Journal of Psychosomatic Research 73 (2012) 295–300

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Journal of Psychosomatic Research

Perfectionism and health functioning in women with fibromyalgia

Danielle S. Molnar a, b,⁎, Gordon L. Flett a, Stan W. Sadava b, Jennifer Colautti a
a
Department of Psychology, York University, Toronto, Ontario, Canada
b
Department of Psychology, Brock University, St. Catharines, Ontario, Canada

a r t i c l e i n f o a b s t r a c t

Article history: Objective: The purpose of this study was to examine the associations between dimensions of perfectionism
Received 7 June 2012 (self-oriented, other-oriented, and socially prescribed perfectionism) and health functioning in a sample of
received in revised form 1 August 2012 489 women with fibromyalgia.
accepted 6 August 2012 Methods: Hierarchical multiple regression was used to determine whether dimensions of perfectionism were
differentially associated with health functioning among women with fibromyalgia after accounting for
Keywords:
broader personality traits related to both perfectionism and health functioning.
Fibromyalgia
Health functioning
Results: The results confirmed that both socially prescribed perfectionism and self-oriented perfectionism
Perfectionism were associated with lower health functioning. Moreover, these associations were found after accounting
Personality for the effects of conscientiousness, extraversion, and neuroticism. The findings involving self-oriented per-
Women's health fectionism were particularly complex and suggested that moderate self-oriented perfectionism may be
somewhat adaptive, but too much or too little self-oriented perfectionism is associated with substantial re-
ductions in health functioning among women with fibromyalgia.
Conclusion: Collectively, these findings clarify that overall levels of perfectionism are not elevated among
women with fibromyalgia, but those women who are exceptionally high in levels of self-oriented perfection-
ism or high in socially prescribed perfectionism are particularly likely to suffer lower health functioning.
These results suggest that perfectionism should be specifically assessed and targeted for intervention
among women with fibromyalgia and there should be a particular emphasis on the pressure to meet per-
ceived or actual expectations imposed on the self.
© 2012 Elsevier Inc. All rights reserved.

Introduction
Fibromyalgia syndrome (FMS) is a chronic condition typified by
widespread musculoskeletal pain that has been shown to have vast
consequences for daily living [1–3]. Indeed, it has been reported that
quality of life is lower among individuals suffering from FMS than
among relatively healthy individuals and even individuals suffering
from other chronic health conditions [4,5]. At present, there is no con-
sensus regarding the specific underlying causes and pathogenesis of
FMS, but it is clear that FMS involves a complex interplay of biological
and psychosocial factors [2,6–8].
This paper focuses on perfectionism and health functioning in women
with FMS in light of indications that perfectionism is a personality factor
implicated in FMS. Case accounts have documented how perfectionism
complicates the ability to cope with FMS [9,10] and the three main psy-
chological causes reported spontaneously by patients with FMS are
stress, perfectionism, and traumatic events [11]. Psychological causes or
correlates of FMS also make frequent references to the role of perfection-
ism [12]. A study that examined clinical impressions of individuals with
⁎ Corresponding author at: Department of Psychology, York University, Toronto,
Ontario, Canada M3J 1P3. Tel.: +1 905 688 5550x5558; fax: +1 905 6886922.
E-mail address: dsm@yorku.ca (D.S. Molnar).
FMS found that about one-quarter (23%) of 105 physicians and
physicians-in-training reported that they observed perfectionism as pres-
ent in their patients with FMS either frequently or very frequently, and
that perfectionism was more common among older patients [13]. Fur-
thermore, Van Houdenhove and colleagues observed that the onset of
FMS is frequently related to extreme forms of perfectionism and an over-
active lifestyle [14,15]. Specifically, Van Houdenhove and colleagues have
included perfectionism as part of a premorbid condition described as
“high action proneness,” which they operationally defined as an
individual's propensity toward direct action and achievement. Moreover,
this orientation toward living an overactive lifestyle has been implicated
as a maintaining factor in the experience of FMS and chronic fatigue syn-
drome [15]. In light of these observations, Grisart and colleagues issued
an explicit call for future studies on the role of perfectionism in FMS [16].
The current study used the multidimensional conceptualization of
perfectionism advanced by Hewitt and Flett [17]. This model states that
perfectionism includes interpersonal as well as intrapersonal aspects
and posits that perfectionism consists of three dimensions centered on
interpersonal source and direction: self-oriented perfectionism (i.e., the
setting of excessively high personal standards, accompanied by strict
guidelines and evaluations of personal behavior); other-oriented perfec-
tionism (i.e., the tendency to hold exceedingly high standards for other
people); and socially prescribed perfectionism (i.e., the need to attain

0022-3999/$ – see front matter © 2012 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.jpsychores.2012.08.001
296 D.S. Molnar et al. / Journal of Psychosomatic Research 73 (2012) 295–300
standards perceived to be imposed by significant others). The potential
relevance of these dimensions in health problems was demonstrated
by Fry and Debats in a longitudinal 7-year study of health outcomes in
a large sample of middle-aged Canadians [18]. They found that
self-oriented and socially prescribed perfectionism predicted early
all-cause mortality after accounting for other personality factors impli-
cated in health problems, such as conscientiousness and neuroticism.
While multidimensional perfectionism has not been explored spe-
cifically in individuals with FMS, recent research with patients with
colitis or Crohn's disease suggests that perfectionism hinders the abil-
ity to cope with chronic illness in general. Flett and colleagues found
that trait perfectionism was associated robustly with maladaptive
coping and greater sickness impact ratings in terms of the psychoso-
cial impact of colitis or Crohn's disease [19]. This finding held even
after accounting for the impact of other personality factors such as
optimism and conscientiousness.
The present research focuses on the associations that socially pre-
scribed perfectionism and self-oriented perfectionism have with health
functioning among women with FMS. Why should these dimensions be
relevant to an understanding of FMS? Socially prescribed perfectionism
can be regarded as a chronic form of psychosocial stress that can involve
an inherent sense of helplessness or hopelessness [17]. It is associated
with a range of coping and self-regulation deficits [20]. The coping dif-
ficulties and links that this dimension has with psychological distress
should exact a toll on people with FMS. Similarly, self-oriented perfec-
tionism should also be relevant in adaptation to FMS, despite conflicting
results demonstrating that self-oriented perfectionism is associated
with poorer health [18] and with better health [21]. However, a key pre-
mise of this study is that elevated self-oriented perfectionism is a vul-
nerability factor that adds substantially to the significant health
challenges already facing individuals with FMS. Individuals with FMS
who are also high in self-oriented perfectionism may regard themselves
as failures due to an inability to work, or they may continue to try to
strive relentlessly in a manner that adds to their pain and other health
problems. The stress and distress of self-oriented perfectionists who
must cope with FMS should be reflected in diminished health function-
ing, especially if the self-oriented perfectionists are highly focused on
not living up to their perfectionistic ideals. Indeed, research has demon-
strated that stress is a key factor that exacerbates the symptoms of FMS,
with studies showing that individuals suffering from FMS consistently
report that stress aggravates their symptoms [22,23]. Personal short-
comings should be particularly salient during periods when pain inher-
ent in FMS interferes with goal-directed pursuit as documented by
Affleck and colleagues [24].
These hypotheses were assessed by administering measures tapping
personality and health functioning to a large sample of women with FMS.
Trait measures of neuroticism, extraversion, and conscientiousness were
included to assess the unique links involving perfectionism. We were
particularly interested in contrasting the results for self-oriented perfec-
tionism and conscientiousness, given evidence that conscientiousness is
adaptive in terms of health functioning [25,26] and in coping with chron-
ic illness [27]. Some researchers have emphasized the need to distinguish
between conscientiousness and over-conscientiousness in the form of
self-oriented perfectionism [28]. Perhaps extreme perfectionism is mal-
adaptive, while moderate levels of self-oriented perfectionism are more
akin to conscientiousness and are related to better health. This possibility
points to the need to test curvilinear associations involving perfectionism
and health functioning. There have been few tests of curvilinear effects in
the perfectionism literature despite some clear indications that such tests
should be conducted. Research on a related construct, self-criticism, has
found curvilinear effects of self-criticism on depression among women
with gestational diabetes [29], with high self-criticism having an exacer-
bated link with depression. Other recent data on disability and coping
with musculoskeletal pain has found a curvilinear association with
patients who continue to relentlessly pursue achievement goals also
experiencing an exacerbated level of pain [30]. This non-monotonic
curvilinear association could, at least in part, reflect having a personality
dominated by a history of striving relentlessly to achieve impossibly high
personal standards and finding it difficult to disengage from this deeply
ingrained tendency. Linear and non-linear relationships between consci-
entiousness and health functioning were also explored given our interest
in distinguishing perfectionism and conscientiousness.
In summary, the unique purpose of this study was to test the hy-
potheses that socially prescribed and self-oriented perfectionism are
associated with diminished health functioning among women with
FMS. We also examined the unique predictive ability of perfectionism
when considered along with conscientiousness, extraversion, and
neuroticism.
Method
Participants and procedure
A web-based sample of women who reported that they were diag-
nosed with FMS by a physician was recruited into the study through on-
line support groups and websites that were created for the benefit of
people with FMS. Women who agreed to participate (N=489) complet-
ed a confidential web-based questionnaire through a URL link that was
posted on the websites. Participation was anonymous and no individual
incentives were given. Participants ranged in age from 20 to 79 years
(M=48.78, SD =10.41) and 66% were American citizens. The majority
of participants were married (58%), 24% had a Bachelor's degree, and
16% had completed college. Overall, 36% were on disability and 25%
were employed full-time. The average household income of the partici-
pants was between $50,000 and $59,999 (range= under $5000 to over
$100,000). The average time since diagnosis ranged from less than
1 year to more than 10 years, with 35% of participants reporting that
they had been diagnosed with FMS for at least 10 years or longer. The
survey did not assess respondent ethnicity or race.
Measures
Perfectionism
Perfectionism was assessed with the Multidimensional Perfectionism
Scale [MPS-HF; 17]. The self-oriented perfectionism subscale measures the
extent to which individuals place high standards on themselves (e.g.,
“One of my goals is to be perfect in everything I do”). The other-oriented
perfectionism subscale measures the extent to which an individual places
high standards of achievement on significant others (e.g., “I cannot stand
to see people close to me make mistakes”). Finally, the socially prescribed
perfectionism subscale measures the extent to which people feel that high
standards are being imposed on them by significant others (e.g., “The
people around me expect me to succeed in everything I do”). The
MPS-HF and all of its subscales have demonstrated adequate reliability
and validity in both clinical and non-clinical samples [31].
Health functioning
Multiple indicators were used to assess health functioning. The
following measures were used:
SF-36 physical health. The four physical health subscales of the
Short Form-36v1 Health Survey [32] were used as indicators of
self-reported physical health. The physical functioning component
consists of 10 items (e.g., “climbing several flights of stairs”, “walking
one block”). The role-physical component consists of four items. Re-
spondents were asked whether they had any problems with work or
regular activities (e.g., “accomplished less than you would like”). The
bodily pain component consists of two items; one assessing severity
of pain (rated from 1 — none to 6 — severe) and one assessing the
interference of pain in daily functioning (rated from 1 — not at all
 D.S. Molnar et al. / Journal of Psychosomatic Research 73 (2012) 295–300 297

to 5 — extremely). The general health component includes five items.
For the first item, respondents were asked to report their perception
of their health on a scale ranging from 1 (excellent) to 5 (poor). The
other four items (e.g., “my health is excellent”) were rated on a
5-point scale ranging from 1 (definitely true) to 5 (definitely false).
neuroticism and socially prescribed perfectionism, and between conscientiousness and
self-oriented perfectionism. As seen in Table 1, self-oriented perfectionism was also as-
sociated positively with neuroticism, yet conscientiousness and neuroticism had a sig-
nificant negative association.
Regression analyses

The SF-36v1 has exhibited sound psychometric properties [32].
Health symptoms. Health symptoms, adapted from Macmillan, [33]
were assessed by 21 items pertaining to general health symptoms
such as sleep problems, shortness of breath, upset stomach, pains
and ailments, fatigue, and the extent to which ill health affected
their daily functioning. Participants rated how frequently they had
experienced each symptom on a Likert scale ranging from 1 (never)
to 5 (always). All items were recoded prior to analyses and averaged
to form a composite symptom measure, such that higher values indi-
cated better health. That is, a higher score actually reflected fewer
symptoms.
Composite physical functioning score. A composite health func-
tioning measure was computed by standardizing and averaging
the four physical health subscales of the SF-36v1 and the composite
symptom measure so as to reduce the number of statistical analyses.
Higher values indicated better health functioning.
Personality
The 40-item ‘Mini-Markers’ measure of the Five-Factor Model (FFM)
of personality developed by Saucier was utilized to assess extraversion,
neuroticism, and conscientiousness [34]. Each factor was assessed by
eight items, each rated on a Likert Scale ranging from 1 (extremely inaccu-
rate) to 9 (extremely accurate). A composite variable for each factor was
computed by averaging each of their respective item scores.
Results
Descriptives
Means, standard deviations, and correlations between all model variables are
presented in Table 1. It is important to note that the means represented in Table 1
are very much in keeping with general population norms found for community sam-
ples of women and men [31,35]. This runs counter to the notion that most people
with FMS are perfectionists.
At the level of correlations, results revealed that self-oriented and socially pre-
scribed perfectionism were each linked with experiencing poorer health functioning,
while other-oriented perfectionism was not related to health functioning. The impor-
tance of considering the unique predictive ability after accounting for neuroticism
and conscientiousness is underscored by the significant links that were found between
A four step hierarchical multiple regression was employed using SPSS 19 statistical soft-
ware. A quadratic term for self-oriented perfectionism was created to test for possible cur-
vilinear associations between self-oriented perfectionism and health, as was a quadratic
term for conscientiousness. Because composite variables, such as the quadratic terms, are
correlated with their component variables, to reduce nonessential multicollinearity and to
ease the interpretation and probing of significant interactions, each of the component vari-
ables was centered around their sample mean before the quadratic terms were computed
and only the centered variables were entered in the regression models [36]. Specifically,
health functioning was regressed on respondent's age, household income, and education
in Step 1, extraversion, conscientiousness, and neuroticism in Step 2, self-oriented perfec-
tionism, other-oriented perfectionism, and socially prescribed perfectionism in Step 3, and
the nonlinear terms represented by the squared term of self-oriented perfectionism, and
the squared term for conscientiousness in Step 4. Overall, the model was significant, ac-
counting for 16% of the variability in health functioning (F11,478 =8.49, pb .001). Examina-
tion of the residuals indicated that the assumptions of normality and homoscedasticity
were tenable. Results are presented in Table 2.
It is clear from Table 2 that older people tended to report better health functioning
than younger people. Household income and education were also positively associated
with health functioning, such that those with higher incomes and greater education
reported better health functioning. As expected, higher levels of neuroticism were associ-
ated with poorer health functioning. After accounting for the demographic variables and
broader personality traits related to both perfectionism and health functioning, socially
prescribed perfectionism was negatively associated with health functioning. Finally, the
quadratic term for self-oriented perfectionism was negatively associated with health
functioning, with results indicating that self-oriented perfectionism shared a non-linear
inverted U-shaped relationship with health functioning (see Fig. 1). None of the other pre-
dictors were statistically significant.
To further probe the curvilinear relationship between self-oriented perfectionism
and health functioning, the maximum of the curve was calculated according to proce-
dures set forth by Aiken and West [36] and was found to be 77.19. Thus, the optimal
level of self-oriented perfectionism for health functioning was found to be .47 standard
deviations above the mean. In general, results from simple slopes analyses demonstrat-
ed that self-oriented perfectionism was associated with poorer health functioning at
levels of 2 standard deviations below the mean or less and was associated with poorer
health functioning at .5 standard deviations above the mean or more. Thus, it appears
that the negative relationship between self-oriented perfectionism and health func-
tioning is more sensitive at higher levels of self-oriented perfectionism rather than at
lower levels for women suffering from FMS.
Discussion
The aim of this study was to determine whether specific dimensions
of perfectionism (i.e., self-oriented, other-oriented, and socially pre-
scribed perfectionism) are associated differentially with health

Table 1
Means, standard deviations, and correlations between all model variables

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

1. Age –
2. Income .10* –
3. Education .10* .27*** –
4. SOP −.10* .14** .04 –
5. OOP −.01 .07 .14** .51*** –
6. SPP −.05 −.03 −.05 .51*** .35*** –
7. E .07 .11* .06 −.11* .01 −.22*** –
8. C .07 .18*** .12** .19*** .15*** −.11* .16*** –
9. N −.23*** −.12** −.15*** .21*** .19*** .35* −.23** −.37*** –
10. PF −.04 .34*** .17*** −.05 −.03 −.11* .04 .13** −.07 –
11. RP −.01 .06 .06 −.03 .03 −.07 −.01 .07 −.09 .39*** –
12. BP .12** .20*** .20*** −.10* .00 −.12** −.02 .11* −.11* .51*** .42*** –
13. GH .19*** .17*** .14** −.11* −.13** −.15*** .07 .16*** −.27*** .46*** .33*** .43*** –
14. Symptom .22*** .21*** .23*** −.17*** −.06 −.25*** .13** .20*** −.30*** −.53*** .38*** .55*** .58*** –
15. HF .20*** .18*** .15*** −.13** −.06 −.21*** .08 .19*** −.25*** .63*** .54*** .63*** .71*** −.81*** –
M 48.78 6.77 4.69 68.23 54.66 55.53 4.99 6.41 4.90 39.29 8.49 25.65 27.77 2.68 −.07
SD 10.41 3.24 1.81 19.18 13.85 16.12 1.55 1.43 1.52 23.23 19.60 17.20 19.39 .47 .73

Note. *p b .05, **p b .01, ***p b .001.

Note. SOP: self-oriented perfectionism, OOP: other-oriented perfectionism, SPP: socially prescribed perfectionism, E: extraversion, C: conscientiousness, N: neuroticism, PF: physical
functioning subscale of the SF-36, RP: role-physical subscale of the SF-36, BP: bodily pain subscale of the SF-36, whereby higher scores reflect less pain and better health, GH: general
health subscale of the SF-36, Symptom: health symptom score where higher scores reflect less symptoms, HF: health functioning.
298 D.S. Molnar et al. / Journal of Psychosomatic Research 73 (2012) 295–300

Table 2 between perfectionism and health-related variables, which has left

Summary of the multiple regression in which health functioning was regressed on some to question the relative importance of perfectionism. This may
respondent's age, household income, extraversion, conscientiousness, neuroticism,
self-oriented perfectionism, other-oriented perfectionism, socially prescribed perfec-
be a particularly salient issue among individuals with FMS given that
tionism, and the nonlinear terms representing self-oriented perfectionism squared many FMS sufferers report experiencing high levels of negative affect,
and conscientiousness squared such as depression and anxiety [38]. In sum, these results indicate that
women with FMS who perceive that others expect them to be perfect
ΔR2 β
and believe that they are being evaluated critically experience poorer
Step 1
health functioning. These results are in line with qualitative studies of
Age .18**
Income .14*** women with FMS where a common theme is that women coping with
Education .08 .10* FMS often feel immense pressure to live up to others' seemingly impos-
Step 2 sible standards and feel frustration, shame, and high levels of stress
Extraversion −.003 when they cannot live up to these expectations [1,39]. Thus, one impli-
Conscientiousness .09
cation of this study is that perfectionism should be specifically assessed
Neuroticism .04 −.16**
Step 3 and targeted for intervention among women with FMS and there
Self-oriented perfectionism −.08 should be a particular emphasis on the pressure to meet perceived or
Other-oriented perfectionism .01 actual expectations imposed on the self.
Socially prescribed perfectionism .03 −.12*
The results involving self-oriented perfectionism were particularly
Step 4
Self-oriented perfectionism2 −.13** revealing in terms of clarifying the role of perfectionism in FMS. A
Conscientiousness2 .02 −.07 small, but significant, negative association was found between self-
N 489 oriented perfectionism and health functioning, but this was qualified
Note. *p b .05, **p b .01, ***p b .001. by evidence of a curvilinear association. Specifically, the results indicated
that for women coping with FMS, self-oriented perfectionism was asso-
ciated with poorer health functioning at both exceptionally high and
functioning in a community sample of women with FMS after accounting exceptionally low levels of self-oriented perfectionism. Conversely,
for demographic variables commonly related to health, and broader per- moderate levels of self-oriented perfectionism were associated with bet-
sonality traits related to both trait perfectionism and health. Results from ter health functioning in a manner suggesting that moderate perfection-
these analyses were also drawn upon to assess whether there is an opti- ism may resemble adaptive conscientiousness. These data illustrate the
mal level of perfectionism in terms of health functioning among women importance of distinguishing a moderate level of striving from excessive
with FMS. over-striving and being relentlessly driven and from disengaged non-
The current findings illustrated the relevance of perfectionism in striving.
FMS, but also clarified that levels of perfectionism are not elevated over- The finding that self-oriented perfectionism had a non-linear rela-
all, relative to normative levels of perfectionism obtained from commu- tionship with health functioning is particularly intriguing, as it ad-
nity samples. However, there is an identifiable subset of women who dresses the current debate in the perfectionism field regarding the
are elevated in one or more trait perfectionism dimensions and these el- relative “adaptiveness” of perfectionism [28]. Unlike the two extreme
evations have significant implications for their health functioning. positions that either cast self-oriented perfectionism as adaptive or
Overall, results supported the notion that socially prescribed perfec- necessarily maladaptive, our research suggests that self-oriented per-
tionism was associated with poorer health functioning among women fectionism is neither healthy nor unhealthy in the absolute sense, but
with FMS. These findings support previous studies that have shown that there may be an optimal level of self-oriented perfectionism, at
that when perfectionistic demands are perceived to be coming from least for women with FMS. The fact that this pattern of associations
others, it is stressful and detrimental to health and well-being [21,37] was found among women with FMS may be particularly telling, as es-
and extend them to women suffering from FMS. More striking, socially pecially low levels of self-oriented perfectionism may be indicative of
prescribed perfectionism maintained its negative association with depression, which has been related to greater severity of FMS symp-
health functioning after accounting for relevant demographic variables toms, whereas the high levels of stress and pressure associated with
and the effects of neuroticism, conscientiousness, and extraversion in trying to meet inordinately high standards would reasonably lead to
the model. Thus, support was garnered for the notion that socially pre- exhaustion and poorer health among women with FMS.
scribed perfectionism is a specific vulnerability factor for poorer health Importantly, results of this study supported the notion that self-
functioning among women with FMS, and not just indicative of high oriented perfectionism is not synonymous with conscientiousness, as
levels of neuroticism. This is a key finding, as few researchers have in- the patterns of relations with health functioning were quite disparate
cluded higher-order personality traits when studying the relationship for each of these constructs. This is in keeping with suggestions that
extreme self-oriented perfectionism is a form of over-conscientiousness
that is empirically and conceptually distinguishable from conscientious-
ness [28]. The current results supported this distinction. A small, but
significant, positive correlation was found between self-oriented perfec-
tionism and trait conscientiousness, but they differed in terms of their as-
sociations with the health measures. At the level of bivariate correlations,
for instance, conscientiousness shared a positive association with health
functioning whereas self-oriented perfectionism was negatively related
to health functioning. Moreover, in the regression model, conscientious-
ness did not share a linear or non-linear relationship with health func-
tioning unlike self-oriented perfectionism, which shared an inverted
U-shape relationship with health functioning. These findings are consis-
tent with research demonstrating that conscientiousness is adaptive in
terms of health behaviors and health consequences [40]. However,
Fig. 1. The relationship between self-oriented perfectionism2 and health functioning
after accounting for the effects of respondent's age, education, household income, ex-
when the perfectionistic individual demands absolute perfection from
traversion, conscientiousness, neuroticism, self-oriented perfectionism, socially pre- the self and from others, this is an exhausting and potentially deadly ori-
scribed perfectionism, and other-oriented perfectionism. entation that results in serious health consequences, especially when
 D.S. Molnar et al. / Journal of Psychosomatic Research 73 (2012) 295–300
perfectionism is combined with difficulties in adapting to life challenges,
such as coping with FMS.
Finally, other-oriented perfectionism was unrelated to health func-
tioning among women with FMS. This finding is consonant with the lit-
erature, which has consistently demonstrated that other-oriented
perfectionism is often not related to personal distress, but to others' dis-
tress. For example, in their study of male and female pain patients and
their spouses, Hewitt and colleagues found that individuals with part-
ners who were high in other-oriented perfectionism reported poorer
family functioning and marital adjustment compared to individuals
whose partners reported lower levels of perfectionism [41]. Consistent
with theory, individuals' own levels of other-oriented perfectionism
were not associated with their own levels of relationship satisfaction.
The lack of personal distress associated with other-oriented perfection-
ism is also in line with self-focused attention models of depression,
which maintain that attention focused away from the self is less detri-
mental than when greater attention is directed at the self [42,43].
Thus, future studies should explore the role of other-oriented perfec-
tionism in health functioning in samples of couples and families, as
one would expect other-oriented perfectionism to affect the health
and well-being of those for whom the perfectionism is directed at rather
than affect the health and well-being of the perfectionist him or herself.
It would further be expected that the effects of being the target of exces-
sively high demands and critical evaluation would be even more pro-
nounced when the target of other-oriented perfectionism is coping
with FMS and therefore less likely to be able to meet the perfectionistic
demands of others.
Certain limitations of this study must be noted. First, it cannot be
assumed from a cross-sectional investigation that trait perfectionism
causes poorer health functioning among women with FMS. Indeed, it
was noted earlier that a bi-directional conceptualization makes sense
in that the extreme perfectionist may appraise FMS as an indication of
personal failure or not meeting others' expectations and feel enhanced
frustration and dissatisfaction as a result of not being able to relentlessly
strive.
Second, assessments of all of the constructs of interest were derived
from self-report data. Self-reported health measures have been criti-
cized, as research has shown that they not only assess actual health
problems, but may also tap neuroticism [44]. However, subjective
self-report measures of health functioning have demonstrated impres-
sive construct and predictive validity. Indeed, simply asking individuals
to rate their health on one single-item scale predicts subsequent mor-
tality, even after statistically accounting for health-risk factors, such as
physician ratings, diagnosed illnesses, SES, and health-risk behaviors
[45]. Further, unique relationships between perfectionism and health
functioning for women with FMS emerged when the effects of neuroti-
cism were accounted for in the model, thus diminishing the interpreta-
tion that the link between perfectionism and health functioning
reflected a general proclivity toward negativity. Nonetheless, it is im-
portant for researchers to corroborate the link between perfectionism
and health functioning in women with FMS with objective measures
of health.
Moreover, on a separate, but related issue, participants in this study
self-reported their diagnosis of FMS. Thus, their condition cannot be
verified. In an effort to mitigate against the falsification of data, we
only included participants who reported that they had been formally di-
agnosed by their health-care provider and who also reported the num-
ber of years that they have been diagnosed with the condition by their
health-care provider. However, future research would be well served
to test the current work with individuals with FMS whose health status
has been verified by a trained rheumatologist to increase the validity of
the findings.
Finally, given that FMS primarily affects women, this study focused on
women coping with FMS rather than men. While sex-related differences
tend not to be present in the perfectionism literature, future research
should include both men and women with FMS to determine whether
299
the associations between perfectionism and health functioning found
with women coping with FMS can be generalized to men as well.
To our knowledge, the current investigation of perfectionism and
health functioning in women with FMS is the most comprehensive
one conducted thus far. Clearly, there are several potentially fruitful di-
rections for future research. Given general evidence linking trait perfec-
tionism with maladaptive coping styles, and recent data suggesting that
perfectionists with chronic illness have greater illness impact as a result
of stress and coping difficulties [19,20], it seems essential to examine
how perfectionism relates to coping styles and coping resources in fu-
ture studies of FMS, health status, and pain management. Numerous
studies attest to the role of individual differences in coping and func-
tioning in people with FMS [46]. Perfectionists who rely on maladaptive
coping styles, both in general and illness-specific coping, should be par-
ticularly at risk for poorer health functioning.
In conclusion, the results of this study both clarified and highlighted
the role of perfectionism in FMS. While overall levels of perfectionism in
our sample of women with FMS were not elevated, trait perfectionism
was associated with poorer health functioning and it is clear that
women with FMS who are elevated in perfectionism have greater coping
difficulties, and this is not simply a reflection of other personality traits
such as neuroticism and conscientiousness. As predicted, socially pre-
scribed perfectionism was associated with poorer health functioning.
Self-oriented perfectionism had a non-linear relationship with health
functioning, such that exceptionally high and exceptionally low levels
of self-oriented perfectionism were associated with poorer health func-
tioning. These data suggest that women with FMS who are characterized
by exceptionally high levels of self-oriented or socially prescribed per-
fectionism have a level of pressure on them that is not conducive to
well-being and adjustment. In all likelihood, these women are highly
vulnerable and should feel overwhelmed when other life stressors and
setbacks are experienced. These women should benefit greatly from in-
terventions designed to enhance their coping skills and ability to engage
in appropriate self-regulation.
Conflict of interest
There is no conflict of interest.
Acknowledgements
Preparation of this article was supported by a Social Sciences and
Research Council of Canada postdoctoral fellowship awarded to
Danielle S. Molnar and by a Canada Research Chair in Personality
and Health awarded to Gordon L. Flett.
References
[1] Arnold LM, Crofford LJ, Mease PJ, Burgess SM, Palmer SC, Abetz L, et al. Patient
perspectives on the impact of fibromyalgia. Patient Educ Couns 2008;73:114-20.
[2] Bernard AL, Prince A, Edsall P. Quality of life issues for fibromyalgia patients. Arthritis
Care Res 2000;13:42-50.
[3] van Middendorp H, Lumley MA, Jacobs JW, van Doornen LJ, et al. Emotions and
emotional approach and avoidance strategies in fibromyalgia. Psychosom Res
2008;64:159-67.
[4] Burckhardt CS, Clark SR, Bennett RM. Fibromyalgia and quality of life: a comparative
analysis. J Rheumatol 1993;20:475-9.
[5] Hoffman DL, Dukes EM. The health status burden of people with fibromyalgia: a review
of studies that assessed health status with the SF-36 or the SF-12. Int J Clin Pract
2008;62:115-26.
[6] Crofford LJ, Clauw DJ. Fibromyalgia: where are we a decade after the American
College of Rheumatology classification criteria were developed? Arthritis
Rheumatol 2002;46:1136-8.
[7] Goldenberg DL, Mossey CJ, Schmid CH. A model to assess severity and impact of
fibromyalgia. J Rheumatol 1995;22:2313-8.
[8] Sorensen J, Bengtsson A, Ahlner J, Henriksson KG, Ekselius L, Bengtsson M. Fibro-
myalgia: are there different mechanisms in the processing of pain? A double blind
crossover comparison of analgesic drugs. J Rheumatol 1997;24:1615-21.
[9] Risor MB. Illness explanations among patients with medically unexplained symptoms:
different idioms for different contexts. Health 2009;13:505-21.
300 D.S. Molnar et al. / Journal of Psychosomatic Research 73 (2012) 295–300
[10] Wood PB, Ledbetter CR, Patterson JC. Changes in hippocampal metabolites after
effective treatment for fibromyalgia. Clin J Pain 2009;25:810-4.
[11] van Wilgen CP, van Ittersum MW, Kaptein AA, van Wijhe M. Illness perceptions in
patients with fibromyalgia and their relationship to quality of life and
catastrophizing. Arthritis Rheum 2008;58:3618-26.
[12] Boissevain MD, McCain GA. Toward an integrated understanding of fibromyalgia
syndrome: 2. Psychological and phenomenological aspects. Pain 1991;25:239-48.
[13] Sansone RA, Levengood JV, Sellbom M. Psychological aspects of fibromyalgia: research
vs. clinical impressions. J Psychosom Res 2004;56:185-8.
[14] Van Houdenhove B. Fibromyalgia: a challenge for modern medicine. Clin Rheumatol
2003;22:1-5.
[15] Van Houdenhove B, Neerinckx E, Onghena P, Lysens R, Vertommen H. Premorbid
“overactive” lifestyle in chronic fatigue syndrome and fibromyalgia: an etiological
factor or proof of good citizenship? J Psychosom Res 2001;51:571-6.
[16] Grisart J, Masquelier E, Desmedt A, Scaillet N, Luminet O. Behavioral and representation
components of hyperactivity in fibromyalgia syndrome patients. J Musculoskel Pain
2010;18:226-34.
[17] Hewitt PL, Flett GL. Perfectionism in the self and social contexts: conceptualization,
assessment, and association with psychopathology. J Pers Soc Psychol 1991;60:
456-70.
[18] Fry PS, Debats DL. Perfectionism and the five-factor personality traits as predictors of
mortality in older adults. J Health Psychol 2009;14:513-24.
[19] Flett GL, Baricza C, Gupta A, Hewitt PL, Endler NS. Perfectionism, psychosocial impact,
and coping with irritable bowel disease: a study of patients with Crohn's disease and
ulcerative colitis. J Health Psychol 2011;16:561-71.
[20] Hewitt PL, Flett GL. Perfectionism and stress processes in psychopathology. In: Flett
GL, Hewitt PL, editors. Perfectionism: theory, research, and treatment. Washington,
DC: American Psychological Association; 2002. p. 255-85.
[21] Molnar DS, Reker DL, Culp NA, Sadava SW, DeCourville NH. A mediated model of
perfectionism, affect, and physical health. J Res Pers 2006;40:482-500.
[22] Bennett RM, Jones J, Turk DC, Russell IJ, Matallana L. An internet survey of 2596
people with fibromyalgia. BMC Musculoskelet Disord 2007;8:27.
[23] Waylonis GW, Ronan PG, Gordon C. A profile of fibromyalgia in occupational envi-
ronments. Am J Phys Med Rehabil 1994;73:112-5.
[24] Affleck G, Tennen H, Urrows S, Higgins P, Abeles M, Hall C, et al. Fibromyalgia and
women's pursuit of personal goals: a daily process analysis. Health Psychol
1998;17:40-7.
[25] Bogg T, Roberts BW. Conscientiousness and health behaviors: a meta-analysis of
the leading behavioral contributors to mortality. Psychol Bull 2004;130:887-919.
[26] Kern ML, Friedman HS. Do conscientious individuals live longer? A quantitative
review. Health Psychol 2008;27:505-12.
[27] Christensen AJ, Ehlers SL, Wiebe JS, Moran PJ, Raichle K, Ferneyhough K, et al. Patient
personality and mortality: a 4-year prospective examination of chronic renal insuffi-
ciency. Health Psychol 2002;21:315-20.
[28] Hewitt PL, Flett GL. When does conscientiousness become perfectionism? Curr
Psychiatr 2007;6:53-64.
[29] Besser A, Priel B, Flett GL, Wiznizer A. Linear and nonlinear models of vulnerability
to depression: personality and postpartum depression in a high risk population.
Ind Differ Res 2007;5:1–29.
[30] Karsdorp PA, Vlaeyen JWS. Goals matter: both achievement and pain-avoidance
goals are associated with pain severity and disability in patients with low back
and upper extremity pain. Pain 2011;152:1382-90.
[31] Hewitt PL, Flett GL. The multidimensional perfectionism scale: technical manual.
Toronto: Multi-Health Systems Inc.; 2004.
[32] Ware JE, Snow KK, Kosinski M, Gandek B. SF-36® Health Survey Manual and Inter-
pretation Guide. Boston, MA: New England Medical Center, The Health Institute;
1993.
[33] Macmillan AM. The Health Opinion Survey: techniques for estimating prevalence
of psychoneurotic and related types of disorder in communities. Psychol Rep
1957;3:325-39.
[34] Saucier G. Mini-markers: a brief version of Goldberg's unipolar Big-Five markers. J Pers
Assess 1994;3:506-16.
[35] Hewitt PL, Flett GL, Turnbull-Donovan W, Mikail SF. The multidimensional perfec-
tionism scale: reliability, validity, and psychometric properties in psychiatric
samples. Psychol Assess 1991;3:464-8.
[36] Aiken LS, West SG. Multiple regression: testing and interpreting interactions. London:
Sage Publications Inc.; 1991.
[37] Marten TR, Flett GL, Hewitt PL, Krames L, Szanto G. Personality correlates of depression
and health symptoms: a test of a self-regulation model. J Res Pers 1996;31:264-77.
[38] Yunus MB. Psychological aspects of fibromyalgia syndrome: a component of the
dysfunctional spectrum syndrome. Baillieres Clin Rheumatol 1994;8:811-37.
[39] Raheim M, Haland W. Lived experience of chronic pain and fibromyalgia:
Women's stories from daily life. Qual Health Res 2006;16:741-61.
[40] Roberts BW, Walton KE, Bogg T. Conscientiousness and health across the life
course. Rev Gen Psychol 2005;9:156-68.
[41] Hewitt PL, Flett GL, Mikail SF. Perfectionism and relationship maladjustment in
chronic pain patients and their spouses. J Fam Psychol 1995;9:335-47.
[42] Musson RF, Alloy LB. Depression and self-directed attention. In: Alloy LB, editor.
Cognitive processes in depression. New York: Guilford Press; 1988. p. 193-220.
[43] Smith TW, Ingram RE, Roth DL. Self-focused attention and depression:
self-evaluation, affect, and life stress. Motiv Emot 1985;9:381-9.
[44] Watson D, Pennebaker JW. Health complaints, stress, and distress: exploring the
central role of negative affectivity. Psychol Rev 1989;96:234-54.
[45] Idler EL, Benyamini Y. Self-rated health and mortality: a review of 27 community
studies. J Health Soc Behav 1997;38:21-37.
[46] Martin MY, Bradley LA, Alexander RW, Alarcon GS, Triana-Alexander M, Aaron LA,
et al. Coping strategies predict disability in patients with primary fibromyalgia.
Pain 1996;68:45-53.