When perfectionists adopt health behaviors: perfectionism and self-efficacy as determinants of health behavior, anxiety and depression
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Institute of Psychology, University of Wroclaw, Wroclaw, Poland
Teacher Education Center, University of Wroclaw, Wroclaw, Poland
Monika A. Kozlowska   

Institute of Psychology, University of Wroclaw, Wroclaw, Poland
Submission date: 2021-11-23
Final revision date: 2022-08-10
Acceptance date: 2022-10-28
Online publication date: 2022-11-25
The study aims to show interrelations between self-efficacy, perfectionism (adaptive and maladaptive), health behavior, and mental health outcomes such as anxiety and depression as an exponent in maintaining optimal health. In the analyses, we focused on one category of health behaviors – preventive practices.

Participants and procedure:
Of the gathered data, 295 complete datasets were analyzed (age: M = 28.16, SD = 9.41; 72.8% participants female). We pro-posed two path models with personality traits (as exogenous variables) and health behaviors (as endogenous variables) in predicting depression and anxiety.

Multiple regression analysis revealed that maladaptive perfectionism and generalized self-efficacy significantly predicted health behaviors in general and mental health outcomes whereas adaptive perfectionism and generalized self-efficacy were significant predictors of preventive practices. The path analyses showed that generalized self-efficacy and perfectionism are related directly to mental health outcomes as well as indirectly, through health behaviors. Interestingly, we found a negative indirect effect of an interaction between generalized self-efficacy and preventive practices as well as of an interac-tion between adaptive perfectionism and preventive practices on mental health outcomes. The model fitted well with the data.

The findings show that a balanced and more holistic approach to maintaining health is beneficial for people high in self-efficacy in comparison with high focus on disease prevention. Additionally, the results demonstrate that adaptive perfec-tionists and people high in self-efficacy may also be prone to anxiety and depression (not just maladaptive perfectionists) when their health focus is too narrow.

Alonso, J., Angermeyer, M. C., Bernert, S., Bruffaerts, R., Brugha, T. S., Bryson, H., de Girolamo, G., Graaf, R., Demyttenaere, K., Gasquet, I., Haro, J. M., Katz, S. J., Kessler, R. C., Kovess, V., Lépine, J. P., Ormel, J., Polidori, G., Russo, L. J., Vilagut, G., Almansa, J., … ESEMeD/MHEDEA 2000 Investigators, European Study of the Epi-demiology of Mental Disorders (ESEMeD) Project (2004). Prevalence of mental disorders in Europe: Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scan-dinavica. Supplementum, 21–27.
Angermeyer, M. C., Holzinger, A., Matschinger, H., & Stengler-Wenzke, K. (2002). Depression and quality of life: Results of a follow-up study. International Journal of Social Psychiatry, 48, 189–199.
Bandura, A. (1994). Self-efficacy. In V. S. Ramachandran (Ed.), Encyclopedia of human behavior (Vol. 4, pp. 71–81). Academic Press.
Baumgart, M., Spinda, M., Radzimińska, A., Goch, A., & Zukow, W. (2015). Self-efficacy and health behavior. Journal of Education, Health and Sport, 5, 226–235.
Blalock, J. A., & Joiner, T. E. (2000). Interaction of cognitive avoidance coping and stress in predicting depres-sion/anxiety. Cognitive Therapy and Research, 24, 47–65.
Blatt, S. J. (1995). The destructiveness of perfectionism: Implications for the treatment of depression. American Psychologist, 50, 1003–1020.
Bobak, M., Pikhart, H., Pajak, A., Kubinova, R., Malyutina, S., Sebakova, H., Topor-Madry, R., Nikitin, Y., & Marmot, M. (2006). Depressive symptoms in urban population samples in Russia, Poland and the Czech Re-public. The British Journal of Psychiatry, 188, 359–365.
Boxley, L., Flaherty, J. M., Spencer, R. J., Drag, L. L., Pangilinan, P. H., Bieliauskas, L. A. (2016). Reliability and fac-tor structure of the Hospital Anxiety and Depression Scale in a polytrauma clinic. Journal of Rehabilitation Re-search & Development, 53, 873–880.
Chang, E. C. (2000). Perfectionism as a predictor of positive and negative psychological outcomes: Examining a mediation model in younger and older adults. Journal of Counseling Psychology, 47, 18–26.
Coffman, D. L., & MacCallum, R. C. (2005). Using parcels to convert path analysis models into latent variable models. Multivariate Behavioral Research, 40, 235–259.
Dunkley, D. M., Blankstein, K. R., Halsall, J., Williams, M., & Winkworth, G. (2000). The relation between perfec-tionism and distress: Hassles, coping, and perceived social support as mediators and moderators. Journal of Counseling Psychology, 47, 437–453.
Egan, S. J., Piek, J. P., & Dyck, M. J. (2015). Positive and negative perfectionism and the Big Five personality fac-tors. Behavior Change, 32, 104–113.
Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: a clinical review. Clinical Psychological Review, 31, 203–212.
Eisner, M. D., Blanc, P. D., Yelin, E. H., Katz, P. P., Sanchez, G., Iribarren, C., & Omachi, T. A. (2010). Influence of anxiety on health outcomes in COPD. Thorax, 65, 229–234.
Endler, N. S., Speer, R. L., Johnson, J. M., & Flett, G. L. (2001). General self-efficacy and control in relation to anxi-ety and cognitive performance. Current Psychology, 20, 36–52.
Faul, F., Erdfelder, E., Buchner, A., & Lang, A. G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41, 1149–1160.
George, D., & Mallery, M. (2010). SPSS for windows step by step: a simple guide and reference, 17.0 update (10th ed.). Pearson.
Hamachek, D. E. (1978). Psychodynamics of normal and neurotic perfectionism. Psychology, 15, 27–33.
Hewitt, P. L., & Flett, G. L. (1991). Perfectionism in the self and social contexts. Journal of Personality and Social Psychology, 60, 456–470.
Hewitt, P. L., Flett, G. L., Sherry, S. B., Habke, M., Parkin, M., Lam, R. W., McMurtry, B., Ediger, E., Fairlie, P., & Stein, M. B. (2003). The interpersonal expression of perfection: Perfectionistic self-presentation and psycho-logical distress. Journal of Personality and Social Psychology, 84, 1303–1325.
Hobfoll, S. E. (1989). Conservation of resources: a new attempt at conceptualizing stress. American Psychologist, 44, 513–524.
Jahani, H. J., Ehsanikenari, A., & Sharif, A. S. (2018). Role of self-efficacy and negative perfectionism in the predic-tion of procrastination of narcissistic personality: a study on non-clinical subjects. Emerging Science Journal, 2, 388–399. / esj-2018-01158.
Juczyński, Z. (2001). Measurement tools in health promotion and psychology. Laboratory of Psychological Tests of the Polish Psychological Society.
Juczyński, Z. (2000). Poczucie własnej skuteczności – teoria i pomiar [Self-efficacy – theory and measurement]. Acta Universitstis Lodziensis Folia Psychologica, 4, 11–23.
Kawamura, K. Y., Hunt, S. L., Frost, R. O., & DiBartolo, P. (2001). Perfectionism, anxiety and depression: Are the relationships independent? Cognitive Therapy and Research, 25, 291–301.
Kazmi, S. S. H., Hasan, K., Talib, S., & Saxena, S. (2020). COVID-19 and lockdown: a study on the impact on mental health. Retrieved from Social Science Research Network (SSRN).
Kiejna, A., Adamowski, T., Piotrowski, P., Moskiewicz, J., Wojtyniak, B., Świątkiewicz, G., Stokwiszewski, J., Kan-torska-Janiec, M., Zagdańska, M., & Kessler, R. C. (2015a). Epidemiology of mental disorders and access to mental health care. EZOP Poland – research methodology. Psychiatria Polska, 49, 5–13.
Kiejna, A., Piotrowski, P., Adamowski, T., Moskalewicz, J., Wciórka, J., Stokwiszewski, J., Rabczenko, D., & Kessler, R. (2015b). The prevalence of common mental disorders in the population of adult Poles by sex and age structure – an EZOP Poland study. Psychiatria Polska, 49, 15–27.
Kużel, A., Krajewska-Kułak, E., & Śmigielska-Kuzia, J. (2015). Perception in depression in selected social groups. General Medicine and Health Sciences, 3, 295–302.
Liu, D., Ren, Y., Yan, F., Li, Y., Xu, X., Yu, X., Qu, W., Wang, Z., Tian, B., Yang, F., Yao, Y., Tan, Y., Jiang, R.,.
& Tan, S. (2020). Psychological impact and predisposing factors of the coronavirus disease 2019 (COVID-19) pan-demic on general public in China. Retrieved from Social Science Research Network (SSRN)
Luszczynska, A. (2004). Change of health behavior. Why is good intentions not enough? Gdansk Psychology Pub-lishing House.
Luszczynska, A., Gutiérrez‐Doña, B., & Schwarzer, R. (2005a). General self‐efficacy in various domains of human functioning: Evidence from five countries. International Journal of Psychology, 40, 80–89.
Luszczynska, A., Scholz, U., & Schwarzer, R. (2005b). The General Self-Efficacy Scale: Multicultural validation studies. The Journal of Psychology, 139, 439–457.
Majkowicz, M. (2000). Praktyczna ocena efektywności opieki paliatywnej – wybrane techniki badawcze [Practi-cal assessment of the effectiveness of palliative care – selected research techniques]. In K. de Walden-Gałuszko & M. Majkowicz (Eds.), Ocena jakości opieki paliatywnej w teorii i praktyce [Assessment of the quality of pallia-tive care in theory and practice] (pp. 21–42). Medical University of Gdansk.
Mazza, C., Ricci, E., Biondi, S., Colasanti, M., Ferracuti, S., Napoli, C., & Roma, P. (2020). A nationwide survey of psychological distress among Italian people during the COVID-19 pandemic: Immediate psychological re-sponses and associated factors. International Journal of Environmental Research and Public Health, 17, 3165.
McGrath, D. S., Sherry, S. B., Stewart, S. H., Mushquash, A. R., Allen, S. L., Nealis, L. J., & Sherry, D. L. (2012). Reciprocal relations between self-critical perfectionism and depressive symptoms: Evidence from a short-term, four-wave longitudinal study. Canadian Journal of Behavioural Science, 44, 169–181.
Moghanibashi-Mansourieh, A. (2020). Assessing the anxiety level of Iranian general population during COVID-19 outbreak. Asian Journal of Psychiatry, 51, 102076.
Mowrer, O. H. (1960). Two-factor learning theory: Versions one and two. In O. H. Mowrer (Ed.), Learning theory and behavior (pp. 63–91). John Wiley & Sons Inc.
Murawiec, S., & Wierzbiński, P. (2016). Depresja [Depression]. Via Medica.
Nguyen, H. T., Do, B. N., Pham, K. M., Kim, G. B., Dam, H., Nguyen, T. T., Nguyen, T., Nguyen, Y. H., Sørensen, K., Pleasant, A., & Duong, T. V. (2020). Fear of COVID-19 Scale – associations of its scores with health literacy and health-related behaviors among medical students. International Journal of Environmental Research and Public Health, 17, 4164.
Schwarzer, R., & Jerusalem, M. (1995). Generalized Self-Efficacy Scale. In J. Weinman, S. Wright, & M. Johnston (Eds.), Measures in health psychology: a user’s portfolio. Causal and control beliefs (pp. 35–37). NFER-Nelson.
Schwarzer, R., & Luszczynska, A. (2008). How to overcome health-compromising behaviors: The Health Action Process Approach. European Psychologist, 13, 141–151.
Schwarzer, R., Lippke, S., & Luszczynska, A. (2011). Mechanisms of health behavior change in persons with chronic illness or disability: The Health Action Process Approach (HAPA). Rehabilitation Psychology, 56, 161–170.
Scott, K. M., Bruffaerts, R., Tsang, A., Ormel, J., Alonso, J., Angermeyer, M. C., Benjet, C., Bromet, E., de Giro-lamo, G., de Graaf, R., Gasquet, I., Gureje, O., Haro, J. M., He, Y., Kessler, R. C., Levinson, D., Mneimneh, Z. N., Oakley Browne, M. A., Posada-Villa, J., Stein, D. J., … Von Korff, M. (2007). Depression-anxiety relationships with chronic physical conditions: Results from the World Mental Health Surveys. Journal of Affective Disor-ders, 103, 113–120.
Selye, H. (1956). The stress of life. McGraw-Hill.
Shafran, R., Cooper, Z., & Fairburn, C. G. (2002). Clinical perfectionism: a cognitive-behavioral analysis. Behavior Research and Therapy, 40, 773–791.
Shafran, R., Egan, S., & Wade, T. D. (2010). Overcoming perfectionism: a self-help guide using cognitive behavioral techniques. Constable & Robinson.
Sherry, D. L., Sherry, S. B., Hewitt, P. L., Musquash, A., & Flett, G. L. (2015). The existential model of perfection-ism and depressive symptoms: Tests of incremental validity, gender differences, and moderated mediation. Personality and Individual Differences, 76, 104–110.
Shevlin, M., Nolan, E., Owczarek, M., McBride, O., Murphy, J., Gibson Miller, J., Hartman, T. K., Levita, L., Ma-son, L., Martinez, A. P., McKay, R., Stocks, T., Bennett, K. M., Hyland, P., & Bentall, R. P. (2020). COVID-19-related anxiety predicts somatic symptoms in the UK population. British Journal of Health Psychology, 25, 875–882.
Singh, J., & Wilkes, R. E. (1996). When consumers complain: a path analysis of the key antecedents of consumer complaint response estimates. Journal of the Academy of Marketing Science, 24, 350–365.
Sirois, F. M., & Molnar, D. S. (Eds.) (2016). Perfectionism, health, and well-being. Springer International Publishing.
Smith, M. M., Saklofske, D. H., Yan, G., & Sherry, S. B. (2017). Does perfectionism predict depression, anxiety, stress, and life satisfaction after controlling for neuroticism? A study of Canadian and Chinese undergraduates. Journal of Individual Differences, 38, 63–70.
Szczucka, K. (2010). Polski Kwestionariusz Perfekcjonizmu Adaptacyjnego i Dezadaptacyjnego [The Polish Adap-tive and Maladaptive Perfectionism Questionnaire], Psychologia Społeczna, 1, 71–95.
Teleki, S., Zsidó, A. N., Lénárd, L., Komócsi, A., Kiss, E. C., & Tiringer, I. (2022). Role of received social support in the physical activity of coronary heart patients: The Health Action Process Approach. Applied Psychology: Health and Well-Being, 14, 44–63.
Ueda, M., Stickley, A., Sueki, H., & Matsubayashi, T. (2020). Mental health status of the general population in Ja-pan during the COVID-19 pandemic. Psychiatry and Clinical Neurosciences, 74, 505–506.
Vignola, A., Guzzo, A., Calvo, A., Moglia, C., Pessia, A., Cavallo, E., Cammarosano, S., Giacone, P., Ghiglione, P., & Chio, A. (2008). Anxiety undermines quality of life in ALS patients and caregivers. European Journal of Neu-rology, 15, 1231–1236.
Wang, Y., Di, Y., Ye, J., & Wei, W. (2021). Study on the public psychological states and its related factors during the outbreak of coronavirus disease 2019 (COVID-19) in some regions of China. Psychology, Health & Medicine, 26, 13–22.
Weiner, B. A., & Carton, J. S. (2012). Avoidant coping: a mediator of maladaptive perfectionism and test anxiety. Personality and Individual Differences, 52, 632–636.
Wheeler, H. A., Blankstein, K. R., Antony, M. M., McCabe, R. E., & Bieling, P. J. (2011). Perfectionism in anxiety and depression: Comparisons across disorders, relations with symptom severity, and role of comorbidity. In-ternational Journal of Cognitive Therapy, 4, 66–91.
White, D., Leach, C., Sims, R., Atkinson, M., & Cottrell, D. (1999). Validation of the Hospital Anxiety and Depres-sion Scale for use with adolescents. The British Journal of Psychiatry, 175, 452–454.
Williams, C. J., & Cropley, M. (2014). The relationship between perfectionism and engagement in preventive health behaviors: The mediating role of self-concealment. Journal of Health Psychology, 19, 1211–1221.
World Health Organization (2017). Depression and other common mental disorders: Global health estimates. Re-trieved from
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370.