مدل واسطه کمال گرایی، عاطفه و سلامت جسمی

This study tested a structural model in which positive and negative affect mediate the relationship between perfectionism and physical health. A community sample of young adults completed questionnaires including the Multidimensional Perfectionism Scale (MPS-H; Hewitt & Flett, 1991b), the Positive and Negative Affect States Survey (PANAS; Watson, Clark, & Tellegen, 1988) and items assessing three aspects of physical health. Results supported a structural model in which self-oriented perfectionism was associated with better physical health and this relationship was fully mediated by high positive affect and low negative affect. In contrast, socially prescribed perfectionism was associated with poorer physical health and this relationship was partially mediated by low positive affect and high negative affect. These findings are discussed in terms of the adaptive and maladaptive aspects of perfectionism within a general context of linkages between personality and health.

Despite advances in our understanding of how perfectionism is related to mental health, relatively little is known about how perfectionism is related to physical health. This is surprising, given the plethora of research uncovering relationships between psychological factors and physical health (Cohen and Rodriguez, 1995, Friedman and Booth-Kewley, 1987, Friedman et al., 1984, Leventhal et al., 1996, Littrell, 1996, Meeks et al., 2000 and Pettit et al., 2001) and the recent resurgence of interest in studying the robust relationship between personality and health. Therefore, the objectives of the present study were to test whether specific dimensions of perfectionism, those of self-oriented, socially prescribed, and other-oriented perfectionism are differentially related to physical health. We test a model in which the link between perfectionism and health is mediated by affect. Considerable attention has been directed toward increasing our understanding of perfectionism, a personality construct in which individuals are predisposed to set unrealistically high standards and to make self-esteem contingent on attaining these standards (Burns, 1980 and Frost et al., 1990b). On the one hand, Adler (1956) argues that striving to meet high standards and aspiring for perfection are part of the human condition leading to personal growth and improvement. On the other hand, some empirical research treats perfectionism as maladaptive, associated only with negative outcomes. For example, Pacht (1984) postulated that perfectionism can only result in maladjustment and psychological problems because perfectionists are either disappointed when they do not meet their excessively high standards, or fail to experience satisfaction when they are able to accomplish their goals. To address this contradiction, recent research has taken a multidimensional approach to the study of perfectionism. In this study, we apply this approach by employing Hewitt and Flett’s (**1991b) Multidimensional Perfectionism Scale (MPS-H) to examine the relationship between perfectionism and physical health. The MPS-H assesses three dimensions of perfectionism centred on interpersonal source and direction: self-oriented perfectionism, setting excessively high personal standards, accompanied by a strong motivation to attain perfection; other-oriented perfectionism, a tendency to hold exceedingly high standards for other people; and socially prescribed perfectionism, the perception that significant others place exceptionally high standards on them and evaluate them stringently (Flett & Hewitt, 2002). The reliability and validity of the MPS-H have been shown to be quite impressive (Hewitt, Flett, Turnbull-Donovan, & Mikail, 1991). Recent research findings with regard to the Five-Factor Model of personality (see McCrae & John, 1992) suggest that self-oriented perfectionism incorporates the adaptive components of perfectionism while socially prescribed perfectionism tends to encompass the maladaptive aspects of perfectionism. For example, research has supported the notion that self-oriented perfectionism is positively correlated with the conscientiousness factor, especially with achievement striving (Hill, McIntire, & Bacharach, 1997), while the self-criticism associated primarily with socially prescribed perfectionism is positively correlated with neuroticism, and negatively associated with conscientiousness, agreeableness, extraversion, the value facets of openness to experience, and the trust facet of agreeableness (Dunkley, Blankstein, & Flett, 1997). Thus, Hewitt and Flett’s (1991b) multidimensional model of perfectionism maps well on the larger structural framework of personality. The implication that perfectionism has both maladaptive and adaptive correlates is also congruent with the distinctions that have been made in terms of Hamachek’s (1978) ‘normal’ versus ‘neurotic’ perfectionists, Terry-Short, Owens, Slade, and Dewey’s (1995) ‘positive’ versus ‘negative’ perfectionism, Adkins and Parker’s (1996) ‘passive’ versus ‘active’ perfectionism, and Rice, Ashby, and Slaney’s (1998) ‘adaptive’ versus ‘maladaptive’ perfectionism. These theoretical distinctions have been supported empirically. Factor analytic studies of perfectionism measures have revealed clear two-factor solutions, which researchers have interpreted as representing adaptive and maladaptive features of perfectionism (Bieling et al., 2004, Frost et al., 1993 and Slaney et al., 1995). According to Hamachek (1978) ‘normal’ perfectionists gain pleasure from their arduous efforts, and they are able to strive for success in a flexible manner. Moreover, ‘normal’ perfectionists are able to accept both personal and situational limits and are able to set challenging, yet reasonable goals, which allows them to excel, to become emotionally invested in their activities, and to enjoy their successes (Flett, Hewitt, Blankstein, & O’Brien, 1991b). Hewitt and Flett’s (1991b) self-oriented perfectionism has been considered to have adaptive potential and to exemplify elements of Hamachek’s (1978) ‘normal’ perfectionism (Frost et al., 1993 and Slaney et al., 1995). In contrast, Hewitt and Flett’s (1991b) socially prescribed perfectionism has been found to reflect Hamachek’s (1978) ‘neurotic’ perfectionism (see Frost et al., 1990b, Frost et al., 1993, Hamachek, 1978 and Slaney et al., 1995). According to Hamachek (1978), ‘neurotic’ perfectionists believe they must meet excessively high standards and leave relatively little margin for error or failure. ‘Neurotic’ perfectionists are often unable to meet these exceptionally high standards because they are unrealistic, which results in stress, low self-esteem, depression, and anxiety. Ironically, ‘neurotic’ perfectionists are also unable to experience satisfaction from their painstaking efforts even when successful because they often deem their achievements as unworthy. Thus, it is not surprising that ‘neurotic’ perfectionism is associated with maladjustment (Saboonchi & Lundh, 1997). In short, self-oriented perfectionism tends to reflect achievement striving and the pursuit of success, which tends to result in psychological well-being, whereas socially prescribed perfectionism exemplifies the profound need to avoid failure, which results in poor mental health (Slade & Owens, 1998). A large body of research has emerged suggesting a link between perfectionism and mental health. Indeed, perfectionism has been associated with depression (Flett et al., 2003, Flett et al., 1991a, Flett et al., 1991b, Frost et al., 1990a, Hewitt and Flett, 1991a, Hewitt and Flett, 1993, Hewitt et al., 1996 and Rice et al., 1998), anxiety (Alden et al., 1994, Antony et al., 1998, Flett et al., 1995, Flett et al., 2002 and Kawamura et al., 2001), suicidal ideation (Adkins and Parker, 1996, Hewitt et al., 1992 and Hewitt et al., 1994), hopelessness (O’Connor & O’Connor, 2003), negative affect (Dunkley et al., 2003, Frost et al., 1993, Hewitt and Flett, 1991a, Saboonchi and Lundh, 2003 and Sorotzkin, 1985), personality disorders (Broday, 1988 and Wonderlich and Swift, 1990), obsessive–compulsive disorder (Antony et al., 1998, Frost et al., 1990b, Frost and Steketee, 1997 and Rheaume et al., 2000), and eating disorders (Cooper et al., 1985 and Sutandar-Pinnock et al., 2003). Of greater interest, researchers have begun to distinguish which dimensions of perfectionism are related to maladjustment and psychological problems and which are not. For example, Hewitt and Flett’s (1991b) dimensions of perfectionism have been found to be differentially related to mental health. In general, socially prescribed perfectionism is consistently associated with psychological distress, whereas other-oriented and self-oriented perfectionism tend to be associated with both positive and negative aspects of psychological health (see Enns & Cox, 2002 for review). For example, some researchers have reported significant positive associations between self-oriented perfectionism and depression (Hewitt and Flett, 1991a and Hewitt and Flett, 1993), while others have found evidence to suggest that this dimension may be related to enhanced psychological well-being (Flett et al., 1991a, Flett et al., 1991b, Flett et al., 1994 and Frost et al., 1993). Hewitt and Flett (1993) accounted for these disparate findings by demonstrating that the relationship between self-oriented perfectionism and depression is moderated by daily stress, such that only self-oriented perfectionists who report high levels of daily stress exhibit high levels of depressive symptomatology. Although the relationship between perfectionism and mental health is becoming clearer, relatively little is known about how perfectionism is related to physical health, which is remarkable, given the recent rekindling of interest in studying the robust relationship between personality and health. Thus, one of the goals of the present study was to test whether specific dimensions of perfectionism, those of self-oriented, socially prescribed, and other-oriented perfectionism are differentially related to physical health. The few studies that have examined the relationship between perfectionism and physical health have provided evidence of a direct link between perfectionism and health. In his review of the literature, Pacht (1984) found that perfectionism was significantly related to various disorders, such as irritable bowel syndrome, erectile dysfunction, abdominal pain in children, and ulcerative colitis. Moreover, perfectionism has been found to be associated with an array of somatic problems, such as migraine headaches (Burns, 1980 and Kowal and Pritchard, 1990), chronic pain (Van Houdenhove, 1986), headaches (Stout, 1984), and asthma (Morris, 1961). However, these studies defined perfectionism as a unidimensional construct, which did not permit researchers to examine whether the specific dimensions of perfectionism were differentially related to health. One exception to this is research by White and Schweitzer (2000) who utilized Frost et al.’s (1990b) Multidimensional Perfectionism Scale (MPS-F) to examine the relationship between chronic fatigue syndrome (CFS) and perfectionism. Their results supported the notion that specific dimensions of perfectionism were related to chronic fatigue syndrome, in that the most significant differences between the CFS group and the control group were on the dimensions of concern over mistakes and doubts over action. Saboonchi and Lundh (2003) also employed a multidimensional approach to examine the link between perfectionism and somatic health in a general population sample. Utilizing the MPS-H, they found that self-oriented and socially prescribed perfectionism were positively correlated with somatic complaints such as daytime sleepiness, headaches, tension, and insomnia. However, the relationship between socially prescribed perfectionism and somatic complaints was significant only for women. Finally, Martin, Flett, Hewitt, Krames, and Szanto (1996) utilized the MPS-H and found that only socially prescribed perfectionism was negatively associated with physical health. Although the existing literature suggests a relationship between perfectionism and health, critical issues remain unclear. First, the nature of the relationships between Hewitt and Flett’s (1991b) dimensions of perfectionism and physical health are not yet fully understood, as reported findings are not entirely consistent (Martin et al., 1996 and Saboonchi and Lundh, 2003). Second, past research has been inconsistent with regard to finding sex differences in the association between perfectionism and health. Finally, factors that may mediate the relationship between perfectionism and physical health remain largely unknown. These issues are addressed in the present study. One possible mechanism mediating the relationship between perfectionism and physical health is affect. Two prominent research traditions have emerged within the research literature with regard to positive and negative affect. The bivariate model of affect states that positive and negative affect are independent constructs, but does allow for small correlations between the two constructs due to the possibility of coactivation. Watson (1988) is a proponent of this approach in that he has conceptualized affect as representing two dimensions: positive activation, which refers to pleasurable engagement with the environment, and negative activation, which is a general factor of subjective distress. Conversely, the bipolar model of affect postulates that positive and negative affect are simply polar opposites on a one-dimensional scale and predicts that these constructs share an inverse relationship. Research has supported both models, (see Reich, Zautra, & Davis, 2003) which has given rise to a third approach to the study of affect that integrates both the bivariate and bipolar models of affect, the Dynamic Model of Affect (DMA). The model posits that positive and negative affect are best conceptualized as bivariate, except when individuals are under high levels of stress because high levels of stress are thought to reduce information processing, such that stress diminishes positive information processing while enhancing negative affectivity to cope with the situation (Reich et al., 2003). Recent research has emerged which supports the DMA (Zautra et al., 2000 and Zautra et al., 2001). Given that our sample was comprised of individuals from the general population and not believed to be under unusually high levels of stress, we adopted the bivariate model of affect in our model. Since perfectionism has adaptive and maladaptive correlates, the relationship between perfectionism and affect may be specific to the dimension of perfection. It is plausible that the constant striving, overgeneralization of failure, all or none thinking, and excessively high standards associated with socially prescribed perfectionism (Hewitt & Flett, 1993) increase negative affect and decrease positive affect which, in turn, could have a negative influence on health. On the other hand, it is possible that the self-satisfaction and rewards associated with self-oriented perfectionism, increase positive affect and decrease negative affect, which could have a positive influence on physical health. Recent research has provided evidence of relationships between perfectionism and affect. Adaptive perfectionism, for example, has been reported to be associated with fewer self-defeating behaviors in evaluative situations, and less vulnerability to negative affect (Bieling et al., 2003, Enns et al., 2001 and Rheaume et al., 2000). Self-oriented perfectionism has been associated with higher levels of positive affect (Frost et al., 1993). Conversely, socially prescribed perfectionism has been found to be consistently related to higher levels of negative affect, depression, and psychological distress (Hewitt and Flett, 1991a and Saboonchi and Lundh, 2003). Thus, empirical evidence supports different relationships between self-oriented and socially prescribed perfectionism and positive and negative affect. The finding that affect has a significant relationship with physical health is also well documented. For example, negative affect is thought to be a health risk, associated with unhealthy patterns of physiological functioning. Indeed, empirical work has supported the notion that negative affect is related to health complaints and symptoms (Cohen et al., 1995, Diefenbach et al., 1996, Leventhal et al., 1996 and Watson and Pennebaker, 1989) and associated with increased vulnerability to illness (Cohen et al., 1995, Cohen and Rodriguez, 1995 and Labott et al., 1990). Contradictory findings have been reported regarding the association between positive affect and health, as some researchers have found that positive affect is unrelated to self-reported health problems (Watson & Pennebaker, 1989), while others have reported that positive affect has a significant relationship with health (Pettit et al., 2001, Salovey et al., 2000 and Watson, 1988). Thus, we have the conditions for mediation (Baron & Kenny, 1986); that is, perfectionism is related to health, perfectionism is related to affect, and affect is related to health. In this study, we tested a model of perfectionism and physical health (see Fig. 1) utilizing structural equation modelling procedures. First, we defined perfectionism using Hewitt and Flett’s (1991b) three dimensions. Second, we proposed differential effects of these dimensions on physical health. Finally, we hypothesized that positive and negative affect would mediate the relationship between perfectionism and physical health.