Perfectionistic cognitions appear to play a key role in clinical anxiety

A new study found that perfectionist thinking patterns contributed to posttraumatic stress disorder (PTSD) and generalized anxiety disorder (GAD) symptoms, over and above several known control variables. The findings were published in Cognitive Behaviour Therapy.

Perfectionism involves a desire to perform to the highest standards without allowing room for failure. People with perfectionist beliefs tend to be overly self-critical and put pressure on themselves to perform flawlessly at all times. While perfectionism is often seen as a favorable trait, the attribute has been linked to numerous anxiety disorders such as obsessive compulsive disorder (OCD) and social anxiety disorder (SAD).

Researchers have recently begun exploring the thought patterns that characterize perfectionism — called perfectionist cognitions (PC). As study author Jeremy Tyler and his team say, perfectionist cognitions include expectations about achieving perfection such as, “I can’t stand to make mistakes.” These cognitions have been linked to dysfunctional mental health symptoms like obsessions, distress, and anxiety. However, these associations have yet to be explored among a clinical population.

In a new study, Tyler and his colleagues wanted to extend the current findings by exploring perfectionist thought patterns among a sample of patients with diagnosed anxiety or anxiety-related disorders.

A total of 356 adults between the ages of 18 and 69 participated in the study. The most common primary diagnoses were OCD, SAD, and GAD. More than half (52%) of respondents had more than one mental health disorder diagnosis.

In a self-report survey, the subjects completed the Perfectionism Cognitions Inventory (PCI), which included a list of 25 perfectionist cognitions (e.g., “No matter how much I do, it’s never enough.”). Subjects were asked to rate how often they had experienced each of these thoughts in the last week. They also completed assessments of symptoms of GAD, OCD, SAD, depression, panic disorder, and PTSD. Finally, they completed assessments of emotion regulation difficulties and anxiety sensitivity.

The researchers found that perfectionist cognitions were positively linked to anxiety disorder symptoms across a range of diagnoses. More importantly, scores on the PCI still accounted for a significant percentage of variance in GAD symptoms and PTSD symptoms after controlling for symptoms of depression, anxiety sensitivity, and difficulties in emotion regulation — three factors that are known to relate to both perfectionist thinking, anxiety, and PTSD.

“These findings imply that treatment-seeking individuals experiencing more frequent thoughts about striving towards perfection were more likely to endorse more severe symptoms of GAD and PTSD beyond the contribution of anxiety sensitivity, deficits in emotion regulation, or depressive symptoms,” Tyler and colleagues report.

The authors discuss a few reasons why perfectionist cognitions might lead to increased anxiety. One possibility is that perfectionist thought patterns increase vulnerability to anxiety by encouraging a hyper-focus on perfection and acute awareness of failure that then leads to negative emotions like anxiety. The researchers say their findings suggest this pathway may be even more likely to occur among people with a GAD or PTSD diagnosis.

Tyler and team say their findings provide a basis for future studies regarding the role of PC in anxiety-related disorders. The findings also suggest that the treatment of anxiety disorders might benefit from a focus on addressing the presence of perfectionist cognitions.

The study, “The unique contribution of perfectionistic cognitions to anxiety disorder symptoms in a treatment-seeking sample”, was authored by Jeremy Tyler, Wenting Mu, Jesse McCann, Gina Belli, and Anu Asnaani.