The perniciousness of perfectionism: A meta-analytic review of the perfectionism-suicide relationship

Perfectionism, Self-Image Goals and Compassionate Goals in Health and Mental Health: A Longitudinal Analysis

This research focuses on ego-focused self-image goals as central to understanding the vulnerability inherent in perfectionism and the link that perfectionism has with poorer health and emotional well-being. The present study expands theory and research on perfectionism from a unique motivational perspective through a longitudinal investigation of perfectionism, the pursuit of self-image goals related to self-improvement, and mental and physical health among 187 university students. Our central finding was that trait and self-presentational perfectionism were associated longitudinally with self-image goals and poorer mental and physical health. Longitudinal analyses showed that perfectionistic self-presentation predicted subsequent self-image goals, controlling for initial self-image goals. Additionally, self-image goals were associated with worse mental and physical health and greater loneliness and social anxiety. Collectively, our results illustrate the benefits of assessing problematic personal goals in perfectionism and the need to revise existing motivational accounts by recognizing the important role ego-involved goals play in guiding much of what perfectionists do and how they act in their daily lives.

Going it alone: Examining interpersonal sensitivity and hostility as mediators of the link between perfectionism and social disconnection

OBJECTIVE

Perfectionism is linked to a variety of mental health conditions in university students. The Perfectionism Social Disconnection Model posits that perfectionistic individuals exhibit off-putting interpersonal behaviors (i.e., rejection sensitivity and hostility), which lead to social disconnection, and in turn contribute to psychological distress. Although several longitudinal studies have found that social disconnection mediates the link between perfectionistic traits and psychological distress, less is known about how perfectionism leads to social disconnection. The present study aimed to address this gap.

METHODS

A sample of 877 university students completed one survey a month for three consecutive months.

RESULTS

Our random-intercept cross-lagged panel model results showed significant positive associations between the random intercepts of socially prescribed and self-oriented perfectionism with rejection sensitivity, hostility, and loneliness, with stronger associations for socially prescribed perfectionism. In addition, the random intercept of other-oriented perfectionism showed positive associations with hostility but not rejection sensitivity or loneliness. Moreover, almost all cross-lagged paths were nonsignificant.

CONCLUSION

Collectively, these findings indicate that although perfectionistic traits may be associated with rejection sensitivity and hostility to varying degrees at the between-person level, these behaviors may not cause social disconnection at the within-person level.

You just want a break from the hatred of failure: the lived experience of being a student physiotherapist perfectionist and considerations for educators

Perfectionism is a personality orientation associated with mental health and adjustment problems. Recent evidence demonstrates that perfectionism is widespread among students and on the rise, with recent generations of students placing increasingly more importance on perfection. Whilst the extant literature is vast, it tends to focus on psychopathology and identification of perfectionism correlates rather than the experience of student perfectionism. Furthermore, the education literature is scant and there is a need to understand the deeper processes and nuances of perfectionism, particularly within health professions education where intense study demands, competition to gain entry to educational programmes, and professional cultures may nurture the problem. This phenomenological study explored the lived experiences of ten physiotherapy students as they wrestled with perfectionism in the various facets of their studies. Semi-structured interviews were undertaken, and participants completed log sheets to document perfectionism-related experiences. Idiographic profiles were composed and interview transcripts were analysed, drawing upon features of both phenomenological and thematic analysis. Perfectionism was found to have toxic consequences for the learning experience. Harmful phenomenological experiences included perpetual and excessive achievement striving, punitive self-criticism and health and wellbeing difficulties. A range of sabotaging learning behaviours such as self-handicapping and feedback avoidance was also illuminated, and cultural and organisational influences perceived to foster perfectionism emerged. Findings are discussed in relation to underlying processes and implications for educators. The prospect of findings transferring to other educational contexts is highlighted.

Longitudinal Impact of Perfectionism on Suicidal Ideation among Chinese College Students with Perceived Academic Failure: The Roles of Rumination and Depression

OBJECTIVE

Suicide has become a nonnegligible cause of death among emerging adults, and academic performance is one of the most significant factors in Chinese college students' suicidal ideation. Based on this, we examined the risk and protective sides of perfectionism on suicidal ideation among college students with perceived academic failure experiences.

METHOD

In the current study, a total of 674 Chinese college students (63.6% females, Mage = 19.96, SD = 1.31) with perceived academic failure in the past six months participated in a survey and completed self-report measures assessing perfectionism, rumination, depression, and suicidal ideation twice with a six-month interval.

RESULTS

Negative perfectionism was a risk factor for suicidal ideation, while positive perfectionism had an opposite effect. In addition, intrusive rumination, deliberate rumination, and depression serially mediated the association between positive/negative perfectionism and suicidal ideation.

CONCLUSION

The results indicated perfectionism has both positive and negative sides to suicidal ideation. Clinicians might be aware of the risk and protective components of perfectionism when intervening with suicidal ideation among college students with perceived academic failure experiences.

Suicide Risk Among Medical Students Associated With Loneliness, Burnout, and Depressive Symptoms

Medical students face elevated risks of depression and suicide due to rigorous training demands. However, comparative research between medical and non-medical students is limited, hindering understanding of specific risks. This study compared 337 students (89 medical) on suicide risk, depression, perfectionism, burnout, loneliness, and internet addiction. Medical students showed significantly higher suicide risk, depression, perfectionism, burnout, and loneliness. Regression analysis identified medical student status, depressive symptoms, and loneliness as significant predictors of suicide risk. Mediation analysis revealed loneliness and depressive symptoms mediating the relationship between medical student status and suicide risk. Strategies to address mental health risks among medical students are crucial, including early screening and interventions. However, this study's limitations include self-report measures and a predominantly non-medical student sample. Further research is needed to explore causal relationships and interventions effectively.

Treating perfectionism via the Internet: a randomized controlled trial comparing cognitive behavior therapy to unified protocol

Perfectionism can be problematic when your self-worth is dependent on achievements and leads to inflexible standards, cognitive biases, and rigid behaviors. Cognitive behavior therapy for perfectionism is shown to be effective, including for targeting psychiatric symptoms and when delivered via the Internet (iCBT-P). However, few studies have compared it to an active comparator. The current study randomly assigned 138 participants seeking help for perfectionism to iCBT-P or Internet-based Unified Protocol (iUP). Both treatments provided guidance on demand from a therapist and were eight weeks in duration. The results indicated large within-group effects of Cohen's d 2.03 (iCBT) and 2.51 (iUP) on the Clinical Perfectionism Questionnaire at post-treatment, and maintained effects at 6- and 12-month follow-up, but no between-group difference (β = 0.02, SE = 1.04, p = .98). Secondary outcomes of depression, anxiety, quality of life, self-compassion, procrastination, and stress ranged from small to large, with no differences between the conditions. Both treatments were deemed credible, relevant, of high quality, and well-adhered by the participants. Further research needs to be conducted, but the findings could indicate a lack of specificity, perhaps suggesting there is no need to differentiate between different treatments that are transdiagnostic in nature.

Teen Perspectives on Suicides and Deaths in an Affluent Community: Perfectionism, Protection, and Exclusion

Clusters of youth suicide and death are tragic for communities and present long-term consequences for the surviving youths. Despite an awareness of community-based patterns in youth suicide, our understanding of the social and community factors behind these events remains poor. While links between poverty and suicide have been well documented, wealthy communities are rarely targeted in suicide research. In response to this gap, we conducted ethnographic research in a wealthy U.S. town that, over a recent 10-year period, witnessed at least four youth suicides and seven more youth accidental deaths. Our interviews (n = 30) explored community values and stressors, interpersonal relationships, and high school experiences on participant perceptions of community deaths. Youth participants characterize their affluent community as having (1) perfectionist standards; (2) permissive and sometimes absent parents; (3) socially competitive and superficial relationships; and (4) a "bubble" that is protective but also exclusionary. Our qualitative findings reveal network influence in teen suicides and accidental deaths in a wealthy community. Greater attention paid to the negative effects of subcultural values and stressors in affluent communities is warranted. Further, our work promotes the value of ethnographic, community-based methodologies for suicidology and treatment.

Predicting Lifetime Suicide Attempts in a Community Sample of Adolescents Using Machine Learning Algorithms

Suicide is a major global health concern and a prominent cause of death in adolescents. Previous research on suicide prediction has mainly focused on clinical or adult samples. To prevent suicides at an early stage, however, it is important to screen for risk factors in a community sample of adolescents. We compared the accuracy of logistic regressions, elastic net regressions, and gradient boosting machines in predicting suicide attempts by 17-year-olds in the Millennium Cohort Study (N = 7,347), combining a large set of self- and other-reported variables from different categories. Both machine learning algorithms outperformed logistic regressions and achieved similar balanced accuracies (.76 when using data 3 years before the self-reported lifetime suicide attempts and .85 when using data from the same measurement wave). We identified essential variables that should be considered when screening for suicidal behavior. Finally, we discuss the usefulness of complex machine learning models in suicide prediction.

Exploring the role of personality, perfectionism, and self-compassion on the relationship between clinical decision-making and nurses' wellbeing

BACKGROUND

Clinical decision-making is a core competency of the nursing role, with nurses having to make decisions surrounding patient care and patient safety daily. With decision-making being linked to psychological outcomes, it is important to consider potential areas that may support or hinder nurses' wellbeing whilst navigating clinical decisions.

AIM

The present study sought to investigate the relationship between clinical decision-making and moral distress, and further explore the role of personality, perfectionism, philotimo (a virtue describing the desire to do right by oneself and others, aligning with one's sense of morality), and self-compassion.

DESIGN

An online cross-sectional survey was conducted using Qualtrics. Associations between clinical decision-making and moral distress, burnout, personality, perfectionism, philotimo, and self-compassion were examined using univariate and multivariate statistics.

METHODS

One hundred and forty-three nurses from the United Kingdom completed an online questionnaire. Eligibility criteria included individuals who had practised in the nursing profession for a minimum of six months. To ensure that all participants were practising across the United Kingdom, the eligibility criteria was made clear in the study advertisement, and the consent form. The consent form required participants to confirm that they reached these criteria to proceed with the study.

RESULTS

Results revealed that clinical decision-making was associated with moral distress experience, and that both openness to experience, and philotimo mediated this relationship, independently. In addition to this, self-compassion was significantly associated with clinical decision-making across senior banded nursing roles, but this was non-significant for junior banded nursing roles.

CONCLUSION

Findings highlight the role of individual differences when looking at the impact of clinical decision-making upon nurses' wellbeing and offers explanation for any variance in moral distress experience across nursing professionals. This research identifies fundamental differences between junior and senior nurses in relation to clinical decision-making and self-compassion that should be considered in future research.

A comparison of the effect of two types of brief psychodynamic group therapy on perfectionism-related attitudes, self-relatedness, and self-esteem

Objective: This randomized controlled trial investigated the efficacy of dynamic relational group therapy (DRT) relative to group psychodynamic supportive therapy (PST) in improving perfectionism-related attitudes and components of the perfectionistic self-relationship. Method: Based on a comprehensive conceptualization of perfectionism, 80 community-recruited, highly perfectionistic individuals were randomly allocated to 12 sessions of group DRT (n = 41; 5 groups) or group PST (n = 39; 5 groups). Patients completed measures of dysfunctional attitudes, self-criticism, self-esteem, and self-reassurance at pre-, mid-, and post-treatment, and six months post-treatment. Results: Multigroup latent growth curve modeling revealed significant (p < .05) decreases in dysfunctional attitudes, concern over mistakes, two types of self-criticism, and self-esteem problems, along with a significant increase in self-reassurance, from pre-treatment to six-month follow-up in both DRT and PST. Moderate-to-large between-group differences favoring DRT over PST were found for dysfunctional attitudes and self-reassurance. A majority of patients in both conditions maintained reliable improvement at six-month follow-up in dysfunctional attitudes, concern over mistakes, and self-criticism focused on inadequacy. Conclusion: Findings provide evidence for the use of psychodynamic group therapy approaches in treating perfectionism-related attitudes and self-relational elements of perfectionism, and support the relative efficacy of DRT for dysfunctional attitudes and self-reassurance.

Psychometric properties of an Arabic translation of the Big Three Perfectionism Scale-Short Form (BTPS-SF) in a community sample of adults

BACKGROUND

Despite the high clinical relevance of the perfectionism construct as a transdiagnostic contributor to different mental health symptoms, and the recent burgeoning of research in this area across cultures in the past two decades, the Arab region was one of the cultural settings experiencing the slowest progress in this line of research. This study aimed to make a meaningful contribution to the literature by validating an Arabic-language version of the 16-item Big Three Perfectionism Scale-Short Form (BTPS-SF). In particular, we sought to examine structure and concurrent validity, internal consistency, and measurement invariance across gender groups.

METHOD

A web-based, convenience sampling method was adopted to collect a sample of Arabic-speaking adults from the general population of Lebanon (N = 515; aged 27.55 ± 10.92 years; 69.9% females). The forward-backward method was applied in translating the Arabic version of the BTPS-SF.

RESULTS

The examination of the internal structure, using Confirmatory Factor Analysis (CFA), demonstrated that the three-factor model (i.e., rigid, self-critical, and narcissistic perfectionism) fitted well to the data. All three factors of the Arabic 16-item BTPS-SF yielded excellent reliability estimates, with both Cronbach's alpha and McDonald's omega ranging from 0.83 to 0.86. Multi-group CFA revealed that fit indices showed no significant difference in model fit at the configural, metric, and scalar levels, thus suggesting that the factor loadings, pattern structure, and item intercepts are invariant across gender groups. Finally, BTPS-SF subscales scores correlated positively with psychological distress (i.e., depression, stress and anxiety), and inversely with subjective well-being, indicating an acceptable concurrent validity.

CONCLUSION

The present findings allow us to conclude that the Arabic BTPS-SF permits to capture reliably and validly three main factors of perfectionism. We hope that providing this psychometrically sound scale will encourage its large use not only in empirical research, but also in clinical applications, including psychological screening and treatment monitoring.

Threatening Beliefs About Self and Others Moderate the Association Between Psychoticism and Psychological Distress

ABSTRACT

Psychoticism is a multidimensional personality construct involving odd or eccentric behavior, quasi-psychotic experiences, mistrust, interpersonal detachment, and liability for schizophrenia-spectrum disorders, as well as significant distress. Recent advances suggest it can be understood as a dimension that is continuously distributed in the population, leading to questions about factors that contribute to distress and dysfunction among people with a schizotypal liability. We investigated in a large nonclinical sample of young adults whether associations between psychoticism and psychological distress would increase in the presence of threatening beliefs. In our study ( N = 2127), we found that the association between psychoticism and psychological distress is moderated by threatening beliefs including self-criticism, fear of compassion, and socially prescribed perfectionism. These results suggest that distress increases among people with schizotypal traits in the context of negative beliefs about self and others. We discuss implications for clinical practice and directions for further research.

Examining the Relationship Between Maladaptive Perfectionism and Social Anxiety: The Mediating Role of Self-Compassion

Previous studies have indicated a relationship between perfectionism and social anxiety symptoms, but the mechanisms between these concepts are not well-defined yet. This study focused on the mediator role of self-compassion in the relationship between maladaptive perfectionism and social anxiety symptoms controlling self-esteem. It is hypothesized that maladaptive perfectionism would be related to lower levels of self-compassion and lower levels of self-compassion related to greater social anxiety symptoms controlling self-esteem. The sample consisted of 389 university students who completed a battery of instruments, including measures of The Liebowitz Social Anxiety Scale (LSAS), The Big Three Perfectionism Scale (BTPS), The Self-Compassion Scale (SCS), and The Rosenberg Self-Esteem Scale (RSES). Simple mediation analyses with bootstrapping demonstrated that self-compassion has a significant mediator role in the relationship between maladaptive perfectionism and social anxiety when self-esteem is not included in the model. However, results also revealed that the indirect effect of self-compassion is no longer significant when self-esteem is included in the model as a covariate. Findings suggest that self-compassion has no mediator role independent from self-esteem in the context of perfectionism and social anxiety.

Association of Mindfulness with Perfectionism, Exercise Self-Efficacy, and Competitive State Anxiety in Injured Athletes Returning to Sports

Injured athletes often face performance challenges upon returning to the field, influenced by external factors and negative emotions. This study investigates how mindfulness is associated with perfectionism, exercise self-efficacy, and competitive state anxiety in athletes recovering from injuries. Using snowball sampling and convenience sampling methods with a cross-sectional dataset of 359 participants from southern China (collected between October and November 2022), we employed structural equation modelling to analyse the relationship between mindfulness and competitive state anxiety in returning athletes. The results reveal that mindfulness interventions enhance exercise self-efficacy, boost task-related confidence, reshape perfectionism towards a positive outlook, and decrease competitive state anxiety. This study establishes positive correlations between perfectionism and competitive state anxiety, and a negative correlation between exercise self-efficacy and competitive state anxiety. Moreover, exercise self-efficacy and perfectionism partially mediate mindfulness's positive impact on competitive state anxiety. In conclusion, this research highlights mindfulness's potential to alleviate perfectionism and competitive state anxiety while enhancing exercise self-efficacy among athletes on the road to recovery.

Toward objective characterizations of suicide risk: A narrative review of laboratory-based cognitive and behavioral tasks

Although suicide is a leading cause of preventable death worldwide, current prevention efforts have failed to substantively mitigate suicide risk. Suicide research has traditionally relied on subjective reports that may not accurately differentiate those at high versus minimal risk. This narrative review supports the inclusion of objective task-based measures in suicide research to complement existing subjective batteries. The article: 1) outlines risk factors proposed by contemporary theories of suicide and highlights recent empirical findings supporting these theories; 2) discusses ongoing challenges associated with current risk assessment tools and their ability to accurately evaluate risk factors; and 3) analyzes objective laboratory measures that can be implemented alongside traditional measures to enhance the precision of risk assessment. To illustrate the potential of these methods to improve our understanding of suicide risk, the article reviews how acute stress responses in a laboratory setting can be modeled, given that stress is a major precipitant for suicidal behavior. More precise risk assessment strategies can emerge if objective measures are implemented in conjunction with traditional subjective measures.

Perfectionism and eating disorders in children and adolescents: A systematic review and meta-analysis

There is a consistent link between perfectionism and eating disorders, however no meta-analysis to date has synthesized this literature in children and adolescents. We hypothesized that there would be significant, small pooled correlations between perfectionism dimensions and eating disorder symptoms in children and adolescents. Published, peer-reviewed articles with standardised measures of perfectionism and eating disorder symptoms were included. Articles were excluded if the age range was over 18 years. Overall, 39 studies were included (N = 13,954 participants, M age = 13.7 years). Total perfectionism (r = 0.25), perfectionistic strivings (r = 0.21), and perfectionistic concerns (r = 0.31) had significant positive associations with eating disorder symptoms. Most studies were rated as fair or good quality. Limitations included high heterogeneity, insufficient studies to investigate age as a moderator, the inclusion of only English articles, and predominately cross-sectional studies which precluded causal inference. Higher perfectionism was associated with greater eating disorder symptoms in children and adolescents. Future research should focus on longitudinal studies of eating disorder symptoms in children and adolescents.

The relationship between clinical perfectionism and nonsuicidal self-injury: The roles of experiential avoidance, self-esteem, and locus of control

OBJECTIVES

Perfectionism is linked to nonsuicidal self-injury (NSSI). Individuals with elevated perfectionism tend to avoid undesirable emotions and experience lower self-esteem, which are associated with NSSI. However, it is unclear if these mechanisms explain the link between clinical perfectionism and NSSI, and if locus of control is involved. We aimed to explore whether experiential avoidance and self-esteem would mediate the relationship between clinical perfectionism and NSSI, and if locus of control would moderate links between clinical perfectionism and both experiential avoidance and self-esteem.

METHOD

As part of a larger study, 514 Australian university students (Mage  = 21.15 years, SD = 2.40; 73.5% female) completed an online survey of NSSI, clinical perfectionism, experiential avoidance, self-esteem, and locus of control.

RESULTS

Clinical perfectionism was associated with NSSI history, but not with recent NSSI or past year NSSI frequency. Lower self-esteem, but not experiential avoidance, mediated links between clinical perfectionism and NSSI history, recent NSSI, and NSSI frequency. More external locus of control was associated with NSSI, experiential avoidance, and lower self-esteem, but locus of control did not moderate pathways between clinical perfectionism and experiential avoidance or self-esteem.

CONCLUSION

University students reporting elevated clinical perfectionism may have a tendency to experience lower self-esteem which is associated with NSSI history, recency, and severity.

Burnout, depression, and suicidal ideation among physicians before and during COVID-19 and the contribution of perfectionism to physicians' suicidal risk

Objectives

There is limited data regarding the prevalence of suicidal risk among physicians during COVID-19, and the risk factors relating to it. Dominant risk factors for suicide among physicians are depression and burnout. Maladaptive perfectionism may also serve as a profound risk factor for suicidality among physicians and may aggravate symptoms of distress under the challenges of COVID-19. This study aims to evaluate current suicidal risk, suicidal ideation, depression, and burnout before and during COVID-19 among physicians in Israel, and to identify the best sets of correlates between perfectionism and burnout, depression and suicidal ideation, during these time periods.

Methods

A sample of 246 Israeli physicians (160 before COVID-19 and 86 during COVID-19) completed online surveys assessing lifetime suicidal risk, suicidal ideation during the last year and current suicidal ideation, depression, burnout symptoms and maladaptive perfectionism.

Results

More than one-fifth of the sample (21.9%) reported high suicidal risk (Lifetime suicidal behaviors). More than one-fourth (27.2%) reported suicidal ideation during the last 12 months; and 13.4% reported suicidal ideation during the last 3 months. In addition, more than one-third (34.6%) exhibited moderate-severe levels of depressive symptoms and more than a half of the sample reported burnout symptoms. Maladaptive perfectionism was positively correlated with current suicidal ideation, burnout, and depression. Moderated serial mediation analysis demonstrated indirect effect of perfectionism on suicidal ideation by its impact on burnout and depression only during COVID-19. Before COVID-19, physicians were more likely to experience depressive symptoms.

Conclusion

Physicians in Israel are at increased risk for depression and suicidal ideation, regardless of the COVID-19 pandemic. Maladaptive perfectionism was found to be a risk factor for burnout, depression, and suicidal ideation. During the first waves of the pandemic, physicians were less likely to experience depressive symptoms. However, among physicians who were characterized with high maladaptive perfectionism, depression served as a significant risk factor for suicidal ideation during the pandemic, which places these individuals at increased risk for suicidality. These results highlight the importance of implementing intervention programs among physicians to reduce suicidal risk and to better identify rigid perfectionism and depressive symptoms.

The Importance of Timing, Fundamental Attitudes, and Appropriate Interventions as Key Aspects of Chaplain Suicide Prevention: A European Expert Panel of Mental Health Chaplains

An expert panel consisting of six mental health chaplains from several European countries was convened to ascertain the specific contribution of mental health chaplains to suicide prevention, and to generate good practices for suicide prevention. Three themes emerged: (1) the importance of timing; (2) fundamental attitudes of the chaplain towards the patient, and (3) appropriate interventions.

Interpersonal and intrapersonal predictors of suicidal thoughts and actions in first-year college students

OBJECTIVE

The aim was to determine the unique predictors of suicide risk in first-year college students.

PARTICIPANTS

First-year students (N = 665) at a Midwestern university participated.

METHODS

An online survey assessed Joiner's interpersonal factors (i.e., thwarted belongingness, perceived burdensomeness, and acquired capability) as well as intrapersonal factors (i.e., perfectionism, self-compassion, emotional intelligence/reactivity, and growth mindset) often associated with suicidal thoughts and actions.

RESULTS

Linear regression indicated that the factor set significantly predicted thoughts, F (12, 632) = 114.90, p < .000, R² = .680, and actions, F (12, 632) = 58.42, p < .000, R² = .526. Perceived burdensomeness, acquired capability, and underrepresented sexual orientation were positive predictors of both thoughts and actions, whereas growth mindset was a negative predictor of thoughts and stressful life events was a positive predictor of actions.

CONCLUSION

The results offer direction for evidence-informed interventions aimed at reducing suicide risk in first-year college students.

The Role of Impulsivity and Self-Control in Suicidal Ideation and Suicide Attempt

Two studies are reported examining the relation of self-control, as measured by self-report inventories, to indices of suicidal ideation and suicide attempts. In the first study (n = 113), self-control related significantly (p < 0.05) and negatively to both indices (r = -0.37 and r = -0.26), and, in a hierarchical regression analysis, added significantly to the variance in the suicidal ideation index accounted for by a measure of impulsivity. The second study (n = 223) replicated the findings of the bivariate correlations (r = -0.55 and r = -0.59) with the suicidality indices in the first study, both with the earlier measures and with alternative measures of self-control and impulsivity. Results indicated self-control added to the prediction of both indices and not just the ideation index. The second study also demonstrated that self-control acts as a moderator for perceived stress, a known risk factor for suicidality, such that, at low levels of perceived stress, there is little difference between those high and low in measured self-control, but that at high stress levels, those with high self-control had lower scores on suicidal ideation. The results are interpreted as showing that self-control is a protective factor for suicidality.

A Pragmatic Randomized Controlled Trial Targeting Perfectionism in Young Adolescents

Perfectionism has adverse impacts on mental health and academic outcomes. We evaluated a 5-lesson classroom intervention for young adolescents delivered by teachers for impact on perfectionism, well-being, self-compassion, academic motivation and negative affect, at post-intervention and 3-month follow-up. Classes (N = 636 students, M _age = 13.68, SD = 0.60) were randomized to intervention (n = 343) or classes as usual (n = 293). Data were analyzed using linear mixed models adjusted for baseline observation and clustering. At post-intervention no differences were found between the groups. At 3-month follow-up, anxiety showed a significant increase in the control group with no increase in the intervention group (d = 0.23; 95% CI: 0.05, 0.40); females in the control group had a significant decrease in well-being from post-intervention to 3 month follow-up compared to the intervention group (d = 0.33; 95% CI: 0.08, 0.58); students with high levels of perfectionistic concerns in the intervention had significantly lower perfectionistic strivings at 3 month follow-up than the control group ((d = 0.34, 95% CI: 0.19, 0.49). This intervention shows promising results when delivered by teachers. Australian New Zealand Clinical Trials Registry (ANZCTR) Trial Number: ACTRN12621000457842 (April 19, 2021).

Supplementary Information

The online version contains supplementary material available at 10.1007/s12310-022-09540-3.

Visualizing the Human Body Using an Artistic Approach

This chapter describes an innovative approach to the cross-disciplinary study of anatomy and art to facilitate visualization of the human body. We draw upon the literature, together with our own experience of designing, delivering and researching a cross-disciplinary art and anatomy course, to indicate the critical elements of the approach that foster students' visualization of the anatomy of the human body.Visual arts have been linked with anatomy for centuries, but typically biomedical science has existed in a utilitarian relationship with art only used as an aid. In this chapter, we discuss the rationale underpinning a cross-disciplinary anatomy and art course and describe our experience of devising activities and assessment that create a stimulating and mutually beneficial environment for visualizing the experience and physicality of the human body. We describe the structure of the course which integrates art and anatomy to train students in the language of anatomy and visual representation, by engaging them in a process of attempting their own visual communication. The cross-disciplinary nature of our approach creates a unique social environment that offers a supportive environment for exploration and experimentation without fear of failure. Students' personal growth in resilience, tolerance for uncertainty and creativity prepares them for the inclusion of these values in their career.

Hiding behind the “perfect” mask: a phenomenological study of Filipino university students’ lived experiences of perfectionism

Purpose

Methods

Results

Conclusion

A motivational approach to perfectionism and striving for excellence: Development of a new continuum-based scale for post-secondary students

Perfectionism has been the object of many disputes. One such debate pertains to the nature of perfectionistic strivings. Whereas perfectionistic concerns (PC) have been shown to correlate with negative outcomes, perfectionistic strivings (PS) have been associated with mixed outcomes. This view of perfectionism assumes a motivational perspective; however, commonly used questionnaires assess motivation only implicitly. To create a more explicit measure of motivation as regard perfectionism, we aimed to assess perfectionism in post-secondary education based on Deci and Ryan's self-determination continuum. We posit that introjected motivation represents the variance common to both dimensions of perfectionism. External motivation is considered to be specific to PC and identified motivation to PS. Amotivation represents a lack of meaningful striving. Intrinsic motivation, lacking perfectionism's pressure, is conceptualized to be a self-determined form of striving for excellence. We further posited that this continuum is implicitly underlain by a continuum of self-definition as defined by Blatt. The resulting questionnaire showed an adequate structure with ESEM, followed a simplex structure, and had adequate reliabilities (Study 1a/Study 2). It also showed adequate convergent validity (Study 1b/Study 2). Finally, the questionnaire proved to be invariant over a 6-week period (Study 2). Results suggest that the degree of active goal pursuit, in addition to standards setting, could be a distinguishing characteristic between dimensions of perfectionism as well as striving for excellence.

Perfectionism, Prolonged Stress Reactivity, and Depression: A Two-Wave Cross-Lagged Analysis

Perfectionism is a vulnerability factor for a wide array of psychopathology. Despite much evidence suggesting dysregulated stress response as an intermediary process that links perfectionism to psychopathology, the lack of a cross-lagged examination deterred researchers from making causal interpretations. This study examined the directionality of effects among perfectionism dimensions, stress reactivity, and depression. A total of 189 participants at time 1 and 94 at time 2 completed an online survey that consisted of measures of perfectionism, stress reactivity, and depression, one month apart. Cross-lagged analysis results showed that personal standards perfectionism predicted later prolonged stress reactivity but not depression at time 2. Self-critical perfectionism predicted later depression but not prolonged stress reactivity at time 2. Rather, prolonged stress reactivity at time 1 predicted self-critical perfectionism at time 2. Findings suggest that perfectionism dimensions are distinct in creating a dysregulated stress process. Future studies could incorporate other stress-related variables (e.g., coping) to further explicate the stress-generation process, in conjunction with stress reactivity.

Multidimensional perfectionism and poor sleep: A meta-analysis of bivariate associations

The link between perfectionism and poor sleep has been intensively debated, and previous studies on perfectionism-sleep associations have yielded mixed results. Recent research suggests that the two-dimensional perfectionism model, differentiating perfectionistic concerns (centered around concerns over imperfections) and perfectionistic strivings (centered around excessively high personal standards), may reconcile previously inconclusive findings, as both dimensions might be differentially related to sleep. Thus, to clarify the perfectionism-sleep link, this meta-analysis investigated relations of perfectionistic concerns and strivings with two well-established self-report measures of poor sleep. A systematic literature search yielded 55 effect sizes from 15 studies (N = 10,275) for inclusion in this meta-analysis. Perfectionistic concerns correlated positively with the Insomnia Severity Index (r⁺ = 0.221, 95% CI [0.102, 0.333], p = .004) and the Pittsburgh Sleep Quality Index (r⁺ = 0.248, 95% CI [0.172, 0.321], p < .001). Perfectionistic strivings correlated positively, albeit less strongly, with the Insomnia Severity Index (r⁺ = 0.114, 95% CI [0.039, 0.189], p = .010), but not significantly with the Pittsburgh Sleep Quality Index (r⁺ = 0.028, 95% CI [-0.026, 0.082], p = .247). These meta-analytic findings indicate that perfectionistic concerns are substantially linked to poor sleep, whereas the relation of perfectionistic strivings with sleep is less evident. Although the identified associations were less robust for perfectionistic strivings than for perfectionistic concerns, previously used labels like "positive" or "adaptive" appear inappropriate for perfectionistic strivings in the context of sleep.

Perfectionism typologies among undergraduate and graduate students: Prevalence and associations with psychosocial adjustment and academic performance

Objective: In this study, we examine the prevalence and demographic, academic, and psychosocial correlates of perfectionism typologies among postsecondary students. We focus on a lesser-known typology characterized by low personal standards and moderate self-critical cognitions, which we label "discordant perfectionism." Participants: Our sample of 8,689 students from 15 U.S. institutions was drawn from a larger longitudinal investigation of well-being and academic success. Methods: Students completed self-reported measures of perfectionism, demographics, and psychosocial adjustment in spring 2016. GPA was obtained from registrars in fall 2016. Results: A substantial proportion of students were classified as discordant perfectionists (26.1% of undergraduates, 18.8% of graduate students) with Asian students, men, first-generation undergraduates, and international students overrepresented. Discordant perfectionism was associated with markedly worse outcomes than the other typologies, with the lowest average GPA, subjective well-being, coping self-efficacy, and social connectedness. Conclusions: Discordant perfectionism merits further consideration as a risk factor for postsecondary students.

The Role of Self-Compassion Among Adaptive and Maladaptive Perfectionists in University Students

Using the tripartite model of perfectionism that accounts for combined characteristics of the Perfectionistic Strivings and Perfectionistic Concerns dimensions, this study explored the mediating role of self-compassion to explain differences between adaptive and maladaptive perfectionists in four psychological distress domains: depression, generalized anxiety, social anxiety, and academic distress. A sample of 3,112 university students were classified into adaptive, maladaptive, and nonperfectionists. Results of mediation analyses comparing adaptive and maladaptive perfectionists indicated that adaptive perfectionists reported significantly greater self-compassion and lower psychological distress levels in all four areas. Self-compassion significantly mediated the associations between perfectionist groups in all four domains. These findings were largely supported across various ethnic and international student groups in the analyses by subgroups. Furthermore, parallel mediation analyses demonstrated the unique contributions of individual self-compassion subscales as mediators. Implications for clinical practice, training, and future research are discussed.

Perfectionistic Self-Presentation, Socially Prescribed Perfectionism, Self-Oriented Perfectionism, Interpersonal Hopelessness, and Suicidal Ideation in U.S. Adults: Reexamining the Social Disconnection Model

OBJECTIVE

Research has linked perfectionism to increased suicidal ideation (SI), although less is known regarding the mechanisms that explain this relation. The Perfectionism Social Disconnection Model (PSDM) posits that interpersonal aspects of perfectionism cause interpersonal problems (e.g., hostility, loneliness) which in turn increase a person's risk for experiencing SI. The present study aimed to replicate and extend previous findings related to the PSDM and SI using measures of interpersonal hopeless and general hopelessness.

METHOD

Tenets of the PSDM were tested in a sample of 313 U.S. adults with a history of SI, by determining whether experiences of general hopelessness and interpersonal hopelessness explained the relation between three types of perfectionism: perfectionistic self-presentation (PSP), socially prescribed perfectionism (SPP), and self-oriented perfectionism (SOP).

RESULTS

Results indicated that PSP, SPP, and SOP were positively associated with SI, general hopelessness, and interpersonal hopelessness.The relation between aspects of perfectionism and SI demonstrated an indirect effect through interpersonal hopelessness only.

CONCLUSIONS

These results lend support to the PSDM's assertion that interpersonal problems aid in explaining the relation between perfectionism and SI. The current study was limited by the cross-sectional nature of the study as well as the homogenous sample. Implications for research and clinical work are discussed.HIGHLIGHTSAspects of perfectionism are related to suicidal ideationAspects of perfectionism are related to interpersonal hopelessnessInterpersonal hopelessness explains why perfectionism and suicidal ideation are related.

Effects of the COVID-19 lockdown on mental health in a UK student sample

Background

The COVID-19 pandemic and the resulting restrictions placed upon society have had a profound impact on both physical and mental health, particularly for young people.

Aims

The current study assesses the impact of COVID-19 on student mental health.

Method

Four hundred and thirty four first year Undergraduate students completed a battery of self-report questionnaires (PHQ-P, GAD-7 and SAS-SV) to assess for depression, anxiety and mobile phone addiction respectively with data being collected over a 2 year period. The data from each year was compared (216 and 218 students respectively).

Results

A MANOVA revealed that COVID-19 had a significant impact on self-reported levels of depression, anxiety and smartphone addiction—which all significantly increased from the 2020 to the 2021 group. The percentage of students who had a score which warranted a classification of clinical depression increased from 30 to 44%, and for anxiety increased from 22 to 27%—those students who showed a comorbidity across the two rose from 12 to 21%. Smartphone addiction levels rose from 39 to 50%. Correlational analysis showed a significant relationship between Smartphone usage and depression and anxiety.

Conclusions

This research suggests that COVID-19 has had a major impact upon student mental health, and smartphone addiction. The importance of identifying predictive factors of depression and anxiety is emphasised, and suggestions for intervention are discussed.

Profiles of Perfectionistic Automatic Thoughts and Aggression

In recent years, the study of perfectionistic automatic thoughts (PAT) has increased given its maladaptive nature since it is link to numerous psychological disorders. From our knowledge, no previous research has addressed the relationship between PAT and the four components of aggressive behavior (anger, hostility, verbal aggression, and physical aggression. This study had a double goal. The first aim was to identify distinct profiles of PAT in a sample of 3060 Ecuadorian undergraduates (Mage=22.7, SD = 2.46. The second aim of this study was to determine whether or not statistically significant differences exist between these profiles, based on the four components of aggressive behavior. The Perfectionism Cognitions Inventory (PCI) and the Aggression Questionnaire (AQ) were used. Five profiles with different intensities in the dimensions of perfectionistic automatic thoughts were identified by Latent Class Analysis (1. No-Perfectionistic Automatic Thoughts, 2. Low Perfectionistic Automatic Thoughts, 3. High Perfectionistic Demands, 4. Moderate Perfectionistic Automatic Thoughts, and 5. High Perfectionistic Automatic Thoughts). The moderate and high perfectionistic automatic thoughts profiles obtained the highest mean scores for all components of aggressive behavior (i.e., the four factors that make up AQ: Physical Aggression, Verbal Aggression, Anger, and Hostility), while the No-perfectionistic automatic thoughts and Low perfectionistic automatic thoughts profiles had the lowest mean scores. These results provide new knowledge about the prevalence of PAT in the context of Ecuador. Also, they suggest further research on the topic given the positive relationship of PAT and aggressive behavior.

Your Care Mitigates My Ego Depletion: Why and When Perfectionists Show Incivility Toward Coworkers

Drawing on ego depletion theory and trait activation theory, this study examines why and when employee perfectionism personality is linked with incivility toward coworkers. The study indulges ego depletion as a mediator between perfectionism personality and incivility toward coworkers, with coworker empathic concern moderating the relationship between perfectionism personality and ego depletion. A three-waved questionnaire was incorporated with sample of 253 employee-coworker dyads. Our findings demonstrate that dimensions of perfectionism personality are positively associated with incivility toward coworkers. In addition, our study confirms that ego depletion mediates the relationship between self-oriented perfectionism, other-oriented perfectionism, and incivility toward coworkers. Furthermore, our study shows that high levels of coworker empathic concern weakens the direct effect of self-oriented perfectionism on ego depletion along with the indirect effect of self-oriented perfectionism on incivility toward coworkers. Theoretical and practical implications of the study are discussed in the organizational context.

The Association Between Personality Disorder Traits and Suicidality Following Sudden Bereavement: A National Cross-Sectional Survey

Personality disorder is associated with increased risk of suicidal behavior. The authors aimed to investigate the association between number of personality disorder traits and suicidality risk following sudden bereavement. A secondary analysis of cross-sectional data on 3,167 young adults in the United Kingdom who had experienced sudden bereavement investigated the association between number of traits (measured using a standardized screening instrument) and postbereavement suicide attempt and suicidal ideation. Using multivariable logistic regression, the authors found a linear relationship between number of traits and suicide attempt (adjusted odds ratio [AOR] = 1.36, 95% CI [1.23, 1.49]) and suicidal ideation (AOR = 1.31, 95% CI [1.25, 1.38]) following bereavement. This represented an increase in odds by 36% and 31%, respectively, for each additional personality trait. The authors suggest that individuals with a greater number of traits suggestive of a personality disorder diagnosis are at increased risk of suicidality after a negative life event.

Suicide Risk in Emerging Adulthood: Associations with Screen Time over 10 years

Suicide rates have increased over the past decade, and screen media (and social media in particular) are often blamed for this marked increase. However, there is little longitudinal research on this topic. The current study examined the link between various types of screen media use over a 10-year period (from adolescence to emerging adulthood) to suicide risk in emerging adulthood. Participants included 500 adolescents (51% female) who were first surveyed in 2009, when they were an average of 13.82 years old (range 12-15 years). For girls, a high level of social media or television use in early adolescence followed by a marked increase over time was most predictive of suicide risk in emerging adulthood. Additionally, video game use that increased over time was also associated with a higher risk for developing suicide risk for girls. A passive sensing measurement was also included at the final wave of data collection to obtain a more accurate and complete picture of phone use in particular. The use of entertainment apps was risky for girls while reading apps were risky for boys. Additionally, video game use (for boys) was associated with suicide risk when cyberbullying was also high. Identifying nonnormative patterns of media during adolescence may be instructive in terms of suicide prevention efforts.

Understanding the processes underlying self-harm ideation and behaviors within LGBTQ+ young people: A qualitative study

OBJECTIVE

This study aims to understand the processes underlying self-harmful thoughts and behaviors, with and without suicidal intent, among LGBTQ+ young people.

METHOD

Nineteen semi-structured interviews took place between October 2019 and May 2020. Participants were aged between 16 and 25 years, had experiences of self-harm ideation and behaviors, and were part of the LGBTQ+ umbrella. A range of sexualities and gender identities were represented: eleven participants were cisgender, six were transgender and two were non-binary. Interviews were transcribed verbatim and anonymised. Thematic analysis and reflective member-checking were used to develop a thematic framework.

RESULTS

Three themes were developed from the interviews and evaluated by four participants who engaged with reflective member-checking. Findings indicated that internal processes and external responses to being LGBTQ+ resulted in self-harmful thoughts and behaviors. Alongside these, additional stressors related to being a young person were led to difficulties with self-harm.

CONCLUSIONS

Findings from this study indicate that young people often struggle with accepting their LGBTQ+ identity for a number of reasons, whether this is due to access to a resource or their own feelings about their identity. These negative self-perceptions can be enhanced by poor responses from others and additional life stressors which impact their self-esteem or self-perception.HIGHLIGHTSUnderstanding and accepting that one is LGBTQ+ is not always a simple process, struggling with these thoughts can influence self-harm.Lack of LGBTQ+ terminology hinders self-acceptance and caused young people to engage with self-harm.Peers and family members responses to a young people's LGBTQ+ identity is highly significant and can directly led to self-harmful thoughts and experiences.

Resilience and vulnerability factors influence the cortisol awakening response in individuals vulnerable to suicide

Suicide is a global health issue. Dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, has been identified as one potential risk factor. Evidence is emerging to suggest that different psychological factors may be associated with increased resilience and vulnerability in this context. The current study investigated whether trait resilience, social support, socially prescribed perfectionism, trait worry and trait impulsivity influenced the cortisol awakening response (CAR) over a 7-day study in individuals vulnerable to suicide. 142 participants with a history of suicidal attempt or ideation (suicide vulnerability group; n = 95) and with no suicide risk history (control group; n = 47) were recruited. Participants completed baseline questionnaires before commencing a 7-day study where they provided cortisol samples immediately upon waking, at 15 min, 30 min and 45 min on 7 consecutive days. Higher worry, socially prescribed perfectionism and impulsivity, lower resilience and social support were found in the suicide vulnerability group compared to the control group. Lower levels of resilience, higher levels of socially prescribed perfectionism, worry and impulsivity were associated with significantly lower total CAR. Suicide group membership was also found to have an indirect effect on total CAR via trait worry. The current findings show for the first time, that these well-known psychological risk factors for suicide are associated with smaller total cortisol awakening responses. Researchers ought to elucidate the precise causal mechanisms linking these traits, CAR and suicide risk in order to develop interventions to help build resilience in vulnerable populations.

Measurement Invariance of Perfectionism Measures in Students with and without a History of Non-Suicidal Self-Injury

Perfectionism is a transdiagnostic process which may be implicated in the onset and maintenance of non-suicidal self-injury. No study has evaluated whether reported differences in perfectionism between individuals with and without a history of self-injury represent genuine group differences or measurement artefacts. The present study reports an investigation of the measurement invariance of two common scales of perfectionism, the Frost Multidimensional Perfectionism Scale-Brief (FMPS-Brief) and the Clinical Perfectionism Questionnaire (CPQ), among university students (M_age = 20.48, SD_age = 2.22, 75.3% female, 22.8% male) with and without a history of self-injury (total n = 711). Results revealed full residual error invariance for the two-factor model of FMPS-Brief, while the bifactor model of the FMPS-Brief and the two-factor model of the CPQ demonstrated partial metric invariance. Accounting for partial metric invariance, the bifactor model of the FMPS-Brief also demonstrated partial residual error invariance. The current findings suggest that observed differences using the FMPS-Brief reflect genuine differences in perfectionism between individuals with and without a history of self-injury. Further, while researchers using the bi-factor model can have confidence that the general factor can adequately assess group differences, differential item functioning should be considered if using the strivings and concerns factors. Finally, in the current data, the CPQ did not perform as expected in baseline model fit and future research should replicate assessments of measurement invariance in this measure.

Exploring the role of loneliness in relation to self-injurious thoughts and behaviour in the context of the integrated motivational-volitional model

Suicide is a worldwide public health concern claiming approximately 800,000 lives around the world every year. The impact of loneliness on mental and physical wellbeing has received increasing attention in recent years, however its role in the emergence of self-injurious thoughts and behaviours is unclear. The current study explored loneliness in relation to other psychological variables associated with self-injurious thoughts and behaviour. Data were collected from UK residents (n = 400, aged 18-76 years) via an online survey accessible between September 2018 and April 2019. Univariate multinomial logistic regression analyses identified that loneliness independently distinguished between participants with no history of self-injurious thoughts or behaviours, those with a history of self-injurious thoughts only, and those with a history of self-injurious behaviours. When other key variables were controlled for, loneliness distinguished between controls and those with a self-injurious thoughts or behaviours history. However, loneliness did not distinguish between people with self-injurious thoughts only and those with a history of self-injurious behaviours. To understand how loneliness might contribute towards the emergence of self-injury, analysis exploring the extent to which loneliness moderates established risk factors (e.g., defeat, entrapment) was conducted. The results suggest that loneliness moderates both the relationship between defeat and entrapment, and between entrapment and self-injurious thoughts. Future work exploring these associations prospectively would advance understanding of the role of loneliness in suicide risk and inform the development of clinical and community-based suicide prevention interventions.