Abstract
Perfectionism is highly and increasingly prevalent and is associated with concerning outcomes, including risk factors for suicidal ideation. However, it is not yet known under what conditions or through what mechanism perfectionism comes to be particularly maladaptive. Self-discrepancy theory suggests that perfectionism may be more maladaptive in the context of negative life events, through a pathway of appraisals of falling short of standards; this remains unstudied. To test this model, perfectionism, negative life events, appraisals, and demoralization were measured in a sample of 320 participants. The mediational pathway was supported, and perfectionism presented as a robust risk factor for both demoralization and appraisals of falling short of standards regardless of experience of recent negative life events. Indeed, perfectionism contributed far more variance to demoralization than this well-established risk factor. These results have clinical implications, in that perfectionism may meaningfully influence mental health outcomes even in the absence of activating life stressors, and this pathway may benefit from cognitive intervention. This study builds on extant literature to reveal an important mechanism by which perfectionism may lead to concerning outcomes, and establishes perfectionism as a consequential vulnerability factor independent of, and even relative to, negative life events.
Similar content being viewed by others
Data Availability
The datasets generated during and analyzed during the current study are available from the corresponding author on reasonable request.
Code Availability
The code produced to analyze the date in the current study is available from the corresponding author on reasonable request.
References
Amodeo, D. (2014). Perfectionism and social connectedness in graduate students (Doctoral dissertation). Retreived from ProQuest Dissertations Publishing. (3620430)
Anestis, J. C., Finn, J. A., Gottfried, E. D., Hames, J. L., Bodell, L. P., Hagan, C. R., Arnau, R. C., Anestis, M. D., Arbisi, P. A., & Joiner, T. E. (2018). Burdensomeness, belongingness, and capability: Assessing the interpersonal-psychological theory of suicide with MMPI-2-RF scales. Assessment, 25(4), 415–431.
Antonovsky, A. (1979). Health, stress, and coping. Jossey-Bass.
Beck, A. T. (1964). Thinking and depression: II. Theory and therapy. Archives of General Psychiatry, 10(6), 561–571.
Bennett, P., Lowe, R., & Honey, K. (2003). Brief report; appraisals, core relational themes, and emotions: A test of the consistency of reporting and their associations. Cognition and Emotion, 17(3), 511–520.
Bissell, K., & Rask, A. (2010). Real women on real beauty: Self-discrepancy, internalisation of the thin ideal, and perceptions of attractiveness and thinness in Dove’s campaign for real beauty. International Journal of Advertising, 29(4), 643–668.
Blatt, S. J. (1995). The destructiveness of perfectionism: Implications for the treatment of depression. American Psychologist, 49, 1003–1020.
Blatt, S. J., Bondi, C. M., Sanislow, C. A., Zuroff, D. C., & Pilkonis, P. A. (1998). When and how perfectionism impedes the brief treatment of depression: Further analysis of the national institute of mental health treatment of depression collaborative research program. Journal of Counseling and Clinical Psychology, 66(2), 423–428.
Bollen, K. A. (1984). Multiple indicators: Internal consistency or no necessary relationship? Quality and Quantity, 18(4), 377–385.
Brocklesby, M. (2017). A longitudinal investigation of non-suicidal self-injury and perfectionism in a sample of New Zealand adolescents (Doctoral dissertation). Retreived from ProQuest Dissertations Publishing.
Burns. (1980). The perfectionist’s script for self-defeat. Psychology Today, 14(6), 34–52.
Chang, E. C., & Rand, K. L. (2000). Perfectionism as a predictor of subsequent adjustment: Evidence for a specific diathesis–stress mechanism among college students. Journal of Counseling Psychology, 47(1), 129.
Chen, C., Hewitt, P. L., Flett, G. L., Cassels, T. G., Birch, S., & Blasberg, J. S. (2012). Insecure attachment, perfectionistic self-presentation, and social disconnection in adolescents. Personality and Individual Differences, 52(8), 936–941.
Chen, C., Hewitt, P. L., & Flett. (2015). Preoccupied attachment, need to belong, shame, and interpersonal perfectionism: An investigation of the perfectionism social disconnection model. Personality and Individual Differences, 76, 177–182.
Childs, J. H., & Stoeber, J. (2010). Self-oriented, other-oriented, and socially prescribed perfectionism in employees: Relationships with burnout and engagement. Journal of Workplace Behavioral Health, 25(4), 269–281.
Clements, K., & Turpin, G. (1996). The life events scale for students: Validation for use with British samples. Personality and Individual Differences, 20(6), 747–751.
Conroy, D. E., Kaye, M. P., & Fifer, A. M. (2007). Cognitive links between fear of failure and perfectionism. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 25(4), 237–253.
Coo, S., Milgrom, J., Kuppens, P., & Trinder, J. (2015). Perinatal distress, an appraisal perspective. Journal of Reproductive and Infant Psychology, 33(2), 190–204.
Corrigan, P. W., & Watson, A. C. (2002). The paradox of self-stigma and mental illness. Clinical Psychology: Science and Practice, 9(1), 35–53.
Covault, J., Tennen, H., Armeli, S., Conner, T. S., Herman, A. I., Cillessen, A. H., & Kranzler, H. R. (2007). Interactive effects of the serotonin transporter 5-HTTLPR polymorphism and stressful life events on college student drinking and drug use. Biological Psychiatry, 61(5), 609–616.
Curran, T., & Hill, A. P. (2019). Perfectionism is increasing over time: A meta-analysis of birth cohort differences from 1989 to 2016. Psychological Bulletin, 145(4), 410–429.
Dean, & Range. (1996). The escape theory of suicide and perfectionism in college students. Death Studies, 20(4), 415–424.
Dean, & Range. (1999). Testing the escape theory of suicide in an outpatient clinical population. Cognitive Therapy and Research, 23(6), 561–572.
Disabato, D. (2016, May 22). The double standard against crosssectional mediation. Retrieved fromhttp://www.daviddisabato.com/blog/2016/5/22/the-double-standardagainst-cross-sectional-mediation
Egan, S. J., & Shafran, R. (2017). Cognitive-behavioral treatment for perfectionism. The psychology of perfectionism (pp. 284–305). Routledge.
Enns, M. W., Cox, B. J., Sareen, J., & Freeman, P. (2001). Adaptive and maladaptive perfectionism in medical students: A longitudinal investigation. Medical Education, 35(11), 1034–1042.
Evans, G. W., Jacobs, S. V., Dooley, D., & Catalano, R. (1987). The interaction of stressful life events and chronic strains on community mental health. American Journal of Community Psychology, 15(1), 23–34.
Fang, C.-K., Chang, M.-C., Chen, P.-J., Lin, C.-C., Chen, G.-S., Lin, J., Hsieh, R.-K., Chang, Y.-F., Chen, H.-W., Wu, C.-L., Lin, K.-C., Chiu, Y.-J., & Li, Y.-C. (2014). A correlational study of suicidal ideation with psychological distress, depression, and demoralization in patients with cancer. Supportive Care in Cancer, 22(12), 3165–3174.
Flett, G. L., & Hewitt, P. L. (2008). Treatment interventions for perfectionism—A cognitive perspective: Introduction to the special issue. Journal of Rational-Emotive & Cognitive Behavior Therapy, 26, 127–133.
Flett, G. L., & Hewitt, P. L. (2014). A proposed framework for preventing perfectionism and promoting resilience and mental health among vulnerable children and adolescents. Psychology in the Schools, 51(9), 899–912.
Flett, G. L., Hewitt, P. L., & Rosa, T. (1996). Dimensions of perfectionism, psychosocial adjustment, and social skills. Personality and Individual Differences, 20(2), 143–150.
Flett, G. L., Hewitt, P. L., Blankstein, K. R., & Mosher, S. W. (1995). Perfectionism, life events, and depressive symptoms: A test of a diathesis-stress model. Current Psychology, 14(2), 112–137.
Flett, G. L., Hewitt, P. L., Garshowitz, M., & Martin, T. R. (1997). Personality, negative social interactions, and depressive symptoms. Canadian Journal of Behavioural Science/revue Canadienne Des Sciences Du Comportement, 29(1), 28.
Folkman, S., & Lazarus, R. S. (1980). An analysis of coping in a middleaged community sample. Journal of Health and Social Behavior, 21, 219–239.
Folkman, S., & Lazarus, R. S. (1984). Stress, appraisal, and coping. Springer Publishing Company.
Folkman, S., & Lazarus, R. S. (1985). If it changes it must be a process: A study of emotion and coping during three stages of a college examination. Journal of Personality and Social Psychology, 48, 150–170.
Folkman, S., Lazarus, R. S., Dunkel-Schetter, C., DeLongis, A., & Gruen, R. J. (1986). Dynamics of a stressful encounter: Cognitive appraisal, coping, and encounter outcomes. Journal of Personality and Social Psychology, 50, 992–1003.
Frank, J. D. (1974). Psychotherapy: The restoration of morale. American Journal of Psychiatry, 131(3), 271–274.
Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14(5), 449–468.
Grzegorek, J. L., Slaney, R. B., Franze, S., & Rice, K. G. (2004). Self-criticism, dependency, self-esteem, and grade point average satisfaction among clusters of perfectionists and nonperfectionists. Journal of Counseling Psychology, 51(2), 192.
Hallaraker, E., Arefjord, K., Havik, O. E., & Mæland, J. G. (2001). Social support and emotional adjustment during and after a severe life event: A study of wives of myocardial infarction patients. Psychology and Health, 16(3), 343–355.
Hamachek, D. E. (1978). Psychodynamics of normal and neurotic perfectionism. Psychology: A Journal of Human Behavior, 15(1), 27–33.
Hancock, G. R., & Mueller, R. O. (2010). The reviewer’s guide to quantitative methods in the social sciences. Routledge.
Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Press.
Heidrich, S. (1999). Self-discrepancy across the life span. Journal of Adult Development, 6(2), 119–130.
Herman, K. C., Trotter, R., Reinke, W. M., & Ialongo, N. (2011). Developmental origins of perfectionism among African American youth. Journal of Counseling Psychology, 58(3), 321–334. https://doi.org/10.1037/a0023108
Hewitt, P. L., Flett, G. L., Mikail, S. F., Kealy, D., & Zhang, L. C. (2017). Perfectionism in the therapeutic context: The perfectionism social disconnection model. The psychology of perfectionism (pp. 306–330). Routledge.
Hewitt, C., Flett, S., Collins, & Flynn. (2002). Perfectionism in children: Associations with depression, anxiety, and anger. Personality and Individual Differences, 32(6), 1049–1061.
Hewitt, F., & Ediger. (1996). Perfectionism and depression: Longitudinal assessment of a specific vulnerability hypothesis. Journal of Abnormal Psychology, 105(2), 276–280.
Hewitt, P. L., Flett, G. L., Sherry, S. B., Habke, M., Parkin, M., Lam, R. W., et al. (2003). The interpersonal expression of perfection: Perfectionistic self-presentation and psychological distress. Journal of Personality and Social Psychology, 84(6), 1303–1325.
Hewitt, P. L., Flett, G. L., Turnbull-Donovan, W., & Mikail, S. F. (1991). The multidimensional perfectionism scale: Reliability, validity, and psychometric properties in psychiatric samples. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 3(3), 464.
Hewitt, & Flett. (1989). The multidimensional perfectionism scale: Development and validation. Canadian Psychology, 30(1), 339.
Hewitt, & Flett. (1990). Perfectionism and depression: A multidimensional analysis. Journal of Social Behavior and Personality, 5(5), 423.
Hewitt, & Flett. (1991). Perfectionism in the self and social contexts: Conceptualization, assessment, and association with psychopathology. Journal of Personality and Social Psychology, 60(3), 456.
Higgins, E. T. (1987). Self-discrepancy: A theory relating self and affect. Psychological Review, 94(3), 319–340.
Hill, Z., & Turlington. (1997). Perfectionism and interpersonal problems. Journal of Personality Assessment, 69(1), 81–103.
Jacobsen, J. C., Vanderwerker, L. C., Block, S. D., Friedlander, R. J., Maciejewski, P. K., & Prigerson, H. G. (2006). Depression and demoralization as distinct syndromes: Preliminary data from a cohort of advanced cancer patients. Indian Journal of Palliative Care, 12(1), 8–15.
Johnson, J., Gooding, P. A., Wood, A. M., Taylor, P. J., & Tarrier, N. (2011). Trait reappraisal amplifies subjective defeat, sadness, and negative affect in response to failure versus success in nonclinical and psychosis populations. Journal of Abnormal Psychology, 120(4), 922–934.
Kissane, D. W., Levin, T., Hales, S., Lo, C., & Rodin, G. (2011). Psychotherapy for depression in cancer and palliative care depression and cancer (pp. 177–206). Wiley.
Kissane, D. W., Wein, S., Love, A., & Lee, X. Q. (2004). The Demoralization Scale: A report of its development and preliminary validation. Journal of Palliative Care, 20(4), 269–276.
Klibert, J. J., Langhinrichsen-Rohling, J., & Saito, M. (2005). Adaptive and maladaptive aspects of self-oriented versus socially prescribed perfectionism. Journal of College Student Development, 46(2), 141–156.
Limburg, K., Watson, H. J., Hagger, M. S., & Egan, S. J. (2017). The relationship between perfectionism and psychopathology: A meta-analysis. Journal of Clinical Psychology, 73(10), 1301–1326.
Linden, W. (1984). Development and initial validation of a life event scale for students. Canadian Journal of Counselling and Psychotherapy, 18(3), 106–110.
Linehan, M. M. (1993). Cognitive behavioural therapy of borderline personality disorder. Guilford.
Manassis, K., Tannock, R., & Monga, S. (2009). Anxious by maternal-versus self-report: Are they the same children? Journal of the Canadian Academy of Child and Adolescent Psychiatry, 18(2), 103–109.
Marsa, R., Bahmani, B., Naghiyaee, M., & Barekati, S. (2017). The effectiveness of cognitive-existential group therapy on reducing demoralization in the elderly. Middle East Journal of Family Medicine, 7(10), 42.
McFarland, C., & Alvaro, C. (2000). The impact of motivation on temporal comparisons: Coping with traumatic events by perceiving personal growth. Journal of Personality and Social Psychology, 79(3), 327.
Mehnert, A., Vehling, S., Höcker, A., Lehmann, C., & Koch, U. (2011). Demoralization and depression in patients with advanced cancer: Validation of the German version of the demoralization scale. Journal of Pain and Symptom Management, 42(5), 768–776.
Mitchelson, J. K. (2009). Seeking the perfect balance: Perfectionism and work–family conflict. Journal of Occupational and Organizational Psychology, 82(2), 349–367.
Mullane, M., Dooley, B., Tiernan, E., & Bates, U. (2009). Validation of the demoralization scale in an Irish advanced cancer sample. Palliative & Supportive Care, 7(3), 323–330.
Mushquash, A. R., & Sherry, S. B. (2012). Understanding the socially prescribed perfectionist’s cycle of self-defeat: A 7-day, 14-occasion daily diary study. Journal of Research in Personality, 46(6), 700–709.
Neumeister, K. L. S., & Finch, H. (2006). Perfectionism in high-ability students: Relational precursors and influences on achievement motivation. Gifted Child Quarterly, 50(3), 238–251.
O’Connor, Rasmussen, S., & Hawton, K. (2010). Predicting depression, anxiety and self-harm in adolescents: The role of perfectionism and acute life stress. Behaviour Research and Therapy, 48(1), 52–59.
Portešová, Š, & Urbánek, T. (2013). Typology of perfectionism in a group of mathematically gifted Czech adolescents over one decade. Journal of Early Adolescence, 33(8), 1116–1144.
Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, & Computers, 36(4), 717–731.
Rice, K. G., Ashby, J. S., & Gilman, R. (2011). Classifying adolescent perfectionists. Psychological Assessment, 23(3), 563–577.
Rozental, A., Shafran, R., Wade, T., Egan, S., Nordgren, L. B., Carlbring, P., Landström, A., Roos, S., Skoglund, M., Thelander, E., Trossell, L., Örtenholm, A., & Andersson, G. (2017). A randomized controlled trial of internet-based cognitive behavior therapy for perfectionism including an investigation of outcome predictors. Behaviour Research and Therapy, 95, 79–86.
Shahar, G., Blatt, S. J., Zuroff, D. C., Krupnick, J. L., & Sotsky, S. M. (2004). Perfectionism impedes social relations and response to brief treatment for depression. Journal of Social and Clinical Psychology, 23(2), 140–154.
Sherry, S. B., MacKinnon, A. L., Fossum, K. L., Antony, M. M., Stewart, S. H., Sherry, D. L., et al. (2013). Perfectionism, discrepancies, and depression: Testing the perfectionism social disconnection model in a short-term, four-wave longitudinal study. Personality and Individual Differences, 54(6), 692–697.
Sironic, A., & Reeve, R. A. (2012). More evidence for four perfectionism subgroups. Personality and Individual Differences, 53(4), 437–442.
Slade, P. D., & Owens, R. G. (1998). A dual process model of perfectionism based on reinforcement theory. Behavior Modification, 22(3), 372–390.
Smith, C. A., & Lazarus, R. S. (1993). Appraisal components, core relational themes, and the emotions. Cognition & Emotion, 7(3–4), 233–269.
Smith, M. M., Sherry, S. B., Chen, S., Saklofske, D. H., Mushquash, C., Flett, G. L., & Hewitt, P. L. (2018a). The perniciousness of perfectionism: A meta-analytic review of the perfectionism-suicide relationship. Journal of Personality, 86(3), 522–542.
Smith, M. M., Sherry, S. B., McLarnon, M. E., Flett, G. L., Hewitt, P. L., Saklofske, D. H., & Etherson, M. E. (2018b). Why does socially prescribed perfectionism place people at risk for depression? A five-month, two-wave longitudinal study of the perfectionism social disconnection model. Personality and Individual Differences, 134, 49–54.
Smith, M. M., Sherry, S. B., Rnic, K., Saklofske, D. H., Enns, M., & Gralnick, T. (2016). Are perfectionism dimensions vulnerability factors for depressive symptoms after controlling for neuroticism? A meta-analysis of 10 longitudinal studies. European Journal of Personality, 30(2), 201–212.
Smith, M. M., Sherry, S. B., Saklofske, D. H., & Mushqaush, A. R. (2017a). Clarifying the perfectionism-procrastination relationship using a 7-day, 14-occasion daily diary study. Personality and Individual Differences, 112, 117–123.
Smith, M. M., Speth, T. A., Sherry, S. B., Saklofske, D. H., Stewart, S. H., & Glowacka, M. (2017b). Is socially prescribed perfectionism veridical? A new take on the stressfulness of perfectionism. Personality and Individual Differences, 110, 115–118.
Tein, J.-Y., Sandler, I. N., & Zautra, A. J. (2000). Stressful life events, psychological distress, coping, and parenting of divorced mothers: A longitudinal study. Journal of Family Psychology, 14(1), 27.
Tugade, M. M., & Fredrickson, B. L. (2004). Resilient individuals use positive emotions to bounce back from negative emotional experiences. Journal of Personality and Social Psychology, 86(2), 320.
Vehling, S., Kissane, D. W., Lo, C., Glaesmer, H., Hartung, T. J., Rodin, G., & Mehnert, A. (2017). The association of demoralization with mental disorders and suicidal ideation in patients with cancer. Cancer, 123(17), 3394–3401.
Wetherall, K., & RobbO’Connor, K. A. (2018). An examination of social comparison and suicide ideation through the lens of the integrated motivational-volitional model of suicidal behavior. Suicide and Life-Threatening Behavior, 49(1), 167–182.
Zanicotti, C. G., Perez, D., & Glue, P. (2012). Mood and pain responses to repeat dose intramuscular ketamine in a depressed patient with advanced cancer. Journal of Palliative Medicine, 15(4), 400–403.
Funding
No funds, grants, or other support was received.
Author information
Authors and Affiliations
Contributions
AB: Conceptualization, formal analysis, writing, tables and figures. AP: writing, review and editing, supervision. AS: writing, review and editing, supervision. MK: Investigation, methodology, resources, writing, supervision.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical Approval
The questionnaire and methodology for this study was approved by the Institutional Review Board Research Integrity and Compliance committee of the University of South Florida (Pro00038577). This study was performed in accordance with the ethical standards as instituted in the 1964 Declaration of Helsinki.
Consent to Participate
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Bender, A.M., Peterson, A.L., Schuck, A. et al. Perfectionism, Negative Life Events, and Cognitive Appraisal: A Contextual Model of Perfectionism’s Maladaptive Nature. J Rat-Emo Cognitive-Behav Ther 40, 723–742 (2022). https://doi.org/10.1007/s10942-021-00437-9
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10942-021-00437-9