Perfectionism as a mediator of psychological distress: Implications for addressing underlying vulnerabilities to the mental health of medical students

Self-compassion, perfectionism, impostor phenomenon, stress and anxiety in patients with localized provoked vulvodynia

Studies have shown that psychological distress has a role in the symptomology of localized provoked vulvodynia. Therefore, psychosocial support has been presented as a valuable part of the treatment. However, little is known about which psychological variables that coincide with localized provoked vulvodynia. The purpose of this study was to identify qualities of psychological distress in patients with localized provoked vulvodynia. Patients with localized provoked vulvodynia were consecutively recruited to participate in this cross-sectional questionnaire-based study. Participants completed a self-report questionnaire measuring perfectionism, impostor phenomenon, self-compassion, anxiety and perceived stress. A sample of 30 patients were included. Questionnaire results suggestive of perfectionism was seen in 63%, impostor phenomenon in 80%, low self-compassion in 27%, anxiety in 43% and perceived stress in 23% of the participants. The level of self-compassion was higher in patients in a committed relationship. The investigated qualities appear to be more common in patients with localized provoked vulvodynia than in comparable groups. Impostor phenomenon and perfectionism were particularly common, with more than half of the study population scoring above the cutoff for clinical significance. This motivates research to investigate if interventions targeting impostor phenomenon and perfectionism, may aid in the treatment of localized provoked vulvodynia.

Feedback-related negativity in perfectionists: An index of performance outcome evaluation

It has been suggested that maladaptive perfectionists are more prone to concern over their performance outcomes than adaptive perfectionists. Performance outcome evaluation is reflected in the amplitude of feedback-related negativity (FRN) in brain electroencephalography (EEG). Hence, the amplitude of the FRN after receiving unfavorable feedback indicating a negative performance outcome may reflect personality characteristics. In other words, EEG could be a better marker of personality characteristics than self-report measures. However, the FRN component has not yet been investigated between different types of perfectionists. In the present study, group differences in the FRN were examined between two groups of adaptive and maladaptive perfectionists and a group of non-perfectionists during a monetary gambling task. We observed a larger FRN amplitude for adaptive perfectionists than for maladaptive perfectionists. This finding is consistent with previous reports that reward prediction error is reflected in the amplitude of the FRN. This difference in FRN could be interpreted as the pessimistic outcome expectation biases in maladaptive perfectionists.

Self-critical perfectionism mediates the relationship between self-esteem and satisfaction with life in Lebanese university students

BACKGROUND

The psychological mechanisms that underlie the relationship between self-esteem and life satisfaction remain unclear and not well-understood. We sought through the present study to test the hypothesis that perfectionism plays a significant mediating role in the association between self-esteem and satisfaction with life among Lebanese university students.

METHODS

A cross-sectional study was performed in a sample of 363 students (61.7% females, mean age = 22.65 ± 3.48 years). Three research instruments were used: satisfaction with life scale, Rosenberg self-esteem scale and big three perfectionism scale.

RESULTS

Higher self-esteem was significantly associated with lower self-critical perfectionism (Beta = - 0.47), whereas higher self-critical perfectionism was significantly associated with lower satisfaction in life (Beta = - 0.29). Finally, higher self-esteem was significantly and directly associated with higher satisfaction with life (Beta = 0.48).

CONCLUSION

The present preliminary findings point to the role of self-critical perfectionism as a buffer between self-esteem and satisfaction with life, suggesting the roles of self-esteem and perfectionism as promising avenues for promoting satisfaction with life in adolescent students.

Social Support Mediates the Relationship Between Coping Styles and the Mental Health of Medical Students

Purpose

This study aimed to explore the impact that coping styles and social support have on the mental health of medical students by constructing a corresponding structural situation model that reveals the complex relationship between these three factors. In doing so, it seeks to help medication students better manage mental health problems.

Patients and Methods

The online study was conducted between March 6, 2021 and May 6, 2021. A total of 318 participants from multiple medical schools were involved. The general information questionnaire, simple coping style questionnaire (SCSQ), perceived social support scale (PSSS) and symptom checklist 90 (SCL-90) were used to collect relevant information from the subjects by snowball sampling. An independent t-test, ANOVA, Pearson correlation coefficient analysis, and intermediary effect analysis were all used to analyze the relevant data and construct the structural equation model.

Results

There was a significant difference in SCL-90 between medical students and national college students (1.78±0.70, P < 0.001), and the positive rate of mental health status was as high as 40.3%. Sleep quality, regular diet, and positive coping style were positively correlated with mental health (P < 0.01), while negative coping styles and total scores of coping style as well as family, friends, and other sources of social support and total scores of social support were negatively correlated with mental health problems (P < 0.01). Positive and negative coping styles have an impact on mental health through the mediating effect of between social support and coping styles, as well as in the direct pathway.

Conclusion

The mental health status of medical students was significantly poor. Medical schools should thus pay close attention to the mental health status of students and encourage them to develop healthy living habits, optimize coping styles, and establish stable sources of social support to improve their psychological wellbeing.

Burnout among Male Physicians: A Controlled Study on Pathological Personality Traits and Facets

There is a high prevalence of job burnout in physicians, impacting both the professional and personal levels. This study aimed to investigate whether physicians with burnout show specific pathological traits and facets of their personalities compared with healthy controls, according to the dimensional personality models in the ICD-11 and DSM-5. The role of perceived stress, anxiety, and depression were exploratively investigated regarding group differences. Male physicians (n = 60) were recruited into two groups (burnout vs. healthy). The Personality Inventory for the DSM-5 Brief Form Plus (PID5BF+) and the Maslach Burnout Inventory (MBI) were applied. The Wilcoxon rank-sum test (WRS) showed group differences in five of the six traits and in six of the seventeen facets of the PID5BF+. Multiple binary logistic regression, controlling for age, showed that deceitfulness (3.34 (1.36–9.35), p = 0.013) and impulsivity (10.20 (2.4–61.46), p = 0.004) significantly predicted burnout. Moreover, the WRS showed significant group differences in perceived stress, depressive, and anxiety symptoms (all p < 0.00)]. The findings suggest a relationship between pathological personality facets and burnout in a sample of male physicians. In particular, the facets of deceitfulness and impulsivity appear to play an important role. Furthermore, burnout showed well-known associations with perceived stress, depressive, and anxiety symptoms.

Perfectionism as a predictor of physician burnout

Background

Burnout is common among physicians and has detrimental effects on patient care and physician health. Recent editorials call attention to perfectionism in medicine; however, no studies to date have examined the effect of perfectionism on burnout in physicians practicing in the United States. This study examined associations among demographics, perfectionism and personality traits, and burnout among practicing physicians.

Methods

This cross-sectional study included general pediatric and pediatric sub-specialist physicians. Out of the 152 physicians contacted, 69 enrolled (Meanage = 44.16 ± 9.98; 61% female). Emotional exhaustion, depersonalization, and personal accomplishment burnout were assessed via the Maslach Burnout Inventory. Validated instruments were used to measure personality and perfectionism. Data were analyzed using linear regression models.

Results

Across physicians assessed, 42% reported either high emotional exhaustion burnout or depersonalization burnout. High self-critical perfectionism uniquely predicted both high emotional exhaustion burnout (B = 0.55, 95%CI 0.25–0.85) and depersonalization burnout (B = 0.18, 95%CI 0.05–0.31). Low conscientiousness (B = -6.12; 95%CI, -10.95- -1.28) predicted higher emotional exhaustion burnout and low agreeableness (B = -3.20, 95%CI -5.93- -0.46) predicted higher depersonalization burnout.

Conclusions

Perfectionism is understudied among physicians and the current findings suggest that addressing system and individual-level factors that encourage perfectionism is warranted and may reduce risk for physician burnout.

A longitudinal cohort study observed increasing perfectionism and declining resilience, ambiguity tolerance and calling during medical school which is not explained by student personality

BACKGROUND

The medical degree is a long and challenging program, not just academically, but regarding the expectations engrained in the culture of medical education. The recent proliferation of literature on the poor mental well-being among students suggests a dilemma that often lays the onus on students to improve their health. The link between personality and vulnerability to psychological distress is acknowledged. This longitudinal study looked at personality in 1^st-year and changes in levels of certain psychological traits, as proxy indicators of well-being, in 4^th-year. We aimed to determine to what extent changes in psychological traits over time may be attributed to personality.

METHODS

Medical students completed surveys at the start (1^st-year: baseline) and finish (4^th-year: follow-up) of their medical degree (N = 154). Temperament and character personality, Perfectionism-Concern over mistakes (CoM), Ambiguity Tolerance, Resilience, Calling to medicine, and demographic variables were measured. Paired t-tests compared changes in psychological traits from baseline to follow-up. Linear regression examined whether personality at baseline would predict levels of psychological traits at follow-up.

RESULTS

The temperament and character profile of the sample was as expected, and congruent with previous studies, which describe a mature personality. Over four years, levels of Perfectionism-CoM significantly increased, while Resilience, Ambiguity Tolerance and Calling to medicine decreased. Harm Avoidance, Persistence, Self-Directedness and Cooperativeness at baseline significantly predicted levels of these traits at follow-up, but effect sizes were weak. Correlations were in the expected direction and weak.

CONCLUSIONS

Most commencing medical students, including this cohort, have mature personalities with an industrious temperament and an adaptable character. Yet over four years of medicine, Ambiguity Tolerance, Resilience and Calling declined while Perfectionism-CoM, already elevated at baseline, continued to increase to the final year. Of concern is the increased perfectionism that is strongly associated with poor mental health and psychological distress. The findings suggest a closer look at the entirety of the education environment and how its culture, including secondary school and the medical school admissions processes may influence these trends in students. As medical educators we should question why the pathway to medicine places such unhealthy pressure on students who aspire to be doctors.

Benchmarking in Academic Physical Therapy Using the PT-GQ Survey: Wave 2 Update With Application to Accreditation Reporting

OBJECTIVE

The Benchmarking in Academic Physical Therapy study uses the Physical Therapist-Graduation Questionnaire (PT-GQ) survey to develop comprehensive performance benchmarks for physical therapist education. These benchmarks facilitate interprofessional comparisons and have application to accreditation self-study reporting. The purpose of this study is to report updated benchmarks from enrollment Wave 2 of the study, with an emphasis on curricular areas that align with accreditation standards.

METHODS

Seventy doctor of physical therapy (DPT) programs (26.5% national sample) administered the survey to graduates during 2020-2021. Where possible, respondent data were contextualized by statistical comparison with published medical student data (Welch t test, Hedges g).

RESULTS

There were 1894 respondents who participated in the study (response rate: 63.9%). The average survey duration was 32.9 minutes. White-only, non-Hispanic/Latino/a/x individuals (78.8%) exceeded the 2020 US Census prevalence (60.1%), and only one-half of respondents perceived a benefit to their training from the diversity present in their programs. Over 94% of respondents indicated that their curricula were characterized by "problem solving/critical thinking" and "clinical reasoning," but nearly one-half indicated "busywork" was prevalent. High curricular satisfaction ratings clustered in content areas relating to profession-specific technical skills and low ratings clustered in foundational sciences. DPT respondents reported significantly lower tolerance for ambiguity, significantly more exhaustion, and significantly less disengagement than medical students. Respondents endorsed higher levels of "adaptive" perfectionism (striving for high performance) than "maladaptive" perfectionism (concern over negative evaluations). Respondents with loans (27.7%) had debt exceeding $150,000, the benchmark above which the DPT degree loses economic power.

CONCLUSION

PT-GQ benchmarks revealed strengths (eg, curricula emphasizing problem solving/critical thinking and clinical reasoning) and challenges (eg, low diversity, problematic student debt) in physical therapist education.

IMPACT

Programs can use benchmarking for quality-improvement efforts and as a data source for accreditation self-study reports. The ongoing study will refine national benchmarks and pilot items to address new research questions.