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Copyright 1991 by the American Psychological Association, Inc. 0021-843X/91/$3.00
Dimensions of Perfectionism in Unipolar Depression
Paul L. Hewitt
Brockville Psychiatric Hospital, Brockville, Ontario, Canada and Department o f Psychiatry, University o f Ottawa, Ottawa, Ontario, Canada
Gordon L. Flett
York University, Toronto, Ontario, Canada
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.
Recently there has been renewed interest in personality factors related to depression (see Carson, 1989). Perfectionism is a construct that has been described as a potential vulnerability factor in depression by both psychoanalytic (Bibring, 1953) and cognitive theorists (Beck, 1967; Kanfer & Hagerman, 1981 ). For example, Kanfer and Hagerman contended that excessive selfstandards serve to increase the frequency and magnitude o f failure experiences. Perfectionistic self-standards and attendant failure experiences combine with self-blame or distress to produce depression. Investigations have confirmed the presence o f an association between perfectionism and subclinical depression (Hewitt & Dyck, 1986; Hewitt & Flett, 1990); however, these studies are limited in several respects. For example, there have been no direct examinations of perfectionism in clinically depressed patients, so it is not known whether past findings generalize to the experience of clinical depression. The need for direct research is further indicated by the equivocal findings o f previous studies that have examined clinical depression and certain components of the perfectionism construct, including high self-standards and discrepancies between the actual and ideal self (Carver, LaVoie, Kuhl, & Ganellen, 1988; Ganellen, 1988; Strauman, 1989). Finally, most previous research has been limited by a ten-
An earlier version ofthis article was presented at the annual meeting of the Canadian Psychological Association, Ottawa, Ontario, Canada, May 1990. This research was supported by Grant 410-89-0335 from the Social Sciences and Humanities Research Council of Canada as well as by a grant from the Research and Program Evaluation Committee, Brockville Psychiatric Hospital, Brockville, Ontario, Canada. We thank Jane Baldock, Jeff Jackson, Amde Teferi, Aygodan Ugur, and Zul WaUani for referring patients and Marjorie Cousins, Charles Massey, Rosemary Smith, Wendy Turnbull-Donovan, and the Friendship Centre, Brockville, Ontario, Canada, for their assistance. We also express our gratitude to Norman Endler and the three reviewers for their comments. Correspondence concerning this article should be addressed to Paul L. Hewitt, Department of Psychology, Elmgrove Unit, Brockville Psychiatric Hospital, Brockville, Ontario K6V 5W7, Canada. 98
dency to view the perfectionism construct from a unidimensional cognitive perspective (Burns, 1983). Recent studies have shown that the perfectionism construct is multidimensional and has both personal and social aspects (Frost, Marten, Lahart, & Rosenblate, 1990; Hewitt & Flett, in press). For instance, factor analyses of our Multidimensional Perfectionism Scale (MPS; Hewitt & Flett, 1989, in press) have identified three components of perfectionism: Self-Oriented, Other-Oriented, and Socially Prescribed Perfectionism. According to Hewitt and Flett (in press), self-oriented perfectionism is an intrapersonai dimension characterized by a strong motivation to be perfect, setting and striving for unrealistic self-standards, focusing on flaws, and generalization o f self-standards. Self-oriented perfectionism may also involve a well-articulated ideal self-schema (see Hewitt & Genest, 1990). Other-oriented perfectionism involves similar behaviors, but these behaviors are directed toward others instead o f toward the self. Finally, socially prescribed perfectionism entails the belief that others have perfectionistic expectations and motives for oneself. The need for a multidimensional approach is indicated by research with college students that has shown that both self-oriented and socially prescribed perfectionism are correlated positively with subclinical depression (Flett, Hewitt, Blankstein, & O'Brien, in press; Hewitt & Flett, in press). These findings notwithstanding, it remains to be established whether the various perfectionism dimensions are involved in clinical depression. Thus, the primary goal o f this study was to use a multidimensional perspective to examine whether clinically depressed persons are characterized by high levels of perfectionism. Although our main purpose was to examine perfectionism and clinical depression, we felt it was also important to examine perfectionism and other forms o fpsychopathology, such as anxiety disorders. A link with anxiety is suggested by past research that has shown an association between self-oriented perfectionistic attitudes and trait anxiety in college students (Flett, Hewitt, & Dyck, 1989). An association between socially prescribed perfectionism and anxiety is particularly likely given that a fear of negative social evaluation is an important element of both constructs (Endler & Okada, 1975), as well as the fact
mean years of education. Bond.. Klein.28).001. Patients with a concurrent diagnosis of depression were excluded. The means and standard deviations o f the measures are presented in Table 1.01. Rush.SHORT REPORTS that the discrepancy between the actual self and the ought self has been related to greater anxiety (Higgins. The MPS (Hewitt & Flett. The EMAS-S is a 20-item self-report measure of the autonomic-emotional and cognitive-worry compo- . F(2. 1989. The three groups did not differ on age. 4 generalized anxiety. Method 99 nents of state anxiety.001. & Garbin. but not on Other-Oriented Perfectionism. Univariate tests indicated that the three groups differed on SelfOriented Perfectionism. The patient groups did not differ from one another. In addition.. Hewitt to confirm the DSM-III-R diagnoses from the Research Diagnostic Criteria (Spitzer et al. 1978) and Beck Depression Inventory scores (BDI. depressed and anxious patients had higher levels o f Socially Prescribed Perfectionism than did the normal control subjects. Subjects The depressed group consisted of 22 patients (6 men and 16 women) admitted to an acute-care psychiatric unit. and on Socially Prescribed Perfectionism.59). and test-retest reliabilities over 3 months in 39 patients were . Results Initially.38). Initially. 1978) and to assess inclusion and exclusion criteria. Strauman. Intercorrelations of the subscales range between . ns.73. chose not to participate in the study. wherein both the depressed and anxious patients had higher E M A S . Each patient also had a probable or definite diagnosis of major depression on the basis of Research Diagnostic Criteria (Spitzer. 53) = 0.. & Emery. Hewitt.35 (SD = 0. Turnbull-Donovan. F(2. G r o u p differences on the perfectionism dimensions were exa m i n e d by conducting a multivariate analysis o f covariance with group status as the independent variable and the M P S subscale scores as the dependent variables. & Mikail. .64 years (SD = 11. and they had a mean of 14.27 (SD = 2. 13 patients (4 men and 9 women) diagnosed with an anxiety disorder on the basis of DSM-III-R (American Psychiatric Association. p < . Anxiety levels were also c o m p a r e d a m o n g the groups in a one-way analysis o f covariance. Multiple comparisons revealed that depressed patients had higher m e a n levels o f Self-Oriented Perfectionism than did the other two groups. and multiple comparisons showed that depressed patients had higher BDI scores than did either the anxiety patients or the normal control subjects. Their mean age was 32. . ns. and mean number of previous admissions.40 for students and between . & Strauman. Flett. but did differ on education. respectively. p < . F(2. p < . in press. Respondents make 7-point ratings (1 = stronglydisagreeto 7 = stronglyagree) of statements that reflect Self-Oriented Perfectionism (e. and . 1987) criteria (4 simple phobia..04. Subjects were excluded if they had BDI scores above 8 or if they had had any psychological treatment in the previous 2 years. 22 normal control subjects (6 men and 16 women) were matched on age and gender with the depressed group. F(2.28 and . Endicott. (1989).01. Shaw. F(2. Other-Oriented Perfectionism (e. 53) = 17.25 and . Patients were excluded from the depressed group if they had a concurrent anxiety disorder. and Socially Prescribed Perfectionism (e. 54) = 0. These patients were interviewed by a psychiatrist and were diagnosed as having unipolar depression on the basis of criteria from the Diagnostic and Statistical Manual of Mental Disorders (rev. a second goal o f this study was to determine if differences in perfectionism were specific to depression or generalize to anxiety. Beck Depression Inventory The BDI is a 2 l-item scale designed to measure the severity of depressive symptomatology (Beck et al. I have high expectations for the people who are important to me).. 3rd ed. 53) = 7. Endler Multidimensional Anxiety Scales-State (EMAS-S. 0. One of my goals is to be perfect in every thing I do).001.53 for patients.. Coefficient alphas were reported as .g. 1979). but the anxiety patients and normal control subjects did not differ from one another.68 years (SD = 12. 1987). The multivariate effect o f group status was significant. An analysis o f covariance with BDI scores as the dependent variable was conducted to compare depression scores a m o n g the groups. Endler. mean years of education ofl 1. in press).81 for Socially Prescribed Perfectionism (Hewitt & Flett. in press) has three subscales of 15 items each. 1986.g. p < . American Psychiatric Association.23 (SD = 1. p < . 53) = 3. and . Steer.54 (SD = 1.42). 1988). three potential subjects. or alcohol abuse were asked to volunteer in a study of personality factors and depression.g. These subjects were interviewed to assess inclusion and exclusion criteria. The depressed patients had a mean age of 35. F(2. and n o r m a l control subjects. 1989).001. Finally. Several studies have demonstrated its reliability and validity (Beck. Edwards. The normal control subjects had had m o r e e d u c a t i o n t h a n had either the depressed or anxious patients. 54) = 15. Beck. and mean number of previous admissions of 0. My family expects me to be perfect).36). 104) = 3.78 for these subscales.75. 11.74. psychosis. the anxiety patients had higher BDI scores than did the normal control subjects.05. & Parker. 1989). The depressed and anxious patients did not differ from one another on Socially Prescribed Perfectionism. Patients were interviewed by Paul L. Procedure Depressed and anxious patients with a minimum Grade 8 education and no history of mania. F(6.15 years (SD = 9. two with diagnoses of depression and one of anxiety.88 for Self-Oriented. F(2. 1979) greater than 9. The normal control subjects were recruited from hospital staff and the community and were selected initially on the basis of matches with the depressed patients. Vitelli. Finally.39). Additional evidence indicates that the MPS subscales have adequate concurrent validity in clinical samples (Hewitt & Flett.13). Extensive validity and reliability evidence has been provided by Endler et al. Consequently. Questionnaires were administered in a random order and all subjects were paid $20 Canadian for their participation. anxious patients. Materials Multidimensional Perfectionism Scale. several one-way analyses o f variance were done to compare groups on age and education.67.28. 53) = 30. and 2 panic disorder) were recruited from the acute unit.60) years of education. DSM-III-R. This was addressed by c o m p a r i n g perfectionism levels in depressed patients.184.108.40.206 for OtherOriented. This analysis was significant.S scores than did the normal control subjects but did not differ from one another. 1990). This analysis was significant. In addition. Their mean age was 36. p < . & Robins. All o f the analyses herein used education level as a covariate. 3 obsessive-compulsive.08 (SD = 0. organic impairment.
56*** B cally anxious and normal control subjects. p < . The analyses to predict anxiety found that none of the MPS subscales contributed significant variance after depression had been entered into the equation. Note. Other = Other-Oriented Perfectionism. 1984). The results showed that the depressed patients were differentiated from the other subjects by a higher level of self-oriented perfectionism.63 2. and Social = Socially Prescribed Perfectionism.18 16.39 52. BDI = Beck Depression Inventory.81 20.40 53.64 SD 0. Social 4.11 -.80"** i These correlations and subsequent regression analyses must be interpreted with caution.32* -. and Perfectionism Measures for Depressed.05). Higher scores reflect greater depression. These data indicate that socially prescribed perfectionism is a feature of depression. but it is not necessarily specific to depression. other-oriented perfectionism has been shown to correlate with . Self = Self-Oriented Perfectionism.61 13. Anxious. additional findings revealed that both the depressed and anxious patients had higher levels of socially prescribed perfectionism than did the normal control subjects. Regression analyses were conducted to provide further information with regard to the unique contribution of the MPS dimensions to depression and anxiety. The analyses further revealed that other-oriented perfectionism was not related to depression in this study.82. given that several assumptions are violated when treating data from discrete groups as continuous. Because self-oriented perfectionists tend to equate self-worth with performance (Pacht. and 22 control subjects.10 M 18. and Anxiety Measure MPS 1. 1981) but also the personal impact and meaning of failure experiences. Table 2 presents the correlations among the measures collapsed across groups.46 15. BDI = Beck Depression Inventory.31 58.59 18. after anxiety scores were first entered.55 12. This suggests that these persons may generate their own failures and stressors.60 13.50 55.24 . p < . anxiety.09 76. BDI 5. R2ehaage= .61"** . 1979.54 53. and perfectionism.32 54. The data are based on the responses of 22 depressed patients. Kiloh & Garside.00 60. Other = Other-Oriented Perfectionism. Depression. ~ It can be seen that both Self-Oriented and Socially Prescribed Perfectionism were associated significantly with depression and anxiety. *p<. Self-oriented perfectionists' tendencies to set unrealistic standards and stringently evaluate their own performance increases not only the frequency of failure (Kanfer & Hagerman. Anxiety.87 68. We included these analyses because of the relative paucity of data in this area.001.39 64.68 M 15. EMAS-S 1 2 3 4 . Consistent with expectations.50 SD 9. our results suggest that higher levels of self-oriented perfectionism may be specific to clinical depression and do not generalize to clinical anxiety.98 20. and Social = Socially Prescribed Perfectionism.42** . OtherOriented Perfectionism did not contribute significant unique variance. This corroborates previous results with college students that indicated that socially prescribed perfectionism is related to several types of maladjustment (Hewitt & Flett.06 -. 1963).23 17. falling short of self-imposed standards on a consistent basis may promote chronic deficits in self-esteem and self-evaluation.05 63. Self-oriented perfectionism ought to be related to depression for several reasons. Other 3. MPS = Multidimensional Perfectionism Scale.70 11. ***p<.01. EMAS-S = Endler Multidimensional Anxiety Scales-State.05 52.12 40.03 17. It is also consistent with claims that a neurotic form of anxious depression exists and stems in part from perceived deprivation and lack of gratification from significant others (see Gersh & Fowles. Thus. Although this dimension was not associated with depression or with anxiety.03. Self 2.39 SD 11.76 50.49*** .100 Table 1 SHORT REPORTS Means and Standard Deviations of Depression.17 13. R2c~n~ = . **p<. Self-Oriented Perfectionism contributed a significant amount of variance in depression scores (multiple R = . again after anxiety scores were entered. in press).11 M 2. In this set of analyses. .04.42 15.64 17.96 22. which make them particularly prone to depressive episodes. Discussion The purpose of this study was to use a multidimensional approach to assess whether levels of perfectionism in clinically depressed patients differ from levels of perfectionism in clini- Table 2 Correlations Among Perfectionism Dimensions.35** . 13 anxious patients.83. MPS = Multidimensional Perfectionism Scale.12 SD 12. Socially Prescribed Perfectionism accounted for additional variance (multiple R = .19 15. and Control Subjects Depressed Measure BDI EMAS-S MPS Self Other Social Anxious Control Total M 25. Self = Self-Oriented Perfectionism.05).05. EMAS-S = Endler Multidimensional Anxiety Scales-State.88 Note.46 42. Similarly.
. Research diagnostic criteria: Rationale and reliability.. Cognitive Therapy and Research. & Hagerman.. D. Beck. G.Personality and Individual Differences. our results do not address causality or vulnerability issues. D.. (1967). Hewitt. it remains for future research to establish whether the perfectionism dimensions are involved in susceptibility to these adjustment problems. (1979).. 83-86. & Strauman. Depressed patients were differentiated from the other two groups by higher levels of self-oriented perfectionism. (1975). P.. Journal of Social Behavior and Personality 5. Journal of Personality and Social Psychology Hewitt. E H. 40. Journal of Social and Clinical Psychology. L. R. histrionic.. Medical Aspects of Human Sexuality. S. Reflectionson perfection. The ideal-self: Schematic processing of perfectionistic content in dysphoric university students. and psychometric properties in psychiatric samples. Assessment of state and trait anxiety: Endler Multidimensional Anxiety Scales. 39. CA: Academic Press. Hewitt. Shaw. & Ganellen. L. Vitelli. (1988). & Flett. M. Third. Specificity of attributions and overgeneralization in depression and anxiety. D.. Spitzer. New York: Guilford Press. 59. & O'Brien. 1989 Revision received August 17. and type of discrepancy influence affect. 17. N.. Anxiety Research. T. & Emery. Cognitive concomitants of depression: A further examination of the roles of generalization. Neurotic depression: The concept of anxious depression. Hewitt. A consideration of these factors will be in keeping with self-regulation models (e. The independence of neurotic depression and endogenous depression. 2. & Robins. Washington. Gersh. Endler. Perfectionism and depression: A multidimensional analysis. 35. British Journal of Psychiatry. L. Finally. no attempt was made to examine factors that may mediate the association between perfectionism and depression. Journal of Personality and Social Psychology. (1953). Kanfer & Hagerman.. In E Greenacre (Ed. J. Rehm (Ed.. assessment. Depression: Clinical experimental and theoretical aspects. (1987).. L. 423-438. and vulnerability to depression. Lahart. Edwards.& Mikail. N. R. 802-808. and self-criticism. E L.. 137-142. Manuscript submitted for publication. G. Cognitive therapy of depression: A treatment manual. Depue (Ed. L. In summary. G. Clinical Psychology Review. 98.g. P. in press). 101 References American Psychiatric Association. neuroticism. C.. Self-discrepancies in clinical depression and social phobia: Cognitive structures that underlie emotional disorders? Journal of Abnormal Psychology. Kuhl. T. San Diego. it is apparent that our findings are based on self-report data and ought to be replicated with behavioral measures. this study compared levels of perfectionism in depressed and anxious patients and normal control subjects. 1-14. 13-48). 10. R. Certain limitations of the current study must be noted. E. 143-179). Rush. D. Self-oriented perfectionism. R. & Parker. E. 43. New York: Harper & Row. L. L. San Diego. and maladaptive coping styles (Flett et al. Diagnostic and statistical manual of mental disorders (Rev.. & Genest. 109. T. self-focused attention. J. Turnbull-Donovan. J. J. S. M. Flett. & Dyck. R. A.. Burns. (1989). N. CA: Academic Press.SHORT REPORTS measures of antisocial. R. (1990). G.). 350-365. The mechanism of depression. Bibring. Steer. D. & Dyck.. (1988). Affective disorders (pp. 77-100.. (1981)..). G. L.. Hewitt. R. A. & Flett.. high standards. R. Strauman. Psychometric properties of the Beck Depression Inventory: Twenty-fiveyears of evaluation. E. & Okada. Journal of Personality and Social Psychology. (1990). self-critical attributional style. A. E (1963). Hewitt. P. In R. (1989). (1983). R. The dimensions of perfectionism. R. Ganellen. (in press). R.. 51. G. T. 97. C. 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