کمال گرایی و علائم افسردگی شدت در اختلال افسردگی اساسی

In recent years it has been recognized that perfectionism is a multidimensional construct and two Multidimensional Perfectionism Scales have been developed and investigated in relative isolation [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]. The present study sought to evaluate the association between various dimensions of perfectionism, higher-order personality dimensions, and self and observer rated depressive symptoms in a group of 145 patients with major depressive disorder. Only three of ten perfectionism dimensions (socially prescribed perfectionism, concern over mistakes and self-criticism) displayed medium to large correlations with depressive symptoms, especially self-report symptoms reflecting depressive cognitive distortions. The results are discussed in relation to the specificity of perfectionism dimensions to depression, adaptive versus maladaptive aspects of perfectionism, and in the context of previous research, much of which has relied on college student samples.

Potentially maladaptive effects of perfectionism have been recognized for many years (Hollender, 1965; Hamachek, 1978). Perfectionism has been regarded as a predisposing factor for depression from both cognitive and psychoanalytic perspectives (Bibring, 1953; Beck, 1967). In recent years there has been considerable growth in the perfectionism literature, owing in part to the development of reliable and valid instruments to measure various aspects of perfectionism (for a review see Enns & Cox, in press). Working from different conceptual frameworks, two groups of investigators independently developed instruments entitled the `Multidimensional Perfectionism Scale' (MPS) (Frost et al., 1990; Hewitt & Flett, 1991a). The Frost et al. MPS has the following dimensions based largely on content and potential origins of perfectionism: (1) concern over mistakes, (2) personal standards, (3) parental expectations, (4) parental criticism, (5) doubts about actions and (6) organization. The Hewitt and Flett MPS has dimensions based on the direction of perfectionism: (1) self-oriented perfectionism, (2) other-oriented perfectionism and (3) socially prescribed perfectionism. Three studies of undergraduate students reported correlations between the Frost et al. MPS dimensions and self-reported depression (Frost et al., 1990; Frost et al., 1993; Minarik & Ahrens, 1996). In each report doubts about actions and concern over mistakes showed the strongest association with depression symptoms (concern over mistakes r=0.28 to 0.52; doubts about actions r=0.31 to 0.55). Personal standards and organization showed small or even negative correlations with depression (personal standards r=−0.32 to 0.21; organization r=−0.03 to 0.12). There are no published reports examining the relationship between the Frost et al. MPS dimensions and depression symptoms in clinically depressed samples. Several studies have reported correlations between the Hewitt and Flett MPS dimensions and depression symptoms in undergraduate student samples (Flett et al., 1995; Flett et al., 1991; Frost et al., 1993; Preusser et al., 1994; Saddler & Buckland, 1995; Saddler & Sacks, 1993). Socially prescribed perfectionism quite consistently showed the strongest correlation with depression (r=0.22 to 0.52). Self-oriented perfectionism showed a more variable, though usually positive correlation with depression (r=−0.05 to 0.36), and other-oriented perfectionism generally showed a nonsignificant association with depression (r=−0.25 to 0.24). Hewitt and Flett (1991b) found that depressed patients had higher levels of self-oriented perfectionism than both anxiety patients and controls. Socially prescribed perfectionism was elevated in both depressed and anxiety subjects compared to controls. These results suggest that self-oriented perfectionism may be more specific to clinical depression. Finally, a prospective study of current and former depressed patients supported a specific vulnerability hypothesis (Hewitt, Flett, & Ediger, 1996). Self-oriented perfectionism interacted only with achievement stress to predict depressive symptoms. Socially prescribed perfectionism predicted depressive symptoms as a main effect, but did not show an interaction with stress in predicting depression. The studies reviewed above suggest that the dimensions of perfectionism described by Hewitt and Flett (1991a) and Frost et al. (1990) may vary considerably in their importance to depression. To date, socially prescribed perfectionism and self-oriented perfectionism have received the strongest support. However, there have been few studies on the relationship between the Frost et al. MPS dimensions and depression. Further, only one study has simultaneously investigated correlations between both the Hewitt & Flett and Frost MPS dimensions and self-report depression scores, and it relied on a college student sample (Frost et al., 1993). Socially prescribed perfectionism, concern over mistakes, and doubts about actions all showed significant positive correlations with the Beck Depression Inventory (BDI: Beck, Steer, & Garbin, 1988) (socially prescribed perfectionism r=0.23; concern over mistakes r=0.28; doubts about actions r=0.31). In a related vein, the relationship between depression and the lower-order personality factors dependency and self criticism (Blatt et al., 1976) or sociotropy and autonomy (Beck, 1983) has been extensively studied for over 15 years (Coyne & Whiffen, 1995). A significant conceptual relationship between perfectionism and self-criticism has been noted (Blatt, 1995; Enns & Cox, 1997). For example, Blatt (1995) suggested that ``self-oriented perfectionism involves exceedingly high unrealistic standards and an intensive self-scrutiny and criticism'' (p. 1006). That is, self-criticism may be a maladaptive aspect of self-oriented perfectionism. Blatt also asserted that self-critical depressive individuals ``have a chronic fear of disapproval, criticism and rejection [and] strive for excessive achievement and perfection'' (p. 1009). This striving to achieve and maintain approval and acceptance by others is descriptively rather similar to socially prescribed perfectionism. Only one study directly comparing these alternative conceptualizations in relation to depression has been reported. Hewitt and Flett (1993) found that socially prescribed perfectionism and self-criticism both showed a strong cross sectional relationship with BDI score. Self-criticism also showed large correlations with both self-oriented perfectionism (r=0.57) and socially prescribed perfectionism (r=0.50). The present investigation was conducted to examine the association between various dimensions of perfectionism and depression symptom severity in a group of patients with major depressive disorder. We sought to extend this area of research in several ways. First, the present report simultaneously assessed the association between depression symptoms and the dimensions of perfectionism described by Hewitt and Flett (1991a), and Frost et al. (1990), as well as the related dimension of self-criticism (Blatt et al., 1976). Second, since there has been general agreement that the 21 items of the BDI reflect 3 symptom factors (Beck et al., 1988; Steer et al., 1987), we evaluated the relationship between the dimensions of perfectionism and BDI `subscale' scores using the item assignments from the Steer et al. (1987) factor analytic study1. Third, we evaluated the relationship between perfectionism dimensions and both self-reported (BDI) and observer-rated (Hamilton Depression Rating Scale, HamD; Hamilton, 1960) depression symptoms. Fourth, because the higher-order personality variables of neuroticism and extraversion have been convincingly linked to depression (e.g., Clark & Watson, 1991; Enns & Cox, 1997), the present study also sought to determine whether these lower-order perfectionism variables would remain significantly correlated with BDI scores when neuroticism and extraversion were statistically controlled. Based on previous research it was hypothesized that concern over mistakes, doubts about actions, socially prescribed perfectionism, and self-criticism would be most strongly associated with depression scores. It was also expected that the perfectionism dimensions would show a stronger association with the BDI `cognitive distortions' subscale compared to the `cognitive–affective' and `somatic complaints' subscales. Since the HamD is observer rated and strongly emphasizes somatic/vegetative depression symptoms, it was predicted that smaller correlations between the HamD and perfectionism would be observed.