Case for targeting perfectionism in patients with bipolar disorder

By Lucy Piper, Senior medwireNews Reporter

Anxiety and stress symptoms may mediate the association between perfectionism and depressive symptoms in patients with bipolar disorder in a “transdiagnostic” process, say researchers.

Including self-critical perfectionism in the psychologic treatment of patients with bipolar disorder who have comorbid anxiety may therefore be beneficial, the team suggests.

However, during their study, the researchers did not see the same mediation in relation to manic or hypomanic symptoms of bipolar disorder. This is at odds with the current literature, and the researchers suggest that the null finding may be due to the relatively few patients presenting with significant hypo(manic) symptoms.

Depressive, hypo(manic), anxiety and stress symptoms, and perfectionistic cognitive style were measured in 141 patients with bipolar disorder, of whom 33.1% had a current depressive episode, 10.6% a hypomanic episode, and 3.5% a manic episode.

Comorbid anxiety disorders were common among the patients, with 52.8% having at least one DSM-IV anxiety disorder. The most common were generalized anxiety disorder (32.6%) and social phobia (27.7%).

The average score on the anxiety subscale of the Depression Anxiety Stress Scale (DASS) was 11.2, and 18.9 for the DASS stress subscale.

Mediation models showed that anxiety symptoms significantly mediated the relationship between self-critical perfectionism and depressive symptoms, and between goal attainment beliefs and depressive symptoms, accounting for 55.3% and 61.7% of the relationships, respectively.

The relationships remained significant after taking into account current hypomanic symptoms.

The same was true for stress symptoms, which accounted for 82.7% of the relationship between self-critical perfectionism and depressive symptoms and 66.4% of the relationship between goal-attainment beliefs and depressive symptoms.

The researchers, led by Justine Corry (University of New South Wales, Randwick, Australia), note that stress symptoms also significantly mediated the relationship between self-critical perfectionism and hypomania symptoms, but this was not maintained after taking into account concurrent depressive symptoms.

“It may be that self-critical perfectionism exerts its influence on hypomania through the relationship with depressive symptoms rather than being mediated through anxiety and stress,” they suggest in the Journal of Affective Disorders.

The researchers conclude that “by addressing transdiagnostic processes underlying anxiety maintenance, depressive episodes could potentially be targeted more effectively in psychological treatments for bipolar disorder.”

They refer to a small number of studies that have already tried this approach using cognitive-behavioral therapy to treat perfectionism and found it reduced not only perfectionism, but also anxiety, depression, and eating disorder symptoms.

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