Skip to main content
Top
Published in: Clinical Rheumatology 12/2011

01-12-2011 | Original Article

Self-esteem mediates the relationship between maladaptive perfectionism and depression in chronic fatigue syndrome

Authors: Stefan Kempke, Patrick Luyten, Boudewijn Van Houdenhove, Lutgarde Goossens, Patrick Bekaert, Peter Van Wambeke

Published in: Clinical Rheumatology | Issue 12/2011

Login to get access

Abstract

Patients with chronic fatigue syndrome (CFS) often experience depression which may negatively affect prognosis and treatment outcome. Research has shown that depression in CFS is associated with maladaptive or self-critical perfectionism. However, currently, little is known about factors that may explain this relationship, but studies in nonclinical samples suggest that low self-esteem may be an important mediator of this relationship. The present study therefore examined whether self-esteem mediated the cross-sectional association between maladaptive perfectionism and severity of depression in 192 patients meeting Centres for Disease Control and Prevention criteria for CFS. Patients completed self-report measures of maladaptive perfectionism, self-esteem, depression, and fatigue. Regression analyses and more direct tests of indirect effects (i.e., the Sobel test and bootstrapping) were used to test for mediation. Congruent with expectations, we found that self-esteem fully mediated the relationship between maladaptive perfectionism and depression in CFS. Findings from this study suggest that self-esteem may explain the link between maladaptive perfectionism and depression in CFS, which may have important implications for the treatment and prevention of depression in these patients.
Footnotes
1
There was no evidence for multicollinearity between self-esteem and maladaptive perfectionism. The tolerance values were above the cut-off point 0.40 and the variance inflation factor values were below 2.5.
 
Literature
1.
go back to reference Wessely S, Sharpe M (1998) Chronic fatigue and its syndromes. Oxford University Press, Oxford Wessely S, Sharpe M (1998) Chronic fatigue and its syndromes. Oxford University Press, Oxford
2.
go back to reference Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A (1994) The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med 121:953–959PubMed Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A (1994) The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med 121:953–959PubMed
3.
go back to reference Kanaan RA, Lepine JP, Wessely SC (2007) The association or otherwise of the functional somatic syndromes. Psychosom Med 69:855–859PubMedCrossRef Kanaan RA, Lepine JP, Wessely SC (2007) The association or otherwise of the functional somatic syndromes. Psychosom Med 69:855–859PubMedCrossRef
4.
go back to reference Van Houdenhove B, Kempke S, Luyten P (2010) Psychiatric aspects of chronic fatigue syndrome and fibromyalgia. Curr Psychiatry Rep 12:208–214PubMedCrossRef Van Houdenhove B, Kempke S, Luyten P (2010) Psychiatric aspects of chronic fatigue syndrome and fibromyalgia. Curr Psychiatry Rep 12:208–214PubMedCrossRef
5.
go back to reference Adler RH (2004) Chronic fatigue syndrome (cfs). Swiss Med Wkly 134:268–276PubMed Adler RH (2004) Chronic fatigue syndrome (cfs). Swiss Med Wkly 134:268–276PubMed
6.
go back to reference Arnold LM (2008) Understanding fatigue in major depressive disorder and other medical disorders. Psychosomatics 49:185–190PubMedCrossRef Arnold LM (2008) Understanding fatigue in major depressive disorder and other medical disorders. Psychosomatics 49:185–190PubMedCrossRef
7.
go back to reference Kempke S, Goossens L, Luyten P, Bekaert P, Van Houdenhove B, Van Wambeke P (2010) Predictors of outcome in a multi-component treatment program for chronic fatigue syndrome. J Affect Disord 126:174–179PubMedCrossRef Kempke S, Goossens L, Luyten P, Bekaert P, Van Houdenhove B, Van Wambeke P (2010) Predictors of outcome in a multi-component treatment program for chronic fatigue syndrome. J Affect Disord 126:174–179PubMedCrossRef
8.
go back to reference Kempke S, Van Houdenhove B, Luyten P, Goossens L, Bekaert P, Van Wambeke P (2011) Unraveling the role of perfectionism in chronic fatigue syndrome: is there a distinction between adaptive and maladaptive perfectionism? Psychiatry Res 186:373–377PubMedCrossRef Kempke S, Van Houdenhove B, Luyten P, Goossens L, Bekaert P, Van Wambeke P (2011) Unraveling the role of perfectionism in chronic fatigue syndrome: is there a distinction between adaptive and maladaptive perfectionism? Psychiatry Res 186:373–377PubMedCrossRef
9.
go back to reference Van Houdenhove B, Luyten P (2008) Customizing treatment of chronic fatigue syndrome and fibromyalgia: the role of perpetuating factors. Psychosomatics 49:470–477PubMedCrossRef Van Houdenhove B, Luyten P (2008) Customizing treatment of chronic fatigue syndrome and fibromyalgia: the role of perpetuating factors. Psychosomatics 49:470–477PubMedCrossRef
10.
go back to reference Deary V, Chalder T (2010) Personality and perfectionism in chronic fatigue syndrome: a closer look. Psychol Health 25:465–475PubMedCrossRef Deary V, Chalder T (2010) Personality and perfectionism in chronic fatigue syndrome: a closer look. Psychol Health 25:465–475PubMedCrossRef
11.
go back to reference Moss-Morris R, Spence MJ, Hou R (2010) The pathway from glandular fever to chronic fatigue syndrome: can the cognitive behavioural model provide the map? Psychol Med 41:1099–1107PubMedCrossRef Moss-Morris R, Spence MJ, Hou R (2010) The pathway from glandular fever to chronic fatigue syndrome: can the cognitive behavioural model provide the map? Psychol Med 41:1099–1107PubMedCrossRef
12.
go back to reference Fukuda S, Kuratsune H, Tajima S, Takashima S, Yamagutchi K, Nishizawa Y, Watanabe Y (2010) Premorbid personality in chronic fatigue syndrome as determined by the Temperament and Character Inventory. Compr Psychiatry 51:78–85PubMedCrossRef Fukuda S, Kuratsune H, Tajima S, Takashima S, Yamagutchi K, Nishizawa Y, Watanabe Y (2010) Premorbid personality in chronic fatigue syndrome as determined by the Temperament and Character Inventory. Compr Psychiatry 51:78–85PubMedCrossRef
13.
go back to reference Van Campen E, Van Den Eede F, Moorkens G, Schotte C, Schacht R, Sabbe BG, Cosyns P, Claes SJ (2009) Use of the Temperament and Character Inventory (TCI) for assessment of personality in chronic fatigue syndrome. Psychosomatics 50:147–154PubMedCrossRef Van Campen E, Van Den Eede F, Moorkens G, Schotte C, Schacht R, Sabbe BG, Cosyns P, Claes SJ (2009) Use of the Temperament and Character Inventory (TCI) for assessment of personality in chronic fatigue syndrome. Psychosomatics 50:147–154PubMedCrossRef
14.
go back to reference White C, Schweitzer R (2000) The role of personality in the development and perpetuation of chronic fatigue syndrome. J Psychosom Res 48:515–524PubMedCrossRef White C, Schweitzer R (2000) The role of personality in the development and perpetuation of chronic fatigue syndrome. J Psychosom Res 48:515–524PubMedCrossRef
15.
go back to reference Luyten P, Kempke S, Van Wambeke P, Claes S, Blatt SJ, Van Houdenhove B (2011) Self-critical perfectionism, stress generation and stress sensitivity in patients with chronic fatigue syndrome: relationships with severity of depression. Psychiatry 74:21–30PubMedCrossRef Luyten P, Kempke S, Van Wambeke P, Claes S, Blatt SJ, Van Houdenhove B (2011) Self-critical perfectionism, stress generation and stress sensitivity in patients with chronic fatigue syndrome: relationships with severity of depression. Psychiatry 74:21–30PubMedCrossRef
16.
go back to reference Luyten P, Van Houdenhove B, Cosyns N, Van den Broeck A (2006) Are patients with chronic fatigue syndrome perfectionistic—or were they? A case-control study. Pers Indiv Differ 40:1473–1483CrossRef Luyten P, Van Houdenhove B, Cosyns N, Van den Broeck A (2006) Are patients with chronic fatigue syndrome perfectionistic—or were they? A case-control study. Pers Indiv Differ 40:1473–1483CrossRef
17.
go back to reference Bieling PJ, Israeli AL, Antony MM (2004) Is perfectionism good, bad, or both? Examining models of the perfectionism construct. Pers Indiv Differ 36:1373–1385CrossRef Bieling PJ, Israeli AL, Antony MM (2004) Is perfectionism good, bad, or both? Examining models of the perfectionism construct. Pers Indiv Differ 36:1373–1385CrossRef
18.
go back to reference Dunkley DM, Blankstein KR, Masheb RM, Grilo CM (2006) Personal standards and evaluative concerns dimensions of “clinical” perfectionism: a reply to Shafran et al. (2002, 2003) and Hewitt et al. (2003). Behav Res Ther 44:63–84PubMedCrossRef Dunkley DM, Blankstein KR, Masheb RM, Grilo CM (2006) Personal standards and evaluative concerns dimensions of “clinical” perfectionism: a reply to Shafran et al. (2002, 2003) and Hewitt et al. (2003). Behav Res Ther 44:63–84PubMedCrossRef
19.
go back to reference Enns MW, Cox BJ, Clara I (2002) Adaptive and maladaptive perfectionism: developmental origins and association with depression proneness. Pers Indiv Differ 33:921–935CrossRef Enns MW, Cox BJ, Clara I (2002) Adaptive and maladaptive perfectionism: developmental origins and association with depression proneness. Pers Indiv Differ 33:921–935CrossRef
20.
go back to reference Frost RO, Marten P, Lahart CM, Rosenblate R (1990) The dimensions of perfectionism. Cognit Ther Res 14:449–468CrossRef Frost RO, Marten P, Lahart CM, Rosenblate R (1990) The dimensions of perfectionism. Cognit Ther Res 14:449–468CrossRef
21.
go back to reference Stoeber J, Otto K (2006) Positive conceptions of perfectionism: approaches, evidence, challenges. Pers Soc Psychol Rev 10:295–319PubMedCrossRef Stoeber J, Otto K (2006) Positive conceptions of perfectionism: approaches, evidence, challenges. Pers Soc Psychol Rev 10:295–319PubMedCrossRef
22.
go back to reference Shafran R, Mansell W (2001) Perfectionism and psychopathology: a review of research and treatment. Clin Psychol Rev 21:879–906PubMedCrossRef Shafran R, Mansell W (2001) Perfectionism and psychopathology: a review of research and treatment. Clin Psychol Rev 21:879–906PubMedCrossRef
23.
go back to reference Mann M, Hosman CM, Schaalma HP, de Vries NK (2004) Self-esteem in a broad-spectrum approach for mental health promotion. Health Educ Res 19:357–372PubMedCrossRef Mann M, Hosman CM, Schaalma HP, de Vries NK (2004) Self-esteem in a broad-spectrum approach for mental health promotion. Health Educ Res 19:357–372PubMedCrossRef
24.
go back to reference Orth U, Robins RW, Trzesniewski KH, Maes J, Schmitt M (2009) Low self-esteem is a risk factor for depressive symptoms from young adulthood to old age. J Abnorm Psychol 118:472–478PubMedCrossRef Orth U, Robins RW, Trzesniewski KH, Maes J, Schmitt M (2009) Low self-esteem is a risk factor for depressive symptoms from young adulthood to old age. J Abnorm Psychol 118:472–478PubMedCrossRef
25.
go back to reference Preusser KJ, Rice KG, Ashby JS (1994) The role of self-esteem in mediating the perfectionism-depression connection. J Coll Stud Dev 35:88–93 Preusser KJ, Rice KG, Ashby JS (1994) The role of self-esteem in mediating the perfectionism-depression connection. J Coll Stud Dev 35:88–93
26.
go back to reference Rice KG, Ashby JS, Slaney RB (1998) Self-esteem as a mediator between perfectionism and depression: a structural equations analysis. J Counsel Psychol 45:304–314CrossRef Rice KG, Ashby JS, Slaney RB (1998) Self-esteem as a mediator between perfectionism and depression: a structural equations analysis. J Counsel Psychol 45:304–314CrossRef
27.
go back to reference Creswell C, Chalder T (2002) Underlying self-esteem in chronic fatigue syndrome. J Psychosom Res 53:755–761PubMedCrossRef Creswell C, Chalder T (2002) Underlying self-esteem in chronic fatigue syndrome. J Psychosom Res 53:755–761PubMedCrossRef
28.
go back to reference Fuller-Thomson E, Nimigon J (2008) Factors associated with depression among individuals with chronic fatigue syndrome: findings from a nationally representative survey. Fam Pract 25:414–422PubMedCrossRef Fuller-Thomson E, Nimigon J (2008) Factors associated with depression among individuals with chronic fatigue syndrome: findings from a nationally representative survey. Fam Pract 25:414–422PubMedCrossRef
29.
go back to reference Moss-Morris R, Petrie KJ (2001) Discriminating between chronic fatigue syndrome and depression: a cognitive analysis. Psychol Med 31:469–479PubMedCrossRef Moss-Morris R, Petrie KJ (2001) Discriminating between chronic fatigue syndrome and depression: a cognitive analysis. Psychol Med 31:469–479PubMedCrossRef
30.
go back to reference Michielsen HJ, Van Houdenhove B, Leirs I, Vandenbroeck A, Onghena P (2006) Depression, attribution style and self-esteem in chronic fatigue syndrome and fibromyalgia patients: is there a link? Clin Rheumatol 25:183–188PubMedCrossRef Michielsen HJ, Van Houdenhove B, Leirs I, Vandenbroeck A, Onghena P (2006) Depression, attribution style and self-esteem in chronic fatigue syndrome and fibromyalgia patients: is there a link? Clin Rheumatol 25:183–188PubMedCrossRef
31.
go back to reference Vercoulen JH, Swanink CM, Fennis JF, Galama JM, van der Meer JW, Bleijenberg G (1994) Dimensional assessment of chronic fatigue syndrome. J Psychosom Res 38:383–392PubMedCrossRef Vercoulen JH, Swanink CM, Fennis JF, Galama JM, van der Meer JW, Bleijenberg G (1994) Dimensional assessment of chronic fatigue syndrome. J Psychosom Res 38:383–392PubMedCrossRef
32.
go back to reference Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370PubMedCrossRef Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370PubMedCrossRef
33.
go back to reference Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the Hospital Anxiety and Depression Scale. J Psychosom Res 52:69–77PubMedCrossRef Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the Hospital Anxiety and Depression Scale. J Psychosom Res 52:69–77PubMedCrossRef
34.
go back to reference Brennan C, Worrall-Davies A, McMillan D, Gilbody S, House A (2010) The Hospital Anxiety and Depression Scale: a diagnostic meta-analysis of case-finding ability. J Psychosom Res 69:371–378PubMedCrossRef Brennan C, Worrall-Davies A, McMillan D, Gilbody S, House A (2010) The Hospital Anxiety and Depression Scale: a diagnostic meta-analysis of case-finding ability. J Psychosom Res 69:371–378PubMedCrossRef
35.
go back to reference Morriss RK, Wearden AJ (1998) Screening instruments for psychiatric morbidity in chronic fatigue syndrome. J R Soc Med 91:365–368PubMed Morriss RK, Wearden AJ (1998) Screening instruments for psychiatric morbidity in chronic fatigue syndrome. J R Soc Med 91:365–368PubMed
36.
go back to reference Rosenberg M (1965) Society and the adolescent self-image. Princeton University Press, Princeton Rosenberg M (1965) Society and the adolescent self-image. Princeton University Press, Princeton
37.
go back to reference Blaskovich J, Tomaka J (1991) Measures of personality and social psychological attitudes. In: Robinson JP, Shaver PR, Wrightsman LS (eds) Measures of self-esteem. Academic, San Diego, pp 115–160 Blaskovich J, Tomaka J (1991) Measures of personality and social psychological attitudes. In: Robinson JP, Shaver PR, Wrightsman LS (eds) Measures of self-esteem. Academic, San Diego, pp 115–160
38.
go back to reference Baron RM, Kenny DA (1986) The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51:1173–1182PubMedCrossRef Baron RM, Kenny DA (1986) The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51:1173–1182PubMedCrossRef
39.
go back to reference Preacher KJ, Hayes AF (2004) SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods Instrum Comput 36:717–731PubMedCrossRef Preacher KJ, Hayes AF (2004) SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods Instrum Comput 36:717–731PubMedCrossRef
40.
go back to reference Van Houdenhove B, Bruyninckx K, Luyten P (2006) In search of a new balance. Can high “action-proneness” in patients with chronic fatigue syndrome be changed by a multidisciplinary group treatment? J Psychosom Res 60:623–625PubMedCrossRef Van Houdenhove B, Bruyninckx K, Luyten P (2006) In search of a new balance. Can high “action-proneness” in patients with chronic fatigue syndrome be changed by a multidisciplinary group treatment? J Psychosom Res 60:623–625PubMedCrossRef
41.
go back to reference Shahar G, Davidson L (2003) Depressive symptoms erode self-esteem in severe mental illness: a three-wave, cross-lagged study. J Consult Clin Psychol 71:890–900PubMedCrossRef Shahar G, Davidson L (2003) Depressive symptoms erode self-esteem in severe mental illness: a three-wave, cross-lagged study. J Consult Clin Psychol 71:890–900PubMedCrossRef
42.
go back to reference Fennell MJ (1998) Cognitive therapy in the treatment of low self-esteem. Adv Psychiatr Treat 4:296–304CrossRef Fennell MJ (1998) Cognitive therapy in the treatment of low self-esteem. Adv Psychiatr Treat 4:296–304CrossRef
43.
go back to reference Flett GL, Hewitt PL (2002) Perfectionism and maladjustment: an overview of theoretical, definitional, and treatment issues. In: Flett GL, Hewitt PL (eds) Perfectionism. Theory, research, and treatment. Guilford Press, New York, pp 5–31CrossRef Flett GL, Hewitt PL (2002) Perfectionism and maladjustment: an overview of theoretical, definitional, and treatment issues. In: Flett GL, Hewitt PL (eds) Perfectionism. Theory, research, and treatment. Guilford Press, New York, pp 5–31CrossRef
44.
go back to reference Flett GL, Hewitt PL (2008) Treatment interventions for perfectionism—introduction to the special issue. J Ration Emot Cogn Behav Ther 26:127–133CrossRef Flett GL, Hewitt PL (2008) Treatment interventions for perfectionism—introduction to the special issue. J Ration Emot Cogn Behav Ther 26:127–133CrossRef
45.
go back to reference Surawy C, Hackmann A, Hawton K, Sharpe M (1995) Chronic fatigue syndrome: a cognitive approach. Behav Res Ther 33:535–544PubMedCrossRef Surawy C, Hackmann A, Hawton K, Sharpe M (1995) Chronic fatigue syndrome: a cognitive approach. Behav Res Ther 33:535–544PubMedCrossRef
Metadata
Title
Self-esteem mediates the relationship between maladaptive perfectionism and depression in chronic fatigue syndrome
Authors
Stefan Kempke
Patrick Luyten
Boudewijn Van Houdenhove
Lutgarde Goossens
Patrick Bekaert
Peter Van Wambeke
Publication date
01-12-2011
Publisher
Springer-Verlag
Published in
Clinical Rheumatology / Issue 12/2011
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI
https://doi.org/10.1007/s10067-011-1772-8

Other articles of this Issue 12/2011

Clinical Rheumatology 12/2011 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine