Chronic fatigue syndrome (CFS) is characterized by medically unexplained, severe and prolonged fatigue along with various other symptoms, such as muscle pain, sore throat, headaches, and post-exertional malaise (Fukuda et al., 1994). There is mounting evidence to suggest that CFS is associated with high rates of depression (Adler, 2004, Arnold, 2008, Fuller-Thomson and Nimigon, 2008 and Kempke et al., 2010), and research increasingly indicates that both conditions share common biological and psychosocial factors (Luyten et al., 2006a, Arnold, 2008 and Van Houdenhove et al., 2009). In particular, from a psychosocial perspective, both depression and CFS have been associated with perfectionism (Magnusson et al., 1996, White and Schweitzer, 2000, Shafran and Mansell, 2001, Luyten et al., 2006b and Deary and Chalder, 2010). For example, Magnusson et al. (1996), in a non-clinical sample, reported evidence for an association between fatigue and perfectionism. Other studies have found that patients with CFS exhibit higher levels of perfectionism as compared to a normal control group (White and Schweitzer, 2000 and Deary and Chalder, 2010). Moreover, in one study CFS patients also retrospectively reported higher levels of perfectionism before onset of the disorder (Luyten et al., 2006b).
However, more research is needed to explore the precise nature of perfectionism in CFS (Van Geelen et al., 2007). In particular, it is unclear whether adaptive and maladaptive aspects of perfectionism can be distinguished in CFS (Luyten et al., 2006b). Indeed, studies using current multidimensional measures of perfectionism, like the Multidimensional Perfectionism Scale (MPS-F) developed by Frost et al. (1990), have found evidence for a distinction between adaptive or normal and maladaptive or pathological perfectionism (Dunkley et al., 2000, Enns et al., 2002, Bieling et al., 2004, Dunkley et al., 2006 and Stoeber and Otto, 2006). Maladaptive perfectionism has been conceptualized as a tendency to make overly critical self-evaluations, whereas adaptive perfectionism has been defined as a positive striving for achievement (Frost et al., 1990, Dunkley et al., 2000, Dunkley et al., 2006 and Stoeber and Otto, 2006). Many studies have confirmed this two-factor model of perfectionism, and have shown that adaptive perfectionism is either associated with positive health aspects (e.g., higher self-esteem) or unrelated to negative outcomes (Frost et al., 1990, Dunkley et al., 2000, Enns et al., 2002, Bieling et al., 2004, Dunkley et al., 2006 and Stoeber and Otto, 2006), whereas maladaptive perfectionism has been implicated in the development and maintenance of a wide range of symptoms and disorders including depression, anxiety disorders, and eating disorders (Shafran and Mansell, 2001). However, some studies have failed to replicate these findings, and have found that adaptive perfectionism is also associated with negative consequences (e.g., distress), suggesting that adaptive perfectionism is not always ‘really’ adaptive (Shafran and Mansell, 2001 and Luyten et al., 2006b).
To the best of our knowledge, only two previous studies have more systematically investigated the role of adaptive and maladaptive perfectionism in CFS. Luyten et al. (2006b), in a small study of 43 CFS patients, reported that neither adaptive nor maladaptive perfectionism, as assessed by the MPS-F (Frost et al., 1990), were associated with severity of fatigue. Furthermore, they found that both maladaptive and adaptive perfectionism were positively associated with severity of depression. The authors interpreted these results by suggesting that no clear distinction can be made between maladaptive and adaptive perfectionism in CFS patients. However, they also acknowledged the preliminary nature of these conclusions because of the small sample size of their study, the use of regression analyses instead of more sophisticated methods such as structural equation modelling, and because they did not directly investigate the factor structure of perfectionism. More recently, Deary and Chalder (2010), using the MPS-F (Frost et al., 1990), found that both perfectionism dimensions were related in CFS patients (N = 27), but not in normal controls (N = 30). Moreover, CFS patients reported higher levels of maladaptive, but not adaptive, perfectionism as compared with the control group.
The main aim of the current study was to further explore the nature of perfectionism in CFS. Therefore, we investigated whether adaptive and maladaptive perfectionism were differently associated with severity of fatigue and depression in a large group of CFS patients using structural equation modelling. Consistent with the theoretical distinction between adaptive and maladaptive perfectionism, we hypothesized that maladaptive, but not adaptive, perfectionism would be positively associated with severity of fatigue and depression in CFS.
