کمال گرایی چند بعدی و ویژگی های شخصیتی DSM-5

Encouraging further research on the dimensional assessment of personality disorders (PDs), Section III of the DSM-5 introduced a hybrid model for the assessment of six PDs employing self-reports on 25 maladaptive personality traits (“DSM-5 personality traits”). Following suggestions that multidimensional perfectionism is an important characteristic across various personality disorders (Ayearst, Flett, & Hewitt, 2012), the present study investigated how personal (self-oriented) and interpersonal (other-oriented and socially prescribed) forms of perfectionism predicted the DSM-5 personality traits in a sample of 311 university students. Multiple regressions (controlling for the overlap between the different forms of perfectionism) showed that socially prescribed perfectionism positively predicted the traits defining schizotypal, borderline, avoidant, and obsessive-compulsive PD; other-oriented perfectionism positively predicted the traits defining narcissistic PD; and both socially prescribed and other-oriented perfectionism positively predicted the traits defining antisocial PD. In contrast, self-oriented perfectionism positively predicted only one of the four traits defining obsessive-compulsive PD (rigid perfectionism). Showing that multidimensional perfectionism predicted all DSM-5 traits defining the personality disorders of Section III, the findings suggest that future DSM-5 updates may profit from including interpersonal aspects of perfectionism as a diagnostic criterion.

1.1. Background In a critical article addressed to the personality and personality disorders (P&PD) work group of the DSM-5 task force, Ayearst, Flett, and Hewitt (2012) argued that the group did not recognize the importance of multidimensional perfectionism as a defining trait of personality disorders despite evidence suggesting that multidimensional perfectionism is an important characteristic across various personality disorders. The DSM-5 (American Psychiatric Association, 2013) has now been published retaining the categorical approach to the assessment of the 10 personality disorders from the DSM-IV. However, Section III of the DSM-5 introduced a new hybrid model using a dimensional approach in the assessment of six personality disorders employing self-reports on 25 maladaptive personality traits (consecutively referred to as “the DSM-5 personality traits”). Taking up the American Psychiatric Association’s call to further research on this hybrid model, the present research investigated the relationships between multidimensional perfectionism and the DSM-5 personality traits to explore the role that personal and interpersonal aspects of perfectionism play in the traits defining the six personality disorders of the model: schizotypal, borderline, antisocial, avoidant, narcissistic, and obsessive-compulsive personality disorder (PD). 1.2. Multidimensional perfectionism and personality disorders In their article, Ayearst et al. (2012) argued that the P&PD work group’s view of the role perfectionism played in personality disorders was too narrow because it considered only “rigid perfectionism” as a defining trait of obsessive-compulsive PD. Rigid perfectionism – defined as “rigid insistence on everything being flawless, perfect, and without errors or faults, including one’s own and others’ performance” (American Psychiatric Association, 2013, p. 780) – however does not acknowledge that perfectionism is a multidimensional personality characteristic (e.g., Enns & Cox, 2002), which suggests that the unidimensional conceptualization of perfectionism in the DSM-5 is flawed. Moreover, by including “one’s own or others’ performance,” rigid perfectionism confused self-oriented and other-oriented perfectionism; and it completely ignored socially prescribed perfectionism. According to Hewitt and Flett’s (1991) model of multidimensional perfectionism, it is important to differentiate three forms of perfectionism capturing personal and interpersonal aspects: self-oriented, other-oriented, and socially prescribed perfectionism. Self-oriented perfectionism comprises internally motivated beliefs that striving for perfection and being perfect are important. Self-oriented perfectionists have exceedingly high personal standards, strive for perfection, expect to be perfect, and are highly self-critical if they fail to meet these expectations. In comparison, other-oriented perfectionism comprises internally motivated beliefs that it is important for others to strive for perfection and be perfect. Other-oriented perfectionists expect others to be perfect, and are highly critical of others who fail to meet these expectations. In contrast, socially prescribed perfectionism comprises externally motivated beliefs that striving for perfection and being perfect are important to others. Socially prescribed perfectionists believe that others expect them to be perfect, and that others will be highly critical of them if they fail to meet these expectations (Hewitt and Flett, 1991 and Hewitt and Flett, 2004). Based on a review of empirical research and case studies, Ayearst et al. (2012) argued that interpersonal aspects of perfectionism (other-oriented and socially prescribed perfectionism) should play a more important role in the assessment of personality disorders than personal aspects (self-oriented perfectionism). The reason is that self-oriented perfectionism – showing substantial conceptual overlap with rigid perfectionism – has failed to show any unique positive relationships with personality disorders other than obsessive-compulsive PD (except for a negative relationship with dependent PD). In contrast, other-oriented perfectionism has shown unique positive relationships with narcissistic and antisocial PD; and socially prescribed perfectionism has shown unique positive relationships with obsessive-compulsive, schizotypal, borderline, antisocial, avoidant, paranoid, passive-aggressive, and dependent PD (see also Hewitt & Flett, 1991). 1.3. DSM-5 personality traits If Ayearst et al. (2012) analyses are correct, multidimensional perfectionism should also play a role in the six personality disorders of the hybrid model introduced in Section III of the DSM-5 (see 1.1.). Applying this model, clinicians would assess personality disorders based on an individual’s self-ratings on the DSM-5 personality traits defining borderline and antisocial PD (each defined by seven traits), schizotypal PD (six traits), avoidant and obsessive-compulsive PD (four traits each), and narcissistic PD (two traits; see Table 1, Column 2 for details). Moreover, following Ayearst and colleagues’ analyses, multidimensional perfectionism – and in particular other-oriented and socially prescribed perfectionism – should be expected to show significant unique relationships with the DSM-5 personality traits defining the six personality disorders.