Perfectionism as a transdiagnostic process in psychopathology

Claus, Nathalie (2024): Perfectionism as a transdiagnostic process in psychopathology: evidence on temporal relations from clinical and non-clinical samples. Dissertation, LMU München: Fakultät für Psychologie und Pädagogik

Abstract

The transdiagnostic perspective on psychopathology promises to overcome short-comings of a strictly disorder-focused approach to research and treatment. Recent years have seen efforts to identify processes which may be implicated in the development and maintenance of several different disorders, in an attempt to streamline progress within clinical psychology: so-called transdiagnostic processes. One such potential transdiagnostic process may be perfectionism, as it has been related to a wide range of psychological symptoms in cross-sectional, longitudinal, and few experimental studies, as well as in treatment studies. Although a considerable body of research builds on the assumption of perfectionism as a transdiagnostic process, studies investigating temporal relations in several different disorders are scarce and inconsistent, leaving the question of causality unanswered. What remains unclear is whether perfectionism temporally precedes symptoms of several disorders at once, how its impact on psychological treatments may be characterized, and how perfectionism may lead to differing specific disorders in different individuals. To tackle these outstanding questions, the present thesis is the first to apply a transdiagnostic heuristic as proposed by Nolen-Hoeksema and Watkins (2011) to perfectionism. Thus, both multifinality (i.e., does perfectionism lead to a general risk of psychopathology) and divergent trajectories (i.e., what determines the resulting specific disorder) can be addressed within one dissertation project. The four studies presented in this thesis use different methodological approaches to understand the role of perfectionism in both development of initial and maintenance of existing psychopathology. In addition, they differentiate between two perfectionism dimensions which have been shown to be differentially related with psychological symptoms: perfectionistic strivings and perfectionistic concerns. Using a longitudinal design, studies 1 and 2 aimed to judge multifinality by testing temporal relations between perfectionism dimensions and psychopathology. More specifically, these two studies aimed at understanding the onset of symptoms in non-clinical samples, accounting for possible bidirectional effects. In study 1, N = 447 healthy women (18-30) completed a two-wave online study across 6 months, measuring perfectionism as well as symptoms of depression, anxiety, eating disorders, and obsessive-compulsive disorder (OCD). Both cross-sectional and longitudinal network analysis was used to map the interplay between variables across time. Cross-sectionally, perfectionistic concerns, but not perfectionistic strivings, emerged as a strong bridge variable connecting symptom clusters. However, neither perfectionism dimension served as a longitudinal predictor of psychopathology. To investigate these longitudinal relations in more detail and add an exploration of divergent trajectories, study 2 included a sample of N = 499 healthy women (18-30) from a three-wave online study across 12 months, homing in on perfectionism, eating disorders, and OCD. Data was analyzed using structural equation modelling. In addition, body dissatisfaction and responsibility were included as possible disorder-specific moderator variables, analyzed via multiple hierarchical regressions. Neither perfectionism dimension emerged as a transdiagnostic predictor. Instead, perfectionistic concerns positively predicted OCD symptoms and were positively predicted by eating disorder symptoms. Perfectionistic strivings negatively predicted OCD symptoms and were positively predicted by eating disorder symptoms. No interaction effects with the presumed moderators were observed. Instead, responsibility independently predicted OCD symptoms, and body dissatisfaction independently predicted both eating disorder and OCD symptoms. Further, studies 3 and 4 aimed at understanding the role of perfectionism in the maintenance of already existing symptoms in patient samples. To this end, data was taken from previous uncontrolled treatment studies, and multi-level models were used to test perfectionistic concerns as a predictor of treatment outcome. Both perfectionism and symptom severity were measured at baseline, post-treatment, and at several follow-ups (ranging from four weeks up to 18 months). Of note, studies 3 and 4 focused on so-called “third-wave” treatments to complement previous results from cognitive-behavioural therapy. In study 3, N = 61 patients diagnosed with OCD received eight weeks of meta-cognitive training or mindfulness-based training in an outpatient group-setting. In study 4, N = 49 patients diagnosed with depression received four weeks of meta-cognitive training for depression and suicidal ideation in an inpatient group-setting. In both studies, baseline perfectionistic concerns did not predict primary symptoms across time. However, a reduction of perfectionistic concerns or clinical perfectionism predicted a subsequent reduction in symptoms. In sum, this thesis aimed to overcome the limitations of previous research by elucidating the temporal relations between perfectionism dimensions and symptoms of various disorders. The present results question the role of perfectionism as a transdiagnostic process implicated in the development of symptoms, but instead point towards its role in the maintenance of symptoms. Perfectionistic concerns in particular may contribute to the perpetuation and proliferation of psychopathology. Methodological limitations are discussed. Moreover, implications for both theory and methodology as well as directions for future research on perfectionism in psychopathology are outlined.

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Keywords: Psychopathologie, Klinische Psychologie, Perfektionismus, Risikofaktoren
• Themengebiete: 100 Philosophie und Psychologie ; 100 Philosophie und Psychologie > 150 Psychologie
• Fakultäten: Fakultät für Psychologie und Pädagogik
• Sprache der Hochschulschrift: Englisch
• Datum der mündlichen Prüfung: 5. Juli 2024
• 1. Bericht­erstatter:in: Cludius, Barbara