Randy O. Frost

THE DIMENSIONS OF PERFECTIONISM

Perfectionism is a major diagnostic criterion for one DSM-III diagnosis, and it has been hypothesized to play a major role in a wide variety of psychopathologies. Yet there is no precise definition of, and there is a paucity of research on, this construct. Based on what has been theorized about perfectionism, a multidimensional measure was developed and several hypotheses regarding the nature of perfectionism were tested in four separate studies. The major dimension of this measure was excessive concern over making mistakes. Five other dimensions were identified, including high personal standards, the perception of high parental expectations, the perception of high parental criticism, the doubting of the quality of ones actions, and a preference for order and organization. Perfectionism and certain of its subscales were correlated with a wide variety of psychopathological symptoms. There was also an association between perfectionism and procrastination. Several subscales of the Multidimensional Perfectionism Scale (MPS), personal standards and organization, were associated with positive achievement striving and work habits. The MPS was highly correlated with one of the existing measures of perfectionism. Two other existing measures were only moderately correlated with the MPS and with each other. Future studies of perfectionism should take into account the multidimensional nature of the construct.

A comparison of two measures of perfectionism

Abstract This study compares two recently developed measures of perfectionism. College students completed the Frost, Marten, Lahart and Rosenblate (1990; Cognitive Therapy and Research, 14 , 449–468) Multidimensional Perfectionsim Scale and the Hewitt and Flett (1991; Journal of Personality and Social Psychology, 60 , 456–470) scale of the same name. Their relationship to each other, as well as to measures of affect, were examined. There was considerable overlap in the two measures of perfectionism. Frost et al. s Total Perfectionism score appears to reflect a global dimension of perfectionism which is correlated with Hewitt and Fletts Self-Oriented and Socially-Prescribed scales, and less closely related to the Other-Oriented scale. Frost et al. s Personal Standards scale was most closely associated with Hewitt and Fletts Self-Oriented Perfectionism scale. Frost et al. s Concern over Mistakes, Parental Expectations and Parental Criticism scales were independently correlated with Hewitt and Fletts Socially-Prescribed Perfectionism scale. The subscales from each measure showed differential relationships with measures of positive and negative affect. Those dimensions which have been found to be related to symptoms of psychopathology were most closely related to negative affect (e.g. Concern over Mistakes, Socially- Prescribed Perfectionism), while those which have been found to be related to more “healthy” characteristics were associated with positive affect (e.g. Personal Standards, Other-Oriented Perfectionism). A factor analysis using the 9 subscales resulted in a conceptually clean two-factor solution. The first of these reflected maladaptive evaluation concerns, and the second reflected positive achievement strivings. The implications of these findings for the understanding of the construct of perfectionism are discussed.

Cognitive assessment of obsessive-compulsive disorder

Recent theories of obsessive-compulsive disorder (OCD) emphasize the importance of cognitive contents (beliefs and appraisals) and cognitive processes in the etiology and maintenance of OCD. In order to evaluate these theories and to assess the mechanisms of treatment-related change, it is necessary to develop measures of the relevant cognitive contents and processes. Several scales have been developed, although many are unpublished and there is a great deal of overlap among measures. The purpose of the present article is to describe the progress of an international group of investigators who have commenced a coordinated effort to develop a standardized set of cognitive measures. This article describes the theoretical bases and clinical importance of such an endeavor, and the proceedings of the working group meetings are summarized. Several methods of assessment are reviewed, including idiographic methods, information processing paradigms, and self-report measures. The working group is currently developing and evaluating self-report measures of appraisals about intrusions, and self-report measures of OC-related beliefs. Consensus ratings indicated that 6 belief domains are likely to be important in OCD. These are beliefs pertaining to: (1) inflated responsibility; (2) overimportance of thoughts; (3) excessive concern about the importance of controlling ones thoughts; (4) overestimation of threat; (5) intolerance of uncertainty; and (6) perfectionism.

A cognitive-behavioral model of compulsive hoarding.

Compulsive hoarding is a little studied phenomenon within the research literature. The information available on compulsive hoarding is diverse and not well integrated. In the present article we propose a tentative cognitive-behavioral model of compulsive hoarding. The purpose of such a model is to provide a framework for the development and testing of hypotheses about compulsive hoarding. In this model hoarding is conceptualized as a multifaceted problem stemming from: (1) information processing deficits; (2) problems in forming emotional attachments; (3) behavioral avoidance; and (4) erroneous beliefs about the nature of possessions. Specific hypotheses about each of these are discussed.

Psychometric validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory: Part I

This article reports on the validation of the Obsessive Beliefs Questionnaire (OBQ) and Interpretations of Intrusions Inventory (III) developed by the Obsessive Compulsive Cognitions Working Group (OCCWG) to assess the primary beliefs and appraisals considered critical to the pathogenesis of obsessions. A battery of questionnaires that assessed symptoms of anxiety, depression, obsessive-compulsive symptoms and worry was administered to 248 outpatients with a DSM-IV diagnosis of Obsessive-Compulsive Disorder (OCD), 105 non-obsessional anxious patients, 87 non-clinical adults from the community, and 291 undergraduate students. Tests of internal consistency and test-retest reliability indicated that the OBQ and III assessed stable aspects of OC-related thinking. Between-group differences and correlations with existing measures of OC symptoms indicated that the OBQ and III assess core cognitive features of obsessionality. However, the various subscales of the OBQ and III are highly correlated, and both measures evidenced low discriminant validity. The findings are discussed in terms of the relevance and specificity of cognitive constructs like responsibility, control and importance of thoughts, overestimated threat, tolerance of uncertainty and perfectionism for OCD.

The Yale-Brown Obsessive Compulsive Scale : Interview versus Self-report

Several studies have demonstrated the reliability and validity of the Yale-Brown Obsessive Compulsive Scale (YBOCS) conducted by trained interviewers. The present study examined several aspects of a self-report YBOCS version relative to the usual interview format in two non-clinical samples (ns = 46 and 70) and in a clinical OCD sample (n = 36) and a clinical non-OCD group (n = 10). The self-rated instrument showed excellent internal consistency and test-retest reliability, performing somewhat better than the interview. There was good agreement between symptom checklist categories across the two versions, though clinical subjects reported more symptoms on the self-report form than on the interview. Some order effects were evident for non-clinical subjects only: those who received the self-report first scored lower on both self-report and interview than those who received the interview first. No order effects were observed in the clinical sample. The self-report version showed strong convergent validity with the interview, and discriminated well between OCD and non-OCD patients. Although more study is needed, particularly on clinical samples, these findings suggest that the self-report YBOCS may be a time-saving and less costly substitute for the interview format in assessing OCD symptoms.

The nature and measurement of compulsive indecisiveness

Indecisiveness is an often mentioned symptom of obsessive compulsive disorder and obsessive compulsive personality disorder, yet very little research has been done examining its nature and measurement. Three studies are presented here which examine the nature of compulsive indecisiveness using a newly developed scale. In study 1 the Indecisiveness Scale was correlated with measures of obsessionality and compulsive checking among normal S s. It was also correlated with the maladaptive evaluative concern dimensions of perfectionism and with compulsive hoarding. In study 2 indecisive S s (as measured by the Indecisiveness Scale) were found to score higher on measures of procrastination and general psychopathology. In addition, they reported problems in making decisions in a variety of life domains (social, academic, family and everyday). In study 3 S s who scored high on the Indecisiveness Scale were found to have longer latencies on an experimental decision-making task. The implications of these findings for the nature of indecisiveness were discussed.

Perfectionism in Obsessive-Compulsive Disorder patients

Considerable theory and anecdotal evidence has suggested that patients with Obsessive-Compulsive Disorder (OCD) are more perfectionistic. Evidence with non-clinical populations supports this hypothesis. However, no data are available on levels of perfectionism among patients diagnosed with OCD. The present study extends findings on perfectionism and OCD by comparing perfectionism levels of OCD-diagnosed patients with those of non-patients and a group of patients diagnosed with panic disorder with agoraphobia (PDA). As predicted, patients with OCD had significantly elevated scores on Total Perfectionism, Concern Over Mistakes, and Doubts About Actions compared to non-patients controls. However, they did not differ from patients with PDA on Total Perfectionism or Concern Over Mistakes. Patients with OCD did have higher Doubts Actions scores than those with PDA. The implications for role of perfectionism in OCD and other anxiety disorders are discussed.

Mood, personality disorder symptoms and disability in obsessive compulsive hoarders : a comparison with clinical and nonclinical controls

Hoarding is a symptom of obsessive compulsive disorder (OCD), as well as a diagnostic criterion for obsessive compulsive personality disorder (OCPD). One recent study suggests that people who suffer from compulsive hoarding report more general psychopathology than people who do not [Frost, R.O., Krause, M.S., & Steketee, G. (1996). Hoarding and obsessive compulsive symptoms. Behavior Modification, 20, 116-132]. The present study addressed whether persons with OCD hoarding exhibit more depression, anxiety, OCD and personality disorders symptoms than community controls, OCD nonhoarders, or other anxiety disorder patients. Disability was also examined. Hoarding subjects were older than the other three groups, but age did not account for any of the differences observed among the groups. Compared to controls, OCD hoarding, nonhoarding OCD and anxiety disorder patients showed elevated YBOCS scores, as well as higher scores on depression, anxiety, family and social disability. Compared to nonhoarding OCD and anxiety disorder patients, OCD hoarding patients scored higher on anxiety, depression, family and social disability. Hoarding subjects had greater personality disorder symptoms than controls. However, OCD hoarding subjects differed from OCD nonhoarding and anxiety disorder subjects only on dependent and schizotypal personality disorder symptoms. The findings suggest that hoarding is associated with significant comorbidity and impairment compared to nonhoarding OCD and other anxiety disorders.

The economic and social burden of compulsive hoarding

The aim of the present study was to determine the economic and social burden of compulsive hoarding in a large sample of individuals with self-identified hoarding, as well as a separate sample of family members of individuals who hoard. Self-identified hoarding participants (N=864, 94% female, 65% met research criteria for clinically relevant compulsive hoarding) and family informants (N=655, 58% described a relative who appeared to meet research criteria for compulsive hoarding), completed an internet survey. Questions were derived in part from those used in the National Comorbidity Survey (NCS), and when possible, hoarding participants were compared to NCS participants. Compulsive hoarding was associated with an average 7.0 work impairment days in the past month, equivalent to that reported by individuals with psychotic disorders and significantly greater than that reported by female NCS participants with all other anxiety, mood, and substance use disorders. Severity of hoarding predicted the degree of work impairment after controlling for age, sex, and non-psychiatric medical conditions. Hoarding participants were nearly three times as likely to be overweight or obese as were family members. Compared to female NCS participants, hoarding participants were significantly more likely to report a broad range of chronic and severe medical concerns and had a five-fold higher rate of mental health service utilization. Eight to 12% had been evicted or threatened with eviction due to hoarding, and 0.1-3.0% had a child or elder removed from the home. These results suggest that compulsive hoarding represents a profound public health burden in terms of occupational impairment, poor physical health, and social service involvement.