Automatic Self Recriminations: Development and Validation of a Measure of Self-Condemnatory Internal Dialogue.

This article introduces a measure of self-condemnatory internal dialogue as an element of the relationship with the self: The Automatic Self-Recrimination Scale (ASRS). Using the construct validation approach to test construction, we describe the initial development of items and report on findings from a clinical and nonclinical sample showing the ASRS is best understood as a multidimensional measure of self-critical internal dialogue composed of one higher-order factor and four lower-order facets: Not Mattering, Self as Failure, Undeserving Self, and Loathsomeness. The overall scale and four subscales demonstrated acceptable internal consistency and test-retest reliability. Moreover, there was evidence of good convergent and incremental validity of the ASRS subscales with measures of perfectionism, self-criticism, and dysfunctional attitudes. Overall, the ASRS appears to be a reliable and valid measure of an automatic self-recriminatory internal dialogue.

The equivalence of psychodynamic therapy and cognitive behavioral therapy for depressive disorders in adults: A meta-analytic review.

BACKGROUND: Meta-analyses on the relative efficacy of psychodynamic psychotherapy (PDT) and cognitive behavioral therapy (CBT) for depressive disorders are limited by heterogeneity in diagnostic samples and comparators and a lack of equivalence testing. OBJECTIVE: We addressed this through a meta-analytic test of the equivalence of manualized PDT and CBT in treating adults with depressive disorders as determined by diagnostic interviews. Sensitivity analyses evaluated the impact of pretreatment differences, mixed diagnostic samples, author allegiance, study quality, year of publication and outliers on findings. METHOD: A comprehensive literature search across multiple databases using reliable screening methods identified nine randomized controlled trials directly comparing manualized PDT and CBT for diagnosed depressive disorders in adults. Following pre-registration, we employed random effect models for our meta-analyses and two one-sided test procedures for equivalence testing. RESULTS: Independent raters determined that all studies were of adequate quality. Immediately posttreatment, depressive symptoms were statistically equivalent across PDT and CBT (k = 9; g = -0.11, 90% confidence interval [90% CI]: -0.24 to 0.02, pequivalence = .048, pNHST = .212, I2 = 32.7). At follow-up, the longest time point within a year, depressive symptoms were neither statistically equivalent nor statistically different (k = 6; g = -0.16, 90% CI: -0.31 to -0.02, pequivalence = .184, pNHST = .126, I2 = 0.00). CONCLUSION: The efficacy of manualized PDT is equal to manualized CBT immediately at posttreatment for depressive disorders in the adult general population. Nevertheless, insufficient data exists to reach a conclusion regarding equivalence at follow-up.

Perfectionistic Self-Presentation and Psychopathology: A Systematic Review and Meta-Analysis.

Decades of research implicate perfectionism as a risk factor for psychopathology. Most research has focused on trait perfectionism (i.e., needing to be perfect), but there is a growing focus on perfectionistic self-presentation (PSP) (i.e., the need to seem perfect). The current article reports the results of a meta-analysis of previous research on the facets of PSP and psychopathology outcomes (either clinical diagnoses of psychiatric disorders or symptoms of these disorders). A systematic literature search retrieved 30 relevant studies (37 samples; N = 15,072), resulting in 192 individual effect-size indexes that were analysed with random-effect meta-analysis. Findings support the notion of PSP as a transdiagnostic factor by showing that PSP facets are associated with various forms of psychopathology, especially social anxiety, depression, vulnerable narcissism and-to lesser extent-grandiose narcissism and anorexia nervosa. The results indicated that there both commonalities across the three PSP and some unique findings highlighting the need to distinguish among appearing perfect, avoiding seeming imperfect and avoiding disclosures of imperfections. Additional analyses yielded little evidence in the results across studies including undergraduates, community samples and clinical samples. Our discussion includes a focus on factors and processes that contribute to the association between PSP and psychopathology.

A comparison of the effect of two types of brief psychodynamic group therapy on perfectionism-related attitudes, self-relatedness, and self-esteem.

Objective: This randomized controlled trial investigated the efficacy of dynamic relational group therapy (DRT) relative to group psychodynamic supportive therapy (PST) in improving perfectionism-related attitudes and components of the perfectionistic self-relationship. Method: Based on a comprehensive conceptualization of perfectionism, 80 community-recruited, highly perfectionistic individuals were randomly allocated to 12 sessions of group DRT (n = 41; 5 groups) or group PST (n = 39; 5 groups). Patients completed measures of dysfunctional attitudes, self-criticism, self-esteem, and self-reassurance at pre-, mid-, and post-treatment, and six months post-treatment. Results: Multigroup latent growth curve modeling revealed significant (p < .05) decreases in dysfunctional attitudes, concern over mistakes, two types of self-criticism, and self-esteem problems, along with a significant increase in self-reassurance, from pre-treatment to six-month follow-up in both DRT and PST. Moderate-to-large between-group differences favoring DRT over PST were found for dysfunctional attitudes and self-reassurance. A majority of patients in both conditions maintained reliable improvement at six-month follow-up in dysfunctional attitudes, concern over mistakes, and self-criticism focused on inadequacy. Conclusion: Findings provide evidence for the use of psychodynamic group therapy approaches in treating perfectionism-related attitudes and self-relational elements of perfectionism, and support the relative efficacy of DRT for dysfunctional attitudes and self-reassurance.

Dynamic changes in perfectionism dimensions and psychological distress among adolescents assessed before and during the COVID-19 pandemic.

This prospective longitudinal study evaluated changes in psychological distress among adolescents, pre-pandemic to intra-pandemic, the extent to which within-person and between-person differences in trait multidimensional perfectionism were associated with such changes, and the role of stress in explaining associations between perfectionism and psychological distress. Adolescents (N = 187; 80% female; 78% White, 7% Asian Canadian, 2% Indigenous Peoples in Canada, 2% Black or African Canadian, 2% Latin Canadian, or 9% Other; Mage  = 17.96 years) completed online surveys assessing perfectionism (i.e., self-oriented perfectionism and socially prescribed perfectionism), depression, anxiety, and stress pre-pandemic (i.e., March 12, 2020 or earlier) and during Ontario, Canada's first (i.e., March 13, 2020 to July 24, 2020) and second (December 26, 2020 to February 7, 2021) government-mandated lockdowns. Between-person differences and within-person changes in multidimensional trait perfectionism were associated with increases in psychological distress and perceived stress. Perceived stress served as an intermediary pathway linking multidimensional trait perfectionism to psychological distress during the pandemic.

Attachment anxiety, reflective functioning and well-being as predictors of burn-out and psychological distress among psychotherapists: A longitudinal study.

OBJECTIVE: This study aims to longitudinally investigate the effects of individual's factors on subsequent burn-out/psychological distress in a sample of mental health practitioners, testing if higher attachment anxiety and avoidance and lower reflective functioning (i.e., certainty and uncertainty of mental states) and well-being at baseline may lead to a greater psychological distress and burn-out 1 year later. METHODS: The sample consisted of 40 experienced psychotherapists (females: 72.5%; mean age: 47.40 ± 9.48 years) who completed a battery of questionnaires at baseline and 1 year later. Statistical analyses were conducted with Bayesian multiple linear regressions. RESULTS: Greater attachment anxiety and certainty about mental states and lower individual's well-being at baseline predicted greater burn-out 1 year later. Similarly, greater attachment anxiety and lower individual's well-being at baseline predicted psychological distress at 1 year follow-up. Of note, uncertainty of mental states and avoidant attachment were not associated with outcomes. CONCLUSION: These findings suggest that the levels of burn-out and psychological distress among psychotherapists may be alleviated with interventions targeting attachment insecurity, specific aspects of reflective functioning (i.e., certainty about mental states) and well-being.

Childhood emotional neglect and depressive and anxiety symptoms among mental health outpatients: the mediating roles of narcissistic vulnerability and shame.

BACKGROUND: Theorized to stem from experiences of childhood emotional neglect, narcissistic vulnerability has been identified as contributing to expressions of psychiatric distress such as depressive and anxiety symptoms, particularly due to shame-proneness. AIMS: To investigate narcissistic vulnerability and shame as mediators between perceived childhood emotional neglect and depressive and generalized anxiety symptoms among psychiatric outpatients. METHODS: Adults (N = 137) attending community mental health services completed self-report measures at intake. Mediation analyses tested the indirect effect of perceived emotional neglect on depressive and generalized anxiety symptom severity through narcissistic vulnerability; shame was added to subsequent models to examine narcissistic vulnerability and shame as sequential mediators. RESULTS: Perceived emotional neglect was significantly associated with narcissistic vulnerability, which in turn was linked with depressive and generalized anxiety symptoms as separate dependent variables. Indirect effects were significant in each model, indicating narcissistic vulnerability as a significant mediator. With the inclusion of shame, narcissistic vulnerability and shame were significant as sequential mediators. CONCLUSION: Narcissistic vulnerability and shame may operate as mechanisms in conferring affective symptom severity from perceived childhood emotional neglect. Narcissistic vulnerability and susceptibility to shame may thus be important treatment targets when addressing psychological distress in the context of childhood adversity.

Perfectionism unbound: An integrated individual and group intervention for those hiding imperfections.

The tendency to hide and mask suffering and one's perceived imperfections is one of the biggest obstacles in treating those with prominent perfectionistic traits. In this single case, we present an integrative form of psychotherapy for patients with recurrent strategies aimed at neither displaying nor disclosing their perfectionism. Emily was a 26-year-old woman diagnosed with Major Depressive Disorder and reported a personality pathology as diagnosed through the Alternative Model of Personality Disorders. The intervention comprised of a 4-month individual therapy and 2-month group therapy. The former is based on Metacognitive Interpersonal Therapy protocol for personality disorders. The latter is a protocol that integrates the Dynamic Relational Treatment for Perfectionism and Compassion Focused Therapy. At the end of this integrative treatment, Emily remitted from Major Depressive Disorder and personality pathology. Further studies should confirm our promising results in larger samples.

Other-Oriented Perfectionism in Children and Adolescents: Development and Validation of the Other-Oriented Perfectionism Subscale-Junior Form (OOPjr).

Research on adults indicates other-oriented perfectionism (requiring perfection from others) is associated with various consequential outcomes independent of self-oriented perfectionism (requiring perfection of the self) and socially prescribed perfectionism (believing others require perfection of the self). However, historically, the most widely used and researched measure of trait perfectionism in children, the Child-Adolescent Perfectionism Scale (CAPS), has omitted other-oriented perfectionism. In the present study, we address this by reporting on the multisource development and validation of the first self-report measure of other-oriented perfectionism specifically intended for youths: the Other-Oriented Perfectionism Subscale-Junior Form (OOPjr). Children (N = 107; Mage = 11.5, SD = 1.7) completed the OOPjr, CAPS, and measures of perfectionistic self-presentation, narcissism, social disconnection, depressive symptoms, and parental psychological control. Parents provided ratings of children's self-oriented, socially prescribed, and other-oriented perfectionism. Psychometric analyses indicated the OOPjr is a homogenous and internally reliable scale that, when factor analyzed alongside the CAPS, displays measurement invariance across gender and replicates the three-factor solution found in adults. Furthermore, parent ratings of other-oriented perfectionism showed unique positive relationships with OOPjr scores, but not CAPS scores. Likewise, other-oriented perfectionism had independent positive relationships with narcissistic superiority and achievement-oriented parental psychological control, after controlling for self-oriented and socially prescribed perfectionism. Overall, our findings provide preliminary support for the use of the OOPjr as a measure of other-oriented perfectionism in youths.

What Lies Beyond the Superordinate Trait Perfectionism Factors? The Perfectionistic Self-Presentation and Perfectionism Cognitions Inventory Versus the Big Three Perfectionism Scale in Predicting Depression and Social Anxiety.

Extreme perfectionism has been linked with distress and dysfunction. This association is reflected by the recent development of the Big Three Perfectionism Scale (BTPS), which has superordinate trait-based scales that assess 3 broad elements-rigid, self-critical, and narcissistic perfectionism. We examined psychometric features of the BTPS as well as the links between the BTPS and indexes of distress. A sample of 602 undergraduates completed the BTPS, the Perfectionistic Self-Presentation Scale, the Perfectionism Cognitions Inventory, and measures of social anxiety and depression. Support was obtained for the psychometric qualities of the BTPS. All 3 superordinate trait factors were associated with social anxiety and depression. Analyses also established that rigid perfectionism, self-critical perfectionism, and narcissistic perfectionism are associated with perfectionistic cognitions and perfectionistic self-presentation. In addition, the results of a series of regression analyses established that perfectionistic self-presentation and perfectionistic cognitions accounted for significant unique variance in distress beyond the variance attributable to rigid, narcissistic, and self-critical perfectionism. Overall, our results suggest that the BTPS has significant promise as a predictor of various forms of dysfunction, but the cognitive and self-presentational aspects of the perfectionism construct are also uniquely relevant and not redundant with the BTPS superordinate trait factors.

Dynamic-relational treatment of perfectionism: An illustrative case study.

OBJECTIVE: Perfectionism has been described as a multidimensional core vulnerability factor in various forms of dysfunction and disorders. Recently, we described our empirically supported-dynamic-relational treatment for perfectionism. This treatment integrates psychodynamic and interpersonal principles to reduce perfectionism and symptoms and enhance relationships with others and self by focusing on underlying relational patterns. METHOD: We discuss this approach and present Azure, a 27-year-old woman who completed our group treatment and subsequent individual therapy as a follow-up. RESULTS: Azure underwent a comprehensive psychological pretreatment assessment, the results of which were used to develop a working formulation that guided the group and individual psychotherapy. A description of the formulation and her experience in therapy are discussed and pre- and post-treatment data illustrate changes in Azure's perfectionism and symptoms. CONCLUSIONS: We discuss changes that occurred over the course of treatment.

Perfectionistic traits and self-presentation are associated with negative attitudes and concerns about seeking professional psychological help.

Numerous factors influence whether an individual is able and willing to seek professional help for psychological difficulties. One of these may be perfectionism, a multidimensional personality construct that has been linked to poor psychological adjustment. The current study investigated whether perfectionism traits and self-presentational facets were associated with negative help-seeking attitudes and concerns about psychotherapy. Samples of university (N = 299) and community (N = 77) men and women completed the Multidimensional Perfectionism Scale, Perfectionistic Self-Presentation Scale, Attitudes Towards Seeking Professional Help Scale, and Thoughts About Psychotherapy Survey. Various components of perfectionism were associated with both negative help-seeking attitudes and concerns about psychotherapy. The findings suggest that perfectionistic behaviour may be an important dispositional factor that interferes with seeking and obtaining help for psychological difficulties. Theoretical and clinical implications are discussed.

The perniciousness of perfectionism: A meta-analytic review of the perfectionism-suicide relationship.

OBJECTIVE: Over 50 years of research implicates perfectionism in suicide. Yet the role of perfectionism in suicide needs clarification due to notable between-study inconsistencies in findings, underpowered studies, and uncertainty about whether perfectionism confers risk for suicide. We addressed this by meta-analyzing perfectionism's relationship with suicide ideation and attempts. We also tested whether self-oriented, other-oriented, and socially prescribed perfectionism predicted increased suicide ideation, beyond baseline ideation. METHOD: Our literature search yielded 45 studies (N = 11,747) composed of undergraduates, medical students, community adults, and psychiatric patients. RESULTS: Meta-analysis using random effects models revealed perfectionistic concerns (socially prescribed perfectionism, concern over mistakes, doubts about actions, discrepancy, perfectionistic attitudes), perfectionistic strivings (self-oriented perfectionism, personal standards), parental criticism, and parental expectations displayed small-to-moderate positive associations with suicide ideation. Socially prescribed perfectionism also predicted longitudinal increases in suicide ideation. Additionally, perfectionistic concerns, parental criticism, and parental expectations displayed small, positive associations with suicide attempts. CONCLUSIONS: Results lend credence to theoretical accounts suggesting self-generated and socially based pressures to be perfect are part of the premorbid personality of people prone to suicide ideation and attempts. Perfectionistic strivings' association with suicide ideation also draws into question the notion that such strivings are healthy, adaptive, or advisable.

The Impact of Angelina Jolie (AJ)'s Story on Genetic Referral and Testing at an Academic Cancer Centre in Canada.

In May 2013, Angelina Jolie revealed to the media that she had undergone preventive double mastectomy after testing positive for a BRCA1 gene mutation. Media coverage has been extensive, but it is not clear how such a personal story affected the public and cancer genetics clinics. We conducted a retrospective review using data from the clinical database of the Familial Cancer Program at our centre. The impact of Ms. Jolie's story on genetic counseling referrals and the appropriateness of such referrals were assessed and reported. The number of women referred for genetic counseling increased by 90 % after 6 months and remained high one year after AJ's story with an increase of 88 % from baseline. The number of women who qualified for genetic testing increased by 105 % after 6 months; this increase persisted but was somewhat lower after one year with an increase of 68 % from baseline. Furthermore the number of BRCA1/2 carriers identified increased by 110 % after 6 months and by 42 % after one year.The effect of Mrs. Jolie's story persisted one year after its release; however in the latter half of the year, the hereditary cancer risk of referred women was significantly lower than initially observed. The next challenge for our health care system will not only be to meet the increased demand for cancer genetic services in our region, but also to ensure that referrals and hence use of genetic counseling resources are appropriate.

Pathological narcissism's impact on psychodynamic group therapy for perfectionism.

Several decades of theory suggest that pathological narcissism (PN) may limit psychotherapy success, but empirical evidence for such theories is limited and mixed. In addition, it has been proposed that individuals with high levels of PN may benefit more from supportive compared to interpretive psychodynamic therapies, but no studies thus far have investigated this question empirically. As such, our study aimed to extend past research by investigating (a) whether higher levels of pretreatment PN predict poorer treatment outcome and (b) whether the type of psychodynamic therapy (supportive or interpretive therapy) moderates these findings, in a sample of patients undergoing group psychodynamic psychotherapy for perfectionism. The sample was drawn from the University of British Columbia Perfectionism Treatment Study II (Hewitt et al., 2023) and consisted of 80 treatment-seeking adults with elevated perfectionism. Contrary to expectations, multilevel and multiple regression analyses showed that pretreatment PN did not significantly predict posttreatment changes in symptom severity, life satisfaction, or work and social impairment. We also did not find that either grandiose or vulnerable narcissism predicted likelihood of patient dropout. Finally, treatment type did not moderate the relationship between pretreatment PN and treatment outcome, suggesting that, contrary to our hypotheses, PN does not impact treatment outcome regardless of the interpretive nature of the psychodynamic group therapy. These results, taken together with past findings, suggest that PN may not be associated with poorer psychotherapy outcomes in certain contexts, such as in the case of supportive or interpretive psychodynamic group psychotherapy for perfectionism. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Perfectionistic self-presentation, coping, and affective response during laboratory performance.

BACKGROUND AND OBJECTIVES: The impact of trait perfectionism on coping and affective response has been well-documented in laboratory performances, and yet little is known about the role played by perfectionistic self-presentation in performances beyond the effects of trait perfectionism. DESIGN: We aimed to address this knowledge gap by examining the relationships between perfectionistic self-presentation, maladaptive emotion-focused coping, and affective response to laboratory problem-solving tasks. METHODS: A group of 130 undergraduates attempted challenging, time-limited arithmetic and anagram tasks. Upon task completion, participants' scores were announced along with their mistakes. Additionally, participants completed measures assessing their positive and negative affect before and after lab performance, as well as coping strategies utilized during performance. RESULTS: Participants with elevated perfectionistic self-presentation experienced greater levels of negative affect and maladaptive emotion-focused coping. Moreover, nondisclosure of imperfection emerged as a significant predictor of lowered positive affect from pre- to post-performance after controlling for self-oriented perfectionism and socially prescribed perfectionism. Path analysis indicated that both nondisplay of imperfection and nondisclosure of imperfection exerted an indirect effect on post-performance negative affect via maladaptive emotion-focused coping. CONCLUSIONS: Our findings highlight the unique contribution of perfectionistic self-presentation beyond trait perfectionism in performance settings and suggest a need for future research.

The efficacy of group psychotherapy for adults with perfectionism: A randomized controlled trial of dynamic-relational therapy versus psychodynamic supportive therapy.

OBJECTIVE: This randomized controlled trial investigated the efficacy of group dynamic-relational therapy (DRT) relative to group psychodynamic supportive therapy (PST) in treating perfectionism and improving psychological functioning. HYPOTHESIS: Psychodynamically informed therapies, particularly DRT, will be efficacious in treating perfectionism and functioning outcomes. METHOD: Based on a comprehensive conceptualization of perfectionism, 80 community-recruited, highly perfectionistic individuals were randomly allocated to 12 sessions of group DRT (n = 41; 5 groups) or group PST (n = 39; 5 groups). Patients completed measures of trait perfectionism, perfectionistic self-presentation, perfectionistic cognitions, symptom distress, life satisfaction, and work and social adjustment at pre-, mid-, and posttreatment and 6 months posttreatment. RESULTS: Multigroup latent growth curve modeling revealed significant (p < .05) decreases in all perfectionism components and improvements in all functioning outcomes from pretreatment to 6-month follow-up in both DRT and PST. Likewise, analyses revealed substantial reliable improvement across conditions for all perfectionism components. Last, moderate-to-large between-group differences favoring DRT over PST were found for self-oriented perfectionism, perfectionistic self-promotion, nondisplay of imperfection, nondisclosure of imperfection, and work and social adjustment. CONCLUSION: Findings provide evidence for the use of psychodynamic approaches in the treatment of perfectionism and support the relative efficacy of DRT for components of perfectionism. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Managing daily responsibilities among collegiate student-athletes: Examining the roles of stress, sleep, and sense of belonging.

Objectives: Student-athletes are unique in their undertaking of full-time academic and athletic roles. Their dual roles impose a multitude of responsibilities in their daily lives, yet little is known about the factors that may negatively impact their ability to effectively manage these responsibilities. Participants: Data from a large sample of Canadian varsity athletes (N = 1,353) were used for the present study. Methods: The association between stress and difficulties managing daily responsibilities, while simultaneously investigating the roles of sleep difficulties and sense of belonging as contributing factors was examined. Results: Findings indicated that the moderated mediation model was significant, revealing that sleep difficulties were a significant mediator in the relationship between stress and difficulties managing daily responsibilities and that sense of belonging moderated the relationship between stress and sleep difficulties. Conclusions: The results expose complex ways that student-athletes' performances (academic and athletic) can be impaired, signaling the need to develop strategic actions toward prevention and management of stress among student-athletes.

Group dynamic-relational therapy for perfectionism.

The interest in treating underlying core vulnerability factors or transdiagnostic processes has been a focus of much attention. In this paper we describe our application of group dynamic-relational psychotherapy to the treatment of perfectionism, a core personality vulnerability factor associated with various forms and types of dysfunction and disorders that have profound costs to the individual both socially and subjectively. Over the course of the past three decades, we developed an evidence-based integrative group treatment that targets the psychodynamic and relational underpinnings of perfectionism. The treatment is based on an integration of psychodynamic and interpersonal perspectives and therapeutic approaches. In this paper we present our model of perfectionism and describe our group dynamic-relational therapy for the treatment of its pernicious outcomes. By drawing on illustrative case material, we describe the approach as applied to one such group as it progresses through four phases of group development that we have termed engagement and pseudo attachment, pattern interruption, self-redefinition/painful authenticity, and termination. Finally, we present some of the accumulating evidence of the effectiveness and efficacy of dynamic-relational therapy.

The destructiveness and public health significance of socially prescribed perfectionism: A review, analysis, and conceptual extension.

Perfectionism is a multidimensional personality construct with various components. Socially prescribed perfectionism (i.e., perceived social pressures and expectations to be perfect) is one key element. This trait dimension represents a chronic source of pressure that elicits feelings of helplessness and hopelessness at extreme levels. Unfortunately, at present, the destructiveness of socially prescribed perfectionism has not been fully recognized or extended conceptually despite the extensive volume of research on this dimension. To address this, we first trace the history and initial conceptualization of socially prescribed perfectionism. Next, we summarize and review findings that underscore the uniqueness and impact of socially prescribed perfectionism, including an emphasis on its link with personal, relationship, and societal outcomes that reflect poor mental well-being, physical health, and interpersonal adjustment. Most notably, we propose that socially prescribed perfectionism is a complex entity in and of itself and introduce new conceptual elements of socially prescribed perfectionism designed to illuminate further the nature of this construct and its role in distress, illness, dysfunction, and impairment. It is concluded that socially prescribed perfectionism is a significant public health concern that urgently requires sustained prevention and intervention efforts.