Perfectionism as a transdiagnostic process: A clinical review

Egan, Sarah J.; Wade, Tracey D.; Shafran, Roz

doi:10.1016/j.cpr.2010.04.009

Cited by 961Perfectionism, Procrastination, Anxiety StudiesAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesBody Image and Dysmorphia Studies

Perfectionism as a transdiagnostic process: A clinical review

Egan, Sarah J., Wade, Tracey D., Shafran, Roz·2011·Clinical Psychology Review

DOI 10.1016/j.cpr.2010.04.009

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Abstract

Perfectionism is a risk and maintaining factor for eating disorders, anxiety disorders and depression. The objective of this paper is to review the four bodies of evidence supporting the notion that perfectionism is a transdiagnostic process. First, a review of the literature was conducted that demonstrates the elevation of perfectionism across numerous anxiety disorders, depression, and eating disorders compared to healthy controls. Data is presented that shows perfectionism increases vulnerability for eating disorders, and that it maintains obsessive-compulsive disorder, social anxiety and depression as it predicts treatment outcome in these disorders. Second, evidence is examined showing that elevated perfectionism is associated with co-occurrence of psychopathology. Third, the different conceptualisations of perfectionism are reviewed, including a cognitive-behavioural conceptualisation of clinical perfectionism that can be utilised to understand this transdiagnostic process. Fourth, evidence that treatment of perfectionism results in reductions in anxiety, depression and eating pathology is reviewed. Finally, the importance of clinicians considering the routine assessment and treatment of perfectionism is outlined.

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Perfectionism is a transdiagnostic risk and maintaining process across anxiety, depression, and eating disorders.
“Perfectionism is a transdiagnostic risk and maintaining process across anxiety, depression, and eating disorders (Egan et al., 2011; Limburg et al., 2017).”
From Coming of age: A reflection of the first 21 years of cognitive behaviour therapy for perfectionism (2023) · cites this paper as Egan et al., 2011
Some examples of transdiagnostic mechanisms that have been found to play a fundamental role in EDs are intolerance to uncertainty, rumination, perfectionism, or thought suppression.
“Some examples of transdiagnostic mechanisms that have been found to play a fundamental role in EDs are intolerance to uncertainty [104], rumination [105], perfectionism [106], or thought suppression [107].”
From Negative and positive affect regulation in a transdiagnostic internet-based protocol for emotional disorders: Randomized controlled trial (2021) · cites this paper as [106]

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Garner (1983) · doi:10.1002/1098-108x(198321)2:2

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Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: a systematic review
Sloan, E., Hall, K., Moulding, R., Bryce, S., Mildred, H., & Staiger, P. K. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.09.002 · Cited by 1,052 · see citing works
Emotion Regulation as a Transdiagnostic Factor in the Development of Internalizing and Externalizing Psychopathology: Current and Future Directions
Aldao, A., Gee, D. G., De Los Reyes, A., & Seager, I. (2016) · Development and Psychopathology · doi:10.1017/s0954579416000638 · Cited by 636 · see citing works
The Relationship between Perfectionism and Psychopathology: A Meta-analysis
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Predictors of treatment outcome in individuals with eating disorders: A systematic review and meta‐analysis
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Death anxiety and its role in psychopathology: Reviewing the status of a transdiagnostic construct
Iverach, L., Menzies, R. G., & Menzies, R. E. (2014) · Clinical Psychology Review · doi:10.1016/j.cpr.2014.09.002 · Cited by 459 · see citing works
“Cognitive behavioral models have been devised to describe the contribution of transdiagnostic constructs to the development and maintenance of psychopathology (Egan et al., 2011; Lo & Abbott, 2013; McEvoy et al., 2013; Shafran & Mansell, 2001).”
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Interpersonal relatedness and self-definition in normal and disrupted personality development: Retrospect and prospect.
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Predictors of treatment outcome in individuals with eating disorders: A systematic review and meta‐analysis
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Evidence-based psychological treatments for mental disorders: modifiable barriers to access and possible solutions
Harvey, A. G., & Gumport, N. B. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.02.004 · Cited by 221 · see citing works
Can psychological interventions reduce perfectionism? A systematic review and meta-analysis
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The Role of Implicit Theories in Mental Health Symptoms, Emotion Regulation, and Hypothetical Treatment Choices in College Students
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A systematic review of the relationship between rigidity/flexibility and transdiagnostic cognitive and behavioral processes that maintain psychopathology
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The Development and Psychometric Properties of an Informant-Report Form of the Personality Inventory for DSM-5 (PID-5)
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Social appearance anxiety, perfectionism, and fear of negative evaluation. Distinct or shared risk factors for social anxiety and eating disorders?
Levinson, C. A., Rodebaugh, T. L., White, E. K., Menatti, A. R., Weeks, J. W., McClendon, J., & Warren, C. S. (2013) · Appetite · doi:10.1016/j.appet.2013.04.002 · Cited by 198 · see citing works
Integrating theory-driven and empirically-derived models of personality development and psychopathology: A proposal for DSM V
Luyten, P., & Blatt, S. J. (2010) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.09.003 · Cited by 186 · see citing works
Perfectionism, procrastination, and psychological distress.
Rice, K. G., Richardson, C. M. E., & Clark, D. (2012) · Journal of Counseling Psychology · doi:10.1037/a0026643 · Cited by 196 · see citing works
Toward a unified treatment for emotional disorders: Update on the science and practice
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Self-compassion moderates the perfectionism and depression link in both adolescence and adulthood
Ferrari, M., Yap, K., Scott, N., Einstein, D. A., & Ciarrochi, J. (2018) · PLOS ONE · doi:10.1371/journal.pone.0192022 · Cited by 173 · see citing works
Effectiveness of a school-based mindfulness program for transdiagnostic prevention in young adolescents
Johnson, C., Burke, C., Brinkman, S., & Wade, T. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2016.03.002 · Cited by 167 · see citing works
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Perfectionistic Self‐Presentation, Socially Prescribed Perfectionism, and Suicide in Youth: A Test of the Perfectionism Social Disconnection Model
Roxborough, H. M., Hewitt, P. L., Kaldas, J., Flett, G. L., Caelian, C., Sherry, S., & Sherry, D. L. (2012) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.2012.00084.x · Cited by 157 · see citing works
CBT at the crossroads: the rise of transdiagnostic treatments.
Schaeuffele, C., Schulz, A., Knaevelsrud, C., Renneberg, B., & Boettcher, J. (2021) · International Journal of Cognitive Therapy · doi:10.1007/s41811-020-00095-2 · Cited by 150 · see citing works
Work addiction, obsessive-compulsive personality disorder, burn-out, and global burden of disease: implications from the ICD-11
Atroszko, P. A., Demetrovics, Z., & Griffiths, M. D. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17020660 · Cited by 138 · see citing works
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Review of the Theoretical, Empirical, and Clinical Status of Adaptive and Maladaptive Perfectionism
Lo, A., & Abbott, M. J. (2013) · Behaviour Change · doi:10.1017/bec.2013.9 · Cited by 132 · see citing works
Conceptualizing eating disorder psychopathology using an anxiety disorders framework: Evidence and implications for exposure-based clinical research
Schaumberg, K., Reilly, E. E., Gorrell, S., Levinson, C. A., Farrell, N. R., Brown, T. A., Smith, K. M., Schaefer, L. M., Essayli, J. H., Haynos, A. F., et al. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2020.101952 · Cited by 121 · see citing works
Why self‐critical patients present with more severe eating disorder pathology: The mediating role of shame
Kelly, A. C., & Carter, J. C. (2012) · British Journal of Clinical Psychology · doi:10.1111/bjc.12006 · Cited by 121 · see citing works
Repetitive negative thinking as a transdiagnostic factor in depression and anxiety: A conceptual replication
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The efficacy of randomised controlled trials of cognitive behaviour therapy for perfectionism: A systematic review and meta-analysis
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The Role of Perfectionism in Daily Self‐Esteem, Attachment, and Negative Affect
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Preoccupied attachment, need to belong, shame, and interpersonal perfectionism: An investigation of the Perfectionism Social Disconnection Model
Chen, C., Hewitt, P. L., & Flett, G. L. (2015) · Personality and Individual Differences · doi:10.1016/j.paid.2014.12.001 · Cited by 110 · see citing works
Are Perfectionism Dimensions Risk Factors for Anxiety Symptoms? A Meta-Analysis of 11 Longitudinal Studies
Smith, M. M., Vidovic, V., Sherry, S. B., Stewart, S. H., & Saklofske, D. H. (2018) · Anxiety, Stress, & Coping · doi:10.1080/10615806.2017.1384466 · Cited by 106 · see citing works
Development and Validation of the Frost Multidimensional Perfectionism Scale–Brief
Burgess, A. M., Frost, R. O., & DiBartolo, P. M. (2016) · Journal of Psychoeducational Assessment · doi:10.1177/0734282916651359 · Cited by 116 · see citing works
Emotional Awareness: A Transdiagnostic Predictor of Depression and Anxiety for Children and Adolescents
Kranzler, A., Young, J. F., Hankin, B. L., Abela, J. R. Z., Elias, M. J., & Selby, E. A. (2015) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2014.987379 · Cited by 106 · see citing works
Self-critical perfectionism and binge eating symptoms: A longitudinal test of the intervening role of psychological need frustration.
Boone, L., Vansteenkiste, M., Soenens, B., Van der Kaap-Deeder, J., & Verstuyf, J. (2014) · Journal of Counseling Psychology · doi:10.1037/a0036418 · Cited by 100 · see citing works
A Randomised Controlled Trial of Group Cognitive Behavioural Therapy for Perfectionism
Handley, A. K., Egan, S. J., Kane, R. T., & Rees, C. S. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.02.006 · Cited by 99 · see citing works
Evaluating a Web-Based Cognitive-Behavioral Therapy for Maladaptive Perfectionism in University Students
Radhu, N., Daskalakis, Z. J., Arpin-Cribbie, C. A., Irvine, J., & Ritvo, P. (2012) · Journal of American College Health · doi:10.1080/07448481.2011.630703 · Cited by 94 · see citing works
The Relationship Between Perfectionism, Stress and Burnout in Clinical Psychologists
D'Souza, F., Egan, S. J., & Rees, C. S. (2011) · Behaviour Change · doi:10.1375/bech.28.1.17 · Cited by 100 · see citing works
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Perfectionism, neuroticism, and daily stress reactivity and coping effectiveness 6 months and 3 years later.
Dunkley, D. M., Mandel, T., & Ma, D. (2014) · Journal of Counseling Psychology · doi:10.1037/cou0000036 · Cited by 96 · see citing works
Parsing relationships between dimensions of anxiety and action monitoring brain potentials in female undergraduates
Moser, J. S., Moran, T. P., & Jendrusina, A. A. (2011) · Psychophysiology · doi:10.1111/j.1469-8986.2011.01279.x · Cited by 94 · see citing works
Attachment insecurities, maladaptive perfectionism, and eating disorder symptoms: A latent mediated and moderated structural equation modeling analysis across diagnostic groups
Dakanalis, A., Timko, C. A., Zanetti, M. A., Rinaldi, L., Prunas, A., Carrà, G., Riva, G., & Clerici, M. (2013) · Psychiatry Research · doi:10.1016/j.psychres.2013.10.039 · Cited by 93 · see citing works
A Transdiagnostic Intervention for Youth Sleep and Circadian Problems
Harvey, A. G. (2015) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2015.06.001 · Cited by 94 · see citing works
Depressive Symptoms and Vegetarian Diets: Results from the Constances Cohort
Matta, J., Czernichow, S., Kesse‐Guyot, E., Hoertel, N., Limosin, F., Goldberg, M., Zins, M., & Lemogne, C. (2018) · Nutrients · doi:10.3390/nu10111695 · Cited by 92 · see citing works
Perfectionism and negative repetitive thoughts: Examining a multiple mediator model in relation to mindfulness
Short, M. M., & Mazmanian, D. S. (2013) · Personality and Individual Differences · doi:10.1016/j.paid.2013.05.026 · Cited by 90 · see citing works
The Reliability and Validity of the Clinical Perfectionism Questionnaire in Eating Disorder and Community Samples
Egan, S. J., Shafran, R., Lee, M., Fairburn, C. G., Cooper, Z., Doll, H. A., Palmer, R. L., & Watson, H. J. (2016) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465814000629 · Cited by 90 · see citing works
“Furthermore, it is a transdiagnostic “construct” and is a risk and maintaining factor in eating disorders, anxiety disorders and depression (Egan et al., 2011).”
Self-citation
Self-critical perfectionism, experiential avoidance, and depressive and anxious symptoms over two years: A three-wave longitudinal study
Moroz, M., & Dunkley, D. M. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.11.006 · Cited by 89 · see citing works
Self-criticism as a mediator in the relationship between unhealthy perfectionism and distress
James, K., Verplanken, B., & Rimes, K. A. (2015) · Personality and Individual Differences · doi:10.1016/j.paid.2015.01.030 · Cited by 87 · see citing works
A randomised controlled trial of face to face versus pure online self-help cognitive behavioural treatment for perfectionism
Egan, S. J., van Noort, E., Chee, A., Kane, R. T., Hoiles, K. J., Shafran, R., & Wade, T. D. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.09.009 · Cited by 101 · see citing works
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Because excellencism is more than good enough: On the need to distinguish the pursuit of excellence from the pursuit of perfection.
Gaudreau, P., Schellenberg, B. J. I., Gareau, A., Kljajic, K., & Manoni-Millar, S. (2022) · Journal of Personality and Social Psychology · doi:10.1037/pspp0000411 · Cited by 86 · see citing works
Is there a perfectionist in each of us? An experimental study on perfectionism and eating disorder symptoms
Boone, L., Soenens, B., Vansteenkiste, M., & Braet, C. (2012) · Appetite · doi:10.1016/j.appet.2012.06.015 · Cited by 84 · see citing works
Risk Factors for Eating Disorder Psychopathology within the Treatment Seeking Transgender Population: The Role of Cross‐Sex Hormone Treatment
Jones, B. A., Haycraft, E., Bouman, W. P., Brewin, N., Claes, L., & Arcelus, J. (2018) · European Eating Disorders Review · doi:10.1002/erv.2576 · Cited by 84 · see citing works
Neuroticism and perfectionism as predictors of social anxiety
Newby, J., Pitura, V. A., Penney, A. M., Klein, R. G., Flett, G. L., & Hewitt, P. L. (2016) · Personality and Individual Differences · doi:10.1016/j.paid.2016.10.057 · Cited by 84 · see citing works
When or why does perfectionism translate into eating disorder pathology? A longitudinal examination of the moderating and mediating role of body dissatisfaction.
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Personality traits as a risk factor for postpartum depression: A systematic review and meta-analysis.
Puyané, M., Subirà, S., Torres, A., Roca, A., Garcia-Esteve, L., & Gelabert, E. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.11.010 · Cited by 81 · see citing works
The association between eating disorders and perfectionism in adults: A systematic review and meta-analysis
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The relationship between anorexia nervosa and body dysmorphic disorder
Hartmann, A. S., Greenberg, J. L., & Wilhelm, S. (2013) · Clinical Psychology Review · doi:10.1016/j.cpr.2013.04.002 · Cited by 78 · see citing works
The role of perfectionism in body dissatisfaction
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A combined analysis of the Frost Multidimensional Perfectionism Scale (FMPS), Child and Adolescent Perfectionism Scale (CAPS), and Almost Perfect Scale—Revised (APS-R): Different perfectionist profiles in adolescent high school students.
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A randomized controlled trial of internet-based cognitive behavior therapy for perfectionism including an investigation of outcome predictors
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Perfectionism interventions targeting disordered eating: A systematic review and meta-analysis
Robinson, K., & Wade, T. D. (2021) · International Journal of Eating Disorders · doi:10.1002/eat.23483 · Cited by 86 · see citing works
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Mindfulness-Based Cognitive Therapy Versus Pure Cognitive Behavioural Self-Help for Perfectionism: a Pilot Randomised Study
James, K., & Rimes, K. A. (2017) · Mindfulness · doi:10.1007/s12671-017-0817-8 · Cited by 75 · see citing works
A systematic review of the psychometric properties of death anxiety self-report measures
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The transdiagnostic process of perfectionism = El proceso transdiagnóstico del perfeccionismo
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New approaches in theory and treatment of clinical perfectionism in social anxiety, obsessive-compulsive disorder and eating disorders
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Clinical Perfectionism as a Transdiagnostic Process: A Cognitive-Behavioural Conceptualisation
Ussorowska-Krokosz, A. (2026) · Przegląd Psychologiczny · doi:10.31648/przegldpsychologiczny.13027
Perfectionism as a transdiagnostic risk factor: longitudinal online studyPreprint
Claus, N., Cludius, B., Egan, S., Ehring, T. W., Shafran, R., Takano, K., & Limburg, K. (2021) · doi:10.17605/osf.io/c3p4w
Self-citation

Authors: Egan, S. J., Wade, T. D., & Shafran, R.
Affiliations: Curtin University (AU)
Flinders University (AU)
University of Reading (GB)
Corresponding author: Egan, Sarah J.
ORCID: Egan, Sarah J.
Wade, Tracey D.
Shafran, Roz
Venue: Clinical Psychology Review
Publisher: Elsevier BV
Published: 2011-03
Volume: 31
Issue: 2
Pages: 203-212
ISSN: 0272-7358 (ISSN-L)
DOI: 10.1016/j.cpr.2010.04.009
OpenAlex: W2092825860
Cited by: 961
References: 126
Citations by year: 2026: 60 · 2025: 73 · 2024: 65 · 2023: 64 · 2022: 81 · 2021: 94 · 2020: 59 · 2019: 83 · 2018: 64 · 2017: 76 · 2016: 52 · 2015: 59 · 2014: 48 · 2013: 30 · 2012: 32
FWCI: 3.84
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Clinical Psychology Review (publishedVersion)
PubMed (publishedVersion)
CentAUR (University of Reading) (acceptedVersion)
UCL Discovery (University College London) (submittedVersion)
eSpace (Curtin University) (submittedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Perfectionism, Procrastination, Anxiety Studies
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
Keywords: perfectionism, transdiagnostic mechanisms, eating disorders, anxiety disorders, depression, obsessive-compulsive disorder, social anxiety, co-occurring psychopathology, treatment outcomes
MeSH terms: Anxiety, Anxiety Disorders, Feeding and Eating Disorders, Depression, Humans, Personality, Cognitive Behavioral Therapy

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Perfectionism as a transdiagnostic process: A clinical review

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