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To explore the role of perfectionism across anxiety disorders, 175 patients with either panic disorder (PD), obsessive compulsive disorder (OCD), social phobia, or specific phobia, as well as 49 nonclinical volunteers, completed two measures [Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R., (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14, 449-468; Hewitt, P. L., & Flett, G. L., (1991). Perfectionism in the self and social contexts: Conceptualization, assessment and association with psychopathology. Journal of Personality and Social Psychology, 60, 456-470.] that assess a total of nine different dimensions of perfectionism. Relative to the other groups, social phobia was associated with greater concern about mistakes (CM), doubts about actions (DA), and parental criticism (PC) on one measure and more socially prescribed perfectionism (SP) on the other measure. OCD was associated with elevated DA scores relative to the other groups. PD was associated with moderate elevations on the CM and DA subscales. The remaining dimensions of perfectionism failed to differentiate among groups. The clinical implications of these findings are discussed.

The term `perfectionism' refers to the desire to achieve the highest standards of performance, in combination with unduly critical evaluations of one's performance (Frost et al., 1990). Perfectionistic individuals, then, are individuals who believe that they can and should achieve perfect performance, perceive anything less than perfect performance as unsatisfactory, and selectively attend to cues that their standards have not been met (Hamacheck, 1978; Burns, 1980; Pacht, 1984). Thus, perfectionistic individuals are likely to be unsatisfied with their performance, as they consistently set demands that they are unable to meet. Although the detrimental effects of this paradox are obvious, and clinicians have long proposed a relationship between perfectionism and psychopathology, only recently have investigators attempted to define the construct of perfectionism precisely enough for its role in psychopathology to be examined empirically. Furthermore, whereas earlier theorists had described perfectionism as a unidimensional construct (see Burns, 1980; Pacht, 1984), investigators have only recently begun to consider the multidimensional nature of perfectionism. Frost et al. (1990)were the first to develop a measure designed specifically to assess dimensions of perfectionism in clinical and nonclinical groups. Through review of the existing literature on perfectionism, this group of researchers hypothesized that the construct of perfectionism is comprised of six dimensions: (a) a tendency to react negatively to mistakes and to equate mistakes with failure (concern over mistakes), (b) a tendency to doubt the quality of one's performance (doubts about actions), (c) a tendency to set very high standards and place excessive importance on these for self-evaluation (personal standards), (d) a tendency to perceive one's parents as having high expectations (parental expectations), (e) a tendency to perceive one's parents as being overly critical (parental criticism) and (f) a tendency to emphasize the importance of order and organization (organization). The scale based on these dimensions was referred to as the multidimensional perfectionism scale (MPS-F). At about the same time, Hewitt and Flett (1991a)also developed a multidimensional measure of perfectionism. These researchers argued that the existing views of perfectionism were too narrow, focusing only on self-criticism and ignoring interpersonal situations in which perfectionistic standards might be activated. They argued that perfectionism consists of three dimensions: (a) the tendency to set exacting standards for oneself as well as to evaluate one's own behavior stringently (self-oriented perfectionism), (b) the tendency to have unrealistically high standards for the behavior of significant others (other-oriented perfectionism) and (c) the tendency to believe both that significant others have unrealistically high standards for oneself, and that they engage in stringent evaluation of one's behavior (socially prescribed perfectionism). Hewitt and Flett (1991a)also titled their scale the multidimensional perfectionism scale (MPS-H). Although there is overlap in the constructs measured by the MPS-F and MPS-H (e.g. the socially prescribed perfectionism scale from the MPS-H is correlated with the parental criticism and parental expectations scales on the MPS-F, the dimensions from the two measures do not overlap entirely (Frost et al., 1993). Perfectionism, as measured by these scales, is related to general symptoms of anxiety in nonclinical samples (Minarik and Ahrens, 1996), mixed groups of psychiatric patients (Hewitt and Flett, 1993), and samples of individuals with depression and anxiety disorders (Hewitt and Flett, 1991b). Furthermore, perfectionism is implicated in the development and maintenance of specific anxiety disorders. For instance, cognitive theories of obsessive–compulsive disorder (OCD) have suggested that perfectionistic thinking contributes to certain types of obsessions (e.g. doubts about whether a task was completed correctly) and compulsive activity (e.g. washing until it feels `just right') (McFall and Wollersheim, 1979; Obsessive Compulsive Cognitions Working Group, 1997). This hypothesis is supported in a study by Frost and Steketee (1997), in which perfectionism (as measured by the MPS-F) was compared across clinical samples of individuals with OCD and panic disorder and a sample of nonanxious volunteers. Patients with OCD had higher overall scores on the MPS-F than did nonanxious volunteers, which was accounted for by elevations on the `concern over mistakes' and `doubts about actions' subscales. Additionally, the OCD sample had higher `doubts about actions' scores than did a sample of patients with panic disorder. Interestingly, although psychological models of panic disorder have not included perfectionistic beliefs as a relevant precipitating factor (McNally, 1990; Antony et al., 1992; Antony and Barlow, 1996), those with panic disorder also had higher scores on the `concern over mistakes', `parental criticism', and total perfectionism scores than the nonanxious controls. At least two additional studies support the relationship between perfectionism and OCD symptomatology. Rhéaume et al. (1995) found that scores on each of the MPS-F subscales except organization were significantly correlated with scores on the Padua inventory, a measure of OCD severity. In a study by Frost and Shows (1993), concern over mistakes and doubts about actions were significantly correlated with compulsive indecisiveness (a symptom often reported by people with OCD) in undergraduate students. Perfectionistic beliefs are also considered important to the development and maintenance of social phobia. In their comprehensive model of social phobia, Heimberg et al. (1995)described three types of beliefs held by individuals with social phobia: (a) social situations are potentially dangerous because they may lead to humiliation, (b) meeting a very high standard of social performance is the only way to avoid or prevent humiliation in social situations and (c) this standard is never met. Juster et al. (1996)indeed found that compared to nonanxious controls, individuals with social phobia had higher scores on the `concern over mistakes', `doubts about actions' and `parental criticism' scales of the MPS-F. At this time, then, specific dimensions of perfectionism have been identified, and existing models of mood and anxiety disorders have implicated particular types of perfectionistic beliefs in their development and maintenance. Furthermore, empirical support for the role of various types of perfectionistic beliefs in these disorders has been obtained. Although these data may help to forward our understanding of the mechanisms and treatment of psychopathology, more research investigating dimensions of perfectionism and their relationship to various disorders is necessary. For instance, to date, no published studies have compared individuals with a broad range of anxiety disorders to nonclinical volunteers, nor have any studies directly compared individuals with OCD to those with social phobia. This comparison is of interest because of the anxiety disorders, these two have been hypothesized to be the most closely linked to perfectionism. Finally, of the studies that have examined the role of perfectionism in various anxiety disorders, only the MPS-F dimensions have been studied. No published study has yet examined the Hewitt and Flett (1991a)dimensions in patients with particular anxiety disorders. The purpose of the present paper was to compare dimensions of perfectionism across anxiety disorders. Specifically, patients with social phobia, OCD, panic disorder and specific phobia, and a sample of nonanxious volunteers were compared on the six dimensions of perfectionism identified by Frost et al. (1990)and the three dimensions of perfectionism identified by Hewitt and Flett (1991a). All patient groups were diagnosed using a structured interview based on DSM-IV criteria. Based on existing models for specific anxiety disorders, and current empirical findings, it was hypothesized that, relative to other groups, patients with OCD and social phobia would show higher levels of perfectionism on the MPS-F and MPS-H scales. It was expected that the social phobia group would have higher scores on the `concern over mistakes', `doubts about action', and `parental criticism' scales than the panic disorder, specific phobia and nonclinical groups. We also expected that social phobia would be associated with higher levels of self-oriented and socially prescribed perfectionism than other clinical and nonclinical groups. Furthermore, we expected that OCD would be associated with higher scores on the `doubts about action' than other anxiety disorders. Finally, panic disorder patients were expected to report levels of perfectionism intermediate between patients with social phobia or OCD on the one hand, and individuals with specific phobias or no anxiety disorder on the other hand. All procedures in the present study were approved by the Ethics Review Committee in the Department of Psychiatry at the University of Toronto.