Perfectionism is multidimensional: a reply to Shafran, Cooper and Fairburn.

provided a cognitive-behavioural analysis of perfectionism that focused primarily on self-oriented perfectionism. They argued against studying perfectionism from a multidimensional perspective that they regard as inconsistent with prior work on perfectionism as a self-oriented phenomenon. We respond to by offering historical, empirical, and theoretical support for the usefulness and the importance of a multidimensional model of perfectionism involving both intrapersonal processes and interpersonal dynamics. It is concluded that a multidimensional approach to the study of perfectionism is still warranted.

Death from anorexia nervosa: age span and sex differences.

The purpose of this study was to assess characteristics of individuals who died from anorexia nervosa by assessing the frequency with which anorexia nervosa is listed as a causal factor related to the death of individuals in the USA. Data from over 10 million death records (all National Center for Health Statistic registered deaths in the USA for 1986-90) were examined for mention of anorexia nervosa as a primary or contributing cause of death. Only 724 were found, which equals an average of 145 annual deaths, and a rate of 6.73 per 100,000 deaths. The age and sex distribution suggests two fatal forms of anorexia nervosa, an early-onset form comprising 89% women and a later form comprising 24% men. The findings suggest that the mortality risk from current anorexia nervosa may be lower than formerly supposed and that it is not confined to young adults and adolescents.

Multicenter evaluation of a pathogenic mycobacterium screening probe.

The introduction of nucleic acid amplification assays into the clinical laboratory has reduced the time needed to diagnose diseases caused by members of the Mycobacterium tuberculosis complex (MTBC). However, several mycobacterial species other than those of the MTBC are known to cause disease, especially in immunocompromised individuals. A screening assay has been developed for the detection of the major pathogenic mycobacterial species. The assay utilizes pan-genus primers to amplify mycobacterial DNA and a screening probe (KY493) that detects all major pathogenic mycobacteria. A multicenter European study was conducted to assess the performance of the screening probe in the clinical laboratory. The screening probe was evaluated against individual probes specific for M. tuberculosis, M. avium, and M. intracellulare, a genus-specific probe with broader species coverage, and culture. The screening probe had a sensitivity equivalent to that of the species-specific probes; all specimens positive with any of the species-specific probes were also positive with the screening probes. Compared to culture, the sensitivity of the screening probe was 89% (154 of 173) for all culture-positive specimens tested. This value was 89.6% for the genus-specific probe. The screening probe was more specific than the genus-specific probe. Specificity was 93.9% (661 of 704) compared to culture results alone. The comparable specificity value for the genus-specific probe was 84.8%. When clinical data were taken into consideration, the sensitivity of the screening assay was similar to that of culture (81% versus 76.2%) but the positive predictive value of the test was lower (76.2% versus 100% for culture). However, the screening probe was more sensitive than smear and may be a useful tool in the rapid diagnosis of mycobacterial disease.

Inhibited expression of negative emotions and interpersonal orientation in anorexia nervosa.

OBJECTIVE: This study examined inhibited expression of negative feelings and interpersonal orientation in women with anorexia nervosa. METHOD: Twenty-one women meeting DSM-IV criteria for anorexia nervosa were compared with 21 psychiatric and 21 normal control women matched on education. Two measures were used to assess inhibited expression of negative feelings and interpersonal orientation: the State-Trait Anger Expression Inventory assesses the suppression and expression of anger and the Silencing the Self Scale assesses four cognitive schemas involving the repression of needs and feelings to protect interpersonal relationships. RESULTS: Women with anorexia nervosa reported significantly higher scores on the four Silencing the Self schemas and on suppressed anger after controlling for age. These group differences were maintained for two of the cognitive schemas (Care and Silence) after controlling for depression, self-esteem, and global assessment of functioning. Inhibited expression of negative emotion and interpersonal orientation scores were also significantly related to cognitive and affective components of body image dissatisfaction and to trait and self-presentational dimensions of perfectionism. DISCUSSION: These findings are reviewed in the context of health psychology, as well as feminist and temperament theories. Implications for treatment are addressed.

Psychological distress and the frequency of perfectionistic thinking.

Five studies tested the hypotheses that there are individual differences in the frequency of automatic thoughts involving perfectionism and that these thoughts are associated with psychological distress. Research with the Perfectionism Cognitions Inventory (PCI) established that this new measure has adequate psychometric properties, and high PCI scorers tend to spontaneously report perfectionistic thoughts in naturalistic situations. Additional research confirmed that frequent perfectionism thoughts account for unique variance in distress, over and above variance predicted by standard measures of negative automatic thoughts and trait perfectionism measures. Overall, the findings support the view that personality traits involved in depression and anxiety have a cognitive component involving ruminative thoughts and that activation of this cognitive personality component contributes to distress.

Is anorexia nervosa associated with elevated rates of suicide?

OBJECTIVES: The purpose of this study was to ascertain whether individuals with anorexia nervosa are more likely to commit suicide, as suggested by previously noted associations between anorexia nervosa and mood disorders. METHODS: Data from death records representing over 5 million women were examined, yielding 571 cases in which anorexia nervosa was mentioned as an existing condition. The women with anorexia were compared with 1713 control subjects matched for age, sex, and race. RESULTS: The percentage of suicides among those listed as having anorexia nervosa was only 1.4%, compared with 4.1% for the controls. CONCLUSIONS: These findings suggest that the suicide rate is not elevated among individuals currently suffering from anorexia nervosa.

Performance of a PCR assay for detection of Pneumocystis carinii from respiratory specimens.

This study evaluates the performance of a PCR assay for the detection of Pneumocystis carinii from respiratory specimens that has been designed for use in the clinical microbiology laboratory. The test includes a simple method for nucleic acid extraction and amplification, a colorimetric probe hybridization technique for detection of amplicons, and an internal control to evaluate for the presence of inhibitors of amplification. Two hundred thirty-two clinical specimens (120 induced-sputum [IS] and 112 bronchoalveolar lavage [BAL] specimens) from 168 patients were tested by both immunofluorescent (direct fluorescent-antibody [DFA]) staining and PCR. Of the 112 BAL specimens, 17 were positive for P. carinii by DFA staining and PCR. An additional two specimens were DFA negative and PCR positive. For BAL specimens, the sensitivity and specificity of PCR compared to DFA were 100 and 98%, respectively. Eighteen IS specimens were positive for P. carinii by DFA, and 27 were positive by PCR. One of the 18 DFA-positive IS specimens was negative by PCR; this patient had just completed therapy for P. carinii pneumonia. Of the 10 specimens that were PCR positive and DFA negative, 4 were from patients who had a subsequent BAL specimen that was positive by DFA and PCR. For IS specimens, the sensitivity of DFA and PCR was 82 and 95%, respectively. The specificity of PCR for IS specimens was 94%. Due to the high sensitivity of PCR for the detection of P. carinii from IS specimens, a PCR-based diagnostic test may be a useful screening test and may alleviate the need for bronchoscopy in some patients.

Dimensions of perfectionism, hopelessness, and attempted suicide in a sample of alcoholics.

This study assessed whether specific dimensions of perfectionism and hopelessness were elevated in individuals who had made a serious suicide attempt in comparison to individuals with no history of suicide attempts. A sample of 39 inpatients with alcoholism who had made a serious suicide attempt and a matched sample of 39 inpatients with alcoholism but no history of suicide attempts completed the Multidimensional Perfectionism Scale, the Hopelessness Scale, ratings of achievement and social hopelessness, and the Beck Depression Inventory. The attempter group had higher scores on socially prescribed perfectionism, generalized hopelessness, achievement hopelessness, social hopelessness, and depression. A discriminant function analysis revealed that depression, social hopelessness, socially prescribed perfectionism, and other-oriented perfectionism were unique discriminators of the suicide groups. The results are discussed in terms of the importance of social personality variables in attempted suicide.

Perfectionism and suicide ideation in adolescent psychiatric patients.

This study was conducted to examine the relations between dimensions of perfectionism and suicide ideation in an adolescent psychiatric sample. A sample of 66 adolescents from an inpatient psychiatric facility completed the Child and Adolescent Perfectionism Scale, the Child's Hopelessness Scale, and the Suicide Ideation Questionnaire. Overall, the results indicated that socially prescribed perfectionism was associated with greater suicide ideation and that it, along with hopelessness, accounted for unique variance in suicide ideation scores. The findings are discussed in terms of their practical and theoretical significance as well as their consistency with similar research with adults.

The operating room--perceptions of a change in working environment.

The questionnaire surveyed OR staff on themes such as design, security, and workload. Surgical nurses had greater expectations for their roles and functions in the new facility. Levels of physical comfort improved; however, mood was not affected positively.

Perfectionism and depression: longitudinal assessment of a specific vulnerability hypothesis.

The authors tested whether perfectionism dimensions interact with specific stress to predict depression over time. A sample of 103 current and former patients completed measures of perfectionism and depression at Time 1 and measures of stress and depression 4 months later. After controlling Time 1 depression, self-oriented perfectionism interacted only with achievement stress to predict Time 2 depression. Socially prescribed perfectionism did not interact with achievement or social stress to predict Time 2 depression, but it did predict Time 2 depression as a main effect. The results provide support for the contention that perfectionism dimensions are involved in vulnerability to depression over time.

Detection of Mycobacterium tuberculosis by PCR amplification with pan-Mycobacterium primers and hybridization to an M. tuberculosis-specific probe.

Nucleic acid amplification techniques such as the PCR are very useful in the rapid diagnosis of infections by Mycobacterium tuberculosis. However, recent studies have shown that the accuracy of results can vary widely when tests are performed with nonstandardized reagents. We have developed a PCR assay for the detection of M. tuberculosis that is both rapid and accurate. The assay reagents are standardized and quality controlled. False-positive results due to carryover contamination are prevented by the incorporation of dUTP coupled with uracil-N-glycosylase restriction. This assay also employs pan-Mycobacterium amplification primers, allowing for flexibility in the mycobacterial species that can be identified from a single amplification reaction. The amplification is very sensitive; amplification products generated from as few as three bacteria can be detected by agarose gel electrophoresis. DNAs isolated from 33 of 34 mycobacterial species tested were amplified efficiently. Only DNA from Mycobacterium simiae did not amplify. The amplification is also very specific. Amplification products were generated only from the DNAs of bacteria in closely related genera such as Corynebacterium. The nonmycobacterial amplicons do not pose a problem, as they do not hybridize to mycobacterium-specific probes. Hybridization of amplicons to an M. tuberculosis-specific probe allows for the unambiguous identification of M. tuberculosis complex organisms. The clinical performance of this PCR assay was evaluated against that of culture in 662 respiratory specimens. Sensitivities of 100 and 73.1% were obtained from smear-positive and -negative respiratory specimens, respectively. The corresponding specificities were 100 and 99.8%. The high sensitivity and specificity, coupled with the potential for detecting a wide range of mycobacteria, make this assay a useful tool in the clinical management of mycobacterial infections.

Panic disorder or social phobia: which is worse?

Twenty-eight patients with panic disorder (PD) and 30 with social phobia (SP) were compared on demographic and psychopathology measures. The demographic comparisons showed that, although people with SP were better educated, they were more likely to be single, living alone, and unemployed. The comparisons of psychopathology showed that the proportion of people with PD and SP with a life time major affective disorder did not differ, nor did the two groups differ on the proportion of Ss reporting past suicide attempts. However, a greater proportion of patients with SP had Brief Michigan Alcohol Screening Test scores above 5, indicating alcohol abuse problems. The implications of these findings are discussed.

Perfectionism traits and perfectionistic self-presentation in eating disorder attitudes, characteristics, and symptoms.

OBJECTIVE: The purpose of this study was to assess the association between several dimensions of perfectionism and measures of eating disorder symptoms, body image, and appearance self-esteem in college students. METHOD: A sample of 81 female university students completed the Multidimensional Perfectionism Scale, the Perfectionistic Self-Presentation Scale, the Eating Attitudes Test, the Bulimia Test, the Body Image Avoidance Questionnaire, and two measures of self-esteem. RESULTS: It was found that whereas self-oriented perfectionism was related only to anorexic symptoms, the social facets of perfectionism, especially socially prescribed perfectionism and the perfectionistic self-presentation dimensions, were related to eating disorder symptoms as well as body image avoidance and self-esteem. DISCUSSION: The findings support the usefulness of differentiating personal and interpersonal dimensions of perfectionism as well as trait versus self-presentational aspects of perfectionism in investigating personality and attitudes and behaviors related to eating disorders.

Dimensions of perfectionism, daily stress, and depression: a test of the specific vulnerability hypothesis.

We tested whether perfectionism dimensions interact with specific stressors to predict depression. A depressed patient sample (N = 51) and a general psychiatric sample (N = 94) completed measures of perfectionism, hassles, and depression. Subjects in Sample 2 also completed other personality measures to assess the amount of unique variance in depression. Partial support was obtained in that in both samples self-oriented perfectionism interacted only with achievement stressors to predict depression. Socially prescribed perfectionism interacted with interpersonal stress in Sample 1 and with achievement stress in Sample 2 to predict depression. Several personality variables, including socially prescribed perfectionism, accounted for unique variance in depression. The results suggest that perfectionism dimensions are associated with depression and may constitute specific vulnerability factors.

Perfectionism and suicide potential.

The present study employed a multidimensional approach to examine the association between perfectionism and suicide threat. The present study also examined whether perfectionism variables predicted variance in suicide threat and suicide intention that is not accounted for by other well-known predictors (i.e. depression and hopelessness). A sample of 87 psychiatric patients completed the Multidimensional Perfectionism Scale, the MMPI Threat Suicide Scale and the Beck Depression Inventory. The Multidimensional Perfectionism Scale assesses self-oriented perfectionism, other-oriented perfectionism, and socially prescribed perfectionism. The analyses revealed that socially prescribed perfectionism was the only perfectionism dimension correlated significantly with suicide threat and intent. Moreover, hierarchical regression analyses showed that socially prescribed perfectionism predicted variance in suicide scores that was not accounted for by depression or hopelessness. Overall, the findings suggest that suicide potential is associated with a dispositional tendency to perceive that other people are unrealistic in their expectations for the self. The results are discussed in terms of their implications for intervention.

Perfectionism in the self and social contexts: conceptualization, assessment, and association with psychopathology.

This article attempted to demonstrate that the perfectionism construct is multidimensional, comprising both personal and social components, and that these components contribute to severe levels of psychopathology. We describe three dimensions of perfectionism: self-oriented perfectionism, other-oriented perfectionism, and socially prescribed perfectionism. Four studies confirm the multidimensionality of the construct and show that these dimensions can be assessed in a reliable and valid manner. Finally, a study with 77 psychiatric patients shows that self-oriented, other-oriented, and socially prescribed perfectionism relate differentially to indices of personality disorders and other psychological maladjustment. A multidimensional approach to the study of perfectionism is warranted, particularly in terms of the association between perfectionism and maladjustment.

Dimensions of perfectionism in unipolar depression.

We tested the hypothesis that self-oriented perfectionism, other-oriented perfectionism, and socially prescribed perfectionism are related differentially to unipolar depression. The Multidimensional Perfectionism Scale was administered along with measures of depression and anxiety to 22 depressed patients, 22 matched normal control subjects, and 13 anxiety patients. It was found that the depressed patients had higher levels of self-oriented perfectionism than did either the psychiatric or normal control subjects. In addition, depressed patients and anxious patients reported higher levels of socially prescribed perfectionism than did the normal control subjects. The results suggest that various dimensions of perfectionism may play an important role in clinical depression.

The ideal self: schematic processing of perfectionistic content in dysphoric university students.

This study assessed ideal-self-schematic processing, recall of perfectionistic content rated as not descriptive of the actual self or ideal self, and content-specific processing as a function of dysphoria. College students (n = 219) made structural (ST), ideal-self (IS), and actual-self (AS) ratings on perfectionistic, negative, and neutral words, and completed an incidental recall task. Words rated with the IS task were recalled better tha words rated with the ST task, but recall did not differ between the IS and AS tasks. Subjects recalled no-rated perfectionistic words better with the IS and AS tasks than with the ST task. Finally, dysphoric and nondysphoric subjects did not differ in processing specific content. The results support the belief that the IS functions as a schema and suggest that non-self- and non-ideal-self-descriptive perfectionistic content is involved in ideal- and actual-self-schemas.

Clinical depression and attributional complexity.

Recent research on attributional complexity with college student samples has indicated that mild and moderate depression are associated with increased attributional complexity but more severe depression may be related to decreased attributional complexity. The present study examined levels of attributional complexity in clinically depressed patients and normal controls. The results confirmed that severe depression is associated with reduced attributional complexity. The results are discussed in terms of the need for a multidimensional model of attribution and depression that incorporates individual differences in variables such as attributional complexity.