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

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Abstract

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

Introduction

In the past decade, there has been increasing interest in the perfectionism construct and its role in the etiology, maintenance, and course of clinical disorders (see Flett & Hewitt, 2002a; Shafran & Mansell, 2001). The perfectionism construct has become viewed as a multidimensional construct and has been conceptualized and defined in many different ways (see Flett & Hewitt, 2002b). Multidimensional conceptualizations that have generated considerable interest have been those of Hewitt and Flett (e.g., 1991) and Frost and colleagues (Frost, Marten, Lahart, & Rosenblate, 1990). Hewitt and Flett (1991) conceptualized the perfectionism construct as consisting of both intrapersonal (i.e., self-oriented perfectionism) and interpersonal (i.e., other-oriented perfectionism, socially prescribed perfectionism) dimensions. On the other hand, Frost and colleagues (1990) considered perfectionism to be comprised of several different aspects, including personal standards (PS), concern over mistakes, doubts about actions, parental expectations, parental criticism, and organization.

Shafran, Cooper, and Fairburn (2002), however, argued against studying perfectionism from a multidimensional perspective and provided a cognitive behavioral analysis of “clinical perfectionism”. They considered clinical perfectionism to be a unidimensional construct 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” (p. 778). Shafran et al.'s (2002) cognitive behavioral analysis of clinical perfectionism is an insightful discussion of specific maintaining mechanisms that make perfectionists vulnerable to a wide range of adjustment problems. We also believe Shafran, Cooper, & Fairburn (2002), Shafran, Cooper, & Fairburn (2003) are correct to suggest that a focus on specific mechanisms of maintenance is most likely to lead to advances in the treatment of Axis I psychopathology.

Shafran et al. (2002) made an important point in suggesting that “simply using standard-setting as the sole determinant of perfectionism is inadequate...other factors must be taken into account” (p. 778). However, Shafran, Cooper, & Fairburn (2002), Shafran, Cooper, & Fairburn (2003) own phrasing often contradicts their assertion that perfectionism is a unidimensional construct. Whereas Shafran, Cooper, & Fairburn (2002), Shafran, Cooper, & Fairburn (2003) considered their clinical perfectionism concept to involve both the determined pursuit of self-imposed standards and extremely vulnerable self-evaluation as a unidimensional construct, we suggest that clinical perfectionism is better conceptualized as tapping two distinct, albeit related, dimensions. Factor analytic studies of the subscales from the Hewitt and Flett (1991) Multidimensional Perfectionism Scale (HMPS) and the Frost et al. (1990) Multidimensional Perfectionism Scale (FMPS) have consistently yielded two factors in both college student (e.g., Bieling, Israeli, & Antony, 2004; Blankstein & Dunkley, 2002; Dunkley, Zuroff, & Blankstein, 2003; Frost, Heimberg, Holt, Mattia, & Neubauer, 1993; Slaney, Ashby, & Trippi, 1995) and clinical populations (Cox, Enns, & Clara, 2002). These factor analytic studies distinguished between a higher-order perfectionism factor that focuses on PS from a higher-order perfectionism factor that focuses on self-critical evaluation concerns.

In their reply to Shafran et al. (2002), Hewitt, Flett, Besser, Sherry, and McGee (2003) made several important points. Their most noteworthy criticism was that Shafran et al. (2002) offered “a simplified, purely agentic model of perfectionism wherein the perfectionist is represented as a self-contained unit divorced from his/her social context” (p. 1226). Hewitt et al. (2003) substantiated this criticism with a summary of the literature citing interpersonal aspects of perfectionism. However, Hewitt et al. (2003) argued against Shafran et al.'s (2002) view that the negative impact of mistakes on self-evaluation is the critical component of perfectionism. In contrast to Hewitt et al.'s (2003) assertion that perfectionism and self-evaluative reactions/self-judgments are distinct constructs, we build on previous evidence suggesting self-criticism as a primary indicator of the maladaptive evaluative concerns perfectionism dimension (Dunkley et al., 2003). We examine in two diverse study groups of undergraduate students and patients with binge eating disorder (BED) whether self-criticism explains the relation between perfectionism measures and depressive, anxiety, and eating disorder symptoms.

The main goal of our reply to Shafran, Cooper, & Fairburn (2002), Shafran, Cooper, & Fairburn (2003) and to Hewitt et al. (2003) is to consider the theoretical, empirical, and clinical implications of the findings identifying two underlying dimensions of perfectionism and how the various points raised by Shafran, Cooper, & Fairburn (2002), Shafran, Cooper, & Fairburn (2003) and Hewitt et al. (2003) can be accommodated and organized under this two-dimensional framework of perfectionism.

Section snippets

Personal standards and evaluative concerns dimensions of “clinical” perfectionism

We refer to the two dimensions of perfectionism as PS perfectionism and evaluative concerns (EC) perfectionism, respectively (see Blankstein & Dunkley, 2002; Dunkley, Blankstein, Halsall, Williams, & Winkworth, 2000). PS perfectionism involves the setting of high standards and goals for oneself. On the other hand, EC perfectionism involves overly critical evaluations of one's own behavior, an inability to derive satisfaction from successful performance, and chronic concerns about others’

Does self-criticism explain the effects of self-oriented perfectionism and socially prescribed perfectionism?

Hewitt et al. (2003) rejected Shafran et al.'s (2002) suggestion that the critical component in perfectionism is the impact of mistakes on self-evaluation. However, we do not believe Hewitt et al. (2003) are correct in their claim that “the need to distinguish perfectionism and self-evaluative processes is clearly evident in research and theory on perfectionism and self-efficacy” (p. 1229). First, Hewitt et al. (2003) cited Alden et al.'s (2002) two-component model of perfectionism, but this

Participants

Participants were 527 university students with a mean age of 20.34 (SD=5.06) enrolled in an undergraduate Introductory Psychology course at the University of Toronto at Mississauga. Although information on ethnic and racial origin for our sample was not available, the university serves a multiculturally diverse, primarily middle-class student population. Approximately 50% of students are of European descent, with approximately 15% Asian, 10% East Indian, and smaller percentages of South

Study 2: the special case of eating disorders

Shafran et al. (2002) suggested that eating disorders may be an expression of perfectionism “where patients stubbornly pursue standards of control over eating, weight or shape despite adverse consequences such as being markedly underweight, feeling persistently hungry, being vulnerable to binge eating, being preoccupied with thoughts about food, eating, shape and weight, and having difficulty eating with others” (p. 784). We suggest that this account of eating disorder patients might be better

General discussion of Study 1 and Study 2

These findings from two diverse study groups of undergraduate students and patients with BED indicate that self-criticism accounts in substantial part for the relation between self-oriented perfectionism and socially prescribed perfectionism measures and depressive, anxious, and eating disorder symptoms. Our results are consistent with previous observations (e.g., Alden et al., 2002) and findings (e.g., Dunkley et al., 2003). These analyses support our proposed hypotheses and conceptual

Clinical implications of distinguishing PS perfectionism from EC perfectionism

The distinction between PS and EC is relevant to understanding which characteristics of perfectionism might impede treatment process and outcome, consistent with Shafran et al.'s (2003) suggestion that the perfectionism construct should be conceptualized in such a way as to yield advances in the treatment of Axis I disorders. Both the Dysfunctional Attitude Scale (DAS; Weissman & Beck, 1978) perfectionism scale and the DEQ self-criticism scale have been demonstrated to predict negative

Conclusion

The identification of two higher-order dimensions of perfectionism that cut across the many different existing perfectionism measures (e.g., Bieling et al., 2004; Blankstein & Dunkley, 2002; Cox et al., 2002; Frost et al., 1993; Slaney et al., 1995) represents an important advance in the perfectionism field. These core dimensions, which reflect PS and self-critical evaluative tendencies, can be considered the building blocks of description on which subsequent attempts at explanation of the

Acknowledgments

Support for this work was provided by a Douglas Utting Fellowship for Studies in Depression (DMD); a Social Sciences and Humanities Research Council (Canada) General Research Grant and a University of Toronto at Mississauga Internal Research Grant (KRB); and National Institute of Health (DK 49587) and Donaghue Medical Research Foundation Grants (CMG).

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