کمال گرایی و لکنت زبان: یافته های یک نظرسنجی آنلاین

Purpose Using a multi-dimensional measure of perfectionism: the Frost Multi-dimensional Perfectionism Scale (FMPS: Frost, Marten, Lahart, & Rosenblate, 1990), this study investigates: (a) whether adults who stutter (AWS) display more perfectionistic attitudes and beliefs than those who do not stutter, and (b) whether, in AWS, more perfectionistic attitudes and beliefs are associated with greater self-reported difficulty communicating verbally and speaking fluently. Method In the first analysis, FMPS responses from 81 AWS and 81 matched, normally-fluent controls were analyzed using logistic regression to investigate the relative contributions of four FMPS perfectionism-subscale self-ratings to the likelihood of being in the AWS group. In the subsequent analyses, data from the 81 AWS were analyzed using linear multiple regression to determine which FMPS subscale self-ratings best predicted their Communication-Difficulty and Fluency-Difficulty scores. Results Both the likelihood of being a member of the AWS group, and also the magnitude of the AWS group's Communication-Difficulty and Fluency-Difficulty scores, were positively part-correlated to respondents’ Concern over Mistakes-Doubts about Actions (CMD) subscale self-ratings but negatively part-correlated to their Personal Standards (PS) subscale self-ratings. Conclusions The FMPS profiles of respondents who stutter suggest that, as a group, they are not abnormally perfectionistic overall, but may be (or perceive themselves to be) abnormally error-prone. Also, AWS who are more concerned about their errors and uncertain of their actions experience more difficulty communicating verbally and speaking fluently. Educational Objectives: After reading this article, participants will be able to: (a) describe the findings of previous research investigating the role of perfectionism in stuttering and psychopathologies; (b) discuss why a multidimensional assessment of perfectionism is important in relation to stuttering; (c) discuss ways in which data from perfectionism assessments can contribute to the planning of therapy for adults who stutter.

The possibility of a link between perfectionism and stuttering has been hypothesized by a number of researchers over the years (Amster, 1995, Amster and Klein, 2007, Amster and Klein, 2008, Brocklehurst et al., 2013, Froeschels, 1948, Johnson, 1946, Starkweather, 2002 and Van Riper, 1973). Despite the recurrence of such ideas in the stuttering literature, surprisingly little empirical research has been conducted into the actual relationship between perfectionism and stuttering, and there is currently no reliable data to indicate whether stutterers and non-stutterers differ in any of the standards of (speech or non-speech) performance that they aspire to. The present study constitutes our attempt to provide some such data. For the study, we use a multi-dimensional measure of perfectionism, the Frost Multi-dimensional Perfectionism Scale (FMPS: Frost, Marten, Lahart, & Rosenblate, 1990). This allows us to investigate the ways in which different dimensions of perfectionism may be associated with persistent stuttering in adults. In particular it allows us to explore whether, in AWS, the experience of difficulty communicating verbally and, more specifically, difficulty speaking fluently in everyday situations may be associated with raised levels of (domain-general) perfectionism. The study design is cross-sectional and, as such, does not investigate possible causal relations between perfectionism and stuttering. We begin with an introduction to the concept of perfectionism. We then review key literature concerning associations between stuttering and perfectionism. Following this we present the analysis of the survey data acquired in the current study. The first analysis compares the FMPS data from 81 AWS and an individually matched control group of Adults who do not stutter (AWNS). Subsequent analyses investigate relationships between the FMPS profiles of the 81 AWS and their self-rated communication and fluency difficulty scores. All three analyses indicate that some, but not all, dimensions of perfectionism are associated with stuttering. 1.1. The nature of perfectionism Although there is no universally agreed definition of perfectionism, there is nevertheless general agreement that the setting of high standards is central to the concept (e.g. Burns, 1980, Flett and Hewitt, 2002, Frost et al., 1990 and Hollender, 1965). Perfectionism is also frequently associated with high levels of concern over mistakes (e.g. Beck, 1976, Burns, 1980 and Frost et al., 1990) and with hypervigilance (Hewitt et al., 2003 and Shafran et al., 2002), although these are neither necessary nor sufficient criteria. In some circles, for example in the world of performing arts, perfectionism is regarded in a positive light and associated with outstanding achievements. However, from the perspective of psychopathology, it has tended, at least until recently, to be regarded as an undesirable and debilitating trait (e.g. Burns, 1980 and Pacht, 1984), associated with dysfunctional thinking styles (Beck, 1976), and a tendency to consistently overestimate how well an action has to be performed in order for it to fulfill its intended purpose. Such views reflect Hollender's (1965, p. 94) definition of perfectionism as “demanding of oneself or others a higher quality of performance than is required by the situation” although, as Hollender himself pointed out, this definition is problematic unless there is a consensus regarding what standards really are required by the situation. 1.1.1. Dimensions of perfectionism Early conceptualizations of perfectionism (e.g. Hollender, 1965) tended to be unidimensional in nature, describing it as a personality trait. More recently, it has come to be considered as a multi-dimensional construct, involving a network of beliefs, attitudes, ideals and expectations (Frost et al., 1990 and Hewitt and Flett, 1991). This more recent trend has led to the development of two multidimensional scales: the Frost Multidimensional Perfectionism Scale (FMPS; Frost et al., 1990), and the Hewitt & Flett Multidimensional Perfectionism Scale (MPS-HF; Hewitt & Flett, 1991), which are now the two predominant measures of perfectionism used in research and clinical practice (Egan, Wade, & Shafran, 2011). A notable result of this trend towards multidimensional conceptualizations of perfectionism and the use of multidimensional scales in research has been the steady accumulation of evidence supporting the view, originally proposed by Hamachek (1978), that the factors or dimensions underlying perfectionism fall into two distinct categories: positive, characterized by positive strivings and maintained primarily by positive reinforcement, and negative, characterized by the desire to avoid negative outcomes or evaluations ( Enns & Cox, 1999; e.g. Frost et al., 1993, Slaney et al., 1995 and Terry-Short et al., 1995, see also Stöber & Otto, 2006 for a recent review of such evidence). The distinction between positive and negative dimensions of perfectionism is clearly reflected in the six FMPS subscales, three of which are “positive” (Personal Standards, Parental Expectations, and Organization), and three of which are “negative” (Concern over Mistakes, Parental Criticism, and Doubts about Actions). The current study makes use of the FMPS which is described in more detail in Section 1.3.1 of this article. 1.1.2. Error evaluation and monitoring Central to perfectionism is the desire to achieve a perfect or near-perfect state or performance. However, whether such a desire is likely to be fulfilled depends, amongst other things, upon the judgments that an individual makes regarding what constitutes a perfect state or performance. Such value judgments are by their nature, categorical and, when made in reference to situations or performances, frequently involve drawing a line where, objectively speaking, no line exists. Thus, central to perfectionism is the concept of an “error” or “mistake”, and again, the point at which an individual judges a performance or state of affairs to be adequate or “good enough” is dependent on the way in which errors or mistakes are evaluated. Hewitt and Flett (1991) point out that an individual may draw the line in different places depending on whether the priority, when performing an action, is to achieve one's own personal goals or to gain the approval or acceptance of others. Individuals may also draw the line differently with respect to their own performance and the performance of others. Perfectionism is frequently associated with high levels of monitoring for errors (Hewitt et al., 2003 and Shafran et al., 2002), and neural responses associated with domain-general action monitoring (error-related negativity and error positivity) have been found to be of higher amplitude in people who score more highly on measures of (negative) dimensions of perfectionism (Schrijvers, De Bruijn, Destoop, Hulstijn, & Sabbe, 2010). These findings suggest an association between perfectionism and fast automatic monitoring processes as revealed in EEG profiles by error-related negativity (ERN) as well as slower ‘conscious’ processes as revealed in EEG profiles by error positivity (Pe). In the Schrijvers et al. study, error-related negativity and error positivity amplitudes evoked during a non-verbal Flanker Task (see Eriksen & Eriksen, 1974) were associated with specific FMPS subscale scores: ERN amplitude was negatively associated with FMPS Doubts about Actions scores, whereas Pe amplitude was positively associated with FMPS Concerns about Mistakes (Schrijvers et al., 2010). In contrast, in the same study, neither ERN nor Pe amplitudes were found to be associated with scores on standardized measures of depression (Hamilton Depression Rating Scale; Hamilton, 1960) or anxiety (State-Trait Anxiety Inventory; Spielberger, Gorsuch, Lushene, 1970). These findings therefore indicate a specific relationship between domain general action monitoring and negative dimensions of perfectionism. 1.1.3. Perfectionism and psychopathology As mentioned in Section 1.1, from the perspective of psychopathology, perfectionism has tended to be regarded as an essentially undesirable and debilitating trait (e.g. Burns, 1980 and Pacht, 1984), associated with dysfunctional thinking styles (Beck, 1976), and a tendency to consistently overestimate how well an action has to be performed in order for it to fulfill its intended purpose. Generally speaking “negative” dimensions of perfectionism (e.g. fear of failure and uncertainty about actions) are more likely to be associated with psychopathology than “positive strivings”, and in this regard Stöber and Otto concluded, on the basis of the evidence presented in their (2006) review that in the absence of a fear of adverse outcomes, positive strivings (as exemplified by high personal standards) are generally associated with adaptive behavior. However, the association between psychopathology and negative dimensions of perfectionism is not straightforward and high levels of positive strivings do also play a role in a number of pathological conditions (see Shafran & Mansell, 2001, for a review). Maladaptive perfectionism is associated with raised anxiety and stress response (Frost and DiBartolo, 2002, Gnilka et al., 2012 and Wirtz et al., 2007; for a review see Egan et al., 2011). People with disorders associated with perfectionism are prone to catastrophization (Beck, 1976), and high levels of rumination (Egan, Hattaway, & Kane, 2014). Individuals may be more perfectionistic with regard to some aspects of their life than others, and (as noted previously) they may apply different standards to themselves compared to others. In these regards Flett and Hewitt (2002) have suggested that the more domain-general perfectionism becomes, the more likely it is to cause difficulties, and that perfectionism is most likely to become maladaptive when it becomes global and over-generalized. In a review of clinical studies of perfectionism, Shafran et al. (2002, p. 773) proposed “that the defining feature of clinically significant perfectionism is the overdependence of self-evaluation on the determined pursuit (and achievement) of self-imposed personally demanding standards of performance in at least one salient domain, despite the occurrence of adverse consequences”. Maladaptive perfectionism is particularly associated with high levels of perfectionistic concerns (negative perfectionism; see Section 1.1.1), whereas adaptive perfectionism is associated with high levels of perfectionistic strivings only (positive perfectionism; see Section 1.1.1; see also Stöber & Otto, 2006). With respect to the FMPS, dimensions associated with maladaptive perfectionism are Concerns about Mistakes, Doubts about Actions, and Parental Criticism, whereas dimensions associated with adaptive perfectionism are Personal Standards, Organization and Parental Expectations (see Rice & Ashby, 2007). The clinical consequences of maladaptive perfectionism are widespread, and it has been identified as an important factor behind a number of common pathological conditions including: depression, anxiety disorders, eating disorders, obsessive-compulsive disorders, post-traumatic stress disorder, and suicidal tendencies (Bieling et al., 2004, Egan et al., 2014 and Shafran and Mansell, 2001). In this respect it has been suggested that perfectionism is best characterized as “an aspect of cognition or behavior that may contribute to the maintenance of a psychological disorder” (Egan et al., 2011 and Harvey et al., 2004, p. 14). Indeed, the presence of perfectionistic cognitions can predispose an individual to a number of psychological disorders, and it is not uncommon to find individuals with such cognitions presenting with a number of co-morbidities (Bieling et al., 2004). However, as measures of perfectionism have come to reflect its multiple dimensions, it has become apparent that the perfectionism profiles of such psychological disorders differ substantially from one another. For example high Doubts about Actions and Concern over Mistakes FMPS subscale self-ratings have been confirmed to be associated with self-reported depression ( Frost and DiBartolo, 2002 and Frost et al., 1993), clinically diagnosed eating disorders ( Minarik and Ahrens, 1996 and Sassaroli et al., 2008), and Beck Depression Inventory (BDI: Beck, Steer, & Carbin, 1988) scores in patients with major depressive disorder ( Enns & Cox, 1999), whereas other specific patterns of FMPS subscale scores have been shown to be associated with Social Phobia ( Juster et al., 1996) and Obsessive Compulsive Disorder ( Frost and Steketee, 1997 and Sassaroli et al., 2008).

This study investigated whether adults with persistent stuttering have more perfectionistic attitudes and beliefs than matched controls, and whether associations exist, in such adults, between the extent of their perfectionistic attitudes and beliefs and the extent of difficulty they experience communicating verbally and speaking fluently. Its findings suggest that stuttering and stuttering severity in adults tends to be associated with higher self-ratings of concern over mistakes and doubts about actions. However, it is not associated with higher personal standards. Importantly, by abandoning a uni-dimensional construct of perfectionism and using regression modeling to evaluate these findings, it was possible to reveal a profile of attitudes and beliefs, in adults who stutter, that could in part reflect an adaptive response to underlying speech and/or language production impairments that cause their speech to be error-prone and unreliable. The findings of the current study are of interest clinically. In particular, they highlight the potential usefulness of multidimensional measures of perfectionism in the planning and implementation of therapies, such as CBT, that aim to help people who stutter re-evaluate their personal standards – both with regard to speech as well as other life domains – and make appropriate adjustments. The findings of this current study point to the need for researchers to make use of perfectionism measures that allow a distinction to be made between the levels of respondents’ personal standards and their level of their concern over mistakes and doubts about actions.