Skip to main content
SpringerLink
Log in

Perfectionism in Intensive Residential Treatment of Obsessive–Compulsive Disorder

  • Original Article
  • Published:
Cognitive Therapy and Research Aims and scope Submit manuscript

Abstract

Perfectionism is frequently noted in obsessive–compulsive disorder (OCD) and some data suggest that treatment outcomes with cognitive behavioral therapy (CBT) are poorer for OCD patients with higher levels of perfectionism. However, this literature includes inconsistent findings and has thus far been limited to outpatient samples. Existing studies have also not utilized measures of perfectionism in-line with the multidimensional nature of this construct, which includes both adaptive and maladaptive forms of perfectionism. This study administered measures of multidimensional perfectionism and OCD severity at admission and discharge in a large sample (N = 154) of adult OCD patients undergoing intensive residential treatment (IRT). Results indicated that more perfectionistic patients had slightly longer treatment duration. Adjusting for treatment duration and baseline severity, pre-treatment perfectionism did not significantly predict OCD outcomes. However, all domains of perfectionism significantly improved following treatment, and changes in perfectionism significantly predicted OCD outcomes. In particular, greater reduction in maladaptive perfectionism uniquely predicted better OCD symptom outcomes. These results suggest that high initial levels of perfectionism may not prevent OCD patients from benefitting from IRT, and that reduction in perfectionism significantly accounts for OCD treatment gains. Limitations and avenues for future research are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Aldea, M. A., & Rice, K. G. (2006). The role of emotional dysregulation in perfectionism and psychological distress. Journal of Counseling Psychology,53(4), 498.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, 4th edition, text revision. Washington, DC: American Psychiatric Association.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.

    Google Scholar 

  • Baer, L., Jenike, M. A., Ricciardi, J. N., Holland, A. D., Seymour, R. J., Minichiello, W. E., et al. (1990). Standardized assessment of personality disorders in obsessive-compulsive disorder. Archives of General Psychiatry,47(9), 826–830.

    CAS  PubMed  Google Scholar 

  • Blatt, S. J., Quinlan, D. M., Pilkonis, P. A., & Shea, M. T. (1995). Impact of perfectionism and need for approval on the brief treatment of depression: The National Institute of Mental Health Treatment of Depression Collaborative Research program revisited. Journal of Consulting and Clinical Psychology,63, 125–132.

    CAS  PubMed  Google Scholar 

  • Blatt, S. J., Zuroff, D. C., Bondi, C. M., Sanislow, C. A., & Pilkonis, P. A. (1998). When and how perfectionism impedes the brief treatment of depression: Further analyses of the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology,66, 423–428.

    CAS  PubMed  Google Scholar 

  • Bjorgvinsson, T., Hart, A. J., Wetterneck, C., Barrera, T. L., Chasson, G. S., Powell, D. M., et al. (2013). Outcomes of specialized residential treatment for adults with obsessive-compulsive disorder. J Psychiatr Pract.,19, 429–437.

    PubMed  Google Scholar 

  • Bjorgvinsson, T., Wetterneck, C. T., Powell, D. M., Chasson, G. S., Webb, S. A., Hart, J., et al. (2008). Treatment outcome for adolescent obsessive-compulsive disorder in a specialized hospital setting. J Psychiatr Pract.,14, 137–145.

    PubMed  Google Scholar 

  • Boschen, M. J., Drummond, L. M., & Pillay, A. (2008). Treatment of severe, treatment-refractory obsessive- compulsive disorder: A study of inpatient and community treatment. CNS Spectrums,13, 1056–1065.

    PubMed  Google Scholar 

  • Brennan, B. P., Lee, C., Elias, J. A., Crosby, J. M., Mathes, B. M., Andre, M. C., et al. (2014). Intensive residential treatment for severe obsessive-compulsive disorder: Characterizing treatment course and predictors of response. Journal of Psychiatric Research,56, 98–105.

    PubMed  PubMed Central  Google Scholar 

  • Cavedini, P., Erzegovesi, S., Ronchi, P., & Bellodi, L. (1997). Predictive value of obsessive–compulsive personality disorder in antiobsessional pharmacological treatment. European Neuropsychopharmacology,7(1), 45–49.

    CAS  PubMed  Google Scholar 

  • Dreessen, L., Hoekstra, R., & Arntz, A. (1997). Personality disorders do not influence the results of cognitive and behavior therapy for obsessive compulsive disorder. Journal of Anxiety Disorders,11(5), 503–521.

    CAS  PubMed  Google Scholar 

  • Drummond, L. M. (1993). The treatment of severe, chronic, resistant obsessive-compulsive disorder. An evaluation of an in-patient programme using behavioural psychotherapy in combination with other treatments. British Journal of Psychiatry,163, 223–229.

    CAS  PubMed  Google Scholar 

  • Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: A clinical review. Clinical Psychology Review,31, 203–212.

    PubMed  Google Scholar 

  • Egan, S. J., Wade, T. D., & Shafran, R. (2012). The transdiagnostic process of perfectionism. Revista de Psicopatologia y Psicologia Clinicia (Spanish Journal of Clinical Psychology),17, 279–294.

    Google Scholar 

  • Egan, S. J., Wade, T. D., Shafran, R., & Antony, M. M. (2016). Cognitive-behavioral treatment of perfectionism. New York: Guilford Publications.

    Google Scholar 

  • Federici, A., Summerfeldt, L. J., Harrington, J. L., McCabe, R. E., Purdon, C. L., Rowa, K., et al. (2010). Consistency between self-report and clinician-administered versions of the Yale-Brown Obsessive-Compulsive Scale. Journal of Anxiety Disorders,24(7), 729–733.

    PubMed  Google Scholar 

  • Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research,14, 449–468.

    Google Scholar 

  • Gibbon, M., Spitzer, R. L., Williams, J. B., Benjamin, L. S., First, M. B. (1997). Structured clinical interview for DSM-IV axis II personality disorders (SCID-II). American Psychiatric Pub., Washington D. C.

  • Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., Charney, D. S. (1989a). The Yale-Brown obsessive compulsive scale: I. Development, use, and reliability. Archives of General Psychiatry46(11), 1006–1011.

    CAS  PubMed  Google Scholar 

  • Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Delgado, P., Heninger, G. R., et al. (1989). The Yale-Brown obsessive compulsive scale: II. Validity. Archives of General Psychiatry,46(11), 1012–1016.

    CAS  PubMed  Google Scholar 

  • Gordon, O. M., Salkovskis, P. M., & Bream, V. (2016). The impact of obsessive compulsive personality disorder on cognitive behaviour therapy for obsessive compulsive disorder. Behavioural and Cognitive Psychotherapy,44(4), 444–459.

    PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • Koran, L. M., Leventhal, J. L., Fireman, B., & Jacobson, A. (2000). Pharmacotherapy of obsessive-compulsive disorder in a health maintenance organization. American Journal of Health-System Pharmacy,57(21), 1972–1978.

    CAS  PubMed  Google Scholar 

  • Kyrios, M., Horden, C., & Fassnacht, D. B. (2015). Predictors of response to cognitive behavioural treatment for obsessive-compulsive disorder. International Journal of Clinical and Health Psychology,15, 181–190.

    PubMed  PubMed Central  Google Scholar 

  • McGlashan, T. H., Grilo, C. M., Sanislow, C. A., Ralevski, E., Morey, L. C., Gunderson, J. G., et al. (2005). Two-year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders: Toward a hybrid model of axis II disorders. American Journal of Psychiatry,162(5), 883–889.

    PubMed  Google Scholar 

  • O'Connor, R. C. (2007). The relations between perfectionism and suicidality: A systematic review. Suicide and Life-Threatening Behavior,37(6), 698–714.

    PubMed  Google Scholar 

  • Obsessive Compulsive Cognitions Working Group. (1997). Cognitive assessment of obsessive-compulsive disorder. Behaviour Research and Therapy,35(7), 667–681.

    Google Scholar 

  • Obsessive Compulsive Cognitions Working Group. (2005). Psychometric validation of the obsessive belief questionnaire and interpretation of intrusions inventory—Part 2: Factor analyses and testing of a brief version. Behaviour Research and Therapy,43(11), 1527–1542.

    Google Scholar 

  • Pinto, A., Ansell, E., Wheaton, M. G., Krueger, R. F., Morey, L., Skodol, A. E., et al. (2018). Obsessive–compulsive personality disorder and component personality traits (p. 459). Handbook of Personality Disorders: Theory, Research, and Treatment.

    Google Scholar 

  • Pinto, A., Dargani, N., Wheaton, M. G., Cervoni, C., Rees, C. S., & Egan, S. J. (2017). Perfectionism in obsessive-compulsive disorder and related disorders: What should treating clinicians know? Journal of Obsessive-Compulsive and Related Disorders,12, 102–108.

    Google Scholar 

  • Pinto, A., Liebowitz, M. R., Foa, E. B., & Simpson, H. B. (2011). Obsessive compulsive personality disorder as a predictor of exposure and ritual prevention outcome for obsessive compulsive disorder. Behavior Research and Therapy,49, 453–458.

    Google Scholar 

  • Pinto, A., Mancebo, M. C., Eisen, J. L., Pagano, M. E., & Rasmussen, S. A. (2006). The Brown longitudinal obsessive compulsive study: clinical features and symptoms of the sample at intake. Journal of Clinical Psychiatry,67, 703–711.

    PubMed  Google Scholar 

  • Raines, A. M., Carroll, M., Mathes, B. M., Franklin, C. L., Allan, N. P., & Constans, J. I. (2019). Examining the relationships between perfectionism and obsessive-compulsive symptom dimensions among rural veterans. Journal of Cognitive Psychotherapy,33(1), 58–70.

    Google Scholar 

  • Rice, K. G., & Aldea, M. A. (2006). State dependence and trait stability of perfectionism: A short-term longitudinal study. Journal of Counseling Psychology,53, 205–212.

    Google Scholar 

  • Rice, K. G., Ashby, J. S., & Slaney, R. B. (1998). Self-esteem as a mediator between perfectionism and depression: A structural equations analysis. Journal of Counseling Psychology,45(3), 304.

    Google Scholar 

  • Rice, K. G., Richardson, C. M., & Clark, D. (2012). Perfectionism, procrastination, and psychological distress. Journal of Counseling Psychology,59(2), 288.

    PubMed  Google Scholar 

  • Ruscio, A. M., Stein, D. J., Chiu, W. T., & Kessler, R. C. (2010). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry,15(1), 53–63.

    CAS  PubMed  Google Scholar 

  • Slaney, R. B., & Ashby, J. S. (1996). Perfectionists: Study of a criterion group. Journal of Counseling & Development,74(4), 393–398.

    Google Scholar 

  • Slaney, R. B., Johnson, D. P. (1992). The almost perfect scale. Unpublished manuscript, Pennsylvania State University, University Park, Pennsylvania.

  • Slaney, R. B., Rice, K. G., Mobley, M., Trippi, J., & Ashby, J. S. (2001). The revised almost perfect scale. Measurement and evaluation in counseling and development,34(3), 130.

    Google Scholar 

  • Skapinakis, P., Caldwell, D. M., Hollingworth, W., Bryden, P., Fineberg, N. A., Salkovskis, P., et al. (2016). Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis. The Lancet Psychiatry,3(8), 730–739.

    PubMed  PubMed Central  Google Scholar 

  • Starcevic, V., & Brakoulias, V. (2014). New diagnostic perspectives on obsessive-compulsive personality disorder and its links with other conditions. Current Opinion in Psychiatry,27(1), 62–67.

    PubMed  Google Scholar 

  • Steketee, G., Frost, R., & Bogart, K. (1996). The Yale-Brown obsessive compulsive scale: Interview versus self-report. Behaviour Research and Therapy,34(8), 675–684.

    CAS  PubMed  Google Scholar 

  • Stewart, S. E., Stack, D. E., Farrell, C., Pauls, D. L., & Jenike, M. A. (2005). Effectiveness of intensive residential treatment (IRT) for severe, refractory obsessive-compulsive disorder. Journal of Psychiatric Research,39, 603–609.

    PubMed  Google Scholar 

  • Stewart, S. E., Yen, C. H., Stack, D. E., & Jenike, M. A. (2006). Outcome predictors for severe obsessive-compulsive patients in intensive residential treatment. Journal of Psychiatric Research,40, 511–519.

    PubMed  Google Scholar 

  • Thamby, A., & Khanna, S. (2019). The role of personality disorders in obsessive-compulsive disorder. Indian Journal of Psychiatry,61(Suppl 1), S114.

    PubMed  PubMed Central  Google Scholar 

  • Wheaton, M. G., & Pinto, A. (2019). Transdiagnostic Factors in Obsessive-Compulsive Personality Disorder (p. 345). Compulsions and Related Phenomena: A Transdiagnostic Approach to Obsessions.

    Google Scholar 

  • Wilhelm, S., Berman, N. C., Keshaviah, A., Schwartz, R. A., & Steketee, G. (2015). Mechanisms of change in cognitive therapy for obsessive compulsive disorder: Role of maladaptive beliefs and schemas. Behaviour Research and Therapy,65, 5–10.

    PubMed  Google Scholar 

  • Widiger, T. A. (2007). Dimensional models of personality disorder. World Psychiatry,6(2), 79–83.

    PubMed  PubMed Central  Google Scholar 

  • Widiger, T. A., & Sanderson, C. J. (1995). Toward a dimensional model of personality disorders. In W. J. Livesley (Ed.), Diagnosis and treatment of mental disorders (pp. 433–458). The DSM-IV personality disorders: Guilford Press, New York.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, Barnard College, New York, NY, USA

    Michael G. Wheaton

  2. Department of Psychology, Baruch College/City University of New York, New York, NY, USA

    Angela Marinilli Pinto

  3. Department of Psychology, Stony Brook University, Stony Brook, NY, USA

    Cynthia Cervoni

  4. OCD Institute, McLean Hospital/Harvard Medical School, Belmont, MA, USA

    Jesse M. Crosby, Eric D. Tifft, Brittany M. Mathes, Lauryn E. Garner, Nathanial Van Kirk & Jason A. Elias

  5. Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, USA

    Brittany M. Mathes

  6. Department of Psychology, Fordham University, Bronx, NY, USA

    Lauryn E. Garner

  7. Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA

    Anthony Pinto

  8. Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA

    Anthony Pinto

Authors
  1. Michael G. Wheaton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Angela Marinilli Pinto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cynthia Cervoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jesse M. Crosby
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eric D. Tifft
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Brittany M. Mathes
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lauryn E. Garner
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nathanial Van Kirk
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jason A. Elias
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Anthony Pinto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael G. Wheaton.

Ethics declarations

Conflict of Interest

Michael G. Wheaton, Angela Marinilli Pinto, Cynthia Cervoni, Jesse Crosby, Eric D. Tifft, Brittany M. Mathes, Lauryn E. Garner, Nathanial Van Kirk, Jason Elias, Anthony Pinto declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Animals Rights

No animal studies were carried out by the authors for this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wheaton, M.G., Pinto, A.M., Cervoni, C. et al. Perfectionism in Intensive Residential Treatment of Obsessive–Compulsive Disorder. Cogn Ther Res 44, 136–144 (2020). https://doi.org/10.1007/s10608-019-10047-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10608-019-10047-6

Keywords

Search

Navigation