Perfectionism and Depression

Introduction

The association between perfectionism and depression importantly investigated by several researchers because of the perfectionistic attitudes may lead depression over time. Hewit and Flett (1991) described perfectionism as latent vulnerability factor in the development of depression. Having perfectionistic behaviors and struggles trigger depression by means of extreme self-evaluation and elevated depressive symptomology. Perfectionism has multidimensional nature and rising of depression has variable association with the nature of multidimensional perfectionism. In this report, the characteristics of perfectionism and depression was analyzed by giving several examples from literature. The role of several factors influencing depression such as stress and anxiety were put into center to understand the link between perfectionistic struggles and depression. Including the previous findings and some limitations, several reports were discussed to investigate the link between two clinical important diseases: perfectionism and depression.

The Definition and Nature of Perfectionism

Hollander (1978) describes perfectionism where perfectionistic individuals request excessive level of performance compared to other individuals. However, according to Stoeber and Joorman (2001) the definitions behind perfectionism occurs when the perfectionistic individual set overmuch higher standards against his/her own behaviors and actions. Hewitt and Flett (1991) define multidimensional perfectionism as self-oriented, other-oriented and socially prescribed perfectionism. Self-oriented perfectionism (SOP) qualifies the behaviors of perfectionistic individual with unrealistic excessive standards, perfection, motivation to be flawless. The one who sets those features and self-standards on his/her own can be named as self-oriented perfectionistic. The similar attitudes and behaviors occur the same in other-oriented perfectionism (OOP). However, those behaviors are driven and directed by other individuals. The excessive expectancies and unrealistic standards occurring in socially-prescribed perfectionism (SPP), however govern the perfectionistic individuals according to the perfectionistic expectancies of others.

            In the later studies, perfectionism is identified as maladaptive and adaptive form. In earlier studies, however this two forms matched as neurotic and normal one. According to Hamachek (1978), in the normal form of perfectionism, perfectionistic handle to manage his/her own unrealistic standards. In contrast, in neurotic type of perfectionism, the perfectionistic individual never satisfy in his/her own standards. By the same way, in adaptive perfectionism, perfectionistic individual set higher level of self-confidence, positive outcomes while dealing with stress. In contrast, in maladaptive perfectionism, higher level of anxiety and depression was found with lower level of self-respect and self-confidence among participants (Ashby, Noble & Gnilka, 2012).

            The measurement of multidimensional perfectionism levels was done by multidimensional perfectionism scale (MPS). Hewitt and Flett (1991b) designed 45 items scale named as MPS-H and Frost and his colleagues (1990), designed 35 items scale named as MPS-F. These two measurements use dimensions of perfectionism by evaluating “concern over mistakes, criticism and personal standards” in MPS-F, while they were evaluating OOP, SPP, SOP in MPS-H scales.

The Definition and Nature of Depression

            In depression, individual are involved an emotional state where they feel low self-worth, guilt, lower pleasure from life activities. 21 item scale, Beck Depression Inventory (BDI) identifies depressive symptomology cognitive, motivational, physiological, affective and behavioral symptoms as well as cognitive distortions. According to Cohen (2008), the underlying structures in BDI differ through symptomology. In depression, people having cognitive problems demonstrate interest loss, concentration problems, people having affective problems develop pleasure loss and sadness. Physiological factors influence the depression by changing in appetite and sleep. In behavioral symptomology, people loss their energy and motivation. Finally, in cognitive distortions, guilt feelings are surrounded with low self-esteem and self-worth emotions. Freundestein and colleagues (2012) proposes self-critical depression where self-evaluation of own person influence on person’s low self-esteem, shame and failure feelings. Those individuals set high standards for themselves with those feelings.  Differently, in anaclitic depression, individuals are depended on their surrounding environment.

            Anxiety and stress as depressive symptomology has link with perfectionism. Individuals are involved anxiety situations under stressors have tendency to develop depression. Anxiety development with outstanding worries and expectations as well as stressful events with self-evaluation and low self-worth may lead depression and both of them was associated with perfectionism.

Research on Perfectionism and Depression

            There are growing research in literature which investigates the link between perfectionism and depression. Current literature aims to find the psychopathology behind perfectionism and its association with depression.

            As previous mentioning, depression has many other sources such as stress and anxiety. According to study of Flett and his colleagues (2005), in socially prescribed perfectionism, stress levels and daily difficulties result in depressive symptomology in perfectionists. This study mainly focused on potential influence of immature and neurotic defense styles among socially prescribed perfectionism and depression in young adults. Additionally, they found that maladaptive defense styles are the mediator in the course of depression and socially prescribed perfectionism. Another significant data from the research tells us that personal traits of SPP individuals are unique to symptoms occurring in depression. It means that the perfectionistic motives directed by others’ perfectionistic thoughts are the main reason in the linkage between depression and perfectionism.

            In an older report, Enns and Cox (1999) finds the SOP and SPP as most common type perfectionism type in the association with depression through perfectionism. Nevertheless, SPP is widely and strongly connected to depression in those perfectionism types. They propose two striking mechanisms for this relationship: (i) perfectionistic individuals have potential stress factors which highly effects their own life expectations, performance and satisfactions and (ii) the perfectionistic individuals meet failures that result in the reduction of their self-worth. Therefore, perfectionists generate oversensitive reactions to the potential source of stress (Flet, Bessern, Hewitt & Davis, 2007). These both study approached perfectionism and depression by considering stress and self-criticism nature of perfectionism. Enns and Cox (1999) also found that cognitive distortions factor of BDI scale was significantly higher than somatic and affective factors of BDI scale among samples. This situation refers the perfectionistic symptomology arise with cognitive distortions in the individuals rather than somatic and affective item factors. Therefore, distorted thinking might be the main reason in perfectionistic attitudes in depression.

            Another work by Kawamura and his colleagues (2001) shows the link between SPP and depression. In this study, anxiety and stress as depressive symptomology play high degree of role with maladaptive and adaptive dimensions of perfectionism. They also showed that anaclitic depression symptomology has positive correlation with SPP. This is because, in anaclitic depression, depressive symptomology is depended to surrounding environment and SPP individuals set their unrealistic standards according to other’s expectancies.

            According to Ashby et al. (2012), maladaptive perfectionists have higher level of stress and depression and as well as lower coping abilities in depression and stress rather than adaptive perfectionists. Results clearly shows that pathologic form of perfectionism result in elevated levels of perfectionistic struggles and depression levels under life stress. Consequently, they cannot deal with those situations in their daily life.

Conclusions and Future Outlook

            This review article provides several examples to the association between perfectionism and depression. Firstly, perfectionism has multidimensional characteristics with three dimensions as follows: (a) self-oriented, (b) other-oriented and (c) social-prescribed. When multidimensional perfectionism was considered, previous literature suggests that SOP and SPP are the main perfectionism types that have link with depression. However, literature finds more link between SPP and depression compared to SOP and OOP. The underlying speculations behind might be done as those comments: (1) Socially prescribed perfectionist judges themselves with surrounding anxiety and stress factors related to their excessive expectations. Potential stress factors as well as developed anxiety, reduction in self-worth and increase in self-criticism cause to set higher excessive standards that SPP individuals can fail in their standards and own performance. (2) Distorted thinking might lead to change in thoughts by means of depression and perfectionism. Since perfectionist have impairment in thoughts via depression, perfectionistic attitudes are being developed. If we consider SOP individuals, they put themselves in the center. Their negative evaluations onto themselves result in low self-esteem and increase in self-criticism.

            Another point of view can be analyzed by considering adaptive and maladaptive type of perfectionism. As Ashby et al., (2012) showed, higher level stress and lower coping abilities distinguish maladaptive perfectionists from adaptive one. Therefore, when the neurotic form of perfectionism is considered, psychopathology might be analyzed by considering other influencer such as stress levels, coping styles in the course of disease. Maladaptive perfectionists have potentially rough personality dimensions where in the end, they cannot deal with external and internal stressors and other stimuli.

            From the general outlook, researches have some limitations. For example, several mental disorders including depression and perfectionism, there are always common associations in terms of presenting symptomology. When we simultaneously considered perfectionism and depression, we see that anxiety, stress, self-silencing, that whole, lead to depression. Further, we check the association between perfectionism and depression. We might assume that lack of coping abilities lead to stress, that stress lead to anxiety and therefore depression. However, from general outlook, it is really difficult to find the real causes and background in the mental diseases. Therefore, all those symptomologies are being telescoped, it is hard to predict the real reasons.

            In clinical therapies, psychologist and clinicans can gather useful information from current literature. For example, according to the results of Flett et al., (2005) work, maladptive defense style has meaningful association in the course of SPP. Therefore, once the therapist know the SPP related symptomology, he can understand basic cause of maladaptive defense style and can accordingly direct his/her treatment. Current literature additionally suggest some recommendations to clinicians while the patient on treatment. Clinicans and psychologist can advice and direct the perfectionists to let them be imperfect and decrease their self-criticism (Ashby et al., 2012)

            Finally, all those research helps us to understand the basic mechanisms behind the disease. Having more knowledge will make easier both the patient’s life and clinician’s responsibility. As a result, the negative consequences related to perfectionism and depression will be eliminated.

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