(PS4-A15) Perfectionism Is Associated with Emotion Dysregulation Among Children and Adolescents Receiving a Transdiagnostic Treatment for Common Mental Health Problems

Background: Although holding oneself to high standards can be adaptive, perfectionism is associated with risk for mental health (MH) problems in youths [1]. Emotion dysregulation, which refers to difficulties in managing and expressing emotions, is also a common feature of youth MH problems [2], and prior work has linked these constructs [e.g., 3]. However, no studies have examined associations between perfectionism and emotion regulation (ER) over the course of a transdiagnostic treatment, during which participants may exhibit substantial variation over time in perfectionism and ER. Further, it is unclear which facets of ER (i.e., inhibition, expression, coping) are related to perfectionism.  

Method: Data come from an effectiveness trial of a transdiagnostic youth psychotherapy [MATCH; 4] in which participants (N=168 youths ages 6-15; 59.5% male; 85.1% Caucasian) were treated for common MH problems in community clinics. Participants provided self-report ratings of MH symptoms throughout treatment. Perfectionism was measured by the Youth Self-Report [5] item, “I feel I have to be perfect.” ER was measured by the sadness and worry subscales of the Children’s Emotion Management Scale [6]. Each emotion has three subscales: coping (e.g., “I try to calmly deal with what is making me sad”), dysregulated expression (e.g., “I say mean things to others when I’m sad”), and inhibition (e.g., “I hold my sad feelings in”). To examine the associations between ER and perfectionism, we used hierarchical linear models with a time*perfectionism interaction to test whether changes in perfectionism over the course of treatment were associated with ER changes.

Results: Perfectionism was significantly associated with inhibition of sadness (β=.52; p =.029; R²=.32) and worry (β=0.44; p=.027; R²=.42) such that children who endorsed higher perfectionism had higher levels of inhibition. Additionally, perfectionism was positively associated with dysregulated expressions of sadness (β=.44; p =.006; R²=.21) and worry (β =0.53, p< .001; R²=.22). There were no significant associations between perfectionism and coping for either emotion (ps >.51). Dysregulated expression of sadness (β=-0.50; p =.012) and worry (β=-0.55; p=.003) improved throughout treatment, but coping and inhibition did not change (ps >.07). All interactions were insignificant (ps >.49), except for time*perfectionism in predicting coping with worry (β=0.63; p=.03; R²=.31).

Conclusion: Treated youths’ need to be perfect was associated with emotion dysregulation. Specifically, perfectionism was associated with increased inhibition—a tendency to hide one’s emotions. However, participants also reported dysregulated emotion expression. Together, these findings may suggest that perfectionistic youths experience reduced tolerance of emotional expression (i.e., inhibition), but when emotions do emerge, their expression is dysregulated. If dysregulated expression of emotions is the result of failed attempts to inhibit negative emotions deemed imperfect, these findings highlight a mechanism through which ER may be improved: targeting rigid thinking such as perfectionism to decrease emotional inhibition seems promising, and has been acknowledged by Radically Open DBT [7].