Clinical Perfectionism as a Transdiagnostic Process: A Cognitive-Behavioural Conceptualisation

Anna Ussorowska-Krokosz

Mental Health in Sport Foundation, Zawodnik w Centrum
https://orcid.org/0009-0008-4584-9063


Abstract

Aim: The aim of this article is to present clinical perfectionism as a transdiagnostic process within the cognitive-behavioural framework and to discuss its implications for the conceptualisation and treatment of mental disorders.

Theses: It is proposed that clinical perfectionism may function as a transdiagnostic process. Its presence is observed across a range of mental disorders, and elevated perfectionistic concerns are associated with greater symptom severity, comorbidity of psychological difficulties, and poorer treatment outcomes.

Conclusion: A review of empirical studies and systematic reviews indicates that clinical perfectionism constitutes a clinically significant element of cognitive-behavioural case conceptualisation. The article presents theoretical models of perfectionism, its developmental factors and maintenance mechanisms, as well as its associations with selected groups of mental disorders. Commonly used measures of perfectionism are described, and findings from research on the efficacy of therapeutic interventions targeting its reduction are reviewed. Incorporating perfectionism into diagnosis and case conceptualisation may support the planning of therapeutic interventions, particularly in cases involving comorbid psychological difficulties.


Keywords:

clinical perfectionism, transdiagnostic processes, cognitive-behavioural therapy, psychopathology


Affrunti, N. W., Gramszlo, C., & Woodruff-Borden, J. (2016). Executive function moderates the association between fearful temperament and dimensions of perfectionism. Personality and Individual Differences, 89, 117–122. https://doi.org/10.1016/j.paid.2015.10.012
Crossref   Google Scholar

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425596
Crossref   Google Scholar

Bardone-Cone, A. M., Wonderlich, S. A., Frost, R. O., Bulik, C. M., Mitchell, J. E., Uppala, S., & Simonich, H. (2007). Perfectionism and eating disorders: Current status and future directions. Clinical Psychology Review, 27(3), 384–405. https://doi.org/10.1016/j.cpr.2006.12.005
Crossref   Google Scholar

Bieling, P. J., Israeli, A. L., & Antony, M. M. (2004). Is perfectionism good, bad, or both? Examining models of the perfectionism construct. Personality and Individual Differences, 36(6), 1373–1385. https://doi.org/10.1016/S0191-8869(03)00235-6
Crossref   Google Scholar

Burns, D. D. (1980). Feeling good: The new mood therapy. William Morrow.   Google Scholar

Callaghan, T., Greene, D., Shafran, R., Lunn, J., & Egan, S. J. (2024). The relationships between perfectionism and symptoms of depression, anxiety and obsessive-compulsive disorder in adults: A systematic review and meta-analysis. Cognitive Behaviour Therapy, 53(2), 121–132. https://doi.org/10.1080/16506073.2023.2277121
Crossref   Google Scholar

Chęć, M., Michałowska, S., Gnych-Pietrzak, A., Rybarska, A., & Strochalska, K. (2024). Temperament and the experience of tension and self-injurious behaviour in adolescents—The mediating role of maladaptive perfectionism. Brain Sciences, 14(11), Article 1140. https://doi.org/10.3390/brainsci14111140
Crossref   Google Scholar

Claus, N., Cludius, B., Egan, S. J., Shafran, R., Ehring, T., Takano, K., & Limburg, K. (2025). Perfectionism as a risk factor for psychopathology in a community sample of young women: Disorder-specific pathways to disordered eating or obsessive-compulsive symptoms. Cognitive Behaviour Therapy, 54(5), 664–684. https://doi.org/10.1080/16506073.2025.2461472
Crossref   Google Scholar

Curran, T., & Hill, A. P. (2019). Perfectionism is increasing over time: A meta-analysis of birth cohort differences from 1989 to 2016. Psychological Bulletin, 145(4), 410–429. https://doi.org/10.1037/bul0000138
Crossref   Google Scholar

Damian, L. E., Stoeber, J., Negru, O., & Băban, A. (2013). On the development of perfectionism in adolescence: Perceived parental expectations predict longitudinal increases in socially prescribed perfectionism. Personality and Individual Differences, 55(6), 688–693. https://doi.org/10.1016/j.paid.2013.05.021
Crossref   Google Scholar

De Rosa, L., & Keegan, E. (2024). Implicaciones clínicas del perfeccionismo: Relación entre autocrítica, rumiación y malestar psicológico en estudiantes universitarios. Revista Brasileira de Terapia Cognitiva, 20, Article e20240467. https://dx.doi.org/10.5935/1808-5687.20240467
Crossref   Google Scholar

De Rosa, L., Miracco, M. C., Galarregui, M. S., & Keegan, E. G. (2021). Perfectionism and rumination in depression. Current Psychology, 42, 4851–4861. https://doi.org/10.1007/s12144-021-01834-0
Crossref   Google Scholar

Domocus, I. M., & Damian, L. E. (2018). The role of parents and teachers in changing adolescents’ perfectionism: A short-term longitudinal study. Personality and Individual Differences, 131, 244–248. https://doi.org/10.1016/j.paid.2018.05.012
Crossref   Google Scholar

Dunkley, D. M., Blankstein, K. R., Halsall, J., Williams, M., & Winkworth, G. (2009). The relation between perfectionism and distress: Hassles, coping, and perceived social support as mediators and moderators. Journal of Counseling Psychology, 47(4), 437–453. https://doi.org/10.1037/0022-0167.47.4.437
Crossref   Google Scholar

Dunkley, D. M., Sanislow, C. A., Grilo, C. M., & McGlashan, T. H. (2006). Perfectionism and depressive symptoms 3 years later: Negative social interactions, avoidant coping, and perceived social support as mediators. Comprehensive Psychiatry, 47(2), 106–115. https://doi.org/10.1016/j.comppsych.2005.06.003
Crossref   Google Scholar

Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: A clinical review. Clinical Psychology Review, 31(2), 203–212. https://doi.org/10.1016/j.cpr.2010.04.009
Crossref   Google Scholar

Egan, S. J., Wade, T. D., & Shafran, R. (2012). The transdiagnostic process of perfectionism. Revista de Psicopatología y Psicología Clínica, 17(3), 279–294. https://doi.org/10.5944/rppc.vol.17.num.3.2012.11845
Crossref   Google Scholar

Egan, S. J., Wade, T. D., Shafran, R., & Antony, M. M. (2024). Cognitive-behavioural treatment of perfectionism. Edra Urban & Partner.   Google Scholar

Enns, M. W., & Cox, B. J. (2002). The nature and assessment of perfectionism: A critical analysis. In G. L. Flett & P. L. Hewitt (Eds.), Perfectionism: Theory, research, and treatment (pp. 33–62). American Psychological Association. https://doi.org/10.1037/10458-002
Crossref   Google Scholar

Etherson, M. E., Curran, T., Smith, M. M., Sherry, S. B., & Hill, A. P. (2022). Perfectionism as a vulnerability following appearance-focused social comparison: A multi-wave study with female adolescents. Personality and Individual Differences, 186, Article 111355. https://doi.org/10.1016/j.paid.2021.111355
Crossref   Google Scholar

Fardouly, J., & Vartanian, L. R. (2016). Social media and body image concerns: Current research and future directions. Current Opinion in Psychology, 9, 1–5. https://doi.org/10.1016/j.copsyc.2015.09.005
Crossref   Google Scholar

Flett, G. L., Besser, A., & Hewitt, P. L. (2014). Perfectionism and interpersonal orientations in depression: An analysis of validation seeking and rejection sensitivity in a community sample of young adults. Psychiatry, 77(1), 67–85. https://doi.org/10.1521/psyc.2014.77.1.67
Crossref   Google Scholar

Flett, G. L., Hewitt, P. L., Blankstein, K. R., & Gray, L. (1998). Psychological distress and the frequency of perfectionistic thinking. Journal of Personality and Social Psychology, 75(5), 1363–1381. https://doi.org/10.1037/0022-3514.75.5.1363
Crossref   Google Scholar

Flett, G. L., Hewitt, P. L., Oliver, J. M., & Macdonald, S. (2002). Perfectionism in children and their parents: A developmental analysis. In G. L. Flett & P. L. Hewitt (Eds.), Perfectionism: Theory, research, and treatment (pp. 89–132). American Psychological Association. https://doi.org/10.1037/10458-004
Crossref   Google Scholar

Frost, R. O., & DiBartolo, P. M. (2002). Perfectionism, anxiety, and obsessive-compulsive disorder. In G. L. Flett & P. L. Hewitt (Eds.), Perfectionism: Theory, research, and treatment (pp. 341–371). American Psychological Association.
Crossref   Google Scholar

Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14(5), 449–468. https://doi.org/10.1007/BF01172967
Crossref   Google Scholar

Galloway, A., Watson, H., Greene, D., Shafran, R., & Egan, S. (2021). The efficacy of cognitive behavioral therapy for perfectionism: A meta-analysis of randomized controlled trials. Cognitive Behaviour Therapy, 51(2), 170–184. https://doi.org/10.1080/16506073.2020.1859905
Crossref   Google Scholar

Hamachek, D. E. (1978). Psychodynamics of normal and neurotic perfectionism. Psychology: A Journal of Human Behavior, 15(1), 27–33.   Google Scholar

Harvey, A., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment. Oxford University Press. https://doi.org/10.1093/med:psych/9780198528883.001.0001
Crossref   Google Scholar

Heimberg, R. G., Juster, H. R., Hope, D. A., & Mattia, J. I. (1995). Cognitive-behavioral group treatment for social phobia: Description, case presentation, and empirical support. In M. B. Stein (Ed.), Social phobia: Clinical and research perspectives (pp. 293–321). American Psychiatric Press.   Google Scholar

Hewitt, P. L., & Flett, G. L. (1991). Perfectionism in the self and social contexts: Conceptualization, assessment, and association with psychopathology. Journal of Personality and Social Psychology, 60(3), 456–470. https://doi.org/10.1037/0022-3514.60.3.456
Crossref   Google Scholar

Hewitt, P. L., Flett, G. L., & Ediger, E. (1996). Perfectionism and depression: Longitudinal assessment of a specific vulnerability hypothesis. Journal of Abnormal Psychology, 105(2), 276–280. https://doi.org/10.1037/0021-843X.105.2.276
Crossref   Google Scholar

Hewitt, P. L., Flett, G. L., & Mikail, S. F. (2017). Perfectionism: A relational approach to conceptualization, assessment, and treatment. Guilford Publications.   Google Scholar

Hewitt, P. L., Flett, G. L., Sherry, S. B., & Caelian, C. (2006). Trait perfectionism dimensions and suicidal behavior. In S. R. Shankman & T. E. Joiner (Eds.), Perfectionism and suicide (pp. 215–230). American Psychological Association. https://doi.org/10.1037/11377-010
Crossref   Google Scholar

Hong, R. Y., Lee, S. S., Chng, R. Y., Zhou, Y., Tsai, F. F., & Tan, S. H. (2016). Developmental trajectories of maladaptive perfectionism in middle childhood. Journal of Personality, 85(3), 409–422. https://doi.org/10.1111/jopy.12249
Crossref   Google Scholar

Iranzo-Tatay, C., Gimeno-Clemente, N., Barberá-Fons, M., Rodriguez-Campayo, M. Á., Rojo-Bofill, L., Livianos-Aldana, L., & Rojo-Moreno, L. (2015). Genetic and environmental contributions to perfectionism and its common factors. Psychiatry Research, 230(3), 932–939. https://doi.org/10.1016/j.psychres.2015.11.020
Crossref   Google Scholar

Kamakura, T., Ando, J., Ono, Y., & Maekawa, H. (2003). A twin study of genetic and environmental influences on psychological traits of eating disorders in a Japanese female sample. Twin Research and Human Genetics, 6(4), 292–296. https://doi.org/10.1375/136905203322296647
Crossref   Google Scholar

Keegan, E. (Ed.). (2024). Clinical perfectionism: Conceptualisation and treatment. Gdańskie Wydawnictwo Psychologiczne.   Google Scholar

Kwarcińska, K., Sanna, K., Kamza, A., & Piotrowski, K. (2022). Perfekcjonizm w teorii i badaniach [Perfectionism in theory and research]. Przegląd Psychologiczny, 65(3), 27–42. https://doi.org/10.31648/przegldpsychologiczny.8033
Crossref   Google Scholar

Limburg, K., Watson, H. J., Hagger, M. S., & Egan, S. J. (2017). The relationship between perfectionism and psychopathology: A meta-analysis. Journal of Clinical Psychology, 73(10), 1301–1326. https://doi.org/10.1002/jclp.22435
Crossref   Google Scholar

Mansell, W., Harvey, A., Watkins, E. R., & Shafran, R. (2009). Conceptual foundations of the transdiagnostic approach to CBT. Journal of Cognitive Psychotherapy, 23(1), 6–19. https://doi.org/10.1891/0889-8391.23.1.6
Crossref   Google Scholar

Neumeister, K. L. S. (2004). Factors influencing the development of perfectionism in gifted college students. Gifted Child Quarterly, 48(4), 259–274. https://doi.org/10.1177/001698620404800402
Crossref   Google Scholar

Oliveira, D., Martins, C., Faísca, L., Brás, M., Nunes, C., & Carmo, C. (2025). The role of parental perfectionism and child temperament in the intergenerational transmission of perfectionism: A pilot study. Children, 12(11), Article 1452. https://doi.org/10.3390/children12111452
Crossref   Google Scholar

Pacht, A. R. (1984). Reflections on perfection. American Psychologist, 39(4), 386–390. https://doi.org/10.1037/0003-066X.39.4.386
Crossref   Google Scholar

Popiel, A., & Pragłowska, E. (2022). Psychoterapia poznawczo-behawioralna. Teoria i praktyka [Cognitive-behavioural psychotherapy: Theory and practice]. Wydawnictwo Naukowe PWN.
Crossref   Google Scholar

Reivan Ortiz, G. G., Rivera Tapia, C. J., Elizalde Martínez, B. A., & Icaza, D. (2022). Mediating mechanisms of perfectionism: Clinical comorbidity of OCD and ED. Frontiers in Psychiatry, 13, Article 908926. https://doi.org/10.3389/fpsyt.2022.908926
Crossref   Google Scholar

Robinson, K., & Wade, T. D. (2021). Perfectionism interventions targeting disordered eating: A systematic review and meta-analysis. International Journal of Eating Disorders, 54(4), 473–487. https://doi.org/10.1002/eat.23483
Crossref   Google Scholar

Rothbart, M. K. (2004). Commentary: Differentiated measures of temperament and multiple pathways to childhood disorders. Journal of Clinical Child and Adolescent Psychology, 33(1), 82–87. https://doi.org/10.1207/s15374424jccp3301_8
Crossref   Google Scholar

Shafran, R., Cooper, Z., & Fairburn, C. G. (2002). Clinical perfectionism: A cognitive-behavioural analysis. Behaviour Research and Therapy, 40(7), 773–791. https://doi.org/10.1016/S0005-7967(01)00059-6
Crossref   Google Scholar

Shafran, R., Egan, S. J., & Wade, T. D. (2010). Overcoming perfectionism: A self-help guide using cognitive behavioural techniques. Constable & Robinson.   Google Scholar

Slaney, R. B., Rice, K. G., Mobley, M., Trippi, J., & Ashby, J. S. (2001). The revised Almost Perfect Scale. Measurement and Evaluation in Counseling and Development, 34(3), 130–145. https://doi.org/10.1080/07481756.2002.12069030
Crossref   Google Scholar

Smith, M. M., Hewitt, P. L., Sherry, S. B., Flett, G. L., Kealy, D., Tasca, G. A., Ge, S., Ying, F., & Bakken, K. (2023). A meta-analytic test of the efficacy of cognitive behavioural therapy for perfectionism: A replication and extension. Canadian Psychology / Psychologie Canadienne, 64(4), 355–376. https://doi.org/10.1037/cap0000360
Crossref   Google Scholar

Stoeber, J., & Otto, K. (2006). Positive conceptions of perfectionism: Approaches, evidence, challenges. Personality and Social Psychology Review, 10(4), 295–319. https://doi.org/10.1207/s15327957pspr1004_2
Crossref   Google Scholar

Strelau, J. (2008). Temperament jako regulator zachowania. Z perspektywy półwiecza badań [Temperament as a regulator of behaviour: Fifty years of research]. Gdańskie Wydawnictwo Psychologiczne.   Google Scholar

Suh, H., Sohn, H., Kim, T., & Lee, D. G. (2019). A review and meta-analysis of perfectionism interventions: Comparing face-to-face with online modalities. Journal of Counseling Psychology, 66(4), 473–486. https://doi.org/10.1037/cou0000355
Crossref   Google Scholar

Vogel, E. A., Rose, J. P., Roberts, L. R., & Eckles, K. (2014). Social comparison, social media, and self-esteem. Psychology of Popular Media Culture, 3(4), 206–222. https://doi.org/10.1037/ppm0000047
Crossref   Google Scholar

Wade, T. D., & Bulik, C. M. (2007). Shared genetic and environmental risk factors between undue influence of body shape and weight on self-evaluation and dimensions of perfectionism. Psychological Medicine, 37(5), 635–644. https://doi.org/10.1017/s0033291706009603
Crossref   Google Scholar

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Published
2026-05-11

Cited by

Ussorowska-Krokosz, A. (2026). Clinical Perfectionism as a Transdiagnostic Process: A Cognitive-Behavioural Conceptualisation. The Review of Psychology, 69(1), 93–106. https://doi.org/10.31648/przegldpsychologiczny.13027

Anna Ussorowska-Krokosz 
Mental Health in Sport Foundation, Zawodnik w Centrum
https://orcid.org/0009-0008-4584-9063