A report in the current issue of the Journal Of Psychotherapy And Psychosomatics (P&P) describes the role perfectionism may play in development of chronic fatigue syndrome (CFS) and in other possibly related medical disorders such as irritable bowel syndrome and fibromyalgia that are frequently coexistent.
The report observes that biopsychosocial CFS models suggest that personality and stress have predisposing and perpetuating influence in developing the persistent and unexplained fatigue that characterizes what has been classified as a functional somatic syndrome. The authors point to studies indicating that personal characteristics of many CFS patients frequently include achievement-oriented and perfectionist personalities, and that those tendencies coupled with a drive toward self-criticism in these individuals that can compel them to work beyond the point of exhaustion to a degree that may initiate or perpetuate chronic fatigue symptoms.
The report also notes that while research indicates that CFS patients typically apply maladaptive coping strategies more frequently than do healthy controls, it remains unknown as to whether this represents true relative to other chronic illness groups.
The P&P study compared perfectionism dimensions and maladaptive coping styles observed in CFS patients with corresponding behaviors of healthy controls and two other chronic illness groups, with participant subjects drawn from larger samplings of community-dwelling adults in various US or Canadian locations who completed an anonymous online personality and health survey and who had provided informed consent. The study authors selected individuals who had indicated on a medical checklist having been diagnosed by a medical professional with one or more of 13 different chronic health conditions including CFS, irritable bowel syndrome (IBS), or fibromyalgia (FM)/arthritis. Remaining participants were screened for presence of other chronic diseases, yielding a final healthy sample of 564 subjects that was subdivided into 6 random samples corresponding in size to the illness groups — one of which they randomly selected as the healthy control group.
The scientists found significant correlation of maladaptive perfectionism such as self-blame coping in both the CFS group and the healthy controls, with correlation between maladaptive perfectionism and behavioral disengagement coping also significant among members of both groups. These correlations did not differ significantly, a standard of perfectionism was not significantly associated with self-blame coping in the CFS group, but negatively correlated in healthy controls. The researchers observed that correlations with behavioral disengagement coping were negative in the CFS group and controls, and not significantly different. However, in the IBS group, significant correlation was observed between maladaptive perfectionism and each of four maladaptive coping styles, whereas standards perfectionism negatively correlated with denial and behavioral disengagement.
With the FM/arthritis group, maladaptive perfectionism was significantly correlated with all but the substance use coping mechanism and standards perfectionism was not significantly correlated with any of the coping strategies.
The scientists conclude that overall, their findings suggest that maladaptive perfectionism promotes self-critical thoughts which in turn exacerbate a tendency to attempt coping with stress by becoming consumed with self-blame rather than taking constructive action, and that tendency that may be pronounced in persons with CFS. This dynamic consequently contributes to prolongation of chronic stress and subsequent allostatic crashes that had been posited by previous studies. Additionally their findings provide evidence that cognitive behavioral interventions that target perfectionism may help enhance coping capacities of persons afflicted with CFS.
A 2011 Belgian study published in the journal Psychiatry Research also investigated whether the distinction between adaptive (i.e. perfectionistic personal standards) and maladaptive (i.e. excessive concern over mistakes and doubt about actions) perfectionism that had been describes in the literature was also valid in patients with CFS
The paper, entitled “Unraveling the role of perfectionism in chronic fatigue syndrome: Is there a distinction between adaptive and maladaptive perfectionism?“ (30 April 2011, Vol.186(2):373377, doi:10.1016/j.psychres.2010.09.016) was coauthored by Stefan Kempke and Patrick Luyten of the University of Leuven Department of Psychology at Leuven, Belgium; and Boudewijn Van Houdenhove, Patrick Bekaert, Lutgarde Goossens, and Peter Van Wambeke of the University Hospitals Leuven’s Chronic Fatigue Syndrome reference centre at the University of Leuven.
In the study, the researchers investigated whether the distinction between adaptive (i.e. high personal standards) and maladaptive (i.e. excessive concern over mistakes and doubt about actions) perfectionism noted in previous studies was also valid in patients with chronic fatigue syndrome (CFS). They hypothesized that maladaptive, but not adaptive, perfectionism would be significantly and positively related to severity of fatigue and depression in CFS.
This hypothesis was examined in a sample of 192 CFS patients using structural equation modeling (SEM), and the researchers note that although the two perfectionism dimensions were related to each other, results supported a model in which only maladaptive perfectionism was positively related to severity of fatigue and depression.
Moreover, the investigators found that depression fully mediated the effect of maladaptive perfectionism on fatigue — these results suggesting that adaptive and maladaptive perfectionism are two distinct, albeit related, dimensions in CFS, findings that could have have important implications for theory and treatment of CFS, particularly for cognitive behavioral therapies.
Journal Of Psychotherapy And Psychosomatics
University of Leuven