Perfectionism and Distress Tolerance as Psychological Vulnerabilities to Traumatic Impact and Psychological Distress in Persons with Psychotic Illness

Perfectionism has been linked with various indices of maladjustment but has not yet been formally investigated in persons with psychotic illness. There is also a call for more psychological formulations of psychotic illness and related interventions for assisting affected persons, particularly given the relevance of trauma in the development of psychosis. Accordingly, an exploratory study was conducted to evaluate socially prescribed perfectionism, perfectionistic self-presentation, and distress tolerance as psychological vulnerabilities associated with poorer theory of mind, stronger traumatic impact, and worse psychological distress in persons with psychotic illness. A sample of 61 persons with a diagnosed psychotic illness was recruited from a tertiary care organization in Toronto, Canada. Correlational results suggest that, as predicted, higher trait perfectionism and higher perfectionistic self-presentation were associated with lower distress tolerance, more shame, greater stress, and poorer theory of mind. Lower distress tolerance was also associated with elevated stress, shame, and poorer theory of mind. The results also support conceptual overlap among perfectionism, social anxiety, and paranoid ideation in persons with psychotic illness. A trauma-informed person-centered clinical formulation is presented, describing how perfectionism, perfectionistic self-presentation, and low distress tolerance may stem from disrupted attachment experiences and other circumstances with associated traumatic impact. Formulation-based clinical approaches that may benefit affected persons are described. The study results are also contextualized within the broader literatures on psychosis, perfectionism, trauma, and psychotherapy. Finally, future research directions are indicated.