Perfectionism, depression and anxiety in chronic fatigue syndrome: A systematic review, 2020, Cherry et al

[Andy]

Objective
High levels of depression and anxiety are experienced alongside Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). Psychological causal and maintenance factors are not well-understood. Perfectionism is a multifactorial, transdiagnostic risk factor for various physical and mental health conditions. This systematic review assesses the association between perfectionism and depression and/or anxiety in people with CFS/ME.

Method
Systematic literature searches used a combination of terms for ‘perfectionism’, ‘depression’, ‘anxiety’ and ‘CFS/ME’. Peer-reviewed English-language papers reporting quantitative data regarding the relationship between perfectionism and depression and/or anxiety in adults (aged 18–65 years) with a clinical diagnosis of CFS/ME were included. Screening, selection and assessment of risk of bias was completed independently by two authors. Bivariate and multivariate associations between perfectionism and anxiety and depression were extracted. Data were synthesised narratively.

Results
Seven studies, reported in eight papers, were included. Seven examined the relationship between perfectionism and depression. Moderate-strong significant positive associations were found between depression and maladaptive perfectionism (r = 0.42 to .48, p < .01), and its component factors of concern over mistakes (r = 0.40 to .60, p < .01) and doubts about actions (r = 0.51 to .60, p < .01). Methodological limitations included sample size justification and selection, psychometric measures, and control of potential confounders.

Conclusion
Maladaptive perfectionism is consistently associated with depression in patients with CFS/ME. The relationship between perfectionism and anxiety is under-researched. Corroboration is required from longitudinal, cross-cultural studies. Clinical understanding may be increased through examining the interplay between maladaptive perfectionism, depression and anxiety and the physical and cognitive symptoms of CFS/ME.

Open access, https://www.sciencedirect.com/science/article/pii/S0022399920308849

 

[Sly Saint]

Starts from the Beard Mcevedy/ neurasthenia stance.

adults with CFS/ME frequently experience co-morbid depression and/or anxiety [26]. Around 36% to 70% of patients experience clinical levels of depression [27,28]

2 papers cited: one based on a survey done in Canada 2000/2001 the other
"
This material is based primarily on our experience at the
Outpatient Fatigue Clinic of the Department of Internal Medicine and at the Depart-
ment of Psychiatry, Osaka University Hospital"

The rest is all about perfectionism.

Four studies, reported in five papers, recruited from the same hospital-based CFS centre

Only one study randomly selected participants from a waiting list [69]. Subsequently, generalizability of findings to the wider CFS/ME population is questionable.

From table on bias
Unbiased selection of cohort? all studies rated 'partially'.
Adequate description of cohort? all studies rated 'partially'.

Systematic searches revealed a paucity of data regarding anxiety and heterogeneity in measures of both depression and perfectionism. Results therefore focus on associations between depression and specific aspects of perfectionism in people with CFS/ME.

Subsequently, it is not known whether the relationship between maladaptive perfectionism and depression in CFS/ME would hold once other variables are controlled for.

Targeting maladaptive perfectionism could increase adaptive coping strategies and adjustment to living with chronic illness. This could reduce ‘boom and bust’ activity patterns [103] and checking behaviours, triggered by a desire to meet unrealistic, self-imposed and possibly pre-morbid standards. This is relevant to relapse prevention, regarding both CFS and co-morbid depression. Psychoeducation regarding the advantages and disadvantages of perfectionism would give a focus for change.

will be interesting to see if they apply the same 'logic' to long-covid patients

 

[Arnie Pye]

This idea that "maladaptive perfectionism" is a problem amongst patients with ME has always puzzled me. I look at myself, my life, my home, and I don't see any evidence of this perfectionism at all. Is it just a cheap way of categorising people as mentally ill, even when it is absolute nonsense?

 

[Mithriel]

It is a "get out of jail" idea. People with depression are often unmotivated to do anything so they let things like housework go. ME people who keep themselves clean and have a tidy house have depression but also perfectionism which is why they do not fit the stereotype. Heads they win, tails we lose.

 

[Mij]

Wow, a good reason not to refer to PEM as PENI (psychoendoneuroimmunology (PENI))! Laugh and be well- ugh.

 

[Barry]

Maladaptive perfectionism is consistently associated with depression in patients with CFS/ME

Is "in patients with CFS/ME" of any relevance? Is it not the case that anyone with maladaptive perfectionism is going to be more prone to depression? I don't see that ME/CFS has any relevance.

 

[rvallee]

GIGO aside, it's amazing seeing things like this:

Psychological causal and maintenance factors are not well-understood

A frank admission that the current model is complete bullshit. The current paradigm, ongoing for a few decades now, is literally this, built on the premise that these people do understand it, hence why it is acceptable to lie and manipulate with intent. Millions of people have been subjected to it, mostly by denying any support but still, this is what the model calls for. It's been a disaster and this point has been made endlessly. Still the model persists because of the above, which the people peddling this nonsense readily admit is completely false. Amazing.

Even more so that the "recommendations" are LITERALLY THE CURRENT MODEL:

Targeting maladaptive perfectionism could increase adaptive coping strategies and adjustment to living with chronic illness. This could reduce ‘boom and bust’ activity patterns [103] and checking behaviours, triggered by a desire to meet unrealistic, self-imposed and possibly pre-morbid standards. This is relevant to relapse prevention, regarding both CFS and co-morbid depression. Psychoeducation regarding the advantages and disadvantages of perfectionism would give a focus for change.

Forget eminence-based medicine this is amnesia-based medicine. The past doesn't exist, unless it is to support the need to continue doing the same. The future must be the same as the past, which has never been tried, even though it currently literally is the standard paradigm. Everything is new again. Always. Never been tried, but tried-and-tested. Nobody could have ever expected this to happen but we've always known about it. We know everything there is to know about this but don't ask questions because nobody knows.

And that's all putting aside just how stunningly stupid the whole premise is. Seriously there are actual cults out there that are less delusional than this.

 

[Invisible Woman]

maladaptive perfectionism

What is maladaptive? What's maladaptive for one individual might be perfectly appropriate for another.

What is perfectionism? Again what's perfectionism for one is appropriate behaviour for another.

Just another way to patient blame & use it to justify your own existence. What makes this individual an appropriate arbiter of what's appropriate or not, other than their own ego of course.

Subjective nonsense.

 

[ladycatlover]

Oh God, yet another rubbish psych paper from Liverpool!

I didn't have any problems from any of my lecturers at Liverpool John Moore's Uni, why should Liverpool Uni be so different? Is it because it's one of the Russell Group?

 

[chrisb]

Oh God, yet another rubbish psych paper from Liverpool!

I thought that but didn't want to say it. There is a tradition to maintain.

 

[MEMarge]

Both paediatric and adult "CFS Clinics at Liverpool" are regularly reported to be dreadful. Both their lead clinicians Dr Theo Anbu and Dr Michael Beadsworth are on the NICE GDL team atm.

The name Peter Fisher sounds familiar. Did another PhD student of his recently produce another pointless paper on CFS.

 

[shak8]

Wow, a "systematic literature search" using those key words that yields a whopping 7 studies.

I could plug in such key words as artichoke, depression, and vocal chord trauma, and pull up some studies.

I find the promotion of this old trope of purported causation to be part of a maladapted career choice.

The paper is all over the place, from causation to trying to define adaptive perfectionism (which they failed to do). I won't bother with a close reading when I have to read every citation to see its relevance to an irrelevant and dated paper.

Maladapted perfectionism is such a useless term. More important would be looking at the losses entailed with the illness. Coping with getting through the day. Lack of understanding by family and society and healthcare, economic deprivation, the lack of help, and other issues that plague PwME.

They could look at CNS abnormalities for any increases in anxiety and depression. They could try to replicate other studies on the associations they take for granted.

But no, this is psychosomatic 'medicine.' So irrelevant. Another example of a belief system that precludes original thought.

 

[ME/CFS Skeptic]

Four of the seven studies were done by the same research team in Belgium.

When treated as a unidimensional construct, perfectionism was not consistently associated with depression in people with CFS/ME. However, maladaptive perfectionism, and the composite subscales of doubts about actions and concern over mistakes, were consistently associated with depression in this patient group

So it could be that maladaptive perfectionism was singled out post-hoc: researchers tested for perfectionism and when it doesn't show the results anticipated, they look for subscales that are more 'interesting'.

Only two studies [71,73] controlled for cross-sectional confounders; one of these being other factors of perfectionism

So even If there is a consistent relationship between depression and the subscale maladaptive perfectionism, we don't really know what it means. It could be that both correlate with other things. One study, for example, found maladaptive perfectionism was no longer a significant statistical predictor of depression severity, when controlling for self-esteem.

 

[cfsandmore]

The Thesis
https://s4me.info/threads/chronic-f...ion-and-anxiety-2020-wright-d-clin-psy.17317/

 

[Perrier]

Off topic but: I looked into what was happening with folks struck by MS. Their lot is not really cheerier. Here is a simple read which is a good summary: https://multiplesclerosis.net/living-with-ms/portable-history-ms/

And then there is this one: https://pubmed.ncbi.nlm.nih.gov/7373820/ and then this short blurb: https://jamanetwork.com/journals/jama/article-abstract/373333

You know, I am not ill with ME but watching a daughter's life destroyed, and watching so much suffering, no wonder there is anxiety and depression--but these are reactive. And 'perfectionism' can also be reactive, to a body over which one has no control, to a life robbed of normal rhythms. I think I have to stop reading this stuff because it's so primitive.

 

[Barry]

So it could be that maladaptive perfectionism was singled out post-hoc: researchers tested for perfectionism and when it doesn't show the results anticipated, they look for subscales that are more 'interesting'.

Is there another simple explanation. People with an obsessive craving to always achieve well beyond their realistic capabilities, are more likely to do exactly that when recovering from a debilitating illness - which is the very thing they should not be doing. It wouldn't mean that pwME or long covid are inevitably that kind of person, far from it, but it would tend to show people with such tendencies more strongly represented. Folk with such a tendency would be harder to treat, and to convince they should back off from exertion, rather than obsessively insist on pushing through.

ETA: And if you were to look at the opposite extreme, the lifelong couch potatoes might be much less likely to succumb.

 

[ladycatlover]

So this one looks like a re-write for publication of the first half of her thesis? I haven't got time to read tonight. (Come to that I don't think I'll bother as it's kind of like word salad, it appears to be in English, but doesn't make sense) It seemed to be what the BPS lot did a lot of - write up the same stuff a load of times and get in different journals.

 

[Forbin]

Ah, Psychology, dear Psychology - so mercifully free of the ravages of perfectionism.

 

[Hutan]

Is there another simple explanation. People with an obsessive craving to always achieve well beyond their realistic capabilities, are more likely to do exactly that when recovering from a debilitating illness - which is the very thing they should not be doing. It wouldn't mean that pwME or long covid are inevitably that kind of person, far from it, but it would tend to show people with such tendencies more strongly represented.

It's possible Barry, although we have no evidence that being a couch potato is protective against ME/CFS and pushing on with exercise while in the acute stage of being ill is a risk factor. Given that there is no evidence, I don't think we have to go with that idea.

It's more likely that people who really care about performing to a high level are the ones who work hard to get a diagnosis. They are the ones lining up to be in research trials. They are the ones who doctors remember, either because of the bright shining careers lost, or the fact that they are very annoying as they try to make their doctors fix them. On the other hand, the ME/CFS couch potatoes with little ambition might not even get diagnosed with ME/CFS. Instead, they might just be regarded as lazy by their family and themselves, or they might get a mis-diagnosis of depression and sit watching reality television all day. They almost certainly won't be jumping through hoops to get on a research trial.

And, we don't even need to resort to those ideas to try to explain why there might be an association between ME/CFS and perfectionism and depression. Because the data is all over the place. There's no good evidence that people with ME/CFS are more depressed than people with other chronic illnesses, certainly once you take into account differences in family and financial support. There's no good evidence that people with ME/CFS are more perfectionist than people in general. I think even the BPS literature is now begrudgingly acknowledging this, which is why they try to find subsets, as they have done here.

If you poke into the questionnaires designed to measure perfectionism and depression, they are a mess of confounding. As this review acknowledges, the studies are just terribly flawed: 'Methodological limitations included sample size justification and selection, psychometric measures, and control of potential confounders.'

There's really nothing here but a smoke screen - wave words including depression and perfectionism vaguely around in the abstract to help provide justification for the BPS industry (including the part that churns out rubbish studies) to keep fiddling around in ME/CFS.

 

[Forbin]

Is there another simple explanation. People with an obsessive craving to always achieve well beyond their realistic capabilities, are more likely to do exactly that when recovering from a debilitating illness - which is the very thing they should not be doing.

Another version of this might be that of the "driven" person, or just a person who happens to have a demanding job, who gets insufficient sleep, eats on the run, has no time to relax - who then gets hit by some sort of infection. The resulting illness may be more severe do to his depleted condition, and this increased severity may have something to do with the triggering of ME.

We do know from the Dubbo study that the greater apparent severity of an infection is correlated with an increased likelihood of the onset of ME. This seems somewhat at odds with the development of long-Covid, where the severity of the infection doesn't seem to predict persistence symptoms of the development of new symptoms.

The type of person @Barry mentions above - one who returns to their pursuits too quickly following illness - could well be the same type of person who sets themselves up for illness in the first place by not looking after themselves in a high pressure environment.

This need not be due to perfectionism. It may just be due to trying to maintain a job in a highly competitive workplace.