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Depression

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Running head: PERSONALITY AND DEPRESSION

Association between Two Aspects of Personality and Depression

Eshagh Shehniyilagh

Abstract

The relationship between depression and two aspects of personality e.g., perfectionism and obsessive-compulsiveness was investigated. This study investigates how these personality traits contribute to depression. Three instruments were administered; the Beck Depression Inventory-II (BDI-II), Beck (1996), Frost Multidimensional Perfectionism Scale (FMPS), Frost (1990), and the Obsessive Compulsive Scale (OCS), (Gibb, Baily, Best, & Lambirth 1983). Sixty-three participants selected by using nonprobability sampling. These participants were graduate and undergraduate students enrolled in the 1999 Fall Semester psychology lecture classes at Tennessee State University. Participants were from various ethnicities, genders, and academic backgrounds with ages ranging from 18 to 55. The primary hypothesis was that obsessive-compulsiveness expected to correlate positively with depression. Two of the revised FMPS subscales such as concern over mistakes and doubts (CMD) and expectations and criticism (PEC) correlated positively with depression and obsessive-compulsiveness. However, the other two subscales of perfectionism, personal standards (PS), and organization (O) had lesser effects on depression and obsessive-compulsiveness.

Introduction

Finkelstein (1994) reported that at least 11 million people in the United States experience an episode of depression each year. Seventy-two present of the people in the labor force are depressed. The total cost of this disorder estimated at 44 billion dollars by the American Pharmaceutical industry. Of that figure, 28% is the direct cost of medical, psychiatric, and drug treatment, 17% is the result of the more than 18, 000 associated suicides, and 55% is due to absenteeism and lowered productivity. These figures exclude the non-monetary costs of cigarette smoking, drug abuse, and physical illness. This estimate also excludes the financial cost to family members who lose time from work and must provide household services for the depressed person. Finkelstein (1994) emphasized the seriousness of depression by reporting that at least half of all people who commit suicide are severely depressed.

There have been several studies demonstrating an association between perfectionism and depression. However, this study extends those literatures by focusing on different dimensions of perfectionism such as subscales concern over mistakes and doubts (CMD), expectations and criticism (PEC), personal standards (PS), and organization (O). The purpose of this paper is to explore the relationship between two aspects of personality e.g., perfectionism and obsessive-compulsiveness with depression.

The reason for depression is not always apparent. Every case of depression is unique. It is often impossible to point to one specific aspect of depression. However, two things to realize are, (1) that depression is the fault of no one and (2) that no one is to blame for the situation. Perhaps people with certain personality traits e.g., perfectionism, and obsessive-compulsiveness are good candidates for depression. It may be that people who set extremely high standards in their lives and do not live up to that are more prone to depression.

When unhappy feelings become overwhelming and begin to interfere with a person’s ability to function, or the person has symptoms such as negative thoughts about self, world, and the future, an illness can occur. The illness is depression. Depression can affect a person’s mood, outlook on life, behavior, and physical health in a number of ways. Feelings of anxiety or fear that something terrible may happen accompany symptoms of depression.

One of the many things that may relate to depression may be the way one’s personality shaped, such as being perfectionist or obsessive-compulsive. Personality functioning and depressive illnesses are complexly interrelated.

A perfectionist’s high standards may contribute to depression, and obsessive-compulsiveness increase the frequency and magnitude of perceived failures, which may contribute to depression.

Flett (1996) reviewed the concepts of positive and negative perfectionism and the dual process model of perfectionism. He reported that there are two types of perfectionism: “positive” or “healthy” form of perfectionism and “negative” or unhealthy. He suggested that positive perfectionism partially motivated by fear of failure.

According to the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorder-IV, DSM-IV (1994), perfectionism is one of the characteristics of obsessive-compulsive personality disorder. The purpose of this paper is to determine whether there is an association between obsessive-compulsive personality and depression.

The following illnesses and psychological disorders were found to be related to the high scores on perfectionism: anorexia nervesa, (Sullivan, Bulik, Fear, and Pickering, 1998), trait anxiety (Flett, Hewitt, and Webber 1989), chronic headaches (Kowal and Pritchard 1990), and suicide ideations (Hewit, Flett, and Webber 1994) and (Blatt 1995).

Sullivan, Bulik, Fear, and Pickering (1998) determined that perfectionism and cognitive restraint were characteristic of anorexia and depression. They used a case control design to try to improve knowledge about the outcome of anorexia nervosa. All new female patients in the study with anorexia nervosa referred to an eating disorder service between 1981 and 1984. All of these participants interviewed with the Diagnostic Interview for Genetic Studies. Participants completed several relevant self-report inventories. A minority of the patients (10%) continued to meet the criteria for anorexia nervosa. Perfectionism and cognitive restraint found to be a characteristic of anorexia nervosa. Depression, alcohol dependence, and some anxiety disorders were also high among these participants.

Flett, Hewitt, and Weber (1989) investigated whether individual differences in perfectionism related to anxiety. The possible mediating role of life stress on the association between these constructs also investigated. They used 162 undergraduate participants who completed perfectionism scale, a social readjustment rating scale, the Eyseneck Personality Inventory, and the State-Trait Anxiety Inventory. Correlational analysis revealed that perfectionism marginally correlated with neuroticism. A strong correlation found between perfectionism and trait anxiety.

Kowal and Pritchard (1990) reported that perfectionism contributes to chronic headaches. They compared 23, nine to twelve year old children with chronic headaches with 23 controls matched on self and parental rating of anxiety, depression, shyness-sensitivity, sleeping difficulties, perfectionism, headache, and parental expectations. Subjects with anxiety, perfectionism, and life stress contributed significantly to the prediction of headaches.

Hewitt, Flett, and Weber (1994) discussed the dimensions of perfectionism and suicide ideation. They conducted two studies to examine the relationship between dimensions of perfectionism and suicide ideation (SI). They studied the importance of dimensions of perfectionism in SI when considered in the context of other predictors such


as depression and hopelessness. They measured whether PFM moderates the association between life stress and SI. In their first study, they used 91 psychiatric patients, and in their second study, they used 160 college students. Both groups completed the Multidimentional Perfectionism scale, the Hopelessness scale, the Beck Depression Inventory, and the Scale for Suicide Ideation. The subjects in the second study completed a measure of negative life stress. The results of this study confirmed that self-oriented and socially prescribed perfectionism are associated with greater suicide ideation.

Blatt (1995) indicated that intense perfectionism and severe self-criticism played a role in the suicides of three individuals. The role of perfectionism in these suicides was consistent with recent extensive investigations of aspects of perfectionism. Further analyses of The Depression Collaborative Research Program (TDCRP) indicated that intense perfectionism interfered significantly with a therapeutic response in the various brief treatments for depression. Self-critical individuals, however, made substantial improvement in long-term intensive treatment.

The general patients may respond differently to various types of therapy. Researchers suggested that extensive therapy may be necessary for many highly perfectionistic, self-critical patients.

In the Blatt, Zuroff, Quintan, and Pilkonis (1996) study findings indicated that it is actually more difficult to do psychotherapy with perfectionist patients than with other patients. They analyzed data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. The minimal differences in therapeutic outcome among 3 brief treatments were discussed. When patients' pretreatment levels of perfectionism examined, there were a significant negative relationship between perfectionism and residualized measures of clinical improvement. The analyses indicated that the quality of the therapeutic relationship reported by patients early in treatment contributed significantly to the prediction of therapeutic change. The quality of the therapeutic relationship was only marginally predictive of therapeutic gain at low and high levels of perfectionism. However, the quality of the therapeutic relationship significantly predicted therapeutic gain at moderate levels of perfectionism.

The implications of the co-occurrence of obsessive-compulsiveness with depression and perfectionism have not been fully discussed. Many authors have thought that perfectionism contributes to depression. However, only a few research studies have found that obsessive-compulsiveness leads to depression and other disorders. Among them are Hardy and Barkham et al., (1995), Rees, Hardy and Barkham (1997), and Enns and Cox (1997). Their work has implications for this research.

Hardy and Barkham et al.,(1995) discussed the relationship between cluster C personality disorder (that is, avoidant, obsessive-compulsive and dependent personality disorder) on outcomes of brief psychotherapy for depression. They used 114 clients with a mean age of 40.25 years and standard deviation of 9.5 years. The participants consisted of 60 female clients and 74 male clients. Twenty-seven of 114 depressed clients obtained Cluster C diagnoses whereas the remaining 87 did not. All clients completed either 8 or 16 sessions of cognitive-behavioral or psychodynamic-interpersonai psychotherapy. Obsessive-compulsive clients whose depression’s were also relatively severe showed significantly less improvement after treatment than did either the obsessive-compulsive participants with less severe depression or the other participants.

Rees, Hardy, and Barkham (1997) examined the relationship between two standardized diagnostic procedures, one assessing the presence of depression and anxiety, and the other assessing the presence of Cluster C personality disorders. One hundred and eighty-four clients with an age range of 19 to 61 years referred to their research outpatient psychological clinic. The clients met the acceptance criterion of 16 or more on the Beck Depression Inventory at screening. They diagnosed as depressed, anxious, or both using both Present State Examination and the Diagnostic and Statistical Manual of Mental State Disorders Criteria. These clients assessed for the presence of Cluster C personality disorders using the Personality Disorders Examination. Twenty-two percent of the clients were diagnosed with either avoidant, dependent or obsessive-compulsive personality disorder. Significant correlation found to be between depression index scores and total scores on the 3 Cluster C personality disorders, although little correlation found between diagnostic related to depression. Some associations were shown between the clinical components of the personality disorder traits in the anxious-fearful group and current anxiety symptoms.

Enns and Cox (1997) used clinically depressed adult patients to explore the relationship between personality dimensions and depression. In this study, neuroticism appeared to be the most powerful contributor of depression. Lower-order factors that showed a significant and consistent relationship with depressive illness were dependency, self-criticism, obsessionality, and perfectionism. The associations between depression, dependency, and self-criticism had the strongest empirical support.

Most of the findings suggest that different dimensions of perfectionism lead to depression and other psychological illnesses. The literature review reveals the relationship between depression and personality and other illnesses. This experiment intends to explore whether perfectionism and obsessive-compulsiveness.

Hypotheses

I- The primary hypothesis is that obsessive compulsiveness and perfectionism expected to correlate positively with depression.

II- Two of the revised FMPS subscales, concern over mistakes and doubts (CMD), expectations and criticism (PEC), also expected to correlate positively with depression and obsessive-compulsiveness.

III-The other two subscales of perfectionism, personal standards (PS), and organization (O) expected to marginally correlate with depression and/or obsessive-compulsiveness.

The primary independent variables or predictors in this study are the aspects of personality such as perfectionism and (OCD). The dependent variable or criterion is depression. Comparatively, in hypothesis II and III obsessive-compulsiveness is also a dependent variable or criterion.

Method

Participants

Sixty-three graduate and undergraduate students who were enrolled in the 1999 fall semester psychology lecture classes at Tennessee State University were selected by nonprobability sampling to participate in this study. Their academic backgrounds, ethnicities, and genders varied. Their ages ranged from 18 to 55.

Permission granted from Department of Psychology and Institutional Review Board for the protection of the rights and welfare of human subjects. Participants signed the subject’s pool forms to participate in the study at a convenient time.

Instruments

Each participant completed a demographic questionnaire and three paper and pencil instruments. The instruments were the Beck Depression Inventory-11 (BDI-II) Beck (1996), the Frost Multidimensional Perfectionism Scale (FMPS), Frost (1990), and the Obsessive Compulsive Scale (OCS), Gib, Baily, Best, and Lambirth (1983).

Permission to use these instruments were granted by the authors. The instruments presented to the participants in the following order: (1) Perfectionism Scale, (2) OC Scale, (3) BDI-II Scale.

Frost multidimfinsional perfectionism scale

The Frost Multidimensional Perfectionism Scale (FMPS) originally developed by Frost (1990) to measure perfectionism. This scale is a 35-item instrument designed to measure several components of perfectionism.

The FMPS has good concurrent validity, significantly correlating with three other perfectionism scales: The BURNS, Eating Disorder Inventory (EDI) and Irrational Beliefs Test (IBT). The overall FMPS, and several of its subscales, has good construct validity, correlating with a variety of measures of psychopathology including the Brief Symptom Inventory, the Depressive Experience Questionnaire, several measures of compulsivity, and the Procrastination Scale.

The FMPS has a good to excellent reliability, with alphas that range from .77 to .93 for the subscales. The alpha for the total scale is .91, for the Burns Scale is .82, for the IBT Scale it is .78, and for the EDI Perfectionism Scale it is .70.

Frost (1990) identified six subscales for his perfectionism instrument. These dimensions are (a) excessive concern over making mistakes (CM), (b) high personal standards (PS), (c) the perception of high parental expectations (PEL), (d) the perception of high parental criticism (PC), (e) the doubting of the quality of one's action (DA), and (f) a preference for order and organization (OR). Each subscale has a good to excellent alpha.

The reliability coefficients of the FMPS subscales were also consistent with the above perfectionism' subscales: CM=.91, PS=.81, PE=.82, PC=.77, D=.79, and 0=.94.

All of the subscales of the FMPS, except for the Organization subscale, are highly correlated with other subscales of FMPS and other measures of perfectionism.

Obsessive-compulsive scale

The Obsessive-Compulsive Scale (OCS) developed using 114 college students with mean scores of 11.15 and 11.24 for males and females, respectively. The mean for a clinical sample (N=57) was 11.22 (see Appendix J). The OCS originally developed by Gibb, Baily, Best, and Lambirth (1983) to measure degree of compulsivity. This 22 item instrument measures a concept widely discussed in clinical practice but for which there are few systematic measurement tools. The OCS focuses on a general tendency toward obsessive thoughts and compulsive behaviors. The true-false format makes the OCS easy to complete. This instrument is correlated with Clinician's Ratings of Client Compulsivity, Comrey's Order Scale, and with a Measure of Flexibility.

The OCS has evidence of internal consistency and test-retest reliability. The internal consistency was estimated by correlating each item with the total, and these correlations are significant, To provide a measure of internal consistency, in terms of the correlation of an item with total score, a point biserial item correlation was calculated for every item on the OCS. These correlational data indicate that for every item on the OCS the probability of the occurrence of a coefficient as large as one found or larger was less than .02. The test-retest reliability correlation was .82 over a three-week period, indicating good stability. The concurrent validity was used for validity check.

Beck depression inventory-II

According to the Beck, Steer, and Brown (1996), the Beck Depression Inventory (BDI) has for the last 35 years been one of the most widely accepted instruments for measuring the severity of depression in diagnosed patients and for detecting possible depression in the normal population. After 35 years of experience and research with the BDI, it modernized and revised in the Beck Depression Inventory-11 (BDI-II).

The BDI-II is a 21 item self-report instrument for measuring the severity of depression in adults and adolescents aged 13 years and older. The BDI-II developed for the assessment of symptoms corresponding to criteria for diagnosing disorders listed in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition DSM-IV (1994).

The 21 depressive symptoms and attitudes were chosen by Beck et al. (1961). The decision to expand of the number of the items was based on the verbal descriptions of patients. Items were not selected to reflect any particular theory of depression. These items address (1) Mood, (2) Pessimism, (3) Sense of Failure, (4) Self Dissatisfaction, (5) Guilt, (6) Punishment, (7) Self-Dislike, (8) Self-Accusation, (9) Suicidal Ideas, (10) Crying, (11) Irritability, (12) Social Withdrawal, (13) Indecisiveness, (14) Body Image, (16) Insomnia, (17) Fatigability, (18) Loss of Appetite, (19) Weight Loss, (20) Somatic Preoccupation, and (21) Loss of Libido.

For the revised version BDI-II, items for four areas (Weight Loss, Body Image Change, Somatic Preoccupation, and Work Difficulty) were dropped and replaced by new items covering Agitation, Worthlessness, Concentration Difficulty, and Loss of Energy in order to index symptoms typical of severe depression. Two items were changed to allow for increases as well as decreases in appetite and sleep. The BDI-II constitutes a substantial revision of the original BDI.

Procedure

The participants were asked to read and sign the informed consent form. Then, a package containing a demographic questionnaire with questions about their age, gender, marital status, ethnicity and education level and three instruments with a total of 78 questions were handed to them. The participants were asked to complete the demographic questionnaire first and then proceed with the instruments. Order of the instruments in this package was as follows: the FMPS, the OCS. The three instruments combined took approximately fifteen minutes to complete.

Participants were advised of the confidentiality of the information they provided. After briefed on the number of questions, they asked to sign the consent forms to participate. Finally, they responded to a twenty-two item OCS, 21 item BDI-II, and 35 item FMPS.

Results

It hypothesized that depression positively related to two aspects of personality: obsessive-compulsiveness and perfectionism. Hypothesis ( I ) stated that obsessive-compulsiveness correlates positively with depression. Partial correlation revealed a positive correlation between them. The results showed that (r = .61, p< .01), where .61 is the correlation and .01 is the probability, respectively, a significant relationship. A strong positive correlation also found between perfectionism and depression. The results showed that (r = .67, p< .01), a significant relationship. In addition, a strong positive correlation found between the perfectionism and obsessive-compulsiveness. The results showed that (r = .55, p< .01), a significant relationship.

Table 1

Partial Correlation between Depression, OCPD, and Perfectionism



Note. OCPD=Obsessive Compulsive Personality Disorder, N=63, *P<.01

The results from partial c, orrelations for Hypothesis (II) indicated that there is a positive correlation between several dimensions of perfectionism and depression or obsessive-compulsiveness. Concern over mistakes and doubts (CMD) and parental expectations and criticism (PEC) positively related to depression.

Table 2

Partial Correlation between CMD, PEC, and Perfectionism




Note. CMD= Concern over Mistakes and Doubts, PEC= Parental expectations and Criticism, N=63, *P<.01

The results of partial correlation between CMD and depression showed that (r = .53, p<.01), respectively, a significant relationship. The CMD and PEC also positively related to obsessive-compulsiveness. The results of correlation between CMD and obsessive-compulsiveness showed that (r = .44, p< .01). The results of correlation between PEC and obsessive-compulsiveness showed that (r = .23, p< .01), respectively, a significant relationship. The breakdowns of the results listed in Tables 2 and 3.

Table 3

Partial Correlation between CMD, PEC, and OCPD

CMD

PEC

OCPD

CMD

_

0.69*

0.44*


Note. OCPD=Obsessive Compulsive Personality Disorder, CMD= Concern over Mistakes and Doubts, PEC= Parental expectations and Criticism N=63, *P<.01

CMD= Concern over Mistakes and Doubts, PEC= Parental expectations and Criticism CMD= Concern over Mistakes and Doubts, PEC= Parental expectations and Criticism Table 4



0.18

0.11

_

Note. PS= Parental Standards, O= Organization, N=63, *P<.01

The results from partial correlations for Hypothesis (III) stated that the other two subscales of perfectionism, i.e., parental standards (PS) and organization (O) where marginally correlated to depression and obsessive-compulsiveness. The results of correlation between PS and O with depression (r = .18, p< .08) and (r = .11, p< .01),

The results of partial correlation between PS and O with obsessive-compulsiveness showed that (r =.30, p< .01) and (r =.42, p< .01), respectively, indicating a significant relationship. The breakdowns of the results listed in Tables 4 and 5.

Table 5

Partial Correlation between PS, O, and OCPD

PS

O

OCPD

PS

_

0.40*

0.18

O

0.40*

_

0.11

OCPD

0.18

0.11

_

Note. PS= Parental Standards, O= Organization, N=63, *P<.01

Discussion

The primary goal of this paper is to investigate the relationship of perfectionism and obsessive-compulsiveness with depression. Obsessive-compulsiveness and perfectionism found to be significantly related to depression. This paper also examined the relationship between depression and four revised dimensions of perfectionism.

This research study suggests that there may be an association between perfectionism and depression. Two dimensions of perfectionism, concern over mistakes and doubts (CMD), and parental expectations and criticism (PEC) found to have positive correlations to depression. In contrast, two other subscales, personal standards (PS) and organization (O) had marginal correlations to depression.

Two dimensions of perfectionism, CMD and PEC, had positive correlations with obsessive compulsiveness and the other subscales. PS and O were marginally correlated.

Participants who scored high on the perfectionism scale also scored high on the obsessive-compulsiveness and depression scales. Perhaps these results may indicate that perfectionism and obsessive-compulsiveness are strongly related to depression.

Depression does not usually occur alone. The combination of factors involved including biological, genetic, psychological and perhaps personality factors. Certain life conditions such as extreme stress or grief may also bring out a predisposition for psychological or biological tendency toward depression.

What provokes some people to become depressed in response to external events such as loss of a job, breaking up a relationship, or failure to be admitted to graduate school while others do not get depressed is not fully known. Researchers have suggested a number of possible factors including personality factors such as perfectionism and obsessive-compulsiveness. However, what forces a person to be a perfectionist or

obsessive-compulsive is not known. One possibility is that children may learn by modeling or copying their parents. Children may learn from their parents to be depressed. Another possible factor is the role of genetics. Some people appear to have inherited a predisposition for depression. Furthermore, if other people in one’s immediate family are prone to have depression, the chances are one will be prone to depression. Perhaps the findings of this study will pave the way for a larger network of research on personality and depression.

Shehniyilagh (1991) suggested that inter-individual, intra-individual differences and environmental differences may be factors related to depression. Depressive moods and happiness are different sides of the same coin. Sigmund Freud once said that happiness stems from love and work. If we are satisfied with our work and our jobs, and are enjoying our lives with our loved ones, we are on the happy face end of this coin.

Perfectionists think unrealistically as they demand unrealistic things from themselves and others. They ignore loving relationships and the pleasures of life; instead, they want to be godlike and perfect. They want to prove themselves instead of being themselves. Perfectionists would much demand that it must be, because they want it to be. Perfectionists consequently spend a great deal of their lives complaining, crying, and depressing themselves when they are not getting their particular piece of pie. In other words, when things are not going their way, they become depressed. Perfectionists are less likely to become depressed if they accept themselves as error-prone humans.

Perfectionists have a poor therapeutic response when pushed through short term treatments for depression. Perfectionists do make substantial improvement in long-term intensive treatment. Extensive therapy may be necessary for many highly perfectionistic, compulsive, self-critical patients.

In the treatment of perfectionism, a key concept is “excessive.” According to Ellis, (1996), 85% of the time, people can tell when they are overreacting. Sometimes they do not want to admit it, but they can tell. Ellis believes that if someone were to tap them on the shoulder when they were having an outburst or were obsessed about something, and ask them nicely if they are being obsessive about this issue, they might snap back at them, but they do know.

Underneath the perfectionism is often a deep-seated fear of failure and rejection, which tells the perfectionist to bite off more than what they can chew. This fear of failure and rejection directs them to feelings of self-defeat and failure. Perfectionists caught in a never-ending cycle that will never let them feel okay. Recommendations include being more flexible in their thoughts and standards. Perfectionists are rigid people, and every rigid person will break someday and become ill.

Limitation of the study and Implication for Further Research

As a function of the limitations of the study, a number of implications for further research identified. A larger sample would provide a greater variety and frequency of response in terms of the variables under investigation in the current study. A combination of student as well as non-student participants would enhance our ability to generalize with regard to the study.

Investigating what causes people to be perfectionists or obsessive-compulsive and tracing the family history of a perfectionist or obsessive-compulsive person might be very helpful to track perfectionism or obsessive-compulsiveness in an individual.

In addition, learning about the possible mediators between the perfectionism/obsessive-compulsiveness and depression or the possible mediators between perfectionism and obsessive-compulsiveness will be helpful.

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Depression

To learn more about depression click here
http://www.helpguide.org/topics/depression.htm







Running head: PERSONALITY AND DEPRESSION

Association between Two Aspects of Personality and Depression

Eshagh Shehniyilagh

Abstract

The relationship between depression and two aspects of personality e.g., perfectionism and obsessive-compulsiveness was investigated. This study investigates how these personality traits contribute to depression. Three instruments were administered; the Beck Depression Inventory-II (BDI-II), Beck (1996), Frost Multidimensional Perfectionism Scale (FMPS), Frost (1990), and the Obsessive Compulsive Scale (OCS), (Gibb, Baily, Best, & Lambirth 1983). Sixty-three participants selected by using nonprobability sampling. These participants were graduate and undergraduate students enrolled in the 1999 Fall Semester psychology lecture classes at Tennessee State University. Participants were from various ethnicities, genders, and academic backgrounds with ages ranging from 18 to 55. The primary hypothesis was that obsessive-compulsiveness expected to correlate positively with depression. Two of the revised FMPS subscales such as concern over mistakes and doubts (CMD) and expectations and criticism (PEC) correlated positively with depression and obsessive-compulsiveness. However, the other two subscales of perfectionism, personal standards (PS), and organization (O) had lesser effects on depression and obsessive-compulsiveness.

Introduction

Finkelstein (1994) reported that at least 11 million people in the United States experience an episode of depression each year. Seventy-two present of the people in the labor force are depressed. The total cost of this disorder estimated at 44 billion dollars by the American Pharmaceutical industry. Of that figure, 28% is the direct cost of medical, psychiatric, and drug treatment, 17% is the result of the more than 18, 000 associated suicides, and 55% is due to absenteeism and lowered productivity. These figures exclude the non-monetary costs of cigarette smoking, drug abuse, and physical illness. This estimate also excludes the financial cost to family members who lose time from work and must provide household services for the depressed person. Finkelstein (1994) emphasized the seriousness of depression by reporting that at least half of all people who commit suicide are severely depressed.

There have been several studies demonstrating an association between perfectionism and depression. However, this study extends those literatures by focusing on different dimensions of perfectionism such as subscales concern over mistakes and doubts (CMD), expectations and criticism (PEC), personal standards (PS), and organization (O). The purpose of this paper is to explore the relationship between two aspects of personality e.g., perfectionism and obsessive-compulsiveness with depression.

The reason for depression is not always apparent. Every case of depression is unique. It is often impossible to point to one specific aspect of depression. However, two things to realize are, (1) that depression is the fault of no one and (2) that no one is to blame for the situation. Perhaps people with certain personality traits e.g., perfectionism, and obsessive-compulsiveness are good candidates for depression. It may be that people who set extremely high standards in their lives and do not live up to that are more prone to depression.

When unhappy feelings become overwhelming and begin to interfere with a person’s ability to function, or the person has symptoms such as negative thoughts about self, world, and the future, an illness can occur. The illness is depression. Depression can affect a person’s mood, outlook on life, behavior, and physical health in a number of ways. Feelings of anxiety or fear that something terrible may happen accompany symptoms of depression.

One of the many things that may relate to depression may be the way one’s personality shaped, such as being perfectionist or obsessive-compulsive. Personality functioning and depressive illnesses are complexly interrelated.

A perfectionist’s high standards may contribute to depression, and obsessive-compulsiveness increase the frequency and magnitude of perceived failures, which may contribute to depression.

Flett (1996) reviewed the concepts of positive and negative perfectionism and the dual process model of perfectionism. He reported that there are two types of perfectionism: “positive” or “healthy” form of perfectionism and “negative” or unhealthy. He suggested that positive perfectionism partially motivated by fear of failure.

According to the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorder-IV, DSM-IV (1994), perfectionism is one of the characteristics of obsessive-compulsive personality disorder. The purpose of this paper is to determine whether there is an association between obsessive-compulsive personality and depression.

The following illnesses and psychological disorders were found to be related to the high scores on perfectionism: anorexia nervesa, (Sullivan, Bulik, Fear, and Pickering, 1998), trait anxiety (Flett, Hewitt, and Webber 1989), chronic headaches (Kowal and Pritchard 1990), and suicide ideations (Hewit, Flett, and Webber 1994) and (Blatt 1995).

Sullivan, Bulik, Fear, and Pickering (1998) determined that perfectionism and cognitive restraint were characteristic of anorexia and depression. They used a case control design to try to improve knowledge about the outcome of anorexia nervosa. All new female patients in the study with anorexia nervosa referred to an eating disorder service between 1981 and 1984. All of these participants interviewed with the Diagnostic Interview for Genetic Studies. Participants completed several relevant self-report inventories. A minority of the patients (10%) continued to meet the criteria for anorexia nervosa. Perfectionism and cognitive restraint found to be a characteristic of anorexia nervosa. Depression, alcohol dependence, and some anxiety disorders were also high among these participants.

Flett, Hewitt, and Weber (1989) investigated whether individual differences in perfectionism related to anxiety. The possible mediating role of life stress on the association between these constructs also investigated. They used 162 undergraduate participants who completed perfectionism scale, a social readjustment rating scale, the Eyseneck Personality Inventory, and the State-Trait Anxiety Inventory. Correlational analysis revealed that perfectionism marginally correlated with neuroticism. A strong correlation found between perfectionism and trait anxiety.

Kowal and Pritchard (1990) reported that perfectionism contributes to chronic headaches. They compared 23, nine to twelve year old children with chronic headaches with 23 controls matched on self and parental rating of anxiety, depression, shyness-sensitivity, sleeping difficulties, perfectionism, headache, and parental expectations. Subjects with anxiety, perfectionism, and life stress contributed significantly to the prediction of headaches.

Hewitt, Flett, and Weber (1994) discussed the dimensions of perfectionism and suicide ideation. They conducted two studies to examine the relationship between dimensions of perfectionism and suicide ideation (SI). They studied the importance of dimensions of perfectionism in SI when considered in the context of other predictors such


as depression and hopelessness. They measured whether PFM moderates the association between life stress and SI. In their first study, they used 91 psychiatric patients, and in their second study, they used 160 college students. Both groups completed the Multidimentional Perfectionism scale, the Hopelessness scale, the Beck Depression Inventory, and the Scale for Suicide Ideation. The subjects in the second study completed a measure of negative life stress. The results of this study confirmed that self-oriented and socially prescribed perfectionism are associated with greater suicide ideation.

Blatt (1995) indicated that intense perfectionism and severe self-criticism played a role in the suicides of three individuals. The role of perfectionism in these suicides was consistent with recent extensive investigations of aspects of perfectionism. Further analyses of The Depression Collaborative Research Program (TDCRP) indicated that intense perfectionism interfered significantly with a therapeutic response in the various brief treatments for depression. Self-critical individuals, however, made substantial improvement in long-term intensive treatment.

The general patients may respond differently to various types of therapy. Researchers suggested that extensive therapy may be necessary for many highly perfectionistic, self-critical patients.

In the Blatt, Zuroff, Quintan, and Pilkonis (1996) study findings indicated that it is actually more difficult to do psychotherapy with perfectionist patients than with other patients. They analyzed data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. The minimal differences in therapeutic outcome among 3 brief treatments were discussed. When patients' pretreatment levels of perfectionism examined, there were a significant negative relationship between perfectionism and residualized measures of clinical improvement. The analyses indicated that the quality of the therapeutic relationship reported by patients early in treatment contributed significantly to the prediction of therapeutic change. The quality of the therapeutic relationship was only marginally predictive of therapeutic gain at low and high levels of perfectionism. However, the quality of the therapeutic relationship significantly predicted therapeutic gain at moderate levels of perfectionism.

The implications of the co-occurrence of obsessive-compulsiveness with depression and perfectionism have not been fully discussed. Many authors have thought that perfectionism contributes to depression. However, only a few research studies have found that obsessive-compulsiveness leads to depression and other disorders. Among them are Hardy and Barkham et al., (1995), Rees, Hardy and Barkham (1997), and Enns and Cox (1997). Their work has implications for this research.

Hardy and Barkham et al.,(1995) discussed the relationship between cluster C personality disorder (that is, avoidant, obsessive-compulsive and dependent personality disorder) on outcomes of brief psychotherapy for depression. They used 114 clients with a mean age of 40.25 years and standard deviation of 9.5 years. The participants consisted of 60 female clients and 74 male clients. Twenty-seven of 114 depressed clients obtained Cluster C diagnoses whereas the remaining 87 did not. All clients completed either 8 or 16 sessions of cognitive-behavioral or psychodynamic-interpersonai psychotherapy. Obsessive-compulsive clients whose depression’s were also relatively severe showed significantly less improvement after treatment than did either the obsessive-compulsive participants with less severe depression or the other participants.

Rees, Hardy, and Barkham (1997) examined the relationship between two standardized diagnostic procedures, one assessing the presence of depression and anxiety, and the other assessing the presence of Cluster C personality disorders. One hundred and eighty-four clients with an age range of 19 to 61 years referred to their research outpatient psychological clinic. The clients met the acceptance criterion of 16 or more on the Beck Depression Inventory at screening. They diagnosed as depressed, anxious, or both using both Present State Examination and the Diagnostic and Statistical Manual of Mental State Disorders Criteria. These clients assessed for the presence of Cluster C personality disorders using the Personality Disorders Examination. Twenty-two percent of the clients were diagnosed with either avoidant, dependent or obsessive-compulsive personality disorder. Significant correlation found to be between depression index scores and total scores on the 3 Cluster C personality disorders, although little correlation found between diagnostic related to depression. Some associations were shown between the clinical components of the personality disorder traits in the anxious-fearful group and current anxiety symptoms.

Enns and Cox (1997) used clinically depressed adult patients to explore the relationship between personality dimensions and depression. In this study, neuroticism appeared to be the most powerful contributor of depression. Lower-order factors that showed a significant and consistent relationship with depressive illness were dependency, self-criticism, obsessionality, and perfectionism. The associations between depression, dependency, and self-criticism had the strongest empirical support.

Most of the findings suggest that different dimensions of perfectionism lead to depression and other psychological illnesses. The literature review reveals the relationship between depression and personality and other illnesses. This experiment intends to explore whether perfectionism and obsessive-compulsiveness.

Hypotheses

I- The primary hypothesis is that obsessive compulsiveness and perfectionism expected to correlate positively with depression.

II- Two of the revised FMPS subscales, concern over mistakes and doubts (CMD), expectations and criticism (PEC), also expected to correlate positively with depression and obsessive-compulsiveness.

III-The other two subscales of perfectionism, personal standards (PS), and organization (O) expected to marginally correlate with depression and/or obsessive-compulsiveness.

The primary independent variables or predictors in this study are the aspects of personality such as perfectionism and (OCD). The dependent variable or criterion is depression. Comparatively, in hypothesis II and III obsessive-compulsiveness is also a dependent variable or criterion.

Method

Participants

Sixty-three graduate and undergraduate students who were enrolled in the 1999 fall semester psychology lecture classes at Tennessee State University were selected by nonprobability sampling to participate in this study. Their academic backgrounds, ethnicities, and genders varied. Their ages ranged from 18 to 55.

Permission granted from Department of Psychology and Institutional Review Board for the protection of the rights and welfare of human subjects. Participants signed the subject’s pool forms to participate in the study at a convenient time.

Instruments

Each participant completed a demographic questionnaire and three paper and pencil instruments. The instruments were the Beck Depression Inventory-11 (BDI-II) Beck (1996), the Frost Multidimensional Perfectionism Scale (FMPS), Frost (1990), and the Obsessive Compulsive Scale (OCS), Gib, Baily, Best, and Lambirth (1983).

Permission to use these instruments were granted by the authors. The instruments presented to the participants in the following order: (1) Perfectionism Scale, (2) OC Scale, (3) BDI-II Scale.

Frost multidimfinsional perfectionism scale

The Frost Multidimensional Perfectionism Scale (FMPS) originally developed by Frost (1990) to measure perfectionism. This scale is a 35-item instrument designed to measure several components of perfectionism.

The FMPS has good concurrent validity, significantly correlating with three other perfectionism scales: The BURNS, Eating Disorder Inventory (EDI) and Irrational Beliefs Test (IBT). The overall FMPS, and several of its subscales, has good construct validity, correlating with a variety of measures of psychopathology including the Brief Symptom Inventory, the Depressive Experience Questionnaire, several measures of compulsivity, and the Procrastination Scale.

The FMPS has a good to excellent reliability, with alphas that range from .77 to .93 for the subscales. The alpha for the total scale is .91, for the Burns Scale is .82, for the IBT Scale it is .78, and for the EDI Perfectionism Scale it is .70.

Frost (1990) identified six subscales for his perfectionism instrument. These dimensions are (a) excessive concern over making mistakes (CM), (b) high personal standards (PS), (c) the perception of high parental expectations (PEL), (d) the perception of high parental criticism (PC), (e) the doubting of the quality of one's action (DA), and (f) a preference for order and organization (OR). Each subscale has a good to excellent alpha.

The reliability coefficients of the FMPS subscales were also consistent with the above perfectionism' subscales: CM=.91, PS=.81, PE=.82, PC=.77, D=.79, and 0=.94.

All of the subscales of the FMPS, except for the Organization subscale, are highly correlated with other subscales of FMPS and other measures of perfectionism.

Obsessive-compulsive scale

The Obsessive-Compulsive Scale (OCS) developed using 114 college students with mean scores of 11.15 and 11.24 for males and females, respectively. The mean for a clinical sample (N=57) was 11.22 (see Appendix J). The OCS originally developed by Gibb, Baily, Best, and Lambirth (1983) to measure degree of compulsivity. This 22 item instrument measures a concept widely discussed in clinical practice but for which there are few systematic measurement tools. The OCS focuses on a general tendency toward obsessive thoughts and compulsive behaviors. The true-false format makes the OCS easy to complete. This instrument is correlated with Clinician's Ratings of Client Compulsivity, Comrey's Order Scale, and with a Measure of Flexibility.

The OCS has evidence of internal consistency and test-retest reliability. The internal consistency was estimated by correlating each item with the total, and these correlations are significant, To provide a measure of internal consistency, in terms of the correlation of an item with total score, a point biserial item correlation was calculated for every item on the OCS. These correlational data indicate that for every item on the OCS the probability of the occurrence of a coefficient as large as one found or larger was less than .02. The test-retest reliability correlation was .82 over a three-week period, indicating good stability. The concurrent validity was used for validity check.

Beck depression inventory-II

According to the Beck, Steer, and Brown (1996), the Beck Depression Inventory (BDI) has for the last 35 years been one of the most widely accepted instruments for measuring the severity of depression in diagnosed patients and for detecting possible depression in the normal population. After 35 years of experience and research with the BDI, it modernized and revised in the Beck Depression Inventory-11 (BDI-II).

The BDI-II is a 21 item self-report instrument for measuring the severity of depression in adults and adolescents aged 13 years and older. The BDI-II developed for the assessment of symptoms corresponding to criteria for diagnosing disorders listed in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition DSM-IV (1994).

The 21 depressive symptoms and attitudes were chosen by Beck et al. (1961). The decision to expand of the number of the items was based on the verbal descriptions of patients. Items were not selected to reflect any particular theory of depression. These items address (1) Mood, (2) Pessimism, (3) Sense of Failure, (4) Self Dissatisfaction, (5) Guilt, (6) Punishment, (7) Self-Dislike, (8) Self-Accusation, (9) Suicidal Ideas, (10) Crying, (11) Irritability, (12) Social Withdrawal, (13) Indecisiveness, (14) Body Image, (16) Insomnia, (17) Fatigability, (18) Loss of Appetite, (19) Weight Loss, (20) Somatic Preoccupation, and (21) Loss of Libido.

For the revised version BDI-II, items for four areas (Weight Loss, Body Image Change, Somatic Preoccupation, and Work Difficulty) were dropped and replaced by new items covering Agitation, Worthlessness, Concentration Difficulty, and Loss of Energy in order to index symptoms typical of severe depression. Two items were changed to allow for increases as well as decreases in appetite and sleep. The BDI-II constitutes a substantial revision of the original BDI.

Procedure

The participants were asked to read and sign the informed consent form. Then, a package containing a demographic questionnaire with questions about their age, gender, marital status, ethnicity and education level and three instruments with a total of 78 questions were handed to them. The participants were asked to complete the demographic questionnaire first and then proceed with the instruments. Order of the instruments in this package was as follows: the FMPS, the OCS. The three instruments combined took approximately fifteen minutes to complete.

Participants were advised of the confidentiality of the information they provided. After briefed on the number of questions, they asked to sign the consent forms to participate. Finally, they responded to a twenty-two item OCS, 21 item BDI-II, and 35 item FMPS.

Results

It hypothesized that depression positively related to two aspects of personality: obsessive-compulsiveness and perfectionism. Hypothesis ( I ) stated that obsessive-compulsiveness correlates positively with depression. Partial correlation revealed a positive correlation between them. The results showed that (r = .61, p< .01), where .61 is the correlation and .01 is the probability, respectively, a significant relationship. A strong positive correlation also found between perfectionism and depression. The results showed that (r = .67, p< .01), a significant relationship. In addition, a strong positive correlation found between the perfectionism and obsessive-compulsiveness. The results showed that (r = .55, p< .01), a significant relationship.

Table 1

Partial Correlation between Depression, OCPD, and Perfectionism


Note. OCPD=Obsessive Compulsive Personality Disorder, N=63, *P<.01

The results from partial c, orrelations for Hypothesis (II) indicated that there is a positive correlation between several dimensions of perfectionism and depression or obsessive-compulsiveness. Concern over mistakes and doubts (CMD) and parental expectations and criticism (PEC) positively related to depression.

Table 2

Partial Correlation between CMD, PEC, and Perfectionism





Note. CMD= Concern over Mistakes and Doubts, PEC= Parental expectations and Criticism, N=63, *P<.01

The results of partial correlation between CMD and depression showed that (r = .53, p<.01), respectively, a significant relationship. The CMD and PEC also positively related to obsessive-compulsiveness. The results of correlation between CMD and obsessive-compulsiveness showed that (r = .44, p< .01). The results of correlation between PEC and obsessive-compulsiveness showed that (r = .23, p< .01), respectively, a significant relationship. The breakdowns of the results listed in Tables 2 and 3.

Table 3

Partial Correlation between CMD, PEC, and OCPD




Note. OCPD=Obsessive Compulsive Personality Disorder, CMD= Concern over Mistakes and Doubts, PEC= Parental expectations and Criticism N=63, *P<.01

CMD= Concern over Mistakes and Doubts, PEC= Parental expectations and Criticism CMD= Concern over Mistakes and Doubts, PEC= Parental expectations and Criticism Table 4

Partial Correlation between PS, O, and Depression




Note. PS= Parental Standards, O= Organization, N=63, *P<.01

The results from partial correlations for Hypothesis (III) stated that the other two subscales of perfectionism, i.e., parental standards (PS) and organization (O) where marginally correlated to depression and obsessive-compulsiveness. The results of correlation between PS and O with depression (r = .18, p< .08) and (r = .11, p< .01),

The results of partial correlation between PS and O with obsessive-compulsiveness showed that (r =.30, p< .01) and (r =.42, p< .01), respectively, indicating a significant relationship. The breakdowns of the results listed in Tables 4 and 5.

Table 5

Partial Correlation between PS, O, and OCPD





Note. PS= Parental Standards, O= Organization, N=63, *P<.01

Discussion

The primary goal of this paper is to investigate the relationship of perfectionism and obsessive-compulsiveness with depression. Obsessive-compulsiveness and perfectionism found to be significantly related to depression. This paper also examined the relationship between depression and four revised dimensions of perfectionism.

This research study suggests that there may be an association between perfectionism and depression. Two dimensions of perfectionism, concern over mistakes and doubts (CMD), and parental expectations and criticism (PEC) found to have positive correlations to depression. In contrast, two other subscales, personal standards (PS) and organization (O) had marginal correlations to depression.

Two dimensions of perfectionism, CMD and PEC, had positive correlations with obsessive compulsiveness and the other subscales. PS and O were marginally correlated.

Participants who scored high on the perfectionism scale also scored high on the obsessive-compulsiveness and depression scales. Perhaps these results may indicate that perfectionism and obsessive-compulsiveness are strongly related to depression.

Depression does not usually occur alone. The combination of factors involved including biological, genetic, psychological and perhaps personality factors. Certain life conditions such as extreme stress or grief may also bring out a predisposition for psychological or biological tendency toward depression.

What provokes some people to become depressed in response to external events such as loss of a job, breaking up a relationship, or failure to be admitted to graduate school while others do not get depressed is not fully known. Researchers have suggested a number of possible factors including personality factors such as perfectionism and obsessive-compulsiveness. However, what forces a person to be a perfectionist or

obsessive-compulsive is not known. One possibility is that children may learn by modeling or copying their parents. Children may learn from their parents to be depressed. Another possible factor is the role of genetics. Some people appear to have inherited a predisposition for depression. Furthermore, if other people in one’s immediate family are prone to have depression, the chances are one will be prone to depression. Perhaps the findings of this study will pave the way for a larger network of research on personality and depression.

Shehniyilagh (1991) suggested that inter-individual, intra-individual differences and environmental differences may be factors related to depression. Depressive moods and happiness are different sides of the same coin. Sigmund Freud once said that happiness stems from love and work. If we are satisfied with our work and our jobs, and are enjoying our lives with our loved ones, we are on the happy face end of this coin.

Perfectionists think unrealistically as they demand unrealistic things from themselves and others. They ignore loving relationships and the pleasures of life; instead, they want to be godlike and perfect. They want to prove themselves instead of being themselves. Perfectionists would much demand that it must be, because they want it to be. Perfectionists consequently spend a great deal of their lives complaining, crying, and depressing themselves when they are not getting their particular piece of pie. In other words, when things are not going their way, they become depressed. Perfectionists are less likely to become depressed if they accept themselves as error-prone humans.

Perfectionists have a poor therapeutic response when pushed through short term treatments for depression. Perfectionists do make substantial improvement in long-term intensive treatment. Extensive therapy may be necessary for many highly perfectionistic, compulsive, self-critical patients.

In the treatment of perfectionism, a key concept is “excessive.” According to Ellis, (1996), 85% of the time, people can tell when they are overreacting. Sometimes they do not want to admit it, but they can tell. Ellis believes that if someone were to tap them on the shoulder when they were having an outburst or were obsessed about something, and ask them nicely if they are being obsessive about this issue, they might snap back at them, but they do know.

Underneath the perfectionism is often a deep-seated fear of failure and rejection, which tells the perfectionist to bite off more than what they can chew. This fear of failure and rejection directs them to feelings of self-defeat and failure. Perfectionists caught in a never-ending cycle that will never let them feel okay. Recommendations include being more flexible in their thoughts and standards. Perfectionists are rigid people, and every rigid person will break someday and become ill.

Limitation of the study and Implication for Further Research

As a function of the limitations of the study, a number of implications for further research identified. A larger sample would provide a greater variety and frequency of response in terms of the variables under investigation in the current study. A combination of student as well as non-student participants would enhance our ability to generalize with regard to the study.

Investigating what causes people to be perfectionists or obsessive-compulsive and tracing the family history of a perfectionist or obsessive-compulsive person might be very helpful to track perfectionism or obsessive-compulsiveness in an individual.

In addition, learning about the possible mediators between the perfectionism/obsessive-compulsiveness and depression or the possible mediators between perfectionism and obsessive-compulsiveness will be helpful.

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