Exploring perfectionism as a vulnerability to psychological distress: The mediating role of cognitive distortions

Philadelphia

Background: Perfectionism has been implicated in the development and maintenance of a wide variety of mental disorders, to the extent that it is conceptualized as a transdiagnostic phenomenon (Egan, Wade, & Shafran, 2011). Findings supporting its predictive validity and stability suggest that it may act as a predisposing variable to psychological distress. These research findings may be explained by the cognitive vulnerability stress-interaction model, which is an integrated cognitive model that focuses on factors contributing to the development, maintenance, and recurrence of psychological issues. According to this model, the relationship between a vulnerability (i.e., perfectionism) and psychological distress is explained by a third, mediating variable (i.e., cognitive distortions). Additional research is needed to clarify the nature of perfectionism and to identify underlying pathways to psychological distress. Method: 352 graduate students from a Northeastern medical school were asked to participate during the summer and fall 2015 terms; 147 students completed measures at Time 1 and Time 2. Participants were surveyed early in an academic trimester during a time of low stress and then again immediately following an academic stressor (i.e., a midterm or final exam). This enabled us to evaluate the stability and predictive validity of perfectionism and cognitive distortions as a mediator. We assessed perfectionism, cognitive distortions, stressors, and symptoms of psychological distress using the following self-report measures: Clinical Perfectionism Questionnaire (CPQ), Cognitive Distortions Scale (CDS), Life Experiences Survey (LES), and Brief Symptom Inventory-18 (BSI-18).Results: Results from a paired-samples t test indicated that perfectionism was moderately stable over from Time 1 to Time 2; a statically significant increase in scores on the CPQ at Time 2 also emerged. After controlling for Time 1 distress, results from a hierarchical multiple regression showed that perfectionism predicted distress at Time 2; however, stress and the Perfectionism x Stress interaction were not significant predictors of distress. A MANOVA revealed significant differences between low, average, and high levels of perfectionism on measures of stress, cognitive distortions, and distress. Finally, results from the bootstrapping method and Sobel test indicated that there was an indirect effect of perfectionism on psychological distress via cognitive distortions, which supported cognitive distortions as a mediating variable. Conclusions: Results provided partial support for the cognitive vulnerability model of perfectionism. Specifically, results from this study provided insight into who is most likely to develop psychological distress, namely students with high levels of perfectionism. Further, evidence that perfectionism is related to psychological distress through a cognitive pathway offered additional support for the cognitive vulnerability model. Without evidence showing that symptoms increased after a stressor, it remains to be seen when symptoms are most likely to emerge. Taken together, this study expands on existing literature by further clarifying the nature of perfectionism and it also contributes to empirical support for the cognitive vulnerability model.