کمال گرایی و خود آگاهی در هراس اجتماعی و اختلال هراس با موقعیت هراس

Social phobics were compared to patients with panic disorder with agoraphobia and normal controls on perfectionism and self-consciousness. On concern over mistakes and doubts about action, social phobics scored higher than patients with panic disorder. Social phobics also demonstrated a higher level of public self-consciousness than patients with panic disorder and when this difference was controlled for the significant differences on perfectionism disappeared. Within each patient group, however, perfectionism was more robustly related to social anxiety than was public self-consciousness, which replicates the findings of Saboonchi and Lundh [Saboonchi, F. & Lundh, L. G. (1997). Perfectionism, self-consciousness and anxiety. Personality and Individual Differences, 22, 921–928.] from a non-clinical sample. The results are discussed in terms of public self-consciousness being a differentiating characteristic of the more severe kind of social anxiety which is typical of social phobia.

Research on perfectionism has established a wide array of associations between various aspects of perfectionism and numerous forms of psychopathology, including depression (Hewitt and Flett, 1991a and Hewitt & Flett, 1993; Blatt, Quinlan, Pilkonis & Shea, 1995), social phobia (Juster et al., 1996; Lundh & Öst, 1996), obsessive–compulsive disorder (Frost & Steketee, 1997), eating disorders (e.g. Joiner, Heatherton, Rudd & Schmidt, 1997) and borderline personality disorder (Hewitt, Flett & Turnbull, 1994). There are at present two main multidimensional approaches to the empirical study of perfectionism. In the Frost et al., (1990) approach, perfectionism is defined as consisting of dimensions of personal standards, concern over mistakes, doubts about the quality of one's own actions, organisation, and parental expectations and criticism. Of these dimensions, concern over mistakes (CM), doubts about action (DA) and parental criticism (PC) have been found to be more associated with psychopathology. In the Hewitt and Flett (1991a) approach, on the other hand, three dimensions of perfectionism are identified: self-oriented perfectionism, other-oriented perfectionism and socially prescribed perfectionism. The latter two dimensions address the interpersonal aspects of perfectionistic demands and socially prescribed perfectionism has been found to be more likely to be related to psychopathology. It can be asked whether perfectionism is a general characteristic of psychopathology or whether different forms of psychopathology differ on perfectionism or on some dimensions of perfectionism. With regard to anxiety disorders, higher levels of concern over mistakes, doubts about action and parental criticism were reported in social phobics compared to controls by Juster et al. (1996) and by Lundh and Öst (1996). Frost & Steketee, (1997) found that both patients with obsessive–compulsive disorder (OCD) and patients with panic disorder with agoraphobia had higher levels of concern over mistakes than the controls, but that they did not differ from one another. On doubts about action, the pattern was different; OCD patients scored higher than both panic patients and normal controls, who did not differ from one another. On parental criticism, finally, the panic patients scored higher than both the OCD patients and the controls, who did not differ from one another. The main purpose of the present study was to compare patients with social phobia, panic disorder with agoraphobia and normal controls on the Frost et al. (1990) Multidimensional Perfectionism Scale. Since social anxiety by definition involves a preoccupation with one's social presentation and doubts about one's ability to convey a desired impression on other persons (Schlenker & Leary, 1982; Clark & Wells, 1995; Rapee & Heimberg, 1997), a certain overlap with perfectionistic concerns is apparent. According to the Rapee and Heimberg (1997, pp. 743–744) conceptualization of social phobia, for example, the social phobic ``formulates a prediction of the performance standard or norm which he/she expects the audience to utilize in the given situation. The discrepancy between the person's perception of the audience's appraisal of his/her performance (appearance and/or behavior) and the person's perception of the audience's standard for the evaluation of his/her appearance and/or behavior, determines the perceived likelihood of negative evaluation from the audience''. The more perfectionistic standards the individual has, or believes that the audience has, the more likely will a negative evaluation appear, which is what the social phobic fears. With these clear indications of associations between social anxiety and perfectionism, two questions can be raised. First, is perfectionism more specifically related to social phobia than other psychopathological forms of anxiety? Second, what aspects of perfectionism account for this relationship? Although in a non-clinical population, a similar issue was attended to earlier by Saboonchi and Lundh (1997). Several dimensions of perfectionism, primarily concern over mistakes (CM), doubts about actions (DA) and socially prescribed perfectionism (SPP), showed strong patterns of relationship with a variety of anxiety measures (social anxiety, agoraphobic fears, and fears of bodily injury, death and illness). Social anxiety, however, correlated stronger than agoraphobic fears with CM and stronger than fears of bodily injury, death and illness with CM and socially prescribed perfectionism. The present study aims to test the hypothesis that social phobia involves more of perfectionism than panic disorder with agoraphobia, by comparing two groups of patients with these diagnoses and a control group on the Frost et al. (1990) Multidimensional Perfectionism Scale. Another concept that is relevant in this context is that of public self-consciousness. Public self-consciousness is an aspect of self-awareness defined by Fenigstein et al., (1975) as reflecting awareness of the self as a social object. This definition addresses the preoccupation with, and the degree of attention directed to, aspects of the self that are accessible to others such as looks, impressions etc. Social anxiety has been found to correlate positively with public self-consciousness (Fenigstein et al., 1975; Hope & Heimberg, 1988) and individuals with social phobia have been found to score higher on public self-consciousness than normal controls and individuals with other anxiety disorders (Bruch, Heimberg, Berger & Collins, 1989; Bruch & Heimberg, 1994). In the earlier study by Saboonchi and Lundh (1997), however, findings indicated a non-significant pattern of relationship between public self-consciousness and social anxiety when dimensions of perfectionism were controlled for. Since these results were found in a non-clinical sample of subjects, it was unclear whether the same results would be obtained with a clinical sample of patients with a diagnosis of social phobia. A second purpose of the present paper, therefore, was to explore this issue. In summary, three hypotheses are tested by this study: (a) both social phobia and panic disorder with agoraphobia are characterized by elevated degrees of perfectionism, particularly on the subscales concern over mistakes, doubts about action and parental criticism. (b) Social phobia is characterized by a higher degree of perfectionism than panic disorder with agoraphobia. (c) Social phobia is also characterized by higher scores on public self-consciousness than both panic disorder with agoraphobia and normal controls; this difference, however, disappears when degree of perfectionism is controlled for. On the other hand, the differences on perfectionism remain when public self-consciousness is controlled for.