Simon B. Sherry

Early stages in the development of bipolar disorder

BACKGROUND Numerous studies have observed that offspring of bipolar parents manifest a broad spectrum of psychiatric disorders. We tested the hypothesis that in high risk offspring, bipolar disorder evolves in a predictable clinical sequence from non-specific (non-mood) to specific (mood) psychopathology. METHODS Offspring from well-characterized families with one bipolar parent (high risk) or two well parents (controls) were assessed annually or at anytime symptoms developed using KSADS-PL interviews for up to 15 years. DSM-IV diagnoses were made on blind consensus review using all available clinical material. We compared the age-adjusted risks of lifetime psychopathology between high risk and control subjects and assessed the conditional probability of developing a mood disorder given a history of non-mood disorders. In subjects meeting full DSM-IV criteria for bipolar disorder, we assessed the sequence of psychopathology against a clinical staging model. RESULTS High risk offspring manifest higher rates of anxiety and sleep disorders, as well as major mood and substance use disorders compared to controls. Antecedent anxiety increased the age-adjusted risk of mood disorder from 40 to 85% (hazard ratio of 2.6). High risk subjects who developed a mood disorder had an increased risk of a substance use disorder (hazard ratio of 2.4), typically meeting diagnostic criteria during or after the first major mood episode. The evolution of psychopathology leading to bipolar disorder generally followed the proposed sequence, although not all subjects manifest all stages. LIMITATIONS Larger numbers of high risk offspring prospectively assessed over the risk period would allow confirmation of these preliminary findings. CONCLUSIONS Clinical staging may be a useful approach to refine the early diagnosis and facilitate research into the evolution of bipolar disorder in those at familial risk.

The interpersonal expression of perfection: Perfectionistic self-presentation and psychological distress.

A concept involving the interpersonal expression of perfection, perfectionistic self-presentation, is introduced. It is argued that perfectionistic self-presentation is a maladaptive self-presentational style composed of three facets: perfectionistic self-promotion (i.e., proclaiming and displaying ones perfection), nondisplay of imperfection (i.e., concealing and avoiding behavioral demonstrations of ones imperfection), and nondisclosure of imperfection (i.e., evading and avoiding verbal admissions of ones imperfection). Several studies involving diverse samples demonstrate that perfectionistic self-presentation is a valid and reliable construct and a consistent factor in personal and interpersonal psychological distress. It is argued that the need to promote ones perfection or the desire to conceal ones imperfection involves self-esteem regulation in the interpersonal context.

Perfectionism in children: associations with depression, anxiety, and anger

Abstract The relationships among measures of dimensions of perfectionism, depression, anxiety, stress, and anger were investigated in 114 children (45 males and 69 females, aged 10–15 years). Based on previous research [e.g. Hewitt, P. L. & Flett, G. L. (1993). Dimensions of perfectionism, daily stress, and depression: a test of the specific vulnerability hypothesis. Journal of Abnormal Psychology , 102 , 58–65], self-oriented perfectionism and socially prescribed perfectionism were hypothesized to interact with either achievement stress or social stress to predict concurrent depression. Participants completed the Child-Adolescent Perfectionism Scale, Childrens Depression Inventory, Childrens Manifest Anxiety Scale-Revised, Childrens Hassles Scale, and Pediatric Anger Expression Scale. Results revealed that self-oriented perfectionism was significantly associated with depression and anxiety, whereas socially prescribed perfectionism was significantly correlated with depression, anxiety, social stress, anger-suppression, and outwardly directed anger. Findings also indicated that: (1) self-oriented perfectionism interacted with social stress to predict anxiety; and that (2) self-oriented perfectionism interacted with achievement stress and with social stress to predict depression. Results suggest that dimensions of perfectionism may be relevant variables in, and differential predictors of, maladjustment and distress in children.

Perfectionism is multidimensional: A reply to Shafran, Cooper and Fairburn (2002)

provided a cognitive-behavioural analysis of perfectionism that focused primarily on self-oriented perfectionism. They argued against studying perfectionism from a multidimensional perspective that they regard as inconsistent with prior work on perfectionism as a self-oriented phenomenon. We respond to by offering historical, empirical, and theoretical support for the usefulness and the importance of a multidimensional model of perfectionism involving both intrapersonal processes and interpersonal dynamics. It is concluded that a multidimensional approach to the study of perfectionism is still warranted.

Perfectionism Dimensions, Perfectionistic Attitudes, Dependent Attitudes, and Depression in Psychiatric Patients and University Students.

P. L. Hewitt and G. L. Fletts (1991b) model of perfectionism dimensions (i.e., self-oriented, other-oriented, and socially prescribed perfectionism) was compared with A. T. Becks model (G. P. Brown & A.T. Beck, 2002) of dysfunctional attitudes (i.e., perfectionistic attitudes [PA] and dependent attitudes [DA]) in predicting depression in 70 psychiatric patients and 280 university students. Socially prescribed perfectionism uniquely predicted both PA and DA. Dysfunctional attitudes failed to consistently predict additional variance in depression beyond perfectionism dimensions (and vice versa). Evidence for Hewitt and Fletts specific vulnerability hypothesis and Becks specific cognitive vulnerability hypothesis was equivocal. Becks conceptualization of perfectionism as a unitary cognitive style obscures important information by overlooking the distinction between the self-related and socially based features of perfectionism. Hewitt and Fletts conceptualization of perfectionism as 3 distinct personality traits allows for precise conclusions by recognizing the differential contribution of the self-related and socially based features of perfectionism.

The perfectionism model of binge eating: tests of an integrative model

This study proposes, tests, and supports the perfectionism model of binge eating (PMOBE), a model aimed at explaining why perfectionism is related to binge eating. According to this model, socially prescribed perfectionism (SPP) confers risk for binge eating by generating exposure to 4 triggers of binge episodes: interpersonal discrepancies, low interpersonal esteem, depressive affect, and dietary restraint. In testing the PMOBE, a daily diary was completed by 566 women for 7 days. Predictions derived from the PMOBE were supported, with tests of mediation suggesting that the indirect effect of SPP on binge eating through triggers of binge episodes was significant. Reciprocal relations were also observed, with certain triggers of binge episodes predicting binge eating (and vice versa). Results supported the incremental validity of the PMOBE over and above self-oriented perfectionism and neuroticism and the generalizability of this model across Asian and European Canadian participants. The PMOBE offers a novel view of individuals with high levels of SPP as active agents who raise their risk of binge eating by generating conditions in their daily lives that are conducive to binge episodes.

The Impact of Perfectionistic Self-Presentation on the Cognitive, Affective, and Physiological Experience of a Clinical Interview

Abstract Perfectionistic self-presentation is proposed as a deleterious interpersonal style that has an influence in clinical contexts that involves promoting a public image of perfection and avoiding displays and self-disclosures of imperfections. A sample of 90 clinical patients taking part in a clinical interview were assessed in terms of their levels of perfectionistic self-presentation and trait perfectionism and their affective, cognitive, and physiological reactions. Perfectionistic self-presentation dimensions were associated with (1) greater distress before and after the interview, (2) negative expectations and greater threat prior to the interview, and (3) post-interview dissatisfaction. Analyses of physiological data found that perfectionistic self-presentation was associated with higher levels of heart rate when discussing past mistakes, and, as expected, the need to avoid disclosing imperfections predicted higher levels of and greater change in heart rate when discussing past mistakes. Analyses that controlled for trait perfectionism and emotional distress showed that the need to avoid disclosing imperfections was a unique predictor of (1) appraisals of the interviewer as threatening before the interview and as dissatisfied after the interview; (2) negative pre and post self-evaluations of performance; and (3) greater change in heart rate when discussing mistakes. Perfectionistic self-presentation is discussed as an interpersonal style that can influence therapeutic alliance and treatment success.

Are Perfectionism Dimensions Vulnerability Factors for Depressive Symptoms After Controlling for Neuroticism? A Meta-analysis of 10 Longitudinal Studies

Extensive evidence suggests neuroticism is a higher–order personality trait that overlaps substantially with perfectionism dimensions and depressive symptoms. Such evidence raises an important question: Which perfectionism dimensions are vulnerability factors for depressive symptoms after controlling for neuroticism? To address this, a meta–analysis of research testing whether socially prescribed perfectionism, concern over mistakes, doubts about actions, personal standards, perfectionistic attitudes, self–criticism and self–oriented perfectionism predict change in depressive symptoms, after controlling for baseline depression and neuroticism, was conducted. A literature search yielded 10 relevant studies (N = 1,758). Meta–analysis using random–effects models revealed that all seven perfectionism dimensions had small positive relationships with follow–up depressive symptoms beyond baseline depression and neuroticism. Perfectionism dimensions appear neither redundant with nor captured by neuroticism. Results lend credence and coherence to theoretical accounts and empirical studies suggesting perfectionism dimensions are part of the premorbid personality of people vulnerable to depressive symptoms. Copyright

Reformulating and testing the perfectionism model of binge eating among undergraduate women: a short-term, three-wave longitudinal study.

The perfectionism model of binge eating (PMOBE) is an integrative model explaining why perfectionism is related to binge eating. This study reformulates and tests the PMOBE, with a focus on addressing limitations observed in the perfectionism and binge-eating literature. In the reformulated PMOBE, concern over mistakes is seen as a destructive aspect of perfectionism contributing to a cycle of binge eating via 4 binge-eating maintenance variables: interpersonal discrepancies, low interpersonal esteem, depressive affect, and dietary restraint. This test of the reformulated PMOBE involved 200 undergraduate women studied using a 3-wave longitudinal design. As hypothesized, concern over mistakes appears to represent a vulnerability factor for binge eating. Bootstrapped tests of mediation suggested concern over mistakes contributes to binge eating through binge-eating maintenance variables, and results supported the incremental validity of the reformulated PMOBE beyond perfectionistic strivings and neuroticism. The reformulated PMOBE also predicted binge eating, but not binge drinking, supporting the specificity of this model. The reformulated PMOBE offers a framework for understanding how key contributors to binge eating work together to generate and to maintain binge eating.

Perfectionistic Self-Presentation in Children and Adolescents: Development and Validation of the Perfectionistic Self-Presentation Scale—Junior Form

Research on adults indicates that perfectionistic self-presentation, the interpersonal expression of ones perfection, is associated with a variety of psychopathological outcomes independent of trait perfectionism and Big Five traits. The current article reports on the development and evidence for the validity of the subtest score interpretations of an 18-item self-report measure of perfectionistic self-presentation for children and adolescents. Analyses conducted on data from two clinical samples and one nonclinical sample of children and adolescents found that the Perfectionistic Self-Presentation Scale--Junior Form (PSPS-Jr) reflected a multidimensional model of perfectionistic self-presentation with three subscales: Perfectionistic Self Promotion, Nondisplay of Imperfection, and Nondisclosure of Imperfection. The subscale scores were found to demonstrate internal consistency, and there was good evidence supporting the validity of the interpretation of subscale scores based on this new measure. The subscales were associated with maladaptive outcomes, but were not influenced unduly by biases that included social desirability and differential item functioning by gender. Overall, the PSPS-Jr appears to be a useful measure of the expression of perfection among youths and an important tool in attempting to understand the nature and the consequences of perfectionistic self-presentation in children and adolescents.