Perfectionism, Stress, and Depression

This is a guest post by Dominic Ippolito, one of my top student writers from Fall of 2006

Everyone knows a "perfectionist." We think of him or her as someone who strives for, and often attains, a high level of performance. But what are the psychological effects of this behavior? Psychologists categorize perfectionists according to two commonly accepted forms. Adaptive ('healthy') perfectionists set high standards for themselves, and use these goals to elicit their best effort. This form of perfectionism, measured by a subscale of the Almost Perfect Scale-Revised (APS-R), called the High Standards scale, is associated with positive psychological outcomes such as high self-esteem and social adjustment.

Maladaptive ('unhealthy') perfectionists, on the other hand, set unattainably lofty goals, that is, no level of achievement is ever enough. This form of perfectionism, measured by another subscale of the APS-R, called the Discrepancy scale, is correlated with several unhealthy outcomes, including depression, substance abuse and eating disorders. It is said that adaptive perfectionists have drive while maladaptive perfectionists are driven.

A study led by Kenneth Rice followed 499 students to find out how colleges might successfully intervene to help maladaptive high-achieving students attain a healthier psychological profile. One goal of the study was to identify the relationship between the healthy and unhealthy forms of perfectionism and depression, where depression is measured by the Center for Epidemiologic Studies Depression scale (CES-D) and the Beck Hopelessness Scale.

The results confirm expectations: Unhealthy perfectionism leads to more depression and hopelessness, while healthy perfectionism is either unrelated or negatively related depending on the depression measure. In short, high-achieving students are served well when they set high standards, but are adversely affected when their perfectionist tendencies get out of hand.

How Do Stress and Social Connectedness Interact with Discrepancy To Affect Outcome?
The authors next consider how stress, which is measured by the Perceived Stress Scale, interacts with unhealthy perfectionism to affect the risk of depression. The authors find two important results. First, unhealthy perfectionism and stress both independently lead to more depression. Second, unhealthy perfectionism, in combination with high stress, leads to an even higher level of depression. In other words, a high level of stress or a high discrepancy score alone can be problematic for depression, but in combination their effects are magnified.

To quantify their results, the authors use their statistical results to predict outcome scores for four hypothetical individuals who have either a 'high' or 'low' stress level, and either a 'high' or 'low' level of unhealthy perfectionism. To facilitate the interpretation of these results, I entered their calculations into an Excel spreadsheet, and then created bar charts from these data.

The results show depression as measured by the Beck Hopelessness Scale (the results are similar for the CES-D depression measure). For reference, a Beck score above 9 defines clinical depression.

The figure shows that, when stress is low, the Beck score is relatively low, independent of the value of the discrepancy score -- the indicator of unhealthy perfectionism. When stress is high, however, hopelessness increases markedly, and the effect is especially pronounced for individuals who have high unhealthy perfectionism. Students with both high levels of stress and high unhealthy perfectionism have much higher risks of depression than those with either high stress or unhealthy perfectionism alone.

Finally, the authors look at the relationship between social connectedness, which is measured by The Social Connectedness scale, and depression. A high score on The Social Connectedness scale indicates that one has more friends and spends more time socializing. The results are shown in the figure below.

Note that for students who have a high level of social connectedness, the risk of depression is low regardless of the level of unhealthy perfectionism. The risk remains low for students who have low scores for social connectedness if they also have low unhealthy perfectionism. The Beck scores, however, increase dramatically for students who have both a low level of social connectedness and high unhealthy perfectionism. Put simply, unhealthy perfectionism is not as problematic in students who have high levels of social interaction.

Implications of the Study
The authors are careful to avoid assigning causality in their results. Perhaps some individuals have hidden attributes that make them driven, stressful, avoidant of social connections. Or, perhaps driven students create undue internal stress, and also avoid socializing owing to their compulsion to do more work. Either way, the authors suggest that by adopting a more aggressive counseling program, and encouraging more social contact, the university could mitigate the deleterious effects of unhealthy perfectionism among high-achieving students.

While this study contributes to our understanding of how the various forms of perfectionism affect one's psychological well being, it is important to note that the issue of perfectionism's origins, in either of its forms, is left unanswered.

Rice, K.G., Leever, B.A., Christopher, J., & J.D. Porter (2006). Perfectionism, Stress and Social (Dis)Connection: A Short-Term Study of Hopelessness, Depression, and Academic Adjustment Among Honors Students. Journal of Counseling Psychology, 53(4), 524-534.