Personality and Individual Differences 50 (2011) 1126–1130

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Personality and Individual Differences

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Perfectionism and clinical disorders among employees

Nico W. Van Yperen a,⇑, Marc Verbraak b, Ellen Spoor c

a University of Groningen, The Netherlandsb Behavioral Science Institute, Radboud University Nijmegen, The Netherlands, and HSK Group, Arnhem, The Netherlandsc Eindhoven University of Technology, The Netherlands

a r t i c l e i n f o

Article history:Received 5 November 2010Received in revised form 12 January 2011Accepted 29 January 2011Available online 19 February 2011

Keywords:PerfectionismAchievementBurnoutDepressionAnxietyComorbidity

0191-8869/$ - see front matter � 2011 Elsevier Ltd. Adoi:10.1016/j.paid.2011.01.040

⇑ Corresponding author. Address: University ofPsychology, Grote Kruisstraat 2/I, 9712 TS Groningen50 363 63 32; fax: +31 50 363 45 81.

E-mail address: N.van.Yperen@rug.nl (N.W. Van Yp

a b s t r a c t

We examined differences in perfectionism between burned-out employees (n = 77), depressed employees(n = 29), anxiety-disordered employees (n = 31), employees with comorbid disorders, that is, a combina-tion of clinical burnout, depression, or anxiety disorder (n = 28), and individuals without clinical burnout,depression disorder, or anxiety disorder (clinical control group; n = 110). The results suggest that settinghigh personal standards per se is not associated with clinical disorders. In contrast, maladaptive aspects ofperfectionism, including perceived discrepancy between standards and performance and sociallyprescribed perfectionism, were related to clinical disorders, and in particular to comorbidity.

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1. Introduction

Although no definition of perfectionism has been formallyagreed upon, the centrality of high personal standards is evident(Flett & Hewitt, 2002; Slaney, Rice, & Ashby, 2002). Severalresearchers have demonstrated that setting high personal stan-dards (Slaney et al., 2002) or self-oriented perfectionism (Flett &Hewitt, 2002), was positively associated with positively valencedvariables such as self-esteem, problem-focused coping, career sat-isfaction, and physical health (e.g., Bieling, Israeli, & Antony, 2004;Enns & Cox, 2002; Slaney et al., 2002; Stoeber, Feast, & Hayward,2009). Similarly, in goal-setting research, high standards of perfor-mance have typically been found to be associated with focusedattention, effort, and persistence, all of which are likely to enhancework motivation and job performance (Locke & Latham, 1990).Therefore, we argue and will demonstrate that, relative to theiroccurrence in a clinical control group, only maladaptive character-istics of perfectionism are prevalent among employees diagnosedwith clinical disorders, and in particular among individuals withcomorbid disorders.

Specifically, not high standards per se, but individuals’ percep-tions that they consistently fail to meet their personal standards,

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eren).

henceforth referred to as perceived discrepancy (Slaney et al.,2002), may elevate levels of distress, and lead to the developmentof clinical disorders. Several studies consistently report that per-ceived discrepancy is associated with negative adjustment indica-tors such as lack of self-esteem, worry, and psychological distress(e.g., Slaney, Rice, Mobley, Trippi, & Ashby, 2001; Van Yperen &Hagedoorn, 2008). A perceived discrepancy between standardsand criteria of success in meeting those standards is distressing be-cause it interferes with people’s basic need for competence and theneed to actually succeed in getting what they want (Ellis, 2002;Ryan & Deci, 2002).

Similarly, the perception that others are imposing high stan-dards on the self (i.e., socially prescribed perfectionism) has typicallybeen found to be associated with a variety of negative outcomes,including depressive symptomatology, fear of negative evaluation,and negative affect (e.g., Flett & Hewitt, 2002; Stoeber et al., 2009).In contrast to personally adopted high standards, socially imposedhigh standards create concerns about others’ criticism and expec-tations (Clara, Cox, & Enns, 2007; O’Connor, O’Connor, & Marshall,2007). Focusing on others’ high standards tends to raise a want to anecessity which is irrational and self-defeating, and accordingly,may decrease one’s sense of self-efficacy and self-esteem, increasepsychological distress, and, ultimately, leads to clinical disorders(cf., Ellis, 2002).

The assumed links between clinical disorders, including comor-bidity, on the one hand, and maladaptive characteristics of perfec-tionism, on the other, are discussed below.

N.W. Van Yperen et al. / Personality and Individual Differences 50 (2011) 1126–1130 1127

1.1. Burnout

From the beginning, burnout (for the five common elements ofburnout, see Table 1) was associated with perfectionism(Freudenberger, 1974). However, to our knowledge, there are nostudies among employees that link dimensions of perfectionismto clinical burnout. Maladaptive aspects of perfectionism, includingthe perception of consistently failing to meet one’s own standardsand a chronic concern about others’ criticism and expectations,may however lead to the development of severe burnout symp-toms (Clara et al., 2007; Stoeber & Otto, 2006). Employees witha clinical burnout meet the criteria of the ICD-10 (i.e., the 10threvision of the International Statistical Classification of Diseasesand Related Health Problems) equivalent of job- or work-relatedneurasthenia (Schaufeli, Bakker, Schaap, Kladler, & Hoogduin,2001). That is, for the diagnosis clinical burnout, the listed symp-toms (see Table 1) have to be present each day for at least6 months. Table 1 also shows that the elements of burnout arevery similar to the criteria for neurasthenia in ICD-10 and thosefor an undifferentiated somatoform disorder. In the DSM-IV(i.e., Diagnostic and Statistical Manual of Mental Disorders, 4thedition), undifferentiated somatoform disorder includes neuras-thenia, which was abandoned as a separate category (Hickie,Hadzi-Pavlovic, & Ricci, 1997).

1.2. Depression

According to the criteria of the DSM-IV, the symptoms of a ma-jor depressive episode include persistent sad mood, feelings ofhopelessness or worthlessness, loss of interest in activities thatwere once enjoyed, and thoughts of death or suicide. Individualsmay be more likely to develop depressive symptomatology, andin the long term, clinical depression when they are high in per-ceived discrepancy (e.g., Bieling, Israeli, & Antony, 2004; Claraet al., 2007). Such individuals are too critical of their own achieve-ments, making them vulnerable to experiences of failure and thedevelopment of depressive symptomatology. Also, individualswho consistently feel that others are imposing high standards onthem develop these symptoms because externally imposed stan-

Table 1Comparison of the five common burnout elements as identified by Maslach and Schaufelisomatoform disorder (DSM-IV).

Common elements of burnout asidentified by Maslach and Schaufeli(1993)

Job or work-related neurasthenia (ICD-1

1. A predominance of fatigue symptomssuch as mental or emotionalexhaustion, tiredness, and depression

The feeling of either mental or physical faand exhaustion after minimal effort

2. Various atypical physical symptomsof distress may occur

At least two out of seven symptoms shoumuscular aches and pain, dizziness, tenssleep disturbance, inability to relax, irritdyspepsia

3. These symptoms are work-related The life-management difficulty criterionICD-10’s definition of burnout corresponrelatedness

4. The symptoms manifest themselvesin ‘normal’ persons who did not sufferfrom psychopathology before

These symptoms should not better be acpresence of a depression or anxiety disorthe more specific disorders in the ICD-1

5. Decreased effectiveness and impairedwork performance occurs because ofnegative attitudes and behaviors

In the clarification of neurasthenia the adisorder with impaired occupational perreduced coping efficiency in daily tasks

dards are typically perceived as uncontrollable (Blatt, 1995; O’Con-nor et al., 2007).

1.3. Anxiety

Several researchers have reported a robust link between per-ceived discrepancy and anxiety, suggesting that people’s percep-tions that they consistently fail to meet their personal standardslead to the development of an anxiety disorder (Slaney et al.,2001). Similarly, the perception that one must meet others’ highexpectations may be perceived as being excessive and uncontrolla-ble, and ultimately, lead to the development of an anxiety disorder.For example, Hewitt and Flett (1991) found higher levels of sociallyprescribed perfectionism in a group of patients with anxiety disor-ders than in healthy respondents.

Hence, Hypothesis 1 was that, relative to the individuals in thecontrol group, burned-out individuals, depressed individuals, andanxiety-disordered individuals would be higher in perceived dis-crepancy and socially prescribed perfectionism.

Comorbidity may be associated with even higher levels of per-ceived discrepancy and socially prescribed perfectionism; this isdiscussed in the following paragraph.

1.4. Comorbidity

In the present research, comorbidity refers to the co-occurrenceof clinical burnout, depression, or anxiety disorders within thesame individual. Assuming that socially prescribed perfectionismand perceived discrepancy are related to one of these mental disor-ders (see Hypothesis 1), the most severe and maladaptive forms ofperfectionism may be associated with comorbidity (cf., Bieling,Summerfeldt, Israeli, & Antony, 2004). For example, individualswho score high on socially prescribed perfectionism and perceiveddiscrepancy feel chronically anxious because they feel that theytypically do not meet others’ high standards and their own highstandards, respectively. This may make them feel depressed andless energetic, making it difficult for them to work harder. In turn,this increases their feeling of falling short of the socially imposedor personally adopted standards, which is likely to elevate anxiety

(1993), the criteria for neurasthenia (ICD-10), and the criteria for an undifferentiated

0) Undifferentiated somatoform disorder (DSM-IV)

tigue or weakness The presence of one or more physical complaints persistingfor 6 months or longer. The most frequent complaints arechronic fatigue, loss of appetite, or gastrointestinal orgenito-urinary symptoms

ld be present: i.e.,ion headaches,ability, and

put forward inds to work-

counted for by theder, or any other of0 classification

The complaints are not better accounted for by anothermental disorder, or are not intentionally produced orfeigned

ssociation of theformance oris made explicitly

The symptoms must cause clinically significant distress orimpairment in social, occupational, or other importantareas of functioningThe complaints cannot be fully explained by a knowngeneral medical condition or by the direct effects of asubstance. When there is a related general medicalcondition the physical complaints or resultant impairmentare grossly in excess of what could be expected from thehistory, physical examination, or laboratory findings

1128 N.W. Van Yperen et al. / Personality and Individual Differences 50 (2011) 1126–1130

and fatigue to even higher levels. Hence, these individuals developsubsequently, or simultaneously, a burnout syndrome, depression,or an anxiety disorder. Therefore, Hypothesis 2 stated that, relativeto burned-out individuals, depressed individuals, anxiety-disor-dered individuals, and individuals in the control group, individualswith comorbid disorders would be higher in perceived discrepancyand socially prescribed perfectionism.

In sum, we expected that only maladaptive characteristics ofperfectionism are prevalent among employees diagnosed withclinical disorders, and in particular among individuals with comor-bid disorders. No differences between the groups were anticipatedwith regard to high standards and self-oriented perfectionism.

2. Method

2.1. Participants

Complete datasets were available from 275 participants (56.4%men, 98.1% Caucasian) who represented a broad range of indus-tries. They were consecutive clients of a Dutch mental health careinstitute specialized in diagnosing and treating people with work-related psychological problems. The participants were referred bytheir occupational physician, which is common practice in theNetherlands.

The average age was 42 years (SD = 9.1), ranging from 22 to 59.Relative to the general Dutch population, the level of educationwas quite high: 43.3% had a BSc degree or higher, 47.0% had com-pleted high school or had had technical or vocational training at anintermediate level, and the remaining 9.7% had had technical orvocational training at the lowest level.

2.2. Procedure

As part of the standardized intake procedure at the institute, allparticipants were routinely subjected to a standardized clinicalsemi-structured interview (the Mini-International Neuropsychiat-ric Interview, or MINI) in order to arrive at one or more DSM-IV clas-sifications describing their complaints (Sheehan et al., 1998). Theinterviews were conducted by, approximately, 30 different, well-trained and licensed psychologists. The interviews were rated inpairs, one was the assessor at the first (intake) assessment, the otherthe psychologist at the second (intake feedback and treatment allo-cation) assessment. Classification was reached by means of consen-sus. The overall percentage of agreement before consensus was high(i.e., between 79% and 98%; Verbraak et al., submitted).

After the intake, clients diagnosed as burned-out (n = 77), de-pressed (n = 29), anxiety-disordered (n = 31), or with comorbidityof two or more of the aforementioned disorders (n = 28), wereasked to participate in the research project on ‘work-related psy-chological problems’. Furthermore, clients with minor work-related complaints without mention of clinical burnout, depres-sion, or anxiety disorders anywhere in their clinical profile (mostlyadaptation disorders, V-codes, disorders of impulse control) wereasked to participate (clinical control group; n = 110). All the partic-ipants were told that participation was completely voluntary andthat the data would be treated confidentially and anonymously.Almost all eligible clients (91%) were willing to participate. Beforethe second visit to the institute, the participants had completedand returned (to the secretary’s office) the completed question-naire, including a signed informed consent.

2.3. Measures

Emotional exhaustion. This core symptom of burnout (Maslach &Schaufeli, 1993) was measured using the corresponding scale of

the widely used and validated Maslach Burnout Inventory-GeneralSurvey (MBI-GS; Schaufeli, Leiter, Maslach, & Jackson, 1996). Thisscale consists of five items, including ‘‘I feel emotionally drainedfrom my work.’’ Each item was followed by a seven-point LikertScale, ranging from 0 (never) to 6 (every day). The Dutch version,the Utrecht Burnout Scale-A (UBOS-A), was developed and vali-dated by Schaufeli and Van Dierendonck (2000). They found inter-nal consistency reliabilities between .84 and .90 among eightsamples representing different occupations, and high correlationswith indicators of fatigue and psychological complaints. In the cur-rent sample, Cronbach’s alpha was .92.

Self-reported depressive symptomatology was assessed using the16-item subscale ‘Depression’ of the Symptom CheckList-90 (SCL-90, Derogatis & Cleary, 1977). Cronbach’s alpha was .91.

Self-reported anxiety was assessed by the 10-item subscale ‘Anx-iety’ of the SCL-90. Cronbach’s alpha was .88.

The SCL-90 items ask respondents to indicate the amount towhich they were bothered by symptoms of depression, anxiety,etc. during the previous week on a five-point Likert scale, rangingfrom 1 (not at all) to 5 (very much). The SCL-90 depression andanxiety subscales (both the English and the Dutch versions)showed good convergent and divergent validity, and high internalconsistencies (Arrindell & Ettema, 2003; Derogatis & Cleary, 1977;Koeter, 1992; Morgan, Wiederman, & Magnus, 1998).

High standards was measured with the seven-items subscalefrom the Almost Perfect Scale Revised (APS-R; Slaney et al.,2001). A sample item is: ‘‘I have high expectations of myself.’’Cronbach’s alpha was .82.

Perceived Discrepancy was measured with the 12-items subscalefrom the APS-R, for example, ‘‘I hardly ever feel that what I’ve doneis good enough.’’ Cronbach’s alpha was .94.

Self-oriented Perfectionism was assessed by the 15-items sub-scale from the Multidimensional Perfectionism Scale (MPS; Hewitt& Flett, 1991). A sample item is: ‘‘I strive to be as perfect as I canbe.’’ Cronbach’s alpha was .74.

Socially Prescribed Perfectionism was assessed by the 15-itemssubscale from MPS, and comprises items such as ‘‘People expectnothing less than perfection from me’’. Cronbach’s alpha was .70.

For all APS-R scales and MPS scales, participants responded on a7-point Likert-scale from 1 (strongly disagree) to 7 (strongly agree).All subscales (both the English and the Dutch versions) showedgood convergent and divergent validity, and high internal consis-tencies (e.g., Hewitt & Flett, 1991; Slaney et al., 2002; Van Yperen& Hagedoorn, 2008).

Occupational context. Because work-related psychological prob-lems usually result from both the characteristics of the employeeand the nature of the work situation, we assessed three key workcharacteristics (Karasek & Theorell, 1990) in order to statisticallycontrol for the potential impact of occupational context. The mea-sures of Job Demands (11 items) and Lack of Job Control (11 items)were developed and validated by Van Veldhoven and Meijman(1994). Cronbach’s alpha was .74 for Job Demands, and .86 for Lackof Job Control. The Job Social Support measure (four items) wasadopted from Van Yperen and Hagedoorn (2003). Cronbach’s alphawas .87. All items were followed by a four-point scale, rangingfrom 0 (never) to 3 (always).

3. Results

We conducted a multivariate analysis of covariance (MANCOVA)with emotional exhaustion, SCL depression, SCL anxiety, high stan-dards, perceived discrepancy, self-oriented perfectionism, and so-cially prescribed perfectionism as the dependent variables. Thecovariates were age, educational level, job demands, lack of jobcontrol, and job social support. At the multivariate level, the differ-

N.W. Van Yperen et al. / Personality and Individual Differences 50 (2011) 1126–1130 1129

ences between the five groups were significant, F(28,1048) = 5.92,p < .001, Np = .14). Sex differences were examined in preliminaryanalyses, but no significant results were obtained (ps > .22). Hence,sex was omitted from further consideration.

Our primary objective was to demonstrate that various classifi-cations of clinical disorder were associated with varying profiles ofperfectionistic characteristics. Therefore, it is important to validateclinician’s consensus diagnoses first, that is, to examine for differ-ences between the five diagnostic groups in emotional exhaustion,depression, and anxiety. In line with the diagnoses, the findings atthe univariate level and the results of the follow-up analyses (LSDcontrasts), presented in Table 2, show that both burned-out indi-viduals and individuals with comorbid disorders scored higher onemotional exhaustion relative to the other three groups. Further-more, both the depressed individuals and the individuals withcomorbid disorders scored higher on the depression scale thanthe other three groups. With regard to the anxiety scale, the pic-ture was somewhat less straightforward. As expected, the anxi-ety-disordered individuals were higher in anxiety than theburned-out individuals and the individuals in the control group,but they were not higher relative to the depressed individuals.Individuals with comorbid disorders reported the highest levelsof anxiety. All together, these findings indicate high validity of cli-nicians’ diagnoses.

3.1. Hypotheses testing

The univariate results and the follow-up analyses (LSD con-trasts) indicated that Hypothesis 1 was partially supported (seeTable 2). That is, relative to the individuals in the control group,burned-out individuals and depressed individuals, but not anxi-ety-disordered individuals, were higher in socially prescribedperfectionism.

Furthermore, relative to the other four groups, individuals withcomorbid disorders were higher in perceived discrepancy (seeTable 2), so that support was obtained for Hypothesis 2. Individualswith comorbid disorders were also higher in socially prescribedperfectionism, but only relative to the anxiety-disordered individ-uals and the individuals in the control group. The differences withthe burned-out individuals and the depressed individuals were inthe expected direction, but lacked significance.

Table 2 also shows that – as expected – no differences betweenthe groups were observed with regard to high standards and self-oriented perfectionism.

4. Discussion

The present study extends previous research by showing differ-ences in maladaptive characteristics of perfectionism betweengroups of employees with distinct clinical profiles. First, relativeto the individuals in the control group, burned-out individuals

Table 2Differences between diagnostic groups (n = 275)1.

Clinical burnout (n = 77) Depression (n = 29)

M SD M SD

Emotional exhaustion 21.51a 5.92 15.24b 8.00SCL-depression 36.38a 9.54 48.93b 10.89SCL-anxiety 19.39a 6.22 24.48bc 8.40High standards 35.85 7.28 35.94 7.49Perceived discrepancy 42.91a 13.91 43.38a 15.55Self-oriented perfectionism 65.75 14.40 66.83 14.10Socially prescribed perfectionism 58.41ab 9.23 58.21ab 12.09

1Within each row, initial sample means that do not share a common subscript differ at2⁄p < .05 ⁄⁄p < .01 ⁄⁄⁄ p < .001.

and depressed individuals were higher in socially prescribed per-fectionism. Secondly, relative to the other four groups, individualswith comorbid disorders more strongly perceived a discrepancybetween their own high standards and their performances. In addi-tion, they more strongly felt that they had to live up to the highstandards presumably imposed by others. Their probably too crit-ical attitudes towards their own achievements may have madethem vulnerable to experiences of failure and the development ofdepressive symptomatology. Similarly, the perception that onemust meet others’ high expectations tends to be perceived as beingexcessive and uncontrollable, eliciting anxiety, strain, and fatigue(cf., Blatt, 1995; Crocker & Wolfe, 2001). This may have causedthese individuals to feel depressed and lacking in energy to workharder, which, in turn, increased their feeling of falling short ofthe imposed or personally adopted standards, elevating anxietyand fatigue to even higher levels, etc.

In contrast, no differences between the groups of employeeswere observed with regard to the tendency to set high personalstandards, or self-oriented perfectionism. This supports previousfindings indicating that setting high personal standards of perfor-mance per se may not be considered as a maladaptive aspect ofperfectionism (e.g., Enns & Cox, 2002; Flett & Hewitt, 2002; Slaneyet al., 2002; Stoeber & Otto, 2006).

4.1. Strengths and limitations

A strength of our research is the nature and the size of the sam-ple, and the distinctive clinical profiles of the five groups. Appar-ently, clinicians can reliably differentiate burned-out individualsfrom depressed individuals (cf., Brenninkmeijer, Van Yperen, &Buunk, 2001). Burned-out individuals are particularly high in emo-tional exhaustion, whereas depressed individuals are high indepressive symptomatology. Similarly, anxiety-disordered individ-uals were higher in anxiety than burned-out individuals and indi-viduals in the control group. However, anxiety-disorderedindividuals and depressed individuals were equally high in anxiety,which is in line with the extant literature showing that depressedindividuals are typically high in anxiety as well (e.g., Brown,Campbell, Lehman, Grisham, & Mancill, 2001). Furthermore, indi-viduals with comorbid disorders were highest in emotionalexhaustion, depression, and anxiety. In contrast, the lowest scoreson these symptoms were observed among the individuals in theclinical control group.

A limitation of this initial exploration of the relationships be-tween clinical disorders and perfectionism, is the absence of ethnicand nationality diversity within the sample (98.1% Dutch Cauca-sian). Also, highly educated people were overrepresented.Although we statistically controlled for demographic variables(e.g., age and educational level), and found no sex differences, gen-eralization to another context is possible only with great caution.Furthermore, we cannot make causal inferences on the basis of

Anxiety (n = 31) Comorbidity (n = 28) Control (n = 110) F(4265)2 Np

M SD M SD M SD

12.87b 8.53 23.32a 5.52 13.66b 7.60 20.45⁄⁄⁄ .2435.58a 12.39 47.61b 12.22 34.82a 12.10 13.71⁄⁄⁄ .1722.55b 8.02 26.50c 8.23 18.72a 7.60 8.95⁄⁄⁄ .1233.77 7.94 37.71 5.80 35.58 6.67 1.83 .0342.77a 17.25 51.68b 13.42 40.11a 14.77 4.19⁄⁄ .0664.40 14.54 68.36 12.32 65.00 14.68 .69 .0156.44ac 8.80 61.70b 12.13 53.78c 10.91 2.66⁄ .04

p < .05 minimally.

1130 N.W. Van Yperen et al. / Personality and Individual Differences 50 (2011) 1126–1130

the present data. That is, perfectionism may lead to distress andclinical disorders, but clinical disorders may elicit or strengthenmaladaptive forms of perfectionism. Indeed, rather than a unidi-rectional link, a reciprocal link between perfectionism and clinicaldisorders is most likely. Furthermore, work-related clinical disor-ders may be associated with other dispositional variables thanmaladaptive forms of perfectionism, such as neuroticism (Roelofs,Huibers, Peeters, & Arntz, 2008) and self-efficacy (Murris, 2002). Inthis regard, it is important to note that exclusive use of disposi-tional arguments in order to gain an understanding of and explainthe development of work-related psychological problems is unde-sirable: these may raise difficult ethical and political questionssince these arguments imply that employers should select employ-ees with the ‘‘appropriate’’ dispositions (cf., Newton & Keenan,1991). Work-related psychological problems usually result fromboth the characteristics of the employee and the nature of the worksituation. When examining the role of personality factors, it istherefore important to statistically control for the potential impactof the occupational context.

4.2. Practical implications

Socially prescribed perfectionism may interfere with people’sbasic need for autonomy, which refers to the need to be the per-ceived origin or source of one’s own behavior (Ryan & Deci,2002). Moreover, the perception that one consistently fails to meetone’s own standards may decrease one’s sense of self-efficacy (VanYperen & Hagedoorn, 2008). These two maladaptive aspects of per-fectionism tend to raise a want to a necessity which is irrationaland self-defeating (Ellis, 2002). To relieve the psychological dis-tress that accompanies maladaptive perfectionism, cognitive inter-ventions and stress management training courses should addressthe following questions: (1) Can the self-critical perceptions ofthe discrepancy between personal standards of performance andcriteria of success in meeting those standards be changed? Relatedto this, are people able to discriminate between standards and dis-crepancy? (2) Is there a fit between personally adopted high stan-dards and the standards perceived to be imposed by others? If thesupposedly imposed standards are clearly higher, why is that? Andwhy is it important for individuals to meet these imposed highstandards? (3) Is the wish to achieve the high standards a desire(‘‘preference’’) or is it perceived as an absolute need (‘‘demand’’)?The present findings suggest that in treatment, these so-calledself-critical evaluative concerns of perfectionism as perceivinggreater discrepancies between standards and performance, andthe perception that others are imposing unrealistic high demandson the self, warrant the clinician’s attention more than does simplyaddressing the level, quantity, and quality of individuals highstandards.

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