DEPRESYON, KAYGI VE OBSESİF-KOMPULSİF BELİRTİLERİN TETİKLEYİCİLERİ OLARAK MÜKEMMELLİYETÇİLİK VE BELİRSİZLİĞE TAHAMMÜLSÜZLÜK: TANILAR ÜSTÜ YAKLAŞIM TEMELİNDE YAPISAL BİR MODEL

Year 2023, Volume: 10 Issue: 2, 675 - 700, 24.10.2023

Servet Kaçar Başaran

Abstract

Mükemmeliyetçilik, belirsizliğe tahammülsüzlük ve ayrı ayrı psikopatoloji belirtileri arasındaki ilişkiler literatürde pek çok çalışmada incelenmiştir. Ancak, tanılar üstü faktörler olan mükemmeliyetçilik ve belirsizliğe tahammülsüzlük ile birden fazla psikopatoloji arasındaki ilişkiyi inceleyen çalışma azdır. Ayrıca mükemmeliyetçilik ölçümlerine yeni bir soluk getiren Büyük Üçlü Mükemmeliyetçilik Ölçeği (BÜMÖ) ile psikopatoloji belirtileri arasındaki ilişkiyi araştıran araştırmalar da nadirdir. Bu çalışma, üç büyük faktör ile kavramsallaştırılan mükemmeliyetçilik (öz-eleştirel, katı ve narsisistik mükemmeliyetçilik) ile kaygı, depresyon ve obsesif-kompulsif bozukluk (OKB) belirtileri arasındaki ilişkileri incelemeyi amaçlamaktadır. Ayrıca, belirsizliğe tahammülsüzlük aracılığıyla mükemmeliyetçiliğin kaygı, depresyon ve OKB belirtileri üzerindeki dolaylı etkisini incelemek amacıyla bir yapısal eşitlik modeli test edilmiştir. Araştırmanın örneklemini 377 yetişkin (Yaş Ort: 25.29, SS: 7.81) katılımcı oluşturmuş ve katılımcılar ilgili ölçüm araçlarını tamamlamışlardır. Yapısal modelin sonuçları, mükemmeliyetçiliğin belirsizliğe tahammülsüzlük üzerinden depresyon, kaygı ve OKB belirtilerini istatistiksel olarak yordadığını göstermiştir. Mükemmeliyetçilik, belirsizliğe tahammülsüzlük ile pozitif olarak ilişkilidir ve bu da daha yüksek düzeyde depresyon, kaygı ve OKB belirtilerinin ortaya çıkmasına katkı sağlamaktadır. Bu model, bu üç bozukluğun eş tanılanmasını anlamak için önemli çıkarımlar sunmaktadır.

Keywords

büyük üçlü mükemmeliyetçilik, belirsizliğe tahammülsüzlük, tanılar üstü faktörler, depresyon, kaygı, obsesif-kompulsif bozukluk belirtileri

Project Number

-

PERFECTIONISM AND INTOLERANCE OF UNCERTAINTY AS TRIGGERS OF DEPRESSION, ANXIETY AND OBSESSIVE- COMPULSIVE SYMPTOMS: A STRUCTURAL MODEL BASED ON TRANSDIAGNOSTIC APPROACH

Abstract

The relationship among perfectionism, intolerance of uncertainty (IoU), and psychopathology symptoms are well documented in literature. However, studies examining the relationship between perfectionism and IoU (which are transdiagnostic factors) and more than one psychopathology are scarce. In addition, research exploring the relationship between psychopathology symptoms and the big three perfectionism scale (BTPS), which bring a new breath to perfectionism measures, is also rare. This study investigated the relationships between perfectionism conceptualized as the big three factor (Self-critical, rigid, and narcissistic perfectionism as facets) and anxiety, depression, and obsessive–compulsive disorder (OCD) symptoms. In addition, a structural equation model for the indirect effect of perfectionism on the relationship between anxiety, depression, and OCD symptoms through IoU was tested. A sample of 377 adults (Mage = 25.29, SD = 7.81) completed the relevant scales. The results of the structural equation model demonstrated that perfectionism statistically predicted depression, anxiety, and OCD symptoms mediated by IoU. Perfectionism was positively associated with IoU, which in turn contributed to higher depression, anxiety, and OCD symptoms. This model yields important implications for understanding the comorbidity of these three disorders.

Keywords

Big three perfectionism, intolerance of uncertainty, transdiagnostic factors, depression, anxiety, obsessive–compulsive disorder symptoms

Supporting Institution

-

Project Number

-

Thanks

-

References

• Ashby, J. S., & Gnilka, P. B. (2017). Multidimensional perfectionism and perceived stress: Group differences and test of a coping mediation model. Personality and Individual Differences, 119, 106-111. https://doi.org/10.1016/j.paid.2017.07.012
• Berenbaum, H., Bredemeier, K., & Thompson, R. J. (2008). Intolerance of uncertainty: Exploring its dimensionality and associations with need for cognitive closure, psychopathology, and personality. Journal of Anxiety Disorders, 22(1), 117-125. https://doi.org/10.1016/j.janxdis.2007.01.004
• Black, J., & Reynolds, W. M. (2013). Examining the relationship of perfectionism, depression, and optimism: Testing for mediation and moderation. Personality and Individual Differences, 54(3), 426-431. https://doi.org/10.1016/j.paid.2012.10.012
• Bomyea, J., Ramsawh, H. J., Ball, T. M., Taylor, C. B., Paulus, M. P., Lang, A., & Stein, M. (2015). Intolerance of uncertainty as a mediator of reductions in worry in a cognitive behavioral treatment program for generalized anxiety disorder. Journal of Anxiety Disorders, 33, 90-94. https://doi.org/10.1016/j.janxdis.2015.05.004
• Boswell, J. F., Thompson-Hollands, J., Farchione, T. J., & Barlow, D. H. (2013). Intolerance of uncertainty: A common factor in the treatment of emotional disorders. Journal of Clinical Psychology, 69(6), 630-645. https://doi.org/10.1002/jclp.21965
• Bowerman, B. L., & O'Connell, R. T. (1990). Linear statistical models: An applied approach. Brooks/Cole.
• Browne, M. W., & Cudeck, R. (1992). Alternative ways of assessing model fit. Sociological Methods & Research, 21(2), 230-258.https://doi.org/10.1177/0049124192021002005
• Buhlmann, U., Etcoff, N. L., & Wilhelm, S. (2008). Facial attractiveness ratings and perfectionism in body dysmorphic disorder and obsessive-compulsive disorder. Journal of Anxiety Disorders, 22(3), 540-547. https://doi.org/10.1016/j.janxdis.2007.05.004
• Buhr, K., & Dugas, M. (2002). The intolerance of uncertainty scale: Psychometric properties of the English version. Behaviour Research and Therapy, 40(8), 931-945. https://doi.org/10.1016/s0005-7967(01)00092-4
• Buhr, K., & Dugas, M. J. (2006). Investigating the construct validity of intolerance of uncertainty and its unique relationship with worry. Journal of Anxiety Disorders, 20(2), 222-236. https://doi.org/10.1016/j.janxdis.2004.12.004
• Bulik, C. M., Tozzi, F., Anderson, C., Mazzeo, S. E., Aggen, S., & Sullivan, P. F. (2003). The relation between eating disorders and components of perfectionism. American Journal of Psychiatry, 160(2), 366-368. https://doi.org/10.1176/appi.ajp.160.2.366
• Burns, G., Keortge, S. G., Formea, G. M., & Sternberger, L. G. (1996). Revision of the Padua Inventory of obsessive compulsive disorder symptoms: Distinctions between worry, obsessions, and compulsions. Behaviour Research and Therapy, 34(2), 163-173. https://doi.org/10.1016/0005-7967(95)00035-6
• Byrne, B. M. (2016). Structural Equation Modeling with AMOS: Basic Concepts, Applications, and Programming. (3rd ed.). New York: Routledge.
• Carleton, R. N., Norton, M. P. J., & Asmundson, G. J. (2007). Fearing the unknown: A short version of the Intolerance of Uncertainty Scale. Journal of Anxiety Disorders, 21(1), 105-117. https://doi.org/10.1016/j.janxdis.2006.03.014
• Carleton, R. N. (2016). Into the unknown: A review and synthesis of contemporary models involving uncertainty. Journal of Anxiety Disorders, 39, 30-43. https://doi.org/10.1016/j.janxdis.2016.02.007
• Carleton, R. N., Mulvogue, M. K., Thibodeau, M. A., McCabe, R. E., Antony, M. M., & Asmundson, G. J. (2012). Increasingly certain about uncertainty: Intolerance of uncertainty across anxiety and depression. Journal of Anxiety Disorders, 26(3), 468-479. https://doi.org/10.1016/j.janxdis.2012.01.011
• Casale, S., Fioravanti, G., Rugai, L., Flett, G. L., & Hewitt, P. L. (2019). What lies beyond the superordinate trait perfectionism factors? The perfectionistic self-presentation and perfectionism cognitions inventory versus the big three perfectionism scale in predicting depression and social anxiety. Journal of Personality Assessment, 102(3), 370-379. https://doi.org/10.1080/00223891.2019.1573429
• Dry, S. M., Kane, R. T., & Rooney, R. M. (2015). An investigation into the role of coping in preventing depression associated with perfectionism in preadolescent children. Frontiers in Public Health, 3, 1-9. https://doi.org/10.3389/fpubh.2015.00190
• Dugas, M. J., Schwartz, A., & Francis, K. (2004). Brief report: Intolerance of uncertainty, worry, and depression. Cognitive Therapy and Research, 28(6), 835-842. https://doi.org/10.1007/s10608-004-0669-0
• Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: A clinical review. Clinical Psychology Review, 31(2), 203–212. https://doi.org/10.1016/j.cpr.2010.04.009
• Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: A clinical review. Clinical Psychology Review, 31(2), 203-212. https://doi.org/10.1016/j.cpr.2010.04.009
• Ehring, T., & Watkins, E. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1(3), 192–205. https://doi.org/10.1521/ijct.2008.1.3.192
• Feher, A., Smith, M. M., Saklofske, D. H., Plouffe, R. A., Wilson, C. A., & Sherry, S. B. (2020). The big three perfectionism scale–short form (BTPS-SF): Development of a brief self-report measure of multidimensional perfectionism. Journal of Psychoeducational Assessment, 38(1), 37-52. https://doi.org/10.1177/0734282919878553
• Flett, G. L., & Hewitt, P. L. (2016). Still measuring perfectionism after all these years. Journal of Psychoeducational Assessment, 34(7), 615-619. https://doi.org/10.1177/0734282916651540
• Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14(5), 449-468. https://doi.org/10.1007/bf01172967
• Galloway, R., Watson, H., Greene, D., Shafran, R., & Egan, S. J. (2021). The efficacy of randomised controlled trials of cognitive behaviour therapy for perfectionism: A systematic review and meta-analysis. Cognitive Behaviour Therapy, 51(2), 170-184. https://doi.org/10.1080/16506073.2021.1952302
• George, D., & Mallery, P. (2010). SPSS for Windows step by step: A simple guide and reference, 17.0 update. Allyn & Bacon.
• Gnilka, P. B., Ashby, J. S., & Noble, C. M. (2012). Multidimensional perfectionism and anxiety: Differences among individuals with perfectionism and tests of a coping-mediation model. Journal of Counseling & Development, 90(4), 427-436. https://doi.org/10.1002/j.1556-6676.2012.00054.x
• Hartmann, A. S., Thomas, J. J., Greenberg, J. L., Matheny, N. L., & Wilhelm, S. (2014). A comparison of self-esteem and perfectionism in anorexia nervosa and body dysmorphic disorder. Journal of Nervous & Mental Disease, 202, 883-888. https://doi.org/10.1097/nmd.0000000000000307
• Harvey, A. G., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive Behavioural Processes across Psychological Disorders: A Transdiagnostic Approach to Research and Treatment. https://oxfordclinicalpsych.com/view/10.1093/med:psych/9780198528883.001.0001/med-978019852888
• Hewitt, P. L., & Flett, G. L. (1991). Perfectionism in the self and social contexts: Conceptualization, assessment, and association with psychopathology. Journal of Personality and Social Psychology, 60(3), 456-470. https://doi.org/10.1037/0022-3514.60.3.456
• Hill, R. W., Huelsman, T. J., & Araujo, G. (2010). Perfectionistic concerns suppress associations between perfectionistic strivings and positive life outcomes. Personality and Individual Differences, 48(5), 584-589. https://doi.org/10.1016/j.paid.2009.12.011
• Kaçar-Başaran, S. (2022). Perfectionism: Its structure, transdiagnostic nature, and cognitive behavioral therapy. Current Approaches in Psychiatry 14(4), 518-525. https://doi.org/10.18863/pgy.1082001
• Kaçar-Başaran, S., Gökdağ, C., Erdoğan-Yıldırım, Z., & Yorulmaz, O. (2022). A different view to perfectionism: An investigation of the psychometric properties of the big three perfectionism scale in a Turkish community sample. Current Psychology, 41(9), 6511-6521. https://doi.org/10.1007/s12144-020-01131-2
• Kaçar-Başaran, S., & Arkar, H. (2023). Common vulnerability factors in obsessive-compulsive and major depressive disorders: a transdiagnostic hierarchical model. Current Psychology, 42 (10), 8414-8424, https://doi.org/10.1007/s12144-021-02599-2.
• Karababa, A. (2020). The moderating role of hope in the relationship between maladaptive perfectionism and anxiety among early adolescents. The Journal of Genetic Psychology, 181(2-3), 159-170. https://doi.org/10.1080/00221325.2020.1745745
• Kawamoto, T., & Furutani, K. (2018). The mediating role of intolerance of uncertainty on the relationships between perfectionism dimensions and psychological adjustment/maladjustment among mothers. Personality and Individual Differences, 122, 62-67. https://doi.org/10.1016/j.paid.2017.10.008
• Kline, R. B. (2015). Principles and practice of structural equation modeling. Guilford publications.
• Kokkoris, M. D. (2019). New insights into the association of maximizing with facets of perfectionism. Personality and Individual Differences, 142, 100-102. https://doi.org/10.1016/j.paid.2019.01.040
• Kotov, R., Gamez, W., Schmidt, F., & Watson, D. (2010). Linking “big” personality traits to anxiety, depressive, and substance use disorders: A meta-analysis. Psychological Bulletin, 136(5), 768-821. https://doi.org/10.1037/a0020327
• Kuchynka, S. L., & Bosson, J. K. (2018). The psychodynamic mask model of narcissism: Where is it now?. In Handbook of trait narcissism (pp. 89-95). Springer, Cham.
• Limburg, K., Watson, H. J., Hagger, M. S., & Egan, S. J. (2017). The relationship between perfectionism and psychopathology: A meta-analysis. Journal of Clinical Psychology, 73(10), 1301-1326. https://doi.org/10.1002/jclp.22435
• Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression anxiety stress scales. Sydney: Psychology Foundation.
• Mahoney, A. E., & McEvoy, P. M. (2012). Changes in intolerance of uncertainty during cognitive behavior group therapy for social phobia. Journal of Behavior Therapy and Experimental Psychiatry, 43(2), 849-854. https://doi.org/10.1016/j.jbtep.2011.12.004
• Mahoney, A., & McEvoy, P. M. (2012). A transdiagnostic examination of intolerance of uncertainty across anxiety and depressive disorders. Cognitive Behaviour Therapy, 41(3), 212–222. https://doi.org/10.1080/16506073.2011.622130
• McEvoy, P. M., Hyett, M. P., Shihata, S., Price, J. E., & Strachan, L. (2019). The impact of methodological and measurement factors on transdiagnostic associations with intolerance of uncertainty: A meta-analysis. Clinical Psychology Review, 73, 101778. https://doi.org/10.1016/j.cpr.2019.101778
• McEvoy, P. M., & Mahoney, A. E. (2012). To be sure, to be sure: Intolerance of uncertainty mediates symptoms of various anxiety disorders and depression. Behavior Therapy, 43(3), 533-545. https://doi.org/10.1016/j.beth.2011.02.007
• Moroz, M., & Dunkley, D. M. (2019). Self-critical perfectionism, experiential avoidance, and depressive and anxious symptoms over two years: A three-wave longitudinal study. Behaviour Research and Therapy, 112, 18-27. https://doi.org/10.1016/j.brat.2018.11.006
• Nolen-Hoeksema, S., & Watkins, E. (2011). A heuristic for developing transdiagnostic models of psychopathology. Perspectives on Psychological Science, 6(6), 589–609. https://doi.org/10.1177/1745691611419672
• Pereira, A. T., Cabaços, C., Araújo, A., Amaral, A. P., Carvalho, F., & Macedo, A. (2022). COVID-19 psychological impact: The role of perfectionism. Personality and Individual Differences, 184, 111160. https://doi.org/10.1016/j.paid.2021.111160
• Raykov, T. & Marcoulides, G. A. (2008). An introduction to applied multivariate analysis (first edition). New York: Taylor & Francis Group.
• Reuther, E. T., Davis, T. E., Rudy, B. M., Jenkins, W. S., Whiting, S. E., & May, A. C. (2013). Intolerance of uncertainty as a mediator of the relationship between perfectionism and obsessive-compulsive symptom severity. Depression and Anxiety, 30(8), 773-777. https://doi.org/10.1002/da.22100
• Sarıçam, H. (2018). The psychometric properties of Turkish version of depression anxiety stress scale-21 (DASS-21) in community and clinical samples. Journal of Cognitive-Behavioral Psychotherapy and Research, 7(1), 19-30. https://doi.org/10.5455/jcbpr.274847
• Sarıçam, H., Erguvan, F. M., Akın, A., & Akça, M. Ş. (2014). The Turkish short version of the intolerance of uncertainty (IUS-12) scale: The study of validity and reliability. Route Educational and Social Science Journal, 1(3), 148-157. https://doi.org/10.17121/ressjournal.109
• Schermelleh-Engel, K., Moosbrugger, H., & Müller, H. (2003). Evaluating the fit of structural equation models: Tests of significance and descriptive goodness-of-fit measures. Methods of Psychological Research Online, 8(2), 23-74. https://doi.org/10.1.1.509.4258&rep=rep1&type=pdf
• Sherry, S. B., Mackinnon, S. P., & Nealis, L. J. (2018). Perfectionism and interpersonal problems: Narcissistic and self-critical perfectionism. In The psychology of perfectionism (pp. 177-199). Routledge.
• Shihata, S., McEvoy, P. M., & Mullan, B. A. (2017). Pathways from uncertainty to anxiety: An evaluation of a hierarchical model of trait and disorder-specific intolerance of uncertainty on anxiety disorder symptoms. Journal of Anxiety Disorders, 45, 72-79. https://doi.org/10.1016/j.janxdis.2016.12.001
• Shikatani, B., Antony, M. M., Cassin, S. E., & Kuo, J. R. (2016). Examining the role of perfectionism and intolerance of uncertainty in postevent processing in social anxiety disorder. Journal of Psychopathology and Behavioral Assessment, 38(2), 297-306. https://doi.org/10.1007/s10862-015-9516-8
• Smith, M. M., Saklofske, D. H., Stoeber, J., & Sherry, S. B. (2016). The big three perfectionism scale. Journal of Psychoeducational Assessment, 34(7), 670-687. https://doi.org/10.1177/0734282916651539
• Stoeber, J., & Damian, L. E. (2016). Perfectionism in employees: Work engagement, workaholism, and burnout. In Perfectionism, health, and well-being (pp. 265-283). Springer, Cham.
• Stoeber, J. (2017). The psychology of perfectionism: Theory, research, applications. Routledge.
• Stoeber, J., & Gaudreau, P. (2017). The advantages of partialling perfectionistic strivings and perfectionistic concerns: Critical issues and recommendations. Personality and Individual Differences, 104, 379-386. https://doi.org/10.1016/j.paid.2016.08.039
• Stoeber, J., & Otto, K. (2006). Positive conceptions of perfectionism: Approaches, evidence, challenges. Personality and Social Psychology Review, 10(4), 295-319. https://doi.org/10.1207/s15327957pspr1004_2
• Stoeber, J., Madigan, D. J., & Gonidis, L. (2020). Perfectionism is adaptive and maladaptive, but what's the combined effect? Personality and Individual Differences. https://doi.org/10.1016/j.paid.2020.109846
• Tabachnick, B. G. & Fidell, L. S. (2006). Using multivariate statistics (5th ed.). Boston: Allyn & Bacon.
• Toroslu, B., & Çırakoğlu, O. C. (2022). Do perfectionism and intolerance of uncertainty mediate the relationship between early maladaptive schemas and relationship and partner related obsessive–compulsive symptoms? Current Psychology. https://doi.org/10.1007/s12144-022-03050-w
• Tükel, R., Meteris, H., Koyuncu, A., Tecer, A., & Yazıcı, O. (2006). The clinical impact of mood disorder comorbidity on obsessive–compulsive disorder. European Archives of Psychiatry and Clinical Neuroscience, 256(4), 240-245. https://doi.org/10.1007/s00406-006-0632-z
• Tükel, R., Polat, A., Özdemir, Ö., Aksüt, D., & Türksoy, N. (2002). Comorbid conditions in obsessive-compulsive disorder. Comprehensive Psychiatry, 43(3), 204-209. https://doi.org/10.1053/comp.2002.32355
• Viswanath, B., Narayanaswamy, J. C., Rajkumar, R. P., Cherian, A. V., Kandavel, T., Math, S. B., & Reddy, Y. J. (2012). Impact of depressive and anxiety disorder comorbidity on the clinical expression of obsessive-compulsive disorder. Comprehensive Psychiatry, 53(6), 775-782. https://doi.org/10.1016/j.comppsych.2011.10.008
• Weijters, B., & Baumgartner, H. (2021). On the use of balanced item parceling to counter acquiescence bias in structural equation models. Organizational Research Methods, 25(1), 170-180. https://doi.org/10.1177/1094428121991909
• Wheeler, H. A., Blankstein, K. R., Antony, M. M., McCabe, R. E., & Bieling, P. J. (2011). Perfectionism in anxiety and depression: Comparisons across disorders, relations with symptom severity, and role of comorbidity. International Journal of Cognitive Therapy, 4(1), 66-91. https://doi.org/10.1521/ijct.2011.4.1.66
• Williams, B. M., & Levinson, C. A. (2021). Intolerance of uncertainty and maladaptive perfectionism as maintenance factors for eating disorders and obsessive‐compulsive disorder symptoms. European Eating Disorders Review, 29(1), 101-111. https://doi.org/10.1002/erv.2807
• Wu, K. D., & Cortesi, G. T. (2009). Relations between perfectionism and obsessive–compulsive symptoms: Examination of specificity among the dimensions. Journal of Anxiety Disorders, 23(3), 393-400. https://doi.org/10.1016/j.janxdis.2008.11.006
• Yorulmaz, O., Karanci, A. N., Dirik, G., Bastug, B. T., Göka, E., & Burns, G. L. (2007). Padua Envanteri-Washington Eyalet Üniversitesi Revizyonu: Türkçe versiyonunun psikometrik özellikleri. Türk Psikoloji Yazıları, 10(20), 75-85.
• Zhu, W. (1997). Making bootstrap statistical inferences: A tutorial. Research Quarterly for Exercise and Sport, 68(1), 44-55. https://doi.org/10.1080/02701367.1997.10608865