsignificant
correlations (e.g., Dunkley & Kyparissis, 2008; Hewitt & Flett, 2004; Rice et al.,
2007). This indicates that socially prescribed perfectionism is negatively related to
extraversion, but the relationship is much weaker than the positive relationship that
socially prescribed perfectionism shows with neuroticism. Still, the findings suggest
that socially prescribed perfectionists tend to be less talkative, sociable, assertive,
enthusiastic, and energetic, and—importantly—may show a reduced capacity for
joy. In contrast, self-oriented perfectionism and other-oriented perfectionism
showed no consistent pattern of relationships with extraversion. Indeed, the majority
of studies found nonsignificant correlations, which suggests that both self-oriented
and other-oriented perfectionism are largely unrelated to extraversion.
The reviewed studies on openness suggest that this FFM dimension does not play
a significant role in multidimensional perfectionism. Whereas there are singular
studies reporting small negative correlations between socially prescribed
perfectionism and openness (e.g., Stoeber et al., 2009), the vast majority of studies
examining the perfectionism dimensions of Hewitt and Flett’s (1991) model failed
to find any significant correlations with openness (e.g., Hewitt & Flett, 2004; Hill,
McIntire, & Bacharach, 1997; Rice et al., 2007). Hence, perfectionists do not
appear to be less open to experience than non-perfectionists.
As regards agreeableness, the case was different. In particular, other-oriented
perfectionism showed substantial negative correlations with agreeableness across
studies (e.g., Hewitt & Flett, 2004; Hill, McIntire, & Bacharach, 1997; Stoeber, in
press) which indicates that social antagonism (low agreeableness) is highly
characteristic of other-oriented perfectionists. Socially prescribed perfectionism
was also negatively correlated with agreeableness, but these correlations were often
considerably smaller than those of other-oriented perfectionism (e.g., Hill,
McIntire, & Bacharach, 1997) and sometimes nonsignificant (e.g., Hewitt & Flett,
2004). In contrast, self-oriented perfectionism appeared to be largely unrelated to
agreeableness. Except for one study finding a negative correlation (Stoeber et al.,
2009), all other studies found self-oriented perfectionism to show nonsignificant
correlations with agreeableness (e.g., Dunkley & Kyparissis, 2008; Hewitt & Flett,
2004; Rice et al., 2007).
Turning to conscientiousness, all reviewed studies found self-oriented perfectionism
to show positive and often substantial correlations with this personality factor (e.g.,
Hewitt & Flett, 2004; Hill, McIntire, & Bacharach, 1997; Rice et al., 2007). This
was not the case for the other two perfectionism dimensions. Other-oriented
perfectionism showed only small positive correlations with conscientiousness that
were significant in approximately half of the reviewed studies (e.g., Hill, McIntire,
& Bacharach, 1997; Rice et al., 2007) and nonsignificant in the other half (e.g.,
Molnar et al., 2012; Nathanson et al., 2006). In contrast, socially prescribed
perfectionism showed mostly nonsignificant correlations (e.g., Dunkley & Kyparissis,
2008; Hill, McIntire, & Bacharach, 1997) except for a few studies that found
significant negative correlations (e.g., Hewitt & Flett, 2004; Molnar et al., 2012).
FFM Facets
One advantage of the FFM is that—while the five dimensions provide a broad
framework for an economical analysis of individual differences in personality
traits—the model also allows for a more fine-grained analysis. The reason is that
the FFM is conceptualized as a hierarchical model in which each of the five broad
dimensions (domain level) is composed of a number of lower-level dimensions that
are more specific (facet level). The most widely used measure to examine the FFM
at the facet level is the NEO Personality Inventory-Revised (NEO PI-R; Costa &
McCrae, 1992) which assesses six facets for each of the five dimensions.3 Table 4.1
shows the NEO-PI-R dimensions and facets (see also Costa & McCrae, 1995a).
Three studies have examined how Hewitt and Flett’s perfectionism dimensions
relate to the NEO PI-R facets. Unfortunately, only two of the studies included
other-oriented perfectionism (Hewitt & Flett, 2004 [Table 6.19]; Hill, McIntire,
& Bacharach, 1997) whereas the third examined self-oriented and socially
prescribed perfectionism only (Dunkley & Kyparissis, 2008). When we reviewed
these studies focusing on the convergent findings—that is, the correlations that
were significant across the studies—the following picture emerged.
As regards the neuroticism facets, self-oriented perfectionism showed non
significant correlations across all studies, confirming again that self-oriented
perfectionism has no strong links with neuroticism. The same applied to
TABLE 4.1 FFM Domains and Facets
Neuroticism Extraversion Openness Agreeableness Conscientiousness
Anxiety Warmth Fantasy Trust Competence

Angry hostility Gregariousness Aesthetics Straightforwardness
Order
Depression Assertiveness Feelings Altruism Dutifulness
Self- Activity Actions Compliance Achievement
consciousness striving
Impulsiveness Excitement seeking Ideas Modesty Self-discipline
Vulnerability Positive emotions Values Tender-mindedness Deliberation
Note: FFM = five-factor model of personality. Domain and facet scales from the NEO-PI-R (Costa &
McCrae, 1992, 1995a).
other-oriented perfectionism with the notable exception that both studies including
other-oriented perfectionism found a positive correlation with angry hostility,
which dovetails with the FFM findings linking other-oriented perfectionism to
social antagonism (low agreeableness). In contrast, socially prescribed perfectionism
showed positive correlations with five of the six neuroticism facets—anxiety, angry
hostility, depression, self-consciousness, and vulnerability—across all three studies,4
and positive correlations with the remaining neuroticism facet—impulsiveness—
across two of the studies (Dunkley & Kyparissis, 2008; Hewitt & Flett, 2004). This
again demonstrates that socially prescribed perfectionism shares the strongest and
most consistent links with neuroticism.
Regarding the extraversion facets, it is noteworthy that self-oriented perfectionism
showed positive correlations with two facets—assertiveness and activity—across all
studies. This finding indicates that self-oriented perfectionists may not be more
extraverted than others in general, but may be more assertive and active. Moreover,
it also demonstrates the value of examining FFM facets in addition to FFM
dimensions. Other-oriented perfectionism also showed positive correlations with
activity across the two studies that included other-oriented perfectionism, but not
with assertiveness which was surprising given that other-oriented perfectionists
tend to report high self-esteem (e.g., Flett, Hewitt, Blankstein, & O’Brien, 1991).
In contrast, socially prescribed perfectionism showed negative correlations with the
positive emotions facets across all studies, suggesting that socially prescribed
perfectionists have a lower capacity to experience positive emotions. There are
studies indicating that low positive emotionality is a risk factor for depression
(Khazanov & Ruscio, 2016), and thus the finding of socially prescribed perfectionism
showing negative correlations with positive emotions dovetails with the finding of
socially prescribed perfectionism showing positive correlations with depression
(e.g., Hewitt & Flett, 2004; Smith, Sherry, Rnic, et al., 2016). Furthermore, the
finding suggest that socially prescribed perfectionists may not be less extraverted
than others in general, but may have a lower capacity for joy.
Turning to the openness facets, there was only one correlation significant across
studies: Socially prescribed perfectionism showed a negative correlation with
openness to values. This indicates that socially prescribed perfectionists may not be
generally less open to experience than others, but they may be less open-minded
regarding values, ideas, and principles and less willing to accept that values, ideas,
and principles may be relative and open to change and different interpretations.
The agreeableness facets and self-oriented perfectionism did not show any
significant correlations across studies. This finding is in line with the domain-level
findings indicating that self-oriented perfectionism is largely unrelated to
agreeableness. In contrast, other-oriented perfectionism showed significant
negative correlations with five of the six facets—trust, straightforwardness, altruism,
compliance, and modesty—across the two studies including other-oriented
perfectionism, which further corroborates the strong links of other-oriented
perfectionism and low agreeableness. The picture was different for socially
prescribed perfectionism which showed no negative correlations with any
agreeableness facet that were significant across all studies. This again shows that,
even though numerous FFM studies found socially prescribed perfectionism to
show negative correlations with agreeableness at the domain level, socially
prescribed perfectionism is not as strongly linked to low agreeableness as other-
oriented perfectionism, but shows much stronger links with neuroticism.
Finally, as regards the conscientiousness facets, self-oriented perfectionism showed
significant negative correlations with five of the facets—competence, order,
dutifulness, achievement striving, and self-discipline (but not deliberation)—across
all three studies. Moreover, the correlation with achievement strivings was always
larger than the other correlations, indicating that achievement striving is the
conscientiousness facet most closely related to self-oriented perfectionism. In
contrast, neither other-oriented perfectionism nor socially prescribed perfectionism
showed any correlations with the conscientiousness facets that were significant
across studies.
Summary
The finding from the studies examining how the perfectionism dimensions of
Hewitt and Flett’s (1991) model relate to the FFM dimensions and facets
demonstrate that the three perfectionism dimensions have a unique personality
profile for four of the five FFM dimensions: neuroticism, extraversion, agreeableness,
and conscientiousness (but not openness). Self-oriented perfectionism is primarily
characterized by high conscientiousness. This suggests self-oriented perfectionists
tend to show a high degree of organization, persistence, and goal-directed behavior,
and can be regarded as organized, responsible, thorough, efficient, and self-
disciplined. Furthermore, self-oriented perfectionists may show higher levels of
extraversion regarding assertiveness and activity. Other-oriented perfectionism is
primarily characterized by low agreeableness. This suggests that other-oriented
perfectionists show a high degree of social antagonism (i.e., the opposite of
agreeableness) and may be unsympathetic, uncooperative, egotistical, cold, and
impersonal (cf. Saucier & Goldberg, 1996). Furthermore, other-oriented
perfectionists may show higher levels of neuroticism regarding angry hostility
which is in line with other-oriented being a socially antagonistic form of
perfectionism (Hewitt & Flett, 1991; Stoeber, 2014a, 2014b). Socially prescribed
perfectionism is primarily characterized by high levels of neuroticism. This suggests
that socially prescribed perfectionists tend to be moody, nervous, anxious, touchy,
and emotional. Furthermore, they are prone to psychological distress, dysfunctional
beliefs, and maladaptive coping responses, which corresponds to findings that
socially prescribed perfectionism is a decidedly maladaptive form of perfectionism
associated with emotional distress and psychological maladjustment (e.g., Hewitt &
Flett, 1991, 2004). In addition, socially prescribed perfectionism showed negative
relationships with extraversion and agreeableness indicating that socially prescribed
perfectionists may be introverted and socially antagonistic. We should note,
however, that the negative relationships with extraversion tended to be small and
were often nonsignificant; and the negative relationships with agreeableness tended
to be weaker than those found for other-oriented perfectionism. Consequently,
low levels of extraversion and agreeableness seem to characterize socially prescribed
perfectionism to a lesser extent than high levels of neuroticism. Furthermore, low
levels of agreeableness seem to be more characteristic of other-oriented
perfectionism than socially prescribed perfectionism.
The HEXACO Model

Another important structural model of personality based on psycholexical analyses
is the HEXACO model (Ashton & Lee, 2007; Ashton et al., 2004). The main
difference to the FFM is that the HEXACO model suggests that the FFM is missing
an important dimension of personality labeled honesty-humility. Honesty-humility
differentiates people who are sincere, honest, faithful, loyal, modest, unassuming,
and fair-minded from those who are sly, greedy, pretentious, hypocritical, boastful,
and pompous. Consequently, the HEXACO model comprises six broad personality
dimensions: honesty-humility (H), emotionality (E), extraversion (X), agreeableness
(A), conscientiousness (C), and openness (O). Emotionality, conscientiousness, and
openness are supposed to correspond to FFM neuroticism, conscientiousness, and
openness, but agreeableness has different characteristics than FFM agreeableness:
HEXACO agreeableness differentiates people who are patient, tolerant, peaceful,
mild, agreeable, lenient, and gentle from those who are ill-tempered, quarrelsome,
stubborn, and choleric (Ashton & Lee, 2007).
Like the FFM, the HEXACO is conceptualized as a hierarchical model because
each of the six broad dimensions (domain level) is comprised of a number of
lower-level dimensions (facet level). To assess these facets, Ashton and Lee
developed a 100-item version of the HEXACO Personality Inventory-Revised
(HEXACO-PI-R) assessing four facets for each of the six dimensions (Lee &
Ashton, n.d.). Table 4.2 shows the HEXACO-PI-R dimensions and facets. (Note
that Lee and Ashton consider perfectionism to be a unidimensional facet of
conscientiousness.)
Multidimensional Perfectionism and the HEXACO Model

Unfortunately, so far only one study (Stoeber, 2014a) employed the HEXACO-
PI-R to examine how the three perfectionism dimensions of Hewitt and Flett’s
model relate to the dimensions and facets of the HEXACO model. However, due
to space restrictions, Stoeber only reported the correlations with the domain scores.
Consequently, correlations from Stoeber (2014a) are reproduced here with facet
scores included (see Table 4.2). In addition, Table 4.2 presents partial correlations
controlling for the overlap between the three perfectionism dimensions to examine
the dimensions’ unique relationships with the HEXACO dimensions and facets
(cf. Stoeber & Gaudreau, 2017).
TABLE 4.2 Multidimensional Perfectionism: Correlations with the HEXACO Model of

Personality Domains and Facets
Bivariate correlations Partial correlations
Domains and facets SOP OOP SPP SOP OOP SPP
Honesty-humility
Sincerity .01 –.15** –.14** .10 –.11* –.10
Fairness .12* –.09 –.13* .21*** –.06 –.17**
Greed-avoidance –.29*** –.33*** –.31*** –.15** –.18** –.11
Modesty –.11 –.36*** –.27*** .07 –.27*** –.12*
Domain score –.11 –.34*** –.31*** .09 –.22*** –.19***
Emotionality
Fearfulness .12* .17** .06 .07 .14* –.05
Anxiety .26*** .08 .15** .22*** –.05 .05
Dependence .03 .12* .03 .00 .13* –.04
Sentimentality .13* .06 .07 .11* .01 .01
Domain score .18** .15** .11 .13* .09 –.01
Extraversion
Social self-esteem .01 .02 –.36*** .17** .23*** –.46***
Social boldness .10 .25*** .03 .05 .26*** –.13*
Sociability .14* .08 .00 .15** .07 –.10
Liveliness .07 .03 –.17** .15** .12* –.25***
Domain score .11 .13* –.16** .16** .23*** –.31***
Agreeableness
Forgiveness –.07 –.19*** –.12* .02 –.15** –.03
Gentleness –.01 –.29*** –.09 .09 –.30*** .05
Flexibility –.21*** –.28*** –.17* –.12* –.20*** .01
Patience .04 –.16** –.13* .14* –.14* –.09
Domain score –.08 –.30*** –.17** .04 –.26*** –.03
Conscientiousness
Organization .41*** .05 .03 .45*** –.05 –.15**
Diligence .60*** .17** .04 .65*** .07 –.33***
Perfectionism .67*** .15** .13* .69*** –.04 –.23***
Prudence .35*** .02 –.05 .42*** –.02 –.22***
Domain score .64*** .12* .05 .70*** –.02 –.32***
Openness
Aesthetic
appreciation –.04 –.14* –.10 .02 –.11 –.03
Inquisitiveness –.06 –.09 –.09 –.02 –.04 –.04
Creativity .04 –.03 –.12* .10 .02 –.14**
Unconventionality –.05 –.02 –.07 –.03 .03 –.06
Domain score –.04 –.10 –.13* .03 –.04 –.09
Note: N = 321 university students (50 male, 271 female). SOP = self-oriented perfectionism, OOP =
other-oriented perfectionism, SPP = socially prescribed perfectionism. Partial correlations =
correlations of SOP controlling for OOP and SPP, SPP controlling for SOP and OOP, and OOP
controlling for SOP and SPP. Domain score = total score aggregated across the four facets.
*p < .05. **p < .01. ***p < .001.
Source: Data from Stoeber (2014a, Study 2).
Honesty-humility and self-oriented perfectionism were not significantly

correlated. However, a unique positive relationship was observed of self-oriented
perfectionism with fairness and a unique negative relationship with greed-
avoidance, suggesting that self-oriented perfectionists value fairness but may be
greedy. In contrast, other-oriented perfectionism showed a unique negative
relationship with the domain score, sincerity, greed-avoidance, and modesty. This
suggests that other-oriented perfectionists may not only be greedy (like self-
oriented perfectionists), but generally manifest a deficit in honesty/sincerity and
humility/modesty, which dovetails with studies linking other-oriented
perfectionism to callousness and narcissistic grandiosity (Smith, Sherry, Chen, et
al., 2016; Stoeber, 2015; Stoeber, Sherry, & Nealis, 2015). Also, socially prescribed
perfectionism showed a unique negative relationship with the domain score and
modesty, but—differently from the other perfectionism dimensions—also showed
a unique negative relationship with fairness. It appears that socially prescribed
perfectionists do not value fairness, and that socially prescribed perfectionists are
perfectionists who “don’t play nicely with others” (Sherry, Mackinnon, &
Gautreau, 2016).
As regards emotionality, the pattern of correlations was unexpected because self-
oriented perfectionism showed a unique positive relationship with the domain
score whereas socially prescribed perfectionism did not. This stands in stark contrast
to the FFM studies in which socially prescribed perfectionism showed consistent
positive correlations with neuroticism whereas self-oriented perfectionism did not.
Also, as regards the emotionality facets, the pattern of correlations was unexpected.
Self-oriented perfectionism had unique positive relationships with anxiety and
sentimentality, and other-oriented perfectionism had unique positive relationships
with fearfulness and dependence. In contrast, socially prescribed perfectionism was
not significantly correlated with any emotionality facets once the overlap with the
other two perfectionism dimensions was partialled out. Whereas the correlations
that other-oriented perfectionism showed are odd and not in line with previous
findings that other-oriented perfectionism is unrelated to neuroticism, there are
findings linking self-oriented perfectionism to anxiety (e.g., Hewitt & Flett, 2004;
Klibert, Langhinrichsen-Rohling, & Saito, 2005). Moreover, Ashton and Lee
(2007) suggest that HEXACO emotionality is linked to empathy and attachment,
and self-oriented perfectionism shares positive relationships with nurturance and
intimacy (Stoeber, 2014a). Nevertheless, the present findings do not align with
Ashton and Lee’s (2007) assertion that emotionality is comparable to neuroticism.
However, further research on multidimensional perfectionism and emotionality is
needed before firm conclusions can be drawn.
The pattern of correlations for extraversion showed close correspondence with
the findings from the FFM studies including analyses at the facet level. Self-oriented
perfectionism had unique positive relationships with the domain score, social self-
esteem, sociability, and liveliness, which corresponds to the finding that self-oriented
perfectionism showed positive correlations with the FFM extraversion facets of
assertiveness and activity. Other-oriented perfectionism showed unique positive
relationships with the domain score, social self-esteem, and social boldness whereas
socially prescribed perfectionism showed unique negative relationships with the
domain score, social self-esteem, social boldness. Also, these findings highlight the
close correspondence to the findings with the FFM extraversion facets. Furthermore,
the negative correlation with social self-esteem replicates previous research
indicating that socially prescribed perfectionists have low social self-esteem (Flett,
Hewitt, & De Rosa, 1996).
Regarding agreeableness, self-oriented perfectionism did not show a unique
relationship with the domain score but showed a unique negative relationship with
flexibility, and a unique positive relationship with patience. Whereas this finding
dovetails with the FFM findings that self-oriented perfectionism shows no
consistent relationships with agreeableness, it suggests that self-oriented
perfectionists may lack flexibility in social relations, but show patience when
interacting with other. In contrast, other-oriented perfectionism had unique
negative relationships with both the domain score and all facets—forgiveness,
gentleness, flexibility, and patience—which is in line with the FFM findings that
other-oriented perfectionism shows consistent negative relationships with
agreeableness. Conversely, socially prescribed perfectionism showed no significant
unique relationships—neither with the domain score nor with any of the facets—
which again demonstrates that socially prescribed perfectionism is less strongly and
less consistently linked to low agreeableness than other-oriented perfectionism.
As regards conscientiousness, self-oriented perfectionism showed large-sized
positive relationships with the domain score and all facets across bivariate and
partial correlations, confirming the FFM finding that self-oriented perfectionists
are primarily characterized by high conscientiousness. As expected, there were no
significant relationships between other-oriented perfectionism and
conscientiousness or any of the facets scores once the overlap with the other
perfectionism dimensions was controlled. In contrast, socially prescribed
perfectionism showed unique negative relationships with the domain score and all
facet scores once the overlap with the other two perfectionism dimensions was
controlled. This suggests that socially prescribed perfectionists are not very
conscientious, and corroborates the studies that found socially prescribed
perfectionism to show significant negative correlations with FFM conscientiousness
(e.g., Hewitt & Flett, 2004; Molnar et al., 2012).
Finally, as regards openness, no perfectionism dimension showed any significant
unique relationships with the domain score or any of the facet scores, except that
socially prescribed perfectionism showed a small negative partial correlation with
creativity. This finding is in line with the FFM findings indicating that
multidimensional perfectionism is largely unrelated to openness, but if perfectionism
shows small negative relationships with openness and its facets, it is most likely
socially prescribed perfectionism that will show these relationships.
Overall, the findings with the HEXACO dimensions and facets show
considerable correspondence with the findings from studies of the FFM
dimensions and facets with respect to extraversion, openness, agreeableness, and
conscientiousness (but not emotionality). Going beyond the FFM, the HEXACO
findings indicate that both other-oriented perfectionism and socially prescribed
perfectionism are associated with low honesty-humility (even though they
showed somewhat different relationships with the honesty-humility facets). This
suggests that not only other-oriented perfectionism is a personality disposition
that has “dark” features (cf. Marcus & Zeigler-Hill, 2015), but so also is socially
prescribed perfectionism, which complements prior findings that socially
prescribed perfectionism showed unique positive relationships with callousness
and deceitfulness (Stoeber, 2014b, 2015).
Neuropsychological Models of Personality

In contrast to structural models of personality, neuropsychological models of
personality aim to provide an account of the underlying emotion, motivation, and
learning bases of individual differences and, more specifically, to provide
neuropsychologically anchored principles and constructs to understand the
foundations of temperament and the underpinnings of general personality
descriptive systems, including the FFM (Corr, DeYoung, & McNaughton, 2013).
The major assumption of this specific approach is that a small number of approach
and avoidance systems underlie many general personality factors.
Eysenck’s PEN Theory

A prominent neuropsychological model of personality is Eysenck’s PEN theory
(Eysenck, 1970). Whereas the PEN theory also functions as a structural model
of personality, it is not based on psycholexical analyses, but on theory and
research on individual differences in neuropsychological functioning (Eysenck &
Eysenck, 1985).
The PEN theory differentiates three broad personality dimensions: psychoticism
(P), extraversion (E), and neuroticism (N). Factor analytic studies suggest that the
PEN dimensions of extraversion and neuroticism closely correspond to the FFM
dimensions of extraversion and neuroticism, whereas psychoticism appears to be a
combination of low agreeableness and low conscientiousness (Costa & McCrae,
1995b). Unfortunately, there is only one study (Hewitt, Flett, & Blankstein, 1991)
examining how Hewitt and Flett’s three perfectionism dimensions are related to
psychoticism (as conceptualized by Eysenck’s PEN theory), and the findings were
mixed: In male participants, perfectionism showed no significant correlations with
psychoticism, whereas self-oriented and socially prescribed perfectionism showed a
positive correlation in female students and other-oriented perfectionism showed a
positive correlation in female patients. Still, Eysenck’s PEN theory of personality is
important in the present context because the E and N factors of the theory
(regarding the neuropsychological foundations of extraversion and neuroticism)
laid the foundation for Gray’s reinforcement sensitivity theory (Gray, 1982; Gray
& McNaughton, 2000; for a review, see Corr, 2008).
Reinforcement Sensitivity Theory (RST)

The reinforcement sensitivity theory (RST) is a prominent neuropsychological
theory of personality explaining individual differences in approach- and
avoidance-related behaviors and associated conflicts. It assumes the existence of three
emotional-motivational systems: one approach system (the behavioral approach
system [BAS]) and two avoidance systems (the behavioral inhibition system [BIS] and
the fight-flight-freeze system [FFFS]). The most distinctive features of the two
avoidance systems are emotional output and defensive direction: The BIS activates
behavioral repertoire when moving toward threat, eliciting the emotional state of
anxiety; in contrast, the FFFS activates behavior that moves the individual away from
threat, eliciting the emotional state of fear. Further refinement and theoretical
elaboration of RST resulted in a progressive revision of RST (Corr & McNaughton,
2008, 2012; McNaughton & Corr, 2004). Consequently, the latest measure of
RST—the Reinforcement Sensitivity Theory Personality Questionnaire (RST-PQ;
Corr & Cooper, 2016)—captures individual differences in seven RST components:
four components of the BAS (reward interest, goal-drive persistence, reward
reactivity, and impulsivity) plus BIS, FFFS, and a separate factor of defensive fight.
Three studies have investigated how the three dimensions of Hewitt and Flett’s
model relate to the components of revised RST. The first study (Randles, Flett,
Nash, McGregor, & Hewitt, 2010) examined two samples of university students
using Carver and White’s (1994) BIS/BAS Scales to differentiate five RST
components: BAS drive, BAS fun seeking, BAS reward responsiveness, the BIS,
and the FFFS.5 Across the two samples, self-oriented perfectionism showed positive
correlations with BAS reward responsiveness, BAS drive, and the BIS whereas
socially prescribed perfectionism only showed a positive correlation with the BIS.
Otherwise, findings were mixed. In particular, other-oriented perfectionism did
not show a clear pattern of significant relationships across the two samples. The
second and third study (Stoeber & Corr, 2015, 2017) also examined university
students, but this time used Corr and Cooper’s RST-PQ differentiating all seven
components of revised RST. Moreover, the studies not only examined bivariate
correlations, but also computed multiple regressions to examine the perfectionism
dimensions’ unique relationships with the RST components. If we focus on the
unique relationships that were significant across both studies, the following picture
emerges. Self-oriented perfectionism showed unique positive relationships with
BAS goal-drive persistence, BAS reward reactivity, and BIS. Other-oriented
perfectionism showed a unique positive relationship with defensive fight, and a
unique negative relationship with the BIS. In contrast, socially prescribed
perfectionism showed unique positive relationships with BAS impulsivity and the
BIS, and a unique negative relationship with BAS goal-drive persistence.
Taken together, the studies examining multidimensional perfectionism from
the perspective of revised RST suggest that the three perfectionism dimensions of
Hewitt and Flett’s model have unique profiles of relationships with emotional-
motivational systems and associated approach- and avoidance-related behaviors.
Self-oriented perfectionists appear to be highly goal-directed—driven by goals and

persistent in the pursuit of goals—while at the same time highly reactive to both
positive and negative reinforcing stimuli. Socially prescribed perfectionists are
highly reactive only to negative reinforcing stimuli, and their approach-related
behaviors appear impulsive. By contrast, other-oriented perfectionists appear to
show a reduced reactivity to negative reinforcing stimuli, which differentiates
them from other perfectionists. Whereas both self-oriented and socially prescribed
perfectionism were associated with higher BIS levels (suggesting that they are
prone to experience anxiety), other-oriented perfectionists reported lower BIS
levels (suggesting they are unlikely to experience anxiety). In addition, other-
oriented perfectionism was the only dimension that showed a unique positive
relation with defensive fight. This suggests that other-oriented perfectionists may
become highly defensive when attacked, and will attack back. The combination
of an overactive defensive fight system with an underactive BIS (indicating a
reduced sensitivity to negative reinforcers) dovetails with findings that other-
oriented perfectionism shows links with aggression and psychopathy (Stoeber,
2014b, 2015).
Furthermore, these results show that it is important to go beyond structural
models of personality (like the FFM and the HEXACO model) and also examine
neuropsychological models if we want to gain a deeper understanding of how
multidimensional perfectionism is linked with emotional-motivational systems that
directly feed into approach- versus avoidance-related behavior. This is important
because different dimensions of perfectionism show different profiles of relationships
with approach and avoidance motivation (see Chapter 2). Moreover, individual
differences in the sensitivity to positive and negative reinforcers may determine
whether perfectionism takes on forms that have adaptive aspects, or forms that are
maladaptive and lacking any adaptive aspects (Slade & Owens, 1998).
Open Questions and Future Research

In concluding this chapter, it is important to point out that our review focused on
Hewitt and Flett’s (1991) tripartite model of perfectionism. On the one hand, this
focus provided us with a coherent framework when reviewing the different
relationships of different perfectionism dimensions with the FFM and HEXACO
dimensions and facets and with the revised RST components. On the other hand,
it also presented a limitation as there are other prominent multidimensional models
of perfectionism, most notably those of Frost et al. (Frost, Marten, Lahart, &
Rosenblate, 1990), Slaney et al. (Slaney, Rice, Mobley, Trippi, & Ashby, 2001),
and Hill et al. (Hill et al., 2004). We note, however, that self-oriented perfectionism
is a key indicator of perfectionistic strivings, and socially prescribed perfectionism
a key indicator of perfectionistic concerns (Stoeber & Otto, 2006). Consequently,
one can expect the respective key indicators in these other models to show
comparable patterns of relationships with the FFM, HEXACO model, and revised
RST dimensions, facets, and components. In particular, personal standards (Frost
et al., 1990), high standards (Slaney et al., 2001), and striving for excellence
(Hill et al., 2004) are key indicators of perfectionistic strivings, and should show
similar relationships as self-oriented perfectionism. As well, concern over mistakes
(Frost et al., 1990; Hill et al., 2004) and discrepancy (Slaney et al., 2001) are key
indicators of perfectionistic concerns and should show similar relationships as
socially prescribed perfectionism. Two studies employing the FFM confirm this
expectation (Cruce, Pashak, Handal, Munz, & Gfeller, 2012; Rice et al., 2007). In
contrast, for both the HEXACO model and revised RST, this is an open question
that needs to be answered in future research.
There are further questions that remain to be answered. One question regarding
the FFM findings concerns the degree to which the overlap between the three
perfectionism dimensions of Hewitt and Flett’s model influenced the findings. Self-
oriented, other-oriented, and socially prescribed perfectionism show substantial
overlap: Intercorrelations are often in the .40s, but can be in the .50s (e.g., Hewitt &
Flett, 2004). Consequently, when this overlap is controlled and unique relationships
are regarded, the findings may be different (Stoeber & Gaudreau, 2017). For example,
socially prescribed perfectionism tends to show significant negative correlations with
agreeableness, but this may be due to its overlap with other-oriented perfectionism
(which shows consistent negative correlations with agreeableness). Once this overlap
is removed, socially prescribed perfectionism may show nonsignificant relationships
with FFM agreeableness, as was the case for HEXACO agreeableness (see Table 4.2).
Furthermore, socially prescribed perfectionism tends to show nonsignificant
correlations with conscientiousness, but this may be due to its overlap with self-
oriented perfectionism (which shows consistent positive correlations with
conscientiousness). Once this overlap is removed, it remains to be seen if socially
prescribed perfectionism is negatively related with conscientiousness, as was the case
for HEXACO conscientiousness (see again Table 4.2).
Another question is whether there are gender differences in the perfectionism–
personality relationships. For example, Hewitt et al. (1991) found that
multidimensional perfectionism showed significant correlations with psychoticism
in women, but not in men (see the above section on Eysenck’s PEN theory). In
addition, they found that self-oriented perfectionism was positively correlated with
neuroticism only in women, but not men. Furthermore, Hill, Zrull, and Turlington
(1997) investigated perfectionism and personality from an interpersonal circumplex
perspective. They found that male self-oriented perfectionists tended to be arrogant-
calculating whereas female self-oriented perfectionists tended to be warm-agreeable
(cf. Chapter 9) which suggests that there also may be gender differences in how
self-oriented perfectionism relates to agreeableness.
Finally, the perhaps most important question is whether individual differences
in personality contribute to the development of individual differences in
perfectionism. Flett, Hewitt, Oliver, and Macdonald (2002) provided a
comprehensive analysis of potential factors contributing to the development of
perfectionism, and one factor they suggested to play a role was the child’s
“temperament.” If we replace “temperament” with “personality,” this would
suggest that personality contributes to the development of perfectionism.

Furthermore, the findings presented in this chapter suggest that different personality
dimensions contribute to the development of different perfectionism dimensions.
This suggestion was put to the test in a two-wave longitudinal study examining
whether the FFM dimensions predicted changes in adolescents’ self-oriented and
socially prescribed perfectionism (Stoeber et al., 2009). In line with cross-sectional
findings linking self-oriented perfectionism with conscientiousness and socially
prescribed perfectionism with neuroticism, conscientiousness was expected to
predict increases in self-oriented perfectionism, and neuroticism was expected to
predict increases in socially prescribed perfectionism. Even though the study found
support only for one of the expectations—conscientiousness predicted increases in
self-oriented perfectionism, but neuroticism did not predict increases in socially
prescribed perfectionism—the study is important as it is the first to demonstrate
that personality may play a role in the development of perfectionism. Unfortunately,
longitudinal studies examining developmental antecedents of perfectionism are
scarce and usually focus on parental factors, but do not include measures of the
child’s personality (Stoeber, Edbrooke-Childs, & Damian, in press). Further
longitudinal research on perfectionism and personality is needed—including other
models of perfectionism as well as other models of personality—to determine
which perfectionism–personality relationships reflect mere covariations showing us
where the different personality dimensions “fit” within broader personality theories
and models, and which relationships reflect dynamic processes of personality
dimensions contributing to the development of perfectionism.
Notes
1 For a “gentle introduction” to factor analysis in personality research—what it is, what it
does, and how it works—the interested reader is referred to Ashton (2013, Chapter 3.2).
2 Stairs et al. (2012) were included because they measured “perfectionism toward others”
using items from Hewitt and Flett’s (1991) measure of other-oriented perfectionism.
3 Successively an improved NEO-PI-R version was developed called the NEO-PI-3
(McCrae, Costa, & Martin, 2005).
4 The minus sign before the correlation of socially prescribed perfectionism and anxiety in
Table 2 of Hill, McIntire, and Bacharach’s (1997) article is a typographical error. The
correlation should be positive (R. W. Hill, personal communication, September 6, 2016).
5 Note that the BIS/BAS Scales are based on the old, unrevised RST and do not
differentiate the BIS and the FFFS, but some items of the BIS Scale can be used to assess
the FFFS (Heym, Ferguson, & Lawrence, 2008).
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5
PERFECTIONISM COGNITION
THEORY
The Cognitive Side of Perfectionism
Gordon L. Flett, Paul L. Hewitt, Taryn Nepon, and

Avi Besser
Overview
The cognitive reactivity of perfectionists plays a key role in perfectionism as a
diathesis for distress and health problems. Cognitive factors and processes are also
strongly implicated in the development, expression, and experience of perfectionism.
Accordingly, in this chapter, we make “the case for cognition.” We begin by
providing an overview of the influential history of perfectionism from a cognitive
perspective. We then illustrate the relevance of the cognitive elements of
perfectionism by describing research on individual differences in perfectionistic
cognitions. It will be seen that perfectionistic cognitions are an important
supplement not only in clinical assessments, but also in perfectionism research.
Finally, in an attempt to promote additional research on cognitive components of
perfectionism, we describe and expand our recently developed perfectionism
cognition theory. We go well beyond the initial version of the theory and its main
focus on the role of cognitive perseveration in perfectionism by analyzing these
elements in terms of a framework from the depression literature. Directions for
future research are highlighted throughout this chapter.
Introduction
It is clear when tracing the history of the perfectionism construct that the
development of multidimensional measures of perfectionism in the early 1990s
ushered in a new era of theory and research with an emphasis on perfectionism as
a stable personality trait. Hewitt and Flett (1991) conceptualized perfectionism as
representing an underlying diathesis or vulnerability factor that is activated when
perfectionists encountered setbacks and other life feedback indicating their lives are
not perfect and things are not going according to plan. This emphasis on a trait
90 Flett, Hewitt, Nepon, & Besser
perspective was based on our sense that simply focusing on perfectionism as a belief
or attitude would not capture the relentless striving and all-or-nothing approach to
self-evaluation that characterizes extreme perfectionism. This decision proved
timely in terms of the subsequent inclusion of perfectionism as part of the
workaholic style of achievement striving (Spence & Robbins, 1992).
The trait approach should dominate the perfectionism field for the next several
decades. However, there is much to be gained by trying to understand perfectionism
from other orientations. In the current chapter, we examine perfectionism from a
cognitive perspective. The role of cognitive factors is perhaps best illustrated by
considering what types of information are useful when conducting clinical
assessments of people who seem to be suffering greatly from the costs of perfectionism,
especially in terms of personal health and relationships. Typically, cognitive factors
and processes come into play in several ways. Most notably, distressed people who
fit the description of “neurotic perfectionists” as described by Missildine (1963) and
Hamachek (1978) tend to be highly focused on their cognitive appraisals of having
fallen short of their ultimate goal of being perfect. Adler (1938/1998) suggested that
these people are “perpetually comparing themselves with the unattainable ideal of
perfection” (p. 38). A subset of these distress-prone individuals will be ruminating
obsessively about a key mistake they made that perhaps represents a key life turning
point for them. Consider, for instance, the case of “Mr. C” introduced by Hewitt
and Flett (2007), which is outlined below.
Mr. C was a 50-year-old professional writer. Mr. C had suffered from depression
for a very long time but had kept it hidden from others until he attempted to take
his own life by shooting himself. Clearly, in retrospect, he had several characteristics
identified by Flett, Hewitt, and Heisel (2014) as factors that amplify the risk of
suicide for perfectionists undergoing intense psychological pain, including the
tendency to hide behind a front of apparent flawlessness. But what is most
noteworthy about Mr. C is that his despair could be traced back to the point when
he discovered an error in one of his published works, and his cognitive and
emotional reactions to this error resulted in losing his confidence in his writing
abilities and in himself. Mr. C continued to reflect on this error and then amplified
its impact by engaging in a harsh, overgeneralized self-assessment that was centered
on his perceptions of his diminished writing ability. His intense psychological pain
led ultimately to his decision to try to end his life.
Similar case excerpts and our evaluation of research findings in the published
literature had led us to introduce the concept of “perfectionistic reactivity.” This
focus on perfectionistic reactivity reflects our view that the vulnerability of
perfectionists such as Mr. C actually stems largely from the cognitive, emotional,
motivational, social, and behavioral responses and reactions they exhibit when life
setbacks are experienced (Flett & Hewitt, 2016). That is, there are characteristic
response tendencies that typically accompany perfectionism. These tendencies
represent less than optimal responses and reactions when life outcomes suggest that
things are far from perfect and the individual perfectionist seems to have deficits or
defects in the self that preclude ever being perfect.
Perfectionism and Cognition 91
Our emphasis on cognitive perfectionism is guided by an overarching desire to

get a better understanding of the self and identity issues that we believe are central
in perfectionism. Recent work on the role of self-image goals and concerns in
perfectionism (Nepon, Flett, & Hewitt, 2016) reflects our sense that there is
substantial merit in an Adlerian view of perfectionism as being a defensive way of
compensating for perceived limitations and deficits in the self. We try to keep in
mind as much as possible that the ultimate goal of extreme self-oriented perfectionists
is to beat the odds; that is, they accept that no one is perfect but they want to
become the one person who is perfect and who has attained the ideal self. Clearly,
for such individuals, perfectionism is a quest that is deeply personal.
According to our broader and extended conceptual model of perfectionism,
which frames perfectionism in relational terms (Hewitt, Flett, & Mikail, 2017),
perfectionists have relationships with others, but they also have a relationship with
the self and one component is reflected by automatic thoughts such as “I have to
be perfect.” This relationship with the self could involve self-compassion and
self-forgiveness but more commonly involves a perfectionism-related self-
dialogue, self-criticism and derogation, and—in some instances—abject self-hatred
and shame.
Returning to our theme of cognitive perfectionism, an early study by Frost and
Henderson (1991) is noteworthy not only because it illustrated the relevance of
multidimensional perfectionism among athletes, but it also showed the interplay of
self and cognitive factors in perfectionism. They reported that perfectionistic
athletes with a high level of concern over mistakes had a greater preponderance of
negative thoughts 24 hours prior to competition along with negative appraisals of
their sports self-confidence. These athletes also had a cognitive tendency to engage
in self-talk and they endorsed items such as “Images of my mistake control my
mind for the rest of the competition.” Clearly, perfectionistic athletes who are
anxiety-prone appear to have a cognitive orientation that should negatively impact
their performance.
With these observations in mind, we now consider the cognitive side of
perfectionism from an historical perspective. It struck us while conducting this
review that the cognitive approach to perfectionism has yielded many key insights
into the perfectionism construct and more attention to cognitive perfectionism is
clearly warranted.
Perfectionism and Cognition from an Historical Perspective

Karen Horney (1950) was one of the first theorists to describe cognitive self-related
aspects of perfectionism. She described neurotic individuals whose automatic
thoughts and self-dialogue reflected the “tyranny of the shoulds” (p. 65). She
indicated that these internal dictates or demands are used to attempt to reconcile
and reduce the disparate actual self from the ideal self. These cognitive thoughts or
internal dialogues dominate the perfectionistic individual’s internal world but also
govern and guide his or her behavior.
According to Albert Ellis (2002), perfectionism is best viewed as an irrational

belief and associated cognitive tendencies. Ellis maintained that perfectionism
becomes irrational when the person feels that perfection must be obtained and it
becomes a personal imperative. If taken to the extreme, the need to be perfect can
become a compulsive orientation that overtakes reason and logic. This viewpoint
was first expressed in a classic article by Ellis (1958) titled “Rational Psychotherapy,”
which introduced the rational-emotive perspective. Ellis listed perfectionism as
one of 12 irrational beliefs. This emphasis on being thoroughly competent,
intelligent, and achieving in all respects was contrasted with learning to accept the
self as imperfect.
Ellis (1958) went on to equate perfectionistic thinking and other types of
irrational thinking with neurosis. Specifically, he observed:
Neurosis, then, usually seems to originate in and be perpetuated by some

fundamentally unsound, irrational ideas. The individual comes to believe in
some unrealistic, impossible, often perfectionistic goals—especially the goals
that he should always be approved by everyone, should do everything
perfectly well, and should never be frustrated in any of his desires—and then,
in spite of considerable contradictory evidence, refuses to give up his original
illogical beliefs.
(pp. 43–44)
This is an elegant and important observation by Ellis because he not only highlighted
the tendency of perfectionists to make sweeping generalizations (i.e., be approved
of by absolutely everyone and have do everything perfectly well), he also suggested
that perfectionists are inherently prone to chronic frustration yet feel that they
should never be frustrated. This is accompanied by a perfectionistic rigidity and
refusal to abandon these extreme beliefs.
Ellis (1958) also introduced the concept of catastrophization (i.e., the tendency
to see setbacks and other negative outcomes as horrible catastrophes) and noted
that this type of thinking is common among those people who focus on absolutes
and categorical judgments. Catastrophization is becoming a more prominent
concept in the clinical psychology field as illustrated by Gellatly and Beck’s (2016)
conclusion that catastrophic thinking is transdiagnostic and contributes broadly to
various forms of emotional distress. We discuss the tendency for reactive
perfectionists to engage in catastrophic thinking later in this chapter.
The conceptual framework outlined by Ellis (1958, 1962) sparked other
contributions such as McFall and Wollersheim’s (1979) analysis of the perfectionistic
irrational beliefs that underscore obsessive-compulsive neurosis. It also fostered
the development of irrational beliefs measures with subscales tapping perfectionism.
Jones’ (1968) Irrational Beliefs Test (IBT), for example, has a high personal
expectations subscale. It includes items such as “It is highly important to me to be
successful in everything I do.” The IBT also has a subscale that taps a belief in the
need for perfect solutions to life problems. Extensive use of the IBT has yielded
several key insights about the nature of the perfectionism construct. For instance,
IBT analyses suggest that self-oriented perfectionism reflects a complex blend of
irrational beliefs that fuses high self-expectations with frustration reactivity,
demand for approval from others, and the need for perfect solutions to life
problems (see Flett, Hewitt, Blankstein, & Koledin, 1991; Flett, Hewitt, & Cheng,
2008). Other research supports a self-punitiveness model of dysphoria that
predicts that people are at risk if they are characterized by the combination of
perfectionistic self-expectations, overgeneralization, and self-criticism (Flett,
Hewitt, & Mittelstaedt, 1991).
The next developments in the cognitive perfectionism field grew out of Beck’s
(1967) cognitive model of depression and the inclusion of perfectionism as a theme
tapped by Weissman and Beck’s (1978) Dysfunctional Attitude Scale (DAS).
Dysfunctional attitudes reflect a cognitive vulnerability that is activated following
relevant life experiences (e.g., a humiliating failure experienced by someone who
believes that being perfect will result in a more perfect life). Brown and Beck
(2002) provided several important insights about perfectionism and dysfunctional
attitudes in their chapter on this topic. For instance, they observed that the extreme
wording of items throughout the DAS makes it generally suitable as a measure of
perfectionism. They noted that many items reflect if-then contingency statements
directly relevant to perfectionism (e.g., “If I am not a success then my life is
meaningless”) while other items assess perfectionistic imperatives (e.g., “I should
always have complete control over my feelings”).
David Burns also worked with Beck. Burns (1980) developed the 10-item
Burns Perfectionism Scale (BPS). This inventory has dysfunctional attitudes
statements such as “If I don’t set the highest standards for myself, I am likely to end
up a second-rate person.” The BPS items include several items that focus on how
other people would react to the individual’s imperfections and failures, so it is not
surprising that BPS scores are highly correlated not only with self-oriented
perfectionism but also with socially prescribed perfectionism (Hewitt, Flett,
Turnbull-Donovan, & Mikail, 1991).
The cognitive elements of perfectionism are also reflected in the Frost
Multidimensional Perfectionism Scale (FMPS; Frost, Marten, Lahart, & Rosenblate,
1990). The FMPS includes several items taken from various cognitively based
measures, including scales assessing obsessionality as well as the DAS and BPS. The
central dimension in the FMPS—the nine-item concern over mistakes subscale—
includes six DAS items. Thus, composite measures of evaluative concerns
perfectionism that include this subscale have a substantial cognitive component.
Cognitive perfectionism is also relevant to the other primary scale used to assess
perfectionism in many earlier investigations: the perfectionism subscale of the
Eating Disorder Inventory (EDI; Garner, Olmstead, & Polivy, 1983). The six
items of the EDI perfectionism subscale are cognitively based due to the authors’
sense that the perfectionism found among people with anorexia is a byproduct of
a dichotomous all-or-none thinking style involving personal and parental pressures
to be perfect (also see Garner, Garfinkel, & Bemis, 1982).
The Ideal Self-Schema and Automatic Thoughts Reflecting the

Need to Be Perfect
The next major development in the cognitive perfectionism field occurred when
Hewitt and Genest (1990) argued that people not only have a current self-schema
that reflects their actual characteristics, but also have an ideal self-schema that is
particularly salient among perfectionists. Their views were informed by research
conducted by Deutsch, Kroll, Weible, Letourneau, and Goss (1988), who had
participants rate the degree of self-descriptiveness of frequently endorsed self traits
and ideal traits. Words representing these traits were presented tachistoscopically,
and reaction times were assessed for judgments of the self-descriptiveness of these
traits. Deutsch and colleagues reported that the highest ratings of self-descriptiveness
were given for the self traits, but the ideal traits had higher ratings than words
from a random list of traits. Most notably, reaction times for self traits and ideal
traits did not differ and were faster than the reaction times to the words from the
random list. Their results suggested the possibility that there is a cognitive side to
the ideal self.
Hewitt and Genest (1990) went further and posited that there is an ideal self-
schema that is implicated in the processing of self-relevant information. They had
participants make structural, ideal self, or actual self ratings of three types of words:
neutral words (e.g., playful, forgiving), negative words (e.g., glum, weary), and
perfectionistic words (e.g., exact, persevering). A subsequent recall task showed
that words rated from the perspective of the actual self or the ideal self were recalled
better than words rated from a structural task orientation. Most importantly, there
was enhanced recall for perfectionistic words that were rated as not self-descriptive
in the ideal self and actual self conditions (i.e., words that reflects a discrepancy
between the current self and the ideal self). Hewitt and Genest concluded that the
ideal self functions as a schema that includes a cognitive representation of personal
attributes that fall short of the perfectionistic ideal.
Nasby (1997) extended this work by maintaining that there is a cognitive
prototype of the ideal self and that the ideal self can be represented cognitively and
emotionally from a private stance as well as a public stance. His findings indicated
that people high in private self-consciousness (chronic self-focused attention
directed inward) are attuned cognitively to the private component of the ideal self,
whereas people high in public self-consciousness are attuned cognitively to the
public component of the ideal self. We have extrapolated from this work the
notion that people who are high in perfectionistic self-presentation (i.e., the need
to seem perfect rather than be perfect) and have the public self-consciousness that
accompanies this personality style will have a cognitive prototype or self-structure
that emphasizes the ideal public self (Hewitt et al., 2003).
Regarding the nature of the ideal self, we maintain that the content and thematic
focus of the ideal self will vary among different types of perfectionists in ways that
reflect the distinctions between trait self-oriented perfectionism versus perfectionistic
self-presentation. Some perfectionists will have internalized extreme requirements
for the self and these self-oriented perfectionists will be invested in trying to be
perfect. These driven individuals will have what we refer to as an “internalized ideal
self.” Other perfectionists will be more focused on trying to seem perfect (i.e.,
perfectionistic self-presenters). These individuals will develop an “internal idealized
self” similar to the idealized self described by Horney (1950). The internal idealized
self is fueled by a dependent need to appear perfect and avoiding appearing
imperfect to gain recognition, approval, and acceptance. This proposed “internal
idealized self” reflects a history of trying to project an image of living up to the
ideals projected by other people, and it should be particularly salient for people
who are hiding a defective sense of their actual self or possible selves. These
individuals will have an organization of schemas that reflects the idealized self and
a highly salient “undesired self” that was first articulated by Ogilvie (1987). This
undesired self is a feared self that they must avoid.
Flett, Hewitt, Blankstein, and Gray (1998) built on the findings of Hewitt and
Genest (1990) and suggested that there are individual differences in the salience of
the ideal self and perfectionists are people who should be particularly prone to
experience frequent automatic thoughts that reflect their need to be perfect and
their concerns and doubts about not being perfect. The Perfectionism Cognitions
Inventory (PCI) was developed to assess the frequency of automatic thoughts such
as “I should be perfect” and “Why can’t I be perfect?” The development of this
measure was in keeping with Blatt and Shichman’s (1983) observation that self-
critical people tend to ruminate excessively about failures to meet personal standards
and maintain a sense of control.
One way of thinking about perfectionistic cognitions versus trait perfectionism
is that perfectionistic cognitions reflect a more cognitively immediate element of
perfectionism that is closely linked with daily events and current concerns. The
internal dialogue can become a form of “internal pressure” that reflects what is
going on in a person’s life and whether perfectionism is actively in someone’s
mind. Not surprisingly, because the cognitions facet captures a unique component
of the perfectionism construct, research has established that frequent perfectionistic
cognitions are linked uniquely with various forms of emotional distress and negative
automatic thoughts about the self, as well as related tendencies such as engaging in
perseverative thinking about failures (Flett et al., 1998) and having a deficit in
positive self-talk (Flett, Hewitt, Whelan, & Martin, 2007).
The PCI is growing in terms of its use and it has now been included in over 50
studies across more than 40 journal articles. Evidence continues to indicate the
relevance of perfectionistic cognitions in both anxiety and depression. For instance,
Pirbaglou et al. (2013) administered the PCI along with measures of negative
automatic thoughts, anxiety sensitivity, anxiety, and depression to over 900
university students. PCI scores were associated significantly with all of the other
measures and support was found for a mediational model of anxiety sensitivity and
negative automatic thoughts as mediators of the links that perfectionistic automatic
cognitions had with anxiety and depression. Perfectionistic cognitions are also
implicated uniquely in burnout (e.g., Hill & Appleton, 2011).
Other work has also examined perfectionistic cognitions from an eating disorder
perspective. Flett, Newby, Hewitt, and Persaud (2011) reported that undergraduate
women with elevated PCI scores also tended to have more frequent bulimic
automatic thoughts. Moreover, PCI scores explained unique variance in bulimic
thoughts beyond the variance attributable to negative automatic thoughts and trait
perfectionism. Other research by Downey, Reinking, Gibson, Cloud, and Chang
(2014) established among undergraduate women that the links found between trait
perfectionism and reported dieting behavior were fully mediated by perfectionistic
cognitions.
Scores on the PCI are also associated with obsessive-compulsive tendencies.
Ferrari (1995) described research with two undergraduate student samples and a
third sample of 65 people who acknowledged a past history of being diagnosed
with obsessive-compulsive symptoms. The PCI was correlated with self-reported
obsessions and compulsion as well as anger directed inward at the self and expressed
outwardly in public. There were particularly robust associations between PCI
scores and both obsessions (r = .69) and compulsions (r = .67) in those people who
had been diagnosed with obsessive-compulsive symptoms.
Perfectionistic cognitions are conceptualized as “state-like” because they are, in
part, a reflection of current concerns and daily life experiences. However, it seems
that those perfectionists who tend to think about needing to be perfect seem to
have chronic, trait-like thoughts, though these thoughts will vary somewhat
according to daily experience. This tendency was illustrated by Mackinnon,
Battista, Sherry, and Stewart (2014). They utilized a 21-day experience sampling
design to investigate the associations among perfectionistic self-presentation,
perfectionistic cognitions, depression, and social anxiety in 165 undergraduate
students. Daily assessments were obtained with an abbreviated three-item PCI (i.e.,
“I should be perfect,” “I expect to be perfect,” “My work should be flawless”).
Generalizability theory analyses showed that there was substantial variability
between people in the frequency of perfectionistic cognitions and there was also
person-by-day variability in the frequency of cognitions. Other analyses showed
with both between-subjects correlations and within-subject correlations,
perfectionistic cognitions were associated with depression and social anxiety (rs
ranging from .30 to .52).
Space restrictions preclude us from providing a more detailed review and
analysis of extant research and theory on the concept of perfectionistic cognitions.
Extended accounts can be found in Flett and Hewitt (2015) and in Flett, Nepon,
and Hewitt (2015). However, it is important to underscore two key points. First,
Flett et al. (1998) observed that there is merit in examining perfectionistic cognitions
from a multidimensional perspective, and subsequent research with a
multidimensional framework has confirmed that it is possible and meaningful to
distinguish different types of perfectionistic cognitions (Stoeber, Kobori, & Tanno,
2010). Stoeber, Kobori, and Brown (2014) reported that subfactors exist within the
PCI and it may be multidimensional even though it was conceived of as a
unidimensional measure. We have outlined why we believe it is best to still regard
the PCI as unidimensional (Flett & Hewitt, 2014), but the notion of exploring
facets of perfectionistic cognitions should be revisited.
Second, given mounting evidence of the unique predictive ability of
perfectionistic cognitions, it seems clear that research and theory that focuses solely
on trait perfectionism could be missing a vital element of the perfectionism
construct. The failure to consider cognitive perfectionism seems particularly
egregious in the eating disorders field. Vitousek and Hollon (1990) have argued
cogently that schemas involving themes such as perfectionism become fused and
interconnected with schemas reflecting eating, appearance, and weight-related
concerns, so a measure that reflects schema activation such as the PCI should relate
to various phenomena and factors involving eating and appearance. We feel that
there is much to be gained by future lines of investigations that seek to tie together
body image ideals, the internalization of these ideals, the ideal self as perfect, and
cognitions related to the pursuit of perfection. Bardone, Sturm, Lawson, Robinson,
and Smith (2010) illustrated the general merits of an emphasis on perfectionistic
cognitions by showing that young adult females who had fully recovered from an
eating disorder showed substantially lower PCI scores compared with a group of
young women who still had an eating disorder. Consequently, we have incorporated
perfectionistic cognitions as a major intrapersonal component of our comprehensive
model of perfectionistic behavior and the perfectionism social disconnection model
(see Hewitt et al., 2017). The intrapersonal component in these models involves
perfectionistic cognitions and information processing as well as automatic self-
derogation, both of which reflect the self-relational dialogue of perfectionists.
The Perfectionism Mindset

No chapter on perfectionism and cognition would be complete without a broader
analysis of the general mindset of vulnerable perfectionists. To our knowledge, the
term “perfectionism mindset” has not been introduced in the literature until now.
The perfectionism mindset that we describe below should be especially evident
when the individual perfectionist perceives failure or shortfalls and/or has made
some key mistakes that are not easily remedied. This is in keeping with our concept
of perfectionistic reactivity and the underlying vulnerability of perfectionists.
We maintain that a key observation when considering the perfectionism mindset
is that perfectionists are dominated cognitively by an evaluative set geared toward
seeing people (especially themselves) and circumstances as perfect or not perfect.
Perfectionists are over-represented among those people who see the world around
them in terms of its goodness versus badness (or who and what is perfect versus
who or what is not perfect). They are highly evaluative people who are constantly
involved in cognitive appraisals even when appraisals and judgments may not be
needed or wanted, in contrast to people who have a more descriptive orientation.
This evaluative set contributes to a tendency and a need to make quick categorical
assessments. Perfectionists, relative to non-perfectionists, are more likely to
interpret ambiguous situations and feedback as good or bad, or positive versus
negative, even when the information available really does not support such
definitive conclusions. This tendency likely reflects their needs for predictability
and certainty and the discomfort and negative arousal fostered by ambiguous
circumstances.
The evaluative nature of perfectionistic individuals is seen clearly in the
treatment of perfectionism, and addressing it is a major goal in the psychotherapeutic
process (see Hewitt et al., 2017, and Chapter 15). This means that the therapist
encourages, models, and structures the treatment so the patient can suspend the
negative evaluative “default option” and work toward exploring and discovering
aspects of themselves without a sense of evaluation but one of discovery and
acceptance (also see Horney, 1950).
Another key factor when considering the perfectionism mindset applies to those
perfectionists with workaholic tendencies who overstrive relentlessly and take on
so many demands and challenges that they become burned out. These people are
not only emotionally depleted, they are also cognitively depleted. No account of
cognitive perfectionism would be complete without acknowledging the need to
distinguish the perfectionist who is cognitively burned out versus the perfectionist
who seems to be functioning reasonably well. Depleted perfectionists will have a
form of cognitive exhaustion that contributes to difficulties in cognitive functioning
and in cognitive performance, and this is evident in terms of both voluntary and
involuntary cognitive processes. While there has been extensive work on
perfectionism and burnout (cf. Hill & Curran, 2016), the cognitive aspects of being
“burned out” have not been systematically evaluated. Future research on cognitive
burnout seems like an essential direction for future perfectionism research.
Research on the cognitive aspects of perfectionism tends to support the
observations put forth by theorists such as Ellis (1958, 1962), Burns and Beck
(1978), and Pacht (1984). Collectively, there is substantial empirical evidence
indicating that perfectionists tend to be rigid and engage in all-or-nothing
dichotomous thinking (e.g., Egan, Piek, Dyck, & Rees, 2007). Earlier, we alluded
to the tendency to engage in various forms of catastrophic thinking, and this
tendency has been confirmed in various investigations (Davis & Wosinski, 2012;
Graham et al., 2010; Rudolph, Flett, & Hewitt, 2007). Both self-oriented and
socially prescribed perfectionism are linked consistently across several studies with
pathological forms of catastrophic worry (Flett et al., 2015). Given the established
role of perceived personal deficiencies in catastrophic worry (see Davey & Levy,
1998), it follows that perfectionistic worriers with self-doubts should be especially
prone to experience multiple forms of catastrophic thinking and the iterative
information processing styles that reflect this type of thinking.
Other elements of the perfectionism mindset include the tendencies to engage
in overgeneralization (Flett et al., 1991; Hewitt et al., 1991) and personalization
(Davis & Wosinski, 2012), and endorse irrational beliefs that emphasize an
overdeveloped sense of personal responsibility (Rhéaume, Ladouceur, & Freeston,
2000). When these tendencies are combined with the rumination and perseveration
shown by vulnerable perfectionists, it is not surprising that these perfectionists can
develop a form of cognitive exhaustion that is not in keeping with healthy forms
of mindfulness and adaptive cognitive self-regulation.
It is important to get a better understanding of just how and why perfectionists
come to rely on these highly maladaptive styles. Teasdale et al. (2001) provided
some useful insights as part of their attempt to account for how dichotomous
thinking contributes to relapse among people prone to depression. They noted that
according to Harter (1999), it is actually the case that all-or-none thinking is
normative from a developmental perspective and this type of thinking is quite
common in very early to middle childhood. Perhaps the cognitive aspects of
perfectionism reflect the compulsive and ritualistic period and the “just right
phase” found among young children (see Evans et al., 1997). Teasdale et al. (2001)
posited that distress activates mood-dependent depressive schemata that are
“developmentally early” and are uncorrected by the reappraisals that people
typically learn as they cognitively mature. In short, depression-prone people tend
to revert back to earlier thinking styles such as dichotomous thinking. When we
consider this possibility for perfectionists, it must be noted that perfectionists are
also susceptible to dichotomous thinking as a result of having defined success in
such absolute, categorical ways over the years.
The proposed perfectionism mindset can be detected among perfectionists
undergoing treatment, and it often contributes to treatment resistance. Egan, Piek,
Dyck, Rees, and Hagger (2013) reported that the majority of their 40 clinical
participants said they would rather keep their perfectionism rather than change it.
Moreover, their clients anticipated catastrophic consequences upon changing their
perfectionism. Some clinical participants also had a dichotomous tendency to see
the self as either up to the challenge or falling short and simply “not good enough.”
Perfectionism Cognition Theory: An Expanded Analysis

It is important that the cognitive perfectionism field has a strong theoretical focus.
Accordingly, with this in mind, we will conclude this chapter with an expanded
account of the perfectionism cognition theory introduced by Flett et al. (2015).
Relevant research is also summarized.
The initial version of perfectionism cognition theory (PCT) has several elements,
but its central tenets are as follows: (a) Perfectionism is associated with faster and
more frequent onset of rumination as well as persistent and prolonged rumination.
(b) Perfectionists are prone to experience a wide array of various types of recurrent
thoughts and forms of cognitive perseveration, including some types of overthinking
that are quite unique to perfectionism. And (c) excessive cognitive activation and
perseveration leads to an overdeveloped memory for mistakes, failures, and stressful
experiences that highlight a sense of personal inadequacy. This cognitive activity is
accompanied by a hypervigilance and cognitive bias toward related cues that signal
the possibility of failure, mistakes, and negative social evaluations.
Below, we provide an extended description of PCT using the cognitive
taxonomy proposed by Ingram and colleagues as part of their information processing
model of depression (Ingram, 1990a; Ingram & Kendall, 1986; Ingram, Miranda,
& Segal, 1998). This useful framework consists of four levels: the structural level,
the propositional level, the operational level, and the cognitive products level.
At the structural level, there are cognitive structures at a deep level and these
include core schemas about the self, long-term memories, and associated cognitive
networks that have been established by deeper cognitive processing. Cognitive
structures can also include neural networks and associated physiological factors.
The propositional level includes bits of information and memory traces, but it
consists mostly of beliefs and assumptions (i.e., dysfunctional attitudes and irrational
beliefs). These beliefs and attitudes are stored in cognitive structures, so the
propositional and structural levels interact with each other. Propositions are
described as centralized and reflect a person’s sense of self and identity. At the
propositional level, propositional beliefs about the self can become connected to
other propositional structures. Ingram (1990b) has suggested that rumination and
stress stem, in part, from the presence of conflicting propositions.
The next level—the operational level—reflects the active cognitive operations
that people engage in. Deficits in encoding and retrieval operations reflect the
operational level. Ingram (1990b) posited that based on a spreading activation
model of internal cognitive processes, negative internal thoughts about the self are
primed and become predominant in ways that create a high level of self-focused
attention. If taken to the extreme, people with heightened self-focused attention
can become self-absorbed in ways that reduce their cognitive capacity.
Finally, the cognitive products level consists of the cognitive outputs experienced
by the individual. Typically, these products are automatic thoughts and other types
of self-statements. It also includes the cognitions, ruminative thoughts, and images
that may preoccupy someone with deficits in cognitive control, such as the
daydreams and unfocused thoughts characteristic of the person who engages in
mind-wandering.
The framework outlined above is useful in considering cognitive perfectionism
in vulnerable perfectionists. It was developed to represent the cognitive factors and
processes implicated in depression, and it is widely accepted that certain
perfectionism dimensions have consistent links with depression (e.g., Smith et al.,
2016). Accordingly, we now consider cognitive perfectionism at each of the four
levels.
Cognitive Perfectionism at the Structural Level

At a deep structural level, perfectionists will have multiple self-representations that
can become activated depending on current life experiences. Perfectionists are
people who have a core sense of self and identity that reflects their conviction that
they (or others) must be perfect, and this will be incorporated into cognitive
structures reflecting schemas for the actual self and the ideal self as perfect (either
the internalized ideal self or the idealized self). The actual self-schema and the ideal
self-schema are linked with each other in an associative network; and as opposed
to most people, extreme perfectionists will incorporate self-characteristics and

related experiences that are self-descriptive but also include attributes that they lack
and that detract from their sense of being perfect.
Consideration of the cognitive structures at this level includes the degree of
interconnectedness within the schema that emerges as a result of life experiences.
Because it is unlikely that extreme perfectionists who are prone to experience
dissatisfaction will have many exceptionally positive experiences whereas failures
and setbacks will often be experienced, it is reasonable to postulate that there will
be extensive interconnectedness involving negative self-attributes and related
experiences. However, there will be much less interconnectedness when it comes
to cognitive representations of positive self-attributes.
Cognitive perfectionism at a deep structural level also incorporates long-term
memories and other episodic memories that reflect vivid recall of intense
autobiographical events. Great accomplishments and great failures that are
personally significant and emotionally charged will be enduring and vividly
remembered, as will autobiographical events stretching back to childhood or
adolescence that promote a sense of personal inferiority and not meeting
expectations (or grandiose self-superiority in the case of perfectionists with
narcissistic tendencies; see Chapter 9). Overall, however, we suggest that memories
will blend together, so that instead of recalling specific memories, perfectionists
will typically recall general memories over a broad time period that include events
involving a generalized sense of not being perfect and generalized views of the self.
Unfortunately, there has been a paucity of research thus far on the
autobiographical memories of perfectionists and their impact. However,
Rasmussen, O’Connor, and Brodie (2008) did establish among parasuicide patients
that both overgeneral positive memories and overgeneral negative memories
interacted with socially prescribed perfectionism to predict depression and suicide
ideation. Nandrino, Doba, Lesne, Christophe, and Pezard (2006) also provided
indirect evidence. They showed that anorexic patients, relative to control
participants, had overgeneral positive and negative memories. Perfectionism likely
played a role given that the anorexic patients had exceptionally high EDI scores,
and perfectionism is a subscale of the EDI as described earlier.
Cognitive Perfectionism at the Propositional Level

At the propositional level, the main focus is on stored cognitive content in terms
of perfectionistic dysfunctional attitudes that typically reflect self-worth
contingencies (i.e., “If I am perfect, I will be loved and respected”) and absolutist
irrational beliefs that reflect the theme that perfection must be obtained and failures
and mistakes must be avoided. These thoughts vary somewhat for people focused
on seeming perfect rather than being perfect (i.e., “If I seem perfect, I will be loved
and respected”).
We also propose that there are at least two key distinctions at the propositional
level that are highly relevant in cognitive perfectionism. First, Burns (1980)
highlighted the need to consider “emotional perfectionism” in terms of the

dysfunctional beliefs about the importance of maintaining perfect emotional
control. This is a key element at the propositional level. The experience of intense
emotional experiences and negative arousal and distress that may accompany
certain beliefs and thoughts will be inconsistent with this dysfunctional attitude
emphasizing emotional perfectionism. Repeated experiences of negative emotions
will have disruptive and arousing cognitive implications for perfectionists who
interpret these negative emotions as further indicators of their lack of emotional
perfection and their overall imperfections.
Cognitive perfectionism at the propositional level should also reflect the
approach–avoidance conflict that characterizes many perfectionists. Covington
(2000) characterizes perfectionists as defensive overstrivers who are focused jointly
on striving in order to be successful and great and to avoid failure and the deep-
seated sense of shame that comes from failures to meet prescribed expectations and
personal standards. At the propositional level, the approach–avoidance conflict will
be represented cognitively by endorsing beliefs and attitudes about the rewards
inherent in achieving perfection and the consequences of failing to be perfect. At
the propositional level, this conflict should represent a source of tension and stress
for individuals who are driven to be perfect but who also have the potential to
become just as driven to avoid the shame and humiliation of being imperfect.
Cognitive Perfectionism at the Operational Level

At the operational level, our expanded PCT makes three main assertions. First,
perfectionists will have an attentional bias and reactivity toward threat cues,
especially evaluative cues that have implications for their personal characteristics.
Perfectionists who have chronic fears of negative evaluation and being publicly
exposed as inadequate will be particularly attentive to social cues connoting failure
or lack of acceptance. Second, perfectionists will have a cognitive orientation
toward and bias for enhanced perfectionism-relevant cues and stimuli, especially
when in negative mood states that activate the ideal or idealized self-schema. Third,
this attentional bias and cognitive preoccupation will act as a form of cognitive
interference that limits the cognitive capacity of working memory in ways that are
comparable to the working memory deficits that accompany anxiety (Whitmer &
Gotlib, 2013). As suggested above, these cognitive tendencies will be especially
apparent among those perfectionists experiencing emotional distress or having
elevated levels of stress or pressure.
At present, there is only limited research evidence testing the assertions of PCT,
but other available evidence supports these suggestions. Experiments with the
Stroop task have established that trait perfectionism is associated with cognitive
responses to threat stimuli (Lundh & Öst, 1996, 2001). Lundh and Öst (2001)
showed that participants with a high concern over mistakes took longer to process
social threat cues. This was also found in a related investigation that used verbal
priming to show changes in perfectionistic thinking in response to socially
evaluative cues (Saboonchi & Lundh, 1999). Kobori and Tanno (2012) had 40
undergraduate students with varying levels of self-oriented perfectionism perform
a modified Stroop task. They found that students with elevated self-oriented
perfectionism, relative to students with low self-oriented perfectionism, did not
take longer to respond to failure words than to neutral words; they did, however,
have significantly longer reaction times to failure words.
A recent study by Howell et al. (2016) compared attentional processing in 31
perfectionistic participants (high scores on FMPS concern over mistakes) and 25
non-perfectionists (low scores). An attentional probe task examined responses to
stimulus words that varied in valence and in terms of their relevance to perfectionism.
This investigation showed that the perfectionistic participants, relative to the non-
perfectionists, were characterized by greater attention to negative words but only
words that also reflected perfectionistic themes (e.g., failure, insufficient). Another
recent experiment (Ben-Artzi & Raveh, 2016) used a word-list paradigm to
examine the accuracy of memories and found that a measure of perfectionistic
strivings predicted more accurate memories, whereas a measure of perfectionistic
concerns was associated positively with the presence of false memories. Perhaps
more importantly, participants with elevated perfectionistic concerns had
demonstrably lower levels of memory discriminative ability, suggesting reduced
capacity in working memory.
Besser, Flett, Guez, and Hewitt (2008) introduced the notion that perfectionism
is associated with a memory bias for perfectionism-relevant stimuli. An experiment
was conducted to assess the effects of positive versus negative mood on recognition
memory. It was hypothesized that perfectionists induced into a negative mood
state would have greater recognition memory for negative content and
perfectionism-related content (i.e., words reflecting these categories). It was found
that perfectionists recognized more words with perfectionistic themes when
induced into a negative mood state but this did not translate into better memory of
perfectionistic words. The main finding that emerged was that high PCI scorers
(i.e., participants high in perfectionistic cognitions measured with the PCI) had
greater recognition memory for negative words when in a negative mood state
than did high PCI scorers in a neutral mood, whereas this enhanced recall for
negative words when in a negative mood was not found among low PCI scorers.
This significant interaction between perfectionistic cognitions and mood induction
was interpreted as evidence of a dynamic relation between the cognitive
manifestations of perfectionism and the experience of negative mood states. This
enhanced recognition memory suggests that certain perfectionists engage in
elaborative processing of negative information when in a negative mood in a
manner that fits with the claim that there is a negative cognitive diathesis for
depression activated when depression-prone people experience stress (Scher,
Ingram, & Segal, 2005).
A more recent experiment conducted by Desnoyers (2013) also supports
predictions derived from the PCT. This complex investigation involved exposing
121 participants to a mood induction and a threat condition prior to performing
three cognitive tasks, including one task that involved the recall of positive, negative,
neutral, and perfectionistic words. A key finding was that high PCI scorers in the
negative mood induction condition, as opposed to those in the neutral or positive
mood induction conditions, had quicker reaction times to the perfectionism words.
However, high PCI scorers had slower reaction times to all four types of words, and
this was interpreted as evidence of their cognitive preoccupations and their reduced
ability to dedicate cognitive resources to performance tasks.
Cognitive Perfectionism at the Product Level

The PCT postulates that at the product level, “cognitively activated” perfectionists
will experience automatic thoughts and various other forms of perseverative
cognition. Moreover, they will experience frequent uncontrollable intrusive
images related to being perfect and falling short of perfection. The frequent
thoughts and images that are experienced will drain cognitive resources and will
trigger relatively ineffective attempts to engage in thought suppression because
such thoughts are not in keeping with the perfectionist’s goals and objectives.
The various forms of perseverative cognition experienced here have been
described by Flett et al. (2015). Cognitive activation can include various forms of
uncontrollable worry and cognitive products such as mistake ruminations and
stress-related rumination. Here it is important to reiterate Martin and Tesser’s
(1989) observation that these ruminative thoughts reflect the frustration of not
reaching an important goal while in a stage of “endstate thinking” where the focus
is on the goal itself instead of strategies to achieve the goal.
Regarding the proposed experience of intrusive images, it follows that the
heightened cognitive activation of perfectionists should contribute to various forms
of cognitive interference, including bouts of mind-wandering, and these cognitive
difficulties will be especially evident when in states of high stress or high arousal.
Evidence of the presence of these intrusive cognitions was provided in research
linking PCI scores with reports of intrusive images following the experience of
stressful events (Flett, Madorsky, Hewitt, & Heisel, 2002). Other relevant evidence
was reported by Flett et al. (1998) who examined PCI scores and responses to the
Distressing Thoughts Questionnaire (DTQ; Clark & Hemsley, 1985). The DTQ
taps distressing thoughts and images related to depressive themes (e.g., “thoughts
and images that I am a failure”) and anxious themes (e.g., “thoughts or images that
something is, or may in the future be wrong with my health”). Correlational
results indicated that people who experience frequent rumination about needing to
be perfect also tend to experience thoughts and intrusive images associated with
depression and anxiety in daily life.
Concluding Comments
The extended version of the PCT outlined above will be modified as relevant
research accumulates. As we noted earlier, it is our hope that the current chapter
and our more extensive description of the PCT will provide additional impetus
for future research on perfectionism and cognition. Hopefully, this research will
incorporate a greater emphasis on positive thoughts and tests the possibility that
perfectionism is largely about an absence of positive thoughts. Deficits in positive
cognition are not surprising if someone has an information processing system that
promotes chronic self-evaluation according to an exacting cognitive prototype
that links self-attributes and personal events with an extremely idealistic
self-schema.
A final aspect of the PCT is our belief that perfectionism, including the cognitive
elements, typically has a purpose and serves a function for the perfectionistic
individual (see Hewitt et al., 2017). So what functions are served by the cognitive
elements of perfectionism? As stated earlier, the cognitive elements reflect the
intrapersonal self-relational component of our model. We maintain that
perfectionism, in general, represents a reparative solution to the problem of
depleted self-worth and an abiding sense of not fitting in, not belonging, or not
mattering to others. Perfectionistic cognitions form one component of that solution
and one can think of automatic perfectionistic cognitions as encouragements to be
perfect, to put forth efforts that will result in perfection, preparation for feedback,
or even, a distorted form of self-soothing in the face of failure. According to
Horney (1939), a key purpose is prevention. She suggested that the person who is
overly concerned with appearing perfect experiences internal thoughts in the form
of “self-recriminations.” These self-recriminations also serve the purpose of
motivating the perfectionist so that he or she can achieve and act in ways that
prevent possible humiliations before they occur. The self-criticism elements can
also serve the purpose of excessive self-punishment and inducement for perfection
in the future that may reflect early learning about how to be perfect (cf. Flett,
Hewitt, Oliver, & Macdonald, 2002).
Given the important distinction between striving for excellence versus striving
for perfection, it is likely that highly illuminating information will come from
cognitive research that contrasts people who are driven to achieve absolute
perfection and people with slightly more modest goals. Thus far, programmatic
research comparing these different types of individuals has not been conducted, so
despite all that has been done so far in the perfectionism field, there is still much
more work that remains to be done.
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PART II
Perfectionism in
Special Populations
6
PERFECTIONISM AND ANXIETY
IN CHILDREN
Nicholas W. Affrunti and Janet Woodruff-Borden
Overview
Although perfectionism has long been implicated in anxiety disorders in adults, it
has only recently begun to show similar associations among children. During the
past decade, research has shown that perfectionism is associated with greater anxiety
symptoms, greater severity of disorders, and poor treatment response for childhood
anxiety disorders. This chapter will begin by outlining the research that links
perfectionism with anxiety symptoms, disorders, and treatment response in
children. Then, factors that may influence and explain why perfectionism is
connected with child anxiety will be examined. The chapter will close with a call
for further research in the area. Despite advances in our understanding of the role
of perfectionism in childhood anxiety disorders, there remain many important
areas in need of continued study.
Perfectionism in Childhood Anxiety

Perfectionism has been implicated as a factor that contributes to the development and
maintenance of anxiety disorders (Affrunti & Woodruff-Borden, 2014; Egan, Wade,
& Shafran, 2011; Wheeler, Blankstein, Antony, McCabe, & Bieling, 2011). In adults,
perfectionism predicts social anxiety (Heimberg, Juster, Hope, & Mattia, 1995),
panic disorder (Antony, Purdon, Huta, & Swinson, 1998), generalized anxiety
disorder (Santanello & Gardner, 2007), and obsessive-compulsive disorder (OCD;
Frost & Steketee, 1997; Norman, Davies, Nicholson, Cortese, & Malla, 1998).
Though research on the role of perfectionism and anxiety in children is less prevalent
than research using adults, evidence is beginning to support similar associations.
Theoretically, children who are highly perfectionistic may worry, or feel
anxious about not meeting expectations (Flett, Coulter, Hewitt, & Nepon, 2011;
114 Affrunti & Woodruff-Borden
Flett, Hewitt, Oliver, & Macdonald, 2002). Additionally, these children may fear
the consequences of mistakes as threats with which they cannot cope. Children
who are anxious may use high, rigid standards as a maladaptive strategy to assuage
anxiety in challenging situations. For these children, when standards are met, the
anxiety is reduced and those standards are positively reinforced. This may suggest
to children that rigid standards are needed to provide a sense of certainty in their
pursuit that would otherwise cause anxiety if absent. When standards are not met,
anxiety increases and failing to achieve those standards may be punished (e.g., by
parental criticism or a poor grade). This may lower children’s self-perceived
competence and create greater fear when presented with a subsequent situation
where they may not meet their standards. In this way, high and rigid standards may
predispose children for increased anxiety.
Though these hypotheses remain untested empirically, they suggest that there
are multiple reasons that perfectionistic children are at risk of developing anxiety.
As such, in this chapter we will not only review the literature that links perfectionism
with childhood anxiety but also those factors which may explain the associations
between perfectionism and childhood anxiety. Because this research is in its nascent
stages, it should be interpreted with some caution. In addition, given the preliminary
nature of this research, a future directions section will provide suggestions to
expand the current knowledge base. For the purposes of this chapter, children will
refer to individuals under 18 years of age, adolescents will refer to individuals
between 13 and 18 years of age, and adults will refer to individuals over 18 years
of age.
Associations With Total Anxiety Symptoms

Evidence from numerous studies supports the notion that perfectionism is a risk
and maintenance factor for the development of anxiety symptoms in children. This
section will review research that pertains to total anxiety symptoms, rather than
specific diagnoses, because the majority of studies examining perfectionism and
anxiety in childhood use scales that assess total anxiety symptoms (Hewitt et al.,
2002). Those studies examining symptoms within specific diagnoses (e.g.,
obsessive-compulsive symptoms) are reviewed in a separate section. Individual
studies are summarized in Table 6.1.
TABLE 6.1 Summary of Reviewed Studies Linking Perfectionism With Anxiety Symptoms
and Disorders in Children
Study Symptoms/ Sample Perfectionism Key findings

disorders characteristics dimensions
Affrunti & Worry, N = 61; ages SOP-critical, SOP-critical predicted

Woodruff- anxiety 7–13 years SPP greater worry; SPP
Borden (2016) symptoms predicted greater anxiety
symptoms
Perfectionism and Child Anxiety 115
Affrunti & Worry N = 66; ages SOP-critical, SOP-critical and SPP

Woodruff- 7–13 years SPP predicted greater worry
Borden (in press)
Essau, Conradt, Anxiety N = 632; ages
Perfectionism Perfectionism decreased
Sasagawa, & symptoms 6–12 years during anxiety
Ollendick (2012) prevention program;
perfectionism predicted
lower treatment gains
Essau, Leung, Anxiety N = 1,022; ages SOP, SPP SOP and SPP associated
Conradt, Cheng, symptoms 12–17 years with greater anxiety
& Wong (2008) symptoms
Flett, Coulter, Worry, N = 81; mean SOP, SPP SOP associated with
Hewitt, & rumination age = 12.8 years worry and rumination;
Nepon (2011) SPP associated with
worry
Hewitt et al. Anxiety N = 114; ages SOP, SPP SOP and SPP associated
(2002) symptoms 10–15 years with greater anxiety
symptoms
Libby, Reynolds, OCD N = 118; 28 PS, CM, PE, PS, CM, and O
Derisley, & Clark diagnosis diagnosed with PC, O associated with an OCD
(2004) OCD; ages diagnosis
11–18 years
McCreary, Anxiety N = 481; SOP-critical, SOP-critical and SPP
Joiner, Schmidt, symptoms African SOP-striving, predicted greater anxiety
& Ialongo, American SPP symptoms over 1 year
(2004) sample; mean
age = 11.8 years
Mitchell, Newall, Anxiety N = 67; SOP, SPP SOP decreased during
Broeren, & symptoms diagnosed with anxiety treatment; pre-
Hudson, (2013) anxiety disorder; treatment SOP predicted
ages 9–12 years lower treatment effect
Nobel, Manassis, Anxiety N = 78; ages SOP, SPP SOP associated with
& Wilansky- symptoms 8-11 years greater anxiety
Traynor (2012) symptoms
O’Connor, Anxiety N = 737; mean SOP-critical, SOP-critical and SPP
Rasmussen, & symptoms age = 15.2 years SOP-striving, predicted greater anxiety
Hawton (2010) SPP symptoms over 6
months
Soreni et al. OCD N = 94; SOP-striving, SOP-critical and CP
(2014) severity diagnosed with SPP, SM, CE, predicted greater OCD
OCD; ages CP, NFA symptom severity
9–17
Ye, Rice, & OC N = 31; SM, CE, CP, SM associated with
Storch (2008) symptoms diagnosed NFA greater OC symptoms
OCD; ages
7–18 years
Note: Symptoms/disorders: OCD = obsessive-compulsive disorder, OC = obsessive-compulsive.

Perfectionism dimensions: SOP = self-oriented perfectionism, SPP = socially prescribed
perfectionism, perfectionism = single dimension of perfectionism used, PS = personal standards,
CM = concern over mistakes, PE = parental expectations, PC = parental criticism, O = organization,
SM = sensitivity to mistakes, CE = contingent self-esteem, CP = compulsiveness, NFA = need for
admiration.
Within this literature, studies vary in their use of sample sizes, sample
characteristics, anxiety rating scales, and methodology. Despite differences in these
specifics, similarities do appear to emerge. First, there are consistent findings that
perfectionism and total anxiety symptoms are positively associated in cross-sectional
studies (Affrunti & Woodruff-Borden, 2016; Essau, Leung, Conradt, Cheng, &
Wong, 2008; Hewitt et al., 2002; Nobel, Manassis, & Wilansky-Traynor, 2012).
For example, in the largest of these studies, Essau and colleagues (2008) examined
self-oriented perfectionism and socially prescribed perfectionism (Hewitt & Flett,
1991) in 594 children aged 12 to 17 years and found that both forms of perfectionism
were positively associated with total anxiety symptoms. Similar findings were
reported in children aged 8 to 11 years (Nobel et al., 2012). Second, the dimensions
of perfectionism that predict increased total anxiety symptoms may differ depending
on the study. For example, Hewitt et al. (2002) found that both self-oriented
perfectionism and socially prescribed perfectionism predicted total anxiety
symptoms, whereas Affrunti and Woodruff-Borden (2016) found that socially
prescribed perfectionism predicted total anxiety symptoms when controlling for
depressive and worry symptoms. Such differences make direct comparisons
difficult; however, it appears likely that different dimensions of perfectionism are
related to anxiety symptoms in different circumstances. Third, perfectionism
predicts increased total anxiety symptoms longitudinally, as demonstrated in two
studies (McCreary, Joiner, Schmidt, & Ialongo, 2004; O’Connor, Rasmussen, &
Hawton, 2010). These studies found that the same dimensions of perfectionism
predicted anxiety symptoms at six-month and one-year follow-ups in large samples
of children with mean ages of 11 and 15 years respectively. These studies provide
the strongest evidence yet that increased perfectionism leads to increased anxiety,
rather than the two simply co-occurring. In sum, though studies are sparse, current
research has consistently linked perfectionism with total anxiety symptoms in
youths. As such, perfectionism appears not only to commonly occur alongside
anxiety, but is predictive of anxiety over time.
Although these studies did not differentiate anxiety symptoms, they provide
important information on the nature of perfectionism and anxiety in children. For
example, studies linking perfectionism and total anxiety symptoms suggest that
children who are perfectionistic may be more fearful and vigilant for threat in their
environments, regardless of situation. Indeed, such biases have been shown related
to perfectionism in adults (Lundh & Öst, 2001). Further, studies linking
perfectionism with total anxiety symptoms suggest perfectionism and anxiety
symptoms arise from similar processes. For example, anxious rearing—a parental
style characterized by a focus on the negative consequences of mistakes and the use
of controlling behaviors to minimize those consequences—is linked with both
perfectionism and child anxiety (Affrunti & Woodruff-Borden, 2015; Mitchell,
Broeren, Newall, & Hudson, 2013). Importantly, these hypotheses remain to be
tested. Yet, knowledge of the links between perfectionism and total anxiety
symptoms allows further analysis into prospective mutual causes and effects and
specific anxiety symptom dimensions.
Associations With Worry

In addition to studies examining perfectionism and total anxiety symptoms, studies
have found perfectionism to be positively associated with childhood worry. Worry
may have a particular link with perfectionism as children who are perfectionistic
may worry in an attempt to control their emotions (Affrunti & Woodruff-Borden,
2016). Additionally, children who are perfectionistic may see worry as beneficial
and necessary to achieve their standards. Such cognitions are often seen in high
worriers (Gosselin et al., 2007). However, few studies have examined the role of
perfectionism in childhood worry as a separate anxiety symptom. Yet, within those
few studies, common findings appear.
The three studies that currently have linked perfectionism and worry in children
have used relatively small community samples (all under 100 children) and cross-
sectional data, which greatly limit the conclusions that can be made. However, two
of these studies have found that both self-oriented perfectionism and socially
prescribed perfectionism were implicated in childhood worry, such that higher
perfectionism scores predicted greater worry (Affrunti & Woodruff-Borden, in
press; Flett et al., 2011). One study found that only self-oriented perfectionism
predicted greater worry, when controlling for other symptoms of anxiety and
depressive disorders (Affrunti & Woodruff-Borden, in press). Despite the noted
limitations in this research, there are consistent findings suggesting that perfectionism
predicts greater worry in children. Further research will be needed to determine if
such relationships hold over time and extend to clinical samples.
Associations With Anxiety Disorders

Distinct from the above reviewed studies, previous work has examined the role of
perfectionism in specific anxiety disorders. Additionally, this section will include
studies examining anxiety at the symptom level provided they do so within a
specific disorder (e.g., OCD). Importantly, this body of research is relatively sparse
compared with those examining total anxiety symptoms. Yet, it is important to
differentiate between the two areas of research because research focusing on a
discrete anxiety disorder may yield more specific information as to how associations
differ across anxiety disorders (Affrunti & Woodruff-Borden, 2014).
The only anxiety disorder that has been investigated with specificity is OCD.
Libby, Reynolds, Derisley, and Clark (2004) examined perfectionism using the
Frost Multidimensional Perfectionism scale which differentiates six perfectionism
dimensions: personal standards, concern over mistakes, doubts about actions,
parental expectations, parental criticism, and organization (Frost, Marten, Lahart,
& Rosenblate, 1990). They found personal standards, concern over mistakes, and
organization were positively associated with a diagnosis of OCD. Parental
expectations and parental criticism were not associated with a diagnosis of OCD,
and the dimension of doubts about actions was not evaluated. Although the
investigation into a specific anxiety disorder is a strength of this study, the use of a
small sample and cross-sectional data limit the study’s conclusions. Soreni et al.
(2014) reported that perfectionism was positively associated with the severity of
OCD symptoms in a sample of children and adolescents, aged 9 to 17 years,
diagnosed with OCD. Similar findings were reported by Ye, Rice, and Storch
(2008) in a separate sample of children and adolescents, aged 7 to 18 years,
diagnosed with OCD. Taken together, these studies suggest that perfectionism is
associated with greater and more severe symptoms in OCD, which parallels
findings from research on adults (Frost & Steketee, 1997; Rhéaume, Freeston,
Dugas, Letarte, & Ladouceur, 1995). However, the directionality of the relationship
is not clear. At this point, no longitudinal studies have been conducted examining
perfectionism and OCD in children. Future work must remedy this. Additionally,
the lack of research examining perfectionism in other childhood anxiety disorders
(e.g., social phobia, separation anxiety disorder, generalized anxiety disorder) is a
glaring gap in the literature. Far more work is needed in this area to understand the
role of perfectionism across childhood anxiety disorders.
The Effect of Perfectionism on Anxiety Treatment

Further evidence for the role of perfectionism in childhood anxiety disorders
comes from research examining the effects of perfectionism in the treatment and
prevention of anxiety disorders. Perfectionism has been hypothesized to interfere
and undermine effective treatment and prevention by creating unrealistic standards
for coping in the patient (Hewitt & Flett, 1991). Because these standards cannot be
reached during treatment, patients perceive treatment to have failed and return to
previous patterns of thinking and behaving. For example, children may expect the
elimination of all distress from treatment. When this does not occur, they can
become emotionally reactive; not only distressed by the stressor in the environment,
but also by their failure to meet the treatment goal. Additionally, some children
may also struggle with the process of working toward their goals in therapy, either
hiding their difficulty completing tasks to appear perfect or refusing to engage in
tasks due a perception that they will fail at meeting their goals. Though there is
some evidence for these assumptions in the treatment of childhood depression
(Jacobs et al., 2009; Nobel et al., 2012), findings are less clear in the treatment of
childhood anxiety disorders.
In the only examination of the role of perfectionism in the treatment for
children diagnosed with an anxiety disorder, Mitchell, Newall, Broeren, and
Hudson (2013) found that pre-treatment self-oriented perfectionism (but not
socially prescribed perfectionism) predicted poorer treatment outcome for a group
of children receiving cognitive-behavioral treatment (CBT). These findings were
the same at post-treatment and six-month follow-up. Furthermore, two studies
investigated perfectionism in the prevention of anxiety disorders and symptoms in
at-risk children (Essau, Conradt, Sasagawa, & Ollendick, 2012; Nobel et al. 2012).
Similar to the findings of Mitchell, Newall et al. (2013), Essau et al. (2012) found
that perfectionism impeded treatment gains of a CBT prevention program at a
12-month follow-up. That is, children with lower levels of perfectionism had
greater decreases in symptoms 12 months after the completion of the prevention
program. The authors speculated that those children with greater levels of
perfectionism saw lower decreases in symptoms because they may have struggled
to generate problem-solving strategies and may have made more perseverative
errors, which reduced the efficacy of the treatment. Discrepant from these findings,
Nobel et al. (2012) found that perfectionism did not impact treatment outcomes
for a school-based CBT program for at-risk children. Data were only collected at
post-treatment, but long-term follow-up data were not reported. It is possible that
the discrepant findings from Nobel et al. are the result of different follow-up times.
For example, it is possible that perfectionistic children at-risk of anxiety disorders
show immediate treatment gains from such a prevention program. However, these
gains may not last. Indeed, consistent with Hewitt and Flett’s (1991) theory,
children with high levels of perfectionism may revert to old patterns of behavior
over time because their standards for coping are not met. At-risk children may be
more likely to show immediate treatment gains, when compared to diagnosed
children, because experiences with strong negative emotions arise less frequently
for at-risk children than diagnosed children. As such, in the short term, at-risk
children may function better until reverting to old patterns of behavior because of
unmet standards for coping. Future studies focusing on the trajectory of treatment
for perfectionistic children, both within and after treatment is completed, are
needed to contextualize these findings. Additionally, differences in how
perfectionism affects treatments aimed at at-risk children versus treatments aimed
at diagnosed children need to be further understood.
The growing body of literature linking perfectionism with childhood anxiety
disorders lends initial support to the theory that perfectionism is a significant factor
for the development and maintenance of these disorders. Perfectionism predicts
total anxiety symptoms, suggesting perfectionistic children are more fearful overall
and biased toward threat across environments. Additionally, the link between
perfectionism and worry in children may arise because perfectionistic children are
more fearful. That is, perfectionistic children may worry as an attempt to control
emotions such as fear. By engaging in worry, perfectionistic children perpetuate
their fear and emotion dysregulation. Separately, perfectionism may have similar
associations with OCD. Perfectionistic children may engage in compulsive
behaviors as a maladaptive attempt to cope with obsessive thoughts. Despite the
above hypotheses on why perfectionism associates with anxiety disorders in
children, the unique contribution of perfectionism to the development and
maintenance of anxiety disorders over developmental factors such as temperament,
executive function, and parenting is not well known.
To help explain how and why the above associations between perfectionism
and child anxiety exist, mediating factors must be examined (cf. Baron & Kenny,
1986). Such factors may explain why perfectionism is associated with multiple
anxiety disorders. It is likely that various factors occurring throughout development
act as mechanisms through which perfectionism exerts its effect on childhood
anxiety disorders. Although such research is in its infancy, a growing body of

evidence suggests that perfectionism may associate with anxiety disorders through
a number of separate mechanisms.
Mediators of Perfectionism and Anxiety Disorders

Theory and research have implicated multiple mechanisms linking perfectionism
and anxiety (Hill, Hall, & Appleton, 2010; Libby et al., 2004; Moretz & McKay,
2009). Intolerance of uncertainty, lowered perceived competence, “not just right
experiences,” and effortful control have all shown associations with perfectionism
and anxiety disorders. Indeed, these factors have been theorized as possible
mechanisms through which perfectionism relates to the development of anxiety
disorders (Affrunti & Woodruff-Borden, 2014). They may also represent possible
paths that are part of multiple causal routes within the development of these
disorders. Importantly, much of this research remains preliminary, limiting our
understanding of the exact nature of the associations observed across development.
Additionally, research using children is sparse. Consequently, in the following
section, we will also review research using adult samples where research using
children is absent from the literature.
Intolerance of Uncertainty
Intolerance of uncertainty reflects the concept that ambiguity in situations is
inherently threatening or negative and should be avoided (Dugas, Buhr, &
Ladouceur, 2004), and it has been implicated in disorders such as generalized
anxiety disorder, OCD and depression (Buhr & Dugas, 2006; Dugas, Schwartz, &
Francis, 2004; Gallagher, South, & Oltmanns, 2003; Gentes & Ruscio, 2011;
Tolin, Abramowitz, Brigidi, & Foa, 2003). Intolerance of uncertainty may link
perfectionism with anxiety disorders because the high and rigid standards and
perceived negative consequences that occur in perfectionism make uncertainty a
fearful prospect. In uncertain situations, perfectionistic children may be unsure if
standards have been met, creating fear and worry about that situation. This
increased distress may in turn increase their risk of developing an anxiety disorder.
This may be especially true for generalized anxiety disorder and OCD. For
example, perfectionistic children who are also intolerant of uncertainty may engage
in worry or compulsive behaviors in an attempt to reduce distress around uncertain
situations.
Research examining the relationship of intolerance of uncertainty and
perfectionism has only been correlational. Buhr and Dugas (2006) reported
significant positive correlations between intolerance of uncertainty and
perfectionism in 197 undergraduates. Similar significant correlations were found in
a sample of 191 adolescents, 14 to 18 years of age (Boelen, Vrinssen, & van Tulder,
2010). No conclusions can be drawn about temporal or causal directionality or
specific dimensions. Yet, these findings are consistent with the proposition that
intolerance of uncertainty mediates the association between perfectionism and

child anxiety.
In some contemporary cognitive models of OCD, intolerance of uncertainty
and perfectionism are conceptualized as specific dysfunctional beliefs that give rise
to obsessive-compulsive symptoms (Clark, 2004; Frost & Steketee, 2002; Libby et
al., 2004). Indeed, in factor analytic studies, perfectionism and intolerance of
uncertainty in adults have collapsed into a single factor (Taylor, Afifi, Stein,
Asmundson, & Jang, 2010). This suggests that those who are highly perfectionistic
are also likely to develop intolerance of uncertainty in the context of OCD.
Longitudinal studies are needed to determine directionality and strengths of these
relationships across development. Preliminary evidence for intolerance of
uncertainty as a mediator between perfectionism and OCD comes from a sample
of 475 undergraduates (Reuther et al., 2013). Researchers found that intolerance
of uncertainty mediated the relationship between perfectionism and obsessive-
compulsive symptoms. Although the data were not longitudinal, the findings are
consistent with the theory that perfectionism leads to distress in uncertain,
unexpected situations, which may lead to increased risk for anxiety disorders.
The need for further investigation of perfectionism and intolerance of
uncertainty across development is clear. As no studies have investigated
perfectionism and intolerance of uncertainty in children, hypothetical explanations
for their association are presented. It is plausible that intolerance of uncertainty and
perfectionism influence each other throughout development, putting children at
increased risk for anxiety. Additionally, perfectionism and intolerance of uncertainty
together may prime children to worry, or engage in compulsive behaviors,
increasing their risk of generalized anxiety disorder and OCD. Longitudinal studies
are required to understand the temporal directionality and causality of these
relationships.
Perceived Competence
Perceived competence has been defined as the belief in one’s own mastery over
things in the environment. This has been conceptualized as including separate but
related domains of competence: cognitive, social, and physical (Harter, 1982). Yet,
these competence-based domains relate to a global factor of competence (Granleese
& Joseph, 1994). Both the competence-based domains and the global factor have
shown links with perfectionism and anxiety disorders (Grills & Ollendick, 2002;
McVey, Pepler, Davis, Flett, & Abdolell, 2002; Rice, Choi, Zhang, Morero, &
Anderson, 2012). Theoretically, continued perceived failure at achieving high and
rigid standards would lead to the development of low competence. This low
competence would then lead to anxiety disorders by raising anxiety and lowering
coping. For example, children who perceive themselves as failures in the social
domain may become more anxious in social situations, which puts them at risk of
developing social phobia. Whereas no study has examined these assumptions across
development, separate lines of research do provide some support.
Perfectionism has been linked with low perceived competence. In a sample of

286 undergraduates, interpersonal competence was negatively associated with
perfectionism (Jackson, Towson, & Narduzzi, 1997). Similar results were reported
in a sample of 363 females with a mean age of 13 years (McVey et al., 2002). In a
sample of 187 females with a mean age of 14 years, perfectionism was found to be
negatively associated with domain-specific competencies (McArdle, 2010). That is,
perfectionism about cognitive tasks was associated with low perceived competence
about cognitive tasks, but not with low perceived competence about physical tasks.
Conversely, perfectionism about physical tasks was associated with low perceived
competence about physical tasks, but not with low perceived competence about
cognitive tasks. This suggests that perfectionism leads to domain-specific
competence deficits. Yet, some research has shown that perfectionism predicts
greater global deficits of competence (DiBartolo, Frost, Chang, LaSota, & Grills,
2004; Rice, Ashby, & Slaney, 1998).
Separately, there is a large body of research that has linked poor competence
with anxiety disorders (Masten, Burt, & Coatsworth, 2006; Messer & Beidel, 1994;
Rutter, Kim-Cohen, & Maughan, 2006). For example, in a longitudinal study
following 87 children from Grade 2 to Grade 5, perceptions of social incompetence
were predictive for subsequent internalizing problems, including anxiety (Hymel,
Rubin, Rowden, & LeMare, 1990). Further, more specifically, lower self-
competence predicted child anxiety symptoms (Affrunti & Ginsburg, 2012; Messer
& Beidel, 1994). A longitudinal study examining predictors of social anxiety and
fear of negative evaluation in children of 13 to 18 years, found that a lack of
perceived social competence predicted social anxiety (Teachman & Allen, 2007).
In a separate longitudinal study following 205 children from the age of 8 years to
28 years, social incompetence predicted subsequent internalizing problems at all
follow-ups: 7, 10, and 20 years after the initial assessment (Burt, Obradović, Long,
& Masten, 2008). Furthermore, children diagnosed with an anxiety disorder tend
to perceive themselves as less competent when compared to their non-diagnosed
peers (Ekornås, Lundervold, Tjus, & Heimann, 2010).
No study so far has combined these two lines of research. Taken together,
however, the extant research suggests that individuals high in perfectionism may
develop low competence when faced with frequent perceived failure. This may
occur when a perfectionistic individual fails to achieve to the standard set by them
or by others, perceiving themselves to have failed. This may influence domain-
specific areas of competence. For example, specific areas of perfectionistic concern
(e.g., social relationships) may lead to reduced competence for this specific area
when a standard is not met. This reduced competence may then increase the risk
of developing anxiety disorders in children.
Importantly, research has not yet investigated the temporal or causal directionality
of the relationship between perfectionism and lowered self-competence.
Competence, like perfectionism, is likely influenced by multiple developmental
factors. For example, parental control and authoritarian parenting have shown to
be predictive of competence deficits by restricting a child’s ability to develop
competence in challenging situations (de Minzi, 2006; Grolnick & Ryan, 1989).
These parental factors have also shown to be predictive of perfectionism in children
(e.g., Affrunti & Woodruff-Borden, 2015) and adolescents (Soenens et al., 2008).
Future research must better clarify the role of perfectionism in the development of
competence and the multiple pathways they may create in the development of
anxiety disorders in children.
“Not Just Right Experiences”

The phenomenon of a “not just right experience” (NJRE) reflects experiences
when individuals report uncomfortable sensations that compel them to perform
certain behaviors until the uncomfortable sensation is resolved as being “just right”
(Coles, Frost, Heimberg, & Rhéaume, 2003). These behaviors are conceptualized
as a striving for perfection, certainty, or control that needs to be achieved in order
to reduce distress. That distress likely arises out of a mismatch between input and
expectations (Coles, Frost, Heimberg, & Steketee, 2003). NJREs are often
observed in OCD, though they have also been observed in individuals with tic
disorders (Ghisi, Chiri, Marchetti, Sanavio, & Sica, 2010; Miguel et al., 2000; Neal
& Cavanna, 2013). There is also some research indicating that NJREs are positively
related to generalized anxiety disorder symptoms and worry (Fergus, 2014).
Perfectionism likely leads to the sensation that certain experiences are imperfect, or
“not just right,” which leads to distress. Behaviors such as compulsions or worry
may function as a way to decrease this distress, leading to anxiety disorders such as
OCD and generalized anxiety disorder.
Few studies have investigated the association between perfectionism and
NJREs. However, in these few studies, perfectionism has been found to be strongly
positively associated with NJREs. Coles, Frost, Heimberg, and Rhéaume (2003)
found that NJREs positively associated with all perfectionism dimensions of two
perfectionism questionnaires in a sample of 119 undergraduates. Similar results
were reported in another undergraduate sample of 188 students (Moretz & McKay,
2009). Whereas these studies provide preliminary evidence for the link between
NJREs and perfectionism, they are limited by their use of undergraduates and
cross-sectional data. More research is needed to confirm that perfectionism
precedes the development of NJREs in the development of OCD or worry.
Furthermore, more research is needed exploring these developmental links in
children.
Though NJREs are understudied in children, sensory intolerance may represent
analogous experiences in children. Sensory intolerance reflects the phenomenon of
marked intolerance or intrusive re-experiencing of sensory stimuli that drive
compulsive behaviors (Hazen et al., 2008). As such, sensory intolerance may
include NJREs as one possible subtype (Miguel et al., 2000) and is common in
children diagnosed with OCD or tic disorders (Ferrão et al., 2012; Hazen et al.,
2008). Yet, the role of perfectionism within sensory intolerance experiences is not
well understood. Though clinical case studies report co-occurrences between
sensory intolerance and perfectionism (Hazen et al., 2008), no studies have

empirically investigated this connection. It is possible that NJREs and sensory
intolerance are indicators of perfectionism in children, which may put them at risk
of anxiety disorders. However, far more research is needed in exploring the
associations between NJREs, sensory intolerance, perfectionism, and anxiety
among children.
Effortful and Emotional Control

Effortful control is the ability to suppress a dominant response in order to perform
a subdominant response. It is often conceptualized as a temperament factor and
refers to the focusing and shifting of attention and inhibiting behavior when
appropriate (Rothbart, Ellis, & Posner, 2004). In particular, it is the combination
of attentional and inhibitory control that acts to regulate experience and overlaps
with executive function, temperament, and self-regulation (Kochanska, Murray, &
Harlan, 2000). Additionally, effortful control can assist in the modulation of
emotional responses using executive function (Gioia, Isquith, Guy, & Kenworthy,
2000). Separate lines of research have linked effortful control with perfectionism
(Mandel, Dunkley, & Moroz, 2015; Tangney, Baumeister, & Boone, 2004) and
anxiety (Lonigan & Vasey, 2009; Muris, van der Pennen, Sigmond, & Mayer,
2008; Muris, de Jong, & Engelen, 2004) in children. These studies suggest that
perfectionism may predispose children to effortful control deficits, which may
predict increased anxiety symptoms and disorders in youths. Hypothetically,
perfectionism may predict lower effortful control by preventing children from
regulating their actions when perceived failure occurs. Perfectionistic children may
experience distress when perceived failure occurs, be unable to regulate that
distress, and feel anxious or worry about that situation in the future. Although
research has yet to test this hypothesis directly, previous research has provided
indirect support for it (e.g., Muris et al., 2004; Tangney et al., 2004)
Similarly, emotional control, or the ability to modulate emotional responses
using executive control, has been theorized to associate with both increased
perfectionism and anxiety symptoms (Affrunti & Woodruff-Borden, 2014).
Perfectionism may predict decreased emotional control, as children who are
perfectionistic may be unable to modulate their emotional responses when
perceived failure occurs. This may show when a child becomes overwhelmed and
has difficulty coping with strong emotions in the face of perceived failure. There
are studies suggesting that emotional control and perfectionism are linked, yet they
have been primarily conducted with adult samples (Rudolph, Flett, & Hewitt,
2007; Wirtz et al., 2007). Additionally, this decreased ability to control their
emotions may cause children to become anxious or worried about future situations.
Indeed, children with emotional control deficits have shown to be at risk for
increased anxiety (Suveg & Zeman, 2004) and worry (Gramszlo & Woodruff-
Borden, 2015). A single study has linked these two areas of research. In this study
of 66 children, aged 7 to 13 years, emotional control deficits were found to mediate
the association between perfectionism and worry (Affrunti & Woodruff-Borden,

in press). Although this was not a clinical sample and only measures of worry, not
anxiety, were used, the findings provide preliminary support for the above
propositions.
Although the factors discussed above all have some studies providing empirical
evidence to suggest they mediate the relationship between perfectionism and
childhood anxiety, there are few conclusive studies. Directionality and causality
remain poorly understood and require further studies. Additionally, few studies
have used child samples. Unique associations may be observed in children. Further,
the mediators mentioned may be implicated in specific anxiety disorders. As noted
earlier, perfectionism may put children at risk of developing social phobia by
decreasing their perceived self-competence in social situations. Similarly,
perfectionism may put children at risk of generalized anxiety disorder by increasing
worry and distress in uncertain situations. In these ways, perfectionism may act as
a risk factor for multiple anxiety disorders.
Conclusions
Research has provided some support for the link between perfectionism and
childhood anxiety disorders. Although this area of study is burgeoning and much
remains to be known, it appears that perfectionism predicts greater total anxiety
symptoms, worry, and the diagnosis of an anxiety disorder. Moreover, it disrupts
the treatment of anxiety disorders in children. As noted throughout, this research
is not without its limitations. Many studies examining the role of perfectionism in
childhood anxiety have used small samples, correlational analyses, cross-sectional
data, and have differed in their measurement of anxiety and perfectionism. Such
inconsistencies do restrict the conclusions that can be drawn from these studies.
However, research to date also provides an important foundation to build upon.
This is because research has begun to identify the link between perfectionism and
childhood anxiety, allowing further research to test more specific hypotheses using
more advanced methodologies. Furthermore, recent studies (e.g., Mitchell,
Newall, et al., 2013; Soreni et al., 2014) have looked beyond simple associations
between perfectionism and childhood anxiety into how perfectionism may affect
symptom severity and treatment outcomes. Not only this, but preliminary findings
have allowed researchers to attempt to understand why and how associations
between perfectionism and childhood anxiety disorders occur.
Although research is sparse, there is evidence that further variables may act as
factors through which perfectionism impacts childhood anxiety. The four factors
reviewed here (intolerance of uncertainty, perceived competence, “not just right
experiences,” and effortful and emotional control), however, have so far the best
empirical support. These factors likely help explain why perfectionism links with
many different anxiety disorders and other psychopathologies (see Figure 6.1).
There is research from both child and adult studies that supports these links (e.g.,
Buhr & Dugas, 2006; Flett, Hewitt, & Cheng, 2008). However, further research
Intolerance of
uncertainty
Perceived
competence
Anxiety
Perfectionism Worry
OCD
NJREs
Effortful/
emotional control
FIGURE 6.1 he effect of perfectionism through mediators on child anxiety, worry, and
T
obsessive-compulsive disorder (OCD). NJREs = not just right experiences.
will be needed to determine whether the observed relationships are causal. It is

possible that perfectionism and the four factors influence each other over time and
are best characterized by bidirectional relationships that increase the risk of
developing anxiety disorders in children. Furthermore, the four factors may be
important in the treatment of anxious children. Indeed, research has begun to
identify intolerance of uncertainty, competence, and effortful control as factors that
influence treatment outcomes for childhood anxiety disorders (Kendall, 1994;
Krain et al., 2008; Rapee, Schniering, & Hudson, 2009). As such, they may explain
not only why perfectionism positively relates to child anxiety, but also why it
negatively impacts treatment outcomes. Interventions addressing perfectionism
may profit from also addressing the factors reviewed here to increase the efficacy of
childhood anxiety disorder prevention and treatment (cf. Chapter 13).
Future Directions
Given the preliminary nature of the research on perfectionism and childhood
anxiety, many suggestions for future research have been presented throughout the
chapter. However, there remain specific directions that may serve to accelerate
understanding in this area. First, similar factors may explain the development of
both childhood anxiety and perfectionism. For example, Flett and colleagues
(2002) detail a model suggesting the role of anxious parenting practices in
contributing to the development of perfectionism. Indeed, such parenting practices
have shown links with both childhood anxiety (Affrunti & Woodruff-Borden,
2014) and childhood perfectionism (Mitchell, Broeren, et al., 2013). Yet, the
trajectory of these links remains poorly understood. Do these parenting practices

increase perfectionism and subsequently anxiety, or do they increase anxiety and
subsequently perfectionism? More research is needed to understand the relationship
of similar developmental constructs in the etiology of both childhood anxiety and
perfectionism.
As noted earlier, few studies have examined perfectionism within specific
childhood anxiety disorders. Beyond understanding the role that perfectionism
plays in these different disorders, future research should explore why and how
perfectionism creates risk for these distinct disorders. Perfectionism may place
children at risk for, and interact with, other cognitive deficits that may lead to
specific anxiety disorders. For example, perfectionistic children may be more likely
to experience NJREs due to their high and rigid standards, and thus be at risk for
developing OCD. More research is needed exploring possible mechanisms for the
development of specific anxiety disorders. Furthermore, findings from such
research may serve to help devise treatments to address perfectionism within a
specific disorder. Although the contribution of perfectionism may be similar across
disorders (i.e., incorporating high and rigid standards, and valuing only the
attainment of these standards), it may depend on the domain in which the child is
perfectionistic as perfectionism is typically focused on selected domains (Stoeber &
Stoeber, 2009). As such, children who are perfectionistic in social domains may not
be perfectionistic in academic domains. This may show as the former children
being socially reticent, whereas the latter may engage in high levels of checking,
for example, when working on home assignments.
Treatments would be required to address the salient domain and the subsequent
relevant mediators. Novel treatment methods have been devised to address
perfectionism (e.g., Egan et al., 2014; Sullivan, Keller, Paternostro, & Friedberg,
2015; see also Chapters 13–15), but their applicability to children with specific
anxiety disorders is not well known. Given the various links between perfectionism
and anxiety in children, effective prevention and treatment of perfectionism may
not only reduce the dysfunctional effects of perfectionism in children, but may also
help treat childhood anxiety disorders.
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7
PERFECTIONISM IN
GIFTED STUDENTS
Kristie L. Speirs Neumeister
Overview
Perfectionism frequently emerges as a concern for parents, educators, and counselors
of intellectually gifted students. For those whose achievement is not commensurate
with their ability, or for those who indicate psychological distress through stress,
anxiety, or depression, the possibility of perfectionism as a contributing factor is
frequently explored. Consequently, a considerable body of literature has developed
over the past two decades as professionals have attempted to construct a thorough
understanding of perfectionism in the gifted population. Theoretical contributions
and research studies examining perfectionism in gifted individuals center on four
broad themes: development, with a focus on identifying antecedent factors that shape
the type, degree, and incidence of perfectionism; typologies, with a focus on
understanding different “types” of perfectionism primarily through cluster analyses;
incidence, with a focus on determining if perfectionism (and if, what types) may be
more prevalent among the gifted than the general population, or within the gifted
population depending on cultural group, grade level, gender, or birth order; and
outcomes with a focus on understanding how perfectionism may relate to
psychological and educational outcomes. The purpose of this chapter is twofold.
The first goal is to provide a synthesis and analysis of the current body of literature
according to these four themes. A second goal is to outline recommendations for
future research that both addresses current gaps in the literature and effectively
situates the study of giftedness and perfectionism within the broader context of
current perfectionism research.
Perfectionism in Gifted Students 135
Synthesis and Analysis of Current Literature on Perfectionism

and Giftedness
Development of Perfectionism in Gifted Students

Compared with studies examining the incidence and types of perfectionism among
gifted students, relatively few studies have been conducted examining how
perfectionism may actually develop. In 2002, Flett, Hewitt, Oliver, and Macdonald
proposed an overarching model of how perfectionism may develop within the
general population including three primary areas of influence: family, child, and
environmental factors. The research on the development of perfectionism in gifted
students will be reviewed according to these three areas.
Family Factors
Flett and colleagues (2002) proposed four different family history models: the social
expectations model, the social reaction model, the social learning model, and the
anxious rearing model. In the social expectations model, the authors postulated
that perfectionism may develop from parental approval contingent upon the child’s
performance. Children who experience such contingent approval may develop a
sense of helplessness if they are not able to meet their parents’ expectations.
Consequently, children may develop a sense of conditional self-worth, a central
component of socially prescribed perfectionism (Hewitt & Flett, 1991).1
The social expectations model provides a framework for understanding
perfectionism in gifted children. In this population, contingent self-worth may
develop in children in response to receiving positive feedback based on their high
intelligence level (Kamins & Dweck, 1999). Because their advanced levels of
thinking and accomplishments often impress adults, gifted children may receive a
profusion of such feedback from their parents and teachers. As Kamins and Dweck
proposed, children may begin to perceive their self-worth as contingent upon their
advanced intelligence. Consequently, if they fail, they may interpret the failure as
a sign that they are not as intelligent as previously thought and, therefore, not as
worthy. As such, they may strive for perfection in an attempt to preserve their
self-worth.
The social expectations model is consistent with previous research examining
the development of perfectionism in gifted middle-school, high-school, and
college students. In a study examining perfectionism in middle-school gifted
students, Siegle and Schuler (2000) found that both gifted students who were first-
born and gifted male students reported parents as having high expectations for their
performance. In a study of high-school students attending a residential academy for
gifted students (Speirs Neumeister, Williams, & Cross, 2009), students described
their perfectionism as developing in part in response to conditional parental
approval. Parents were either explicit in their conditional approval by specifically
communicating their disapproval when their child did not meet their expectations,
136 Speirs Neumeister
or they communicated their disapproval implicitly through nonverbal cues. Finally,

in a study of self-oriented perfectionism in gifted college students (Speirs
Neumeister, 2004b), participants also reported that their parents had high
expectations for them; however, the parents were perceived as supportive rather
than punitive when the participants did not meet those expectations.
Flett and colleagues (2002) also described a second developmental family history
model, the social reaction model, through which children may develop
perfectionism in response to exposure to a punitive environment characterized by
physical abuse or psychological distress caused by withdrawing love, shaming, or
experiencing chaos within the family dynamics. According to Flett and colleagues,
a child in this situation may develop perfectionistic tendencies as a coping strategy
to escape abuse, reduce shame, or develop a sense of control in a chaotic
environment. Flett and colleagues noted that, whereas this model may overlap
with the social expectation model, the chief difference is that within the social
reaction model, individuals experience harsh punitive effects including hostility
and lack of warmth when expectations are not met.
Support for the social reactions model can also be found from existing literature
on the development of perfectionism in gifted students. Speirs Neumeister et al.
(2009) found that gifted high-school students with high levels of socially prescribed
perfectionism believed that, if they did not achieve perfection, they would experience
harsh or cruel reactions from their parents including being yelled at, threatened,
shamed, and ridiculed. Additionally, Speirs Neumeister (2004b) found that the
socially prescribed perfectionists in her study of college students indicated that their
perfectionism resulted in part from the experience of growing up with one or more
authoritarian parents who were harsh and demanding and held unrealistic expectations
for their performance. When expectations were not met, the participants in this
study also indicated that they were either punished or made to feel shameful, resulting
in insecurity and feelings of self-worth contingent upon their achievements.
Finally, in an empirical study of perfectionism in gifted college students, Speirs
Neumeister and Finch (2006) also found that both authoritarian and uninvolved
parenting styles predicted insecure attachment, which then predicted either self-
oriented or socially prescribed perfectionism. These findings provide support for
both the social expectations and the social reaction model. In their discussion of the
social expectations model, Flett and colleagues (2002) noted that perfectionism may
emerge when children do not receive any parental input. In this situation, children
set high expectations for themselves as a way of coping with their uncertainty about
how their behaviors will be received by their parents. This may provide an
explanation for why uninvolved parenting in Speirs Neumeister and Finch’s (2006)
study predicted insecure attachment, which then predicted perfectionism. Likewise,
their finding regarding authoritarian parenting may be consistent with the social
reaction model because by definition this type of parent has high expectations but
lacks demonstration of warmth and affection for the child.
Flett and colleagues’ (2002) third family history model, the social learning
model, stresses the inclination for children to model perfectionistic behaviors they
observe in their parents. Support for this finding in gifted students is also evident.
Speirs Neumeister (2004b) found that when participants were specifically asked
what contributed to the development of their perfectionism, both self-oriented
and socially prescribed perfectionists attributed the development in part to the
observance of their parents’ modeling of perfectionist behaviors. Additionally, the
gifted high-school students in Speirs Neumeister et al.’s (2009) study attributed
perceived parental perfectionism as contributing to the development of their own
perfectionism. Interestingly, with a younger sample, Parker and Stumpf
(unpublished study, cited in Parker, 2002) found that parental perfectionism, as
measured by parental self-report, contributed little to the variance in the
perfectionism scores of their academically talented sixth-grade sample.
One explanation for the discrepant findings of these studies may be that
children’s perception of their parents’ levels of perfectionism is more closely related
to the development of the children’s perfectionism than is parental self-report of
perfectionism. Research beyond the field of gifted education provides evidence for
this conclusion. For example, one study (Damian, Stoeber, Negru, & Băban, 2013)
found a positive relationship between children’s self-reported levels of perfectionism
and perceptions of their parents’ expectations and criticism. Moreover, other
studies found no significant relationship between children’s self-reported levels of
perfectionism and parental self-reported levels of perfectionism (Clark & Coker;
2009; Cook & Kearney, 2009, 2014). In a study of elite junior athletes and their
parents, Appleton, Hall, and Hill (2010) examined both child perceptions of
parental perfectionism and parental self-report of perfectionism to determine what,
if any, relationship could be found with either of these indicators and the level of
perfectionism in elite junior athletes. The researchers found a positive relationship
between the junior athletes’ perfectionism and their perceptions of their parents’
perfectionism, but not a relationship with their parents’ self-report of perfectionism.
Together, these studies provide evidence for the importance of examining
perceptions of parental perfectionism when studying the development of
perfectionism in both gifted and typically functioning individuals.
Lastly, Flett and colleagues (2002) identified a fourth family history model, the
anxious rearing model, which states that perfectionistic strivings and over-concern
with mistakes may develop as a function of exposure to anxious parents who
themselves perseverate on mistakes and the negative consequences of making
mistakes. To date, no studies with gifted students have been conducted that offer
support for this model. In summary, the current literature offers support for three
of the four family history models suggesting that the developmental path for
perfectionism in gifted children may be, in part, consistent with the pathways
found in the general population.
Child Factors
In addition to family influence, Flett and colleagues (2002) suggested that
perfectionism may also develop in response to specific child factors including
temperament, attachment style, openness to societal influence, and need for

approval and recognition as well as environmental factors such as culture, society,
and school. With regard to the study of perfectionism within gifted individuals,
however, additional child and environmental factors may have significant influence
on the development of perfectionism such as high levels of intelligence and
achievement that preclude any opportunity to experience failure within the early
years of schooling. Research findings offer support for the notion that perfectionism
in gifted students may arise in part from a lack of challenge in their early educational
experiences (Schuler, 2002; Speirs Neumeister, 2004b; Speirs Neumeister,
Williams, & Cross, 2007). These studies suggest that without academically
challenging work, gifted students often achieve perfection in their classwork
effortlessly; and based on these experiences, they maintain perfection as the
expected standard for their performance, even as they encounter challenging
material later in their academic careers.
Presently, our understanding of the role that lack of challenge plays in the
development of perfectionism within gifted students has been constructed
primarily on the basis of qualitative findings (e.g., Speirs Neumeister, 2004b;
Speirs Neumeister et al., 2007, 2009). These studies have provided a theoretical
foundation for understanding the influence that lack of challenging academic
experiences has on the development of perfectionism. Now empirical,
longitudinal studies are needed that monitor the development and degree of
perfectionism in gifted students beginning at the primary level and continuing
throughout their tenure in formal schooling. Such studies should include a
comparison of gifted students participating in challenging gifted programs that
provide opportunities for continued enrichment and acceleration compared with
gifted children participating only in traditional general-education programs.
These studies would provide insight on the potential short-term and long-term
impact that lack of challenge may have on the development of perfectionism and
academic achievement.
Environmental Factors
With the exception of culture (discussed in the next section), only a few research
studies have examined other environmental factors that may influence perfectionism.
Flett and colleagues (2002) suggested that competitive school environments and
relationships with peers may influence perfectionism. These contextual variables
merit investigation when studying perfectionism in gifted students. Services for
gifted students may vary from one extreme wherein all students are identified as
gifted (and all subjects are taught with a rigorous, above grade-level curriculum) to
less intensive programming in the form of a weekly enrichment pullout that may
not even be connected to the curriculum of studies to any other service option in
between. Studies are needed that systematically examine each of the contextual
variables of competitive versus noncompetitive gifted programs, time spent in
rigorous programming, degree of rigor in the program, and influence of learning
with equally able peers compared with “non-identified” peers2 to gain a better
understanding of how environmental factors influence the development of
perfectionism in gifted students. Finally, more studies are needed to examine the
effect of introduced challenge on achievement behaviors and self-perceptions of
students who already have developed perfectionistic tendencies. Studies are needed
that examine these students’ reactions to increased challenge and how their
responses may differ according to their degree of positive striving and/or evaluative
concerns (as will be discussed further below).
Typologies of Perfectionism in Gifted Students

With the 1990s came a shift in the conceptualization of perfectionism from a
unidimensional to a multidimensional construct. Three scales were developed,
each providing a different conceptual lens on the multidimensional nature of
perfectionism. Frost, Marten, Lahart, and Rosenblate (1990) developed a scale—
the Frost Multidimensional Perfectionism Scale (FMPS)—comprised of six
subscales capturing personal standards, concern over mistakes, doubts about
actions, parental expectations, parental criticism, and organization. In this scale,
personal standards and organization are considered adaptive, and concern for
mistakes, doubts about actions, parental expectations, and parental criticism are
considered maladaptive (Frost, Heimberg, Holt, Mattia & Neubauer, 1993).
Hewitt and Flett (1991) developed a scale differentiating personal and social
aspects of perfectionism—the Hewitt–Flett Multidimensional Perfectionism Scale
(HF-MPS)—comprised of three subscales capturing self-oriented perfectionism,
other-oriented perfectionism, and socially prescribed perfectionism. Finally,
Slaney, Mobley, Trippi, Ashby, and Johnson (1996) developed a scale—the
Almost Perfect Scale–Revised (APS-R)—comprised of three subscales capturing
high standards, discrepancy, and order (Slaney, Rice, Mobley, Trippi, & Ashby,
2001). The high standards subscale measures the high standards one sets for
oneself, the discrepancy subscale measures the discrepancy between one’s
perceived standards and one’s actual performance, and the order subscale measures
a personal preference for order and organization.
The advent of these three multidimensional perfectionism scales paved the
way for the subsequent two decades of typological research across the entire field
of perfectionism, including the study of gifted individuals. Wayne Parker
emerged as the most prolific early researcher on typologies of perfectionism in
gifted students. Independently and with colleagues he published multiple studies
(Parker, 1997, 2002; Parker & Mills, 1996; Parker, Portesová, & Stumpf, 2001;
Parker & Stumpf, 1995) using cluster analyses to determine different types of
perfectionism and examine their psychological correlates in gifted students.
Employing the FMPS, Parker’s (1997) research on academically talented sixth-
grade students identified three clusters he labeled “nonperfectionists,” “healthy
perfectionists,” and “dysfunctional perfectionists.” The nonperfectionist cluster
(32% of the sample) was characterized by low scores on personal standards,
parental expectations, and organization as well as a low FMPS total score. The
healthy perfectionist cluster (42% of the sample) was characterized by low scores
on concern over mistakes, doubts about actions, and parental criticism coupled
with a high score on organization, a moderately high score on personal standards,
and a moderate FMPS total score. Finally, the last cluster, dysfunctional
perfectionists (26% of the sample), was characterized by the highest scores on
personal standards, concern over mistakes, doubts about actions, parental
expectations, and parental criticism and had the highest FMPS total score. Other
research on gifted middle-school students employing different measures of
perfectionism supports this tripartite structure (LoCicero & Ashby, 2000; Schuler,
2000; Vandiver & Worrell, 2002).
Dixon, Lapsley, and Hanchon (2004) attempted to replicate Parker’s typology
with academically talented high-school students. However, instead of finding the
three-cluster structure identified in Parker’s research, their research identified four
clusters. Cluster 1, labeled “mixed-adaptive perfectionists” and compromising 36%
of the sample, scored relatively high on personal standards, organization, and
parental expectations and relatively low on concern over mistakes, doubts about
actions, and parental criticism. Cluster 2, labeled “pervasive perfectionists” and
comprising 21% of the sample, was characterized by uniformly high scores on all
dimensions of perfectionism. Cluster 3, labeled “self-assured, nonperfectionists”
and comprising 28% of the sample, was characterized by uniformly low scores on
all dimensions. Cluster 4, labeled “mixed-maladaptive perfectionists” and
comprising 14% of the sample, was characterized by relatively high scores on
personal standards, concern over mistakes, doubts about actions, and parental
criticism and relatively low scores on parental expectations and organization. A
comparison of Parker’s typology with Dixon et al.’s typology suggests that Parker’s
healthy cluster corresponds to Dixon and colleague’s mixed-adaptive cluster, his
dysfunctional cluster corresponds to their pervasive cluster, and his nonperfectionist
cluster corresponds to their self-assured, nonperfectionist cluster. The remaining
cluster identified by Dixon and colleagues, mixed maladaptive, was not found in
Parker’s typology. However, this cluster may have been subsumed under Parker’s
dysfunctional cluster, as both clusters shared high scores on personal standards,
concern over mistakes, doubts about actions, parental expectations, and parental
criticism.
The results of two more recent studies also challenge the validity of a common
tripartite model of perfectionistic clusters in gifted students. In a follow-up study of
perfectionism typologies in mathematically gifted Czech students, Portesová and
Urbánek (2013) found that—while their original 2000 cohort (Parker et al., 2001)
confirmed Parker’s (1997) three-cluster typology—data from two additional
cohorts (2005 and 2010) did not support this typology. Whereas the researchers did
find the same cluster of healthy perfectionists as described by Parker (1997) and
Dixon et al. (2004), who labeled it “mixed-adaptive,” Portesová and Urbánek did
not find a nonperfectionist cluster characterized by low scores on all FMPS
subscales in either their 2005 or 2010 cohort. Instead, the second cluster in these
cohorts included students with average scores on maladaptive and high scores on
adaptive dimensions resembling Dixon and colleagues’ mixed-maladaptive type
rather than a nonperfectionist type. Additionally, instead of the third cluster of
dysfunctional perfectionists found in the original 2000 cohort (Parker et al., 2001)
and by Parker (1997), the third cluster in the 2005 and 2010 cohorts was comprised
of students who scored high not only on maladaptive dimensions but also on
adaptive dimensions. The researchers labeled this cluster “mixed maladaptive-
adaptive” and noted that it had the same characteristics as the pervasive cluster
found by Dixon et al. (2004).
Mofield and Parker Peters (2015) also conducted a replication study using the
FMPS to determine if the same typologies would be found in a suburban middle-
school sample of gifted students. Results of this study did not replicate the previous
findings. Initially, only a two-cluster solution emerged, and when a three-cluster
solution was imposed on the data, the three clusters were not the same as those
found by Parker (1997). Cluster 1, labeled “unhealthy perfectionists,” had the
highest scores on all subscales with the exception of organization. This cluster
corresponded to the pervasive cluster found by Dixon et al. (2004) and the mixed
maladaptive-adaptive cluster found by Portesová and Urbánek (2013). Cluster 2
was tentatively labeled “functional perfectionists” showing a pattern similar to
Parker’s (1997) and Dixon et al.’s (2004) healthy/adaptive clusters, but as Mofield
and Parker Peters noted, their sample was skewed in that their Cluster 2 also scored
highly on the maladaptive dimensions of concern over mistakes, doubts about
actions, and parental criticism. Cluster 1 and Cluster 2 only differed in that
functional perfectionists (Cluster 2) had lower scores compared to unhealthy
perfectionists (Cluster 1) on the maladaptive dimensions but not necessarily higher
scores on the adaptive dimensions. Cluster 3 was comprised of nonperfectionists
with relatively low scores on all perfectionism dimensions compared with
participants in the other two clusters.
Both Portesová and Urbánek (2013) and Mofield and Parker Peters (2015)
suggested contextual changes as explanations for their discrepant findings in the
typologies compared with the tripartite structure identified in previous research. In
the case of Portesová and Urbánek, the authors credited the cultural revolution
that took place as the Czech Republic transformed from a totalitarian communist
society to a democracy. The authors noted that the increased emphasis on
prestigious private schools and competition for quality education may have fueled
more perfectionistic tendencies. Likewise, Mofield and Parker Peters hypothesized
that the cultural shift in the United States following the No Child Left Behind
legislation led to an increased focus on standardized testing with an emphasis on
performance over learning that may have led to an increase in perfectionism.
Collectively, these studies stress the importance of considering contextual factors in
addition to child factors (in this case, giftedness) when determining types of
perfectionism within a population.
Incidence of Perfectionism in Gifted Students
Incidence of Perfectionism in Gifted Individuals Compared With

General Population
In addition to identifying different types of perfectionism in gifted students, a
second line of research has been dedicated to determining whether or not
perfectionism is more common in the gifted compared with the general population.
In the traditional lore of gifted education (e.g. Adderholdt-Elliott, 1987),
perfectionism is a prevalent characteristic among gifted individuals that results in
psychological maladjustment. Research findings, however, are not supportive of
this conventional wisdom. The findings of two research studies indicate that
perfectionism is not more common among gifted students compared with
nonidentified students. In one of these studies, Parker and Mills (1996) compared
the scores on the FMPS of a sample of gifted sixth-grade students with a comparison
group of nonidentified students, and their results indicated inconsequential
differences between the two groups. In a second study, Parker et al. (2001) also
compared differences among mathematically gifted and nonidentified Czech
students in the prevalence of category membership for the different perfectionism
typologies of nonperfectionists, healthy perfectionists, and dysfunctional
perfectionists. Their results indicated that among the mathematically gifted students,
37% were classified as nonperfectionists, 35% as healthy perfectionists, and 28% as
dysfunctional perfectionists. In contrast, among the nonidentified students, 20%
were classified as nonperfectionists, 35% as healthy perfectionists, and 45% as
dysfunctional perfectionists. Instead of finding gifted students to be more
perfectionistic and maladjusted as conventional wisdom would suggest, in this
study the nonidentified students were more likely to be both perfectionistic and
dysfunctionally perfectionistic.
Whereas other studies have shown gifted students to be more perfectionistic
than their nonidentified counterparts, in each of these studies, the gifted students
have only scored higher on dimensions of perfectionism that are traditionally
associated with adaptive, rather than maladaptive outcomes. For example, in their
study of middle-school students, LoCicero and Ashby (2000) found that gifted
students had significantly higher levels of adaptive perfectionism (as defined by
scores on the high standards subscale of the APS-R) than nonidentified students
and significantly lower levels of maladaptive perfectionism (as defined by scores on
the discrepancy subscale of the APS-R). In a study of French fifth- and sixth-grade
students, Guignard, Jacquet, and Lubart (2012) found that gifted sixth-grade
students scored significantly higher on self-oriented perfectionism than
nonidentified sixth-grade students. Additionally, the gifted sixth-grade students did
not score significantly different on any dimension of compared to their nonidentified
same-age peers (who were fifth-grade students).
Kornblum and Ainley (2005) compared the level of perfectionism between
gifted and nonidentified Australian students aged 11 to 16 years. Using the FMPS
to measure perfectionism, the researchers found that gifted students scored higher
than nonidentified students only on the subscale of personal standards. The
researchers were also able to replicate the three perfectionism clusters found by
other researchers (Parker & Mills, 1996; Rice & Mirzadeh, 2000), and they found
only borderline-significant differences between giftedness and perfectionism
cluster type: Whereas gifted students held greater membership in the perfectionistic
clusters than nonidentified students, the gifted students were not significantly
more likely to be either healthy or unhealthy perfectionists compared with
nonidentified students.
Finally, at the high-school level, Shaunessy, Suldo, and Friedrich (2011) sought
to compare the levels of perfectionism measured with the APS-R between
academically advanced students participating in the rigorous International
Baccalaureate program compared with general-education students. The researchers
found that the academically advanced students scored significantly higher on the
adaptive dimension of perfectionism (as defined by the high standards subscale)
and significantly lower on the maladaptive dimension (as defined by the
discrepancy subscale).
Collectively, the research findings summarized above suggest that the traditional
concerns regarding a greater incidence of perfectionism leading to maladjustment
in the gifted population may not be supported. Whereas individual gifted students
certainly may struggle with perfectionistic tendencies, imposing this maladaptive
tendency as a central characteristic of this group of students is not warranted.
Incidence of Perfectionism in Gifted Students Cross-Culturally

Whereas studies have been conducted examining the prevalence of perfectionism
in gifted students compared with nonidentified students in Western cultures
(Guignard et al., 2012; Parker et al., 2001; Portesová & Urbánek, 2013), the
majority of cross-cultural studies on perfectionism has been conducted on gifted
Asian students. Similar to the research conducted on Western students, Chan’s
research on gifted Chinese students (e.g., Chan, 2009, 2010, 2012) has focused on
classifying students as healthy or unhealthy perfectionists and examining
psychological correlates. With his samples of Chinese gifted students, Chan found
substantially greater numbers of healthy compared with unhealthy perfectionists,
and he also found that those classified as healthy perfectionists were most likely to
set learning goals and reported being the happiest and most satisfied with their
lives. Chan highlighted the importance of considering culture when interpreting
the results of research on perfectionism. Cultural differences may account for the
high percentage of Chinese students identifying as healthy perfectionists, and for
the relationship to positive psychological outcomes, because setting high standards
and striving for excellence are often encouraged and considered desirable (Chan,
2010; Fong & Yuen, 2014).
In contrast to Chan’s findings of greater numbers of healthy perfectionists
among Chinese gifted students, Basirion, Majid, and Jelas’s (2014) work with
16-year-old gifted Malaysian students found that the majority (58%) were classified
as dysfunctional perfectionists. In their study, only 30% were classified as healthy
perfectionists and 12% as nonperfectionists. The researchers suggested that the
findings may be attributed to cultural differences between Eastern and Western
cultures as other researchers have found that Asian Americans reported more
pressure from others to be perfect than White Americans (Wei, Mallinckrodt,
Russell, & Abraham, 2004).
The discrepancy between Chan’s findings and Basirion et al.’s findings indicate
that perhaps a blanket categorization of Eastern compared to Western cultures is
too broad to form generalizations regarding the prevalence of perfectionism
types in gifted students. More studies are needed that explore subtle differences
among “Asian” cultures including differences in parenting styles, attitudes toward
educational achievement, and values in order to better understand the role that
culture may play in influencing perfectionism. The same suggestion applies to
the study of “Western” cultures because changes in educational policy and
government leadership may lead to changes in the prevalence of perfectionism
even within the same cultural groups (e.g., Mofield & Parker Peters, 2015;
Portesová & Urbánek, 2013).
Incidence of Perfectionism in Gifted Students According to Gender

Differences in perfectionism between male and female gifted students have not
been studied extensively. Only a few studies have been conducted, and the findings
are not consistent. In three studies of cluster analyses of perfectionism typologies
(Chan, 2009, 2012; Parker & Mills, 1996), no significant gender differences were
found for membership in each cluster group (healthy, unhealthy, and non
perfectionist). Also a study of mathematically gifted middle-school students (Tsui
& Mazzocco, 2006) did not find any significant gender differences on perfectionism
measured with the FMPS. Similarly, Parker and Mills (1996) did not find significant
differences in the total perfectionism score measured with the FMPS. However,
they did find gender differences among the FMPS subscales with gifted boys
scoring higher on concern over mistakes than gifted girls, and gifted girls scoring
higher on organization than gifted boys. Siegle and Schuler (2000) also found
differences between the genders in perfectionism subscale scores for their gifted
middle-school participants: Females scored significantly higher on organization,
and males scored significantly higher on parental expectations. Likewise, in a study
of Chinese gifted students, Chan (2007) found that gifted girls rated themselves
higher on a measure of positive perfectionism than males. Finally, in a study of
gifted middle- and high-school students, Margot and Rinn (2016) found no main
effect for gender and perfectionism as measured by the FMPS. However, they did
find a gender × birth order interaction3 such that male first-borns and only children
scored higher on parental expectations than male middle and last children as well
as females of all birth orders. Additionally, they found female middle children had
higher scores on the parental expectations subscale than first-borns, only children,
and last children; and they also found a gender × grade level interaction for the
parental expectations subscale such that males scored higher at all grades levels
except for the eighth and twelfth grade, and peaking at the tenth grade. In contrast,
females showed a significant increase in subscale scores from eleventh to twelfth
grade, and peaking at the twelfth grade.
With merely a few published studies examining gender differences within
perfectionism in gifted individuals, only preliminary conclusions may be drawn.
While initial findings suggest no significant gender differences on overall
perfectionism scores or cluster membership in typology classifications, results do
indicate that subtle differences may exist when examining subscale scores on
perfectionism measures and when including additional variables such as grade level
and birth order within the analyses. Consequently, future studies are warranted to
form a more complete understanding of potential contextual variables that may
influence differences in the manifestation of perfectionism in gifted males compared
with gifted females.
Incidence of Perfectionism in Gifted Students According to Birth Order

As with gender, the potential influence of birth order on perfectionism in gifted
individuals has only been explored minimally. In a study of perfectionism
typologies, Parker (1998) reported that only children were more likely to be
categorized as healthy perfectionists. Additionally, he reported that last children
were the least likely to be classified as unhealthy perfectionists, and they were more
likely to be nonperfectionists. In their study of gifted middle-school students,
Siegle and Schuler (2000) found birth order differences on the perfectionism
subscales of parental expectations and parental criticism with first-borns reporting
higher levels than last children. Two studies (Margot & Rinn, 2016; Sondergeld,
Schultz, & Glover, 2007) attempted to replicate Siegle and Schuler’s findings with
a similar sample of gifted middle-school students. Sondergeld and colleagues (2007)
found only one birth order effect: Middle children scored higher on the doubts
about actions subscale compared to first-borns and last children. Margot and Rinn’s
(2016) replication study indicated several birth order effects for perfectionism
subscale scores with first-borns and only children scoring higher on the concern
over mistakes subscale than both middle children and last children. Additionally,
on the personal standards subscale, first-borns, only children, and middle children
scored higher than last children. On the parental expectations subscale, male first-
borns and only children scored higher than male middle and last children as well as
females of all birth orders. And, finally, first-borns reported higher parental criticism
and parental expectations than last children.
Taken together, the results of these studies suggest that gifted students who are
first-borns or only children are at greatest risk for parental influence on perfectionism
in the form of high parental expectations and criticism. This finding is not unique
to the gifted population as other studies have shown that first-borns and only
children in the general population may also experience greater scrutiny from
parents (Hotz & Pantano, 2015). As the majority of studies has been conducted on
gifted middle-school students, more studies with gifted students at different
developmental stages are necessary to more fully understand the potential influence
of birth order on perfectionism.
Incidence of Perfectionism in Gifted Students Across Grade Levels

Whereas perfectionism in gifted students has been studied across middle-school,
high-school, and college samples (Parker, 2002; Schuler, 2000; Shaunessy et al.,
2011; Speirs Neumeister, 2004c; Speirs Neumeister et al., 2009), relatively few
studies have compared how the incidence of perfectionism may differ across levels
of schooling. Results of these studies suggest that differences may exist. For
example, Kornblum and Ainley (2005) compared the levels of perfectionism, as
measured with FMPS, in gifted Australian students ranging in age from 11 to 16
years and sampled in three grades (sixth, eight, and eleventh grade). Results
indicated that scores for concern over mistakes, doubts about actions, parental
expectations, and parental criticism increased with grade (over the three grades
sampled in school) for gifted students starting below the mean and ending above
the mean. The researchers suggested that these findings may be the result of gifted
students experiencing greater parental pressure to live up to their abilities as they
went further in their schooling. Kline and Short (1991) also found an increase in
perfectionism from lower to higher school grades for gifted females. Siegle and
Schuler (2000) found an increase in concern over mistakes for gifted females from
sixth through eighth grade whereas scores for males increased in seventh grade but
then decreased in eighth grade. Margot and Rinn (2016) found that seventh-
graders had significantly lower scores on concern for mistakes compared with
eighth-graders, and seventh-graders had significantly higher scores on organization
than eleventh-graders.
Similar to the research on birth order, the number of studies examining
differences in perfectionism across grade levels is too scant to draw definitive
conclusions. However, as preliminary results suggest that differences may occur,
future studies are needed to more specifically determine if patterns can be found in
the rise and fall of specific perfectionism dimensions (associated with positive and
negative outcomes) across years in school, and how increases or decreases may be
associated with changes in the academic environment such as exposure to a more
rigorous curriculum and higher stakes for academic performance.
Perfectionism, Psychological Well-Being, and Achievement in

Gifted Students
The relationship among perfectionism, measures of psychological well-being, and
achievement are gaining attention in the field of gifted education. Studies exploring
typologies of perfectionism in gifted students have demonstrated that “healthy” or
“adaptive” perfectionism has been associated with positive outcomes such as
happiness and life satisfaction (Chan, 2010), greater academic competence and
superior adjustment (Dixon et al., 2004), and agreeableness, conscientiousness, and
orientation to achieve (Parker, 1997). In contrast, “unhealthy” or “dysfunctional”
perfectionism has been associated with negative outcomes such as anxiety and
disagreeableness (Parker, 1997) as well as dysfunctional coping, poor mental health,
and psychological maladjustment (Dixon et al., 2004). In a study of honors college
students and using the APS-R, Rice and colleagues (2006) also found that
discrepancy was associated with psychological problems whereas having high
standards was associated with healthy functioning (although not as consistently as
discrepancy was associated with psychological problems).
Other studies have examined the effects of perfectionism on various achievement
processes and outcomes including achievement goal orientations. Using the
HF-MPS, Speirs Neumeister (2004a, 2004b, 2004c; Speirs Neumeister & Finch,
2006) studied gifted college students who scored highly on either self-oriented
perfectionism or socially prescribed perfectionism. The findings of her mixed-
methods research program suggest that gifted college students scoring high on
socially prescribed perfectionism tended to over-generalize their failures and
adopted either performance-approach (desire to seem competent in the eyes of
others) or performance-avoidance (desire to avoid seeming incompetent in the
eyes of others) goal orientations (Elliot, 1999). In contrast, the self-oriented
perfectionists were more likely to adopt a performance-approach or mastery (goal
of gaining competence, regardless of performance) goal orientations than a
performance-avoidance orientation. Although this program of research used a
different typological scheme than the other studies reviewed previously, the
findings corroborate the notion that different types of perfectionism may be related
to more adaptive or maladaptive processes and outcomes.
The findings of Speirs Neumeister, Fletcher, and Burney’s (2015) study,
however, paint a more complex picture of perfectionism and achievement goal
orientations in high ability students. These researchers examined high ability
students’ goal orientation and perfectionism through the framework of the 2 × 2
model of dispositional perfectionism proposed by Gaudreau and Thompson (2010;
see also Chapter 3). As expected, pure self-oriented perfectionism was associated
with higher scores on performance-approach and mastery goal orientation than
nonperfectionism, and pure socially prescribed perfectionism was associated with
lower mastery goal orientation than pure self-oriented perfectionism and “mixed
perfectionism” (i.e., high self-oriented perfectionism combined with high socially
prescribed perfectionism). With regard to performance-approach goals, however,
pure socially prescribed perfectionism only showed significantly lower scores than
mixed perfectionism, but not nonperfectionism or pure self-oriented perfectionism.
Finally, those students with mixed perfectionism scored the highest among the
four subtypes of perfectionism on the performance-approach goals. As performance-
approach goals can be associated with either positive or negative outcomes,
depending on the root of the goal as either a fear-of-failure or a need-for-
achievement motivation (Elliot, 1999), caution is warranted when making
inferences about the psychological well-being of gifted perfectionistic students

who adopt these goals.
Recommendations and Priorities for Future Research

The current body of research on examining perfectionism in gifted students has
provided insights on developmental contributors, factors influencing the prevalence
of perfectionism, and the relationship between perfectionism and psychological
and achievement outcomes. Future research may extend this body of work by
addressing some of the methodological inconsistencies that have limited full
interpretation of the current work such as standardizing how perfectionism and
giftedness are operationalized, and comparing participants of different ages and in
different educational contexts.
Of particular importance is the need to better articulate how perfectionism is
defined. Researchers beyond research on gifted education (Frost, Heimberg, Holt,
Mattia, & Neubauer, 1993; Gaudreau, 2012; R. W. Hill et al., 2004; Stoeber &
Otto, 2006) have shifted to identifying higher-order factors of perfectionism that
consistently emerge across different measures of perfectionism: the factor of positive
striving (also referred to in the literature as perfectionistic strivings, personal
standards perfectionism, or conscientious perfectionism) and evaluative concerns
(also referred to as perfectionistic concerns, evaluative concerns perfectionism, or
self-evaluative perfectionism). When researchers analyze data by arranging
perfectionism dimensions along these factors, findings regarding the healthy versus
unhealthy debate of perfectionism are clear: Indicators of positive striving are often
associated with adaptive characteristics, processes, and outcomes such as
conscientiousness, internal locus of control, and positive affect whereas indicators
of evaluative concerns are typically associated with maladaptive characteristics,
processes, and outcomes such as neuroticism, anxiety, and negative affect (Stoeber
& Otto, 2006).
However, just as blue by itself or red by itself does not make purple, neither do
positive striving nor evaluative concerns by themselves make perfectionism. Both are
necessary ingredients. Consequently, to facilitate clarity, researchers are called to
reserve the label of perfectionism for only those who score highly on both positive
striving and evaluative concerns. The phrase “high on positive striving” should
replace the current terminology of “adaptive” or “healthy” perfectionism to reflect
those who only score highly on positive striving and not evaluative concerns.
Likewise, rather than using the terms “unhealthy,” “dysfunctional,” or
“maladaptive” perfectionism to describe those who score highly only on evaluative
concerns and not positive striving, researchers should consider using the phrase
“high on evaluative concerns.” Finally, the term “nonperfectionist” may be used
to describe those who score low on both positive striving and evaluative concerns
(cf. Gaudreau & Thompson, 2010). Common terminology such as this will not
only help to clarify research findings, but it will also effectively shift the discussion
from the debate on whether or not perfectionism is healthy to a more productive
understanding of how perfectionism relates differentially to various psychological

and achievement outcomes compared with nonperfectionism, positive striving, or
evaluative concerns alone.
Clarifying the definition of giftedness within the study of perfectionism is also
paramount. Current studies of perfectionism within gifted individuals may be
more appropriately named as studies of perfectionism within high-achieving gifted
students. The participants in these studies are frequently students enrolled in honors
classes or special schools or programs for gifted students. Calling these samples
“gifted” is problematic because participation in these services requires one to be
high achieving as well as intellectually able. To gain a more comprehensive
understanding of perfectionism within the gifted population, researchers need to
study not just those who are enrolled in academically advanced classes, courses, or
programs but also those who are not participating in these offerings, despite their
availability. Inclusion of this group of “underachieving” or “nonparticipating”
gifted students may paint an entirely different picture of the incidence of
perfectionism with this population and its correlates to adaptive and maladaptive
outcomes.
The study of perfectionism in academically gifted individuals would also benefit
from cross-collaboration with researchers studying perfectionism with other gifted
performers in different domains such as sport, dance, and music (A. P. Hill, 2016;
Stoeber & Eismann, 2007). Perhaps the unique factor of being talented in one’s
domain, regardless of the domain, would yield similar findings with regard to the
manifestation of perfectionism and correlates with performance outcomes and
adjustment versus maladjustment.
Moreover, the field would also benefit from an in-depth analysis of how gifted
students experience perfectionism. Whereas the incidence of perfectionism
generally does not appear to be greater in the gifted population than the general
population, the current research does not address whether or not gifted individuals
experience perfectionism differently than nonidentified individuals in terms of their
psychological well-being and achievement orientation. As a group, gifted students
are more emotionally intense and sensitive than nonidentified students (Neihart,
Pfeiffer, & Cross, 2016). Consequently, the impact of high levels of perfectionism
may be greater for these students. Empirical studies are needed that examine
giftedness as a moderating variable for the relationship between perfectionism and
various psychological and achievement outcomes.
Finally, perhaps the greatest need is for future studies to examine the effectiveness
of potential interventions in preventing and/or reversing high levels of evaluative
concerns within gifted individuals. In a review of the literature on perfectionism,
Parker and Adkins (1995) wrote that “while there have been many studies on
educational interventions for the gifted, little has been studied in the area of
differential interventions for perfectionistic and non-perfectionistic gifted children
and hence, little is known” (p. 17). In a literature review on the state of research
on perfectionism in gifted students, Speirs Neumeister (2007) echoed this need for
studies focused on examining the effectiveness of interventions for gifted students
with high levels of evaluative concerns. Despites these pleas, however, these studies
have not yet emerged.
Implications
Implications from two decades of research on perfectionism in gifted students
suggest that, most critically, parents and teachers need to understand the distinction
between the two factors that comprise perfectionism: positive striving and
evaluative concerns. According to Speirs Neumeister (2016), gifted students with
high levels of positive striving coupled with low levels of evaluative concerns are
likely to experience adaptive outcomes with behaviors rooted in conscientiousness,
a need-for-achievement motive, and mastery goal orientation. As a result, with
teacher and parental support, these students are likely to thrive and not need
interventions related to perfectionism. In contrast, gifted students with high levels
of positive striving coupled with high levels of evaluative concerns, as well as
students with only high levels of evaluative concerns, may benefit from interventions
such as counseling. Their high levels of evaluative concerns may be rooted in a fear
of failure and may result in high levels of anxiety, depression, and feelings of low
self-worth (Hewitt & Flett, 1991). Consequently, these students may be
experiencing psychological distress, despite their high levels of achievement.
Collectively, these recommendations suggest a need for parents, teachers, and
counselors to explore the underlying factors of students’ perfectionistic behaviors
to determine appropriate guidance, support, and/or interventions (Speirs
Neumeister, 2016).
Current research on perfectionism in gifted education has provided a solid
foundation for understanding how perfectionism may develop and manifest in this
population, its prevalence, and its correlates to various indicators of psychological
well-being and academic adjustment. While conventional wisdom holding that
gifted students as a whole are more likely to be perfectionistic compared with their
nonidentified counterparts was not borne out in the literature, individual gifted
students may still suffer from perfectionistic tendencies that prevent them from
achieving their potential. Future research that defines perfectionism as a combination
of high levels of both positive striving and evaluative concerns will allow researchers
to better understand how different educational contexts may influence the
development of perfectionistic tendencies within gifted students. Such clarity in
the research is vital, as it will enable parents, teachers, and counselors to guide
gifted students toward thoughts and behaviors that facilitate, rather than inhibit,
their academic development and psychological well-being.
Notes
1 Hewitt and Flett’s (1991) model of perfectionism differentiates self-oriented
perfectionism (setting unrealistically high standards for oneself), other-oriented
perfectionism (adopting unrealistically high standards for others), and socially prescribed
perfectionism (perceiving that others have unrealistic expectations/standards for one to

meet).
2 Students not identified as gifted or not participating in programs designed for gifted or
high-achieving students.
3 The psychology of birth-order effects differentiates four groups of children: first-borns,
middle children, last children, and only children.
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8
PERFECTIONISM IN SPORT, DANCE,
AND EXERCISE
Andrew P. Hill, Gareth E. Jowett, and
Sarah H. Mallinson-Howard
Overview
Perfect performance, flawlessness, and the perfect body are revered in sport, dance,
and exercise. As such, sport, dance, and exercise provide ideal domains in which to
study perfectionism. This chapter provides an overview of research that has
examined multidimensional perfectionism in these domains. We place particular
emphasis on the most recent research in this area and provide suggestions to guide
future research. It will be argued that perfectionism is a complex characteristic with
particular relevance in sport, dance, and exercise. In addition, in its various guises,
perfectionism can be problematic, beneficial, and also ambivalent with regards to
motivation, well-being, and performance. To better understand the effects of
perfectionism in sport, dance, and exercise, we call for research that adopts
longitudinal designs, examines moderating factors, develops and refines
measurement tools, and focuses on the influence of perfectionism among exercisers.
Introduction
It is common for athletes and dancers to describe themselves as perfectionists. Some
of the notable examples we and others have previously highlighted include world
champions from various sports (rugby: Jonny Wilkinson; snooker: Ronnie
O’Sullivan; cycling: Victoria Pendleton), multiple tennis Grand Slam winners
(Andy Murray, Andre Agassi, John McEnroe), and celebrated professional dancers
(Karen Kain, Daria Klimentová). We believe the accounts of these individuals
serve to illustrate both how common perfectionism is in these domains and the
complexity of perfectionism. On the one hand, the aforementioned individuals are
all extremely successful and often attribute their success, at least in part, to
perfectionism. On the other hand, in each case these individuals have described
156 Hill, Jowett, & Mallinson-Howard
how their perfectionism has had a detrimental impact on their motivation, well-
being, and performance at one time or another.
The complexity of perfectionism is readily apparent in the accounts of other self-
identified perfectionists and is worth briefly exemplifying again here. The
professional tennis player Eugenie Bouchard provides a recent case. Following a
breakthrough year when she was named WTA Newcomer of the Year (2013), and
a season in which she reached the semifinals of the Australian Open and French
Open and the final of Wimbledon, Bouchard suffered a huge loss of form that
included a series of early round losses to qualifiers and unseeded players. As a result,
having started the year with an ATP ranking of seventh in the world, she finished
the year ranked 48th. In explaining her performance slump in interviews to the
media, she described the mounting sense of pressure she experienced from the
outside world, the inability to cope with the subsequent stress, and—significantly—
the inability to satisfy her own desire for perfection (Flatman, 2015; Osmond, 2015).
The swimmer Amanda Beard is another case, albeit more extreme. A four-time
Olympian (1996, 2000, 2004, 2008) and winner of seven Olympic medals (two
gold, four silver, and one bronze), she has recounted in her autobiography how
throughout her career she struggled with depression, bulimia, self-harm, and drug
abuse (Beard, 2012). In doing so, she described the sense of pressure she experienced
as a result of her own standards and the need for every dive to be the “perfect dive”
and every turn the “perfect turn” (p. 107). This left her exhausted and took a heavy
toll on her mental health. Dissatisfaction with her body was particularly central to
her experiences. She describes how she “wanted to be a great and fast swimmer,
but more than that I wanted to be pretty, skinny, and perfect” (p. 101). The dual
nature of perfectionism as both a powerful motivational force and, at the same
time, a source of psychological difficulties is summarized poignantly by Beard:
“The perfectionist drive that made me a star athlete in the water, out of the water
tore me apart. As I nitpicked every little aspect of myself, I discovered over and
over again that I wasn’t any good” (p. 89).
To further complicate matters, views vary among researchers and practitioners
interested in perfectionism with regards to its likely consequences. Some hold the
view that, in some guises, perfectionism can be healthy and a defining characteristic
of elite performers (e.g., Dunn, Causgrove Dunn, Gamache, & Holt, 2014; Gould,
Dieffenbach, & Moffett, 2002; Henschen, 2000). Others argue that perfectionism
is likely to have few desirable long-term effects and is instead a significant
vulnerability factor for athletes to possess (e.g., Flett & Hewitt, 2014, 2016; Hall,
2016). Whether perfectionism is something to be encouraged or avoided is a
question that forms the backdrop for the current chapter. It is ultimately an
empirical question that can be answered through the systematic study of
perfectionism in athletes, dancers, and exercisers. As will be evident in this chapter,
researchers and practitioners have dedicated considerable amounts of time to
uncovering the correlates and consequences of perfectionism and, although there
is still a considerable way to go, we are making good headway in terms of answering
this question.
Perfectionism in Sport, Dance, Exercise 157
Research examining perfectionism in sport, dance, and exercise began some 25

years ago. Frost and Henderson (1991) examined the relationship between
perfectionism and reactions to mistakes during competition among athletes. At a
similar time, Szymanski and Chrisler (1991) compared athletes and non-athletes in
terms of factors common among those with eating disorders, and one of these
factors was perfectionism. The earliest studies in dance and exercise were published
at a similar time (Archinard & Scherer, 1995; Davis, 1990). However, most of the
research in these three domains has appeared much more recently. Based on the
review of research presented in this chapter and elsewhere (Jowett, Mallinson, &
Hill, 2016), we estimate that approximately 75% of all empirical studies examining
perfectionism in sport, dance, and exercise have appeared in the last 10 years
compared to 25% in the 15 years before. The field has now grown to the point
where we have recently been able to dedicate a special issue of the International
Journal of Sport Psychology to this topic as well as an edited book (Hill, 2016; Hill,
Appleton, & Hall, 2014)
In this chapter we aim to illustrate the findings of research in sport, dance, and
exercise by focusing on the latest research. The chapter includes an overview of the
two-factor model (or hierarchical model) of perfectionism and an updated review
of research adopting an independent effects approach. In presenting our updated
review we build directly on our previous efforts to review research in sport, dance,
and exercise reported in Jowett, Mallinson, and Hill (2016). We highlight the
current state of knowledge in this area, consider whether perfectionism is something
to be encouraged or avoided based on research in sport, dance, and exercise, and
make suggestions regarding directions for future research.
Two-Factor Model of Perfectionism

To provide a better understanding perfectionism and the findings of the reviews
we describe later, we start with a brief overview of the two-factor model of
perfectionism (cf. Chapter 1), also referred to as the hierarchical model of
perfectionism. As in other domains, a number of different models and instruments
have been used in sport, dance, and exercise to examine perfectionism, with
those developed by Frost, Marten, Lahart, and Rosenblate (1990), Dunn and
Gotwals (Dunn et al., 2006; Gotwals & Dunn, 2009), Hewitt and Flett (1991),
and Stoeber, Otto, and Stoll (2006) the most popular. Because details of these
models and instruments as they are used in sport, dance, and exercise have been
provided elsewhere (Stoeber & Madigan, 2016), we do not repeat this information
here and use the available space for novel content. Instead, we provide a
description of the two-factor model of perfectionism of which these individual
models and instruments form a part. The two-factor model has been used
previously to integrate and organize lines of research adopting different models
of perfectionism in sport, dance, and exercise (e.g., Gotwals, Stoeber, Dunn, &
Stoll, 2012; Jowett, Mallinson, & Hill, 2016; Stoeber, 2011). We use it here in
the same manner.
The two-factor model of perfectionism is comprised of two positively related

higher-order dimensions of perfectionism, namely perfectionistic strivings (PS) and
perfectionistic concerns (PC).1 The dimensions are measured using subscales from
the instruments developed by the researchers identified above. Current practice is
to use subscales from the same instruments or multiple subscales from different
instruments to capture the two dimensions. In sport, dance, and exercise, PS are
most commonly measured using subscales capturing high personal standards, self-
oriented perfectionism (imposing the need for perfection on the self), and striving
for perfection. By contrast, PC are most commonly measured using subscales
capturing concern over mistakes, negative reactions to imperfection, and socially
prescribed perfectionism (believing others expect perfection). In summarizing the
content of the higher-order dimensions of perfectionism, PS have been described
as capturing “aspects of perfectionism associated with self-oriented striving for
perfection and the setting of very high personal performance standards” and PC as
capturing “aspects associated with concerns over making mistakes, fear of negative
social evaluation, feelings of discrepancy between one’s expectations and
performance, and negative reactions to imperfection” (Gotwals et al., 2012,
p. 264). Evidently, these are broad constructs conceived in a manner designed to
encompass different models.
The two-factor model is based on factor-analytical studies that have examined
the underlying structure of instruments designed to measure perfectionism (e.g.,
Bieling, Israeli, & Antony, 2004; Cox, Enns, & Clara, 2002; Frost, Heimberg,
Holt, Mattia, & Neubauer, 1993). This research suggests that, regardless of the
individual content, the two higher-order dimensions are represented in most
instruments designed to measure perfectionism. Moreover, a two-factor model
may even be a better representation of underlying structure than each instrument
modeled separately (Bieling et al., 2004). The two-factor model is also based on
evidence of “functional homogeneity” among its subdimensions (Gaudreau &
Verner-Filion, 2012). That is, subdimensions indicative of PS or PC tend to have
similar correlates and consequences. This can be observed in research in most
domains including sport, dance, and exercise (see Jowett, Mallinson, & Hill, 2016).
As such, the two-factor model emphasizes conceptual and empirical overlap
evident between different perfectionism models and instruments, and offers a
useful heuristic when reviewing research.
Independent Effects Approach to Multidimensional Perfectionism

In the following part of the chapter, we summarize the findings of a previous
review of research on perfectionism in sport, dance, and exercise before we present
a review of the most recent research in these domains. Together, the reviews aim
to illustrate the main findings in this area of research and should place the reader at
the forefront of current understanding of perfectionism in these domains. In both
these reviews, we adopted an “independent effects approach.” We therefore start
with a brief description of this approach.
One way of studying multidimensional perfectionism is to examine the effects

of the two higher-order dimensions separately. The independent effects approach
does this by examining the two dimensions in either an unpartialled or partialled
manner. When examining the dimensions in an unpartialled manner, the two
dimensions are simply examined separately. Both remain conceptually and
statistically unaltered. That is, no attempt is made to take into account or control
for the relationship between them. This is the case when bivariate correlations are
examined. By contrast, when examining the two dimensions in a partialled manner,
the effects of one of the dimensions are examined when holding the effects of the
other constant (i.e., the effects of PS on a criterion variable when PC is zero or
another fixed value). In this case, the two dimensions of perfectionism are
conceptually and statistically altered in that new residual variables are created whose
relationship with any criterion variable is unique, that is, independent of the
contribution of the other dimension of perfectionism. To reflect this fact, we have
previously used the terms “pure PS” and “pure PC” when discussing these
variables. However, so as to avoid confusion with other uses of the term “pure” in
this area (e.g., the 2 × 2 model of perfectionism), we use the terms “residual PS”
and “residual PC” in this chapter.2
Adopting an independent effects approach allows examination of the unique (or
independent) effects of PS and PC. This is advantageous because the two dimensions
of perfectionism are typically positively related and often display opposing
relationships with the same criterion variable. Therefore, it can be difficult to
discern which dimension is responsible for a relationship with a given criterion
variable, that is, to discern whether the relationship is unique to one particular
dimension or whether it reflects common or shared variance. Comparison of
bivariate correlations and partial correlations can also help identify instances of
suppression whereby the two dimensions may act on each other so to increase or
change the direction of their relationship with a given criterion variable. In some
circumstances, suppression can pose interpretative difficulties but it can also add to
our understanding of the relationship between predictor variables and criterion
variables (Lynam, Hoyle, & Newman, 2006). For instance, comparison of PS, PC,
and their residual counterparts can help identify the degree to which an observed
relationship is attributable to the positive relationship between PS and PC.
Therefore, the examination of partialled effects can be especially useful when
studying multidimensional perfectionism.
Updated Review of Research Adopting an Independent

Effects Approach
We recently reviewed research adopting an independent effects approach in sport,
dance, and exercise (Jowett, Mallinson, & Hill, 2016). This review extended earlier
reviews in sport, notably Stoeber’s (2011) and Gotwals et al.’s (2012), in terms of
coverage of sport research, as well as by including research in dance and exercise.
In addition, whereas previous reviews included only criterion variables if they were
clearly adaptive or maladaptive, and focused mainly on PS, we included all

substantive criterion variables along with bivariate and partial correlations for both
PS and PC. The review was based on an electronic search of PsycINFO,
PsycARTICLES, and SPORTDiscus using the terms “perfection*” (capturing all
words containing “perfection” such as perfectionism, perfectionist, and
perfectionistic) AND sport OR dance OR exercise, from January 1990 to August
2015, and included peer-reviewed journal articles published in English. In total,
our review included 70 studies published between January 1991 and August 2015.
This was 44 more studies and 1,736 additional bivariate and partial correlations
than had previously been reviewed.
The findings of our review were similar to the two earlier reviews (Gotwals et
al., 2012; Stoeber, 2011). In particular, PS displayed a mix of positive relationships
with adaptive and maladaptive criterion variables suggesting that PS are ambivalent
in sport, dance, and exercise. This was evident in how PS were related to motivation
(e.g., intrinsic and introjected regulation, harmonious and obsessive passion, task
and ego orientation) and well-being (e.g., positive and negative affect, confidence
and worry) in context of a positive relationship with performance (e.g., season’s
best performances, actual performances). By contrast, residual PS were not
ambivalent (with a few exceptions detailed below). Most of the positive relationships
with maladaptive criterion variables that characterized PS were diminished or
reversed whereas the positive relationships with adaptive criterion variables were
typically unaltered or strengthened when residual PS were examined. This was
evident for motivation (e.g., task orientation, ego orientation, obsessive passion)
and well-being (e.g., bulimia symptoms, social physique anxiety, need thwarting)
as well as performance (e.g., season’s best performances, actual performances). Two
notable exceptions were exercise dependence and eating pathology with which PS
and residual PS tended to be positively related. Across the criterion variables, the
sizes of the relationships varied but medium to large-sized effects were common
(based on r = .10, .30, and .50 being small, medium, and large-sized effects; Cohen,
1992).
The review also revealed that PC displayed a consistent pattern of positive
relationships with maladaptive criterion variables. This was evident for motivation
(e.g., extrinsic regulation, ego orientation, fear of failure, amotivation) and well-
being (e.g., worry, anxiety, low satisfaction). PC also displayed a pattern of negative
relationships (or no relationships) with adaptive criterion variables. This included
motivation (e.g., intrinsic regulation, identified regulation, and harmonious
passion), well-being (e.g., friendship quality, task orientation, and self-esteem), and
performance (e.g., season’s best performances and actual performances). These
relationships remained basically unaltered when residual PC were examined.
However, there were some cases where residual PC were more maladaptive. This
included instances where statistically nonsignificant relationships with adaptive
criterion variables became negative and statistically significant (e.g., friendship
quality), and positive and statistically significant relationships with maladaptive
criterion variables were strengthened (e.g., amotivation). Again, across the criterion
variables, the sizes of the relationships varied but medium to large-sized effects
were common.
Results of the Review of Research Adopting an Independent

Effects Approach
For this chapter, a second electronic search was conducted using the same
parameters as the previous review but searching over the time period since (August
2015 to April 2016; search carried out on April 17, 2016). The search produced 55
new studies. After reviewing the articles’ abstracts for relevance (i.e., studies that
provided empirical examination of perfectionism in sport, dance, or exercise), the
number of studies was reduced to 12. One of these studies was a qualitative study
(Hill, Witcher, Gotwals, & Leyland, 2015), and two studies examined uni
dimensional perfectionism (Tao & Sun, 2015; Watson Breeding & Anshel, 2015)
which left us with nine studies (Barcza-Renner, Eklund, Morin, & Habeeb, 2016;
Bennett, Rotherham, Hays, Olusoga, & Maynard, 2016; Cheng & Hardy, 2016;
Costa, Coppolino, & Oliva, 2016; Hill, Robson, & Stamp, 2015; Neves, Meireles,
Carvalho, Almeida, & Ferreira, 2016; Madigan, Stoeber, & Passfield, 2016a, in
press; Oliveira et al., 2015). In addition, there were six published (or soon to be
published) studies examining multidimensional perfectionism in sport, dance, and
exercise that we were aware of but were not retrieved from the electronic search
(Gustafsson, Hill, Stenling, & Wagnsson, 2016; Jowett, Hill, Hall, & Curran, 2016;
Lizmore, Dunn, & Causgrove Dunn, 2016; Madigan, Stoeber, & Passfield, 2015,
2016b, 2017) giving us a total of 15 studies. After excluding four further studies—
three studies that did not report bivariate correlations (Barcza-Renner et al., 2016;
Bennett et al., 2016; Oliveira et al., 2015) and one that reported correlations only
for total perfectionism (Neves et al., 2016)—we arrived at a final number of 11
studies examining multidimensional perfectionism in sport, dance, and exercise
that were not included in the previous review (Jowett, Mallinson, & Hill, 2016).
Table 8.1 shows the independent effects analyses for these 11 studies.
There are a number of notable observations from the present review. The first
notable observation is the emergence of a number of longitudinal studies. In the
previous review, only three of 70 studies used longitudinal designs. In two studies,
Madigan et al. (2015, 2016b) examined the relationships between multidimensional
perfectionism and athlete burnout (total burnout and individual burnout symptoms)
in adolescent and adult athletes across two time points, three months apart. Madigan
and colleagues found that PS were negatively related to total burnout at both time
points and negatively related to reduced sense of accomplishment at Time 1, and
exhaustion and devaluation at Time 2. Unexpectedly, PS were also positively
related to reduced sense of accomplishment at Time 2.3 Residual PS negatively
predicted changes in total burnout and two other symptoms, reduced sense of
accomplishment and devaluation, over time. By contrast, PC were unrelated to
total burnout and unrelated to reduced sense of accomplishment, exhaustion, and
devaluation. Residual PC positively predicted changes in total burnout and one
TABLE 8.1 An Updated Review of Research Adopting an Independent Effects Approach to Perfectionism in Sport, Dance, and Exercise (August 2015–
April 2016)
Perfectionistic PS PC PS PC
Study Sample Domain Measure Strivings Concerns rPS, PC Criterion variable r r pr pr

(PS) (PC)
Cheng & Hardy 485 university dance Dance FMPS, SMPS, PStan CM – Cognitive anxiety – – – –
(2016) students (87% females) SMPS-2
Physiological anxiety – – – –
Regulatory anxiety .51 – – –
Costa et al. (2016) 169 adult exercisers Exercise FMPS – CoPC – Autonomy thwarting .30 – – –
(50% females)
Competence thwarting .42 – – –
Relatedness thwarting .47 – – –
Autonomy satisfaction –.17 – – –
Competence satisfaction –.14 – – –
Relatedness satisfaction –.15 – – –
Need thwarting .47 – – –
Need satisfaction –.17 – – –
ED: Withdrawal .28 – – –
ED: Continuance .20 – – –
ED: Tolerance .18 – – –
ED: Lack of control .27 – – –
ED: Reduction in other .28 – – –
activities
ED: Time .06 – – –
ED: Intention effects .16 – – –
ED: Total .29 – – –
Gustafsson et al. 237 adolescent athletes Sport FMPS SF PStan CM .68 Learning/enjoyment .10 –.14 .26 –.28
(2016) (48% females) climate
Worry conducive climate .27 .46 –.05 .36
Success without effort .12 .18 .00 .13
climate
BO: Reduced .29 .48 –.04 .37
accomplishment
BO: Exhaustion .31 .49 –.03 .36
BO: Devaluation .23 .45 –.09 .39
Hill, Robson, & 248 adult exercisers (41% Exercise HF-MPS SF SOP SPP .38 Perfectionistic .45 .57 .21 .39
Stamp (2015) females) self-promotion
Nondisplay of .29 .47 .11 .37
imperfection
Nondisclosure of .32 .45 .14 .34
imperfection
ED: Withdrawal .30 .22 .23 .11
ED: Continuance .23 .19 .17 .11
ED: Tolerance .30 .18 .25 .07
ED: Lack of control .29 .20 .23 .09
ED: Reduction .24 .21 .17 .13
ED: Time .26 .10 .24 .00
ED: Intention effects .29 .22 .22 .11
Jowett, Hill, et al. 222 adolescent athletes Sport HF-MPS SF, CoPS CoPC .22 Need satisfaction .44 –.07 .47 –.15
(2016) (56% females) SMPS-2
Need thwarting –.16 .42 –.23 .46
Total engagement .41 –.07 .44 –.15
BO: Total –.26 .36 –.32 .41
TABLE 8.1 continued
Perfectionistic PS PC PS PC
Study Sample Domain Measure Strivings Concerns rPS, PC Criterion variable r r pr pr

(PS) (PC)
Lizmore et al. 343 adult curlers Sport SMPS-2 PStan CM .35 RM: Anger and dejection .15 .46 –.01 .43
(2016) (42% females) (low criticality)
RM: Self-confidence and .12 –.26 .22 –.32
optimism (low criticality)
RM: Anger and dejection .14 .48 –.03 .46
(high criticality)
RM: Self-confidence and .10 –.28 .20 –.33
optimism (high criticality)
Madigan et al. 103 adolescent athletes Sport SMPS, MIPS CoPS CoPC .54 BO: Total (Time 1) –.31 .08 –.42 .28
(2015)† (20% females)
BO: Total (Time 2) –.40 .14 –.56 .39
Madigan et al. 130 adolescent athletes Sport SMPS, MIPS CoPS CoPC .60 Positive attitudes towards –.08 .10 –.17 .18
(2016a) (100% males) doping
Madigan et al. 129 adult athletes Sport SMPS, MIPS CoPS CoPC .78 BO: Reduced –.33 –.08 –.43 .27
(2016b)† (49% females) accomplishment (Time 1)
BO: Exhaustion (Time 1) –.13 .08 –.31 .29
BO: Devaluation (Time 1) –.32 –.07 –.42 .27
BO: Total (Time 1) –.29 –.02 –.44 .32
BO: Reduced .29 –.02 .49 –.37
accomplishment (Time 2)
BO: Exhaustion (Time 2) –.21 –.02 –.31 .22
BO: Devaluation (Time 2) –.29 –.02 –.44 –.32
BO: Total (Time 2) –.31 –.05 –.43 .29
Madigan et al. 141 adolescent athletes Sport SMPS, MIPS CoPS CoPC .54 Training distress (Time 1) –.07 .24 –.23 .33
(2017)† (11% females)
Training distress (Time 2) .09 .33 –.10 .33
Madigan et al. 261 adolescent and adult Sport MIPS SP NRI .62 Reasons for training: .20 .31 .01 .23
(in press) athletes (26% females) Avoidance of negative
affect
Reasons for training: .14 .28 –.04 .24
Weight control
Reasons for training: .20 .14 .14 .02
Mood control
Note: FMPS = Frost Multidimensional Perfectionism Scale (Frost et al., 1990), FMPS SF = FMPS, short form (Cox et al., 2002), HF-MPS SF = Hewitt–Flett
Multidimensional Perfectionism Scale, short form (Cox et al., 2002), SMPS = Sport Multidimensional Perfectionism Scale (Dunn et al., 2006), SMPS-2 = Sport
Multidimensional Perfectionism Scale, Version 2 (Gotwals & Dunn, 2009), MIPS = Multidimensional Inventory of Perfectionism in Sport (Stoeber et al., 2006);
PStan = Personal Standards, CoPS = a composite of multiple subscales indicative of PS, SOP = Self-Oriented Perfectionism, SP = Striving for Perfection;
CM = Concern over Mistakes, CoPC = a composite of multiple subscales indicative of PC, SPP = Socially Prescribed Perfectionism, NRI = Negative Reactions to
Imperfection; ED = exercise dependence, BO = burnout, RM = reactions to mistakes; r = bivariate correlation, pr = partial correlation; Significant correlations (p < .05)
are boldfaced. † = Correlations between dimensions of perfectionism are for Time 1.
symptom, reduced sense of accomplishment, over time. Effect sizes over time
tended to be small to medium-sized (e.g., PS–total burnout, PS–reduced sense of
accomplishment, PS–devaluation, and PC–reduced sense of accomplishment).
These findings provide an important extension to research in this area by confirming
evidence from cross-sectional research and redressing null findings from the one
previous study examining multidimensional perfectionism and athlete burnout
longitudinally (Chen, Kee, & Tsai, 2009).
In another study, Madigan et al. (2017) supplemented their work on burnout
by examining the related concept of training distress (a psychological precursor of
overtraining syndrome). Again, this study employed a longitudinal design to
examine the relationship between multidimensional perfectionism and training
distress and did so among adolescent athletes across two time points, three months
apart. Madigan and colleagues found that PS were not related to training distress at
either time point and that residual PS did not predict changes in training distress
over time. However, PC were positively related to training distress at both time
points, and residual PC positively predicted changes in training distress over time.
The effect of PC on training distress over time was small- to medium-sized. When
taken alongside the aforementioned research examining athlete burnout, we
believe that a picture is beginning to emerge that suggests that PC and residual PC
may be important in the progressive development of the inability to cope with, or
adapt to, the psychological demands of sport participation.
The second notable observation is the continued interest of researchers in the
influence of multidimensional perfectionism on exercise dependence. The
possibility that dimensions of perfectionism are a risk factor for exercise dependence
has long been of interest to our research group. Building on our previous work on
this topic, a study by Hill, Robson, and Stamp (2015) examined the relationship
between multidimensional perfectionism, perfectionistic self-presentation, and
exercise dependence in adult exercisers. Hill and colleagues found that PS and
residual PS were positively related to all symptoms of exercise dependence. In
addition, PC were positively related to all but one symptom of exercise dependence
(time spent in activities necessary for exercise) whereas residual PC were positively
related to only two symptoms (giving up activities to engage in exercise and
engaging in exercise in larger amounts than intended). Effects tended to be small-
to medium-sized. Based on these and previous findings (e.g., Miller & Mesagno,
2014), exercise dependence continues to be one of the few maladaptive criterion
variables that PS and residual PS are consistently related to in research in this area.
Examining exercise dependence further may therefore be particularly valuable in
terms of gaining a better understanding of what psychological costs are associated
with PS and residual PS.
The third notable observation is the inclusion of examination of new criterion
variables that are of interest and importance in the psychology of sport, dance, and
exercise. Athlete engagement (the supposed antithesis of burnout), psychological
need satisfaction (perceived lack of opportunities for need fulfillment), reasons for
training, and training distress have all recently been examined for the first time.
One particularly exciting development in this regard has been the publication of a
study examining perfectionism and attitudes toward doping. In this study, Madigan
et al. (2016a) found that residual PS (but not PS, PC, or residual PC) negatively
predicted positive attitudes toward doping in a sample of adolescent athletes. The
effect was small- to medium-sized. Doping continues to be a hot topic in sport,
and the possibility that perfectionism may explain individual differences in attitudes
toward doping and doping behavior is likely to be of significant interest to the
wider field. We would therefore like to see additional research of this kind. This is
also especially the case because Madigan et al.’s findings contradict other research
that found both PS and PC to be positively related to positive attitudes toward
doping in other athletic samples (e.g., Bahrami, Yousefi, Kaviani, & Ariapooran,
2014) and are counter to the notion that perfectionism may push athletes toward
immoral behaviors that place themselves or others at risk of harm in pursuit of
extremely high standards (Flett & Hewitt, 2014).
The fourth notable observation is that recent research has also extended our
understanding of possible mediating mechanisms that might explain some of the
relationships displayed by multidimensional perfectionism. Jowett, Hill, et al.
(2016) provided evidence that the link between dimensions of perfectionism with
both athlete burnout and athlete engagement may be mediated by perceptions of
psychological need satisfaction and need thwarting (perceptions of active
obstruction to need fulfillment). In a sample of adolescent athletes, Jowett and
colleagues found that residual PS were negatively related to total burnout via a
positive relationship with need satisfaction and a negative relationship with need
thwarting, and positively related to athlete engagement via a positive relationship
with need satisfaction. By contrast, residual PC were positively related to total
burnout via a negative relationship with need satisfaction and a positive relationship
with need thwarting, and negatively related to athlete engagement via a negative
relationship with need satisfaction (but not via need thwarting).
Interestingly, Costa et al. (2016) found similar support for the mediating role of
need thwarting when examining perfectionism and exercise dependence. In a
sample of adult exercisers, PC were found to be positively related to exercise
dependence via a positive relationship with need thwarting (but not via any
relationship with need satisfaction). We have previously argued that perfectionism
(PC, in particular) may impoverish the fulfillment of psychological needs and
contribute to a range of difficulties (see Mallinson & Hill, 2011). Exercise
dependence and burnout are two examples of these difficulties. We believe that
other difficulties associated with lower need fulfillment such as anti-social behavior
and sport drop-out also warrant examination. The relationship between
perfectionism and lower need fulfillment appears to be a key component in
understanding why PC are likely to have a detrimental impact on the motivation
and well-being of athletes, dancers, and exercisers. We encourage researchers to
consider testing these assertions in future work.
The final notable observation is that studies are beginning to test more complex
models that include moderating situational or contextual factors alongside
perfectionism and various criterion variables. Gustafsson et al. (2016), for example,
extended the work on perfectionism and athlete burnout by also examining the
influence of perceptions of the parental climate (expectations evident in the
behavior of parents that shape personal perspectives on success) in adolescent
athletes. They found that the adolescent athletes at greatest risk of burnout were
those higher in both PS and PC who also perceived their parents to emphasize
concerns about failure and winning without trying one’s best. Also of note from
this study is that it is the first time, to our knowledge, that PS have been found to
have a positive statistically significant relationship with burnout symptoms.
Specifically, PS displayed a positive small to medium-sized relationship with all
three burnout symptoms. It is not clear why this was the case in this particular
study. However, alongside research that has found PS to be unrelated and negatively
related to burnout symptoms, this finding can be taken as evidence that the
relationship between PS and burnout is subject to moderation by other factors.
These factors will need to be identified in future research.
Another study that examined perfectionism and moderating factors has been
provided by Lizmore et al. (2016). In their study they integrated perceptions of
event criticality into an examination of the relationship between perfectionism
and reactions to mistakes in a sample of adult curlers. They found that that PS
and PC displayed relatively consistent relationships with anger/dejection and
self-confidence/optimism across low and high critical events. Specifically, they
found PS to be positively related to anger/dejection in both conditions of low
and high criticality and positively related to self-confidence/optimism in
conditions of low criticality. By contrast, PC was positively related to anger/
criticality, and negatively related to self-confidence/optimism, in both conditions
of low and high criticality. Effects were small-sized for PS and small- to medium-
sized and large-sized for PC. Even though no evidence of moderation was found,
this study and the study by Gustafsson et al. (2016) are extremely valuable as they
are among the few that have attempted to understand when PS and PC are likely
to be beneficial or problematic for athletes, dancers, and exercisers, not just if.
This is surely a more realistic and reasonable line of enquiry for future research
than assuming that dimensions of perfectionism will be beneficial or problematic
for all individuals all of the time.
Overall, the findings of the present review are consistent with the findings of
our previous review of perfectionism in sport, dance, and exercise (Jowett,
Mallinson, & Hill, 2016). Research continues to find PC and residual PC to
exhibit a pattern of relationships with maladaptive criterion variables that suggests
they are undesirable and debilitating. By contrast, PS continue to be more
complex and ambivalent showing a positive relationship with both adaptive and
maladaptive criterion variables. Moreover, residual PS continue to exhibit a
pattern of relationships with adaptive and maladaptive criterion variables that
suggests residual PS are benign, or even beneficial (with exercise dependence
being a notable exception).
Recommendations for Future Research

We close the chapter by directing attention to a number of additional issues that
we believe need to be addressed in future research. The first issue is an over-
reliance on cross-sectional designs. Most research to date on perfectionism in sport,
dance, and exercise has adopted cross-sectional designs. The weaknesses of cross-
sectional designs are well-documented. In particular, cross-sectional designs do not
allow inference of causality between variables as there is no temporal component
in the design (i.e., all variables are measured at the same time point). These designs
provide only a static “snapshot” of the relationships they examine. They offer no
means of assessing whether the magnitude or direction of the relationships change
over time, or whether variables act on one another to varying degrees over time
(i.e., the existence of reciprocal effects). Consequently, we know a considerable
amount regarding the relationship between perfectionism and various criterion
variables, but little about whether these are causal relationships or in which
direction this is the case. As identified earlier, studies are emerging that use
longitudinal designs to address these issues, and their findings indicate that
perfectionism can predict change in various criterion variables. However, more
longitudinal studies are sorely needed.
The second issue is that too few studies have employed designs examining
factors that moderate the relationship of PS and PC with outcomes in sport, dance,
and exercise. The reasons for this are unclear. One reason may be that researchers
examine moderation effects, but only report them when they are statistically
significant (p < .05). Another reason may be that interactions—signifying
moderation effects—are difficult to detect in correlational research, and statistical
analyses require large sample sizes to have sufficient statistical power to detect these
effects (e.g., McClelland & Judd, 1993). Studies examining sport, dance, and
exercise, however, often do not have large samples comprising several hundred
participants. Still, research searching for moderators (and probing for interactions)
is important because this research addresses whether there are situational or personal
factors that provide resiliency toward the negative consequences of perfectionism.
This research is also necessary in order to test important assertions that include the
idea that those higher in perfectionism are vulnerable to psychological and
motivational difficulties following achievement stress (the specific-vulnerability
hypothesis) or may respond to difficult life circumstances in a fashion that is
problematic (perfectionistic reactivity; Flett & Hewitt, 2016).
A third issue is the availability of quality instruments to measure perfectionism.
As the area of research develops further, we must continue to develop and refine
the instruments we use in sport, dance, and exercise to measure perfectionism.
Outside of sport, dance, and exercise, researchers have been active in developing
new measures and scrutinizing existing measures (e.g., Smith, Saklofske, Stoeber,
& Sherry, 2016; Stoeber, in press). Although there have recently been similar
developments in sport (e.g., Hill, Appleton, & Mallinson, 2016; Madigan, 2016),
there is still considerable scope for more research of this kind. In particular, there
are currently no instruments that have been developed specifically to measure

perfectionism in dance or exercise, which may partly explain why perfectionism
research in these two domains lags behind perfectionism research in sport. Because
perfectionism may be best measured using domain-specific instruments (e.g.,
Stoeber & Stoeber, 2009), the development of instruments designed to capture
perfectionism as it is uniquely manifested in dance and exercise would be extremely
valuable.
A final issue is the amount of research that has been dedicated to examining
perfectionism in exercisers. In comparison to sport and dance, the correlates and
consequences of perfectionism in exercisers have received much less attention.
This is surprising because, anecdotally, perfectionism appears to be part of a culture
common among some exercisers that includes a focus on “perfecting the body”
(e.g., Morrison, Morrison, & Hopkins, 2003). Furthermore, the small number of
studies that have examined perfectionism in an exercise domain indicates that
perfectionism is related to the experiences of exercisers (e.g., Longbottom, Grove,
& Dimmock, 2012). Exercise is also a particularly interesting domain in that
dimensions of perfectionism that are sometimes associated with adaptive criterion
variables in sport and dance (i.e., PS and residual PS) are often associated with
maladaptive criterion variables in this domain (e.g., exercise dependence; Hill,
Robson, & Stamp, 2015). For these reasons, we consider research examining
perfectionism in exercise to be another priority for future research.
Concluding Comments
In this chapter we illustrated the correlates and consequences of perfectionism in
sport, dance, and exercise by providing an updated review of research. Examination
of multidimensional perfectionism continues to illustrate the unique (and often
opposing) effects of PS and PC. Notably, this includes recent longitudinal work
that suggests that perfectionism can predict changes in the experiences of athletes
over time. Research has also begun to examine mediating and moderating factors.
All this research is important because whether perfectionism is desirable or
debilitating will depend on the degree to which a particular dimension is exhibited,
whether the other dimension of perfectionism is considered, and what other
individual differences and contextual factors are evident. Based on current research,
most guises of perfectionism are associated with some psychological costs to
motivation and well-being. Only when the correlates and consequences of PS are
considered independently from PC is this not the case (i.e., residual PS). To
progress our understanding of perfectionism further, a number of recommendations
were made for future research including a call for further studies employing
longitudinal designs, a focus on moderating factors, the continued development
and refinement of instruments to measure perfectionism, and more research on the
influence of perfectionism among exercisers.
Notes
1 Also referred to as personal standards perfectionism and evaluative concerns perfectionism
(Dunkley, Blankstein, Halsall, Williams, & Winkworth, 2000; see also Gaudreau &
Thompson, 2010)
2 The labels “pure PS” or “pure PC” can also be considered misleading in that they
suggest that these variables are unrelated to each other (something we have stated in
error when describing this approach previously; Jowett, Mallinson, & Hill, 2016). When
fully controlled for, it is the residualized variable and the unresidualized opposite that are
unrelated (e.g., residual PS and PC).
3 Based on the correlations, this is likely to be a reporting error.
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PART III
Vulnerability and
Resilience
9
PERFECTIONISM AND
INTERPERSONAL PROBLEMS
Narcissistic and Self-Critical Perfectionism
Simon B. Sherry, Sean P. Mackinnon, and

Logan J. Nealis
Overview
Many perfectionists struggle to benefit from and to participate in harmonious,
satisfying, and stable interpersonal relationships. Perfectionism seems to thwart a
basic human need for close interpersonal relationships. Congruent with this view,
perfectionism is linked with interpersonal problems (Hewitt, Flett, Sherry, &
Caelian, 2006; Sherry, Mackinnon, & Gautreau, 2016), including negative social
outcomes (e.g., romantic breakup), negative social behaviors (e.g., hostile
interactions), and negative social cognitions (e.g., seeing others as displeased). In
this chapter, we examine the interpersonal lives of self-critical and narcissistic
perfectionists, highlighting how these individuals view themselves and others. We
also examine the interpersonal behaviors of self-critical and narcissistic perfectionists,
and we consider how interpersonal problems lead to psychological distress in self-
critical and narcissistic perfectionists. In this chapter, we also present two case
studies illustrating our points: Sylvia Plath (mainly a self-critical perfectionist) and
Bobby Knight (mainly a narcissistic perfectionist).
Narcissistic and Self-Critical Perfectionism

Let us first define narcissistic and self-critical perfectionism. Self-critical
perfectionism involves a family of traits including a tendency to be intensely self-
critical, to be preoccupied with mistakes, to be doubtful about performance
abilities, and to see others as demanding perfection of oneself (Dunkley, Berg, &
Zuroff, 2012). This family of traits robustly predicts numerous negative outcomes
(Sherry, Nealis, et al., 2013). In contrast, narcissistic perfectionism involves a family
of traits including a tendency to direct the demand for perfection outward onto
others in a grandiose, entitled, and hypercritical way (Nealis, Sherry, Sherry,
178 Sherry, Mackinnon, & Nealis
Stewart, & Macneil, 2015). Although theory has speculated about a constellation
of narcissistic and perfectionistic traits (Millon & Davis, 2000), researchers have
only recently started using research to bridge the gap between narcissism and
perfectionism (Nealis, Sherry, Lee-Baggley, Stewart, & Macneil, 2016). Preliminary
findings suggest narcissistic perfectionism is distinct from self-critical perfectionism,
with each perfectionism construct uniquely predicting negative social behaviors,
including a characteristic view of self and others that complicates relationships.
View of Self
The way people view themselves, often described as self-concept or self-schema,
plays a role in how people experience the world and interact with it. Rather than
being a static mental representation, self-concept is dynamic—it reflects ongoing
behavior while also regulating behavior (Markus & Wurf, 1987). Self-concept is
multifaceted, including an actual self and one or more possible selves (e.g., an ideal
self). These possible selves serve a motivating, evaluative, and interpretive function
for behavior (Markus & Nurius, 1986), but can also create problems. From a
cognitive perspective, Beck and Freeman (1990) emphasized how “dysfunctional
feelings and conduct … are largely due to the function of certain schemas that tend
to produce consistently biased judgments and a concomitant consistent tendency
to make cognitive errors in certain types of situations” (p. 5).
Intrapersonally, self-schemas provide an organizing structure for information
processing (e.g., self-monitoring, self-appraisal, and self-evaluation), emotion
regulation, and motivation (Beck & Freeman, 1990). Rather than self-schemas
being a personal affair operating in the private confines of the mind, these beliefs
exert wide-reaching influence on interpersonal behavior and the social environment
through social perception, selection of social contexts, and characteristic methods
of interaction and reaction (Markus & Wurf, 1987). Similar to how personality
disorders have characteristic self-schemas (Young, 1994), narcissistic perfectionism
and self-critical perfectionism are each linked to their own characteristic view of
self that drives how these personality styles manifest in a social context and
contribute to social problems.
Narcissistic Perfectionism
Available theory and evidence suggests narcissistic perfectionists characteristically
view themselves as perfect, superior people who have largely attained the idealized
image they hold for themselves (see Table 9.1). In their mind, they see themselves
in exceedingly positive ways: They manifest the glory of perfection and bask in
their perceived achievement of this idealized image. Theoretical work has long
described narcissistic perfectionists as having an inflated and idealized view of self
that they rigidly pursue and maintain (Horney, 1950). Research links grandiosity
to other-oriented perfectionism (Flett, Sherry, Hewitt, & Nepon, 2014; Sherry,
Gralnick, Hewitt, Sherry, & Flett, 2014; Smith, Sherry, et al., 2016; Stoeber,
Perfectionism and Interpersonal Problems 179
Sherry, & Nealis, 2015; Watson, Varnell, & Morris, 1999), and empirical models
of narcissistic perfectionism suggest these individuals maintain a grandiose, perfect
image of themselves (Nealis et al., 2016; Nealis et al., 2015). A recently validated
scale for narcissistic perfectionism also features grandiosity and superiority in its
conceptual structure (Smith, Saklofske, Stoeber, & Sherry, 2016), further
highlighting the tendency for narcissistic perfectionists to view themselves as
perfect and worthy of praise.
Supplemental analyses of data from Nealis et al. (2015, Study 1) suggest
narcissistic perfectionists tend to experience minimal discrepancy between their
actual and ideal selves. Multiple regression on a sample of 323 undergraduates
indicated narcissistic perfectionism was uniquely and negatively associated with
discrepancies (b = –.14), as measured by the revised Almost Perfect Scale (Slaney,
Rice, Mobley, Trippi, & Ashby, 2001), after including self-critical perfectionism
in the model (Nealis & Sherry, 2016). Despite a relatively small effect, this
stands in sharp contrast to the strong positive relation between self-critical
perfectionism and discrepancies (b = .69). Published data also suggest narcissistic
perfectionism has little relation to socially prescribed discrepancies (i.e., a
perceived difference between the actual self and other people’s expectations)
over a four-week period (Nealis et al., 2015). Narcissistic perfectionists see
themselves as “shining stars” while remaining relatively unconcerned about
living up to the expectations of others.
It is unsurprising that narcissistic perfectionists see themselves in a positive light
and generally feel quite good about themselves. Key traits involved in the
measurement of narcissistic perfectionism, such as other-oriented perfectionism
(Hewitt & Flett, 1990), tend to show moderate positive correlations with self-
esteem (Watson et al., 1999) and positive self-regard (Stoeber, 2015). Despite this
overt self-assurance, unconditional self-acceptance is elusive for narcissistic
perfectionists (Flett, Besser, Davis, & Hewitt, 2003), and a positive view of the self
may only be possible when they are on the “winning team” (Zeigler-Hill, Clark,
& Pickard, 2008). With a moderate to large overlap between narcissistic and
TABLE 9.1
Prototypical Forms of Cognition, Affect, and Behavior for Self-Critical and
Narcissistic Perfectionists
Domain Narcissistic perfectionists Self-critical perfectionists
View of self perfect, superior, ideal, and imperfect, deficient, flawed,

grandiose and defective
View of others inferior, flawed, disappointing,harsh, hyper-critical,
and deserving of criticism punitive, and demanding
Affective experience angry and hostile angry, hostile, anxious,
depressed, and ashamed
Interpersonal behaviors hostile-dominant, self-enhancing, hostile and/or submissive,
and conflictual self-concealing, and
conflictual
self-critical perfectionism, it is possible grandiosity gives way to self-criticism

(Nealis et al., 2015; Nealis et al., 2016; Ronningstam, 2010) when these conditions
are not met. Such an underlying vulnerability makes it vitally important for a
narcissistic perfectionist to maintain a sense of superiority over others.
A question remains as to whether narcissistic perfectionists regard themselves
through rose-colored glasses, or whether this view is consistent with others’
perspective. Evidence supports the latter view, with self-reports and informant
reports of narcissistic perfectionism overlapping by approximately 25% (Nealis et
al., 2016). People may also have unique biases in self-perception compared to
how others see them, with different relationship types (e.g., parents, friends,
romantic partners) showing different systematic biases. Informant-report data
from Nealis et al. (2016) were disaggregated based on relationship type to
examine this possible bias in detail (see Figure 9.1). People tended to rate
themselves as more grandiose than others rated them, although informant reports
from romantic partners and family members showed the greatest similarity to
self-reports. In contrast, friends and parents tended to rate people as less grandiose
(Nealis & Sherry, 2016). This suggests people see themselves in the most idealized
way, while others may agree (or disagree) with this view according to how they
relate to the person. Biases in ratings of entitlement were much smaller. Only
participants’ parents seemed to rate them as less entitled than others, including
when compared to self-reports. Both indicators of other-oriented perfectionism
(other-oriented perfectionism and high standards for others) were relatively
consistent across relationship types with the exception of romantic partners, who
tended to rate participants as having much higher expectations of others than
indicated by self-reports or reports from other relationship types. This suggests
romantic partners may be particularly vulnerable to lofty demands for perfection
in the context of intimate relationships.
These data are exploratory, however, and should be interpreted with caution.
Average levels of self- versus informant-reported traits provide only a snapshot of
similarities and differences between informant types, and larger samples are needed
(especially for certain relationship types, such as romantic partners) before firm
conclusions are made. These ratings also reflect perceived personality traits and
only act as a proxy for how people view and evaluate themselves or others. Future
studies in this area may yield important insights into the possible biases and
distortions involved in how narcissistic perfectionists view themselves versus how
others see them.
American basketball coaching legend Bobby Knight illustrates many aspects of
the characteristic view of self maintained by narcissistic perfectionists. Most of what
people know about Knight comes from depictions of him through media, most
notably a video depicting Knight flinging a chair across the basketball court in a fit
of rage. These actions were described as showing a flagrant disregard for authority
and social convention (Walton, 2000), suggesting he sees himself as superior and is
dismissive of the rules or opinions of others in favor of an approach emphasizing
winning at all costs.
FIGURE 9.1 S elf-reports and disaggregated informant reports of indicators for narcissistic
perfectionism based on relationship type. Reports for multiple informants
within the same category (e.g., multiple friends) were aggregated to create
a single “friends” estimate for each indicator. Additional information
regarding measurement can be found in Nealis et al. (2016).
Note: DD-N = Jonason and Webster’s (2010) narcissism subscale of the Dirty Dozen;
PES = Campbell, Bonacci, Shelton, Exline, and Bushman’s (2004) Psychological Entitlement Scale;
HSFO = Hill et al.’s (2004) high standards for others subscale of the Perfectionism Inventory;
OOP = Hewitt and Flett’s (1990) other-oriented perfectionism subscale. Error bars represent 95%
confidence intervals.
An interview in Playboy provided insight into Knight’s view of self (Grobel, 2014).
During the interview, which occurred during a harrowing 12-hour drive, Knight
frequently described his superiority over others and demanded respect for his
accomplishments while minimizing or justifying the behavior described as abusive
by former players (see also Walton, 2000). He described his infuriation when the
host of a talk show failed to recognize his positive accomplishments while
introducing him and instead focused on the infamous video of him throwing a
chair across the court (Grobel, 2014). His sensitivity to criticism also became
apparent at one point during the interview when he became irate and uncooperative,
saying: “You haven’t brought up one [expletive] positive thing I’ve said or done
since we’ve been talking. I’m tired of it” (Grobel, 2014, paragraph 156).
Similar to narcissistic perfectionists, Knight shows little discrepancy between his
actual and ideal self. In defending his actions, Knight declared: “What was right
twenty-five years ago is still right. I’m not going to change—it’s up to them to
change. The best teachers I’ve known are intolerant people. They don’t tolerate
mistakes” (Huber, 2008, paragraph 29). Even in his more sensitive and candid
moments, he described how his coaching job was unfairly stripped away from him
(Grobel, 2014), seemingly without recognition of his contribution to that outcome.
This betrays a superior view of self where he is the tragic, unappreciated hero.
Self-Critical Perfectionism
Whereas narcissistic perfectionists see themselves as superior and perfect, self-
critical perfectionists see themselves as flawed, imperfect, and deficient (see Table
9.1). In their mind, they are incapable of living up to the lofty and idealized
standards they strive for, whether these are the standards imposed on themselves,
or seemingly imposed by others. An idealized state of perfection is the ultimate
goal, similar to narcissistic perfectionists; for self-critical perfectionists, however,
life is constantly reminding them just how far away from this ideal they really are.
The discrepancy between the actual self and the ideal self is a core feature of
self-critical perfectionism. Research often uses discrepancies as part of a constellation
of traits for self-critical perfectionism and related constructs (e.g., perfectionistic
concerns; Blankstein, Dunkley, & Wilson, 2008; Richardson & Rice, 2015;
Suddarth & Slaney, 2001). Some researchers see discrepancies as a pillar of self-
critical perfectionism, rather than merely a down-stream correlate (Blankstein et
al., 2008), with a resultant self-schema that is imperfect, flawed, and largely, if not
entirely, unworthy. The day-to-day experience of self-critical perfectionists is
dominated by concerns they are imperfect in others’ eyes, not just in their own
(Nealis et al., 2015).
With a view of self predominated by weakness and inferiority, self-critical
perfectionists place a low value on themselves. Theoretical accounts link the
discrepancy between the actual and ideal self as a prime contributor to low self-
esteem in perfectionists (Horney, 1950), and research supports this notion (Dunkley
et al., 2012). In addition to doubting their self-worth, self-critical perfectionists are
more likely to see themselves as being ineffectual in attaining the lofty performance
standards they feel compelled to pursue (Stoeber, Hutchfield, & Wood, 2008).
Rather than a chronically low sense of self-worth, self-critical perfectionists ride
a roller coaster of discrepancies, fragile self-worth, and emotional upheaval. They
show an overall pattern of low self-esteem and negative affect, but these experiences
tend to fluctuate from day to day (Dunkley et al., 2012). Decreases in self-esteem
and problems with social interactions trigger corresponding emotional difficulties.
Instability in self-esteem often betrays a fragile sense of self (Kernis, Paradise,
Whitaker, Wheatman, & Goldman, 2000), driven largely by how far the person
feels from his or her ideal self on a particular day. Such fragility of self-worth is
common when self-concept is contingent on external events, rather than a more
internal, global, and stable sense of self (Greenier et al., 1999). Because self-critical
perfectionists set unrealistic standards for themselves and feel others set unobtainable
standards for them (Sherry, Law, Hewitt, Flett, & Besser, 2008), it is unsurprising
their day-to-day experience is that of inadequacy and distress at the perceived
reality of being imperfect. These individuals have great difficulties with
unconditional self-acceptance (Flett et al., 2003), and devote substantial energy to
the attainment or maintenance of self-esteem. This drive comes at a cost: The
pursuit of self-esteem can thwart the development of competence and close
relationships with others (Crocker, 2002).
The self-view maintained by self-critical perfectionists is only somewhat
consistent with how other people view them. Published data suggest only a modest
overlap (12.3%) between self-reports and informant reports of self-critical
perfectionism (Sherry, Nealis, et al., 2013). Similar to narcissistic perfectionism,
there appear to be differences in how component traits of self-critical perfectionism
are endorsed through self-report and informant report depending on relationship
type (see Figure 9.2). Analysis of empirical data showed romantic partners reported
similar overall levels of self-criticism compared to self-reports, but all other
relationship types reported lower levels of this tendency. A similar pattern was
evident for doubts about actions, although to a lesser degree. Interestingly,
informant reports from romantic partners indicated the highest estimates of a
participant’s concern over mistakes compared to informant reports from others and
the participant’s own self-reports. In contrast, socially prescribed perfectionism was
similar across self- and informant reports. These results suggest differences in
perception of these component traits, with certain traits less likely to be reported
based on someone’s relationship with the individual in question. For example, the
self-abasement and self-doubt of a self-critical perfectionist may not be broadcasted
widely to others in that person’s social network, while romantic partners may have
a privileged window into her or his private world. In contrast, concern over
mistakes may manifest through verbalizations and behavior in performance
contexts, with others being more likely to pick up on these concerns relative to
self-doubt. The discrepancy between self- and partner reports suggests people have
blind spots in regard to their pre-occupation with mistakes, potentially as a result
of being immersed in these thoughts and not having an outside perspective.
Partners may be particularly likely to see these concerns manifest while also having
an external perspective with which to compare, making them particularly well
situated to comment on a person’s self-critical perfectionism.
Sylvia Plath is a widely cited example of the destructiveness of self-critical
perfectionism (Nealis et al., 2015; Sherry et al., 2016), with a self-view characteristic
of this personality style being evident in her biography and poetry. Plath’s writings
are understood to represent an accurate portrayal of her inner experience, thus
affording an intimate window into her inner life and views of self (Shulman, 1998).
Plath frequently gave voice to a fragile self that was deeply afraid of being
deficient, making mistakes, and not living up to her own idealized expectations. In
her published diaries, Plath (2000) described her perfectionism as having a “demon
who wants me to run away screaming if I am going to be flawed, fallible. It wants
me to think I’m so good I must be perfect. Or nothing” (p. 619). She then
FIGURE 9.2 Self-reports and disaggregated informant reports of indicators for self-
critical perfectionism based on relationship type. Reports for multiple
informants within the same category (e.g., multiple friends) were aggregated
to create a single “friends” estimate for each indicator. Additional
information regarding measurement can be found in Nealis et al. (2016).
Note: SPP = short form of Hewitt and Flett’s (1991) socially prescribed perfectionism subscale of their
Multidimensional Perfectionism Scale; DEQ = Bagby, Parker, Joffe, and Buis’s (1994) self-criticism
subscale of the reconstructed Depressive Experiences Questionnaire; COM = a short form of Frost,
Marten, Lahart, and Rosenblate’s (1990) concern over mistakes subscale of their Multidimensional
Perfectionism Scale; DAA = doubts about actions subscale of the same scale. Error bars represent 95%
confidence intervals.
continued, describing her own social deficiencies as stemming from this “demon”
and standing in the way of living a more tolerable life: “If I get through this year,
kicking my demon down when it comes up, I’ll be able, piece by piece, to face the
field of life, instead of running from it the minute it hurts” (p. 619).
Her biography and poetry depict intense self-criticism and self-devaluation
(Firestone & Catlett, 1998; Shulman, 1998). These writings also point to periodic
discrepancies when she perceived her actual self as largely deficient compared to
her ideal self, and these discrepancies tended to be bring periods of intense distress
and suicidality (Shulman, 1998). These discrepancies were intermittent, however,
and often mixed with periods of lesser discrepancy when Plath would describe
herself in more positive terms (Shulman, 1998). It is unclear whether she truly
believed herself when speaking in positive terms, or whether this represented a
desperate defense against the “demon” of perfectionism that threatened her.
View of Others
Perfectionists also have characteristic ways of viewing others in their social context.
These views are often complementary and each contributes in its own way to a
person’s affective experience and interpersonal behavior. Cognitive theory largely
focuses on the impact of schemas, both on the self and the world beyond, and how
they influence social behavior in a mutually dependent way (Beck & Freeman,
1990; Young, 1994). Social cognitive theory broadens and extends this framework
to emphasize the mutual and reciprocal relationships between intrapersonal factors
(e.g., cognition, affect), overt behavior, and the environment (Bandura, 1999). In
this system, individual characteristics (e.g., cognitive structures, affect) influence
the social-environmental contexts people seek out and how these contexts are
interpreted. Though the factual aspects of the social environment exerts an
influence, it is often the social environment as it is perceived to be that carries meaning
for the individual and has implications for a person’s emotional experience and
subsequent behavior (Beck & Freeman, 1990; Young, 1994). Narcissistic and self-
critical perfectionists both have characteristic views of others that contribute to
interpersonal problems.
Alongside their view of themselves as superior and perfect, narcissistic perfectionists
view others in a complementary but less favorable way—namely as inferior, flawed,
and deserving of criticism. They see themselves as natural leaders (Stoeber et al.,
2015) who deserve to be hoisted up on a pedestal for all of their positive qualities
and actualized greatness, while others are relegated to subordinate roles and
devalued for their perceived inadequacies. The sense of superiority inherent in this
trait constellation is frequently documented, with forms of other-oriented
perfectionism associated with feelings of superiority over others (Stoeber, 2015)
and devaluation of others (Stoeber et al., 2015). Narcissistic perfectionists take it
upon themselves to lead and dominate others, and react with confusion and
indignation when these inferior others do not submit to their will (Nealis et al.,
2016). They see the world as one big “mistake,” and they deputize themselves to
“fix” it.
While narcissistic perfectionists largely see themselves as living up to their lofty
and idealized standards, others do not bask in the same glow. Over 28 days of
intensive measurement, those higher on narcissistic perfectionism tended to report
others as frequently failing to live up to expectations (Nealis et al., 2015). Narcissistic
perfectionists view others from an elevated position, with constant and inevitable
disappointment being the only expectations that these others ever seem to be able
to meet.
In contrast, narcissistic perfectionists are unperturbed by the possibility of not
measuring up to others’ expectations (Nealis et al., 2015). They view themselves as
meeting normative standards for performance, especially in comparison to others
to whom they are in direct competition. When there are clear discrepancies
between their actual self and others’ expectations, these discrepancies may be
dismissed as arising from the expectations of “inferior” people and thus of little
consequence
These characteristics of narcissistic perfectionists are evident in writings
describing Knight. His actions and words frequently betray a view of others as
being weak, deficient, and worthless. On one occasion, he was reputed to use a
piece of soiled toilet paper to convey his opinion of his players while chastising
them in the locker room (Grobel, 2014). This behavior was not an isolated
incident. There are frequent reports of him treating players, officials, and colleagues
with a blatant disrespect (Huber, 2008), while railing against others for not affording
him the respect he felt he deserved (Feinstein, 2000). Knight voiced a similar
disparaging attitude toward journalists during his Playboy interview, describing the
media as biased and incapable of doing anything right (Grobel, 2014). When
discussing the aftermath of his dismissal from the University of Indiana, he described
the administration in unfavorable terms, disparaging them as self-interested and
neglecting the welfare of faculty and students alike (Grobel, 2014). The only times
when he described others positively were seemingly in the context of others
showing him admiration.
Unlike the contrast between self-view (favorable) and view of others (unfavorable)
demonstrated by narcissistic perfectionists, self-critical perfectionists tend to view
others with ambivalence. Self-critical perfectionists are prone to social comparison,
often seeing themselves in a “one-down” position relative to others (Wyatt &
Gilbert, 1998). At the same time, they are vulnerable to social anxiety (Cox &
Chen, 2015; Saboonchi & Lundh, 1997), seeing others not as benevolent and
accepting of flaws but as harsh judges who are always vigilant to possible mistakes,
lying in wait to cast a critical eye. In this way, self-critical perfectionists view
others as “oppressors” who subject the self to painfully high standards that cannot
be satisfied.
Similar to self-critical perfectionists’ view of self, discrepancies are a key feature
for their view of others. Interpersonal discrepancies reflect the concern of being
unable to live up to the unobtainable standards set by others. This experience is
central to the social disconnection experienced by self-critical perfectionists, where
these individuals tend to interpret others as being highly critical and demanding
(Dunkley, Sanislow, Grilo, & McGlashan, 2006; Hewitt et al., 2006). Self-critical
perfectionists feel that others are chronically dissatisfied with their performance,
over both day-to-day interactions (Nealis et al., 2015) and week-to-week

interactions (Sherry, Mackinnon, et al., 2013).
The view of others as being dissatisfied and critical can result in intra- and
interpersonal problems. Intrapersonally, the perception of others being critical
and demanding feeds into the underlying concern with oneself being flawed and
imperfect, making one more prone to emotional distress (Sherry et al., 2008;
Sherry, Mackinnon, et al., 2013). It can also catalyze interpersonal friction, as
others are seen as acting unfairly and harshly toward the self, and the self-critical
perfectionist may react with either overt hostility or unexpressed indignation
(Nealis et al., 2015). Discrepancies are central to this process, as self-critical
perfectionists simultaneously hold a view of themselves as failing to live up to
others’ expectations while also viewing others as being flawed in their own way,
making them unjust and hypocritical in their expectations. The key difference
between narcissistic perfectionism and self-critical perfectionism is that the self-
critical perfectionist lashes out not because others are flawed and in need of
correction, but because others are perceived to be unfairly critical and demanding.
We see problems of social disconnection play out with Plath. In her journals,
she expresses a concern about being under the watchful eyes of others, who largely
judge and criticize her:
I talk to myself and look at the dark trees, blessedly neutral. So much easier
than facing people, than having to look happy, invulnerable, clever. With
masks down, I walk, talking to the moon, to the neutral impersonal force
that does not hear, but merely accepts my being. And does not smite me
down.
(Plath, 2000, p. 200)
Although she often expressed idealization of others in her life, she was also known
to be deeply critical of people she was fond of while being suspicious and cynical
toward their intentions (Firestone & Catlett, 1998). This was especially true after
discovering her husband’s (Ted Hughes) infidelity: “Privately, Sylvia puzzled over
what to tell people. Confiding in her friend Elizabeth Compton, she called Ted
a ’little man.’ This sounded to Elizabeth like a cry over a fallen idol” (Rollyson,
2013, paragraph 6). Plath’s experiences accord with data from Nealis et al. (2015)
who found self-critical perfectionists tended to derogate others when they felt
disappointed by them.
Beyond any particular relationship, however, Plath may have felt so socially
disconnected that she perceived others as being unable to receive her affection,
while also being unable to give her the love and affection she so desperately needed:
“I have never found anybody who could stand to accept the daily demonstrative
love I feel in me, and give back as good as I give” (Plath, 2000, p. 455). Although
this, in and of itself, sounds grandiose, elsewhere in her journal she takes a more
pleading tone, seeking the affection and understanding that others were withholding
from her, rather than simply incapable of giving: “Someone, somewhere, can you
understand me a little, love me a little? For all my despair, for all my ideals, for all
that—I love life. But it is hard, and I have so much—so very much to learn” (Plath,
2000, p. 25).
Interpersonal Behaviors
In this section, we emphasize interpersonal behaviors, rather than cognitions or
affect, and use the interpersonal circumplex to describe the interpersonal world of
perfectionistic people. The interpersonal circumplex is a two-dimensional model
of interpersonal space, organized into a circular shape (Gurtman, 2009). The y-axis
represents agency (i.e., dominance, power, status, control) and the x-axis represents
communion (i.e., love, warmth, affiliation, union). From these axes, a location in
angular coordinates ranging from 0° to 360° can be specified for each person.
Gurtman (2009) showed most circumplex models are split into the following
generic octants: friendly (0°), friendly-dominant (45°), dominant (90°), hostile-
dominant (135°), hostile (180°), hostile-submissive (225°), submissive (270°), and
friendly-submissive (315°).
The interpersonal lives of people high in narcissistic perfectionism tend to fall into
the hostile-dominant octant of the interpersonal circumplex (Habke & Flynn,
2002; Hill, Zrull, & Turlington, 1997; Southard, Noser, Pollock, Mercer, &
Zeigler-Hill, 2015; see Table 9.1). The hostile-dominant octant represents an
interpersonal style that prioritizes self-enhancement, personal achievement, and
domination (i.e., high agency, low communion). This manifests in disagreeable
behaviors such as dishonesty, grandiosity, cold-heartedness, and antisocial
behaviors. Stoeber (2014a) found other-oriented perfectionism had a moderate
positive association with “dark” personality traits (narcissism, Machiavellianism,
and psychopathy), and was negatively correlated with facets of agreeableness.
Stoeber also found robust positive relationships of other-oriented perfectionism
with agentic social goals (leadership and dominance) and negative relationships
with communal social goals (nurturance and intimacy). Similarly, Smith, Saklofske,
et al. (2016) found a large negative correlation between agreeableness and narcissistic
perfectionism. Thus, narcissistic perfectionists direct their hostility outwards,
seeking to dominate their interpersonal world as a means of enhancing themselves.
Hewitt et al. (2003) described three dimensions of perfectionistic self-
presentation: perfectionistic self-promotion (brash public displays of one’s supposed
perfection), nondisplay of imperfection (concealing and avoiding imperfect
behaviors), and nondisclosure of imperfection (avoiding verbal admissions of
imperfection). The self-presentation style of narcissistic perfectionists is characterized
by self-promotion. A meta-analysis of eight studies (N = 2,307) found narcissistic
grandiosity was more strongly related to perfectionistic self-promotion (r = .30)
than nondisclosure of imperfection (r = .19) or nondisplay of imperfection (r = .12;
Smith, Sherry, et al., 2016). A similar pattern has been found for other-oriented
perfectionism (Hewitt et al., 2003; Sherry et al., 2014). Thus, narcissistic
perfectionists often attempt to gain admiration and respect by demonstrating their
supposed perfection. Unfortunately, this behavior is often seen as interpersonally
aversive, and may evoke hostility from narcissistic perfectionists when others fail to
acknowledge their supposed perfection (Hewitt et al., 2003).
The conflictual interpersonal lives of narcissistic perfectionists are motivated by
the sense others are disappointing or deficient, which can evoke angry hostility.
Miller et al. (2011) found grandiose narcissism was positively correlated with the
tendency to experience and express anger, be rude, yell and threaten others, and to
use physical aggression in a hypothetical social interaction. Similarly, when using a
sham aggression paradigm where participants were able to administer shocks to an
ostensible confederate, Reidy, Foster, and Zeichner (2010) found people high in
narcissism administered more shocks more quickly than people low in narcissism.
Aggression from narcissists was also more likely to be unprovoked (i.e., not in
retaliation to receiving a shock themselves). And Wiehe (2003) found parents
investigated for child abuse in the United States tended to have elevated narcissism
levels versus nonabusive foster parents.
The relationship between narcissism and popularity is more nuanced. Küfner,
Nestler, and Back (2013) found narcissism had an indirect effect on popularity
through assertive (dominant and expressive) and aggressive (arrogant and combative)
behaviors during videotaped discussions. Interestingly, assertive behaviors were
positively associated with popularity, while aggressive behaviors were negatively
associated with popularity; thus, the overall effect of narcissism on popularity was
close to zero.
There do not appear to be studies linking other-oriented perfectionism to
concrete interpersonal behaviors. Instead, the evidence is limited to self-report of
socially aversive behaviors. Stoeber (2015) found other-oriented perfectionism was
positively linked to aggressive humor, callous traits, and uncaring traits. Stoeber
(2014b) also found other-oriented perfectionism was the only form of perfectionism
to be positively correlated with the DSM-5 personality traits domains of antagonism
(Krueger, Derringer, Markon, Watson, & Skodol, 2012), after controlling for self-
oriented and socially prescribed perfectionism. However, other-oriented
perfectionism was unrelated to dyadic conflict in romantic couples after controlling
for dyadic self-critical perfectionism in one longitudinal study, even though it had
a positive bivariate correlation with dyadic conflict (Mackinnon et al., 2012). To
date, there is only one study linking narcissistic perfectionism to self-reports of
socially aversive interpersonal behaviors. Nealis et al. (2015) found that narcissistic
perfectionism led to other-oriented discrepancies (i.e., a sense that others are falling
short of one’s own standards) which in turn led to hostile conflict and derogation
of others.
Other-oriented discrepancies and hostility are evident in the life of Knight.
Araton (2012) noted Knight once grabbed Neil Reed (a former player) by the neck
and choked him out of anger during a practice. Moreover, when he began to lose
more games, Knight dismissed Reed from the team and tried to publicly humiliate
him by making sure some of the younger teammates belittled and kicked him on
his way out of the door (Araton, 2012). As this example shows, other people are
often perceived as a barrier to achieving perfection in narcissistic perfectionists’
lives, and derogating others’ perceived imperfections is one means to maintaining
their grandiose sense of self-worth.
The interpersonal lives of people high in self-critical perfectionism are also fraught
with interpersonal difficulties. However, the nature and source of these problems
differs from those of people high in narcissistic perfectionism (Table 9.1). Narcissistic
perfectionists come from a place of self-entitlement and high self-worth, and
dominate other people as a means of demonstrating their superiority. The self-
critical perfectionist comes from a place of self-hatred and uncertainty, accompanied
by a perception that other people are enforcing a set of unrealistic standards. When
placed in context with the Big Five personality traits, self-critical perfectionism
shows a positive relationship with neuroticism and negative relationships with
extraversion, suggesting increased negative affect, a lack of positive affect, and
lower social dominance (Smith, Saklofske, et al., 2016; Stoeber, 2014b). Self-
critical perfectionists are difficult to place within the interpersonal circumplex,
showing opposing elements of hostile-dominance and friendly-submission (Habke
& Flynn, 2002; Hill et al., 1997; Slaney, Pincus, Uliaszek, & Wang, 2006). This
seemingly contradictory set of findings belies an interesting set of gender differences.
Men high in self-critical perfectionism tend toward the hostile-dominant octant,
while women high in self-critical perfectionism tend toward the friendly-submissive
octant (Habke & Flynn, 2002; Slaney et al., 2006). For men, the perceived societal
pressures of perfection may evoke anger, causing men to lash out at others as they
attempt to reach the unrealistic standards they believe are imposed on them. In
contrast, women high in self-critical perfectionism may experience problems with
expressing anger, nonassertiveness, and exploitability. This gender difference may
arise from the societal ideals of a “perfect” man or woman, and indeed seems to
represent widely held gender stereotypes for interpersonal behavior. It may also
suggest an interaction with agreeableness—a highly gendered personality trait
(Weisberg, DeYoung, & Hirsh, 2011)—where the type of interpersonal problems
experienced by self-critical perfectionists might vary from outright hostility (low
agreeableness) to exploitability (high agreeableness). Though this remains
speculative, data are suggestive of interpersonal subgroups within the self-critical
perfectionism construct (Slaney et al., 2006).
In theory, the self-presentational style of the self-critical perfectionist should be
characterized by a defensive concealment of an imperfect self. This seems
reasonable, given that self-critical perfectionists tend to be less extraverted (Smith,
Saklofske, et al., 2016) and harshly critical of their own mistakes. However, socially
prescribed perfectionism—a key component of self-critical perfectionism—has a
robust positive correlation with perfectionistic self-promotion, nondisplay of

imperfection, and nondisclosure of imperfection in about equal measure (Hewitt
et al., 2003; Hewitt, Habke, Lee-Baggley, Sherry, & Flett, 2008; Sherry et al.,
2014). Similarly, in a three-wave, 130-day longitudinal study of university
freshmen, Mackinnon and Sherry (2012) found self-critical perfectionism indirectly
predicted subjective well-being via a composite of all three perfectionistic self-
presentation styles. In sum, self-critical perfectionists attempt to present themselves
as flawless. However, unlike narcissistic perfectionists (who rely primarily on self-
aggrandizing behaviors), self-critical perfectionists appear to employ a wider variety
of self-presentation strategies to achieve that goal.
Though the strategies self-critical perfectionists use to navigate their interpersonal
world may vary depending on self-held views of “perfection,” the interpersonal
consequences are strikingly similar. For instance, in a three-wave, four-year
longitudinal study, Dunkley et al. (2006) found self-critical perfectionism predicted
future likelihood of negative social interactions (e.g., anger, insensitivity, and
interference). In a set of two 28-day longitudinal studies, Mackinnon and colleagues
(Mackinnon, Kehayes, Leonard, Fraser, & Stewart, in press; Mackinnon et al.,
2012) demonstrated dyadic self-critical perfectionism is robustly linked to increased
conflict in romantic couples (i.e., behaviors such as yelling at or publicly
embarrassing one’s partner). This heightened tendency to come in conflict with
others is likely motivated by a sense that others are critical and pressuring. Sadly,
this may leave the self-critical perfectionist isolated and alone. Shahar, Blatt, Zuroff,
Krupnick, and Sotsky (2004) found pre-treatment self-critical perfectionism was
associated with an impoverished social network (fewer and lower quality
relationships), which in turn impeded the effectiveness of psychotherapy. We can
also see these themes of social disconnection consistently in Plath’s journals, where
she describes intense feelings of self-consciousness and loneliness, despite an
external facade of happiness (e.g., Plath, 2000, entry 36). In sum, self-critical
perfectionists have a wide array of interpersonal problems.
Perfectionism and Negative Affect: The Revised Social

Disconnection Model
The social disconnection model of perfectionism (Hewitt et al., 2006) proposes
self-critical perfectionism confers vulnerability to negative affect via subjective
social disconnection (e.g. perceived social support, perceived loneliness) and
objective social disconnection (e.g., overt conflict, severed relationships). That is,
social disconnection is the mechanism by which perfectionism confers risk for
psychopathology. Sherry et al. (2016) proposed a revised social disconnection
model (RSDM) that incorporated the rich history of diathesis-stress models (Enns,
Cox, & Clara, 2005; Hewitt & Flett, 1993), as well as more recent interest in a
revitalized narcissistic perfectionism construct, into a single integrative model. In
this revised model, each dimension of perfectionism confers risk for psychopathology
via two mechanisms: (a) personality-dependent mediators, such as social
disconnection; and (b) personality-independent moderators, such as stressful life

events. Though the model can be adapted for many different psychopathological
outcomes, our focus here will be on negative affect, with mediating/moderating
variables that are interpersonal in nature.
Self-critical perfectionism appears to be a broadband risk factor for many types of
negative affect (Table 9.1). Stoeber, Schneider, Hussain, and Matthews (2014)
found people high in socially prescribed perfectionism experienced increased
anger, depression, and anxiety after receiving bogus false feedback on a set of
mental rotation tests. When examining the impact of repeated failure on this task,
socially prescribed perfectionism continued to predict increased anger even when
controlling for baseline anger. Besharat and Shahidi (2010) found negative
perfectionism—a close relative of self-critical perfectionism—was robustly
correlated with state anger, trait anger, and anger rumination. Chen, Hewitt, and
Flett (2015) found socially prescribed perfectionism (but not self-oriented or other-
oriented perfectionism) was strongly linked to feelings of shame. A comprehensive
review (Frost, Glossner, & Maxner, 2010) also found self-critical perfectionism was
linked to social anxiety symptoms in non-clinical populations and social anxiety
disorder in clinical populations, even when controlling for depression and
generalized negative affect. This represents a small fraction of the available research
that all speaks to the same point: Self-critical perfectionism is robustly correlated
with negative affect.
There is good evidence to support personality-dependent social disconnection
as a mechanism by which self-critical perfectionism confers risk for negative affect.
Self-critical perfectionists may generate negative affect through their hostile and
rejecting interpersonal behaviors. For instance, in a four-wave, four-week
longitudinal study of romantic couples, Mackinnon et al. (in press) found dyadic
self-critical perfectionism led to increased social negativity directed toward one’s
romantic partner, which in turn predicted increased negative affect and decreased
life satisfaction. Using a two-wave, three-year longitudinal study, Dunkley et al.
(2006) found self-criticism indirectly predicted increases in depressive symptoms
through lower perceived social support and more negative social interactions.
Moreover, using a two-wave, one-year longitudinal design examining 723
community-based adults, Cox, Clara, and Enns (2009) found self-critical
perfectionism indirectly predicted depressive symptoms at a future wave through
personality-dependent life stressors (e.g., trouble with superiors at work). Thus,
there is longitudinal evidence to support this aspect of the RSDM.
Findings on personality-independent moderators tend to be mixed. Early
research found support for the moderating effect of negative interpersonal life
events, with interpersonal stressors intensifying the positive relationship between
socially prescribed perfectionism and negative affect (Hewitt & Flett, 1993).
However, these findings have also failed to replicate in other research (Enns et al.,
2005). This said, research is limited to self-report measures of life events, which
often confound personality-independent stressors (e.g., losing one’s job) and
personality-dependent stressors (e.g., fighting with one’s friend; Cox et al., 2009).
It may be fruitful to look for more objective, ego-involving measures of stress that
are unlikely to be generated by the personality trait via a mediational process if
research in this area is to progress. Sherry, Mackinnon, and Gautreau (2016)
examined the life of Plath in the context of the social disconnection model, and
suggested that loneliness and perceived disconnection served as personality-
dependent mediators, while the stress she endured due to unequal gender roles and
discrimination served as a personality-independent moderator when predicting
Plath’s depression.
Given the relatively recent development of narcissistic perfectionism as a unified
construct, there is little research on the construct’s associations with negative affect.
Nealis et al. (2016) found a positive association between narcissistic perfectionism
and anger when considering both self- and informant reports. Similarly, the review
of the literature in Chapter 4 showed other-oriented perfectionism is generally
uncorrelated with neuroticism, except for a positive relationship with angry
hostility. Moreover, other studies found other-oriented perfectionism is unrelated
to negative affect, depressive symptoms, and anxiety (Hewitt & Flett, 1991; Short
& Mazmanian, 2013). Thus, unlike self-critical perfectionism, there appears to be
no consistent relationship between narcissistic perfectionism and negative affect,
except for a modest positive relationship with anger. Given the generally null
relationship between narcissistic perfectionism and negative affect, studies have not
tended to propose social disconnection as a mediator. Instead, the more fruitful
question may be: Under what circumstances do people high in narcissistic
perfectionism experience negative affect?
Research on grandiose narcissism suggests people high in narcissism may react
more strongly to certain types of stressors, which in turn can generate a
disproportionate amount of negative affect. Besser and Zeigler-Hill (2010) used a
pre-post experimental design asking participants to imagine one of four hypothetical
scenarios: public interpersonal rejection, private interpersonal rejection, public
achievement failure, and private achievement failure. They found grandiose
narcissism was associated with increases in negative affect following public
interpersonal rejection and achievement failures, but not when the rejection or
failure was private. Similarly, when exposed to a public psychosocial stressor (i.e.,
a difficult public speaking task with a non-responsive audience), narcissistic men
experienced more negative affect and greater cortisol reactivity compared to non-
narcissistic men; however, the same pattern was not supported in women (Edelstein,
Yim, & Quas, 2010). Besser, Zeigler-Hill, Pincus, and Neria (2013) found civilian
exposure to rocket and missile fire during the Middle East conflict led to increased
risk for symptoms of anxiety in the forms of post-traumatic stress and generalized
anxiety disorder for participants high in narcissism, but not for those with low
narcissism. Besser and colleagues argued that such uncontrollable traumatic events
may be seen as a kind of “narcissistic injury” that undermines their grandiose self-
views, forcing them to consider that they are just as ordinary and vulnerable as
everybody else, which in turn leads to intense negative affect as their grandiose
sense of self collapses.
Feinstein (2000) recalls a seemingly innocuous event from his past with Knight,
where he refers to him informally as “Knight” (as we do in this chapter). Knight’s
reaction was immediate and intense: “Before the last word was out of my mouth,
he had whirled around and charged back at me, finger in my face, screaming
(expletives deleted) ‘Who do you think you are calling me Knight? I’m almost 20
years older than you, you show me some respect’” (Feinstein, 2000, paragraph 2).
This theme played out again 14 years later when Kent Harvey (a 19-year-old
university freshman) showed a similar lack of respect; except this time, the outburst
led to Knight’s dismissal from Indiana University (Feinstein, 2000). In this way, the
sense of grandiosity and entitlement in Knight’s life led to intense anger whenever
his grandiose self-view was threatened.
The contrast between self-critical versus narcissistic perfectionism is striking.
Self-critical perfectionists are consumed by self-loathing, and feel constant pressure
from themselves and other people. Thus, they often lash out at others, defending
themselves from perceived attacks. However, their own social negativity serves to
confirm their self-deprecating view of themselves, making them feel worse, and
continuing a self-perpetuating cycle of negative emotions. Any deviation from
perfection is a complete and emotionally devastating failure. In this way, a wide
range of negative affect (anger, hostility, anxiety, depression, and shame) appears to
be driven by social disconnection in the self-critical perfectionist.
In contrast, narcissistic perfectionists feel that other people are wrong, and do
not tend to feel guilty or upset about the conflict itself. After all, narcissistic
perfectionists think of themselves as powerful, competent, and entitled to good
things. However, there often comes a time when something happens to challenge
these grandiose views. Perhaps they are fired from their job, they are a victim of a
crime, or their spouse divorces them. At these moments the facade breaks, and
narcissistic perfectionists experiences intense distress as the realization that they
might be as “weak” as those they have criticized becomes too much to bear,
resulting in an outburst of intense negative emotions (i.e., anger and hostility).
Thus, though narcissistic perfectionists do not characteristically experience chronic
negative affect, we might expect intense outbursts of angry hostility when
uncontrollable stressors challenge their grandiose sense of self-worth.
In sum, self-critical and narcissistic perfectionists do not play nicely with others.
In fact, their interpersonal lives are often fraught with conflict and dissatisfaction.
Ample theory and evidence suggests self-critical and narcissistic perfectionism
involve an enduring pattern of thinking, behaving, perceiving, and relating that is
destructive in relationships with others. Both self-critical and narcissistic
perfectionists live amid interpersonal turmoil, but arrive at that place of turmoil in
different ways. Seeing themselves as perfect and others as flawed, narcissistic

perfectionists react angrily in response to the perceived imperfections of others.
And seeing themselves as defective and others as hypercritical, self-critical
perfectionists suffer anger, anxiety, depression, and shame in response to the
perceived demandingness of others.
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10
PERFECTIONISM AND HEALTH
The Roles of Health Behaviors and
Stress-Related Processes
Danielle S. Molnar, Fuschia M. Sirois, Gordon L. Flett,

William F. Janssen, and Paul L. Hewitt
Overview
In this chapter, we advocate for greater attention to be directed at studying the
influence of perfectionism on health and illness. It is from this perspective that our
chapter presents a critical examination of the role of perfectionism in health
outcomes. Although our analysis focuses primarily on how and why perfectionism
relates to health symptoms, we also examine evidence linking perfectionism with
difficulties in coping with chronic illness—an assessment that highlights how
excessive striving for perfection may be a liability in the context of ongoing health
limitations. We then focus on key mechanisms and processes that render certain
perfectionists particularly vulnerable to health problems. A significant limitation
plaguing the perfectionism and health field is that, aside from a few noteworthy
exceptions, research has been largely atheoretical. To this end, we propose two
potential pathways that may help further our understanding of why perfectionism
might be implicated in poor health outcomes, namely stress and health behaviors.
Introduction
It is important to note at the outset that we view perfectionism as reflecting a
behavioral pattern and cognitive, emotional, and motivational orientation toward
a form of hyper-conscientiousness that is distinguishable from conscientiousness.
We must reiterate from a construct validation perspective that, as conceptualized
by Hewitt and Flett (1991), perfectionism is not simply a positive striving for
excellence. Rather, it is a relentless pursuit of perfection such that the extreme
perfectionist does not simply want to be perfect. He or she demands perfection.
This conceptualization incorporates the irrational importance placed on the need
to be perfect that was described by Albert Ellis (2002) and the workaholic,
compulsive drive to be perfect emphasized by Spence and Robbins (1992).
Perfectionism and Health 201
This proposed difference between hyper-conscientiousness versus

conscientiousness and the associated difference between striving for perfection
versus striving for excellence have very important implications when viewed from
a health perspective. Clearly, conscientiousness is adaptive in terms of health
behaviors and health consequences (Roberts, Walton, & Bogg, 2005) and
examination of specific facets has yielded some evidence indicating that the order
facet of conscientiousness predicts greater longevity (Kern & Friedman, 2008).
Thus, it is hard to deny the benefits of being responsible and striving for excellence.
However, when the perfectionistic individual demands absolute perfection from
the self and from others, this is a taxing and potentially deadly orientation that
results in serious health consequences, especially when perfectionism is combined
with difficulties in adapting to life challenges.
Distinguishing perfectionism from conscientiousness, along with other
complexities, such as important nuances in terms of how personality factors are
assessed and conceptualized, and how they contribute to the onset of illness and less
than optimal responses to illness may, in part, explain why we still know relatively
little about perfectionism’s role in physical health relative to our understanding of
the implications that this personality trait has for individuals’ well-being (Gaudreau
& Verner-Filion, 2012), particularly its consequences for mental health outcomes
(Burgess & DiBartolo, 2016). Indeed, the lack of research focusing on how
perfectionism may confer risk or resilience for health-related outcomes appears to
be a striking omission from the literature given the continuing relevance of
personality for a host of significant health outcomes such as morbidity and early
mortality (Ozer & Benet-Martinez, 2006; Roberts, Kuncel, Shiner, Caspi, &
Goldberg, 2007). Furthermore, many theoretical models have been proposed to
explain the associations of personality in general to health (Smith, 2006; Vollrath,
2006). However, to date none of these models have been explicitly applied for
understanding how perfectionism may relate to physical health. To address these
substantial gaps in the literature we first review the role of perfectionism in health-
related outcomes in both healthy and chronically ill samples. We then shift our
discussion to address possible pathways that may explain how and why perfectionism
is related to a variety of consequential health outcomes.
Perfectionism in Health and Illness in Healthy Samples

It is our contention that individuals high in perfectionism are at an increased risk
for a wide variety of illnesses and health problems. Put differently, excessively high
standards, equating self-worth with success, high levels of self-scrutiny, fear of
failure, and inability to experience satisfaction even when successful contribute to
a maladaptive personality style that is linked with increased vulnerability to health
problems. Indeed, as reflected in the historical review by Flett, Hewitt, and Molnar
(2016), the notion that perfectionism is a vulnerability factor for many health risks
is not new; this theme was clearly evident in the medical and psychological
literatures in the 1930s and 1940s. As part of his seminal work, Alfred Adler
202 Molnar, Sirois, Flett, Janssen, & Hewitt
(1938/1998) posited that the behavior of striving toward complete (and

unattainable) perfection represents a constant source of pressure within the self that
can lead to physiological dysregulation, a notion that is supported by Alexander’s
(1939) account of a hypertensive man with an inferiority complex and a chronic
need to strive for and demonstrate perfection.
Pacht (1984) and Blatt (1995) both emphasized that perfectionism is driven by
a fear of failure, extreme self-scrutiny, and self-criticism and underscored the
notion that perfectionism is unhealthy. In particular, Pacht (1984) observed that a
perfectionistic personality is implicated in myriad dysfunctions that compromise
overall health and well-being such as migraines, irritable bowel syndrome, erectile
dysfunction, ulcerative colitis, depression, anxiety, and eating disorders. Indeed,
several cross-sectional investigations have supported the conclusion reached by
Pacht (1984) and Blatt (1995) that perfectionism is highly relevant in the domain
of health. For instance, perfectionism has been implicated in a host of somatic
problems such as migraine headaches (Burns, 1980), chronic pain (Van Houdenhove,
1986), headaches (Stout, 1984), and asthma (Morris, 1961). Longitudinal
investigations, although relatively few in number, established that elevated
perfectionism does indeed predict the experience of greater health symptoms over
time. Pritchard, Wilson, and Yamnatz (2007), for example, assessed perfectionism
and health symptoms in a sample of undergraduate students at the beginning of the
academic year and then again at the end of the academic year. Their findings
indicated that perfectionism at the beginning of the academic year predicted
experiencing greater health symptoms at the end of the academic year, even after
accounting for initial health symptoms. A similar study by Sumi and Kanda (2002)
that was conducted in Japan with male undergraduates investigated whether
perfectionism predicted increases in health symptoms over a time period of six
weeks. Results indicated that men higher in perfectionism reported experiencing
more somatic symptoms both cross-sectionally and six weeks later after accounting
for initial levels of somatic symptoms.
Although the aforementioned studies offer important insights into the role of
perfectionism in physical health, they are limited because perfectionism was
conceptualized as a unidimensional construct. This is a major drawback because it
is now established that the perfectionism construct is multidimensional, as shown
simultaneously by the work of Frost, Marten, Lahart, and Rosenblate (1990) and
Hewitt and Flett (1990, 1991). Indeed, several models and scales of multidimensional
trait perfectionism continue to be commonly employed (Sirois & Molnar, 2016).
Further, mounting evidence indicates that the prevailing measures of trait
perfectionism may actually assess two underlying higher-order factors (i.e.,
perfectionistic concerns [PC] and perfectionistic strivings [PS]) that tend to be
differentially related to a wide variety of outcomes (Dunkley & Blankstein, 2000;
Frost, Heimberg, Holt, Mattia, & Neubauer, 1993; Stoeber & Otto, 2006). PC
consist of severe self-scrutiny, excessive concern over mistakes and others’
evaluations, beliefs that others demand perfection from the self, perceptions of not
living up to self- or other-imposed exacting standards, and disproportionate
reactions to perceived failures, whereas PS consist of the setting and compulsive

striving toward excessively high standards.
A study by Molnar, Reker, Culp, Sadava, and DeCourville (2006) provides a
vivid illustration of the importance of considering perfectionism as a
multidimensional construct when examining perfectionism in the context of
health. Differentiating socially prescribed from self-oriented perfectionism (see
Hewitt & Flett, 1991) in an adult community sample, this study found that PC
(socially prescribed perfectionism) were associated with poorer health via higher
levels of negative affect and lower levels of positive affect, whereas PS (self-oriented
perfectionism) were associated with better health via lower levels of negative affect
and higher levels of positive affect. Findings from a study conducted by Ofoghi and
Besharat (2010) also emphasize the important of multidimensional conceptions of
perfectionism when examining health. They found in a sample of Iranian adults
that PS (self-oriented perfectionism) were associated with fewer self-reported
physical symptoms and more positive perceptions of health. Conversely, PC
(socially prescribed perfectionism) were associated with experiencing greater
physical symptoms and poorer perceived health. These studies are unique in that
they indicate that perfectionism does not invariably compromise health.
Other studies have highlighted the role of both PC and PS in somatic symptoms.
Martin, Flett, Hewitt, Krames, and Szanto (1996) found that PS (self-oriented
perfectionism) and PC (socially prescribed perfectionism) were positively associated
with physical health complaints in a sample of university students at the level of
bivariate correlations. However, they found that the effect of PC was stronger than
that of PS because only PC continued to be a significant predictor of physical
health complaints when the other study variables were entered into the regression
equation. Moreover, they observed a significant interaction between PC and
self-efficacy when predicting health complaints such that individuals who reported
the highest levels of PC and the lowest levels of self-efficacy reported the poorest
health.
Saboonchi and Lundh (2003) found in a Swedish general population sample
that PS (self-oriented perfectionism) and PC (socially prescribed perfectionism)
were each positively correlated with somatic complaints such as daytime sleepiness,
headaches, tension, and insomnia. Whereas the association between PC and
somatic complaints was statistically significant only for women, PS and PC were
both associated with experiencing more negative affect and less positive affect, a
finding that puts into question the notion that PS represent a healthy form of
perfectionism.
Perhaps the most striking evidence for the role of perfectionism in health comes
from a unique study that examined whether perfectionism is a contributing factor
in all-cause mortality. Fry and Debats (2009) found that PS (self-oriented
perfectionism) was longitudinally predictive of all-cause mortality over a time
period of six-and-a-half years in a sample of older adults (ranging in age from 65 to
87 years) such that individuals with high PS scores (70th percentile and above)
were at a 51% increased risk of death relative to individuals with low PS scores
(30th percentile and below). Moreover, they found that PS remained as a risk
factor for early all-cause mortality once other health-related variables (e.g., age,
social support satisfaction, index of disability in daily life, and the number of
medical visits to health-care providers during the previous year) were accounted
for in the analyses. It is noteworthy that PC were largely unrelated to all-cause
mortality in that study. It is also worth noting that the predictive role of trait
perfectionism was evident when perfectionism was examined along with other
personality traits related to health outcomes (e.g., conscientiousness and
neuroticism).
Collectively, the studies reviewed thus far indicate that perfectionism is indeed
relevant for health, and it is tempting to surmise that perfectionism is a risk factor
for poorer health. However, this research also hints at the idea that PS may not
always be detrimental to health and may even carry some health benefits, given
that PS were associated with better health in some of the studies. Further, these
results were limited to relatively healthy populations, which raises the question of
what the health implications of perfectionism are in not so healthy populations. If
we view living with chronic illness as being akin to living with a chronic stressor,
then the apparent differential relations of PC and PS with physical health may not
necessarily hold for health-challenged populations. To the extent that both
perfectionism dimensions are associated with less adaptive responses and outcomes
when in the context of stressful and limiting circumstances, perfectionism may be
a particular liability for poor health-related outcomes in those with chronic illness.
Moreover, stress and its deleterious effects experienced may be amplified by
attempts to strive for perfection while living in the imperfect world of chronic
illness. In the next section we critically review the literature linking perfectionism
to adjustment in the context of chronic illness.
Perfectionism in Chronic Illness

Although the study of perfectionism in chronic illness is in its infancy, both theory
and preliminary empirical evidence suggest that perfectionism plays an important
role in the etiology and maintenance of several chronic illnesses. Molnar, Sirois,
and Methot-Jones (2016), for example, have proposed a theoretical model in
which perfectionism contributes to poor adjustment and adverse health outcomes
in the context of chronic illness via both intrapsychic (i.e., perceived control and
self-evaluative tendencies) and interpersonal processes (i.e., self-concealment and
social support) through the amplification of stress and maladaptive coping processes.
Indeed, the picture that emerges from the research described below is that
perfectionism appears to amplify stress and maladaptive responses, which, in turn,
complicates adjustment to illness. For example, one investigation found that each
of the subscales of the Frost Multidimensional Perfectionism Scale (FMPS; Frost et
al., 1990) predicted greater tinnitus distress and higher levels of depression and
anxiety among tinnitus sufferers (Andersson, Airikka, Buhrman, & Kaldo, 2005).
This is not surprising in light of the robust associations between perfectionism and
maladaptive coping in both healthy (Dunkley, Solomon-Krakus & Moroz, 2016;

Hewitt & Flett, 2002) and chronically ill samples (Sirois & Molnar, 2014).
A recent review of the literature also reveals robust associations of perfectionism
with poorer mental and physical outcomes among people coping with chronic
fatigue syndrome (see Kempke, Van Houdenhove, Claes, & Luyten, 2016). Luyten
et al. (2011) showed that self-critical perfectionism predicted greater stress
generation which, in turn, predicted depression. The same team of investigators
demonstrated in a large sample of patients with chronic fatigue syndrome that PC
(concern over mistakes and doubts about actions) were associated with depression
and that self-esteem mediated the association between PC and depression (Kempke,
Luyten, et al., 2011). These data illustrate the need to examine self-concept
variables as contributors to the link between perfectionism and health problems in
general and coping with chronic illness in particular.
At first glance, there appear to be differential associations between dimensions
of perfectionism and health-related outcomes in the context of chronic fatigue
syndrome. Kempke, Van Houdenhove, et al. (2011), for example, investigated the
role of PC (as measured by concern over mistakes and doubts about actions) and
PS (as measured by personal standards) on physical health in a sample of adult
patients diagnosed with chronic fatigue syndrome. Findings indicated that only PC
were significantly and positively associated with poorer physical health among
patients and that this association was mediated by depression. These results are
congruent with White and Schweitzer (2000) who also found that patients with
chronic fatigue syndrome scored significantly higher on PC (concern over mistakes
and doubts about actions) than controls.
Research from our labs has found that perfectionism is also related to health
functioning in women with fibromyalgia, a rheumatic condition characterized by
muscular or musculoskeletal pain. Molnar, Flett, Sadava, and Colautti (2012), for
example, found that PC and PS (socially prescribed and self-oriented perfectionism,
respectively) were both associated with lower health functioning in adult women
diagnosed with fibromyalgia. Specifically, in the case of PS, there was a curvilinear
relationship between perfectionism and health such that very low and very high
levels of PS were related to considerable reductions in health functioning whereas
moderate levels appeared to be relatively adaptive (i.e., associated with better
health functioning). Thus, our work builds upon the extant literature to further
demonstrate the complex relationship that exists between specific dimensions of
perfectionism and physical health in the context of chronic illness.
Finally, the deleterious impact of perfectionism in chronic illness is further
illuminated by Flett, Baricza, Gupta, Hewitt, and Endler (2011) who examined the
extent to which trait perfectionism (Hewitt & Flett, 1991) and perfectionistic self-
presentation (Hewitt et al., 2003) are associated with coping and psychosocial
adjustment in patients with Crohn’s disease and ulcerative colitis. The focus on
perfectionism in these individuals was suggested by previous work noting the
prevalence of perfectionism in patients with these illnesses. For instance, psychiatric
evaluations in one study found that 25 of 30 patients with ulcerative colitis had
elevated perfectionism (Holub & Kazubska, 1971). Flett et al.’s (2011) study
showed that both trait perfectionism and perfectionistic self-presentation were
associated with a maladaptive emotional preoccupation form of coping with this
chronic illness. In addition, trait perfectionism and perfectionistic self-presentation
were associated robustly with greater sickness impact ratings in terms of the
psychosocial impact of Crohn’s disease and ulcerative colitis. Importantly, the
pattern of findings described above held even after accounting for the impact of
other personality factors such as conscientiousness and optimism. When they are
conducted, comparative tests show that perfectionism remains a significant
predictor of health outcomes and maladaptive illness responses after taking into
account the effects of broad factors such as neuroticism, conscientiousness, and
optimism (e.g., Fry & Debats, 2009). Consequently, it cannot be concluded that
perfectionism is merely a form of neurotic conscientiousness that is redundant with
broader personality orientations.
Perfectionism and Health: The Stress Pathway

Consistent with models linking personality to health (e.g., Friedman, 2000; Smith,
2006; Suls & Rittenhouse, 1990), the final section of our chapter proposes that
perfectionism may contribute to detrimental health outcomes via a direct, stress-
related route and an indirect, behavioral route. Our discussion is also guided by
theoretical advancements in the field of perfectionism such as the diathesis-stress
model of perfectionism (Hewitt & Flett, 1993, 2002) and the self-regulation
resource model (Sirois, 2015, 2016). Key issues and directions for future research
are also included to further advance this rich and important area of research.
Theoretical models linking personality to health provide a foundation for our
proposed pathway linking perfectionism to health via stress processes. Research
aimed at understanding the effects of stress on the body indicates that stress,
particularly prolonged or chronic stress, negatively impacts virtually all systems of
the body and is linked with all leading causes of early mortality (Cohen, Janicki-
Deverts, & Miller, 2007; Juster, McEwen, & Lupien, 2010). Complementary
findings have been discovered in the field of human psychoneuroimmunology
with studies showing that stressful life events contribute to increased vulnerability
to infectious illnesses such as the common cold (Cohen, Tyrrell, & Smith, 1991;
Cohen & Williamson, 1991; Lacey et al., 2000) as well as adverse health (Jorgensen,
Frankowski, & Carey, 1999).
Segerstrom (2000) hypothesized that personality constructs can affect health via
several different pathways. In particular, personality may directly affect the amount
or quality of stress experienced which, in turn, has downstream effects on the
immune system. However, Segerstrom also cautioned that this pathway is complicated
such that personality contributes to the exposure of stressors and to the resulting
reactivity to these stressful events. In addition, she postulated that other potential
pathways, such as health behaviors, may contribute to health-related outcomes either
by exacerbating the effects of stress or by having direct effects on health.
According to the diathesis-stress model of perfectionism (Hewitt & Flett, 1993,

2002) stress can mediate (i.e., represent an explanatory pathway from perfectionism
to health) or moderate (i.e., exacerbate or ameliorate risk or resilience) the
relationship between perfectionism and psychopathology. Specifically, Hewitt and
Flett focused on four important aspects of stress: stress generation, stress anticipation,
stress perpetuation, and stress enhancement. With respect to stress generation,
Hewitt and Flett (2002) suggested that perfectionists are extensively engaged in
stress exposure by continuously pursuing impossible standards. Another possibility
is that perfectionists may generate extensive interpersonal conflict by feeling
pressured by others, or by finding fault with others (see also Chapter 9).
An overview of existing research and theory on perfectionism and stress is
provided below. First, however, we consider two key questions that have not been
the subject of extensive consideration thus far in the perfectionism and health field:
When considering possible pathways to illness for perfectionists, why is it important
to focus extensively on the role of stress in perfectionism and health? And, given
the heterogeneity that exists among perfectionists, which perfectionists are most
susceptible to the stress-induced health problems?
Regarding the first question, our focus on the role of stress is based on our
contention that perfectionists, relative to nonperfectionists, are faced with
substantially higher, if not overwhelming levels of stress throughout their lives.
This stress can come in many forms. Typically, researchers have focused on the
stress that is a result of experiencing major life events and daily life hassles (see
Hewitt & Flett, 2002). However, other forms of stress are also quite commonly
experienced. For instance, research on interpersonal perfectionism and self-critical
perfectionism shows that perfectionism is associated with a greater frequency of
negative social interactions (Dunkley, Sanislow, Grilo, & McGlashan, 2006; Flett,
Hewitt, Garshowitz, & Martin, 1997) and daily event studies point to a link
between perfectionism and a tendency to both experience and contribute to
interpersonal conflicts (Mackinnon et al., 2012; Sherry, Gralnick, Hewitt, Sherry,
& Flett, 2014). This evidence should be particularly disconcerting for perfectionists
given the substantial impact that negative social exchanges can have on people in
terms of their health and well-being.
We maintain that the link between perfectionism and stress has been
underestimated in most research investigations because perhaps the most salient
form of stress for perfectionists has seldom been assessed: pressure. Extreme
perfectionists are under constant and unrelenting pressures to be perfect or to seem
perfect and live up to their own self-imposed demands or the demands of other
people. It is when these pressures are considered that the difficulties and challenges
facing successful perfectionists are perhaps most apparent because being successful
means that the ongoing pressures to be perfectly successful can become even
greater. We maintain that these pressures will lead to emotional and physical
exhaustion, especially among those perfectionists who evaluate their lives according
to the activity-based self-worth contingency identified by DiBartolo, Frost, Chang,
LaSota, and Grills (2004). This self-worth contingency is based on the notion that,
for perfectionists to feel good about themselves (or avoid feeling bad about
themselves), they must be active and they must be striving at all times.
Weiten (1998) has examined pressure as a form of stress, and he developed a
multifaceted inventory that yields an overall assessment of pressure, as well as
pressure in various life domains (e.g., family, school) and self-imposed pressure.
Previously, Hewitt and Flett (2002) reported unpublished results showing in
sample of 100 students that self-oriented perfectionism and socially prescribed
perfectionism were associated with elevated pressure as assessed by Weiten’s (1998)
Pressure Inventory. Moreover, there was a robust correlation of r = .65 between
overall pressure and scores on the Perfectionism Cognitions Inventory (PCI) which
assesses the frequency of current automatic thoughts involving perfectionism (Flett,
Hewitt, Blankstein, & Gray, 1998). We have reexamined these associations in a
second sample of 104 university students and found that self-oriented perfectionism
was not associated with overall pressure scores, though it was linked positively with
school-related pressure. However, associations were found once again between
overall pressure and both socially prescribed perfectionism (r = .37) and PCI scores
(r = .54).
An insightful study by Stoeber and Rennert (2008) also illustrates the potential
destructiveness of pressure. They evaluated perfectionism and the correlates of
burnout in 118 secondary-school teachers. They developed three measures to
assess the extent to which teachers felt a pressure to be perfect emanating from
colleagues, students, and students’ parents. Their results showed that all three forms
of pressure were associated with emotional exhaustion, depersonalization, and
overall levels of burnout as well as negative cognitive appraisals involving threat
and loss. Given that such pressures can be quite unrelenting, it seems that pressure
is a form of stress that can have a profound negative influence on the health and
well-being of vulnerable perfectionists.
As for our second question of which perfectionists are most susceptible to stress-
related health problems, we maintain that the most susceptible perfectionists are
the people who have the “perfectionistic reactivity” that was described recently by
Flett and Hewitt (2016). The essence of the perfectionistic reactivity concept is
that much of the vulnerability and risk inherent in feeling a pressure to be perfect
is based on how people react when their daily events and experiences are not
perfect and they see that their lives are not working out in a manner that fits with
their idealized vision of how life should be. According to Flett and Hewitt,
perfectionistic reactivity includes a wide range of maladaptive cognitive, emotional,
motivational, and behavioral reactions that reflects the all-or-none self-evaluative
tendencies of perfectionists. At the cognitive level, this includes an extensive array
of various forms of perseverative cognitions. The concept of perfectionistic
reactivity when viewed from a cognitive perspective has clear health implications
in light of the findings that support Brosschot, Gerin, and Thayer’s (2006)
perseverative cognition hypothesis (see also Flett, Nepon, & Hewitt, 2016).
We contend that the perfectionists who are most likely to be susceptible to
health problems are those reactive perfectionists who are also particularly prone to
make extreme negative inferences about themselves. These negative inferences can
come in the form of an abiding sense of shame and the sense that the inadequacies
and characterological deficits in the self have been exposed and are on display for
everyone to see. Perfectionists who are overcome by a sense of shame must come
to terms with the sense of being exposed, but also their own personal sense of
being exposed to themselves as individuals who are not perfect and likely never
will be perfect.
But it is even more problematic for distressed, demoralized, and defeated
perfectionists when the stress, pressures, and sense of inadequacy that they are
experiencing combine to create a deep sense of hopelessness that contributes to a
sense of coping inefficacy. Hopelessness is different from helplessness or pessimism
in that the negative outcome expectancies are accompanied by a profound sense of
being incapable of doing anything to overcome the stressors and pressures facing
the individual. We suggest that certain perfectionists are highly susceptible to
hopelessness and this can have grave consequences given the growing literature of
the role of hopelessness in both the etiology of health problems and the exacerbation
of existing health problems (e.g., Kuosmanen et al., 2016). A general form of
global hopelessness should be a strong mediator of the link between perfectionism
and health problems, but a more specific form of social hopelessness should serve
as a mediator of the link that interpersonally based components of the perfectionism
construct (i.e., socially prescribed perfectionism and perfectionistic self-presentation)
have with physical health indices. In light of these observations, research is clearly
needed to examine the role of possible mediators that reflect the negative self-
evaluative tendencies of vulnerable perfectionists.
Finally, it is important to remain cognizant of the fact that there is substantial
heterogeneity among perfectionists, and some perfectionists have been dealing
with a level of stress that started very early in their lives. Flett, Hewitt, Oliver, and
Macdonald (2002) described several developmental models that delineate pathways
to perfectionism, and one of these models (i.e., the social reaction model) suggests
that striving to be perfect is a lifelong coping response for some people. Some
people have a perfectionistic orientation that is underscored by an extensive history
of early adversities, and their perfectionism is largely an attempt to limit further
stressors and traumas. We noted in a recent commentary that the notion that
certain perfectionists have experienced significant trauma has not received extensive
consideration in the literature thus far (see Flett, Molnar, & Hewitt, 2016), and it
is important that this void in the literature is addressed sooner rather than later.
One potentially important focus within this area of research is to assess the physical
health status of perfectionists in terms of not only their current experiences, but
also their possible past history of traumatic experiences.
With these concepts in mind, we now provide an overview of the existing
literature on perfectionism and stress. In general, research has supported Hewitt
and Flett’s (1993, 2002) notion that perfectionism generates stress, which, in turn,
leads to greater psychopathology and a poorer sense of well-being over time (see
Dunkley et al., 2016). For instance, Chang, Watkins, and Banks (2004) found that
stress fully mediated the relationship between perfectionism and negative affect
among Black women and partially mediated the relationship among White women.
Employing daily diary methodology over a six-month period with a sample of
community adults, Dunkley, Ma, Lee, Preacher, and Zuroff (2014) found that PC
(self-critical perfectionism) predicted daily elevations in negative affect and more
persistent negative affect via two stress-related processes: the “disengagement
trigger pattern” and the “disengagement maintenance pattern,” respectively (p. 93;
see also Chapter 11). Each of these patterns consists of negative appraisals about the
self (e.g., event stress) and negative appraisals concerning others (e.g., perceived
criticism) along with coping strategies that are characterized by disengagement
(e.g., avoidant coping) that mediated links between PC and increases in daily
negative affect (disengagement trigger pattern) and more persistent negative affect
across six months (disengagement maintenance pattern). Furthermore, as noted
above, Luyten et al. (2011) have provided initial evidence for stress generation
among self-critical perfectionists coping with illness. Taken together, these results
provide strong support for the notion that some perfectionists generate stress for
themselves and that this stress is, in part, created by their reliance on negative
cognitive appraisals and their use of avoidant coping strategies.
Once stress is generated, perfectionists are at risk for distress and, as we now
suggest, they are also prone to health problems, due to their heightened stress
reactivity and their inability to regulate their stress levels. Recent data from a study
that used a multifaceted self-report measure of vulnerability to stress reactivity
suggest that perfectionists are highly reactive to failure experiences. Also, people
with elevated levels of socially prescribed perfectionism and frequent thoughts
about needing to be perfect are highly reactive to social evaluation and reported
more prolonged stress reactivity (Flett, Nepon, Hewitt, & Fitzgerald, in press).
Likewise, a longitudinal study of stress in students found that perfectionistic students
transitioned into a higher stress category after experiencing academic failure (Rice,
Ray, Davis, DeBlaere, & Ashby, 2015). This finding also highlights the merits of
applying the diathesis-stress model by underscoring the role of the social context.
Experimental evidence also supports the link between perfectionism and stress
reactivity. For example, McGirr and Turecki (2009) found in a community sample
of adults that self-criticism (a construct that forms part of self-critical perfectionism)
predicted greater stress reactivity as evidenced by higher salivary alpha-amylase (a
biomarker of stress) after exposure to a psychosocial stressor. Furthermore, Wirtz
et al. (2007) found in their study of middle-aged men that PC (particularly concern
over mistakes) were associated with higher cortisol stress reactivity, including
hypothalamic-pituitary-adrenal (HPA) axis activation in response to a psychosocial
stressor. A subsequent study of maladaptive perfectionism by Richardson, Rice,
and Devine (2014) found evidence of stress reactivity with respect to cortisol stress
response following exposure to a stress test that involved social-evaluation threats.
Maladaptive coping styles and other maladaptive responses, which also tend to
characterize perfectionists, contribute to stress reactivity, anticipation, and
perpetuation (see Dunkley et al., 2016, and Chapter 11). It has already been noted
within the context of chronic health problems that people high in perfectionism
tend to rely on an emotion-oriented coping style that can exacerbate health
problems (Flett et al., 2011; Sirois & Molnar, 2014). More generally, Flett, Nepon,
and Hewitt (2016) provide compelling evidence to support their cognitive model
of perfectionism, which posits that both PC and PS contribute to chronic forms of
cognitive perseveration, such as rumination, resulting in the protraction of the
stress response that has downstream effects for adverse health outcomes.
Although there is relatively little empirical work on the proposed perfectionism,
stress, and health pathway, some research does support the validity of our assertion.
Initially, Fry (1995) established that trait perfectionism combines with daily hassles
to produce elevated physical symptoms. Organista and Miranda (1991) similarly
showed that perfectionism interacts with life events to predict psychosomatic
symptoms. Specifically, individuals higher in perfectionism who also experienced
a high number of events that threatened self-esteem showed elevated psychosomatic
symptoms. The results of these studies accord with findings indicating that
perfectionists exposed to stress tend to have health-related reactions (Dittner,
Rimes, & Thorpe, 2011) and the experience of daily hassles seems to underscore
the link between trait perfectionism and headaches (Bottos & Dewey, 2004).
The likely importance of exposure to chronic stress should not be underestimated
given that socially prescribed perfectionism entails chronic and ever-present stress
due to the sense of hopelessness about ever being able to please others and meet
their impossible demands (Hewitt & Flett 2002). Chronic stress also plays an
especially important role in health and disease because it is a known precursor of
allostatic load or “wear and tear” on the body, which lays the groundwork for the
development and exacerbation of illness and disease (Cohen et al., 2012; Juster et
al., 2010). Consequently, the chronic exposure to stress, or “toxic stress,”
experienced by perfectionists due to their constant strivings, internal pressures, and
ruminative tendencies can be considered a direct health risk.
Indeed, theory and research support this contention. With respect to chronically
ill samples, Kempke et al. (2016) implicate stress processes as central mechanisms
that explain perfectionism’s role in both the etiology and maintenance of chronic
fatigue syndrome. More specifically, the theoretical model put forth by Kempke
and colleagues posits that perfectionism has downstream effects for cumulative
stress that over time creates “wear and tear” on the body. This cumulative stress
leads to dysregulation of the HPA axis, which, in turn, results in stress intolerance
and then chronic fatigue. Increasing evidence supports their model, as findings
indicate that PC is linked to chronic stress and to changes in the neurobiological
functioning implicated in chronic fatigue syndrome (Van Houdenhove, Luyten, &
Kempke, 2013). These intriguing findings may also provide important insights that
generalize to other illness groups and to healthy samples.
Concerning general samples, Flett, Molnar, Nepon, and Hewitt (2012)
examined perfectionism, daily hassles, and psychosomatic symptoms in 228
university students. Perfectionism was assessed in terms of perfectionistic automatic
thoughts using the PCI, and they found that daily hassles mediated the link between
perfectionism and psychosomatic symptoms. A more comprehensive investigation

by Molnar, Sadava, Flett, and Colautti (2012) involved a web-based survey that
was completed by 538 undergraduate students. Molnar et al. found that there was
a positive association between socially prescribed perfectionism and poor health,
and that this association was fully mediated by higher levels of perceived stress and
lower levels of perceived social support. Further, these findings held even after
accounting for the effects of conscientiousness and neuroticism, thus attesting to
the unique predictive ability of perfectionism.
Collectively, a burgeoning research literature lends support to the notion that
stress is a key pathway linking perfectionism to health and illness. Given findings
demonstrating that perfectionism is implicated in stress processes—namely stress
generation, reactivity, anticipation, and perpetuation—researchers are encouraged
to assess multiple indicators of stress that tap each of these related, yet distinct,
processes. Examination of specific stress processes will not only provide a much
more fine-grained analysis of how perfectionism contributes to stress and health,
but will directly inform prevention and intervention efforts aimed at ameliorating
the deleterious effects of perfectionism on adverse health outcomes. Programmatic
research employing prospective longitudinal designs to explore the mutual effects
of cumulative toxic stress and its resulting allostatic load also provides a valuable
unifying framework to further explore associations between perfectionism
and health over the life course. Although research on the daily impact of
perfectionism on well-being, including stress and psychopathology, is
accumulating (Dunkley, et al., 2014; Dunkley, Zuroff, Blankstein, 2003; see also
Chapter 11), research employing daily diary methodology is also needed to
further understand the processes that link perfectionism to stress and physical
health at a more immediate level.
Perfectionism and Health: The Health Behaviors Pathway

A second and equally important pathway linking perfectionism to physical health
outcomes is that of health behaviors. Commonly referred to as modifiable risk
factors for the prevention of illness (World Health Organization, 2011), health-
promoting behaviors such as healthy eating, regular activity, and good sleep
behaviors are well recognized as key factors for determining health trajectories and
associated outcomes such as morbidity and mortality (Bogg & Roberts, 2013;
Hampson, Goldberg, Vogt, & Dubanoski, 2007). Conversely, smoking, excessive
alcohol use, sedentary behaviors, and an unhealthy diet are established determinants
of poor health and disease (World Health Organization, 2011). Despite these
obvious links to physical health, and the recognized role of health behaviors within
personality and health models, understanding how and why perfectionism may
foster or prevent the practice of important health-promoting behaviors remains a
largely understudied area within the perfectionism and health literature. At the
time of this writing there were only six published studies available on this topic
(Andrews, Burns, & Dueling, 2014; Chang, Ivezaj, Downey, Kashima, & Morady,
2008; Harrison & Craddock, 2016; Molnar, Sadava, et al., 2012; Sirois, 2016;
Williams & Cropley, 2014).
Among this handful of studies that examine perfectionism and health-promoting
behaviors, there are both consistencies and inconsistencies depending on the way
in which perfectionism and health behaviors are conceptualized and measured. In
terms of consistencies, the available evidence generally indicates that PC are
associated with less frequent practice of health-promoting behaviors. For example,
in research conducted by Chang et al. (2008) and Williams and Cropley (2014),
PC (concern over mistakes, doubts about actions, socially prescribed perfectionism)
as well as perceived parental pressure to be perfect (parental expectations, parental
criticism) were negatively associated with measures of general health behaviors,
which included positive health behaviors (e.g., healthy eating, regular exercise) and
avoidance of negative or health risk behaviors (e.g., smoking). The negative link
between PC and health-promoting behaviors has also been noted in undergraduate
students in both cross-sectional research (Harrison & Craddock, 2016; Molnar et
al., 2012) and short-term longitudinal research (Andrews et al., 2014) in which PC
were measured with scales capturing socially prescribed perfectionism (Hewitt &
Flett, 1991) and negative perfectionism (Terry-Short, Owens, Slade, & Dewey,
1995), respectively. Notably, these findings have also been replicated in a study
with community adults (Sirois, 2016) where PC (socially prescribed perfectionism)
were negatively associated with a validated measure of the frequency of general
health-promoting behaviors (i.e., regular exercise, healthy eating habits, stress
management). The convergence of these findings with respect to PC is particularly
notable given the variety of measures used to assess this perfectionism dimension
across the different studies.
With respect to PS, the findings are less consistent. Across the six published
studies, PS were positively associated with measures of health behavior in only two
studies (Andrews et al., 2014; Williams & Cropley, 2014). In the other four studies,
PS were either not significantly associated with health behaviors (Harrison &
Craddock, 2016; Molnar, Sadava, et al., 2012; Sirois, 2016) or were sometimes
related and sometimes unrelated to health behaviors depending on the perfectionism
measure that was used (Chang et al., 2008).
Further evidence that PC and PS are differentially related to health behaviors
comes from a meta-analysis of data sets from one of the authors’ lab. Across all
seven data sets (N = 2,213) which included both community and student samples,
PC were significantly associated with lower scores on a measure assessing the
frequency of a range of health-promoting behaviors (average r = –.21) whereas PS
were significantly associated with higher scores in three of the seven data sets and
not significantly associated in the remaining four data sets (Sirois, 2013).
Accordingly, the average association of PS with the frequency of health-promoting
behaviors was not statistically significant (average r = .09).
Having addressed the question of how perfectionism may be linked to health
behaviors, we now turn our attention to the important question of why perfectionism
may be linked to the practice of health behaviors. As noted previously, there has
been little research focused on this perfectionism–health pathway, and less still on
understanding the potential mechanisms that might explain the differential relations
of perfectionism dimensions to health behaviors. Emerging theory and research
suggest that differences and deficits in self-regulation capacities may help explain
why PC create risk for health behaviors and subsequent health whereas PS may not
pose a risk. Self-regulation, the capacity of being able to control one’s thoughts,
feelings, and actions (Forgas, Baumeister, & Tice, 2009), is critical for the
performance of health behaviors. Health behaviors often require forgoing
immediate desires, temptations, and pleasures in lieu of the long-term rewards
associated with maintaining good health and reducing the risk of disease.
Accordingly, successful performance of health behaviors can be compromised
when self-regulation capacities or resources are depleted.
The self-regulation resource model (SRRM; Sirois, 2015, 2016) is one
theoretical approach that has been applied for understanding why perfectionism
may relate to health behaviors. Derived from research on the role of affect in
self-regulation, the SRRM posits that individuals will be more likely to engage
in health behaviors to the extent that they have available internal resources, such
as positive affect and a future time-orientation, and low levels of negative affect.
Negative affect is one key factor that can threaten self-regulation and derail the
practice of important health behaviors (Wagner & Heatherton, 2015), in part
because it saps valuable resources needed for effective self-regulation (Sirois,
2015; Sirois & Hirsch, 2015). Not surprisingly, PC, but not PS, are robustly
associated with high levels of negative affect, including stress and anxiety (Sirois,
2016), which is consistent with this self-regulation view of perfectionism and
health behaviors. In a direct test of the SRRM’s view of perfectionism and health
behaviors, higher levels of negative affect explained in part the association
between PC and fewer health behaviors in a community sample of adults (Sirois,
2016). Together, this theory and evidence suggest that the frequent and negative
thoughts about not having attained goals or of not living up to other people’s
standards, which characterize PC, may drain the self-regulation resources needed
to perform important health behaviors, and therefore create risk for poor health
outcomes.
The higher levels of stress associated with perfectionism, and PC in particular,
noted earlier, may also have some spillover effects with respect to health behaviors.
Research has demonstrated that stress interferes with the practice of a range of
health-promoting behaviors (Sirois, 2007). From a self-regulation perspective, this
make sense if we consider that stress is experienced as a negative emotional state,
and therefore is expected to be disruptive to effective self-regulation. Indeed, in
the meta-analysis of seven data sets noted previously (Sirois, 2013), this hypothesis
was tested in five of the seven data sets with a mediation analysis. In all five data
sets, stress was a significant mediator of the relationship between PC and fewer
health-promoting behaviors, with standardized paths (betas) ranging from –.16 to
–.60. Although more research is clearly needed to confirm and expand on these
findings to better understand the potential cross-over associations between the
stress and health behavior pathways linking perfectionism to health outcomes, this
preliminary evidence provides one of the first theoretically driven views of why
PC may compromise the practice of important health behaviors.
Conclusions and Future Directions

In this chapter we provided evidence supporting perfectionism’s role in health-
related outcomes in both healthy and chronically ill populations. Using theories
linking personality to health along with the diathesis-stress model of perfectionism
(Hewitt & Flett, 1993, 2002) and the self-regulation resource model (Sirois, 2015,
2016) as guiding conceptual frameworks, we further underscored the importance
of both stress processes and health behaviors as potential mechanisms that may
explain how and why perfectionism may contribute to health and illness. What is
now required is conceptually driven and methodologically sound research that will
enable us to gain a better appreciation and understanding of the associations that
perfectionism has with illness and the mechanisms and processes that contribute to
this association. Future research would also benefit from an examination of
potentially important moderators of the stress and health behavior pathways to
identify the conditions under which these pathways are enhanced or ameliorated.
It could be argued, for example, that the stress pathway from perfectionism to
health is enhanced when individuals perceive that they are not meeting their
excessively high standards or, in other words, are high in perfectionistic discrepancy
(Slaney, Rice, Mobley, Trippi, & Ashby, 2001).
A significant limitation plaguing this field is researchers’ reliance on singular and
self-reported measures of health. Whereas self-reported measures of health, such as
perceived health, are certainly important to capture health outcomes prospectively
predicting morbidity and mortality (Guimaraes et al., 2012), they are not sufficient
to address the complex associations among perfectionism, stress, health behaviors,
and health. Consequently, we encourage researchers to conduct multi-method and
multi-informant studies that better reflect biopsychosocial models of health (e.g.,
Engel, 1977; Suls & Rothman, 2004). It is our hope that research in this area will
also continue the important trend of establishing that health costs associated with
perfectionism are not simply a byproduct of individual differences in broader
personality constructs such as higher levels of neuroticism or lower levels of
conscientiousness and optimism. We believe that there are particular health risks
that accompany extreme perfectionism, and this is a unique vulnerability that is
distinguishable from the health risks and associated factors that are central to these
other personality styles. Once the unique health risks associated with perfectionism
are more fully documented, it will be important to develop a research agenda that
focuses on developing and implementing a preventive approach that jointly aims at
reducing perfectionistic strivings and concerns and bolstering levels of resilience
among at-risk perfectionists who may profit from striving for excellence rather
than perfection.
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11
PERFECTIONISM AND DAILY STRESS,
COPING, AND AFFECT
Advancing Multilevel Explanatory
Conceptualizations
David M. Dunkley
Overview
The main goal of this chapter is to explicate a multilevel explanatory
conceptualization of the role of perfectionism in the daily stress, coping, and
adjustment process. To this goal, I will review studies of university students,
community adults, and depressed patients which used a daily diary method to
examine stress and coping patterns that trigger and maintain daily negative and
positive affect. First, I discuss factor-analytic results identifying personal standards
and self-critical higher-order dimensions of perfectionism and appraisal, coping,
and affect constructs across both situational and dispositional levels. Second, I
examine a within-person trigger model to synthesize several distinct appraisal (e.g.,
perceived event stress) and coping (e.g., avoidant coping) processes that commonly
operate together when the typical individual experiences daily changes in negative
affect and positive affect. I then discuss the differential stress reactivity and coping
(in)effectiveness of perfectionistic individuals to daily stressors. Third, I examine a
between-persons maintenance model to explain how individuals with higher self-
critical perfectionism experience persistent daily negative affect and low positive
affect because of certain maintenance tendencies (i.e., daily stress appraisals,
avoidant coping, low perceived social support). In parallel, I examine problem-
focused coping tendencies that might contribute to compensatory experiences of
positive affect for individuals with higher personal standards perfectionism. Fourth,
I illustrate the trigger and maintenance patterns with a case illustration. Finally, I
discuss the clinical and practical implications of the reviewed studies’ findings for
helping perfectionistic individuals manage stressors and distressing emotions and
bolster resilience in everyday life.
Perfectionism and Daily Stress 223
Introduction
Over the past three decades, the perfectionism construct has become viewed as a
multidimensional construct and has been conceptualized and defined in many
different ways (see Flett & Hewitt, 2002; see also Chapter 1). Three multidimensional
conceptualizations have generated considerable interest, including those of Frost
and colleagues (Frost, Marten, Lahart, & Rosenblate, 1990), Hewitt and Flett
(1991), and Slaney and colleagues (Slaney, Rice, Mobley, Trippi, & Ashby, 2001).
Factor-analytic studies have consistently identified two higher-order dimensions of
perfectionism that underlie the many different perfectionism constructs and
measures in nonclinical samples (e.g., Dunkley, Blankstein, & Berg, 2012) and
clinical samples (e.g., Clara, Cox, & Enns, 2007; Dunkley et al., 2017; see Stoeber
& Otto, 2006). These two higher-order dimensions have been referred to as
personal standards (PS) perfectionism and self-critical (SC) perfectionism, respectively
(e.g., Dunkley, Zuroff, & Blankstein, 2003). PS perfectionism involves the setting
of and striving for high standards and goals for oneself. PS perfectionism measures
include the personal standards scale of Frost et al.’s (1990) Multidimensional
Perfectionism Scale (FMPS), the self-oriented perfectionism scale of Hewitt and
Flett’s (1991) Multidimensional Perfectionism Scale (HF-MPS), and the high
standards scale of Slaney et al.’s (2001) Almost Perfect Scale-Revised (APS-R). On
the other hand, SC perfectionism involves constant and harsh self-scrutiny and
overly critical self-evaluation tendencies that are closely linked with chronic
concerns about others’ criticism and disapproval (e.g., Dunkley et al., 2003). SC
perfectionism measures include FMPS concern over mistakes, HF-MPS socially
prescribed perfectionism, and APS-R discrepancy as well as the self-criticism scores
of the Depressive Experiences Questionnaire (Blatt, D’Afflitti, & Quinlan, 1976)
and the Dysfunctional Attitude Scale (Weissman & Beck, 1978).
In contrast to PS perfectionism measures, SC perfectionism measures have been
consistently related to depressive and anxious symptoms (see Dunkley, Blankstein,
Masheb, & Grilo, 2006; Stoeber & Otto, 2006). Further, several studies have
supported SC perfectionism as a prospective predictor of psychosocial maladjustment
over periods ranging from several months (e.g., Rice, Leever, Christopher, &
Porter, 2006; Sherry, Mackinnon, Macneil, & Fitzpatrick, 2013) to several years
(Dunkley, Sanislow, Grilo, & McGlashan, 2006, 2009; Mandel, Dunkley, &
Moroz, 2015). Additionally, SC perfectionism has been shown to be relatively
resistant to change and have a negative impact on outcome across different forms
of psychotherapy (Blatt & Zuroff, 2005; Kannan & Levitt, 2013).
To improve evidence-based practice, it is critical to address person-centered
explanatory questions (e.g., “Why do individuals with higher SC perfectionism
keep having difficulties?”) that are essential to help achieve the two overarching
therapy goals of reducing clients’ distress and bolstering their resilience (Kuyken,
Padesky, & Dudley, 2009; Persons, 2012). In cognitive-behavior therapy (CBT),
therapists emphasize the present in gathering records summarizing patients’
thoughts, feelings, and behaviors for many situations of daily life (e.g., “I worried
224 Dunkley
I would be blamed when others noticed the mistake I made in my report, so I gave
up and was late finishing the report, and I felt really sad and afraid”). Therapists
then develop cross-sectional explanatory conceptualizations by searching for
themes and patterns across numerous situations when clients’ presenting issues are
activated to identify triggers and maintenance factors (Kuyken et al., 2009). Trigger
patterns can be understood as time-proximal state-level (within-person) effects
whereas maintenance patterns are better understood as disposition-level (between-
persons) effects.
Identification of Coping Trigger and Maintenance Factors

Cognitive appraisals and coping are emphasized as critical explanatory processes in
the relationship between stressful person-environment relations and outcomes by
the cognitive theory of psychological stress and coping developed by Lazarus and
colleagues (e.g., Lazarus & Folkman, 1984). Changes in stress, cognitive appraisals,
and coping occur across situational contexts in perfectionistic individuals who can
also be characterized as having stable dispositions with respect to perceived stress,
cognitive appraisals, and coping (Dunkley et al., 2003).
Although there are many ways to group coping responses within the broad
domain of coping, one of the oldest and most often used distinctions is between
disengagement/avoidant coping responses, which are aimed at escaping the stressor
and are emotionally negative, and engagement/approach responses, which are
aimed at dealing with the stressor and are emotionally positive (Carver & Connor-
Smith, 2010; Skinner, Edge, Altman, & Sherwood, 2003). One fundamental
barrier to the study of coping is that the most often used situational coping measures
(i.e., measures assessing responses to a single, specific stressor) consist of behaviorally
oriented coping scales that measure thoughts and behaviors that are not applicable
to many situations (Aldwin, 2007; Stone & Kennedy-Moore, 1992). For example,
in considering the items of the planful problem-solving scale of the Ways of Coping
Inventory (e.g., Folkman & Lazarus, 1985), one might endorse “I made a plan of
action and followed it” without endorsing “I came up with a couple of different
solutions to the problem” for any specific situation. These kinds of situational
coping scales usually have an unstable factor structure and poor internal consistency,
and are difficult to combine factor-analytically to form broad, internally consistent,
coping constructs. Without internally consistent situational coping measures, it is
difficult to provide precise and meaningful interpretations of individual scale scores
and broader coping dimensions, and coping researchers will be unable to detect
existing relationships (see Folkman, 1992; Stone & Kennedy-Moore, 1992; Watson
& Hubbard, 1996).
An alternative approach to the assessment of situational coping is the use of
construct-oriented measures that are guided by theory (see Stone & Kennedy-
Moore, 1992) such as those of the COPE (Carver, Scheier, & Weintraub, 1989).
The content of the items for each of the COPE scales, such as planning (e.g., “I
tried to come up with a strategy about what to do,” “I made a plan of action”),
directly assess the underlying meaning of coping responses, and the wording of
items is general enough to apply to many specific situations (e.g., work deadlines,
interpersonal conflicts). Theory-guided situational coping scales are likely to
exhibit good internal consistency, be meaningfully subjected to factor analysis, and
be cross-situationally applicable (Stone & Kennedy-Moore, 1992; Watson &
Hubbard, 1996).
Using a daily diary methodology, we found support for the within-person and
between-persons reliabilities of six situational COPE scales assessing avoidant coping
(behavioral disengagement, mental disengagement, denial), problem-focused coping
(active coping, planning), and positive reinterpretation (a form of emotion-focused
coping) in nonclinical adults (Dunkley, Ma, Lee, Preacher, & Zuroff, 2014) and
depressed patients (Dunkley et al., 2017). The within-person reliabilities of these six
scales ranged from moderate to high across the nonclinical adult and depressed
patient samples, demonstrating the ability of the scales to detect differences in
systematic changes of persons over days. The between-persons reliabilities were all
high across the nonclinical and depressed samples, demonstrating the ability of the
scales to differentiate persons at the average daily level. Further, we demonstrated
the feasibility of combining situational coping scales into internally consistent,
higher-order latent constructs (i.e., avoidant coping, problem-focused coping) at
both situational (within-person) and dispositional (between-persons) levels (see
Folkman, 1992; Stone & Kennedy-Moore, 1992). Standardized factor loadings
ranged from .34 to .85 for the within-person model across the nonclinical adult and
depressed patient samples. This supported that the indicators of the avoidant coping
and problem-focused coping latent factors were systematically triggered together in
a variety of daily situations for the typical individual. Standardized factor loadings
ranged from .41 to .98 for the between-persons model across the nonclinical and
depressed samples. This supported that the indicators of the daily avoidant coping
and problem-focused coping latent factors were maintained together at the average
daily level to differentiate individuals.
Thus, relative to behaviorally-oriented measures of situational coping that are
not generalizable to many situations, our results support the promise of theoretically
derived coping scales with cross-situationally applicable items when assessing
situational coping in the context of various stressors of everyday life for both
nonclinical adults and individuals with depression (see Stone & Kennedy-Moore,
1992). Similarly, the latent factors for event stress, perceived social support, negative
affect, and positive affect were supported across levels, suggesting that these factors
are also replicable when situational and dispositional covariation are modeled.
Most importantly, the appraisal, coping, and affect constructs were supported as
meaningful and interpretable building blocks for testing explanatory models of
perfectionism and daily stress, coping, and adjustment processes at both situational
and dispositional levels.
226 Dunkley
Triggers of Daily Affect: Perfectionism, Stress, and

Coping Patterns
Cognitive appraisals, coping strategies, interpersonal influences, and affect
constantly influence each other in stressful situations (Aldwin, 2007; Kuyken et al.,
2009; Lazarus, 2000). We use the term coping action patterns to refer to sets of
appraisals, behaviors, and emotions that are commonly in play together across
many different stressors (see Skinner et al., 2003). Based on an integration of
various theoretical perspectives, our model (Dunkley et al., 2017; Dunkley, Ma, et
al., 2014) articulated disengagement, engagement, and counteraction patterns
consisting of sets of stress appraisals, coping responses, and emotions that are
organized around overarching concerns about competence central to perfectionistic
individuals’ difficulties (A. T. Beck, 1983; Blatt, 2004; Blatt et al., 1976). Figure
11.1 illustrates our theoretical model and findings that elucidate trigger patterns
that are connected to within-person changes in daily negative and positive affect
(Dunkley et al., 2017; Dunkley, Ma, et al., 2014).
Disengagement Trigger Patterns

Daily disengagement trigger patterns involve negative social (e.g., perceived
criticism) and self- (e.g., event stress) appraisals and disengagement coping strategies
(e.g., avoidant coping) that commonly operate together to orient the individual’s
attention away from many daily stressors, and these patterns are connected to
within-person increases in negative affect for the typical individual. In both a
community sample of nondepressed adults (Dunkley, Ma, et al., 2014) and a
clinical sample of depressed patients (Dunkley et al., 2017), we found that, across
many daily stressors, when the typical individual perceives more criticism from
others than usual, he or she uses more avoidant coping and perceives higher event
stress than usual, and this is connected to daily increases in negative affect and
decreases in positive affect (see Figure 11.1, paths aWdWgW and aWdWhW). In
addition, we found that lower perceived control than usual was related to more
avoidant coping than usual which in turn was indirectly related to daily increases in
negative affect and decreases in positive affect through event stress (Figure 11.1,
paths cWdWgW and cWdWhW).
Engagement and Counteraction Trigger Patterns
Engagement Trigger Patterns

Daily engagement trigger patterns involve constructive social (e.g., perceived
social support) and self- (e.g., perceived control) appraisals and engagement
coping strategies (e.g., positive reinterpretation, problem-focused coping) that
commonly facilitate one another to orient the individual’s attention toward many
daily stressors, and these patterns are linked to within-person increases in daily
Avoidant
aW Coping
Disengagement
eW
cW dW
patterns
trigger
Perc fW Negative
Criticism bW gW Affect
Event
Stress
hW
Perc
lW
iW Control
Engagement
pW
patterns
mW
trigger
kW qW
Perc Soc Positive
Support rW Affect
nW
Prob-Foc
Coping sW
jW oW
Positive
Reinterp
Avoidant
aB
Disengagement
Coping
maintenance
patterns
Self-
Criticism
cB
dB
bB
Event eB
Stress Negative
Affect
gB
fB
Perc Soc
maintenance
Engagement
Support
patterns
jB
iB
Positive
Affect
kB
Personal hB Prob-Foc
Standards Coping
FIGURE 11.1 ithin-person trigger (top) and between-persons maintenance (bottom)

W
models, based on Dunkley et al.’s studies (Dunkley et al., 2017; Dunkley,
Ma, et al., 2014; Dunkley et al., 2003).
Note: Perc = Perceived; Soc = Social; Reinterp = Reinterpretation; Prob-Foc = Problem-Focused.
Source: Reprinted from “Advancing Complex Explanatory Conceptualizations of Daily Negative and
Positive Affect: Trigger and Maintenance Coping Action Patterns,” by D. M. Dunkley, D. Ma,
I. Lee, K. J. Preacher, & D. C. Zuroff, 2014, Journal of Counseling Psychology, 61, p. 103. Copyright
2014 by American Psychological Association. Reproduced with permission.
228 Dunkley
positive affect for the typical individual. In our study of nondepressed adults
(Dunkley, Ma, et al., 2014), we found that, across several daily stressors, when the
typical individual perceives more social support than usual, he or she construes
daily stressors in more positive terms than usual, perceives more control, and
engages in more problem-focused coping than usual, and this is linked to daily
increases in positive affect (see Figure 11.1, paths iW to sW). We further examined
the within-person relationships among perceived control, problem-focused
coping, and positive affect in our study of depressed patients (Dunkley et al.,
2017). We found that, when the typical person with depression perceives more
control than usual, he or she engages in more problem-focused coping, and this is
connected to daily increases in positive affect (Figure 11.1, path mWrW), which
replicated our finding for nondepressed adults.
Counteraction Trigger Patterns

Theory and research suggest that disengagement coping and engagement coping
responses each have the ability to suppress or inhibit the other (see Corr, 2002;
Martell, Addis, & Jacobson, 2001; Trew, 2011). Dunkley, Ma, et al. (2014) found
that within-person decreases in avoidant coping were significantly correlated with
increases in problem-focused coping in nondepressed adults, but this link was not
hypothesized in their within-person mediation model. In our study of depressed
patients (Dunkley et al., 2017), we demonstrated complex counteraction trigger
patterns: When the typical person with depression suppresses helplessness appraisals
(lower perceived criticism or higher perceived control), he or she uses less avoidant
coping (see Figure 11.1, paths aW and cW) than usual, and engages in more problem-
focused coping than usual, and this is connected to increases in positive affect (see
Figure 11.1, path lWrW).
Perfectionism, Daily Stress Reactivity, and Coping Effectiveness

In CBT, explanatory conceptualizations are used to understand the links between
the client’s key developmental experiences, dysfunctional attitudes, behavioral
strategies, and situations that often precipitate or trigger heightened reactivity to
daily affect (see Kuyken et al., 2009). Several theorists have discussed how
perfectionism develops in response to parental approval that is conditional on
attaining extremely high parental expectations of success and productivity (e.g.,
Blatt, 1995; Hamachek, 1978). Further, it has been theorized that the development
of SC perfectionism arises from exposure to a combination of excessive parental
expectations as well as parental harshness and punitiveness (Blatt, 1995; Flett,
Hewitt, Oliver, & Macdonald, 2002; Young, Klosko, & Weishaar, 2003).
Understanding the links between past experiences and dysfunctional underlying
assumptions can help therapists and perfectionistic clients make sense out of the
latter’s intensified reactions that often appear mismatched to current circumstances
(cf. Kuyken et al., 2009). Several studies have supported a general vulnerability
model that maintains that individuals with higher levels of either PS or SC

perfectionism who are experiencing life stress will be especially vulnerable to
psychological distress symptoms (e.g., Chang & Rand, 2000; Enns, Cox, & Clara,
2005; Flett, Hewitt, Blankstein, & Mosher, 1995). Further, a large body of research
has examined a specific vulnerability model: Individuals with higher PS or SC
perfectionism, who have contingent self-worth that is based on success and
productivity (e.g., Sturman, Flett, Hewitt, & Rudolph, 2009), are expected to be
specifically vulnerable to achievement-related stressors that reflect personal failure
and loss of control (Blatt & Zuroff, 1992; Dunkley et al., 2003; Hewitt & Flett,
1993). Relatedly, because individuals with higher SC perfectionism have
heightened sensitivity to criticism and disapproval from others, these individuals
might experience more distress in response to negative social exchanges with others
(Dunkley, Berg, & Zuroff, 2012; Dunkley et al., 2003; Hewitt & Flett, 1993).
An important shortcoming of most research examining these moderator
hypotheses is that between-persons designs and analyses were used, which address
whether SC perfectionism in conjunction with individual differences in certain
variables (e.g., perceived stress) predict individual differences in maladjustment.
Moreover, these studies were based on single, one-occasion measures of the
moderators and outcomes, which does not address the common precipitants or
triggers of an individual’s distress. Our studies of university students (Dunkley et
al., 2003) and nondepressed adults (Dunkley, Mandel, & Ma, 2014) have dealt
with some of the limitations of previous research by using a daily diary approach
and within-person analyses to examine whether within-person variations in
appraisals and coping across many different stressors were linked to within-person
fluctuations in daily affect, with participants serving as their own control across all
the stressors that they reported.
Stress Reactivity
We found support for the specific vulnerability hypothesis in that students with
higher SC perfectionism, relative to students with lower SC perfectionism,
exhibited greater increases in daily negative affect when they experienced more
academic hassles and perceived criticism from others than usual, and less perceived
control than usual (Dunkley et al., 2003). Additional findings showed that students
with higher SC or PS perfectionism were emotionally reactive to decreases in self-
esteem, whereas only students with higher SC perfectionism were emotionally
reactive to increases in fear of closeness with others (Dunkley, Berg, & Zuroff,
2012). Further, we have examined the differential stress reactivity of individuals
with higher perfectionism across the short and long term (Dunkley, Mandel, &
Ma, 2014). The same sample of nondepressed adults used in the Dunkley, Ma, et
al. (2014) study described above completed daily diaries for 14 consecutive days
repeatedly at six-month and three-year follow-ups (consecutively referred to as
Month 6 and Year 3). We found that for both adults higher on SC perfectionism
and adults higher on PS perfectionism, compared to adults lower on these
230 Dunkley
perfectionism dimensions, more event stress than usual was associated with greater
increases in negative affect and sadness and greater decreases in positive affect at
Month 6 and Year 3. We also found some support for the specific reactivity
hypothesis in that adults with higher SC or PS perfectionism experienced greater
increases in negative affect and sadness and greater decreases in positive affect at
Year 3 when they perceived less control than usual. However, this result was not
found at Month 6. In addition, daily increases in depressive affect were connected
to more negative social interactions than usual for SC perfectionists only at Month
6 and Year 3. On the other hand, our findings also highlighted conditions under
which individuals with higher PS perfectionism feel more resilient than those with
lower PS perfectionism. Specifically, adults with higher PS perfectionism had
higher daily positive affect than adults with lower PS on days when they perceived
less event stress (at Month 6 and Year 3), more control over their most bothersome
event (at Year 3), and experienced fewer negative social interactions (at Year 3)
than usual (Dunkley, Mandel, & Ma, 2014).
Recently, we have examined the role of heightened stress reactivity (i.e., daily
fluctuations in negative mood in response to daily fluctuations in stress appraisals)
as an important explanatory variable in the relationship between SC perfectionism
and psychosocial maladjustment over time. In two four-year follow-up studies of
the same sample of nondepressed adults, we created stress reactivity (Mandel et al.,
2015) and interpersonal sensitivity (Mandel, Dunkley, & Starrs, 2017) variables that
represented the strength of relationship between a given individual’s daily stress
appraisal and affect at Month 6 and Year 3. Specifically, we created Month 6 and
Year 3 stress reactivity and interpersonal sensitivity variables that captured the
degree to which stress or negative social interactions and sadness were coupled in
each participant, which were then tested as sequential mediators in the relationship
between SC perfectionism and psychosocial maladjustment over four years. Our
results demonstrated that SC perfectionism predicted daily stress reactivity (i.e.,
greater increases in sadness in response to increases in stress) across Month 6 and
Year 3, which in turn mediated the relationship between higher SC perfectionism
and anhedonic depressive symptoms as well as general depressive and anxious
symptoms four years later, controlling for baseline symptoms (Mandel et al., 2015).
Findings also showed that interpersonal sensitivity (i.e., greater increases in daily
sadness in response to increases in daily negative social interactions) mediated the
relationship between SC perfectionism and interpersonal stress generation four
years later, controlling for the effects of depressive symptoms (Mandel, Dunkley, &
Starrs, 2017). Further, in a study of 43 depressed patients undergoing CBT, we
demonstrated that high levels of SC perfectionism in combination with high levels
of daily stress reactivity predicted less depression improvement relative to other
patients one year later (Mandel, Dunkley, Lewkowski, et al., 2017).
Given that intensified stress reactivity appears to play a role in perfectionistic
individuals’ vulnerability to various maladjustment outcomes over time, it is
important for explanatory conceptualizations to discern whether certain coping
strategies commonly make stressful situations worse or whether they can serve a
protective role for these individuals (see Kuyken et al., 2009). For instance,
avoidant coping may be particularly problematic for individuals with higher PS or
SC in that it might contribute to the anticipation of impending personal failure to
meet high expectations of productivity (O’Connor & O’Connor, 2003; Shafran,
Cooper, & Fairburn, 2002).
Coping (In)Effectiveness
Three studies have examined whether certain coping strategies for dealing with
most bothersome daily events may be especially (in)effective for perfectionistic
individuals (Dunkley, Mandel, & Ma, 2014; Dunkley et al., 2003; Stoeber &
Janssen, 2011). We found that, across many different daily stressors, engaging in
more self-blame than usual was coupled with greater increases in daily negative
affect for university students higher on SC perfectionism than for those lower on
SC perfectionism (Dunkley et al., 2003). In addition, using more problem-focused
coping and less avoidant coping than usual was coupled with greater increases in
daily positive affect only for students with lower SC perfectionism, but not for
those with higher SC perfectionism, which indicates that problem-focused coping
might be ineffective for SC perfectionistic students. On the other hand, across
many different daily stressful situations, using more positive reinterpretation than
usual was coupled with greater increases in daily positive affect for students with
higher SC perfectionism (Dunkley et al., 2003). Stoeber and Janssen (2011)
replicated the latter finding in showing that the more students with higher SC
perfectionism used positive reinterpretation to deal with the day’s most bothersome
failures, the more satisfied they felt at the end of the day. Thus, cognitive reframing
might work especially well for self-critical perfectionists.
Given that we found that nondepressed adults with higher levels of perfectionism
have heightened reactivity to stress as they get older, it is important to examine the
(in)effectiveness of coping strategies in adult populations (rather than student
populations) because the cumulative burden of daily stressors that adults typically
experience may diminish their coping resources. Accordingly, we found more
avoidant coping than usual was connected with greater increases in negative affect
and sadness at Month 6 and Year 3 in adults who have higher levels of either SC
or PS perfectionism. On the other hand, engaging in more problem-focused
coping than usual was associated with greater decreases in sadness at Month 6 for
adults with higher SC or PS perfectionism and with greater increases in positive
affect at Month 6 for those with higher SC perfectionism (Dunkley, Mandel, &
Ma, 2014). Previous theory and findings (e.g., O’Connor & O’Connor, 2003;
Sturman et al., 2009) can help explain these findings. Individuals with higher
perfectionism possess conditional self-worth that is contingent on success and
productivity. When perfectionistic individuals do not meet goals they expect to
meet, they believe that they are failing and consequently feel heightened anxiety,
irritability, and guilt (e.g., Blatt, 1995; Shafran et al., 2002; Young et al., 2003). We
also found that engaging in more positive reinterpretation than usual was associated
232 Dunkley
with greater decreases in sadness for adults with higher SC perfectionism at Month
6 and Year 3 (Dunkley, Mandel, & Ma, 2014), which provides further evidence
that perfectionistic individuals respond well to perceiving stressors as challenges
rather than as threats (Dunkley et al., 2003; Stoeber & Janssen, 2011).
Maintenance of Daily Affect: Perfectionism, Stress, and

Coping Patterns
Perfectionism also plays an important role in driving the maintenance of negative
affect and lower positive affect (see Blatt, 2004; Egan, Wade, & Shafran, 2011).
The bottom part of Figure 11.1 depicts our between-persons maintenance model
and findings of the relationships of SC and PS with average daily appraisals, coping,
and affect (Dunkley et al., 2017; Dunkley, Ma, et al., 2014; Dunkley et al., 2003).
Disengagement Maintenance Patterns

Relative to PS perfectionism, SC perfectionism is more closely related to
disengagement maintenance patterns that contribute to intense, prolonged negative
affect. Individuals who show higher levels of SC perfectionism are thought to
instigate daily stress for themselves because they tend to engage in harsh self-
evaluations and magnify the negative aspects of events, thereby interpreting even
mundane stressors as major threats (Dunkley et al., 2003; Hewitt & Flett, 2002).
Individuals with higher SC perfectionism also have a tendency to engage in
avoidant coping resulting from their perceived inability to cope with stressful
situations to their own and others’ satisfaction (Dunkley, Blankstein, Halsall,
Williams, & Winkworth, 2000; Flett, Hewitt, Blankstein, Solnik, & Van Brunschot,
1996). An avoidant coping style in turn fails to address stressors directly, and
thereby increases the severity and duration of stress, leading to a greater susceptibility
to experience additional stressors (Carver & Connor-Smith, 2010; Dunkley et al.,
2003). This tendency for individuals with higher SC perfectionism to engage in
avoidant coping impedes their ability to use other more adaptive coping strategies
that would help them move past the distress related to stressful situations (see
Carver & Connor-Smith, 2010; Dunkley et al., 2003).
We aggregated daily reports across several stressors to empirically derive
maintenance measures of daily stress, appraisals, coping, and affect (Dunkley et al.,
2003). In our study of university students, the relationship between SC perfectionism
and the maintenance of negative affect and lower positive affect over seven days
was mediated by daily avoidant coping and stress maintenance factors. In our six-
month follow-up study of nondepressed adults (Dunkley, Ma, et al., 2014), we
used multilevel structural equation modeling (SEM) to provide unbiased estimates
of between-persons means of several daily stress, coping, and affect reports for each
participant, which allowed a more rigorous test of the indirect effects of
perfectionism dimensions on maintenance of daily affect through stress and coping
than previous studies. As shown in Figure 11.1 (paths aB to fB), the relationship
between SC perfectionism and daily negative affect maintenance six months later
was mediated by daily avoidant coping and event stress maintenance factors, with
avoidant coping related to higher negative and lower positive affect indirectly
through its association with event stress.
In our study of depressed patients (Dunkley et al., 2017), SC perfectionism
exhibited an even stronger correlation (r = .65) with avoidant coping tendencies
compared to the correlation (r = .53) reported in Dunkley et al.’s (2003) study of
university students and the correlation (r = .51) reported in Dunkley, Ma, et al.’s
(2014) study of nondepressed adults. Dunkley et al. (2017) found that avoidant
coping and event stress maintenance factors, in combination, explained why
individuals with depression and higher SC perfectionism had persistent negative
affect as well as lower positive affect. These findings are consistent with our findings
with university students (Dunkley et al., 2003) and nondepressed adults (Dunkley,
Ma, et al., 2014), and demonstrate that people with depression and higher SC
perfectionism have a stronger tendency to avoid many different daily stressors (e.g.,
achievement, interpersonal), which keeps their problems going and perpetuates the
co-existence of depressive and anxious mood. Whereas Dunkley, Ma, et al. found
SC perfectionism to be indirectly related to negative affect and lower positive
affect through greater event stress in nondepressed adults, we did not replicate this
in the sample of depressed patients. This suggests that the ongoing stress that people
with depression and higher SC perfectionism experience is attributable to their
avoidant coping tendencies. Together, these disengagement maintenance patterns
demonstrate that the pervasive theme of defeat, helplessness, and withdrawal
becomes even more accentuated for self-critical perfectionists when they are
depressed, which resonates with clinical observations of these kinds of depressed
patients (cf. A. T. Beck, 1983; Blatt, 2004).
Engagement Maintenance Patterns

In parallel to their disengagement tendencies, individuals with higher SC
perfectionism often lack compensatory experiences of positive affect to provide a
psychological respite because they typically do not utilize engagement resources
and strategies (e.g., Dunkley, Ma, et al., 2014; Dunkley et al., 2003). Specifically,
individuals with higher SC perfectionism often perceive that others are unavailable
or unwilling to help them in times of stress (e.g., Dunkley et al., 2000).
Subsequently, they lack an important resource (i.e., perceived social support) to
encourage more adaptive coping strategies and make stressors seem less
overwhelming. In our study of university students (Dunkley et al., 2003), the
relationship between SC perfectionism and the maintenance of lower positive
affect over seven days was mediated by lower perceived social support (see Figure
11.1, path gBjB). In our six-month follow-up study of nondepressed adults
(Dunkley, Ma, et al., 2014), our findings also indicated that SC perfectionism had
an indirect association with the maintenance of lower positive affect six months
later through lower perceived social support and problem-focused coping
234 Dunkley
maintenance (see Figure 11.1, path gBiBkB). Finally, in our study of depressed
patients (Dunkley et al., 2017), problem-focused coping was associated with
greater maintenance of daily positive affect, but SC perfectionism was unrelated
to problem-focused coping.
In contrast, individuals with higher PS perfectionism have been theorized to
internalize high parental standards and actively strive to meet them (Blatt, 1995;
Hamachek, 1978). PS perfectionistic individuals may also experience higher levels
of stress, but their tendency to engage in active, problem-focused coping appears
to offset the potential negative outcomes of distress (see Dunkley et al., 2000).
However, theorists have suggested that the adaptive tendency of individuals with
higher PS to engage in problem-focused coping might only be present when they
are not depressed (cf. A. T. Beck, 1983; Blatt, 2004). Indeed, we found that PS
perfectionism was indirectly related to positive affect through problem-focused
coping in nondepressed adults (Dunkley, Ma, et al., 2014; see Figure 11.1, path
hBkB), but this was not found in our study of depressed patients (Dunkley et al.,
2017). Together, these findings indicate that individuals with higher PS exhibit
active coping tendencies when they are not depressed, but these individuals show
a loss of self-control, self-direction, and self-discipline when they are depressed.
“This complete turn-around in the person’s behavior constitutes one of the
paradoxes of depression” (A. T. Beck, 1983, p. 276).
Case Illustration of Multilevel Explanatory Conceptualization

In the sections below, I extrapolate key aspects from Kuyken et al.’s (2009) detailed
case example of a single patient, Mark, to illustrate how disengagement and
engagement trigger and maintenance patterns operate in the daily life of a
perfectionistic individual. Mark was in his mid-30s and married with two children.
He was successful in his work but was currently experiencing work difficulties due
to mild to moderate depression and anxiety.
PS and SC Perfectionism
Like many depressed patients (A. T. Beck, 1983; Blatt, 2004; Blatt et al., 1976),
themes of achievement and failure were central to Mark’s difficulties.
Corroborating the distinction between PS perfectionism and SC perfectionism,
Mark and his therapist built a picture of Mark as “someone with high standards
who tries really hard not to make mistakes” (Kuyken et al., 2009, p. 183).
Discussions revealed Mark’s self-critical thoughts about being a failure and a poor
father, husband, and worker (e.g., “I’m useless,” “I’m a waste of space,” “My
theme song is failure”; p. 197) as well as several underlying beliefs (e.g., “If I
make a mistake then it means I am useless,” “If I make a mistake then others will
think less of me”; p. 192), all of which reflect the distinct but related aspects of
the broader SC perfectionism construct. Most importantly, Mark’s therapist
recognized the central role of Mark’s self-critical perfectionistic thinking which
in turn led to a more comprehensive understanding of what triggered and

maintained Mark’s low mood.
Disengagement Trigger Patterns

As is the case for many depressed patients, Mark’s drops in mood seemed to “come
out of the blue” (Kuyken et al., 2009, p. 172), but several examples where his
mood plummeted demonstrate the disengagement trigger patterns detailed above.
Perceived criticism from others was identified as a trigger of avoidant coping
responses (e.g., withdrawal) in many stressful situations and also often signaled
higher event stress and escalating negative affect (e.g., “I worried I would get it
wrong and when others noticed it was wrong I would get the blame. I just got
really wound up and uneasy, like I wanted to run [Starts to cry].”; Kuyken et al.,
2009, p. 140; see Figure 11.1, paths aW, bW, and dW to hW).1 A perceived lack of
control over the ability to successfully handle stressful situations (i.e., lower
perceived control) was also identified by Mark and his therapist as a unique trigger
of avoidant coping responses to give up or disengage across many daily stressors
(e.g., “Some days I just sit staring at the pile of work I am supposed to do and I just
can’t get things done properly, to the right standard or on time. So I just don’t
bother.”; p. 129; path cW). After reviewing many examples, Mark and his therapist
agreed that, when Mark avoids or puts things off (e.g., “stopped working,” “stayed
up really late watching bad TV”), this increased the intensity and duration of
stressors (e.g., “did not finish the report on time,” “tried to watch TV, but kept
thinking about work”), which in turn exacerbated his various negative moods
(e.g., “felt really sad”, “anxious”; pp. 177 and 196; paths dWgW, dWhW, and eW).
Further, Mark and his therapist agreed that their model generalized across situations
in that, when Mark avoided doing things expected of him as a dad or husband or
worker, this made things worse and made him feel even more like a failure.
Engagement and Counteraction Trigger Patterns

Although Mark initially felt like nothing was going right in his life, Mark and his
therapist noticed many days when Mark did not feel low that illustrated the
engagement and counteraction trigger patterns detailed above. When Mark
construed mistakes at work in more positive terms than usual (i.e., positive
reinterpretation), he experienced increases in positive mood and perceived
controllability as well as decreases in avoidance on those days (e.g., “take credit for
good things that happen and admit mistakes without getting too caught up with
them and putting off my work for fear of making a mistake”; “enjoy my day and
think to myself, ‘I enjoy my work and I’m okay at it.’”; p. 188; paths kWcW, kWpW,
and sW). The effect of these positive interpretations and constructive appraisals of
mistakes was that Mark did not avoid work and instead engaged in problem-
focused coping efforts (e.g., “well, it makes it more likely I will carry on doing the
right things”; p. 188). Problem-focused coping in turn helped Mark to manage
236 Dunkley
complex tasks and difficulties more successfully and made it possible for him to feel
better about himself on those days (“I felt pretty good”; p. 187; paths lWrW, mWrW,
and oWrW). Further, when Mark perceived more support from his wife (e.g., “I feel
so lucky to have Claire. She was right; she helped me get out of that funk.”;
p. 218), this motivated Mark to use more positive reinterpretation, perceive more
control, and engage in more active coping than usual (e.g., “I got out of bed and
completed a Thought Record, which was sort of reassuring because it was all
there, the same old thoughts, and I was able to respond to them”), and this was
connected to increases in positive mood (e.g., “we had a good family day
afterwards”; p. 219; paths iW to sW).
Disengagement and Engagement Maintenance Patterns

Mark’s self-critical evaluation tendencies suggesting that he is useless and a failure
contributed to his avoidance across numerous situations (e.g., “I avoid tasks at
work, I avoid John, I avoid lots of things”; p. 184). In reviewing Mark’s list of
examples, Mark and his therapist established a common maintenance pattern where
Mark’s avoidance tendencies made problems worse and built pressure up, and this
kept his mood down (e.g., “I did that with the example when I got the e-mail
about the report. … I didn’t finish the report. The next time I went back to work
the e-mail was still there. So then I felt even worse.”; p. 184; paths aBcBeB, aBcBfB,
and aBdB). Mark and his therapist also established that avoidance did not completely
explain all of Mark’s depressive mood, but that his tendency to perseverate about
mistakes was another important maintaining factor that explained why his mood
did not improve (e.g., “I review all the mistakes I made that day …I find so many
things I have not done or have done badly that I feel worse and worse as the night
goes on.”; p. 185; paths bBeB and bBfB). Finally, when Mark was depressed, he no
longer engaged in problem-focused coping tendencies: “They would say I am hard
working, conscientious, and reliable … I am very organized and thorough. I do my
job to a high standard … well, I used to!” (pp. 126–127; path hBkB).
Translating Multilevel Explanatory Conceptualizations into

Clinical Practice
Relative to past research, our complex explanatory results have richer and more
detailed clinical implications that can help therapists and their patients more
effectively reduce patients’ distress and bolster resilience (Kuyken et al., 2009;
Persons, 2012). Entertaining multiple mechanism hypotheses at multiple levels has
the advantage of increased flexibility in treatment (e.g., shifting between different
mechanism hypotheses to align with the situation and/or patient preferences,
trying different interventions when treatment based on one mechanism hypothesis
fails). Another advantage is the potential for increased power in using multiple
interventions that target more than one precipitant or perpetuating factor of
negative affect and (low) positive affect (Persons, 2012). In keeping with CBT,
explanatory conceptualizations are meant to be used collaboratively and flexibly by

therapists with their clients (see Chapter 14) in that therapy can focus on either
cognitions or behaviors (or alternate between the two), according to which element
is most likely to promote change for each patient at a given moment (Kuyken et
al., 2009; Persons, 2012). Several treatment methods could be used to treat both
depression and anxiety by decreasing daily negative affect and increasing daily
positive affect.
Breaking Up Disengagement Patterns

To decrease daily negative affect and increase daily positive affect, cognitive
strategies might be used to modify harm appraisals, such as perceived event stress
(e.g., J. S. Beck, 1995). Clinicians might reduce self-critical clients’ avoidant coping
across many different stressors by changing their heightened tendency to engage in
destructive self-blame and perceive criticism from others, and instead encouraging
more compassionate ways of typically relating to themselves and more problem-
focused coping. Behavioral activation methods can be used to specifically target
avoidant coping and promote an increase in pleasurable and rewarding activities,
which might decrease the time available for rumination about stress (e.g., Martell
et al., 2001). At the same time, our findings suggest that avoidant coping might also
be suppressed by reducing helplessness appraisals (i.e., perceived criticism, lower
perceived control; Dunkley, Ma, et al., 2014). Our findings suggest that
perfectionistic clients should be helped to move from a reactive mode of responding
automatically to stressors (e.g., avoidance) to a response mode in which they
respond with awareness of the stressor and its effects while working toward goals
that are grounded in their values (see Kuyken et al., 2009; Persons, 2012). Further,
the origins part of the conceptualization can be used to understand how key
developmental experiences (e.g., harsh parental criticism) led to some patients
developing pervasive SC perfectionism, heightened stress reactivity, and avoidant
coping mechanisms. And this understanding can guide interventions to break up
these dysfunctional patterns that are maintaining depression and anxiety.
Promoting Engagement Patterns

The engagement patterns supported in our research help bring alternative adaptive
patterns into focus for clients and highlight specific intervention choice points in
order to improve daily mood for the typical client. When daily stressful situations
seem more uncontrollable than usual, targeting the self by attempting to implement
emotion-focused coping responses (e.g., positive reinterpretation), or targeting the
context by trying to discover available interpersonal contingencies (e.g., perceived
social support) might be healthy alternatives to avoidant coping and rigid
perseveration that exacerbates stressors (e.g., Skinner et al., 2003). When others are
perceived to be more critical than usual, the typical client might focus on improving
social competence (e.g., positive expressions to others, active listening, responding
238 Dunkley
to criticism) in an effort to facilitate more positive supportive relations (e.g., Brand,

Lakey, & Berman, 1995) as a constructive alternative to concealing problems by
avoidance. Further, problem-focused coping efforts might be bolstered not only by
behavioral skills-building strategies (Martell et al., 2001), but also by enhancing
perceived social support, positive reinterpretation, and perceived control (see
Dunkley, Ma, et al., 2014). Finally, the underutilization of adaptive problem-
focused coping strategies in individuals with higher PS perfectionism when they
are depressed suggests that interventions should aim to restore a sense of competence
and goal-directed motivations, in keeping with previous clinical recommendations
for depressed patients (cf. A. T. Beck, 1983).
Limitations and Directions for Future Research

There are a number of limitations in the extant literature that should be addressed
in future research. First, daily diary studies have assessed stress, coping, and affect
only once a day. Future research should assess these variables multiple times
throughout the day to better capture the dynamics of stress and coping processes as
they unfold. This would also help ascertain the direction of causality among
variables. Second, stress appraisals are very rapid and require more frequent
measures than are possible using daily diaries. Future cognitive priming studies that
expose individuals to experimental stimuli and examine subsequent cognitive
reactions (cf. Ingram, Miranda, & Segal, 1998) would be useful to better examine
how stress and coping processes evolve. Third, as the majority of studies have
relied on self-report measures, future studies might also want to supplement self-
report measures with informant reports or assessments of observable behaviors
(e.g., coping). Fourth, the majority of the research presented in this chapter focused
on perfectionists’ appraisals of and reactions to minor or daily stressors. It would be
important to examine the role of stress appraisals and coping in response to major
life events from different domains (e.g., interpersonal, achievement) because more
severe negative events may have a greater effect on the onset of certain problems,
such as depression (see Hammen, 2005). Fifth, the generalizability of the findings
reviewed in this chapter must be examined in various clinical and nonclinical
populations, and in different age or sociocultural groups. In particular, it would be
important to replicate and extend these findings in various psychopathologies (e.g.,
depression, anxiety disorders, eating disorders). Finally, it would be important to
develop and evaluate interventions integrating the various strategies outlined above
to investigate whether treatment outcomes can be improved for individuals with
higher perfectionism.
Conclusion
Employing daily diary methodology together with SEM and multilevel modeling,
our studies have explicated explanatory models that can help therapists and their
clients make more sense of what commonly triggers and maintains negative affect
and (low) positive affect for perfectionistic individuals. Our findings demonstrate
trigger patterns that shed light on how daily increases in negative affect and
decreases in positive affect are precipitated for individuals with higher SC or PS
perfectionism as well as the negative impact that heightened stress reactivity has on
the psychological maladjustment of these individuals over the longer term. We also
showed how depressive mood is maintained for university students, nondepressed
adults, and depressed individuals with higher self-critical perfectionism. In parallel,
our explanatory models brought alternative adaptive engagement patterns (triggers
and maintenance) into focus to orient researchers and therapists toward obtaining
a more holistic view of perfectionism and perfectionistic individuals.
Note
1 To avoid overloading the text with references, all consecutive page numbers in this
case illustration always refer to Kuyken et al. (2009) whereas the paths always refer to
Figure 11.1.
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12
PERFECTIONISM AND
EMOTION REGULATION
Kenneth G. Rice, Hanna Suh, and Don E. Davis
Overview
The goals of the present chapter are (a) to summarize what we know about
perfectionism and emotion regulation and (b) to develop theory to inform a
progressive research agenda for the next era of research in this area. To do this, we
extend and integrate earlier work that positions perfectionism and emotion
regulation within attachment theory (Rice & Mirzadeh, 2000), person-centered
theory (Ashby, Rahotep, & Martin, 2005) and self psychology (Rice & Dellwo,
2002). We use these theories to describe how perfectionistic traits initially emerge
to aid the regulation of self-esteem and self-development (“perfectionism as
outcome” model). Perfectionism is then further developed and maintained through
internal working models of self and others. The “perfectionism as predictor” model
then predicts that perfectionistic tendencies will affect how people regulate stress
and emotions, which in turn affects a variety of domains, including health, mental
health, academics, career development, and relationships. The chapter concludes
with implications for viewing perfectionism as virtue or vice (Chang, 2003), and
presents a conceptual and methodological agenda for applied research aimed at
strengthening perfectionistic resilience and lowering perfectionistic risk. We frame
this chapter within a broader perspective that considers person × environment
interactions, development, and resilience, and not just risk with regard to
perfectionism.
Definitional Considerations
Consistent with other recent statements (Rice, Richardson, & Ray, 2016), we
generally adhere to a definition and operationalization of perfectionism as a
personality construct that involves two primary and self-focused dimensions
244 Rice, Suh, & Davis
referred to as personal strivings (e.g., standards, performance expectations) and

concerns about the adequacy of those strivings (e.g., self-critical performance
evaluation, perceived gap between personal expectations and degree to which one
is meeting those expectations). Perfectionism can have both adaptive and
maladaptive implications, depending on its motivations and consequences. For
example, Adler (1956) wrote that striving for perfection is a normal, innate aspect
of human development. Adopting high standards is how people grow, learn, and
change. However, such striving becomes problematic when individuals accompany
high standards with habits associated with poor emotion regulation, such as
adopting unrealistic standards or cultivating highly punitive self-talk.
We measure perfectionism with the Almost Perfect Scale-Revised (APS-R;
Slaney, Mobley, Trippi, Ashby, & Johnson, 1996; Slaney, Rice, Mobley, Trippi,
& Ashby, 2001; see also Rice, Richardson, & Tueller, 2014, for a short form). This
scale has robust psychometric features, non-overlapping dimensions, allows for
potentially healthy or unhealthy expressions of perfectionism, and avoids
confounding the measurement of perfectionism with relational precursors or
consequences of perfectionism. The APS-R measures self-performance expectations
or strivings (standards),1 perfectionistic concerns in the form of self-critical
evaluation in one’s perceived ability to live up to expected standards (discrepancy),
and a third dimension (order) measuring preferences for organization.
From a self-regulation perspective, adaptive versus maladaptive perfectionism
reflects two contrasting patterns on the two primary dimensions of perfectionism
(standards and discrepancy). Both types involve high standards, which has the
potential to cause greater stress for the individual. The two patterns differ in the
degree to which the individual has a strong set of mental habits (including
physiological response) that can offset that stress and intrapsychic pressure. The
discrepancy scale is named based on characteristics of poor self-regulation. Namely,
one of the primary mental behaviors of maladaptive perfectionists is their tendency
to criticize themselves when falling short of high standards. Thus, adaptives have
high standards, but low self-criticism (i.e., low discrepancy scores); whereas
maladaptives have high standards and high self-criticism (i.e., high discrepancy
scores).
Perfectionism as Outcome: Attachment and Self-Development

We next turn to what we view as compelling theoretical accounts of precursors to
the development of these perfectionism dimensions, and how the dimensions serve
important relational and regulatory functions early and throughout the lifespan.
We integrate theories on attachment, self-actualization, and self psychology into an
integrative account of perfectionism and self-regulation. There is also some limited
research supporting moderate genetic influences on perfectionism (Iranzo-Tatay et
al., 2015; Tozzi et al., 2004), but our emphasis here is on environmental precursors,
some of which potentially interact with genetic predisposition.
Perfectionism and Emotion Regulation 245
Attachment Theory
Attachment theory provides a compelling account of how early environments
affect development of personality, especially traits associated with self-regulation
and performance competencies. According to the theory, humans are innately
programmed to seek proximity to caregivers when stressed, and the emergence of
personality characteristics in how persons tend to deal with security-related threats
are initially shaped by the nature of early infant–caregiver interactions (Bowlby,
1988). To the extent that infants experience early caregivers as reliable, responsive,
and non-invasive sources of support, they develop secure internal working models
of self and others that facilitate both their autonomous exploratory behavior and
appropriate support-seeking. Infants who experience their early care-giving
environments as neglectful, unreliable, or rejecting form an insecure attachment
orientation that predicts suboptimal forms of emotional regulation and support-
seeking. In either case, these early models are “carried forward” as cognitive
representations that, by virtue of the confirmatory biases they impose on the
person’s social-cognitive processes and interpersonal behavior, are likely to shape
the construction of later (adult) relationships in schema-consistent ways. These
characteristics are theorized to affect the acquisition and deployment of adaptive
coping and interpersonal behaviors in adulthood (Lopez & Brennan, 2000).
Person-Centered Theory
To understand the link between early relational experience and perfectionistic
tendencies, we can also draw on two self-oriented theories. Much of the attention
on Carl Rogers’ work has focused on the necessary and sufficient conditions for
personality change to occur through psychotherapy, but Rogers (1959) also
articulated a progression for the early development of a sense of self. Interestingly,
he described an innate motive that drives people to actualize their potential as a
person: “the inherent tendency of the organism to develop all its capacities in ways
which serve to maintain or enhance the organism” (p. 196). This roughly
corresponds to standards within our model. Rogers suggested that people seek to
grow through comparing and seeking to reduce the discrepancy between their
current sense of self with their potential self (called the “organismic valuing
process,” p. 210). He believed humans have an innate sense of what will help or
hurt their ability to actualize themselves.
According to Rogers (1959), humans develop a sense of self within their early
relationships. At first, humans (neonates) experience all relationships as unitary (i.e.,
no perception of a separate “I”). Over time, they move toward gradual discrimination
of what is “me” and “not me.” This differentiation of self occurs through interactions
between the child and parents or other caregivers, and those interactions bring
about several important elements in his theory. For example, children become
aware that their own self-value changes as a result of regard and acceptance of
others, which eventually they realize is contingent on meeting others’ moral and
performance expectations. According to Rogers’ theory, the need for positive

regard is sufficiently strong that children invariably sacrifice congruence with the
“organismic valuing process” and internalize and seek alignment with externally
imposed conditions of worth (i.e., values within a community). Rogers regards this
process as “a natural and tragic development” (p. 226).
Self Psychology
A third theory we integrate into our account of perfectionism as self-regulation
comes from Kohut’s self psychology. According to Kohut and Wolf (1978), the
ways in which children’s needs are met by parents play a crucial role in the
cohesiveness of the child’s self-development and in the management of self-esteem.
Children develop a cohesive self when parents are sufficiently aware of and responsive
to their needs for mirroring and idealizing. Namely, children need to experience
admiration (empathic mirroring) of their grandiosity and perfection by parent
figures. Parents “promote cohesion of the child’s fragile sense of self by remaining
sufficiently in tune with and giving attention to the child and by taking delight in
its proud displays” (Patton & Robbins, 1982, p. 878). They also need to experience
parent figures as all-powerful objects for idealization combined with a sense that
the child is a part of the idealized parent. As Patton and Robbins explain, “this self-
object is constructed in terms of the child and the powerful parent as one and the
same” (p. 879).
Pertinent to this chapter, Kohut and Wolf (1978) posit that a crucial part of
development is learning to deal with mild disruptions in one’s need for admiration
and idealization from parents. These disruptions allow the child opportunities to
self-soothe and otherwise shore up a sense of self that might periodically need to
withstand the absence of otherwise good-enough parenting. When grandiose
needs are reasonably met, children develop assertiveness, healthy expression of
ambitions, realistic admiration and expectations of others, and a clear sense of goals.
Adequate self-development ostensibly is reflected in healthy regulation of self-
esteem, especially during stressful or otherwise threatening situations. In contrast,
children who do not experience reasonable empathic resonance from parents have
limited capacity to manage self-esteem as adults. For example, they may expect
others to admire them, feel shame and embarrassment easily (Patton & Robbins,
1982), or respond aggressively to critical feedback or other ego threats (Bushman
& Baumeister, 1998). Thus, people who had unavailable or unsuitable targets for
idealization continue to seek out others or ideas (religious conversions, political
movements) to provide caretaking functions that were absent or disappointed in
parent–child interactions.
Conceptual Synthesis
These different and richly descriptive literatures on attachment and self-
development provide a means for understanding early origins of perfectionism as
well as its development and maintenance over time. Parents who provide their
children with dependable, generally consistent relationships that are clear and
reasonable regarding expectations, who encourage performance but do not make
their love or positive attention contingent on performance, and who respond to
their children and their efforts in supportive and encouraging ways, are likely to
help children develop high but realistic standards and corresponding views of
themselves as worthy and confident, and views of others as trustworthy and
responsible (Sorotzkin, 1998). In contrast, maladaptive perfectionistic characteristics
are likely to emerge when parents are inconsistent or unclear with expectations, or
clear that their expectations will never be met. In such environments, how children
perform seems to matter too much or not at all, which overshadows any hint of
inherent relational or intrinsic value a child might long for. Children of such
parents may learn to emphasize the importance of their performance over and
above their emotional needs. Being perfect and discounting or suppressing
emotional needs emerge as an unfortunate adaptation required to maintain
recognition from parents or avoid critical or punitive parental responses (Cassidy,
1994). As we later argue, insecure parent–child attachment bonds and corresponding
parental behaviors leave children with an impaired value system (i.e., internalized
values and ability to regulate behavior to gain a sense of integrity) and an unfortunate
foundation for self-critical perfectionism.
Empirical Evidence Linking Attachment with Perfectionism

Conceptually, it might be easy to imagine how perfectionism could emerge as a
way for children to self-soothe in systems that have few or unclear expectations or
that involve unrelentingly demanding expectations. Demonstrating those causal
relationships empirically, however, requires reaching a rather high methodo
logical bar.
Ample evidence points to a correlation between perfectionism with attachment
and parenting behaviors. For example, Morris and Lomax (2014) conducted a
recent review of childhood perfectionism and concluded that there was strong
evidence linking “pushy” parenting (e.g., overprotection from mistakes, intrusive
parenting to push children to achieve at certain levels) and perfectionistic concerns
in children (e.g., Kenney-Benson & Pomerantz, 2005; Mitchell, Newall, Broeren,
& Hudson, 2013). Two recent studies have focused on perfectionistic tendencies
in children (Affrunti, Gramszlo, & Woodruff-Borden, 2016; Affrunti & Woodruff-
Borden, 2015). During achievement and social tasks with parents and children
(ages 3 to 12), parent perfectionism correlated moderately and positively with
over-controlling behavior during the task, which in turn correlated with child
anxiety (Affrunti & Woodruff-Borden, 2015). Although child perfectionism was
not directly measured, anxiety during performance tasks is often an indicator of
perfectionistic concerns in children. For example, in Affrunti et al.’s (2016) study
of parents and children (ages 7 to 13), child-reported perfectionistic concerns (but
not strivings) correlated moderately with parent-reported behavioral indicators of
the child’s emotional control (e.g., overreacting, outbursts) and with child-reported
worry. These studies focused on a reasonable age range to examine the development
of perfectionism, but because they did not separate parenting behavior and
perfectionism in time, the causal direction of the relationship is ambiguous.
In this regard, we have several studies to evaluate the ideas of our chapter.
Herman, Trotter, Reinke, and Ialongo (2011) used parenting variables from first
grade (e.g., monitoring, poor discipline, and specific praise) to predict perfectionism
in sixth grade. Perfectionism as the outcome involved four latent profiles: critical
(maladaptive: high strivings, high concerns), non-critical (adaptive: high strivings,
low concerns), non-striving (extremely low strivings), and non-perfectionists (low
strivings, low concerns). Only one parenting variable predicted differences in
perfectionism: The non-critical (adaptive) group had experienced more specific
praise five years earlier compared with the non-striving group.
In another study also spanning five years, Hong et al. (2017) studied children
beginning at age 7 with the measurement of multiple predictors (e.g., child
temperament, parenting behavior during a problem-solving task, socio-economic
status [SES], cognitive abilities). Follow-ups—conducted at ages 8, 9, and 11—
included two measures of perfectionistic concerns. Results identified three latent
classes with different growth trajectories: (a) high self-criticism that increased over
time, (b) high self-criticism that decreased over time, and (c) low self-criticism that
increased over time. Parent behavior but not temperament variables predicted class
membership. Specifically, relative to the third class, children in the first two classes
had more intrusive parents who tried to help their child with the problem-solving
task even though children gave no signs of distress, confusion, or difficulty.
Compared with the other classes, children in the third class had parents who were
more likely to use negative control behaviors (e.g., harsh punishment or ignoring).
Cultural or contextual variables may explain why one study (Hong et al., 2017)
found that parenting practices influenced subsequent patterns of change in
perfectionism but the other did not (Herman et al., 2011). The studies focused on
different samples, with Hong et al. sampling middle-class children in Singapore,
and Herman et al. sampling low-income Black children in the United States. This
suggestion is consistent with results from another study in which parent
perfectionism correlated strongly with child perfectionism in White, but not in
Black families (Rice, Tucker, & Desmond, 2008). Clarifying how various cultural
factors affect the relationship between parenting behavior and the development of
perfectionism will require a series of programmatic studies.
In addition to these highly rigorous longitudinal studies, we can also draw some
evidence from retrospective studies in which adolescents and parents rate the
child’s current perfectionism and other variables during the child’s formative years.
Such retrospective methods have known limitations, such as potential memory bias
based on current state of mind or for parenting practices to change over time.
Despite those limitations, these studies have consistently demonstrated moderate
correlations between adolescent perfectionism and retrospective ratings of parenting
variables. For example, several studies linked perfectionism with authoritarian
parenting (e.g., Gong, Fletcher, & Bolin, 2015; Speirs Neumeister & Finch, 2006;
cf. Hibbard & Walton, 2014).
We can also draw indirect evidence for the link between parenting behavior
and perfectionism in children from studies examining the relationship between
perfectionism in parents and perfectionism in their children. These studies have
generally reported a moderate, positive correlation between parents and children,
with some studies finding stronger effects for mother than father perfectionism
(Frost, Lahart, & Rosenblate, 1991; Soenens, Elliot, et al., 2005) and others finding
evidence that the patterns of transmission might be gender-specific (Vieth & Trull,
1999). In different studies of Dutch samples, Soenens and colleagues (Soenens,
Elliot, et al., 2005; Soenens, Vansteenkiste, Luyten, Duriez, & Goossens, 2005)
found that parents with high levels of perfectionistic concerns were likely to be
psychologically controlling, which in turn was associated with their late-adolescent
daughters’ perfectionistic concerns. More adaptive perfectionism (perfectionistic
strivings controlling for perfectionistic concerns) was directly associated with
daughters’ levels of perfectionistic striving. Soenens, Vansteenkiste, et al. (2005)
also found that lack of parental responsiveness (i.e., lack of positivity and perceived
warmth) was associated with perfectionistic concerns among adolescents. In a
longitudinal extension of their earlier research, Soenens et al. (2008) found that
parental psychological control significantly predicted adolescent perfectionistic
concerns a year later, though effects were stronger for adolescents’ reports on their
parents than parents’ self-reports.
Summary
Taken together, parenting behaviors (e.g., authoritarian parenting, attunement,
responsiveness, intrusiveness, control, and flexibility) tend to correlate (and in a
few studies predict) the development of perfectionistic characteristics among
children, adolescents, and young adults. There are two possible moderators worth
exploring in future work and perhaps meta-analyses. First, the relationship seemed
stronger and more consistent for perfectionistic concerns rather than strivings.
Second, race and SES seemed to moderate the relationship between parenting and
perfectionism in children. This relationship was most stable in European or
European American samples, and to some extent Asian samples; however, it
showed greater variability in African American, male, or low SES samples. Thus,
more work is needed to clarify how cultural differences may influence the
development of perfectionism.
Given that perfectionism involves a value system linking self-worth and
achievement, it seems worth contextualizing the results of our review on parenting
behavior and perfectionism within the broader literature on the intergenerational
transmission of values. Not surprisingly, there is a strong connection between
parent values and the social attitudes and values adopted by their children (e.g.,
Glass, Bengtson, & Dunham, 1986; Miller & Glass, 1989). For example, there is
impressive longitudinal evidence of intergenerational transmission of religious
beliefs, with stronger linkages emerging as a function of quality of early parent–

child relationships (Min, Silverstein, & Lendon, 2012). However, although effect
sizes for religious belief tend to be sizable (r = .42), effect sizes for other domains,
such as achievement values (r = .22), tend to be more moderate (Grønhøj &
Thøgersen, 2009) and comparable in size with some reported associations between
parent and child perfectionism (e.g., Soenens, Elliot, et al., 2005).
The intergenerational transmission or continuity of attachment (Besser & Priel,
2005) also is implicated in the connection between attachment and perfectionism
that extends into late adolescence and young adulthood. The general patterns of
association seem to hold whether attachment is measured as the perceived bond
with parents (Rice & Mirzadeh, 2000) or as adult attachment orientations based on
bonds with romantic partners are the focus of measurement (Wei, Mallinckrodt,
Russell, & Abraham, 2004).
Perfectionism as Predictor of Stress, Emotion Regulation,

and Outcomes
Stress Generation and Stress Enhancement

Two complementary conceptual models can serve as foundations for making the
next connection in understanding how perfectionism might trigger emotion
regulatory responses or tendencies. Both models address stress, stressors, and stress
reactivity. Stressors can be understood as challenges to homeostatic or allostatic
balance. Humans, perhaps especially perfectionistic ones, have the capacity to not
only experience physical or social threats as acutely stressful, but also can generate
anticipatory threat and chronic stress in rather unique ways compared with other
species (Sapolsky, 2004). Acute stress for a perfectionist might be a pop-quiz or
other performance-related activity whereas chronic stress could be experienced by
regularly thinking negative, self-defeating thoughts that overemphasize mistakes
and perceived inadequacies. However, as research persistently shows, all
perfectionists are not the same, and some important components must be in place
to determine whether an environmental or internal experience is stressful.
We rely on Lazarus and Folkman’s (1984) transactional model of stress as a
major conceptual foundation because of its explanatory power involving individual
differences in perception of a stressor and coping responses to that stressor.
According to this model, how much stress individuals experience depends on two
appraisals. First, individuals appraise the degree to which the stressor is threatening
or challenging (primary appraisal). Second, they appraise the degree to which they
have coping resources to psychologically manage the experience of threat
(secondary appraisal). Thus, perceived stress is fundamental to this model, as are
characteristics of the person that are intimately tied to stress appraisals (Bibbey,
Carroll, Roseboom, Phillips, & de Rooij, 2013).
Bolger and Zuckerman (1995) described how personality characteristics can
increase the likelihood of exposure to stressors (“differential exposure model”), can
affect reactivity to stressors (“differential reactivity model”), or both (“differential

exposure/reactivity model”). Consistent with their conceptualization, hypotheses
can be formed regarding how perfectionism may influence stress and the need for
emotion regulation. The stress-generation hypothesis positions self-critical
perfectionism as a precursor to experiences of subsequent stress (Hewitt & Flett,
2002). This hypothesis predicts that self-critical perfectionists create their stress,
increase their likelihood of exposure to stressors, or are simply more likely to
appraise experiences as stressful by, for example, putting themselves in high-
pressure situations and negatively evaluating their performance in such situations.
By contrast, in the stress-enhancement hypothesis, self-critical perfectionism intensifies
the effects that stress has on eventual outcomes. Stress enhancement is consistent
with a diathesis-stress model that positions perfectionism as a moderator of how
stress affects an outcome. Consistent with the MacArthur approach to defining
moderators (Chmura Kraemer, Kiernan, Essex, & Kupfer, 2008), in order for
perfectionism to moderate stress, it should temporally precede the experience or
appraisal of stress. Bolger and Zuckerman (1995) also position stress as a mediator
through which personality (perfectionism) might lead to later outcomes. The
temporal position for a stress-as-a-mediator model is also consistent with the
MacArthur approach (Chmura Kraemer et al., 2008).
Emotion Regulation
Stressful experiences produce cognitive and emotional reactions that have
implications for the eventual effects of perfectionism on outcomes such as goals,
performance, and mental health (Gross & John, 2003; Koole, 2009). Emotion
regulation strategies can be considered features of characteristic adaptations, which
are specific ways that individuals learn to react to their environment based on their
own configuration of personality traits (Gross, 2008; McAdams & Pals, 2007).
Nolen-Hoeksema (2012) referred to emotion regulation as “the range of activities
that allow an individual to monitor, evaluate, and modify the nature and course of
an emotional response, in order to pursue his or her goals and appropriately respond
to environmental demands” (p. 163). Drawing upon Gross and Thompson’s (2007)
emotion regulation process model, our focus is on major strategies identified in the
emotion regulation literature (e.g., Aldao, Nolen-Hoeksema, & Schweizer, 2010;
Kohl, Rief, & Glombiewski, 2012; Webb, Miles, & Sheeran, 2012) and their links
to perfectionism.
Emotion Regulation Process Model

We draw on the emotion regulation process model (Gross & Thompson, 2007) to
consider how certain emotion regulation strategies might be more effective at
different phases, given that perfectionism both generates and enhances stress.
According to this model, emotion regulation strategies can be differentiated
according to whether an emotional response is fully generated or not.
Antecedent-focused strategies, such as selecting or modifying situations, shifting

attention, or reappraising, occur before a substantial emotional response has
occurred. Response-focused strategies, such as suppression, occur after a substantial
emotional response has occurred and are implemented to modulate the experience
or expression of emotion.
Aldao et al.’s (2010) review organized emotion regulation according to strategies
identified as adaptive (e.g., reappraisal) or maladaptive (e.g., rumination).
Rumination—or more specifically, a “brooding” form of rumination (Treynor,
Gonzalez, & Nolen-Hoeksema, 2003)—refers to excessive and persistent self-
focused attention on negative emotions without engaging in problem-solving to
reduce or redirect those emotions. As Nolen-Hoeksema (2012) pointed out,
rumination is not simply a failure to down-regulate negative affect, but also a
perseverative wallowing in the causes, consequences, and experience of negative
affect without resolution. Rumination is a robust correlate of maladaptive
perfectionism (O’Connor, O’Connor, & Marshall, 2007), and this tendency to
ruminate about failures may explain why perfectionism causes and amplifies stress.
Attachment, Perfectionism, Stress, and Emotion Regulation

There is not only an extensive literature linking attachment to stress and stress
reactivity (Diamond, 2015), but there are also several studies connecting attachment
with contemporary formulations of emotion regulation and perfectionism. For
example, Shaver and Mikulincer (2007) found that individuals with higher levels
of attachment anxiety were likely to amplify distress through appraising events as
catastrophic or ruminating. Caldwell and Shaver (2012) showed that attachment
anxiety, along with rumination, predicted higher levels of negative affect, decreased
efforts at mood repair, and thus lower levels of ego-resiliency in the face of
challenging situational demands. By contrast, attachment-related avoidance,
coupled with emotional suppression, was related to diminished clarity and repair of
moods, which similarly predicted lower ego-resiliency.
Likewise, self-critical perfectionism predicts various forms of stress (Dunkley,
Solomon-Krakus, & Moroz, 2016), including heightened (Wirtz et al., 2007) or
blunted (Richardson, Rice, & Devine, 2014) psychological stress responsiveness
consistent with chronic stress. Perfectionistic concerns also lead to problematic
cognitive and emotional regulation responses (Aldea & Rice, 2006; Rice, Vergara,
& Aldea, 2006) likely to prolong or worsen, rather than reduce or control, stress.
Consistent with Hamachek’s (1978) differentiation of normal from neurotic
perfectionism, however, are a set of perfectionistic characteristics aligned with
secure attachment, healthy emotion regulation and stress responsiveness, and a
general pattern of resilient adjustment and well-being. For example, Richardson et
al. (2014) found support for a latent profile of adaptive perfectionists who, compared
with other groups, had higher standards and lower self-criticism, used more
adaptive coping strategies (i.e., more reappraisal and less suppression), and showed
moderate levels of stress reactivity. Aldea and Rice (2006) found that high personal
performance standards (controlling for self-criticism) were predictive of healthier

psychological functioning, with that effect mediated by positive emotional
regulation. These results are also consistent with other findings that perfectionists
with high standards and low self-criticism tend to have secure rather than anxious
bonds with others (Rice & Mirzadeh, 2000; Wei et al., 2004).
Binding Ties
High personal standards and expectations may develop when caregivers value or
require performance. For some, self-criticism may become intertwined with
standards, resulting in a toxic combination of needing to perform at a high level
and never really gaining a sense of satisfaction that the level has been attained. In
contrast, the consequences of high perfectionistic strivings without lurking self-
criticism appear to be consistently positive or at worse, benign, in terms of
numerous academic, emotional, interpersonal, and occupational outcomes. Thus,
it makes sense why people maintain this type of perfectionism—because it works.
What is less clear is what maintains maladaptive perfectionism. Why do those with
high standards blended with self-criticism hold on so dearly to what seem to be a
self-punishing, discouraging, and depressogenic combination of personality factors?
Although maintaining a punishing style of perfectionism seems highly costly to the
individual, we suspect that many individuals resist changing this maladaptive form
of perfectionism because it would result in some other form of substantial loss, such
as losing or disrupting an important relational connection. Because defending
against such loss is likely to thwart change efforts, we suggest the need for creative
preventive, secondary, and tertiary interventions that circumvent resistance and
retain the benefits of perfectionistic strivings, but weaken self-criticism.
In the development of depth-oriented brief therapy (now called coherence
therapy), Ecker and Hulley (2000) explained why it can be “compellingly
necessary” to have a problem like maladaptive perfectionism “despite the suffering
or trouble incurred by having it” (p. 162). The “depth” in their approach focused
on helping clients achieve goals through a new understanding of the “emotional
truth” of a problem. What makes their approach so different from many others is
that they eschewed direct efforts to counteract or correct the symptom or problem.
Rather than, for example, helping maladaptive perfectionists monitor, challenge,
and change irrational thoughts, Ecker and Hulley advocated a process of experiential
discovery that included an emphasis on understanding the adaptive necessity of the
seemingly maladaptive issue for the individual. That level of understanding, they
argued, was crucial because a deeper acknowledgment of the symptom’s function
would then allow for more conscious integration, and then transformation, of the
symptom or problem. As is probably evident, coherence therapy is consistent with
many of the emotion-focused, strengths-based, and humanistic counseling
traditions (e.g., Greenberg, 2014). Coherence therapy emphasizes models of
growth and development over pathology through respecting the healing capacity
of the individual over his or her deficits or dysfunctions.
Based on the theories we have considered in this chapter (i.e., attachment

theory, person-centered theory, and self psychology), maladaptive perfectionism
may serve the adaptive purpose of helping individuals maintain a relationship bond
with attachment figures who—from the child’s perspective, and for a variety of
reasons—are difficult to consistently please. Seeking a consistent and stable sense of
positive connection, the child develops a habit of adopting very high standards and
a rigid style of evaluating their current progress toward meeting those standards.
From attachment theory, maladaptive perfectionism results in retaining allegiance
to self-critical, negative, internalized working models of the self and others, and in
that way, perpetuates a relational connection with those who contributed to the
formation of those internal models. From humanistic theory and person-centered
therapy, continuing to adhere to conditions of worth despite how unworthy those
conditions make one feel is likely motivated by the same strong need for positive
regard that initiated the suspension of attending to internal standards of self-
acceptance in favor of external, contingent standards of others. From self
psychology, maladaptive perfectionism may emerge through the combination of
non-empathic parents who were excessively critical and poorly suited for
idealization (Rice & Dellwo, 2002). Thus, all three theories converge on the idea
that maladaptive perfectionism helps individuals self-validate through desperately
seeking to achieve relentlessly high standards.
Thus, some perfectionists may have strong adaptive needs tied to self–other
relational dynamics resulting in them wanting to preserve what otherwise seems
like a maladaptive combination of strivings and self-criticism. It is striking, for
instance, that if clients choose to change their standards, they are more likely to set
standards higher following failure (Egan, Piek, Dyck, Rees, & Hagger, 2013).
Obviously, such approaches are risky. Performance-related disappointments and
failures (real or perceived) are inevitable, and adjusting expectations to be even
higher after failure seems likely to perpetuate despair. What makes having high
standards maladaptive for some may involve a combination of vulnerabilities,
including (a) rigid reliance on an externally-mandated rather than self-generated
value system, (b) chronic shame emanating from a vulnerable self-system that then
exacerbates self-criticism, (c) limited or dysfunctional emotion regulatory resources,
(d) impoverished social connections, and (e) a less diversified strategy for
performance and performance-related reactivity. Thus, the theories we reviewed
converge on the idea that what may help individuals develop an adaptive form of
perfectionism may involve virtues such as forgiveness of self and others, tolerance
of failure and imperfection, the ability to scaffold goals after failure (i.e., to set a
series of achievable goals that build on each other), an ability to disentangle self-
worth from performance or productivity, high-quality relationships that are
reciprocally supportive, and a diversified portfolio of effective strategies for
reactivity and regulation in response to disappointment.
Research Agenda
We recently concluded that emotion up- and down-regulation approaches may be
a primary mechanism linking perfectionism to various outcomes, and made several
recommendations for studies along those lines (Rice et al., 2016). Several of those
ideas seem appropriate to raise in future research addressing perfectionism and
emotion regulation, but we should also acknowledge that complex interdisciplinary
and multi-method studies already have been done or are underway, so our
recommendations are also partly a commentary on the present.
Extending measurement of perfectionism beyond self-report scales of trait-like
qualities seems worthy to pursue. The fact that emotional states can affect self-
reports (Bagby, Buis, & Nicholson, 1995) poses a particular challenge for studies of
personality and emotion regulation. Thus, we strongly recommend future studies
integrate other methods, including informant reports (Connelly & Ones, 2010),
implicit measures (De Cuyper, Pieters, Claes, Vandromme, & Hermans, 2013),
and markers of cardiovascular and neuroendocrine responsiveness (Appleton &
Kubzansky, 2014) or coping process measures that can clarify how types of
perfectionists appraise and attempt to cope with failures differently.
Another important direction for future research involves exploring how
diversity-related variables sometimes moderate the relationship between
perfectionism and outcomes (DiBartolo & Rendón, 2012). Given our theorizing
that perfectionism may arise through how individuals learn to stay connected to
attachment figures and internalized cultural values, it is important to understand
how this process may vary in societies with different values associated with
perfectionistic strivings and concerns. Some cultures value and normalize self-
criticism as important for growth. Zane and Song (2007) commented that “research
in Japan and other East Asian societies indicates that … the basic underlying
motivation is to be self-critical and to make continual efforts to improve oneself
and to reduce one’s shortcomings” (p. 295; see also Lo, Helwig, Chen, Ohashi, &
Cheng, 2011). In East Asian countries, it is possible that what strongly distinguishes
maladaptive perfectionism in the United States and other Western countries (i.e.,
variability in self-criticism) may involve other constructs that are associated with
chronic shame in these cultures.
Comments and recommendations regarding interventions for (maladaptive)
perfectionists often focus on psychotherapy or self-help and infrequently advocate
preventive approaches (cf. Chapter 13). To be sure, there is a growing literature
supporting psychotherapeutic approaches to reducing self-critical perfectionism
and reducing psychological problems (Egan, Wade, Shafran, & Antony, 2014; see
also Chapters 14 and 15). Nevertheless, there is also reason for being guarded about
how much psychotherapy can do for the most self-critical perfectionists. Many
maladaptive perfectionists do not view their self-criticism as a problem (e.g.,
Stoeber & Hotham, 2013), and they may resist efforts to change perfectionistic
tendencies because these tendencies play crucial roles in maintaining bonds with
others and shoring up personal integrity. Thus, until we know more, we advise
exploring a range of alternative approaches for thinking about how to intervene

with maladaptive perfectionists.
Several variations to traditional intervention have shown promise. Several teams
have augmented treatment studies with self-help and web-based resources. For
example, Wimberley, Mintz, and Suh (2016) found support for a mindfulness-
based bibliotherapy approach to reducing self-critical perfectionism and perceived
stress that left personal standards unchanged. Egan et al. (2014) reviewed other
promising approaches, such as guided or pure self-help, and online administration
of interventions, with generally positive results supporting their use. Although
relatively small sample sizes and other methodological limitations exist in these and
related studies, overall, this is an exciting and promising area of research making
creative use of technology and other modalities (see Kazdin & Blase, 2011), which
may ultimately expand access to treatment options and benefits for perfectionists.
Going beyond these psychotherapy or self-help variations, some alternative
approaches specifically address several major issues experienced by the most
maladaptive of perfectionists: stress, ill health, academic or other performance
concerns, and problems with social belonging. So-called “wise” interventions
(Walton, 2014) make use of theory and research to bring about strong, positive
effects while using relatively few but creative and efficient resources. Some
examples include values or self-affirmation to reduce stress (Sherman, 2013; Taylor
& Walton, 2011), altering implicit personal theories of personality (Yeager et al.,
2014), and enhancing social belonging through “saying-is-believing” (Walton &
Cohen, 2011). Because of the centrality of stress and emotion regulation in the
lives of self-critical perfectionists—and because self-affirmation seemingly runs
counter to how highly self-critical, maladaptive perfectionists are likely to view
themselves—we provide more detail about values affirmation interventions.
Given the vulnerable sense of self experienced by maladaptive perfectionists,
self-affirmation theory (Cohen & Sherman, 2014) aligns squarely with the theories
of perfectionism we describe earlier. For example, a key element in self-affirmation
theory is that people are motivated to maintain self-integrity, “a sense of global
efficacy, an image of oneself as able to control important adaptive and moral
outcomes in one’s life. Threats to this image evoke psychological threat” (p. 336).
Furthermore, people need “to maintain a global narrative of oneself as a moral and
adaptive actor … to be competent enough in a constellation of domains to feel that
one is a good person, moral and adaptive … not to esteem or praise oneself but
rather to act in ways worthy of esteem or praise” (ibid.). Self-affirmation
interventions are based on subtle techniques designed to activate inherent
motivations to maintain perceived self-worth and self-integrity (Cohen & Sherman,
2014). Thus, these interventions can reduce appraisals of threat (primary appraisals)
as well as perceived resources for coping with stress (secondary appraisal).
Evidence supports self-affirmation interventions as facilitating better
neuroendocrine or cardiovascular stress reactivity in stressful situations (Creswell et
al., 2005; Tang & Schmeichel, 2015). For example, Sherman, Bunyan, Creswell,
and Jaremka (2009) found that, compared with nonaffirmed students, students who
had gone through an affirmation procedure earlier in the semester had less
physiological stress reactivity on the morning of an exam. As an important
implication regarding perfectionism, the positive effects of self-affirmation in that
study were most conspicuous among students with the greatest concerns about
consequences they might experience as a result of performing poorly on the exam.
The common social-disconnection difficulties of self-critical perfectionists
might be improved through social belonging interventions (e.g., Walton & Cohen,
2011), as might related issues of stress and threat. Participants in social belonging
interventions come to interpret their stressful experiences as common (shared
connection with others) and temporary rather than pessimistically chronic. For
at-risk groups, such interventions have been credited with positive health and
performance outcomes (see Walton, 2014, for a comprehensive summary). Other
intervention studies could examine the effects of procedures for changing beliefs
about personality. Such an intervention might help self-critical perfectionists shift
their understanding of personality and adopt a more flexible and ultimately more
adaptive view of self and others. Yeager et al. (2014) have demonstrated that such
an intervention pays off in terms of lower stress, and better health and academic
performance.
Thus, future research in the area of perfectionism and emotion regulation
interventions might examine interventions being developed and supported in areas
other than what traditionally might be considered counseling or clinical psychology.
These approaches have the potential to benefit larger groups while using
dramatically fewer resources than traditional psychotherapy. Theory and practice
in the area of perfectionism seem likely to benefit regardless of the outcomes
produced by such studies. For example, if self-critical perfectionists do not benefit
from such interventions in the ways that others do, then an important moderator
of the effectiveness of these interventions will have been identified and variations
of those approaches might be in order. Further, values affirmation or implicit
personality interventions may work for younger but not older perfectionists, or
perhaps “wise” interventions need to be paired with other approaches in order to
be helpful (e.g., brief psychotherapy, guided self-help, group therapy). If, on the
other hand, such interventions prove effective, then efficient and easy to implement
methods will be at the disposal of those interested in addressing perfectionism and
the related emotion regulation difficulties of the most impaired perfectionists.
Note
1 Originally called “high standards.”
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PART IV
Prevention and
Treatment
13
PREVENTION OF PERFECTIONISM
IN YOUTH
Tracey D. Wade
Overview
This chapter focuses on the current and future directions for universal prevention
targeting unhelpful perfectionism in youth (children and adolescents before the age
of 18 years). Universal approaches are those delivered to all youth, regardless of risk
status, typically in classroom settings. Unhelpful perfectionism is broadly defined as
the types, dimensions, and aspects of perfectionism that lead to adverse outcomes
in youth. The following questions will be addressed: (a) What do we need to know
about perfectionism in youth to develop effective preventions? (b) How is
perfectionism defined in children and adolescents? (c) What models of perfectionism
have been tested in youth? (d) What studies inform our understanding of whether
unhelpful perfectionism can be prevented? And (e) what specific recommendations
does this suggest for future prevention?
What Do We Need to Know About Perfectionism in Youth to

Develop Effective Preventions?
Whenever one is thinking about developing interventions, whether prevention or
treatment, it is useful to start at the point of having a clear definition of the primary
construct that one wants to change, along with an associated measure, as well as
having a theoretical model that can parsimoniously inform which targets of an
intervention are likely to effect the maximal process of change in the primary
variable and any resultant outcomes (Craig et al., 2008, 2013; Medical Research
Council, 2000). The process of testing the relevant theory, developing an
intervention suggested by this theory, and evaluating the efficacy and long-term
effectiveness of the intervention, can then inform revisions of the model.
266 Wade
On the one hand, all of these processes could be considered to be at an early

stage in research on child and adolescent perfectionism (Morris & Lomax, 2014),
thereby limiting the development of effective prevention strategies. To date,
operationalization of unhelpful perfectionism in child-appropriate questionnaires
has resulted in a relatively diverse range of constructs (cf. Table 13.1). Additionally,
there is some debate as to the inclusion of self-oriented perfectionism (i.e., setting
very high personal standards) in the category of unhelpful perfectionism. There are
no youth-specific models, and very few interventions have been conducted with
youth that can be used to inform models. On the other hand, the importance of
proactively designing and implementing school-based preventive programs with
specific components designed to enhance resilience and reduce levels of risk among
young perfectionists has been highlighted as a priority (Flett & Hewitt, 2014). The
purpose of this chapter is to summarize our knowledge relating to developing
effective interventions in youth, and to consider what is needed in order to move
forward in the development of effective universal prevention approaches for
perfectionism in youth.
How is Perfectionism Defined in Children and Adolescents?

With youth, as with adults, there is a suggestion that perfectionism can be both
helpful and unhelpful (Stoeber & Otto, 2006). In adults, two higher-order factors
have been identified that were originally labeled “positive striving” and “maladaptive
evaluation concerns” (Frost, Heimberg, Holt, Mattia, & Neubauer, 1993), but are
now commonly called “personal standards perfectionism” and “evaluative concerns
perfectionism” respectively. The former is associated with healthy outcomes and
the latter with unhealthy outcomes. Other manifestations of positive striving have
been associated with positive outcomes in youth. For example, high standards—
measured with the APS-R (see Table 13.1)—have been associated with better
adjustment in adolescents (Rice, Ashby, & Gilman, 2011), personal standards and
organization—measured with the FMPS (see Table 13.1)—have been associated
with conscientiousness in sixth-grade children (Stumpf & Parker, 2000), and
higher contingent self-esteem—measured with the AMPS (see Table 13.1)—has
been associated with a more positive self-concept (Rice, Kubal, & Preusser, 2004).
Evidence would suggest that the pursuit of excellence that has positive impact on
self-esteem is not unhealthy, and cluster analyses in children and adolescents suggest
that healthy perfectionism groups exist (Hawkins, Watt, & Sinclair, 2006; Parker,
1997; Rice et al., 2011). Such groups are typified by high scores on personal high
standards but low scores on dimensions reflecting concern over mistakes, self-
doubt, and discrepancy (i.e., the perception that personal high standards are not
being met). In an interesting cross-sectional study of 576 adolescents (Damian,
Stoeber, Negru, & Băban, 2014) using the 2 × 2 model of perfectionism (Gaudreau
& Thompson, 2010) as analytic framework, four subgroups were identified from
their levels of self-oriented perfectionism and socially prescribed perfectionism
(i.e., perceiving that others have very high standards for oneself). Those adolescents
Prevention of Perfectionism in Youth 267
with high levels of self-oriented perfectionism (and low levels of socially prescribed
perfectionism) showed the highest levels of positive affect and lowest levels of
negative affect. Those adolescents with high levels of socially prescribed
perfectionism (and low levels of self-oriented perfectionism) showed the lowest
levels of positive affect and the highest levels of negative affect. Those with high
levels of both types of perfectionism and non-perfectionists (low levels of self-
oriented and socially prescribed perfectionism) had the second and third highest
levels of positive affect respectively, whereas the former had high levels of negative
affect and the latter had levels of negative affect comparable to the adolescents with
high self-oriented perfectionism (and low levels of socially prescribed perfectionism).
However, there is debate in the literature as to the helpfulness of self-oriented
perfectionism because it has been argued that self-oriented perfectionism is a
vulnerability factor activated during times of stress and failure, and that this type of
perfectionism is more costly than beneficial in most instances (Flett & Hewitt,
2014). Certainly, extreme levels of self-oriented perfectionism have several inherent
features that limit its adaptiveness, including rigid and inflexible thinking and an
excessive self-focus. The domain in which self-oriented perfectionism is expressed
may also contribute to its maladaptiveness. For example, if it is expressed in the
domain of body shape and weight, it may result in an eating disorder. Generally,
we require a clearer differentiation between the functional pursuit of excellence
and the dysfunctional pursuit of black-and-white, personally demanding high
standards. This is an important piece of work to conduct if we are to develop
effective prevention strategies with youth, as youth is a critical time when life goals
are formulated and pursued. Any interventions that seek to lower standards are
unlikely to be welcomed in school settings, and the goals of interventions should
support the basic human motivations recognized in self-determination theory
(Ryan & Deci, 2000) including competence, autonomy, and relatedness.
Definitions of unhelpful perfectionism have largely been formulated in the
context of adult populations. Adults whose perfectionism leads to adverse outcomes
have been described in a number of ways, for example, as people “whose standards
are high beyond reach or reason, people who strain compulsively and unremittingly
toward impossible goals and who measure their own worth entirely in terms of
productivity and accomplishment” (Burns, 1980, p. 34); people having “high
standards of performance which are accompanied by tendencies for overly critical
evaluations of one’s own behavior” (Frost et al., 1990, p. 450); or people having
an “overdependence of self-evaluation on the determined pursuit of personally
demanding, self-imposed standards” (Shafran, Cooper, & Fairburn, 2002, p. 778).
Attention has also been paid to the unhelpful aspects of interpersonal dimensions
of perfectionism, particularly socially prescribed perfectionism, which involves the
perception that others demand high levels of performance from oneself (Hewitt,
Flett, Turnbull-Donovan, & Mikail, 1991). This type of perfectionism may be of
particular relevance to youth who are more likely than adults to be influenced by
expectations of parents, teachers, and peers. The role of self-criticism has also been
highlighted, with the suggestion that it accounts for the impact of perfectionism on
268 Wade
maladjustment (Dunkley, Zuroff, & Blankstein, 2006). In summary, it appears that

all definitions of unhelpful perfectionism in adults involve: (a) rigidly high standards
(self-oriented and/or socially prescribed), (b) measuring self-worth entirely in
terms of productivity and accomplishment, and (c) self-criticism when goals are
not met.
In the absence of definitions of unhelpful perfectionism specific to youth,
examination of measures of perfectionism suitable for children and adolescents can
inform us of what have been considered important aspects of unhelpful perfectionism
in this group. The measures of perfectionism which have been investigated with
respect to validity and reliability in children or adolescents are summarized in Table
13.1. It is immediately apparent that a number of constructs have been defined as
consisting of unhelpful perfectionism in youth, some of which overlap with the
definitions provided in the preceding paragraph. These include the setting of very
high, rigid, and all-or-nothing personal standards and the nonattainment of goals
resulting in self-criticism, along with distress as a result of making errors, the need
to appear perfect to others, low tolerance of display of imperfection and mistakes,
perceiving others to have very high standards for oneself, the need for social
approval, and the perception that personal high standards are not being met.
In a review of these measures, Morris and Lomax (2014) concluded that,
whereas there is a range of tools for clinicians and researchers to choose from when
assessing perfectionism in children, there were two limitations. First, for almost all
of the measures, there were no validation studies or factor analyses published by
independent authors (i.e., authors not involved in the construction of the measures),
thus entertaining the possibility that the publications associated with these measures
may have been subject to bias. Second, and of relevance to the issues explored in
this chapter, the multiplicity of measures presents a problem when testing theories.
Consequently, Morris and Lomax recommended that authors of the key measures
collaborate to develop a single tool which can inform the development of models
and interventions.
What Models of Perfectionism Have Been Tested in Youth?

Only one model examining perfectionism as a central construct has been tested in
youth. This model—called the perfectionism social disconnection model (Hewitt,
Flett, Sherry, & Caelian, 2006; see also Chapters 9 and 15)—originally focused on
how perfectionism relates to suicidal outcomes and was tested by Roxborough et
al. (2012) cross-sectionally in young adolescents (mean age = 12.9 years). Results
showed that the relationships of socially prescribed perfectionism (measured with
the CAPS; see Table 13.1) and perfectionistic self-presentation (measured with the
PSPS-JR; see again Table 13.1) with outcomes related to suicide were mediated by
experiences of social disconnection, as indicated by social hopelessness and being
bullied. Of relevance to the elaboration of this model are findings showing that
perceived parental expectations predicted increases in socially prescribed
perfectionism over a seven- to nine-month period in a sample of adolescent
TABLE 13.1 Measures of Perfectionism Validated in Youth
Measure (authors) Original structure: Items, response scale, subscales Tests of reliability and validity with youth
Adaptive/Maladaptive 27 items rated on a 4-point scale: 1 (really unlike me) to Rice et al. (2004): In children aged 9–12 years, sensitivity to
Perfectionism Scale 4 (really like me) mistakes associated with decreased happiness and satisfaction,
(AMPS; Rice & (1) Sensitivity to Mistakes: distress as a result of making errors higher contingent self-esteem corresponded to more positive
Preusser, 2002) (2) Contingent Self-Esteem: based on meeting high standards self-concept, compulsiveness and need for admiration were
(3) Compulsiveness: conscientiousness and organization both significantly and inversely related to emotional stability.
(4) Need for Admiration: desire for recognition and Specific patterns of results differed between boys and girls.
admiration
Rice et al. (2007): Different factor structure in adolescents
aged 12–16 years, three-factor solution omitting Contingent
Self-Esteem items. Differences between boys and girls noted
again (e.g., sensitivity to mistakes and compulsiveness
accounted for significant variation in depression for girls, but
not boys).
Almost Perfect Scale- 23 items rated on a 7-point scale: 1 (strongly disagree) to Rice et al. (2011): In adolescents (mean age = 14.6 years),
Revised (APS-R; 7 (strongly agree) high standards were associated with better adjustment, and
Slaney et al., 2001) (1) High Standards: adaptive and healthy striving for high discrepancy was associated with psychological and academic
personal standards difficulties.
(2) Discrepancy: the perception that personal high standards
are not being met
(3) Order: measures preferences for order and organization
(this subscale is rarely utilized)
TABLE 13.1 continued
Measure (authors) Original structure: Items, response scale, subscales Tests of reliability and validity with youth
Child–Adolescent 22 items rated on 5-point scale: 1 (False—not at all true of me) McCreary et al. (2004) and O’Connor, Dixon, & Rasmussen
Perfectionism Scale to 5 (Very true of me) (2009): Both studies (youth aged 11–12 and 15–16 years
(CAPS; Flett et al., (1) Self-Oriented Perfectionism (SOP): setting very high respectively) showed that a 14-item, three-factor structure
2016) personal standards, with nonattainment of goals leading to was a better fit in which SPP emerged as a single factor, but
self-criticism SOP was better modelled as two factors, viz. SOP–striving
(2) Socially Prescribed Perfectionism (SPP): perceiving that (striving toward perfectionism) and SOP–critical (self-
others have very high standards for oneself criticism). Invariant across gender and time, but boys reported
setting higher self-standards (SOP-striving) than girls. SOP–
striving associated with psychopathology in children and
adolescents, including depression, anxiety, and disordered
eating (Boone et al., 2010; Huggins et al., 2008; Mitchell et
al., 2013; Soreni et al., 2014).
Children’s Dysfunctional 40 items Abela & Sullivan (2003) and D’Alessandro & Burton (2006):
Attitudes Scale (CDAS; In children rated on a 4-point scale: 0 (never true) to 40-item CDAS showed a one-factor solution derived from
D’Alessandro & Abela, 3 (always true) principal components analysis.
2001), derived from the In adults rated on a 7-point scale: 1 (totally disagree) to
McWhinnie et al. (2009): 15-item CDAS showed two-factor
adult DAS (Beck et al., 7 (totally agree)
structure (self-critical perfectionism, personal standards
1991)
perfectionism) in youth aged 6–14 years. The former factor
was more strongly associated with depressive symptoms,
maladaptive coping strategies, and impaired interpersonal
relationships than the latter.
Rogers et al. (2009): Using the DAS with 12- to 17-year-olds
found a 26-item, two-factor solution (perfectionism, need for
social approval). Invariant across gender and age. Both factors
had moderate correlations with depression.
Frost Multidimensional 35 items rated on a 5-point scale: 1 (not at all true) to Stumpf & Parker (2000): In sixth-grade children, two higher-
Perfectionism Scale 5 (very true) order factors were identified across four lower-order factors
(FMPS; Frost et al., (1) Personal Standards (PS) (PS, CM + DA, PE + PC, and O). Healthy perfectionism
1990) (2) Concern Over Mistakes (CM) (PS + O) correlated with conscientiousness and unhealthy
(3) Doubts About Actions (DA) perfectionism (CM + DA + PE + PC) correlated with low
(4) Parental Expectations (PE) self-esteem.
(5) Parental Criticism (PC)
Hawkins et al. (2006): In 12- to 16-year-old girls, the same
(6) Organization (O)
four lower-order factors emerged in an exploratory factor
Subsequent studies found a four-factor structure combining
analysis applied to 33 items, but the suggestion of two
CM with DA and PE with PC (e.g., Stöber, 1998).
higher-order factors (healthy vs. unhealthy perfectionism)
was rejected.
Perfectionism 25 items rated on a 5-point scale: 0 (not at all) to Flett, Hewitt, et al. (2012): In older adolescents (15–19 years),
Cognitions Inventory 4 (all of the time) the PCI showed a one-factor solution. PCI scores were
(PCI; Flett et al., 1998) significantly correlated with trait perfectionism, self-criticism,
and dependency, and predicted unique variance in depression
over and above trait personality measures and negative
automatic thoughts.
Perfectionistic Self- 18 items rated on a 5-point scale: 1 (not at all) to 5 (extremely) Hewitt et al. (2011): All subscales positively correlated with
Presentation Scale– (1) Perfectionistic Self-Promotion: the need to appear perfect psychopathy in youth aged 8–17 years.
Junior Form (PSPS-JR; to others
Flett, Coulter, and Hewitt (2012): Nondisclosure of
Hewitt et al., 2011) (2) Nondisplay of Imperfection: behaviorally concealing one’s
imperfection had relatively low internal consistency in
imperfection
adolescents (mean age = 13.0 years). Significant associations
(3) Nondisclosure of Imperfection: verbally concealing one’s
between the subscales, trait perfectionism, and dysfunctional
imperfection
attitudes; and PSPS-JS subscales predicted unique variance in
social anxiety over and above trait perfectionism.
Note: Measures are presented in alphabetical order.

272 Wade
high-school students aged 15–19 years (Damian, Stoeber, Negru, & Băban, 2013).
No such effect was found for self-oriented perfectionism.
Three longitudinal studies have examined the way perfectionism works together
with other variables to lead to higher levels of problems with body image and
disordered eating, and can inform the development of models in this area. In young
adolescent girls (mean age = 13.0 years), higher levels of personal standards and
concern over mistakes (measured with the FMPS) have been shown to interact
with higher levels of body dissatisfaction to result in significant increases in
importance of weight and shape at 12-month follow-up (Boone, Soenens, &
Luyten, 2014). Importance of weight and shape has been described as the “core
psychopathology” of eating disorders (Cooper & Fairburn, 1993), forms part of the
diagnostic criteria for both anorexia nervosa and bulimia nervosa, and predicts
increased diagnostic threshold levels of disordered eating behaviors in adolescents
(Wilksch & Wade, 2010).
A second study, of 12- to 15-year-old boys and girls (Boone, Vansteenkiste,
Soenens, van der Kaap-Deeder, & Verstuyf, 2014), showed that higher levels of
concern over mistakes (measured with the FMPS) resulted in higher levels of need
frustration which, in turn, resulted in an increase of tendencies to think about, and
engage in, bouts of uncontrollable overeating. Need frustration (measured with the
Balanced Measure of Psychological Needs; Sheldon & Hilpert, 2012) refers to
frustration of needs of competence, autonomy, and relatedness, that is, the
constructs that are key to self-determination theory (Ryan & Deci, 2000). These
needs are thought to be of relevance to self-critical perfectionists whose positive
feelings after achievement are short-lived and replaced with a focus on the next
demanding standard so that attainment of goals is often dismissed.
A third study examined longitudinal mediation pathways to the increased risk
of developing disordered eating in young adolescents (Wade, Wilksch, Paxton,
Byrne, & Austin, 2015). The relationship between higher levels of concern over
mistakes at baseline (measured with the FMPS) and increased risk for disordered
eating over time was mediated by higher levels of ineffectiveness. Risk for
disordered eating was measured in two ways. The first was the importance of
weight and shape, and the second was the cumulative total of weight and shape
concern, depression, and negative comments about weight which have been
shown to predict the development of full or subthreshold eating disorders in
college women (Jacobi et al., 2011). Ineffectiveness (measured with the Eating
Disorder Inventory; Garner, Olmstead, & Polivy, 1983)—which included items
related to feelings of inadequacy, insecurity, worthlessness, and having no control
over one’s life—can be likened to the concept of low self-efficacy or difficulties
with managing life and strong emotion. Perfectionistic concern over mistakes can
result in feelings of ineffectiveness because of the perceived discrepancy between
desired standards and abilities. Interestingly, when baseline personal standards
(measured with the FMPS) were examined, there was no significant relationship
with either levels of subsequent ineffectiveness or increases in the importance of
weight and shape.
A clear limitation across these three studies is the lack of inclusion of the wide
range of adjustment difficulties associated with perfectionism in children and
adolescents. Self-oriented perfectionism has been associated with clinically
diagnosed anxiety and has been shown to predict poorer treatment outcome
(Mitchell, Newall, Broeren, & Hudson, 2013). Self-oriented perfectionism and
socially prescribed perfectionism have been shown to predict depression and
obsessive compulsive disorder (Huggins, Davis, Rooney, & Kane, 2008; Soreni
et al., 2014). Socially prescribed perfectionism has been associated with suicide
ideation (Boergers, Spirito, & Donaldson, 1998) and self-harm (O’Connor,
Rasmussen, Miles, & Hawton, 2009). The combination of high levels of personal
standards and high levels of concern over mistakes has been associated with eating
disorder symptoms (Boone, Soenens, Braet, & Goossens, 2010). It should be noted,
however, that self-oriented perfectionism has been associated with better goal
progress in university students once the impact of self-criticism was removed
(Powers, Koestner, Zuroff, Milyavskaya, & Gorin, 2011), which is of potential
relevance to the development of a prevention approach for youth because such an
approach should not curb adaptive goal processes. Therefore, the development of
a parsimonious model predicting broad outcomes in order to improve the
understanding and prevention of unhelpful perfectionism in youth is required.
What Studies Inform Our Understanding of Whether Unhelpful

Perfectionism Can Be Prevented?
A recent overview of school-based interventions (Flett & Hewitt, 2014) came to
the conclusion that the evidence to date supports the use of extensive, multifaceted
interventions focused solely on perfectionism rather than multiple targets, to
eliminate the negative impacts of perfectionism. This is consistent with the finding
that cognitive-behavioral interventions targeting perfectionism in adult clinical
populations have been shown to be associated with large decreases in perfectionism
and moderate decreases in anxiety and depression (Lloyd, Schmidt, & Tchanturia,
2015; see also Chapter 14). Key themes for building resilience and decreasing
perfectionism in classroom settings have been highlighted (Flett & Hewitt, 2014),
including reducing the perceived importance of achieving impossible standards,
seeing failures as pathways to success and growth, and promoting self-acceptance
and self-compassion to counter self-criticism as well as providing stress inoculation
and stress management. Table 13.2 summarizes the results of the three school-
based intervention studies that have so far evaluated interventions focused directly
on perfectionism.
The first of these studies (Wilksch, Durbridge, & Wade, 2008), using eight class
lessons with 15-year-old girls, compared the efficacy of two interventions, one
targeting perfectionism (Group 1) and the other media literacy (Group 2),
compared to control classes (Group 3). At three-month follow-up, the perfectionism
group showed a significant reduction in concern over mistakes (measured with the
FMPS) compared to the other two groups. The perfectionism intervention group
TABLE 13.2 Three Studies: Contents of School-Based Programs Focused Directly on Perfectionism
Study Participants Program content by lesson
Wilksch et al. N = 127 girls; (1) What is perfectionism?

(2008) Mage = 15.0 years (2) What’s bad about being too good (perfectionism vs. the pursuit of excellence)?
(SD = 0.4)
(3) What leads to and maintains perfectionism?
(4) How to challenge the thinking that feeds perfectionism
(5) Changing behavior: rewards, incentives, and redefining success
(6) Reframing failure: making mistakes is good
(7) Coping with perfectionism
(8) The final wrap-up (including class presentations and the take-home message)
Nehmy & N = 688 girls and (1) Introduction, ground rules, motivational exercise; introduction to perfectionism; costs of unhelpful
Wade (2015) boys; perfectionism; finding benefits in mistakes and failures
Mage = 14.9 years (2) How thoughts affect feelings, identifying thinking errors associated with perfectionism, focus on flexible
(SD = 1.0). thinking
(3) Media influences on perfectionism: becoming critical consumers of the media, ways in which the media
promotes unrealistic ideals, the role of social media in promoting perfectionism, becoming a “social activist”
against perfectionism
(4) Learning about emotions: understanding their evolutionary function, identifying emotional urges, avoidance
and exposure, identifying reactions and choosing helpful alternative behaviors
(5) Learning helpful thinking: thought challenging, realistic and balanced thinking
(6) Dealing with procrastination, over-commitment, negative thinking biases; gratitude
(7) Stress and self-criticism; responding with self-compassion
(8) Personal values and summary
Fairweather- N = 125 girls and (1) Description of perfectionism (differentiating between perfectionism that causes problems from “trying your
Schmidt & boys; best”), the good and the bad aspects of mistakes, finishing with a message challenging overdependence of self-
Wade (2015) Mage = 11.6 years evaluation on the determined pursuit of personally demanding standards (e.g., “you are more than your
(SD = 0.8) achievements”)
(2) Developing skills related to dealing with self-criticism and paying attention to, and celebrating, successes,
using brain-storming activities; presentation of media clips demonstrating perfectionistic behavior (and associated
consequences), classroom discussion to talk through the benefits of making errors, and individual-oriented
reflective exercises recollecting disappointing or success experiences in relation to personal goals or achievements
Note: Studies are presented in the sequence in which they are discussed in the text.
276 Wade
also had significantly lower levels of personal standards (FMPS) at follow-up

compared to the media literacy intervention group. A particular focus of the two
interventions was to decrease risk for disordered eating. Consequently, the
participants in each group deemed to be at high risk for developing an eating
disorder were also examined separately. Of the 17 high-risk participants in the
perfectionism intervention group, over 50% had clinically significant reductions in
both FMPS dimensions of perfectionism, weight and shape concern, and dieting at
three-month follow-up. However, it should be noted that around 40% of the
group experienced no change, or even experienced deterioration, with the high-
risk participants only accounting for 7 to 14% of the subgroup.
The second study (Nehmy & Wade, 2015) examined a perfectionism
intervention that resulted in significantly lower levels of self-critical perfectionism
at 12-month follow-up after eight lessons with boys and girls (mean age = 14.9
years) compared to a control group. The focus of this intervention was on
transdiagnostic outcomes, so it is of interest to note that the intervention group
showed significantly lower levels of perfectionism, self-judgment, and negative
affect than the control group at six-month follow-up. The presence of prevention
effects were also examined in a subgroup of adolescents with low negative affect at
baseline, corresponding to a “moderate” level of clinical symptoms on the
Depression Anxiety Stress Scales (Lovibond & Lovibond, 1995). Those adolescents
in the control group showed an increase in negative affect at six-month follow-up
while the adolescents in the perfectionism intervention did not, which suggests
that the intervention had a “prevention effect.”
The third study (Fairweather-Schmidt & Wade, 2015) is so far the only universal
program targeting perfectionism that has been evaluated in pre-adolescents. Given
the absence of evaluation of programs with an explicit focus on perfectionism in
children or pre-adolescents (Morris & Lomax, 2014), a “proof-of-principle”
approach was taken to investigate whether results of an intervention with children
(mean age = 11.6 years) supported further development and evaluation of
perfectionism-focused interventions. Therefore, this pilot study explored the
effectiveness of a two-lesson perfectionism intervention compared to a control
condition at the end of the intervention and at one-month follow-up. Results
showed that the group receiving the intervention reported significantly lower
levels of self-oriented perfectionism-striving (measured with the CAPS; see
O’Connor et al., 2009)—which reflects statements like “I try to be perfect in
everything I do,” “I want to be the best at everything I do,” and “I always try for
the top score in a test”—when compared to the control group at the end of the
intervention and at one-month follow-up. No changes on the other CAPS
subscales were detected, but there were lower levels of hyperactivity and emotional
problems at the end of the intervention in the perfectionism group compared to
the controls.
What can we conclude from the three studies? The first conclusion is that
classroom interventions focused directly on perfectionism result in significantly
lower levels of perfectionism in both children and adolescents compared to control
conditions. These effects seem to be medium- to long-term (i.e., ranging from one
to 12 months) and affect the setting of very high and rigid personal standards as well
as self-critical perfectionism. The second conclusion is that targeting perfectionism
in children and adolescents shows a similar effect to treatment studies in adults with
respect to short-term transdiagnostic outcomes (Lloyd et al., 2015), notably
negative affect, negative self-judgment, weight and shape concern, dieting, and
behavioral problems. The absence of longer-term effects in these types of outcomes
may speak to the need for booster sessions in each year of school, tailored for
specific developmental issues that are of relevance to the respective age group. The
third conclusion is that, in the studies of adolescents, there appears to be a “sleeper
effect” characterized by an initial absence of group differences at post-intervention
after which significant differences between groups become apparent over time
(Possel, Horn, Groen, & Hautzinger, 2004). The reasons for this effect are unclear,
but the effect may indicate that the benefits of these interventions become apparent
only once the adolescent has had a chance to use the new skills as situations of stress
and challenge emerge.
Limitations in this handful of investigations of school-based interventions should
be noted. All three studies were conducted by researchers from the same research
group, and all three focused on similar themes and issues of relevance to
perfectionism. None of the studies attempted to promote resilience and reduce
perfectionism by engaging parents in the process as has been suggested (Flett &
Hewitt, 2014), despite the body of research suggesting that parental factors are
important in the formation of socially prescribed perfectionism and perfectionistic
concern over mistakes and doubts about actions (Damian et al., 2013; Soenens et
al., 2008). The challenges involved in engaging parents in school-based interventions
are considerable, but could inform our understanding about the relative importance
of the factors which are proposed to contribute to the development and maintenance
of perfectionism (cf. Flett, Hewitt, Oliver, & Macdonald, 2002). It is also possible
that a greater emphasis on equipping the child to stand up to socially prescribed
perfectionism (as reflected in CAPS items like “there are people in my life who
expect me to be perfect,” “people expect more from me than I am able to give”)
from other people including parents, teachers, peers, and (social) media may result
in stronger intervention effects. This suggestion is supported by the results of a
longitudinal study of African American children from sixth to 12th grades (Herman,
Wang, Trotter, Reinke, & Ialongo, 2013), with a mean age at study entry of 6.2
years. Over time, four developmental trajectories of socially prescribed perfectionism
(measured with the CAPS) emerged representing consistently high, consistently
low, increasing, or decreasing levels of perfectionism. By 12th grade, those children
with consistently high levels of perfectionism had significantly higher levels of
depression than those with low or decreasing levels, and those with increasing
levels of perfectionism had significantly higher levels of depression than those with
consistently low levels of perfectionism. Correspondingly, those with consistently
high and increasing levels of perfectionism had significantly higher levels of anxiety
than those with consistently low levels of perfectionism.
278 Wade
A further limitation of these studies to be addressed in future research is the

failure to include measures related to resilience and well-being (in addition to
measures of psychopathology and poor adjustment) in recognition of the general
issue that the absence of poor adjustment does not necessarily indicate the presence
of well-being. Studies including measures related to resilience and well-being
would be particularly informative in helping us identify which measures of
perfectionism in children are actually adaptive. Moreover, it would assist with the
development of measures that capture functional pursuit of excellence and
competence whose identification is necessary for refining our prevention programs
so we can discuss what children and adolescents can safely aim for rather than what
they should avoid.
What Specific Recommendations Does This Suggest for

Future Prevention?
Consideration of the state of affairs in the prevention of unhelpful perfectionism in
youth gives rise to a number of recommendations for future work and research.
First, there is no need to generate further measures of perfectionism in youth, but
rather a need for authors of the key measures to collaborate to develop a single tool
which can inform the development of clinically useful models and interventions
that can prevent unhelpful perfectionism in youth (Morris & Lomax, 2014), and
thus impact on a wide range of transdiagnostic outcomes. This single tool could
incorporate the dimensions identified as important across adult definitions of
unhelpful perfectionism, including rigidly high standards (self-oriented and/or
socially prescribed), the measurement of self-worth primarily in terms of
productivity and accomplishment, and self-criticism when goals are not met. Such
dimensions are already present across the variety of measures validated with youth
(cf. Table 13.1).
Second, there needs to be agreement as to the choice of a measure of a functional
need for pursuit of excellence and competence, that recognizes the damaging role
of frustrated needs (Boone, Vansteenkiste, et al., 2014) and ineffectiveness (Wade
et al., 2015). For example, self-determination theory (Ryan & Deci, 2000) has
produced a number of measures related to competence, autonomy, and relatedness
that may be of use in informing the differential impact of interventions for unhelpful
perfectionism. Showing that we can decrease unhelpful perfectionism while not
touching, or even improving, drives for competency and autonomy and goal-
directed activity, will help justify the use of such interventions in school settings.
Third, further work is required on the development of a model that will inform
optimal targets for classroom interventions focused on unhelpful perfectionism that
relates to transdiagnostic outcomes, including goal pursuit and well-being, rather
than outcomes in one domain such as eating disorders. Such a model will recognize
different groups of perfectionism trajectories across adolescent development in
order to make interventions relevant to all in the classroom. Such models can be
tested and refined through evaluation of interventions. For example, it has been
suggested that “attempts to promote resilience and reduce perfectionism will

engage parents in this process” (Flett & Hewitt, 2014, p. 908) in order to tackle
socially prescribed perfectionism. Such an approach could be compared to one that
does not involve parents, which can provide valuable information about the types
of perfectionism that are most critical in promoting adverse outcomes.
Fourth, given the relationship between the prevention of perfectionism and the
prevention of psychopathology more generally, it may be that we need to consider
“rebranding” our perfectionism prevention interventions and their contents so
they may be considered as generic interventions for well-being and resilience. This
would also have the advantage of side-stepping confusion about the construct of
perfectionism and its meaning in the eyes of the wider community. Furthermore,
we need to address the question of whether the content of the perfectionism
prevention interventions would be made more effective if integrated with other
interventions, and aid in strengthening and maintaining the effects observed across
the few studies so far conducted.
Finally, intervention studies in particular present good opportunities to
investigate mediators and moderators (Kraemer, Wilson, Fairburn, & Agras, 2002)
by examining for whom under what conditions an intervention is effective
(moderators) and the mechanisms through which an intervention has its effect on
outcome variables (mediators). As we conduct further intervention studies, as well
as longitudinal correlational studies, opportunity should be taken to investigate
mediating and moderating variables that will inform the development of theoretical
and working models for an effective prevention of perfectionism in youth.
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14
COGNITIVE-BEHAVIORAL TREATMENT
FOR PERFECTIONISM
Sarah J. Egan and Roz Shafran
Overview
This chapter reviews the literature relating to cognitive-behavioral therapy (CBT)
for perfectionism. The core of treatment strategies being based on an individualized
cognitive-behavioral formulation will be discussed. A brief outline of treatment
strategies will be presented including examples from a case study. Furthermore,
empirical studies supporting the efficacy of CBT for perfectionism are reviewed.
Finally, directions for future research will be outlined for areas that have received
little attention to date.
The Cognitive-Behavioral Model of Clinical Perfectionism

Personality-based approaches to the understanding of perfectionism have a long
history but it was only relatively recently that a cognitive-behavioral approach was
proposed. The cognitive-behavioral approach to perfectionism focused on one
particular aspect, clinical perfectionism, which was defined as “the overdependence
of self-evaluation on the determined pursuit of personally demanding, self-imposed,
standards in at least one highly salient domain, despite adverse consequences”
(Shafran, Cooper, & Fairburn, 2002, p. 778).
This definition was proposed to focus on a specific form of perfectionism with
the view that such a focus would be more likely to yield clinical benefits since no
treatment interventions for perfectionism were available at the time (Shafran &
Mansell, 2001). A cognitive-behavioral model was proposed to account for the
factors which were hypothesized to maintain clinical perfectionism (see Figure
14.1). The model was then updated (Shafran, Egan, & Wade, 2010) with the
purpose of considering behavioral factors, for example performance checking, and
emotional aspects, which were not made explicit in the original account (see
Figure 14.2).
CBT for Perfectionism 285
FIGURE 14.1 he original cognitive-behavioral model of clinical perfectionism,

T
reproduced with permission from Shafran, Cooper, and Fairburn (2002),
Copyright 2002 Elsevier.
The cognitive-behavioral model of perfectionism is used by the clinician to

collaboratively guide clients at the start of treatment to develop their own
individualized version of the model. This individualized maintenance model is
then used to tailor treatment strategies to match the specific cognitive and
behavioral processes that maintain perfectionism (Egan, Wade, Shafran, & Antony,
2014). At the core of the construct of clinical perfectionism is that a perfectionist
286 Egan & Shafran
FIGURE 14.2 he updated cognitive-behavioral model of clinical perfectionism, from

T
Shafran, Egan, and Wade (2010), reproduced with permission from
Constable & Robinson.
bases his or her self-esteem on striving and achievement (Shafran et al., 2002).
Hence, as can be seen in Figure 14.2, self-worth overly dependent on striving and
achievement is the starting point of the model from which the setting of inflexible
standards, operationalized as rigid rules, arises. If individuals with clinical
perfectionism think they are only good enough as a person if they meet their goal,
then they will typically set a range of rigid standards and rules concerning their
performance. For example, as can be seen in Figure 14.3, a client, Emmy, based
her self-worth on achieving her goals of having a perfect, neat, and tidy house and
being excellent at her job as a teacher. She reported that she had a general
dichotomous (all-or-nothing) rule that one should either “do something right, or
not at all.” An example of her inflexible standards was having a perfectly clean and
tidy house (i.e., “I must always have a perfect house”). As a result of this inflexible
standard, Emmy would frequently engage in dichotomous (all-or-nothing)
thinking where she would think “unless I can put the time in to cleaning my house
perfectly, then I will not do it at all.” Due to this thinking style, Emmy would then
engage in counterproductive behaviors including procrastination, and the house
would become rather dirty and untidy. Emmy then looked at the house each day
regarding how messy it was and engaged in intense self-criticism thinking that she
was “useless” and “disgusting” which resulted in her thinking “I am a failure.” This
FIGURE 14.3 n example individualized formulation tailored from the cognitive-

A
behavioral model of perfectionism (Shafran et al., 2010).
reinforced her self-worth being dependent on striving and achievement and left
her in a vicious cycle of maintenance of clinical perfectionism.
Emmy reported other salient cognitive biases which are common maintenance
factors in clinical perfectionism including “shoulds” and “musts” (e.g., “I must
always have a perfect house”). Such biases are typically reflected in inflexible
standards and selective attention, focusing on errors in performance whereas success
and achievement are discounted (e.g., “I made a spelling error in one child’s report
therefore I am a bad example to the children”). She also demonstrated the common
cognitive biases seen in perfectionism of overgeneralizing (e.g., “because I made an
error in a report I am useless at my job”) and double standards where the individuals
hold more lenient standards for others than themselves (e.g., “I understand when
288 Egan & Shafran
other teachers make an error in a report, but I should never do that as I expect
better from myself”).
Another critical aspect of the model of clinical perfectionism is the manner in
which individuals judge whether they have met their personal standards for
achievement. According to the cognitive-behavioral account, individuals with
clinical perfectionism are often left in a no-win situation where they either fail to
meet their standards and hence reinforce thinking they are “not good enough” and
make their self-worth dependent on achievement, or they discount their success
and set their standard higher next time. In the example of Emmy, when she failed
to meet standards, for example, by rarely cleaning her house, this led to intense
self-criticism and further reinforcement of her self-worth as based on achievement
because she felt like a failure when her house was not perfectly tidy and clean.
Another outcome regarding evaluation of standards is avoidance, where individuals
with clinical perfectionism avoid evaluating their standards, usually due to a fear of
failure. For example, Emmy avoided meeting with her boss for her performance
review as a result of her anxiety regarding her performance and went on stress leave
for a week. Commonly people with clinical perfectionism have occasional times
when they temporarily meet standards. In the example of Emmy, her standard was
to be excellent at work, and when she finally met her boss for her performance
review, he gave Emmy feedback that she had received the top rating of all teachers
at the school. The problem, however, is that often clients with perfectionism
reappraise standards as insufficiently demanding when standards are met or discount
their success, as demonstrated by Emmy who thought “he [her boss] probably just
said that as he knows I have taken stress leave: even if I did get the top rating, it is
no big deal as I am not working at the best school in the city.” This reappraisal,
along with her performance-related behaviors of comparisons (i.e., directly asking
colleagues what their performance review results were) and reassurance seeking
(i.e., seeking reassurance from colleagues regarding her performance review)
reinforced her self-worth being based on achievement. Other typical performance-
related behaviors in perfectionism include goal achievement behaviors which can
be any behavior the person engages in in an attempt to meet their goals but that is
unhelpful, for example, rewriting a paragraph over and over for many hours to get
it flawless, and testing performance, where the person tests out how well they are
doing at achieving a goal (Egan, Wade, et al., 2014).
The cognitive-behavioral model of clinical perfectionism has received support
through several studies which have investigated hypotheses arising from the model.
The resetting of standards has been investigated in several experimental studies,
where for example individuals have been found to reset standards higher following
failure on experimental tasks (e.g., Stoeber, Hutchfield, & Wood, 2008; Kobori,
Hayakawa, & Tanno, 2009). This aspect of the model has also been demonstrated
in qualitative studies. For example, Egan, Piek, Dyck, Rees, and Hagger (2013)
found that, when individuals high in negative perfectionism (Terry-Short, Owens,
Slade, & Dewey, 1995) were asked what they would do regarding setting of
standards after failure, they reported they would set higher standards next time. In
contrast, individuals low in negative perfectionism said they would set lower
standards next time. Another qualitative study (Riley & Shafran, 2005) also
supported aspects of the model including self-criticism after perceived failure to
meet standards, avoidance, and setting inflexible rules for performance. The
cognitive biases proposed in the model have also been supported in studies. For
example, the prediction that perfectionistic individuals judge standards through an
all-or-nothing thinking style was supported in a study where dichotomous thinking
was found to account for significant variance in negative perfectionism (Egan,
Piek, Dyck, & Rees, 2007). In an experimental study, Howell et al. (2016) found
support for selective attention as a maintenance factor where those with high levels
of perfectionistic concern over mistakes (Frost, Marten, Lahart, & Rosenblate,
1990) exhibited an attentional bias to negative, perfectionism-relevant information
when compared to those with low levels. Finally, some of the negative emotional
consequences of self-criticism following failure have been demonstrated in an
experimental study where individuals with elevated levels of self-oriented and
socially prescribed perfectionism (Hewitt & Flett, 1991) showed higher shame and
guilt following failure in an experimental task (Stoeber, Kempe, & Keogh, 2008).
Cognitive-Behavioral Treatment for Perfectionism: An Overview
Assessment and Treatment Planning

In starting CBT for perfectionism, it is suggested that, in addition to a regular
clinical interview assessing psychiatric history and administering measures of
psychopathology, the clinician assesses perfectionism thoroughly with questions in
the interview addressing the major maintaining factors in the cognitive-behavioral
model of clinical perfectionism (Shafran et al., 2002; Shafran et al., 2010) as well as
self-report measures of perfectionism including the Clinical Perfectionism
Questionnaire (CPQ; Fairburn, Cooper, & Shafran, 2003). Egan, Wade, et al.
(2014) have outlined in detail the assessment strategy and questions to help derive
the individualized cognitive-behavioral formulation of perfectionism. To conduct
a comprehensive assessment and derive an individualized formulation these detailed
questions should be used, so the outline presented below provides only examples
of the areas that should be assessed and the questions that should be asked.
• High standards and striving: “In what areas do you set high standards?”
• Adverse consequences of clinical perfectionism: “What impact do you
think striving has on your life?”
• Self-evaluation overly dependent on achievement: “How much of your
self-esteem is made up of how well you are meeting your high standards?”
• Setting of inflexible standards and rules: “Do you change your standards
and rules when you discover they cannot be met?”
• Cognitive biases: “When you think about your performance, what do you
tend to focus on?”
290 Egan & Shafran
• Performance-related behaviors: “Do you tend to check repeatedly to assess

how well you are doing at things?”
• Evaluation of standards: “After you meet your goals, do you set even higher
goals for next time?”
• Avoidance of meeting standards: “What do you avoid due to worry about
your performance?”
• Self-criticism and counterproductive behaviors: “How do you feel when
you make a mistake?”
(Egan, Wade, et al., 2014, pp. 114–115)
Such questions are used to derive a formulation for the individual that will be
different for each client (individualized formulation) and conducted in a
collaborative manner. Once the individualized formulation is complete, then the
treatment plan should be derived.
CBT for perfectionism is typically conducted based on an individualized
formulation with treatment strategies matched to address the particular maintaining
factors for the client, and therefore it is based on the general principles of treatment
with strategies utilized in a flexible manner. Treatment may follow particular
formats such as pure self-help, guided self-help, and individual or group-based
treatment, for each of which specific structured protocols have been developed
(see Egan, Wade, et al., 2014, for details). Still, all treatment should be based on the
individualized formulation rather than rigidly following a structured protocol.
Examples of Techniques in The Cognitive-Behavioral Treatment

of Perfectionism
The intention of this section is to provide examples of techniques that are included
in treatment. Readers who are interested in learning more how to do the treatment
should consult Egan, Wade, et al. (2014).
Motivation to Change
The first step in treatment following the individualized formulation is enhancing
motivation toward treatment. Motivation to change can often be difficult for
perfectionists. Studies have found that, given the choice between staying perfectionistic
or changing, individuals stated that they would prefer to stay perfectionistic as
perfectionism was associated with more benefits (Egan et al., 2013). It is important
therefore that clinicians address if there is ambivalence regarding changing
perfectionism. Perfectionists commonly report specific predictions regarding what
they believe may happen if they were no longer perfectionists, for example, that they
will “completely let themselves go and achieve nothing at all.” Addressing motivation
to change involves focusing on the importance of change (i.e., how important it is to
the client to change; the pros and cons of change) as well as clients’ confidence in their
ability to change (i.e., their self-efficacy). This is a key point as clients may rate the
importance of change as high, but their confidence in their ability to change as low,
or vice versa, both of which poses problems regarding engagement in treatment.
Importance and confidence can be rated on scales (e.g., from 0 = low to 10 = high),
and then the clinician can ask questions regarding these ratings to help the clients
understand why they may have a low rating on the importance of changing or
confidence in their ability to change. Discussion regarding importance of and
confidence in change can be useful in increasing motivation to change. Techniques
such as motivational interviewing and examining the pros and cons of change can be
useful to enhance motivation to change. However, it is important not to spend too
much time hypothetically debating the pros and cons of change without translating
this into action using behavioral experiments because the biggest motivator for
change comes from seeing the positive benefits it brings. Behavioral experiments are
therefore often used to address specific negative predictions regarding what clients
fear may happen if they were to change (e.g., “others will not praise me any more
for my good work”).
Self-Monitoring
Self-monitoring is an important early step in the treatment of perfectionism because
asking clients to monitor thoughts, behaviors, and emotions associated with
perfectionism can increase their insight into the problem which may help to initiate
change. Further, self-monitoring is often associated with significant decreases in the
problem that is being monitored. Therefore, self-monitoring is an important
technique in treatment in its own right, rather than being just a way to enhance
understanding of maintenance factors for the client. Another important reason for
self-monitoring is that it can increase objectivity, where clients start to see their issues
with perfectionism in a more objective manner and therefore as something that they
can change. The clinician should therefore try to engage the clients in regular
monitoring; if possible, by recording self-monitoring of their perfectionistic thoughts
and behaviors (using pen and paper, a smartphone, or any other personal electronic
device). Individualized self-monitoring forms can be developed for the client, or
existing self-monitoring forms can be used (see Egan, Wade, et al., 2014, and Shafran
et al., 2010). Areas to self-monitor include general perfectionistic thoughts,
perfectionist behaviors, self-critical thinking, avoidance, procrastination, and
counterproductive behaviors. The clinician can ask clients to monitor any of the
maintaining factors that have been identified in the individualized formulation. It is
particularly helpful to emphasize with clients that it is most useful if they record the
self-monitoring information at the time it occurs and that, if this is not possible, they
should record it close to the time when the particular information occurred.
Psychoeducation
Another important area to address early in treatment is psychoeducation regarding
perfectionism. There are common myths that many people high in perfectionism
292 Egan & Shafran
hold that can serve to maintain their perfectionism and also be a barrier to change.
Common myths are, for example, “the harder I work the better I will do,” “to be
good at something you need to dedicate your entire life to it,” “practice makes
perfect,” and “you can do anything you want to if only you want it badly enough”
(Egan, Wade, et al., 2014, p. 144). Particular strategies to address these myths can
include using Socratic questioning to allow clients to think of instances when these
myths may not be true. For example, to challenge the myth “the harder I work the
better I will do,” the clinician can ask clients to think of examples that run counter
to this myth such as when staying up all night to study for an exam and not sleeping
at all leads to poorer performance than when they have a few hours of sleep before
an exam. The clinician can also ask the client to think of any examples where the
myth may not be true in friends, colleagues, or family members, or think of general
examples such as when athletes “overtrain” and do not have adequate rest periods,
leading to poorer performance or injury.
Surveys
A key cognitive-behavioral strategy is the use of surveys. The main purpose of
surveys is to try and gather objective information from other people to help clients
challenge their specific perfectionism cognitions. A survey is usually designed
specifically for the client based on his or her idiosyncratic beliefs. An example of
this for the client Emmy is that she had the belief that “in order for parents not to
complain, I must spend at least five hours in preparing each report for every child
that I teach.” The clinician asked Emmy to conduct a survey to gather data about
what other teachers do in regard to how many hours they spend preparing reports,
and how many parents complain about the reports. If a client is concerned about a
survey coming across as “strange” to others, then the clinician and client can think
of creative ways to explain this survey to others. Emmy, for example, explained to
other teachers that she was addressing report writing as a professional development
goal and therefore was seeking to find out more information. Example survey
questions that Emmy asked her colleagues were: “How long do you spend on each
report? How many times do you rewrite your reports? How many times have
parents complained about your reports? If parents have complained about your
reports, was this related to how much time you had spent writing them (e.g., if you
had written them in a rush)?” As a result of this survey, Emmy discovered that
there was great variety in the amount of time that other teachers spent writing
reports, ranging from a few minutes per report to up to two hours, but no colleague
was spending five hours per report. She also discovered that only one colleague
engaged in rewriting reports, whereas all other colleagues said they never engaged
in this behavior. To her surprise, Emmy found that most colleagues had never
experienced a parent complaining to them about their reports, and there were no
colleagues who said that any complaints they had were related to how much time
they had spent writing the report. She was also surprised to learn that one female
colleague had written in her survey that the one time she had received a complaint
from a parent about a report, she had spent much longer writing the report than
usual, but this was a parent who complained about everything, so the colleague did
not think the complaint had anything to do with the quality of her report. This
survey helped Emmy to start shifting her belief that it is necessary to spend many
hours writing each report to guard against the possibility of parents complaining
about her reports, and increased her confidence in being able to engage in a
behavioral experiment to further challenge this belief that was maintaining her
perfectionism.
Behavioral Experiments
Behavioral experiments are a core technique in CBT and are used extensively in
CBT for perfectionism in most stages of the treatment. A definition of behavioral
experiments is “planned experiential activities, based on experimentation or
observation, which are undertaken by patients in or between cognitive therapy
sessions” (Bennett-Levy et al., 2004, p. 8). Behavioral experiments in CBT for
perfectionism are a key way to get clients to challenge their unhelpful beliefs that
maintain perfectionism, and consequently to change their behaviors, reduce self-
critical aspects of perfectionism, and instead create new, more helpful beliefs. The
use of behavioral experiments to challenge negative thinking has been linked to
earlier and more generalizable belief change than the use of thought records1
(McManus, Van Doorn, & Yiend, 2012). Moreover, behavioral experiments are
considered to provide information that is of high evidential value to the client due
to their specific and personal nature. Entire books have been written on how to do
behavioral experiments (e.g., Bennett-Levy et al., 2004), but for the present
chapter it should suffice to point out that, when designing behavioral experiments,
it is important that the prediction is testable and specific, that the rationale for the
purpose of the experiment is clear, and that the experiments are designed in a
collaborative manner. Moreover, it is helpful to have record sheets to detail the
outcome of the behavioral experiments. For example, the key steps involved in the
development of behavioral experiments addressing a dysfunctional belief are as
follows (adapted from Egan, Wade, et al., 2014, p. 192):
• Step 1: Consider the formulation. Collaboratively identify a dysfunctional

belief that keeps the client stuck in the vicious cycle of perfectionism. Ask the
client to rate how much he or she endorses the belief (0–100%).
• Step 2: Collaboratively brainstorm ideas for an experiment to test the belief.
Ensure the experiment is not likely to be too challenging, but that it will likely
yield useful and meaningful information. Be specific about when and where
the experiment will be conducted.
• Step 3: Elicit multiple specific predictions about the outcome of the experiment
and devise a method to record the outcome.
• Step 4: Anticipate problems and brainstorm solutions.
• Step 5: Conduct the behavioral experiment.
294 Egan & Shafran
• Step 6: Review the experiment, including the predictions. Ask the client to
re-rate how much he or she endorses target belief, and draw conclusions.
To have a concrete example, a behavioral experiment was conducted to test

Emmy’s belief regarding the amount of time that she thought needed to be spent
when writing reports to guard against her feared outcome of a parent complaining.
Here are the key elements and outcomes:
• Belief: The identified belief was “In order for parents not to complain, I must
spend at least five hours in preparing each report for every child that I teach.”
The degree to which Emmy endorsed the belief was 95% on a scale from
0–100%.
• Experiment: It was agreed that Emmy would write half of her reports using
her old method of spending five hours for each report, and the other half
spending a maximum of 30 minutes per report.
• Specific predictions: Emmy’s specific predictions, the subjective probability of
which she rated on a scale from 0–100%, were that she would get a lot of
complaints about the reports that she would spend little time on (probability
= 95%) and very few complaints about the reports she would spend her usual
amount of time on (probability = 100%), and that she would feel extremely
anxious sending out the reports (probability = 95%).
• Results: Emmy did the experiment as planned. She felt very anxious, though
a little less than she expected (80%). However, no parent complained about
the reports, neither the ones she had done quickly (0%) nor the ones she had
spent her usual amount of time on (0%).
• Re-rate belief: When asked to re-rate the degree to which she endorsed
her belief (“In order for parents not to complain, I must spend at least five
hours in preparing each report for every child that I teach”), Emmy gave a
rating of 60%.
• Conclusions: The results of the experiment were very surprising for Emmy.
She was sure she would have received complaints about the reports that she
had spent less time on, but did not. This made her realize that she may have
been spending too much time writing her reports and could probably reduce
the time she spent on writing reports. Her new revised belief was “I can do
good reports which parents do not complain about without spending so much
time on them.”
This is a good example of how behavioral experiments can serve to challenge a

perfectionism belief and to initiate a change in the associated behavior. Had the
clinician purely relied on thought records (e.g., merely asking Emmy to think of
alternatives to the target belief), it would have been unlikely to help her realize that
no parent would complain. Emmy had to test this out in real life to see what
happened. This example also highlights that several behavioral experiments may be
needed to effectively shift a particular belief. Emmy would require a few more
times of testing this experiment out in real life before she abandoned her
dysfunctional belief and effectively changed her behavior in the long term.
Cognitive Strategies and Broadening Self-Evaluation

There are common thinking styles that are encountered in clients with high levels
of perfectionism that can be challenged through a range of cognitive techniques.
Common thinking styles to assess and challenge are selective attention (noticing
the negative), discounting the positive (minimizing the importance of positive
data), double standards (holding a harsher set of rules for oneself than others),
overgeneralizing (such as concluding from one mistake that one is a failure overall),
“should” and “must” statements (e.g., “I should always be the best at work”), and
dichotomous thinking (e.g., “one spelling error in a report means the whole report
is bad”). Techniques to challenge these thoughts include thought records, using
orthogonal and standard continua to challenge dichotomous thinking, daily
recording of positive evidence versus lack of negative evidence for regarding
performance and selective attention, and turning rules in to guidelines (see Egan,
Wade et al., 2014, for details).
An important target for cognitive strategies is to challenge self-critical thinking
which is dominant in perfectionism. The main steps involved in challenging self-
criticism are “(1) the identification of self-criticism and its pervasiveness, (2)
positive beliefs about the usefulness and value of self-criticism, (3) identification of
the cost of self-criticism, (4) developing a self-compassionate and respectful
response, (5) practicing a new way of responding” (Egan, Wade, et al., 2014,
p. 213). Numerous techniques including the use of specific analogies and ways to
increase self-compassion are included. This can include seeing the self-critical
thoughts from an “arm’s length” view, for example, what might someone who
cares about you say in response to your critical thought, and therapeutic letter
writing from the point of view of a compassionate other.
Another useful technique is pie charts where clients think about which domains
(i.e., areas) of their life comprise their self-evaluation. Typically, in perfectionistic
clients, achievement in domains that are most valued by the individual such as
work or musical ability comprise the majority of their self-evaluation. Pie charts are
used to broaden the dysfunctional scheme for self-evaluation which is at the core
of the problem. This technique is widely used in the treatment of eating disorders
(Fairburn, 2008). In the case of Emmy, her self-evaluation was predominantly
determined by achievement at work (65%), having a clean and tidy house (25%),
and appearance (10%). The therapist helped Emmy to see that she had many
domains in her life that were important in self-evaluation, but were not necessarily
based on achievement, and that some domains had been overvalued (e.g., work).
This led to the problem of her putting all of her “eggs in one basket” (viz. work)
regarding her self-esteem, so that when one small problem happened at work, then
this impacted on her self-view greatly. The new domains to comprise her self-
worth in a more balanced manner when Emmy was asked to do a new, more
296 Egan & Shafran
functional pie chart were work (35%), having a clean and tidy house (10%), friends
(20%), volunteer charity work (20%), enjoying music (10%), and appearance (5%).
Procrastination and Time Management

There are many techniques which have been outlined in detail regarding how to
change the common problem of procrastination in perfectionism. Some techniques
include self-monitoring of the procrastination, conducting a “vicious cycle
formulation of the link between perfectionism and procrastination” (Egan, Wade,
et al., 2014), motivational interviewing, behavioral experiments, and problem-
solving techniques. Ways to improve management of time (e.g., reduce avoidance)
and increase pleasant events should also be addressed. Rozental, Forsell, Svensson,
Andersson, and Carlbring (2015) have developed a CBT program to specifically
target procrastination, for example, through psychoeducation on goal-setting
techniques, addressing avoidance behavior via behavioral activation and learning to
prioritize, and challenging dysfunctional cognitions related to procrastination
through behavioral experiments. This program has shown to be effective when
delivered via the Internet as guided and unguided self-help, and can be useful
when addressing procrastination in CBT for perfectionism.
Relapse Prevention
Finally, at the end of treatment, CBT for perfectionism should also address relapse
prevention strategies. This involves summarizing the main take-home messages
and strategies that have been discussed and learned as well as designing an action
plan and blueprint for how to deal with future problems with perfectionism.
Research Examining the Efficacy of Treatment for Perfectionism

Is there any evidence that CBT for perfectionism is effective? The answer is yes.
The efficacy of treatment of CBT for perfectionism has been demonstrated in a
growing number of studies, and in the next section of this chapter, we present a
summary of the most important studies and their findings differentiating between
studies examining non-clinical samples and studies examining clinical samples.
Nonclinical samples
Several studies have examined nonclinical samples to test techniques used in CBT
for perfectionism. In an early experimental study, DiBartolo, Dixon, Almodovar,
and Frost (2001) found that an eight-minute session of cognitive restructuring was
more effective than distraction in reducing anxiety regarding a public speaking task
in female undergraduate students with elevated levels of perfectionistic concern
over mistakes. Despite the brief nature of this intervention, the study was the first
to suggest that cognitive techniques are useful for treating perfectionism.
Pleva and Wade (2007) conducted the first examination of self-help CBT for
perfectionism in a nonclinical sample where participants were randomly allocated
to either guided self-help or pure self-help based on Antony and Swinson’s (1998)
book When Perfect Isn’t Good Enough. Clinically significant reductions in
obsessionality, anxiety, and depression were found in both conditions, although
guided self-help was more effective. Arpin-Cribbie et al. (2008) investigated an
online self-help CBT intervention in undergraduate psychology students who
were randomly allocated to one of three conditions: (a) a 10-week online CBT for
perfectionism plus stress management, (b) stress management, or (c) control.
Whereas the participants in the stress management condition showed significant
decreases in self-oriented perfectionism and perfectionistic concern over mistakes
only, participants in the CBT plus stress management condition additionally
showed significant decreases in socially prescribed perfectionism and depression.
Furthermore, a follow-up examination of this CBT intervention found significant
decreases in anxiety (Radhu, Zafiris, Arpin-Cribbie, Irvine, & Ritvo, 2012). While
the results of these studies using non-clinical samples are encouraging regarding the
efficacy of online CBT intervention and self-help for perfectionism, it is difficult to
say if the findings generalize to individuals with psychological disorders.
Consequently, we next turn to studies examining clinical samples.
Clinical Samples
There have been several studies examining the efficacy of CBT for perfectionism
in clients diagnosed with eating disorders, obsessive-compulsive disorder (OCD),
anxiety disorders, and depression. In an early case study of CBT for perfectionism,
Shafran, Lee, and Fairburn (2004) examined a female client with elevated clinical
perfectionism and binge eating disorder and found that a 10-session CBT for
perfectionism intervention reduced clinical perfectionism, symptoms of binge
eating disorder, and bulimic episodes as well as depressive symptoms. Moreover,
these changes were maintained at five-month follow-up. Although this study gave
an indication of the feasibility of CBT for perfectionism in targeting eating disorder
and associated symptoms, no generalizations can be made because the study was
not a randomized controlled trial (RCT).
Steele and Wade (2008) conducted a RCT with 42 participants who met
criteria for an eating disorder (bulimia nervosa or eating disorder not otherwise
specified) who were randomly assigned to three conditions: CBT for perfectionism,
CBT for bulimia nervosa, or a “dismantled” mindfulness control.2 The CBT for
perfectionism intervention comprised six weeks of guided self-help based on
Antony and Swinson’s (1998) book. Even though there were no statistically
significant differences between the three conditions at three-month follow-up,
clients in the two CBT conditions showed reductions in anxiety and depression
symptoms that corresponded to large effect sizes as measured by Cohen’s d
(Cohen, 1988). This study is important because the effect sizes seen in the CBT
for perfectionism condition on a range of psychological symptoms provide support
298 Egan & Shafran
for the proposition of Egan, Wade, and Shafran (2011) that perfectionism is a
“transdiagnostic process” indicating perfectionism is implicated in the risk and
maintenance of a broad range of psychological disorders (cf. Harvey, Watkins,
Mansell, & Shafran, 2004). Hence, one of the main rationales for the treatment of
perfectionism has been that CBT for perfectionism represents a transdiagnostic
treatment that may be useful in targeting a number of symptoms of co-occurring
psychological disorders at the same time (Egan et al., 2011; Egan, Wade, &
Shafran, 2012).
Further studies have examined the efficacy of CBT for perfectionism in
transdiagnostic clinical groups, that is, clients with a range of anxiety disorders,
OCD, and depression. Glover, Brown, Fairburn, and Shafran (2007) conducted a
study with nine participants diagnosed with anxiety disorders and depression using
a single-case design and evaluating a ten-session CBT for perfectionism inter
vention. Results showed that there were clinically significant reductions in clinical
perfectionism, overall perfectionism,3 and depression. Similarly, in another study
using a single-case experimental design, Egan and Hine (2008) found clinically
significant reductions in perfectionistic concern over mistakes in a sample of four
participants with mixed anxiety disorders and depression following eight sessions of
CBT for perfectionism.
Whereas these early studies can be regarded as important pilot studies testing the
feasibility of the treatment in transdiagnostic samples, several RCTs have since
been published that provide stronger evidence for the efficacy of CBT for
perfectionism. Riley, Lee, Cooper, Fairburn, and Shafran (2007) conducted the
first RCT evaluating a ten-session individual CBT for perfectionism in 20
participants with anxiety disorders or depression who were randomly allocated to
either treatment or a wait-list control. The study found statistically significant
reductions in depression and anxiety that were maintained at two-month follow-up.
In addition, the study found clinically significant reductions in clinical perfectionism
in 75% of the treatment group. Further, the number of participants who had an
anxiety disorder or depression diagnosis after treatment was reduced by 50%,
compared to no change in the wait-list control group.
In the largest RCT examining CBT for perfectionism to date, Egan, van Noort,
et al. (2014) compared face-to-face individual CBT for perfectionism to an eight-
week pure self-help CBT for perfectionism delivered online and a wait-list control
in 52 participants with anxiety, depression, and eating disorders. The CBT for
perfectionism intervention in this study was based on a protocol for a manualized
individual treatment (published in Egan, Wade, et al., 2014). The pure self-help
CBT consisted of weekly readings from the self-help book Overcoming Perfectionism
(Shafran et al., 2010) that were emailed to the participants of the pure online self-
help group along with assigned homework exercises. The same weekly readings
were also given to the participants in the face-to-face group who had a 50-minute
weekly session with a therapist to work through the treatment strategies. Whereas
there were no changes in any measures at post-treatment in the wait-list control
group, there were statistically significant reductions in perfectionism in both
treatment groups regarding perfectionistic personal standards and concern over

mistakes (Frost et al., 1990), self-criticism (Imber et al., 1990), and dysfunctional
attitudes (Weissman & Beck, 1978). However, only the face-to-face group also
experienced large effect size reductions in depression, anxiety, and stress and
significant increases in self-esteem, but not the online self-help group.
The findings of Egan, van Noort, et al. (2014) indicate that, although the online
self-help CBT for perfectionism resulted in significant reductions in perfectionism
that were not statistically different from those experienced by the face-to-face
CBT group at post-treatment, the online self-help CBT was not as effective as the
face-to-face CBT treatment in reducing depression, anxiety, and stress symptoms,
and boosting self-esteem, and these effects were maintained at six-month follow-up.
Furthermore, whereas both treatment groups showed maintenance of reductions
in perfectionism at six-month follow-up, the reductions were significantly larger in
the face-to-face group. Consequently, it appears that—even though self-help CBT
for perfectionism can reduce perfectionism—CBT for perfectionism delivered face
to face has superior efficacy compared to pure self-help versions of the treatment.
CBT for perfectionism has also been found to be effective when delivered as a
group treatment. Steele et al. (2013) investigated the efficacy of group CBT for
perfectionism in 21 participants who had elevated perfectionism and a range of
anxiety disorders, OCD and depression. There was a four-week wait-list control
period, followed by four weeks of psychoeducation where participants read the
first four chapters of Shafran et al.’s (2010) self-help book, and then an eight-
session CBT for perfectionism group treatment, delivered in a two-hour weekly
session, as outlined in Egan, Wade, et al. (2014). There was no change over the
wait-list or psychoeducation periods, which suggests that psychoeducation alone is
not effective. There were significant changes however after group treatment, with
significant decreases in perfectionism in clinical perfectionism (Fairburn et al.,
2003), self-criticism (Weissman & Beck, 1978), and personal standards and
perfectionistic concern over mistakes (Frost et al., 1990). Participants also showed
significant decreases post-treatment in anxiety, stress, and depression. Importantly,
the large effect size reductions in perfectionism, depression, and anxiety were
maintained at three-month follow-up.
An RCT of group CBT for perfectionism in 42 participants with a range of
anxiety disorders, depression, OCD, and eating disorders has also showed promising
results (Handley, Egan, Kane, & Rees, 2015). The treatment consisted of the same
eight-session group treatment protocol (Egan, Wade, et al., 2014) found to be
effective in Steele et al. (2013). Compared to the wait-list control group, those
receiving group CBT for perfectionism demonstrated significant large effect size
reductions at post-treatment on measures of perfectionism, and significant medium
effect size reductions in anxiety, depression, and social anxiety, which were
maintained at six-month follow-up.
In summary, there is substantial evidence that CBT for perfectionism delivered
in a variety of treatment formats is effective. Examining the effect sizes of treatment
outcomes is important as this can indicate the clinical significance of changes
300 Egan & Shafran
(Kraemer et al., 2003). A meta-analysis (Lloyd et al., 2015) of eight studies of CBT
for perfectionism (Arpin-Cribbie et al., 2012; Egan & Hine, 2008; Glover et al.,
2007; Pleva & Wade, 2007; Radhu et al., 2012; Riley, Lee, Cooper, Fairburn, &
Shafran, 2007; Steele et al., 2013; Steele & Wade, 2008) found large pooled effect
size reductions in self-oriented perfectionism and perfectionistic personal standards
and concern over mistakes, indicating reliable, large effect size reductions in
perfectionism. Further, Lloyd et al. (2015) reported medium pooled effect size
reductions for anxiety and depression. This meta-analysis, however, did not include
the two largest RCTs to date (Egan, van Noort et al., 2014; Handley et al., 2015),
which both found large effect size reductions in depression and anxiety. CBT for
perfectionism has also been found to result in large effect size reductions in eating
disorder symptoms (Steele & Wade, 2008) and stress (Steele et al., 2013). When
these effect sizes are considered as a whole, it can be concluded that CBT for
perfectionism is effective in reducing perfectionism, anxiety, depression, stress, and
eating disorder symptoms. This is important also because the findings that CBT for
perfectionism reduces a range of psychological disorders and symptoms provide
support for perfectionism being a transdiagnostic process (i.e., a maintaining
mechanism for psychopathology across disorders; Egan et al., 2011). Further, it is
important to target perfectionism given it has been shown in some studies to
impede standard evidence-based treatments for specific disorders. Perfectionism
measured with the Dysfunctional Attitude Scale (Weissman & Beck, 1978) predicts
poorer treatment response in depression (Blatt, Quinlan, Pilkonis, & Shea, 1995;
Blatt et al., 1998). Lundh and Öst (2001) found that people who did not respond
to social anxiety treatment had higher pre-treatment perfectionism. Ashbaugh et al.
(2007) found that changes in perfectionistic concern over mistakes and doubts
about actions predicted symptoms of social anxiety following group CBT, although
perfectionism reduced after treatment. Similarly, Chik, Whittal, and O’Neill
(2008) found that doubts about actions predicted poorer response to treatment for
OCD. Pinto, Liebowitz, Foa and Simpson (2011) reported that perfectionism was
the only criterion of obsessive-compulsive personality disorder to predict poorer
treatment outcome in OCD. Similarly, two studies have indicated that perfectionism
and uncertainty measured with the Obsessive Belief Questionnaire (Obsessive
Compulsive Cognitions Working Group, 2005) predicts poorer outcome to
treatment in OCD (Kyrios, Hordern, & Fassnacht, 2015; Wilhelm et al., 2015; see,
however, Su et al., 2016). Overall, the findings showing perfectionism can interfere
with treatment response provide some indirect evidence of perfectionism as a
transdiagnostic maintaining mechanism (Egan et al., 2011).
Other Treatment Approaches

Whereas there are psychodynamic approaches for treating perfectionism (e.g.,
Fredtoft, Poulsen, Bauer, & Malm, 1996; Greenspon, 2008; Sorotzkin, 1998), only
one study to date has examined the efficacy of psychodynamic treatment for
perfectionism (Hewitt et al., 2015; see also Chapter 15). Hewitt and colleagues
conducted a study investigating the impact of 11 sessions of psychodynamic/

interpersonal group psychotherapy for perfectionism, where 43 participants
received treatment and were compared to 17 participants in a wait-list control
group. The authors reported that the treatment group showed a large-sized
reduction in self-oriented perfectionism and a medium-sized reduction in socially
prescribed perfectionism compared to the control group. In addition, the treatment
group showed a significant reduction in depression, but not in anxiety. However,
psychological diagnoses were not assessed and, whereas the authors reported that
42% of the sample had had previous treatment for depression and 15% for anxiety,
it cannot be determined if the sample included any clinical participants. Further, it
was not reported if treatment impacted on psychological diagnoses.
Future Research on Treatment of Perfectionism

There are several areas of research which are important to examine in future
research. First, the periods between intervention and follow-up have been relatively
short in most studies, with the longest follow-up periods being six months post-
treatment. To examine the durability of effects of CBT for perfectionism, longer
follow-ups (e.g., 12–24 months) should be examined. Future studies examining
CBT for perfectionism should also investigate the efficacy of the treatment in
comparison to other active treatments, particularly disorder specific CBTs, to assess
efficacy of the treatment as a first-line treatment for specific psychological disorders,
given that only one study to date has compared CBT for perfectionism to an active
treatment (Steele & Wade, 2008). There are also several avenues for research which
would be useful to investigate, including CBT for perfectionism in children and
adolescents who meet criteria for psychological disorders. While prevention
approaches focused on perfectionism have been investigated in young people (see
also Chapter 13), there have been no studies to date which have examined the
efficacy of CBT for perfectionism in children and adolescents with psychological
disorders to demonstrate that CBT for perfectionism is not only effective in
reducing perfectionism and associated psychological symptoms in adults, but also
in youth. Such research studies have the potential to further develop, refine, and
disseminate interventions for the treatment of perfectionism across the lifespan.
Notes
1 Thought records involve recording an activating event, beliefs, and emotional
consequences of the beliefs. The client records challenges to their dysfunctional beliefs
to arrive at revised, more helpful beliefs (for further details, see Beck, 2011).
2 The term “dismantled mindfulness” was used as the intervention was based on adapting
techniques from a book on mindfulness-based cognitive therapy for depression (Segal,
Williams, & Teasdale, 2002), and the dismantled nature of the intervention suggested it
should not be classified as a “mindfulness” intervention.
3 Represented by the total score of Frost et al.’s (1990) perfectionism scale.
302 Egan & Shafran
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15
PERFECTIONISM IN THE
THERAPEUTIC CONTEXT
The Perfectionism Social Disconnection Model
Paul L. Hewitt, Gordon L. Flett, Samuel F. Mikail,

David Kealy, and Lisa C. Zhang
Overview
This chapter discusses the role of perfectionism in psychotherapy process and
outcome and presents several studies addressing these issues. Based on the
perfectionism social disconnection model (PSDM; Hewitt, Flett, & Mikail, 2017;
Hewitt, Flett, Sherry, & Caelian, 2006), perfec tionism (a broad personality
variable that includes perfectionism traits, perfectionistic self-presentation, and
perfectionism cognitions; Hewitt & Flett, 1991, 2004), although driven by
inordinate needs for acceptance, results in others’ negative reactions that produce
alienating social disconnection. We present an extension of this model, with
reference to the treatment situation, to shed light on the clinical challenges that
different components of perfectionism pose in the process of seeking, initiating,
and maintaining psychotherapy. Our discussion includes an explication of how
perfectionism traits and self-presentational facets influence treatment negatively
and an overview of research supporting the pernicious role of perfectionism in
treatment.
Perfectionism and Psychological Treatment

Numerous writers have pointed out that perfectionism is a difficult issue in
psychotherapy both in terms of its intransigence and its effect on the treatment
process (see Blatt, 2004; Salzman 1980; Zuroff et al., 2000). It is now reasonably
well established that perfectionistic individuals require intensive and often complex
treatment interventions (see Blatt & Zuroff, 2002; Hewitt, Flett, & Mikail, 2017).
An accrual of empirical evidence—along with a substantial clinical case report
literature—attests to the deleterious effects of perfectionism on both the individual
and on the clinical process itself (see Horney, 1950; Salzman, 1980).
Perfectionism in the Therapeutic Context 307
What are some of the reasons for the difficulties in treating perfectionism? It has
been established that perfectionism tends to function as a core vulnerability factor
for multiple problems—often reflected in terms of comorbidity. Several studies
have established that perfectionism is found typically among people who have
multiple diagnosable disorders (e.g., Ayearst, Flett, & Hewitt, 2012; Bieling,
Summerfeldt, Israeli, & Antony, 2004; Van Yperen, Verbraak, & Spoor, 2011;
Wheeler, Blankstein, Antony, McCabe, & Bieling, 2011) and treatment challenges
are more likely when perfectionism is combined with various disorders, with a
complex intertwining of symptoms and syndromes (see Flett, Molnar, & Hewitt,
2016; Neely et al., 2013; Tarocchi, Aschieri, Fantini, & Smith, 2013).
Our understanding of the complexity of perfectionism as a core vulnerability
factor may be facilitated by revisiting the classic views of three clinician/scholars all
of whom saw perfectionism as a reflection of self and identity issues. Alfred Adler
(1956) described perfectionism as a form of overcompensation for an abiding sense
of inferiority by striving for superiority and perfection. Similarly, Karen Horney
(1950) saw perfectionism as a reflection of “the tyranny of the should” and the
neurotic pursuit of an idealized self. The key element is the presence of negative
self-directed affect. Horney recounted that “while focusing on the attitude toward
the self, I realized that people hated and despised themselves with the same intensity
and the same irrationality with which they idealized themselves” (p. 368). The
notion that perfectionism is a reaction to perceived defects in the self was discussed
at length by Hilde Bruch (1988) who noted in her description of the prototypical
young woman with anorexia nervosa that “all her efforts, her striving for perfection
and thinness, are directed toward hiding the fatal flaw of her fundamental
inadequacy” (p. 6).
Empirical contributions over the past years have expanded the work of these
scholars by elaborating the complex multidimensional nature of perfectionistic
behavior. Although perfectionism has been written about for over 60 years, in
the early 1990s it became evident that the perfectionism construct is more
complex than first realized. Different trait elements of perfectionism were
conceptualized by Frost, Marten, Lahart, and Rosenblate (1990) and by Hewitt
and Flett (1990, 1991). Initially, our group focused on three trait dimensions:
self-oriented perfectionism (i.e., requiring perfection of the self), other-oriented
perfectionism (i.e., requiring perfection of others), and socially prescribed
perfectionism (i.e., perception that others require the self to be perfect). An
extended view of perfectionism involved the demonstration of individual
differences in automatic perfectionistic thoughts (Flett, Hewitt, Blankstein, &
Gray, 1998; see also Chapter 5) as well as perfectionistic self-presentation (Hewitt
et al., 2011; Hewitt et al., 2003). Perfectionistic self-presentation is the need to
appear or seem perfect rather than to be perfect and has three facets: perfectionistic
self-promotion (i.e., the drive to seem perfect by displaying an image of
perfection), nondisplay of imperfection (i.e., the drive to conceal overt displays
of shortcomings and imperfections), and the nondisclosure of imperfection (i.e.,
the drive never to disclose imperfections).
308 Hewitt, Flett, Mikail, Kealy, & Zhang
The Perfectionism Social Disconnection Model

The PSDM is derived from the stress generation model of perfectionism discussed
by Hewitt and Flett (2002). The early version of the PSDM (Hewitt, Flett, Sherry,
& Caelian, 2006) was inspired by evidence that perfectionism is associated with
interpersonal problems (Hill, Zrull, & Turlington, 1997; Slaney, Pincus, Uliaszek,
& Wang, 2006) and poor social networks (Shahar, Blatt, Zuroff, Krupnick, &
Sotsky, 2004).
Hewitt et al. (2017) extended the PSDM by incorporating perfectionism traits,
self-presentational facets, and automatic perfectionistic and self-recriminatory
thoughts (Flett et al., 1998; Hewitt & Flett, 1991; Hewitt et al., 2017; Hewitt et
al., 2003) as well as by discussing the development of perfectionism from early
relational experiences. It was further expanded by illustrating how perfectionism is
associated with distress, dysfunction, and disorders through interpersonal (i.e.,
relationships with others) and intrapersonal (i.e., relationship with self) means. In
essence, the model attempts to capture the relational importance of perfectionism
in terms of its development, its purpose in serving self- and other-relational goals,
and, finally, its association with myriad difficulties by interfering with connection
with others and the world more broadly.
According to the PSDM, perfectionism is driven by powerful, thwarted
relational needs such as needs to be accepted, to matter, and to belong as well as
to avoid rejection, ridicule, and abandonment. Perfectionism functions as a
reparative attempt to obtain a sense of self-cohesion and regard, a sense of fitting
in with others, and a sense of safety and security in the world. It is argued that,
over the course of development, the perfectionistic individual develops an identity
that is devoid of self-worth, a sense of self as defective, and models of others as
either unavailable and unwilling to accept, care for, and love the person or as
punishing, judging, and powerful sources of rejection. Perfectionism is thought to
develop in response so as to find communion and connection with others and
repair the defective sense of self. In essence, the person learns that if he or she is
or appears to be perfect, then acceptance by both self and others is possible and
that mattering to and fitting with others will ensue. He or she will then “be ok.”
Thus, perfectionism is seen as a multifarious way of being in the world that
attempts to repair the self and to develop a connection and sense of belonging in
the world (see Hewitt et al., 2017).
Although the perfectionistic person’s behavior involves preoccupation with and
requirement for perfection (or the appearance of perfection) for self- and other-
relational goals, this preoccupation and striving often has deleterious consequences.
For some, the requirement for perfection or appearance of perfection evokes an
internal state of interpersonal sensitivity to rejection; whereas for others, this
produces rebarbative or off-putting behaviors in interpersonal encounters. These
features generate distance between the perfectionist and others, culminating in
rejection, social withdrawal by self and/or others, alienation, and social
disconnection—often with a profound sense of not only being alone but also
remaining fundamentally flawed and defective. This self-defeating behavior or

“neurotic paradox” involves the perfectionism behavior itself leading to the exact
outcomes the perfectionist is attempting to avoid. It is argued that the social
disconnection and self- and other-alienation contributes to the cause and
maintenance of many difficulties experienced by perfectionistic individuals.
The PSDM is depicted in Figure 15.1 with two pathways to negative outcomes.
First, perfectionism (i.e. traits, self-presentation, cognitions/attitudes) leads to off-
putting interpersonal behaviors (e.g., overt or subtle hostility or similar repellent
behaviors such as coldness, aloofness, lack of engagement) that result in others
recoiling, avoiding, or blatantly rejecting the person. For the perfectionistic
individual this then produces internal experiences of objective and subjective social
disconnection, negative affect, self-censure, and alienation, culminating in distress,
dysfunction, and disorder. Objective social disconnection is also thought to occur
as a result of the aversive interpersonal behaviors that perfectionists express in their
relationships (Habke & Flynn, 2002; Haring, Hewitt, & Flett, 2003; Hill et al.,
1997) as well as other behaviors such as distancing the self from others, self-
concealment, nondisclosures, and passive aggressiveness (see Hewitt et al., 2003;
Hewitt, Habke, Lee-Baggley, Sherry, & Flett, 2008; Kawamura & Frost, 2004).
The second pathway suggests that perfectionism leads to interpersonal sensitivity
reflected by internal processes such as anticipation of rejection, interpretations of
others’ behavior as indicative of lack of mattering, and judgments of others as
threatening or critical. This leads to a subjective sense of social disconnection that
can compel the individual to withdraw from others, again resulting in further
internal experiences of disconnection, shame, and self-censure. Subjective
disconnection is thought to arise as a result of perfectionists’ tendency to be highly
sensitive to cues of interpersonal rejection and to feel rejected more often and
Objective social
disconnection
Off-putting
interpersonal behavior
Perfectionistic traits, Negative affect, Distress, dysfunction,

self-presentation, self-censure, alienation disorder
cognitions/attitudes
Interpersonal
sensitivity
Subjective social
disconnection
FIGURE 15.1 erfectionism social disconnection model (adapted from Hewitt et al.,
P
2017).
more erroneously than others (Flett, Besser & Hewitt, 2014; Flett, Hewitt, &
De Rosa, 1996; Hewitt & Flett, 1991).
Both pathways of the PSDM are thought to generate problems for perfectionistic
persons because disconnection—actual or perceived—generates intense self-
conscious affects (shame, humiliation) and an internal dialogue that involves
perfectionistic and self-denigrating themes reflecting defectiveness and
unworthiness. The ensuing constriction of self-acceptance and self-compassion
leaves perfectionistic individuals feeling as disconnected from themselves as they
are from others.
Empirical support for aspects of the PSDM continues to accumulate. A complete
review of the growing body of evidence supporting elements of this model (see
Casale, Fioravanti, Flett, & Hewitt, 2014, 2015; Sherry et al., 2012) and other
conceptual extensions of this model (Sherry, Mackinnon, & Gautreau, 2016) is
beyond the scope of the current chapter; however, we shall discuss a few particularly
relevant examples. With respect to the link between perfectionism and objective
social disconnection, Roxborough and colleagues (2012) found that all three facets
of perfectionistic self-presentation were linked to suicide risk and that experiences
of being bullied, a marker of objective disconnection, acted as a partial mediator.
Similarly, Mackinnon et al., (2012) found that objective interpersonal disconnection
in the form of partner-conflict was a significant mediator between perfectionistic
concerns and depression symptoms.
Several studies support the link between perfectionism and subjective social
disconnection. Dunkley, Blankstein, Halsall, Williams, and Winkworth (2000)
found that socially prescribed perfectionists tend to perceive lower levels of social
support, which leads to psychological distress. Moreover, Sherry, Law, Hewitt,
Flett, and Besser (2008) found that perceived social support mediated the link
between socially prescribed perfectionism and depressive symptoms. However,
socially prescribed perfectionism was not associated with low levels of actual
received social support, suggesting that the internal experience of disconnection
may be more important in predicting depressive symptoms than actual level of
support. Roxborough and colleagues (2012) found support for the PSDM in
children and adolescents using social hopelessness as a marker of subjective social
disconnection. Social hopelessness partially mediated the links that perfectionistic
self-promotion, nondisclosure of imperfection, and socially prescribed perfectionism
showed with suicide risk, and fully mediated the link for nondisplay of imperfection.
Subjective social disconnection and perfectionism have also been studied, showing
the mediating effects of self-esteem and of mattering to others (Cha, 2016; Flett,
Galfi-Pechenkov, Molnar, Hewitt, & Goldstein, 2012).
The PSDM in the Clinical Context

In addition to shedding light on perfectionistic individuals’ relationships generally,
the PSDM can be extended to the treatment context. We believe that the model
can be a useful heuristic to understand how perfectionistic behavior can negatively
influence helping relationships and to alert researchers and clinicians to the kinds
of behaviors that may be important to understand when providing help.
A depiction of the PSDM in the clinical context is presented in Figure 15.2. In
the figure it can be seen that, as in the general PSDM, we have indicated that a
patient’s perfectionism can result in behaviors or interpersonal sensitivity that will
have a negative impact on the therapy process. Rebarbative interpersonal behaviors
are thought to have an impact on the therapist (or group in group psychotherapy)
by contributing to the therapist becoming annoyed, defensive, or feeling ineffective
and defeated. In individual psychotherapy, this is known as negative counter
transference. If not attended to, negative countertransference experiences can
potentially lead the therapist—in either a subtle or not-so-subtle manner—to
withdraw from the patient or act out toward the patient, with consequent
therapeutic relationship problems that may adversely affect outcome (Hayes, Gelso,
& Hummel, 2011; Ligiéro & Gelso, 2002).
Similarly, the interpersonal sensitivity that can arise from perfectionism affects
the treatment process in much the same way it affects other relationships. The
perfectionistic individual can experience the clinical process as one fraught with
possibilities of rejection, harsh judgments, and negative evaluations by therapists
or group members. Thus, as described in Hewitt et al. (2017), the perfectionistic
person is likely to view others (e.g., therapists or groups) as powerful sources of
potential rejection—and as either unwilling to or incapable of supplying support,
caring, and help. Such perceptions contribute to a sense of caution and trepidation
in the process, accompanied by potentially hopeless expectations of harsh
judgments, rejection, and nonsupport. Participation and engagement in the
process can thus be compromised: Behaviors that are essential for psychotherapy—
personal disclosures, openness with and trust in the therapist—are felt to be too
risky to engage in. Such behaviors, if not attended to in treatment, can
compromise the therapeutic alliance and reduce treatment efficacy. Thus, the
PSDM accounts for the ways in which interpersonal and intrapersonal processes
associated with perfectionism can ultimately foster disconnection in therapeutic
relationships.
Critical to the prevention and amelioration of these potential treatment problems
is the therapist’s attention to his or her emotional responses to the patient’s
interpersonal sensitivity and behaviors, consistent with research suggesting that lack
of awareness and management of therapist countertransference is harmful to the
therapeutic alliance and the patient’s progress in therapy (Kiesler, 2001; Ligiéro &
Gelso, 2002). The PSDM provides a framework by which the therapist can situate
such reactions in the world of the perfectionistic patient, in order that he or she
may consider alternate ways of responding that can maintain or repair the
therapeutic alliance.
Objective disconnection:
(countertransference)
If unattended:
Off-putting interpersonal Therapist withdraws
behavior
Therapeutic relationship
Perfectionistic traits, Poor
rupture, disruptive
self-presentation, outcome
behaviors, early termination
cognitions/attitudes
If unattended:
Interpersonal sensitivity
Patient withdraws
Subjective disconnection:
(transference)
FIGURE 15.2 Perfectionism social disconnection model in the clinical process.

The Perfectionistic Individual in Psychological Treatment

It is useful to consider the clinical process as involving three components or stages,
each of which can be compromised by perfectionism. The first involves the
individual’s decision to seek help, the second occurs during the initial evaluation or
assessment of the individual’s difficulties, and the third involves the psychotherapy
itself. Perfectionism can impact the therapeutic process at any or each of these stages.
For example, prior to the initial consultation with the clinician, the perfectionist’s
experience is shaped by an internal image and expectation of the therapist, the self in
therapy, and the manner in which the encounter will unfold. For self-oriented and
socially prescribed perfectionists, feelings of shame and self-recrimination can make
the anticipated and actual encounter with the therapist a daunting, anxiety-filled
experience. In contrast, other-oriented perfectionists view their difficulties as a
function of others’ failures, an interpersonal stance that has them ready to focus upon
and point out any perceived shortcomings or limitations of the therapist. Psychotherapy
cannot yield meaningful and sustained benefit in the absence of honest self-reflection
and a willingness to change one’s perceptions, behaviors, attitudes, or ways of relating.
Yet, the internal experience of the perfectionistic individual, encompassing exquisite
interpersonal sensitivity to potential rejection, non-acceptance, or perceived harsh
judgments by the clinician, can become an insurmountable obstacle to therapeutic
progress, not only by limiting the perfectionistic individual’s openness to self-
examination, but also through the mobilization of distancing interpersonal behaviors
that threaten the therapeutic alliance.
Perfectionistic individuals are likely to harbor many unrealistic expectations of
assessment and treatment as well as unrealistic expectations of the therapist and
themselves. These expectations can result in a sense of being a failure as a patient
or failing at therapy even before the patient interacts with any clinician. Indeed, it
has been argued that perfectionistic individuals have a failure orientation in
processing information about themselves or others. This has been described as a
negative future-events schema (Andersen, Spielman, & Bargh, 1992) or negative
person schema (Baldwin, 1992) that not only influences the kind of evaluative
information processed (Besser, Flett, & Hewitt, 2004; Hewitt & Genest, 1990) but
affects a negative bias that can turn neutral or successful events into failures (see
Hewitt et al., 2017). For the self-oriented perfectionist, an implicit or explicit
expectation of failure may be driven by the belief that the self is fundamentally
flawed. In contrast, the other-oriented perfectionist may approach the experience
with an attitude of cynicism and the expectation that the therapist will fail to offer
any meaningful help, whereas the socially prescribed perfectionist imposes an
expectation on the self to be the perfect patient in order to derive any benefit from
the assessment and treatment. One such patient expressed this fear stating “because
you are the only one who can really help me with my perfectionism, I better not
screw this up. It feels like my one and only chance.”
Similarly, perfectionistic individuals have an evaluative approach when
considering information about themselves, extending this to the clinical context
where the approach should be one of discovery and acceptance rather than
evaluation. Their immediate response to discovered elements of the self or others
is to evaluate, usually negatively, which in turn triggers feelings of shame or
hostility that ultimately limit the possibility of personal connection. Moreover,
engagement with the clinical process is not viewed as an opportunity to improve
the self but instead as a powerful marker of a failure in living. Thus perfectionism
can result in significant anxiety, especially when the task of the assessment and
treatment is to talk about and reveal perceived imperfections and distress (see
Hewitt et al., 2008).
The perfectionist’s admission to the self and to others (i.e., the therapist,
receptionist, and other people in the waiting room) that he or she is in need of
psychological help is often a shame-filled experience (see Gilbert, 2005, 2011;
Greenspon, 2008) that can both exacerbate the pain and turmoil for the person and
decrease the likelihood of actually engaging in the process (see Hewitt, Dang,
Deng, Flett, & Kaldas, 2016; Hewitt et al., 2008). It is often found that highly
perfectionistic patients delay the process of seeking treatment until they experience
intense levels of pain and distress or have insistent “encouragements” from family
members (e.g., Hewitt et al., 2017). Thus, one of the major, over-arching tasks of
treatment with perfectionistic individuals involves helping them achieve self-
acceptance, including acceptance of the need for help. This can be a tall order for
people who have lived a life of nonacceptance and who equate self-acceptance
with giving up, failing, and ultimately losing (Greenspon, 2008; Hewitt et al.,
2017; Horney, 1950; Sorotzkin, 1985).
A multitude of fears and concerns are also often brought in to the clinical process
by the perfectionistic patient, including fears of being stigmatized, being judged
harshly, being let down by the incompetence of the therapist, not getting better,
or discovering unwanted and unacceptable parts of self. These fears tend to be
compounded by the excessive level of general anxiety commonly experienced by
perfectionistic people seeking treatment (see Hewitt et al., 2008; Hewitt, Dang, et
al., 2016), along with the aforementioned fear of failure (Conroy, Kaye, & Fifer,
2007). This fear of failure can be expressed in clinical contexts by a difficulty with
or unwillingness to try new tasks or consider new perspectives or a great reluctance
to even consider abandoning the pursuit of attaining perfection. Many perfectionists
in treatment are fearful of the consequences of not striving for perfection. Some
authors have suggested that this fear is actually a fear of mediocrity—and that
abandoning the quest to be perfect is comparable to being sentenced to a life of
being of little worth (see Dryden & Neenan, 2004; Grieger, 1991).
A related concern for perfectionists is the fear of being exposed as someone who
is far from perfect. Research on perfectionistic self-presentation has shown that this
style is linked with a sense of being an imposter (Hewitt et al., 2003; Thompson,
Foreman, & Martin, 2000). Those who struggle with perfectionistic self-
presentation tend to be overly focused on the possibility that their inadequacies and
defects will become publicly exposed. Leahy (2001) observed that this orientation
can fuel strong resistance that feeds into the unwillingness to no longer try to be or
seem perfect. Specifically, he noted that “it is as if the patient is saying, ‘I can’t give
up my perfectionism because then my true helplessness will be manifested’”
(p. 117). In light of these observations, it is really not surprising that one recent
study found that the majority of perfectionists undergoing treatment expressed an
unwillingness to forego their perfectionism (see Egan, Piek, Dyck, Rees, & Hagger,
2013; see also Chapter 14).
The presence of such anxiety and fear suggests that perfectionistic individuals
are over-represented among those people who are unwilling or psychologically
unable to seek help when treatment is required. Several research groups have
conducted research on the negative help-seeking orientation of people with
elevated levels of trait perfectionism or concerns with mistakes (e.g. Ey, Henning,
& Shaw, 2000; Rasmussen, Yamawaki, Moses, Powell, & Bastian, 2013;
Zeifman et al., 2015). For example, in a recent study that included both university
student and community member samples, Hewitt, Dang, et al. (2016) examined
perfectionism and help-seeking attitudes and fears and thoughts about engaging in
psychotherapy. They found that perfectionism traits and self-presentation facets
were associated broadly with increased negative attitudes toward seeking help and
with increased fears and concerns about engaging in psychotherapy. The negative
attitudes most consistently associated with the perfectionism variables included
decreased stigma tolerance and interpersonal openness, as well as concerns about
how perfectionists will appear to the therapist in psychotherapy and whether the
therapist will coerce them into experiencing fearful emotions. Moreover, it was
found that for participants who had sought treatment in the past, all traits and self-
presentational facets were associated with increased difficulty and discomfort
seeking help and continuing with the treatment to completion. This suggests that
perfectionism can influence the initial seeking of help as well as the maintenance
of and adherence to treatment.
Initiation of Assessment and Treatment

The interaction and engagement with the therapist also threatens to erode the
clinical process for individuals with perfectionism, in that defensive efforts to
provide a sense of safety and security (i.e, by avoiding scrutiny and rejection) are
mobilized. This reflects the paradoxical nature of perfectionism (Hewitt et al.,
2017) whereby, on the one hand, the person yearns for closeness and connection
but, on the other, cannot engage in processes to actually obtain closeness and
intimacy. The defensive processes limit the prospect of experiencing a meaningful
and sustained intimacy necessary for a therapeutic alliance. For intimacy by its
nature requires a willingness to reveal the self and the capacity to tolerate and
accept differences that invariably contribute to tension, conflict, and periods of
disconnection that are then followed by a willingness to engage in the work
of reconciling and reconnecting. For the perfectionist, any one of these aspects of
intimacy is challenging, whether in personal or therapeutic relationships. The
perfectionist’s defenses are intended to keep painful affects and threatening
experiences at bay. Fosha (2000) points out that “in the most profound way, affect
is how the individual stays in touch with himself and with his own take on the
world; it is also how he communicates to others that essential information about
himself” (p. 23). Fosha goes on to say that “in the realm of core affective experience,
the difference between aloneness and the sense of being integrated in the mainstream
of mutuality-community is created by the act of affective communication with one
other person, who is open and interested” (p. 28). It is this affective constriction
that is at the heart of the perfectionist’s social disconnection. It serves to distance
the self from others while perpetuating a view of self as worthless and a view of
intimacy as dangerous.
Emotional avoidance and ambivalence is particularly evident among individuals
with pervasive feelings of shame—one of the most salient and pervasive emotions
found among perfectionists undergoing treatment. Tangney (2002) has provided
an analysis of shame and other self-conscious emotions in perfectionism, and
several studies have now confirmed links between shame and both trait perfectionism
and perfectionistic self-presentation (Ashby, Rice, & Martin, 2006; Chen, Hewitt,
& Flett, 2015). The implications of shame and perfectionism in the treatment
context, however, have not been fully considered. Of course, shame is distinguished
by an overgeneralized sense of being inadequate and defective in ways that are
known to other people. The sense of shame found among perfectionists in
treatment can create a detachment that reflects the desire to avoid others and escape
scrutiny. The pervasiveness of shame (see Stolorow, 2010) underscores the need
for a treatment focus that is designed to restore a more accepted sense of self and
an ability to engage in self-soothing, self-compassion, and self-forgiveness when
people inevitably fall short of being perfect (see Gilbert, 2005).
We stated that behaviors and processes germane to perfectionism can be off-
putting or reflect interpersonal sensitivity and ultimately threaten disconnection
within the psychotherapeutic context. It must be underscored, however, that
disconnection and therapeutic disaster is not an inevitable outcome. Although
responding to the interpersonal dynamics of the perfectionist can be challenging,
well-trained clinicians employing a therapeutic approach that attends to process
themes—including transference and countertransference dynamics—would be able
to recognize these dynamics and respond to them appropriately and therapeutically.
In the following sections, we describe behaviors that individuals with perfectionism
exhibit in a relational context that reflect either the overt repellent processes that
contribute to objective disconnection (countertransference) and the more internal
interpersonal sensitivity-related processes that lead to subjective disconnection
(transference). As presented in Figure 15.2, if countertransference or transference
responses are left unattended, the alliance suffers, potentially compromising
therapeutic outcome (Hayes et al., 2011). It is important to note the interactional
nature of such ruptures for they can arise from the patient’s actions and perceptions,
the therapist’s responses, or, most likely, the interplay of the two.
One of the interpersonal problems associated with perfectionism is a tendency
toward hostile-dominant behaviors (Habke & Flynn, 2002; Hill et al., 1997; see
also Chapter 9). For instance, self-oriented perfectionism has been associated with
hostile-dominant interpersonal problems in men (e.g., ignoring others, possessing
a sense of entitlement) and friendly dominant interpersonal problems (e.g., being
overly responsible for others, care-taking, parentification) in women. Other-
oriented perfectionism has been associated with “dark” personality traits including
narcissistic grandiosity and entitlement, psychopathy, social dominance, hostility,
low agreeableness, and a lack of empathy for others (e.g., Nealis, Sherry, Sherry,
Stewart, & Macneil, 2015; Stoeber, Sherry, & Nealis, 2015), whereas socially
prescribed perfectionism has been associated with arrogant and socially distant
qualities in men and diverse interpersonal problems in women (Hill et al., 1997).
Hostile-dominant behaviors can present significant challenges in psychotherapy
influencing the development of therapeutic alliance (Muran, Segal, Samstag, &
Crawford, 1994), lower levels of emotional resonance with the therapist in the
context of individual psychotherapy, and less intimate relationships and problems
with involvement with others (Gurtman, 1996).
Self-Oriented Perfectionism and Social Disconnection

The essence of self-oriented perfectionism is a relentless concern with perfection
and an avoidance of imperfection at all costs. Repeated failures to realize this
unattainable expectation become the foundation for such patients’ hostile
dominance. The hostility is particularly unique in that it is aimed primarily at the
self, yet it has an indirect and unintended negative impact on others.
At first glance it may seem that the self-oriented patients’ hostility toward
themselves would evoke empathy and reassurance rather than social disconnection.
Yet, the unyielding and extreme nature of the self-attack and self-blame
communicates dismissal of the therapist’s efforts to comfort and reassure. In essence,
the self-rejection contributes to an unintentional rejection of the therapist that
ultimately fuels mutual frustration and interpersonal distance. The therapist may
find it difficult to maintain a stance of compassion in the face of the patient’s
unremitting self-hatred that consistently deflates the therapist’s efforts to invite
acceptance of the patient’s humanity.
Moreover, effective psychotherapy extends beyond empathy and support. The
patient must be open to exploring and altering self-limiting aspects of his life. This
is achieved through the therapist’s attempts to help the patient see parts of the self
that have been denied or remain unrecognized. Accomplishing this requires a
readiness to empathically confront and reflect upon problematic interpersonal
patterns when these arise; this can be a daunting task when undertaken against a
backdrop of a patient’s pervasive self-attack and self-blame. Subjectively, the
therapist’s time with the self-oriented perfectionist is akin to walking through an
emotional minefield.
Other-Oriented Perfectionism and Social Disconnection

In many ways the other-oriented perfectionist patient can be considered a mirror
image of the self-oriented perfectionist patient. Although both share an expectation
of perfection, the focus of the other-oriented individual is external, whereby others
are expected to be unfailingly perfect. This orientation, which is often by no means
subtle, is characterized by excessive blaming of others, putting others down,
responding in a punitive manner, and telling others that they are wrong and are
deserving of punishment. Control takes the form of taking charge of everything and
insisting that others adhere to rigid expectations, telling others what to do and how
to do it, or taking charge to ensure that things turn out right. Within the context of
psychotherapy, the other-oriented patient tends to experience the therapist’s attempts
to summarize and empathize as being somewhat—or profoundly—off the mark. On
the occasions that the patient considers a therapeutic reflection to be accurate, this
reflection is met with responses preceded by “yes, but” or “perhaps, but what you
don’t realize is.” With repetition, this stance can trigger therapists’ feelings of
therapeutic paralysis and self-doubt. It is in dealing with these patients that less
seasoned clinicians are likely to scan their bookshelves and workshop announcements
in search of ways to shore up therapeutic skill that feels stale or inadequate.
Socially Prescribed Perfectionism and Social Disconnection

Socially prescribed perfectionists harbor the belief that others expect them to be
perfect and are constantly evaluating them. Here too, the individual’s focus is
predominantly external, but in contrast to the other-oriented person, the objective is
to gain acceptance by pleasing others. Socially prescribed patients strive to please by
deferring to the wishes of others and doing whatever they believe others want them
to do. Their interpersonal stance is one of conformity and a view of self as victim.
This can often be infused with overtones of resentment. Therapeutic efforts to
empower the individual by pointing out their strengths are experienced as burdensome
expectations. The individual is thus caught in a bind whereby he or she feels an
immense pressure to be the perfect patient, yet, at the same time, feels resentment
and anger build in response to being caught in yet another web of external demands
that require perfection. The most viable solution is to protect their fragile self-esteem
by presenting a compliant, cooperative, yet inauthentic self that perpetuates the
feeling of being rejected and alone in a hostile demanding world. It is this seemingly
perfect yet false self that may be experienced by others—including the therapist—as
arrogant and distant, thereby exacerbating the patient’s feelings of social disconnection.
Perfectionistic Self-Presentation, Perfectionism Cognitions/

Self-Recriminations and Social Disconnection
Other components of the perfectionism construct are relevant in affecting the
process of psychotherapy and the therapeutic alliance. For example, all facets of
perfectionistic self-presentation involve the presentation of a facade or inauthentic

self in an attempt to conceal the perceived flawed and unworthy self from others.
This presentation can be aversive to people in general as well as to clinicians. In
addition, the more directly concealing facets of perfectionistic self-presentation
involve not displaying or not disclosing imperfections, and this can provide a sense
of safety for the patient in avoiding painful affect but may cause significant
frustration and feelings of ineffectiveness on the part of the therapist. Concealing
the self within the therapeutic encounter can also take the form of fewer disclosures,
particularly disclosures of a highly personal nature (see Flynn, Hewitt, Ko, Mikail,
& Flett, 2016; Kawamura & Frost, 2004). Similarly, perfectionistic patients engage
in various strategies and processes—including automatic perfectionistic thoughts
and self-recriminations—that serve to deflect the therapist’s efforts at exploring
painful affective experiences. This can be frustrating for therapists who can feel
ineffective and stymied in their attempts to elicit more affective, relational, and
personal material in order to be helpful to the patient (see Salzman, 1980).
Understanding such ruminative and self-recriminating thinking as a defensive
process can help therapists to appreciate the patient’s sense of dread, and thus avoid
becoming overly frustrated at being thwarted in their therapeutic efforts.
Defensive Positions in Treatment

Finally, there are other ways that perfectionistic individuals’ coping styles and
defenses can interfere with therapeutic process and influence the therapeutic
alliance. For example, research evaluating coping styles and perfectionism has
shown that components of trait perfectionism were associated with maladaptive
coping styles (Dunkley et al. 2000; Haring et al., 2003) often characterized by
avoidance (Hewitt, Flett, & Endler, 1995). This work suggests that, especially in
distressing contexts, perfectionistic individuals may engage in maladaptive coping
to reduce negative or painful emotional states within therapeutic encounters.
Moreover, research on perfectionism and ego defenses, which can operate at
implicit and explicit levels, found that all three trait dimensions of perfectionism
were associated with mature defenses (e.g., rationalization, sublimation) whereas
other-oriented and socially prescribed perfectionism were associated with neurotic
defenses (e.g., idealization, passive aggression) and immature defenses (e.g., acting
out, projection). Moreover, the use of maladaptive defenses mediated the link
between socially prescribed perfectionism and depression suggesting that the use of
such defenses is not very effective in reducing distress (Besser et al., 2004; Flett,
Besser, & Hewitt, 2005). Likewise, Dickinson and Ashby (2005) found that what
they termed maladaptive perfectionism (excessive levels of discrepancy between
high standards and performance) was associated with immature defenses but not
with neurotic or mature defenses.
Several authors have suggested that the defensive positions that perfectionists
use in psychotherapy can be problematic for therapists and the therapy process
(e.g., Hewitt & Flett, 2004; Horney, 1950; Salzman, 1980). These defensive
positions can allow the perfectionist to avoid painful emotions and, given that
psychotherapy is about experiencing emotional states, these positions become
apparent in treatment. One, in particular, that forms part of the perfectionist’s
behavior is intellectualization. For example, Salzman (1980) wrote:
The emphasis on intellectuality is another means of avoiding the potential

humiliation of not being perfect. It prevents real involvements in any
emotional exchange and thereby sidetracks the possibility of being influenced
or affected by the therapist’s interpretation or observation. Intellectualizing
and philosophizing about life is a most successful device to avoid participating
in it. The obsessional (perfectionist) exhibits great skill in avoiding any
involvement with the therapist, although he may talk extensively about
involvement and the problems of transference and counter transference. He
will even talk about feelings and emotions. However, it will be a succession
of words drawn from an intellectual comprehension of the issues involved,
devoid of any real emotional response.
(p. 204)
Similarly, perfectionistic individuals will seek and press the therapist for specific
information, immediate solutions in the form of readings, and explanations of
models of perfectionism or treatment more generally rather than focus on emotion-
laden issues. An intellectualizing stance, along with the obtaining of “information”
to solve problems, reinforces the patient’s illusion that providing information holds
the key to solving their difficulties and can be a potential source of tension
throughout the therapy. This stance may also reflect a way of attempting to be a
perfect patient and trying to garner approval and caring from the therapist or may
serve to protect the patient from the anticipated harsh judgments of the therapist
should treatment not go well. This sort of stance, especially if rigidly held, can
interfere with doing the work of therapy and may induce feelings of being stymied,
ineffective, and frustrated in the therapist.
Research Supporting the PSDM in a Clinical Context

Although the revised PSDM (Hewitt et al., 2017) and our extension to the clinical
process are new, there are some clinical research findings that pertain to elements
of the model. We have already described the work on perfectionism and the
consideration and seeking of professional help (Hewitt, Dang, et al., 2016). Other
findings from that study support the idea that the difficulties experienced by
perfectionists while seeking treatment can also interfere with benefiting from that
treatment. For example, in the two subsamples of participants who had sought help
in the past in that study, we found that socially prescribed perfectionism and both
perfectionistic self-promotion and nondisclosure of imperfection were associated
with terminating treatment early and not benefiting from treatment. Furthermore,
it was found that all traits and self-presentational facets, in combination with
discomfort seeking and continuing treatment, were associated with increased odds
of dropping out early and of doing poorly in treatment.
Similarly, in terms of the interactions between clinician and patient in an
assessment context, we are beginning to accumulate evidence which indicates that
perfectionism is associated with patients’ negative reactions to treatment and that
the characteristics of the perfectionistic patient seem to elicit negative responses
from their therapists. Hewitt and colleagues (2008) conducted research focused on
how 90 community adults who were seeking psychiatric help responded to a
clinical interview that involved them openly discussing stressful failures. Hewitt
and colleagues found that high levels of concealing one’s imperfections (i.e.,
nondisplay of imperfection) was associated with greater distress before and after the
interview, a greater sense of threat prior to the interview, and greater post-interview
dissatisfaction. Further, analyses of concurrent physiological responses showed that
the perfectionistic self-presentation facets uniquely predicted adults’ elevated heart-
rate while revealing mistakes and flaws with a clinician, and these associations were
still detectable beyond the variance explained by trait perfectionism.
Recently, we conducted follow-up analyses that focused on how patients’
perfectionism influenced therapists’ judgments and perceptions of those patients
during that initial clinical interview (Hewitt, Chen, et al., 2016). Results indicated
that patients’ levels of perfectionism were associated with therapists’ less favorable
judgments of their patients. More specifically, trait perfectionism dimensions in
patients were negatively related to the extent to which therapists liked their patients
and wanted to work with them in the future, with socially prescribed perfectionism
being associated negatively with the extent to which patients were expected to
benefit from treatment. Perfectionistic self-presentation also seemed to play a role.
Specifically, patients’ perfectionistic self-promotion and nondisclosure of
imperfection were associated negatively with the extent to which their therapists
liked them, and nondisclosure of imperfection was also related to how much
therapists would like to take them on as future patients. Finally, it was found that
the relationship between other-oriented perfectionism and therapist’s disliking of
patients was mediated by patients’ level of hostility.
In terms of treatment studies, findings that perfectionism-related attitudes
predict poorer outcome in treatment of depression and that this relationship is
mediated by therapeutic and external relationships (Blatt, Zuroff, Quinlan, &
Pilkonis, 1996; Shahar et al., 2004; Zuroff et al., 2000) are consistent with our
model (also see van der Kaap-Deeder, Smets, & Boone, 2016). The findings
support the idea that perfectionism influences negative outcome through its effect
on relationships.
In other treatment research from our University of British Columbia Perfectionism
Treatment Study (see Hewitt et al., 2017; Hewitt et al., 2015), we found that
perfectionism traits (self-oriented and socially prescribed perfectionism in particular)
and perfectionistic self-presentation (nondisclosure in particular) were positively
associated with higher levels of distress, lower levels of personal disclosures, and
being less liked by group members over the course of treatment (Flynn, Hewitt
et al., 2016). Further, it was found that these perfectionism components were
associated with decreased liking by the therapists and that therapists’ levels of liking
patients were negatively associated with treatment effectiveness.
Moreover, in another study (Kaldas, Hewitt, Mikail, & Flett, 2016), 69
residential patients who received daily intensive dynamic-relational group
psychotherapy completed measures of perfectionism during the first session and
measures of interpersonal problems, perceptions of therapists’ interpersonal
behavior, and group cohesion on five consecutive days of treatment. Over the
course of the five days, trait and self-presentation components of perfectionism
predicted lower group cohesion, and this relationship was mediated, in part, by the
patients’ interpersonal difficulties as well as their perceptions of therapists’
interpersonal behavior. Overall, this study suggested that patients with excessive
levels of perfectionism tend to struggle more with therapeutic alliance and other
therapeutic processes in group therapy. This occurred across perfectionism
components. Importantly, each dimension or facet had an impact on different
process factors although, taken together, perfectionism negatively impacted all
group therapy process factors under investigation.
Lastly, preliminary findings from an ongoing study examining the relationship
between perfectionism and various process and outcome variables for a group
treatment based on cognitive-behavioral therapy (Zhang et al., 2016) suggested
that perfectionism traits and perfectionism cognitions were negatively associated
with group process factors. Specifically, both self-oriented perfectionism and
perfectionism cognitions were negatively associated with secure emotional
expression, a measure of feelings of safety and comfort within groups (Macnair-
Semands & Lese, 2000).
Overall, these studies provide preliminary support for components of the PSDM
in the therapeutic context. This model may thus be considered a fruitful empirically
informed guide to help clinicians understand some of the mechanisms involved in
the pernicious role perfectionism can take in treatment.
Evidence Supporting the Treatment of Perfectionism

As the preceding discussion makes clear, the treatment of perfectionism in
psychotherapy involves considerable attention to the patient’s overt and covert
behaviors, interpersonal processes, and affective states. Moreover, such treatment
requires careful attention to the clinician’s own emotional reactions in the context
of maintaining the therapeutic alliance and responding appropriately and
therapeutically to the patient’s interpersonal difficulties. We thus contend that a
psychodynamically informed approach—containing a dual intrapersonal and
interpersonal focus—is indicated in the treatment of perfectionism in its various
permutations. It is our belief that such an approach will be beneficial in making
significant changes not just in symptoms the person might be experiencing but also
in making fundamental changes to the person’s sense of self, relationships with
others, and the perfectionistic behavior itself.
We have evidence supporting the effectiveness of such a dynamic-relational

treatment designed to address perfectionism. Hewitt et al. (2015) described the
evaluation of this treatment in a group psychotherapy format. This research was
conducted in a sample of 60 patients with elevated levels of perfectionism traits,
perfectionistic self-presentation, or perfectionism cognitions. The results (pre-
treatment, post-treatment, and follow-up) for the intervention group were
compared with a wait-list control group. They showed that various components of
perfectionism and distress were reduced at significant levels following treatment
and at a four-month follow-up. Moreover, the reductions in components of
perfectionism were associated with changes in symptoms. Finally, they showed
evidence suggesting that the reduction in components of perfectionism was greater
in those receiving treatment compared to the wait-list control group.
So what was the nature of the intervention? Our dynamic-relational group
psychotherapy approach combines knowledge of critical components of
interpersonal group psychotherapy (MacKenzie, 1990; Yalom & Leszcz, 2005) and
key ingredients in the psychodynamic treatment of perfectionists in individual and
group psychotherapy (see Hewitt et al., 2017; Tasca, Mikail, & Hewitt, 2005). The
intervention focused on the relational and developmental precursors, interpersonal
impact, and underlying relational processes of perfectionism rather than focusing
on reducing perfectionistic behaviors per se (e.g., negative evaluations, stringent
expectations). That is, the emphasis was on addressing perfectionism-related
relational patterns manifest in interactions among group members as well as those
described by members within the context of other relationships, including one’s
relationship with self. This approach is consistent with models of psychodynamic
and interpersonal therapy (McWilliams, 2004; Sullivan, 1953) and with other
psychodynamic treatments of perfectionism (e.g., Fredtoft, Poulsen, Bauer, &
Malm, 1996; Greenspon, 2008; Sorotzkin, 1985). An important role for the
therapists was to keep group discussion rooted in the “here and now” and to
encourage group members to explore their relationships and experiences within
the group. Therapists emphasized the expression of affect, interpersonal feedback
among members, and interpretations of group processes. Interpretation of
transference responses within the group or between group members and therapists
was underscored as a means of exploring and challenging self-limiting interpersonal
dynamics. There was also an explicit emphasis on relying on perfectionism as a
means of creating safety or defending the self against perceived or actual
abandonment, rejection, criticism, intimacy, interpersonal conflict and tension, or
a lack of control over one’s relational world. Finally, interpersonal transitions were
also addressed throughout the sessions with an explicit focus in later sessions on the
termination of group participation.
Conclusion
Overall we have argued that because perfectionism is a difficult personality variable
to treat—involving negative influences on the treatment process—it is important
to understand how and why perfectionism exerts its negative impact. We presented
an extension of our PSDM in an effort to understand the processes involved with
perfectionism and its influence on both patient and therapist and, most importantly,
on the therapeutic alliance and treatment outcome. It is hoped that outlining the
model and processes that perfectionism brings to the treatment situation will
stimulate further research regarding this issue. Such research can help clinicians to
further understand the complexity of perfectionism in the clinical context and
ultimately provide better resources and treatment options for its effective treatment.
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PART V
Conclusions
16
THE PSYCHOLOGY OF
PERFECTIONISM
Critical Issues, Open Questions, and
Future Directions
Joachim Stoeber
Overview
In this concluding chapter, I follow the approach of the introductory chapter in
taking a personal perspective to discuss what I see are critical issues, open questions,
and future directions in perfectionism research. Because all chapters of this book
address open questions and future directions, I only discuss topics that the chapters
did not cover or that I would like to emphasize again. These include the definition
and measurement of perfectionism, the question of whether perfectionism is a trait
or a disposition, the need for more longitudinal studies, and the search for mediators
and moderators. Further, I make a call for more research on perfectionism going
beyond self-reports and point to three areas that I believe are “under-researched”:
perfectionism at work; ethnic, cultural, and national differences in perfectionism;
and perfectionism across the lifespan. Moreover, I address three critical issues that
I find problematic because they may present obstacles to further progress in our
understanding of perfectionism: focusing on perfectionistic concerns (and ignoring
perfectionistic strivings), employing cluster analyses to investigate differences in
multidimensional perfectionism, and assessing perfectionism with measures that do
not measure perfectionism.
Critical Issues
Focusing on Perfectionistic Concerns (and Ignoring

Perfectionistic Strivings)
The first issue I find problematic (see also Stoeber & Gaudreau, 2017) is that there
are studies that examine only indicators of perfectionistic concerns and do not
include indicators of perfectionistic strivings, or do not report any findings they
334 Stoeber
obtained for indicators of perfectionistic strivings (cf. Chapter 1, Table 1.1). As to

why this is the case, I can only speculate. Maybe the studies’ focal interest was
psychological maladjustment and—because perfectionistic strivings often fail to
show unique positive relationships with maladjustment (Stoeber & Otto, 2006)—
the studies did not include perfectionistic strivings and only examined perfectionistic
concerns (which reliably show positive relationships with maladjustment). Or
maybe the studies originally included perfectionistic strivings but—for the same
reason as above—perfectionistic strivings did not show any significant relationships,
and so they were dropped from the final analyses that were reported.
Whatever the motivation, studies that do not include perfectionistic strivings
are problematic. One reason is that such studies may give a distorted view of
perfectionism because they exclusively focus on its maladaptive aspects while
blending out aspects that may be harmless, benign, or even adaptive (see Chapters
2, 3, 8, 11, and 12). In addition, such studies may fail to provide an accurate
account of how maladaptive perfectionistic concerns are, or even severely
underestimate the degree to which perfectionistic concerns are maladaptive. First,
including perfectionistic strivings allows for comparisons, so readers can see how
maladaptive perfectionistic concerns are relative to perfectionistic strivings. Second,
perfectionistic strivings and perfectionistic concerns usually show substantial
overlap. Because perfectionistic strivings tend to be less maladaptive than
perfectionistic concerns, this overlap may attenuate (or “dampen”) the positive
relationships that perfectionistic concerns show with indicators of psychological
maladjustment as well as the negative relationships they show with indicators of
psychological adjustment. To investigate if this is the case, statistical analyses
controlling the overlap can be employed (Stoeber & Gaudreau, 2017), and the
resulting unique relationships can then be compared with the original relationships
(cf. Chapter 8, Table 8.1). Third, research following the 2 × 2 model of
perfectionism (Gaudreau & Thompson, 2010) has demonstrated that perfectionistic
concerns tend to be more maladaptive when combined with low levels of
perfectionistic strivings (see Chapter 3 for details). Fourth, it is important to note
that—whereas perfectionistic strivings often do not show unique positive
relationships with indicators of psychological maladjustment—there are numerous
studies where they do show such relationships and explain variance in psychological
maladjustment beyond perfectionistic concerns (e.g., dietary restraint in disordered
eating; Bardone-Cone, 2007; Stoeber, Madigan, Damian, Esposito, & Lombardo,
in press). For all these reasons, even researchers whose main interest is perfectionism
and psychological maladjustment should not exclusively focus on perfectionistic
concerns, but also take perfectionistic strivings into account.
Finally, and perhaps most importantly, the conceptualization of perfectionism as
a multidimensional characteristic has been central to perfectionism theory and
research since the 1990s. It was also responsible for the steep rise in the number of
scientific publications on perfectionism and the associated progress in our
understanding of perfectionism (cf. Chapter 1). Studies focusing on perfectionistic
concerns (and ignoring perfectionistic strivings) represent a regression to the
Perfectionism: Critical Issues 335
one-dimensional conceptions of perfectionism that dominated the 1980s and risk

discounting everything we have learned and achieved in the past 25 years.
Cluster Analyses and “Types” of Perfectionists

The second issue I find problematic is the use of cluster analyses in perfectionism
research. By this, I do not mean the use of cluster analyses per se, but how they are
used and how their findings are reported. Cluster analyses typically take
multidimensional measures of perfectionism and then use the scores from these
measures to “cluster” participants into groups that show similar patterns on these
scores (cf. Hair, Black, Babin, Anderson, & Tatham, 2006, Chapter 9). However,
there are problems with this approach. First, some studies employing cluster
analyses suggest that the clusters represent “types” of perfectionists. However,
these clusters are not discrete types in the classic sense representing different kinds
of perfectionists (Meehl, 1992). They are merely groups of perfectionists
representing different within-person combinations of continuous perfectionism
dimensions (see also Broman-Fulks, Hill, & Green, 2008).
Second, some studies use cluster analyses to examine perfectionism against the
theoretical frameworks of two models of perfectionism: the tripartite model of
perfectionism differentiating healthy perfectionists, unhealthy perfectionists, and
non-perfectionists (Parker, 1997; Stoeber & Otto, 2006), and the 2 × 2 model of
perfectionism differentiating pure personal standards perfectionism, pure evaluative
concerns perfectionism, mixed perfectionism, and non-perfectionism (Gaudreau &
Thompson, 2010; see Chapter 3). This too is problematic for a number of reasons.1
For example, the clusters frequently show significant differences in more than one
perfectionism dimension (e.g., healthy perfectionists showing not only lower
perfectionistic concerns than unhealthy perfectionists, but also lower perfectionistic
strivings). In these cases, it is unclear which dimension is responsible for the
differences between clusters (e.g., why healthy perfectionists show lower adjustment
problems than unhealthy perfectionists). If researchers want to investigate whether
data conform to the tripartite model or the 2 × 2 model of perfectionism, I would
recommend they use variable-centered approaches such as multiple regressions and
then test for significant differences between non-perfectionism and pure evaluative
concerns perfectionism (Gaudreau, 2012). If the two show no significant
differences, the data support the tripartite model. If they show significant differences,
the data support the 2 × 2 model (Stoeber, 2014).
Third, the results of cluster analyses are often not comparable between studies.
Even when studies find the same number of clusters, the clusters usually show
different perfectionism profiles (e.g., healthy perfectionists in one study show higher
perfectionistic strivings and concerns than healthy perfectionists in another study).
Fourth, cluster analyses do not allow to probe for interactions between different
perfectionism dimensions (e.g., interactions between perfectionistic strivings and
concerns), and they cannot differentiate common, unique, and interactive effects of
the different dimensions (see also Stoeber & Gaudreau, 2017, Appendix A).
336 Stoeber
A final problem is that studies employing cluster analyses often fail to report the
bivariate correlations between the perfectionism dimensions and the key variables
of interest. Instead, they report only differences between the clusters they created.
This is problematic not only because crucial information is missing (i.e., what
correlations the clusters are based on), but also because the studies are of limited use
for secondary data analyses such as quantitative literature reviews and meta-analyses
(cf. Hill & Curran, 2016; Gotwals, Stoeber, Dunn, & Stoll, 2012). Consequently,
my recommendation is to follow good research practice and always report bivariate
correlations. This goes not only for studies employing cluster analyses, but for all
studies employing multivariate analyses based on correlations or covariances such
as multiple regressions, structural equation modeling, and factor analyses as well as
latent class and latent profile analyses.
Measures of Perfectionism Not Measuring Perfectionism

The third issue I find problematic is what can be described as “measures of
perfectionism not measuring perfectionism.” In particular, I see two problems. The
first (and most frequently encountered) concerns the use of the Positive and
Negative Perfectionism Scale (PANPS; Terry-Short, Owens, Slade, & Dewey,
1995). The PANPS has a number of shortcomings. First and foremost, the items of
the positive perfectionism subscale do not capture perfectionistic strivings, but
characteristics, feelings, and behaviors that people high in perfectionistic strivings
are expected to show if they feel positive about themselves and their accomplishment
(e.g., “I enjoy the glory gained by my successes”). Consequently, the subscale
captures positive consequences of perfectionistic strivings that Terry-Short and
colleagues associate with “positive perfectionism,” but this is not perfectionism (see
also Flett & Hewitt, 2006). The items of the negative perfectionism subscale are less
problematic because many are similar to items from established measures of
perfectionistic concerns (see Chapter 1, Table 1.1). A few items, however, are
similar to items other measures use to capture perfectionistic strivings (e.g., “I set
impossibly high standards for myself”). Hence it comes as no surprise that the
PANPS has shown problems with factorial validity. Haase and Prapavessis (2004)
had to discard 21 of the 40 items before a two-factorial structure emerged
differentiating positive and negative perfectionism. Similar problems were reported
by Egan, Piek, Dyck, and Kane (2011). Moreover, Egan and colleagues found that
positive perfectionism showed positive relationships with depressive symptoms, and
Haase, Prapavessis, and Owens (1999) found positive relationships with disordered
eating. Both findings contradict Terry-Short et al.’s conceptualization of positive
perfectionism. Hence, the PANPS cannot be regarded as a reliable and valid measure
of perfectionism differentiating perfectionistic strivings and perfectionistic concerns.
The second (less frequently encountered) problem concerns the use of scales
and items capturing self-criticism as measures of perfectionism. Examples are the
self-criticism subscale of the Depressive Experiences Questionnaire (Blatt,
D’Afflitti, & Quinlan, 1976) and the self-critical items from the Dysfunctional
Attitude Scale (Weissman & Beck, 1978). This is problematic because they are
measures of self-criticism, not measures of perfectionism or perfectionistic concerns
(cf. Chapter 1). Neither are they measures of self-critical perfectionism, because
self-critical perfectionism is a hybrid form of perfectionism that is typically assessed
by combining measures of self-criticism with measures of perfectionistic concerns
(Dunkley, Zuroff, & Blankstein, 2003; Smith, Saklofske, Stoeber, & Sherry, 2016;
see also Chapters 9 and 11). Self-criticism is not an indicator, proxy, or defining
component of perfectionism or perfectionistic concerns, but a separate psychological
construct that should be differentiated from perfectionism and perfectionistic
concerns (e.g., Dunkley, Blankstein, Masheb, & Grilo, 2006; Sherry, Stoeber, &
Ramasubbu, 2016). I am aware that the multitude of measures used in perfectionism
research can be confusing, but researchers who use scales or items measuring self-
criticism should be clear in their publications that they measured self-criticism, not
perfectionism (cf. Stoeber, Hutchfield, & Wood, 2008).
Open Questions
The Definition and Measurement of Perfectionism:

Too Many Perfectionisms?
There are two open questions that I would like to discuss which the individual
contributions have not discussed. The first question is: Are there “too many
perfectionisms” in perfectionism theory and research, that is, more definitions,
models, and measures of perfectionism than are healthy for the discipline? This
question reflects two issues that are sometimes lamented in perfectionism research.
One is that there is no commonly agreed definition of perfectionism. The other is
that there are so many different models and measures of perfectionism.
As regards the first issue, I am not sure how problematic this is. True, there is
no commonly agreed definition of perfectionism. And because perfectionism
researchers like to disagree about specific aspects of perfectionism (as alluded to in
Chapter 1), I see little chance for a commonly agreed definition in the near future.
On the positive side, I think that most perfectionism researchers are in tacit
agreement about the core components that define perfectionism. To support this
view, I have only anecdotal evidence. In our publications, for example, we usually
define perfectionism as “a personality disposition characterized by striving for
flawlessness and setting exceedingly high standards of performance accompanied by
overly critical evaluations of one’s behavior” (e.g., Stoeber, Haskew, & Scott,
2015, p. 171) or use similar definitions along these lines. These definitions have
never been seriously challenged in peer review, which to me suggests that the core
elements of these definition are widely agreed. And I get the same impression from
the discussions we have at conferences and symposia when presenting papers and
posters on perfectionism.
As regards the second issue, I agree that the many models and measures of
perfectionism that have been developed over the past 25 years must be confusing
338 Stoeber
for anyone who is not an expert in perfectionism research. But how to address this
issue? One suggestion has been to follow the example of the Obsessive Compulsive
Cognitions Working Group (OCCWG, 1997) and get all the leading perfectionism
researchers together, discuss and agree the core elements of perfectionism, and
develop a commonly agreed measure of perfectionism as did the OCCWG with
obsessive-compulsive beliefs (OCCWG, 2001). However, when this suggestion
was made at the last Perfectionism Network Meeting (University of Kent, 12–13
July 2016)—a meeting where most of the leading perfectionism researchers were
present—the response was muted. Consequently, I also see little chance for a
commonly agreed measure of perfectionism in the near future.
But are there really too many measures? I personally do not think so. First, the
vast majority of research on perfectionism is based on only two measures—the
Frost Multidimensional Perfectionism Scale (FMPS; Frost, Marten, Lahart, &
Rosenblate, 1990) and the Hewitt–Flett Multidimensional Perfectionism Scale
(HF-MPS; Hewitt & Flett, 1991)—followed by the Almost Perfect Scale–Revised
(Slaney, Rice, Mobley, Trippi, & Ashby, 2001) in a distant third place. This means
that most perfectionism research is based on three measures only (or short forms
and adaptations of these measures). Second, all widely used multidimensional
measures of perfectionism have subscales capturing perfectionistic strivings and
perfectionistic concerns, the two higher-order dimensions of the two-factor model
of perfectionism (see Chapter 1). Consequently, the two-factor model provides a
common conceptual framework to understand and compare the findings from
different studies using different measures of perfectionism (Stoeber & Otto, 2006;
see also Gotwals et al., 2012; Jowett, Mallinson, & Hill, 2016).
Further, there are good reasons why we have so many different measures of
perfectionism. Perfectionism can affect all domains of life, but most perfectionists
are not perfectionistic across all domains of life (Stoeber & Stoeber, 2009). Instead,
perfectionism is often domain-specific, meaning that perfectionists are usually
more perfectionistic in some domains than in others (Dunn, Gotwals, & Causgrove
Dunn, 2005; McArdle, 2010). Consequently, it makes sense to have not only
general measures of perfectionism, but also measures that assess perfectionism in
specific domains such as sport, dance, exercise, parenting, physical appearance, or
sex (Snell, Overbey, & Brewer, 2005; Stoeber, Harvey, Almeida, & Lyons, 2013;
Stoeber & Madigan, 2016; Yang & Stoeber, 2012). Moreover, domain-specific
measures of perfectionism are useful because they have been shown to explain
variance in specific populations or specific variables beyond general measures of
perfectionism (e.g., sport perfectionism → body image in athletes: Dunn, Craft,
Causgrove Dunn, & Gotwals, 2011; physical appearance perfectionism → eating
disorder symptoms in students: Stoeber & Yang, 2015). Further note that most
domain-specific measures of perfectionism are adaptations of general measures of
perfectionism (like the FMPS and HF-MPS) or were inspired by these measures
(cf. Stoeber & Madigan, 2016). Consequently, the many different measures we see
in perfectionism research often share the same underlying models and have
comparable dimensions.
Finally, theory and research on perfectionism are still evolving and developing,
and this includes the expansion of extant models of dispositional perfectionism,
perfectionistic self-presentation, and perfectionism cognitions (including the
expansion in new domains). In addition, there is a continued development of
further models of perfectionism including new, hybrid forms of perfectionism. All
this evolution, expansion, and development requires reliable and valid measures
(e.g., Ferreira, Duarte, Pinto-Gouveia, & Lopes, in press; Flett, Nepon, Hewitt,
Molnar, & Zhao, in press; Smith et al., 2016). Furthermore, perfectionism research
has a strong tradition of revisiting established measures of perfectionism for a critical
reexamination of their psychometric properties (e.g., De Cuyper, Claes, Hermans,
Pieters, & Smits, 2015; Stöber, 1998) as well as developing reliable and valid short
forms of these measures (e.g., Burgess, Frost, & DiBartolo, in press; Stoeber, in
press). Consequently, I do not see the multitude of perfectionism models and
measures that we have (and the continued development of further models and
measures) as a problem or a sign of weakness. To me, they signify that perfectionism
theory and research is alive and well, and flourishing.
Perfectionism: Trait or Disposition?

The second open question I would like to discuss (but discuss more concisely), is
whether perfectionism is a personality trait or a personality disposition. Like the
first question, this question is not easy to answer, and other researchers may have
views and preferences different from the ones presented here. Following Allport
(1937), personality traits are commonly defined as broad descriptions of individual
differences between people that are relatively general and enduring and are
responsible for consistent patterns—consistent across time and consistent across
situations—in the way individuals behave, feel, and think (McAdams, 2006; Pervin,
Cervone, & John, 2005). Prominent trait models of personality include the five-
factor model and the HEXACO model described in Chapter 4. Some of these
models include perfectionism on the facet level (i.e., as a facet of a broad personality
trait), most notably Cloninger’s model of personality (where perfectionism is a
facet of persistence) and the HEXACO model of personality (where it is a facet of
conscientiousness) (Cloninger, Przybeck, Svrakic, & Wetzel, 1994; Lee & Ashton,
2004). But is perfectionism itself a trait?
Whereas the chapters in this book use the terms “trait perfectionism” and
“dispositional perfectionism” interchangeably, I prefer to regard perfectionism as a
disposition rather than a trait. There are a number of reasons. In research on
personality and individual differences, the term “trait” usually refers to stable
individual differences with high cross-situational consistency that have a neuro-
biological basis and are to a significant extent inherited. Like most individual
differences, perfectionism has a genetic component (see Iranzo-Tatay et al., 2015,
for a review). Developmental models of perfectionism, however, suggest that—
whereas the child’s temperament may play a role in the development of
perfectionism—individual differences in perfectionism are mostly learned and
340 Stoeber
shaped by children’s and adolescents’ experiences and expectations (Flett, Hewitt,

Oliver, & Macdonald, 2002; Rice, Lopez, & Vergara, 2005; Stoeber, Edbrooke-
Childs, & Damian, in press). Social-cognitive theories of personality development
that regard stable individual differences as learned and shaped by the environment,
however, tend to regard these differences as dispositions, not as traits (cf. Fleeson,
2012; Mischel, Shoda, & Ayduk, 2007). Further, there are questions about the
generality and stability of perfectionism. As already mentioned, only a few
perfectionists are perfectionistic across all domains of life (Stoeber & Stoeber,
2009). Instead, perfectionism is often domain-specific (e.g., Dunn et al., 2005;
McArdle, 2010). Moreover, longitudinal studies have shown that perfectionism—
while relatively stable—may show changes over fairly short periods of time and
that these changes are the result of individual differences in perceptions,
expectations, and experiences (Damian, Stoeber, Negru, & Băban, 2013; Damian,
Stoeber, Negru-Subtirica, & Băban, in press; Soenens et al., 2008). Consequently,
I find that perfectionism has more characteristics of a personality disposition than a
personality trait.
Future Directions
Longitudinal Studies
The final section of this chapter discusses some areas that, from my view, future
research should take on if we want to continue making progress in our understanding
of perfectionism. First and foremost, I think we need more longitudinal studies on
perfectionism. This includes prospective studies as well as diary studies and other
methods of ecological momentary assessment (Bolger, Davis, & Rafaeli, 2003;
Shiffman, Stone, & Hufford, 2008). All such studies have more than one
measurement point and thus allow us to investigate the temporal relationships
between perfectionism and key variables of interest, providing stronger evidence
for causal influences and the direction of these influences. Unfortunately, the vast
majority of published research on perfectionism still uses cross-sectional designs (all
measurements are taken at one point of time). Such studies, however, are limited
because they cannot tell us whether perfectionism is an antecedent or a consequence
of a variable of interest, whether the two show reciprocal relationships, or whether
they are mere correlates. Regarding the question of perfectionism as an antecedent,
longitudinal studies are important to examine the effects of perfectionism because
only such studies can determine if perfectionism predicts changes in an outcome
variable over time (e.g., Madigan, Stoeber, & Passfield, 2015). In addition, if they
comprise three or more measurement points, longitudinal studies allow for
modeling between-person as well as within-person changes (e.g., Madigan,
Stoeber, & Passfield, 2016; see also Chapter 11). Furthermore, only longitudinal
studies with three or more measurement points can properly test mediation effects
(Cole & Maxwell, 2003). Regarding the question of perfectionism as a consequence,
longitudinal studies are important to understand the development of perfectionism.
This is an area of research where we have various theoretical models suggesting

developmental antecedents of perfectionism (e.g., Flett et al., 2002; Stoeber et al.,
in press) but only very few longitudinal studies actually examining developmental
antecedents of perfectionism (e.g., Damian et al., 2013; Damian et al., in press;
Soenens et al., 2008; Stoeber, Otto, & Dalbert, 2009).
Furthermore, it is important that longitudinal studies test for reciprocal effects,
because these tests can yield important new (and sometimes surprising) insights.
For example, Gautreau, Sherry, Mushquash, and Stewart (2015) conducted a
12-month, three-wave study examining self-critical perfectionism and social
anxiety. Results showed that self-critical perfectionism did not predict increases in
social anxiety. Instead, social anxiety predicted increases in self-critical perfectionism,
suggesting that social anxiety may contribute to the development of perfectionistic
concerns. As another example, Damian et al. (in press) conducted a nine-month,
three-wave study examining perfectionism and academic achievement. Differently
from what was expected, perfectionistic strivings did not predict increases in
academic achievement. Instead academic achievement (and academic self-efficacy)
predicted increases in perfectionistic strivings, suggesting that students who are
high achievers and believe in their academic abilities may develop perfectionistic
strivings. Finally, it is important to note that longitudinal studies do not have to be
“long.” Any study on perfectionism using more than one measurement point
qualifies as a longitudinal study, and any findings from such a study are likely to
provide valuable new insights into perfectionism. Moreover, short-term
longitudinal studies (also known as “shortitudinal” studies) may have higher
statistical power for finding longitudinal effects than studies with longer intervals
between measurement points (Dormann & Griffin, 2015), which is something
worth keeping in mind.
Mediators and Moderators

Second, more research examining mediators and moderators of the relationships
and effects of perfectionism is needed.2 Research on mediators is important because
we need to know how perfectionism, as a relatively stable personality disposition,
affects an outcome X (perfectionism → mediator → X). However, not all variables
qualify as mediators, and not all research designs are suitable for testing mediation
effects. According to Cole and Maxwell (2003), “a mediator is a mechanism of
action, a vehicle whereby a putative cause has its putative effect” (p. 559).
Consequently, only variables that represent actions or processes qualify as mediators
(not stable individual differences, personality dispositions, or traits). Further, Cole
and Maxwell point out that “a mediator cannot be concurrent with X” (p. 561).
Consequently, proper mediation analyses require longitudinal studies. Whereas a
full mediation design requires three measurement points (perfectionism at Time 1
→ mediator at Time 2 → outcome at Time 3), it is worth pointing out that also
studies with two measurement points can be used to test mediation effects
by employing a so-called “half-mediation model.” In this model, the
342 Stoeber
predictor–mediator relationships (perfectionism at Time 1 → mediator at Time 2)

and mediator–outcome relationships (mediator at Time 1 → outcome at Time 2)
are tested separately to establish longitudinal mediation (see Cole and Maxwell,
2003, for details). I am not aware of any perfectionism studies applying this model,
but would like to encourage researchers to give this model a try if they have studies
with two measurement points including potential mediators.
Researchers should also continue looking for possible moderators of
perfectionism–outcome relationships, that is, variables that show significant
interactions with perfectionism when predicting an outcome X (see also Chapter
8). Research on moderators is important because they show that the relationships
(or effects) of perfectionism are dependent on a third variable. Important questions
in the search for moderators are, for example, whether there are any variables
buffering the negative effects of perfectionistic concerns (e.g., daily coping;
Dunkley, Blankstein, Halsall, Williams, & Winkworth, 2000; Stoeber & Janssen,
2011) or what the circumstances are under which perfectionistic strivings are
adaptive versus maladaptive (see Chapter 3, Figure 3.3). However, there is a
problem. Interactions between naturally occurring individual differences (e.g.,
perfectionism × daily coping) are usually smaller in size than interactions between
experimental conditions (which can be manipulated to provide large-sized
differences). Consequently, interactions between naturally occurring individual
differences tend to be difficult to detect and may require large sample sizes
(McClelland & Judd, 1993). This could also be the reasons why we seldom find
significant interactions between perfectionistic strivings and perfectionistic concerns
(cf. Hill, 2013; Stoeber & Yang, 2010). Still, these difficulties should not deter
researchers from probing for interactions between perfectionism and possible
moderators, or between perfectionistic strivings and perfectionistic concerns (see
also Gaudreau, 2012).
Going Beyond Self-Reports

Finally, I think that perfectionism research needs more studies including data that
are not from self-reports. Don’t get me wrong. Self-reports in psychological
research are invaluable. They provide reliable and valid information about people’s
thoughts, feelings, and behaviors, and they are practical, economical, and easy to
interpret (Paulhus & Vazire, 2007). Moreover, because only self-reports have an
inside perspective, they can provide “information no one else knows” (Baldwin,
2000). Still, we would be missing essential parts of the perfectionism puzzle if we
only examined self-reported antecedents, self-reported correlates, and self-reported
consequences of perfectionism. Perfectionism research needs to go beyond inner
experiences, and take a look at what perfectionism does in the outside world.
Whereas most studies examining perfectionism do not go beyond self-reports,
there are notable exceptions. First, a significant number of studies have included
objective measures of academic performance (e.g., students’ grade point average).
Other studies have examined perfectionism and objective performance in aptitude
tests and laboratory tasks or sports. These studies have provided valuable new
insights into perfectionism indicating that only perfectionistic strivings show
consistent positive relationships with performance whereas perfectionistic concerns
usually show no relationships (see Stoeber, 2012, for a review). In addition, a
number of studies have included observer ratings (also known as observer reports
or informant reports). Self-reports and observer ratings have been described as the
“counterpoint of personality assessment” (McCrae, 1994). Applied to perfectionism
research, they show us how perfectionists see themselves and how others see them
(see Chapter 9 for an illustrative example). Furthermore, some studies have begun
to go beyond self-reported stress and included physiological measures of stress (e.g.,
Albert, Rice, & Caffee, 2016; Richardson, Rice, & Devine, 2014). Finally, there
are two longitudinal studies examining how perfectionism predicts what is perhaps
the ultimate objective outcome: mortality. Unfortunately, the studies’ findings
were inconclusive. Whereas the first study found that self-oriented perfectionism
predicted lower survival rates (Fry & Debats, 2009), the second study found the
opposite: Self-oriented perfectionism predicted higher survival rates (Fry & Debats,
2011). Clearly more research including observer ratings and objective measures of
stress, health, and well-being is needed to address the complex associations among
perfectionism, stress, health behaviors, health, and, ultimately, mortality (see also
Chapter 10).
Under-Researched Areas
Perfectionism at Work
Finally, I would like to draw attention to three areas that I think are under-
researched. The first is perfectionism at work. We know that work comes out top
when people are asked what domains of life perfectionism affects most (Slaney &
Ashby, 1996; Stoeber & Stoeber, 2009). For example, Stoeber and Stoeber (2009)
investigated how perfectionistic people are across a list of 22 domains of life. They
found that 58% of a university student sample and 53% of an Internet sample
indicated they were perfectionistic at work, putting work at the first position on
both lists. Consequently, perfectionism at work should be an important research
topic. Yet, compared to the number of studies examining perfectionism in students,
relatively few studies have examined perfectionism in employees and how
perfectionism relates to variables that are of key interest in the domain of work
such as workaholism (e.g., Stoeber, Davis, & Townley, 2013; Tziner & Tanami,
2013) or job burnout (e.g., Childs & Stoeber, 2010; Li, Hou, Chi, Liu, & Hager,
2014). Beyond workaholism and job burnout, there is even less research on
perfectionism at work. In particular, we do not know how perfectionism affects
people’s social relations at work and their work performance (individual
performance and team performance). Both questions would be important to
investigate given that perfectionism is linked with interpersonal problems (see
Chapters 9 and 15) and has been associated with higher-quality performance, but
344 Stoeber
reduced productivity and efficiency (Sherry, Hewitt, Sherry, Flett, & Graham,
2010; Stoeber & Eysenck, 2008). Consequently, perfectionism research may profit
from further research on perfectionism at work. In addition, because many jobs
require team work, this research should go beyond individual-level aspects of
perfectionism and also examine group-level aspects like “team perfectionism”
(Hill, Stoeber, Brown, & Appleton, 2014), that is, the level of perfectionism in
teams and how this level influences the team (e.g., team relationships and coherence,
team performance). Whereas we found team perfectionism to predict higher
performance in sport (Hill et al., 2014), team perfectionism may have different
effects at work, but until we investigate perfectionism at work, we will not know.
Ethnic, Cultural, and National Differences

Another question I think is under-researched is the question of ethnic, cultural,
and national differences in the relationships that perfectionism shows with key
variables of interest such as psychological adjustment and maladjustment. Note that
I am not referring to differences in levels of perfectionism (e.g., whether Group A
shows higher or lower levels of perfectionism compared to Group B). I am referring
to differences in the relationships of perfectionism (e.g., whether perfectionism in
Group A shows stronger or weaker relationships with psychological adjustment
and maladjustment compared to perfectionism in Group B) and differences in the
effects of perfectionism (e.g., whether perfectionism in Group A has more adaptive
or more maladaptive effects compared to perfectionism in Group B). For example,
it is conceivable that socially prescribed perfectionism—the belief that striving for
perfection and being perfect are important to others—is less dysfunctional in
collectivistic cultures where people tend to have an interdependent conception of
the self and conforming to expectations from others is the norm. In comparison,
socially prescribed perfectionisms may be more dysfunctional in individualistic
cultures where people have an independent conception of the self and expectations
are primarily self-focused (cf. Markus & Kitayama, 1991; Stoeber, Kobori, &
Tanno, 2013).
Unfortunately, systematic research on ethnic, cultural, and national differences
in perfectionism is lacking. More studies are needed comparing the relationships
and effects of perfectionism across samples from different nations (e.g., Sherry et
al., 2016), different ethnicities (e.g., C. Chen, Hewitt, & Flett, 2017), and different
cultures (e.g., Stoeber, Kobori, & Tanno, 2013). In this endeavor, however, there
are three important points to consider. First, when comparing perfectionism across
cultures, researchers need to make sure that their measures are equivalent across
cultures so they do not compare “chopsticks with forks” (F. F. Chen, 2008).
Second, researchers should not only look for differences, but also for similarities.
And they should make sure they publish studies that find more similarities than
differences as well as studies that do not find any differences (cf. Sherry et al., 2016;
Smith, Saklofske, Yan, & Sherry, 2016). This is to avoid biasing the published
literature in a direction suggesting there are more differences than similarities.
Publishing only studies that find significant differences is a serious problem in

psychological science (e.g., Ferguson & Heene, 2012). As is the case with gender
differences (Hyde, 2005), it may be that the similarities between different nations,
ethnicities, and cultures regarding perfectionism are much greater and more
important than any differences. And if we find differences, we need to demonstrate
that these differences are reliable and replicate in other studies and samples. In
addition, we need theories than can explain these differences.
Perfectionism Across the Lifespan

Concluding this section, another question I think deserves more attention is the
question of how perfectionism develops across the life span. When I give talks
about perfectionism, one question that is frequently asked is if we know what
happens with perfectionism when people get older. In particular, do people
become less perfectionistic when they get older? Unfortunately, the answer to
these questions is: We don’t know. Whereas numerous studies have investigated
how major personality traits develop across the life span (e.g., McCrae et al., 1999;
Roberts, Walton, & Viechtbauer, 2006), I am not aware of any studies that have
investigated how perfectionism develops across the lifespan.
There are, however, a few studies suggesting that perfectionism declines with
age. For example, Landa and Bybee (2007) examined the dimensions of
perfectionism from Frost et al.’s (1990) model comparing undergraduates of a
sorority (mean age = 19.9 years) with alumnae of the same sorority (mean age =
33.7 years). They found that the alumnae showed significant lower levels of
perfectionism regarding personal standards, concerns over mistakes, doubts about
actions, and parental expectations, suggesting that both perfectionistic strivings and
perfectionistic concerns decline with age. Stoeber and Stoeber (2009) examined
self-oriented and socially prescribed perfectionism from Hewitt and Flett’s (1991)
model in an Internet sample including adults from below 20 to above 70 years of
age. Both self-oriented and socially prescribed perfectionism showed small negative
correlations with age, again suggesting that perfectionistic strivings and
perfectionistic concerns decline with age. In comparison, Hewitt and Flett (2004)
examined a large community sample of adults from 18 to over 45 years of age and
found that older adults showed lower levels of socially prescribed perfectionism
(but not self-oriented or other-oriented perfectionism), suggesting that
perfectionistic concerns decline with age, but not perfectionistic strivings. Taken
together, the findings point in the direction of perfectionism showing declines
over the lifespan, particularly perfectionistic concerns (cf. Hewitt & Flett, 2004;
Landa & Bybee, 2007). Because perfectionistic concerns are closely linked with
trait neuroticism (e.g., Stoeber & Otto, 2006), this would be in line with findings
from research on personality across the lifespan showing that levels of neuroticism
decline across the life span, with particularly steep declines in the first decades of
adulthood (McCrae et al., 1999; Roberts et al., 2006). What is unclear, however,
is why perfectionistic strivings also seem to decline even though perfectionistic
346 Stoeber
strivings are closely linked with trait conscientiousness, and conscientiousness

shows increases across the lifespan (McCrae et al., 1999; Roberts et al., 2006).
Clearly there are important questions on how perfectionism and its various aspects,
forms, and dimensions develop across the lifespan, and what explains these
developments. I hope that future research will engage with these questions and
provide answers.
Concluding Comments
I have the same hope for the other open questions addressed in this chapter as well
as the open questions that the other chapters of this book addressed. But looking
back at the past 25 years of research on multidimensional perfectionism and all that
has been achieved in these years—and also looking at the individual contributions
in this book that not only reflect past achievements, but also point toward future
achievements—I am confident that the next 25 years will see all these questions
answered, and more.
Notes
1 See also Chapter 3 for a detailed discussion of why cluster analyses should not be used
to examine the 2 × 2 model of perfectionism.
2 See Baron and Kenny’s (1986) classic article for an explanation of mediators and
moderators.
References
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AUTHOR INDEX
Numbers in bold denote tables; numbers in italic denote figures; n denotes notes.
Abdolell, M. 121 Anderson, R. E. 335

Abela, J. R. Z. 270 Andersson, G. 204, 296
Abraham, W. T. 144, 250 Andrews, D. M. 212–13
Abramowitz, J. S. 120 Ansbacher, H. L. 4
Adderholdt-Elliot, M. 142 Ansbacher, R. R. 4
Addis, M. E. 228 Anshel, M. H. 161
Adkins, K. K. 149 Antl, S. 31–2
Adler, A. 4, 90, 201, 244, 307 Antony, M. M. 7, 20, 46, 114, 158, 255,
Adler, Alfred see Adler, A. 285, 297, 307
Affrunti, N. W. 11, 113, 114–15, 116–17, Appleton, A. A. 255
120, 122–6, 247 Appleton, P. R. 9, 23, 32–4, 95, 120, 137,
Afifi, T. O. 121 157, 169, 344
Agras, W. S. 279 Arana, F. G. 48, 63n1
Ainley, M. 142, 146 Araton, H. 189–90
Airikka, M.-L. 204 Araujo, G. 23
Akay-Sullivan, S. 4 Archinard, M. 157
Albert, P. 343 Ariapooran, S. 167
Aldao, A. 251–2 Arpin-Cribbie, C. A. 297, 300
Aldea, M. A. 252 Aschieri, F. 307
Aldwin, C. M. 224, 226 Ashbaugh, A. 300
Alexander, F. 202 Ashby, J. S. 71, 82, 122, 139–40, 142, 179,
Allen, J. P. 122 210, 215, 223, 243–4, 266, 316, 319,
Allport, G. W. 70, 339 338, 343
Almeida, I. 338 Ashton, M. C. 70, 76, 78, 84n1, 339
Almeida, S. S. 161 Asmundson, G. J. 121
Almodovar, S. 296 Atkinson, J. W. 20–1, 37
Altman, J. 224 Austin, S. B. 272
Andersen, S. M. 313 Ayduk, O. 340
Anderson, D. 121 Ayearst, L. E. 307
354 Author Index
Băban, A. 25, 49, 137, 266, 272, 340 Blase, S. L. 256

Babin, B. J. 335 Blatt, S. J. 95, 191, 202, 223, 226, 228–9,
Bacharach, V. R. 71–3, 84n4 231–4, 300, 306, 308, 321, 336
Back, M. D. 189 Boelen, P. A. 120
Bagby, R. M. 184, 255 Boergers, J. 273
Bahrami, S. 167 Bogg, T. 201, 212
Bakermans-Kranenburg, M. J. 61 Bolger, N. 250–1, 340
Baldwin, M. W. 313 Bolin, J. H. 249
Baldwin, W. 242 Bonacci, A. M. 181
Bandura, A. 185 Bong, M. 24–5
Banks, K. H. 209 Bono, J. E. 52
Barcza-Renner, K. 31–2, 161 Boone, A. L. 124
Bardone, A. M. 97. Boone, L. 47–8, 63n3, 270, 272–3, 278, 321
Bardone-Cone, A. M. 334 Borjali, A. 48
Bargh, J. A. 313 Bottos, S. 211
Baricza, C. 205 Bowden, S. C. 70
Baron, R. M. 119, 346n2 Bowlby, J. 245
Barros, E. 58 Braaten, A. 56
Basirion, Z. 143–4 Braet, C. 47, 273
Bastian, B. 315 Brand, E. F. 238
Battista, S. R. 96 Bratton, S. C. 4
Bauer, D. J. 48 Brennan, K. A. 260
Bauer, M. 300, 323 Brewer, A. L. 338
Baumeister, R. F. 124, 214, 246 Brigidi, B. D. 120
Beal, D. J. 58 Brodie, D. 101
Beard, A. 156 Broeren, S. 115, 116, 118, 126, 247, 273
Beck, A. T. 92–3, 98, 178, 185, 223, 226, Broman-Fulks, J. J. 335
233–4, 238, 270, 299–300, 337 Bromet, E. J. 63
Beck, J. S. 237, 301n1 Brosschot, J. F. 208
Becker, C. 21–2 Brown, A. 9–10, 96, 344
Beidel, D. C. 122 Brown, G. P. 93, 298
Belsky, J. 61 Bruch, H. 307
Bemis, K. M. 93 Bruch, Hilde see Bruch, H.
Ben-Artzi, E. 103 Buhr, K. 120, 125
Benet-Martinez, V. 201 Buhrman, M. 204
Bengtson, V. L. 249 Buis, T. 184, 255
Bennett, J. 161 Bunyan, D. P. 256
Bennett-Levy, J. 293 Burgess, A. 201, 339
Berg, J.-L. 71, 177, 223, 229 Burnam, A. 31
Berman, S. 238 Burney, V. H. 25, 56
Besharat, M. A. 192, 203 Burns, D. D. 4, 93, 98, 101, 202, 267
Besser, A. 10, 12n1, 103, 179, 183, 193–4, Burns, L. R. 212
250, 310, 313, 319 Burt, K. B. 122
Bibbey, A. 250 Burton, K. D. 270
Bieling, P. J. 7, 20, 46, 113, 158, 307 Bushman, B. J. 181, 246
Black, W. C. 335 Bybee, J. A. 345
Blaga, M. 56 Byeon, E. 32–3
Blankstein, K. R. 7, 10, 20, 31, 33, 60, 71, Byrne, S. M. 272
74, 80, 93, 95, 113, 171n1, 182, 202,
208, 212, 223, 229, 232, 268, 307, 310, Caelian, C. 9, 177, 268, 306, 308
337, 342 Caffee, L. 343
Author Index 355
Caldwell, J. G. 252 Clark, S. 115, 117, 137

Campbell, J. D. 71 Cloninger, C. R. 339
Campbell, W. K. 181 Cloud, J. A. 96
Cardinal, G. 31 Coatsworth, J. D. 122
Carey, M. P. 206 Cohen, G. L. 256–7
Carlbring, P. 296 Cohen, J. 71. 160, 297
Carroll, D. 250 Cohen, S. 206, 211
Carvalho, P. H. B. 161 Coker, S. 137
Carver, C. S. 81, 224, 232 Colautti, J. 71, 205, 212
Casala, S. 310 Cole, D. A. 340–2
Caspi, A. 201 Coles, M. E. 123
Cassidy, J. 247 Combs, J. L. 7, 71
Catlett, J. 184, 187 Connelly, B. S. 255
Cattell, R. B. 10, 70 Connor-Smith, J. 57, 224, 232
Causgrove Dunn, J. 23, 58, 156, 161, 338 Conradt, J. 115, 116, 118
Cavanna, R. E. 123 Conroy, D. E. 21, 24, 314
Cecchini-Estrada, J.-A. 50 Cook, L. C. 137
Cervone, D. 69, 339 Cooper, A. 81
Cha, M. 310 Cooper, P. J. 272
Chan, D. W. 143–4, 147 Cooper, Z. 231, 267, 272, 284, 285, 289,
Chang, E. 32–4 298, 300
Chang, E. C. 96, 209, 212–13, 229, 243 Coppolino, P. 161
Chang, P. 122, 207 Corr, P. J. 10, 35, 80–1, 228
Chen, C. 192, 316, 344 Cortese, L. 113
Chen, F. F. 344 Costa, P. T., Jr. 70, 73, 73, 80, 84n3
Chen, J. 186 Costa, S. 161, 162, 167
Chen, K.-T. C. 31 Coulter, L.-M. 113, 115, 271
Chen, L. 8, 25 Covington, M. V. 102
Chen, L. H. 166 Cox, B. J. 12, 36, 71, 158, 166, 191–3,
Chen, S. 78 223, 229
Chen, S. X. 255 Cox, S. L. 186
Cheng, C. M. 225 Craddock, A. E. 213
Cheng, H. 115, 116 Craft, J. M. 58, 338
Cheng, W. M. W. 93, 125 Craig, P. 265
Cheng, W. N. K. 161, 162 Crawford, C. E. 317
Chi, H.-Y. 47, 343 Creswell, J. D. 256
Chik, H. M. 300 Crocker, J. 183
Childs, J. H. 8, 343 Crocker, P. R. E. 50, 53–4, 57–8, 60
Chiri, L. R. 123 Cropley, M. 213
Chmura Kraemer, H. 251 Cross, T. L. 135, 138, 149
Choi, C. C. 121 Cruce, S. E. 83
Chrisler, J. C. 157 Cumming, J. 21, 47–8
Christophe, V. 101 Curran, T. 31, 35, 37, 46, 98, 161, 336
Christopher, J. 223
Church, M. A. 56 D’Afflitti, J. P. 223, 336
Claes, L. 255, 339 D’Alessandro, D. U. 270
Claes, S. 205 Dalbert, C. 49, 71, 341
Clara, I. P. 71, 158, 191–2, 223, 229 Damian, L. E. 8, 10, 12n1, 25–6, 36,
Clark, C. B. 179 49–50, 54, 58, 84, 137, 266, 272, 277,
Clark, D. A. 104, 121 334, 340–1
Clark, R. A. 20 Dang, S. 314–5, 320
356 Author Index
Davé, P. N. 21 Dugas, M. J. 118, 120, 125

Davey, G. C. L. 98 Dunham, C. C. 249
Davis, A. 340 Dunkley, D. M. 7, 11, 20, 71–4, 124,
Davis, C. 71, 157 171n1, 177, 182, 186, 191–2, 202, 205,
Davis, C. R. 32, 343 207, 209–10, 212, 223–6, 227, 228–34,
Davis, D. E. 11, 210 237–8, 252, 268, 310, 319, 337, 342
Davis, F. 113 Dunn, J. G. H. 20, 23, 46, 58, 156–7, 161,
Davis, M. C. 98, 273 165, 336, 338, 340
Davis, P. A. 57–8 Durbridge, M. 283
Davis, R. 121, 197 Duriez, B. 249
Davis, R. A. 179 Dweck, C. S. 135
De Cuyper, K. 255, 339 Dyck, M. J. 98–9, 254, 288–9, 315, 336
De Rosa, T. 79, 310
Debats, D. L. 203, 206, 343 Ecker, B. 253
DeBlaere, C. 210 Edbrooke-Childs, J. H. 84, 340
DeCharms, R. 21 Edelstein, R. S. 193
Deci, E. L. 29, 30, 31, 55, 267, 272, 278 Edge, K. 224
Dellwo, J. P. 243, 254 Egan, S. J. 11, 98–9, 113, 127, 232, 254–6,
Deng, X. 314 284–5, 286, 288–93, 295–6, 298–300,
Derisley, J. 115, 117 315, 336
Derringer, J. 189 Eismann, U. 31, 33–4, 149
Desmond, F. F. 248 Eklund, R. C. 31, 161
Desnoyers, A. 103 Ekornås, B. 122
Deutsch, F. M. 94 Elliot, A. J. 22, 24, 26–8, 55–6, 147,
Devine, D. P. 210, 252, 343 249–50
Dewey, D. 211 Ellis, A. 92, 98, 200
Dewey, M. E. 213, 288, 336 Ellis, Albert see Ellis, A.
DeYoung, C. G. 80, 190 Ellis, L. K. 124
Di Paula, A. 71 Endler, N. S. 205, 319
Diamond, L. M. 252 Engel, G. L. 215
DiBartolo, P. M. 8, 122, 201, 207, 255, Engelen, S. 124
296, 339 Enns, M. W. 12, 36, 71, 158, 191–2, 223,
Dickinson, W. L. 319 229
Dieffenbach, K. 156 Esposito, R. M. 10, 334
Dimmock, J. A. 32, 170 Essau, C. A. 115, 116, 118
Dittner, A. J. 211 Essex, M. 251
Dixon, A. 296 Eum, K. 25
Dixon, D. 270 Evans, D. W. 99
Dixon, F. A. 140–1, 147 Exline, J. J. 181
Doba, K. 101 Ey, S. 315
Donaldson, D. 273 Eysenck, H. J. 45, 70, 80, 83
Donovan, R. J. 21 Eysenck, M. W. 80, 344
Dormann, C. 341 Eysenck, S. G. B. 70
Douilliez, C. 54, 58, 60
Downey, C. A. 96, 212 Fairburn, C. G. 231, 267, 272, 279, 284,
Dryden, W. 314 285, 289, 295, 297–300
Duarte, C. 339 Fairweather-Schmidt, A. K. 275, 276
Dubanoski, J. P. 212 Fantini, F. 307
Duda, J. L. 21–4, 28, 32–4, 47–8 Fassnacht, D. B. 300
Dudley, R. 223 Feast, A. R. 32–4
Dueling, J. K. 212 Feinstein, J. 186, 194
Author Index 357
Fergus, T. A. 123 223, 249, 266–7, 271, 289, 296, 299,

Ferguson, C. J. 345 301n3, 307, 309, 319, 338–9, 345
Ferguson, E. 84n5 Fry, P. S. 203, 206, 211, 343
Fernández-Río, J. 50 Fu, C.-C. 25
Ferrão, Y. A. 123 Furlan, L. 48, 63n1
Ferrari, J. R. 96
Ferreira, C. 339 Galfi-Pechenkov, I. 310
Ferreira, M. E. C. 161 Gallagher, N. G. 120
Fifer, A. M. 21, 314 Gamache, V. 156
Finch, H. 25, 136, 147, 249 García-Fernández, J. M. 47
Finnie, S. B. 23 Gardner, F. L. 113
Fioravanti, G. 310 Gareau, A. 31, 50
Firestone, L. 184, 187 Garfinkel, P. E. 93
Fitzgerald, K. 210 Garner, D. M. 4, 93, 272
Fitzpatrick, S. 223 Garshowitz, M. 207
Flachsbart, C. 57 Gaudreau, P. 7–8, 10, 12n2, 21–3, 25–8,
Flatman, B. 156 31–2, 34, 44–50, 52–60, 63, 76, 83,
Fleeson, W. 58, 340 147–8, 158, 171n1, 201, 266, 333–5,
Fletcher, K. L. 25, 28, 35, 47–8, 56, 147, 342
249 Gautreau, C. M. 53, 78, 177, 193, 310, 341
Flett, G. L. 5, 6, 8, 8–12, 12n1, 20, 32–5, Gellatly, R. 92
46, 60–1, 66, 68–9, 71–6, 78–83, 84n2, Gelso, C. J. 311
89–91, 93, 95–99, 103–5, 113–14, 115, Genest, M. 94–5, 313
115–19, 121, 124–6, 135–9, 150, 150n1, Gentes, E. L. 120
156–7, 167, 169, 177–9, 181, 183, 184, Gerin, W. 208
191–3, 200–3, 205–13, 215, 223, 228–9, Gfeller, J. D. 83
232, 251, 266–8, 270–1, 273, 277, 279, Ghamary, A. 25
289, 306–10, 313–6, 319, 322, 336, Ghisi, M. 123
338–41, 344–5 Gibson, J. M. 96
Flynn, C. A. 188, 190, 309, 316, 319, 321 Gilbert, P. 186, 314, 316
Foa, E. B. 120, 300 Gilman, R. 266
Folkman, S. 50, 224–5, 250 Ginsburg, G. S. 122
Fong, R. W. 143 Gioia, G. A. 124
Foreman, P. 314 Glass, J. 249
Forgas, J. P. 214 Glombiewski, J. A. 251
Forsell, E. 296 Glossner, K. 192
Fosha, D. 316 Glover, D. S. 298, 300
Foster, J. D. 189 Glover, L. K. 145
Franche, V. 10, 31, 45, 50, 52–4, 58–9 Goldberg, L. R. 70, 75, 201, 212
Francis, K. 120 Goldman, B. N. 182
Frankowski, J. J. 206 Golzari, M. 48
Fraser, R. 191 Gong, X. 249
Fredtoft, T. 300, 323 Gonzalez, R. 252
Freeman, A. 178, 185 Gonzálvez, C. 47
Freeston, M. H. 98, 118 Goossens, L. 47, 249, 273
Friedberg, R. D. 127 Gorin, A. A. 273
Friedman, H. S. 201, 206 Goss, R. L. 94
Friedrich, A. 143 Gosselin, P. 117
Frost, R. O. 5, 6, 7, 8, 19–21, 69, 82–3, Gotlib, I. H. 102
91, 93, 113, 117–18, 121–3, 139, 148, Gotwals, J. K. 20, 23, 34, 36, 46, 50, 58,
157–8, 165, 184, 192, 202, 204, 207, 157–61, 165, 336, 338
358 Author Index
Gould, D. 156 Harlan, E. T. 124

Graham, A. R. 71, 98, 344 Harrison, F. 213
Gralnick, T. M. 71, 178, 207 Harter, S. 99, 121
Gramszlo, C. 124, 247 Harvey, A. 298
Granleese, J. 121 Harvey, B. 31
Gray, J. A. 80 Harvey, L. N. 338
Gray, L. 10, 95, 208, 307 Haskew, A. E. 26, 337
Green, B. A. 335 Hautzinger, M. 277
Greenberg, L. S. 253 Hawkins, C. C. 266, 271
Greenier, K. D. 182 Hawton, K. 115, 116, 273
Greenspon, T. S. 300, 314, 323 Hayakawa, M. 288
Grieger, R. M. 314 Hayes, J. A. 311, 316
Griffin, M. A. 341 Hays, K. 161
Grills, A. E. 121–2, 207 Hayward, J. A. 32–4
Grilo, C. M. 186, 207, 223, 337 Hazen, E. P. 123–4
Grobel, L. 181–2, 186 Heatherton, T. F. 214
Groen, G. 277 Heene, M. 345
Grolnick, W. S. 123 Heimann, M. 122
Grønhøj, A. 250 Heimberg, R. G. 5, 20, 69, 113, 123, 139,
Gross, J. J. 251 148, 158, 202, 266
Grouzet, F. M. E. 31 Heisel, M. J. 90, 104
Grove, J. R. 32, 170 Helwig, C. C. 255
Gucciardi, D. F. 21, 25, 32–4 Hemsley, D. R. 104
Guez, J. 103 Henderson, K. J. 21, 91, 157
Guignard, J.-H. 142–3 Henning, K. R. 315
Guimaraes, J. M. N. 215 Henschen, K. 156
Gupta, A. 205 Herman, K. C. 248, 277
Gurtman, M. B. 188, 317 Hermans, D. 255, 339
Gustafsson, H. 161, 163, 168 Hewitt, P. L. 5, 6, 8, 8–12, 12n1, 20, 35,
Guy, S. C. 124 46, 60–1, 68–9, 71–6, 78–83, 84n2,
89–91, 93–8, 103–5, 113–14, 115, 116,
Haase, A. M. 336 118–19, 124–5, 135, 139, 150, 150n1,
Habeeb, C. M. 31, 161 156–7, 167, 169, 177–9, 181, 183, 184,
Habke, A. M. 10, 188, 190–1, 309, 316 186, 188–9, 191–3, 200–3, 205–11, 213,
Hager, M. J. 47, 343 215, 223, 228–9, 232, 251, 266–8, 271,
Hagger, M. S. 99, 254, 288, 315 273, 277, 279, 289, 300, 306–11,
Hair, J. F., Jr. 335 313–16, 319–23, 336, 338–40, 344–5
Hall, H. K. 21, 23, 31, 50, 120, 137, Heym, M. 84n5
156–7, 161 Hibbard, D. R. 249
Hall, P. A. 71 Higgins, E. T. 9
Halsall, J. 7, 20, 171n1, 232, 310, 342 Hill, A. P. 9, 11, 20–1, 23, 31–5, 37, 37n1,
Hamacheck, D. E. 4, 71, 90, 228, 234, 252 46, 50, 54, 57–8, 95, 98, 120, 137, 149,
Hamel, R. 31 157–9, 161, 163, 166-70, 171n2, 336,
Hammen, C. 238 338, 342, 344
Hampson, S. E. 212 Hill, R. W. 7, 8, 23, 71–3, 82–3, 84n4,
Hanchon, T. A. 140 148, 181, 188, 190, 308–9, 316–7, 335
Handal, P. J. 83 Hilpert, J. 272
Handley, A. 299–300 Hine, P. 298, 300
Harackiewicz, J. M. 24, 27 Hirsch, J. K. 214
Hardy, L. 161, 162 Hirsh, J. B. 190
Haring, M. 309, 319 Hofer, S. M. 24
Author Index 359
Hollender, M. H. 4 Jalleh, G. 21
Hollon, S. D. 97 Jang, K. L. 121
Holt, C. S. 5, 20, 69, 139, 148, 158, 202, Janicki-Deverts, D. 206
266 Janssen, D. P. 231–2, 342
Holt, N. L. 156 Janssen, W. F. 11
Holub, A. 206 Jaremka, L. M. 256
Hong, R. Y. 248 Jelas, Z. M. 143
Hope, D. A. 113 Joffe, R. T. 184
Hopkins, C. 170 John, O. P. 69–70, 339, 251, 339
Hordern, C. 300 Johnson, D. G. 139, 244
Horn, A. B. 277 Joiner, T. E. 115, 116
Horney, K. 4–5, 91, 95, 98, 105, 178, 182, Jonason, P. K. 181
306–7, 314, 319 Jones, R. G. 92
Horney, Karen see Horney, K. Jong, P. J. de, 124
Hotham, S. 25, 28, 255 Jorgensen, R. S. 206
Hotz, V. J. 146 Joseph, S. 121
Hou, Z.-J. 47, 343 Jowett, G. E. 11, 20, 23, 31–4, 36, 157–9,
Howell, J. A. 103, 303 161, 163, 167–8, 171n2, 338
Hoyle, R. H. 159 Judd, C. M. 169, 342
Huang, C. 56 Judge, T. A. 52
Hubbard, B. 224–5 Juster, H. R. 113
Huber, R. 182, 186 Juster, R.-P. 206, 211
Hudson, J. L. 115, 116, 118, 126, 247, 273
Huelsman, T. J. 23 Kaap-Deeder, J. van der 272, 321
Hufford, M. R. 340 Kaldas, J. 314. 322
Huggins, L. 270, 273 Kaldo, V. 204
Hulleman, C. S. 27 Kamins, M. L. 135
Hulley, L. 253 Kane, R. 273, 299, 336
Hummel, A. M. 311 Kannan, D. 223
Hussain, R. 192 Kao, P.-C. 31
Huta, V. 113 Karlov, L. 8, 25
Hutchfield, J. 37, 182, 288, 337 Karvinen, K. 71
Hwang, A. 24 Kashima, Y. 212
Hyde, J. S. 345 Kaviani, E. 167
Hymel, S. 122 Kawamura, K. Y. 309, 319
Kaye, M. P. 21, 25, 314
Ialongo, N. S. 115, 116, 248, 277 Kazdin, A. E. 256
Ijzendoorn, M. H. van 61 Kazubska, M. 206
Imber, S. D. 299 Kealy, D. 11
Inglés, C. J. 47–8 Kearney, C. A. 137
Ingram, R. E. 100, 103, 238 Kee, Y. H. 166
Iranzo-Tatay, C. 244, 339 Kehayes, I.-L. 191
Irvine, J. 297 Keller, M. 127
Isquith, P. K. 124 Kempe, T. 61, 289
Israeli, A. L. 7, 20, 46, 158, 307 Kempke, S. 205, 211
Ivezaj, V. 212 Kendall, P. C. 100, 126
Jackson, T. 122 Kennedy-Moore, E. 224–5
Jacobi, C. 272 Kenney-Benson, G. A. 247
Jacobs, R. H. 118 Kenny, D. A. 119, 346n2
Jacobsen, N. S. 228 Kenworthy, L. 124
Jacquet, A.-Y. 142 Keogh, E. J. 61, 289
360 Author Index
Kern, M. L. 201 Lakey, B. 238

Kernis, M. H. 182 Landa, C. E. 345
Kerr, A. W. 23 Langhinrichsen-Rohling, J. 78
Kessler, R. C. 63 Lapsley, D. K. 140
Khazanov, G. K. 74 LaSota, M. 122, 207
Kiernan, M. 251 Law, A. 183, 310
Kiesler, D. J. 311 Lawrence, C. 84n5
Kim, L. E. 8, 25 Lawson, M. A. 97
Kim, S. 25 Lazarus, R. S. 50, 224, 226, 250
Kim-Cohen, J. 122 Leahy, R. L. 314
Kitayama, S. 344 Lee, A. 32–3
Kleitman, S. 8, 25 Lee, I. A. 210, 225, 227
Klibert, J. J. 78 Lee, K. 76, 78, 339
Kline, B. E. 146 Lee, M. 297–8, 300
Kline, P. 5, 10 Lee, S. M. 32–3
Kljajic, K. 10, 50 Lee-Baggley, D. L. 9–10, 71, 178, 191,
Klosko, J. S. 228 309
Ko, A. 319 Leever, B. A. 223
Kobori, O. 10, 96, 103, 288, 344 Lefèvre, F. 54, 58, 60
Kochanska, G. 124 LeMare, L. 122
Koestner, R. 37, 273 Lemyre, P.-N. 23
Kohl, A. 251 Lendon, J. P. 250
Kohut, H. 246 Lens, W. 56
Koledin, S. 93 Leonard, K. E. 191
Köller, O. 53 Lese, K. P. 322
Komarraju, M. 31 Lesne, A. 101
Koole, S. L. 251 Leszcz, M. 323
Kornblum, M. 142, 146 Letarte, H. 118
Kozub, S. A. 23 Letourneau, L. A. 94
Kraemer, H. C. 279, 300 Leung, P. W. L. 115, 116
Krain, A. L. 126 Levinson, C. A. 54
Krames, L. 203 Levitt, H. M. 223
Kroll, J. F. 94 Levy, S. 98
Krueger, R. F. 189 Lewkowski, M. D. 230
Krupnick, J. L. 191, 308 Leyland, A. F. 173
Kubal, A. E. 266 Li, X. 47–8, 343
Kubzansky, L. D. 255 Libby, S. 115, 117, 120–1
Küfner, A. P. 189 Liebowitz, M. R. 300
Kuncel, N. R. 201 Ligiéro, D. P. 311
Kuo, J. Y.-C. 31 Liu, J. 47, 343
Kuosmanen, K. 209 Lizmore, M. R. 161, 164, 168
Kupfer, D. J. 251 Lloyd, S. 273, 277, 300
Kuyken, W. 223–4, 226, 228, 231, 234–7, Lo, C. 255
239n1 LoCicero, K. A. 140, 142
Kyparissis, A. 71–4 Lomax, C. 247, 266, 268, 276, 278
Kyrios, M. 300 Lombardo, C. 10, 334
Long, J. D. 122
Lacey, K. 206 Longbottom, J.-L. 32–4, 170
Ladouceur, R. 98, 118, 120 Lonigan, C. J. 124
Lahart, C. 5, 19, 82, 93, 117, 139, 157, Lopes, C. 339
184, 202, 223, 249, 289, 307, 338 Lopez, F. G. 8, 245, 340
Author Index 361
Lovibond, P. F. 276 Mahoney, J. 21

Lovibond, S. H. 276 Majid, R. A. 143
Lowell, E. L. 20 Malla, A. K. 113
Lubart, T. I. 142 Mallinckrodt, B. 144, 250
Lundervold, A. J. 122 Mallinson, S. H. 20, 50, 53, 58, 157–9,
Lundh, L.-G. 102–3, 116, 186, 203, 161, 167–9, 171n2, 338
300 Mallinson-Howard, S. H. 11
Lupien, S. J. 206 Malm, M. 300, 323
Luyten, P. 205, 210–11, 249, 272 Manassis, K. 115, 116
Lynam, D. R. 159 Mandel, T. 124, 223, 229–32
Lyons, E. 338 Mansell, W. 284, 289
Marchetti, I. 123
Ma, D. 210, 225–6, 227, 228–34, 238 Marcus, D. K. 9, 80
McAdams, D. P. 69, 251, 339 Margot, K. C. 144–6
McArdle, S. 23, 32–4, 122, 338, 340 Markon, K. E. 189
McCabe, R. E. 113, 307 Markus, H. 178, 344
MacCann, C. 8, 25 Marsh, H. W. 52–3
McClelland, D. C. 20 Marshall, R. 252
McClelland, G. H. 169, 342 Martell, C. R. 228, 237–8
McCrae, R. R. 70, 73, 73, 80, 84n3, 343, Marten, P. 5, 19, 82, 93, 117, 139, 157,
345–6 184, 202, 223, 289, 307, 338
McCreary, B. T 115, 116, 270 Martin, A. J. 52
McCreary, D. R. 71 Martin, F. 314
MacDermid, S. M. 58 Martin, J. L. 243, 316
Macdonald, S. 83, 105, 114, 135, 209, 228, Martin, L. L. 104
277, 340 Martin, T. A. 84n3
McEwen, B. S. 206 Martin, T. R. 10, 95, 203, 207
McFall, M. E. 92 Martinelli, G. 10
McGee, B. J. 12 Masheb, R. M. 223, 337
McGirr, A. 210 Masten, A. S. 122
McGlashan, T. H. 186, 207, 223 Matthews, J. 23
McGregor, H. A. 24, 55 Matthews, K. 192
McGregor, I. D. 81 Mattia, J. I. 5, 20, 69, 113, 139, 148, 158,
McIntire, K. 71–3, 84n4 202, 266
McKay, D. 120, 123 Maughan, B. 122
MacKenzie, K. R. 323 Maxner, S. 192
Mackinnon, S. P. 11, 53, 78, 96, 177, 187, Maxwell, S. E. 340–2
189, 191–3, 207, 223, 310 Mayer, B. 124
McManus, F. 293 Maynard, I. 161
Macnair-Semands, R. R. 322 Mazmanian, D. 193
McNaughton, N. 80–1 Mazzocco, M. M. M. 144
Macneil, M. A. 9, 178, 223, 317 Medical Research Council 265
McVey, G. L. 121–2 Meehl, P. E. 335
McWhinnie, C. M. 270 Meireles J. F. F. 161
McWilliams, N. 323 Méndez-Giménez, A. 50, 53, 58
Madigan, D. J. 8, 10, 27, 31–2, 36–7, 54, Mercer, S. H. 188
58, 157, 161, 164–5, 166–7, 169, 334, Mesagno, C. 166
338, 340 Messer, S. C. 122
Madjar, N. 25 Methot-Jones, T. 204
Madorsky, D. 104 Meyer, H. A. 24
Maehr, M. L. 24 Michou, A. 31–2
362 Author Index
Miguel, E. C. 123 Muris, P. 124

Mikail, S. F. 8, 11, 91, 93, 267, 306, 319, Murray, K. T. 123
322–3 Mushquash, A. R. 341
Mikulincer, M. 252
Miles, E. 251 Nadler, D. R. 31
Miles, J. 273 Nandrino, J. L. 101
Miller, B. W. 23 Narduzzi, K. 122
Miller, G. E. 206 Nasby, W. 94
Miller, J. D. 189 Nash, K. A. 81
Miller, K. J. 166 Nathanson, C. 71, 73
Miller, R. B. 249 Neal, M. 123
Mills, C. J. 139, 142–4 Nealis, L. J. 9, 11, 78, 177–80, 181, 182–3,
Mills, J. S. 31, 33 184, 185–7, 189, 193, 317
Milyavaskaya, M. 273 Neely, L. L. 307
Min, J. 250 Neenan, M. 314
Mintz, L. B. 256 Negru, O. 8, 25, 49, 137, 266, 272, 340
Minzi, M. C. R. de 123 Negru-Subtirica, O. 36, 340
Miquelon, P. 31–2 Nehmy, T. 274, 276
Miranda, D. 45 Neihart, M. 149
Miranda, J. 100, 211, 238 Nepon, T. 10, 91, 96, 113, 115, 178, 208,
Mirzadeh, S. A. 143, 243, 250, 253 210–11, 339
Mischel, W. 340 Neria, Y. 193
Missildine, W. H. 4, 90 Nerland, E. 23
Mitchell, J. H. 115, 116, 118, 125–6, 247, Nestler, S. 189
270, 273 Neubauer, A. L. 5, 20, 69, 139, 148, 158,
Mittelstaedt, W. 93 202, 266
Mobley, M. 82, 139, 179, 215, 223, 244, Neves, C. M. 161
338 Newall, C. 115, 116, 118, 125, 247, 273
Moffett, A. 156 Newby, J. 96
Mofield, E. 141, 144 Newman, J. P. 159
Moller, A. C. 28 Nguyen, T. T. 31
Möller, J. 53 Nicholls, J. G. 22, 24
Molnar, D. S. 11, 71–3, 79, 201–5, 209, Nicholson, I. R. 113
211–3, 307, 310, 339 Nicholson, R. A. 225
Morady, A. R. 212 Nobel, R. 115, 116, 118–19
Morero, Y. I. 121 Noh, A. 24
Moretz, M. W. 120, 123 Nolen-Hoeksama, S. 251–2
Morin, A. J. S. 31, 161 Noort, E. van 298–300
Moroz, M. 124, 205, 223, 252 Norman, R. M. 113
Morris, L. 247, 266, 268, 276, 278 Norman, W. T. 70
Morris, R. J. 179 Noser, A. E. 188
Morris, R. P. 202 Nurius, P. 178
Morrison, M. A. 170
Morrison, T. G. 170 O’Brien, S. 74
Moses, J. 315 O’Connor, D. B. 231, 252
Mosewich, A. D. 50 O’Connor, R. C. 46, 101, 115, 116, 231,
Mosher, S. W. 60, 229 252, 270, 273
Mouratidis, A. 31–2, 56 O’Neill, M. P. 300
Munz, D. C. 83 Obradović, J. 122
Mural, J. C. 317 Obsessive Compulsive Cognitions
Murayama, K. 26 Working Group 300, 338
Author Index 363
Odbert, H. S. 70 Pickard, J. D. 179

Ofoghi, Z. 203 Piek, J. P. 98–9, 254, 288–9, 315, 336
Ogilvie, D. M. 95 Pieters, G. 255, 339
Ohashi, M. M. 255 Pilkonis, P. A. 300, 321
Oliva, P. 161 Pincus, A. L. 190, 193, 308
Oliveira, L. P. D. 161 Pinto, A. 300
Oliver, J. M. 83, 105, 114, 135, 209, 228, Pinto-Gouveia, J. 339
277, 340 Pintrich, P. R. 24
Ollendick, T. H. 115, 118, 121 Pirbaglou, M. 95
Olmstead, M. P. 4, 93, 272 Plath, S. 183, 187–8, 191
Oltmanns, T. F. 120 Plath, Sylvia see Plath, S.
Olusoga, P. 161 Pleva, J. 297, 300
Ommundsen, Y. 23 Pluess, M. 61
Ones, D. S. 255 Pohlmann, B. 53
Organista, P. B. 211 Polivy, J. 4, 93, 272
Osmond, E. 156 Pollock, N. C. 188
Öst, L.-G. 102, 116, 300 Pomerantz, E. M. 247
Otto, K. 7, 12, 20–1, 25, 36, 49, 69, 71, Porter, J. D. 223
82, 148, 157, 202, 223, 266, 334–5, 338, Portesová, S. 139–41, 143–4
341, 345 Posner, M. I. 124
Overbey, G. A. 338 Possel, P. 277
Owens, R. G. 23, 27, 82, 213, 288, 336 Postmes, T. 56
Ozer, D. J. 201 Poulsen, S. 300, 323
Powell, L. 315
Pacht, A. R. 5, 98, 202 Powers, T. A. 37, 273
Padesky, C. A. 223 Prapavessis, H. 336
Pals, J. L. 251 Preacher, K. J. 210, 225, 227
Pantano, J. 146 Preusser, K. J. 266, 269
Papay, K. A. 52 Priel, B. 250
Paradise, A. W. 182 Pritchard, M. E. 202
Parker Peters, M. 141, 144 Przybeck, T. R. 339
Parker, J. D. A. 184 Purdon, C. L. 113
Parker, W. D. 137, 139–47, 149, 266, 271, Purrezaian, H. 48, 63n1
335 Purrezaian, M. 48, 63n1
Parkes, J. 21
Pashak, T. H. 83 Quas, J. A. 193
Passfield, L. 27, 31, 54, 161, 340 Quested, E. 21, 33–4, 47–8
Paternostro, J. 127 Quinlan, D. M. 223, 300, 321, 336
Patton, M. J. 246
Paulhus, D. L. 71, 342 Radhu, N. 297, 300
Paxton, S. J. 272 Rafaeli, E. 340
Pekrun, R. 26 Rahotep, S. S. 243
Pennen, E. van der 124 Ramasubbu, C. 337
Pepler, D. 121 Rambow, A. 8, 21
Persaud, C. 96 Rand, K. L. 229
Persons, J. B. 223, 236–7 Randles, D. 81
Pervin, L. A. 69–70, 339 Rapee, R. M. 126
Pescheck, E. 25 Rasmussen, K. R. 315
Pezard, L. 101 Rasmussen, S. 101, 115, 116, 270, 273
Pfeiffer, S. I. 149 Raveh, M. 103
Phillips, A. C. 250 Ray, M. E. 210. 243
364 Author Index
Rees, C. S. 98–9, 254, 288–9, 315 Rutter, M. 122

Reeve, C. L. 52 Ryan, R. M. 29, 30, 55, 123, 267, 272,
Reeve, R. A. 47–8 278
Reidy, D. E. 189
Reinke, W. M. 248, 277 Saboonchi, F. 103, 186, 203
Reinking, K. R. 96 Sadava, S. W. 71, 203, 205, 212–13
Rendón, M. J. 255 Sæther, S. A. 23
Rennert, D. 8, 208 Sagar, S. S. 21–2
Reuther, E. T. 121 Saito, M. 78
Reynolds, S. 115, 117 Saklofske, D. H. 9–10, 54, 70–1, 169, 179,
Rhéaume, J. 98, 118, 123 188, 190, 337, 344
Rice, K. G. 8, 11, 25, 47, 71–3, 82–3, 115, Salmi, O. 25
118, 121–2, 139, 143, 147, 179, 182, Salzman, L. 306, 319–20
210, 215, 223, 243–4, 248, 250, 252–5, Sameroff, A. 49–50
266, 269, 316, 338, 340, 343 Samstag, L. W. 317
Richardson, C. M. E. 182, 210, 243–4, Sanavio, E. 123
252, 343 Sanislow, C. A. 186, 207, 223
Rief, W. 251 Sanmartín, R. 47
Riley, C. 289, 298, 300 Santanello, A. W. 113
Rimes, K. 211 Sapolsky, R. M. 250
Rinn, A. N. 144–6 Sasagawa, S. 115, 118
Rittenhouse, J. D. 206 Saucier, G. 70, 75
Ritvo, P. 297 Scheier, M. F. 224
Rnic, K. 71–2, 74 Scher, C. D. 103
Robbins, A. S. 90, 200 Scherer, U. 157
Robbins, S. B. 246 Schmeichel, B. J. 256
Roberts, B. W. 201, 212, 345–6 Schmidt, N. B. 115, 116
Roberts, G. C. 23 Schmidt, U. 273
Robinson, D. P. 97 Schneider, N. 192
Robson, S. J. 161, 163, 166, 170 Schniering, C. A. 126
Rogers, C. R. 245–6 Schuler, P. A. 135, 138, 140, 144–6
Rogers, Carl see Rogers, C. R. Schultz, R. A. 145
Rogers, G. M. 270 Schwartz, A. 120
Rollyson, C. 187 Schweitzer, R. 205
Ronningstam, E. 180 Schweizer, S. 251
Rooij, S. R. de 250 Scott, C. 26, 337
Rooney, R. 273 Segal, Z. V. 100, 103, 238, 301n2, 317
Roseboom, T. J. 250 Segerstrom, S. C. 206
Rosenblate, R. 5, 20, 82, 93, 117, 139, Senko, C. 27
157, 184, 202, 223, 249, 289, 307, 338 Seong, H. 32
Rothbart, M. K. 124 Settles, R. E. 7, 71
Rotherham, M. 161 Shabani, S. E. H. S. 25
Rothman, A. 215 Shafran, R. 11, 113, 231–2, 255, 267,
Rowden, L. 122 284–6, 285–7, 289, 291, 297–300
Roxborough, H. M. 268, 310 Shahar, G. 191, 308, 321
Rozental, A. 296 Shahidi, S. 192
Rubin, K. H. 122 Shanahan, M. J. 48
Rudolph, S. G. 98, 124, 229 Shaunessy, E. 143, 146
Ruscio, A. M. 74, 120 Shaver, P. R. 252
Russell, D. W. 144, 250 Shaw, D. L. 315
Russell, J. A. 54 Shea, M. T. 300
Author Index 365
Sheeran, P. 251 Sorotzkin, B. 247, 300, 314, 323

Sheldon, K. 272 Sotsky, S. M. 191, 308
Shelton, J. 181 South, S. C. 120
Sherman, D. K. 256 Southard, A. C. 188
Sherry, D. L. 178, 317 Speirs Neumeister, K. L. 11, 25–6, 56, 58,
Sherry, S. B. 9–11, 12n1, 53–4, 71–2, 74, 135–8, 146–7, 149–50, 249
78, 96, 169, 177–80, 183, 187, 189, 191, Spence, J. T. 90, 200
193, 207, 223, 268, 306, 308–10, 317, Spielman, L. A. 313
337, 341, 344 Spirito, A. 273
Sherwood, H. 224 Spoor, E. 307
Shichman, S. 95 Srivastava, S. 70
Shiffman, S. 340 Stairs, A. M. 7, 71, 84n2
Shih, S. S. 25 Stamp, G. M. 161, 163, 166, 170
Shim, S. S. 25, 28, 35, 47–8 Starrs, C. J. 230
Shiner, R. 201 Steele, A. L. 297, 299–301
Shoda, Y. 340 Stein, M. B. 121
Short, E. B. 146 Steketee, G. 113, 118, 121, 123
Short, M. M. 193 Stenling, A. 161
Shulman, E. 183–5 Stewart, S. H. 9, 96, 178, 191, 317, 341
Sica, C. 123 Stöber, J. 4, 8, 271, 339
Siegle, D. 135, 144–6 Stoeber, F. S. 12, 127, 170, 338, 340, 343,
Sigmond, R. 124 345
Silverstein, M. 250 Stoeber, J. 7, 8, 8–10, 12, 12n1, 20–23,
Simpson, H. B. 300 25–28, 31–37, 45–6, 49, 54, 60–1, 69,
Sinclair, K. E. 266 71–2, 75–6, 77, 78, 80–4, 96, 127, 137,
Sirois, F. M. 11, 202, 204–6, 211, 213–5 148–9, 157, 159–61, 165, 169–70,
Sironic, A. 47–8 178–9, 182, 185, 188–90, 192, 202, 208,
Skaalvik, E. M. 24 223, 231–2, 255, 266, 272, 288–9, 317,
Skinner, E. A. 224, 226, 237 333–45
Skodol, A. E. 189 Stoll, O. 20, 25, 46, 157, 336
Slade, P. D. 23, 27, 82, 213, 288, 336 Stolorow, R. D. 316
Slaney, R. B. 8, 8, 47, 71, 82–3, 122, 139, Stone, A. A. 224–5, 340
179, 182, 190, 215, 223, 244, 269, 308, Storch, E. A. 115, 118
338, 343 Stout, M. A. 202
Smets, J. 321 Stumpf, H. 137, 139, 266, 271
Smith, A. P. 206 Sturm, K. 97
Smith, G. T. 7 Sturman, E. D. 229, 231
Smith, J. D. 307 Su, Y. J. 300
Smith, M. M. 9–10, 54, 71–2, 74, 78, 100, Sudarshan, N. J. 70
169, 178–9, 188–90, 337, 339, 344 Suddarth, B. H. 8, 182
Smith, R. 97 Suh, H. 11, 256
Smith, T. W. 201, 206 Suldo, S. M. 143
Smits, D. 339 Sullivan, C. 270
Snell, W. E., Jr. 338 Sullivan, H. S. 323
Soenens, B. 47, 56, 123, 249–50, 272–3, Sullivan, J. M. 4
277, 340–1 Sullivan, P. J. 127
Solnik, M. 232 Suls, 206, 215
Solomon-Krakus, S. 205, 252 Summerfeldt, L. J. 307
Sondergeld, T. A. 145 Sun, Y. 161
Song, A. 255 Suveg, C. 124
Soreni, N. 115, 118, 125, 270, 273 Svensson, A. 296
366 Author Index
Svrakic, D. M. 339 Tyrrell, D. A. 206

Swinson, R. P. 113, 297 Tziner, A. 343
Syrotuik, D. G. 23
Szanto, G. 203 Uliaszek, A. A. 190, 308
Szymanski, L. A. 157 Uphill, M. A. 25, 28
Urbánek, T. 140–1, 143–4
Tamminen, K. 57
Tanami, M. 343 Vallerand, R. J. 31
Tang, D. 256 Van Brunschot, M. 232
Tangney, J. P. 124, 316 Van Doorn, K. 293
Tanno, Y. 10, 96, 103, 288, 344 Van Houdenhove, B. 202, 205, 211
Tao, Z. 161 Van Yperen, N. W. 25, 37n2, 56, 307
Tarocchi, A. 307 Vandiver, B. J. 140
Tasca, G. A. 323 Vandromme, H. 255
Tatham, R. L. 335 Vansteenkiste, M. 25, 28, 31–2, 56, 249,
Taylor, J. J. 52, 58 272, 278
Taylor, S. 121 Varnell, S. P. 179
Taylor, V. J. 256 Varzaneh, A. G. 25
Tchanturia, K. 273 Vasey, M. W. 124
Teachman, B. A. 122 Vazire, S. 342
Teasdale, J. D. 99, 301n2 Verbraak, M. 307
Terry-Short, L. A. 213, 288, 336 Vergara, D. 8, 252, 340
Tesser, A. 104 Verner-Filion J. 25–6, 45, 50, 52, 58, 158,
Thayer, J. F. 208 201
Thøgersen, J. 250 Verstuyf, J. 272
Thompson, A. 8, 12n2, 44–5, 48, 50, Vicent, M. 47
53–5, 58, 60, 147–8, 171n1, 266, 334–5 Viechtbauer, W. 345
Thompson, R. A. 251 Vieth, A. Z. 249
Thompson, T. 314 Vijver, F. J. R. van de 70
Thorpe, S. 211 Vitousek, K. B. 97
Tice, D. M. 214 Vogt, T. M. 212
Tiikkaja, J. 25 Vollrath, M. E. 201
Tjus, T. 122 Voltsis, M. 25
Tolin, D. F. 120 Vrinssen, I. 120
Topciu, R. A. 37
Townley, J. 32, 343 Wade, T. D. 11, 113, 232, 255, 272–3,
Towson, S. 122 274–5, 276, 278, 284–5, 286, 288–93,
Tozzi, F. 244 295–301
Trew, J. L. 228 Wagner, D. D. 214
Treyner, W. 252 Wagnsson, S. 161
Trippi, J. 82, 139, 179, 215, 223, 244, 338 Walton, B. 180–1
Trotter, R. 248, 277 Walton, G. E. 249
Trull, T. J. 249 Walton, G. M. 256–7
Tsai, Y. M. 166 Walton, K. E. 201, 345
Tsui, J. M. 144 Wang, C. 25
Tucker, C. M. 248 Wang, K. T. 25, 27, 190, 277, 308
Tueller, S. 244 Watkins, A. 209
Tulder, F. van 120 Watkins, E. 298
Turecki, G. 210 Watson Breeding, T. 174
Turlington, S. 83, 188, 308 Watson, D. 189, 224–5
Turnbull-Donovan, W. 93, 267 Watson, P. J. 179
Author Index 367
Watt, H. M. G. 266 Wood, K. V. 37, 182, 288, 337

Webb, J. B. 52 Woodruff-Borden, J. 11, 113, 114–15,
Webb, T. L. 251 116–17, 120, 123–6, 247
Webster, G. D. 181 World Health Organization 212
Wei, M. 144, 250, 253 Worrell, F. C. 140
Weible, A. L. 94 Wosinski, N. L. 98
Weinstock, M. P. 25 Wurf, E. 178
Weintraub, K. J. 224 Wyatt, R. 186
Weisberg, Y. J. 190
Weishaar, M. E. 228 Xu, M. 52
Weiss, H. M. 58
Weissman, A. N. 93, 223, 299, 337 Yalom, I. D. 323
Weiten, W. 208 Yamawaki, N. 315
Wetzel, R. D. 339 Yamnatz, B. 202
Wheatman, S. R. 182 Yan, G. 54, 344
Wheeler, H. A. 113, 307 Yang, H. 61, 338, 342
Whelan, T. 10, 95 Ye, H. J. 115, 118
Whitaker, D. J. 182 Yeager, D. S. 256–7
White, C. 205 Yiend, J. 293
White, T. L. 81 Yim, I. S. 193
Whitmer, A. J. 102 Young, J. E. 178, 185, 228, 231
Whittal, M. L. 300 Young, R. E. 315
Wiehe, V. R. 189 Yousefi, B. 167
Wilansky-Traynor, P. 115, 116 Yuen, M. 143
Wilhelm, S. 300
Wilksch, S. M. 272–3, 274 Zafiris, J. D. 297
Williams, C. J. 213 Zane, N. 255
Williams, J. M. G. 301n2 Zapolski, T. C. B. 7, 71
Williams, K. K. 135, 138 Zeichner, A. 189
Williams, K. M. 71 Zeifman, R. J. 315
Williams, M. 7, 20, 171n1, 232, 310, 342 Zeigler-Hill, V. 9, 80, 179, 188, 193
Williamson, G. M. 206 Zeman, J. 124
Wilson, G. S. 202 Zhang, L. C. 11, 321–2
Wilson, G. T. 279 Zhang, Y. 121
Wilson, J. 182 Zhao, W. 339
Wimberley, T. E. 256 Zhargmi, M. 25
Winkworth, G. 7, 20, 171n1, 232, 310, Zrull, M. C. 83, 188, 308
342 Zuckerman, A. 250–1
Wirtz, P. H. 124, 210, 252 Zuroff, D. C. 177, 191, 210, 212, 223,
Witcher, C. S. G. 161 225, 227, 229, 268, 273, 306, 308, 321,
Wolf, E. S. 246 337
Wollersheim, J. P. 92
Wong, T. 115, 116
SUBJECT INDEX
Numbers in bold denote tables; numbers in italic denote figures.
2 × 2 model of perfectionism 8, 10, 44–63, adjustment: psychological adjustment 7–8,

147, 159, 266, 334–5 see also two-factor 20, 37, 45–6, 49–50, 56, 60–1, 62, 62,
model of perfectionism 147, 149, 266, 269, 334, 344;
psychological maladjustment 7–10, 20,
abandonment 308, 323 37, 46, 49–50, 54–6, 61–2, 70, 75,
academic achievement 138, 341 see also 142–3, 147, 149, 229–30, 239, 268, 334,
achievement; academic self-efficacy 341 344; psychosocial maladjustment 223,
acceptance 95, 98, 308, 314, 317–8; 230; adjustment problems 335;
acceptance of others 245; lack of psychological problems 147, 225
acceptance 102; non-acceptance 313; Adler, Alfred see author index; Adlerian
self-acceptance see self-abasement view of perfectionism 91
accomplishment: importance of adolescence 53, 101, 205 see also youth;
accomplishment 181, 267–8, 278; adolescents 50, 53–4, 62, 84, 114, 118,
reduced sense of accomplishment 161, 120, 123, 161, 163–5, 166–8, 248–9,
163–4, 166 265–279, 301, 310, 340
achievement: 2 × 2 achievement goal affect 179, 185, 188, 214, 222, 225, 228–
theory 22–7; 3 × 2 achievement goal 239, 319, 323; positive affect 5, 7, 20,
theory 22, 26–7; achievement goals 50, 52, 58–60, 148 160, 190, 203, 214,
22–8, 55–6; achievement goal 222, 225, 227, 228–239, 267; negative
orientations 22–8, 147; achievement affect 7, 20, 54, 59–60, 148, 160, 165,
striving 73, 75, 90, 286, 286–7 182, 190–4, 203, 210, 222, 225, 227,
adaptive aspects: adaptive aspects of 229–239, 252, 267, 276–7, 307, 309,
perfectionism 4, 12, 23, 28, 38, 82, 139, 309; negative affectivity 54
148, 234, 244, 269, 334; adaptive effects African American samples 115, 249, 277 see
of perfectionism 344; adaptive outcomes also Black samples
of perfectionism 160, 168–9, 204–5; age 204, 248; age differences in
adaptive relationships of perfectionism 2 perfectionism 345–6; age groups 62,
Adaptive/Maladaptive Perfectionism Scale 238, 277
(AMPS) 269 agency 188
Subject Index 369
aggression 82, 189; aggressive reactions orientation 24, 27, 36–7; approach-
246; passive aggression 309, 319 avoidance conflict 81, 102; mastery-
agreeableness 70–2, 73, 74–6, 77, 79–80, approach goals 24–8, 56;
83, 147, 188, 190, 317; disagreeableness performance-approach goals 24–8, 56,
147, 188 147
alienation 29, 306, 308–9, 309 see also approval 92–3, 95, 138, 268, 270, 320;
social disconnection conditional approval 135, 228; social
all-or-nothing thinking 90, 93, 98, 268, approval 268, 270; disapproval 135–6,
286, 289; all-or-none thinking 99, 208; 223, 229
dichotomous thinking 93, 98, 99, 285, arousal 54, 104; negative arousal 98, 102
286, 289, 295 Asian samples 143–4, 249, 255; Asian
Almost Perfect Scale–Revised (APS-R) 8, American 144; Asian Canadian 52;
139, 179, 223, 244, 269, 338 Chinese 143–4; Japanese 202, 255;
altruism 73, 74 Malaysian 144, 248
ambivalence 186, 290, 316; ambivalent asthma 202
relationships of perfectionism 155, 160, athlete burnout see burnout
168 athletes 28, 35, 50, 52–4, 57, 62, 91, 137,
amotivation 29, 30, 31–2, 34, 36–7, 160 155–7, 161, 163–5, 166–8, 170, 292,
anger 54, 57, 96, 164, 168,189, 190–5, 338; elite athletes 137, 156
318; angry hostility 73, 74–5, 179, 189, attachment 78, 244, 246–7, 250, 252, 255;
193–4 attachment style 138; attachment theory
anorexia (nervosa) 93, 101, 272, 307 see 243–5, 254; insecure attachment 136,
also eating disorders 245, 247; secure attachment 252
antagonism 189; social antagonism 71–2, authoritarian style 122, 136, 248–9 see also
74–5 see also agreeableness parents
anxiety 29, 54, 73, 74, 77, 78, 81–2, 95–6, autobiographical events 101;
102, 104, 113–127, 147–8, 150, 160, autobiographical memories 101, 156 see
162, 192–5, 202, 204, 214, 231, 234, also memory
237, 247, 270, 273, 276–7; anxiety automatic thoughts 10, 91, 95–6, 100, 104,
disorders 113–127, 192, 194–5, 238, 208, 211, 271, 307–8, 319 see also
273, 297–9; anxiety proneness 91; perfectionism cognitions
anxiety sensitivity 95; anxiety symptoms autonomous motivation 19, 31–2, 34,
114–122, 124–5, 192–3, 223, 230; 36–7
separation anxiety 118; social anxiety 54, avoidance 24, 26, 28, 81–2; avoidance
96, 186, 192, 271; social physique goals 26–7, 56; avoidance orientation 24,
anxiety 160 27; avoidant coping see coping; mastery-
anxious feelings 70, 75, 113–14, 116, 121, avoidance goals 24–8, 56; performance-
124, 126, 294; anxious mood 233, 235; avoidance goals 24–6, 56, 147
anxious rearing model 126, 135, 137;
anxious themes 104 behavioral approach system (BAS) 35, 81
appearance: physical appearance 97, 295–6, see also approach; behavioral experiments
338 291, 293–4, 296; behavioral inhibition
appraisals 57, 91, 222–38, 250; cognitive system (BIS) 35, 81–2
appraisals 90, 97, 208, 210, 223, 226; bifactor model of perfectionism 45 see also
negative appraisals 91, 210; primary two-factor model of perfectionism
appraisal 250; reappraisal 99, 252, 256, birth order 144–6
288; secondary appraisal 250, 256; stress Black samples 210, 248
appraisals 222, 226, 230, 238, 250–1; body dissatisfaction 156; body image 97,
threat appraisals 57, 208, 256 272, 338; body shape and weight 267;
approach 24, 26, 28, 35, 37, 81–2; perfect body 155, 170; weight control
approach goals 26–7, 56; approach 165
370 Subject Index
bulimia (nervosa) 156, 160, 172, 297 see 284–301, 322; individualized
also eating disorders formulation in CBT 284–5, 287, 289–91
burnout 37, 95, 98, 155, 208; athlete coherence therapy 253; depth-oriented
burnout 54, 161, 166–8; job burnout brief therapy 253
208, 343 communion 188, 308
Burns Perfectionism Scale (BPS) 4, 93 community samples 117, 192, 203, 210,
213–14, 315, 321, 345
case studies: Amanda Beard 156; Eugenie compassion 71, 237, 295, 317; self-
Bouchard 156; Emmy 286–8, 292–5; compassion 91, 273, 274, 295, 310, 316
Bobby Knight 177, 180–1, 186, 189–90, competence 73, 75, 92, 194, 238, 256,
194; Mark 234–6; Mr. C 90; Sylvia Plath 267, 278; absolute/intrapersonal
177, 183, 185, 187–8, 191, 193 competence 24; academic competence
catastrophizing 92, 98–9, 252 147; competence satisfaction 162;
child perfectionism 247–8, 250 see also competence thwarting 162; concerns
youth about competence 226; demonstrating
Child–Adolescent Perfectionism Scale competence 27; developing competence
(CAPS) 268, 270, 276–7 22; need for competence 267, 272, 278;
childhood 99, 101; childhood anxiety 114, normative competence 24; perceived
125–7; childhood anxiety disorders competence 114, 120–3, 125, 126, 126;
118–19, 125–7; childhood depression social competence 237
118; childhood perfectionism 126, concern over mistakes 5, 8, 46, 83, 91, 93,
247–50, 266; childhood worry 117, 248 102–3, 115, 117, 139–41, 144–6, 158,
children 99, 113–27, 135–8, 144–5, 149, 165, 183, 184, 202, 205, 210, 213, 223,
245–9, 265–6, 268, 269–71, 273, 276–8, 266, 271, 272–3, 277, 289, 296–300
301, 310, 340 conflict: conflict resolution 50, 53; conflict
Children’s Dysfunctional Attitudes Scale with therapist 315; dyadic conflict 189,
(CDAS) 270 see also dysfunctional 191, 310; interpersonal conflict 179,
attitudes 189, 191, 194, 207, 225, 323
chronic fatigue syndrome 205, 211 conscientiousness 20, 49, 70–73, 73, 75–6,
cleanliness 286, 287, 288, 295–6 see also 77, 79–80, 83–4, 147–8, 150, 200–1,
tidiness 204, 206, 212, 215, 236, 266, 269, 271,
clients see patients; client-centered therapy 339, 346; hyper-conscientiousness 200–1
254 see also Rogers, Carl control: cognitive control 57, 100, 214;
clinical assessments 89; clinical context effortful control 124–5, 126, 126;
310–14, 320–2, 324; clinical interview emotional control 102, 117, 119, 124–5,
289, 321; clinical process 306, 311–15, 126, 248; lack of control 29, 162–3,
320; clinical samples 54, 99, 117, 123, 235, 272, 323; locus of control 29; loss
125, 192, 223, 226, 238, 273, 296–301; of control 229; perceived control 93, 95,
clinical observations 233; clinical 123, 204, 226, 228–30, 235–8; sense of
perfectionism see perfectionism; clinical control 95, 136
psychology 92, 257 controlled motivation 19, 31–2, 36–7
clinicians 237, 268, 285, 289–92, 294, 307, coping 49, 55, 57–8, 114, 118–9, 121, 156,
311, 313, 316, 318–19, 321–2, 324 166, 205, 224–39, 250, 255–6, 319, 342;
close relationships 183; closeness 315; fear active coping 225, 234, 236; adaptive
of closeness with other 229 coping 232–3, 245, 252; avoidant coping
cluster analysis 47–8, 139–41, 143–5, 266, 20, 210, 224–6, 227, 228, 231–3, 235,
335–6 237; coping effectiveness 228–9, 231–2;
coaches 44, 54–5, 57–8, 63, 180, 182 coping inefficacy 209, 231–2; coping
cognitions see perfectionism cognitions with illness 200, 205, 210; coping with
cognitive behavioral therapy (CBT) perfectionism 274; disengagement
118–19, 223, 228, 230, 236, 273, coping 210, 224–6, 228; dysfunctional
Subject Index 371
coping 147; emotion-focused coping 233–5, 238, 319, 321; depressive mood
124, 206, 211, 225, 237; maladaptive 236, 239; depressive schemas 99;
coping 70, 75, 204–5, 210, 270, 319; depressive symptoms 193, 223, 230, 270,
perfectionism as a coping strategy 136; 310, 336; in children 116–7; depressive
positive reinterpretation 225; problem- themes 104; proneness to depression 99,
focused coping 20, 225–6, 227, 228, 103, 253
231, 233–8 Depressive Experiences Questionnaire
cortisol response 193, 210 see also stress (DEQ) 184, 223, 336
counseling 150, 253; counseling despair 90, 188, 254
psychology 257; counselors 60, 134, 150 devaluation: of others 185; self-devaluation
counterproductive behaviors 286, 286, 184; sport devaluation 54–5, 161, 163–4,
290–1 see also procrastination 166
countertransference see transference development of perfectionism 83–4, 89,
criticism: (perceived) criticism from others 126–7, 134–9, 146, 150, 209, 228, 237,
69, 187, 191, 195, 210, 223, 226, 227, 246–9, 277–8, 308, 339–341; in gifted
228–9, 235, 237–8, 309, 323; criticism students 134–9; developmental
of others 69, 177, 179, 185; parental antecedents of perfectionism 7, 146, 148,
criticism 5, 7, 114, 115, 117, 137, 139– 244–7, 323, 341
141, 145–6, 213, 237, 254, 271; self- diary studies 210, 212, 222, 225, 229, 238,
critical perfectionism see perfectionism; 340
self-criticism 3, 69, 91, 93, 95, 105, 180, diathesis-stress model of perfectionism
183, 184, 184, 190, 192, 202, 201, 223, 60–1, 89, 103, 191, 206–7, 210, 215,
227, 234, 236–7, 244, 248, 252–5, 251
267–8, 270–1, 273, 274–5, 278, 285, dichotomous thinking see all-or-nothing
286, 286, 287, 288–91, 295, 299, 336–7; thinking
sensitivity to criticism 181, 229 dietary restraint 334; dieting 96, 276–7
cross-cultural studies 143 see also culture differential susceptibility hypothesis 61–2
culture 138, 143–4; cultural differences disappointments, self-related 254, 275;
134, 141, 143, 248–9, 333–5; cultural disappointing view of others 179, 186–7,
revolution/shift 141; cultural values 255; 189
personality–culture fit 52 discrepancy (perceived inability to live up
cynicism 187, 313 to expected standards) 8, 83, 94, 139,
142–3, 147, 159, 179, 181–2, 215, 223,
daily hassles 207, 211, 229; daily stress 222, 244, 269, 272, 319; between actual and
225, 226, 228, 230–233, 235, 237–8 ideal self 94, 182, 184–6, 245, 266;
dance 47, 149, 155, 157–61, 162, 166, interpersonal discrepancies 186–7, 189
168–70, 338; dancers 155–6, 167–8 disengagement 19, 37, 210, 226, 226, 227,
dark personality traits 9, 80, 188, 317; dark 228, 232–7 see also coping
triad 9 dissatisfaction see satisfaction
defensiveness 81, 91, 102, 190, 311, 315, distress 12, 54, 63, 89–90, 99, 102, 118,
319–20; defensive fight 81–2; ego 120–1, 123–5, 183–4, 194, 210, 223,
defenses 319 229, 232, 234, 236, 248, 252, 268, 269,
deficits associated with perfectionism 78, 308–9, 309, 314, 319, 321, 323;
90–1, 95, 100, 102, 105, 122, 124, 127, distressing thoughts 104; chronic distress
209, 214 61; emotional distress 92, 95, 102, 187,
depression 7, 54, 58, 60, 73, 74, 89–90, 93, 222; mental distress 63; psychological
95–6, 99–101, 103–4, 120, 134, 150, distress 70, 75, 134, 136, 150, 177, 229,
154, 179, 192–5, 202, 204–5, 225, 310
233–4, 237–8, 253, 269–71, 272–3, domains; domains of perfectionism 35, 127,
276–7, 297–301; in children 118; 149, 155, 158, 162–5, 170, 202, 243,
depressed patients 222, 225–6, 228, 230, 267; of life 12, 44, 58–60, 208, 238,
372 Subject Index
338–40, 343; domain-specific athlete engagement 163, 166–7; school

perfectionism 58, 59, 59–60, 170, 338, engagement 36
340 entitlement 177, 180, 181, 190, 194, 317
dominance: social dominance 185, 188, ethnicity; ethnic differences 344–4
190, 317 evaluation: maladaptive evaluation
doping 164, 167 concerns 7; negative evaluation 122,
doubts about actions 5, 8, 46, 117, 139–41, 311, 322; self-evaluation 5, 50, 52–3,
145–6, 183, 184, 205, 213, 271, 277, 232, 267, 275, 284, 285, 289, 295; social
300, 345 evaluation 210
dual-process model of perfectionism 24, 27 evaluative concerns 139, 148–50;
dyadic conflict 189; dyadic perfectionism 9, evaluative concerns perfectionism (ECP)
69, 189, 191–2 see perfectionism
Dysfunctional Attitude Scale (DAS) 93, exams 28, 292; exam performance 26;
223, 300, 336–7 exam stress
dysfunctional attitudes 93, 100–1, 228, excellence 46; pursuit of 266–7, 274, 278;
271, 299; dysfunctional beliefs 70, 75, striving for 8, 83, 105, 143, 200–1, 215,
102, 121, 293, 295; dysfunctional 266
behaviors 4, 267 exercise 47, 155, 157–60, 161–3, 168–70,
213, 338; exercise dependence 163, 165,
Eating Disorder Inventory (EDI) 4, 93 166–8, 170
eating disorders 96–7, 157, 202, 238, 267, exhaustion 54–55, 98–99, 156, 161, 163–4,
272–3, 276, 278, 295, 297–300; eating 207–8
disorder symptoms 338; eating pathology extraversion 70–2, 73, 74–6, 77, 78–80,
160; disordered eating 270, 272, 276, 190 see also introversion
334, 336 extrinsic motivation 19, 29, 30, 31;
effect sizes 49, 53, 166, 250; of therapeutic extrinsic regulation 160
interventions 297, 299–300
efficiency 71, 75; reduced 344 factor analysis 5, 8, 20, 70, 80, 121, 158,
effort 22, 138, 163, 247, 252, 307; effortful 222–5, 268, 271, 336
control 120, 124–5, 126, 126 failure 21, 24, 60, 93, 95, 97, 99, 101–5,
ego defenses see defensiveness 118, 121–2, 124, 135, 138, 147, 193–4,
ego goals 22–4, 28, 36; ego orientation 160 203, 229, 231, 234–6, 252, 254–5, 267,
see also performance goals 273–4, 278, 285, 286, 287, 295, 313–4,
ego-resiliency see resilience 317, 321; reaction to 61, 103, 192, 210,
Ellis, Albert see author index 254, 274, 288–9
embarrassment 246 see also shame family factors 135–7 see also parents
emotion see also affect: emotion regulation fear 81, 120; of change 294, 314–5; of
49, 55, 57–8, 119, 178, 243–4, 250–7; closeness 229; of failure 21–2, 27, 147,
emotion suppression 51, 252; emotional 150, 160, 168, 201–2; of imperfection
control 117, 119, 124–5, 126, 248; 37; of making mistakes 5, 114, 235 see
emotional exhaustion 54–5, 207, 208; also concern over mistakes; fear of
emotional stability 70, 269 see also negative social evaluation 9, 102, 122,
neuroticism; emotionality 75–6, 77, 78, 158; fearfulness 77, 78, 116–120
80; positive emotions 73,74, 244; flexibility 77, 79, 249, 257, 274, 286;
negative emotions 54, 102, 119, 194, inflexibility 267, 286, 287, 287, 289 see
214, 244, 252, 289, 315, 319–20; also rigidity
negative emotionality 54 forgiveness 77, 79, 254; self-forgiveness 91,
empathy 78, 246, 317; lack of 254, 317 254, 316
employees 55, 63, 343 friendliness 188, 190, 317; friends 180,
engagement 57, 244, 226, 227, 233–7, 181, 184, 292, 296; friendship 50, 53,
239; lack of 309 see also disengagement; 59, 160
Subject Index 373
Frost Multidimensional Perfectionism Scale historical perspectives on perfectionism

(FMPS) 8, 93, 103, 117, 139–42, 144, 4–5, 91-92
146, 162–3, 204, 223, 266, 271, 272–3, honesty 78, 313; honesty-humility 76, 77,
276, 338 78, 80; dishonesty 188
frustration 92–3, 104; in therapy 317, 319, hope of success 19, 21–22, 27, 37;
320; need frustration 272, 278 hopelessness 311
Horney, Karen see author index
gender: gender differences 83, 144–5, 190, hostility 136, 177, 179, 187–90, 192, 194,
249, 345; gender invariance 270, 345 309, 314, 316–18, 321; angry hostility
generalized anxiety disorder 113, 118, 120, 73, 74–5, 189, 193–4
121, 123 see also anxiety humanistic counseling 253; humanistic
genetic influences on perfectionism 244, theory 254 see also Rogers, Carl
339 humiliation 93, 102, 105, 190, 310, 320;
giftedness 135, 141, 148–9; gifted children humility 78 see also honesty-humility
135, 137, 149; gifted education programs hyperactivity 276; hypercriticism 177, 179,
137–8, 142–3, 148; gifted students 195; hypervigilant monitoring 113, 285
134–50; differences between gifted and
nonidentified students 142–3, 149–50 illness 200–15; chronic illness 200, 204–6;
goals: goal-directed behavior and motivation physical illness 48, 63
35, 71, 75, 82, 238; goal-drive persistence immune system 206
81; goal progress 53, 59, 273; goal pursuit imperfection 37, 92–3, 95, 102, 123, 179,
278; goal scaffolding 254; goal setting 182–3, 187, 190, 195, 254, 268, 314,
296; social goals 28, 35, 188 317; negative reactions to 8, 158;
grades 53, 146; grade point average 53, 342 nondisclosure/nondisplay of
see also academic achievements imperfection 9, 163, 188, 191, 271, 307,
grandiosity 78, 101, 177–9, 179, 180, 310, 319–21
187–90, 193–4, 246, 317 impossible demands/goals/standards 92,
group: group therapy 257; group cohesion 207, 211, 267, 273
in therapy 322 imposter 314
guilt 29, 55, 194, 231, 289 incompetence 24, 29, 147; social
incompetence 122 see also
happiness 50, 147, 187, 191, 269 competence
headaches 202–3, 211 independent effects approach 157–9, 161,
health 49, 63, 90, 243, 256–7, 343; mental 162–5 see also two-factor model of
health 4, 147, 156, 201, 243, 251, ; perfectionism
physical health 200–15; health behaviors inflexibility 267, 286, 286, 287, 287, 289
201, 212–15, 343; complaints 203; see also rigidity
problems 89, 201, 205, 207, 209–11; informant reports 180, 181, 183, 184, 193,
health outcomes 200–1, 204, 206, 215, 238, 255, 343
211–12, 214–15, 257; symptoms 200, insecure attachment 136, 245, 247;
202; risk 201, 211; psychological health insecurity, feelings of 136, 272
50, 63, 253; healthy perfectionism see interactions: interpersonal/social
perfectionism; psychosomatic symptoms interactions 58, 70–1, 177–8, 182, 187,
211–12; somatic symptoms 202–3, 211; 189, 191–2, 207, 230 see also
physical symptoms 203, 211 interpersonal; interactions with therapist
heart rate 321 315, 321; parent–child interactions 245;
helplessness 135, 209, 228, 233, 237, 315 statistical interactions of perfectionism
help-seeking 313, 315 103, 144–5, 169, 190, 208, 243, 335,
Hewitt-Flett Multidimensional 342 see also moderators
Perfectionism Scale (HF-MPS) 8, 139, internalizing problems 122
147, 163, 223, 338 Internet-based interventions 296
374 Subject Index
interpersonal adjustment 50, 53, 70; 214–15, 236–7, 255, 300, 322, 341
interpersonal circumplex 83, 188, 190; see also mediators
interpersonal conflicts/problems 177–95, mediators 49, 55, 95–6, 119–21, 124–5, 126,
207, 343, 225, 308, 317, 323, 343; 127, 167, 170, 191–3, 205, 207, 209–12,
interpersonal competence 122; 214, 228, 230, 232–3, 251, 253, 268, 272,
interpersonal sensitivity 230, 308–9, 309, 279, 310, 319, 321–2, 333, 340–2
311, 312, 313, 316, 322; interpersonal memories and memory performance
relations/relationships 10, 177–95, 270 99–103, 248
see also relationships; interpersonal mindfulness 99, 256, 297
therapy 301, 323 moderators 60, 169, 207, 249, 251, 255
interventions see also treatment: efficacy/ mood 99, 165, 235, 252: anxious mood
effectiveness of interventions 118–9, 233; depressive mood 233, 236, 239;
126–7, 149, 191, 236, 257, 265–7, 267, negative mood 102–4, 230, 235; positive
273, 279, 294–301, 311, 317, 319, 320, mood 235–6; moody 70, 75
322–4; flexibility of therapeutic morbidity 201, 212, 215; mortality 201,
interventions 236–7, 290 203–4, 206, 212, 215, 343
intimacy 53, 78, 180, 188, 315–17, 323 motivation 5, 9, 19–37, 50, 55–6, 80–2, 90,
intolerance of uncertainty 120–1, 125, 126, 105, 147, 155–6, 160, 167, 169–70, 178
126 189, 191, 200, 208, 236, 238, 244, 254–6,
intrinsic motivation 19, 29, 30, 31–4; 267, 274; motivation to change 290–1,
intrinsic regulation 160 296; motives 19–22, 27, 35, 37, 150, 245
introversion 70, 75 see also extraversion Multidimensional Inventory of
irrational beliefs, thoughts, and convictions Perfectionism in Sport (MIPS) 8
92–3, 98, 100–1, 200, 253, 307 Multidimensional Perfectionism Scale
see Frost Multidimensional Perfectionism
job burnout see burnout Scale (FMPS) and Hewitt-Flett
Multidimensional Perfectionism scale
latent class analysis 47–8; latent profile (HF-MPS)
analysis 248, 252, 336 multilevel models 58–60, 222–39
leisure 59 music 149, 295–6
life events 60, 192–3, 206–7, 211, 238; life
satisfaction see satisfaction narcissism 9, 78, 101, 178, 181, 188–9,
locus of causality 29; locus of control 193–4, 317; narcissistic perfectionism 9,
29 35, 69, 177–95
loneliness 191, 193 needs: need for achievement 20, 56, 147,
longitudinal studies 36, 54, 84, 116, 118, 150; acceptance 306; admiration 115,
121–2, 138, 155, 161, 166, 169–70, 189, 246, 269; affiliation 20; approval,
191–2, 202–3, 210, 212–13, 248–9, 272, positive regard, and recognition 138,
277, 279, 340–3 see also diary studies 246, 254, 268, 270; autonomy 272;
closeness 177; competence 272, 278;
maladaptive aspects of perfectionism 4, 12, perfection 9–10, 19, 37, 92–3, 156, 158;
23, 28, 38, 82, 139, 148, 244; power 20; relatedness 272; stimulation
maladaptive effects 344; maladaptive 70–1; need frustration and thwarting
evaluation concerns 7, 266; maladaptive 177, 278
outcomes 160, 168–9 neuroticism 4, 20, 49, 70–3, 73, 73–6, 78,
mastery goals 24, 26, 147, 150; mastery- 80, 83–4, 91, 148, 190, 193, 204, 206,
approach goals see approach; mastery- 212, 215, 307, 309, 319, 345; neurotic
avoidance goals see avoidance perfectionism see perfectionism
mattering to others 105, 308–10 nondisclosure/nondisplay of imperfection
mechanisms of perfectionism 49, 60, see imperfection
119–20, 127, 167, 191–2, 200, 211, not just right experiences 120, 123–4, 126
Subject Index 375
observer ratings see informant reports 285, 286, 286–9, 297–9; conscientious
obsessive beliefs and thoughts 119, 200, 148; dysfunctional 5, 7, 12, 139–42, 144,
338; obsessive passion 160; obsessive- 147, 344; evaluative concerns (ECP) 7,
compulsive disorder (OCD) 113, 115, 10, 20, 45–9, 51, 52–7, 59, 61, 93, 148,
126, 272, 297; obsessive-compulsive 266, 335; functional 7, 21, 141; healthy
personality disorder 300; obsessive- 7, 62, 139–46, 148, 156, 203, 244, 266,
compulsive symptoms 92, 96, 114, 116, 271, 335; maladaptive 7, 140, 142, 148,
121, 338 210, 244, 247, 252–6, 269, 319, 334;
occupational outcomes 253 see also work multidimensional 3, 4–5, 6, 7, 8, 9–12,
openness/openness to experience 70–2, 73, 19–20, 22, 24, 27, 31–7, 68–9, 71–2, 76,
74–6, 77, 79, 86, 313, 316–7; openness 77, 78–9, 81–3, 89, 91, 93, 96, 117, 139,
to others 138, 313, 315 155, 158–9, 161, 162–5, 166–7, 170,
order and organization 5, 7–8, 71, 73, 75, 184, 202–4, 223, 271, 307, 333–5, 338,
77, 115, 117, 139–41, 144, 146, 201, 346; narcissistic see narcissism; negative
236, 244, 266, 269, 271 7, 192, 213, 288–9, 336; neurotic 4–5,
other-oriented perfectionism see 71, 90, 252; normal 4, 252; personal
perfectionism standards (PSP) 7, 10, 20, 45–9, 51,
overdependence 267, 275, 284 52–8, 59, 59–61, 62, 62–3, 148, 222–3,
227, 229–32, 234, 238, 239, 266, 270,
panic disorder 113 335; other-oriented 3, 5, 7–10, 35,
parents 29, 44, 63, 136, 150, 168, 180, 181, 68–9, 71–5, 77, 78–83, 139, 178–80,
184, 245–9, 267, 277, 279; parent–child 181, 185, 188–9, 193, 307, 313, 318–19,
interactions 246; parent–child 321, 345; positive 7, 144, 336; positive
relationships 250; parental approval 135, striving 7, 139, 148–50, 200, 266; self-
228; control 122, 249; criticism, critical 35, 177–95, 205, 207, 210, 223,
harshness, and punishment 5, 7, 114, 228–34, 237, 239, 247, 251–2, 255–7,
115, 117, 136–7, 139–41, 145–6, 213, 270, 272, 276–7, 337, 341; self-oriented
228, 237, 254, 271, ; expectations 5, 7, 5, 8, 9–10, 59, 68–9, 71–5, 77, 78–84,
115, 117, 135, 137, 139–40, 144–6, 168, 91, 93–5, 98, 103, 115, 116–18, 136–7,
213, 228, 234, 268, 271, 345; parental 139, 142, 147, 163, 192, 203, 205, 208,
factors 84, 123, 277 see also family factors; 223, 266–8, 270, 272–3, 276, 278, 289,
parental perfectionism 137, 247–50; 297, 300–1, 207, 313, 317–18, 321–2,
standards 234; pressure 93, 146, 208, 213; 343, 345; socially prescribed 5, 8, 9–10,
support 150; parenting 59, 116, 119, 122, 46, 59, 68–9, 71–6, 77, 78–84, 93, 98,
126–7, 136, 144, 246–9, 338 101, 115, 116–17, 135–7, 139, 147, 158,
passion 160 163, 183, 184, 189–90, 192, 203, 205,
pathways of perfectionism 50, 123, 137, 208–13, 223, 266–8, 270, 273, 277–9,
200–1, 206–7, 209, 211–15, 272–3, 289, 297, 301, 307, 310, 313, 317–21,
309–10 see also mediators 344–5; unhealthy 7, 12, 141, 143–5,
patients 80, 98, 101, 118, 205, 222–3, 147–8, 202, 244, 271, 335; team 9, 344;
225–6, 228, 230, 233–8, 293, 311, 312, unhelpful 265–8, 273, 274, 278
313–24 see also clinical samples perfectionistic cognitions 10, 89–105, 309,
perfectionism cognitions 3, 8, 10, 89–105; 312 see also perfectionism cognitions;
Perfectionism Cognitions Inventory perfectionistic concerns 3, 5, 7, 8, 8–10,
(PCI) 95–7, 103–4, 208, 271, 292, 306, 19–37, 69, 82–3, 89, 103, 122, 148, 158,
318, 322–3, 339 162–5, 182, 202–5, 210–11, 213–15,
Perfectionism Inventory (PI) 8, 181 244, 247–9, 252, 272, 277, 289, 296–
perfectionism social disconnection model 300, 310, 333–8, 341–3, 345 see also
(PSDM) 9, 11, 97, 191–5, 268, 306–24 evaluative concerns perfectionism (ECP);
perfectionism: adaptive 7, 140, 142, 146, perfectionistic reactivity 90, 97, 169,
148, 244, 249, 252; clinical 284, 285, 208; perfectionistic self-presentation 3,
376 Subject Index
9–10, 35, 94–6, 166, 188, 191, 209, 215, possible selves see selves
268, 271, 306–7, 309, 310, 314, 316, preoccupation 102, 104, 183, 308
318–19, 321, 323, 339 see also pressure 44, 55, 60
nondisclosure/nondisplay of prevention: prevention focus of
imperfection; perfectionistic self- perfectionism 9, 105; prevention of
promotion 9, 188, 191, 205–6, 310, health problems 212; prevention of
312, 320; perfectionistic standards 46 see perfectionism 127, 212, 253, 255,
also personal standards; perfectionistic 265–79, 301; of treatment problems 311;
strivings 3–5, 7, 8, 8–10, 19–37, 69, relapse prevention 296
82–3, 137, 148, 158, 162–5, 202–5, 211, pride 29, 61; proud displays 246
213–15, 249, 253, 255, 333–8, 341–3, procrastination 274, 286, 287, 291, 296
345 see also personal standards productivity 63, 228–9, 231, 254, 267–8,
perfectionism (PSP) 292, 344; counterproductive behaviors
Perfectionistic Self-Presentation Scale– 286, 286, 287, 290–1
Junior Form (PSPS-JR) 271 psychodynamic theory 4; psychodynamic
performance 22, 24, 26–9, 37, 44, 52, treatment 300–1, 322–3
54–5, 91, 98, 103–4, 123–4, 135–6, psychoeducation 291–2, 296, 299
138–9, 141, 146–7, 149, 155–6, 158, psychopathology 5, 60–61, 125, 191–2,
160, 177, 183, 186, 244–7, 250–1, 207, 209, 212, 238, 270, 272, 278–9,
253–4, 246–7, 284, 285, 286, 286, 287, 289, 300; psychopathy 9, 82, 188, 317,
287–90, 292, 295, 319, 342–4; 271
performance goals 24, 26–8; psychotherapy see therapy
performance-approach goals see psychoticism 80, 83
approach; performance avoidance goals punishments 29, 34–5, 114, 136, 248, 253,
see avoidance 308, 318; punitiveness 318, 136, 179,
perseveration 89, 95, 98–9, 104, 119, 228, 244, 247
137, 208, 211, 236–7, 252 see also
rumination randomized control trial (RCT) 297
personal standards see standards; personal reinforcement 114, 287–8, 320;
standards perfectionism (PSP) see reinforcement sensitivity 35;
perfectionism reinforcement sensitivity theory (RST)
personality 10, 57, 68–84, 188, 189, 190–3, 80–2
201, 204, 206, 212, 215, 245, 250–1, rejection 193, 245, 308, 309, 311, 315,
253, 255–7, 271, 317, 340, 343, 345; 317, 318, 323; self-rejection 317;
personality disorders 178, 189, 300; sensitivity to interpersonal rejection 308
personality–culture fit 52; Big Five relationships: team relationships 344;
model 70, 190; five-factor model 70–6, therapeutic relationship
82–4, 339; HEXACO model 76–80, resilience 169, 201, 207, 215, 222–3, 230,
82–4, 339; neuropsychological models 236, 243, 252, 266, 273, 277–9; ego-
80–84; PEN theory 80 resiliency 252
person-centered approach in perfectionism rewards 29, 34–5, 81, 102, 214, 237,
research 47–8, 223; person-centered 274
theory 243, 245–6, 254 see also Rogers, rigidity 92, 98, 178, 237, 254, 267, 268,
Carl 286, 318, 320; rigid standards 114,
pessimism 209, 257 120–1, 127, 268, 277–8, 286
physical appearance see appearance; physical Rogers, Carl see author index
health see health; physical symptoms 203, romance 59; romantic couples 191–2;
211 romantic difficulties 48, 177; romantic
Positive and Negative Perfectionism Scale partners 180, 183, 250
(PANPS) 336 rumination 90, 95, 98–100, 104, 115, 192,
positive emotions 73, 74 see also affect 211, 237, 252, 319
Subject Index 377
sadness 54, 230–2; sad feeling 224, 235 self-monitoring 291, 296; self-oriented
satisfaction 29, 44, 61, 143, 160, 201, perfectionism see perfectionism; self-
231–2, 253, 269; academic satisfaction presentation see perfectionistic self-
52, 55, 60; autonomy satisfaction 162; presentation; self-promotion see
competence satisfaction 162; perfectionistic self-promotion; self-
dissatisfaction 61, 101, 156, 186–7, 194, recriminations 105, 308, 313, 318–9;
272, 321; life satisfaction and satisfaction self-regard 179; self-regulation 9, 99,
with life 50, 52, 147, 192; need 124, 206, 214, 244–6; self-regulation
satisfaction 162–3, 166–7; social support resource model (SRRM) 214–5; self-
satisfaction 204; relatedness satisfaction schema see schemas; self-scrutiny 201–2,
162 223; self-talk 91, 95, 244; self-value 245;
schemas 97, 245; future-event schema 313; self-view 295; self-worth 52, 101, 105,
depressive schema 99; self-schema 94–5, 135–6, 150, 182, 190, 194, 201, 207,
100–2, 105, 178, 182, 185 229, 231, 249, 256, 268, 278, 286, 286,
school 59, 139, 208; activities 55; 287, 287–8, 308
engagement 36; students 135–7, 140–6, selves: actual self 91, 94–5, 100, 178, 179,
272; environment 138 see also teachers; 182; feared self 95; ideal self 91, 94–5,
school settings 267, 278; school-based 97, 100, 182, 307; possible selves 178
prevention programs 119, 266, 272–3, sensitivity see anxiety, interpersonal, and
274–5, 277; schooling 138, 146 reinforcement
self psychology 243–6, 254 sensory intolerance 123–4
self-abasement 183; self-absorption 100; sex 338 see also gender
self-acceptance 92, 179, 183, 273, 310, shame 29, 54–5, 61, 91, 102, 136, 179,
314; self-actualization 244; self- 192, 194–5, 209, 246, 254–5, 289,
affirmation 256–7; self-blame 231, 237, 309–10, 313–4, 316
317; self-censure 309, 309; self- social approval see approval; social
compassion 91, 273, 274, 295, 310; antagonism see antagonism; social goals
self-cohesion 308; self-concealment 190, see goals; social disconnection see
204, 309; self-concept 50, 52–3,178, perfectionism social disconnection model
182, 205, 266, 269; self-confidence 91, (PSDM); social learning model 135–6 see
164, 168; self-consciousness 74, 94, 191; also parents; social network 183, 191,
self-control 234; self-criticism 69, 91, 93, 308; social phobia 118, 121, 125; social
105, 180, 184, 184, 202, 210, 223, 227, evaluations see evaluations; social
244, 248, 252–5, 267–8, 270–1, 273, expectations model 135–6 see also
274–5, 278, 285, 286, 286, 288–90, parents; social reaction model 135–6,
295, 299, 336–7; self-determination 28, 209; social relationships 53, 79, 1212,
49, 55–6; self-determination theory 343; social support 192, 204, 212, 222,
(SDT) 29–37, 267, 272, 278; self- 225, 228, 233, 237–8, 310
development 244, 246; self-dialogue 91; socially prescribed perfectionism see
self-discipline 71, 73, 75, 234; self-doubt perfectionism
98, 183, 318; self-efficacy 272, 290, 341; society 29, 36, 138, 141, 255; societal ideals
self-esteem 49–50, 52–3, 74, 77, 79, 190; societal influence 138; societal
115, 160, 182–3, 205, 210, 243, 246, pressure 190
266, 269, 271, 286, 289, 295, 299, 310, sport 8, 27, 35, 47, 50, 53–5, 57, 91, 149,
318; self-evaluation 5, 50, 52–3, 90, 105, 155–70, 338, 343–4 see also exercise
178, 208, 223, 267, 284, 285, 289, 295; Sport Multidimensional Perfectionism Scale
self-focus 26, 94, 100, 267; self- (SMPS and SMPS-2) 162–5
forgiveness 91, 316; self-harm 156, 273; standards 29, 114, 117, 120, 156, 182,
self-hatred 91, 317; self-help 255–7, 290, 185–6, 189, 202, 207, 214, 244–5, 247,
296–9 see also therapy; self-image 91; 254, 275, 284, 285—7, 287–90; double
self-integrity; self-knowledge 45; standards 287, 295; high standards 3, 5,
378 Subject Index
8, 44, 46, 66, 69, 83, 93, 127, 139, suppression: emotion suppression 57, 247,
142–3, 147, 158, 167, 180, 181, 186, 252; coping response suppression 228,
201, 203, 215, 223, 234, 236, 244, 237; thought suppression 104;
252–4, 254, 266–8, 269–70, 277–8, 289, suppression/suppressor effects in
319, 336–7; impossible standards 207, statistical analyses 22–3, 159
273; inflexible standards 286–7, 286–7, surveys in cognitive-behavioral therapy
289; personal standards 5, 7, 8, 10, 45, 292–3
69, 82, 95, 102, 115, 117, 139–40, 143,
145, 148, 158, 162–4, 205, 222–3, 227, task goals 22–4, 26–8, 36; task orientation
253, 256, 266, 268, 269–71, 272–3, 57, 94, 160 see also mastery
276–7, 285, 288, 299–300, 335; personal teachers 29, 44, 63, 135, 150, 182, 208,
standards perfectionism (PSP) see 267, 277
perfectionism; normative standards 186; temperament 56, 80, 83, 124; child
rigid standards see rigidity; unrealistic temperament 83, 119, 138, 339
standards 118, 182, 190, 244 therapy 118, 191, 223, 237, 254–5, 257,
stigma 314–5 306, 313–24 see also cognitive behavioral
stress 59–60, 62, 63, 100, 102–4, 134, 156, therapy (CBT); bibliotherapy 256; brief
169, 193, 200, 204–15, 222, 224–6, 227, therapy 253, 257; coherence therapy
228–239, 243, 244, 250–2, 256–7, 267, 253; group therapy 257, 311, 322–3;
273, 274, 277, 297, 299–300, 343 see interpersonal therapy 322; rational
also daily hassles; stress enhancement 207, therapy/rational-emotive (behavior)
250–1; stress generation 205, 207, 210, therapy 92; therapeutic alliance 311,
212, 230, 250–1, 308; stress management 313, 315, 317–8, 322, 324; therapeutic
213, 273, 297 see also coping; stress approaches 255, 316, 323; therapeutic
reactivity 210, 222, 228–30, 237, 239, context 306–24; therapeutic goals 118,
250, 252, 256–7 see also diathesis-stress 223; therapeutic paralysis 318;
model; transactional model of stress 250; therapeutic process 98, 306, 311, 313,
stressors 52, 60–1, 118, 192–4, 204, 206, 319; therapeutic progress 311, 313;
209–10, 222, 224–6, 228–9, 231–3, 235, therapeutic outcome 316; therapists 98,
237–8, 250–1; stressful (life) events and 223–4, 228, 234–9, 311, 312, 313–24
experiences 60–1, 99, 104, 192, 206, thought records 236, 293–5; thought
251, 257; chronic stress 204, 206, 211, suppression see suppression
250; threats and feelings of threat 57, 81, 102–3,
students: college students 135–6, 146–7, 114, 116, 119–30, 136, 185, 194, 208,
272; school students see school; 210–11, 232, 245–6, 250, 256–7, 309,
university students 50, 53–6, 59, 63, 77, 315, 321 see also appraisals; threatening
81, 95, 203, 208, 211, 222, 229, 231–3, others 189
239, 343, 273, 315 tidiness 286, 288, 295–7 see also order and
subgroups of perfectionists 48, 190, 266, organization
276 see also cluster analysis; subtypes of time management 296 see also
perfectionism see 2 × 2 model of procrastination
perfectionism training (sport, exercise, dance) 28, 54;
success 61, 93, 102, 155, 163, 168, 201, training distress 165, 166; overtraining
214, 228–9, 231, 273, 274–5, 287–8, 166
336 see also hope of success; being transference 312, 316, 320, 323;
successful 92, 102, 207, 234, 236 countertransference 311, 312, 316, 320
suicide 90, 101, 273, 310; suicidality 184, trauma 209; traumatic events/experiences
268 194, 209; post-traumatic stress 193
superiority 22, 179, 180–1, 190, 307; treatment 98–9, 191, 236–7, 265 see also
feeling superior 101, 178, 179, 180, 182, therapy; treatment of perfectionism in
185 children 115, 126–7; treatment
Subject Index 379
flexibility see interventions; treatment vulnerability 60–1, 73, 74, 89–90, 93,
resistance 99; treatment outcomes 238; 97–8, 100, 156, 169, 180, 186–7, 191,
treatment studies 256, 277; treatment of 194, 200–1, 206, 208–10, 215, 228–30,
childhood anxiety 118–20, 125; 254, 256, 267, 307
treatment efficacy in nonclinical samples
296–7; in clinical samples 297–300 wait-list control 298–9, 301, 323
tripartite model of perfectionism 139–40 well-being 44, 50, 52, 155–6, 160, 167,
trust 73, 74, 311; trustworthiness of others 170, 201–2, 207–9, 212, 252, 278–9,
247 343; psychological well-being 146–50;
two-factor model of perfectionism 3, 7–9, subjective well-being 191
36, 45, 157–8, 338 work 59, 96, 138, 192, 225, 234–6, 287,
types of perfectionism 134–5, 139, 141–2, 288, 291–2, 295–6, 343–4; workaholism
144, 147, 244, 256, 267, 279 see also 90, 98, 200, 343
subtypes of perfectionism; types of worry 68, 98, 104, 112–3, 114–5, 116–7,
perfectionists 94, 134, 255, 335 see also 119–21, 123–5, 126, , 160, 163, 248,
subgroups of perfectionists 290 see also anxiety
uncertainty see intolerance of uncertainty youth: perfectionism in youth 116,

265–279, 301
variable-centered approach 47–8, 335
view: view of self see self-view; view of
others 257

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What is the focus of the book?

What is the focus of the book?

What perspectives on perfectionism does the book examine?

What perspectives on perfectionism does the book examine?

THE PSYCHOLOGY OF

This milestone text provides a comprehensive and state-of-the art overview of

Joachim Stoeber is a Professor of Psychology at the University of Kent. With a

Edited by Joachim Stoeber

ISBN: 978-1-138-69102-5 (hbk)

1 The Psychology of Perfectionism: An Introduction 3

2 Perfectionism: A Motivational Perspective 19

3 The 2 × 2 Model of Perfectionism: Assumptions, Trends,

4 Perfectionism and Personality 68

5 Perfectionism Cognition Theory: The Cognitive Side of

6 Perfectionism and Anxiety in Children 113

7 Perfectionism in Gifted Students 134

8 Perfectionism in Sport, Dance, and Exercise 155

9 Perfectionism and Interpersonal Problems: Narcissistic and

10 Perfectionism and Health: The Roles of Health Behaviors

11 Perfectionism and Daily Stress, Coping, and Affect:

12 Perfectionism and Emotion Regulation 243

13 Prevention of Perfectionism in Youth 265

14 Cognitive-Behavioral Treatment for Perfectionism 284

15 Perfectionism in the Therapeutic Context:

16 The Psychology of Perfectionism: Critical Issues,

Author Index 353

Nicholas W. Affrunti, MA, Department of Psychological and Brain Sciences,

Philip J. Corr, PhD, Department of Psychology, City, University of London,

Lavinia E. Damian, PhD, Department of Psychology, Babeş-Bolyai University,

Don E. Davis, PhD, Department of Counseling and Psychological Services, Georgia

David M. Dunkley, PhD, Department of Psychiatry, Lady Davis Institute, Jewish

Sarah J. Egan, PhD, School of Psychology and Speech Pathology, Curtin

Véronique Franche, BA, School of Psychology, University of Ottawa,

Patrick Gaudreau, PhD, School of Psychology, University of Ottawa, Ottawa,

Paul L. Hewitt, PhD, Department of Psychology, University of British Columbia,

Andrew P. Hill, PhD, School of Sport, York St John University, York, UK

Gareth E. Jowett, PhD, Carnegie School of Sport, Leeds Beckett University,

David Kealy, PhD, Department of Psychiatry, University of British Columbia,

Kristina Kljajic, BA, School of Psychology, University of Ottawa, Ottawa, Canada

Sean P. Mackinnon, PhD, Department of Psychology and Neuroscience,

Daniel J. Madigan, MSc, School of Sport, York St John University, York, UK

Sarah H. Mallinson-Howard, PhD, School of Sport, York St John University,

Gabrielle Martinelli, BA, School of Psychology, University of Ottawa, Ottawa,

Danielle S. Molnar, PhD, Department of Child and Youth Studies, Brock

Logan J. Nealis, BA, Department of Psychology and Neuroscience, Dalhousie

Taryn Nepon, MA, Department of Psychology, York University, Toronto, Canada

Donald H. Saklofske, PhD, Department of Psychology, University of Western

Simon B. Sherry, PhD, Department of Psychology and Neuroscience, Dalhousie

Fuschia M. Sirois, PhD, Department of Psychology, University of Sheffield,

Martin M. Smith, MSc, Department of Psychology, University of Western

Kristie L. Speirs Neumeister, PhD, Teachers College, Ball State University,

Joachim Stoeber, PhD, School of Psychology, University of Kent, Canterbury,

Hanna Suh, PhD, Department of Counseling, School, and Educational Psychology,

Tracey D. Wade, PhD, School of Psychology, Flinders University, Adelaide,

Janet Woodruff-Borden, PhD, Department of Psychological and Brain Sciences,

Lisa C. Zhang, MA, Department of Psychology, University of British Columbia,

A Brief History of Perfectionism Theory and Research

Horney’s conception of perfectionism as a highly neurotic disposition. Accordingly,

Perfectionistic Strivings and Perfectionistic Concerns

negative affect, and depression, Dimension 1 showed a positive correlation with

Author Index 353

FIGURE 3.3 ypothetical illustration of a differential susceptibility hypothesis. At a

TABLE 4.2 Multidimensional Perfectionism: Correlations with the HEXACO Model of